Indian Journal of Ophthalmology最新文献

Purpose: To look at the outcomes of various interventions in treatment-naive pediatric rhegmatogenous retinal detachment (RRD).

Methods: This study was conducted at a tertiary care hospital in North India. Children below 16 years with treatment-naive RRD with a minimum 6-month follow-up were enrolled retrospectively from July 2012 to June 2021 and prospectively from July 2021 to June 2022. Patient demographics at presentation, risk factors, preoperative ophthalmic findings including best-corrected visual acuity (BCVA), the choice of surgery and tamponade, and postoperative assessment parameters were recorded. The primary outcome measure was anatomical success after surgery. Secondary outcome measures included functional success, that is, postoperative BCVA at last follow-up, improvement in vision, number of surgeries required to achieve final anatomical success, and correlation of factors such as age and etiology with outcomes. Functional success was taken as postoperative BCVA ≥ logMAR 1.3.

Results: Among the 333 pediatric patients (348 eyes), the most common etiology was trauma (44.8%), followed by high myopia (17%) and idiopathic causes (15.5%). Primary anatomical success was achieved in 66.9% of cases, improving to 88.5% with additional surgeries. Functional success was recorded in 46.3% of cases. Combined scleral buckling (SB) and pars plana vitrectomy (PPV) provided the best anatomical (66.01%) and functional (48.32%) outcomes.

Conclusion: Pediatric RRD presents significant management challenges. Combined SB + PPV yielded superior outcomes. Functional recovery remains limited, emphasizing the need for early detection, improved surgical strategies, and long-term follow-up for optimal visual rehabilitation.

Purpose: To determine the factors associated with compliance with recommended intravitreal injections (IVIs) for retinal diseases among out-of-pocket, insured, and fully subsidized (non-paying) patients.

Methods: This retrospective observational hospital-based study included patients recommended for IVI in at least one eye between November 2011 and May 2022. Three cohorts of patients were assessed: out-of-pocket payers, insured, and those fully subsidized (non-paying) by the hospital. The main outcome measure was the compliance rate, defined as the proportion of patients receiving an injection after one was recommended. The impact on the visual outcome in each cohort was a secondary outcome.

Results: Overall, 50,408 IVI were recommended for at least one eye and were included in the analyses. Male patients were more common (66.72%), and the mean age was 55.36 ± 16.39 years. The overall compliance rate with the first recommended injection was 51.37%, which increased and eventually stabilized with subsequent recommendations to approximately 80% (range: 77.48%-82.93%). Insured patients had a higher compliance rate with the first recommendation compared to the non-insured (100% vs. 49.84%; P < 0.000 01 ), and non-paying patients had a higher compliance rate after the first recommendation compared to paying patients (62.51% vs. 48.66%; P < 0.000 01 ). Patients with insurance achieved a better visual outcome at the last follow-up compared to other cohorts.

Conclusion: Insured patients have a much higher compliance rate with recommended IVIs compared to out-of-pocket or non-paying patients. The high non-compliance rate among non-paying patients suggests that factors other than the direct cost of the injections may impact compliance with recommended treatment.

Three-port pars plana vitrectomy (PPV) requires thorough visualization of the peripheral vitreous base, typically achieved using scleral depression. Traditional methods, involving either a trained assistant or chandelier illumination, are limited by cost, assistant dependency, and inconsistent visualization. In this article, we describe a "do it yourself"(DIY) cost-effective, improvised illuminated scleral depressor-"The Lumi-Indent"-created by inserting a 25-gauge endoilluminator into the cap of a disposable hypodermic needle and securing it with sterile tape. The device was used in 50 consecutive vitreoretinal surgeries with 360° vitreous base shaving. No intraoperative complications were noted. We also review existing techniques, including Veckeneer's Tyndall effect-enhanced transillumination with triamcinolone and PFCL; Bamonte's simplified method using a venflon cannula sleeve; Mandelcorn's light pipe and finger-mounted ring depressor; Todorich's digital heads-up system with a molded adapter tip; and Tan's cotton swab-modified depressor. While each approach improves surgeon independence and peripheral visualization, many require either costly equipment or present structural limitations. Our Lumi-Indent depressor offered consistent illumination, scleral rigidity, and smooth conjunctival navigation, without the risk of bending or damaging the light pipe. Its negligible cost and simplicity make it an ideal solution for high-volume or resource-limited settings. In conclusion, the Lumi-Indent is a safe, frugal, and efficient tool for assistant-free vitreous base shaving, expanding the accessibility of advanced surgical techniques.

In view of the growing global presence of what is already the leading contributor to death and disability on the planet - systemic hypertension - we need to better suspect, recognize, and interpret hypertensive retinopathy in the context of systemic implications and multiple organ damage. Hypertension itself is grossly underdiagnosed and undertreated, calling for the ophthalmologist's discretion to proactively suspect systemic hypertension in both young and older adults, separate acute from chronic retinal changes, pick up the subtle clues of choroidopathy, and appreciate the implications of disc edema in systemic hypertension. Far from acting as a mere referee, we need to guide and direct the urgency and nature of systemic management by the physicians and relevant sub-specialists.

