Sutureless Transconjunctival 20 Gauge pars plana Vitrectomy

PURPOSE: Sutureless Transconjunctival 20 Gauge Vitrectomy (20G STV) is a technique that reduces the operating time and the post-operative inflammation. PATIENTS AND METHOD: Eighty-four eyes underwent this new technique. Conjunctival diathermy over the ports before sclerostomy produced adhesions adequate to stop transoperative conjunctival chemosis. The MVR blade introduced into the conjunctiva-sclera in a bevelled direction. The tunnel incision that was created left without a suture at the end of the operation. RESULTS: Three patients (3,5%) had hypotony (2-6 mmHg) on day 1 that was normalized 3 days later. Two of them had a bleb formation and the rest a very minor leakage through a flat conjunctiva. No other serious complications occurred as a result of this novel transconjunctival approach. Also there were no differences in visual acuity, intraocular pressure, redetachments, or inflammations between the patients who underwent this technique and the patients having the conventional 20-gauge pars plana technique. CONCLUSION: 20G STV is a safe and practical technique for the full spectrum of vitreoretinal surgery. It makes the surgery quicker and is well tolerated by patients.     

Outcomes of 25-gauge pars plana vitrectomy with encircling scleral band for acute retinal necrosis-related rhegmatogenous retinal detachment

Purpose:The aim of this study was to evaluate the anatomic and functional outcomes of 25-gauge pars plana vitrectomy (25G PPV) with encircling scleral band (ESB) in patients with acute retinal necrosis (ARN)-related rhegmatogenous retinal detachment (RRD).Methods:Single-center retrospective interventional case series of patients who underwent 25G PPV with ESB for ARN-related RRD. Complete anatomic success was defined as the complete attachment of retina after primary PPV. Functional success was measured by the final best-corrected visual acuity (BCVA) ≥20/400. Intraoperative and postoperative complications were also noted.Results:14 eyes of 13 patients were included in the study. Six patients (46.1%) were immunocompromised. The mean follow-up was 23.64 ± 9.95 (range 6-42) months. Silicone oil was used as tamponade in 13 eyes and C₃F₈ gas in one eye. After the primary PPV, complete anatomical success was seen in all eyes (100%), however, one eye developed phthisis bulbi after silicone oil removal (SOR). Statistically significant improvement of BCVA was seen, from LogMAR 2.03 ± 0.29 preoperatively to LogMAR 1.57 ± 0.63 postoperatively (p-value 0.014). Six eyes (42.9%) had functional success. Nine eyes (64.3%) had improvement in vision while 4 eyes (28.6%) maintained preoperative vision. 10 eyes (71.4%) underwent cataract surgery, nine eyes (64.3%) underwent SOR while 2 eyes (14.3%) had epiretinal membrane (ERM) under oil during follow-up.Conclusion:25G PPV combines the advantages of minimally invasive vitrectomy surgery while offering improved anatomic outcomes in patients with ARN-related RRD. The functional outcome varies depending on the status of the optic disc and macula.     

Boston type 1 keratoprosthesis: the CHUM experience

Objective: To describe the characteristics, indications, complications, and outcomes of the patients who underwent Boston type 1 keratoprosthesis (KPro) surgery at the Université de Montreal affiliated Notre-Dame Hospital.Design: Retrospective case series.Participants: Forty-seven eyes of 43 patients who underwent KPro surgery.Methods: The charts of all patients who underwent KPro surgery at Notre-Dame Hospital between October 2008 and February 2010 were retrospectively reviewed. Preoperative, intraoperative, and postoperative parameters were collected and analyzed.Results: The indication for Boston type 1 KPro was corneal graft failure in 27 eyes; 20 eyes had KPro as a primary procedure. Preoperative diagnoses included aniridia (34%), mechanical trauma (11%), infections (9%), surgery-related bullous keratopathy (9%), chemical burns (9%), corneal dystrophies (9%), and Stevens-Johnson syndrome (2%). A known history of glaucoma was present in 36 eyes (77%). Median preoperative best-corrected visual acuity (BCVA) was hand motion (range, 20/100 to light perception). The assembly of the KPro and surgery were uneventful in all cases. Mean follow-up was 10 ± 5 months. Median BCVA at last follow-up was 20/150 (range, 20/30 to no light perception). The device retention rate was 100% at the end of the follow-up period. Postoperative complications included retroprosthetic membrane in 12 eyes (26%) and glaucoma progression in 11 eyes (23%).Conclusions: Our study demonstrates an excellent retention rate of the Boston type 1 KPro and an improvement of BCVA in the majority of patients. Many patients undergoing KPro surgery have ocular comorbidities that require ongoing care to prevent further vision loss following KPro surgery.     

