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   2017| December  | Volume 65 | Issue 12  
    Online since December 5, 2017

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Posterior capsular rent: Prevention and management
Arup Chakrabarti, Nazneen Nazm
December 2017, 65(12):1359-1369
DOI:10.4103/ijo.IJO_1057_17  PMID:29208816
This review article deals with a potentially sight threatening complication – rupture of the posterior capsule – during cataract surgery. Cataract surgery is the most commonly performed surgical procedure in ophthalmology and despite tremendous technical and technological advancements, posterior capsular rent (PCR) still occurs. PCR occurs both in the hands of experienced senior surgeons and the neophyte surgeons, although with a higher frequency in the latter group. Additionally, certain types of cataracts are prone to this development. If managed properly in a timely manner the eventual outcome may be no different from that of an uncomplicated case. However, improper management may lead to serious complications with a higher incidence of permanent visual disability. The article covers the management of posterior capsular rent from two perspectives: 1. Identifying patients at higher risk and measures to manage such patients by surgical discipline, and 2. Intraoperative management of posterior capsular rent and various case scenarios to minimize long-term complications.This review is written for experienced and not-so-experienced eye surgeons alike to understand and manage PCR.
  8,871 1,363 -
Pediatric cataract
Sudarshan Kumar Khokhar, Ganesh Pillay, Chirakshi Dhull, Esha Agarwal, Manish Mahabir, Pulak Aggarwal
December 2017, 65(12):1340-1349
DOI:10.4103/ijo.IJO_1023_17  PMID:29208814
Pediatric cataract is a leading cause of childhood blindness. Untreated cataracts in children lead to tremendous social, economical, and emotional burden to the child, family, and society. Blindness related to pediatric cataract can be treated with early identification and appropriate management. Most cases are diagnosed on routine screening whereas some may be diagnosed after the parents have noticed leukocoria or strabismus. Etiology of pediatric cataract is varied and diagnosis of specific etiology aids in prognostication and effective management. Pediatric cataract surgery has evolved over years, and with improving knowledge of myopic shift and axial length growth, outcomes of these patients have become more predictable. Favorable outcomes depend not only on effective surgery, but also on meticulous postoperative care and visual rehabilitation. Hence, it is the combined effort of parents, surgeons, anesthesiologists, pediatricians, and optometrists that can make all the difference.
  8,755 1,343 -
Corneal edema after phacoemulsification
Namrata Sharma, Deepali Singhal, Sreelakshmi P Nair, Pranita Sahay, SS Sreeshankar, Prafulla Kumar Maharana
December 2017, 65(12):1381-1389
DOI:10.4103/ijo.IJO_871_17  PMID:29208818
Phacoemulsification is the most commonly performed cataract surgery in this era. With all the recent advances in investigations and management of cataract through phacoemulsification, most of the patients are able to achieve excellent visual outcome. Corneal edema after phacoemulsification in the immediate postoperative period often leads to patient dissatisfaction and worsening of outcome. Delayed onset corneal edema often warrants endothelial keratoplasty. This review highlights the etiopathogenesis, risk factors, and management of corneal edema in the acute phase including descemet's membrane detachment (DMD) and toxic anterior segment syndrome. Various investigative modalities such as pachymetry, specular microscopy, anterior segment optical coherence tomography, and confocal microscopy have been discussed briefly.
  8,970 963 -
Optimizing outcomes with toric intraocular lenses
Manpreet Kaur, Farin Shaikh, Ruchita Falera, Jeewan S Titiyal
December 2017, 65(12):1301-1313
DOI:10.4103/ijo.IJO_810_17  PMID:29208810
Toric intraocular lenses (IOLs) are the procedure of choice to correct corneal astigmatism of 1 D or more in cases undergoing cataract surgery. Comprehensive literature search was performed in MEDLINE using “toric intraocular lenses,” “astigmatism,” and “cataract surgery” as keywords. The outcomes after toric IOL implantation are influenced by numerous factors, right from the preoperative case selection and investigations to accurate intraoperative alignment and postoperative care. Enhanced accuracy of keratometry estimation may be achieved by taking multiple measurements and employing at least two separate devices based on different principles. The importance of posterior corneal curvature is increasingly being recognized in various studies, and newer investigative modalities that account for both the anterior and posterior corneal power are becoming the standard of care. An ideal IOL power calculation formula should take into account the surgically induced astigmatism, the posterior corneal curvature as well as the effective lens position. Conventional manual marking has given way to image-guided systems and intraoperative aberrometry, which provide a mark-less IOL alignment and also aid in planning the incisions, capsulorhexis size, and optimal IOL centration. Postoperative toric IOL misalignment is the major factor responsible for suboptimal visual outcomes after toric IOL implantation. Realignment of the toric IOL is needed in 0.65%–3.3% cases, with more than 10° of rotation from the target axis. Newer toric IOLs have enhanced rotational stability and provide precise visual outcomes with minimal higher order aberrations.
  5,978 1,088 -
Managing the posterior polar cataract: An update
Abhay R Vasavada, Vaishali A Vasavada
December 2017, 65(12):1350-1358
DOI:10.4103/ijo.IJO_707_17  PMID:29208815
Posterior polar cataracts (PPC) have always been a challenge for cataract surgeons due to their inherently higher propensity for posterior capsule rupture. Over the years, several technical modifications have been suggested to enhance safety and reduce posterior capsule rupture rates in these polar cataracts. This review article tries to present the various techniques and strategies to published in literature to manage PPCs. It also discusses pearls for making surgery more reproducible and consistent, as well as the role of newer diagnostic and surgical technology based on the published literature on the subject.
