Indian Journal of Ophthalmology最新文献

Purpose: Scleral-fixated intraocular lens (SFIOL) is the mainstay of restoration of vision where natural lens or its support is absent for placing an IOL in the bag. The aim of the study was to clinically evaluate the novel four-flange SFIOL technique using 532 nm laser for flange making in a tertiary eye care center in central India.

Methods: We reviewed total 33 patients who have undergone four-flanged SFIOL between January 2023 to October 2023. The clinical parameters like best corrected visual acuity (BCVA), intraocular pressure (IOP), spherical equivalent (SE), and postoperative complication like cystoid macular edema (CME) were evaluated. All the surgeries were performed by a senior vitreo-retinal (VR) surgeon in a tertiary eye care center.

Results: The mean preoperative BCVA was improved from 0.7 log MAR unit to 0.21 log MAR unit postoperatively. The mean preoperative IOP and SE improved from 19.48 mmHg to 17.12 mm Hg and 8.98D to 0.63D on postoperative follow-up, respectively. Early complications, within 1 month of surgery, noted in 15 patients (45%) and includes corneal edema - six cases (18.18%), CME - three cases (9.09%), intraocular lens tilting - two cases (6.06%), flange exposure - two cases (6.06%), and one case (3.03%) each of vitreous hemorrhage and glaucoma.

Conclusion: Four-flange SFIOL using green laser for flange formation is a safe and effective modification of sutured SFIOL with good outcome in long term.

Purpose: The purpose of this study is to present the clinico-demographic characteristics of pseudophakic bullous keratopathy (PBK), its visual outcomes, factors associated with the choice of treatment, and poor visual outcomes of PBK.

Methods: In this hospital-based retrospective study, electronic medical records data of new patients who presented to a multi-tier ophthalmology hospital network in India (November 2010-June 2022) were extracted. Patients with at least 4 weeks of follow-up were analyzed for visual outcome data. Bivariate analysis and multivariate logistic regression were used to determine the factors associated with the treatment choice and poor visual outcomes.

Results: Of the 3,323,247 electronic records (with an average follow-up of 293 days) examined, 10,522 eyes of 10,158 patients (0.3%) had PBK. The majority were managed non-surgically ( n = 7372; 70.1%), with increased odds of poor visual outcome by 3.46 times (AdjOR: 3.04-3.92, P < 0.001). Those belonging to the non-paying category had higher odds of poor visual outcome (AdjOR: 1.48, 95%CI: 1.29-1.69; P < 0.001). Surgical management improved vision by 0.72 logMAR (95%CI: 0.60-0.73; P < 0.001). A total of 41.2% ( n = 113/274) of cases that underwent Descemet's membrane endothelial keratoplasty and 18.4% ( n = 285/1551) of Descemet's stripping endothelial keratoplasty attained last follow-up visual acuity (LVA) of 6/18 or better.

Conclusion: About three in every thousand patients had PBK. Surgical interventions improved visual acuity significantly. About four in ten patients who underwent DMEK attained a vision of 6/18 or better at the last follow-up visit. Markers of lower socioeconomic strata were independently associated with poor visual outcomes.

Purpose: To assess the effectiveness of selective laser trabeculoplasty (SLT) in Indian eyes with open-angle glaucoma (OAG).

Settings and design: Single-center, prospective, interventional study.

Methods: Patients undergoing SLT from January 2014 to June 2018 for OAG were included in the study. Treatment-naive naive as well as patients on antiglaucoma medications (AGM) with suboptimal intraocular pressure (IOP) control were included. The main outcome measure was the percentage reduction in IOP. Complete success was defined as IOP reduction > 20% from baseline after 12 months or reduction in the number of AGM. Qualified success was defined as > 20% IOP reduction at 12 months with AGM. Secondary outcomes were occurrence of adverse events and factors predicting treatment outcomes.

Results: A total of 104 eyes of 62 Indian patients underwent SLT for OAG. Eighty-three (79.81%) eyes were treatment-naïve, and 21 (20.19%) eyes were on AGM. The median (IQR) baseline IOP was 20 (16-26) mmHg. At 12 months, the median IOP was 16 (4-19) mmHg, the median decrease in IOP was 4 (0-6.5) mmHg, and the percentage reduction in IOP was 17.42% (0%-30.76%). Maximum IOP reduction was noted at 12 months. Overall, success was achieved in 48 (46.15%) patients. Five eyes (4.8%) experienced minor SLT-related complications. Age, gender, prior use of AGM, type of OAG, and higher baseline IOP were not found to be predictive factors for treatment outcome.

