Indian Journal of Ophthalmology最新文献

Purpose: To compare AcrySof MA60AC (Alcon Laboratories, Fort Worth, TX, USA) and Sensar AR40e (Johnson and Johnson, Santa Ana, CA, USA) used in Yamane sutureless scleral fixation technique in terms of visual acuity, refractive stability, and complications.

Methods: A retrospective, cross-sectional study was conducted in Istanbul Başakşehir Çam and Sakura City Hospital. Patients were divided into two groups: The first group consisted of patients with MA60AC lenses, while the second group consisted of patients with AR40e. Aphakic patients who underwent secondary intraocular lens (IOL) implantation and had postoperative minimum 3-month follow-up records were included. Visual acuity, refractive outcomes, perioperative and postoperative complications were recorded.

Results: Forty-nine patients were included in the study. Twenty-two patients were in the first group and 27 patients were in the second group. Age, gender, and follow-up time were similar between groups (P = 0.546, 0.213, and 0.347, respectively). The median lenticular astigmatism value was 0.86 (0.08-2.11) D in group 1 and 0.99 (0.31-2.96) D in group 2 (P = 0.898). There was no significant difference between groups in terms of visual acuity, spherical, cylindrical, and spherical equivalent values (P = 0.752, 0.375, 0.073, and 0.949, respectively). In group 1, a haptic tip fracture and optic-haptic separation were observed perioperatively. Optic-haptic junction separation was observed in one patient in group 1 on postoperative day 1. In group 1, epiretinal membrane development was significantly higher (P = 0.019).

Conclusions: Both AcrySof MA60AC and Sensar AR40e IOLs via the modified Yamane technique yielded favorable and predictable outcomes. Although statistically insignificant, haptic problems were more common in the first group.

Background: The bent ab-interno needle goniectomy (BANG) represents a low-cost indigenous modification designed for ab-interno excisional goniectomy. This technique employs a reverse cystitome (24 G needle) and yields outcomes equivalent to those achieved with the Kahook Dual Blade goniectomy. However, reflux bleeding from Schlemm's canal, with or without anterior chamber shallowing, often impedes angle visualization, thereby limiting the desired treatment extent. Recommended preventive measures for managing or treating hyphema include avoiding treatment in high-risk patients (on anticoagulants), blood washing, employing cohesive ophthalmic viscosurgical device (OVD), hydrating wounds under high air pressure tamponade, and maintaining a propped-up position postoperatively. Despite these precautions, hyphema can impair intraoperative angle visualization. Among patients experiencing hyphema, a quarter require drainage. Washing blood away by re-injecting OVD or with bimanual irrigation aspiration often leads to intraoperative delay and subsequent rebleeding.

Purpose: This article describes a novel modification aimed at managing intraoperative angle bleeding and anterior chamber shallowing while ensuring a clear angle view, as performed in 27 eyes, including patients with primary open-angle and angle-closure glaucoma.

Synopsis: Our surgical technique, termed irrigating BANG (i-BANG), involves bending a 1 mm 24 G needle toward the bevel at a right angle to create a goniectome. The needle hub is connected to Alcon's CENTURION® system, and continuous infusion is initiated at 100 mmHg IOP. A 120° goniectomy is fashioned under continuous fluid infusion nasally, allowing for the clearance of any refluxing blood during the procedure. Air is injected through the side port as the irrigating needle is withdrawn, and the ports are hydrated.

Highlights: • i-BANG achieves passive aspiration at minimal cost. • It effectively addresses intraoperative hyphema and anterior chamber shallowing. • None of the 27 patients in our study experienced procedure abandonment or incomplete treatment during i-BANG. • Only 12 eyes exhibited minimal blood layering in the angle, which was completely absent by one week postoperatively.

Video link: https://youtu.be/YmPeoBDpN54.

Purpose: The purpose of the study is to evaluate the percentage differences in ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (pRNFL) parameters in fellow eyes of the same patient with varying severities of glaucomatous damage. As only the eyes of the same patient with different severities of glaucoma were included in the present study, it could be inferred that the difference in parameters represents the loss leading to the next stage of glaucoma.

