Effect of myopia and optic disc area on ganglion cell-inner plexiform layer and retinal nerve fiber layer thickness

Purpose:

The aim of this work was to study the impact of myopia and different optic disc areas on ganglion cell-inner plexiform layer (GCIPL) and retinal nerve fiber layer (RNFL) thickness profiles in myopic patients by spectral-domain optical coherence tomography (SD-OCT).

Methods:

This was a cross-sectional study of 100 eyes of 50 myopic individuals. All patients underwent complete ophthalmic evaluation and SD-OCT examination. According to spherical equivalent (SE), patients were divided into M1, M2, and M3 (low, moderate, and high myopia group). According to optic disc area values, patients were divided into D1, D2 and D3 (small, medium and large disc groups). Average GCIPL and RNFL thickness recorded globally and separately for all quadrants and also according to 12 clock hours and analyzed with respect to different myopic groups, optic disc area groups, and axial length.

Results:

Quadrantic RNFL thickness profiles and their average RNFL thickness were significantly thinner in high myopic group compared to low myopic group, except for the temporal quadrant (P < 0.05). Average RNFL and RNFL thickness of all quadrants were significantly thicker in the large disc group than in the small disc group (P < 0.05). Average GCIPL and GCIPL thicknesses of all sectors were significantly thinner in high myopic group compared to low myopic group (P < 0.05). No significant correlation was observed between GCIPL and disc area changes. Average RNFL thickness correlated significantly with SE (3.667 μm/diopter), axial length (–5.3805 μm/mm) and optic disc area (9.4617 μm/mm²). Also, average GCIPL thickness correlated statistically significantly with SE (1.6807 μm/diopter) and axial length (–2.626 μm/mm).

Conclusion:

Myopia and axial length significantly reduce RNFL and GCIPL thickness profiles but the optic disc area significantly increases RNFL thickness, but not GCIPL thickness.

Ocular manifestation of rickettsial disease in South Indian population

Purpose

The aim of this work was to study the ocular manifestations and its management in spotted fever and typhus group of rickettsial disease.

Methods

A retrospective analysis of 50 patients with serologically confirmed Rickettsial disease. In all patients, relevant history, investigations and treatment details were collected and they underwent complete ophthalmic evaluation including measurement of best-corrected visual acuity, anterior segment examination and dilated fundus examination.

Results

Mean age was 12.5 ± 8.99 years. Of the 50 patients, 40 patients were ≤18 years of age and 27 (54%) had ocular involvement. Out of 27 patients, bilateral involvement was seen in 10 patients. Most of the patients had no ocular symptoms. Ocular findings included, Retinal vasculitis 6 (22.22%); macular edema 4 (14.81%); vasculitis with macular edema 1 (3.7%); Retinitis 7 (25.92%); Papilloedema 6 (22.22%); Papilloedema with 6^th cranial nerve palsy 1 (3.7%); Isolated 6^th cranial nerve palsy 1 (3.7%) and optic neuritis 1 (3.7%). Ocular involvement was more common in double antigen group (68%) than spotted fever group (50%) or Scrub typhus group (21%) (P = 0.01). Ocular involvement was seen in 94% of the patients with CNS involvement. Cases with bilateral involvement (P = 0.01), pediatric age group (P = 0.01) and CNS involvement (P = 0.02) had poor visual outcome.

Conclusion

Rickettsioses patients can have ocular manifestations with predominant posterior segment involvement during acute phase of illness. Ocular involvement was more common in the double antigen group. For any patient who presents with fever and rash living in endemic area, ophthalmic evaluation should be part of routine checkup during the acute phase of illness associated with less frequent ocular symptoms.

Acute and Chronic Ophthalmic Involvement, Severity, and Sequelae in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Purpose

To study the ocular manifestations, its severity and sequelae in patients with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).

Methods

Prospective study of 44 consecutive patients (30 SJS and 14 TEN) presenting in the acute phase of the disease. Patients were evaluated by dermatologist as well as physician for systemic status, skin lesions and mucosal involvement. Detailed history taking, visual acuity, ophthalmic evaluation (lid margin, corneal, conjunctival changes, tear film and ocular surface). Ocular severity score (OSS) was assessed at baseline (acute) and at 6 months (chronic / OSS6), graded as mild, moderate and severe.

