The cosmetic outcome of external dacryocystorhinostomy scar and factors affecting it

Purpose:To study the cosmetic outcome of external dacryocystorhinostomy (Ex-DCR) and to detect the factors affecting it.Results:The mean scar grading was 0.98 ± 1.0 and 1.3 ± 1.0 in patients’ and examiner''s assessment. About 27.5% described their scars as cosmetically significant. The cosmetic outcome was significantly affected by the type of incision with only 5% significant scars in subciliary incision group. Prolene 6-0 suture was associated with better cosmetic results with 15% significant scars. 50% of dark-skinned patients showed cosmetically significant scars. Although no correlation was found between patients’ age and cosmetic outcome, pediatric patients showed higher tendency to scar visibility with mean scar grade 1.2 ± 1.0 and 1.5 ± 0.9 in patients’ and examiner''s assessment.Conclusion:Dark skinned and pediatric patients are more prone to visible Ex-DCR scar. The use of subciliary approach and prolene 6-0 skin sutures is associated with more favorable cosmetic outcome.     

The Long-Term Follow-Up Results of External Dacryocystorhinostomy Skin Incision Scar with “W Incision”

Abstract

Objective: To determine the effect of “W incision” instead of classical vertical incision at external DCR on scar formation.

Materials and Methods: Patients with acquired nasolacrimal duct obstruction (NLDO) who were treated with external DCR with classical vertical incision, and patients who were treated with external DCR with “W incision” were included in the study. The first 39 eyes were operated with a vertical incision, and the remaining 37 eyes were operated with a “W incision”. All the skin incision scars of the patients were assessed and scored by at least the 6th month. The assessment was made by both the patients themselves, and by an ophthalmologist other than the surgeon himself, each scored the incision scar separately (single-masked study). Scores for both groups were compared, and statistical analyses were performed.

Results: Self-assessment scores for the incision scar were Grade 2.28?±?0.94 in the Vertical incision group, and Grade 1.68?±?0.57 in the “W incision” group (p?<?0.01). The “W incision” scar formation was significantly less noticable than the Vertical incision scar formation. Similarly, the assessment scores of the ophthalmologist other than the surgeon himself were significantly lower for the “W incision” group than for the Vertical incision group. The mean scar assessment scores were Grade 2.13?±?0.95 in the Vertical incision group, and Grade 1.57?±?0.68 in the “W incision” group (p?<?0.01).

Conclusion: Skin scar tissue was found to be significantly reduced with a “W incision” in external DCR operations.     

Half Minimally Invasive Strabismus Surgery (MISS): A single para-muscular approach to horizontal muscle strabismus surgery

Purpose:Minimally invasive surgeries are gaining popularity. We compared two different approaches to rectus muscles: namely the standard para limbal (SPL) and the single para-muscular (SPM).Methods:Thirty-six patients planned for monocular horizontal strabismus surgery were block randomized to SPL and SPM approach. SPM approach involved a single para-muscular 10-mm conjunctival incision levelled at the inferior border of rectus muscle. We compared the post-operative grades of redness, congestion, chemosis, foreign body sensation, and drop intolerance at day 1, 2 weeks, and 6–8 weeks; scar visibility and success rates at 6–8 weeks and operation duration in minutes. We compared the results using Mann–Whitney U-test for inflammatory grades, Fisher’s exact test for proportions, and t-test for parametric measures. Significance was set at P < 0.05.Results:On postoperative follow-up at any time point, no significant difference was found on comparing inflammatory grades, scar visibility, and success rates. In terms of duration, SPL approach was on an average 21.5 minutes quicker than SPM (P = <0.001).Conclusion:The SPM is comparable to the SPL approach in terms of postoperative comfort and appearance, but takes significantly longer to accomplish.     

Tips on How to Avoid the DCR Scar

A permanent facial scar following external approach (transcutaneous) dacryocystorhinostomy is fortunately rare. Meticulous surgical technique is the key factor in avoiding a visible scar.

