Comparison of phaconit rollable IOL with acrylic foldable IOL

Background: Phaconit or ultra micro incision phacoemulsification cataract surgery involves phacoemulsification through a 0.9 millimetre sleeveless phaco tip and irrigating chopper followed by implantation of a rollable intraocular lens. The procedure leads to negligible astigmatism and faster visual recovery as compared to phacoemulsification with a foldable intraocular lens.     

Manual Small Incision Cataract Surgery: Experience at a Military Hospital

Background

Small incision cataract surgery came into practice with the advent of phacoemulsification. However, manual small incision cataract surgery (SICS) is a useful alternative for those who do not have access to phacoemulsification machine.

Method

A total of 69 cases of cataract were undertaken for manual incision cataract surgery and intra ocular lens (IOL) implantation using 6mm straight incision. The surgical technique and postoperative results are compared with the results of phacoemulsification and IOL implantation.

Result

Average postoperative astigmatism was ± 0.75 dioptres. Postoperative uncorrected visual acuity (UCVA) of 6/18 or better was observed in 51(71.9%) cases after first week of the surgery.

Conclusion

The study concludes that both phacoemulsification and small incision cataract surgery with intraocular lens (IOL) implantation are effective methods. However SICS with IOL implantation is a useful alternative in the absence of phacoemulsification machine.Key Words: Manual Small Incision Cataract Surgery (SICS), Extra Capsular Cataract Extraction (ECCE), Phacoemulsification, Intraocular lens implantation     

Management of Nucleus and IOL Drop

Background

Thirty six cases of lenticular nucleus drop following phacoemulsification and 43 cases of posterior dislocation of intraocular lens (IOL) inclusive of two paediatric cases were managed by a modified vitrectomy procedure without using perfluorocarbon liquid (PFCL).

Methods

In these cases the incision was placed inferotemporally at pars plana. The limbal sites of the earlier cataract surgery were utilised as the other two ports. In either case adequate vitrectomy was performed first. In cases of nuclear drop, the nucleus was impaled (speared) with a micro vitreo retinal blade and brought into the anterior chamber from where it was delivered out. In cases of IOL drop the same was picked up by an intra-vitreal forceps.

Result

Of the 77 adult cases treated 57 (74%) of the eyes had a visual recovery of 6/18 or more.

Conclusion

Prompt surgical management in cases of nuclear drop or posterior dislocation of IOL yields good results.Key Words: Phaco-emulsification, Intraocular lens drop, Nucleus drop, Vitrectomy     

AC/PC Intraocular Lens Exchange with Penetrating Keratoplasty in Pseudophakic Bullous Keratopathy

Background

Evaluation of penetrating keratoplasty in cases of pseudophakic bullous keratopathy with AC/PC IOL exchange.

Methods

This retrospective study included 120 cases of pseudophakic bullous keratopathy managed over 9 years at three tertiary care eye centres followed up for 4 years. Cases were taken up for penetrating keratoplasty along within adjuvant procedures like IOL explantation and Secondary Posterior Chamber IOL implantation over the frill of posterior capsule.

Results

Lens exchange with Penetrating Keratoplasty (PK) was done in 93 and PK without lens exchange in 27 cases. 25% required systemic steroids for 2-3 weeks. Re-grafting was performed in 5% and 85% attained moderate visual acuity.

Conclusion

Intra ocular lens exchange and Posterior chamber IOL are suitable for penetrating keratoplasty in terms of optical clarity, graft survival and visual outcome.Key Words: PBK, IOL exchange (AC/PC)     

Phacotrabeculectomy Versus Conventional Combined Technique in Coexisting Glaucoma and Cataract

Background

To evaluate and compare efficacy and outcome after single site phacotrabeculectomy and conventional combined surgery in cases of coexisting primary open angle glaucoma and cataract.

Methods

This prospective study on fifty patients of concurrent primary open angle glaucoma and cataract, who had undergone combined surgery as single site phacotrabeculectomy or conventional single site trabeculectomy with extracapsular lens extraction with IOL implantation in 25 cases each. Evaluation was based on operative and postoperative complications, control of IOP and visual outcome. The follow up period ranged between twelve months to eighteen months.

