Jaspreet Sukhija

INDICATIONS AND OUTCOME OF OPTICAL PARTIAL THICKNESS LAMELLAR KERATOPLASTY

Purpose. To review the indications and outcome of optical partial thickness lamellar keratoplasty (LKP) over a 22-year period. Methods. The study is a retrospective review of 138 eyes of 126 patients. Snellen visual acuity, preoperative clinical condition, and postoperative clinical status were assessed. Results. Postoperative follow-up ranged from 1 month to 174 months (average, 34.5). In descending order of frequency, climatic droplet keratopathy, infectious keratitis scar, and band-shaped keratopathy were the most common indications for surgery. Follow-up records were available for 130 eyes; 93% of grafts remained transparent. One hundred eyes (80%) preoperative measured Snellen acuity of 6/60 or less. Postoperatively, only 20 eyes (13.4%) were assessed as worse than 6/60. Mean best-corrected visual acuity postoperative was 0.58 ± 0.24. Twenty-two eyes (16.9%) demonstrated postoperative visual acuity of better than 6/12. Complications included presumed rejection in two eyes, nonhealing epithelial defect in two eyes, and graft infection in seven eyes. Conclusion. Vision gain following LKP is generally moderate (visual acuity, 6/18–6/12) in the majority of eyes (61.5%). Vision-threatening complications are low (6.9%). There is scope for reducing complications like postoperative infections and improving visual gain through deep lamellar keratoplasty.

Complications in the First 5 Years Following Cataract Surgery in Infants With and Without Intraocular Lens Implantation in the Infant Aphakia Treatment Study

PURPOSE To compare rates and severity of complications between infants undergoing cataract surgery with and without intraocular lens (IOL) implantation. DESIGN Prospective randomized clinical trial. METHODS A total of 114 infants were enrolled in the Infant Aphakia Treatment Study, a randomized, multi-center (12) clinical trial comparing the treatment of unilateral aphakia in patients under 7 months of age with a primary IOL implant or contact lens. The rate, character, and severity of intraoperative complications, adverse events, and additional intraocular surgeries during the first 5 postoperative years in the 2 groups were examined. RESULTS There were more patients with intraoperative complications (28% vs 11%, P = .031), adverse events (81% vs 56%, P = .008), and more additional intraocular surgeries (72% vs 16%, P < .0001) in the IOL group than in the contact lens group. However, the number of patients with adverse events in the contact lens group increased (15 to 24) in postoperative years 2-5 compared to the first postoperative year, while it decreased (44 to 14) in years 2-5 compared to the first postoperative year in the IOL group. If only one half of the patients in the contact lens (aphakic) group eventually undergo secondary IOL implantation, the number of additional intraocular surgeries in the 2 groups will be approximately equal. CONCLUSION The increased rate of complications, adverse events, and additional intraocular surgeries associated with IOL implantation in infants <7 months of age militates toward leaving babies aphakic if it is considered likely that the family will be successful with contact lens correction.

Keratoconus in Asian eyes at a tertiary eye care facility

Background: The purpose of this study was to assess the demographic variables, age at diagnosis, keratometry and slitlamp signs in keratoconus.

Anterior and posterior capsulorhexis in pediatric cataract surgery with or without trypan blue dye: randomized prospective clinical study.

Purpose: To evaluate the clinical efficacy of trypan blue 0.1% dye (Blurhex®) in creating a complete anterior and posterior capsulorhexis during pediatric cataract surgery. Setting: Tertiary eyecare center, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Methods: In a prospective randomized study, an anterior (ACCC) and posterior (PCCC) continuous curvilinear capsulorhexis were performed in pediatric patients. In Group 1 (n = 19), the ACCC and PCCC were created without use of trypan blue dye. In Group 2 (n = 23), intracameral trypan blue dye was used to stain the anterior and posterior capsules. Results: In Group 1, 14 eyes (73.6%) had a complete ACCC and 10 (52.6%) had a complete PCCC. In Group 2, 21 eyes (91.3%) had a complete ACCC and 19 (82.6%) had a complete PCCC. Conclusion: In cases of pediatric cataract, staining the anterior and posterior capsules with trypan blue 0.1% allowed recognition of capsule flaps and facilitated the creation of complete ACCCs and PCCCs.

