Sonam Angmo Bodh

Lower eyelid suspension using polypropylene suture for the correction of punctal ectropion.

OBJECTIVE To evaluate the efficacy and complications of lower eyelid suspension with the modified Safdarjung hospital technique using 5:0 polypropylene suture for punctal ectropion. STUDY DESIGN Prospective case series. METHOD Thirty one eyelids in 19 patients with mild and moderate ectropion and all types of laxity including involutional and paralytic were included. All patients underwent lower eyelid suspension with the modified Safdarjung hospital technique. A 5:0 polypropylene suture was passed in the pre-tarsal plane between the attachments of the lateral and medial canthal tendons near their insertion at the orbital rim. Successful outcome was judged by the anatomical restoration of the apposition of the punctum to the globe in the upward gaze and the physiological relief of epiphora. The recurrence of lid laxity, overall lid/globe apposition and complications were also noted. RESULTS At 1 year follow up anatomical success was achieved in 28 (90%) patients and functional success noted in 27 (87%) patients. Recurrence of lid laxity was noted in 2 patients. There was a suture exposure in one case and a suture granuloma in another case. The results did not correlate to the degree of ectropion and type of laxity. CONCLUSION Lower eyelid suspension using 5:0 polypropylene suture is a useful procedure for the treatment of involutional and paralytic punctal ectropion. It is simple and effective with minimal complications. However, the effect on scleral show and the concern related to suture material biodegradation over years needs to be further evaluated.

Rosai-dorfman with bilateral involvement of lacrimal sac as extranodal disease.

A 45 year old female presented with painless swelling over the inner side of both eyes since one year. Magnetic resonance imaging (MRI) scan revealed well defined lesions in the bilateral lacrimal sac area with extension along the naso-lacrimal duct. Systemic work up showed polyclonal hyperglobulinemia, raised erythrocyte sedimentation rate (ESR) and anemia. The patient also had subcutaneous swelling in thoracic area over back. The histopathology of the bilateral excised tumor and fine needle aspiration cytology of thoracic swelling was consistent with features of Rosai-Dorfman syndrome.

Manual small incision cataract surgery for subluxated cataract with lens coloboma

INTRODUCTION The lens coloboma results from a segmental defective or absent development of the zonules. It is usually unilateral and bilateral cases are rare. These eyes are at greater risk of complications during cataract surgery due to ocular malformations. In addition the capsular bag requires stabilization using modified capsule tension ring, capsular tension segment or capsular anchor. METHODS Lens extraction is indicated for cataract or subluxation if visual function is sufficiently compromised. We report our surgical experience in a patient with bilateral isolated lens coloboma by performing manual small incision cataract surgery (MSICS) in left eye and phacoemulsification in right eye. RESULTS The nuclear rotation was hampered because of the lack of zonules and presence of lens coloboma. MSICS was converted to the intracapsular technique in left eye, though breaking the nucleus into pieces during phacoemulsification in right eye enabled its mobilization and successful completion with implantation of modified capsule tension ring. CONCLUSIONS A patient with lens subluxation and lens coloboma is better managed by phacoemulsification as compared to the MSICS.

Orbital Myiasis Complicating Squamous Cell Carcinoma in Xeroderma Pigmentosum

Ophthalmomyiasis is a rare infection seen in susceptible individuals. We report a case of orbital myiasis in squamous cell carcinoma (SCC) in a patient of xeroderma pigmentosum. On presentation, reddish brown ulcerated mass with numerous maggots in orbit were seen. Computed tomography scan showed the presence of soft tissue lesion without any bony destruction. Following debridement, emergency exenteration with sacrifice of eyelid skin was performed. The diagnosis of SCC was confirmed on histopathologic evaluation. The maggots belonged to family Calliphoridae and secondary bacterial infection with Klebsiella organism was identified. Management issues included extensive involvement requiring exenteration, non-availability of skin graft, delayed secondary healing and recurrence of pigmented lesions in skin lining of orbit. The skin grafting was avoided as it can harbour the neoplasm.