Results

The mean medically controlled preoperative intraocular pressure was 22 mm of Hg (Range 18 to 35 mm of Hg) by applanation method of tonometry. The range of postoperative intra-ocular pressure after one year was 11 to 22 mm of Hg in first and 14 to 26 mm Hg in second group. Failure to maintain optimum postoperative IOP without Beta-blocker was more frequent after conventional combined procedure. There was no significant difference in incidence and pattern of postoperative complications.

Conclusion

Phacotrabeculectomy provides effective and sustained visual recovery and adequate control of intraocular pressure as compare to conventional combined procedure.Key Words: Phacotrabeculectomy, Comparison with conventional combined procedure     

A clinical study to evaluate the results after toric intraocular lens implantation in cases of corneal astigmatism

Backgroud

Modern day cataract surgery aims at a spectacle free vision which becomes difficult in cases with pre-operative astigmatism more than 1.5 D. Implantation of toric intra-ocular lenses (IOL) after phacoemulsification in such eyes is one of the ways to counteract this problem.

角膜缘隧道切口白内障超声乳化折叠式人工晶体植入术

目的 :评价角膜缘隧道切口的白内障超声乳化折叠式人工晶体植入术的效果。　方法 :对 6 6例 (72眼 )老年性、并发性、外伤性白内障采用 3.2 mm角膜缘隧道切口 ,行白内障超声乳化并植入折叠式人工晶体 ,观察手术前后视力、角膜曲率、角膜地形图的变化。　结果 :术后 1天、1周、1个月的视力达 0 .5以上者分别占 6 9.4%、80 .6 %和86 .1% ,术后 1周平均散光为 (1.85± 0 .89) D,比术前增加 0 .30 D(P<0 .0 1) ,角膜地形图显示切口处轻度陡峭或平坦 ,术后 1个月平均散光为 (1.48± 1.0 2 ) D,P>0 .0 5 ,角膜地形图显示已恢复术前状态。　结论 :角膜缘隧道切口的白内障超声乳化折叠式人工晶体植入术能简化手术步骤 ,术后视力恢复快 ,炎症反应轻 ,具有早期恢复至术前眼屈光状态的优势     

糖尿病患者白内障超声乳化吸除联合折叠式人工晶体植入术189例

目的:探讨糖尿病患者白内障超声乳化吸除联合折叠式人工晶体植入术的疗效和并发症。方法:对189例糖尿病性白内障行超声乳化吸除联合折叠式人工晶体植入术。结果:术后1周裸眼视力≥0.7者24例,占13%;0.6～0.4者117例,占61%;≤0.3者24例,占26%。结论:糖尿病患者采用超声乳化白内障吸除联合折叠式人工晶体植入术,术后并发症明显减少,术后视力恢复快,对糖尿病患者是一种安全有效、实用的手术方式。更重要的是有利于眼底观察,为及时治疗视网膜病变提供了条件。     

AkreosAdapt折叠式人工晶体植入的临床体会

目的：探讨Akreos Adapt折叠式人工晶体植人的临床疗效。方法：对62例（68眼）白内障患者行超声乳化术植人Akreos Adapt折叠式人工晶体作为观察组，以植入两襻亲水性丙烯酸酯折叠式人工晶体（oii）71例（80眼）作为对照组。术后观察视力、角膜曲率和角膜内皮细胞密度变化，术后3个月观察人工晶体的位置和晶状体后囊膜的混浊情况，对两组结果进行统计学分析。结果：术后早期矫正视力、手术性散光度数、晶状体后囊膜混浊的发生率、人工晶体位置，观察组均优于对照组，两组比较差异有统计学意义（P〈0．05）。术后3个月矫正视力、角膜内皮细胞的丢失率、手术性散光度数，两组比较差异无统计学意义（P〉0．05）。结论：Akreos Adapt折叠式人工晶体植人方便，居中性好，安全性高，视力恢复快，并发症少，是较为理想的人工晶体。     

