Indian Journal of Ophthalmology最新文献

Purpose: To evaluate the efficacy of retinal massage combined with autologous blood covering in the treatment of persistent macular holes following vitrectomy in eyes with high myopia.

Settings and design: Retrospective, consecutive case series in a tertiary eye center.

Methods: A total of 12 highly myopic eyes with persistent macular holes after vitrectomy and internal limiting membrane peeling received combined retinal massage, air/fluid exchange, autologous blood covering, and gas/silicone oil tamponade. Best-corrected visual acuity, axial length, and optical coherence tomographic images before and after the treatment were compared.

Results: The mean hole diameter before this intervention was 931.58 ± 244.58 μm (range, 508-1270), and the axial length was 30.39 ± 2.13 mm (range, 27.08-34.64). During the 6-month follow-up period, hole closure was achieved in eight eyes (66.67%). The mean best-corrected visual acuity improved significantly from 1.40 ± 0.50 logarithm of the minimum angle of resolution (logMAR) at baseline to 1.10 ± 0.30 logMAR ( P < 0.05). No complications were observed.

Conclusions: Combined retinal massage and autologous blood covering, which is easy to manipulate, can promote the closure of persistent macular holes after vitrectomy and improve vision in high myopia with an axial length less than 29 mm.

The Descemet membrane (DM) is the basement membrane of corneal endothelial cells, which are responsible for maintaining corneal transparency. DM detachment (DMD) can occur due to various reasons, with the most common etiology being post-surgical. Older age, blunt instruments, and faulty surgical technique predispose to the intraoperative or postoperative occurrence of DMD, and one should have a high index of suspicion for DMD in cases with unexplained or an atypical pattern of corneal edema after surgery. Prompt intervention for DMD management is imperative to effect early visual rehabilitation, decrease corneal morbidity, and avoid permanent damage leading to scarring of the cornea. Various classifications of DMD and management protocols have been described. Anterior-segment optical coherence tomography (AS-OCT) imaging is the most effective imaging to detect DMD and quantify its extent. Desmetopexy with air/gas is the initial treatment of choice and could be aided by suture fixation. Non-responsive cases might need endothelial keratoplasty.

Purpose: To report the initial experience of performing capsulotomy in eyes with mature white cataracts using selective laser capsulotomy (SLC) in Indian eyes.

Methods: This was a prospective, noncomparative, open-label study. All adults presenting to our institution with mature cataracts whose pupils dilated >6 mm and who were willing for phacoemulsification were invited to participate. During surgery, after staining the anterior capsule with a proprietary trypan blue, the CAPSULaser device (Excel-Lens Inc, Los Gatos, CA, USA) was used to create a capsulotomy of size ranging from 5 to 5.5 mm and phacoemulsification was carried out. The primary outcome was the size, centration, and continuity of the capsulotomy edge at the end of the surgery. Secondary outcomes were the surgical time for capsulotomy, capsulotomy centration on the intraocular lens (IOL) at 3 months, and adverse effects.

Results: Thirty eyes were studied of 30 patients who were recruited with a mean age of 66.4 ± 8.3 years, of which 17 (57%) were men. The intraoperative size of capsulotomy was the same as intended in all eyes and the edges were smooth. None of the eyes experienced any visible capsular tears or run out events; one had a capsular tag. The time for capsulotomy including capsular staining was 3 ± 0.23 min. All IOLs were well centered at 3 months with a capsulotomy size remaining the same. The endothelial cell count had dropped by 8% at 3 months post-op, and the vision improved significantly to 0.03 log of minimum angle of resolution. None of the eyes experienced any intraoperative complications or laser-induced adverse effects.

Conclusion: SLC was a safe and effective technique providing precise, well-centered anterior capsulotomies in mature white cataracts.