Purpose: To evaluate the outcomes of 27-gauge (27G) microincision vitrectomy surgery (MIVS)-assisted scleral fixation of intraocular lenses (SFIOLs) using anterior segment optical coherence tomography (AS-OCT). The study assesses postoperative intraocular lens (IOL) tilt, decentration, and iris to IOL distance and their impact on visual and refractive outcomes.

Methods: This retrospective study included 36 patients undergoing 27G MIVS-assisted SFIOL implantation. Preoperative data, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), endothelial cell count, and surgical indications, were recorded. Postoperatively, BCVA, IOP, and endothelial cell count were assessed at 3 months. Additionally, postoperative AS-OCT was performed to assess IOL tilt, decentration, and distance of the IOL from the posterior iris surface. Surgical complications were documented.

Results: The mean IOL tilt was 3.58 ± 0.57 degrees, IOL decentration was 0.22 ± 0.47 mm, and IOL to posterior iris distance was 0.76 ± 0.66 mm. At three months, BCVA significantly improved from 0.85 ± 0.53 log MAR to 0.38 ± 0.38 log MAR ( P = 0.03). Hyperopic shift (manifest refractive spherical equivalent [MRSE]: +1.14 ± 0.62 D) correlated strongly with increased distance of IOL from the posterior iris surface. Complications included early postoperative IOL tilt ( n = 4, requiring refixation), vitreous hemorrhage ( n = 3, resolving spontaneously), and choroidal detachment ( n = 2, resolving with corticosteroids).

Conclusions: The 27G MIVS-assisted SFIOL technique demonstrates favorable outcomes with minimal IOL tilt and decentration. The technique offers a safe and effective alternative for scleral fixation, optimizing surgical efficiency and patient outcomes.

Background: There is no consensus on the mode of anesthesia for laser in ex-preterm infants with retinopathy of prematurity (ROP).[1,2] It is technically difficult to perform laser under topical anesthesia, particularly in large infants. Conventional general anesthesia (GA) with endotracheal intubation appears appropriate; however, it has high cardio-respiratory complications.[3].

Purpose: This video describes a method of inhalational GA with spontaneous respiration using sevoflurane at low concentration with laryngeal mask airway (LMA) in ex-preterm infants undergoing laser for ROP.

Synopsis: Evaluation and correction of anemia remain the most important preoperative consideration. The procedure of GA includes induction with 2-5% sevoflurane followed by insertion of LMA and maintenance with 1.5-3% sevoflurane in combination with nitrous oxide. In case of intraoperative apnea, the inhalational agents are discontinued, and if spontaneous respiration is not restored in 20 seconds, then manual ventilation with flow-inflated bag is started. Following the laser, inhalational agents are stopped, and the LMA is removed after recovery of protective reflexes.

Highlights: Use of benzodiazepines, opioids, skeletal muscle relaxants, and endotracheal intubation with mechanical ventilation can be avoided as far as possible.[4] Induction and titration of GA can be better achieved with inhalational anesthetic agents (sevoflurane). An appropriately placed laryngeal mask airway (LMA) with spontaneous respiration or pressure-assisted ventilation not only provides airway control but also helps to minimize the cardio-respiratory complications associated with endotracheal intubation during and after the laser.[5] Under appropriate resource settings, laser for severe ROP can be safely performed under GA using sevoflurane and LMA.

Video link: https://youtu.be/UURZrz_b7_o.

Background: Macular edema is a leading cause of vision impairment in patients with branch retinal vein occlusion (BRVO). While anti-vascular endothelial growth factor (anti-VEGF) therapies are commonly used, some patients experience persistent or recurrent edema despite multiple injections. Subthreshold micropulse (STMP) laser therapy using a 532 nm green laser has emerged as a potential alternative treatment.

Methods: This prospective interventional cohort study included 30 eyes with persistent macular edema secondary to BRVO, unresponsive to at least three prior anti-VEGF injections. Participants underwent 532 nm STMP laser treatment, with follow-up assessments at 1, 3, and 6 months. Primary outcomes measured were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) over the 6-month period.

Results: The mean baseline BCVA was 0.80 ± 0.24 LogMAR, improving to 0.72 ± 0.34 at 6 months (P < 0.04). CMT significantly decreased from 448 ± 68.77 µm at baseline to 353.23 ± 88.33 µm at 6 months (P < 0.01). Complete resolution of macular edema was observed in 16.67% of eyes at 3 months and 33.33% at 6 months. Rescue laser treatment was required in 20% of eyes at 3 months. No procedure-related complications were reported.

Conclusion: The 532 nm STMP laser therapy appears to be a safe and effective treatment for persistent macular edema secondary to BRVO, offering significant anatomical and functional improvements over a 6-month period. Further studies with larger sample sizes and longer follow-up are recommended to validate these findings.