Visual outcomes and quality of life before and after photorefractive keratectomy

Purpose:To compare visual outcomes and vision-related quality of life (VRQoL) between subjects before and after photorefractive keratotomy (PRK) and controls. In addition, VRQoL was compared between subjects at different periods of PRK surgery.Methods:This was a cross-sectional study that included subjects with refractive errors aged 19–40 years and age-matched controls. Subjects were divided into three groups: pre-, post-PRK, and control. Subjects in the post-PRK group were divided into three subgroups (1-week, <6-month, and >6-month follow-up visits). Measurements including uncorrected distance visual acuity (UCVA), corrected distance visual acuity (CDVA), spherical equivalent (SE) of manifest refraction, and corneal topography were obtained for all participants. The Quality of Life Impact of Refractive Correction (QIRC) questionnaire was administered to compare VRQOL between groups and between post-refractive surgery subgroups.Results:A total of 145 participants were included in this study. The mean age ± standard deviation (SD) of all participants was 26.29 ± 5.1 years. There was a significant difference (P < 0.001) in total QIRC scores between groups. The total QIRC score was better in the post-PRK group than in the pre-PRK and control groups. The scores of items included in the convenience, well-being, and health concern domains were significantly higher in the post-PRK group than in the pre-PRK and control groups. Within the post-PRK group, significant differences (P < 0.001) were found in UCVA and SE between the post-PRK subgroups. Uncorrected VA and SE were better in the post-PRK groups who were followed up in the < 6 and > 6 months subgroups than in the 1-week follow-up subgroup (P < 0.0001).Conclusion:A significant improvement in visual outcomes and VRQoL occurred after PRK surgery. Subjects enjoyed their VRQoL after refractive surgery.     

Cataract surgery in retinitis pigmentosa

Purpose:The aim of this study was to evaluate visual outcomes of cataract surgery in patients with retinitis pigmentosa.Methods:This retrospective case series includes a review of the medical records of all patients with retinitis pigmentosa undergoing cataract surgery between 2005 and 2018. The primary outcome measure was corrected distant visual acuity and change in vision impairment after surgery.Results:Of the 103 (132) patients, 60 (58.3%) were men and 43 (41.7%) were women. The mean age of the study population was 51.3 ± 11.3 (22–74) years. The mean symptom duration was 35.4 ± 44.5 (1–300) months. The most common morphology of cataracts was a combination of nuclear sclerosis, posterior subcapsular, and cortical cataract (n = 65 eyes, 49.3%). Phacoemulsification (87 eyes, 65.9%) was the preferred surgical technique. The mean preoperative corrected distant visual acuity of 1.21 ± 0.87 log MAR units improved significantly (P < 0.001) to 0.60 ± 0.56 log MAR units after surgery. The number of blind patients reduced from 27 (26.2%) to 8 (7.8%) patients. Zonular dialysis and posterior capsule tear were seen in six (4.5%) eyes each. Good preoperative vision (odds ratio: 6.1 [95% confidence interval: 2.9–13.0], P < 0.0001) was associated with better outcome, wheras reduced central macular thickness (odds ratio: 3.5 [95% confidence interval: 1.3–9.2], P = 0.011) was associated with poor outcome.Conclusion:A considerable number of patients presented with advanced cataracts and severe vision impairment. Significant improvement in visual acuity and alleviation of vision impairment was seen after surgery, with few complications. Good preoperative visual acuity predicted a good outcome, whereas macular thinning predicted a poor outcome.     

