Comparative evaluation of biomechanical changes and aberration profile following accelerated collagen cross-linking using hypo-osmolar and iso-osmolar riboflavin: A prospective study

PURPOSE

To compare the changes encountered in corneal biomechanics and aberration profile following accelerated corneal collagen cross-linking (CXL) using hypo-osmolar and iso-osmolar riboflavin in corneal thicknesses of <400 and >400 microns, respectively.

METHODS

This is a prospective, interventional, comparative study involving 100 eyes of 75 patients with progressive keratoconus. Eyes were divided into two groups based on corneal thickness: group 1 included eyes with a corneal thickness of <400 microns who underwent hypo-osmolar CXL, and group 2 included eyes with a corneal thickness of >400 microns who underwent iso-osmolar CXL. Corneal biomechanical and aberration profiles were evaluated and compared between groups.

RESULTS

In group 1, all higher-order aberrations (HOA) except secondary astigmatism significantly decreased from baseline; however, in group 2, only coma and trefoil decreased. The corneal resistance factor and corneal hysteresis significantly improved in both groups, which was significantly greater in group 2 than in group 1. The change in inverse radius, deformation amplitude, and tomographic biomechanical index was significantly improved in group 2 as compared to group 1.

CONCLUSION

Improvement in corrected distance visual acuity and decrease in HOA were significantly better in the hypo-osmolar CXL group; however, the improvement in biomechanical strength of the cornea was significantly better in the iso-osmolar group.

Comparative Evaluation of Topographic Parameters Using Three Different Topographers in Keratoconic and Cross-linked Keratoconic Corneas

PURPOSE

To compare the parameters of three different topographic devices (Pentacam HR, Oculus Optikgeräte GmbH; Sirius, Costruzione Strumenti Oftalmici; and Cassini, i-Optics) in grading the severity of keratoconus in cross-linked and non-cross-linked eyes.

METHODS

This was a prospective comparative interventional study done in a tertiary eye care center, wherein 114 eyes of 68 patients with keratoconus were divided into two groups: 62 eyes that were observed and 52 eyes that were cross-linked. All eyes were evaluated on all three topographers at baseline, 3-month follow-up, and 6-month follow-up.

RESULTS

The Sirius showed significantly lower values of mean flat keratometry in comparison to the Pentacam HR (limits of agreement [LoA]: 1.75 to 3.51%) and Cassini (LoA: 1.75 to 3.51%). The mean steep keratometry values were higher for the Cassini in comparison to the Pentacam HR (LoA: 4.39 to 7.02%) and Sirius (LoA: 3.51 to 6.14%). The mean steep keratometry values of the Sirius were significantly lower than those of the Pentacam HR and in both the cross-linked and observation groups (LoA: 3.51 to 6.14%). The mean keratometry values were significantly higher in the Cassini compared to the Pentacam HR (LoA: 3.51 to 8.77%) and significantly lower in the Sirius in comparison to the Pentacam HR (LoA: 3.51 to 6.14%). The mean difference in astigmatism was also statistically significant between the three tomographers in both groups, with the Cassini showing higher values (LoA: 3.51 to 5.26%) and the Sirius lower values than the Pentacam HR (LoA: 5.26 to 6.14%).

CONCLUSIONS

The authors conclude the three devices cannot be used interchangeably. The Cassini showed better agreement and correlation with the Pentacam HR in the staging of keratoconus, whereas the Sirius tended to underdiagnose and under-stage the disease. [J Refract Surg. 2024;40(4):e260-e269.].

Vaccination coverage against COVID-19 among rural population in Haryana, India: A cross-sectional study

BACKGROUND

Conducting a study in rural pre-dominant areas will help to understand the penetration of the vaccination campaign during the COVID-19 health crisis. This study aimed to investigate vaccination coverage against COVID-19 among the rural adult population in India and to identify factors associated with vaccination coverage.

METHODS

A population-based cross-sectional study was conducted among the rural population in one district of north India from January to February 2023. A semi-structured questionnaire was designed on the SurveyMonkey digital platform for interviewing the participants, which consisted of questions related to socio-demographic profile, health problems, vaccination status, types of vaccine, re-infection after vaccination, and functional difficulties. The data regarding infection with COVID-19 was collected based on self-reported positive testing for SARS-CoV 2 on RT-PCR.

FINDINGS

A total of 3700 eligible individuals were enumerated for the survey, out of which 2954 (79.8%) were interviewed. The infection rate of past COVID-19 infection, based on self-report of testing positive, was 6.2% (95%CI: 5.3-7.1). Covishield vaccine was received by most participants (81.3%, 2380) followed by Covaxin (12.3%, 361) and Pfizer manufactured vaccine (0.03,1). The coverage for first, second, and booster doses of the vaccine was 98.2% (2902), 94.8% (2802), and 10.7% (315) respectively. The risk of reinfection at 12 months or more among participants with two doses of vaccine was 1.6% (46/2802, 95%CI: 1.2-2.1). The coverage among those with severe functional difficulties was lesser as compared to those with some or no difficulties.

INTERPRETATION

Vaccination coverage against COVID-19 in rural Haryana, India is not dependent on factors like gender or occupation but is dependent on age and education. Although the full and partial vaccination coverage is high, the booster dose coverage is poor. In addition, the presence of severe disability was significantly associated with reduced vaccination coverage.

Retinol palmitate in management of chronic Steven-Johnson Syndrome with ocular surface keratinization

PURPOSE

To study the outcomes of topical Retinol Palmitate ophthalmic solution in chronic Stevens-Johnson Syndrome with ocular surface keratinisation.

METHODS

It was a comparative interventional study conducted at Rajendra Prasad Centre for Ophthalmic Sciences, Delhi, India from 2020 to 2022 evaluating outcomes of addition of topical Retinol Palmitate to conventional treatment objectively as well as subjectively from baseline up to 12 weeks.

RESULTS

A statistically significant improvement was seen in patients who received topical Retinol palmitate at 12 weeks in terms of Schirmer-1 test(p=<0.01), tear prism height on ASOCT(p = 0.02), Rose Bengal staining score of cornea(p = 0.01) and conjunctiva (p < 0.01), reduction of ocular surface keratinisation on impression cytology(p = 0.01) and subjective evaluation using OSDI questionnaire(p = 0.04).Impression cytology revealed goblet cells in Retinol palmitate group at 1 week after initiation of therapy, which increased further at 1 month follow up but reduced at 3 months. No goblet cells were seen in control group at any follow-up. No significant difference was noted between the two groups in terms of visual acuity, tear film breakup time, inflammatory cells on impression cytology and inflammatory markers in tears.

