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   2009| January-February  | Volume 57 | Issue 1  
    Online since December 12, 2008

 
 
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SYMPOSIUM
Wound construction in manual small incision cataract surgery
SS Haldipurkar, Hasanain T Shikari, Vishwanath Gokhale
January-February 2009, 57(1):9-13
DOI:10.4103/0301-4738.44491  PMID:19075401
The basis of manual small incision cataract surgery is the tunnel construction for entry to the anterior chamber. The parameters important for the structural integrity of the tunnel are the self-sealing property of the tunnel, the location of the wound on the sclera with respect to the limbus, and the shape of the wound. Cataract surgery has gone beyond just being a means to get the lens out of the eye. Postoperative astigmatism plays an important role in the evaluation of final outcome of surgery. Astigmatic consideration, hence, forms an integral part of incisional considerations prior to surgery.
  11,018 2,096 7
Small incision cataract surgery: Complications and mini-review
Parikshit M Gogate
January-February 2009, 57(1):45-49
DOI:10.4103/0301-4738.44512  PMID:19075410
This article reviews the literature on manual small incision cataract surgery (MSICS) and its complications. Various articles on MSICS published in indexed journals were reviewed, as well as the sections on complications of MSICS. The Pubmed search engine on the Internet was used to find out articles published since 1985 on MSICS in any language in indexed journals. Books published by Indian authors and the website of Indian Journal of Ophthalmology were also referred to. MSICS has become very popular technique of cataract surgery in India, and it is often used as an alternative to phacoemulsification. Studies on its efficacy and safety for cataract surgery show that, being a variant of extracapsular cataract surgery, MSICS also has similar intraoperative and postoperative complications. The considerable handling inside the anterior chamber during nucleus delivery increase the chances of iris injury, striate keratitis, and posterior capsular rupture. The surgeon has to be extra careful in the construction of the scleral tunnel and to achieve a good capsulorrhexis. Postoperative inflammation and corneal edema are rare if surgeons have the expertise and patience. The final astigmatism is less than that in the extracapsular cataract surgery and almost comparable to that in phacoemulsification. There is, however, a concern of posterior capsular opacification in the long term, which needs to be addressed. Although MSICS demands skill and patience from the cataract surgeon, it is a safe, effective, and economical alternative to competing techniques and can be the answer to tackle the large backlog of blindness due to cataract.
  10,579 1,590 18
ORIGINAL ARTICLE
Manual small incision cataract surgery under topical anesthesia with intracameral lignocaine: Study on pain evaluation and surgical outcome
Sanjiv Kumar Gupta, Ajay Kumar, Deepak Kumar, Swati Agarwal
January-February 2009, 57(1):3-7
DOI:10.4103/0301-4738.44488  PMID:19075400
The authors here describe manual small incision cataract surgery (MSICS) by using topical anesthesia with intracameral 0.5% lignocaine, which eliminates the hazards of local anesthesia, cuts down cost and time taken for the administration of local anesthesia. Aims: To evaluate the patients' and surgeons' experience in MSICS using topical anesthesia with intracameral lignocaine in terms of pain, surgical complications, and outcome. Settings and Design: Prospective interventional case series. Materials and Methods: Ninety-six patients of senile cataract were operated by MSICS under topical anesthesia with intracameral lignocaine using "fish hook technique." The patients and the single operating surgeon were given a questionnaire to evaluate their experience in terms of pain, surgical experience, and complications. Statistical Analysis Used: Statistical analysis software "Analyseit." Results: There were 96 patients enrolled in the study. The mean pain score was 0.7 (SD 0.97, range 0-5, median 0.0, and mode 0.0). Fifty-one patients (53%) had pain score of zero, that is, no pain. Ninety-one patients (~95%) had a score of less than 3, that is, mild pain to none. All the surgeries were complication-free except one and the surgeon's experience was favorable in terms of patient's cooperation, anterior chamber stability, difficulty, and complications. The ocular movements were not affected, and hence, the eye patch could be removed immediately following the surgery. Conclusions: MSICS can be performed under topical anesthesia with intracameral lignocaine, which makes the surgery patient friendly, without compromising the outcome.