Visual outcomes of binocular implantation of a new extended depth of focus intraocular lens

Purpose:To evaluate the visual outcomes of bilateral implantation of a new hydrophobic foldable extended depth of focus (EDOF) IOL.Methods:All cases undergoing phacoemulsification with bilateral implantation of Supraphob Infocus IOL between December 2017 and July 2018 at a tertiary eye care center were recruited in this prospective interventional study. The primary outcome measures were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA). Postoperative follow-up was done on day 1, 1 week, 1 month, and 3 months.Results:One hundred and four eyes of 52 patients with a mean age of 58.4 ± 9.3 years were included. The mean UDVA improved from 0.84 ± 0.32 logMAR preoperatively to 0.11 ± 0.08 logMAR at 3 months following surgery. At the final follow-up, the binocular UDVA, UIVA, and UNVA was 0.03 ± 0.07, 0.14 ± 0.06, and 0.36 ± 0.05 logMAR, respectively. The mean CS was 1.47 ± 0.06 logCS. The distance and near stereopsis was 90.2 ± 24.8 s of arc (arcsec) and 62.5 ± 19.4 arcsec, respectively. The mean total higher-order aberration (HOA), point spread function, and modulation transfer function were 0.30 ± 0.13, 0.07 ± 0.08, and 0.26 ± 0.07, respectively.Conclusion:The Supraphob Infocus EDOF IOL provides good unaided visual acuity for distance, intermediate, and near along with a high quality of vision as assessed by contrast sensitivity, HOAs, and stereoacuity. It may be a potential alternative to the currently available EDOF IOLs in providing good visual acuity at variable distances.     

Modified posterior drainage of post-operative suprachoroidal hemorrhage

Purpose:To study the anatomical and functional outcomes of trans-conjunctival 23G or 25G cannula-guided modified posterior passive drainage of post-operative suprachoroidal hemorrhage (SCH).Methods:A retrospective study was done on 15 eyes in the last nine years. Vitrectomy with perfluorocarbon liquid injection to push SCH from inside along with 23G or 25G cannula-guided passive drainage of SCH was performed by making multiple sutureless posterior sclerotomies at 10–15 mm behind the limbus. Postoperatively, best corrected visual acuity (BCVA), intraocular pressure (IOP), and posterior segment findings were compared from pre-operative findings.Results:Mean age at presentation was 64.93 ± 7.62 years. Complete resolution of SCH with attached retina was achieved in 60% (9/15) of cases. Mean pre-operative BCVA of Log MAR 2.82 ± 0.21 improved to mean post-operative BCVA Log MAR 1.04 ± 0.53 (P < 0.001). Mean pre-operative IOP of 27.87 ± 8.67 mmHg improved significantly to post-operative IOP of 10.2 ± 5.16 mmHg (P < 0.001). Silicone oil removal was possible in 11/15 (73.33%) cases.Conclusion:Posterior passive drainage of post-operative SCH by multiple sclerotomies using 23G or 25G cannulas can salvage these eyes with both anatomical and functional recovery.     

Management of moderate and severe corneal astigmatism with AcrySof? toric intraocular lens implantation – Our experience

Purpose

Visual performance following toric intraocular lens implantation for cataract with moderate and severe astigmatism.

Setting

Cataract services, Shroff Eye Centre, New Delhi, India.

Design

Case series.

Method

This prospective study included 64 eyes of 40 patients with more than 1.50 dioptre (D) of pre-existing corneal astigmatism undergoing phacoemulsification with implantation of the AcrySof® toric IntraOcular Lens (IOL). The unaided visual acuity (UCVA), best corrected visual acuity (BCVA), residual refractive sphere and refractive cylinders were evaluated. Toric IOL axis and alignment error was measured by slit lamp method and Adobe Photoshop (version 7) method. Patient satisfaction was evaluated using a satisfaction questionnaire at 3 months.

Results

The mean residual refractive astigmatism was 0.57 D at the final follow-up of 3 months. Mean alignment error was 3.44 degrees (SD = 2.60) by slit lamp method and 3.88 degrees (SD = 2.86) by Photoshop method. Forty-six (71.9%) eyes showed misalignment of 5 degrees or less, and 60 (93.8%) eyes showed misalignment of 10 degrees or less. The mean log MAR UCVA at 1st post-op day was 0.172 (SD = 0.02), on 7th post-op day was 0.138 (SD = 0.11), and on 30th post-op day was 0.081 (SD = 0.11). The mean log MAR BCVA at three months was −0.04 (SD = 0.76).

Conclusion

We believe that implantation of AcrySof® toric IOL is an effective, safe and predictable method to correct high amounts of corneal astigmatism during cataract surgery.     