CONCLUSION

Topical Retinol palmitate is a safe and effective drug in cases of chronic SJS with ocular surface keratinisation. It has the potential to reverse keratinisation of the ocular surface and promote development of goblet cells. However, the survival of goblet cells is not long lasting.

Assistive technology usage, unmet needs and barriers to access: a sub-population-based study in India

Background

Assistive technology (AT) is essential to minimize functional limitations. The current study aimed to estimate the prevalence of needs, met and unmet needs for AT, and barriers to accessing AT among a subnational population in India.

Methods

This cross-sectional study was conducted in eight districts, representing four zones of India, using the WHO Rapid Assistive Technology Assessment (rATA) tool. The tool was administered by trained staff using read aloud technique. Multi-stage cluster random sampling was used, as well as the probability proportional to size, to select smaller administrative units from the larger ones.

Findings

In total, 8486 participants were surveyed out of 8964 individuals enumerated with a response rate of 94.6%. The sample prevalence of at least one difficulty was 31.8% (2700), with 6.3% (532) having severe or total difficulties. The sample prevalence for AT need was 27.8% (2357) with an estimated population prevalence of 24.5% (95% CI: 23.5-25.4). Similarly, the sample prevalence of unmet needs was 9.7% (823) with an estimated population unmet needs of 8.0% (95% CI: 7.43-8.60). The unmet needs among persons with severe or total difficulties was 52.3% (278/532), and was higher among females, rural residents, and older persons. Spectacles were the most used products, followed by canes/sticks, tripods, and quadripods. Nearly two-thirds of AT users purchased assistive products at their own expense, particularly from the private sector. The inability to afford AT (36.9%) was the most common barrier.

Interpretation

The results show that the need for AT was substantial in the study population, the highest being for seeing difficulties. The unmet needs are higher in females, older population, rural residents, and persons having serious difficulties. While the majority of users have to make out-of-pocket payments to obtain AT, inability to afford and limited availability were the common barriers among those with unmet needs.

Funding

This research is non-commercial, and was conducted in the interest of public health. The authors have not declared any specific grant for this research.

Impact of Topical Cyclosporine-A or Topical Chloroquine on Post-LASIK Ocular Surface Stability - A Randomized Controlled Trial

PURPOSE

To compare effect of topical cyclosporine-A 0.05% (CsA) and chloroquine phosphate 0.03% (CHQ) as an adjunct to standard therapy in maintaining post-laser assisted in situ keratomileusis (LASIK) ocular surface stability.

METHODS

Randomized controlled trial on 100 eyes undergoing femtosecond-LASIK randomized into three groups: 33 eyes in Group I (Standard Treatment group), 34 eyes in Group II (CsA group) and 33 eyes in Group III (CHQ group). Standard treatment included topical moxifloxacin, topical prednisolone and carboxymethyl cellulose. Group II received topical CsA 0.05% twice daily for three months and group III received topical CHQ 0.03% twice daily for three months in addition to standard treatment. Primary outcome measure was change in ocular surface disease index (OSDI) at 6 months. Secondary outcome measures were tear break up time (TBUT), Schirmer-I score, tear film osmolarity, tear film MMP-9 and visual acuity. Follow-up was performed at postoperative 1, 3 and 6 months.

RESULTS

At 6 months, OSDI score, MMP-9, tear osmolarity, TBUT and Schirmer score were significantly better in both CsA and CHQ groups as compared with controls (p < 0.001). OSDI, Tear osmolarity, TBUT, MMP-9 levels were comparable in CsA and CHQ group (p > 0.05). In CsA group, tear film MMP-9 levels at 6 months were comparable to preoperative baseline (p = 0.09). There was no significant change in the Schirmer score from baseline in the CsA group; in addition, the Schirmer score was significantly better than the CHQ group at 6 months (p = 0.02). Visual acuity was comparable in all three groups. Adverse effects including burning sensation, stinging, pain and redness were reported by ten patients (CsA group- 3, CHQ group-7; p = 0.28).

CONCLUSION

Both CsA and CHQ are useful adjuncts to standard therapy in maintaining ocular surface stability after refractive surgery. Cyclosporine A has more potent and sustained anti-inflammatory effect with less ocular irritative effects.

Improving assistive technology access to students with low vision and blindness in Delhi: A school-based model

Purpose

Assistive technology (AT) has recently received considerable attention around the world. Studies have shown poor access to assistive technology for visual impairment (ATVI) in schools for the blind in India. The present article aimed at designing a school-based model to improve AT access in schools and provide hands-on training, and identify types of ocular morbidities present among students.

Methods

The vision rehabilitation (VR) team of a tertiary eye-care center visited schools for the blind as a part of community-based VR services. The team conducted a basic eye examination and assessed best-corrected vision acuity (BCVA) and provided VR services. Furthermore, two schools were selected to establish an ATVI learning center as a pilot model.

Results

In total, 1887 students were registered for VR and obtained their disability certificates in 2019-20. Retina problems (25.7%), globe abnormalities (25.5%), optic nerve atrophy (13.6%), and squint (12.0%) were common ocular problems identified in students. Around 50.3% of students had BCVA³ 1/60 in the better eye who would be benefited from visual-based AT, and the remaining students with visual substitution AT. Further, 20.8% of them who had near vision between N18 to N24 would be benefitted from large print books. Two schools were provided ATVI with support from the WHO. Familiarization, demonstration, and initial training for ATVI were carried out.

Conclusion

A sizable number of the students would be benefitted from visual-based AT apart from visual substitutions AT. Students were interested to have such ATVI centers in the school for academic and non-academic skills development.

Intraoperative optical coherence tomography-guided donor corneal tissue assessment and preparation

Purpose

To evaluate the role of intraoperative optical coherence tomography (i-OCT) in donor grading, selection, and preparation during different types of keratoplasty.

Methods

Seventy-one consecutive donor corneas collected over 6 months, after clinical grading, were observed by an experienced corneal surgeon under an i-OCT equipped microscope. The donor preparation (manual/automated) for different types of keratoplasty procedures was also undertaken under i-OCT.

Results

The mean central corneal thickness of optical and nonoptical grade tissues was 533 ± 19 and 662 ± 52 μm, respectively. The i-OCT-based grading matched with clinical grading in 98.5% cases. Irregular thickness, anterior stromal hyperreflectivity, and previous scars were appreciated in 1.4, 1.4, and 7.04% donors, respectively. During Descemet stripping automated endothelial keratoplasty, i-OCT facilitated selection of appropriate microkeratome head for automated donor preparation in all cases, besides allowing manual dissection of partially dissected lenticule, identification of site of inadvertent perforation, and eccentric trephination in one case each. During Descemet membrane endothelial keratoplasty, i-OCT-based assessment of preexisting scar (five cases) guided careful tissue selection (2/5) and preparation. During predescemetic endothelial keratoplasty, precise needle advancement allowed successful type-1 bubble formation in all cases. All manually punched donors demonstrated an extra endothelial ledge, while those with automated preparation showed tapering donor margins.