Results

Mean age was 28.15 ± 15.78 years. Sixty-five eyes of 33 patients were included for final analysis. Thirty-eight patients (86.4%) had ocular manifestations. Drugs were the most common causative factor (95.4%). At base line mild, moderate, and severe OSS was seen in 43.1%, 44.6%, and 12.3% eyes. At 6 months mild, moderate, and severe OSS was seen in 44.6%, 7.7%, and 6.2% of eyes. There was a significant correlation between age of the patient and OSS at 6 months (p = 0.02). Younger age had higher chronic OSS. Patients with TEN had higher acute (p = 0.001) and chronic (p = 0.001) OSS than SJS. Three mucosal surface involvement associated with higher acute and chronic OSS (p = 0.001). No long-term ocular complications observed in 27 / 65 (41.5%) eyes. Acute OSS correlated significantly with chronic OSS, at 1 and 6 months (p = 0.001).

Conclusions

Greater severity of the disease, more number of mucosal surfaces involved and shorter symptom lag correlated with more severe acute and chronic ocular manifestations. The severity of lid margin involvement and corneal involvement in acute stage were good predictors of severity of chronic ocular findings. Initial severity of ocular involvement correlated with severity of ocular sequelae.

Retinal functional imager (RFI): non-invasive functional imaging of the retina

Retinal functional imager (RFI) is a unique non-invasive functional imaging system with novel capabilities for visualizing the retina. The objective of this review was to show the utility of non-invasive functional imaging in various disorders. Electronic literature search was carried out using the websites www.pubmed.gov and www.google.com. The search words were retinal functional imager and non-invasive retinal imaging used in combination. The articles published or translated into English were studied. The RFI directly measures hemodynamic parameters such as retinal blood-flow velocity, oximetric state, metabolic responses to photic activation and generates capillary perfusion maps (CPM) that provides retinal vasculature detail similar to flourescein angiography. All of these parameters stand in a direct relationship to the function and therefore the health of the retina, and are known to be degraded in the course of retinal diseases. Detecting changes in retinal function aid early diagnosis and treatment as functional changes often precede structural changes in many retinal disorders.

Comparison of morphological and functional endothelial cell changes after cataract surgery: phacoemulsification versus manual small-incision cataract surgery

PURPOSE

To compare the morphological (cell density, coefficient of variation and standard deviation) and functional (central corneal thickness) endothelial changes after phacoemulsification versus manual small-incision cataract surgery (MSICS).

DESIGN

Prospective randomized control study.

MATERIALS AND METHODS

In this prospective randomized control study, patients were randomly allocated to undergo phacoemulsification (Group 1, n = 100) or MSICS (Group 2, n = 100) using a random number Table. The patients underwent complete ophthalmic evaluation and specular microscopy preoperatively and at 1and 6 weeks postoperatively. Functional and morphological endothelial evaluation was Noncon ROBO PACHY SP-9000 specular microscope. Phacoemulsification was performed, the chop technique and MSICS, by the viscoexpression technique.

RESULTS

The mean difference in central corneal thickness at baseline and 1 week between Group 1 and Group 2 was statistically significant (P = 0.027). However, this difference at baseline when compared to 6 week and 1 week, 6 weeks was not statistically significant (P > 0.05). The difference in mean endothelial cell density between groups at 1 week and 6 weeks was statistically significant (P = 0.016). The mean coefficient of variation and mean standard deviation between groups were not statistically significant (P > 0.05, both comparisons).

CONCLUSION

The central corneal thickness, coefficient of variation, and standard deviation were maintained in both groups indicating that the function and morphology of endothelial cells was not affected despite an initial reduction in endothelial cell number in MSICS. Thus, MSICS remains a safe option in the developing world.