Effectivity of intraoperative adjustable suture technique in horizontal strabismus

AIM:To compare the long-term effectivity of intraoperative adjustable suture technique with traditional non-adjustable strabismus surgery.METHODS:Two hundred and thirty-three patients, who underwent strabismus surgery either with traditional procedures or one-stage intraoperative adjustable suture technique, were included in our long-term follow-up study. One hundred and eighteen patients were evaluated in traditional surgery group (TSG) and 115 who underwent adjustable suture were in the one-stage intraoperative adjustable surgery group (ASG). In this group 9 patients had paralytic strabismus and 16 had reoperations, 2 patients had restrictive strabismus related to thyroid eye disease. The mean follow up in the TSG was 26.2 months and it was 24.8 months in the ASG group.RESULTS:In patients with exotropia (XT) the mean correction of deviation for near fixation in ASG (32.4±13.2PD) and in TSG (26.4±8.2PD) were similar (P=0.112). The correction for distant fixation in ASG (33.2±11.4PD) and TSG (30.9±7.2PD) were not significantly different (P=0.321). In patients with esotropia (ET) even the mean correction of deviation for both near (31±12PD) and distant (30.6±12.8PD) fixations were higher in ASG than in TSG, for both near (28.27±14.2PD) and distant (28.9±12.9PD) fixations, the differences were not significant (P=0.346, 0.824 respectively). The overall success rate of XT patient was 78.9% in TSG and 78.78% in ASG, the difference was not significant (P=0.629). The success rates were 78.75% in TSG and 75.51% in ASG in ET patient, which was also not significantly different (P=0.821).CONCLUSION:Although patients in ASG had more complex deviation such as paralysis, reoperations and restrictive strabismus, success rates of this tecnique was as high as TSG which did not contain complicated deviation. One-stage intraoperative adjustable suture technique is a safe and effective method for cooperative patient who has complex deviation.     

Anterior vestibule salvaging technique to limit silicone orbital implant extrusion following evisceration

Purpose: The anterior vestibule salvaging (‘Birdcage’) technique may limit orbital implant extrusion following evisceration.

Methods: A 10-year retrospective chart review from 2005 to 2015 of individuals who underwent evisceration procedures utilizing the vestibule salvaging technique was performed.

Results: A total of 96 patients (61 male; 35 female; average age 64 years; range 17–96 years) underwent evisceration with a technique avoiding anterior scleral relaxing incisions. Three (3.1%) patients had documented extrusion of the silicone implant. Time from evisceration to extrusion ranged from 26 to 372 days.

Conclusions: Maintenance of the anterior scleral vestibule during evisceration may decrease extrusion rates after surgery compared with traditional evisceration techniques that utilize anterior relaxing incisions.     

Outcomes of 25-gauge pars plana vitrectomy for cytomegalovirus retinitis-related retinal detachment

Purpose:The purpose of this study is to evaluate the anatomical and functional outcomes of 25-gauge (G) pars plana vitrectomy (PPV) in patients with cytomegalovirus retinitis (CMVR)-related rhegmatogenous retinal detachment (RRD).Methods:Single-center retrospective consecutive case series of patients who underwent 25-G PPV for CMVR-related RRD repair with a minimum follow-up of 3 months. Complete anatomic success was defined as the complete attachment of retina including the periphery. Best-corrected visual acuity (BCVA) of ≥20/400 was defined as functional success.Results:Sixteen eyes of 15 patients were included in the study. Eleven patients were human immunodeficiency virus positive, three patients had hematological malignancies, and one patient suffered from dyskeratosis congenita. The mean follow-up was 20.5 ± 17.4 months (range 3–60 months). Complete anatomical success was seen in 15 eyes (93.75%). One eye had a residual inferior detachment with attached macula. Silicone oil was used as tamponade in 15 eyes and C₃F₈ gas in one eye. The mean change in BCVA was statistically significant, preoperative LogMAR BCVA was 2.05 ± 0.94 while the final follow-up postoperative LogMAR BCVA was 1.03 ± 0.61 (P < 0.001). Thirteen eyes (81.25%) had final BCVA ≥20/400.Conclusion:Microincision vitrectomy surgery can achieve excellent retinal reattachment rates in post-CMVR RRDs without significant intraoperative and postoperative complications. The visual outcome varies depending on the status of the optic disc and macula. Majority of the patients maintained functional vision.     

