Neelima Aron

Continuous intraoperative OCT guided management of post-deep anterior lamellar keratoplasty descemet’s membrane detachment

Continuous intraoperative optical coherence tomography (iOCT) integrated into the operating microscope is a new modification in the current operating microscope to aid in the surgical procedures involving both the anterior and the posterior segment. This helps in intraoperative planning, modification of the surgical steps if required and confirmation of the surgical endpoint in the operating room itself. iOCT was used for the successful management of descemet’s membrane detachment (DMD) following deep anterior lamellar keratoplasty (DALK) with intracameral injection of 20% Sulphur hexafluoride. The gas was injected under direct visualization through the microscope with continuous real time monitoring of the change in height of the detached Descemet’s membrane (DM). Additionally stab incisions were given through the anterior cornea due to the presence of residual fluid above the DM which was visible on continuous iOCT images. This led to the successful apposition of the DM which otherwise would have remained detached due to the residual fluid. This highlights the importance of continuous iOCT monitoring of the ophthalmic surgical procedures in order to produce a successful anatomical outcome of the surgery without disruption of the surgical procedure.

Conjunctival Microbial Flora in Ocular Stevens-Johnson Syndrome Sequelae Patients at a Tertiary Eye Care Center.

Purpose: To evaluate the conjunctival microbial flora in cases of ocular Stevens–Johnson Syndrome (SJS) in a tertiary eye care center. Methods: This prospective study comprised 176 eyes of 88 patients with ocular SJS compared with 124 eyes of normal subjects. The conjunctival swabs were collected and sent for microbiological analysis for bacterial isolation and antibiotic sensitivity examination. The type of bacteria isolated and its antibiotic sensitivity pattern were studied. Results: Of 176 eyes, 104 (59%) had positive cultures for bacteria in cases of SJS and 16 (12.9%) had positive culture in the control group, the difference being statistically significant (P = 0.001). In the SJS group, 14 different types of bacterial isolates were identified. The most common isolate was coagulase-negative staphylococci (CNS) (30/104, 28.8%) followed by Corynebacteria species (35/104, 33.6%) and Staphylococcus aureus (19/104, 18.2%). More than 1 bacteria were isolated in 7 eyes (6.7%). Most of the isolates showed resistance to ciprofloxacin with no resistance to gatifloxacin and moxifloxacin. In the control group, only 2 bacteria were isolated, which included CNS (14/16, 87.5%) and Streptococcus pneumoniae (2/16, 12.5%). CNS showed resistance to ciprofloxacin, and S. pneumoniae was resistant to tobramycin and gentamycin. Conclusions: Ocular SJS is associated with alteration of the normal microbial flora residing in the conjunctival sac. The study of which is vital in cases of infection in these eyes with compromised ocular surface. Mixed flora are seen more often in cases of ocular SJS as compared with controls.

Modified Approach in Management of Submacular Hemorrhage Secondary to Wet Age-Related Macular Degeneration.

PurposeThe aim of this study was to evaluate the surgical outcomes of a modified approach in the management of thick submacular hemorrhage in patients with wet age-related macular degeneration. DesignThis was a retrospective study. MethodsA retrospective chart review was performed on 10 eyes of 10 patients with submacular hemorrhage secondary to wet age-related macular degeneration treated with 23-gauge pars plana vitrectomy, followed by submacular injection of recombinant tissue plasminogen activator (12.5 &mgr;g/0.1 mL), bevacizumab (2.5 mg/0.1 mL), and air (0.3 mL). Gas tamponade was given with 20% SF6 and postoperative propped-up positioning. Patients were evaluated for displacement of hemorrhage, preoperative and postoperative best-corrected visual acuity, occurrence of intraoperative and postoperative complications, and recurrence of hemorrhage. All patients were followed up for 6 months. ResultsDisplacement of the submacular bleed was achieved in all cases. Improvement of best-corrected visual acuity was seen in 8 of 10 patients. Rebleed was seen in 2 eyes that were retreated with intravitreal injection of recombinant tissue plasminogen activator, bevacizumab, and 20% SF6 gas. ConclusionsThis modified technique aids in the effective displacement of thick submacular hemorrhage with simultaneous treatment of the underlying choroidal neovascular membrane, which halts the disease progression resulting in significant improvement of visual acuity.