We describe the hybrid technique of tuck-in Tenon's patch graft (TPG) and tissue adhesive bandaged contact lens (TABCL) for large corneal perforations (>5 mm) with intact surrounding stroma. Management of large corneal perforation is often challenging, and urgent availability of donor cornea might be difficult; Tenon patch alone does not provide tectonic support; hence, this hybrid technique can be used safely in large perforations. This involves freshening the perforation edges, creating a 360 0 stromal pocket, harvesting a Tenon's graft 1 mm oversized, tucking into the pocket, and suturing. Then areas of leakage were noted, and only those areas were supplemented with minimal cyanoacrylate glue (CG) at the graft edges. This technique was used in two eyes, one with a large corneal perforation and intact surrounding stroma and the other with 4 mm corneal fistula post healed keratitis with a failed primary TPG alone, and led to epithelialization and a smooth corneal surface at 6 weeks. The advantages include autologous tissue, cost-effective, easily available, minimal post-operative inflammation, vascularization, and surface irregularity.

Purpose: The gut microbiota might be closely related to central retinal artery occlusion (CRAO), but the causality has not been well defined. Two-sample Mendelian randomization (MR) study was used to reveal the potential causal effect between the gut microbiota and CRAO.

Methods: Data for gut microbiota were obtained from the genome-wide association studies of the Dutch Microbiome Project (DMP) ( n = 7738) and the MiBioGen consortium ( n = 18,340), and data on CRAO were obtained from samples of FinnGen project (546 cases and 344,569 controls). Causalities of exposures and outcomes were explored mainly using the inverse variance weighted method. In addition, multiple sensitivity analyses including MR-Egger, weighted median (WM), simple mode, weighted mode, and MR Pleiotropy RESidual Sum and Outlier were simultaneously applied to validate the final results.

Results: We identified three microbial pathways (two risk factors/one protective factor) and seven microbial taxa (two risk factors/five protective factors) associated with CRAO in the DMP study. Based on the data from the MiBioGen consortium, we identified seven microbial taxa (two risk factors/five protective factors) associated with CRAO, including the Eubacterium genus, which was consistently identified as a risk factor in both the DMP and the MiBioGen consortium MR analyses.

Conclusion: Our study implicates the potential causal effects of specific microbial taxa and pathways on CRAO, potentially providing new insights into the prevention and treatment of CRAO through specific gut microbial taxa and pathway. Since our conclusion is a hypothesis derived from secondary genome-wide association studies (GWAS) data analysis, further research is needed for confirmation.

Purpose: To evaluate the prediction error (PE) in pediatric traumatic cataract surgery involving primary or secondary intraocular lens implantation (IOL) and the factors affecting it.

Methods: Retrospective data of unilateral traumatic cataract eyes of children aged ≤16 years were collected between February 2019 and March 2022 at a tertiary eye care hospital. Absolute PE was calculated by deducting the target refraction from the observed refraction at 6 weeks postsurgery following suture removal. Simulated PE was calculated in eyes with corneal scar replacing the affected eye keratometry (K) with the K of the fellow eye and standard K (44D) and was then compared with absolute PE.

Results: Fifty children with a mean age of 9.5 years (2-16 years) were included. Mean absolute PE was 1.63 ± 1.8D (0 to 9D). Absolute PE was not affected by the age at surgery, method of biometry, duration of injury, type of cataract surgery, position of IOL, and preoperative keratometry. The absolute PE was affected by axial length (AXL) being <1.5D in AXL of 22.73 ± 0.84 mm, <1.5-2D in AXL of 22.07 ± 0.61 mm, and >2D in AXL of 22.01 ± 0.74 mm ( P = 0.039) in univariate analysis. In multivariate analysis, none of the factors affected the absolute PE. In 34 eyes with corneal scar, higher variability in PE was observed. The standard K resulted in greater simulated PE as compared to the affected eye average K in eyes with scar involving the visual axis.

Conclusion: Absolute PE following pediatric traumatic cataract was studied. It was higher in shorter AXLs. In corneal scar involving the visual axis, using the fellow eye K yielded lesser simulated PE as compared to standard K.