Intravitreal anti-vascular endothelial growth factor with and without topical non-steroidal anti-inflammatory in centre-involving diabetic macular edema

Purpose:Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is the mainstay in the management of center-involving diabetic macular edema (CI-DME). Topical nonsteroidal anti-inflammatory drugs (NSAIDs) have been used to treat CI-DME as well. Whether there is any benefit of using both together has not been explored. The aim of this study was to compare visual acuity and OCT outcomes in patients with CI-DME who receive intravitreal anti-VEGF with and without topical NSAIDs in CI-DME.Methods:This was A retrospective observational study in two centers in India. The study compared visual and OCT parameters of patients with CI-DME treated with intravitreal anti-VEGF monotherapy (group 1, N = 100) versus intravitreal anti-VEGF therapy with topical NSAIDs (group 2, N = 50) over 1-year follow-up. Continuous and categorical parameters were compared using parametric and nonparametric tests, respectively.Results:Over the 1-year follow-up, group 2 received more mean number of intravitreal injections (group 1: 2.26 ± 1.71 vs. group 2: 3.74 ± 2.42; P < 0.0001). There were no differences between the groups in visual acuity and OCT thickness at 1-year follow-up.Conclusion:Combination therapy of topical NSAIDs with intravitreal anti-VEGF did not show any beneficial effects in terms of visual outcomes, reduction in central subfoveal thickness, or reduction in the mean number of injections in our study.     

Visual outcomes and optical quality after implantation of a diffractive multifocal toric intraocular lens

Background:This study evaluated the visual function after implantation of a multifocal toric intraocular lenses (IOLs).Results:At 6 months postoperatively, uncorrected distance visual acuity (logarithm of the minimum angle of resolution) was 0.09 ± 0.04, corrected distance visual acuity was 0.02 ± 0.11, and uncorrected near visual acuity was 0.12 ± 0.07. The mean SE was −0.095 ± 0.394 D (±0.50 D in 90%). Refractive astigmatism at the 6-month follow-up visit was significantly reduced to 0.35 ± 0.32 D from 1.50 ± 0.41 D presurgery (P < 0.05). The mean IOL axis rotation was 3.20 ± 1.55°. Postoperative CS levels were high. Postoperative total order aberrations (TOAs), lower-order aberrations (LOAs), higher-order aberrations (HOAs), and spherical aberrations were decreased compared with preoperative values (P < 0.05). At 3 months postoperatively, TOAs, LOAs, and HOAs with a 3 mm pupil diameter as well as TOAs, LOAs, and astigmatism aberrations with a 5 mm pupil diameter were statistically lower than those at 1-month post surgery, but without subsequent significant changes (P > 0.05). There was an increase in MTF results between preoperative and postoperative evaluations at all spatial frequencies.Conclusions:The diffractive multifocal toric IOL is able to provide a predictable astigmatic correction with apparently outstanding levels of optical quality after implantation.     

Management of Acute Submacular Hemorrhage with Intravitreal Injection of Tenecteplase,Anti-vascular Endothelial Growth Factor and Gas

PurposeTo evaluate the visual and anatomical outcomes for neovascular age-related macular degeneration with submacular hemorrhage after intravitreal injections of tenecteplase (TNK), anti-vascular endothelial growth factor (VEGF) and expansile gas.MethodsThis study was a retrospective clinical case series following 25 eyes of 25 patients. All patients received a triple injection using 0.05 mL TNK (50 µg), 0.05 mL anti-VEGF and 0.3 mL of perfluoropropane gas. Retreatment with anti-VEGF was performed as needed. Preoperative and postoperative best-corrected visual acuity and central retinal thickness were analyzed.ResultsThe mean logarithm of the minimum angle of resolution of best-corrected visual acuity improved significantly from 1.09 ± 0.77 at baseline to 0.52 ± 0.60 at 12 months (p < 0.001). The mean central retinal thickness also improved significantly from 545 ± 156 at baseline to 266 ± 107 at 12 months (p < 0.001). A visual improvement of 0.3 logarithm of the minimum angle of resolution unit or more was achieved in 15 eyes (60%). During the 12 postoperative months, an average of 4.04 intravitreal anti-VEGF injections was applied.ConclusionsA triple injection of TNK, anti-VEGF, and a gas appears to be safe and effective for the treatment of submacular hemorrhage secondary to neovascular age-related macular degeneration.     