Conclusion: SLT was found to be a relatively safe and effective procedure in Indian eyes with OAG.

Purpose: To study the different subtypes of glaucoma and to analyze the demographic and clinical profile of glaucoma patients along with associated risk factors in a multi-locational North Indian study.

Methods: Newly diagnosed and known glaucoma patients on treatment were enrolled in the study. Complete history was taken, and clinical evaluation was done by senior glaucoma experts.

Results: Five hundred and eighty-six patients (1121 eyes) were included with 383 males (65.4%) and 203 females (34.6%). Of these, 508 (86.7%) had primary glaucoma and 78 (13.3%) had secondary glaucoma. Also, 263 (44.9%) patients had primary open angle glaucoma (POAG) and 172 (29.4%) had primary angle closure glaucoma. Four hundred and fifty-one (77%) were graduates or postgraduates and 293 (50%) were dependents on family income. One hundred and forty-one (24%) had a positive family history. Secondary glaucoma patients had a lower average age (52.6 ± 16.8 years) and higher average intraocular pressure (IOP; 34.23 ± 13 mm) compared to primary glaucoma patients (26.6 ± 9.7 mm) ( P < 0.0001). Thirty-three (47.8%) out of 78 secondary glaucoma patients had advanced disease. Seventy-four (12.6%) were first-time diagnosed and 18 had advanced disease. In addition, 161 eyes had one or more glaucoma surgeries done (128 trabeculectomy and 28 phacotrabeculectomy). Ninety-five (16.2%) patients were advised surgery at our centers (46 trab, 26 phacotrab, 15 phaco, five Ahmed glaucoma valve implantation, and three pars plana vitrectomy). Disease progression was noted in 62 patients reporting good compliance to medicines.

Conclusion: POAG was the most common variant in this study. Secondary glaucoma patients were youngest in age and had the highest IOP. Trabeculectomy was the most performed surgery. A good literacy rate did not prevent late presentations.

Purpose: To assess the factors associated with malignant glaucoma (MG) following intraocular surgery.

Design: Retrospective case-control study.

Setting: Institutional.

Study population: A total of 40 eyes with MG and 80 controls were included.

Methods: A total of 40 patients who developed malignant glaucoma following intraocular surgery between January 1995 and December 2013 were compared with 80 age- and gender-matched controls who underwent surgery during the study period.

Main outcome measures: The associated factors for the development of malignant glaucoma following intraocular surgery.

Results: Diagnosis in cases included primary angle closure glaucoma (PACG: 31 [77.5%]), primary open-angle glaucoma (POAG: 2 [5%]), pseudoexfoliation glaucoma (PXFG: 4 [10%]); in controls included PACG 44 (55%) and POAG 36 (45%), (P < 0.001). Trabeculectomy was performed in 24 cases (50%) and 28 (35%) controls, phaco-trabeculectomy in 14 cases (35%) and 52 eyes (65%) in controls, and cataract surgery in 2 cases (5%) (P = 0.004). Factors associated on univariate analysis included PACG (odds ratio [OR]: 12.68, 95% confidence interval [CI]; 2.84, 56.62, P < 0.001, synechial angle closure > 180° (OR: 10.1, 95% CI: 2.87, 35.44, P < 0.001, higher preoperative IOP > 22 mmHg (OR: 5.32, 95% CI: 2.64, 10.73, P < 0.001), trabeculectomy (OR: 3.05, 95% CI: 1.36, 6.83, P = 0.007) and axial length < 22 mm (OR: 6.80, 95% CI: 2.51, 18.46, P < 0.001. The use of postoperative cycloplegics was protective on univariate analysis (OR: 0.268, 95% CI: 0.12, 0.596), P < 0.001). Preoperative IOP > 22 mmHg (2.85, 95% CI: 1.11, 7.31, P = 0.02), and trabeculectomy (OR: 4.09, 95% CI: 1.48, 11.3, P = 0.007) remained significant on multivariate analysis.

Conclusion: PACG eyes with higher preoperative IOP and eyes undergoing trabeculectomy surgery alone, increased the likelihood of developing MG.

