Indian Journal of Ophthalmology最新文献

Purpose: To analyze the visual outcomes and patient satisfaction following presbyopic lens exchange (PRELEX) with bilateral implantation of multifocal intraocular lenses (MFIOLs).

Methods: A single-center, multi-surgeon study involving retrospective analysis of patients with presbyopia who underwent bilateral implantation of MFIOLs with trifocal designs after phacoemulsification or femtosecond laser-assisted cataract surgery (FLACS) at a tertiary eye care hospital in South India. The visual outcomes were assessed at 2 weeks and after 6 months postoperatively, both objectively and subjectively.

Results: A total of 90 eyes of 45 patients with a mean age of 55.16 ± 6.57 years were included. 90% of the patients were hyperopic presbyopes. Postoperatively, the uncorrected distance, intermediate, and near visual acuity (VA) were logMAR 0.04 ± 0.08, 0.03 ± 0.09, and 0.11 ± 0.01, respectively, and remained stable from 2 weeks till beyond 6 months, with 82.22%, 65.55%, and 93.33% achieving a UDVA, UIVA, and UNVA of 20/20 or better at the end of follow-up. A total of 4.44% and 8.88% of the eyes required enhancement by laser refractive surgery and Nd:YAG capsulotomy for posterior capsular opacification, respectively, after a 3-month postoperative period. A total of 95.36% of the patients achieved spectacle independence, with only 15.55% complaining of glare/halos.

Conclusions: PRELEX with multifocal lens implantation proves to be a safe and effective procedure that yields good visual outcomes along with patient satisfaction, especially in hyperopic presbyopes.

Purpose: The Reper device (Reper-NN LTD, Nizhny Novgorod, Russia), an acrylic iris diaphragm combined with an intraocular lens (IOL), may be adapted for patients with various iris defects and aphakia. We aim to present our experience using the Reper artificial iris-IOL device.

Setting: Tertiary medical center.

Methods: This study includes patients who underwent implantation of the Reper artificial iris-IOL device at a single tertiary medical center between 2017 and 2023. The non-parametric signed test was used to compare preoperative and postoperative outcomes.

Results: Fifteen patients with aphakia and partial aniridia were included (four females [27%], mean age: 68.3). Mean follow-up time was 7.87 ± 5.62 months (range: 1-20). Following surgery, 87% (13 patients) showed improvement in corrected distance visual acuity (CDVA), while 13% (two patients) maintained their preoperative CDVA. The mean improvement in CDVA was 0.68 ± 0.19 logMAR (P value = 0.0015 [95% confidence interval (CI): 0.28-1.08. Unpaired t-test]). Moreover, all patients (100%) expressed complete satisfaction with postoperative cosmetic outcomes.

Conclusion: This study represents the largest reported series on Reper artificial iris-IOL implantation procedure and provides initial insights into its outcomes. No surgical complications were reported, and most patients experienced VA improvement and cosmetic satisfaction. These findings may assist ophthalmic surgeons in evaluating the benefits and risks of this implant. Larger, longer-term studies are needed to better establish its safety and efficacy.

Background: Thyroid stimulating hormone, T3, T4, and thyroid auto-antibodies are essential in diagnosis of immune thyroiditis, Graves' and Hashimoto's. These, however, may not correlate with thyroid eye disease or TED. In recent years, a new blood test for thyroid stimulating immunoglobulins (TSI) is in use. However, there is no sufficient clinical evidence of their role in TED. The purpose of the current study is to evaluate the correlation between TSI and TED activity and to examine if TSI is a predictor for the severity of the disease.

Methods: A retrospective analysis of electronic medical records of all patients who attended TED clinic at Sheba Medical Center, Israel between 2017 and 2022 and had at least one TSI sample was performed. Data included demographics, comprehensive ophthalmic examination, clinical activity scores (CASs), laboratory tests, and quality of life assessment by the Graves' Orbitopathy QOL questionnaire.

Results: 60 patients with 43 females (72%) were included. TSI at presentation correlated with eyelid retraction, IOP (Pearson correlation, 0.369, P< =0.01), and CAS (Pearson correlation, 0.392, P = 0.029). TSI values >500% were found to be significantly correlated with the use of medical treatment including high-dose steroids (P = 0.05), steroid treatment according to the European Group on Graves' Orbitopathy protocol (P = 0.02), and radioactive iodine (P = 0.03). Moreover, it was also significantly correlated with surgical procedures including decompression (P = 0.016) and strabismus surgeries (P = 0.024).

Conclusions: TSI is correlated with more severe clinical presentation and higher likelihood of medical or surgical treatment. Therefore, TSI can be considered as a predictor factor for the disease. Routing testing for TSI may be warranted for all TED patients.

Intumescent white cataracts are challenging because of the high risk of intraoperative complications and poor outcomes. Several techniques have been proposed to mitigate altered lenticular dynamics; however, they require surgical expertise or additional costly devices. Here, we report the safety and outcomes of a recently described bimanual decompression technique. We retrospectively reviewed consecutive cases of intumescent cataract between January 2020 and July 2023. We assessed the rates of intraoperative complications, post-op refractive outcomes, and deviations from predicted values. Fifty-nine patients (mean age, 63 years) underwent this procedure. All the patients underwent planned monofocal single-piece intraocular lens (IOL) without intraoperative complications. The preoperative visual acuity was 20/200 or worse in all patients. Postoperatively, 92% of the patients achieved a visual acuity of 20/60 or better. Predicted refraction accuracy within 0.5 diopters was achieved in 56% of patients, and 90% were within 1 diopters. Automated bimanual decompression is a simple, safe, and cost-effective method for managing intumescent cataracts. This method provides a practical solution to the challenges associated with capsulorhexis formation in these complex cases.

