Aditya Kelkar

How to prevent endophthalmitis in cataract surgeries

Postoperative endophthalmitis is a very devastating complication and every step should be taken to reduce its occurrence. Unattended air conditioning filter systems are often the culprits and regular maintenance of the filters is of paramount importance. Shedders of pathogenic organisms amongst the theater personnel should be identified by regular screening and should be promptly treated. In addition to the use of Povidone iodine 5% solution in the conjunctival sac few minutes prior to surgery, proper construction of wound, injectable intraocular lenses, use of prophylactic intracameral antibiotics or prophylactic subconjunctival antibiotic injection at the conclusion of cataract surgery, placing a patch after the surgery for at least 4 h and initiating topical antibiotics from the same day of surgery helps to lower the frequency of postoperative endophthalmitis. Intraoperative posterior capsule rupture and anterior vitrectomy are risk factors for acute endophthalmitis, and utmost care to prevent posterior capsular rent should be taken while performing cataract surgery. Also, in case of such complication, these patients should be closely monitored for early signs of endophthalmitis in the postoperative period. In the unfortunate event of endophthalmitis the diagnosis should be prompt and treatment must be initiated as early as possible.

Cytomegalovirus retinitis in a seronegative patient with systemic lupus erythematosus on immunosuppressive therapy

AimThe purpose of this study is to report a rare case of cytomegalovirus (CMV) retinitis in a seronegative patient with systemic lupus erythematosus (SLE) on immunosuppressive therapy.MethodsA seronegative patient with SLE who was on immunosuppressive therapy developed CMV retinitis. The immunosuppressive therapy was tapered, and the patient was given intravitreal ganciclovir and foscarnet in addition to systemic ganciclovir. The follow-up visits were documented.ResultThe patient responded to the treatment and there was complete resolution.ConclusionCMV retinitis is a rapidly progressive condition and patients on immunosuppressive therapy should be referred to an ophthalmologist for periodic check-up for early diagnosis and treatment of this devastating ophthalmic condition. For clinically resistant CMV retinitis in seronegative patients with SLE, a combination therapy of intravitreal foscarnet with oral and intravenous ganciclovir is useful.

Antibiotic prophylaxis practice patterns for cataract surgery in India – Results from an online survey

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.

Repeat Descemetopexy after Descemet's Membrane Detachment following Phacoemulsification.

Descemets membrane detachment (DMD) is an uncommon condition with a wide range of possible etiologies. Probably the commonest cause is a localized detachment occurring after cataract extraction surgery. Descemetopexy gives good anatomic attachment rates and visual outcomes and has become the standard treatment for DMD. However, in cases with failed initial descemetopexy, the next step in the management of such cases remains unclear. Before initiating a complex surgical procedure like keratoplasty, which requires good postoperative care and regular follow-ups, repeat descemetopexy with a long-term tamponade using 14% C3F8 gas for recurrent DMD is definitely a worthwhile attempt.

Comparison of single injection of intravitreal triamcinolone versus single injection of intravitreal bevacizumab in macular edema secondary to branch retinal vein occlusions with regard to changes in best corrected visual acuity and central macular thickness in the short term

Importance of Retinal Evaluation before Refractive Surgery. Intraocular Implant & Refractive Society, India.Vol.1May 2004 to August 2004. Intravitreal Avastin (Bevacizumab) injection for Ocular Ischemic Conditions. Orissa journal of ophthalmology Oct 2007 Vol. 16: 64-5. Intravitreal Avastin (Bevacizumab) injection for Ocular Ischemic Conditions. POSTER – Poona Ophthalmological society Nov. 2007. Anterior Luxation of rollable intraocular lens.Indian Journal of Ophthalmology Jan-Feb 2007 Vol.55 No.1:82-83. The Use of Intravitreal Bevacizumab in Neovascular Glaucoma. A Case report. Bull.Soc.Belgium Ophthalmology – 2007 ;( 303):43-45. How to prevent endophthalmitis in cataract surgeries? Indian Journal of Ophthalmology. 2008 Sep-Oct; Vol.56 (5):403-7. Comparison of single injection of intravitreal triamcinolone versus single injection of intravitreal bevacizumab in macular edema secondary to branch retinal vein occlusions with regard to changes in best corrected visual acuity and central macular thickness in the short term. Indian Journal of Ophthalmology. 2009 May-Jun; Vol. 57(3):243-4. Late posterior subluxation of rollable intraocular lens after an uneventful microphacoemulsification cataract surgery. Indian J Ophthalmology.2010 July-August; Vol.58 (4):350-351. Retina and Lasik. Intraocular implant and Refractive surgery Journal April 2004. Editorship of Poona Ophthalmological society magazine – POSTER, April 2005-2007.