高原地区超微切口白内障超声乳化联合AKreos MI60人工晶体植入术的临床研究

目的：探讨高原地区超微切口白内障超声乳化联合AKreos MI60人工晶体植入术的临床疗效。方法：将180例白内障患者随机分为对照组与试验组,每组为90眼。试验组行1.8mm同轴超微切口超声乳化吸除联合Akreos MI60人工晶状体植入术,对照组行3.0～3.2mm标准角膜切口超声乳化吸除联合Akreos AO人工晶体植入术。比较两组治疗前后视力、角膜散光及并发症发生率等。结果：（1）术中试验组平均超声乳化时间为（0.43±0.22）min,有效超声能量为（4.83±2.72）%,术中对照组平均超声乳化时间为（0.79±0.18）min,有效超声能量（9.50±3.48）%,两组比较试验组平均超声乳化时间为更短,超声能量更少,差异具有统计学意义（P〈0.05）。（2）两组术后视力较术前均有一定的改善,试验组术后与对照组术后相比,差异具有统计学意义（P〈0.05）（3）术后角膜散光均有不同程度的改变,术后第1天、第1周角膜散光对照组大于试验组,有显著性差异（P〈0.001）,术后1月趋于稳定,两组角膜散光差异无统计学意义（P〉0.05）。结论：高原地区超微切口白内障超声乳化联合AKreos MI60人工晶体植入术治疗白内障,前房密闭稳定、超声乳化时间短、超声效率较高、手术源性散光减小,早期视力恢复快,并发症少,手术安全性较高,应加以推广及应用。     

高度近视伴未成熟期白内障超声乳化手术治疗

目的评价高度近视眼伴未成熟期白内障患者行Phaco+IOL手术治疗的临床效果及患者满意度调查。方法高度近视合并未成熟期白内障患者35例68眼,年龄42～55岁,球镜光屈度均>-9.75.00D,平均-11.3±1.26 D,眼轴长度均>27.32 mm,平均(29.22±1.87)mm;所有患者均行透明角膜切口白内障超声乳化吸除+可折叠式IOL植入术;术后随访6个月,分别于术后3天、1个月、3个月、6个月行视力和眼部状况检查,并记录其视力及眼部并发症情况。结果视力恢复情况:随访至术后6个月裸眼视力≥0.5者48眼,占70.58%,其中有10眼裸眼视力≥0.8;并发症情况:术中有3眼发生后囊破裂,予植入张力环后均顺利植入人工晶体;术后早期部分患者出现角膜内皮水肿及一过性眼压升高现象,予以对症治疗后均恢复正常;至术后6个月时有7眼出现后发性白内障。结论高度近视合并白内障患者眼部状况复杂,在白内障未成熟期行超声乳化联合人工晶体植入既可矫正高度近视,又可有效避免眼部并发症的发生,手术安全系数高,患者满意度高。     

Evaluation of Posterior Capsular Opacification following Phacoemulsification,Extracapsular and Small Incision Cataract Surgery

Background

Posterior capsular opacification is the most common complication of modern cataract surgery.

Methods

A prospective study was conducted on 150 patients (150 eyes) out of which 50 eyes each underwent cataract surgery by extracapsular cataract extraction, small incision cataract surgery and phacoemulsification technique. On postoperative follow up posterior capsular opacification and Neodymium: Yttrium Aluminium Garnet laser capsulotomy rate was evaluated.

Result

Posterior capsular opacification rate was significantly less (p=0.03) in eyes which had undergone phacoemulsification as compared to extracapsular cataract extraction. However capsulotomy rate was not statistically significant after comparison of the three surgical techniques of cataract surgery.

Conclusion

Posterior capsular opacification following cataract surgery can be minimized by the use of small incision cataract surgery and phacoemulsification.Key Words: Posterior capsular opacification, Capsulorrhexis, Hydrodissection     

IOL Master与A超生物测量屈光结果的对比研究

目的：对比分析光学相干生物测量仪（IOLMaster）与接触式A超测算IOL度数的精确性,以评价IOLMaster的临床应用价值。方法：本研究属于前瞻性的临床研究,80例（97艰）老年性白内障患者,均行白内障超声乳化联合IOL植入术。术前分别用IOLMaster、接触式A超联合手动角膜曲率计测量眼轴长度和角膜曲率,使用SRK—Ⅱ（眼轴≤26．00mm）或SRK／T（眼轴〉26．00mm）公式计算IOL度数。术后随诊3个月检查患者的屈光状态。结果：IOLMaster和接触式A超所测眼轴分别是（24．07±2．37）mm、（23．99±2．32）mm,两者对比差异有统计学意义（t=2．863,P=0．005〈0．05）。IOL Master和手动角膜曲率计所测角膜曲率分别是（44．74±1．67）D、（44．69±1．58）D,两者对比差异无统计学意义（t=O．850,P=0．398〉0．05）。术后3个月平均绝对屈光误差（MAE）：IOLMaster和接触式A超联合手动角膜曲率汁分别是（0．48±0．36）D和（O．58±0．52）D。将IOLMaster和A超联合角膜曲率计的MAE以1．00D为界做x2检验,差异有统计学意义（x2=7．56．P=0．004〈0．05）。结论：与接触式A超相比,IOLMaster对眼轴长度的测量精确性较高,IOL度数测算更精确．     

