6-6-2020: A date that went viral among ophthalmologists

6-6-2020 was a landmark date for the ophthalmology community, not only because of the normal visual acuity connotation of 6/6 and 20/20, but because it genuinely reflects every ophthalmologist’s dream to bring back perfect vision for every patient. The Covid-19 pandemic had forced ophthalmologists to “refuse to operate” albeit for a short period. This narrative describes how, during a telemedicine call, a surgeon experienced the distress of refusing to operate on a mature cataract. It reveals the trauma caused by the disordered goals of eye care during the pandemic, when elective procedures were abandoned and only emergency services were provided.

Late within the Capsular Bag Intraocular Lens Dislocation (Ten – Year Experience)

Purpose: To find out the frequency and causes of within the bag intraocular lens dislocation. Study Design: Descriptive, retrospective study. Place and Duration of Study: Federal Government Services Hospital Islamabad, from 2008 to 2018. Methods: Records of all the patients who underwent uneventful phacoemulsification were studied. Patients with Pseudoexfoliation and glaucoma were excluded. Out-of-the bag IOL dislocations and early dislocations that occurred within first three months after the cataract surgery were also not included. Percentage of patients with dislocated lens within the capsular bag after three months or more was calculated and the cause of dislocation was found. Results were presented in percentages. Results: Three thousand patients underwent uneventful phacoemulsification. Two thousand nine hundred thirty two (2932) patients fulfilled the inclusion criteria while 68 patients did not return for follow up. Age ranged between 25 and 75 years. There were 1600 males and 1332 were females. One thousand seven hundred and sixty were right eyes and one thousand one hundred and seventy two were left eyes. Sixty one (2.08%) developed late IOL dislocations, 35 (57.3%) males and 26 (42.7%) females. Patients of age group 50 – 75 years had more IOL dislocations. Causes of dislocation included; advanced mature cataract 21.3%, 19.7% with postoperative trauma, uveitis 14.7%, Myopia 9.8%, Silicon plate design in 9.8%, eccentric capsulorhexis 8.1%, small capsulorhexis 6.5%, retinitis pigmentosa 3.2% and in 6.5% no cause was found. Conclusion: Advanced mature cataract and postoperative trauma were the commonest causes of IOL dislocation. Key Words: Cataract surgery, Phacoemulsification, Trauma, Capsulorhexis. Intra ocular lens dislocation.

Uveal effusion syndrome in combination with mature cataract and secondaryangle closure

Актуальность. Синдром увеальной эффузии(УЭС) - редкое клиническое состояние, включающее в себя спонтанную цилиохориоидальную отслойку и серозную отслойку сетчатки у пациентов с неотягощенным анамнезом. Несмотря на характерный симптомокомплекс, постановка данного диагноза нередко затруднена. Цель. Анализ клинического случая УЭС. Материал и методы. Пациент Г., 46 лет. При обращении: острота зрения OS – 0,01 н/к, ВГД –16 мм рт.ст. ПЗО OS - 21,56 мм. При биомикроскопии – мелкая передняя камера, диффузно мутный хрусталик. По данным офтальмосонографии и УБМ – субтотальная цилиохориоидальная отслойка и закрытие угла передней камеры. Выставлендиагноз: зрелая катаракта, осевая гиперметропия, синдром увеальной эффузии OS. Выполнена факоэмульсификация катаракты с имплантациейзаднекамерной ИОЛ и одномоментной задней трепанацией склеры. Результаты. В послеоперационном периоде: зрение OS – 0,5 c cyl. – 1,5 дптр = 0,9. ВГД – 16 ммрт.ст. Цилиохориоидальная отслойка не определялась. ОКТ макулярной зоны OS: выявлена обширная отслойка нейроэпителия, что подтвердило диагноз УЭС. Выводы. В результате проведенного лечения достигнута высокая острота зрения и восстановление нормальных анатомо – функциональных взаимоотношений между структурами переднего и заднего отрезков глаза. Закрытие УПК может быть объяснено смещением иридохрусталиковой диафрагмы кпереди на фоне скопления жидкости в супрахориоидальном пространстве.