Effect of intraoperative 5-fluorouracil and low molecular weight heparin on the outcome of high-risk proliferative vitreoretinopathy

PURPOSE

To evaluate the efficacy of a combination of 5-fluorouracil (5-FU) and low molecular weight heparin (LMWH) during vitrectomy, as adjuvants in preventing proliferative vitreoretinopathy (PVR).

DESIGN

Double-blind, prospective, randomized placebo-controlled trial.

METHODS

Forty consecutive patients diagnosed with rhegmatogenous retinal detachment with high-risk PVR, were randomized to study and control groups (n = 20 each). Study group (group 1) patients underwent vitrectomy with the use of both intraoperative 5-FU (0.2 mg/ml) and LMWH (5 IU/ml). In the control group (group 2), a similar surgery was performed without the use of adjuvants. Patients were evaluated at 1 month, 3 months and 6 months after surgery. Postoperative retinal reattachment, recurrence of PVR, best-corrected visual acuity and complications at the end of 6 months were compared between the two groups. A Chi-square statistical analysis was used on all of the outcome measures.

RESULTS

At 6 months post-surgery, 62.5% of patients had reattached retina. There was no significant difference (Chi-square test showed x (2) = 0.106, P = 0.7447, P > 0.05) in retinal reattachment in both of the groups. The rate of postoperative PVR in the control group was 55%; in the study group, the rate was 45% (the Chi-square test showed x (2) = 0.4, P = 0.5271, P > 0.05), which proves statistically insignificant. In addition, there was no statistically significant difference in visual outcomes between the two groups (Chi-square test showed x (2) = 0.1002, P > 0.05), no significant difference in the complication rate and drug toxicity was noted between two groups.

CONCLUSIONS

This study fails to prove the efficacy of the intraoperative use of 5-FU and LMWH in combination as an antiproliferative regiment for the prevention of postoperative PVR or improvement in final visual acuity. At the same time, no significant complications could be attributed to the treatment.

Effect of Topical Calcium Channel Blockers on Intraocular Pressure in Steroid-induced Glaucoma

Purpose: To evaluate the effect of 0.125% verapamil and 0.5% diltiazem eye drops on intraocular pressure (IOP) in steroid-induced glaucoma in rabbit eyes.

Methods: A total of 18 rabbits with steroid-induced glaucoma were divided into three groups (A, B and C; n = 6 each). Right eyes in groups A, B and C received 0.5% diltiazem, 0.125% verapamil and 0.5% timolol eye drops twice daily for 12 days, respectively; whereas, left eyes received distilled water. IOP was measured with Tono-pen XL at baseline, day 4, day 8, and day 12 of treatment.

Results: Both 0.5% diltiazem and 0.125% verapamil eye drops significantly reduced IOP compared to control eyes (p < 0.05). Reduction of IOP by 0.5% diltiazem, 0.125% verapamil eye drops were comparable to 0.5% timolol. No surface toxicity or systemic side effects were noted during the study period.

Conclusion: Calcium channel blockers, verapamil, and diltia-zem significantly reduced IOP in rabbiteyes. This group of drugs may have a potential role in treatment of glaucoma

How to cite this article: Ganekal S, Dorairaj S, Jhanji V, Kudlu K. Effect of Topical Calcium Channel Blockers on Intraocular Pressure in Steroid-induced Glaucoma. J Current Glau Prac 2014;8(1):15-19.

Prevalence and etiology of amblyopia in Southern India: results from screening of school children aged 5-15 years

PURPOSE

To determine the prevalence and etiology of amblyopia in school children.

METHODS

A total of 4020 school children aged between 5 and 15 years were screened in a population-based, cross-sectional study. Best corrected visual acuity and detailed ophthalmic evaluation were performed in all participants. Amblyopia associated with degraded visual input due to high refractive error was labeled ametropic amblyopia. Anisometropic amblyopia was diagnosed in participants with interocular refractive error difference ≥1 diopter. Strabismic amblyopia included that due to conflicting visual inputs between the eyes due to squint. Stimulus deprivation amblyopia was defined as amblyopia due to obstruction of the visual axis.

