Neha Midha

Comparative evaluation of 23- and 25-gauge microincision vitrectomy surgery in management of diabetic macular traction retinal detachment.

Purpose To compare the efficacy, outcomes, and complications of 23-G and 25-G microincision vitrectomy surgery (MIVS) in cases of diabetic tractional retinal detachment (TRD). Methods This is a prospective, single-blinded, randomized, comparative study. Fifty eyes of 50 patients with diabetic TRD involving or threatening macula were randomized into 2 groups of 25 each. Group 1 underwent 23-G MIVS and group 2 underwent 25-G MIVS. Patients were followed up at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year after surgery. The primary outcome measure was anatomic and visual success after surgery. We also compared the 2 alternative MIVS systems and assessed various intraoperative and postoperative parameters. Results Anatomic achievement was achieved in all eyes and both groups showed a significant improvement in vision after surgery (p = 0.033 and p = 0.004, respectively) and were comparable (p = 0.584). Mean surgical time in 25-G surgery was significantly longer than in 23-G surgery by 4.60 minutes (p<0.001). Postoperative mean astigmatism was comparable in the 2 groups and postoperative hypotony was not encountered in either group. No port-related breaks were seen in either group; however, iatrogenic breaks occurred in 4 eyes in the 23-G group and 5 eyes in the 25-G group (p = 1.000). There was significantly less immediate postoperative pain and foreign body sensation in the 25-G group compared with the 23-G group. Conclusions Both 23-G and 25-G MIVS have comparable visual and anatomic results for diabetic TRD; however, 25-G surgery may be associated with less postoperative pain and discomfort than 23-G surgery.

Intraoperative optical coherence tomography guided bleb needling

Two patients with history of trabeculectomy presented with uncontrolled intraocular pressure (IOP) postoperatively. The first patient had a flat and vasularized bleb 10 weeks after the surgery, and the second subject developed encapsulated bleb 3 months postoperatively. Both patients were taken to the operating room and intraoperative optical coherence tomography (OCT) guided bleb needling was performed to restore aqueous egress into the subconjunctival space. Postoperatively, IOP of the operated eyes ranged 14-18 mmHg at week 6 and month 3. None of the eyes had any intraoperative or postoperative complications. This novel application of the intraoperative OCT for bleb needling facilitates precision surgery under direct visualization and reduces the risk of complications.

‘Van Herick Plus’: a modified grading scheme for the assessment of peripheral anterior chamber depth and angle

Aim To evaluate the accuracy of a new, modified grading scheme involving a short vertical slit beam, at the inferior angle for peripheral anterior chamber depth (PAC) and angle estimation and its correlation with anterior segment optical coherence tomography (ASOCT). Methods A cross-sectional study of consecutive phakic patients, above 40 years of age, was performed. Using a short, vertical slit beam not reaching the pupil, the inferior angle at the sclerolimbal junction was evaluated, photographed and assessed by a ratio of peripheral anterior chamber depth to peripheral corneal thickness (PAC:PCT) and iridocorneal angle (ICA) on ImageJ software. The inferior angle at the same meridian was also recorded on ASOCT. Results Based on the PAC:PCT ratio, the subjects were divided into four groups: I (<1/4), II (1/4-1/2), III (>1/2–1) and IV (>1). The clinically assessed angle by short vertical slit beam correlated well with ASOCT values, trabecular-iris angle (TIA) (r=0.918; p<0.001) and scleral spur angle (r=0.903, p<0.001). The mean difference between ICA and TIA on ASOCT was 0.7970; 95% limits of agreement:−5.7670 to 7.3610 (±1.96 SD). For angles graded narrow on ASOCT (TIA <200), using a cut-off of peripheral PAC:PCT <1/4, the area under the curve was 0.918 with a sensitivity of 85.2% and a specificity of 88.2%. There was good agreement between ImageJ parameters with those assessed subjectively on photograph of the slit beam examination by a glaucoma fellow (weighted kappa=0.74) as compared with a general ophthalmologist, where there was moderate agreement (weighted kappa=0.57). Conclusion A short, vertical slit lamp beam evaluation at the inferior angle is an easy and relatively accurate method for both peripheral anterior chamber depth and angle assessment. It correlated well with ASOCT and can be used as a more reliable screening tool to identify eyes with possibly occludable angles.