Outcome of cataract surgery with primary intraocular lens implantation in children

Aim To report the results of paediatric cataract surgery with primary intraocular lens (IOL) implantation. Methods Children with congenital or developmental cataract who underwent phacoaspiration with posterior chamber (PC) IOL implantation were retrospectively studied. Group A included children with polymethyl methacrylate, group B hydrophobic acrylic and group C silicone IOLs. Outcome measures were visual axis clarity, visual outcome and refractive changes. Results There were 230 children (381 eyes) with the age ranging from 1 months to 15 years. Group A comprised 208, group B 144 and group C 29 eyes. Posterior capsule opacification was seen in 38/208 in group A and 21/144 in group B and 4/29 eyes in group C. The mean refractive error at 2 weeks, 1 year and 3 years after cataract surgery in the age group ≤2 years was +3.38±3.07 D (median +3.75 D), +1.72 D±3.19 (median +1 D) and −0.51 D±3.59 (median −0.5 D); in the age group >2–8 years +0.84±3.18 D (median+1.5 D), +0.27 D±3.14 (median +0.5 D) and −0.62 D±2.81(median −0.75D); and in the age group >8 years −0.44±1.73 D (median −0.5 D), −0.70±1.77 D (median −0.75 D) and −0.89 D±1.60 (median −0.75D) respectively. Children ≤2 years had a significant myopic shift (p<0.001). LogMAR visual acuity was ≥0.3 in 62.2% of eyes in bilateral and 30.90% in the unilateral group. Conclusions Paediatric cataract surgery with primary PCIOL implantation is safe. Refractive changes and PCO are the main hurdles for achieving optimal visual outcome.

Primary intraocular lens implantation in the first two years of life: Safety profile and visual results

PURPOSE To study the safety profile of primary intraocular lens (IOL) implantation in the first two years of life. MATERIALS AND METHODS A prospective nonrandomized, interventional study was done at the tertiary care center. Forty-five eyes of 27 children (aged three weeks to two years) with congenital cataract who underwent phacoaspiration with continuous curvilinear capsulorrhexis combined with primary posterior capsulotomy and anterior vitrectomy with in the bag placement of IOL at primary surgery were included. Outcome measures were clarity of visual axis, postoperative inflammation, fixation pattern and retinoscopy. RESULTS The mean IOL power was 23.95 +/- 0.87 diopter (D) (range 22D to 27D). Follow-up ranged from 12 months to 48 months (mean 18 +/- 9.13 months). In infants, hypermetropia decreased from 6.60D +/- 2.64D at one week postoperatively to 3.03D +/- 2.53D at one year following surgery and 4.78D +/- 1.93D to 2.56D +/- 1.5D in children older than one year at the time of surgery. Re-opacification of the central visual axis was observed in six eyes (13.3%). Significant posterior synechiae due to irido-capsular adhesion was seen in seven eyes (15.6%). Five of these seven eyes also had significant posterior capsular opacification. CONCLUSIONS Meticulously performed primary IOL implantation and primary posterior capsulorrhexis with anterior vitrectomy in the first two years of life is a safe and effective method of aphakic correction.

Outcome of Therapeutic Penetrating Keratoplasty in Infectious Keratitis

BACKGROUND AND OBJECTIVE To study the outcome of therapeutic penetrating keratoplasty in eyes with microbial keratitis. PATIENTS AND METHODS A prospective database on 134 therapeutic cornea transplants in 134 patients recorded demographic details on age and gender of the patient, indication for surgery, size of the donor and recipient bed, graft clarity, complications, and residual morbidity. Patients included in this analysis had a minimum follow-up of 1 year. All patients underwent therapeutic penetrating keratoplasty by a similar method that involved a donor button that was oversized by 0.5 mm and 16 bites of interrupted sutures. RESULTS Most of the 134 ulcers needing therapeutic grafts were bacterial (n = 54) or fungal (n = 54). One hundred eighteen eyes had perforation at presentation. One hundred six (90%) of the therapeutic grafts achieved anatomical success. The most common complication of glaucoma occurred in 22% of eyes with presurgical perforated ulcers and 1% of nonperforated ulcers. Persistent epithelial defects were significantly more frequent in grafts of 9 mm or more (P = .05). CONCLUSIONS Our results confirm that therapeutic penetrating keratoplasty for infections is successful in restoring anatomic integrity in most eyes.

