Indian Journal of Ophthalmology最新文献

Purpose: To compare the clinical outcomes of cataract surgery by injecting intracameral triamcinolone or dexamethasone in children with bilateral congenital or developmental cataracts.

Design: Prospective, interventional, assessor-blinded, randomized controlled trial.

Methods: This was an institutional study in which 24 children aged <6 years with congenital/developmental cataracts were randomly divided into two groups. Eyes with other associated ocular conditions were excluded. Intracameral triamcinolone acetonide 1.2 mg/0.03 ml in the control group and dexamethasone 0.4 mg/0.1 ml in the study group were injected at the end of cataract surgery. The primary aim was to compare the number of eyes requiring surgery and postoperative outcomes such as anterior segment inflammation, intraocular lens pigment deposition, and posterior synechiae.

Results: The mean age was 20.04 months ± 17.88 (SD) (range 6 to 72 months) out of the 24 children being studied. One eye in the control group and three eyes in the study group required synechiolysis, membranectomy, and dialing of the intraocular lens with no statistically significant difference between the two groups (P = 0.60). The median intraocular pressure and central corneal thickness did not change significantly postoperatively in either group. Both groups showed similar cellular reactions and rate of complications.

Conclusions: Intracameral dexamethasone can be used as an effective alternative to intracameral triamcinolone for modulating postoperative anterior segment inflammation in pediatric cataract surgery. This pilot study compares the safety and efficacy of two drugs used in pediatric cataract surgery, despite limitations such as a small sample size and a short follow-up period.

Purpose: To study 12-month visual outcome and complications of photorefractive keratectomy (PRK) in low (-0.50 to <-3.00D), moderate (-3.00 to <-6.00D), and high myopia (-6.00D to -10.00D).

Design: Prospective observational study.

Methods: A total of 78 participants (78 eyes) underwent PRK at a tertiary care center in central India. Inclusion criteria were patients aged 18-35 years with stable refraction for at least 1 year and patients who discontinued contact lenses. Individuals were excluded if they had experienced ocular infections in the past 3 months, had undergone intraocular surgery, had an existing ocular or systemic condition, or were pregnant. The study compared outcomes between 26 eyes with high myopia and 52 eyes with low-to-moderate myopia following the PRK procedure. Postoperative evaluations were conducted on days 1 and 7, and at 1, 3, and 12 months. Key parameters assessed included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), the presence of corneal haze, and any postoperative complications.

Conclusion: PRK effectively reduced myopia over 12 months with minimal complications and is a suitable alternative for patients contraindicated for LASIK.

This article presents the development and functional design of a motorized semi-automated prism bar intended to enhance the accuracy and reliability of horizontal fusional vergence testing. Conventional prism bar techniques are prone to several limitations, including examiner-dependent variability, incorrect prism positioning, and discomfort for patients due to improper handling or inconsistent distance from the eye. These factors contribute to significant measurement errors. Additionally, even small deviations in prism placement or holding angle can lead to large discrepancies in prism diopter readings, ultimately affecting diagnosis and therapy outcomes. To address these challenges, a cost-effective, semi-automated prism bar system has been developed using a 24-V DC motor, lead screw, gear set, stroke rod, and limit switch mechanisms. The motorized device allows linear movement of the prism bar in 1.5-cm increments with the push of a button, ensuring precise alignment with the patient's eye. A chin-and-headrest system maintains a constant prism-to-eye distance, minimizing human error and enhancing patient comfort during measurements. The system incorporates limit switches to prevent overextension and employs a control unit to manage DC power supply efficiently. This innovation meets the clinical needs for fixed prism positioning, thus improving accuracy and repeatability.

Purpose: To characterize the impact of neovascular glaucoma (NVG) and its underlying etiology on mortality and determine the association between NVG and cause of death.

Design: Retrospective cohort study.

Participants: A total of 210 subjects with NVG were included in the descriptive study. Of the 210 subjects, 132 with a definite date of NVG onset were included in the survival analysis.

Methods: Patients with NVG seen at our tertiary care center from 2015-2016 were identified. Demographic information, underlying etiology, and medical conditions were documented. The Centers for Disease Control and Prevention National Death Index (CDC NDI) was used to designate if subjects were alive on December 31, 2021, and to determine the primary cause of death. Kaplan-Meier and Cox proportional hazard regression analyses were performed on subjects with a definitive date of NVG onset.

