Sutureless Manual Extracapsular Cataract Extraction with Lollipop

Purpose: To evaluate the efficacy and safety of cataract extraction through small pupil with the help of a specially designed instrument called lollipop. Study Design: Interventional case series. Place and Duration of Study: Euro eye clinic from January 2019 to December 2019. Methods: Seventeen consecutive patients with pupil diameter of <4mm after maximal pharmacological dilatation were recruited for study. Inclusion criteria was patients with less than 4mm pupil size after maximum pharmacological dilation. Patient with previous anterior segment surgery and small pupil with posterior synechea were excluded. The instrument (lollipop) was originally designed for breaking posterior synechae. Sutureless Manual Extracapsular Cataract Extraction (SMECE), more commonly known as MSICS, was performed in all cases. After tunnel formation and capsulotomy, lollipop was used to bring lens edge out in pupillary margin. Lens was then maneuvered into anterior chamber and expressed out. Results: All 17 patients had successful SMECE. In one patient pupil was stretched before applying instrument. None of the patients had posterior capsular rupture or hyphaema. Conclusion: This instrument designed in Center of Ophthalmic Instrument and Equipment Designing (COIED) is very useful, safe and cost effective. In Extra Capsular Cataract Extraction (ECCE) or SMECE, surgeons usually do keyhole iridotomy, mechanical stretching or multiple sphincterotomies for managing small pupil. With this new instrument, cataract extraction can be done without surgical trauma to the pupil, thus preserving pupil shape. Key Words: Sutureless Manual Extra capsular Cataract Extraction (SMECE), Manual Small Incision Cataract Surgery (MSICS), Miosis.

Outcomes and longitudinal trend of traumatic cataract wound dehiscence in patients with blunt ocular injury

Longitudinal trends on traumatic cataract wound dehiscence are scant. In this study, we present the characteristics of traumatic cataract wound dehiscence using 15 years of longitudinal trend in one of the largest medical centers in Taiwan for a period when cataract surgeries were gradually shifting from extracapsular cataract extraction (ECCE) to phacoemulsification. All patients with a prior cataract surgery who suffered from blunt open globe trauma between 2001 and 2015 at a tertiary referral center in Taiwan were included. The number of cases per year; type of prior cataract surgery; visual acuity (VA); mechanism and place of injury were analyzed. The risk factors associated with final VA were investigated in patients followed up for ≥ 1 month. Seventy-six eyes of 75 patients were included and all of them were traumatic cataract wound dehiscence with a prior ECCE (65 eyes) or phacoemulsification. The most common mechanism and place of injury was fall and at home in both cataract surgical types. The mean log of the minimal angle resolution (logMAR) of final VA was 2.15 ± 0.88 (ECCE) and 1.61 ± 0.83 (phacoemulsification) (P = .026). The most significant risk factors associated with worse final VA were retinal detachment at the initial visit and low ocular trauma score (both P < .001). Long-term visual outcome of phacoemulsification wound dehiscence was better than that of ECCE wound after a blunt trauma.

Acquired acoria and iris pearls in leprosy: Case report

Purpose: To describe a case of a patient presenting with acquired acoria and iris pearls, a rare eye manifestation and pathognomonic finding for leprosy; to reinforce clinical, histopathological, and therapeutic aspects of ocular involvement in leprosy. Methods: Case report. Case description: A 62-year-old male presenting with acquired acoria and iris pearls in both eyes due to leprosy also had anterior uveitis and cataract. Histopathological diagnosis of iris pearls was confirmed by the presence of Hansen’s bacilli. Ophthalmological examination revealed improvement of the visual acuity after iridectomy and extracapsular cataract extraction. Conclusions: To our knowledge, this is the first reported case of acquired acoria in a leprosy patient. It led to impaired vision and reversible blindness. Proper diagnosis and ophthalmological treatment of patients with these conditions are essential for the maintenance of a good quality of life.

State of corneal nerve fibers after phacosurgery

The question of potential changes in CNF induced by phacosurgery remains poorly understood. The need for research in this direction is dictated by a number of circumstances: the introduction into clinical practice of confocal microscopy of the cornea, the need for phacosurgery against the background of changes in the cornea of various genesis, the possibility of the negative impact of laser radiation in the process of hybrid (femtolaser) phacoemulsification. Purpose. Assessment of changes in CNF after various methods of microinvasive phacosurgery. Material and methods. The studies were conducted in two groups of patients aged 50 to 60 years who underwent standard ultrasound and hybrid PV (30 operations each, respectively). The algorithm for assessing the state of the nerve fibers of the cornea included laser confocal microscopy using original software. To quantify the state of nerves, two coefficients were used: directivity anisotropy (K Δ L) and directivity symmetry (Ksym). Results. Regardless of the operation methodology, a tendency toward a decrease in the directivity anisotropy coefficient and an increase in the directivity symmetry coefficient, conditionally comparable with previously identified age-related changes in nerve fibers, was noted. After hybrid phacoemulsification, a decrease in the directivity anisotropy coefficient 2–2.5 months after the intervention turned out to be statistically less significant compared to the standard ultrasound technique. Further research should be aimed at analyzing the long-term results of both microinvasive phacosurgery techniques and the “classical” extracapsular cataract extraction, which still remains the method of choice in a number of clinical situations. Key words: corneal nerve fibers, phacosurgery, in vivo laser microscopy.