Can lubrication of the eyelid speculum reduce overall pain perception associated with cataract surgery by phacoemulsification performed under topical anesthesia?

Purpose:This study aimed to evaluate the effect of using the lubricated eyelid speculum on the overall pain perception by the subject patients who underwent cataract surgery by phacoemulsification technique under topical anesthesia.Methods:A prospective interventional randomized comparative study was conducted at the tertiary eye care center, wherein adult patients scheduled for bilateral cataract surgery with phacoemulsification techniques under topical anesthesia were randomized to undergo surgery with two different modes of eyelid speculum insertion, either with or without lubrication of the eyelid speculum. Fifty percent of the patients underwent surgery with eyelid speculum without lubrication, and 50% with lubrication of the eyelid speculum. The primary outcome was to compare the level of overall pain perception among the subject patients of the two groups by using the Visual Analogue Scale (VAS) in the immediate postoperative period.Results:The study included 130 patients who underwent bilateral cataract surgery (n = 260 eyes) under topical anesthesia, wherein n = 130 eyes underwent surgery using lubricated eyelid speculum and n = 130 eyes underwent surgery with dry eyelid speculum. Pain perception score assessed on the VAS (0–10 cm) ranged from 0.5 to 6, with a mean ± standard deviation of 2.06 ± 1.12. A significant correlation was found with two different methods of eyelid speculum insertion with reduced overall pain perception in patients with the use of lubricated eyelid speculum compared to the dry eyelid speculum (P = 0.0001).Conclusion:The overall pain perception associated with cataract surgery performed by phacoemulsification technique under topical anesthesia can be further minimized by lubricating the eyelid speculum prior to insertion for exposing the globe.     

Outcomes of surgery for retinal detachment in eyes having choroidal coloboma

PurposeTo study the anatomical and visual outcomes of surgery for retinal detachment (RD) in patients with choroidal coloboma.MethodsForty-six eyes of 46 patients underwent surgery for RD with choroidal coloboma. Patients were divided into three groups, according to the extent of choroidal coloboma: Coloboma not involving the disc and macula (Group A), coloboma involving the disc (Group B), and coloboma involving the disc and macula (Group C). Thirty-eight eyes underwent pars plana vitrectomy with silicone oil (SO) (Group 1) and eight eyes underwent scleral buckling surgery (Group 2). SO removal was carried out in 18 eyes at final follow up.ResultsAfter a mean follow-up of 16.2 months, 40 eyes (86.9%) had an attached retina and the best corrected visual acuity (VA) improved from a preoperative median of 20/800 to 20/250 (p = 0.001). Thirty-four eyes (74%) recovered ≥20/400 VA. The final median VA in Group A (20/200) was better than in Group B (20/800) and Group C (light perception and hand movement) which was statistically significant (p = 0.01). Redetachment occurred in 10 eyes (21.8%), of which 7 eyes (18.91%) belonged to Group 1 and 3 eyes (37.5%) belonged to Group 2, and all of these eyes underwent resurgery. Of these 10 eyes, 9 had an attached retina at final follow up.ConclusionPostoperative visual recovery in RD with choroidal coloboma is dependent upon the involvement of the disc and macula with the colobomatous area. Resurgery following redetachment improves the final anatomical outcomes.     