Human amniotic membrane transplantation with fibrin glue in management of primary pterygia: a new tuck-in technique.

Purpose: To report the use of fibrin glue for attaching the human amniotic membrane graft with a tuck-in technique after primary pterygium excision. Methods: Twelve patients with primary pterygium (grade 2 or 3) underwent pterygium excision. The bare sclera was covered with an oversized human amniotic membrane graft by using fibrin glue for graft adherence. The edges of the graft were tucked underneath the adjacent free margin of conjunctiva on 3 sides. Various parameters such as operative time, patients postoperative comfort, graft adherence, time of graft epithelialization, and recurrence of pterygium were assessed. Results: The amniotic membrane graft adhered successfully in 11 patients. Average surgical time was 15.5 minutes (range, 13-21 minutes). The postoperative period was generally comfortable. Epithelialization of the graft was rapid, occurring within 7 days in 11 eyes. In 1 patient, the graft was found dislodged partially on the first postoperative day. Eleven eyes showed no recurrence at the end of 1-year follow-up. Conclusions: Use of fibrin glue for attaching human amniotic membrane graft in primary pterygium surgery is effective. It not only reduces the surgical time but also minimizes postoperative discomfort and complications.

Correlation of nuclear density using the Lens Opacity Classification System III versus Scheimpflug imaging with phacoemulsification parameters

Purpose To grade nuclear cataracts using the Lens Opacity Classification System III (LOCS III) and the correlation with maximum nuclear density on Scheimpflug imaging and phacoemulsification parameters. Setting Tertiary care center. Design Longitudinal interventional study. Methods The nuclear density of significant age‐related cataracts was evaluated by comparing slitlamp images with standard photographic charts of the LOCS III system. Maximum nuclear density was calculated using a Scheimpflug imaging system (Pentacam). All patients had phacoemulsification and posterior chamber intraocular lens implantation. Intraoperatively, parameters (eg, phaco time, power consumed, balanced salt solution used) were noted and compared with different grades of cataract and maximum nuclear densities. Results One hundred patients with visually significant age‐related cataract were evaluated. There was a positive linear correlation between the LOCS III grading and Scheimpflug maximum nuclear density (P<.001). The LOCS III grading and Scheimpflug maximum nuclear density had a linear correlation with preoperative corrected distance visual acuity (r = 0.588 and r = 0.525, respectively), cumulative dissipated energy (CDE) (r = 0.607 and r = 0.847, respectively), total ultrasound (US) time (r = 0.627 and r = 0.802, respectively), and fluid used (r = 0.623 and r = 0.678, respectively). Conclusion Both systems had a linear correlation with total US power, CDE, and fluid used; however, the Scheimpflug imaging system had a stronger correlation with these phacoemulsification parameters. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Intracorneal epithelial ingrowth after descemet stripping endothelial keratoplasty and stromal puncture.

Purpose: To report a case of intracorneal epithelial ingrowth after Descemet stripping endothelial keratoplasty (DSEK) with stromal puncture for phakic bullous keratopathy. Methods: A 35-year-old man underwent DSEK for phakic bullous keratopathy in his right eye after an episode of trauma some years ago. Intraoperative drainage of interlamellar fluid was assisted by stromal punctures. Postoperatively, the patient had a best-corrected visual acuity of 20/40 in his right eye. A small area of epithelial ingrowth appeared in the corneal intrastromal interface inferiorly as an irregular flat haze about a month after surgery. It was in continuity with the inferior stromal puncture incision made intraoperatively. By 10 months, the epithelial pearls became confluent and homogenously white with a sharp demarcation. Results: Because the epithelial ingrowth remained stationary till the last follow-up (13 months), no surgical intervention was planned. The central visual axis was clear and the best-corrected visual acuity was 20/40. Conclusions: Epithelial ingrowth into the cornea may occur after an uncomplicated DSEK with stromal puncture. Patients undergoing DSEK should be closely monitored for development and progression of intracorneal epithelial ingrowth, especially when stromal punctures have been made to drain interface fluid.