Visual and autorefraction outcomes following toric intraocular lens insertion without calculation of posterior corneal astigmatism in the UK National Health Service

ObjectiveTo ascertain visual and refractive outcomes following toric intraocular lens (IOL) implantation in the UK National Health Service (NHS) without posterior corneal astigmatism calculation, with multiple surgeons of different grades, pooled input and output pathways and autorefraction as the refractive outcome measure.MethodsPreoperative and 1-month post-operative data were analysed retrospectively in 114 eyes (95 patients) receiving a toric IOL between 2014 and 2016 at Imperial College NHS Trust. Preoperative keratometric astigmatism was ≥2 dioptres (D).ResultsMean preoperative best-corrected visual acuity (BCVA) was 0.50 logMAR (±0.46), improving to a mean uncorrected VA (UCVA) of 0.35 logMAR (±0.36) postoperatively (p < 0.001) with 65% of eyes attaining a UCVA ≤ 0.30 logMAR. Excluding 33 eyes with pre-existing visual comorbidities and one targeting monovision, mean post-operative UCVA was 0.24 logMAR (±0.29) (p < 0.001), and 85% had UCVA ≤ 0.30 logMAR, 62% UCVA ≤ 0.20 logMAR. Mean refractive astigmatism improved from 3.04 D (±1.46) to 1.36 D (±1.13) (p < 0.001). In total, 52% of eyes had post-operative refractive astigmatism ≤1.00 D. The Alpins correction index was 1.05 (±0.22), indicating a tendency to overcorrect. Toric IOL misalignment was noted in two eyes, and two cases of posterior capsule rupture were converted to a non-toric IOL.ConclusionsVisual outcomes of toric IOL implantation in our pooled pathway are comparable to single-surgeon case series where posterior corneal astigmatism has not been accounted for. However, with 1-month post-operative autorefraction, only 52% of eyes had ≤1 D refractive astigmatism, which is lower than previously published series, but may be standard for 1-month autorefraction outcomes.Subject terms: Outcomes research, Health services     

Comparison of Serum Cortisol and Testosterone Levels in Acute and Chronic Central Serous Chorioretinopathy

PurposeTo compare the levels of serum cortisol and testosterone in acute and chronic central serous chorio-retinopathy (CSC).MethodsSerum cortisol and testosterone levels in 30 patients with either acute or chronic CSC were evaluated using chemiluminescent immunoassay.ResultsThe mean age was 42.43 ± 6.37 years (range, 32 to 56 years). The mean 8:00 to 9.00 a.m. serum cortisol level was 12.61 ± 4.74 µg/dL (range, 6.58 to 27.42 µg/dL). The mean serum testosterone level was 5.88 ± 1.57 ng/dL (range, 2.81 to 9.94 ng/dL). The mean visual acuity was 20 / 65.07 ± 40.56 (range, 20 / 25 to 20 / 200). There was no statistically significant difference in the mean levels of serum cortisol and testosterone between the acute and chronic cases (p > 0.05), but there was a statistically significant difference in the mean presenting visual acuity in the two groups (p < 0.05).ConclusionsAll except one patient in the acute group had normal levels of serum cortisol. Testosterone levels were within the normal range in both the acute and chronic cases of CSC. There is unlikely to be any statistically significant difference in the mean levels of serum cortisol and testosterone between the acute and chronic cases, but there may be a statistically significant difference in the mean presenting visual acuity in these groups.     

