Usha K Raina

Functional outcomes of acrylic intraocular lenses in pediatric cataract surgery

Purpose: To evaluate the functional outcomes of in‐the‐bag implantation of acrylic intraocular lenses (IOLs) with posterior continuous curvilinear capsulorhexis (PCCC), without PCCC, with PCCC and anterior vitrectomy, and with PCCC and optic capture in pediatric cataract surgery. Setting: Pediatric Ophthalmology Service, Guru Nanak Eye Centre, New Delhi, India. Methods: Forty‐two eyes of 25 children were included in this prospective study. All eyes had in‐the‐bag implantation of an AcrySof® IOL (Alcon). Twenty‐five eyes had had an anterior continuous curvilinear capsulorhexis (ACCC) (Group A). Seventeen eyes had PCCC along with ACCC (Group B), 4 had anterior vitrectomy combined with PCCC (Group C), and 6 had PCCC with IOL optic capture through the PCCC (Group D). Secondary opacification of the visual axis, visual acuity, and possible complications were observed and analyzed. Results: The mean age of the patients was 78 months (range 36 to 144 months). The mean follow‐up was 13 months (range 6 to 18 months). Four eyes (16%) in Group A developed visually significant posterior capsule opacification (PCO) involving the central visual axis and required secondary capsulotomy. All eyes in Groups B, C, and D had a clear visual axis at the last follow‐up and did not require a secondary procedure. Minimal postoperative inflammation (ie, aqueous flare and IOL deposits) was seen in all groups. The mean preoperative decimal best corrected visual acuity (BCVA) in Groups A, B, C, and D was 0.095, 0.055, 0.174, and 0.039, respectively. Postoperatively, the BCVA was 0.54, 0.66, 0.66, and 0.66, respectively. Conclusions: An optimal‐sized ACCC followed by in‐the‐bag implantation of a foldable acrylic IOL helped maintain a clear visual axis by delaying the onset of PCO and leading to milder PCO. The benefits of a foldable acrylic IOL in pediatric cataract surgery can be increased by combining it with PCCC, with or without anterior vitrectomy, or with optic capture of the IOL.

Posterior continuous curvilinear capsulorhexis with and without optic capture of the posterior chamber intraocular lens in the absence of vitrectomy

PURPOSE To evaluate the efficacy of posterior continuous curvilinear capsulorhexis (PCCC) with optic capture of the posterior chamber intraocular lens (PC IOL) in the absence of vitrectomy in preventing secondary opacification of the visual axis following pediatric cataract surgery. PATIENTS AND METHODS Thirty-four eyes of 28 children with congenital or developmental cataract, aged 1.5 to 12 years (mean, 6.39 years), were included in this prospective, randomized study. Anterior continuous curvilinear capsulorhexis (ACCC) with PCCC without optic capture of the PC IOL was performed in group A (18 eyes) and ACCC with PCCC with optic capture of the PC IOL was performed in group B (16 eyes). None of the eyes underwent anterior vitrectomy. Secondary opacification of the visual axis, visual acuity, and possible complications were observed and analyzed. RESULTS The follow-up period ranged from 8 to 28 months (mean, 17.5 months). All 16 eyes (100%) in group B had a clear visual axis at the end of follow-up. Eight eyes (44.4%) in group A had significant opacification of the visual axis. The difference between the two groups was statistically significant (P = .0011). No eye in group B required secondary intervention, whereas all 8 eyes in group A with significant secondary opacification required secondary intervention. There was no statistically significant difference in other complications such as anterior chamber reaction, fibrin formation, lenticular precipitates, and posterior synechiae. The final best-corrected visual acuity at the end of follow-up was comparable in the two groups (P > .05). CONCLUSION PCCC with optic capture of the PC IOL prevents secondary opacification of the visual axis even in the absence of vitrectomy.

Tubercular endophthalmitis simulating retinoblastoma

PURPOSE To report a case of tubercular endophthalmitis simulating retinoblastoma. METHODS Case report. An 8-year-old female presented with a history of complete loss of vision and a white pupillary reflex in the left eye of 3 months duration. RESULTS Retinoblastoma could not be excluded on the basis of clinical examination and relevant investigational studies. In the left eye, a computed tomography (CT) scan demonstrated a large vitreous mass with foci of calcification. Enucleation in the left eye was performed, and histopathological examination revealed a chronic granulomatous endophthalmitis and acid-fast bacilli consistent with tubercular pathology. CONCLUSION This case illustrates that tubercular endophthalmitis with leukocoria and a vitreous mass containing focal calcification may simulate retinoblastoma.

