Indian Journal of Ophthalmology最新文献

Purpose: To compare the surgical outcomes of femtolaser-assisted cataract surgery (FLACS) vs. conventional phacoemulsification (CP) in nanophthalmic eyes.

Setting: Tertiary eye care Hospital.

Design: Randomized controlled trial (RCT). Computer-generated randomization was done.

Methods: We included 20 eyes of 20 nanophthalmic patients with visually significant cataracts and randomized them to undergo FLACS or CP. We included only one eye of each patient from each group, choosing the eye with worse visual acuity.

Results: The median corrected distance visual acuity (CDVA) improved significantly from baseline in both groups at all postoperative visits. The FLACS group showed a significant reduction in retinochoroidal scleral (RCS) thickness compared to the CP group at the 3rd-month postoperative visit (P = 0.002). The percentage of endothelial cell loss (ECL) was lower in FLACS (7.2) than CP (11.9) at 1-month follow-up (P = 0.247) and equal at 3 months (13.25 and 13.6 in FLACS and CP, respectively, P = 0.428). The median total surgical time in FLACS was significantly lower than the CP group (10 vs. 25.5, P = 0.034), and the median cumulative dissipative energy (CDE) was also lower in FLACS (6.65) than CP (8.46), though this difference was not statistically significant (P = 0.495).

Conclusion: Both FLACS and CP are equally safe surgeries, causing significant improvement in postoperative visual acuity in nanophthalmic eyes. FLACS, however, had greater RCS reduction than CP and also required significantly lesser surgical time and lower CDE than CP. FLACS was also slightly more beneficial in protecting the endothelium in short eyes.

Purpose: To assess the spectrum of bacterial flora from preoperative conjunctival swabs and analyze their antimicrobial susceptibility patterns.

Design: This is a retrospective observational clinical study.

Methods: This retrospective, observational study analyzed conjunctival swab cultures collected 24-48 hours prior to elective ophthalmic surgeries at a tertiary eye care center in North India from January 2015 to December 2022. Aerobic bacterial cultures were performed using standard microbiological techniques. Isolates were identified and tested for antibiotic susceptibility using the Kirby-Bauer disk diffusion method following CLSI guidelines. Data were stratified by patient age groups and analyzed using descriptive statistics and Chi-square testing.

Results: Of the 8671 conjunctival swabs analyzed, 1287 (14.8%) showed significant bacterial growth. The most prevalent isolates were Coagulase-negative Staphylococci (CoNS, 53.3%), Corynebacterium species (32.9%), and Staphylococcus aureus (10.7%). Methicillin resistance was observed in 40% of Staphylococcal isolates, with significant coresistance to fluoroquinolones, macrolides, and tetracyclines. No Vancomycin resistance was observed. Gram-negative bacteria, though infrequent (1.7%), were predominantly isolated from adult and elderly patients. Resistance trends showed a rising pattern over the 8-year period, particularly against fluoroquinolones and cefoxitin. Agewise, bacterial positivity was similar across pediatric (12.0%), adult (15.1%), and elderly (15.1%) groups (P = 0.1462).

Conclusion: This large-scale study highlights the predominance of CoNS and Corynebacterium in the conjunctival flora and the rising resistance among Staphylococcal isolates, particularly to fluoroquinolones. These findings underscore the importance of region-specific surveillance and antimicrobial stewardship in guiding perioperative prophylaxis in ophthalmology. Vancomycin and aminoglycosides remain effective options, while empirical use of fluoroquinolones warrants cautious re-evaluation.

Purpose: Irreversible corneal blindness disproportionately affects low- and middle-income countries where there remains a critical demand for surgeons skilled in corneal transplantation. Penetrating keratoplasty (PK) is a critical skill for ophthalmologists, especially as it remains the most widely performed type of corneal transplant in these parts of the world. Tools to teach and assess trainees in corneal transplantation are needed to help standardize training internationally. Here, we present an Ophthalmology Surgical Competency Assessment Rubric (OSCAR) aimed at assessing the competence and progress of residents in PK.