Methods: This was a cross-sectional study of 136 adult primary glaucoma eyes of 68 patients. They were divided as follows: Group 1 - normal visual field in one eye and superior nasal step, (mild), in the other, Group 2 - superior nasal step in one eye and superior arcuate scotoma, (moderate) in the other, and Group 3 - superior arcuate scotoma in one eye and biarcuate scotoma, (severe) in the other. GCC and pRNFL measurements on spectral domain optical coherence tomography (SD-OCT) were statistically assessed as applicable.

Results: The percentage difference in GCC parameters in fellow eyes from normal field to mild, mild to moderate, and moderate to severe glaucoma in average GCC was 10.04 ± 6.33%, (P = 0.0001), 15.77 ± 9.62%, (P = 0.0001), and 9.06 ± 6.41%, (P = 0.021); in inferior GCC, it was 13.25 ± 8.7%, (P = 0.0002), 18.94 ± 12,61%, (P = 0.0001), and 9.02 ± 6.92%, (P = 0.658), and in superior GCC, it was 7.42 ± 5.79%, (P = 0.002) 15.31 ± 11.07%, (P = 0.004), and 11.23 ± 9.82%,(P = 0.003), respectively. The percentage difference in average pRNFL of fellow eyes from normal field to mild, mild to moderate, and moderate to severe glaucoma in was 16.9 ± 9.85%, (P = 0.001), 18.23 ± 10.47%, (P < 0.0001), and 9.0 ± 7.35%, (P = 0.0004); in inferior pRNFL, it was 18.76 ± 12.38%, (P = 0.001), 19.6 ± 10.3%, (P < 0.0001), and 8.41 ± 7.3%, (P = 0.019), and in superior pRNFL, it was 15.3 ± 9.8%, (P = 0.015), 18.24 ± 13.56%, (P = 0.0003), and 11.46 ± 9.74%, (P = 0.001), respectively. A total of 136 eyes were regrouped by glaucoma severity, and in mild, moderate, and severe glaucoma subgroups. The percentage difference in average GCC was 11.01 ± 9.07%, 17.53 ± 11.29%, and 18.48 ± 11.69%.

Conclusion: A percentage difference of GCC and pRNFL values could be used for both diagnosis and progression of glaucoma.

Objectives: To demonstrate corneal remodeling after corneal allograft intrastromal ring segment (CAIRS) with an anterior-segment optical coherence tomography (AS-OCT).

Design: A prospective observational single-center study.

Methods: This observational study included keratoconus patients who underwent CAIRS implantation into a stromal tunnel. Topographical, refractive, and visual changes were obtained from the patient records. Epithelial thickness (ET), anterior stromal thickness (AST), allograft corneal ring thickness (ACRT), and posterior stromal thickness (PST) were measured on the first day and 1, 3, 6, and 12 months postoperatively using AS-OCT.

Results: The study included 35 eyes of 27 patients with advanced keratoconus. The mean keratometry decreased from 48.26 ± 4.78 D to 44.50 ± 4.42 D at 1-year postoperatively ( P = 0.004), mean corrected distance visual acuity increased from 0.29 ± 0.18 to 0.70 ± 0.24 ( P < 0.001), and spherical equivalent (SE) decreased from -6.94 ± 4.32 D to -1.44 ± 4.44 D ( P < 0.001). The mean AST decreased by 17.39 ± 5.78 µm in the postoperative 1 st month compared to 1 st day after surgery ( P = 0.040). No statistically significant variations were observed in AST after the first month. There was no statistically significant difference in the mean ET, ACRT, and PST measurements between follow-up times. Significant negative correlations were found between SE change and ET (r = -0.543, P = 0.023) and between K1 change and ACRT (r = -0.548, P = 0.008).

Conclusion: CAIRS is an effective treatment method to improve visual acuity and keratometry measurements and does not cause significant changes in graft thickness or recipient corneal epithelial and stromal thicknesses during the 1-year follow-up period. The observed correlations between SE, keratometry, and corneal thickness suggest that epithelial and stromal remodeling play crucial roles in postoperative outcomes of CAIRS.

Purpose: To assess repeatability and agreement of Eyestar 900 (Haag-Streit, Köniz, Switzerland) with Pentacam AXL Wave system (Oculus, Wetzlar, Germany), Anterion (Heidelberg Engineering GmBH, Heidelberg, Germany), and MS-39 (CSO, Florence, Italy) in measuring anterior segment parameters.