  6,480 1,453 7
SYMPOSIUM
Nucleus management with Blumenthal technique: Anterior chamber maintainer
Krishan PS Malik, Ruchi Goel
January-February 2009, 57(1):23-25
DOI:10.4103/0301-4738.43047  PMID:19075404
The Blumenthal`s 'Mininuc' technique enables nuclear expression through a 5-6.5-mm sclerocorneal tunnel incision using a Sheet's lens glide and anterior chamber maintainer (ACM). A 6-mm or larger capsulorrhexis, reduction in nuclear size by hydroprocedure and its manipulation manually into the anterior chamber are performed. The nucleus is expressed out of the chamber by use of hydrostatic pressure created by balanced salt solution delivered continuously through the ACM. This continuous flow from ACM to anterior chamber keeps the eye under positive pressure physiological state besides clearing the chamber of cortex, blood and pigments offering excellent visualization. The procedure, with an initial learning curve, is highly effective, applicable to all grades of cataracts, has minimum intraocular instrumentation resulting in an early rehabilitation of the patient.
  6,623 686 6
Capsulotomy and hydroprocedures for nucleus prolapse in manual small incision cataract surgery
Rengaraj Venkatesh, Kannusamy Veena, Ravilla D Ravindran
January-February 2009, 57(1):15-18
DOI:10.4103/0301-4738.44494  PMID:19075402
Manual small incision cataract surgery (MSICS) involves the manual removal of nucleus through a scleral tunnel. To achieve 100% success every time, one has to do a good capsulotomy and should master the technique to prolapse the nucleus into anterior chamber. During conversion from extracapsular cataract surgery to MSICS, one can perform a can-opener capsulotomy and prolapse the nucleus. However, it is safer and better to perform a capsulorrhexis and hydroprolapse the nucleus, as it makes the rest of the steps of MSICS comfortable. Use of trypan blue in white and brown cataracts makes the capsulorrhexis and prolapse simple and safe. Extra caution should be taken in cases with hypermature cataracts with weak zonules and subluxated cataracts.
  4,746 809 4
Nucleus management in manual small incision cataract surgery by phacosection
MS Ravindra
January-February 2009, 57(1):41-43
DOI:10.4103/0301-4738.44509  PMID:19075409
Nucleus management is critical in manual small incision cataract surgery (MSICS), as the integrity of the tunnel, endothelium and posterior capsule needs to be respected. Several techniques of nucleus management are in vogue, depending upon the specific technique of MSICS. Nucleus can be removed in toto or bisected or trisected into smaller segments. The pressure in the eye can be maintained at the desired level with the use of an anterior chamber maintainer or kept at atmospheric levels. In MSICS, unlike phacoemulsification, there is no need to limit the size of the tunnel or restrain the size of capsulorrhexis. Large well-structured tunnels and larger capsulorrhexis provide better control on the surgical maneuvers. Safety and simplicity of MSICS has made it extremely popular. The purpose of this article is to describe nucleus management by phacosection in MSICS.
  4,300 591 2
GUEST EDITORIAL
Role of small incision cataract surgery in the Indian scenario
Ravi Thomas
January-February 2009, 57(1):1-2
DOI:10.4103/0301-4738.44485  PMID:19075399
  3,417 1,325 4
SYMPOSIUM
Nucleus management with irrigating vectis
Aravind Srinivasan
January-February 2009, 57(1):19-21
DOI:10.4103/0301-4738.43045  PMID:19075403
The main objective in modern cataract surgery is to achieve a better unaided visual acuity with rapid post-surgical recovery and minimal surgery-related complications. Early visual rehabilitation and better unaided vision can be achieved only by reducing the incision size. In manual small incision cataract surgery (MSICS), incision is between 5.5 to 7 mm. Once the nucleus is prolapsed into the anterior chamber, it can be extracted through the tunnel. Nucleus extraction with an irrigating vectis is a very simple technique, which combines mechanical and hydrostatic forces to express out the nucleus. This technique is time-tested with good results and more than 95% of nuclei in MSICS are extracted in this way offering all the merits of phacoemulsification with the added benefits of having wider applicability, better safety, shorter learning curve and lower cost.
