Indian Journal of Ophthalmology最新文献

Purpose: This study evaluates the performance and safety of the Optiflex Trio trifocal intraocular lens (IOLs) in Indian cataract patients.

Design: Single-arm prospective clinical study.

Methods: Patients undergoing phacoemulsification for senile cataracts received bilateral Optiflex Trio trifocal IOLs. Visual outcomes, spherical equivalent, reading performance, contrast sensitivity, stereo acuity, and high-order aberrations were assessed at 1 week, 1 month, 3 months, 6 months, and 12 months.

Results: A total of 93 eyes were implanted with IOL and showed significant improvement from pre-op to 12 months in the uncorrected distance (UDVA: 0.74 ± 0.33 to 0.01 ± 0.04 logMAR, P = 0.0001), intermediate (UIVA: 0.62 ± 0.20 to 0.01 ± 0.03 logMAR, P = 0.0001) and near visual acuity (UNVA: 0.57 ± 0.20 to 0.01 ± 0.02 logMAR, P = 0.0001), best-corrected distance visual acuity (BCDVA: 0.45 ± 0.29 to 0.00 ± 0.01 logMAR, P = 0.0001), and distance-corrected visual acuities (DCIVA and DCNVA: 0.32 ± 0.23 to 0.00 logMAR, P = 0.0001). The contrast sensitivity increased from 0.52 ± 0.40 to 1.49 ± 0.05 (P = 0.0001), while high-order and total aberrations decreased (0.87 ± 0.71 to 0.16 ± 0.11 mm and 1.55 ± 1.13 to 0.21 ± 0.07 mm, both P = 0.0001). Near/intermediate reading speeds improved by 5.18 ± 8.72 and 5.15 ± 8.72 words/min (P = 0.000). Stereo acuity significantly enhanced, with FD2 from 265.14 ± 124.93 to 83.41 ± 12.56 and Near Radnor from 211.71 ± 114.60 to 74.77 ± 6.98 (P < 0.0001). No adverse events were reported.

Conclusion: Optiflex Trio trifocal IOL enhances vision, reduces aberrations, and supports spectacle independence.

Purpose: To compare the efficacy and safety of micropulse transcleral cyclophotocoagulation (MP-TSCPC) using the original and revised pars plana probe in patients with glaucoma.

Methods: Retrospective review of records who underwent MP-TSCPC between August 2020 and July 2023. Patients aged >12 years and with a minimum follow-up of 1 year were included. Success was defined as intraocular pressure (IOP) ≥ 6 and ≤21 mm Hg with the same or fewer antiglaucoma medications and a minimum of 20% IOP reduction.

Results: A total of 21 eyes treated with the original probe and 22 eyes treated with the revised probe were included. Baseline characteristics were comparable between the two groups. Mean IOP reduced from 30.3 ± 9.9 mm Hg to 21.8 ± 8.2 and 20.2 ± 7.5 (P < 0.001) mm Hg at 6 months and 1 year, respectively, with the original probe and from 26.1 ± 8.4 mm Hg to 19.1 ± 7.4 and 18.8 ± 5.8 (P = 0.009) mm Hg at 6 months and 1 year, respectively, with the revised probe. The difference between the probes was not statistically significant at all-time points. The mean number of antiglaucoma medications reduced from 3.9 ± 0.7 to 3.3 ± 1 at 1 year (P = 0.006) with the original probe and from 3.9 ± 1.1 to 3.4 ± 1.4 at 1 year (P = 0.045) with the revised probe. The probability of qualified success at 1 year was 33.3% for the original probe and 40.9% for the revised probe (P = 0.755).

Conclusion: MP-TSCPC is a safe and effective treatment for reducing IOP with both the original and revised probes, but the efficacy is not long-lasting.

Abstract: IgG4-related orbital disease is an emerging systemic fibroinflammatory disease that has gained considerable recognition in the past 2 decades. The varied location and presentation of this indolent disease may often result in a diagnostic dilemma for clinicians. Early recognition, comprehensive systemic evaluation, and multidisciplinary approaches are essential for its management. Delayed diagnosis can cause irreversible organ damage, and this disease has shown to be associated with an increased risk of death. This article provides an update on the ophthalmic disease presentation, diagnostic criteria, and management.

Purpose: We aim to study the Vision Centre-Based Community Eye Health Programs in an underserved urban slum in Pune city, India, using Budget Impact Analysis from a payer's perspective.

Methods: Input costs, training, human resources, capital equipment cost, recurrent consumable costs, salaries, and rent were calculated from January 2015 to December 2022. The income earned from subsidized outpatient care, optical services, and surgeries was calculated. The monthly reports of the center were used to calculate the number of beneficiaries. Data were stored in Excel and analyzed in R software. Free surgeries, consultations, and spectacles were distributed to needy patients occasionally during these years.