Methods: Two hundred normal eyes, 50 keratoconus (KC) eyes, and 50 post-refractive surgery eyes underwent three sequential scans on each instrument. The order of scans was randomized. Repeatability was assessed using within-subject standard deviation (Sw) and intraclass correlation coefficient (ICC). Bland-Altman analysis was used to assess the 95% limits of agreement.

Results: Eyestar 900 had comparable repeatability to Anterion and MS-39 across groups. ICC was overall >0.8. Pentacam AXL Wave had lower Sw (better repeatability) across all groups. In normal eyes, Eyestar 900 can be used interchangeably with MS-39 and Anterion (P > 0.23). Eyestar 900 and Pentacam AXL Wave did not show agreement on any parameter, except anterior chamber depth (ACD) (P = 0.92). Eyestar 900 in KC eyes can be used interchangeably with MS-39, except for posterior keratometry (pK) and thinnest corneal thickness (TCT) (P < 0.001), and with Anterion, except for TCT and ACD (P < 0.001). In post-refractive eyes, Eyestar 900 can be used interchangeably with MS-39, except for pK (P < 0.001), and with Anterion, except for ACD (P < 0.001). Pentacam AXL Wave and Eyestar 900 cannot be used interchangeably in KC and post-refractive eyes.

Conclusions: Newer devices such as Eyestar 900 can be used interchangeably with Anterion and MS-39 in normal eyes and partly in KC and post-refractive eyes. Pentacam AXL Wave and Eyestar 900 cannot be used interchangeably across the various groups. However, these multifunctional hybrid tools of combined topography, AS-OCT, can be helpful in refractive clinics.

Purpose: The aim of the study was to assess the early postoperative efficacy and safety of Tanito microhook (TMH) ab interno trabeculotomy combined with phacoemulsification in patients with primary open-angle glaucoma (POAG).

Methods: This prospective interventional study was conducted on consecutive patients with visually significant cataract and mild-moderate POAG. All patients underwent a temporal clear corneal phacoemulsification combined with TMH ab interno trabeculotomy. Postoperative evaluation was done on day 1, 1 month, and 3 months. The outcome measures included intraocular pressure (IOP) at different follow-ups and postoperative complications.

Results: In total, 30 eyes of 30 patients were included in the study. There were 16 (53.3%) females and 14 (46.7%) males with a mean age of 62.63 ± 6.7 years. The mean IOP reduced from 23.57 ± 1.65 to 17.33 ± 2.84 at 3 months ( P < 0.001). All eyes had a corrected distance visual acuity ≥6/9 at 1 month postoperatively. Postoperative complications included corneal stromal edema in eight (26.7%) eyes, hyphema in four (13.3%) eyes, and IOP spike in one (3.3%) eye.

Conclusion: TMH ab interno trabeculotomy combined with phacoemulsification in patients with mild-moderate POAG is an effective and safe procedure with fewer complications.

Purpose: This study aimed to evaluate and compare surgical outcomes among neovascular glaucoma patients undergoing trabeculectomy (Trab), glaucoma drainage device (GDD) implantation, or trans-scleral cyclophotocoagulation (TSCPC).

Methods: This study analyzed the records of 176 neovascular glaucoma cases treated surgically between January 2017 and December 2021 at four Indian centers. Procedures included trabeculectomy with MMC in 80 eyes, GDD implantation in 25 eyes, and TSCPC in 71 eyes. Outcome measures comprised intraocular pressure (IOP) reduction, antiglaucoma medication (AGM) usage, complications, and best-corrected visual acuity (BCVA).

Results: Following surgery, all groups exhibited a significant reduction in IOP. One year postoperatively, complete success rates were 42.9% for the implant group, 54.3% for the Trab group, and 33.3% for the TSCPC group, with corresponding qualified success rates of 57.1%, 36.7%, and 58.9%, respectively. Improvement in postoperative vision was noted, with an increase of 0.24 LogMAR in the Trab group, 0.11 in the GDD group, and a decrease of 0.35 in the TSCPC group. Complications occurred in 27% of Trab and 14% of TSCPC cases, while the GDD group experienced a hypertensive phase in 40% of eyes.

Conclusion: In managing neovascular glaucoma, trabeculectomy, GDD, and TSCPC provide comparable IOP control, with GDD showing a higher medication dependency. Trabeculectomy yields superior vision outcomes but carries a higher risk of postoperative complications, emphasizing the importance of individualized treatment selection and vigilant postoperative care.