Methods: A team of cornea specialists developed a rubric for PK using previously published OSCARs as a template. The draft included 11 key steps of PK and six global indices, with a grading scale based on a modified Dreyfus model. The rubric was then reviewed for face and content validity by a panel of eight international experts using an iterative feedback process. The draft underwent multiple cycles of feedback and revisions until a consensus was reached among the authors and the international expert panel.

Results: The rubric contains 11 essential steps and six global indices with descriptions of expected functioning at four levels of competency (novice, beginner, advanced beginner, and competent).

Conclusions: This OSCAR for PK contributes to the global standardization of ophthalmology training, helping to meet the increasing demand for corneal transplant services with high-quality care for all.

Purpose: To describe the clinicopathological characteristics of ophthalmic Rosai-Dorfman disease (RDD).

Methods: A 15-year single-center retrospective case series on ophthalmic RDD.

Results: Thirteen cases of ophthalmic RDD were identified, including eight males and five females, with a mean age of 49.2 years. The most common presenting signs were eye redness (76.9%) and proptosis (61.5%). The orbit was the most frequently involved site (84.6%). Epibulbar masses occurred in 53.8% of cases, and one case had a concurrent uveal lesion. Eyelid involvement was noted in 46.2% (six cases). Compressive optic neuropathy was documented in 23.1% (three patients). Bone erosion was observed in 53.8% (seven patients). Systemic involvement was present in 69.2% (9 patients), and lymphadenopathy was detected in 15.4% (two patients). Paranasal sinus infiltration occurred in 38.5% (five patients). Other systemic associations included skin and retroperitoneum/kidney (both 15.4%), cerebrum (7.7%), and cardiovascular system (7.7%). Histopathology revealed large S-100-positive histiocytes with emperipolesis in an inflammatory and fibrotic background in all cases. All were BRAF V600E negative, except one with a coexisting Erdheim-Chester-like lesion, suggesting mixed histiocytosis due to overlapping phenotypes with Erdheim-Chester disease (ECD). Increased IgG4-positive plasma cells were seen in 38.5% (five cases).

Conclusions: Ophthalmic RDD most frequently presents with orbital and epibulbar masses and rarely involves the uvea. Increased IgG4-positive plasma cells in some RDD cases necessitate careful differentiation from IgG4-related disease. In rare conditions, overlapping clinicopathological phenotypes with ECD and BRAF V600E mutation suggest a diagnosis of mixed RDD/ECD.

Purpose: To report the effectiveness of bimedial plication and vertical transposition for correction of exotropia associated with A- or V-pattern and compare it with bimedial resection and vertical transposition.

Methods: We retrospectively reviewed the results of surgery in patients who underwent bimedial plication (group I) versus bimedial resection (group II) with vertical offset to correct both exotropia and pattern deviation not secondary to oblique overaction in the period between January 2021 and January 2023. The results of both groups were compared. Success was considered when pattern deviation was ≤8 prism diopters (PD) and horizontal deviation was within 10 PD of orthophoria at 6 months postoperatively.

Results: The mean preoperative angle of exotropia in PD was 40.6 ± 7.2 in group I and 41.1 ± 7.5 in group II (P = 0.8). At 6 months postoperatively, they achieved angle of 4.6 ± 4.1 and 2.5 ± 4.5 PD, respectively (no significant difference between both groups; P = 0.19). The mean preoperative pattern deviation was 21.3 ± 3.7 PD in group I and 21.6 ± 4.4 in group II. Postoperative pattern collapse was 16.7 ± 5.6 and 16.6 ± 4.1, respectively. The percentage of success in pattern collapse was 90.6% in group I and 84.4% in group II (no significant difference between the groups; P = .71).

Conclusion: Vertical transposition with plication of medial recti is a safe, effective, and rapid technique for correction of cases of A- or V-pattern exotropia not associated with oblique overaction. Results were not significantly different from resection/vertical transposition.