Unilateral Congenital Cataract: Clinical Profile and Presentation

PURPOSE To study the clinical profile and presentation of children with unilateral cataract. METHODS In this hospital-based, observational, cross-sectional study, patients 15 years of age or younger who presented with unilateral cataract were recruited. Cases of cataract secondary to causes such as trauma or uveitis were excluded. Age at detection and presentation, distance from the treatment center, presenting complaints, cataract morphology, and biometry were noted for each case. RESULTS A total of 76 patients were recruited. Most patients presented with complaints of leukocoria. Persistent fetal vasculature accounted for 27.6% of cases and was the most common identifiable cause of cataract in this study. Subsequently, patients were divided into two groups: no persistent fetal vasculature (control) and persistent fetal vasculature. A male predominance was noted in both groups. The mean age at detection was 27.58 ± 37.02 and 6.17 ± 8.42 months and the mean age at presentation was 55.613 ± 45.21 and 14.83 ± 17.75 months in the control and persistent fetal vasculature groups, respectively. In the persistent fetal vasculature group, a significant difference was noted in the axial length, keratometry, and corneal diameter between the affected and normal eyes (P = .027, .00176, and .0114, respectively). In the control group, this difference was observed only in keratometry readings (P = .0464). The mean distance traveled by patients to reach the treatment center was 211 km. CONCLUSIONS Persistent fetal vasculature is an important and less identified cause of unilateral cataract. A significant delay is noted in the detection and presentation of unilateral cataract. [J Pediatr Ophthalmol Strabismus. 2018;55(2):107-112.].

Innovations in glaucoma surgery from Dr. Rajendra Prasad Centre for Ophthalmic Sciences

Trabeculectomy surgery is the current standard of care in glaucoma for achieving a low target intraocular pressure if medical therapy is not adequate. Augmentation of trabeculectomy with antimetabolites brought a revolutionary change in the long-term success rates of trabeculectomy, but along with it came a plethora of complications. There still is a big window for therapeutic innovations on this subject. The foremost target for these innovations is to modulate the wound healing response after glaucoma drainage surgery. Achieving the desired balance between long-term success of filtering blebs versus early failure due to scarring of blebs and hypotony due to dysfunctional filtering blebs poses a unique challenge to the ophthalmologists. Alternatives to trabeculectomy such as glaucoma drainage devices and minimally invasive glaucoma surgeries cannot solve the problem of glaucoma blindness in our country, mainly due to their unpredictable results and unfavorable cost-benefit ratio. In this article, we present a summary of our innovations in glaucoma surgery to advance patient care by making it more effective, safer, and economical.

Prognosis of different glaucomas seen at a tertiary center: A 10-year overview

Aim: This study aims to determine treatment patterns, long-term intraocular pressure (IOP) and perimetric control in different glaucomas seen at a tertiary eye center. Settings and Design: Hospital-based, cross-sectional chart review of patients routinely following up at an outpatient glaucoma service. Methods: Patients with a follow-up of at least 10 years were evaluated. Their mean IOP, visual field (VF) status, and medications/surgery required at final assessment were noted. Statistical Analysis: Descriptive statistics (mean, standard deviation, and range) were used for all parameters. Results: A total of 230 patients met our inclusion and exclusion criteria, 79 having ocular hypertension with open angles or primary angle closure (PAC), 35 primary open angle glaucoma (POAG), 50 PAC glaucoma (PACG), 20 primary congenital glaucoma (PCG), 46 secondary glaucoma patients. Ocular hypertensives with open angles showed progression to POAG in 3.7%, those with PAC in 5.2%, at a mean IOP of 17.3 ± 3.37 mmHg and 17.13 ± 4.41 mmHg, respectively. A progression on Humphrey Field Analyzer was seen in 11% of POAG and PACG eyes at a mean IOP of 13.50 ± 5.07 and 13.09 ± 3.95 mmHg, respectively. Fifteen percent of primary congenital glaucomas (PCGs) showed a glaucomatous VF defect after 10 years. In secondary glaucoma eyes, the mean IOP at last follow-up visit was 12.38 ± 3.74 mmHg, with progression noted in 7.69% of eyes. Conclusion: This study provides evidence that routine delivery of care can provide well controlled IOP in glaucomas, both primary and secondary, and the VF stabilized in about 90% of patients over a period of 10 years, with the currently available glaucoma medications and trabeculectomy.

