Ophthalmic surgery

This chapter discusses the anaesthetic management of ophthalmic surgery. It begins with a description of general principles, including anatomy and physiology of the globe and orbit, preoperative considerations of ophthalmology patients, and a discussion of different ocular block techniques. Surgical procedures covered include cataract extraction and intra-ocular lens (IOL) implantation; strabismus surgery; vitreo-retinal surgery; dacrocystorhinostomy (DCR), and repair of penetrating eye injuries.

Visual Outcome of Combined Descemet Stripping Endothelial Keratoplasty and Sutured Scleral Fixated Intraocular Lens in Endothelial Decompensation with Coexistent Aphakia or Intra Ocular Lens Subluxation

Purpose To elucidate visual outcome of patients after combined Descemet stripping endothelial keratoplasty (DSEK) with scleral fixated intra ocular lens (SFIOL) implantation in patients of endothelial decompensation with coexistent aphakia or lens subluxation. Materials and Methods A prospective interventional study of combined DSEK with sutured SFIOL in the patients who have undergone surgery at our center over 6-month follow-up period. Preoperative visual acuity and slit lamp findings were documented. Postoperative follow-up was done at days 1, 3, and 7 subsequently, months 1 and 3, and thereafter monthly till the sixth month. Results Mean age of the patients was 60.47 years. Six patients had aphakic bullous keratopathy, while 11 patients had pseudophakic bullous keratopathy with subluxated posterior chamber IOL (PCIOL). Preoperative visual acuity ranged from hand movements close to face (LogMar 2.4) with accurate projection of rays to 1/60 (LogMar 2) due to existing corneal edema and aphakia. Postoperatively uncorrected visual acuity at 6 months improved up to 6/36 (LogMar 0.8) in all cases. There was gradual improvement in corneal clarity and compactness during the follow-up. A good donor tissue endothelial count and an adequate IOP control were vital prognostic factors for the successful outcome. Conclusion This novel surgical merger reduces the complications of lenticule dislocation into vitreous and repeated surgeries and shows results akin to when performed in a staged manner.

Insights into Bone Morphogenetic Protein—(BMP-) Signaling in Ocular Lens Biology and Pathology

Bone morphogenetic proteins (BMPs) are a diverse class of growth factors that belong to the transforming growth factor-beta (TGFβ) superfamily. Although originally discovered to possess osteogenic properties, BMPs have since been identified as critical regulators of many biological processes, including cell-fate determination, cell proliferation, differentiation and morphogenesis, throughout the body. In the ocular lens, BMPs are important in orchestrating fundamental developmental processes such as induction of lens morphogenesis, and specialized differentiation of its fiber cells. Moreover, BMPs have been reported to facilitate regeneration of the lens, as well as abrogate pathological processes such as TGFβ-induced epithelial-mesenchymal transition (EMT) and apoptosis. In this review, we summarize recent insights in this topic and discuss the complexities of BMP-signaling including the role of individual BMP ligands, receptors, extracellular antagonists and cross-talk between canonical and non-canonical BMP-signaling cascades in the lens. By understanding the molecular mechanisms underlying BMP activity, we can advance their potential therapeutic role in cataract prevention and lens regeneration.

Tertiary Cataract- A Rare Postoperative Complication after Cataract Surgery: A Case Study

Introduction: IOL opacification is a rare and serious complication of post operative diminution of vision with the only effective treatment being lens explantation and replacement, preferably involving lens of different material1. Following cataract surgery, it can occur anytime varying from months to years after the surgery. Case Report: A 57-years-old male presented with chief complaints of left eye diminution of vision since 2 years which was painless and progressive. Patient had undergone both eyes cataract surgery 4 years back elsewhere. He was a known case of Ischemic Heart Disease on treatment. On examination, his best corrected visual acuity (BCVA) was 6/9 in right eye and 6/36 in left eye. On slit light examination, there was presence of white pupillary reflex in left eye giving appearance of white cataract. On dilated examination, both eyes were found to be pseudophakic with left eye having posterior chamber opacified foldable Intra Ocular Lens and posterior segment details in left eye were not visible. B Scan was done and noted to be normal.He was posted for Left eye IOL (Intra Ocular Lens) exchange with rigid IOL Implantation with surgical capsulotomy after which his vision improved. Conclusion: Cases of opacified Intraocular lenses if visually significant require IOL exchange procedure for treatment which is associated with good visual prognosis. Key words: Pseudophakia, Intra Ocular Lens (IOL), Opacified IOL, Acrylic, Hydrophilic, Hydrophobic.

