Indian Journal of Ophthalmology最新文献

Purpose: The wound healing process in the graft-host junction (GHJ) after deep anterior lamellar keratoplasty (DALK) can affect the outcome. We studied the anterior segment optical coherence tomography (OCT) features of the GHJ in the early and late postoperative stages.

Methods: OCT scans for 45 eyes of 43 patients within 4 weeks of DALK between 2014 and 2023 were retrospectively examined. Sixteen of these had a second scan 2 years or later postsurgery. GHJ profile, thickness, suture tracks, alignment (steps and shelves), and epithelial changes were examined and compared between early and late scans.

Results: The GHJ profile at 2 to 4 weeks postoperative was perpendicular (7 eyes, 43.7%), zigzag (4 eyes), C shaped (4 eyes), or mixed (1 eye). These profiles were persistent in most of the eyes (13 eyes, 81.2%) in the late scans. The thickest region was predominantly in the graft (13 eyes, 81.2%). This disparity disappeared in the late scans. Suture tracks were seen as hyper-reflective lines which remained visible in the late scans even after suture removal. Five eyes (31.2%) had anterior and 1 eye (0.6%) had posterior graft steps which disappeared in the late scans. Host shelves were seen in 43.3% in the first scan, and all of them had disappeared or became attenuated in the late scan.

Conclusions: These findings can help surgeons assess their technique to reduce misalignment which could influence the outcomes and improve the understanding of the effect of the wound healing process in the GHJ.

Purpose: The purpose of this study was to evaluate the refractive outcomes of cataract surgery in eyes with previous myopic corneal refractive surgery using total keratometry (TK) and the Barrett True-K No History method for intraocular lens (IOL) power calculation.

Setting: Four clinical centers in India.

Design: Ambispective case series.

Methods: All eyes had previously undergone either myopic photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK) and underwent cataract surgery with monofocal IOL implantation. Before surgery, TK and standard keratometry (K) were measured with the IOLMaster 700 (Carl Zeiss Meditec AG, Jena, Germany), while simulated keratometry (Sim K) was measured with the Pentacam HR (Oculus). IOL power calculations were performed with the Barrett True-K No History with TK. Prediction errors (PEs) and median absolute errors (MAEs) were calculated.

Results: A total of 35 patients were included. The MAE and mean PE with the Barrett True-K No History with TK (0.42 ± 0.34 D, 0.01 ± 0.54 D) were more accurate compared to the Barrett True-K No History with K (0.47 ± 0.43 D, 0.11 ± 0.63 D), Barrett True-K No History with Sim K (0.68 ± 0.79 D, -0.30 ± 1.00 D), Haigis with TK (0.70 ± 0.57 D, -0.56 ± 0.71 D), and Haigis L with K (0.59 ± 0.45 D; 0.20 ± 0.72 D), all P < 0.05.

Conclusions: In eyes with previous myopic PRK and LASIK, the combination of the Barrett True-K No History with TK from the IOLMaster 700 allowed for improved refractive outcomes, with the highest percentage of eyes achieving the target refraction.

Purpose: To study 12-month visual outcome and complications of photorefractive keratectomy (PRK) in low (-0.50 to <-3.00D), moderate (-3.00 to <-6.00D), and high myopia (-6.00D to -10.00D).

Design: Prospective observational study.

Methods: A total of 78 participants (78 eyes) underwent PRK at a tertiary care center in central India. Inclusion criteria were patients aged 18-35 years with stable refraction for at least 1 year and patients who discontinued contact lenses. Individuals were excluded if they had experienced ocular infections in the past 3 months, had undergone intraocular surgery, had an existing ocular or systemic condition, or were pregnant. The study compared outcomes between 26 eyes with high myopia and 52 eyes with low-to-moderate myopia following the PRK procedure. Postoperative evaluations were conducted on days 1 and 7, and at 1, 3, and 12 months. Key parameters assessed included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), the presence of corneal haze, and any postoperative complications.

Conclusion: PRK effectively reduced myopia over 12 months with minimal complications and is a suitable alternative for patients contraindicated for LASIK.

Purpose: To compare the clinical outcomes of cataract surgery by injecting intracameral triamcinolone or dexamethasone in children with bilateral congenital or developmental cataracts.

Design: Prospective, interventional, assessor-blinded, randomized controlled trial.

