Indian Journal of Ophthalmology最新文献

Purpose: Irreversible corneal blindness disproportionately affects low- and middle-income countries where there remains a critical demand for surgeons skilled in corneal transplantation. Penetrating keratoplasty (PK) is a critical skill for ophthalmologists, especially as it remains the most widely performed type of corneal transplant in these parts of the world. Tools to teach and assess trainees in corneal transplantation are needed to help standardize training internationally. Here, we present an Ophthalmology Surgical Competency Assessment Rubric (OSCAR) aimed at assessing the competence and progress of residents in PK.

Methods: A team of cornea specialists developed a rubric for PK using previously published OSCARs as a template. The draft included 11 key steps of PK and six global indices, with a grading scale based on a modified Dreyfus model. The rubric was then reviewed for face and content validity by a panel of eight international experts using an iterative feedback process. The draft underwent multiple cycles of feedback and revisions until a consensus was reached among the authors and the international expert panel.

Results: The rubric contains 11 essential steps and six global indices with descriptions of expected functioning at four levels of competency (novice, beginner, advanced beginner, and competent).

Conclusions: This OSCAR for PK contributes to the global standardization of ophthalmology training, helping to meet the increasing demand for corneal transplant services with high-quality care for all.

Purpose: To describe the clinicopathological characteristics of ophthalmic Rosai-Dorfman disease (RDD).

Methods: A 15-year single-center retrospective case series on ophthalmic RDD.

Results: Thirteen cases of ophthalmic RDD were identified, including eight males and five females, with a mean age of 49.2 years. The most common presenting signs were eye redness (76.9%) and proptosis (61.5%). The orbit was the most frequently involved site (84.6%). Epibulbar masses occurred in 53.8% of cases, and one case had a concurrent uveal lesion. Eyelid involvement was noted in 46.2% (six cases). Compressive optic neuropathy was documented in 23.1% (three patients). Bone erosion was observed in 53.8% (seven patients). Systemic involvement was present in 69.2% (9 patients), and lymphadenopathy was detected in 15.4% (two patients). Paranasal sinus infiltration occurred in 38.5% (five patients). Other systemic associations included skin and retroperitoneum/kidney (both 15.4%), cerebrum (7.7%), and cardiovascular system (7.7%). Histopathology revealed large S-100-positive histiocytes with emperipolesis in an inflammatory and fibrotic background in all cases. All were BRAF V600E negative, except one with a coexisting Erdheim-Chester-like lesion, suggesting mixed histiocytosis due to overlapping phenotypes with Erdheim-Chester disease (ECD). Increased IgG4-positive plasma cells were seen in 38.5% (five cases).

Conclusions: Ophthalmic RDD most frequently presents with orbital and epibulbar masses and rarely involves the uvea. Increased IgG4-positive plasma cells in some RDD cases necessitate careful differentiation from IgG4-related disease. In rare conditions, overlapping clinicopathological phenotypes with ECD and BRAF V600E mutation suggest a diagnosis of mixed RDD/ECD.

Purpose: To report the effectiveness of bimedial plication and vertical transposition for correction of exotropia associated with A- or V-pattern and compare it with bimedial resection and vertical transposition.

Methods: We retrospectively reviewed the results of surgery in patients who underwent bimedial plication (group I) versus bimedial resection (group II) with vertical offset to correct both exotropia and pattern deviation not secondary to oblique overaction in the period between January 2021 and January 2023. The results of both groups were compared. Success was considered when pattern deviation was ≤8 prism diopters (PD) and horizontal deviation was within 10 PD of orthophoria at 6 months postoperatively.

Results: The mean preoperative angle of exotropia in PD was 40.6 ± 7.2 in group I and 41.1 ± 7.5 in group II (P = 0.8). At 6 months postoperatively, they achieved angle of 4.6 ± 4.1 and 2.5 ± 4.5 PD, respectively (no significant difference between both groups; P = 0.19). The mean preoperative pattern deviation was 21.3 ± 3.7 PD in group I and 21.6 ± 4.4 in group II. Postoperative pattern collapse was 16.7 ± 5.6 and 16.6 ± 4.1, respectively. The percentage of success in pattern collapse was 90.6% in group I and 84.4% in group II (no significant difference between the groups; P = .71).