Long-term vision-threatening complications of phakic intraocular lens implantation for high myopia

AIM:To report the long-term vision-threatening complications in patients who underwent phakic intraocular lens (pIOLs) implantation for high myopia.METHODS:This study was designed from a consecutive series of phakic intraocular lens complication and corrective surgeries. Sixteen eyes of 13 patients had implantation of phakic intraocular lens for correction high myopia and developed serious complications have been included in this study. The mean age of patients was 38.6±6.35y (range 32-50y) and the mean time of history of pIOL implantation for high myopia was 6±2y (range 2-10y). Before corrective surgery, best spectacle-corrective visual acuity (BSCVA) ranged from perception to 20/200 in the eyes in which severe complications occurred.RESULTS:Corneal decompensation occurred in 12 eyes of 9 high myopic patients after anterior chamber pIOL implantation. Rhegmatogenous retinal detachment (RRD) occurred in 4 eyes of 4 high myopic patients following anterior chamber and posterior chamber pIOL implantation. Patients with corneal decompensation, had combined procedures consisting of pIOL removal and penetrating keratoplasty (PKP). Removals of pIOL, phacoemulsification and pars plana vitrectomy (PPV) with silicone oil tamponade were performed in patients with RRD. After corrective surgeries, all patients but one (P+, patient 2, right eye) achieved moderate BSCVA ranged from 20/200 to 20/50 at the last visit.CONCLUSION:Phakic IOLs may be effective for the correction of high myopia. Although these IOLs may have severe complications and it affects safety and efficacy of this surgery. As seen here, corneal decompensation and rhegmatogenous retinal detachment are possible postoperative vision-threatening complications of phakic IOLs. Patients must be carefully examined before and after surgery for possible endothelial cell loss and vitreoretinal problems.     

Prophylactic corneal crosslinking in myopic small-incision lenticule extraction - Long-term visual and refractive outcomes

Purpose:To analyze the efficacy, safety, predictability, and stability in myopic and astigmatic small-incision lenticule extraction (SMILE) with simultaneous prophylactic corneal crosslinking (CXL) in thin corneas.Methods:A total of 48 eyes from 24 patients who underwent myopic and astigmatism SMILE with simultaneous prophylactic CXL were included in this retrospective study. All patients had a 24-month follow-up. A femtosecond laser was performed with VisuMax (Carl Zeiss Meditec). CXL treatment was applied when the predicted stromal thickness was less than 330 μm.Results:The patients’ mean age was 31.58 ± 6.23 years. The previous mean spherical equivalent was − 6.85 ± 1.80 (−9.75 to − 2.00) D. The postoperative mean spherical equivalent was − 0.50 ± 0.26 (−1.00 to + 0.25) D; 60% of the eyes had 20/20 or better; 19% lost one line; 58% were within ± 0.50 D; and 8.3% of the eyes changed 0.50 D or more between 3 and 24 months.Conclusion:Prophylactic CXL with simultaneous SMILE for myopia and astigmatism femtosecond laser surgery technique appears to be partially effective, safe, predictable, and stable after 24 months of follow-up.     

Effect of preoperative vitreous status on visual outcomes following vitrectomy for epiretinal membrane repair

Objective: To determine the correlation between clinically observed posterior vitreous detachment (PVD) and both surgical status of the hyaloid and the visual outcome following epiretinal membrane (ERM) surgery.Design: Retrospective chart review.Participants: One hundred and nine eyes of 109 consecutive patients who underwent vitrectomy and repair of idiopathic ERM between January 2006 and September 2008.Methods: Preoperative exam notes from selected charts were reviewed for the presence or absence of a PVD. Operative notes were queried to whether the hyaloid was attached or detached at the onset of surgery. The postoperative visual acuity (VA) was correlated with the intraoperative status of the hyaloid. Preoperative observation of PVD was correlated with the hyaloid status at the time of vitrectomy.Results: Hyaloid status did not impact postoperative VA. Eyes with an attached hyaloid at the onset of surgery had an average postoperative best corrected visual acuity (BCVA) of 20/60 and eyes with PVDs found during surgery had an average BCVA of 20/60⁺¹ (p = 0.66). Of the 109 patients, 72 had a preoperative fundoscopic examination whose results positively correlated with the intraoperative status of the hyaloid.Conclusions: Having an attached hyaloid did not have a significant impact on postoperative visual outcomes in eyes undergoing ERM when compared with outcomes for eyes having a detached hyaloids prior to surgery. Detection of a PVD on preoperative fundoscopic examination was highly sensitive for a «true« PVD, i.e., actual detachment of the posterior hyaloid membrane as confirmed during surgery.     

