nan Kamlesh

Contrast sensitivity and depth of focus with aspheric multifocal versus conventional monofocal intraocular lens

BACKGROUNDnLaboratoires Domilens, Lyon, France, has introduced a new aspheric multifocal intraocular lens (IOL), the Progress 3. The central portion, measuring 4.7 mm in diameter, has an anterior surface of progressively increasing power, such that there is a central add of +5.00 dioptres. We compared contrast sensitivity and depth of focus in patients who received the Progress 3 and in those who received a conventional monofocal IOL.nnnMETHODSnProspective study. Forty patients with age-related cataract were randomly divided into two groups: 20 patients received the Progress 3 aspheric multifocal IOL, and 20 patients received a conventional monofocal IOL of similar design. Contrast sensitivity was measured with the Pelli-Robson letter-based chart. Depth of focus was determined by dialling a series of overcorrections over the patients manifest refraction until the patient read 6/12 clearly. The depth of focus was defined as the range over which 6/12 or better acuity was achieved. Quality of vision was evaluated by patient questionnaire.nnnRESULTSnMean contrast sensitivity was significantly lower in the patients with a multifocal IOL than in those with a monofocal IOL (1.38 vs. 1.56 log units) (p < 0.001). The mean depth of focus values for the two groups were 3.10 D and 1.65 D respectively (p < 0.001). The prevalence of subjective problems was similar in the two groups.nnnINTERPRETATIONnIn our opinion, aspheric multifocal IOLs should be reserved for patients who are willing to trade increased depth of focus for reduced contrast sensitivity postoperatively.

Long-term results of Unilateral lateral rectus recession in intermittent exotropia

PURPOSEnUnilateral lateral rectus recession is an alternative procedure in the treatment of moderate angle intermittent exotropia. However, long-term results of unilateral lateral rectus recession have not yet been studied. The aim of this study was to determine the long-term stability of alignment following unilateral lateral rectus recession in patients with intermittent exotropia with a deviation of 25 to 30 PD.nnnPATIENTS AND METHODSnThirty-two patients with intermittent exotropia with a deviation of 25 to 30 PD were included in this study. All patients underwent 8-mm unilateral lateral rectus recession by conventional techniques.nnnRESULTSnSatisfactory results (+/- 5 PD of orthophoria) were obtained in 77.7% of the patients after a 3-year follow-up period. The mean correction achieved was 22.9 PD.nnnCONCLUSIONnOur results indicate that 8-mm unilateral lateral rectus recession is an attractive alternative procedure in the treatment of intermittent exotropia with a deviation of 25 to 30 PD.

Intraoperative daunorubicin versus conjunctival autograft in primary pterygium surgery.

Purpose. To evaluate the safety and efficacy of intraoperative daunorubicin during a bare sclera procedure in primary pterygium surgery and to compare with conjunctival autograft. Methods. The data for 84 patients who underwent pterygium surgery at Safdarjung Hospital and Guru Nanak Eye Center were analyzed retrospectively. The patients were divided into two groups: group A, those who underwent bare sclera excision along with conjunctival autograft, and group B, those who underwent bare sclera excision with intraoperative daunorubicin (0.02%) for 3 minutes. We evaluated pterygium recurrence and postoperative complications for both groups. Recurrence of pterygium was defined as growth of 2 mm of fibrovascular tissue over the corneoscleral limbus into the clear cornea in the area of previous pterygium excision. Results. Follow-up ranged from 18 to 37 months (mean, 27). Recurrence rates of 8.33% (three of 36) and 7.14% (three of 42) were found in groups A and B, respectively. When compared statistically, the difference was not significant. All the recurrences occurred in patients younger than 30 years of age. Pyogenic granuloma, graft edema, loose graft, and dellen formation were seen, respectively, in 5.5% (two of 36), 2.77% (one of 36), 2.77% (one of 36), and 2.77% (one of 36) patients in group A. Nine of 42 (21.42%) patients in group B had chemosis of the conjunctiva and two of 42 (4.76%) had delayed epithelization. Conclusion. We conclude that intraoperative daunorubicin (0.02%) and conjunctival autograft are both equally effective adjuncts to pterygium surgery.