STUDY OF VISUAL OUTCOME IN PATIENTS AFTER AC-IOL (ANTERIOR CHAMBER INTRA-OCULAR LENS) IMPLANTATION DURING CATARACT SURGERY

Background: Following posterior capsular rupture (PCR) and vitreous loss during cataract surgery, sometimes there is inadequate support for implanting a conventional intra-ocular lens (IOL) in the capsular bag. Flexible openloop anterior chamber intraocular lens, trans-sclerally sutured posterior chamber intraocular lens and iris-claw lenses are the most acceptable alternatives in such a scenario. Objective: To review our experience with primary anterior chamber intraocular lens implantation at a District Hospital in Rajkot. Methods: Analysis of medical records of a consecutive series of primary anterior chamber intraocular lens implantations carried out at the G.T. Sheth Eye Hospital at Rajkot, from September 2011 to April 2013. Eyes with complicated or traumatic cataracts, ocular co-morbidity and cases of combined surgery were excluded from the analysis of visual outcome. Results: There were 70 cases of primary anterior chamber intraocular lens implantations during the study period. Posterior capsule rupture and resultant inadequate capsular support was the commonest indication for implanting the anterior chamber intraocular lens. Postoperatively 82.85% had a best corrected visual acuity of 6/12 or better. The commonest postoperative complications were cystoid macular oedema, recurrent iritis and persistent elevated intra-ocular pressure (IOP). Conclusion: Our results indicate a satisfactory visual outcome with primary implantation of anterior chamber intraocular lenses. Caution should be exercised when implanting an anterior chamber intraocular lens following complicated cataract surgery, particularly in the absence of appropriate capsular support.

Comparison of post-op quality of vision of spheric IOL and aspheric hydrophilic acrylic yellow tinted intraocular lens implantation following phacoemulsification cataract surgery

Purpose: To compare the post-op visual quality of spheric and aspheric acrylic yellow tinted intraocular lens following phacoemulsification cataract surgery. Place of study: Al-Majeed Laser Eye Hospital. Methods: Total 60 subjects (aged 40-65years) with age related mature cataracts were included. Data was assembled by non-probability convenient sampling technique at Al-Majeed Laser Eye Hospital. All patients presenting with mature cataract were include in this study without any other pathology and fundus abnormality. Pre and post-operative visual acuity was measured by using standard snellen visual acuity testing chart. For the purpose of accuracy repetitive values were taken for each patient. Post-operative vision was recorded one month followed by phacoemulsification. Comparisons was made between spheric and asphereic acrylic yellow tinted intraocular lens by applying (descriptive) statistics and paired sample t test for the analysis of results. Results: Quality of vision was compared post-operatively after implantation of aspheric hydrophilic acrylic IOL and spheric IOL in posterior chamber under the same phaco surgeon. All subjects after intra ocular implantation had better corrected visual acuity of 6/9 and more improved 6/6. There were found statistically differences in recorded visual acuity with aspheric yellow tinted iol implanation and spheric iol (p = 0.15) between the two types of intra-ocular lens. The mean, standard deviation, t-value found with spheric IOL were.1867, .18889, 2.517 respectively. However, of aspheric hydrophilic acrylic intra-ocular lens mean, standard deviation and t values found .800, .13493 and 2.5493 respectively. There was significant variance in statistics and quality of vision between the two types of lenses. Conclusions: This study concludes that post –operative improvement in quality of vision was better with aspheric hydrophilic yellow tinted lenses than spheric iol implantation. Implanting a foldable aspheric acrylic IOL gave much advantage in visual outcome to pseudophakes by protecting retina from light of shorter wavelength and decrease of chromatic aberration under the photopic circumstances particularly in subjects at hazard of age-related macular degeneration (AMD).