V-Prechop nucleodissection technique feasibility in the phacoemulsification in dogs with cataracts. Clinical aspects and specular microscopy

The aim of this study was to evaluate the feasibility of the V-Prechop nucleodissection technique in the phacoemulsification in dogs and the clinical aspects and of the specular microscopy in the postoperative period. Fourty three dogs of different breeds, males and females, aged 3 to 10 years, with mature (n=22) and immature (n=21) cataracts were used. After surgery, patients were evaluated weekly for visual acuity, intraocular pressure, and endothelial corneal cell density (by non-contact specular microscopy) and quantitative flare (by laser flare photometry) during different periods. The "V-prechop" technique presented technical difficulties in implementation in patients with a mature cataract. In selected cases of patients with an immature cataract, the technique can be employed, as the nuclei are softer, allowing confection of the linear fragments in “V” to be performed. In addition, the eyes of dogs with a mature cataract presented more intensive postoperative uveitis, probably related to the greater difficulty in conducting the "V" nucleodissection. There was decreased endothelial corneal cell density in dogs with mature and immature cataracts. This occurrence was greater in patients with a mature cataract, given the increased intraocular manipulation and surgical time due to the difficulty in performing the “V” nucleodissection. According to the results obtained, the “V-prechop” nucleodissection technique can be indicated in selective cases of dogs with an immature cataract.

Ocular Injury Caused by the Sprayed Venom of the Asian Giant Hornet (Vespa mandarinia)

This report presents the details of a case of sight-threatening injury in the right eye of a 77-year-old man which was caused by the venom of the Asian giant hornet (Vespa mandarinia). The patient was not stung, rather the venom was sprayed into his eye. Although the injured eye was washed as a first aid treatment, persistent corneal defect, corneal endothelial decompensation, iris atrophy, pupil dilation, and mature cataract were observed and a hand movement visual acuity was recorded 8 weeks after the injury. Since a slight a-wave was detected in his electroretinogram (ERG) result after the corneal epithelial defect had healed, we performed cataract surgery and Descemet stripping automated endothelial keratoplasty (DSAEK). After the DSAEK, the cornea of the right eye became clearer; however, the visual acuity of his right eye did not improve. Fundus examination revealed branch retinal artery occlusion but no optic disc atrophy. ERG showed that the a-wave amplitude of the injured eye recorded after the surgery was almost half of that of the fellow eye. The iris atrophy and mature cataract show that the sprayed Vespa venom of the Asian giant hornet can permeate into the intraocular area even without stinging. Whether the venom directly affects retinal function is unclear, but the decreased a-wave of the injured eye shows that the venom caused damage of retinal function in some way. Irrigation of the anterior chamber as well as eye washing is needed as a first aid treatment in similar cases.

Evaluation of biometric parameters in phacomorphic glaucoma and mature cataracts

Purpose: The aims of this study were to compare the biometric parameters and axial lengths of eyes with phacomorphic glaucoma and mature cataract and to identify differences that might predispose to development of phacomorphic glaucoma. Methods: Three hundred forty-two patients were enrolled in this retrospective study. The eyes were divided into four groups—Group (G)1: phacomorphic glaucoma ( n = 29), G2: mature cataract ( n = 313), G3: contralateral phacomorphic glaucoma ( n = 29), and G4: contralateral mature cataract ( n = 313). Central corneal thickness and anterior chamber depth were assessed by optical low-coherence reflectometry (Lenstar LS 900®; Haag-Streit AG, Switzerland), while axial length was determined by A-scan ultrasound biometry. Results: The mean central corneal thickness of G1 was significantly higher than in other groups ( p < 0.001) and the mean anterior chamber depth of G1 was the lowest among the groups ( p < 0.001). Also, G2 had lower mean anterior chamber depth than G4 ( p < 0.001) and G3 had lower mean anterior chamber depth than G4 ( p = 0.007). Anterior chamber depth less than 3.27 mm had the higher odds ratio for distinguishing G3 versus G4 (odds ratio = 10.79, p < 0.001). Furthermore, patients aged ⩾68.9 years had the higher odds ratio for distinguishing G1 versus G2 (odds ratio = 2.82, p = 0.019). There was no significant difference in the presence of pseudoexfoliation material between G1 and G2 ( p = 0.057). There were no significant differences in axial length values among the four groups ( p = 0.097). Conclusion: Advanced age and shallow anterior chamber depth were found to be risk factors for developing phacomorphic glaucoma, but the presence of pseudoexfoliation material was not found to play a role as a risk factor in phacomorphic glaucoma development.

