Indian Journal of Ophthalmology最新文献

Context: Pseudoexfoliation is a genetically determined condition that causes significant problems during cataract surgery. Although most patients with pseudoexfoliation experience uneventful cataract surgery, complications, when they arise, can be particularly challenging. Therefore, it is crucial to identify those at risk for intraoperative complications during the preoperative assessment.

Purpose: To study the association of preoperative A-scan parameters with intraoperative complications of phacoemulsification in eyes with pseudoexfoliation syndrome.

Setting and design: This was a retrospective study conducted in a tertiary care center in the private sector in South India.

Methods: A retrospective study of 200 eyes of 184 patients with pseudoexfoliation syndrome, who underwent phacoemulsification. Preoperative A-scan measurements (IOLMaster700), best-corrected visual acuity, lens status, and pupil sizes were noted. Intraoperative complications were correlated with A-scan parameters.

Statistical analysis: SPSS 26.0 software.

Results: Out of 200 study eyes, 34 eyes (17%) had intraoperative complications. Eyes with less anterior chamber (AC) depth (2.74 ± 0.758 mm) or more lens thickness (4.81 ± 0.565 mm) had a significant association (P < 0.05) with intraoperative complications. There was a 36.8% risk for complications in eyes with <2.5 mm AC depth. Eyes with an increased ratio of axial length to AC depth (8.67 ± 1.517) had more chance of complications.

Conclusions: Caution should be taken in pseudoexfoliation syndrome patients with shallow AC or thick lenses as there is more risk for complications during cataract surgery.

Purpose: To analyze the demographic characteristics, causes, risk factors, and outcomes of resurgeries following primary glaucoma surgery.

Methods: This retrospective observational study analyzed medical records of patients who underwent resurgeries following primary glaucoma surgeries conducted from January 1, 2018, to December 31, 2020. The investigation included an assessment of preoperative risk factors, reasons prompting resurgery (such as complications or failure), types of interventions, and their respective outcomes.

Results: Out of 1147 eyes subjected to primary surgeries, 30 eyes (2.6%) necessitated resurgery within the first year, at a mean interval of 4.2 ± 3.4 months. The resurgery rate for trabeculectomy was 3.3% (13/389), 1.5% (9/592) for phaco-trabeculectomy, and 4.8% (8/166) for tube surgeries. Multivariate analysis identified male gender and higher preoperative intraocular pressure (IOP) as significant risk factors. Uveitic glaucoma (12.1%), traumatic glaucoma (11.1%), and eyes with prior vitreoretinal surgeries (8.5%) exhibited the highest resurgery rates. Early postoperative resurgeries (1-3 months) were predominantly due to surgical complications, while late resurgeries (>3 months) were attributed to primary surgery failure. Resurgeries following trabeculectomy were primarily driven by surgical failure (61.5%), while complications played a major role in phaco-trabeculectomy (66.6%) and tube surgeries (87.5%).

Conclusion: We observed an overall resurgery rate of 2.6%, with higher resurgery rates in tube surgeries compared to filtering surgeries. Reasons for resurgery in the early period were complications and those that occurred late were due to surgical failure. Male gender and elevated preoperative IOP were significant risk factors for resurgery.

Objective: To describe long-term outcomes of posterior lamellar [Descemet stripping automated endothelial keratoplasty (DSAEK) and non-Descemet stripping (n-DSAEK)] and the role of microscope-integrated optical coherence tomography (Mi-OCT) in buphthalmic eyes.

Design: Retrospective study.

Methods: The medical records of all patients who were diagnosed with buphthalmos and underwent Mi-OCT-guided standard DSAEK/n-DSAEK since 2015 were evaluated. Intraoperative difficulties, graft survival, and complications were recorded.

