Sudarshan Khokhar

Study of the psychosocial aspects of strabismus.

PURPOSE To systematically evaluate the perception of psychosocial difficulties due to strabismus and the impact of corrective surgery in adolescents and young adults in India. METHODS Patients 15 to 25 years of age with childhood onset (< or = 5 years of age) of constant concomitant squint (> or = 30 prism diopters of deviation for distance) were included in the study. After a detailed orthoptic evaluation, demographic data of the patients and their parents were recorded. Postgraduate Institute Health Questionnaire N-2 (standardized in India) was administered to rule out neuroticism in the patients. Psychosocial problems faced by the patients were evaluated with a semistructured interview schedule. Patients were evaluated 3 months after surgery using a similar interview schedule to assess the psychological impact of surgery. RESULTS Eighty percent of both male and female patients had problems in their social life; 85% of the males and 75% of the females had personal problems due to squint. After surgery, a positive change in appearance was noticed by 97.5% and 95% noticed a change in self-esteem and self-confidence. CONCLUSION These patients had difficulties with self-image and interpersonal relationships, faced ridicule at school and work, and generally avoided activities that brought attention to their defect. Substantial changes were noticed in them after corrective surgery, and the differences in their scores before and after surgery were statistically significant.

Amniotic membrane transplantation in refractory neurotrophic corneal ulcers: a randomized, controlled clinical trial.

Purpose: This study was designed to compare and evaluate the efficacy of amniotic membrane transplantation with the conventional management (tarsorrhaphy and bandage contact lens) in eyes with refractory neurotrophic corneal ulcers. Methods: Thirty eyes of 30 patients (14 females and 16 males) with neurotrophic corneal ulcers refractory to medical management were included and divided randomly into group 1 (n = 15), who received conventional management with a tarsorrhaphy (n = 11) or bandage contact lens (n = 4), and group 2 (n = 15), who underwent Amniotic Membrane Transplantation. The outcome parameters evaluated were epithelialization time, duration of healing of corneal ulcers, and improvement in best corrected visual acuity. Results: The mean age in our study was 37 ± 14.71 years. At the end of 3 months follow-up, 10 of 15 patients (66.67%) in group 1 showed complete epithelialization and subsequent healing and 11 of 15 patients (73.33%) in group 2 showed complete epithelialization and healing (P > 0.05). The median time for complete epithelialization was 21 days in both groups. Both groups showed an improvement in the best-corrected visual acuity. Conclusions: Both amniotic membrane transplantation and conventional management (tarsorrhaphy or bandage contact lens) are effective treatment modalities for refractory neurotrophic corneal ulcers.

Corneal astigmatism correction with opposite clear corneal incisions or single clear corneal incision : Comparative analysis

PURPOSE: To compare the astigmatic correcting effect of paired opposite clear corneal incisions (OCCIs) on the steep axis with that of single clear corneal incisions (CCIs) in cataract patients having phacoemulsification. SETTING: Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India. METHODS: This randomized prospective clinical study comprised 40 eyes of 40 patients with topographic astigmatism of more than 1.50 diopters (D). Paired 3.2 mm OCCIs were made in the steep axis in Group 1 and single CCIs in Group 2. Preoperative evaluation included uncorrected visual acuity, refraction, applanation tonometry, dilated fundoscopy, biomicroscopic examination, keratometry, and topography. The steep axis was marked before sub‐Tenons anesthesia was given and routine phacoemulsification was performed through a 3.2 mm CCI on the steep axis. An additional opposite 3‐step self‐sealing CCI was made in Group 1. Patients were examined 1, 4, and 12 weeks postoperatively. Visual acuity, refraction, keratometry, and topography were evaluated. RESULTS: The mean preoperative and postoperative topographic corneal astigmatism was 2.51 D ± 0.92 (SD) and 0.91 ± 0.54 D, respectively, in Group 1 and 2.16 ± 0.80 D and 1.57 ± 0.70 D, respectively, in Group 2. Mean astigmatic correction was 1.66 ± 0.5 D and 0.85 ± 0.75 D in Group 1 and Group 2, respectively. Mean surgically induced astigmatism, measured by a vector‐corrected method, was 1.66 ± 0.50 D and 0.85 ± 0.75 D in Group 1 and Group 2, respectively (P = .00). The coupling ratio was −0.96 in Group 1 and −0.87 in Group 2. The spherical equivalent was +0.23 ± 0.41 D in Group 1 and +0.11 ± 0.17 D in Group 2 at 12 weeks. Uncorrected visual acuity was better in Group 1 than in Group 2 (P = .032). There was no difference in best corrected visual acuity between the groups. There were no incision‐related complications. CONCLUSION: Paired OCCIs were predictable and effective in providing an enhanced effect for correcting preexisting corneal astigmatism in cataract surgery.