  3,906 554 2
JOURNAL ABSTRACTS
Small incision cataract surgery: Review of journal abstracts
Rajesh Sinha, Prakashchand Agarwal, Chandrashekhar Kumar
January-February 2009, 57(1):79-82
  3,683 705 -
BRIEF COMMUNICATIONS
Central retinal vein occlusion following Sirsasana (headstand posture)
Nikunj J Shah, Urmi N Shah
January-February 2009, 57(1):69-70
DOI:10.4103/0301-4738.44496  PMID:19075418
We report a case of central retinal vein occlusion (CRVO) following Sirsasana, a head-down postural yoga. A 55-year-old male patient presented to us, with sudden-onset loss of vision following Sirsasana, in the right eye. The patient had suffered from pulmonary thromboembolism 5 years earlier and was receiving warfarin prophylaxis. Over 6 months of follow-up, the patient developed neovascularization of the iris and was subjected to panretinal laser with no improvement in visual acuity. Sirsasana could be an important risk factor for CRVO especially in predisposed patients.
  3,565 283 2
Bilateral persistent hyperplastic primary vitreous
Tarun P Jain
January-February 2009, 57(1):53-54
DOI:10.4103/0301-4738.44487  PMID:19075412
A case of bilateral persistent hyperplastic primary vitreous (PHPV) in a 3-month-old male infant, who had bilateral leukokoria, is presented. The child was referred for imaging with a clinical suspicion of retinoblastoma. Gray-scale ultrasound evaluation revealed an echogenic band in the posterior segment of both globes, extending from the posterior surface of the lens capsule to the optic disc. Doppler examination revealed the presence of arterial flow in the band in both globes. Associated echogenic hemorrhage was also seen, which was confirmed by computed tomography. Most cases of PHPV are sporadic and unilateral, and bilateral PHPV is rare. The imaging features in this case suggest the diagnosis of bilateral PHPV and differentiate it from retinoblastoma. This entity, although infrequent, should be considered in the differential diagnosis while evaluating bilateral leukokoria.
  3,331 401 4
Calotropis procera -induced keratitis
Nidhi Pandey, AK Chandrakar, ML Garg, Santosh Singh Patel
January-February 2009, 57(1):58-60
DOI:10.4103/0301-4738.44492  PMID:19075415
Calotropis procera produces copious amounts of latex, which has been shown to possess several pharmacological properities. Its local application produces intense inflammatory response. In the 10 cases of Calotropis procera -induced keratitis reported here, the clinical picture showed corneal edema with striate keratopathy without any evidence of intraocular inflammation. The inflammation was reversed by the local application of steroid drops.
  3,289 323 4
SYMPOSIUM
Nucleus management with Fishhook
A Hennig
January-February 2009, 57(1):35-37
DOI:10.4103/0301-4738.43046  PMID:19075407
The fishhook technique developed at the Lahan eye hospital is widely used in Nepal and other countries. Its specialty is the extraction of the nucleus with a bent 30-G needle (Fishhook) out of the capsular bag and the self-sealing tunnel. All sizes of nuclei can be extracted. The fishhook technique has a short learning curve, a low complication rate and provides excellent immediate visual outcome. It is cost-effective and has proved to be useful also for high-volume cataract surgery and thus can play an important role in the reduction of cataract blindness.
  2,995 524 1
BRIEF COMMUNICATIONS
Patient-reported barriers to glaucoma medication access, use, and adherence in southern India
Betsy L Sleath, R Krishnadas, Minhee Cho, Alan L Robin, Rakhi Mehta, David Covert, Gail Tudor
January-February 2009, 57(1):63-68
DOI:10.4103/0301-4738.44495  PMID:19075417
The objectives of the study were to (a) describe the different types of problems that patients in southern India reported having when taking their glaucoma medications and (b) examine the relationship between patient reported-problems in taking their glaucoma medications and the self-reported patient adherence. A survey was conducted by clinical staff on 243 glaucoma patients who were on at least one glaucoma medication in an eye clinic in southern India. We found that 42% of patients reported one or more problems in using their glaucoma medications. Approximately 6% of patients reported being less than 100% adherent in the past week. Unmarried patients and patients who reported difficulty squeezing the bottle and difficulty opening the bottle were significantly more likely to report nonadherence.