  5,339 722 -
Optimizing outcomes with multifocal intraocular lenses
Gitansha Shreyas Sachdev, Mahipal Sachdev
December 2017, 65(12):1294-1300
DOI:10.4103/ijo.IJO_1072_17  PMID:29208809
Modern day cataract surgery is evolving from a visual restorative to a refractive procedure. The advent of multifocal intraocular lenses (MFIOLs) allows greater spectacle independence and increased quality of life postoperatively. Since the inception in 1980s, MFIOLs have undergone various technical advancements including trifocal and extended depth of vision implants more recently. A thorough preoperative workup including the patients' visual needs and inherent ocular anatomy allows us to achieve superior outcomes. This review offers a comprehensive overview of the various types of MFIOLs and principles of optimizing outcomes through a comprehensive preoperative screening and management of postoperative complications.
  4,241 914 -
Prevention and management of postoperative endophthalmitis: A case-based approach
Lalit Verma, Arindam Chakravarti
December 2017, 65(12):1396-1402
DOI:10.4103/ijo.IJO_1058_17  PMID:29208820
Endophthalmitis following intraocular surgery is a disastrous complication and can lead to poor visual outcomes and loss of globe integrity. It should be differentiated from toxic anterior segment syndrome (TASS) where management differs drastically. This article presents basic knowledge about postoperative endophthalmitis and describes nine different real–world scenarios ranging from TASS to milder forms of endophthalmitis responding to intravitreal antibiotics alone and more complicated forms associated with corneal involvement, fungal endophthalmitis and cases requiring intraocular lens removal, radical vitrectomy with hyaloid peeling, base dissection, and silicone oil. A case-based approach is followed where practical considerations have been adopted with each case such that it facilitates the readers' ability to apply theoretical knowledge to real-life clinical situations.
  4,455 683 -
Review of manual small-incision cataract surgery
Kamaljeet Singh, Arshi Misbah, Pranav Saluja, Arun Kumar Singh
December 2017, 65(12):1281-1288
DOI:10.4103/ijo.IJO_863_17  PMID:29208807
Cataract surgery has undergone many changes with the size of incision progressively decreasing over time with an incision of 12.0 mm for intracapsular cataract extraction to 2.2–2.8 mm in phacoemulsification. However, phacoemulsification due to high cost and equipment maintenance cannot be employed widely in developing countries. Manual small-incision cataract surgery (MSICS) offers similar advantages with the merits of wider applicability, less time consuming, a shorter learning curve, and lower cost. MSICS can be performed in high-volume setups due to fast technique. Here, we review the various techniques, safety and efficacy of MSICS, and its progress and utility in developing and underdeveloped countries.
  4,283 721 -
B-HEX pupil expander: Pupil expansion redefined
Suven Bhattacharjee
December 2017, 65(12):1407-1410
DOI:10.4103/ijo.IJO_673_17  PMID:29208822
The B-HEX® Pupil Expander (Med Invent Devices) is a disposable 6.5 mm flexible hexagonal device with notches at corners and flanges at sides. Alternate flanges with positioning holes are tucked under the iris to engage the notches to the margin of the pupil to provide a 5.5 mm expanded pupil. Unlike devices with scrolls or pockets which require an injector to avoid snagging the incision, the preloaded B-HEX is inserted and removed through a 1 mm or larger incision using a manipulator or 23-gauge micro-forceps. The thin profile and uniplanar design allow unhindered instrument movement during phacoemulsification, cortical cleaning, and intraocular lens implantation. The B-HEX is safely used even after capsulorhexis since the thin uniplanar notches are directly visualized to avoid the capsule margin. It is useful in coaxial phacoemulsification, coaxial sub 2.00 mm micro incision cataract surgery (MICS), biaxial 1.5 mm MICS, femtosecond laser assisted cataract surgery (FLACS), small pupil pars plana vitrectomy, and shallow anterior chamber eyes.
  4,652 315 -
Cataract surgery in small pupils
Boris Malyugin
December 2017, 65(12):1323-1328
DOI:10.4103/ijo.IJO_800_17  PMID:29208812
This paper presents the review of historical aspects and the current state-of-the-art in various pupil dilatation methods to be used in cataract surgery. The surgical algorithm in managing small pupil cases should include topical and intraocular mydriatics, appropriately selected viscosurgical device and mechanical dilatation with instruments, iris hooks, and/or pupil expanders.
  3,876 662 -
Comparison of visual performance and after cataract formation between two monofocal aspheric intraocular lenses following phacoemulsification for senile cataract: A randomized controlled study
Shikha Yadav, Pranita Sahay, Prafulla K Maharana, Jeewan S Titiyal, Rasik B Vajpayee, Namrata Sharma
December 2017, 65(12):1445-1449
DOI:10.4103/ijo.IJO_757_17  PMID:29208832
Purpose: Monofocal aspheric intraocular lenses (IOLs) provide better visual outcome compared to other available IOLs following cataract surgery. However, the imported IOLs are expensive and are not affordable by all subset of patients in low- to middle-income countries like India. The aim of this study is to compare the safety and efficacy of a relatively low cost indigenous IOL (Acriol EC) with an imported aspheric IOL (AcrySof IQ). Methods: A randomized controlled trial was conducted at a tertiary care centre. Two hundred and five eyes of 137 patients >45 years of age with uncomplicated age-related cataract were recruited. All cases underwent standard phacoemulsification and randomly assigned to one of the IOL implantations (Group I: AcrySof IOL; Group II: Acriol EC IOL). Primary outcome measure was best-corrected visual acuity (BCVA). Secondary outcomes included visual function (VF) score, spherical equivalent, contrast sensitivity, optical aberrations, and posterior capsular opacification. Independent t-test to compare two means; Mann–Whitney test; Pearson's Chi-square test, and McNemar's test were used for analyzing the nonparametric data such as incidence of posterior capsule opacification. Results: There was no significant difference in the mean postoperative BCVA at 1, 3, 6, and 12 months in either group (P > 0.05). The contrast sensitivity, wavefront aberrations, VF score, and posterior capsular opacification were comparable between the groups except for higher-order aberrations and spherical aberration, which were higher in Group II. Conclusions: Acriol EC IOL provides visual outcomes comparable to other commonly used aspheric IOLs with comparable safety and efficacy at an affordable cost.