Conclusion

i-OCT might serve as a useful imaging tool for objective assessment of donor characteristics. The modality may complement clinical evaluation for donor grading, selection, and preparation.

Management of descemetocele: Our experience and a simplified treatment algorithm

Purpose:

To formulate a treatment algorithm for the management of descemetocele.

Methods:

This was a prospective interventional study that was conducted at a tertiary eye-care center. All consecutive cases of descemetocele during the study period (April 1, 2017–March 31, 2018) were evaluated for the following parameters: age, sex, previous medical or surgical therapy, risk factors, preexisting ocular diseases, location, site and size of descemetocele, interventions undertaken, visual acuity, and the fellow eye status. The surgical modalities and fellow eye status were correlated individually with therapeutic and functional outcomes, based on which a treatment algorithm was formulated.

Results:

The study included 24 eyes of 24 patients (19M, 5F) with a median age of presentation of 45 years. The mean follow-up duration was 6.79 ± 3.97 months (3–12 months). The most common cause of descemetocele was microbial keratitis (66.66%), and most cases were central (50%), small (58.33%), and non-perforated (79.16%). The surgical interventions undertaken were cyanoacrylate glue (CG, 37.5%), penetrating keratoplasty (PKP, 33.33%), patch graft (16.66%), and deep anterior lamellar keratoplasty (DALK, 12.5%). Therapeutic success was noted in 13/24 eyes (54.16%). Final visual acuity > 3/60 was seen in 25% cases. Suboptimal therapeutic (P = 0.07) and visual (P = 0.34) outcomes were noted in subjects with non-functional fellow eye.

Conclusion:

PKP was preferred for descemetoceles with active microbial keratitis and extensive infiltrates, while CG and DALK were undertaken for healed microbial keratitis, neurotrophic keratitis, and ocular surface disorders with partial limbal stem cell deficiency (LSCD). For total LSCD, amniotic membrane graft was preferred.

Preserving posterior capsular integrity in post-endothelial keratoplasty posterior capsular opacification

Endothelial keratoplasty (EK) with pseudophakia often presents with late-onset proliferative after-cataract with posterior capsule distension. We performed a modified technique of capsular bag lavage in 11 eyes with late-onset PCO after EK (4 cases: post-DSAEK, 7 cases: post-DMEK). Anterior capsular rim was separated from the underlying IOL optic using MVR blade. Circumferential relaxing radial nicks were made on the capsular rim to create space for the passage of irrigation-aspiration (IA) probes behind the IOL. Bimanual IA of the flocculent cortical material was performed without damaging the posterior capsule. Air was injected at end of surgery to ensure graft apposition. All cases gained 1-3 lines of Snellen’s acuity and no case developed graft failure, rejection, or endothelial decompensation. An intact posterior capsule is associated with better outcomes post a repeat graft, if required. Our technique helps avoid complications related to a disturbed anterior hyaloid phase and minimizes postoperative inflammation.

Determination of surgical outcomes with a novel formulation of intrastromal natamycin in recalcitrant fungal keratitis: A pilot study

Purpose:

To evaluate the outcomes of water-soluble intrastromal natamycin (IS-NTM) as an adjunct therapy for recalcitrant fungal keratitis.

Methods:

This was a prospective interventional pilot study in the setting of a tertiary eye-care center. Twenty eyes of 20 consecutive patients with microbiologically proven recalcitrant fungal keratitis (ulcer size >2 mm, depth >50%, and not responding to topical NTM for 2 weeks) were recruited. The selected patients were injected with a novel composition of IS-NTM (10 ug/0.1 mL, soluble natamycin) prepared aseptically in the ocular pharmacology department. All the patients continued using topical NTM suspension 5% 4-hourly until the ulcer healed. Repeat injections were undertaken after 72 h depending on the clinical response and all the patients were followed till 6 months.

Results:

The mean age of the patients was 40.42 ± 10.09 years. The mean duration of the presentation was 20.8 ± 5.1 days. The most commonly isolated organisms were Aspergillus sp. (12/20, 60%) and Fusariumsp. (8/20, 40%). No patient had iatrogenic perforation or precipitate formation after IS-NTM injection. The overall cure rate with IS-NTM was 95% (19/20 patients). The number of patients who healed with the 1^st, 2^nd, and 3^rd injection was 13, 5, and 1, respectively. One (5%) had no response to treatment and was subjected to penetrating keratoplasty. The average time taken for the resolution of the epithelial defect, stromal infiltrates, and hypopyon was 34 ± 5.2 days, 35.3 ± 6.4 days, and 15 ± 2.5 days. Healing with deep vascularization and cataract was noted in 6/19 eyes (31%) and 13/19 eyes (68.42%), respectively.

Conclusion:

Intrastromal injection of a novel formulation of NTM holds a promising role as adjunctive therapy to topical NTM in the management of recalcitrant filamentous fungal keratitis. The preliminary results are encouraging and further studies are required to validate the results.

Novel technique of tetra trephination for elliptical-shaped tectonic patch grafts in peripheral sterile keratolysis

PURPOSE

To describe a novel technique of tectonic patch grafts for elliptical-shaped peripheral sterile keratolysis with iris prolapse.

METHODS

We performed a full thickness corneo-scleral patch graft in five eyes of five patients with elliptical-shaped peripheral sterile keratolysis with perforation and iris tissue prolapse. In this technique, four disposable trephines with predetermined diameter were employed to fashion both the host and the donor without any free-hand dissection. An intact anatomical integrity of the globe without the need for any repeat tectonic measures was considered as a successful outcome.

RESULTS

The mean age was 34.2 ± 10.2 years (18-45). The mean total surgical time and donor preparation time was 94.4 ± 7.12 min and 7.6 ± 1.14 min, respectively. The intraoperative course was uneventful in all cases and all eyes had a well-maintained corneal integrity till 6 months follow up.

CONCLUSION

We describe a simple, reproducible, and time-saving technique of performing elliptical shaped corneoscleral patch grafts for peripheral corneal perforations with iris prolapse.

Role of Microscope-Intraoperative Optical Coherence Tomography in Pediatric Keratoplasty: AComparative Study

PURPOSE

We evaluate the role of microscope-integrated intraoperative optical coherence tomography (i-OCT) in pediatric keratoplasty.

DESIGN

Combined prospective and retrospective, comparative, interventional study conducted at the Dr Rajendra Prasad Center for Ophthalmic Sciences in New Dehli, India.

