Indian Journal of Ophthalmology最新文献

The scope of eye banking activities has been expanding with the advances and techniques of keratoplasty. With the popularity of descemet membrane endothelial keratoplasty (DMEK) in the recent decade, there is a need to adopt the preparation of DMEK tissues in the eye banks. This necessitated surgical training of the eye bank technicians, development of infrastructure in the eye bank, innovative methods of graft preparation, and delivery for the surgery at distant surgery centers. Eye banks across various countries have devised and adopted different methods of providing DMEK grafts based on the demands and preferences of corneal surgeons. This review focuses on the strategies of DMEK graft preparation and its distribution at the eye banks.

Purpose: To evaluate the outcome and ocular adverse events of bedside bilateral sequential intravitreal anti-vascular endothelial growth factor injections for retinopathy of prematurity (ROP) (BBSIR).

Methods: This retrospective interventional study included infants who received BBSIR with a follow-up of at least 1 month. Clinical history, intravitreal injection details, indications, intraoperative and postoperative ocular adverse events, and outcomes were analyzed.

Results: The study cohort included 192 babies (384 eyes) spread over 9 years. The mean gestational age was 30.2 ± 2.6 weeks (28.8-34.1), and the birth weight was 1098.11 ± 271.65 g (650-2000). The indications for BBSIR were as follows: 73.4% (n = 141 infants) were too sick to transfer to an ophthalmic unit, 10.9% (n = 21 infants) due to the parents' inconvenience of traveling to the ophthalmic center, and 15. 6% (n = 30 infants) due to both reasons. The injections were given by an ROP specialist/ROP-trained ophthalmologist after due parental consent, considering each eye as a fresh eye with separate scrubbing and draping. Light from the head-worn indirect ophthalmoscope served as the source of illumination. The retinopathy was regressing/regressed in 92.4% of babies until the last follow-up. The major ocular complication was cataract in 2 eyes (0.5%). There was no incidence of endophthalmitis till last follow-up (median 5.7 months).

Conclusions: As per this study, BBSIR was observed to be effective and safe if given by those fully trained in the management of ROP. Though the rate of complications like cataract is small, they can pose management challenges and impact vision in a growing child.

Purpose: To compare the incidence, type, interval for reactivation, and structural outcomes in infants with aggressive retinopathy of prematurity (A-ROP) treated with ranibizumab or bevacizumab.

Method: It is a single-center, retrospective, consecutive, case series. We included infants with A-ROP which were initially treated with either intravitreal ranibizumab (IVR, 0.25 mg) or intravitreal bevacizumab (IVB, 0.625 mg) between January 2017 and December 2023. The infants were followed up for reactivation. The demographic and clinical data were collected. The time, zone, type of reactivation, its treatment, type of final structural outcome, and factors associated with reactivation were analyzed.

Results: One hundred eight among the 322 infants with A-ROP were included in the study. Fifty-five received IVR, while 53 received IVB. Infants treated with IVR had higher incidence of reactivation (92.7% vs 52.8%, P < 0.001) at an earlier interval than IVB (7.7 weeks vs 12.8 weeks, P < 0.001). Infants treated with IVR had approximately 3.3 times higher possibility of reactivation than those treated with IVB. Three infants (5.9%) in the IVR group and five (9.4%) in the IVB group attained complete vascularization of the retina ( P = 0.72). More infants treated with IVB had regression with a persistent avascular retina (PAR) than IVR (52.8% vs 15.7%, P < 0.001). Infants in the IVB group had 10 times higher possibility of regression with PAR.

Conclusion: Infants of A-ROP treated with IVR have a higher incidence and earlier reactivation, while those treated with IVB have less incidence and delayed reactivation, albeit with a higher possibility of regression with a PAR.

Purpose: The purpose of the study was to compare the choroidal thickness (CT) in pre-eclamptic (PE), healthy pregnant, and age-matched healthy non-pregnant females by spectral-domain optical coherence tomography (SD-OCT) and to investigate any possible correlation between subfoveal CT (SFCT) and mean arterial pressure (MAP) in PE.

Methods: This was a hospital-based, comparative study. A total of 90 females (30 in each group) aged 20-40 years were recruited prospectively over 1 year. Females with refractive error beyond ±3 D, intraocular pressure >21 mmHg, prior ocular trauma or surgeries, systemic diseases, pregnancy-related complications (except PE), and poor OCT scans were excluded. Following comprehensive ophthalmic evaluation, CT was measured bilaterally using SD-OCT (EDI) at the subfoveal region and at 1500 µm nasal and temporal to fovea. Systolic and diastolic blood pressures were recorded in all.