A novel technique to release sticking haptic of a single-piece hydrophobic acrylic IOL using irrigation-aspiration probe

Purpose To describe a novel technique to release sticking haptic of a single-piece hydrophobic acrylic intraocular lens (IOL) using irrigation-aspiration (I/A) probe. Methods In our technique, the I/A probe is introduced into the anterior chamber on Visco mode. Using the aspiration port of the I/A probe, the sticking haptic is held at its tip and suction force is built up until occlusion is noted. Then the haptic is nudged towards the center of the IOL along its curve. After the haptic is free from optic, the suction is released. Results Several techniques have been described to release the sticking haptic such as squeezing the haptic at the site where it sticks to the IOL or using Sinskey hook for releasing the adhesion. These techniques require extra manipulation of the IOL by introduction of surgical instruments. In our technique, we used the I/A probe itself for separating the sticky haptic successfully. Conclusions This technique allows separation of sticking haptic without any extra instrumentation, thus reducing intraocular maneuvering and total surgery time.

Sensitivity of multifocal electroretinography (mfERG) in detecting siderosis

OBJECTIVE To evaluate use of multifocal electroretinography (mfERG) in diagnosing retinal toxicity from siderosis with normal ERG. DESIGN Prospective case series. PARTICIPANTS Six patients with retained intraocular foreign body were recruited. METHODS The affected eye of the patients had no clinical evidence of siderosis, had similar full-field photopic 3.0 ERG compared with the fellow eye, and had subnormal visual acuity. Group averages in each MfERG ring for implicit time and amplitude at P1 wave were compared between affected and fellow eye to look for latent siderosis. RESULTS On mfERG, no statistical difference in group averaged amplitude was observed; however, a significant difference (p < 0.05) was found in group averaged latency between fellow and affected eye at most tested rings (<2 degree, 2-5 degree, and >15 degree rings). Average latency for overall retinal area mapped also showed significant difference (p = 0.010). CONCLUSIONS Increased mfERG latency may serve as an early predictor of retinal damage from siderosis when full-field ERG is normal.

New Investigations in Ophthalmology

The best ebooks about New Investigations In Ophthalmology that you can get for free here by download this New Investigations In Ophthalmology and save to your desktop. This ebooks is under topic such as new york society for clinical ophthalmology graefes archive laboratory investigations springer new york society for clinical ophthalmology ajo graefes archive laboratory investigations ophthalmology discovery and innovation: stein eye institute research centers graefes archive laboratory investigations ophthalmology graefes archive laboratory investigations ophthalmology graefes archive laboratory investigations ophthalmology journal of clinical & experimental ophthalmology office of inspector general graefes archive laboratory investigations ophthalmology continuing medical education program information and graefes archive clinical investigations ophthalmology cjraefes archive clinical investigations ophthalmology the ophthalmology examinations review second edition (531 bmj open opthamology press release department of health and human services research central to new treatments for retinal diseases t research to prevent blindness and jsei: a new chapter in a glaucoma algorithm and guidelines for glaucoma the pre-operative assessment and investigation of innovation methods of drug delivery emory eye center clinical guidelines retinal vein occlusion (rvo) guidelines arvo 217 annual meeting abstracts 437 basic investigations when to refer to the ophthalmology department university of pennsylvania health system department of koret vision institute beckman vision center department of new trends in glaucoma risk, diagnosis & management infections in & around the eye home | auckland district university of pennsylvania health system department of primary care ophthalmology care ophthalmology resident research guidelines loyola medicine clinical ophthalmology and vision research acedu the ophthalmology examinations review journal of medical diagnostic methods omics international download epub book key topics ophthalmology second bios international space station utilization statistics event faculty llison w shuren, msn, jd i s department of