METHODS

Seventy-five children ≤16 years of age undergoing planned keratoplasty were divided into 2 groups and compared regarding intraoperative course and postoperative outcome. In group 1 (prospective group, n = 56), preoperative anterior segment visualization was performed clinically, with ultrasound biomicroscopy (UBM) and i-OCT and keratoplasty was commenced under i-OCT microscope. In group 2 (retrospective group, n = 19), a conventional microscope was used during keratoplasty.

RESULTS

In group 1, i-OCT, UBM, and clinical examination detected retrocorneal membrane in 10%, 7.5%, and 5% (P = .005), iris adhesions in 62.5%, 57.5%, and 20% (P = .02), iris stump in aniridia 15%, 10%, and 0% (P = .001), shallow central anterior chamber in 22.5%, 22.5%, and 7.5% (P = .003), and shallow peripheral anterior chamber in 65%, 60%, and 17.5% (P = .004) of children, respectively. The use of i-OCT affected intraoperative surgeon decision making in 45% and 33% of cases of anterior and posterior lamellar keratoplasty, respectively. During penetrating keratoplasty, concomitant intraoperative procedures were higher in group 1 than in group 2, namely synechiolysis (19/40 vs 2/15; P = .1), pupilloplasty (4/40 vs 0/15; P = .02), lens extraction (4/40 vs 1/15; P = .5), and anterior vitrectomy (2/40 vs 1/15; P = .4). Postoperative secondary interventions were lower (P = .04) in group 1 (48.21% vs 94.74%).

CONCLUSIONS

Anterior segment imaging with i-OCT and UBM immediately before surgery improves the surgical planning of children with corneal opacities. In addition, the use of i-OCT refines intraoperative steps, thereby optimizing the postoperative outcome of pediatric keratoplasty.

Complications of small incision lenticule extraction

The procedure of small incision lenticule extraction (SMILE) was introduced in 2011, and since then there has been an increase in the number of cases undergoing this procedure worldwide. The surgery has a learning curve and may be associated with problems in the intraoperative and postoperative periods. The intraoperative problems during SMILE surgery include the loss of suction, the occurrence of altered or irregular opaque bubble layer and black spots, difficulty in lenticular dissection and extraction, cap perforation, incision-related problems, and decentered ablation. Most of the postoperative problems are similar as in other laser refractive procedures, but with decreased incidence. The identification of risk factors, clinical features, and management of complications of SMILE help to obtain optimum refractive outcomes.

Femtosecond laser-assisted refractive capsulorhexis - Precise capsulotomy with accurate toric intraocular lens alignment

Femtosecond laser-assisted cataract surgery with refractive capsulorhexis and toric intraocular lens (IOL) implantation was performed in 14 eyes with senile cataract and a preexisting regular corneal astigmatism of 1.5 D or more. Intraoperatively, the accuracy of the capsular rim marks was confirmed using the digital overlay of CALLISTO Eye and Z Align (Carl Zeiss Meditec, Germany). Postoperatively, the mean deviation from target axis of implantation was 2.07° ± 1.49°. Refractive capsulorhexis combines the advantages of a femtosecond laser capsulotomy with a one-step visual guide for intraoperative toric IOL alignment as well as postoperative assessment of rotational stability.

A new normal with cataract surgery during COVID-19 pandemic

Cataract is the second leading cause of preventable blindness on the globe. Several programs across the country have been running efficiently to increase the cataract surgical rates and decrease blindness due to cataract. The current COVID-19 pandemic has led to a complete halt of these programs and thus accumulating all the elective cataract procedures. At present with the better understanding of the safety precautions among the health care workers and general population the Government of India (GoI) has given clearance for functioning of eye care facilities. In order to facilitate smooth functioning of every clinic, in this paper, we prepared preferred practice pattern based on consensus discussions between leading ophthalmologists in India including representatives from major governmental and private institutions as well as the All India Ophthalmological Society leadership. These guidelines will be applicable to all practice settings including tertiary institutions, corporate and group practices and individual eye clinics. The guidelines include triage, use of personal protective equipment, precautions to be taken in the OPD and operating room as well for elective cataract screening and surgery. These guidelines have been prepared based on current situation but are expected to evolve over a period of time based on the ongoing pandemic and guidelines from GoI.

All India Ophthalmological Society - Eye Bank Association of India consensus statement on guidelines for cornea and eyebanking during COVID-19 era

The COVID-19 pandemic has brought with it the huge burden of mortality and morbidity across the world and the added effects of the mandatory lockdown measures to try and control the spread. A number of aspects of healthcare including eye donation and eye collection require adequate safety precautions in place to keep both the involved healthcare workers and patients safe. This paper highlights the consensus-based guidelines by an expert panel on how to restart eye banking and eye collection services and carry out emergency corneal surgeries during this COVID-19 time. These guidelines will be applicable to all eye banks across the country and should help ophthalmologists and eye banking staff to restart eye banking while safeguarding themselves and their patients.

Microkeratome-assisted ultrathin Descemet's stripping automated endothelial keratoplasty: A randomized trial comparing single-pass versus double-pass technique

Purpose:

To compare the outcomes of two techniques, for preparation of microkeratome-assisted ultrathin grafts for Descemet's stripping automated endothelial keratoplasty (DSAEK).

Methods:

The study involved 20 eyes of 20 patients with pseudophakic bullous keratopathy, randomized into two groups. Group 1 eyes underwent microkeratome-assisted DSAEK using the single-pass technique for lenticule preparation, whereas group 2 eyes underwent microkeratome-assisted DSAEK using the double-pass technique. Patients were followed up till 6 months, postoperatively. Best-corrected visual acuity (BCVA) at final follow-up was considered as the primary outcome measure, whereas graft thickness (GT) contrast sensitivity and endothelial cell loss were considered as the secondary outcome measures. A P value of <0.05 was considered as statistically significant.

Results:

Baseline characteristics of two groups were comparable. The mean central GT was comparable in both groups at 6 months follow-up [group 1: 98 ± 24.46 μm, group 2: 129 ± 31.46 μm (P = 0.18)]. Both groups fared equally in terms of BCVA (P = 0.33). Contrast sensitivity was significantly better in group 1 eyes (P = 0.045). A statistically significant negative correlation was found between postoperative BCVA and postoperative GT (R = −0.728, P = 0.016). The percentage endothelial cell loss was slightly higher in group 2 eyes, although not statistically significant. Two eyes in group 2 experienced complications during lenticule preparation. None of the eye experienced any complication in the postoperative period.

Conclusion:

Both techniques provided grafts with comparable thickness and endothelial cell loss and were associated with comparable BCVA, at final follow-up visit. The contrast sensitivity was, however, better in eyes receiving grafts prepared with the single-pass technique.