Capsular tension ring assisted phacoemulsification of morgagnian cataract

Purpose:To describe a novel technique of phacoemulsification in morgagnian cataract using capsular tension ring (CTR).Methods:This was a retrospective, non-comparative, clinical interventional study. Patients with hypermature morgagnian cataract who had undergone CTR-assisted phacoemulsification were included in the study. After capsulorhexis, CTR was inserted in a clockwise manner to stabilize the capsular bag in each case. Phacoemulsification was then performed using either horizontal chopping or vertical chopping. We have used the CTR in these cases without any obvious lens subluxation in order to perform safe emulsification of the nuclear pieces in the capsular bag. We have performed the procedure successfully in eleven eyes with hypermature morgagnian cataract.Results:The mean corrected distance visual acuity (CDVA) improved from 2.62 ± 0.25 Log MAR to 0.35 ± 0.28 Log MAR at 3 months postoperatively (P = 0.00008). Total nine out of 11 patients gained CDVA of 20/40 or better at 3 months postoperatively. No intraoperative complications such as posterior capsular rupture, zonular dialysis, iris trauma, vitreous loss were noted. The mean endothelial cell loss was 148.82 ± 41.52 cells/mm² after 3 months of surgery.Conclusion:The main culprit for intraoperative complications during phacoemulsification in a morgagnian cataract is the vulnerable capsular bag. Following insertion of a CTR after capsulorhexis, the bag becomes stable and the subsequent steps of the surgery become uneventful, thereby, preventing any further complications.     

Outcomes of macular buckling with a T-shaped buckle for myopic tractional maculopathies associated with posterior staphyloma: An Indian experience

Purpose:To report the anatomic and visual outcomes following macular buckling in patients affected by pathological myopia-associated foveoschisis (FS) and macular detachment with or without macular hole (MH).Methods:A retrospective interventional consecutive case series wherein 25 highly myopic eyes (mean axial length 28.46 mm; range, 25–33.8 mm) of 24 patients (16 females and 8 males; mean age 54.1 years; range, 35–74 years) presenting with macular detachment associated with a posterior staphyloma (PS), who underwent macular buckling, were evaluated. Patients with absence or reduction in subretinal fluid by more than 90% during the final follow-up along with inversion of contour of staphyloma were considered to have a successful anatomical outcome and those with improvement or maintenance in visual acuity were considered to have a successful functional outcome. The mean duration of follow-up was 11.2 months.Results:At the time of initial presentation, the mean age of the 24 patients was 54.1 ± 10.28 years. Macular detachment along with FS was present in all cases, whereas full-thickness macular hole-related retinal detachment was present in nine cases. Swept-source optical coherence tomography parameters showed reduction of FS with foveal reattachment in all eyes except one at last visit. Mean axial length decreased from 28.5 mm preoperatively (range 26–33.8 mm) to 26.2 mm (range 24–29.3 mm). The mean best-corrected visual acuity changed from 1.16 log MAR to 1.096 Log MAR (P = 0.165). Visual acuity improved in 10 eyes (40%), remained stable in 11 eyes (44%) and decreased in 4 eyes (16%).Conclusion:Macular buckling is a good surgical technique with encouraging anatomic and visual outcomes in patients with myopic macular detachment associated with PS. Highly selective cases of myopic traction maculopathy can have a viable option of macular buckle surgery in stabilizing the retinal tractional changes, and thereby, vision loss.     

A 12-month prospective study to evaluate the efficacy of using the treat-and-extend regimen with intravitreal aflibercept as a Second-Line Treatment for Diabetic Macular Oedema (the TADI Study)

PurposeTo evaluate the efficacy of intravitreal aflibercept as a second-line therapy in eyes with persistent diabetic macular oedema (DMO) despite receiving initial bevacizumab treatment.MethodsA prospective multicentre study was conducted in nine academic clinics in Israel. Starting from the first follow-up visit, a treat-and-extend regimen was applied in which the treatment intervals were extended by 2 weeks based on macular thickness using SD-OCT. The primary outcome was central subfield thickness (CST) at week 52.ResultsForty-four patients (n = 48 eyes) were recruited to the study, and 43 eyes completed 52 weeks of follow-up. Patients received a mean (±SD) of 7.9 ± 3.5 bevacizumab injections before enrolment. The mean (±SD) CST under aflibercept therapy decreased from 468 ± 131 μm at baseline to 303 ± 67 μm at 52 weeks (p = 0.002), and best corrected visual acuity improved from 64 ± 15 ETDRS letters at baseline to 75 ± 8 letters at week 52 (p = 0.001). Twenty (46%) eyes met the treat-and-extend criteria and received a mean (±SD) of 10.9 ± 2 aflibercept injections.ConclusionsEyes with persistent DMO following initial bevacizumab therapy had a marked reduction in macular thickness and improved visual acuity following 1 year of treatment with intravitreal aflibercept. Less than half of the patients met eligibility criteria for extension of the treatment interval; for these patients, the treat-and-extend regimen resulted in a maximum treatment interval of 10 weeks during the first year.Subject terms: Outcomes research, Retinal diseases     