Sutureless, Glueless, Scleral Fixation of Single-Piece and Toric Intraocular Lens: A Novel Technique.

Sutureless, glueless, scleral fixation of an intraocular lens is a known technique of fixing a lens in the scleral pockets. However, this technique is applied to single-piece and toric lenses instead of 3-piece lenses, allowing the advantage of the use of premium lenses in patients with poor capsular support. Favourable results without complications of pigment dispersion, iris transillumination defects, dysphotopsia, elevated intraocular pressure, intraocular hemorrhage and cystoid macular edema with a well-centered, stable intraocular lens have been observed in the 3-month postoperative period in both cases.

A mobile team for screening of retinopathy of prematurity in India: Cost - effectiveness, outcomes, and impact assessment

Purpose: To study the cost effectiveness, outcomes and impact of retinopathy of prematurity (ROP) screening and management model for urban neonatal intensive care units (NICUs). Study Design: Public health intervention study. Methods: This study was conducted in 2013. Staff of a mobile unit assessed all infants aged less than 34 weeks of Gestation age at birth and/or birth weight 1700 GM or less admitted in five NICUs between 2013 and 2015. A trained ophthalmologist performed bedside ROP screening through dilated pupils using indirect ophthalmoscope. ROP was graded and managed as per the International Classification of Retinopathy of Prematurity treatment guidelines. Counseling and laser treatment were the interventions. The incidence, grade and determinants of ROP were estimated. Direct and indirect costs were calculated to estimate the unit cost of screening and managing a child with ROP using the model. Results: The study sample included 102 preterm/underweight infants. The prevalence of ROP of different grades in either eye was 32% (95% Confidence Intervals (CI): 23.2–41.5). ROP stage I was present in 75% of these eyes. The model could help in preventing/reducing visual disability in 4 infants with advanced stages of ROP. The unit cost of ROP screening, identifying one child with ROP and addressing visual disability due to ROP was US

Tips and Tricks of Intrascleral Fixation of Single-Piece and Toric Intraocular Lens

198.9, 596.7 and 4,137.4 respectively. Conclusion: A mobile screening is likely feasible and cost-effective method to detect ROP and offer timely intervention for NICU in urban areas with limited resources.

Intermittent exotropia: Surgical treatment strategies

Various techniques for scleral fixation of IOL in cases of poor capsular support have been described in past. Sutured scleral fixation of IOLs has been attempted for single piece and toric IOLs also. But this predisposes to various suture releated complications. Sutureless fixation of three piece IOLs with or without glue has gained popularity worldwide. However, odd power lenses and high astigmatism cannot be countered with three piece lenses. Our technique of sutureless, glueless scleral fixation of IOL using single piece and toric IOLs has shown favourable results and a potential option in such scenarios.

Changes in the Retinal Vascular Network Morphology (Diameter and Tortuosity) after Administration of Intravitreal Bevacizumab in a Patient with Ischaemic Branch Retinal Vein Occlusion

Surgical management of intermittent exotropias (IXTs) is ambiguous, with techniques of management varying widely between institutions. This review aims to examine available literature on the surgical management of IXT. A literature search was performed using PubMed, Web of Knowledge, LILACS, and the University of Liverpool Orthoptic Journals and Conference Transactions Database. All English-language papers published between 1958 and the present day were considered.