  4,188 276 -
Eliminating cataract blindness: Are we on target?
Santosh G Honavar
December 2017, 65(12):1271-1272
DOI:10.4103/ijo.IJO_1190_17  PMID:29208802
  2,496 1,739 -
Decision-making and management of uveitic cataract
Nicole Shu-Wen Chan, Seng-Ei Ti, Soon-Phaik Chee
December 2017, 65(12):1329-1339
DOI:10.4103/ijo.IJO_740_17  PMID:29208813
The visual outcome of uveitic cataract surgery depends on the underlying uveitic diagnosis, the presence of vision-limiting pathology and perioperative optimization of disease control. A comprehensive preoperative ophthalmic assessment for the presence of concomitant ocular pathology, with particular emphasis on macula and optic nerve involvement, is essential to determine which patients will benefit from improved vision after cataract surgery. Meticulous examination in conjunction with adjunct investigations can help in preoperative surgical planning and in determining the need for combined or staged procedures. The eye should be quiescent for a minimum of 3 months before cataract surgery. Perioperative corticosteroid prophylaxis is important to reduce the risk of cystoid macular edema and recurrence of the uveitis. Antimicrobial prophylaxis may also reduce the risk of reactivation in eyes with infectious uveitis. Uveitic cataracts may be surgically demanding due to the presence of synechiae, membranes, and pupil abnormalities that limit access to the cataract. This can be overcome by manual stretching, multiple sphincterotomies or mechanical dilation with pupil dilation devices. In patients <2 years of age and in eyes where the inflammation is poorly controlled, intraocular lens implantation should be deferred. Intensive local and/or oral steroid prophylaxis should be given postoperatively if indicated. Patients must be monitored closely for disease recurrence, excessive inflammation, raised intraocular pressure, hypotony, and other complications. Complications must be treated aggressively to improve visual rehabilitation. With proper patient selection, improved surgical techniques and optimization of peri- and post-operative care, patients with uveitic cataracts can achieve good visual outcomes.
  3,293 700 -
Zepto precision pulse capsulotomy: A new automated and disposable capsulotomy technology
David F Chang
December 2017, 65(12):1411-1414
DOI:10.4103/ijo.IJO_737_17  PMID:29208823
Despite the appeal of an automated method of creating a perfectly circular anterior capsulotomy, global adoption of femtosecond laser capsulotomy (FSLC) has been limited by its high acquisition and per case cost. In addition, the femtosecond laser's large size and the need for eye docking create surgical efficiency and workflow challenges. The Zepto precision pulse capsulotomy (PPC) technology creates a circular anterior capsulotomy of a precise diameter using a disposable handpiece and tip that are used in the normal surgical sequence. Extensive preclinical and clinical testing has resulted in the US Food and Drug Administration (FDA) approval of the technology. Zepto PPC holds promise for complicated eyes such as those with intumescent or brunescent lenses, zonulopathy, or small pupils. This paper and the accompanying videos describe and demonstrate the technique and review the published studies.
  3,261 405 -
Antibiotic prophylaxis in cataract surgery – An evidence-based approach
Aravind Haripriya
December 2017, 65(12):1390-1395
DOI:10.4103/ijo.IJO_961_17  PMID:29208819
Various protocols are being followed for endophthalmitis prophylaxis in cataract surgery, and this subject continues to be a matter of debate. We summarize the most recent evidence-based studies on this topic with additional stress on intracameral (IC) antibiotic prophylaxis. Here, we discuss several large, international clinical studies which discuss the efficacy, adoption, safety, cost, and newer trends in antibiotic prophylaxis. Majority of these studies report a significant reduction in endophthalmitis rates with IC antibiotic prophylaxis. Efficacy data have been reported for IC cefuroxime, vancomycin, and moxifloxacin. Surgeons are now looking for alternatives to vancomycin for IC prophylaxis because of its association with the rare but sight-threatening complication of hemorrhagic occlusive retinal vasculitis. A recent large clinical study shows convincing efficacy with IC moxifloxacin prophylaxis. Two large studies have also reported significant endophthalmitis reduction following use of IC antibiotic prophylaxis, in eyes with posterior capsule tear which are at highest risk for infection. Except for one randomized controlled trial, there is a lack of prospective data on this subject; however, considering the complexity of performing such studies, surgeons have to rely on the mounting evidence from other recent big data studies. Availability of approved intraocular antibiotic formulations will see a much higher adoption in the future.
  2,936 675 -
Cataract surgery: The journey thus far
Mahipal Sachdev
December 2017, 65(12):1273-1274
DOI:10.4103/ijo.IJO_1098_17  PMID:29208803
  1,408 1,446 -
Terminal chop: New technique for full thickness nuclear segmentation in mature hard cataract
Rajendra Prasad, Anurag Badhani, Geetika Badhani Dogra
December 2017, 65(12):1415-1418
DOI:10.4103/ijo.IJO_650_17  PMID:29208824
We describe an efficient technique, “Terminal Chop,” for full thickness nuclear segmentation in mature hard cataracts. Terminal chop utilizes the principle of secondary rock breakage system with stress concentration to break these hard nuclei. In this technique consonant to drag picks, a specially designed chopper “Terminator” is used to initiate a unique dispersive mechanical force to create a full thickness nuclear crack (crack formation) at the weakest soft and thin equator, which automatically traverses through the center and to the equator on the other side. Lateral separation of both the instruments placed at the equator, propagates the initial full thickness nuclear crack (crack propagation), breaking the entire nucleus into two complete pieces including the posterior plate. The direction of splitting follows the cleavage plane in a more direct manner, thus requiring least fracture force, least manipulation and stress, much lower than compressive stress, causing minimal trauma, and highly satisfactory postoperative results.