Early Postoperative Pain and Visual Outcomes Following Epipolis-Laser In Situ Keratomileusis and Photorefractive Keratectomy

Purpose

To compare early postoperative pain and visual outcomes after epipolis-laser in situ keratomileusis (epi-LASIK) and photorefractive keratectomy (PRK) in the treatment of myopia.

Methods

A retrospective chart review was designed and included 49 eyes in 30 patients who underwent epi-LASIK and 54 eyes in 29 patients who underwent PRK. During the early postoperative period (days 1 to 5), pain, uncorrected visual acuity (UCVA), and time to epithelial healing were recorded. Visual outcomes were followed for up to six months.

Results

Mean preoperative spherical equivalent refraction for the epi-LASIK group was -3.99±1.39 diopters (D) and that of the PRK group was -3.54±1.27 D. The pain scores on the fourth postoperative day were significantly higher in the epi-LASIK group than in the PRK group (p=0.017). Duration of pain in the epi-LASIK group was longer than in the PRK group (p=0.010). Mean healing time was significantly longer in the epi-LASIK group than in the PRK group (p<0.000). In addition, UCVA in the epi-LASIK group at postoperative days 1 and 3 were significantly lower than those in the PRK group (p=0.021 and p<0.000, respectively). Uncorrected visual acuity at one week and one month after epi-LASIK were lower than those after PRK (p=0.023 and p=0.004, respectively).

Conclusions

In the epi-LASIK patients, pain relief, corneal healing, and visual recovery seemed to be slower during the early postoperative period compared to those of the PRK patients. With longer duration of follow-up, however, there were no significant differences in visual outcome between the two groups.     

Multilayered inverted internal limiting membrane flap technique versus standard internal limiting membrane peeling for large macular holes: A comparative study

Purpose:To evaluate the outcome of vitrectomy with multilayered inverted internal limiting membrane flap technique (ML-IILM) versus vitrectomy with standard ILM peeling for large macular holes in terms of visual acuity and anatomical closure.Methods:A hospital-based, prospective, randomized, interventional study was conducted during three calendar years with a total 150 eyes (75 in each group) in two groups—vitrectomy with ILM peeling (Group A) and vitrectomy with ML-IILM flap technique (Group B) after informed consent of study participants who met the inclusion criteria.Results:The mean minimum and maximum diameter of macular hole did not differ statistically in both the groups. Macular hole index had no significant difference between both groups Pre-operative visual acuity was not statistically significantly different between the two groups. During follow-up, best corrected visual acuity (BCVA) at 1 month, 3 months, 6 months, and 12 months was significantly better in Group B (0.12 ± 0.07 at 1 month, 0.14 ± 0.10 at 3 months, 0.18 ± 0.11 at 6 months, and 0.19 ± 0.12 at 12 months) compared to Group A (0.20 ± 0.11 at 1 month, 0.22 ± 0.13 at 3 months, 0.30 ± 0.12 at 6 months, and 0.31 ± 0.14 at 12 months) (P = 0.001 for each). Type 1 anatomical closure (flattening of cuff and opposition of edges of hole) was achieved in 78.66% (59/75) cases in Group A and 93.33% (70/75) cases in Group B (P 0.0016).Conclusion:Vitrectomy with multilayered inverted ILM flap technique had significantly higher anatomical closure and better visual outcome than vitrectomy with standard ILM peeling.     