Macular hole surgery with internal-limiting membrane peeling and intravitreous air

ObjectiveTo examine the results of macular hole surgery using pars plana vitrectomy, internal-limiting membrane peeling, and intravitreous air in a series of consecutive patients.DesignA retrospective, interventional, noncomparative case series.PatientsFifty consecutive patients (58 eyes) with full-thickness macular holes.InterventionAll eyes underwent a pars plana vitrectomy with internal-limiting membrane peeling and intravitreous air, and patients were asked to position face-down for only 4 days.Main outcome measuresStatus of macular holes, visual acuity, and associated findings and complications.ResultsAll patients had postsurgical follow-up of 6 months or greater. Eight eyes (14%) presented with stage-2 macular holes, 48 eyes (83%) with stage-3 macular holes, and 2 eyes (3%) with stage-4 macular holes. Only 26 eyes (45%) had a macular epiretinal membrane seen before surgery. Fifty-three (91%) of the 58 macular holes were closed with 1 operation, and 55 (95%) had closure of the macular holes with subsequent operations. Five (9%) of 58 eyes had an initial visual acuity of 20/50 or better, and 31 eyes (53%) had a final visual acuity of 20/50 or better. Of the 45 eyes with symptoms of less than 6 months’ duration, 44 (98%) had macular holes that were closed with 1 operation and 27 (60%) had a final visual acuity of 20/50 or better. Of the 13 eyes with symptoms of 6 months’ duration or longer, 9 (69%) had macular holes that were closed with 1 operation and 4 (31%) had a final visual acuity of 20/50 or better. Complications attributed to the operation included retinal tears, retinal detachments, postoperative macular puckers, and macular light toxicity.ConclusionsThe anatomic and visual results in this series are good. The current technique is similar to that of conventional macular hole surgery except for the use of intravitreous air, internal-limiting membrane peeling in all eyes, and only 4 days of postoperative positioning. This study would suggest that peeling of the internal-limiting membrane is an important adjuvant for successful closure of macular holes.     

Goniotomy for initial and re-surgery for childhood glaucoma in Northern India

Purpose:The aim of this study was to describe the effectiveness of goniotomy for childhood glaucoma in Indian eyes.Methods:Consecutive patients with pediatric glaucoma who underwent goniotomy between July 2017 and June 2020, in a single center in Northwest India were prospectively analyzed. Goniotomy was done as a primary procedure or a re-do surgery of the untreated angle in failed filtering surgery. Success was defined as intraocular pressure (IOP) ≦18 mm Hg with or without 2 topical medications.Results:A total of 172 eyes of 126 children underwent goniotomy during this period (37.9% of all pediatric glaucoma surgeries). Goniotomy comprised 132 of 211 (62.5%) primary pediatric glaucoma surgeries and 40 of 243 (16.5%) re-do surgeries. 145, 112, and 54 eyes had a six months, 1-year and 2-year follow-up, respectively. At 1 year, success rates in Primary Congenital Glaucoma (PCG) were 79.7% for primary surgery and 68.4% for re-do surgery. For non-PCG eyes, the success rate was 62% at 1 year. Among PCG subgroups, infantile and newborn glaucoma had 87.5% and 57.1% success rates, respectively. On logistic regression analysis, lower baseline IOP and lesser axial length at presentation were significantly predictive of successful outcomes (P = 0.03 and P = 0.02, respectively). At 1 year, in the primary surgery group, 50% had good vision (better than logMAR 0.5), 28.9% had moderate (better than LOGMAR 1.0) and 20% had severe visual impairment. There were no significant intraoperative or post-operative complications.Conclusion:Goniotomy appears to be an effective surgery for childhood glaucoma in Indian eyes. Being minimally invasive, it obviates the need for conjunctival and scleral dissection and antifibrotic agents.     