  2,167 395 -
Intraocular lens calculations in atypical eyes
Aazim A Siddiqui, Uday Devgan
December 2017, 65(12):1289-1293
DOI:10.4103/ijo.IJO_834_17  PMID:29208808
Cataract surgery is the most performed surgical procedure in the field of ophthalmology. The process of intraocular lens (IOL) calculations is a critical step to achieving successful outcomes. Many IOL formulae exist to guide surgeons through the difficult process of picking the most appropriate lens to achieve a certain target refraction. However, these formulae reach within 0.50 diopters of the target refraction only 75% of the time, leaving 25% of the eyes with a significant refractive surprise. A literature review was performed to investigate all the relevant published material on the history, progress, and recent advancements of IOL calculations. Based on this review, the appropriate history, evolution, progress, limitations, and recent advancements are analyzed and explained. Although the modern IOL formulae and biometric devices perform well for average eyes, they are suboptimal for eyes with atypical biometric parameters and also those that are postrefractive and keratoconic. There has not been a single, perfect formula that can resolve the complexities of this process. Various methods of formula optimization and newer generation of IOL formulae and devices may hold the key to improving outcomes in both typical and atypical eyes. These solutions minimize refractive error by introducing new input parameters and complex mathematical techniques to better estimate postoperative lens position.
  1,870 521 -
Reviewing the visual benefits of femtosecond laser-assisted cataract surgery: Can we improve our outcomes?
Michael Lawless, Lewis Levitz, Chris Hodge
December 2017, 65(12):1314-1322
DOI:10.4103/ijo.IJO_736_17  PMID:29208811
Femtosecond laser-assisted cataract surgery (FLACS) was introduced in 2009 and has increasingly been incorporated into surgical practice. The automation of three key aspects of cataract surgery was expected to deliver a significant improvement in both refractive and safety outcomes. The published literature has not yet shown consistent refractive improvement above conventional techniques. The purpose of this paper is to review current FLACS refractive outcomes and explore factors that may have contributed to the current findings and whether future improvements are possible.
  1,876 315 -
Glued intrascleral haptic fixation of an intraocular lens
Priya Narang, Amar Agarwal
December 2017, 65(12):1370-1380
DOI:10.4103/ijo.IJO_643_17  PMID:29208817
Glued intrascleral haptic fixation of an intraocular lens (glued IOL) has evolved as a technique with various modifications that are adopted and practiced by several surgeons. With adequate and appropriate haptic tuck, glued IOL imparts a stable IOL fixation and is a secured method of secondary IOL placement with no pseudophacodonesis.
  1,802 323 -
Endophthalmitis prophylaxis in cataract surgery
Taraprasad Das
December 2017, 65(12):1277-1278
DOI:10.4103/ijo.IJO_1076_17  PMID:29208805
  1,582 512 -
Comparative analysis of endothelial cell loss following phacoemulsification in pupils of different sizes
Rakesh Maggon, Raghudev Bhattacharjee, Sandeep Shankar, Rajesh Chandra Kar, Vivek Sharma, Shyamal Roy
December 2017, 65(12):1431-1435
DOI:10.4103/ijo.IJO_730_17  PMID:29208829
Purpose: To compare Endothelial cell(EC) loss following Phacoemulsification (PKE) in pupils of different sizes. Methods: A prospective double masked observational study in which a total of 150 eyes of 150 patients between 50 & 70 years of age with senile cataract of nuclear sclerosis grade II were enrolled. Patients were allocated into three groups of 50 eyes each in Group A (pupil size <5 mm), Group B (pupil size 5–7 mm) and Group C (pupil size >7 mm). Pupillary size was measured by determining the height of slit on slit-lamp biomicroscope examination. PKE was done by the same expert surgeon using vertical chop technique and a foldable intraocular lens was implanted in the capsular bag. Corneal EC count and pachymetry were performed twice and average of 2 readings was taken for the purpose of this study. Measurements were taken preoperatively and postoperatively on day 1, day 7 and day 30. Results: The mean EC count loss on postoperative day 1 in Group A was 19.45%, Group B 14.89%, Group C 10.19% with statistical significant difference between Group A and Group B, as also Group A and Group C. The difference was not significant between Group B and Group C, though there was a fall in EC count in Group C as well. Increase in corneal thickness on postoperative day 1 in group A was 5.43%, Group B 3.55%, Group C 2.14% with statistical significant difference between Group A and Group B, as also Group A and Group C with no difference in Group B and Group C. Conclusion: PKE done in eyes with maximal pupillary dilatation of <5 mm causes a greater EC loss and results in thicker corneas postoperatively as compared to eyes with pupillary dilatation of >5 mm at the end of one month.
