Dp Vats

Comparison of Phaconit Rollable IOL with Acrylic Foldable IOL

BACKGROUND Phaconit or ultra micro incision phacoemulsification cataract surgery involves phacoemulsification through a 0.9 millimetre sleeveless phaco tip and irrigating chopper followed by implantation of a rollable intraocular lens. The procedure leads to negligible astigmatism and faster visual recovery as compared to phacoemulsification with a foldable intraocular lens. METHODS This prospective study analysed 80 cases of sub millimetre phaconit surgery with implantation of rollable intraocular lenses(IOL) in 40 cases and acrylic foldable IOL in the remaining 40 cases. Evaluation of efficacy and adaptability of procedure, equipment settings, operative constraints, postoperative complications, keratometric and topographic evaluation of induced astigmatism with visual outcome and patients rehabilitation were studied. RESULTS The intraoperative complications were surge/ chamber collapse in 16 (20%), iris chaffing in one and corneal burns in two cases. All cases had an induced astigmatism of less than or equal to ± 0.25 D in four to six weeks after rollable IOL and ± 0.5 D to ± 0.75 D after acrylic IOL implantation. All patients had best-corrected visual acuity of 6/6 by third post operative day. CONCLUSION Phaconit with rollable IOL is a perfect blend of surgical skill, application of technology and ultra thin IOL.

Macular Hole Surgery : Maiden Experience

Macular holes (MHLs) first described over a century ago by Noyes [1], have seen a renewed interest in their pathophysiology and management in the last two decades. They occur following trauma, laser treatment, cystoid macular edema, retinal vascular disorders, retinal detachment (RD) or may not have any detectable cause. Most MHLs occur as age-related primary idiopathic entities. Full thickness MHLs were once considered untreatable and were treated only when there was an accompanying extensive RD. Initially MHLs were treated with achieving strong vitreo-retinal (VR) adhesions around the MHL but with refinement of VR techniques and emphasis on tangential traction being responsible for the MHL, retinal surgeons are attempting treatment with vitrectomy, membrane peeling and intra-ocular gas tamponade.

Best's Vitelliform Macular Dystrophy

Macular dystrophies are arbitrarily classified on the basis of their tissue of origin into those originating from nerve fibre layer, photoreceptors and retinal pigment epithelium (RPE), RPE alone, Bruchs membrane and choroid. Vitelliform dystrophy of the fovea is a separate entity among the inherited macular dystrophies. It was first reported by Adam [1] and the first pedigree was described by Best. It results in typical vitelliform lesions that are bilateral though asymmetrical and cause only moderate diminution of vision for a long time.

AC/PC Intraocular Lens Exchange with Penetrating Keratoplasty in Pseudophakic Bullous Keratopathy

BACKGROUND Evaluation of penetrating keratoplasty in cases of pseudophakic bullous keratopathy with AC/PC IOL exchange. METHODS This retrospective study included 120 cases of pseudophakic bullous keratopathy managed over 9 years at three tertiary care eye centres followed up for 4 years. Cases were taken up for penetrating keratoplasty along within adjuvant procedures like IOL explantation and Secondary Posterior Chamber IOL implantation over the frill of posterior capsule. RESULTS Lens exchange with Penetrating Keratoplasty (PK) was done in 93 and PK without lens exchange in 27 cases. 25% required systemic steroids for 2-3 weeks. Re-grafting was performed in 5% and 85% attained moderate visual acuity. CONCLUSION Intra ocular lens exchange and Posterior chamber IOL are suitable for penetrating keratoplasty in terms of optical clarity, graft survival and visual outcome.

Phacotrabeculectomy Versus Conventional Combined Technique in Coexisting Glaucoma and Cataract.

