Parul Chawla Gupta

Eye Injury from a Firecracker

A 44-year-old man presented with pain and decreased vision in both eyes after an injury he sustained while lighting a firecracker. Examination and imaging revealed globe rupture and multiple foreign bodies embedded in the corneal stroma.

Toric intraocular lens implantation in children with developmental cataract and preexisting corneal astigmatism

To evaluate the effect of toric intraocular lens (IOL) implantation on the refractive outcomes in children with cataract and preexisting corneal astigmatism.

Cobbler's Technique for Iridodialysis Repair.

We describe a novel “Cobblers technique” for iridodialysis repair in the right eye of a patient aged 18 years, with a traumatic iridodialysis secondary to open globe injury with an iron rod. Our technique is simple with easy surgical maneuvers, that is, effective for repairing iridodialysis. The “Cobblers technique” allows a maximally functional and cosmetic result for iridodialysis.

Knowledge and Attitude Toward Corneal Donation Among High School Children in Northern India.

Purpose: To assess the knowledge and attitude of school-going adolescents regarding corneal donation in government and private schools in an urban area of Northern India. Methods: A school-based cross-sectional study was conducted in an urban field practice area of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. A total of 365 participants of the seventh to 10th grade were enrolled from a government school and a private school. A pretested, semistructured, self-administered, bilingual (English and Hindi) questionnaire was used to assess the sociodemographic profile and knowledge and attitude related to corneal donation. Results: Most (87%) (confidence interval, 83.1%–90.0%) participants had heard about corneal donation. Only 2% of students answered all the knowledge-related questions correctly. None knew about the national toll-free number for corneal donation. Three-fourth (72%) supported the idea of corneal donation. Of them, only 44% (confidence interval, 41.0–47.1) were willing to pledge to donate their own eyes. Fears and myths were the persistent barriers. The government and private schools differed in both knowledge and attitude, with the latter performing better. Conclusions: Knowledge among the selected high school children was poor. Although many supported the idea, only a few were willing to donate. We suggest that program components be evaluated from time to time. Future studies should explore the role of strengthening Information Education and Communication (IEC) activities among high school students for motivating community members to pledge to donate for corneal donation.

Shifting Trends in Bacterial Keratitis in Taiwan: A 10-Year Review in a Tertiary-Care Hospital.

To the Editor: We commend Hsiao et al for an excellent study. However, a few points need further clarification. First, the term “middle to deep corneal infiltrates” used by the authors encompasses what depth of the cornea? Second, what could be the reason for the low bacterial culture positivity rate of 49.3%? Third, could the increase in the oxacillin susceptibility rate be attributed to the increase in methicillinresistant Staphylococcus aureus (MRSA)? Fourth, in vitro susceptibility testing was done only for ciprofloxacin. Why was it not done for the fourth-generation fluoroquinolones? Fifth, what could be the reason for the increased ciprofloxacin sensitivity of S. aureus, including MRSA strains in Taiwan, even though several studies have reported a significantly increasing trend of ciprofloxacin resistance (approximately 30%) among corneal pathogens, particularly in S. aureus? Sixth, the authors need to clarify how many patients were treatment naive? Was any washout period given before the scrapings were done?

Corneal Cross-Linking for Pediatric Keratoconus: Long-Term Results.

To the Editor: We commend Godefrooji et al for an excellent study assessing the efficacy and safety of cross-linking in pediatric patients with keratoconus and providing a systematic literature overview regarding this subject. However, a few untouched and warranted issues need further discussion. First, the major concerns in these patients comprise the accelerated progression of the disease in the pediatric age group and management of comorbidities such as vernal keratoconjunctivitis. No mention has been made about management of vernal keratoconjunctivitis in these patients. Were the patients who progressed even after cross-linking, persistent eye rubbers? Second, visual impairment in pediatric patients may affect social and educational development and overall negatively impact their quality of life. How was visual rehabilitation (spectacles and contacts lenses) performed in patients who had progressive keratoconus despite cross-linking procedure? Third, Chatzis and Hafezi suggested performing CXL as soon as diagnosis of pediatric keratoconus is made due to the very high rate of keratoconus progression in their study. What was the mean interval between the diagnosis and CXL in the children recruited in this study and was the interval more in patients who deteriorated despite treatment? Fourth, in the abstract, authors have mentioned that the systematic search yielded 17 unique articles, whereas in the manuscript they have written 16. Last, in the “Patients and Methods” section, it is stated that the prospective cohort study included all consecutive pediatric patients (ie, younger than 18 years) who underwent epithelium-off CXL procedure for progressive keratoconus from January 2010 through December 2013. However, ophthalmic evaluations were performed even at 60 months (5 years) after undergoing CXL. How could patients recruited in years 2012 and 2013 complete the 5-year follow-up examination as stated by the authors?

