"Show me the way" - Endoilluminator-assisted manual small-incision cataract surgery in a case of corneal scar with a small pupil

Cataracts with coexisting corneal opacities due to various causes present a daunting challenge to surgeons. Adding to the plight could be factors like shallow anterior chamber, small pupil and mono-ocular patient. A manual small-incision cataract surgery (MSICS) could be a saviour in such situations. We demonstrate a case of post perforation corneal scar secondary to Hansen's disease with complicated cataract with non-dilating pupil in a bilaterally blind patient. Due to poor visualisation, there could have been difficulties in capsulorrhexsis, cortex aspiration & many other intraoperative manoeuvres, but use of an endo illuminator providing oblique illumination was very useful, resulting in uneventful surgery with good visual outcome. MSCICS, a surgery with minimal instrumentation, short learning curve and comparable results to phacoemulsification is perhaps the preferred procedure, in India, for complicated cataracts with multiple pre-existing pathologies.

Endoilluminator-assisted pediatric cataract surgery with hazy cornea

The purpose of this study was to demonstrate the usefulness of endoilluminator in pediatric cataract with hazy corneas. We describe a series of three cases of pediatric cataract where visualization of intraocular structures was inadequate under the operating microscope. The endoilluminator was held at the limbus with light directed obliquely to visualize the details of intraocular structures against the hazy cornea using oblique illumination. It allowed structures behind the hazy cornea to be seen with ease. A simple modification in surgical procedure of pediatric cataract using an endoilluminator helps in better visualization of intraocular structures in difficult situations.

Detection of ideal reservoir level after laryngectomy using endoilluminator in voice rehabilitation

OBJECTIVE

To assess the diagnostic value of a novel device, the endoilluminator, in patients who can or cannot attain effective speech after application of voice prosthesis.

STUDY DESIGN

Prospective clinical study.

METHODS

Thirty-four patients who underwent total laryngectomy and whose insufflation test was positive were included. As a result of efforts to develop an insufflation test that includes a light apparatus, we attained a device that we call an endoilluminator. We found that the area it illuminated when a patient achieved effective speech was a predictive factor for the test result. That is, patients for whom the upper part of the tracheostomy (where the standard tracheoesophageal fistula will be opened) was illuminated were categorized as the positive test group, whereas those for whom the neck skin above this region was illuminated were categorized as the negative test group.

RESULTS

In 27 of the 34 patients, appropriate localization was determined using the endoilluminator, and these patients achieved effective speech. In the remaining seven patients, localization was inappropriate and they did not achieve effective speech during the first week, first month, or third month postpuncture. In further investigations of these seven patients, a pharyngoesophageal spasm was detected in five, and a pharyngoesophageal stricture was detected in two.

CONCLUSION

Endoilluminator increases the success rate of the insufflation test by accurately predicting a patient's ability to achieve effective speech after application of voice prosthesis.