Spontaneous extrusion of extraocular cysticercus cysts

PURPOSE We treated two patients who had spontaneous extrusion of cysticercus cysts and subconjunctival swelling. Additionally, one patient had severe myositis and restriction of ocular movements. METHODS The patients were prescribed oral albendazole, 15 mg/kg of body mass per day. Systemic corticosteroids were also given to the patient who had severe myositis. RESULTS Spontaneous extrusion of the cysts occurred in both patients within three to five days of starting albendazole therapy. The conjunctival defects healed without any surgical intervention. The ocular motility in the patient with myositis returned to normal. CONCLUSION As extrusion happened soon after the start of albendazole therapy, it is uncertain whether this therapy played any role. Additionally, it is not clear if systemic therapy must be continued in the absence of systemic and neurologic manifestations.

Spectral-Domain Optical Coherence Tomography Following Nd:YAG Laser Membranotomy in Valsalva Retinopathy

BACKGROUND AND OBJECTIVE To describe spectral-domain optical coherence tomography (SD-OCT) findings following Nd:YAG laser membranotomy in premacular hemorrhage due to Valsalva retinopathy. PATIENTS AND METHODS Interventional case series of 7 eyes with premacular hemorrhage due to Valsalva retinopathy. Best-corrected Snellen visual acuity (BCVA) and color fundus photography were obtained before and after the laser treatment. SD-OCT scans were obtained at 1, 3, and 6 months following treatment. RESULTS SD-OCT revealed a convex dome-shaped cavity lined by a hyperreflective layer in all cases, which persisted until the end of follow-up. Two patients complained of metamorphopsia, although BCVA improved dramatically in all cases. The site of laser puncture was visible in 2 patients. No abnormality was detected in the underlying retinal layers. CONCLUSION SD-OCT reveals formation of a premacular cavity following laser puncture for premacular hemorrhage in Valsalva retinopathy, which may persist despite successful drainage of blood. This may later result in metamorphopsia in certain patients.

Spectral-domain optical coherence tomography of astrocytic hamartomas in tuberous sclerosis

Retinal astrocytic hamartomas are benign tumors of the retinal nerve fiber layer (NFL) that may be found in association with tuberous sclerosis (TS). We describe the spectral-domain optical coherence tomography (SD-OCT) features of type 1 astrocytic hamartomas in a child with TS that may aid in the diagnosis and follow-up of these lesions. Gradual, dome-shaped hyper-reflective elevations of the retinal NFL were seen on SD-OCT with subtle shadowing of the underlying tissues. In addition, the vitreous cortex showed focal adhesions to the surface of the tumor.

Polyglactin Sutures Versus Nylon Sutures for Scleral Flap Suturing in Trabeculectomy

BACKGROUND AND OBJECTIVES To note the effect on filtration function of using polyglactin sutures for scleral flap suturing in trabeculectomy. PATIENTS AND METHODS Polyglactin sutures were compared with nylon sutures to secure the scleral flap of trabeculectomy in 30 consecutive eyes. Parameters studied were intraocular pressure, central anterior chamber depth, and bleb score in this randomized prospective study. RESULTS Observations regarding intraocular pressure, central anterior chamber depth and bleb score in the early postoperative period were comparable in the 2 groups. The results at 12 months follow-up reveal a lower mean IOP (P < 0.05) and a higher mean bleb score (P < 0.05) in the group with polyglactin sutures. Success rate (defined as IOP < 21 mm Hg) at 12 months was 100% with use of polyglactin sutures compared to 80% with nylon sutures. CONCLUSIONS Polyglactin sutures can be used as an alternative to nylon sutures for scleral flap suturing in trabeculectomy, with the possible additional benefit of better long-term filtration function.

Bilateral electrical cataract

Editor,—Electric trauma is not uncommon in India where majority of the population lives in the rural setting. Few cases of electric cataract have been reported in literature probably because few patients survive the high voltage of current that induces cataract formation. Most patients with electric cataract have no subjective complaints early on but become aware of the reducing visual function several months later.1 ### CASE REPORT A 26 year old man complained of gradual and painless diminution of vision in both eyes, right more than left, for the …

Chronic myeloid leukemia presenting with bilateral central retinal vein occlusion and massive retinal infiltrates

Visual impairment as the initial symptom of leukemia, especially chronic myeloid leukemia, is rare, occurring in approximately 3% of all leukemias in children. We describe the case of a 14-year-old boy with vision loss attributable to bilateral central retinal vein occlusion and massive retinal infiltrates. Bone marrow biopsy demonstrated the BCR-ABL translocation, and the patient was diagnosed with chronic myeloid leukemia. A major cytogenetic remission was achieved 6 months after initiation of therapy.

Metallic intraocular foreign body retained for four years—An unusual presentation

Intraocular foreign bodies present a great threat to both sight and the globe of the patient especially if they are metallic and of long duration. We report a case of a metallic intraocular foreign body that presented four years after the initial trauma. The case was successfully managed by a simple technique and the role of ultrasound biomicroscopy (UBM) is highlighted.