Results: Of the 210 subjects, 32% were deceased by December 31, 2021. The commonest diagnosis was proliferative diabetic retinopathy (PDR) (57%), followed by central retinal vein occlusion (CRVO) (29%). Of 132 subjects included in the Kaplan-Meier survival analysis, the mean survival time was 154 ± 15 months (95% CI: 125-183). Cox regression analysis demonstrated that older age (HR 1.03, 95% CI: 1.004-1.06, P = 0.02) and central retinal artery occlusion (CRAO) (HR: 4.63, 95% CI: 1.7-12.44, P = 0.002) were associated with poorer survival.

Conclusions: Increasing age and CRAO-related NVG (compared to CRVO-unrelated) were important predictors of increased mortality. Our results highlight the need for aggressive management of underlying systemic co-morbid conditions contributing to early mortality in patients with NVG.

Purpose: To report efficacy and outcomes of Preserflo MicroShunt surgery in patients with uveitic glaucoma at a tertiary center.

Design: Retrospective cohort study.

Methods: Consecutive patients with uncontrolled uveitic glaucoma who underwent Preserflo MicroShunt surgery with a minimum of 2 years of follow-up. Baseline characteristics, pre-operative and post-operative intraocular pressure (IOP), number of glaucoma medications, visual acuity, and adverse events were recorded.

Results: A total of 48 eyes with uveitic glaucoma underwent Preserflo MicroShunt with 0.4-0.5 mg/mL mitomycin C (MMC) were followed up at 2 years post-operation and 38 eyes at 3 years post-operation. The mean age was 51 ± 17 (21-84) years, and 27 (56.3%) were female. The mean baseline IOP of 29 ± 8 (range: 14-45) mmHg was reduced at each year post-operatively (P < 0.0001). The mean post-operative IOP at 1 year was 12.5 ± 5.0, at 2 years, it was 11.4 ± 4.8, and at 3 years, it was 13.6 ± 6.8 mmHg. The mean number of pre-operative glaucoma medications was 3.2 ± 1.3 (range: 0-5) compared with 0.4 at 1 year, 0.3 at 2 years, and 0.6 at 3 years (P < 0.0001). Adverse events included hypotony (two eyes), required revision of Preserflo MicroShunt (six eyes), and required further glaucoma surgery (six eyes). At the last follow-up visit, the overall success rate (IOP ≤ 21 mmHg and a 20% reduction ± medication) was 75%.

Conclusion: Our study showed good IOP control with Preserflo MicroShunt surgery at 3 years for patients with uncontrolled uveitic glaucoma.

Purpose: To describe the neuro-ophthalmic presentations of intracranial aneurysms (IAs) and highlight the critical role of ophthalmologists in early detection.

Methods: A retrospective, unicentric study of patients with IAs who presented to our neuro-ophthalmology clinic at a tertiary eye care center over 6 months (February-August 2024).

Results: Nine patients with IAs were documented, of whom seven presented first to an ophthalmologist with symptoms like defective vision, diplopia, and visual field defects. Among these seven patients, the mean age was 58.9± 19.4 years (range 23-83). 71% were female. Presenting complaints included diplopia (57%) and defective vision (43%). Systemic comorbidities like diabetes and hypertension were present in 42.8%. Clinical examination revealed signs of third nerve palsy in 28.5%, sixth nerve palsy in 28.5%, and relative afferent pupillary defect and optic disc pallor in 43%. Visual field examination revealed right homonymous hemianopia in 14.2%. Magnetic resonance imaging revealed an anterior circulation aneurysm in all patients, and one also had a posterior circulation aneurysm. Multiple aneurysms were seen in 28.5%. Saccular morphology was predominant (71.4%) compared to fusiform aneurysms (28.5%).

Conclusion: Intracranial aneurysms may initially present with neuro-ophthalmic signs such as isolated cranial nerve palsies or compressive optic neuropathy. Timely imaging and multidisciplinary intervention are crucial to prevent permanent visual loss and life-threatening complications like rupture and subarachnoid hemorrhage. Ophthalmologists are pivotal in the early diagnosis of such potentially fatal conditions.