BACKGROUND To evaluate and compare efficacy and outcome after single site phacotrabeculectomy and conventional combined surgery in cases of coexisting primary open angle glaucoma and cataract. METHODS This prospective study on fifty patients of concurrent primary open angle glaucoma and cataract, who had undergone combined surgery as single site phacotrabeculectomy or conventional single site trabeculectomy with extracapsular lens extraction with IOL implantation in 25 cases each. Evaluation was based on operative and postoperative complications, control of IOP and visual outcome. The follow up period ranged between twelve months to eighteen months. RESULTS The mean medically controlled preoperative intraocular pressure was 22 mm of Hg (Range 18 to 35 mm of Hg) by applanation method of tonometry. The range of postoperative intra-ocular pressure after one year was 11 to 22 mm of Hg in first and 14 to 26 mm Hg in second group. Failure to maintain optimum postoperative IOP without Beta-blocker was more frequent after conventional combined procedure. There was no significant difference in incidence and pattern of postoperative complications. CONCLUSION Phacotrabeculectomy provides effective and sustained visual recovery and adequate control of intraocular pressure as compare to conventional combined procedure.

MANAGEMENT OF CONCURRENT GLAUCOMA AND CATARACT BY PHACOTRABECULECTOMY TECHNIQUE: AN EFFECTIVE ALTERNATIVE APPROACH.

30 cases of open angle glaucoma with cataract who underwent phacoemulsification, PMMA phaco profile IOL implantation and trabeculectomy through same incision were critically evaluated. The mean controlled, preoperative intra ocular pressure was 20 mm of Hg (range 18 to 35 mm of Hg) by aplanation method. Mean post operative pressure after 12 months was 13 mm of Hg (range 11 to 22 mm of Hg) intra operative hyphaema, post operative uveitis were noted problems. Periodic, post operative optic disc and field evaluation remained static in 66% cases. Visual acuity of 6/12 or better was achieved in 60% cases. Failure to restore glaucoma control without medication was seen in 13.3% cases after 9-12 months. The combined phacotrabeculectomy is an effective single step technique of managing concurrent glaucoma with cataract.

RETINAL VASCULITIS and ITS MANAGEMENT IN SERVING SOLDIERS - LONG TERM FOLLOW UP STUDY

200 eyes of 110 male serving military personnel showing retinal vasculitis in various stages were managed with institution of steroids, ATT, photocoagulation, cryoablation and vitreo retinal surgery as indicated in a span of 78 months. 156 eyes showing evidence of vasoproliferation responded favourably to laser photocoagulation. Over all 80% of the patients showed good functional recovery with combined modalities of management thereby obviating recurrent morbidity and invalidation in trained combatant manpower in wage earning age group. Cases with complicated retinal vasculitis had to be treated in a sophisticated retina centre having facilities for Fluorescein angiography, laser and vitreo-retinal surgery.

OUR EXPERIENCE WITH LASER PHOTOCOAGULATION IN DIABETIC MACULAR OEDEMA

Diabetic macular oedema, focal or diffuse, is primarily responsible for visual loss in cases of diabetic retinopathy. When to start photocoagulation in such cases has often been debatable. Over a 3 year period, 80 eyes of 80 patients were subjected to argon green macular grid photocoagulation in a randomized clinical study keeping the other eye (80 eyes) as controls in patients with diabetic macular oedema. It was observed that in 5 per cent of such eyes the vision did improve while in 6.3 per cent of patients deterioration of vision was present as compared to 16.3 per cent in control group. It is concluded that laser photocoagulation has a definite role in arresting the progression of diabetic maculopathy and early intervention should be resorted to in case of clinically significant macular oedema.

OUR EXPERIENCE IN PC IOL IMPLANTATION IN CASES OF POSTERIOR CAPSULAR BREAKS

We implanted posterior chamber intra ocular lenses (PC IOL) in 107 eyes with posterior capsular breaks. Left over posterior capsular frill at the periphery was used to hold and support the PC IOL. After a median follow up of 2.5 years, 96.9% of the patients who developed per operative posterior capsular break and 67.56% who had pre-existing capsular breaks achieved 6/12 or better visual acuity. Remaining 32.44% of the patients with pre-existing capsular break due to previous surgical intervention or trauma achieved 6/18 or worse visual acuity.

OUR EXPERIENCE OF IOL IMPLANTATION IN PAEDIATRIC AGE GROUP

Forty eyes of 35 patients in paediatric age group suffering from congenital/traumatic cataracts were operated. Posterior chamber intra ocular lens (PC IOL) implantation was carried out and followed for four years. Twenty one eyes (52.5%) showed visual recovery of 6/18 or better. Forward thrust was the commonest per operative complication. Uveitis and pupillary distortion were the common post operative complications. PC IOL implantation appears to be safe and promising procedure.