Orbital and adnexal amyloidosis: Thirty years experience at a tertiary eye care center

Purpose:The aim of this work was to study the clinical presentation, management and outcomes of orbital and adnexal amyloidosis.Methods:This retrospective analysis included all the patients diagnosed with orbital and adnexal amyloidosis between January 1990 and December 2019. Positive staining with Congo Red and apple-green birefringence on polarized light microscopy established the diagnosis. Data analyzed included demographic profile, varied presentations, management, and outcome.Results:Thirty-three eyes of 26 patients were included. The male:female ratio was 1:1. The mean age of the study population was 42.6 ± 16 years. The median duration of symptoms was two years. Unilateral involvement was seen in 19 eyes (right = 11, left = 8). The most common presenting feature was acquired ptosis. Eyelid was the most commonly affected site followed by orbit and conjunctiva. Two patients had systemic involvement in the form of multiple myeloma and lymphoplasmacytic lymphoma. Complete excision was done in seven (26.9%) cases while 19 (73.1%) cases underwent debulking. Three patients underwent ptosis surgery. The median duration of follow-up was 1.5 years. Three cases had recurrence and underwent repeat surgery.Conclusion:Orbit and adnexa is a rare site for amyloidosis. It is usually localized; however it can occur as a part of systemic amyloidosis. Eyelid is the most common site of involvement and patients usually present as eyelid mass or ptosis. Complete excision is difficult and most of the patients usually undergo debulking surgery. All patients should undergo screening for systemic amyloidosis     

Viscocanalostomy and combined phacoemulsification with viscocanalostomy: A five-year follow-up

Purpose:To assess the effectiveness and safety of viscocanalostomy (VC) and phaco-viscocanalostomy (PV) surgeries in eyes with a five-year follow-up.Methods:Retrospective review of patients who underwent VC and PV between January 2010 and December 2012 in the Stanley Eye Unit Abergele, UK. Patients were included for the analysis if they had a full 5-year follow-up or required redo surgery in the 5-year period. Success was defined as an intraocular pressure (IOP) of <21 mmHg. The subanalysis included IOP <16 mmHg, IOP reduction >20%, and IOP reduction >30%, the complication rate, and the drop in the use of glaucoma medications post-surgery.Results:A total of 370 eyes from 303 patients were included for the analysis. The mean preoperative IOP was 23 mmHg ± 5.3 mmHg with an average of 3.0 ± 0.1 medications. By year 5, this was reduced to 14.3 mmHg ± 6.5 mmHg with a mean of 1.0+/- 0.9 medications; 47.8% of the eyes had an IOP of <21 mmHg by year 5 without medication with a total of 92.6% of the eyes reaching this target with medication. The main complication in this group was the perforation of the Trabeculo Descemet’s Window (TDW) but this was not associated with a poorer outcome.Conclusion:This large data set of eyes undergoing VC surgery demonstrates the effectiveness and safety of this technique over 5 years.     

Atypical Retinal Hemorrhages after Vitrectomy for Idiopathic Macular Hole: Possible Toxicity of Brilliant Blue G

PurposeTo describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors.MethodsThe medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis.ResultsMultiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD.ConclusionsMultiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.     

Late surgery for unilateral persistent fetal vasculature: long-term visual and anatomic outcomes

BackgroundPersistent fetal vasculature (PFV) is a congenital anomaly caused by failure of the ocular vasculature to regress. We report the visual and anatomic outcomes in patients who underwent surgery for PFV between 7-48 months of age.MethodsThe medical records of patients who underwent lensectomy and anterior or core vitrectomy for unilateral PFV, with or without intraocular lens implantation, were reviewed retrospectively. Inclusion criteria were surgery between 7-48 months of age and at least 12 months of follow-up. Patients with severe posterior segment involvement were excluded. The primary outcome was the final visual acuity using age-appropriate tests converted to logMAR. Secondary outcomes included the rate of adverse events and number of subsequent intraocular procedures.ResultsA total of 20 patients with a mean age at surgery of 19.3 ± 10.5 months and mean follow-up of 73.7 ± 46.7 months were included. Sixteen patients had delayed surgery due to late presentation; the remaining 4 were managed initially with refractive correction and occlusion. Eight patients (40%) achieved a final visual acuity better than 1.0 logMAR. Four eyes had adverse events, including one retinal detachment. No patient developed glaucoma. Four eyes underwent subsequent procedures.ConclusionsIn our study cohort, surgery for unilateral PFV between 7-48 months of age achieved functional visual acuity in over one-third of patients. This is comparable to results achieved with surgery before 7 months of age, but with fewer adverse events. Differences in disease severity could account for later PFV presentation and surgery as well as outcomes.