Usefulness of the preoperative prism adaptation test in patients with intermittent exotropia.

PURPOSEnTo investigate whether the preoperative prism adaptation test is useful in patients with intermittent exotropia.nnnMETHODSnSixty-five consecutive patients with basic-type intermittent exotropia <40 prism diopters (PD) comprised the study population in this prospective study. Patients were divided into two groups based on the results of the prism adaptation test. Patients with a negative response comprised group 1 and patients with a positive response comprised group 2. Group 1 patients (n=26) underwent surgery according to the original angle, and group 2 patients (n=27) underwent surgery in accordance with the change in the angle of deviation with prisms.nnnRESULTSnSatisfactory motor alignment (+/- 5 PD of orthophoria) was achieved in 14 (53.8%) group 1 patients and 24 (88.8%) group 2 patients (P=.01). Mean residual deviation was 9.8 PD in group 1 and 4.5 PD in group 2 (P < or = .05).nnnCONCLUSIONnThe prism adaptation test may be helpful in achieving a favorable surgical outcome in intermittent exotropia.

A clinical evaluation of an aspheric multifocal intraocular lens and its implications for the developing world.

BACKGROUND AND OBJECTIVESnTo evaluate the clinical performance of a new aspheric multifocal intraocular lens (IOL), and to compare the results with a corresponding monofocal IOL.nnnPATIENTS AND METHODSnTwo groups of 20 patients each were implanted with a multifocal and monofocal IOL and prospectively studied. Distance and near vision, contrast sensitivity, depth of focus, and quality of vision were assessed in both groups.nnnRESULTSnIn 85% of multifocal cases and 100% of monofocal cases, the corrected distance vision was 6/9 or better. With distance correction, 80% of multifocal cases had near vision of N9 or better against 10% of monofocal cases. The mean addition required for near vision N6 was +0.8 diopters (D) and +2.6 D in the multifocal and monofocal groups, respectively. Multifocal cases showed significantly decreased contrast sensitivity and increased depth of focus.nnnCONCLUSIONSnMultifocal IOLs are a good option for those with nonexacting visual requirements. The loss in contrast sensitivity seems to be an acceptable trade-off for satisfactory unaided near vision.

Comparative evaluation of diclofenac and dexamethasone following strabismus surgery

PURPOSEnTo compare efficacy of topical diclofenac sodium 0.1% with dexamethasone 0.1% following strabismus surgery.nnnMETHODSnIn this study, 58 patients undergoing strabismus surgery were evaluated. They were randomized into two groups: 29 patients received topical 0.1% diclofenac (Group A), and 29 patients received 0.1% dexamethasone (Group B) for 4 weeks. The baseline parameters were similar in both groups. At each visit comprehensive ocular examination was performed to record patient discomfort, conjunctival inflammation, gap, and intraocular pressure. Follow-up visits were at 1 week, 2 weeks, and 4 weeks, postoperatively.nnnRESULTSnThere was no statistically significant difference in the rate of resolution of the inflammation, conjunctival healing, and intraocular pressure except rise of intraocular pressure at the fourth postoperative week in group B (P value <0.001).nnnCONCLUSIONSnThe results of this study suggest that diclofenac may be used as an alternative to dexamethasone after strabismus surgery.

Intraoperative daunorubicin to prevent the recurrence of pterygium after excision.