Results: The Vision Centre at Phulenagar, Vishrantwadi, Pune, in partnership with Operation Eyesight Universal, has been operational since January 2015, providing critical eye health services to the community. Over 5 years, the center examined 44,535 individuals, with 98.1% re-examined in 2019, and significantly reduced the prevalence of blindness and visual impairment. Budget impact analysis revealed the center's establishment cost, net budget impact, and the economic impacts of various operational scenarios. Sensitivity analysis showed that income from surgeries had the highest influence on total income, while spectacle costs affected total costs the most. Scenario analysis highlighted that a combined approach of reducing costs and increasing income, particularly in the absence of District Blindness Control Society subsidy, could improve the financial sustainability of the Vision Centre.

Conclusion: Vision center-based prevention of blindness and vision impairment programs, combined with home screening, is effective clinically and economically.

Purpose: Patients with transfusion-dependent thalassemia (TDT) are at risk of neuroretinal changes due to chronic anemia, hypoxia, iron overload, and chelation therapy. This study aims to compare central macular thickness (CMT), macular ganglion cell layer thickness (GCL), and peripapillary retinal nerve fiber layer (RNFL) measured using spectral-domain optical coherence tomography (SD-OCT) in TDT patients with controls.

Methods: This is a cross-sectional study of 170 eyes of 85 TDT patients between 5 and 30 years and 170 eyes of 85 controls with similar age ranges and sex distribution. Demographic characteristics, systemic characteristics, and SD-OCT-measured CMT, GCL thickness, and global and quadrant-wise peripapillary RNFL thickness were recorded.

Results: There were 52 (61.2%) male and 33 (38.8%) female cases and 36 (42.4%) male and 49 (57.6%) female controls. The median age of TDT patients was 18 years (range: 6-30 years), while that of the controls was 21 years (range: 7-28 years). The mean GCL (P = 0.002) and global (P = 0.008), inferior (P = 0.013), temporal (P = 0.016), and nasal (P = 0.023) RNFLs were thicker in controls than in TDT patients. There was no difference in CMT (P = 0.495) and superior RNFL (P = 0.303) between TDT patients and controls.

Conclusion: While no significant differences were observed in CMT or superior RNFL between the two groups, controls demonstrated greater GCL and RNFL thickness in three quadrants compared to TDT patients. These findings suggest the possibility of subtle neuroretinal alterations in TDT that may not yet be clinically evident. Larger longitudinal studies are recommended to validate these findings.

Purpose: To compare a newly developed virtual reality-based perimeter (Oculera visual field analyzer) with the Humphrey Field Analyzer (HFA) in patients with idiopathic intracranial hypertension (IIH).

Design: A cross-sectional study.

Methods: In this study, 30 eyes of 15 IIH patients were randomly tested with HFA (24-2, SITA Standard) and Oculera (24-2, Oculera Interactive) on the same visit. Test durations, global indices [visual field index (VFI), mean deviation (MD), and pattern standard deviation (PSD)], and false negative and positive user responses were compared. Spearman correlation was used for statistical analysis.

Results: Correlation analysis showed a statistically significant correlation between the measurements of the two devices in terms of the global indices (VFI, MD, and PSD) and test duration (r = 0.361, P = 0.050; r = 0.395, P = 0.031; r = 0.408, P = 0.025; and r = 0.363, P = 0.049, respectively). The Oculera was within an acceptable range for 83.3% of eyes, considering the MD reproducibility of 1.5-4 dB for HFA. No significant difference was found between the devices in false positive and negative responses (P = 0.098 and P = 0.395, respectively).

Conclusions: Standard automated perimetry is the gold standard for detecting visual field defects, but it is costly and requires prolonged attention and stable fixation. The results of the Oculera, produced with virtual reality technology, were found to be consistent with those of the HFA, and its much lower cost and portability suggest that it has the potential to be an alternative to conventional perimeters.

This study aimed to generate national-level pooled estimates of effective Cataract Surgical Coverage (eCSC)and Relative Quality Gap (RQG) and describe heterogeneity in these estimates across India. We registered the review protocol in PROSPERO (ID-CRD42024609587). We conducted and reported the systematic review and meta-analysis in accordance with the PRISMA 2020 reporting guidelines. Literature searches in PubMed, Scopus, Web of Science, and Embase identified studies in India published until November 4, 2024. Population-based cross-sectional and cohort studies reporting Cataract Surgical Coverage (CSC) and eCSC were included. Study characteristics and estimates were extracted, and quality was assessed using the JBI tool for prevalence studies. We estimated the pooled CSC, eCSC and RQG using random-effects meta-analysis (DerSimonian and Laird estimator) and performed the subgroup analyses and sensitivity analysis for heterogeneity assessment (I² statistic) using R. Seven studies were included in the systematic review, and four studies (34 survey reports) in the meta-analysis. Pooled estimates for CSC [57% (95% CI: 52% to 61%)], eCSC [36% (95% CI: 32% to 40%)], and RQG [37% (95% CI: 33%-40%)] showed high heterogeneity (I² >90%; P < 0.001). Subgroup analysis indicated regional differences for the coverage rates (P < 0.001), with the Northeast showing low coverage rates and low heterogeneity (CSC:36%, 95% CI (32%-42%), I2 = 0%; eCSC: 23%, 95% CI (16%-31%), I2 = 12.6%]. Low CSC, eCSC, and high RQG indicate that quality improvement must accompany efforts to increase coverage. High heterogeneity supports a decentralized, district-focused approach. A task force addressing barriers in the Northeast region could reduce regional inequities.