As a major reason for irreversible vision loss, glaucoma is a significant public health concern. Its multifactorial nature demands a nuanced understanding of its pathophysiology, risk factors, and management. An understanding, and continuous refinement, of diagnostic and therapeutic modalities, including pharmacological interventions, novel methods of drug delivery, and surgical techniques (including minimally invasive glaucoma surgeries) are critical. The advent of personalized medicine, genetic profiling, and innovative biomarkers for identifying susceptible individuals and tailoring treatment strategies may help prevent blindness and improve patient outcomes. Evaluation of the impact of lifestyle modifications and holistic approaches and integration of telemedicine and artificial intelligence in glaucoma management may revolutionize current glaucoma practice. In addressing the global challenge of glaucoma blindness, this narrative review highlights ongoing initiatives, public health policies, and community-based interventions. This includes raising awareness, enhancing early detection programs, and access to care, particularly in underserved populations.

Background: Nasolacrimal duct (NLD) screening is a standard before cataract surgery. Lacrimal sac pressure and syringing rules out NLD obstructions.[1] However, lacrimal syringing is invasive and risks iatrogenic injury to the lacrimal drainage system (LDS).[2].

Purpose: Practice model for lacrimal syringing and understanding outflow obstructions.

Synopsis: The model included an inner functional part and an outer mechanical part. Two circular apertures were first made in the ink dropper (lacrimal sac) and two hollow silicone tubing of 10 mm length were glued to the apertures (upper and lower canaliculi). The tubing were bent using pins for the horizontal and vertical canaliculi. Silicone liquid was then poured into 3D-printed mould with LDS model kept inside and was left for 3-4 h. The inner model was modified by fitting small silicone balls, and obstructions were created at various levels such as lower, upper, common canaliculus, and NLD. In normal LDS, when the fluorescein dye passed through one of the tubing, it exited at the NLD opening. If the dye regurgitated through the same tubing, it suggested same canalicular block. Regurgitation from the opposite tubing suggested either a common canalicular block or an NLD obstruction. The model presents a commendable representation of the NLD system; however, it does exhibit some limitations. Notably, the absence of eyelid margins hinders the precise localization of stenotic puncta and the effective utilization of punctum dilators. In addition, the model cannot replicate the lateral pulling of the eyelid, which is crucial for effective probing procedure.

Highlights: Our Do it yourself (DIY) syringing model called "SYRI" is a cost-effective way to practice syringing, enhancing the understanding of canalicular and NLD blocks. While not meant for probing, its repeated use improves proficiency in syringing, benefiting patient care. The model is easily replicated and can serve as foundation for teaching complex surgeries like dacryocystorhinostomy.

Video link: https://youtu.be/xbKl33-W0VA.

Purpose: To evaluate the feasibility of a three-point flanged optic piercing intrascleral fixation technique for replacing a dislocated multifocal intraocular lens (IOL).

Design: Retrospective cross-sectional study.

Methods: In total, 13 eyes from 13 patients with a dislocated single-piece C-loop or double C-loop diffractive multifocal IOL were enrolled to undergo dislocated multifocal IOL replacement through three-point flanged optic piercing 120 degrees apart intrascleral fixation using 7-0 polypropylene sutures at 2.5 mm posterior to the limbus. Preoperative and postoperative uncorrected distance visual acuity (UDVA), postoperative uncorrected intermediate visual acuity (UIVA) at 66 cm, uncorrected near visual acuity (UNVA) at 40 cm, residual refractive errors, and the amount of IOL decentration were evaluated.

Results: There were six multifocal IOLs and seven multifocal toric IOLs. There was a notable improvement in visual acuity, with the mean UDVA improving from 0.79 ± 0.72 logMAR preoperatively to 0.06 ± 0.08 logMAR postoperatively (P = 0.004). The mean postoperative UIVA and UNVA were 0.04 ± 0.05 and 0.10 ± 0.12 logMAR, respectively. The mean residual refractive sphere, cylinder, and spherical equivalent were -0.04 ± 0.48 D, -0.29 ± 0.25 CD, and -0.18 ± 0.47 D, respectively. The mean residual cylinder was -0.25 ± 0.25 CD in eyes with multifocal toric IOL fixation. The mean amount of IOL decentration was 0.22 ± 0.05 mm.

Conclusion: The three-point flanged optic piercing intrascleral fixation technique for dislocated multifocal IOLs could provide good distance, intermediate, and near vision alongside excellent IOL centration.