RESULTS

Prevalence of amblyopia was 1.1% (n = 44). The number of boys with amblyopia (n = 25, 57%) was slightly higher than the number of girls with amblyopia (n = 19, 43%; p = 0.6). A total of 28 (63.7%) children had mild to moderate amblyopia, whereas 16 (36.3%) had severe amblyopia. Underlying amblyogenic causes were ametropia (50%), anisometropia (40.9%), strabismus (6.8%), visual deprivation (4.5%) and combined causes (2.2%). No statistically significant difference was noted in the prevalence of amblyopia between rural (1.2%) and urban (0.9%) children (p = 0.5).

CONCLUSION

In this study, the prevalence of amblyopia was 1.1% of the school children. Ametropia and anisometropia were the most common causes of amblyopia. We did not find any significant difference in amblyopia prevalence between rural and urban school children.

Conjunctival rhinosporidiosis

A 12-year-old boy presenting with redness and foreign body sensation in his right eye was found to have a granular, pedunculated mass in the upper palpebral conjunctiva near the lid margin. After the mass was excised, the conjunctiva healed completely, with mild overlying scarring. At 6 weeks' follow-up, there was no evidence of recurrence. Histopathological examination of the mass revealed multiple sporangia characteristic of conjunctival rhinosporidiosis.

Morphological patterns of indirect choroidal rupture on spectral domain optical coherence tomography

PURPOSE

To evaluate the morphological types of indirect choroidal rupture (ICR) using spectral domain optical coherence tomography (SD-OCT).

METHODS

This was a prospective interventional study of 18 eyes of 18 patients who presented with a history of blunt ocular trauma resulting in choroidal rupture. All patients underwent detailed ophthalmic evaluation and SD-OCT examination.

RESULTS

Mean age of the patients was 32±9.6 years. Morphologically, two types of choroidal rupture were seen on SD-OCT. The first type seen (Type 1 ICR) was a forward protrusion of the retinal pigment epithelium-choriocapillaris (RPE-CC) layer with an acutely angled pyramid or dome shape. This was associated with either a small loss of continuity of the retinal pigment epithelium layer or elevated RPE-CC projection accompanied by a significant quantity of subretinal hemorrhage. The second type observed (Type 2 ICR) was a larger area of disruption of the RPE-CC layer, photoreceptor inner segment/outer segment junction, and external limiting membrane, with a posteriorly directed concave contour depression at that area and downward sliding of tissues into the defect. At presentation, ten eyes were observed to have Type 1 ICR and eight to have Type 2 ICR. Of the 18 eyes, one with Type 1 ICR and two with Type 2 ICR developed choroidal neovascularization (16.6%).

CONCLUSION

Two distinct tomographic patterns of choroidal ruptures were identified on SD-OCT, which may allow ruptures to be classified into two morphological types. There are morphometric and clinical differences between the two types, which may help to prognosticate visual outcome and anticipate complications following choroidal ruptures.

Pattern Electroretinography Changes in Patients with Established or Suspected Primary Open Angle Glaucoma

PURPOSE

To assess pattern electroretinogram (PERG) changes in patients with established or suspected primary open angle glaucoma (POAG).

MATERIALS AND METHODS

Transient PERG using LV Prasad eye electrodes were performed in 76 normal, 32 glaucomatous and 22 glaucoma suspect eyes. The P50 amplitude, N95 amplitude and P50 latency were analyzed. The results were further analyzed with receiver operating characteristic (ROC) curves and discriminant function analysis (DFA).

RESULTS

The P50 and N95 amplitude of the POAG and glaucoma suspect groups were significantly reduced. There was significant shortening in the P50 latency in the POAG and glaucoma suspect groups. DFA using the P50 amplitude, N95 amplitude and P50 latency waveform parameters showed a sensitivity and specificity of 76.67 and 88.57% respectively.

CONCLUSION

Pattern ERG demonstrated significant changes in POAG patients and suspects. ROC curves for the three wave parameters demonstrated that N95 amplitude was the better indicator for diagnosis of POAG when used individually. How to cite this article: Ganekal S, Dorairaj S, Jhanji V. Pattern Electroretinography Changes in Patients with Established or Suspected Primary Open Angle Glaucoma. J Current Glau Prac 2013;7(2):39-42.