Management of late-onset flocculent after-cataract with capsular bag lavage and posterior continuous curvilinear capsulorhexis

We describe our technique for the management of late-onset liquefied after-cataract (LAC) to ensure long-term visual axis clarity. The densely adherent anterior capsular rim over the intraocular lens (IOL) optic was released with the help of microvitreoretinal blade, and multiple relaxing radial incisions were made on the capsular rim to facilitate easy access to the capsular bag. A thorough capsular bag lavage was performed with the help of bimanual irrigation-aspiration. Posterior continuous curvilinear capsulorhexis (PCCC) was performed after complete aspiration of fluid after-cataract to prevent recurrence. This technique was successfully performed in 14 cases. Postoperatively, IOL was stable and an uncorrected distance visual acuity of >20/32 was achieved in all cases. No recurrence was observed in any case over a follow-up of 1 year. Our technique of capsular bag lavage with PCCC is safe and effective for the management of LAC with optimal visual and anatomical outcomes.

Prevalence and risk factors of dry eye disease in North India: Ocular surface disease index-based cross-sectional hospital study

Purpose:

This study aims to study the prevalence of DED and analyze risk factors in North Indian population.

Methods:

This was a cross-section hospital-based, observational study. Cases enrolled over 2 years (systematic random sampling) were administered ocular surface disease index questionnaire to evaluate the prevalence and risk factors of DED. Schirmer's test and tear break-up time were performed only in the subset of patients giving consent. Categorical data were assessed with Chi-square/Fisher's Exact test, and odds ratio was analyzed using bivariate and multivariate logistic regression. P < 0.05 was statistically significant.

Results:

A total of 15,625 patients were screened. The prevalence of DED was 32% (5000/15625); 9.9% (496/5000) had mild DED; 61.2% (3060/5000) had moderate DED; and 28.9% (1444/5000) had severe DED. Age group of 21–40 years, male sex, urban region, and desk job were associated with increased risk of DED. Hours of visual display terminal (VDT) usage significantly correlated with DED (P < 0.001), and 89.98% of patients with 4 h or more of VDT use had severe dry eye. Cigarette smoking and contact lens usage had increased odds of developing severe DED (P < 0.001). Objective tests were undertaken in 552 patients; of these, 81.3% (449/552) had severe DED.

Conclusions:

The prevalence of DED in North India is 32%, with the age group of 21–40 years affected most commonly. VDT use, smoking, and contact lens use were associated with increased odds of developing DED.

Tear inflammatory mediators and protein in eyes of post allogenic hematopoeitic stem cell transplant patients

AIM

To analyze tear cytokines levels and their correlation to ocular surface parameters in allogenic hematopoietic stem cell transplants (allo-HSCT) patients.

METHODS

Prospective longitudinal study of allo-HSCT patients and controls for ocular surface evaluation (OSDI, TBUT, Schirmer's test, staining scores), tear biochemical analysis for protein, cytokines [IL-10, IL-12, IL-2, IL-4, IL-6, IL-17, interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, VEGF], MMPs [MMP 2, 9, 7, 13, 10 and chemokine (IL-8)], & VEGF on three consecutive follow up visits (at three monthly interval) was done.

RESULTS

Of 24 post allo-HSCT patients (19 males, 5 females) & 12 controls (mean age 34.3 + 5.8 years) enrolled, 20 patients [mean age 33.4 + 7.77 years; mean time of recruitment of 5.2 + 2.12 months following alloHSCT] who completed three consecutive follow up visits were included for analysis. Ocular GVHD (oGVHD) was seen in 8 patients (33.3%). Tears biochemical analysis showed elevated levels of interferon γ, IL 6, IL 8, IL 10, IL 12AP70, IL 17A, MMP 9 and VEGF in oGVHD eyes as compared to non-oGVHD & control eyes. Non-oGVHD eyes showed elevated tear MMP 7 and MMP 9 as compared to healthy controls. Tear protein levels were significantly decreased in oGVHD eyes and were equivocal in nonGVHD and control eyes. TBUT and ocular staining scores to correlate best with tear interleukins and MMPs.

CONCLUSION

Evaluation of levels of tear VEGF, total protein & MMP 9 can be of significance in identifying oGVHD in post alloHSCT patients.

Evaluation of tear samples for Herpes Simplex Virus 1 (HSV) detection in suspected cases of viral keratitis using PCR assay and conventional laboratory diagnostic tools

BACKGROUND

Herpes Simplex Virus (HSV) keratitis is a leading cause of corneal blindness. Definitive laboratory diagnosis is essential for timely management. Collection of corneal scrapings in patients with advanced epithelial keratitis and corneal thinning poses perforation risks; tear fluid is a feasible and convenient alternative but has not been widely evaluated for HSV detection.

METHODS

Tear fluid alone (229) or along with corneal scrapings (153) from patients of suspected herpetic keratitis was tested for HSV-1 antigen by indirect immunofluorescence assay, virus isolation in Hep 2 cells and PCR to amplify the 111bp region of the thymidine kinase (tk) coding gene and the 144bp region from the DNA polymerase coding gene of HSV.

RESULTS

HSV 1 antigen was detected in 31/229 (13.53%) tear specimen and 35/153 (22.87%) corneal scrapings in immunofluorescence assay; virus was isolated from 12/229 (5.2%) tear and 17/153 (11.11%) corneal scrapings, and PCR was positive for both the genes in 32/229 (13.97%) tear specimen and 56/153 (36.66%) corneal scrapings.

CONCLUSION

Corneal scrapings yielded a significantly better HSV positivity than tears in both the PCR assay (p<0.0005) and immunofluorescence assay. PCR was much more sensitive than immunofluorescence and virus isolation. However, tears should be tested for definitive laboratory diagnosis of HSV infection whenever corneal scraping collection is not possible.

Post-operative endophthalmitis: Antibiogram & genetic relatedness between Pseudomonas aeruginosa isolates from patients & phacoemulsifiers

BACKGROUND & OBJECTIVES

Though not frequently but there are reports showing phacoemulsifiers as a potent source of infection in post-operative cases of endophthalmitis. This study was carried out to find antibiogram and genetic relatedness between Pseudomonas aeruginosa isolates from a post-cataract surgery endophthalmitis outbreak (3 patients) and internal tubings of 5 phacoemulsifiers.

METHODS

In vitro antimicrobial sensitivity patterns of the 8 bacterial isolates were observed. Genetic analysis of the bacterial isolates was done using random amplification of polymorphic DNA (RAPD) assay and PCR ribotyping. The resulting DNA band patterns were examined visually and by computer assisted analysis using unweighted pair group method.