  3,034 379 11
SYMPOSIUM
Description of surgical technique: The Bhatti modification for small-incision cataract surgery of the Akahoshi prechop technique
Swaranjit Singh Bhatti
January-February 2009, 57(1):31-33
DOI:10.4103/0301-4738.44501  PMID:19075406
Manual chopping of the nucleus forms the backbone of nucleus reduction in manual small-incision cataract surgery (MSICS). The technique ("prechopping") described by Akahoshi has been modified so that it is safe, predictable, and easy to use in MSICS.
  2,768 502 5
Nuclear management in manual small incision cataract surgery by snare technique
Debasish Bhattacharya
January-February 2009, 57(1):27-29
DOI:10.4103/0301-4738.44498  PMID:19075405
Manual small incision cataract surgery has evolved into a popular method of cataract surgery in India. However, in supra hard cataract, bringing out the whole nucleus through the sclerocorneal flap valve incision becomes difficult. A bigger incision required in such cataracts loses its value action, as the internal incision and corneal valve slips beyond the limbus into sclera. Struggling with the supra hard cataracts through a regular small incision. Phacofracture in the anterior chamber becomes a useful option in these cases. In the snare technique, a stainless steel wire loop when lassoed around the nucleus in the anterior chamber constricts from the equator, easily dividing the hardest of the nuclei into two halves. The wire loop constricts in a controlled way when the second cannula of snare is pulled. The divided halves can easily be brought out by serrated crocodile forceps. This nuclear management can be safely performed through a smaller sclerocorneal flap valve incision where the corneal valve action is retained within the limbus without sutures, and the endothelium or the incision is not disturbed. However, the technique requires space in the anterior chamber to maneuver the wire loop and anterior chamber depth more than 2.5 mm is recommended. Much evidence to this wonderful technique is not available in literature, as its popularity grew through live surgical workshops and small interactive conferences.
  2,593 529 5
Viscoexpression technique in manual small incision cataract surgery
Nikhil S Gokhale
January-February 2009, 57(1):39-40
DOI:10.4103/0301-4738.44507  PMID:19075408
Viscoexpression method of nucleus delivery in manual small incision cataract surgery is described in this article. The practical modifications to the conventional technique in special situations are presented. Intraoperative and postoperative problems likely to be encountered and the steps to avoid them and tackle them effectively are discussed.
  2,451 523 3
BRIEF COMMUNICATIONS
Bilateral iridocorneal endothelial syndrome in a young girl with Down's syndrome
Viney Gupta, Randhir Kumar, Ritesh Gupta, Geetha Srinivasan, Ramanjit Sihota
January-February 2009, 57(1):61-63
DOI:10.4103/0301-4738.44493  PMID:19075416
We describe the occurrence of bilateral iridocorneal endothelial (ICE) syndrome with glaucoma in a young girl with Down's syndrome. A 16-year-old girl with Down's syndrome was found to have secondary glaucoma in the right eye with features of progressive iris atrophy in both eyes. She was uncontrolled on maximum tolerable medical therapy for glaucoma. She underwent an uneventful trabeculectomy with mitomycin-C in her right eye. Scanning electron microscopy of the trabecular meshwork obtained in this case is described.
  2,587 283 4
Orbital floor dermoid: An unusual presentation
Meenakshi Yeola, SR Joharapurkar, AM Bhole, Manisha Chawla, Sumit Chopra, Anup Paliwal
January-February 2009, 57(1):51-52
DOI:10.4103/0301-4738.44486  PMID:19075411
Dermoid cysts are developmental abnormal arrangement of tissues and are often evident soon after birth. Its occurrence in the orbit is relatively rare. We report a case of orbital floor dermoid in an 18-year-old female patient who presented with progressive, painless swelling in the lower eyelid associated with mild proptosis of three months duration. The lesion was excised completely, and histopathology confirmed the diagnosis of dermoid cyst.
