Indian Journal of Ophthalmology最新文献

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.

Surgical skill training in ophthalmology is pivotal for ensuring optimal and safe patient outcomes. Access to traditional training resources such as cadaveric or animal eyes, as well as modern alternatives such as silicone eyeballs and simulators, remains limited, especially in resource-constrained settings. We present a series of innovative and low-cost do-it-yourself (DIY) models for glaucoma training using readily available hospital waste materials. These models allow ophthalmic assistants, fellows, and junior consultants to practice various procedures before transitioning to live patients, thereby enhancing surgical proficiency and minimizing the financial burden on both trainees and training institutions. We were able to practice procedures such as tonometry, central corneal thickness measurement, laser suture lysis, laser iridotomy, anterior chamber decompression, bleb needling, trabeculectomy flap construction, and suturing. By providing a practical and easy training solution, these models have the potential to boost confidence among glaucoma trainees and thus address the growing demand for skilled glaucoma surgeons.

Purpose: To compare the diagnostic ability of macular ganglion cell inner plexiform layer (mGCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thickness on optical coherence tomography (OCT) and macular and peripapillary perfusion changes using OCT angiography (OCTA) in glaucoma suspect and early primary open angle glaucoma (POAG).

Methods: Ninety patients (30 normal, 30 glaucoma suspects, and 30 early POAG) were recruited in this cross-sectional, prospective study. The average thickness of mGCIPL and pRNFL on spectral domain-OCT and macular vessel density (VD), optic nerve head (ONH) perfusion, and ONH flux index (FI) on OCTA were evaluated for early diagnosis of glaucoma.

Results: Macular VD, ONH perfusion, and ONH FI were significantly reduced in early POAG eyes compared to normal. The best correlation was observed between ONH FI and the average RNFL in both glaucoma suspects ( r = 0.47, P < 0.01) and early POAG patients ( r = 0.53, P < 0.01). Out of all the measured OCTA parameters, only ONH perfusion was significantly lower in glaucomatous eyes compared to glaucoma suspects ( P < 0.001). Average GCIPL (0.82) and macular VD (0.76) had the highest area under the receiver operating characteristic (AUROC) curve value among all the OCT and OCTA parameters, respectively, for differentiating glaucoma suspects from controls. Rim area (0.92) and ONH FI (0.81) had the highest AUROC value among all the OCT and OCTA parameters for differentiating early POAG patients from controls.

Conclusion: OCTA vascular parameters had a good correlation with structural damage both at the disc and the macula. OCT parameters were superior to OCTA parameters for diagnosis of glaucoma, although OCTA parameters are deranged very early in the disease.

The success of trabeculectomy surgery depends on the longevity of the filtering bleb. Bleb failure can be categorized into two types: the scarred bleb with high intraocular pressure or the over-filtering and leaking bleb with low intraocular pressure. Bleb scarring is an insidious process over time as a consequence of excessive subconjunctival fibrosis. Timely recognition and early intervention utilizing a stepped-up approach are important for resuscitating the bleb and salvaging the trabeculectomy. Over-filtration and leaky bleb on the other end of the spectrum lead to failure of optimal bleb function and require a different management approach. This review discusses in detail various surgical techniques to revive dysfunctional blebs with a special focus on bleb needling. Timely identification and multifaceted management of bleb-related complications is the key to ultimately improving long-term success rates and patient outcomes.

Sutured scleral fixation of intraocular lenses (SSFIOL) is a stable technique with a low risk of dislocation either from suture dehiscence (suture breakage or loosening) or suture erosion (suture degradation or wear), making it a reliable and durable option for intraocular lenses (IOL) fixation. Dislocation of rigid IOLs is managed conventionally by removing the IOL through a large sclerocorneal section and refixing the same lens or tucking another IOL into the sclera. The procedure described here is a modified ab-externo 4-exit 2-knot technique, wherein the dislocated SSFIOL can be refixated with a closed globe maneuver without removing the entire IOL. The eyelet of the haptic is exteriorized through a small limbal incision, and sutures are replaced at both ends. The IOLs refixated using this technique showed good centration postoperatively. Closed globe refixation of rigid IOLs can be easily performed with minimal or no complications. Minimal tissue handling and early postoperative recovery are advantages over conventional IOL removal and re-surgery.

The role of glaucoma drainage devices (GDDs) for refractory glaucoma is well established because of certain advantages offered over conventional filtering surgeries. However, the correct plane of placement of the GDD tube inside an eye with an opaque cornea can be challenging, due to poor intra-operative visualization. These cases are also challenging if they undergo subsequent corneal grafting. In cases with presence of totally opaque cornea precluding tube visualization within the anterior chamber, we describe a novel technique for ensuring the correct positioning of a GDD tube.

Purpose: To assess the safety and efficacy of non-penetrating deep sclerectomy (NPDS) in advanced open-angle glaucoma patients.

Design: Retrospective observational study.

Methods: Forty-two eyes of 38 patients with advanced glaucoma who underwent NPDS surgery combined with mitomycin-C with or without phacoemulsification were evaluated for up to 12 months at a tertiary eye care center in South India. Patients with intraoperative perforation of the trabeculo-Descemet membrane who did not meet the follow-up criteria were excluded. The primary outcome measured was intraocular pressure (IOP) reduction postoperatively on day 1, week 2, and months 1, 3, 6, and 12. The secondary outcomes measured were the need for antiglaucoma medications (AGMs), postoperative complications, and interventions.

Results: Patients enrolled had a mean age of 61.08 ± 10.2 years. There was a statistically significant reduction ( P < 0.001) of IOP from 29.48 ± 10.89 mmHg (baseline) to 11.58 ± 6.29, 11.90 ± 5.99, 13.60 ± 7.06, 14.03 ± 8.00, 13.94 ± 4.65, and 13.19 ± 3.29 mmHg at day 1, week 2, and months 1, 3, 6, and 12, respectively. The number of AGMs reduced from 3.14 ± 1.03 preoperatively to 1.85 ± 0.83 at 12 months postoperatively ( P < 0.001). Nd: YAG laser goniopuncture was done in 21.4%, bleb needling in 11.9%, and one patient underwent 260° trabeculotomy after NPDS. There were no cases of choroidal detachment or wipeout.

Conclusion: NPDS with or without phacoemulsification has good safety for managing advanced open-angle glaucoma.