Introduction: Ocular trauma is a major cause of monocular blindness. Early and timely reporting is essential for favorable visual outcomes. This study examines health-seeking behaviors in ocular trauma cases, with a focus on traumatic cataracts.

Setting: Single-center study in Western Central India.

Methods: This retrospective study included all first-time traumatic cataract surgeries (previously operated cases excluded) performed between 2009 and 2022. Data from electronic medical records, including demographic and clinical details, were entered into pre-tested online forms, exported to Excel, and analyzed using Statistical Package for Social Sciences version 22. Descriptive statistics and cross-tabulation were applied, with P < 0.05 considered significant.

Outcome measures: Best corrected visual acuity (BCVA).

Study population: A total of 2,093 eyes of 2,093 patients.

Results: Of the cohort, 1,473 (70.3%) were male and 620 (29.6%) female, median age 25 years; 39.4% were pediatric cases. The median interval between trauma and first consultation was 15 days; only 17.2% presented within 24 hours. Reporting interval significantly affected visual outcomes (P = 0.000). Most patients (91%) were from rural areas, and 86.3% were from low socioeconomic backgrounds. Pre- and post-surgical vision showed significant improvement, though delayed reporting reduced the gains. Main reasons for late presentation were lack of awareness, underestimation of severity, ignorance of primary care availability, and financial barriers.

Conclusion: Delayed reporting after ocular trauma leads to poorer visual outcomes. Community counseling and awareness programs for patients, caregivers, and healthcare workers are essential. Promoting early reporting can substantially reduce preventable blindness due to ocular trauma. Data Access Statement: Research data supporting this publication are available from the NN repository located at www.NNN.org/download.

Purpose: This study aims to evaluate the accessibility, accuracy (user-perceived reliability), user-friendliness, and clinical applicability of the Melbourne Rapid Field (MRF) test for visual field evaluation in a real-world clinical setting.

Methods: A prospective study was conducted involving patients undergoing routine visual field assessment for glaucoma, neurological conditions, or other visual disorders. Participants were tested using the MRF device, and their experiences, specifically comfort, satisfaction, ease of use, and acceptability, were recorded through structured questionnaires. The duration of the test and difficulties encountered by either clinicians or participants were also documented.

Results: A total of 369 patients were included. Age showed a negative correlation with ease of use (r = -0.142, P = 0.006), with younger participants finding the MRF more user-friendly. Higher education level was also associated with greater usability (r = -0.258, P = 0.001). Overall, 96.2% of participants agreed or strongly agreed that the device was simple to use, and 84.3% reported satisfaction. A significant inverse relationship was found between test duration and satisfaction (P < 0.05), suggesting that patients who completed the test more quickly were more likely to report high satisfaction. Clinicians reported that minimal training was required to achieve satisfactory levels of perceived accuracy.

Conclusion: The MRF test demonstrates promising potential as a convenient, efficient, and patient-friendly tool for visual field testing, with satisfactory user-perceived reliability in busy clinical environments. However, the absence of direct comparison with the Humphrey Field Analyzer is a key limitation.

Purpose: Facial aging, marked by soft tissue atrophy, ptosis, and midfacial structural changes, has amplified the role of dermal fillers in modern aesthetic practice. The bilaminar injection technique leverages the distinct rheological properties of high and low G prime hyaluronic acid fillers to enable dual-plane facial rejuvenation-deep structural support and superficial contour refinement. This case series investigates the clinical efficacy and safety of this technique in correcting tear trough deformities.

Methods: The study was conducted in a single-center institutional aesthetic setting. Five patients (aged 25-60 years) presenting with midface volume loss and tear trough concerns for both the eyes were included following clinical assessment. Randomization and masking were not applied due to the nature of the procedure. A bilaminar approach was adopted: high G prime fillers were injected supraperiosteally to reinforce & augment deep structures, while low G prime fillers were deposited subdermally for fine contouring. All procedures were performed under aseptic conditions using a combination of needle and cannula techniques.

Results: Primary outcomes included periorbital volume restoration and contour correction assessed at a 2-week follow-up. Adverse events and patient satisfaction (measured via visual analog scale) were also documented for 3-6 months. All patients exhibited visible improvement in midface volume and tear trough contour, with high satisfaction scores. Transient ecchymosis and edema were the only noted minor side effects.

Conclusion: The bilaminar technique offers a precise, anatomically harmonious, and well-tolerated approach to tear trough rejuvenation, establishing itself as a sophisticated tool in advanced facial aesthetics.

This article presents the development and functional design of a motorized semi-automated prism bar intended to enhance the accuracy and reliability of horizontal fusional vergence testing. Conventional prism bar techniques are prone to several limitations, including examiner-dependent variability, incorrect prism positioning, and discomfort for patients due to improper handling or inconsistent distance from the eye. These factors contribute to significant measurement errors. Additionally, even small deviations in prism placement or holding angle can lead to large discrepancies in prism diopter readings, ultimately affecting diagnosis and therapy outcomes. To address these challenges, a cost-effective, semi-automated prism bar system has been developed using a 24-V DC motor, lead screw, gear set, stroke rod, and limit switch mechanisms. The motorized device allows linear movement of the prism bar in 1.5-cm increments with the push of a button, ensuring precise alignment with the patient's eye. A chin-and-headrest system maintains a constant prism-to-eye distance, minimizing human error and enhancing patient comfort during measurements. The system incorporates limit switches to prevent overextension and employs a control unit to manage DC power supply efficiently. This innovation meets the clinical needs for fixed prism positioning, thus improving accuracy and repeatability.