Results: A total of 16 eyes of 16 patients (10 males; 6 females) with a mean age of 9.96 + 6.54 years and a mean follow-up of 24.46 + 7.76 months were evaluated. The mean preoperative acuity was 2.03 + 0.39 log MAR, and the mean corneal diameter was 12.89 + 1.0 mm with a corneal thickness of 874.53 + 105 microns. Ten eyes had a clear lens, two had cataracts, three were aphakic, and one was pseudophakic. Descemet membrane scoring was performed in 10 eyes. The mean donor graft size was 9.14 ± 0.30 mm with a lenticule thickness of 135.9 + 44.54 microns. Intraoperatively, all the grafts were attached on Mi-OCT. The final mean acuity was 1.72 + 0.4 log MAR, and the corneal thickness was 596.18 + 89.12. Graft detachment was seen in the immediate postoperative period in 4 eyes that required rebubbling. Two eyes showed pupillary block that was conservatively managed. Following DSAEK, the cornea cleared at 1 month in 81.25% of eyes. One graft failed at the final follow-up. The mean endothelial loss at final follow-up was 29.1%.

Conclusion: Primary DSAEK is a preferred surgical technique for buphthalmic eyes with compromised corneas. Mi-OCT could be useful in these eyes for various intraoperative maneuvers and to assess graft status thereby improving the outcomes of the procedure.

Purpose: To assess the severity of glaucoma and its worsening using Spaeth/Richman contrast sensitivity (SPARCS). To evaluate its correlation with retinal nerve fiber layer thickness (RNFL) and perimetry.

Methods: In this prospective observational study, 90 eyes of primary open-angle glaucoma were categorized into mild, moderate, and severe glaucoma (30 each). All eyes were subjected to contrast sensitivity measurements by using the Pelli-Robson (PR) chart and SPARCS, Humphrey automated perimetry, and optical coherence tomography (OCT) RNFL, along with routine ophthalmological evaluation at baseline. Contrast sensitivity was repeated at 1, 3, and 6 months. Other investigations were repeated at 6 months. The correlation between contrast sensitivity and other parameters was analyzed at baseline and 6 months.

Results: Total SPARCS showed a significant positive correlation with visual field index, pattern standard deviation, mean deviation, OCT RNFL, and a negative correlation with best corrected visual acuity. Central SPARCS and PR scores exhibited strong positive correlations. Both total and quadrantic SPARCS significantly reduced from mild to moderate to severe glaucoma. The quadrant-wise SPARCS also correlated well with opposite-side RNFL thickness. At 6 months, SPARCS showed a significant reduction along with RNFL measurements preceding any significant changes in visual field parameters.

Conclusion: This study establishes SPARCS as a reliable and reproducible tool in assessing the deterioration of visual function in glaucoma patients even before significant perimetric changes. The specific relationship of quadrantic SPARCS with opposite-side RNFL is a novel yet expected finding. The findings advocate integrating SPARCS into routine glaucoma assessment for timely detection of any worsening and prompt intervention, improving the visual outcomes in these patients.

Purpose: This study aimed to evaluate and compare the effectiveness and safety of Paul glaucoma implant (PGI) and Baerveldt 350 glaucoma implant (BGI) over a 1-year follow-up period.

Methods: This retrospective study was conducted in a private clinic. It compared 27 patients consecutively treated with the PGI to a historical cohort of 29 eyes that received the BGI prior to the introduction of the PGI between 2018 and 2023. Intervention: A new drainage device, the Paul implant, was placed in the anterior or posterior chamber of eyes with uncontrolled intraocular pressure (IOP).

Main outcome measures: The main outcome measures were success rate, final mean IOP, IOP reduction percentage, medication reduction, and complications. Statistical analyses, including adjustments for confounders, were used to compare the performance of PGI and BGI over at least a 12-month period.

Results: Significant reductions in IOP were observed in both groups (P < 0.001). At 1 year, no significant differences were found in mean IOP (BGI: 12.0 mmHg, SD 2.9; PGI: 11.2 mmHg, SD 6.0) or medication usage (P > 0.05). The failure rates were 7% for BGI and 18% for PGI, with complete success rates of 56% for BGI and 32% for PGI. Hypertensive phases occurred in 32% of the BGI cases and in 19% of the PGI cases. No significant differences in the complication rates or postoperative visual acuity were observed between the groups.

Conclusion: PGI and BGI exhibited comparable efficacy and safety profiles after 1 year.