Conclusion: Vertical transposition with plication of medial recti is a safe, effective, and rapid technique for correction of cases of A- or V-pattern exotropia not associated with oblique overaction. Results were not significantly different from resection/vertical transposition.

Purpose: To analyze the visual outcomes and patient satisfaction following presbyopic lens exchange (PRELEX) with bilateral implantation of multifocal intraocular lenses (MFIOLs).

Methods: A single-center, multi-surgeon study involving retrospective analysis of patients with presbyopia who underwent bilateral implantation of MFIOLs with trifocal designs after phacoemulsification or femtosecond laser-assisted cataract surgery (FLACS) at a tertiary eye care hospital in South India. The visual outcomes were assessed at 2 weeks and after 6 months postoperatively, both objectively and subjectively.

Results: A total of 90 eyes of 45 patients with a mean age of 55.16 ± 6.57 years were included. 90% of the patients were hyperopic presbyopes. Postoperatively, the uncorrected distance, intermediate, and near visual acuity (VA) were logMAR 0.04 ± 0.08, 0.03 ± 0.09, and 0.11 ± 0.01, respectively, and remained stable from 2 weeks till beyond 6 months, with 82.22%, 65.55%, and 93.33% achieving a UDVA, UIVA, and UNVA of 20/20 or better at the end of follow-up. A total of 4.44% and 8.88% of the eyes required enhancement by laser refractive surgery and Nd:YAG capsulotomy for posterior capsular opacification, respectively, after a 3-month postoperative period. A total of 95.36% of the patients achieved spectacle independence, with only 15.55% complaining of glare/halos.

Conclusions: PRELEX with multifocal lens implantation proves to be a safe and effective procedure that yields good visual outcomes along with patient satisfaction, especially in hyperopic presbyopes.

Purpose: The Reper device (Reper-NN LTD, Nizhny Novgorod, Russia), an acrylic iris diaphragm combined with an intraocular lens (IOL), may be adapted for patients with various iris defects and aphakia. We aim to present our experience using the Reper artificial iris-IOL device.

Setting: Tertiary medical center.

Methods: This study includes patients who underwent implantation of the Reper artificial iris-IOL device at a single tertiary medical center between 2017 and 2023. The non-parametric signed test was used to compare preoperative and postoperative outcomes.

Results: Fifteen patients with aphakia and partial aniridia were included (four females [27%], mean age: 68.3). Mean follow-up time was 7.87 ± 5.62 months (range: 1-20). Following surgery, 87% (13 patients) showed improvement in corrected distance visual acuity (CDVA), while 13% (two patients) maintained their preoperative CDVA. The mean improvement in CDVA was 0.68 ± 0.19 logMAR (P value = 0.0015 [95% confidence interval (CI): 0.28-1.08. Unpaired t-test]). Moreover, all patients (100%) expressed complete satisfaction with postoperative cosmetic outcomes.

Conclusion: This study represents the largest reported series on Reper artificial iris-IOL implantation procedure and provides initial insights into its outcomes. No surgical complications were reported, and most patients experienced VA improvement and cosmetic satisfaction. These findings may assist ophthalmic surgeons in evaluating the benefits and risks of this implant. Larger, longer-term studies are needed to better establish its safety and efficacy.

Introduction: Ocular trauma is a major cause of monocular blindness. Early and timely reporting is essential for favorable visual outcomes. This study examines health-seeking behaviors in ocular trauma cases, with a focus on traumatic cataracts.

Setting: Single-center study in Western Central India.

