Indian Journal of Ophthalmology最新文献

Background: A long glaucoma implant tube in the anterior chamber (AC) may cause intermittent or persistent tube-corneal endothelial touch.[1-3] This would result in corneal endothelial cell loss, corneal edema, and bullous keratopathy. Various minimally invasive techniques have been described for tube shortening or repositioning of the tube in the AC.[1-4] To shorten the tube, it can be trimmed within the AC to protect the corneal endothelium.

Purpose: We describe a minimally invasive technique of trimming a long tube in the AC after Ahmed glaucoma valve (AGV) implantation for angle recession glaucoma.

Synopsis: Under local anesthesia, a corneal incision is made beside the tube entry point at the 12 o'clock position using an micro vitreoretinal (MVR) blade. Viscoelastic is used to separate the tube from the corneal endothelium. A half-inch 30-gauge needle is bent and passed from a paracentesis at 180 degrees across the tube entry site. The needle from the opposite end is advanced and docked inside the AGV tube. The excess length of the tube is transected with Vannas scissors. The end of the needle is externalized through the corneal incision, and the cut tube fragment is withdrawn by sliding a Sinskey's hook over the needle. The pliable silicone tube fragment is easily glided over the needle. Viscoelastic is aspirated, and the corneal incision is apposed using a 10-0 monofilament nylon suture.

Highlights: The video describes a safe and easy closed chamber technique for trimming the long intracameral portion of the AGV tube without externalization, to correct the tube-endothelial touch.

Video link: https://youtu.be/WdQtax8T45w.

Purpose: Eye injuries are a significant public health concern, yet data on their burden in South Indian communities remains scarce. This study assessed the annual rates of eye injuries, evaluated the effectiveness of vision centers (VCs) in their management, and analyzed the cost-benefit impact of these facilities.

Methods: We conducted a retrospective analysis of VC medical records, including all eye injury cases reported at 35 VCs affiliated with a tertiary eye hospital, Madurai, between 2021 and 2022. A cost analysis accounted for patient expenses, including registration and travel from VCs to the base hospital.

Results: Of the 219,172 outpatients, 6.98% presented with eye injuries, with males comprising 63.9% and females 36.1% of cases. The mean (standard deviation) age of patients was 39 (19.1) years. Individuals under 20 years accounted for 17.5% of cases, while 66.5% occurred in working-age adults (20-59 years; P < 0.001). Globe injuries comprised 85.3% of cases, with the remaining 14.7% being periocular injuries. Most injuries (85.8%) were managed at VCs, while the rest (14.2%) required referral to base hospitals. The VCs generated community savings of ₹5.6 million (US$ 67,233) in travel and registration costs.

Conclusion: Eye injuries impose a substantial burden, particularly among working-age adults and individuals under 20 years. VCs effectively manage the majority of cases locally, providing accessible care and significant cost savings for South Indian communities.

Purpose: To describe outcomes of the intraoperative optical coherence tomography (iOCT)-guided technique of partial-thickness compression sutures (PTS) in acute corneal hydrops. We also provide a comprehensive review of literature of the outcomes of compression sutures in acute hydrops.

Methods: This study involves prospective interventional case series of patients with keratoconus and acute corneal hydrops. iOCT was used to assess the morphological features of the hydrops, observe surgical dynamics during PTS, titrate the magnitude of suture tightness by observing the stromal compaction and minimisation of intrastromal fluid clefts, and confirm the depth of suture placement (intended at 50-60%). The primary outcome measure was time to resolution of hydrops. Suture removal was planned after documenting stability of corneal thickness.

Results: Seven patients (4 males, 3 females; median age 16 years) underwent iOCT-guided PTS with intracameral air. The time interval between onset of hydrops and PTS ranged from 1 to 12 weeks. The preoperative corneal thickness ranged from 1120 to 2363 µm. The initial depth of suture placement on iOCT was observed to be <50%; progressive stromal compaction and collapse of intrastromal fluid pockets allowed deeper penetration with needle during subsequent suture placement. A decrease in separation of DM from stroma was noted; however, no case had on-table complete DM-stromal reattachment. Complete resolution of hydrops was observed by 2 weeks in all cases. Suture removal was performed in 5 cases at 8-12 weeks.