  1,713 341 -
Sutureless 27-gauge needle-assisted transconjunctival intrascleral intraocular lens fixation: Initial experience
Aditya Shrikant Kelkar, Rajesh Fogla, Jai Kelkar, Akshay Anil Kothari, Hetal Mehta, Winfried Amoaku
December 2017, 65(12):1450-1453
DOI:10.4103/ijo.IJO_659_17  PMID:29208833
Purpose: The purpose of the study was to report our initial experience with the transconjunctival Intrascleral Intraocular Lens (SFIOL) fixation with modified Yamane's double-needle technique and flanged haptics. Methods: This was a prospective interventional study that enrolled 31 consecutive patients undergoing SFIOL with the modified Yamane's technique. All patients underwent comprehensive evaluation including uncorrected and best-corrected vision, intraocular pressure, ultrasound biomicroscopy, endothelial cell density, and macular thickness using optical coherence tomography (OCT). We excluded patients with visually significant coexistent pathology such as corneal scars, macular pathology, and glaucoma. Results: The mean age of subjects was 57 ± 16.9 years and 23 were men (74%). Surgery was performed for aphakia following complicated cataract surgery in 10 eyes (32%), with lensectomy for subluxated/dislocated cataract in 6 eyes (19%), and with IOL explantation for subluxated/dislocated IOL in 15 eyes (48%). There were no intraoperative complications. Uncorrected visual acuity improved from median of 1.48 logarithm of minimum angle of resolution (logMAR) units (interquartile range [IQR] = 1.3–2 logMAR) at baseline to 0.3 logMAR (IQR = 0.2–0.4 logMAR) at 6 weeks (P < 0.001) which was maintained at 6 months. There were no significant changes in endothelial cell density (P = 0.34) and OCT-based macular thickness (P = 0.31) at 6 months. Two eyes had slight IOL decentration. Conclusion: Our initial experience suggests that the Yamane's technique for SFIOL is a simple procedure with a short-learning curve and is independent of scleral flaps, tunnels, sutures, and fibrin glue. Using widely available 27-gauge needle instead of 30-gauge thin wall needle as originally described by Yamane makes it possible for the use of various three-piece IOLs available globally. Further studies are required for widespread acceptance of this technique.
  1,587 371 -
Cataract surgery and controversy: Susruta-Daviel-Kelman
VK Raju, Leela V Raju
December 2017, 65(12):1275-1276
DOI:10.4103/ijo.IJO_1104_17  PMID:29208804
  1,531 367 -
Awareness and eye health-seeking practices for cataract among urban slum population of Delhi: The North India eye disease awareness study
Vasundhra Misra, Praveen Vashist, Senjam Suraj Singh, Sumit Malhotra, Vivek Gupta, SN Dwivedi, Sanjeev K Gupta
December 2017, 65(12):1483-1488
DOI:10.4103/ijo.IJO_585_16  PMID:29208840
Purpose: The objective of the study was to assess the awareness and health-seeking practices related to cataract in urban slums of Delhi. Methods: This study design was a population-based cross-sectional study. Participants aged 18–60 years were recruited from randomly selected five slums of South Delhi. They were interviewed using a semi-structured interview schedule on awareness and eye health-seeking practices related to cataract. The practices were recorded if the respondents themselves or any other member of the family was diagnosed with cataract in previous 2 years. Results: A total of 1552 respondents participated in the study, of which, 89.9% had heard of cataract but only (42%) were aware of any symptom of cataract. The common symptoms of cataract reported by the participants were white opacity in eyes (25.9%) and loss of vision (20.6%). Surgery as a treatment of cataract was known to only 559 (40.1%) participants. Awareness about surgery as treatment of cataract was significantly higher among people aged 45–60 years (adjusted odds ratio = 2.89, 95% confidence interval = 2.11–3.97) and in educated people (adjusted OR = 3.69 95% CI = 2.37–5.73). Out of 84 respondents who had been diagnosed with cataract, the health-seeking practices were observed by 70 (83.3%) participants. Among them, 51 (72.9%) had undergone surgery and another 19 (27.1%) had been advised to wait for surgery. Most of the operated patients 48 (94.1%) attended the postoperative follow-up. Conclusion: The study findings suggest the majority of participants have heard of cataract, but there is low awareness of its symptoms and treatment, and good eye health-seeking practices observed for cataract in urban slum population. Gaps in awareness observed can be filled up by implementing proper eye health education programs.
  1,608 245 -
Safety, efficacy and cost-effectiveness of consecutive bilateral cataract surgery on two successive days in tribes at base hospital through community outreach program: A prospective study of Aravali Mountain, North West India
Amit Mohan, Navjot Kaur, Vishal C Bhatanagar
December 2017, 65(12):1477-1482
DOI:10.4103/ijo.IJO_641_17  PMID:29208839
Purpose: The aim of the study was to evaluate the safety and efficacy of consecutive bilateral cataract surgery (CBCS) on two successive days in a single hospital visit. Methods: Prospective study was conducted on 565 patients of various tribes of hilly area of West Rajasthan who had come to our hospital through community outreach programmed (CORP) between January 2015 and March 2016. Patients with significant bilateral cataract without any other ocular morbidity were advised bilateral manual small incision cataract surgery on two consecutive days. Intraoperative and postoperative complications were evaluated, and follow-up was done at 1 week, 1 month, and 3 months. Results: Out of 565 patients, 519 underwent both eye surgeries. Second eye surgery was deferred for a later date in 46 cases. Because of intraoperative and postoperative complications in the first eye, 31 had delayed surgeries while 15 patients refused to undergo another eye surgery either because of postoperative day 1 poor vision in the operated eye due to retinal pathologies (n = 8) or unwillingness (n = 7). The second eye surgery was performed for 519 patients, out of whom six had intra or postoperative complications. At 1 month follow-up, four patients had unilateral cystoid macular edema and three had prolonged postoperative inflammation. At 3 months, all patients were satisfied and had no complications. None of the patients had sight-threatening complications such as endophthalmitis, corneal decompensation, or vitreoretinal complications. Conclusion: CBCS may be considered safe and cost-effective for patients living in remote locations, dependent on CORP.
  1,645 184 -
A simple technique of intraocular lenses explantation for single-piece foldable lenses
Arup Bhaumik, Santanu Mitra
December 2017, 65(12):1428-1430
DOI:10.4103/ijo.IJO_664_17  PMID:29208828
Foldable intraocular lenses (IOLs) are most commonly used in modern-day cataract surgery. Explantation of these IOLs is not frequently encountered, but sometimes extreme situations may demand the same. Commonly explantation is achieved by bisecting the IOL inside the anterior chamber with a cutter and delivering the pieces out one by one. This may require corneal wound extension with associated damage and endothelial loss leading to visual deterioration. We devised a simple, innovative IOL explantation technique utilizing a modified Alcon A cartridge and snare. This can successfully refold the IOL to be explanted inside the eye and deliver it out through the same wound. The device has limitations with very thick optic lenses, multipiece, and silicon IOLs. In conclusion, we describe a simple, innovative, and reproducible technique to explant almost any single piece IOL without compromising the original surgery and yielding very satisfactory outcomes.