Methods: This was an institutional study in which 24 children aged <6 years with congenital/developmental cataracts were randomly divided into two groups. Eyes with other associated ocular conditions were excluded. Intracameral triamcinolone acetonide 1.2 mg/0.03 ml in the control group and dexamethasone 0.4 mg/0.1 ml in the study group were injected at the end of cataract surgery. The primary aim was to compare the number of eyes requiring surgery and postoperative outcomes such as anterior segment inflammation, intraocular lens pigment deposition, and posterior synechiae.

Results: The mean age was 20.04 months ± 17.88 (SD) (range 6 to 72 months) out of the 24 children being studied. One eye in the control group and three eyes in the study group required synechiolysis, membranectomy, and dialing of the intraocular lens with no statistically significant difference between the two groups (P = 0.60). The median intraocular pressure and central corneal thickness did not change significantly postoperatively in either group. Both groups showed similar cellular reactions and rate of complications.

Conclusions: Intracameral dexamethasone can be used as an effective alternative to intracameral triamcinolone for modulating postoperative anterior segment inflammation in pediatric cataract surgery. This pilot study compares the safety and efficacy of two drugs used in pediatric cataract surgery, despite limitations such as a small sample size and a short follow-up period.

Purpose: To characterize the impact of neovascular glaucoma (NVG) and its underlying etiology on mortality and determine the association between NVG and cause of death.

Design: Retrospective cohort study.

Participants: A total of 210 subjects with NVG were included in the descriptive study. Of the 210 subjects, 132 with a definite date of NVG onset were included in the survival analysis.

Methods: Patients with NVG seen at our tertiary care center from 2015-2016 were identified. Demographic information, underlying etiology, and medical conditions were documented. The Centers for Disease Control and Prevention National Death Index (CDC NDI) was used to designate if subjects were alive on December 31, 2021, and to determine the primary cause of death. Kaplan-Meier and Cox proportional hazard regression analyses were performed on subjects with a definitive date of NVG onset.

Results: Of the 210 subjects, 32% were deceased by December 31, 2021. The commonest diagnosis was proliferative diabetic retinopathy (PDR) (57%), followed by central retinal vein occlusion (CRVO) (29%). Of 132 subjects included in the Kaplan-Meier survival analysis, the mean survival time was 154 ± 15 months (95% CI: 125-183). Cox regression analysis demonstrated that older age (HR 1.03, 95% CI: 1.004-1.06, P = 0.02) and central retinal artery occlusion (CRAO) (HR: 4.63, 95% CI: 1.7-12.44, P = 0.002) were associated with poorer survival.

Conclusions: Increasing age and CRAO-related NVG (compared to CRVO-unrelated) were important predictors of increased mortality. Our results highlight the need for aggressive management of underlying systemic co-morbid conditions contributing to early mortality in patients with NVG.

Purpose: To report efficacy and outcomes of Preserflo MicroShunt surgery in patients with uveitic glaucoma at a tertiary center.

Design: Retrospective cohort study.

Methods: Consecutive patients with uncontrolled uveitic glaucoma who underwent Preserflo MicroShunt surgery with a minimum of 2 years of follow-up. Baseline characteristics, pre-operative and post-operative intraocular pressure (IOP), number of glaucoma medications, visual acuity, and adverse events were recorded.

Results: A total of 48 eyes with uveitic glaucoma underwent Preserflo MicroShunt with 0.4-0.5 mg/mL mitomycin C (MMC) were followed up at 2 years post-operation and 38 eyes at 3 years post-operation. The mean age was 51 ± 17 (21-84) years, and 27 (56.3%) were female. The mean baseline IOP of 29 ± 8 (range: 14-45) mmHg was reduced at each year post-operatively (P < 0.0001). The mean post-operative IOP at 1 year was 12.5 ± 5.0, at 2 years, it was 11.4 ± 4.8, and at 3 years, it was 13.6 ± 6.8 mmHg. The mean number of pre-operative glaucoma medications was 3.2 ± 1.3 (range: 0-5) compared with 0.4 at 1 year, 0.3 at 2 years, and 0.6 at 3 years (P < 0.0001). Adverse events included hypotony (two eyes), required revision of Preserflo MicroShunt (six eyes), and required further glaucoma surgery (six eyes). At the last follow-up visit, the overall success rate (IOP ≤ 21 mmHg and a 20% reduction ± medication) was 75%.

Conclusion: Our study showed good IOP control with Preserflo MicroShunt surgery at 3 years for patients with uncontrolled uveitic glaucoma.