Re-evaluating diabetic papillopathy using optical coherence tomography and inner retinal sublayer analysis

Background/ObjectivesTo re-evaluate diabetic papillopathy using optical coherence tomography (OCT) for quantitative analysis of the peripapillary retinal nerve fibre layer (pRNFL), macular ganglion cell layer (mGCL) and inner nuclear layer (mINL) thickness.Subjects/MethodsIn this retrospective observational case series between June 2008 and July 2019 at Moorfields Eye hospital, 24 eyes of 22 patients with diabetes and optic disc swelling with confirmed diagnosis of NAION or diabetic papillopathy by neuro-ophthalmological assessment were included for evaluation of the pRNFL, mGCL and mINL thicknesses after resolution of optic disc swelling.ResultsThe mean age of included patients was 56.5 (standard deviation (SD) ± 14.85) years with a mean follow-up duration of 216 days. Thinning of pRNFL (mean: 66.26, SD ± 31.80 µm) and mGCL (mean volume: 0.27 mm³, SD ± 0.09) were observed in either group during follow-up, the mINL volume showed no thinning with 0.39 ± 0.05 mm³. The mean decrease in visual acuity was 4.13 (SD ± 14.27) ETDRS letters with a strong correlation between mGCL thickness and visual acuity (rho 0.74, p < 0.001).ConclusionAfter resolution of acute optic disc swelling, atrophy of pRNFL and mGCL became apparent in all cases of diabetic papillopathy and diabetic NAION, with preservation of mINL volumes. Analysis of OCT did not provide a clear diagnostic distinction between both entities. We suggest a diagnostic overlay with the degree of pRNFL and mGCL atrophy of prognostic relevance for poor visual acuity independent of the semantics of terminology.Subject terms: Medical research, Outcomes research     

Laser in-situ keratomileusis for refractive error following radial keratotomy

Aim:

To evaluate the safety and efficacy of laser in-situ keratomileusis (LASIK) in eyes with residual/induced refractive error following radial keratotomy (RK).

Design:

Retrospective study.

Materials and Methods:

A retrospective analysis of data of 18 eyes of 10 patients, who had undergone LASIK for refractive error following RK, was performed. All the patients had undergone RK in both eyes at least one year before LASIK. Parameters like uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), contrast sensitivity, glare acuity and corneal parameters were evaluated both preoperatively and postoperatively.

Statistical Software:

STATA-9.0.

Results:

The mean UCVA before LASIK was 0.16±0.16 which improved to 0.64 ± 0.22 (P < 0.001) after one year following LASIK. Fourteen eyes (out of 18) had UCVA of ≥ 20/30 on Snellen''s acuity chart at one year following LASIK. The mean BCVA before LASIK was 0.75 ± 0.18. This improved to 0.87 ± 0.16 at one year following LASIK. The mean spherical refractive error at the time of LASIK and at one year after the procedure was –5.37 ± 4.83 diopters (D) and –0.22 ± 1.45D, respectively. Only three eyes had a residual spherical refractive error of ≥ 1.0D at one year follow-up. In two eyes, we noted opening up of the RK incisions. No eye developed epithelial in-growth till 1 year after LASIK.

Conclusion:

LASIK is effective in treating refractive error following RK. However, it carries the risk of flap-related complications like opening up of the previously placed RK incisions and splitting of the corneal flap.     

Anterior chamber intraocular lens - An effective alternative in traumatic and surgical aphakia in the era of scleral-fixated intraocular lens