Association of systemic comorbidity in diabetic serous macular detachment and comparison of various combination therapies in its management

BACKGROUND

The purpose of this research was to study the association between systemic comorbidity in diabetic serous macular detachment (DSMD) and the effect of different forms of combination therapies in its management.

METHODS

In this prospective analysis, 34 eyes from 34 patients with DSMD were investigated for the presence of systemic comorbidity including anemia, dyslipidemia, nephropathy, and cardiac disease, and treated with combination therapy of either intravitreal bevacizumab + laser (group 1, n = 14) or intravitreal triamcinolone + laser (group 2, n = 20). Sequential macular laser was done 2 weeks after intravitreal pharmacotherapy in both groups. Outcome measures included visual acuity and central foveal thickness at 1 and 3 months.

RESULTS

The mean age of the patients was 55.6 ± 7.6 years. The commonest systemic association was nephropathy (82.3%). In group 1, mean visual acuity improved marginally from 6/17 at baseline to 6/16 at 1 month (P = 0.0001) and was maintained at 3 months (P = 0.008); and mean central foveal thickness decreased from 488.7 μm to 318.7 μm at 1 month (P = 0.0001) but increased to 414.4 μm at 3 months (P = 0.049). In group 2, mean visual acuity improved from 6/22 at baseline to 6/19 at 1 month (P = 0.0001) and 6/12 at 3 months (P = 0.0001); and mean central foveal thickness decreased from 428.8 μm to 323.8 μm at 1 month (P = 0.0001) to 269.2 μm at 3 months (P = 0.0001).

CONCLUSION

Nephropathy should be ruled out in patients with DSMD. Although at 1 month both intravitreal triamcinolone and bevacizumab improved vision and decreased central foveal thickness in eyes with DSMD when administered along with focal laser treatment, the former had a more long-lasting effect in maintaining this gain at 3 months.

Effect of panretinal photocoagulation on macular morphology and thickness in eyes with proliferative diabetic retinopathy without clinically significant macular edema

Background

The purpose of this study was to investigate the effect of panretinal photocoagulation (PRP) on macular morphology and thickness in eyes with proliferative diabetic retinopathy (PDR) and without clinically significant macular edema.

Methods

This was a prospective study of 76 eyes from 68 patients diagnosed to have PDR without clinically significant macular edema. Baseline and post PRP visual acuity, morphological changes on optical coherence tomography (OCT), and central foveal thickness were evaluated at one week, one month, and 3 months.

Results

The mean patient age was 56.47 ± 6.55 years. Sixty-two eyes (81.58%) had stable or improved vision, while 14 eyes (18.42%) had worsened visual acuity at 3 months. Compared with baseline, mean visual acuity dropped as early as one week but was regained by 3 months. Mean preoperative central foveal thickness was 222.05 ± 59.11 μm, which increased significantly to 266.84 ± 84.67 μm at one week (P = 0.001), and remained higher at 264.05 ± 102.56 μm by one month (P = 0.01) and 256 ± 101.38 μm by 3 months (P = 0.04). Thirty-four percent of eyes with a normal macula showed morphological changes following PRP. The most common morphological change on OCT after PRP was spongy edema, seen in 48 eyes (31.6%), followed by cystoid macular edema in 36 eyes (23.7%), vitreomacular traction in 28 eyes (18.4%), epiretinal membrane in 24 eyes (15.8%), and subfoveal serous detachment in 16 eyes (10.5%).

Conclusion

PRP may cause a temporary drop in vision in the early post laser phase, and causes macular morphology/thickness changes in eyes with PDR and without clinically significant macular edema. In this study, the change in central foveal thickness did not correlate with a change in visual acuity, and the type of diabetic macular edema on OCT appeared more relevant and correlated better with the visual outcome.

