Indian Journal of Ophthalmology最新文献

Purpose: To identify the predisposing factors, clinico-microbiological profiles, and treatment responses in patients with atypical mycobacterial keratitis.

Methods: The study retrospectively analyzed patients who presented at a tertiary eyecare center in eastern India with atypical mycobacterial keratitis between 2008 and 2021. The diagnostic criteria included cases positive for acid-fast bacilli on Ziehl-Nielsen stain or culture. The antibiotic susceptibility pattern was observed, and treatment was initiated accordingly.

Results: Out of the 29 cases, ocular predisposing factors were present in 62.1% with an antecedent history of trauma, and vegetative matter was the most common risk factor. There was no predisposing association with systemic conditions in any case. A long lag time was observed between the onset of corneal infection and presentation in 79.3% of cases, with the average time being 43.7 days. Clinical signs mimicked fungal keratitis in most cases. Typical cracked windshield appearance was only observed in two cases. Two patients presented with clinical pictures like peripheral ulcerative keratitis. Topical amikacin was used as treatment in 28 cases. Based on disk diffusion assay, 28 (96.5%) isolates were sensitive to amikacin. Twelve (41.3%) were sensitive to vancomycin, six (20.6%) to gatifloxacin, six (20.6%) to ciprofloxacin, and four (13.7%) to moxifloxacin. Twelve participants showed good final visual acuity posttreatment, which improved to over two lines of Snellen's visual acuity chart (44.5%).

Conclusion: Atypical mycobacteria keratitis may not present with classically described clinical features. The duration of presentation, clinical presentation, special microbiological stains, targeted therapy, and antibiotic susceptibility patterns are the key to successfully managing these intractable infections and obtaining favorable outcomes.

Background/aims: India's linguistic and cultural diversity necessitates a region-specific validated Visual Functioning Questionnaire. The objective of this study was to translate the Indian Vision Function Questionnaire-33 (IND-VFQ-33) into the Kannada language and test its psychometric properties, underlying factor structure, and model fit.

Methods: A cross-sectional study was conducted among 330 participants, and basic psychometric properties (reliability, convergent, discriminant, construct validity, responsiveness, etc.) were assessed. The underlying factor structure was evaluated by exploratory factor analysis (EFA) and model fit by confirmatory factor analysis (CFA).

Results: The Kannada version of IND-VFQ-33 exhibited robust psychometric properties [excellent content validity, reliability (Cronbach α = 0.91), test-retest reliability (Rho S = 0.99; P < 0.001), convergent (Rho S = 0.58; P < 0.001), and discriminant validity (Rho S = 0.06; P = 0.274)]. On EFA, items in the general functioning subscale fell into two categories, namely "Mobility" (10 items: Q1, Q2, Q4-Q9, Q15, and Q16) and "Daily Activities" (8 items: Q3, Q10, Q11, and Q17-Q21), and two other subscales "psycho-social impact" subscale (Q22-Q26) and the "visual symptoms" subscale (Q27-Q32, excluding Q33). Thus, a new Kannada-translated VFQ-29 questionnaire was derived with excellent psychometric properties. All observed variables showed significant factor loadings on their respective latent constructs (>0.50), establishing convergent validity on CFA by using the structural equation model. The model-fit to the data assessed by various indices [Root Mean Squared Error of Approximation = 0.08 (90% CI: 0.081-0.091); Comparative Fit Index = 0.877; Tucker-Lewis Index = 0.866; Akaike's Information Criterion = 23447.133; Bayesian Information Criterion = 23800.45, and Coefficient of Determination = 0.998] demonstrated acceptable fit.

Conclusion: The refined 29-item Kannada-translated IND-VFQ model not only offers an improved factor structure across four subscales but also consistently demonstrates excellent reliability, convergent and discriminant validity, and responsiveness.

Purpose: To analyze the safety and efficacy of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in pediatric eyes with refractory glaucoma.

Design: Hospital-based prospective interventional study.

Methods: Patients less than 18 years of age, receiving MP-TSCPC between December 1, 2022 and May 31, 2023 with at least three follow-ups within 6 months period, were included in the study. Post-laser evaluation was done at day 1, 1 month, 3 months, and 6 months. Success outcomes were calculated at 1, 3, and 6 months follow-up.

Results: A total of 23 eyes of 23 patients were included in the study. Mean intraocular pressure (IOP) lowering agents (P = 0.041) had significant change compared to the baseline value; however, the change was insignificant when eyes requiring additional IOP-lowering surgeries during the follow-up period were excluded. There was a significant reduction in IOP at each follow-up visit compared to the baseline (P = 0.000014). Two (8.6%) eyes required additional intervention within 1-month follow-up, another six eyes (26%) between 1-3 months, and three eyes (13%) between 3-6 months of MP-TSCPC. Total success was highest at 56.5% (13 eyes) at 1-month follow-up and at least 34.7% (8 eyes) at 6-month follow-up. No major complications were reported in our study.

Conclusion: MP-TSCPC was found to be safe and effective in pediatric population. However, we observed a gradual reduction in the success with time, and thus, it can be individualized to patients with high risk for incisional surgery or those requiring immediate IOP reduction.

Objectives: The objectives of the study were to obtain the current estimates of cataract surgical coverage (CSC) at varying thresholds of vision and gender variations across districts in diverse Indian populations aged ≥50 years.

Methods: Data collected from the national blindness survey from 31 Indian districts between 2015 and 2019 were analyzed. CSC at varying thresholds of presenting visual acuity <3/60, <6/60, and <6/18 were estimated along with gender variations across districts in population ≥50 years of age.

