Indian Journal of Ophthalmology最新文献

Purpose: To describe the clinical course and treatment outcomes of Vogt-Koyanagi-Harada (VKH) disease presenting with bullous exudative retinal detachment (bullous ERD).

Methods: This retrospective study included all patients diagnosed with VKH presenting with bullous ERD in one or both eyes between 2016 and 2024. Their best-corrected visual acuity (BCVA), clinical presentations, and treatment outcomes were analyzed.

Results: Among 646 patients with VKH, 12 (22 eyes) presented with bullous ERD in the early stage of the disease. The mean age at presentation was 38.67 years (range: 22-58 years). Bilateral bullous ERD was noted in 10/12 patients, while two had unilateral involvement. The mean BCVA at presentation and the final follow-up was 1.74 logMAR (SD 0.67, range 0.2-2.3 logMAR) and 0.84 logMAR (SD - 0.57, range 0-2.2), respectively. Anterior segment inflammation was noted in 15 eyes (68.1%), disc edema in 16 (72.7%), and vitritis and choroidal detachment in four eyes each (18.2%). The average choroidal thickness on B-scan ultrasonography was 1.79 mm (range: 1.04-3.57 mm). Six eyes (27%) experienced acute exacerbations, and five eyes (22.7%) had recurrences. The mean follow-up was 17 months (range: 6-61). At final follow-up, sunset glow fundus developed in 17 eyes (72%), secondary glaucoma in eight eyes (36.3%), and subretinal fibrosis in nine eyes (41%).

Conclusion: Bullous ERD is a rare manifestation of VKH. Although initial visual recovery is promising, these patients are at higher risk for disease exacerbation, recurrences, and complications. Initial aggressive therapy and prolonged follow-up with sustained immunosuppression are essential for optimal outcomes.

Purpose: To use the Chennai glaucoma study (CGS) dataset to calculate biometric cutoffs to detect primary angle-closure disease (PACD) and assess its accuracy in detecting PACD in a separate clinical subset.

Methods: Clinical subset, prospective recruitment. Categories - normal, PACD (included primary angle-closure suspect-PACS, primary angle closure - PAC, and primary angle-closure glaucoma-PACG), and primary open-angle glaucoma (POAG). Biometric parameters assessed included axial length (AXL), anterior chamber depth (ACD), lens thickness (LT), lens position, relative lens position, and simple crowding value. Additionally, the CGS dataset biometric parameters were used to determine the optimal cutoff values (CVs) for the detection of PACD. These were applied to the clinical dataset.

Results: A total of 942 eyes (474 patients) - clinical, 1844 eyes (1844 patients) - CGS. Mean age: 55.77+/-9.63 yrs - clinical, 52.04 ± 9.75 yrs - CGS (rural), 53.95 ± 9.57 yrs - CGS (urban). Among all biometric parameters across all datasets, ACD had the highest area under the curve (AUC, 0.86-0.89), accuracy (75.56-82.91%). Assessed the ability of ACD CV determined from CGS to detect PACD in the clinical dataset - highest sensitivity, specificity combination seen with CV from CGS (rural) - ACD ≤ 2.815 mm: sensitivity - 63.59%, specificity - 93.21%. Urban and combined rural and urban (U and C) CGS dataset had a similar ACD CV of ≤ 2.695 mm (44.77% sensitivity, 96.74%specificity). At 10% population prevalence, ACD ≤ 2.695 (U and C) had the highest accuracy (91.54%), followed by CGS (rural) CV-ACD ≤ 2.815 (90.24%). At a prevalence 30% accuracy: 81.15% for the U and C and 84.32% for rural CV.

Conclusion: ACD determined from CGS had an accuracy of 92% and 84% in detecting PACD in a clinical setting at 10% and 30% prevalence, respectively. Use of these parameters to determine PACD may be considered with due caution in resource-constrained areas, along with cataract screening.

Purpose: To assess anatomical and functional outcomes of encircling or segmental buckle in premature infants with stage 4 retinopathy of prematurity (ROP).

Methods: This retrospective, single-center, interventional study included preterm infants with stage 4A or 4B ROP who underwent encircling (Group A) or segmental (Group B) scleral buckle. Surgical outcomes, long-term sequelae, and comorbidities were evaluated.

Results: A total of 105 eyes (90 infants) were analyzed-85 in Group A and 20 in Group B. Stage 4A was present in 75 eyes. The mean gestational age was 30.05 ± 2.73 weeks; mean birth weight, 1383 ± 411.01 gram. Primary surgical success was 90.5% in Group A (4A: 93.9%; 4B: 78.9%) and 90% in Group B (4A: 88.8%;4B: 90.9%). Preoperative treatment and combined intraoperative interventions significantly improved anatomical success (P < 0.05). Mean spherical equivalent was -6.00 D in Group A and -3.12 D in Group B. Functional vision (central, steady, maintained) was achieved in 32% of Group A and 55% of Group B. Common sequelae included disc drag and macular ectopia; comorbidities included myopia, strabismus, and nystagmus.