RESULTS

The three P. aeruginosa patient isolates were found to be different from the five phacoemulsifier isolates in sensitivity towards 3 antibiotics and by genetic analysis (33 and 44% homology by RAPD assay and PCR ribotyping). Two of the patient isolates shared 100 per cent genetic homology by RAPD assay and another pair shared 100 per cent homology by PCR ribotyping. The five isolates from phacoemulsifiers did not share significant genetic homology. There was significant genetic variation between bacterial isolates from patients and phaco emulsifiers.

INTERPRETATION & CONCLUSION

Though the three P. aeruginosa isolates obtained from the patients were phenotypically similar and genetically close, they differed from the phaco-machine isolates both genetically, and in their antibiogram profile. However, the five phacoemulsifier isolates were genetically diverse though they shared the same antibiogram profile. Therefore the Ringer's lactate from phacomachines could not be conclusively proven to be the source of infection.

"Tuck In" Lamellar Keratoplasty (TILK) for corneal ectasias involving corneal periphery

AIMS

Evaluation of a new surgical technique for the management of corneal ectasia with peripheral corneal involvement.

METHODS

Twelve eyes of 12 patients with corneal ectasias and peripheral corneal thinning requiring surgical intervention, including eight patients with combined keratoconus and PMD and four patients of keratoglobus, were enrolled for the study in a tertiary care hospital. All patients were contact lens intolerant and had a best corrected visual acuity (BCVA) </=20/120 with nine patients (75%) having BCVA </=20/200. "Tuck In" Lamellar Keratoplasty (TILK) that included a central lamellar keratoplasty with intrastromal tucking of the peripheral flange was performed in these patients. The main outcome measures analysed were uncorrected visual acuity (UCVA), BCVA, keratometry, refractive status and time for epithelial healing.

RESULTS

At the last follow-up (mean: 1.7 years (range 13-48 months)), six patients (50.0%) had BCVA >/=20/60, and all patients had BCVA >/=20/80. The mean keratometry decreased from 57.54 (SD 6.89) D preoperatively to 46.36 (2.39) D (p = 0.003), and the mean spherical equivalent (SEQ) refractive error decreased from -7.8 (4.6) D preoperatively to 1.23 (1.88) D (p = 0.007). A significant decrease was also seen in mean refractive astigmatism which decreased from 5.93 (3.06) D preoperatively to 3.23 (1.14) D (p = 0.037).

CONCLUSION

Our technique of TILK is an effective surgical modality for the management of ectatic corneal dystrophies with peripheral corneal thinning.

Association between amblyopia and higher-order aberrations

We report a case with asymmetric higher-order aberrations and wavefront profiles possibly leading to unilateral amblyopia. Stimulus deprivation, strabismus, substantially unequal refractive error, microtropia, and organic causes were ruled out. Keratographic assessment was similar bilaterally, but there was a between-eye difference by wavefront analysis. The predominant aberration in the left eye was defocus and in the right eye, x-axis trefoil. This resulted in different wavefront profiles and point-spread functions, which could have caused amblyopia during the critical age period. The case shows a previously unreported but logically probable cause of amblyopia. Since a single case can suggest the biological plausibility of a hypothesis but cannot prove the strength of the association, further research is required in patients with no cause or an insufficient explanation for amblyopia, especially patients with a mild refractive error difference.

'Layer by layer' phacoemulsification in posterior polar cataract with pre-existing posterior capsular rent

PURPOSE

To evaluate a new technique of 'Layer by Layer' phacoemulsification in eyes with posterior polar cataract with pre-existing posterior capsular rent (PCR).

METHODS

Layer by layer phacoemulsification was performed in eight eyes of eight patients of posterior polar cataract with pre-existing posterior capsular rent. All the patients had evidence of a posterior capsular defect showing presence of iridescent refractile lens particles in vitreous with onion skinning of central dense plaque.

RESULTS

The mean age of the patients was 43.75+/-2.5 years and six patients were men. All the eyes had vertical posterior capsular defect irrespective of the site of entry of phaco probe. Vitrectomy was not required in any of the eyes. Single piece foldable acrylic intraocular lens was implanted in the bag in all the eyes. The mean preoperative best corrected visual acuity was 0.14+/-0.05, which improved to 0.77+/-0.27.

CONCLUSION

Our technique of 'Layer by layer' phacoemulsification is an effective and safe technique for the management of posterior polar cataract with pre-existing PCR.

Will Descemet’s stripping with automated endothelial keratoplasty (DSAEK) lower the rates of allograft rejection in corneal transplants for endothelial failure?

BACKGROUND

Allograft corneal rejection occurs in a substantial number of full thickness transplants in spite of the relative immune privilege enjoyed by the cornea. Compared to other layers of the cornea, endothelial rejection has most disastrous consequences on graft survival. In the last few years, a new technique, Descemet's stripping with automated endothelial keratoplasty (DSAEK) is being used of selective transplantation of the endothelium. It involves stripping diseased endothelium (and Descemet's) and replacing it by a small lamella fashioned from a cadaveric donor cornea, which consists of endothelium, Descemet's membrane and a part of posterior stoma.

HYPOTHESIS

We hypothesize that DSAEK might substantially reduce the incidence of allograft immune rejection in corneal transplant done for cases with endothelial failure.

EVALUATION OF THE HYPOTHESIS

In published reports of consisting of more than 300 surgeries and three years experience with DSAEK, no case of graft rejection has been reported. In our opinion, this advantage of DSAEK compared to conventional full thickness keratoplasty could be due to four factors: (a) The transplanted tissue is placed in the anterior chamber and has no exposure to the surface, where the antigen presenting cells (APC) and antibodies are present. (b) Significant reduction in the number of sutures connecting the host and donor tissue may lead to lesser suture related rejection episodes. (c) Absence of direct contact between the host stroma vessels and the transplanted tissue disrupts the immune affecter and effecter arcs. (d) Reduced immunogenicity of the donated tissue due to absence of epithelium.

CONSEQUENCES OF THE HYPOTHESIS

If this hypothesis stands true in subsequent studies, it could lead to substantial reduction in the socioeconomic resources involved in management of graft rejection. Even if this hypotheses fails the test of well controlled studies, this would broaden the current understanding of the ocular immunology and the immune privilege with which the anterior chamber of the eye is normally associated with.

Risk factors for postoperative cylindrical prediction error after laser in situ keratomileusis for myopia and myopic astigmatism

PURPOSE

To study the risk factors for the occurrence of cylindrical prediction error (PE) after laser in situkeratomileusis (LASIK) for myopia and myopic astigmatism.

