Dinesh Kumar Mehta

Functional outcomes of acrylic intraocular lenses in pediatric cataract surgery

Purpose: To evaluate the functional outcomes of in‐the‐bag implantation of acrylic intraocular lenses (IOLs) with posterior continuous curvilinear capsulorhexis (PCCC), without PCCC, with PCCC and anterior vitrectomy, and with PCCC and optic capture in pediatric cataract surgery. Setting: Pediatric Ophthalmology Service, Guru Nanak Eye Centre, New Delhi, India. Methods: Forty‐two eyes of 25 children were included in this prospective study. All eyes had in‐the‐bag implantation of an AcrySof® IOL (Alcon). Twenty‐five eyes had had an anterior continuous curvilinear capsulorhexis (ACCC) (Group A). Seventeen eyes had PCCC along with ACCC (Group B), 4 had anterior vitrectomy combined with PCCC (Group C), and 6 had PCCC with IOL optic capture through the PCCC (Group D). Secondary opacification of the visual axis, visual acuity, and possible complications were observed and analyzed. Results: The mean age of the patients was 78 months (range 36 to 144 months). The mean follow‐up was 13 months (range 6 to 18 months). Four eyes (16%) in Group A developed visually significant posterior capsule opacification (PCO) involving the central visual axis and required secondary capsulotomy. All eyes in Groups B, C, and D had a clear visual axis at the last follow‐up and did not require a secondary procedure. Minimal postoperative inflammation (ie, aqueous flare and IOL deposits) was seen in all groups. The mean preoperative decimal best corrected visual acuity (BCVA) in Groups A, B, C, and D was 0.095, 0.055, 0.174, and 0.039, respectively. Postoperatively, the BCVA was 0.54, 0.66, 0.66, and 0.66, respectively. Conclusions: An optimal‐sized ACCC followed by in‐the‐bag implantation of a foldable acrylic IOL helped maintain a clear visual axis by delaying the onset of PCO and leading to milder PCO. The benefits of a foldable acrylic IOL in pediatric cataract surgery can be increased by combining it with PCCC, with or without anterior vitrectomy, or with optic capture of the IOL.

Posterior continuous curvilinear capsulorhexis with and without optic capture of the posterior chamber intraocular lens in the absence of vitrectomy

PURPOSE To evaluate the efficacy of posterior continuous curvilinear capsulorhexis (PCCC) with optic capture of the posterior chamber intraocular lens (PC IOL) in the absence of vitrectomy in preventing secondary opacification of the visual axis following pediatric cataract surgery. PATIENTS AND METHODS Thirty-four eyes of 28 children with congenital or developmental cataract, aged 1.5 to 12 years (mean, 6.39 years), were included in this prospective, randomized study. Anterior continuous curvilinear capsulorhexis (ACCC) with PCCC without optic capture of the PC IOL was performed in group A (18 eyes) and ACCC with PCCC with optic capture of the PC IOL was performed in group B (16 eyes). None of the eyes underwent anterior vitrectomy. Secondary opacification of the visual axis, visual acuity, and possible complications were observed and analyzed. RESULTS The follow-up period ranged from 8 to 28 months (mean, 17.5 months). All 16 eyes (100%) in group B had a clear visual axis at the end of follow-up. Eight eyes (44.4%) in group A had significant opacification of the visual axis. The difference between the two groups was statistically significant (P = .0011). No eye in group B required secondary intervention, whereas all 8 eyes in group A with significant secondary opacification required secondary intervention. There was no statistically significant difference in other complications such as anterior chamber reaction, fibrin formation, lenticular precipitates, and posterior synechiae. The final best-corrected visual acuity at the end of follow-up was comparable in the two groups (P > .05). CONCLUSION PCCC with optic capture of the PC IOL prevents secondary opacification of the visual axis even in the absence of vitrectomy.

Tubercular endophthalmitis simulating retinoblastoma

PURPOSE To report a case of tubercular endophthalmitis simulating retinoblastoma. METHODS Case report. An 8-year-old female presented with a history of complete loss of vision and a white pupillary reflex in the left eye of 3 months duration. RESULTS Retinoblastoma could not be excluded on the basis of clinical examination and relevant investigational studies. In the left eye, a computed tomography (CT) scan demonstrated a large vitreous mass with foci of calcification. Enucleation in the left eye was performed, and histopathological examination revealed a chronic granulomatous endophthalmitis and acid-fast bacilli consistent with tubercular pathology. CONCLUSION This case illustrates that tubercular endophthalmitis with leukocoria and a vitreous mass containing focal calcification may simulate retinoblastoma.

Polyglactin Sutures Versus Nylon Sutures for Scleral Flap Suturing in Trabeculectomy

BACKGROUND AND OBJECTIVES To note the effect on filtration function of using polyglactin sutures for scleral flap suturing in trabeculectomy. PATIENTS AND METHODS Polyglactin sutures were compared with nylon sutures to secure the scleral flap of trabeculectomy in 30 consecutive eyes. Parameters studied were intraocular pressure, central anterior chamber depth, and bleb score in this randomized prospective study. RESULTS Observations regarding intraocular pressure, central anterior chamber depth and bleb score in the early postoperative period were comparable in the 2 groups. The results at 12 months follow-up reveal a lower mean IOP (P < 0.05) and a higher mean bleb score (P < 0.05) in the group with polyglactin sutures. Success rate (defined as IOP < 21 mm Hg) at 12 months was 100% with use of polyglactin sutures compared to 80% with nylon sutures. CONCLUSIONS Polyglactin sutures can be used as an alternative to nylon sutures for scleral flap suturing in trabeculectomy, with the possible additional benefit of better long-term filtration function.

Chemo-paralysis for the removal of a live intraocular worm in ocular angiostrongyliasis.

Angiostrongylus cantonensis is also called the rodent lung worm. It was first discovered in 1935 by Chen in Rattus rattus, in Canton, China. The rodent is the definitive host while infected mollusks, snails and crabs act as the intermediate hosts. Humans are infected by the 3rd stage larvae, either by eating undercooked intermediate hosts or by consuming vegetables. 1 It is a delicate nematode reported in Asia Pacific region most commonly in South‐east Asia and has been reported from Taiwan, Thailand, Indonesia, Vietnam and Sri Lanka. 2 Anterior chamber angiostrogyliasis is extremely rare, and no previous case of ocular angiostrogyliasis from India could be found on Medline search. We report a new technique in the removal of the actively motile thread‐like worm by paralysing it with intracameral preservative free lidocaine, which aids in the easy removal of the intact worm.

Optical coherence tomography study of optic disc melanocytoma.

Optic disc melanocytoma is a well-known clinical entity occurring as a deeply pigmented lesion on the optic nerve head. A 40-year-old man with a pigmented lesion overlying the left optic disc was evaluated with optical coherence tomography. The single high reflectance band from the anterior edge of the disc lesion with optical back shadowing behind on optical coherence tomography helped to pinpoint the diagnosis of the lesion as optic disc melanocytoma. Quantitative assessment of the mass with optical coherence tomography for its growth did not show any increase in size horizontally or vertically after 6 months. Optical coherence tomography is useful for obtaining the exact measurements of the mass lesion and may be used as a tool to follow the progress and growth pattern of the lesion.

Photographic documentation of spontaneous extrusion of a subconjunctival cysticercus cyst.

Spontaneous extrusion of a subconjunctival cysticercus cyst is a rare occurrence. The case reported is of a 20‐year‐old man who presented with a subconjunctival cysticercus cyst that was suspected to be undergoing spontaneous extrusion. The eye was photographed as the parasite extruded through the conjunctival opening with undulating movements over 3−4 min.