Conclusion: iOCT helps titrate depth and tightness of compression sutures in real time to achieve on-table stromal compaction and minimization of intrastromal clefts, with fast resolution of acute hydrops.

Purpose: This investigation aims to assess the clinical outcomes and patient-reported satisfaction associated with non-surgical eyebrow elevation utilizing botulinum toxin (BTX) and hyaluronic acid gel (HAG) formulations with G-prime fillers.

Methods: A retrospective analysis was conducted on a cohort of 460 subjects who underwent eyebrow elevation procedures from 2013 to 2024. The sample comprised 276 females (60%) and 184 males (40%), with a mean age of 50 years (standard deviation [SD] = 31.1 years). In the BTX group, 20 units were administered across five injection sites, including bilateral injections into the corrugator supercilii and a unilateral injection into the procerus muscle, with 0.1 mL (4 units) per site using 31-gauge needles. Pre- and 15-day post-procedure photographic evaluations were analyzed using Adobe Photoshop, and statistical analysis was performed with Microsoft Excel.

Results: In the BTX cohort, the average increase in eyebrow height was 1.35 mm (range: 0.6-2.1 mm; SD = 1.06 mm), with a corresponding elevation from the medial limbus to the lateral brow edge averaging 1.35 mm (range: 1.0-1.7 mm; SD = 0.49 mm). The mean patient satisfaction score at 15 days post-treatment was similar for both groups: 1.73 for BTX and 1.71 for HAG, with no statistically significant difference observed (P = 0.9540).

Conclusion: Both BTX and HAG G-prime fillers demonstrate considerable efficacy in non-surgical brow elevation, enhancing eyebrow contour, and restoring youthful facial aesthetics. These minimally invasive interventions are viable alternatives to surgical brow-lifting techniques, yielding comparable patient-reported outcomes and satisfaction levels.

Purpose: To report the clinical characteristics, risk factors, and outcomes of graft rejection after Descemet membrane endothelial keratoplasty (DMEK).

Methods: Of the total of 1026 eyes of 935 patients that underwent DMEK, 25 eyes of 25 patients had rejection. The risk factors in 25 eyes were compared with those of control eyes without rejection during the same study period. The control group consisted of 98 eyes of 98 patients, who underwent DMEK during the same period and had no episode of rejection at a minimum and regular follow-up period of 2 years from the time of surgery.

Results: Overall, the incidence of rejection was 2.5%. The median age of patients was 53 (interquartile range, IQR, 45-62) years. In the control group, the median age was 65.5 (IQR 56.2-70.8) years. Most (88%) rejection episodes occurred within the first 2 years of surgery. Multivariate analysis showed younger age at surgery, male gender, rebubbling, cessation of topical steroids, and indication of DMEK (failed graft, corneal edema post-cataract surgery, and corneal edema due to inflammatory causes) as significant risk factors for graft rejection. No significant temporal correlation was observed with COVID-19 vaccination in the majority (92%). The mean endothelial cell loss following rejection was 72.5%. Kaplan-Meier survival plot showed the probability of graft survival was 90% at 1 year, 82% at 2 years, 80% at 3 years, 80% at 4 years, and 78% at 5-8 years.

Conclusion: Our study suggests that the risk of rejection is higher for indications such as failed previous graft, post-cataract surgery edema, and edema postinflammatory causes, when compared to Fuchs endothelial dystrophy. Topical steroids should be continued at least up to 2 years after surgery as this is the most common time frame of the rejection episode. The majority (68%) of the rejection episodes were reversible and resulted in a favorable outcome.

Background: Simple priming of the implant is always suggested before Ahmed glaucoma valve (AGV) device implantation. This helps the two valve leaflets to get separated, which aids in smooth jet outflow of fluid from the tube outlet of AGV implant and is initiated only after the priming.

Purpose: To detect the anterior fluid leak and possible dysfunction of the AGV implant by the simple priming procedure.