METHODS

The study was a nested case-control study. Five hundred eyes of 252 consecutive patients who underwent LASIK for myopia and myopic astigmatism on the Chiron Technolas 217C laser and completed 6 months of follow-up. There were 435 controls and 65 cases based on the postoperative refractive cylindrical PE. The probable risk factors studied included preoperative sphere and cylinder, keratometry, pachymetry, suction ring used, flap thickness, hinge centeration, optic zone, ablation depth, and intraoperative complications.

RESULTS

By univariate analysis, the cylindrical PE was found to be associated with preoperative spherical equivalent higher than -6 D (chi(2)=10.83; P=0.001), preoperative sphere higher than -6 D (chi(2)=6.15, P=0.013), preoperative cylinder more than -0.75 D (chi(2)=6.61; P-value=0.010), and an optic zone less than 5.5 mm (chi(2)=19.3; P=0.001). Risk factors for postoperative astigmatism by stepwise multivariate logistic regression analysis were an optic zone of less than 5.5 mm with an odds ratio (OR) of 2.81 (95% confidence interval (CI)=1.62-4.86) and preoperative cylinder more than -0.75 D with an OR of 1.60 (95% CI=0.92-2.77).

CONCLUSION

Postoperative astigmatism (as indicated by the cylindrical PE) is more likely to occur with an optic zone of less than 5.5 mm and a higher preoperative cylindrical error.

Phacoemulsification with nondominant hand

PURPOSE

Evaluation of on axis phacoemulsification surgery through temporal incision using nondominant hand with surgeon sitting at the head end, inpatients with against-the-rule astigmatism.

METHODS

Eighty eyes of 80 patients who underwent phacoemulsification through a temporal clear corneal tunnel for age-related cataract and against-the-rule astigmatism were enrolled and divided into four equal groups. In Group 1A, the surgeon was sitting at the head end for the left eye performing surgery with the left hand (nondominant hand). In group 1B, the surgeon was seated at the temporal side and surgery was performed in the left eye with dominant right hand. In group 2A, the surgeon was sitting at the head end for the right eye and performed surgery holding the phacoemulsification hand piece in his right hand. In group 2B, the surgeon sat on the temporal side of the right eye and performed phacoemulsification with his right hand. The patients were followed up on day 7, 1 month, and 3 months. Parameters evaluated included average phaco power, effective phaco time, uncorrected and best-corrected visual acuity, keratometry, intraocular pressure, surgically induced astigmatism, pachymetry, and endothelial cell counts.

RESULTS

The phaco time and phaco power among the four groups were comparable (phaco time: P=0.368; phaco power: P=0.294). The four groups were also comparable on parameters like surgically induced astigmatism (P=0.674), change in postoperative keratometric astigmatism (P=0.584), endothelial cell loss (0.921), change in ultrasonic pachymetry (P=0.476), and intraocular pressure (P=0.942). No intraoperative or postoperative complications were observed in any of the groups. The mean uncorrected visual acuity at 3 months in group 1 was 0.723+/-0.21; in group 2 it was 0.756+/-0.21; in group 3 it was 0.748+/-0.22, and in group 4 it was 0.732+/-0.23. The best-corrected visual acuity was 0.96+/-0.10, 0.97+/-0.11, 0.95+/-0.13, and 0.96+/-0.10 in the four groups at 3 months.

CONCLUSION

Phacoemulsification surgery can be successfully performed with nondominant hand with a good surgical outcome. The technique gives an alternative approach where surgeon does not have to shift the position to perform on-axis phacoemulsification.

Risk factors for perforation in microbial corneal ulcers in north India

AIM

To identify predisposing factors leading to corneal perforation in patients with microbial keratitis.

METHOD

Two groups of 60 patients each, with perforated corneal ulcers and healed/healing corneal ulcers, respectively, were recruited in a case-control study conducted in northern India. The cases and controls were matched by age and time of presentation. A standardised proforma was used to identify potential predisposing factors for demographic, social, medical, ocular, and treatment history. All participants underwent a detailed ocular examination. Corneal scrapings were performed where relevant.

RESULTS

The characteristics associated with corneal perforation in microbial keratitis were outdoor occupation (p = 0.005), illiteracy (p = 0.02), excessive alcohol use (p = 0.03), history of "something falling into eye" (p = 0.003), trauma with vegetable matter (p = 0.008), vision less than counting fingers at referral (p<0.001), central location of ulcer (p<0.001), lack of corneal vascularisation (p<0.001), delay in starting initial treatment (p<0.001), failure to start fortified antibiotics (p<0.001), and monotherapy with fluoroquinolones (p = 0.002). The lack of corneal vascularisation (OR 6.4, 95% CI 4.2 to 13.5), delay in starting initial treatment (OR 35.6, 95% CI 6.9 to 68.2), and failure to start fortified antibiotics (OR 19.9, 95% CI 2.7 to 64.7) retained significance on a logistic regression model.

CONCLUSIONS

This study characterises microbial keratitis cases at increased risk of corneal perforation and reinforces the need for standardised referral and treatment protocols for patients with corneal ulcer on their first contact at primary care level in the developing world.

Atropine-induced lens extrusion in an open eye surgery

A 2-month-old male baby undergoing penetrating keratoplasty (PKP) under general anesthesia developed bradycardia and a decrease in heart rate to 53 b x min(-1) when stay sutures were taken through the superior and inferior recti. A bolus of 0.1 mg intravenous atropine resulted in tachycardia of up to 180-220 b x min(-1), which persisted for 35 min. After corneal trephination was performed the eyeball seemed to pulsate with the heartbeat. Spontaneous extrusion of the lens and vitreous occurred, which necessitated a lensectomy and vitrectomy in addition to PKP. The role of atropine in corneal transplant surgery is discussed here.

Effect of intraoperative intracameral 2% hydroxypropyl methylcellulose viscoelastic during trabeculectomy

BACKGROUND AND OBJECTIVE

To evaluate the effect of intraoperative intracameral injection of 2% hydroxypropyl methylcellulose (HPMC) on anterior chamber depth and intraocular pressure (IOP) following trabeculectomy in eyes with uncontrolled primary open-angle glaucoma in a prospective randomized manner.

PATIENTS AND METHODS

Thirty consecutive eyes with primary open-angle glaucoma scheduled for trabeculectomy were randomized to conventional trabeculectomy without HPMC injection (group I; n = 15) or to intracameral injection of 2% HPMC during trabeculectomy (group II; n = 15). All patients were observed serially on days 1, 3, 5, 7, and 14 and months 1, 3, and 6 postoperatively. The main outcome measure was restoration of anterior chamber depth to preoperative level with IOP of less than 21 mm Hg with no additional antiglaucoma medication or surgery.