  1,587 184 -
Long-term results of trypan blue dye irrigation in the capsular bag to prevent posterior capsule opacification: A randomized trial
Rajesh Subhash Joshi, Murtaza Saifuddin Hussain
December 2017, 65(12):1440-1444
DOI:10.4103/ijo.IJO_454_17  PMID:29208831
Purpose: To study the effect of capsular bag irrigation of trypan blue dye (0.06%) on posterior capsular opacification (PCO) in eyes undergoing phacoemulsification. Methods: This was a randomized, trial conducted at a tertiary eye care center in central India. The study included 50 patients (100 eyes) with senile cataracts who were scheduled for phacoemulsification and intraocular lens (IOL) implantation and were willing to undergo bilateral cataract surgery. One eye of each patient was randomized to one of two groups. The dye group received 0.2 ml of trypan blue injected in the capsular bag after cortical cleanup under air. The control group (other eye of the same patient) received 0.2 ml of balanced salt solution injected in a similar manner. PCO in the central 3 mm area of IOL optic was analyzed by a masked observer using an evaluation of PCO software computer analysis system at 6, 12, 24, and 36 months. Results: The average age of patients was 62.05 ± 6.22 in the dye group and 64.92 ± 7.16 years in the control group. The mean PCO score at 6 months was significantly lower in the dye group (0.10 ± 0.15) than in the control group (0.22 ± 0.30). There were no significant differences in the PCO scores between the two groups from 12 to 36 months. At the end of 3 years, eight eyes in the dye group and seven in the control group required YAG capsulotomy (P = 0.21). Conclusion: Capsular bag irrigation of trypan blue dye decreased the PCO score at 6 months, but it had no effect at 36 months.
  1,369 340 -
Cataract surgery training during ophthalmology residency in India: Challenges and how to overcome them?
Suresh K Pandey, Vidushi Sharma
December 2017, 65(12):1279-1280
DOI:10.4103/ijo.IJO_1032_17  PMID:29208806
  1,283 316 -
Sutureless glueless intrascleral fixation of posterior chamber intraocular lens: Boon for aphakic
Nagendra Shekhawat, Karishma Goyal
December 2017, 65(12):1454-1458
DOI:10.4103/ijo.IJO_620_17  PMID:29208834
Purpose: To report results of intrascleral fixation of 3-piece IOL without the help of suture and glue. Methods: Study included intrascleral fixation of haptic in 50 eyes by T-fixation technique. Preoperative and postoperative visual acuity, slit lamp and fundus examination, applanation tonometry, keratometry, biometry, optical coherence tomography, Scheimpflug imaging were done for extensive evaluation. Qualitative and quantitative data were summarized in the form of proportion and mean and standard deviation, respectively. The significance of difference was measured by Chi-square test or unpaired t-test or ANOVA whichever is appropriate. P < 0.05 was considered as statistically significant. Results: There was one case in which haptic broke during handshake maneuver and another IOL was required. Postoperative complications included corneal edema (4%), increased intraocular pressure (6%), cystoid macular edema (2%), decentration (4%), and dislocation (2%), which were all managed to the level of good visual recovery. There was no significant change in corneal astigmatism. There was significant change found in best-corrected visual acuity and uncorrected visual acuity after surgery. Conclusion: This modified technique seems to be a good alternative in IOL implantation in eyes with deficient capsules in view of the decrease in the learning time and surgical time and risk for complications.
  1,201 261 -
Redefining evidence in the management of acute post-cataract surgery endophthalmitis in India - The 2014 Adenwalla Oration, All India Ophthalmological Society
Taraprasad Das
December 2017, 65(12):1403-1406
DOI:10.4103/ijo.IJO_755_17  PMID:29208821
The current evidence of postoperative endophthalmitis management in three important components of care-infection control, inflammation control, and prevention was reviewed, and their current relevance and application in an Indian context were evaluated. The publications from India indicated that Gram-negative bacterial and filamentous fungal infections are relatively higher. There are increasing instances of resistance to ceftazidime by Gram-negative microorganisms. Intravitreal dexamethasone limits inflammation in bacterial endophthalmitis when given together with the intravitreal antibiotics. Intracameral antibiotic could reduce postcataract surgery infection at least in less rigorous surgical environment. Systematic collection of data and periodic evaluation of the current practice against the new evidence are necessary to prevent or treat postcataract surgery endophthalmitis.
  1,195 243 -
Lens decompression technique for prevention of intraoperative complications during phacoemulsification of intumescent cataract
Karim Mahmoud Nabil
December 2017, 65(12):1436-1439
DOI:10.4103/ijo.IJO_352_17  PMID:29208830
Purpose: To evaluate intraoperative complications during phacoemulsification of intumescent cataract using lens decompression technique. Methods: Participants with intumescent cataract scheduled for phacoemulsification were recruited and divided into two groups. In both groups, after the anterior capsule was stained with trypan blue, the anterior chamber was filled peripherally with a dispersive ophthalmic viscosurgical device (OVD) followed centrally by a higher viscosity cohesive OVD (Healon GV). In Group 2, a 25-gauge needle was then inserted into the lens center and liquid cortex aspirated by pulling back on the syringe plunger. The outcomes measured were the incidence of capsular radial tears and the incidence of conversion to extracapsular cataract extraction (ECCE). Results: In Group 1 (20 eyes), capsular radial tears occurred in four eyes, and in two eyes, the procedure had to be converted to ECCE. In Group 2 (20 eyes), no capsular radial tears or conversion to ECCE was reported. Conclusion: Lens decompression technique reduced the risk of capsular radial tears and conversion to ECCE during phacoemulsification of intumescent cataract.