Simple measures to avoid a scar include use of local anaesthesia, location of the incision, maintaining a bloodless surgical field, using a skin flap technique and simple orbicularis and skin wound closure.

Although endonasal endoscopic dacryocystorhinostomy is gaining clinical acceptance and popularity, the external dacryocystorhinostomy is regarded as the gold standard in terms of surgical success, with a high patient satisfaction.     

Postoperative evaluation of skin incision in external dacryocystorhinostomy

PURPOSE: To evaluate the appearance of the skin incision in external dacryocystorhinostomy 6 weeks and 6 months after surgery. METHODS: A prospective, interventional, noncomparative case series of consecutive cases of external dacryocystorhinostomy was performed by 3 surgeons. At 6 weeks and 6 months after surgery, patients were asked to grade their incision, and standardized photographs were evaluated by 3 blinded observers. RESULTS: Thirty-four consecutive patients were admitted and followed for 6 months. Six weeks after surgery, 9 of 34 patients could not see their incision site (26%), 13 of 34 graded it as minimally visible (38%), 9 of 34 (26%) graded it as moderately visible, and 3 of 34 patients (9%) graded it as very visible (grade 3). Two of 34 patients (6%) were not satisfied with the appearance of the incision. Six months after surgery, 15 of 34 patients (44%) could not see their incision site (grade 0), 16 of 34 (47%) graded it as minimally visible, 3 of 34 patients (9%) graded it as moderately visible, and no patient graded it as very visible. All patients were satisfied with the appearance of their incision. Photographic evaluation of patients 6 weeks after surgery by the 3 observers showed an average score of 1.12, 1.18, and 1.24. There was not a statistically significant difference between the observers (p = 0.95). At 6 months after surgery, the average scores were 0.56, 0.74, and 0.79. There was not a statistically significant difference between the observers (p = 0.43). The change in appearance of the incision at 6 weeks and at 6 months was statistically significant (p < 0.044), as evaluated by patients and observers (p < 0.001). CONCLUSIONS: The skin incision in external dacryocystorhinostomy is satisfactory to most patients. Its appearance is improved with time; 86% of the incisions were graded invisible or minimally visible by observers and 91% by patients after 6 months.     

Medial canthal defects following tumour excision: To reconstruct or not to reconstruct?

Laissez-faire following excision of peri-ocular tumours has been described, but is not universally well established. We describe our experience with laissez-faire for managing medial canthal defects following tumour excision and compare our outcomes with full thickness skin grafts. Retrospective comparative case series of 68 patients who underwent reconstruction of a medial canthal defect using laissez-faire with sutured Sorbsan (LFS) (n = 36) or a full thickness skin graft (FTSG) (n = 32) at the same centre. Tumour diagnosis, defect size, time taken to epithelialise, functional and cosmetic outcomes, complications, follow-up duration and any secondary interventions were recorded. Basal call carcinoma was the most common neoplasm excised (63/68, 93%). Defect size ranged from 7 × 5 mm to 25 × 10 mm. Mean time for wound epithelialisation in LFS group was 33 days. Mean duration of follow-up was 32 months (range 1–80 months) for LFS and 30 months (range 6–60 months) for FTSG. Good functional and cosmetic outcomes were achieved in all 68 patients. Review of clinical photographs showed epicanthic fold in 2 patients and visible scar in 1 patient in the LFS group and 3 cases of hypopigmented scar and 7 hypertrophic scars in the FTSG group. No cases required secondary intervention. There were no cases of postoperative infection. LFS in the medial canthal region is less likely to lead to hypertrophic scarring or cicatricial sequelae compared to FTSG (p = 0.02). Both techniques are associated with excellent functional and aesthetic outcomes even for larger defects.     