Topical autologous platelet-rich plasma eyedrops for acute corneal chemical injury.

Purpose: Evaluation of efficacy of autologous platelet-rich plasma eyedrops as an adjunct to standard medical treatment as compared with standard medical treatment with artificial tears in acute ocular chemical injury. Methods: Twenty eyes with grade III to grade V chemical injury were randomly assigned to 2 groups. Group I (10 eyes) received autologous platelet-rich plasma eyedrops along with standard medical treatment, and group II (10 eyes) received standard medical treatment alone. Follow-up was on days 3, 7, 14, 21, 30, 60, and 90. Chi-square test for categorical variables and Mann–Whitney test for quantitative variables were applied for statistical analysis. Results: The mean time between exposure and presentation was 2.15 ± 0.93 days (group I, 2.2 ± 0.73 days; group II, 2.1 ± 0.98 days; P = 0.81). Complete epithelialization was achieved in all the eyes. The mean ± SD and median (range) time to complete epithelialization were 40 ± 31.57 days and 25.5 (7–90) days in group I and 47 ± 26.15 days and 30.0 (21–90) days in group II (P = 0.29). For grade III injuries, mean ± SD and median (range) time to complete epithelialization were 14 ± 7 days and 14 (7–21) days in group I and 28.5 ± 3.67 days and 28.5 (21–30) days in group II (P = 0.006) [Wilcoxon rank sum (Mann–Whitney) test]. At 3 months, corneal clarity showed significant improvement in grade I compared with grade II (P = 0.048). Similarly, the percentage improvement in best-corrected visual acuity was 63.64 ± 55.75 and 37.74 ± 9.66 for grades I and II, respectively (P = 0.082). Conclusions: Topical autologous platelet-rich plasma therapy is safe and effective, and it promotes rapid reepithelialization of ocular surface and can be administered along with standard medical therapy.

Combined surgery, cryotherapy, and mitomycin-C for recurrent ocular surface squamous neoplasia.

Purpose. To report the outcome of combined excision, cryotherapy, and antimetabolite treatment of recurrent ocular surface squamous neoplasia. Methods. The patients with recurrent ocular surface squamous neoplasia were treated by excision of lesion, cryotherapy of limbus, and conjunctival margin followed by 0.02% Mitomycin C application at the time of surgery. Patients have been followed up for at least 1 year. Results. A total of five eyes of five patients with recurrent ocular surface squamous neoplasia were treated by combined excision, cryotherapy, and Mitomycin C. Histopathologic diagnosis included invasive squamous cell carcinoma in four cases and squamous dysplasia in one case. No recurrences have been noted for a follow-up period of more than 1 year now. Conclusion. Combining excision with cryotherapy and Mitomycin C application at the time of surgery is a very effective therapy for recurrent ocular surface squamous neoplasia. It is relevant for cases in large, poor countries where patients present late and are less likely to come for follow-up care.