Results: The survey coverage was 93.5%, with 85,135 participants examined. The overall CSC at best corrected visual acuity (BCVA) <3/60, <6/60, and <6/18 in the Indian population was 93.3% (95% confidence interval [CI]: 91.5-94.7), 88.9% (95% CI: 86.5-90.9), and 72.6% (95% CI: 69.1-75.9), respectively. CSC was highest in the north and lowest in the northeast administrative zone at all BCVA cut-offs. Khera district had the highest CSC at BCVA <3/60 (99.1%) and <6/60 (97.9%), whereas Kapurthala district had the highest CSC at <6/18 (88%). Nalbari district had the lowest CSC at BCVA <3/60 (78%) and <6/60 (70.2%), and Nayagarh had the lowest CSC at <6/18 (45.6%). Overall, males had higher CSC than females. Gender variation was highest in Thoubal at BCVA <3/60 (18.7%) and <6/60 (19.2%). At BCVA <6/18, gender variation was highest in Thrissur (15.9%), with males (85.5%) found to have 15.9% higher CSC than females (69.6%).

Conclusions: CSC improved for 3/60 and 6/60 cut-offs, but remained low for 6/18 BCVA cut-off in India, with district- and gender-based inequities that need health system interventions.

Intraocular lens (IOL) dislocation is not an uncommon complication and often requires surgical intervention, depending on the status of capsular bag support. Conventionally, posterior dislocation of a foldable IOL or the IOL-bag complex warrants their removal as foldable IOLs are not ideal for sulcus placement. The technique presented here describes using quadrilateral sutures to refix looped haptic IOLs at the ciliary sulcus with or without a bag complex. The haptic loops act as eyelets, and 4-side suture placement helps in good centration, avoiding lens tilt. The closed globe maneuver causes minimal ocular trauma and helps in faster postoperative recovery.

Purpose: This study aimed to compare the 1-year clinical outcomes of three scleral fixation techniques for intraocular lens (IOL) implantation: ab externo scleral fixation, trocar-cannula-based sutureless fixation ("sutureless fixation"), and four-point scleral fixation.

Methods: This retrospective study evaluated 77 consecutive eyes treated with scleral fixation of the IOL. The ab externo method utilized conventional sutured techniques, while the trocar-cannula-based sutureless method was adapted from the "Yamane" technique, employing a wide-angle fundus lens to facilitate IOL manipulation in the vitreous cavity. The four-point fixation method involved a double-armed polypropylene suture and two 26-gauge needles to secure the four IOL haptics at four distinct sites. One-way analysis of variance (ANOVA) was used for statistical comparison between the groups.

Results: The four-point fixation group exhibited superior best-corrected visual acuity compared to the sutureless and ab externo groups at 1 and 3 months postoperatively (P = 0.004 and P = 0.002, respectively), along with significantly less surgically induced astigmatism (P < 0.001). The sutureless group had the shortest operative time, while the ab externo group had the longest (P < 0.001). No instances of IOL iris capture occurred in the four-point group, while three cases (10.0%) were noted in the sutureless group.

Conclusion: The four-point fixation technique provides significant benefits, including faster visual recovery, enhanced IOL stability, and lower surgically induced astigmatism (SIA) values. The sutureless technique provides the benefit of shorter operative times but does pose a risk of IOL capture in a limited number of cases.

Purpose: The purpose is to study the change in the contact of the IOL with the posterior capsule using intraoperative SD-OCT before and after implantation of the CTR post implantation of the IOL in the capsular bag.

Methods: A total of 51 eyes of 51 patients with senile immature cataract underwent topical phacoemulsification procedure with implantation of an extended depth of focus intraocular lens by a single experienced surgeon. The Rescan 700 SD-OCT system was used for intraoperative imaging. These patients were imaged using intraoperative SD-OCT after implantation of the IOL and before and after implantation of appropriate size of CTR. The vertical height between posterior surface of the lens capsule and the posterior surface of the IOL was measured and compared across 3 CTR sizes.

Results: The vertical height between the posterior surface of the lens capsule and the posterior surface of the IOL reduced significantly post CTR implantation (P value < 0.001) in all three groups. The change in height after CTR implantation was seen highest with the CTR size 13 mm and lowest with CTR size 11 mm.

Conclusion: Significant improvement of contact between the IOL and the posterior capsule was shown after implantation of the CTR. Larger the size CTR, more the contact of the IOL with the bag was shown.

Purpose: To investigate the incidence and management of acute angle-closure glaucoma (ACG) following venomous snakebites, along with its associated systemic complications, and to evaluate the importance of early detection and intervention in preventing long-term visual impairment.

Design: Prospective interventional case series.

Method: This study included patients admitted with venomous snakebites to a tertiary care hospital in rural Tamil Nadu, India, over four years (March 2019 to August 2023). All patients underwent both systemic and ocular assessments, regardless of their presenting symptoms. Ocular complications, particularly ACG, were managed with topical and systemic treatments. Data collected included demographic information, type of snakebite, systemic symptoms, treatment outcomes, and ocular findings.

Results: Of the 126 patients admitted with venomous snakebites, 84 presented with neurotoxic bites and 42 with hematotoxic bites. Nine patients developed bilateral ACG, all of whom had sustained hematotoxic bites. Visual acuity (VA) ranged from hand motion to 6/9, with elevated intraocular pressure (IOP) ranging between 12 and 54 mm of Hg. Systemic complications included acute renal failure in 16 hematotoxic cases, with four patients requiring hemodialysis and subsequently succumbing to renal failure and multiorgan dysfunction. After treatment with antisnake venom, topical IOP-lowering agents, corticosteroids, and systemic therapies, five patients demonstrated full recovery, with normalized IOP and improved VA.

Conclusion: ACG is a significant but underreported complication of hematotoxic snakebites. Early detection and intervention, including routine ocular screening, are crucial to prevent visual impairment. Ocular involvement may also serve as a prognostic indicator of severe systemic envenomation.