Cosmetic evaluation of surgical scars after external dacryocystorhinostomy

AIM: To evaluate the surgical scars of external dacryocystorhinostomy (DCR) cosmetically. METHODS: Totally 50 consecutive cases of primary acquired nasolacrimal duct obstruction (PANDO) were included in the study. Surgical scars were assessed by the patients and two independent observers at 2, 6 and 12wk postoperatively on the basis of visibility of the scars and still photographs respectively and were graded from 0-3. Kappa test was utilised to check the agreement of scar grading between the two observers. Wilcoxan signed ranks test was used to analyse the improvement of scar grading. RESULTS: Thirty-four (68%) patients graded their incision site as very visible (grade 3) at 2wk. At 6 and 12wk, incision site was observed as grade 3 by 7 (14%) and 1 (2%) patients respectively. Photographic evaluation of patients by 2 observers showed an average score of 2.75, 1.94 and 0.94 at 2, 6 and 12wk respectively. Change in scar grading from grade 3 to grade 0 in consecutive follow-up (2, 6 and 12wk) was found to be highly significant both for the patient as well for the observers (P<0.0001). CONCLUSION: The external DCR is a highly effective and safe procedure and in view of low percentage of cases who complained of marked scarring in the present study, thus scarring should not be the main ground for deciding the approach to DCR surgery, even in young cosmetically conscious patients.     

Long-term outcomes of amniotic membrane treatment in acute Stevens-Johnson syndrome/toxic epidermal necrolysis

PurposeTo report the long-term outcomes of amniotic membrane (AM) use in the form of transplantation (AMT) and self-retained amniotic membrane (ProKera® device, PD) in acute Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN).MethodsElectronic records of all patients with a diagnosis of SJS/TEN at Massachusetts Eye and Ear between January 2008 and January 2018 were reviewed. Patients who received AM in acute SJS/TEN were selected. Only patients with follow-up ≥ 3 months after discharge were included.ResultsData of 55 eyes of 29 patients were analyzed. All 55 eyes received the first AM at a median interval of 5 days (inter-quartile range (IQR): 3–7 days) after onset of skin rash. Fifty-six percent of eyes (31/55) received AMT while 44% (24/55) received PD. Forty percent of eyes (22/55) required a repeat AMT or PD. Median follow-up after initial AM was 2.5 years (IQR: 1.2–3.6 years). At last follow-up, the best-corrected visual acuity was ≥20/40 in 87% of eyes (48/55). The most common complications in the chronic phase were meibomian gland disease and dry eye, seen in 78% of eyes (43/55) and 58% of eyes (32/55) respectively.ConclusionsLong-term results show that early use of AM in the acute phase of SJS/TEN may be effective in mitigating severe vision loss after SJS/TEN. However, eyelid-related complications and dry eye remain a common problem even with the use of AM.     

A randomized masked pilot clinical trial to compare the efficacy of topical 1% voriconazole ophthalmic solution as monotherapy with combination therapy of topical 0.02% polyhexamethylene biguanide and 0.02% chlorhexidine in the treatment of Acanthamoeba keratitis

PurposeTo compare the efficacy of topical voriconazole 1% and the combination therapy of 0.02% polyhexamethylene biguanide (PHMB) and 0.02% chlorhexidine for the treatment of Acanthamoeba keratitis (AK).MethodsThis is a prospective, pilot, double-masked randomized comparative study. Twenty-three eyes of 23 patients with microbiologically (smear and/or growth on culture) confirmed AK were randomized to group BG (PHMB 0.02% and chlorhexidine 0.02%) or group VZ (voriconazole 1%). Primary outcome measure was change in geometric mean (GM) of the corneal ulcer size at final visit. Secondary outcome measures were change in visual acuity.ResultsOut of 71 patients with confirmed AK seen during study period, 23 patients were recruited and 18 patients completed minimum 2 weeks of treatment and further analyzed. Ten patients received BG, whereas eight received VZ. Median ulcer size measured as GM of infiltrate decreased from 5.7 mm (IQR, 5.3–6.5 mm) (p = 0.02) to 1 mm (IQR, 0–4.3 mm) in group BG and from 4.5 mm (IQR, 1.8–5.1 mm) (p < 0.05) to 0.7 mm (IQR, 0–1.6 mm) in VZ group. Median visual acuity improved from 1.79 (IQR, 1.48–2.78) to 1.10 (IQR, 0.48–1.79) in BG group (p = 0.02) and from 1.60 (IQR, 1.00–2.78) to 0.80 (IQR, 0.48–1.30) in VZ group (p = 0.18).ConclusionThese outcomes suggest that topical VZ as a monotherapy in AK treatment is effective and comparable to BG combination therapy but needs trials with larger sample size and longer follow-up to provide conclusive evidence.Subject terms: Corneal diseases, Parasitic infection     