  1,159 248 -
Antibiotic prophylaxis practice patterns for cataract surgery in India – Results from an online survey
Aditya S Kelkar, David F Chang, Jai A Kelkar, Hetal M Mehta, Tatyarao Lahane, Ragini Parekh
December 2017, 65(12):1470-1474
DOI:10.4103/ijo.IJO_842_17  PMID:29208837
Purpose: The aim of this study is to assess the current antibiotic prophylaxis practice patterns for cataract surgery in India. Methods: This was a questionnaire-based E-survey carried out at a tertiary eye care center in India. An E-mail invitation to complete an online 20 point questionnaire survey was sent to all members of the All India Ophthalmological Society with valid E-mail addresses using a digital E-mail service. Duplicate entries were prevented. Results: Out of 1228 total respondents (8.2%) who completed the survey 38% reported using routine intracameral (IC) antibiotic prophylaxis. Another 7% place antibiotics in the irrigating solution. Of those using IC antibiotic prophylaxis, 91% adopted this practice within the past 2 years; 92% are using moxifloxacin with 56% using a commercially available moxifloxacin formulation. Those predominantly performing phacoemulsification (43% vs. 25% performing mostly manual small incision cataract surgery, P < 0.001) and more than 500 cataract surgeries annually (45% vs. 33%, P < 0.001) reported greater use of IC moxifloxacin. Self-reported endophthalmitis rates were statistically significantly greater in those not using IC antibiotics (0.045% vs. 0.036, P = 0.04). Although a majority of respondents believe that IC antibiotics are an important option (54%) and that it is important to have a commercially available solution (68%), many believe that other antibiotic prophylaxis methods are sufficient (31%). Conclusion: IC antibiotic prophylaxis for cataract surgery has sharply increased in India. In contrast to the West, intraocular moxifloxacin, which is commercially available in India, is preferred by the vast majority of users.
  1,065 233 -
Severe pigment dispersion after iris-claw phakic intraocular lens implantation
Virgilio Galvis, Néstor I Carreño, Alejandro Tello, Andrea N Laiton
December 2017, 65(12):1492-1494
DOI:10.4103/ijo.IJO_743_17  PMID:29208843
A 23-year-old female patient presented 3 months after the implantation of an Artisan® phakic intraocular lens with a severe depigmentation of the iris and peripheral anterior synechiae. Explantation of the intraocular lens and goniosynechialysis were performed. Eleven months after the explantation appearance of the iris significantly improved. There was no loss of lines of corrected distance visual acuity. Severe pigment dispersion after the implantation of an Artisan® phakic intraocular lens may happen and may require explantation of the lens. Iris depigmentation may improve with time.
  1,043 218 -
A rare case of traumatic subretinal migration of crystalline lens, corroborated histologically
Pritam Bawankar, Dipankar Das, Balmukund Agarwal, Kasturi Bhattacharjee, Shahinur Tayab, Panna Deka, Anshul Singh, Erani Borah, Shriya Dhar
December 2017, 65(12):1495-1497
DOI:10.4103/ijo.IJO_613_17  PMID:29208844
Blunt trauma is the most common cause of posterior dislocation of the crystalline lens. We describe a rare case of subretinal migration of crystalline lens through the giant retinal tear following blunt ocular trauma. This incidental finding of subretinal dislocation of lens following blunt ocular trauma was confirmed on histopathological examination of the enucleated eye. This complication has not been described by histopathological examination in literature so far.
  1,034 210 -
Soemmering's ring
Harsha Bhattacharjee, Saurabh Deshmukh
December 2017, 65(12):1489-1489
DOI:10.4103/ijo.IJO_913_17  PMID:29208841
  952 179 -
Optimizing optical outcomes of intraocular lens implantation by achieving centration on visual axis
Roop , Prakhyat Roop
December 2017, 65(12):1425-1427
DOI:10.4103/ijo.IJO_653_17  PMID:29208827
In existing designs of intraocular lenses (IOLs), optical outcomes are compromised even after perfectly executed surgery. The reason for this is misalignment of optical axis of the eye and its visual axis. There is a need to design an IOL which compensates for this misalignment and hence enhances the optical outcomes of cataract surgery. The present innovation attempts to fulfill this unmet need and optimizes optical outcomes of all IOLs of different optical profiles – spherical, aspheric, toric, and multifocal. In addition, the improvised design of IOL offers other benefits such as delaying the formation of after-cataract and ameliorating negative dysphotopsia.
  915 215 -
Limited vitrectomy in phacomorphic glaucoma
Ritika Sachdev, Avnindra Gupta, Ritesh Narula, Rashmi Deshmukh
December 2017, 65(12):1422-1424
DOI:10.4103/ijo.IJO_668_17  PMID:29208826
One of the challenging situations for a cataract surgeon is phacoemulsification in the shallow anterior chamber like cases of phacomorphic glaucoma. Some of the main concerns of operating in a narrow space include endothelial decompensation, descemet's detachment, and posterior capsular rents. High vitreous pressure predisposes to posterior capsular rents owing to a reduced concavity of the posterior capsule and increasing the proximity of phaco-tip to the posterior capsule. We describe a technique of limited vitrectomy in such cases. A small gauge 23-G/25-G trocar cannula is passed transconjunctivally, and the liquefied vitreous is allowed to egress. Vitrectomy is done extraocularly till the vitreous pressure lowers down. This technique helps to debulk the vitreous and decompress the globe in a controlled manner. The resultant posterior displacement of iris-lens diaphragm causes a deepening of the anterior chamber to facilitate phacoemulsification.
