Vishal Jhanji

“Tuck In” Lamellar Keratoplasty (TILK) for corneal ectasias involving corneal periphery

Aims: Evaluation of a new surgical technique for the management of corneal ectasia with peripheral corneal involvement. Methods: Twelve eyes of 12 patients with corneal ectasias and peripheral corneal thinning requiring surgical intervention, including eight patients with combined keratoconus and PMD and four patients of keratoglobus, were enrolled for the study in a tertiary care hospital. All patients were contact lens intolerant and had a best corrected visual acuity (BCVA) ⩽20/120 with nine patients (75%) having BCVA ⩽20/200. “Tuck In” Lamellar Keratoplasty (TILK) that included a central lamellar keratoplasty with intrastromal tucking of the peripheral flange was performed in these patients. The main outcome measures analysed were uncorrected visual acuity (UCVA), BCVA, keratometry, refractive status and time for epithelial healing. Results: At the last follow-up (mean: 1.7 years (range 13–48 months)), six patients (50.0%) had BCVA ⩾20/60, and all patients had BCVA ⩾20/80. The mean keratometry decreased from 57.54 (SD 6.89) D preoperatively to 46.36 (2.39) D (p = 0.003), and the mean spherical equivalent (SEQ) refractive error decreased from –7.8 (4.6) D preoperatively to 1.23 (1.88) D (p = 0.007). A significant decrease was also seen in mean refractive astigmatism which decreased from 5.93 (3.06) D preoperatively to 3.23 (1.14) D (p = 0.037). Conclusion: Our technique of TILK is an effective surgical modality for the management of ectatic corneal dystrophies with peripheral corneal thinning.

Assessment of perceived difficulties by residents in performing routine steps in phacoemulsification surgery and in managing complications

OBJECTIVE To analyze the perceived difficulties of residents in performing the routine steps of phacoemulsification surgery and in managing complications. DESIGN Cross-sectional questionnaire-based study. PARTICIPANTS Thirty-six residents performing phacoemulsification during their learning curve. METHODS On an 8-point Likert scale, residents noted comfort levels with various steps of cataract surgery and with managing complications. RESULTS The respondents were grouped into Group 1 (second-year residents, n = 19) and Group 2 (third-year residents, n = 17). Residents in Group 2 had greater surgical experience than residents in Group 1 (p = 0.001). The most difficult step in cases of phacoemulsification for Group 1 was loading a foldable intraocular lens (IOL) (mean score 6.05, SD 1.57), and for Group 2 it was nuclear emulsification (mean score 3.59, SD 1.42). Both second- and third-year residents found capsular bag dialysis the most difficult complication (mean scores 6.0 [SD 1.9] and 5.75 [SD 2.14], respectively). The second-year residents had significantly more difficulty with errant capsulorrhexis, anterior chamber IOL placement, and repeated iris prolapse as compared with third-year residents. Group 2 residents reported that mature, senile cataracts were the most difficult cases for them to manage (mean score 6.23, SD 1.56). CONCLUSIONS This study identifies perceived difficulties that residents experience in routine cases of cataract surgery, highlighting specific areas in which they may benefit from additional training and practice.

Donor dislocation after DSAEK for a failed corneal graft

Descemet stripping automated endothelial keratoplasty (DSAEK) is gradually becoming a preferred technique of corneal transplantation in cases with endothelial dysfunction due to its advantages of early visual rehabilitation, absence of suture-related problems and preserving the cornea’s biomechanical properties.1 2 A recent study by Allan et al has revealed that corneal graft rejection episodes were 50% less frequent after DSAEK than penetrating keratoplasty.3 This procedure has also been used successfully to treat cases of failed graft.4 5 We report a case of donor lenticule dislocation that occurred due to issues related to sizing of the donor lenticule after DSAEK surgery that was performed …

Automated vitrector-assisted optical iridectomy: Customized iridectomy

&NA; An automated vitrector was used to create an optical iridectomy in 15 eyes of 15 patients with leucomatous corneal opacities. The optical iridectomy was performed successfully through a standard 1.2 mm incision in all eyes. No intraoperative complications were observed, and there was no case of iatrogenic cataract formation. The median best corrected visual acuity improved from 1/60 (range light perception to 6/60) preoperatively to 6/24 (range 6/60 to 6/12) at the last follow‐up (mean 28 days). An automated vitrector can be successfully used to create an optical iridectomy in eyes with leucomatous corneal opacities. This technique was safe and could be performed through a small surgical incision.

Impact of day care cataract surgery on inpatient services in a tertiary care ophthalmic setup.

We retrospectively reviewed the admission patterns for one year before and one year after the introduction of day care cataract surgery at our cornea services and noted that the number of cataract surgeries per month improved from year 2003 to 2005 (P < 0.001), with a higher number of admissions for non-emergency corneal pathology seen in 2005 (P < 0.001). There was a 69.1% more chance of admission for a corneal pathology patient after the introduction of day care services cataract surgery. Day care cataract surgery decongests non-cataract pathology related inpatient services and is therefore a viable alternative in the developing world.

Inadvertent corneal stromal staining by trypan blue during cataract surgery

We report a case in which the corneal stroma was inadvertently stained with trypan blue during cataract surgery.