Comparison of Topical 0.3% Ofloxacin to Fortified Tobramycin – Cefazolin in the Therapy of Bacterial Keratitis

SummaryBackground: In this study we compared topical ofloxacin with a combination of fortified tobramycin sulphate and cefazolin sodium solutions in the treatment of culture-proved bacterial keratitis. Methods: 30 eyes of culture-proved bacterial corneal ulcers of moderate severity were included in a prospective randomized, controlled, double-masked study for comparison. The cases were randomly allocated to treatment with 0.3% ofloxacin solution (Group I) and combination of fortified antibiotics (1.5% tobramycin and 5% cefazolin solutions – Group II as control) along with supportive cycloplegic, vitamins and antiglaucoma therapy. Time for healing of ulcer and subjective symptoms were main outcome measures. Students t-test was used to compare the results. Results:Staphylococcus aureus and coagulase-negative staphylococci were the two most common organisms isolated. Resolution of the ulcer was achieved in 93% and 87% in the treated and the control group, respectively. The mean duration of symptomatic relief was 7.8 ± 1.54 days in the treated group and 8.33 ± 1.44 days in the control group; for epithelial healing it was 15.0 ± 3.86 days in the treated group and 15.46 ± 3.86 days in the control group. Post resolution the best corrected visual acuity of 20/200 or better was achieved in all but one eye each in both groups. Conclusions: Both ofloxycin 0.3% and combined fortified tobramycin 1.5% and cefazolin 5% topical drops were comparable for treating cases of bacterial corneal ulcer of moderate severity. However, considering the easy availability and cost effectiveness of ofloxacin, a monotherapy with ofloxacin may be preferred over the combined, fortified tobramycin and cefazolin therapy.

Painting technique for staining the anterior lens capsule.

&NA; We describe a technique of capsule staining called capsule painting. Using a Khokhar capsule painting cannula, the dye is spread directly over the anterior capsule but to no other part of the anterior chamber. There is minimal turbulence in the anterior chamber as there is no need to replace the injected viscoelastic material. The use of minimal dye and viscoelastic material reduces the cost of surgery.

SURGICAL OUTCOMES OF EPIBULBAR DERMOIDS

PURPOSE To evaluate results of lamellar keratoplasty in limbal dermoid. METHODS The ocular records were reviewed of 155 consecutive eyes with solid epibulbar dermoids that underwent lamellar keratoplasty at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences from 1977 to 1998. According to the size and location, the dermoids were managed surgically either by sectoral, annular, or central lamellar keratoplasty. RESULTS All but 16 eyes improved cosmetically; while all the patients showed reduction in astigmatism, 116 eyes improved functionally. CONCLUSION Excision with lamellar keratoplasty appears to be an effective means of management for extensive limbal dermoid. To avoid development of amblyopia, surgery at an early age is preferred.

Pseudophakic pupillary block caused by pupillary capture after phacoemulsification and in-the-bag AcrySof lens implantation

We describe a 50-year-old patient who developed pupillary block caused by pupillary capture 1 week after uneventful phacoemulsification and implantation of an AcrySof foldable intraocular lens (IOL). The patient had a large but intact capsulorhexis with the haptics lying in the bag; the optic lay in the pupillary area anterior to the capsulorhexis. This case was successfully managed by a neodymium: YAG laser iridotomy, IOL explantation, and subsequent implantation of a poly(methyl methacrylate) posterior chamber IOL. To prevent this complication, we suggest the optic be larger than the capsulorhexis and advocate correct, gentle insertion of the foldable IOL.

Cysticercosis of the optic nerve.

Cysticercosis of the optic nerve has been reported only twice in the literature. A case of optic nerve cysticercosis in a 50-year-old woman with atypical optic neuritis is reported. Computerized tomography showed a thickened left optic nerve with a ring-enhancing lesion containing an eccentric nodule. An enzyme-linked immunosorbent assay test for cysticercosis further established the diagnosis. The patient was treated with oral prednisolone and albendazole, with no improvement in vision.