Results: The PE group had significantly thinner choroid (SFCT: 337.5 ± 49.8 OD, 333.0 ± 50.8 OS) as compared to the healthy non-pregnant group (SFCT: 351.6 ± 34.4 OD, 365.3 ± 33.6 OS) and healthy pregnant group (SFCT: 374.2 ± 44.1 OD, 377.2 ± 49.5 OS) ( P < 0.05) in all locations (nasal, temporal, and subfoveal) in both eyes (except for OD nasal CT). However, there was no significant correlation between SFCT and MAP in the PE group.

Conclusion: Significantly lower CT in PE without any direct correlation between SFCT and MAP may implicate that choroidal thinning in PE is governed by multifactorial choroidal vasospasm and endothelial dysfunction, instead of MAP solely.

Purpose: To compare the visual outcomes of implantable Collamer lens (ICL) with small incision lenticule extraction (SMILE) in cases of moderate-high myopia.

Methods: A prospective comparative study was conducted on 60 eyes of 30 patients with moderate-high myopia (-3D to -8D with astigmatism ≤1 D) at a tertiary eye care center. Patients underwent either SMILE or ICL in both eyes and had a postoperative follow-up of 1 year.

Results: The manifest refractive spherical equivalent was -5.22 ± 1.05 D and -5.4 ± 1.17 D in the SMILE and ICL groups, respectively ( P = 0.53). The mean sphere and cylinder were comparable between the groups. The mean uncorrected visual acuity improved from 1.18 ± 0.19 logMAR to 0.03 ± 0.07 logMAR in SMILE and 1.14 ± 0.25 logMAR to 0.011 ± 0.04 logMAR in the ICL group. The efficacy for SMILE was 83.3% and that for ICL was 93.3%. Safety and predictability (±0.5D) for both was 100%. A significant increase was observed in ocular aberration with a decrease in modular transfer function in the eyes that underwent SMILE, whereas no significant change in the eyes that underwent ICL. A significant difference was observed in all parameters of ocular aberration except corneal trefoil, corneal astigmatism, and PSF between the two groups at the final follow-up. The contrast sensitivity at final follow-up was higher in ICL cases when compared to SMILE. The quality of vision (QoV) score suggested a better QoV with ICL; however, the difference was not statistically significant.

Conclusion: Both SMILE and ICL are safe in patients with moderate-high myopia. The efficacy, contrast sensitivity, and postoperative ocular aberration profile are better in cases undergoing ICL.

Purpose: To describe the role of wavefront-guided pupilloplasty in improving visual quality and wavefront parameters in post-keratoplasty patients with pathologically irregular, mydriatic pupils.

Methods: A total of 13 eyes of post-penetrating keratoplasty patients with pathologically irregular mydriatic pupil were included in this prospective interventional study. Preoperative wavefront analysis was done with the actual pupil size, and predicted wavefront values were analyzed by setting the postoperative pupil size to 2 mm. Patients showing significant improvement between preoperative and predicted postoperative wavefront values underwent single-pass four-throw pupilloplasty, and all wavefront parameters were again evaluated after 1 week. Preoperative and postoperative best corrected visual acuity (BCVA), pupil size, and wavefront parameters were analyzed.

Results: Mean BCVA improved from a preoperative value of 1.03 ± 0.32 log of minimum angle of resolution (logMAR) units to 0.24 ± 0.09 logMAR units. Mean preoperative pupil size was 6.077 ± 0.787 mm, whereas the achieved postoperative pupil size after pupilloplasty was 2.538 ± 0.139 mm. Mean astigmatism root mean square (RMS) value improved from 4.169 ± 3.876 to 0.875 ± 0.926 µm ( P < 0.05), and mean coma value changed from 1.525 ± 1.962 to 0.128 ± 0.152 µm ( P < 0.05). Mean point spread function Stehl ratio value improved from 0.056 ± 0.032 to 0.223 ± 0.102. Mean RMS (optical path difference) value changed from 6.248 ± 4.721 to 0.943 ± 0.947 µm ( P < 0.001), Mean RMS (high orders) value changed from 3.788 ± 3.537 to 0.328 ± 0.256 µm ( P value 0.003), and the mean spherical aberration value changed from 0.646 ± 0.873 to 0.223 ± 0.102 µm ( P value 0.024). All postoperative wavefront parameters showed statistically significant improvement from the preoperative parameters.

Conclusion: Wavefront-guided pupilloplasty can predict and improve wavefront parameters and visual quality in post-keratoplasty patients with pathologically irregular mydriatic pupils.

Large iris defects are challenging to close due to shortage of tissue and opposite vector force. By using two pupilloplasty methods, we can close large iris defects with less tractional force or tethering. The trifold technique is a combination of trocar-assisted iris repair and single-pass four-throw (SFT) pupilloplasty for non-appositional large iris defects. The initial two trocar-assisted iris repair sutures oppose the unopposed iris ends and the subsequent SFT seals the defect. The combination procedure is less manipulative with no complications for the iris and pupil diaphragm.