Periumbilical fat graft: a new resource to replace large volume in the orbit

Abstract

Goal: To describe the technique we use to obtain a fat graft from the periumbilical area to replace volume in our patients requiring total or partial orbital volume restoration or replacement.

Materials and methods: Under local anaesthesia a one-piece fat auto-graft is obtained from one of the quadrants of the periumbilical zone through a 10- to 15-mm incision at the umbilicus edge.

Results: Excised adipose tissue contains connective tracts, with medium and small vascular vessels with discrete thickened wall and preserved endothelium, with more blood cells, and less dead cells.

Conclusions: Fat grafts are the ideal fillers for patients requiring orbital volume replacement. The periumbilical fat graft technique we describe is simple, safe and fast, the learning slope shallow and the results gratifying in both the replaced volume, and the donor area with an invisible scar. The amount of fat that can be obtained with this technique through a minimal incision can be large enough.     

Decoding fluid droplet generation during phacoemulsification and pars plana procedures in the COVID-19 era—An experimental study

Purpose:The purpose of this study is to evaluate fluid droplet spray generation during phacoemulsification (PE), pars plana vitrectomy (PPV), and fragmatome lensectomy (FL) and assess factors affecting these.Methods:This is an experimental study. PE through 2.2 and 2.8 mm incisions was performed in six goat eyes and four simulator eyes using both continuous and interrupted ultrasound (U/S). PPV and FL were performed in three goat eyes. Generation of visible fluid droplet spray was analyzed from video recordings through the microscope camera and an external digital camera. Hydroxypropylmethylcellulose (HPMC) was applied over the incision site during PE and FL.Results:When PE was performed through both incision sizes, there was no visible fluid droplet spray if the phaco tip was centered in the incision, without sleeve compression. When there was phaco tip movement with the phaco sleeve sandwiched between the tip and the incision wall, there was visible fluid droplet spray generation. It was more difficult to induce fluid droplet spray with 2.8 mm incision, and spray was lesser with interrupted U/S. During PPV, there was no droplet spray. During FL, fluid droplet spray was only seen when U/S was delivered with the fragmatome tip close to the sclerotomy. HPMC impeded droplet spray.Conclusion:Fluid droplet generation during PE can be minimized to a large extent by keeping the phaco tip centered within the incision, avoiding sleeve compression. Smaller incision and continuous U/S were more prone to droplet generation. FL should be performed away from sclerotomy. HPMC over incision is recommended.     

两种术式治疗重度上睑瘢痕性睑内翻的疗效比较

目的：比较显微镜下Hotz法联合睑缘切开皮瓣转位术和单纯Hotz法治疗重度上睑瘢痕性睑内翻的临床效果。

方法：回顾性分析2017-07/2019-07在我院接受上睑内翻倒睫矫正术的患者60例84眼,试验组32例42眼采用显微镜下Hotz法联合睑缘切开皮瓣转位术,对照组28例42眼采用单纯Hotz法。术后随访观察至12mo, 记录患者主观症状、睑缘位置、睫毛外翻情况及满意度。