The study of demographic profile of patients of senile mature cataract attending the eye OPD of GMC Jammu, India

Background: Age related cataract also called as senile cataract is the commonest type of acquired cataract affecting people over the age of 50 years. In developing countries like India, many times patients with cataract report to the hospitals very late, when it has become mature. Keeping this in mind this study was undertaken to study the demographic profile of patients of senile mature cataract attending the OPD of GMC Jammu and to see if there is correlation between demographic factors and time of seeking medical attention.Methods: This study was conducted on 41 patients of senile mature cataract who attended OPD of GMC Jammu from August 2019 to November 2019. All patients were subjected to detailed history taking and ocular examination. Socio-economic status and education level of all patients was assessed. All patients were admitted and underwent cataract surgery with IOL implantation.Results: In study the mean age of patients was 62.46 years with 58.53% patients being females. Majority of patients were from rural background with low socio-economic status and low education levels.Conclusions: From this study we concluded that female sex, low socio-economic status, comorbidities and lower literacy levels are associated with patients seeking medical attention for cataract at an advanced stage.

phacomulsification in senile white mature cataracts;its safety and efficacy

Purpose To evaluate the intraoperative difficulty, complications and post operative outcome in patients with white mature cataracts undergoing phacomulsification and foldable intraocular lens implantation and to develop a strategy for achieving continuous curvilinear capsulorhexis in these cases. Study design Descriptive case series Place and duration Ophthalmology department of Holy family hospital, Rawalpindi in six months interval since January 2017 to June 2017 Material and Methods 50 Patients who had senile white mature cataract were enrolled in this prospective study .Detailed preoperative and intraoperative notes were made. A small capsulorhexis was attempted initially after staining capsule with trypan blue .An initial cut was made with cystotome and it was enlarged with utrata forceps. Endophacomulsification was done with stop and chop technique. Intraoperative difficulties related to continuous curvilinear capsulorhexis, phacomulsification and post operative visual outcomes were analyzed.post operative examinations were done at day 1,1st week,1st month and 3rd month. Results There were 28 males (56%) and 22 females (44%).The mean age was 63.18±7.997 standard deviation years(48-78).The mean preoperative best corrected visual acuity BCVA was 0.0276±0.013 (SD)Snellen, decimal(0.01-0.05) and the mean post operative BCVA was 0.638±0.305 (SD) Snellen, decimal(0.1-1.0) .Mean phaco time was 4.08±1.03 (SD)mins(2.08-6.66).The mean preoperative intraocular pressure IOP was 15.90±1.799 (SD)mmHg (12-22) and mean post op IOP was 11.98±2.035 (SD) mmHg(10-18) .Posterior capsular rupture occurred in 3 (6%) , vitreous loss occurred in 1 (2%) patients. 5 (10%) cases were converted to extra capsular cataract extraction (ECCE). Postoperatively 10 (20%) patients had transient corneal edema, 3 patients (6%) had persistent corneal edema and corneal burn treated with steroids and hyper osmotic agents. Conclusion The intraoperative and postoperative complications rate is higher in white mature cataracts. White mature cataract is a challenge for cataract surgeon, yet by means of additional dyes and proper techniques and expertise, the rate of complications can be reduced. Keywords Phacomulsification, continuous curvilinear capsulorhexis, senile mature cataract, trypan blue, posterior capsular rupture, persistent corneal edema