  896 181 -
Effects of Fuchs uveitis syndrome on the ultrastructure of the anterior lens epithelium: A transmission electron microscopic study
Kemal Tekin, Yasemin Ozdamar Erol, Mustafa Fevzi Sargon, Merve Inanc, Pinar Cakar Ozdal, Nilufer Berker
December 2017, 65(12):1459-1464
DOI:10.4103/ijo.IJO_691_17  PMID:29208835
Purpose: The purpose of the study was to investigate the electron microscopic findings of the lens epithelial cells (LECs) in patients with Fuchs uveitis syndrome (FUS) who suffered from cataracts and to compare those with age-matched controls. Methods: This study was a prospective, comparative case series. The anterior lens capsules (ALC: basement membrane and associated LECs) were taken from 12 eyes of 12 cases of FUS and ten eyes of ten control patients. The ALCs were obtained from cataract surgery and prepared for transmission electron microscopy (TEM). Results: There were no statistically significant differences regarding the age or gender between the FUS group and the control group (P > 0.05). In the TEM examinations of the ALCs, all of the FUS cases revealed similar significant ultrastructural changes when compared to the control patients. In the FUS group, the LECs showed homogeneous thickening and irregularity which included some small vacuoles in different areas of the epithelial tissue. Moreover, in some areas of the LECs, widespread, oval-shaped, pigment clusters were detected. Conversely, in the control group, the LECs and all of their elements were in normal ultrastructural patterns, with the exception of some small intraepithelial vacuoles which were fewer and smaller than those in the FUS group. Conclusion: Ultrastructural analysis of the ALC of the patients with FUS disclosed some significant alterations which may be related to the summation of oxidative stress, intraocular inflammation, and iris atrophy.
  789 170 -
Implantation of a double iris-claw intraocular lens in an aphakic nanophthalmic eye
Filiz Avsin Ozdemir Sarioglu, Yelda Yildiz Tasci, Bengi Ece Kurtul, Sefer Ogün Boluk
December 2017, 65(12):1490-1492
DOI:10.4103/ijo.IJO_441_17  PMID:29208842
A 55-year-old female with an aphakic nanophthalmic eye underwent a secondary intraocular lens implantation (IOL) with double Artisan aphakia iris claw IOLs (ICIOLs) and was evaluated in this research. The patient's preoperative best-corrected visual acuity (BCVA) of the right eye was 0.4 (0.4 logMAR) (with + 21.00 D), postoperative 1st and 3rd month, 1st year, and 3 years BCVAs were 0.4 (0.4 logMAR). The intraocular pressure was 15 mmHg preoperatively, and 14, 12, 12, and 15 mmHg postoperatively at 1st and 3rd month, 1st year, and 3 years, respectively. The preoperative endothelial cell density (ECD) was 2372 cells/mm2, and postoperative ECDs were 2352, 2391, 2246, and 2240 cells/mm2 at 1st and 3rd months, at 1st year, and 3 years respectively. In aphakic nanophthalmic eyes with inadequate capsular support, which require high IOL dioptry, the implantation of double ICIOLs (one in front of the iris and the other behind the iris) seems to be safe and provides good visual rehabilitation.
  741 131 -
Endophthalmitis prophylaxis: My perspective
Suven Bhattacharjee
December 2017, 65(12):1475-1476
DOI:10.4103/ijo.IJO_1151_17  PMID:29208838
  698 158 -
Clinical outcomes in traumatic pseudophacocele: A rare clinical entity
Priya Narang, Amar Agarwal
December 2017, 65(12):1465-1469
DOI:10.4103/ijo.IJO_1068_17  PMID:29208836
Purpose: The purpose of this study is to evaluate the clinical outcomes in patients with traumatic pseudophacocele. Methods: In this retrospective, interventional case series, scleral wound repair with pars plana vitrectomy and glued intrascleral fixation of an intraocular lens (glued IOL) was performed in 5 eyes of 5 patients. Pupilloplasty was performed in 3 cases whereas aniridia glued IOL fixation was done in 1 case that had total avulsion and loss of iris tissue. The main outcome measures were best-corrected visual acuity (BCVA), intraoperative and postoperative complications during the entire follow-up period. Results: The preoperative vision ranged from hand movement to perception of light in all the patients. The mean postoperative BCVA was 0.42 ± 0.21 Snellen's decimal equivalent (SDE) at final follow-up. Postoperatively, all the cases retained good visual acuity with case 1 and case 2 reporting 0.5 SDE, case 3 had 0.33 SDE, case 5 had 0.67 SDE whereas case 4 had a final visual acuity limited to 0.1 SDE due to associated corneal opacity. The mean follow-up period was 20.2 ± 11.7 months (range from 9 months to 36 months). The IOL was well centered, all the wounds were well apposed and the mean postoperative intraocular pressure was 14.6 ± 1.95 mm Hg. No complications were reported in the entire follow-up period. Conclusion: The clinical outcomes of management of pseudophacocele were encouraging with retention of reasonably good visual potential in all cases.
  636 141 -
Spatula scaffold: An iris-sparing technique for lensectomy
Priya Narang, Amar Agarwal
December 2017, 65(12):1419-1421
DOI:10.4103/ijo.IJO_601_17  PMID:29208825
Lensectomy with vitrectomy is often performed for crystalline lenticular subluxation. We report a new technique and a practical approach that involves the placement of a spatula beneath the iris tissue that facilitates retroiridial removal of subluxated lens and acts as a scaffold by protecting the iris tissue from being accidentally trapped into the vitrectomy cutter port. Our technique facilitates management of the lens and vitreous without any trauma to the iris and secondarily obviates the need to perform an iris repair procedure that may arise due to iatrogenic reasons.
  646 114 -