结果：试验组单眼平均手术时间长于对照组(40.8±2.57min vs 28.5±2.64min,P<0.01)。术后1、12mo,试验组治愈率分别为100%、95%,对照组治愈率分别为95%、76%,术后12mo试验组治愈率优于对照组(P=0.013)。 术后1mo两组患者满意度无差异(Z=1.1825,P=0.2371),术后12mo试验组患者满意度高于对照组(Z=3.7346,P<0.01)。

结论：对于重度上睑瘢痕性睑内翻,显微镜下Hotz法联合睑缘切开皮瓣转位术虽手术时间长于单纯Hotz法,但其远期疗效优于单纯Hotz法,术后12mo患者满意度较高。     

Lower Postoperative Scar Height is Associated with Increased Postoperative Trichiasis 1 Year after Bilamellar Tarsal Rotation Surgery

ABSTRACT

Purpose: To investigate the relationship between postoperative scar height and surgical success of the bilamellar tarsal rotation (BLTR) procedure, commonly used to correct trichiasis secondary to trachoma.

Methods: Using data from the Partnership for the Rapid Elimination of Trachoma surgical trial, comparing the new trachomatous trichiasis (TT) clamp with standard BLTR instrumentation, 145 sequential participants (245 eyelids) at their 1-year postoperative visit were examined. We measured internal and external scar heights from the upper eyelid margin for nasal, central and temporal sections and compared these to recurrence location at 1 year. We calculated odds of location-specific postoperative trichiasis and examined possible risk factors associated with postoperative trichiasis.

Results: A total of 77 eyelids (31%) had postoperative trichiasis, which most commonly occurred centrally. Regardless of instrumentation used, the closer the internal scar was to the eyelid margin, the higher the proportion that had recurrence, until 4.5?mm, at which point, the proportion leveled off. In bivariate analyses, the odds of central recurrence were significantly higher at all three locations when the internal scar height was <4.5?mm compared to higher scars. In multivariate analyses, central scar height <4.5?mm and severe baseline trichiasis were independently associated with central postoperative trichiasis.

Conclusion: Internal scar height <4.5?mm measured 1 year after surgery is more likely to be associated with postoperative trichiasis. Given these findings and the current World Health Organization recommendation for an incision height of 3.0?mm, further study into optimum incision height to minimize postoperative trichiasis is warranted.     

An Objective Evaluation of the Upper Eyelid Position after Phacoemulsification Cataract Surgery

Purpose: To objectively measure the upper eyelid position following phacoemulsification cataract surgery and to identify the determinants of postoperative transient ptosis.

Methods: This is a single arm prospective study of patients who underwent cataract surgery from January to May 2017 at a tertiary Eye Hospital in Spain. Data comprised of: the type of anesthesia, the duration that the speculum remained in place and the total surgical time (duration of the procedure). The total surgical time was defined as, the time from the beginning of the paracentesis to the closure of the wounds (incision time). Digital photographs were obtained of: the face with the eye in primary gaze, looking inferiorly and superiorly, preoperatively, and 1, 30, 90 and 180 days postoperatively. Measurements for eyelid crease, levator function, and marginal reflex distance 1 (MRD1) were performed using ImageJ. Statistical analysis was performed of the difference between the preoperative and postoperative measurements.

Results: The study consisted of 112 patients. The median lid crease was 9.0 mm [IQR (interquartile range) 7.5; 10.0] both preoperatively and at 180 days postoperatively (IQR 8.0; 10.8). No statistical difference was determined in the lid crease measurements between these two times (P = .17). The median levator function differed significantly preoperatively, at day 1 and 30, 60 and 180 days postoperatively (P < .01). MRD1 decreased significantly from a median of 3.01 mm preoperatively to 2.7 mm at 30 days postoperatively (P = .05) but was similar at preoperative and after 180 days (P = .7). The correlation of MRD1 to the duration of the speculum in place (P = .2) and the incision time (P = .57) was not significant.

Conclusions: Ptosis, following phacoemulsification cataract surgery, is mild and transient, occurring only in the early postoperative period.     