Multimodal imaging of glistening IOL

ody. A 65-year-old diabetic male presented to our lens clinic with intraocular lens (IOL) glistenings in his left eye which had been operated 15 years back. On examination, he had a best corrected vision of 20/30 and multiple refractile, glittering inclusions within the polymethylmethacrylate (PMMA) IOL body (Fig. 1) as seen on Spectralis Anterior segment Optical Coherence tomography (Heidelberg Engineering GmbH) (Fig. 2a) and Oculus Pentacam HR Scheimpflug imaging (Fig. 2b). Comment Glistenings are fluid-filled microvacuoles in the IOL optic formed when the IOL is in an aqueous environment. They are seen when water permeates the microchannels of the IOL and subsequently forms minute accumulations of water inside the microvoids in the lens material. Differences in the refractive index between the water droplets and the IOL material make the glistenings visible. They are commonly seen with hydrophobic acrylic IOL’s and rarely with PMMA IOL’s due to the phenomenon of surface light scattering. Factors influencing glistening formation include composition of the IOL material, thickness of the IOL, technique of manufacturing/packaging and associated ocular conditions like glaucoma or those leading to breakdown of the blood-aqueous barrier (diabetes and uveitis), as well as concurrent use of ocular medications. Glistenings are usually very small and stable in most of the IOL materials, except the hydrophobic lenses in which they tend to increase a bit over time. Although the impact of glistenings on postoperative visual outcome and their evolution during the late postoperative period remain controversial, IOL explantation has rarely been reported since the visual acuity usually remains unaffected as was seen in our patient. To conclude, even though this finding is not clinically significant in the vast majority of patients, there is still need to dig further to find the exact ideology of this finding and try to come up with ways to eliminate it completely. These artefacts have no adverse effect on the patients’ visual acuity and are primarily a cosmetic phenomenon, and not an optical incident.

Efficacy of Intravitreal Dexamethasone Implant in Patients of Uveitis Undergoing Cataract Surgery

ABSTRACT Purpose: To assess postoperative inflammation using laser flare photometer, following phacoemulsification with or without single intraoperative intravitreal dexamethasone implant in addition to standard of care, in patients of uveitis with cataract. Methods: Prospectively, 30 eyes with uveitic cataract were randomized into 2 groups (i) standard of care (SOC group) (ii) Dexamethasone implant (DEXA group). Both the groups underwent phacoemulsification with intraocular lens implantation and standard of care treatment for uveitis, but DEXA group additionally received intraoperative intravitreal dexamethasone implant. Patients were followed at least till 6 months. Results: DEXA group had significantly less postoperative flare (LFP values) (P<0.05) as compared to SOC group and also recovery of flare to preoperative value occurred much early in DEXA group. 37.5% cases developed CME in SOC group but none in DEXA group. Mean CMT (267.81±34.26μm) and final logMar BCVA (0.036±0.063) was significantly better in DEXA group (p<0.04). Conclusions: Intraoperative intravitreal dexamethasone implant is a safe and effective option for preventing and managing the postoperative inflammation in uveitic cataract.

Outcomes of cataract surgery in children with persistent hyperplastic primary vitreous

Purpose: To evaluate postoperative outcomes of cataract surgery in children with persistent hyperplastic primary vitreous (PHPV) and factors affecting outcomes. Methods: We analyzed 29 eyes of 28 children with PHPV presenting at a tertiary care center in northern India. All eyes underwent phacoaspiration followed by primary posterior capsulotomy with or without cauterization of persistent fetal vasculature under general anesthesia. Hydrophobic intraocular lens was implanted in selective cases. Postoperative outcomes such as clarity of visual axis, need for secondary surgical procedures, and complications were noted. Results: Out of a total of 28 children (16 male and 12 female), 27 were unilateral while 1 patient had bilateral involvement. Mean age at surgery was 25.14 months, ranging from 2 months to 144 months. Mean axial length of the globe at surgery was 19.66 ± 2.28 mm. Cataract surgery with intraocular lens implantation was done in 22 eyes whereas 7 were left aphakic. The most common intraoperative complication noted was intraoperative bleed in 11 eyes (37.9%) resulting in postoperative hyphema in 9 eyes (31%) and vitreous hemorrhage in 8 eyes (27.5%). Visual axis opacification was seen in 12 eyes and all required membranectomy. Three eyes developed glaucoma while retinal detachment was noted in 2 eyes and 1 of them became phthisical. Conclusions: Favorable outcome was more often achieved in anterior PHPV. Surgical outcomes in eyes with PHPV undergoing cataract surgery are limited by intraoperative and postoperative complications such as hyphema, vitreous hemorrhage, recurrent visual axis opacification, glaucoma, and retinal detachment.

Intraocular lens implantation in children with unilateral congenital cataract in the first 4 years of life

Purpose: To describe the outcome of phacoaspiration with intraocular lens implantation in children with unilateral congenital cataract in the first 4 years of life. Methods: A retrospective chart review of children with visually significant unilateral congenital cataract presenting in the first 4 years of life was done. Children with a minimum postsurgical follow-up of 1 year were included. Outcome measures were mean spherical equivalent, visual axis clarity, visual acuity and complications till the last follow-up. Results: Ninety-three children met the inclusion criteria. The mean age of surgery was 13.23 ± 11.89 months and the mean follow-up period was 24.37 ± 17.35 months. Nearly 40% of children presented during their first year of life. No difference was noted between the subgroups in terms of age (p = 0.310), sex (p = 0.475) or laterality (p = 0.349). Surgical membranectomy was performed in 22 eyes (23.6%) after an average period of 4.85 ± 2.58 months after surgery. One eye underwent piggy back intraocular lens and four eyes underwent intraocular lens exchange after a mean duration of 50 months (range 40–60 months). The mean visual acuity was 0.79 ± 0.11 (log MAR chart). A total of 60.7% of these children (n = 31) achieved best corrected visual acuity or 20/80 or better. Conclusion: The results of our study suggest that primary intraocular lens implantation in children with unilateral congenital cataract gives good structural and functional results. Besides a meticulous surgery, visual outcome is affected by the time of presentation and postoperative compliance to amblyopia therapy.