Conclusion: Scleral buckling is an effective and less invasive treatment for selected cases of stage 4 ROP with peripheral traction.

Purpose: To describe optical coherence tomography angiography (OCTA) features of inflammatory choroidal neovascular membrane (iCNV) in Vogt-Koyanagi-Harada (VKH) disease.

Methods: This is a retrospective review of the medical records of patients with iCNV in VKH disease, documented on OCTA, seen by a single uveitis specialist from a tertiary care eye hospital. Each patient had a detailed medical record of the clinical features and underwent swept-source OCTA (SS-OCTA) analyzed by a retina specialist and a uveitis specialist.

Results: Analysis of the 11 eyes of 8 patients who had iCNV and SS-OCTA documentation showed that peripapillary iCNV was the most common. Distinct iCNV patterns noted were filamentous, sea fan, medusa head, and pruned along with flow voids of choroidal granulomas in the active inflammatory stage of the disease. Reduction of the flow signals in iCNV, on OCTA, indicated a response to treatment.

Conclusion: OCTA is a valuable tool in visualization and classification of choroidal neovascularizations and their response to treatment in inflammatory conditions like VKH disease.

Abstract: Myopia is the fastest-growing, chronic eye condition that covers 30% of the population worldwide and is estimated to be around 50% of the global population (5 billion people) by 2050. Since there is an association between myopia onset and binocular vision disorder, this narrative review aims to establish a relation between the accommodative demand and binocular functions among patients using myopia control strategies. The identified articles follow different methodologies and various myopia control interventions. The literature search includes keywords using Boolean operators on the PubMed and Google Scholar databases. The study populations include both children and adults. No date and language restrictions were applied. It was found that all the interventions used for myopia control affect accommodation and binocular vision. Though orthokeratology helps to neutralize the myopia-induced binocular imbalance, atropine has a negligible impact. Similarly, aspherical lenslets significantly affect accommodative microfluctuations, and Defocus incorporated multiple segments lenses show similar responses as single-vision lenses. In addition, encouraging outdoor activities and minimizing continuous near work by incorporating frequent breaks are proven effective strategies to delay myopia, while also having no adverse impact on binocular vision anomalies. Since binocular vision is already impaired before and during the onset of myopia, practitioners should also consider the accommodation and binocular abnormalities brought on by various modalities used to delay the growth of myopia.

Abstract: To describe a surgical technique using a three-flanged Prolene suture for managing zonular dialysis during cataract surgery in a patient with preoperative zonular deficiency in brown cataract. A patient with zonular deficiency and brown cataract underwent cataract surgery complicated by zonular dialysis between the 4 o'clock and 8 o'clock positions. A three-flanged Prolene suture, fashioned in an iris hook-like configuration, was used. A 26-gauge needle was introduced at the 6 o'clock position to pass a 7-0 Prolene suture through the zonular defect. A capsular tension ring (CTR) was placed to stabilize the anterior capsule, and the Prolene suture was engaged at the dialysis site. The suture was cut, cauterized, and buried under the conjunctiva. An intraocular lens was implanted in the capsular bag. Postoperative visual acuity was 6/9, and intraocular pressure was normal. There were no intraoperative complications. The zonular dialysis was effectively managed, and the Intraocular lens (IOL) remained stable. The three-flanged Prolene suture technique is an effective method for managing zonular instability during cataract surgery. Combined with a CTR, it ensures capsule stabilization and IOL positioning, providing reliable outcomes in cases of zonular deficiency, including subluxated cataracts and intraoperative zonular dehiscence.

Purpose: To analyze early outcomes and safety profiles of combined phacoemulsification and suture gonioscopy-assisted transluminal trabeculotomy (phaco-GATT) in Indian eyes with primary and secondary (pseudoexfoliative) glaucoma coexisting with cataract.

Methods: In this retrospective interventional analysis, 42 eyes with primary and secondary (pseudoexfoliative) glaucoma, all with coexisting cataract having follow-up of 6 months to 1 year, were included. Phacoemulsification with suture GATT was performed. Outcome measures included surgical success rate (complete and qualified), intraocular pressure (IOP) reduction post surgery, change in antiglaucoma medications (AGMs) post surgery, change in best corrected visual acuity, and surgical complications. IOP reduction <18 mmHg or ≥30% from baseline without AGM was defined as complete success. IOP reduction <18 mmHg or ≥30% from baseline with AGM was considered as qualified success.

Results: Mean baseline IOP reduced significantly from 23.05+- 7.42 mmHg to 13.4+- 3.20 mmHg at 1 year (P < 0.001, n = 30), with a 44% IOP reduction. Mean AGM use decreased from 1.93+- 0.52 to 0.13+-0.43 at 1 year (P < 0.001, n = 30). The complete and qualified success rates at 1 year were 90% and 93%, respectively. BCVA improved from 0.533+- 0.36 logMAR to 0.013+-0.050 logMAR (P < 0.001). Common complications were IOP spikes (19%) and transient hyphema (16%), all resolving without major intervention.