     

Dacryocystorhinostomy in adolescents and young adults

ObjectiveTo study the relative frequency, causes, anatomical and functional outcomes and complications of dacryocystorhinostomy (DCR) in patients between the second and fifth decade of life.MethodA retrospective, nonrandomized, interventional study of a clinical series of 12 patients who underwent DCR from March 2007 to March 2009, performed by a single surgeon, with an age range between 10 and 48 years. Recorded data included age at surgery, date of surgery, gender, affected side, cause of obstruction, surgical technique, outcome and complications. The relative frequency of such cases over the total was calculated.ResultsDCR in patients between 13-48 years old represented 14.11% of the total (12:85). In this group 88.8% were females and in 75% surgery was on the right side. The most frequent cause of obstruction was low idiopathic obstruction (58.33%) whereas 41.66% were secondary. An external DCR was performed on 66.67% of patients and the rest were endonasal DCR. Anatomical success was achieved with resolution of symptoms in 91.6% of patients. One case had a hypertrophic scar.ConclusionAdolescents and young adults represent a significant percentage of cases undergoing DCR surgery. Both the external and endoscopic approach is shown to be a valid alternative for treating these patients, with good results and low incidence of complications.     

Tug of war: A bimanual technique for anterior circumferential proliferative vitreoretinopathy in recurrent retinal detachment

Purpose:To describe a bimanual technique, “tug of war” for managing anterior circumferential proliferative vitreoretinopathy (PVR) in eyes with recurrent retinal detachment (RRD).Methods:We retrospectively analyzed outcomes from eyes with RRD that underwent reattachment surgery using this maneuver and had a minimum of 6 months follow-up. A chandelier light was inserted for endo-illumination and the circumferential anterior PVR was tackled with two 25-gauge forceps stretching circumferential tractional membranes in opposite direction (tug of war) till they snapped.Results:Eleven eyes of 11 patients with a mean age of 38.2 ± 19.7 years underwent surgery. All eyes had advanced PVR of Grade C A Type 4 (Circumferential). The median duration of RD from the time of first surgery was 6 months (interquartile range = 3–8 months). The tug of war maneuver was successful in relieving the anterior retinal traction leading to retinal reattachment in all eyes without the need for relaxing retinotomies or retinectomies. Small iatrogenic retina tears occurred at the time of tug of war maneuver in 3 (27%) eyes at the site of maximum traction. The mean best-corrected visual acuity (BCVA) improved from 1.87 ± 0.2 logarithm of minimum angle of resolution (logMAR) to 1.3 ± 0.4 logMAR at 6-months follow-up (P = 0.04).Conclusion:The ''tug of war'' maneuver is useful for relieving circumferential anterior traction and reattaching the retina in eyes with RRD without having to resort to large relaxing retinotomies or retinectomies.     

Tribal Odisha Eye Disease Study (TOES). Report # 8. Childhood cataract surgery and determinants of visual outcome in tribal districts

Purpose:The purpose of this study is to describe the demographic profile, clinical features, visual outcomes, and follow-up patterns after successful cataract surgery in children from the tribal community in Odisha, India.Methods:We retrospectively reviewed records of tribal children aged 4 months–16 years, who underwent public health financed cataract surgery at our institute from January 1, 2015, to December 31, 2019. Collected data included demographic profile, clinical features, outcomes, and follow-up. Univariate and multivariate linear regression identified factors affecting the visual outcome at a 6-week follow-up.Results:During this period, a total of 352 children [536 eyes; mean age: 9.11 ± 4.4 years, 219 boys (62%)] underwent cataract surgery. The most common etiology and presenting complaints were idiopathic congenital cataract and decreased vision, respectively. In 304 children (86%), presenting best-corrected visual acuity (BCVA) was <20/200 (1.0 LogMAR), 113 (32%) had associated strabismus, and 57 (16%) had associated nystagmus. The public health agency did not sponsor postoperative follow-up, and only 195 (56%) and 61 (17.3%) children completed a 6-week and a 3-month follow-up, respectively. Median BCVA at 6-week and 3-month review was 20/125 (0.8, interquartile range [IQR], 0.2–2 LogMAR) and 20/60 (0.5, IQR, 0.25–1.35 LogMAR), respectively.Conclusion:This study showed that children from the tribal community presented late with poor presenting VA and had suboptimal visual outcomes with inconsistent follow-ups. Greater advocacy, delivery of care closer to the place of residence, and financial support for follow-up care could improve early detection, regular evaluation, and outcomes.