Risk-Adjusted CUSUM Analysis of the Learning Curve of Femtosecond Laser Assisted Cataract Surgery.

Objectives: To determine the length of the learning curve of femtosecond laser-assisted cataract surgery (FLACS) by a risk-adjusted cumulative sum method. Materials and Methods: This was a retrospective review of the first 288 FLACS performed by three surgeons over a 12-month period. The learning curves were analyzed separately for each surgeon and as pooled data via risk-adjusted cumulative sum methods. Change-point analysis was performed to estimate the length of the learning curve. Results: Rates of complications were as follows: anterior capsular tear (ACT) (3.4%), posterior capsular rupture (PCR) (0.7%), vitreous loss (0.3%), iris trauma (0.7%), Descemet's membrane tear (0.3%). There was a strong confidence level (96%) that there was a stable performance in terms of PCR after case 16 for the pooled data. Surgeon 1 did not have any cases of PCR, surgeons 2 and 3 exhibited change points at case 5 and 16, respectively (confidence levels = 99%, 98%). There was a strong confidence level (99.8%) that there was stable performance in terms of ACT after case 14 for the pooled data, however the individual surgeons demonstrated individual change points at case 1 (surgeon 1, confidence 99%), case 14 (surgeon 2, confidence 99%), and case 49 (surgeon 3, confidence 96%). Conclusions: The results suggest that there is an increased risk of ACT and PCR in FLACS within a surgeon's first 14 and 16 operations, respectively. Measures should be adopted to minimize harm to patients during this phase. However, overall rates of complications were safe.

Periorbital Masson's tumor: a case series.

Intravascular papillary endothelial hyperplasia (IPEH) or Masson's tumor is an unusual variety of benign vascular tumor. Involvement of periorbital area is uncommon. We report 2 cases of periorbital IPEH and review relevant literature.

Management of acute corneal hydrops secondary to keratoconus with intracameral injection of sulfur hexafluoride (SF6).

PURPOSE: To report the use of sulfur hexafluoride (SF6) gas in the management of corneal edema caused by acute corneal hydrops secondary to keratoconus. METHODS: Nine eyes with acute hydrops secondary to keratoconus managed by SF6 gas injected into the anterior chamber (group 1) were compared to another 9 eyes that were managed conservatively with conventional medical therapy (group 2). RESULTS: Of 9 eyes in group 1, 3 had 1 injection, 4 had 2 injections, and the remaining 2 had 3 injections into the anterior chamber. All the eyes in group 1 showed an early resolution of corneal edema at 4 weeks. The same was achieved in group 2 at 12 weeks. The central corneal thickness (CCT) in group 1 and group 2 was >1.0 mm at presentation. The CCT at 3 and 12 weeks in group 1 was 0.99 and 0.65 mm, respectively, whereas CCT in group 2 at 3 weeks was >1.0 mm and at 12 weeks was 0.991 mm (P = 0.001). The mean best spectacle-corrected visual acuity (BSCVA) at 12 weeks in group 1 and group 2 was 0.39 and 0.24, respectively (P = 0.016). The results were significant in favor of group 1 over group 2 both in CCT and BSCVA. CONCLUSION: Early intervention with intracameral SF6 injection is a safe and effective therapy for early reduction of corneal edema in eyes with keratoconus and acute hydrops.

Glial heterotopia of the orbit and extranasal region: an unusual entity.

Glial heterotopia or the occurrence of isolated non-teratomatous extracranial glial tissue is rare. Most of the reported cases of this entity arise in the nose. Herein a rare case of heterotopic glial tissue in the orbit and extranasal region without bony defect is described.

Visual outcome and electron microscopic features of indocyanine green-assisted internal limiting membrane peeling from macular hole of various aetiologies.

PURPOSE: To describe the visual outcome of internal limiting membrane (ILM) peeling for macular hole of various aetiologies and ultrastructural features of the ILM. MATERIALS AND METHODS: The study was conducted on 40 eyes of 38 patients. Thirty eyes with full thickness macular hole were treated with vitrectomy and removal of ILM. Ten eyes with retinal detachment served as negative controls and these patients underwent vitrectomy and ILM removal. The surgical specimens were examined by transmission electron microscopy. RESULTS: The anatomical success rate of the first operation was 90% in idiopathic and myopic groups, whereas it was 100% in traumatic macular hole group. Visual improvement of (3) two lines was noted in 80% of the cases. Electron microscopy revealed the presence of ILM in all surgical specimens. Proliferation of astrocytes and synthesis of new collagen along the inner surface of ILM was noted in the surgical specimens. CONCLUSION: Our findings suggest that the ILM removal helps in closure of the macular hole and retinal reattachment. Vitrectomy with ILM peeling is a reasonable surgical approach to treat macular holes of idiopathic, myopic and traumatic aetiology.

Macular thickness evaluation using the optical coherence tomography in normal Indian eyes.

PURPOSE: To determine the normative values for macular thickness and volume by Optical Coherence Tomography (OCT 3) in healthy Indian subjects. METHODS: The macula of 170 consecutive, randomly selected normal subjects was imaged on OCT 3 in this cross-sectional study. OCT parameters of macular thickness were analysed with baseline variables including age, gender, axial length and refractive error. RESULTS: The average foveal thickness in the population under study was 149.16 +/- 21.15 micro. Macular thickness and volume parameters of OCT correlated significantly (Pearson's Correlation coefficient) with age (r=0.23, P<0.01), but not with gender, axial length and refraction. CONCLUSIONS: The macular thickness and volume parameters have a significant correlation with age. This normative database of macular thickness by OCT in Indian eyes may be a useful guideline for management and further research in diseases of the macula and glaucoma.