Methods: This retrospective study included all first-time traumatic cataract surgeries (previously operated cases excluded) performed between 2009 and 2022. Data from electronic medical records, including demographic and clinical details, were entered into pre-tested online forms, exported to Excel, and analyzed using Statistical Package for Social Sciences version 22. Descriptive statistics and cross-tabulation were applied, with P < 0.05 considered significant.

Outcome measures: Best corrected visual acuity (BCVA).

Study population: A total of 2,093 eyes of 2,093 patients.

Results: Of the cohort, 1,473 (70.3%) were male and 620 (29.6%) female, median age 25 years; 39.4% were pediatric cases. The median interval between trauma and first consultation was 15 days; only 17.2% presented within 24 hours. Reporting interval significantly affected visual outcomes (P = 0.000). Most patients (91%) were from rural areas, and 86.3% were from low socioeconomic backgrounds. Pre- and post-surgical vision showed significant improvement, though delayed reporting reduced the gains. Main reasons for late presentation were lack of awareness, underestimation of severity, ignorance of primary care availability, and financial barriers.

Conclusion: Delayed reporting after ocular trauma leads to poorer visual outcomes. Community counseling and awareness programs for patients, caregivers, and healthcare workers are essential. Promoting early reporting can substantially reduce preventable blindness due to ocular trauma. Data Access Statement: Research data supporting this publication are available from the NN repository located at www.NNN.org/download.

Background: Thyroid stimulating hormone, T3, T4, and thyroid auto-antibodies are essential in diagnosis of immune thyroiditis, Graves' and Hashimoto's. These, however, may not correlate with thyroid eye disease or TED. In recent years, a new blood test for thyroid stimulating immunoglobulins (TSI) is in use. However, there is no sufficient clinical evidence of their role in TED. The purpose of the current study is to evaluate the correlation between TSI and TED activity and to examine if TSI is a predictor for the severity of the disease.

Methods: A retrospective analysis of electronic medical records of all patients who attended TED clinic at Sheba Medical Center, Israel between 2017 and 2022 and had at least one TSI sample was performed. Data included demographics, comprehensive ophthalmic examination, clinical activity scores (CASs), laboratory tests, and quality of life assessment by the Graves' Orbitopathy QOL questionnaire.

Results: 60 patients with 43 females (72%) were included. TSI at presentation correlated with eyelid retraction, IOP (Pearson correlation, 0.369, P< =0.01), and CAS (Pearson correlation, 0.392, P = 0.029). TSI values >500% were found to be significantly correlated with the use of medical treatment including high-dose steroids (P = 0.05), steroid treatment according to the European Group on Graves' Orbitopathy protocol (P = 0.02), and radioactive iodine (P = 0.03). Moreover, it was also significantly correlated with surgical procedures including decompression (P = 0.016) and strabismus surgeries (P = 0.024).

Conclusions: TSI is correlated with more severe clinical presentation and higher likelihood of medical or surgical treatment. Therefore, TSI can be considered as a predictor factor for the disease. Routing testing for TSI may be warranted for all TED patients.

Intumescent white cataracts are challenging because of the high risk of intraoperative complications and poor outcomes. Several techniques have been proposed to mitigate altered lenticular dynamics; however, they require surgical expertise or additional costly devices. Here, we report the safety and outcomes of a recently described bimanual decompression technique. We retrospectively reviewed consecutive cases of intumescent cataract between January 2020 and July 2023. We assessed the rates of intraoperative complications, post-op refractive outcomes, and deviations from predicted values. Fifty-nine patients (mean age, 63 years) underwent this procedure. All the patients underwent planned monofocal single-piece intraocular lens (IOL) without intraoperative complications. The preoperative visual acuity was 20/200 or worse in all patients. Postoperatively, 92% of the patients achieved a visual acuity of 20/60 or better. Predicted refraction accuracy within 0.5 diopters was achieved in 56% of patients, and 90% were within 1 diopters. Automated bimanual decompression is a simple, safe, and cost-effective method for managing intumescent cataracts. This method provides a practical solution to the challenges associated with capsulorhexis formation in these complex cases.