Frequency of Pseudophakic Glaucoma in Patients with Cataract Surgery

Aim: To determine the frequency of pseudophakic glaucoma in patients who underwent cataract surgery. Study Design: Cross-sectional Place and Duration of Study: Department of Ophthalmology, Shaikh Zayed Hospital Lahore from 1st July 2020 to 31st December 2020. Methodology: Ninety five patients of both genders with cataract surgery were enrolled and ages between 45 to 75 years. After taking written consent detailed demographics including age, sex, body mass index, intraocular pressure, and mode of surgery were recorded. Pseudophakic glaucoma was labelled in case of cataract surgery with intraocular lens implantation and intraocular pressure >21 mmHg or more in one eye along with glaucomatous optic disc or retinal nerve fiber layer defect on optical coherence tomography (OCT). Results: There were 58 (61.05%) males and 37 (38.95%) patients were females. Mean ages of patients were 62.36±9.44 years. Sixty two (65.26%) patients had extracapsular cataract extraction and 33 (34.74%) patients had phacoemulsification. Mean intraocular pressure was 19.33±8.56 mmHg. Pseudophakic glaucoma was found in 32 (33.68%) patients. Conclusion: The frequency of pseudophakic glaucoma was high in patients with extracapsular cataract surgery. Keywords: Cataract surgery, Pseudophakic glaucoma, Intraocular pressure (IOP)

Scleral tunnel based sutureless extracapsular cataract extraction: An approach to astigmatic correction in soft cataracts of nuclear sclerosis grade 1

Objectives: A study to see if scleral tunnel based sutureless extracapsular cataract extraction with superior quadrant approach can correct pre-existing corneal astigmatism in soft cataracts of non-structural protein 1 (NS1) grade nuclear sclerosis in patients of younger age profile having “with-the-rule” pattern of corneal astigmatism. Material and Methods: 47 eyes of 41 patients who underwent scleral tunnel based sutureless extracapsular cataract extraction were taken as the study group and a second group of 44 eyes of 38 patients who underwent clear corneal incision based phacoemulsification surgery formed the control group. Soft cataracts of NS1 grade nucleus having “with-the-rule” corneal astigmatism were included in the study. Keratometry measurements were done preoperatively and at 6 weeks post-operative follow-up by Zeiss IOLMaster. Results: Sutureless scleral tunnel based extracapsular cataract extraction was found to neutralize pre-existing corneal astigmatism if it was in range of 1.0–1.5 D. It was also found to change the pattern of astigmatism from “with-the-rule” to “against-the-rule” if the pre-operative astigmatism was in the range of 0.5–1.0 D with little change in the absolute value of the astigmatism. Conclusion: Patients with pre-existing with-the-rule corneal astigmatism undergoing scleral tunnel based sutureless extracapsular cataract extraction had reduced corneal astigmatism. Phacoemulsification, on the other hand, was found to be an astigmatically neutral surgery.

Towards Vision 2020 -Trends of Cataract Surgery in Melaka Hospital, A Malaysian Tertiary Center: 2007-2014

Background Cataract surgery which is the only scientific method to treat cataracts has evolved from large incisions of intracapsular cataract excision to extracapsular cataract excision and now modern day phacoemulsification. Anaesthesia too has progressed from general anaesthesia to local and topical anaesthesia. A variety of intraocular lenses are available ranging from rigid to foldable, multifocal and toric. Day care surgeries are becoming the norm these days. Objective Cataract surgery has advanced with new techniques and modalities. We studied the trends of cataract surgery and outcomes over the years. Method We performed secondary data analysis (National Eye Database) of cataract surgery patients in Hospital Melaka (2007 - 2014). Result Most patients were 60-69 years (mean 65.0 years). Primary cataract rose (p<0.05) but there was no difference in laterality and first or second eye (p>0.05). More patients presented with Hypertension and Diabetes (p<0.05). Pterygium encroaching the cornea showed a rise (p<0.05). Phacoemulsification (80.8%) showed a rise while Extracapsular Cataract Extraction (ECCE) (15.4%) declined (p<0.05). More Specialists operated and fewer combined surgeries were performed (p<0.001). Type of anaesthesia did not change (p>0.05). Operative complications reduced (p<0.001). Anterior chamber, scleral fixated and foldable intraocular lenses usage reduced (p<0.05). There was no change in pre-operative visual acuity (p>0.05) but post-operative vision showed a rise in good outcomes (p<0.05). Conclusion Melaka Hospital shows a rise in phacoemulsification and a decline in Extracapsular Cataract Extraction. More patients presented with primary cataracts. More Specialists operated and there was a reduction in intraoperative and postoperative complications. Post-operative visual outcomes showed a remarkable improvement. This improvement is in keeping with the aim of improved vision for all by 2020.