Assessment of the anterior scleral thickness in central serous chorioretinopathy patients by optical coherence tomography

Purpose

To assess the anterior scleral thickness (AST) and describe the presence of a visible supraciliary space (SCS) in central serous chorioretinopathy (CSC) patients by swept-source optical coherence tomography (SS-OCT).

Study design

Cross-sectional comparative study.

Material and Methods

Three groups were studied: 1) 64 eyes of 54 patients with CSC with persistent subretinal fluid (SRF); 2) 42 fellow eyes of CSC patients without SRF; 3) 65 eyes of 65 controls matched by age, sex and axial length (AL). The AST was measured in the temporal and nasal quadrants at 0, 1, and 2 mm from the scleral spur by SS-OCT. The presence of a visible SCS was also assessed.

Results

No differences were observed in the AST0 among the three groups (p≥ 0.665). The temporal AST1 was significantly thicker in the CSC group (530.3 ±67.1 µm) than in the controls (505.5 ±73.9; p=0.041). Mean AST2 was also thicker in the CSC group and the fellow eyes both for the temporal (519.4 ±89.1 µm and 519.8 ±98.5 µm respectively) and nasal quadrants (564.2 ±124.9 µm and 570.5 ±131.0 µm) than in the controls (450.1 ±76.8 and 473.3 ±111.6 µm) (all p≤0.001). A visible SCS was detected in the eyes of 8 CSC patients, in 4 fellow eyes and only in 1 control eye.

Conclusions

AST measured by SS-OCT was significantly greater in CSC eyes than in healthy eyes. Also, a visible SCS was detected in CSC eyes. Thus, thicker sclera in CSC eyes could be associated with the physiopathology of this disease.

     

Tips on how to avoid the DCR scar

A permanent facial scar following external approach (transcutaneous) dacryocystorhinostomy is fortunately rare. Meticulous surgical technique is the key factor in avoiding a visible scar. Simple measures to avoid a scar include use of local anaesthesia, location of the incision, maintaining a bloodless surgical field, using a skin flap technique and simple orbicularis and skin wound closure. Although endonasal endoscopic dacryocystorhinostomy is gaining clinical acceptance and popularity, the external dacryocystorhinostomy is regarded as the gold standard in terms of surgical success, with a high patient satisfaction.     

Comparison of surgically induced astigmatism in various incisions in manual small incision cataract surgery

AIM:To determine the surgically induced astigmatism (SIA) in Straight, Frown and Inverted V shape (Chevron) incisions in manual small incision cataract surgery (SICS).METHODS:A prospective cross sectional study was done on a total of 75 patients aged 40y and above with senile cataract. The patients were randomly divided into three groups (25 each). Each group received a particular type of incision (Straight, Frown or Inverted V shape incisions). Manual SICS with intraocular lens (IOL) implantation was performed. The patients were compared 4wk post operatively for uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and SIA. All calculations were performed using the SIA calculator version 2.1, a free software program. The study was analyzed using SPSS version 15.0 statistical analysis software.RESULTS:The study found that 89.5% of patients in Straight incision group, 94.2% in Frown incision group and 95.7% in Inverted V group attained BCVA post-operatively in the range of 6/6 to 6/18. Mean SIA was minimum (-0.88±0.61D×90 degrees) with Inverted V incision which was statistically significant.CONCLUSION:Inverted V (Chevron) incision gives minimal SIA.     

Effect of platelet-rich plasma on patients after blepharoplasty surgery

Aim: To evaluate the effect of platelet-rich plasma (PRP) treatment on patients after blepharoplasty surgery.

Materials and methods: After undergoing blepharoplasty, 20 patients were randomly divided into two groups (n = 10 each). One was treated with autologous PRP and the other was not given any post-surgery treatment (basal group). Autologous PRP application was performed intradermically 24 h, 1 month, and 2 months post-surgery, and the outcome of the applications was assessed 1, 2, and 3 months post-surgery. The postoperative wound was assessed on a patient and observer scar assessment scale (POSAS) by patients and by an unblinded clinical observer. Statistical comparison between the two groups was analyzed by using the Mann–Whitney unpaired, two-tailed test. Significant differences were considered with P ≤ 0.05.