ReSTOR多焦点人工晶体的临床应用研究

目的探讨ReSTOR多焦点人工晶体的临床应用效果。方法选取30例（60眼）老年性白内障患者,按统一标准分为两组,其中双眼非同期植入ReSTOR多焦点人工晶体者15例设为MIOL组;双眼非同期植入单焦点人工晶体者15例设为SIOL组。均行角膜缘透明角膜切口,应用超声乳化术摘除白内障联合人工晶体植入。术后1?d观察术眼的屈光状态,裸眼远、近视力;术后1个月观察术眼的屈光状态,裸眼远、近视力,矫正远、近视力,最佳远矫下近视力,焦距深度,对比敏感度,远近立体视锐度,问卷调查视觉质量、各视觉功能区满意度及脱镜率。结果术中术后无严重并发症。两组患者术后均有良好的远视力;MIOL组患者同时获得良好的近、中程视力。术后对比敏感度MIOL组较SIOL组有所下降,但无功能性意义。MIOL组有80%（12例）的患者裸眼近立体视锐度≤60?s,SIOL组所有患者裸眼近立体视锐度≥400?s,差异有统计学意义（χ2=26.28,P＜0.05）;MIOL组有93.33%（14例）的患者矫正近视力下近立体视锐度≤60?s,SIOL组有33.33%（5例）患者矫正近视立下近立体视锐度≤60?s,差异有统计学意义（χ2=12.59,P＜0.05）。MIOL组视近脱镜率80%。结论ReSTOR多焦点人工晶体植入安全有效,可为患者提供良好的全程视力及双眼视觉,患者满意度较高。     

白内障超声乳化、折叠型人工晶体植入、小梁切除三联术

目的 :研究白内障超声乳化、折叠型人工晶体植入术联合小梁切除术治疗青光眼合并白内障的疗效。方法 :研究组 62例、62眼行白内障超声乳化、折叠型人工晶体植入术联合小梁切除术 ;对照组 61例、61眼行白内障囊外摘除、人工晶体植入术联合小梁切除术。对 2组术后视力及并发症进行评价。结果 :术后第1天、第 1周 2组视力恢复 ,眼压控制 ,功能性过滤泡形成 ,炎症反应及术后角膜散光差异有显著性(P <0 0 5 ) ;术后 3个月 2组已无差异性 (P >0 ,0 5 )。结论 :研究组术后早期并发症少 ,视力恢复快 ,角膜散光降至最低 ,为切实可行的术式。     

Role of Oral Appliances in the Management of Sleep Disorders

Background

A study was undertaken with the aim to evaluate the therapeutic and clinical efficacy of oral appliances in the management of upper airway sleep disorders like snoring and obstructive sleep apnea (OSA).

Methods

Oral appliances were prescribed in eight cases of non - apneic snoring and 42 polysomnography (PSG) diagnosed cases of OSA. The cases were assessed on Epworth Sleepiness Scale (ESS) and Apnea - Hypopnea Index (AHI).

Result

62.5% of the non - apneic snoring cases reported gross reduction/cessation of snoring. In the OSA cases, the mean AHI and ESS scores decreased from 51.48 ± 23.70 to 32.78 ± 18.06 and 12.50 ± 3.57 to 7.20 ± 2.917 respectively. A statistically significant (p<0.0001) improvement in AHI and ESS scores was observed.