The Triple Procedure :Analysis of Structural, Functional & Refractive Outcome

PURPOSE:To analyse the outcome of Triple procedure(Combined penetrating keratoplasty, cataract extraction and intraocular lens implantation) is a surgical technique for visually disabling corneal conditions with associated cataract .METHODS:The medical records of 120 patients who underwent triple procedure between January 2007 and December 2011 in terms of demographic data,past ophthalmic history, indications for surgery were retrospectively reviewed.Salient preoperative data included the initial visual acuity at the time of presentation , slit lamp findings of cornea(scar, haze, vascularisation , stromal folds with bullae ), anterior chamber , lens details , intraocular pressure status ,posterior segment examination with the help of indirect ophthalmoscope or B scan ultrasongraphy.RESULTS:A total of 120 corneal triple procedures performed were included in this study . Of 120 patients , 25 (20.83%)were male and 95 (79.17%) were female.Mean age of these patients was 42.45 +/-15.85 years(range 9 to 75 years ) . The mean postoperative follow up was 15.08+/-12.8 months(range ,1.5 to 49 months ).Failed therapeutic grafts(42.5%)-was the common indication found for surgery .Preoperatively , intraocular pressure was increased in 11(9.16%) patients . Conventional triple procedure in terms of combined penetrating keratoplasty with extracapsular cataract extraction with intraocular lens implantation(PK+ECCE+IOL) was performed in 114 ( 95%) eyes , 01(0.83%) eye underwent keratoplasty with phacoemulsification with intraocular lens implantation(PK+PE+IOL), and secondary intraocular lens implantation (PK+IOL)in 05 (4.17%)eyes .CONCLUSION:Triple procedure is an effective surgical option in corneal diseases associated with cataract.It provides an optimal visual and refractive outcome especially in high risk grafts situation.

Cystoid Macular Edema after Extracapsular Cataract Extraction Performed by Residents

Purpose: To determine the frequency and outcome of management of cystoid macular edema after extracapsular cataract extraction performed by residents.Study Design: Interventional case series.Place and Duration of Study: Lady Reading Hospital, MTI, Peshawar from Oct 2018 to Oct 2019.Material and Methods: Total 400 patients with mature cataract were included in our study. Patients having preexistingdisease such as uveitis, hypertensive retinopathy, diabetic retinopathy and retinal degenerations wereexcluded. All surgeries were performed by 4th year residents under supervision. Complicated cases before orduring surgery were excluded from the study. Cystoid macular edema cases were classified as follows; acuteoccurring within three months of cataract extraction and with duration fewer than 6 months, chronic persistingmore than 6 months. Patients were either managed conservatively or with anti-VEGF. All cases were followed for3 months or longer until resolution of cystoid macular edema.Results: Twenty patients developed cystoid macular edema out of which 16 patients (80%) improved withconservative treatment and 4 patients (20%) developed resistant cystoid macular edema. All four patients weregiven intravitreal bevacizumab injection monthly for three months. Our findings showed that best corrected visualacuity (BCVA) before injection ranged from 6/60 to 6/24. After three injections BCVA improved between 6/18 to6/6. Pre injection central subfield thickness (CSFT) was between 611 to 480 micron which improved to 272 -260micron after injections.Conclusion: Cystoid macular edema responds well to conservative treatment but resistant cases need repeatedinj of anti VEGF.

Intra-Operative and Immediate Post-Operative Complications of Cataract Surgery in an Eye Camp

Purpose: To analyze the intra-operative and immediate post-operative complications in patients after cataractsurgery in an eye camp.Study Design: Descriptive cross-sectional study.Place and Duration of Study: The study was conducted in a village of Nawabshah, Sindh, Pakistan from 7th to9th of February 2020.Material and Methods: Fifteen hundred patients were screened for visual disabilities of which 150 were selectedfor the study. They had a visual acuity of less than 6/9 in one or both eyes and had a cataract. The selectedpatients were operated using either phacoemulsification, extracapsular cataract extraction ECCE), intracapsularcataract extraction (ICCE) or small incision cataract surgery (SICS). The immediate intra-operative as well aspost-operative complications on day 1 after surgery were observed.Results: One hundred and fifty patients were operated. Age ranged from 14 years to 90 years, males were58.7% and females were 41.3%. The most common procedure performed was phacoemulsification 51.3%,followed by ECCE 30.0%, then SICS 18.0% and ICCE 0.7%. The most common intra-operative complication wasposterior capsule rent and the most common post-operative complication was striate keratopathy which was seenin 14.0% individuals. There was a significant association found for post-operative complications with gender withfemales having more post-operative complications as compared to males (P-value = 0.001 < 0.001).Conclusion: Camp surgeries when performed with strict sterilization and in experienced hands can play animportant role in treating cataract, which is the commonest cause of preventable blindness in developingcountries