Results: Patient-reported data indicate that compared to the basal group, the PRP group showed no significant differences regarding pain, itching, or color, but had better values for stiffness and thickness (months 1 and 2) as well as scar irregularity (month 1). Data reported by the clinical observer showed that in comparison with the basal group, the PRP group showed no differences in vascularization or pigmentation, but had lower (better) scores regarding thickness, relief, and pliability (at all assessment times). The total assessment values from patients and the observer were significantly better for the PRP than the basal group.

Conclusion: Autologous PRP treatment enhanced some parameters associated with healing properties, suggesting a potential therapeutic value after blepharoplasty surgery.     

Surgically induced astigmatism and posterior corneal curvature changes following phacoemulsification

Purpose:To primarily compare surgically induced astigmatism (SIA), total and posterior corneal curvature, pachymetry, and their stabilization after 2.2 and 2.8 mm clear corneal incision in phacoemulsification.Methods:A randomized, prospective interventional study of 130 patients (130 eyes) of either sex having senile cataract (>40 years) divided randomly into two groups. The patients underwent uncomplicated phacoemulsification surgery with foldable intraocular lens implantation using 2.2 mm (group 1) and 2.8 mm incisions (group 2). The patients were evaluated preoperatively and followed-up at first, third, and sixth weeks.Results:Mean SIA was less in group 1 at all the follow-up visits which was not statistically significant (P value – 0.507 (at week 1), 0.626 (at week 3), and 0.312 (at week 6). Mean SIA decreased from week 1 to week 6 in both the groups. Both the groups showed an increase in SIA with the increase in the hardness of cataract. Posterior keratometry (k1 and k2) showed statistically significant steepening in the first postoperative week, followed by gradual flattening which continued till the sixth week postoperatively. Posterior astigmatism increased in both the groups at week 1 (not statistically significant). Thereafter, it decreases and does not change significantly after 3 weeks. Pachymetry increased significantly (P value < 0.001 in both the groups) in the first week in both the groups and thereafter stabilizing at 3 weeks.Conclusion:Reducing the incision size does not result in any significant reduction in SIA. We observed that the posterior corneal curvature majorly stabilized by 3 weeks, but some stabilization continued till 6 weeks.     

Association between Cataract and Keratinocytic Skin Cancers or Melanoma: Speculating on the Common Role of Sun and Ultraviolet Radiation Exposures

Purpose: Cataract and sun-related skin conditions are proxies to lifetime UV exposure. We examined the association between them using real-world data from an unselected Israeli population.

Methods: Computerized data was obtained from an Israeli health maintenance organization regarding cases of sun-related skin pathologies and cataract diagnosed between 2006 and 2011 in 686,260 members aged 40 or above.

Results: Sun-related skin disorders were found in 9.3% of the study population, more commonly among the elderly, and those who reside in areas of higher socioeconomic status. Cataract was diagnosed in 13.1% of the study population, with highest prevalence (47%) among squamous cell carcinoma patients, who were the oldest group. Multivariable analysis adjusting for age, sex, residential district, birth region, smoking, and chronic comorbidities showed no statistically significant association between melanoma and cataract (OR = 1.06; 95% CI: 0.91–1.22). Basal cell carcinoma, squamous cell carcinomas, and actinic keratosis were associated with increased likelihood of prevalent cataract with adjusted odds ratios (95% CI) of 1.14 (1.08–1.20), 1.11 (1.01–1.19), and 1.16 (1.13–1.19), respectively. When stratified by gender, the association between actinic keratosis and cataract was stronger in women than in men, particularly in patients under 65 years.

Conclusions: The association between the prevalence of skin cancers and the prevalence of cataract enhances the conclusion that cataract is related to UVR exposure.