Correlation of spectral domain optical coherence tomography findings in acute central serous chorioretinopathy with visual acuity

Purpose

To evaluate the structural changes in the acute phase of central serous chorioretinopathy and after its resolution, using spectral domain optical coherence tomography, to correlate these tomographic changes with visual acuity (VA).

Method

This was a prospective study of 100 consecutive patients with acute central serous chorioretinopathy. It was based on presenting the best-corrected VA, divided into three groups (Group 1, n = 36, VA 6/6; Group 2, n = 49, VA 6/9–6/18; Group 3, n = 15, VA > 6/18). All patients underwent fundus evaluation followed by fluorescein angiography and spectral domain optical coherence tomography.

Results

The mean age of the patients was 40 ± 7.17 years. The mean log MAR VA was 0.176 ± 0.0185. Single pigment epithelial detachment (PED), and multiple discrete and multiple confluent PEDs were seen in 21%, 17%, and 32% of the eyes, respectively. The location of the PED was subfoveal in 35% of the eyes. The presence of subretinal fibrin and a rough undersurface of the neurosensory retina were noted in 61% and 64% of the eyes, respectively. On en-face scanning, a break in the walls of the PED and overlying fibrin were seen in 32.8% and 45% of the eyes, respectively. The mean subretinal fluid height at the fovea was 279.11 ± 148.78 μ. The mean outer nuclear layer thickness during the active stage was 95.10 μ and during the resolved stage, it was 77.69 μ (P = 0.012). The average photoreceptor lengths were 73.1 μ, 84.6 μ, and 94.9 μ in groups 1, 2, and 3, respectively, in the acute phase; and 69.5 μ, 70.8 μ, and 61.6 μ, respectively, after resolution (P = 0.013, P = 0.010, and P = 0.011).

Conclusion

In the acute phase of the disease, poorer VA showed statistically significant association with greater dimensions of subretinal fluid – particularly, greater subretinal fluid height and thinning of the outer nuclear layer at the fovea. The presence of fibrin, subretinal precipitates, subfoveal location, or type of PED did not have any association with poor VA. In resolved central serous chorioretinopathy, poorer VA was associated with a persistently thinner outer nuclear layer, shorter photoreceptor lengths, and inner and outer segment junction atrophy.

Prevalence and causes of monocular childhood blindness in a rural population in southern India

PURPOSE

To determine the prevalence and etiology of childhood monocular blindness in a rural population in southern India.

METHODS

A total of 14,423 children younger than 15 years in randomly selected villages (8,222 households) with a total population of 40,336 were screened. Screening was performed in two stages. In the first stage, all children with visual acuity worse than 6/18 in at least one eye were screened. Subsequently, children with visual acuity worse than 3/60 in one eye were referred to a tertiary care hospital for further examination for determination of the cause of visual impairment.

RESULTS

The age range of affected children was 1 to 15 years (median age: 12 years). Fifteen children had monocular visual impairment, yielding a prevalence rate of 1.13 in 1,000 children. Refractive error leading to amblyopia was the most common cause of monocular visual impairment, followed by trauma, congenital disorders, and vitamin A deficiency. One case had toxoplasmosis. Approximately one-third of the children were born of a consanguineous marriage (30.06%). The proportion of first-degree consanguinity (46.4%) was higher than that of second-degree (37.5%) or third-degree (16.1%) consanguinity.

CONCLUSION

The prevalence of childhood monocular blindness was high in the current study, but most causes were preventable or treatable. Improved screening methods (especially for refractive errors), genetic counseling, and therapeutic interventions can reduce the burden of childhood blindness.

Ganglion cell complex scan in the early prediction of glaucoma

OBJECTIVE

To compare the macular ganglion cell complex (GCC) with peripapillary retinal fiber layer (RNFL) thickness map in glaucoma suspects and patients.

SUBJECTS AND METHODS

Forty participants (20 glaucoma suspects and 20 glaucoma patients) were enrolled. Macular GCC and RNFL thickness maps were performed in both eyes of each participant in the same visit. The sensitivity and specificity of a color code less than 5% (red or yellow) for glaucoma diagnosis were calculated. Standard Automated Perimetry was performed with the Octopus 3.1.1 Dynamic 24-2 program.