Purpose. This study examines the safety, efficacy, and complications of 0.02% intraoperative daunorubicin in the prevention of the recurrence of pterygium after excision. Methods. Sixty patients with primary pterygium were included in this prospective, randomized clinical study and were randomly divided into two groups: the treatment group and the control group. Pterygium was excised under a microscope in all patients. The treatment group received intraoperative single application of 0.02% daunorubicin for 3 minutes, whereas the control group received distilled water for the same duration. Recurrence of pterygium and postoperative complications were prime areas of interest. Results. A recurrence rate of 6.67% was seen in the treatment group and was33% in the control group. Chemosis of conjunctiva and delayed epithelization were the only complications noticed after a mean follow-up of 15 months. Conclusion. Initial results indicate that a single intraoperative application of 0.02% daunorubicin for 3 minutes appears to be a safe and effective adjunct therapy to prevent the recurrence of pterygium. However, a much larger cohort study over a considerable number of years will eventually demonstrate the safety.

Surgical Management of Unilateral Elevator Deficiency Associated With Horizontal Deviation Using a Modified Knapp's Procedure

Both horizontal recti are transpositioned in unilateral elevator deficiency, leaving no alternative to correct any significant ipsilateral horizontal deviation. An effective method to correct vertical and horizontal deviations simultaneously is reported. A modified Knapps procedure was performed by transposition of the superior half of equally divided (up to 15 mm) medial and lateral recti for vertical deviation and the inferior half after suitable recession or resection for horizontal deviation. This procedure was performed in ten patients who had type II unilateral elevator deficiency with horizontal deviation ranging from 18 to 45 prism diopters (PD). We were able to correct 20 PD of horizontal deviation and 25 PD of vertical deviation with a modified Knapps procedure without any significant adverse effects after a follow-up of 21 months. A modified Knapps procedure is recommended for unilateral elevator deficiency associated with horizontal deviation.

Preliminary results of intraoperative daunorubicin in strabismus surgery.

PURPOSEnTo evaluate the safety and efficacy of intraoperative daunorubicin (0.02%) for patients with strabismus undergoing a second surgical procedure.nnnPATIENTS AND METHODSnTwenty-four patients with strabismus undergoing a second surgical procedure were randomly divided into two groups. In group A, daunorubicin 0.02% was applied subconjunctivally over the surface of the muscle and bare sclera for 3 minutes by cellulose sponge and then washed off thoroughly. In group B, distilled water was applied for 3 minutes in place of daunorubicin after the removal of adhesions.nnnRESULTSnSatisfactory alignment in primary position with improved ocular motility was obtained in 80% of the patients in group A compared with 40% of the patients in group B after 12 months of follow-up (P = .16).nnnCONCLUSIONnWe recommend intraoperative daunorubicin 0.02% for 3 minutes as an adjunct for better results in patients with strabismus undergoing a second surgical procedure.

Comparison of Minimally Invasive Strabismus Surgery (MISS) and Conventional Strabismus Surgery Using the Limbal Approach

PURPOSEnTo compare minimally invasive strabismus surgery (MISS) with conventional strabismus surgery for horizontal recti in terms of functional outcome and complications.nnnMETHODSnA total of 40 patients requiring surgery for horizontal recti were divided into two groups: those undergoing MISS and those operated on using the conventional limbal technique. In the MISS group, two small keyhole radial cuts were made superior and inferior to the insertion of the muscle margin. Keyhole cut size was almost 1 mm less than the amount of muscle recessed or resected.nnnRESULTSnThere were significant differences in conjunctival redness and swelling in both groups on postoperative days 1 and 7 and week 3. However, after the third week, both groups had a similar appearance. Visual acuity was decreased at postoperative day 1 in both groups, but the difference was not significant. No significant differences were found for final alignment, binocular single vision, other visual acuities, refractive changes, or complications.nnnCONCLUSIONSnThis study shows that this new, small incision, minimal dissection technique is feasible. The MISS technique seems to be superior in the immediate postoperative period because there were fewer conjunctival and eyelid swelling complications. Long-term results did not differ between the two groups. [J Pediatr Ophthalmol Strabismus. 2017;54(4):208-215.].