  2,362 263 6
Central serous chorioretinopathy after dacryocystorhinostomy operation on the same side
Lakshmikanta Mondal, Sayan Basu, Krishnapada Baidya, Gautam Bhaduri
January-February 2009, 57(1):57-58
DOI:10.4103/0301-4738.44490  PMID:19075414
A 43-year-old man developed central serous choroidoretinopathy in his left eye following dacryocystorhinostomy operation on the same side. He was using xylometazoline nasal drops in his left nostril. Action of xylometazoline or the stress related to the operation or the effect of both factors played the role in the causation of this ocular condition. Omission of nasal drops or relief from stress resulted in full recovery of vision and complete resolution of symptoms within one month.
  2,075 226 4
LETTERS TO THE EDITOR
Evaluation of distance and near stereoacuity and fusional vergence in intermittent exotropia
Pramod Kumar Pandey, Pankaj Vats, Ashish Amar, Pooja Jain, Yuvika Bansal
January-February 2009, 57(1):71-71
DOI:10.4103/0301-4738.44497  PMID:19075419
  2,027 272 3
Practical approach to medical management of glaucoma
Atul Bansal, Cecilia H Fenerty
January-February 2009, 57(1):75-76
DOI:10.4103/0301-4738.44506  PMID:19075423
  1,821 320 1
BRIEF COMMUNICATIONS
Cystoid macular edema after bone marrow transplantation
Vikas Khetan, SP Chaudhary, Lingam Gopal
January-February 2009, 57(1):55-57
DOI:10.4103/0301-4738.44489  PMID:19075413
We report a case of cystoid macular edema in a patient who underwent bone marrow transplant for aplastic anemia. After having ruled out all the other causes of cystoid macular edema, we concluded that it was secondary to the bone marrow transplant. The patient had mild visual impairment and did not recover the lost vision. In this case report, we describe in detail the clinical presentation, follow-up, and course of medication that this patient had. It is an illustrated case report of cystoid macular edema after bone marrow transplant with mild visual impairment and no recovery.
  1,802 205 2
LETTERS TO THE EDITOR
Ocular adnexal lymphoma and infectious agents
Adriano M Pellicelli, Valerio Zoli, Daniele Remotti
January-February 2009, 57(1):72-73
DOI:10.4103/0301-4738.44500  PMID:19075420
  1,796 172 1
The crisis in ophthalmology residency training programs
Parikshit M Gogate, Madan D Deshpande
January-February 2009, 57(1):74-75
DOI:10.4103/0301-4738.44504  PMID:19075422
  1,435 205 -
Authors' reply
Pradeep Sharma, Rohit Saxena, Makarand Narvekar, Ritu Gadia, Vimla Menon
January-February 2009, 57(1):71-72
DOI:10.4103/0301-4738.44499  
  1,414 113 -
AIOS proceedings: A response
Babu Rajendran
January-February 2009, 57(1):77-78
DOI:10.4103/0301-4738.44511  PMID:19075425
  1,338 125 -
Author's reply
Rajul S Parikh, Shefali R Parikh, Shoba Navin, Ellen Arun, Ravi Thomas
January-February 2009, 57(1):76-77
DOI:10.4103/0301-4738.44508  
  1,299 134 -
Postgraduate ophthalmic education in India?
Rajul S Parikh
January-February 2009, 57(1):77-77
DOI:10.4103/0301-4738.44510  PMID:19075426
  1,209 180 -
Authors' reply
Dipankar Das, Panna Deka, Kasturi Bhattacharjee, Jayanta Kumar Das, Ganesh Kuri, Akshay Chandra Deka, Harsha Bhattacharjee
January-February 2009, 57(1):73-73
DOI:10.4103/0301-4738.44502  
  1,250 128 -
Evaluation of medical college departments of ophthalmology in India
Prashant Garg
January-February 2009, 57(1):73-74
DOI:10.4103/0301-4738.44503  PMID:19075421
  1,148 195 -
Evaluation of medical college departments of ophthalmology in India
Annie Mathai
January-February 2009, 57(1):75-75
DOI:10.4103/0301-4738.44505  PMID:19075424
  1,122 165 1