STATISTICS

The statistical analysis was performed with the SPSS 10.1 (SPSS Inc. Chicago, IL, EUA). Results were expressed as mean +/- standard deviation and a p value of 0.05 or less was considered significant.

RESULTS

Provide absolute numbers of these findings with their units of measurement. There was a statistically significant difference in average RNFL thickness (p=0.004), superior RNFL thickness (p=0.006), inferior RNFL thickness (p=0.0005) and average GCC (p=0.03) between the suspects and glaucoma patients. There was no difference in optic disc area (p=0.35) and vertical cup/disc ratio (p=0.234) in both groups. While 38% eyes had an abnormal GCC and 13% had an abnormal RNFL thickness in the glaucoma suspect group, 98% had an abnormal GCC and 90% had an abnormal RNFL thickness in the glaucoma group.

CONCLUSION

The ability to diagnose glaucoma with macular GCC thickness is comparable to that with peripapillary RNFL thickness . Macular GCC thickness measurements may be a good alternative or a complementary measurement to RNFL thickness assessment in the clinical evaluation of glaucoma.

Comparative evaluation of suture-assisted and fibrin glue-assisted scleral fixated intraocular lens implantation

PURPOSE

To compare the visual outcomes and complications after suture-assisted and fibrin glue-assisted scleral fixated intraocular (IOL) implantation.

METHODS

Scleral fixated IOL implantation was performed in patients with inadequate capsular support. Intraocular lens fixation was achieved using sutures or fibrin glue. Main parameters evaluated were visual outcomes and complications.

RESULTS

Fifty patients were included in the study (n=25 suture, n=25 glue). The most common indication for scleral fixated IOL implantation was cataract surgery complicated with posterior capsule rupture (29/50 [58%]). No significant differences were noted between demographic characteristics, surgical indications, and preoperative corrected distance visual acuity (CDVA) in either group (P=.680). No intraoperative complications related to IOL fixation were encountered in any case. At last follow-up (6 months), CDVA was 20/40 or better in 88% and 84% of patients in the suture and glue groups, respectively. Postoperative inflammation (48% vs 16%) and glaucoma (40% vs 16%) were seen more frequently in eyes with sutures as compared to eyes with glue. Overall, a significantly higher number of complications were encountered in eyes with suture fixation (14/25 [56%]) compared to eyes with glue fixation (7/25 [28%]) (P=.045).

CONCLUSIONS

Although visual outcomes were similar at the end of 6 months in eyes that underwent suture- and glue-assisted scleral fixated IOL implantation, fibrin glue was associated with fewer complications.

Early outcomes of primary pediatric keratoplasty in patients with acquired, atraumatic corneal pathology

PURPOSE

To evaluate the early outcomes of pediatric corneal transplantation in patients with acquired, nontraumatic corneal pathology.

METHODS

In this retrospective series, the records of children 15 years of age or younger who underwent optical penetrating keratoplasty for acquired nontraumatic corneal pathologies between December 2008 and June 2010 were reviewed. Demographic features, etiology of opacification, visual acuity, and other clinical findings were recorded.

RESULTS

Nineteen eyes of 19 children (10 females) were included. Mean age at time of surgery was 9.1 ± 3.01 years (range, 5-15 years). Adherent leukoma secondary to healed infectious keratitis (n = 12, 63%) and keratoconus (n = 7, 37%) were the leading indications for surgery. The mean follow-up period was 10.2 ± 3.3 months (range, 6-18 months). Postoperatively, clear grafts were seen in 15 cases (79%). Graft failure was noted in 4 eyes secondary to allograft rejection (n = 1), graft infection (n = 1), primary graft failure (n = 1), and uncontrolled glaucoma (n = 1). The most common cause of moderate or poor visual outcome was amblyopia (80%). Overall, 13 patients (68%) had postoperative visual acuity better than the preoperative vision.

CONCLUSIONS

Penetrating keratoplasty can yield good anatomic results in children with acquired, nontraumatic causes of corneal scarring, but amblyopia limits the visual outcomes.