RESULTS

The anterior chamber depth decreased from 2.5 +/- 0.53 to 1.5 +/- 0.94 mm on postoperative day 1 in group I and increased slightly from 2.4 +/- 0.43 to 2.5 +/- 0.36 mm on postoperative day 1 in group II (P = .04). Overall, the IOP decreased to 5.0 +/- 2.8 mm Hg in group I (87% reduction) and 9.0 +/- 4.6 mm Hg in group II (70% reduction). Two eyes developed postoperative flat anterior chamber and related complications in group I, whereas none of the eyes in group II developed such complications.

CONCLUSIONS

Intracameral injection of 2% HPMC during trabeculectomy helps to maintain anterior chamber depth and reduces incidence of complications related to shallow anterior chamber depth following trabeculectomy.

Outcome of penetrating keratoplasty in patients with bilateral corneal blindness

PURPOSE

To evaluate the outcome of penetrating keratoplasty in patients with bilateral corneal blindness.

METHODS

Bilaterally blind patients who had undergone optical penetrating keratoplasty (PK) were evaluated on optical and refractive parameters and presence of complications if any. The results at 3 months, 6 months, and 1 year were compared with age-matched and indication-matched unilaterally blind controls.

RESULTS

The most common indication for surgery in both the groups was the presence of a corneoiridic scar. Best corrected visual acuity of > or =6/18 was seen in five (16.66%) patients in the study group and in 11 (36.66%) patients in the control group (P = 0.14). In all, 15 (50%) grafts in the study group and six (20%) in the control group failed (P = 0.03). The most common cause of failure was graft infection (40%) in the study group and post-PK glaucoma (20%) in the control group. The percentage of graft rejection as a cause of graft failure was the same in both the groups. A composite socioeconomic status scale based on family literacy and income suggested that 70% of the cases in the study group and 30% in the control group belonged to the low socioeconomic group (P = 0.004).

CONCLUSION

The outcome of optical penetrating keratoplasty in patients with bilaterally blinding corneal disease is poorer than those who are unilaterally blind. Low socioeconomic status may be a contributing factor for the poor outcome.

Causes and temporal trends of blindness and severe visual impairment in children in schools for the blind in North India

AIMS

To describe the causes of severe visual impairment and blindness (SVI/BL) in children in schools for the blind in north India, and explore temporal trends in the major causes.

METHODS

A total of 703 children were examined in 13 blind schools in Delhi. A modified WHO/PBL eye examination record for children with blindness and low vision which included sections on visual acuity, additional non-ocular disabilities, onset of visual loss, the most affected anatomical part of the eye concerning visual impairment, and the aetiological category of the child's disorder based on the timing of insult leading to visual loss was administered in all children.

RESULTS

With best correction, 22 (3.1%) were severely visually impaired (visual acuity in the better eye of <6/60) and 628 (89.3%) children were blind (visual acuity in the better eye of <3/60). Anatomical sites of SVI/BL were whole globe in 27.4% children, cornea 21.7%, retina 15.1%, and lens 10.9%. The underlying cause of visual loss was undetermined in 56.5% children (mainly abnormality since birth 42.3% and cataract 8.3%), childhood disorders were responsible in 28.0% (mainly vitamin A deficiency/measles 20.5%), and hereditary factors were identified in 13.4%. Study of temporal trends of SVI/BL by comparing causes in children in three different age groups-5-8 years, 9-12 years, and 13-16 years-suggests that retinal disorders have become more important while childhood onset disorders (particularly vitamin A deficiency) have declined.

CONCLUSIONS

Almost half of the children suffered from potentially preventable and/or treatable conditions, with vitamin A deficiency/measles and cataract the leading causes. Retinal disorders seem to be increasing in importance while childhood disorders have declined over a period of 10 years.

Visual performance after interface haemorrhage during laser in situ keratomileusis

AIM

To study the visual performance in eyes with interface haemorrhage during laser assisted in situ keratomileusis (LASIK).

METHODS

Case records of 20 patients, who had bleeding from the limbal vessels in one eye during LASIK (group 1) and uncomplicated surgery in the fellow eye (group 2) were studied. The parameters evaluated were uncorrected visual acuity (UCVA) best corrected visual acuity (BCVA), spherical equivalent of refraction (SEQ), contrast sensitivity, and glare acuity preoperatively and at 1, 3, and 6 months postoperatively.

RESULTS

The mean preoperative SEQ in group 1 and 2 eyes was -5.79 (2.3) D and -5.27 (1.68) D, respectively. The mean decimal UCVA at 6 months after LASIK in group 1 and 2 eyes were 0.6 (0.2) and 1.0 respectively (p<0.001). The mean decimal BCVA at 1 week after LASIK in group 1 and 2 eyes were 0.89 (0.04) and 1.0 respectively (p<0.05). However, all eyes had a BCVA of 6/6 at 1, 3, and 6 months after LASIK. The mean contrast sensitivity values preoperatively in group 1 and 2 eyes were 161.3 (8.7) and 172 (68.2) respectively. There was a significant decrease in group 1 at 6 months (102 (60.5) (p<0.01)) compared to group 2. The decimal glare acuity preoperatively in group 1 and 2 eyes was 0.95 (0.11) and 0.89 (0.12), respectively. It decreased significantly in group 1 (0.7) (0.1 (p<0.01)) compared to group 2 at the 6 month follow up.

CONCLUSION

Occurrence of intraoperative interface haemorrhage may affect the visual performance following LASIK surgery.

Keratoplasty for keratomalacia in preschool children

AIM

To study the results of surgical management of keratomalacia in children.

METHODS

A clinical case series of all children with keratomalacia, admitted to an Indian centre during the period from June 2000 to June 2001 is presented. The parameters evaluated were demographic data, systemic associations, and results of medical and surgical intervention.

RESULTS

29 children with keratomalacia ranging from 2 months to 5 years of age (mean 1.8 (SD 1.4) years) were included in the study. All children belonged to families of lower socioeconomic status. 27 patients (93.1%) had not been immunised at all. The systemic diseases precipitating the onset of keratomalacia included measles (41.37%), pneumonia (31.03%), and acute diarrhoea (37.93%). 36 eyes (66.7%) had total corneal melting and 11 (20.3%) eyes had paracentral corneal melting. In 15 eyes (27.8%) an emergency tectonic penetrating keratoplasty was performed of which only five grafts (33.3%) remained clear at a mean follow up of 7.3 (6.8) months (range 3-24 months). Seven eyes underwent optical penetrating keratoplasty, of which four grafts (57.14%) remained clear at a mean follow up of 6.4 (3.6) months (range 3-12 months). None of these could achieve a visual acuity better than 6/60.

CONCLUSIONS

Corneal grafting surgery in keratomalacia is associated with poor visual outcome.