Synopsis: Standard priming of the implant was carried out with a 5 cc syringe using a 27-gauge cannula under the operating microscope; normally, jet flow of fluid at the valve outlet indicates implant was in good condition and can be implanted. But in this video, partial flow at the valve outlet and reflux of fluid was noted anteriorly at the tube valve junction, after a few seconds of initial priming, which suggests defection in the AGV implant.

Highlights: Intraoperatively, in our experience, over almost 20 years, we have found three faulty devices. The first and only one postoperative experience we had was with the child with acute proptosis at 5 weeks post implant.[1] This video highlights the importance of the simple priming procedure that should be done under a surgical microscope with cautious observation in identifying any dysfunction in the AGV devices.

Video link: https://youtu.be/cr1sBo03jiM.

Purpose: To compare the tilt and decentration between secondary sulcus-implanted versus optic-captured intraocular lens (IOL) in pediatric aphakia using ultrasound bio-microscopy (UBM).

Design: Prospective, comparative study at "Cairo University" pediatric ophthalmology and strabismus unit.

Methods: Forty-four eyes of 25 aphakics were scheduled for secondary implantation. Patients were randomly divided into two equal groups: Group A underwent sulcus implantation, while Group B underwent optic capture. UBM was performed preoperatively, 3 months and 6 months after surgery to evaluate the anterior chamber depth (ACD), angle width in the four quadrants, horizontal and vertical tilt, and decentration.

Results: Preoperative demographic data, ACD, and angle width did not differ between the groups. Six months after surgery, ACD was significantly higher in the capture group (mean 3.6 mm ± 0.59 [2.25-4.45]) than the sulcus group (mean 3.01 mm ± 0.25 [2.55-3.33]) with a mean difference of 0.59 mm (P = 0.000). The anterior chamber angle (ACA) showed larger values in all four quadrants in the capture group, highly statistically significant in the temporal (47.09° versus 42.23° P = 0.001) and superior (46.38° versus 42.47° P = 0.009) quadrants. Although there was no difference in the horizontal (0.22 versus 0.31 mm) and vertical (0.28 versus 0.30 mm) decentration between both groups, the capture group showed statistically significant more horizontal (1.8 versus 0.83°) and vertical tilt (2.16 versus 0.89°) compared to the sulcus group. This tilt did not affect the target refraction or cylinder and was, therefore, considered clinically insignificant.

Conclusion: Secondary IOL implantation with the capture technique appears to provide a deeper AC and a wider angle than sulcus implantation but could result in greater IOL tilt. UBM discloses changes in IOL position that are not clinically detected during follow-up.

Purpose: To assess the hospital-based prevalence of dry eye disease (DED) among children aged 4 to 18 years and to identify associated risk factors.

Methods: A prospective observational case series was conducted at a tertiary care center. A total of 1,420 pediatric patients attending the ophthalmology outpatient department were initially screened using a symptom-based questionnaire. Those with suggestive symptoms underwent further evaluation, including the Ocular Surface Disease Index (OSDI), Schirmer's test, tear film break-up time (TBUT), fluorescein and lissamine green staining, and a comprehensive ocular examination.

Results: Of the total 1420 children, 124 reported symptoms consistent with DED, and 108 (7.60%) were confirmed to have dry eye. The male-to-female ratio was 2.08:1, with a mean age of 11.40 ± 3.86 years. Among affected children, 85.18% had OSDI scores between 33 and 100, and 14.81% scored between 23 and 32. Notably, 46.29% of patients used smartphones, 68.04% watched television for 1-2 h daily, and 63.88% were diagnosed with seasonal allergic conjunctivitis. Comorbidities included hematological malignancies (n = 3) and juvenile rheumatoid arthritis (n = 1). The mean Schirmer's test values were 30.33 ± 8.05 mm (right eye [RE]) and 30.68 ± 8.03 mm (left eye [LE]). The mean TBUT was 6.66 ± 2.32 s (RE) and 7.53 ± 3.16 s (LE). Most patients (92.59%) had evaporative DED, while 7.40% had the mixed type.

Conclusion: DED should be considered in children presenting with nonspecific ocular complaints. Evaporative dry eye in this population is strongly associated with allergic conjunctivitis and prolonged use of digital devices.