Descemet stripping automated endothelial keratoplasty

Endothelial keratoplasty is at present the gold standard for surgical treatment of corneal endothelial pathologies not associated with significant corneal scar. Tremendous progress has been made in recent years in improving the technology of endothelial keratoplasty techniques, such as descemet stripping automated endothelial keratoplasty (DSAEK) and descemet membrane endothelial keratoplasty. In this review, we discuss the current techniques and outcomes of DSAEK.

New surgical approach in cases of cataract with ocular Stevens-Johnson syndrome

&NA; We describe the intraoperative difficulties encountered in cases of ocular Stevens‐Johnson syndrome as a result of a poor ocular surface, the presence of symblepharon, and varying degrees of corneal opacity with secondary poor visibility of anterior segment structures. Modifications to the standard phacoemulsification technique enabled safe and successful completion of the surgery in these cases. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned.

Antimicrobial Agents for Ocular Use: Bacterial, Fungal, Viral, and Protozoal Infections

Ocular microbial infections are one of the leading causes of avoidable visual impairment in the world with higher prevalence in developing countries. The incidence and organism responsible for ocular infections are attributed to indiscriminate use of antibiotics, corticosteroids, poor sanitary conditions, rising trend of the use of contact lens etc. A wide variety of microorganisms; bacterial, fungal, viral and protozoal in origin are reported to be involved in ocular infections. These ocular infections include conjunctivitis, blepharitis, endophthalmitis and corneal ulcers which are vision threatening if not treated in time. This chapter dwells with the type of antibiotics/antimicrobial agents used for bacterial, fungal, viral and protozoal ocular infections and provides the insight for the judicious use of antibiotics/antimicrobial agents in treating these infections.

Isoexpansile sulfur hexafluoride gas to repair near-total iris disinsertion

Iridodialysis is commonly encountered after blunt trauma to the eye. Most iris detachments are small, superior, and asymptomatic and require no surgical intervention. However, large areas of iridodialysis require early surgical repair to prevent the onset of iris necrosis, pigment dispersion, and secondary glaucoma. Suture fixation of iris to the sclera is the most commonly used method for iris repair; however, this technique becomes difficult in cases of near-total iris disinsertion, even in expert hands. We describe a case of posttraumatic near-total iris disinsertion with subluxated cataract managed with phacoemulsification and iris preservation with the help of intracameral injection of isoexpansile sulfur hexafluoride.

Comment on: Femtosecond laser-assisted cataract surgery versus 2.2-mm clear corneal phacoemulsification

The authors found that 1‐month postoperative endothelial cell loss (ECL) was higher with FLACS with no difference in postoperative central corneal thickness (CCT), without mentioning the intergroup P value. We applied parametric statistics to arrive at the intergroup P = 0.58 comparing the final CCT at 4 weeks. However, a percentage change of CCT in each group with comparative statistics should have been mentioned to arrive at the abovementioned conclusion.

Conjunctival and Corneal Tuberculosis

Tuberculosis (TB) is one of the leading causes of mortality and morbidity worldwide especially in the developing world. However, its incidence is on a rise even in the Western world partly due to immigration from the developing countries and partly due to the opportunistic infections in patients with acquired immunodeficiency syndrome (AIDS) [1, 2]. WHO gives an estimate that one third of the world’s population is infected with the tubercle bacilli. Further, new resistant strains have emerged which are difficult to treat and cause deep-seated infection [2]. Thus, the control of chronic and insidious infectious diseases such as Tb may become a daunting task, and it may continue to remain as one of the leading causes of morbidity and mortality with newer manifestations and previously unseen presentations.

Optimising the surgical outcome in a case of post-traumatic cataract using ultrasound biomicroscopy

A 12-year-old boy was brought with the chief complaint of diminution of vision in his left eye for the past 1 month. History revealed a blunt trauma to his left eye with a wooden stick 6 weeks ago.Visual acuity was 20/20 and hand movement close to face in right and left eye, respectively, without any relative afferent pupillarydefect. Slit-lamp examination showed a total cataractous lens with signs suggestive of suspected posterior capsular (PC) defect. The PC defect was screened initially using B-scan ultrasound of the posterior segment, followed by confirmation of the same using ultrasound biomicroscopy. Left eye lens aspiration along with limited anterior vitrectomy followed by placement of multipiece intraocular lens in the sulcus was performed. Best-corrected visual acuity at 6 months of follow-up was 20/20.