Purpose:To evaluate outcomes of anterior chamber intraocular lens (ACIOL) implantation with vitrectomy in eyes with surgical or traumatic aphakia, and subluxated or dislocated lens.Methods:In this retrospective study, we evaluated patients who underwent pars plans vitrectomy with ACIOL implantation from April 2016 to March 2019. Patients with minimum follow-up period of 1 year and operated by single surgeon were included. Ophthalmic history, indication for surgery, BCVA, IOP, slit-lamp examination, and fundus assessment findings were noted. Postoperatively best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications if any were noted.Results:Ninety eyes of 88 patients were included in the study. The mean age of the patients was 60.2 ± 10.2 yrs. Majority (75.6%) were males and 24.4% were females. Indications for pars-plana vitrectomy (PPV) with ACIOL implantation were nucleus drop in 16.6%, IOL drop in 25.5%, large posterior capsular rupture (PCR) with vitreous disturbance or zonular dehiscence (ZD) during cataract surgery in 33.3%, more than 180° subluxation of lens in 10% and traumatic lens or intraocular lens (IOL) drop in 14.4% cases. Preoperative and postoperative mean Log MAR visual acuity was 1.59 ± 0.44 and 0.36 ± 0.33 respectively, with few complications like cystoid macular edema (CME) in 8.8%, persistently raised IOP in 4.4%, persistent uveitis in 2.2%, retinal detachment (RD) in 2.2%, and tilted IOL in 1.1% cases.Conclusion:Out of different options available for secondary IOL implantation in patients with poor capsular support ACIOL has the advantages of cost-effectiveness, small learning curve, faster surgical time with a lesser rate of complications like IOL tilt, vitreous hemorrhage, and suture erosion as compared to scleral-fixated IOL (SF-IOL). Comparable visual outcome can be obtained by proper patient selection in these cases.     

Pulse cyclophosphamide therapy in the management of patients with macular serpiginous choroidopathy

Purpose:

To evaluate safety and efficacy of intravenous pulse cyclophosphamide (CyP) in acute macular serpiginous choroiditis (SC).

Methods:

Patients with acute macular SC with lesions threatening and/or involving fovea were enrolled. All patients received CyP (1 g/m² ) for 3 days followed by high-dose oral steroids (1.5 mg/kg) tapered over 6 months and monitored for visual acuity, response to treatment and systemic side effects.

Results:

Eight patients (seven unilateral and one bilateral) with median age of 27 years (range: 13–40 years) were recruited. Mean visual acuity at presentation was 0.71 ± 0.35 logarithm of the minimum angle of resolution while postpulse visual acuity was 0.40 ± 0.32. Final mean visual acuity at 1-year was 0.31 ± 0.23 (P ≤ 0.05). Three eyes had recurrence and 3 patients developed transient hair loss with no other adverse effect.

Conclusion:

Intravenous CyP provides rapid resolution of lesion activity and thereby helps in maintaining good functional acuity.     

Postsurgical Cystoid Macular Edema following Posterior Chamber Toric Phakic Intraocular Lens Implantation Surgery: A Case Report

PurposeTo describe a case of cystoid macular edema (CME) developing after posterior chamber toric phakic intraocular lens (PIOL) implantation.MethodsCase report.ResultsA 33-year-old male underwent implantation of toric implantable collamer lenses (ICL), a new generation of PIOLs, for both eyes. Preoperative best spectacle-corrected distance visual acuity (BCVA) was 20/25 in the right eye and 20/32 in the left eye, with a manifest refraction of −9.25 −4.0 × 4° and −9.75 −4.25 × 171°, respectively. On day 1 postoperatively, the left eye had an uncorrected distance visual acuity (UDVA) of 20/60 with a refraction of +2.0 −3.5 × 11°. Despite the rotation of the PIOL, the cylindrical refractive component persisted in the left eye with a refraction of +2.0 −3.5 × 11°. Two weeks after the initial surgery, he presented with a decrease in his visual acuity in the left eye. The UDVA and BCVA were both 20/100 in the left eye with a refraction of +2.0 −4.25 × 3°. Dilated fundus examination and macular optical coherence tomography revealed a CME in the left eye. Following topical nepafenac therapy and explantation of the ICL, we observed a complete resolution of the CME at 3 months with an improvement in BCVA to 20/32 in the left eye.ConclusionsTo our knowledge, this is the first reported case of postsurgical CME following toric ICL implantation. In cases of phakic eyes with an intact posterior capsule, postsurgical CME can develop, thus highlighting the purpose of this report.Key Words: Postsurgical cystoid macular edema, Posterior chamber intraocular lens, Toric implantable collamer lens, Intraocular lens complication