Conclusion: Combined phaco-GATT is a cost-effective and safe surgery with favorable early outcomes, providing significant IOP reduction, reduced medication burden, and minimal complications in patients with primary and secondary (pseudoexfoliative) glaucoma. As a conjunctiva sparing technique, it preserves future surgical options and may delay or avoid need for trabeculectomy.

Purpose: To investigate the incidence and risk factors for steroid-induced ocular hypertension (SI-OHT) in patients receiving intravitreal steroids for retinal inflammatory diseases.

Methods: This retrospective observational study included patients who received either intravitreal triamcinolone acetonide (IVTA/TA group) or dexamethasone intravitreal implant (DEX group) for the management of retinal vascular diseases in the period of 2018-23. SI-OHT in those patients were followed up for 2 years. Steroid responders and nonresponders were characterized based on intraocular pressure (IOP) change from the baseline. The incidence, risk factors, and magnitude of IOP rise and its association with ocular and systemic illness were investigated.

Results: Out of 1178 reviewed, 761 patients were excluded due to irregular follow-up. A total of 382 patients (382 eyes) who received either IVTA/DEX intravitreal implant during the study period were reviewed. The incidence of SI-OHT was found to be 46.3% (IVTA group) and 20.8% (DEX group) at 6 months, respectively. Among patients who received 2 mg IVTA dosage, 16.9% were steroid responders and 11.9% for the 4 mg group.

Conclusion: We found that the incidence of SI-OHT was higher in IVTA group as compared to DEX group. No dose-dependent incidence was observed in the case of IVTA group. Age, gender, number of injections, and myopia were not associated with the risk of SI-OHT. Renal disease showed a significant association with the risk of SI-OHT in the DEX group, and patients with TB, stroke, and other drug allergies experienced a fivefold greater increase in IOP values in those groups.

Purpose: Retinopathy of prematurity (ROP) is a major public health issue in India, with many preterm infants at risk for preventable blindness. Limited structured screening exacerbates undiagnosed and untreated ROP.

Design: Observational retro-prospective cohort study.

Methods: A sustainable ROP screening program was established in Delhi government hospitals' neonatal intensive care units (NICUs) from January 2021 to March 2025, via a public-private partnership (Mission Neonatal Early Evaluation Vision [NEEV]), leveraging existing healthcare frameworks.

Results: Screening was conducted in 24 NICUs. Of 6308 preterm infants screened, 10.62% (670) required treatment with intravitreal injections or retinal laser photocoagulation. The program achieved an 81% follow-up rate. Compared to pre-program screenings, the proportion of infants needing treatment decreased from 14.5% to 10.6%.

Conclusion: This ROP screening program demonstrates an effective and replicable model for early detection and intervention. Integrating trained personnel, technology, and systematic protocols facilitated treatment efficacy and follow-up, suggesting replication potential without adding substantial resources.

Purpose: This study evaluates the performance and safety of the Optiflex Trio trifocal intraocular lens (IOLs) in Indian cataract patients.

Design: Single-arm prospective clinical study.

Methods: Patients undergoing phacoemulsification for senile cataracts received bilateral Optiflex Trio trifocal IOLs. Visual outcomes, spherical equivalent, reading performance, contrast sensitivity, stereo acuity, and high-order aberrations were assessed at 1 week, 1 month, 3 months, 6 months, and 12 months.

Results: A total of 93 eyes were implanted with IOL and showed significant improvement from pre-op to 12 months in the uncorrected distance (UDVA: 0.74 ± 0.33 to 0.01 ± 0.04 logMAR, P = 0.0001), intermediate (UIVA: 0.62 ± 0.20 to 0.01 ± 0.03 logMAR, P = 0.0001) and near visual acuity (UNVA: 0.57 ± 0.20 to 0.01 ± 0.02 logMAR, P = 0.0001), best-corrected distance visual acuity (BCDVA: 0.45 ± 0.29 to 0.00 ± 0.01 logMAR, P = 0.0001), and distance-corrected visual acuities (DCIVA and DCNVA: 0.32 ± 0.23 to 0.00 logMAR, P = 0.0001). The contrast sensitivity increased from 0.52 ± 0.40 to 1.49 ± 0.05 (P = 0.0001), while high-order and total aberrations decreased (0.87 ± 0.71 to 0.16 ± 0.11 mm and 1.55 ± 1.13 to 0.21 ± 0.07 mm, both P = 0.0001). Near/intermediate reading speeds improved by 5.18 ± 8.72 and 5.15 ± 8.72 words/min (P = 0.000). Stereo acuity significantly enhanced, with FD2 from 265.14 ± 124.93 to 83.41 ± 12.56 and Near Radnor from 211.71 ± 114.60 to 74.77 ± 6.98 (P < 0.0001). No adverse events were reported.

Conclusion: Optiflex Trio trifocal IOL enhances vision, reduces aberrations, and supports spectacle independence.