Background: This study aimed to evaluate the effect of fluorescein on intraocular pressure (IOP) measurements using Goldmann applanation tonometry (GAT). The study compared IOP readings with and without fluorescein to determine its influence on measurement accuracy in clinical practice.

Methods: This cross-sectional study included 39 patients (78 eyes). IOP was measured three times under each condition: fluorescein-free with green light and fluorescein-aided with cobalt blue light. The prespecified primary comparison was between the first fluorescein-free reading and the first fluorescein-aided reading, separated by approximately 1 minute (the time needed to apply fluorescein). Statistical analysis (repeated-measures ANOVA for within-series change; Wilcoxon signed-rank tests for paired comparisons) was used to compare measurements, while corneal astigmatism, keratometry, and central corneal thickness were assessed for their potential influence on discrepancies. A sensitivity analysis excluding patients with >3.0 D corneal astigmatism was conducted.

Results: No significant difference was found between the first fluorescein-free and first fluorescein-aided IOP measurements (Wilcoxon P = 0.75; mean difference +0.04 mmHg). Consecutive measurements showed significant IOP reductions within each group, attributed to mechanical effects of the tonometer (repeated-measures ANOVA P < 0.01). Corneal parameters, including central corneal thickness and keratometry, did not significantly affect the differences. Results were unchanged after excluding patients with >3.0 D astigmatism.

Conclusions: Fluorescein does not significantly affect IOP measurements using GAT, supporting fluorescein-free measurement as a viable alternative in routine practice. Further research is needed to evaluate its application in cases of high astigmatism or altered corneal geometry.

Purpose: To evaluate changes in ocular surface parameters, contrast sensitivity (CS), and higher-order aberrations (HOAs) in patients with computer vision syndrome (CVS)/digital eye strain (DES), and to assess associations among these factors.

Design: Prospective observational case-control study.

Methods: Both eyes of 55 CVS cases (CVS-Q score ≥ 6) and 55 age-matched controls (18-40 years) with best-corrected visual acuity (BCVA) of 6/6 were enrolled. Participants with ocular comorbidities were excluded. Central and peripheral CS were assessed using the Pelli-Robson (PR) chart and Spaeth-Richman contrast sensitivity test (SPARCS). Dry eye disease (DED) workup was performed. HOAs were measured using a wavefront aberrometer (iDesign® Refractive Studio, Johnson and Johnson Surgical Vision, Inc.).

Results: PR scores were identical across groups. SPARCS revealed significantly reduced total CS scores (central and peripheral) in the CVS group (W = 3641.000, P < 0.001), highlighting its sensitivity to subtle CS changes. The CVS group showed significantly higher HOA values (%), root mean square HOA error (P < 0.001), and spherical aberration (P = 0.033), along with more severe DED findings.

Conclusion: CVS/DES leads to impaired visual function due to reduced CS, increased HOAs, and dry eye. Assessment of both central and peripheral CS provides a more complete understanding of its impact on visual quality and daily functioning. Early ergonomic interventions and preventive strategies are vital for protecting ocular health in an increasingly digital world.

This systematic review and meta-analysis aims to evaluate the comparability of two swept-source optical coherence tomography (SS-OCT) biometers, Anterion and IOLMaster 700. This systematic review and meta-analysis reviewed articles published until October 1, 2023. Eligibility criteria included a comparative study design, absence of ocular diseases except cataract or refractive errors, same day measurements with both devices, and outcomes such as axial length (AL), mean keratometry, astigmatism vectors, anterior chamber depth (ACD), central corneal thickness, lens thickness (LT), corneal diameter, white-to-white (WTW), and intraocular lens (IOL) power for emmetropia. This systematic review incorporated 17 studies (2943 eyes). The mean difference of AL measurements obtained with Anterion and IOLMaster 700 was -0.01 [-0.09; 0.06]. Anterion provided a significantly larger ACD (0.10 mm [0.08-0.12 mm]) and LT (0.04 mm [0.01; 0.07]), while IOLMaster 700 had significantly larger WTW measurements (0.20 mm [-0.24; -0.16]). Corneal measurements tend to be flatter for Anterion, although no significant differences were found between devices. In conclusion, this meta-analysis showed statistically significant differences in WTW, LT, and ACD measurements between devices. AL measurements were comparable between biometers. Anterior mean and steep and flat keratometry tend to be higher with IOLMaster700. These differences may result in a higher IOL power for emmetropia when data are entered from Anterion measurements. Future studies will be needed to establish the influence of these differences on the refractive predictability of IOL power calculation.