Primary localized amyloidosis presenting as a tarsal mass: Report of two cases

Amyloidosis and its ophthalmic manifestations are rare. The unusual presentation can result in diagnostic delay and increase ocular morbidity. Additionally, there are various predisposing conditions and systemic involvement can affect various organs. Hence, localized disease warrants a thorough clinical evaluation and laboratory investigation. We report two cases of primary localized amyloidosis presenting as a tarsal mass and ptosis. The diagnosis was established on histopathology. There were no predisposing conditions and no systemic involvement. The disease was probably related to the local immunocyte disorder.

Feasibility and Complications between Phacoemulsification and Manual Small Incision Surgery in Subluxated Cataract.

Purpose. To compare the feasibility of cataract surgery with implantation of endocapsular supporting devices and intraocular lens (IOL) in subluxated cataract in phacoemulsification and manual small incision cataract surgery (MSICS). Design. Prospective randomized intervention case series consisting of 60 eyes with visually significant subluxated cataract. Method. The patients were randomly distributed between the two groups equally. The main outcome measure was implantation of in-the-bag IOL, requirement of additional procedure and complications, if any. Results. Capsular bag retention in subluxated lenses is possible in 90% cases in phacoemulsification versus 76.67% cases in MSICS (P = 0.16). Both groups, achieved similar best corrected visual acuity (P = 0.73), although additional procedures, intraoperative, and postoperative complications were more common in MSICS. Conclusions. Achieving intact capsulorhexis and nuclear rotation in MSICS may be difficult in cases with large nucleus size and severe subluxation, but subluxated cataracts can be effectively managed by both phacoemuslification and MSICS.

Re: ‘Long-term surgical outcomes of porous polyethylene orbital implants: a review of 314 cases’

The debate between evisceration and enucleation is well documented in literature. Minimal orbital dissection required in evisceration has made it a more preferable choice except for certain absolute indications for enucleation. Cosmetic appearance, motility, implant exposure and extrusion are the most frequently discussed complications between these two procedures. In a recent study by Jung et al ,1 the fornix contraction was noted in 13.9% cases of enucleation (with unwrapped porous polyethylene) versus 3% cases of evisceration (with porous polyethylene placed …

Clinical Significance of Microbial Growth on the Surfaces of Silicone Tubes Removed From Dacryocystorhinostomy Patients

DRS RICHOZ AND SCHUTZ IN THEIR LETTER RAISE 3 MAIN problems with our article to which I will respond. Concerns were raised regarding the technique that we evaluated because, in their opinion, it is somewhat outdated. The scleral buckling procedure was the only technique used to treat retinal detachment until the development of pneumatic retinopexy and vitrectomy. In a recent study comparing these procedures, scleral buckle was found to be as safe and effective a technique as vitrectomy and had better anatomic results than pneumatic retinopexy. Therefore, we believe that the scleral buckling procedure is a good technique that should be subject to further investigations with the aim of improving its outcomes. We used an encircling band because, unlike segmental buckles, the band relieves high vitreoretinal traction (especially among highly myopic eyes) and probably decreases the recurrence rate of retinal detachment by proliferative vitreoretinopathy. Intraoperative ocular hypotonia was prevented in all cases by an automatic air injection at 20 mm Hg. The pathophysiologic features of choroidal detachment are very complex, especially when it occurs after a scleral buckling procedure, and there is a lack of research in this area. Clinically differentiating between serous, sero-sanguinous, and hemorrhagic choroidal detachment usually is difficult, and we believe that their pathophysiology, in this surgical context, is similar. Thus, it seemed more relevant to include all types of choroidal detachment. We decided to choose systolic blood pressure as a principal outcome in line with our observations of several cases of choroidal detachment in the context of intraoperative arterial hypertension. This choice and the statistical method used in this study stemmed from these observations. We did not select the principal outcome measure after the analysis of the general data.