Conclusion

Short term therapeutic efficacy of oral appliances therapy in non-apneic snoring and OSA cases was observed.Key Words: Snoring, Obstructive sleep apnea, Oral appliances     

折叠式人工晶状体推注式植入的对比观察

目的评价折叠式人工晶状体推注式植入的临床效果。方法 120例老年性白内障超声乳化联合Acrysof折叠式人工晶状体3.2mm切口推注式植入,观察术后视力,散光变化,角膜内皮细胞计数及术后前房炎症反应等。结果与120例120眼3.5~4.0mm切口折叠式植入相比较。结果推注式植入术后1d视力≥0.5者112眼（93.9%）,较对照组高（P〈0.05）。术后1周角膜散光值为（0.93±0.50D）,较对照组低（P〈0.05）。术后1周房水闪光阳性率为17%,低于对照组（P〈0.05）。结论折叠式人工晶状体推注式植入具有术后视力恢复更快、更好、散光变化更小,术后炎症反应更轻,人工晶状体损伤更少等优点,值得进一步推广应用。     

青光眼白内障三联术后早期人工晶体前膜的治疗

目的探讨超声乳化白内障吸除折叠式人工晶状体植入联合复合式小梁切除术（三联手术）后早期人工晶体前膜的治疗方法,并观察疗效。方法选择72例（72眼）行超声乳化白内障吸除折叠式人工晶状体植入联合复合式小梁切除术后形成人工晶体前膜的患者,随机分为二组：观察组35例（35眼）行YAG激光人工晶体前膜切除,对照组37例（37眼）,予以地塞米松3mg,妥布霉素20mg,球结膜下注射治疗1次／d,观察1周后二组视力、人工晶体前膜清除情况,并对数据进行统计学分析。结果观察组与对照组1周后视力、人工晶体前膜清除情况分别与术前比较差异有统计学意义（P〈0．05）;二组1周后视力、人工晶体前膜清除情况比较差异有统计学意义（P〈0．05）,观察组优于对照组。结论对三联手术后人工晶状体前膜早期实行YAG激光治疗是安全有效的,值得临床推广。     

Presentation of Primary Open Angle Glaucoma (POAG) at Lions Sight First Eye Hospital in Blantyre,Malawi

Objective

Primary open angle glaucoma (POAG) is the most common type of glaucoma in Africa. We carried out a study to determine the clinical presentation pattern of patients with primary open angle glaucoma (POAG) at a tertiary hospital in Malawi.

Design

A cross-sectional study

Setting

Lions Sight First Eye Hospital—a major referral and teaching state eye hospital in Blantyre, Malawi

Subjects

Study participants were newly diagnosed POAG patients at specialist eye clinic during study period.

Results

A total of 60 POAG patients were recruited into the study. The mean age was 58.7 years (SD= 16.6, range 18 - 86). There were more male (44, 73.3%) than female (16, 27.7%) patients. The majority of patients (73%) presented one year after onset of visual symptoms. Twenty-six patients (43%) had unilateral blindness (visual acuity < 3/60; WHO classification), while nine patients (15%) presented with bilateral blindness. A vertical cup-to-disc ratio (CDR) of 0.8 or worse was seen in 92 eyes (79%). The mean intraocular pressure (IOP) reading was 35.5 mmHg (SD 13.30). Of the thirty-three eyes that successfully underwent visual field analysis, very advanced defects were recorded in 12 eyes (36%).

Conclusion

This study demonstrates delayed presentation and male predominance among POAG patients at a tertiary eye hospital in Malawi. Glaucoma intervention programmes should aim at identifying patients with treatable glaucoma with particular attention to women.     

A study to determine factors influencing outcomes of paediatric cochlear implants

Background

Cochlear implantation is a powerful tool for helping children with severe to profound sensorineural hearing loss to gain the ability to hear, achieve age appropriate communication skills. However patient selection is of utmost importance to achieve optimum results.

Method

A cross sectional study was done on 75 children who had undergone unilateral cochlear implantation. Hearing was assessed by, The Meaningful Auditory Integration Scale (MAIS) and speech perception was assessed by the Meaningful Use of Speech Scale (MUSS) as a parent reported scale in an interview format.

Results

The cochlear implantation improved auditory skills and speech perception of the children who underwent cochlear implantation. Children who had less than 40 months auditory deprivation and those who had higher educated parents had better auditory skills and speech perception.

Conclusion

Early cochlear implantation and good auditory verbal therapy have better outcomes of hearing and speech.