Visual outcomes and intraoperative complications of small incision cataract surgery performed by junior residents in GMC

To evaluate in intraoperative complications of MSICS performed by Junior Residents and to compare the incidences of major complications in the first six months of training versus last six months of training.It is a retrospective type of study. From March 2018 to February 2019 a total of 293 manual SICS were conducted by the Junior Residents in Department of Ophthalmology. Each of the patients underwent a detailed ophthalmological examination preoperatively and underwent MSICS under peribulbar anesthesia. Consents for surgeries were obtained from each patient.Following intraoperative complications were noted: tunnel related complications, capsulorrhexis related complications, Iridodialysis, posterior capsular rent, zonular dialysis, vitreous leak, surgical aphakia, Descemet membrane detachment, placement of ACIOL, Nucleus drop and IOL drop. The patient’s immediate postoperative vision was also noted. SPSS version 15.0.Tunnel related complications were found in 13.98% patients either as scleral button holing or premature entry. Posterior capsular rents and bag disinsertion were found in total of 11.94% patients owing to which 3.07% were left aphakic. 63.13% patients had visual acuity better than 6/12 by snellens chart on first postoperative day. Performance of adequate anterior capsulotomy, minimal handling of the cornea and avoidance of posterior capsular rent are some of the challenges faced by the residents while learning MSICS. Stepwise supervised training can help a resident doctor master these steps while keeping the complications at acceptably low levels. Stepwise supervised training of residents performing MSICS can minimize complications

Efficacy of Gamma Knife Radiosurgery in Refractory Obsessive-Compulsive Disorder: An Indian Experience

Background Obsessive-compulsive disorder (OCD) is a chronic debilitating psychiatric condition with adverse impact on patient's sociooccupational health. Refractoriness to pharmacotherapy and psychotherapy is not uncommon. Gamma Knife radiosurgery (GKRS) is the comprehensively used and reviewed treatment modality in refractory OCD worldwide. In India, the past two decades of increasing GKRS availability has failed to create the necessary local awareness of its usefulness in refractory OCD. Limited native literature deepens the problem. Objective To analyze our experience with GKRS in refractory OCD, and report the safety and efficacy/long-term outcome in patients using the Yale–Brown Obsessive-Compulsive Scale (Y-BOCS). Materials and Methods A retrospective review of patients receiving GKRS for refractory OCD between 2000 and 2020 was carried out. Case files of the eligible (n = 9) patients were reviewed for clinical, radiotherapeutic, and outcome data. Additionally, patients were contacted via telephone to enquire about their experiences, and to obtain retroactive consent for GKRS in June 2021. Information obtained was collated, computed, and analyzed. Results Male-to-female sex ratio was 8:1. Mean age at the time of GKRS and mean duration of OCD prior to GKRS was 30.1 ± 9.4 and 10.2 ± 5.8 years, respectively. Mean baseline Y-BOCS score was 29.6 ± 4.7. Our first patient received cingulotomy, while the rest underwent anterior capsulotomy. Median margin dose (50% isodose) was 70 Gy. Also, 23.8 ± 7.7 was the mean Y-BOCS score at the last follow-up (median = 30 months). Overall, 44.4% patients showed full/partial response (≥25% reduction in Y-BOCS score) at the last follow-up. In anterior capsulotomy (eight patients), patients with moderate/severe OCD showed better response (4/5 responders) than those with extreme OCD (0/3 responders). Single case of cingulotomy resulted in no response (<25% reduction in Y-BOCS score). No adverse radiation effects were noted. Also, 55.6% patients gave retroactive consent telephonically. Conclusion GKRS is a safe and effective noninvasive treatment modality for refractory OCD. Ventral anterior capsule is the preferred target. Maximum radiation doses of 120 to 160 Gy are well tolerated. Extremely severe OCD cases fared poorer. Proper awareness about the availability and efficacy of GKRS in refractory OCD is required in India.

Interstitial laser anterior capsulotomy for obsessive–compulsive disorder: lesion size and tractography correlate with outcome

BackgroundAnterior capsulotomy is a well-established treatment for refractory obsessive–compulsive disorder (OCD). MRI-guided laser interstitial thermal therapy (LITT) allows creation of large, sharply demarcated lesions with the safeguard of real-time imaging.ObjectiveTo characterise the outcomes of laser anterior capsulotomy, including radiographical predictors of improvement.MethodsPatients with severe OCD refractory to pharmacotherapy and cognitive–behavioural therapy underwent bilateral anterior capsulotomy via LITT. The primary outcome was per cent reduction in Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) score over time. Lesion size was measured on postablation MRI. Disconnection of the anterior limb of the internal capsule (ALIC) was assessed via individual and normative tractography.ResultsEighteen patients underwent laser anterior capsulotomy. Median follow-up was 6 months (range 3–51 months). Time occupied by obsessions improved immediately (median Y-BOCS item 1 score 4–1, p=0.002). Mean (±SD) decrease in Y-BOCS score at last follow-up was 46%±32% (16±11 points, p<0.0001). Sixty-one per cent of patients were responders. Seven patients (39%) exhibited transient postoperative apathy. One patient had an asymptomatic intracerebral haemorrhage. Reduction in Y-BOCS score was positively associated with ablation volume (p=0.006). Individual tractography demonstrated durable ALIC disconnection. Normative tractography revealed a dorsal–ventral gradient, with disconnection of orbitofrontal streamlines most strongly associated with a positive response (p<0.0001).ConclusionsLaser anterior capsulotomy resulted in immediate, marked improvement in OCD symptom severity. Larger lesions permit greater disconnection of prefrontal–subcortical pathways involved in OCD. The importance of greater disconnection is presumably related to variation in ALIC structure and the complex role of the PFC in OCD.

UBM indicators in anterior capsular contraction syndrome

The article presents the results of UBM studies of patients with anterior capsular contraction syndrome (CS). Purpose. Тo use the UBM method to study the state of the ciliary body (CB) and the capsular bag of the lens in patients with CS. Material and methods. The study included 42 patients with capsular CS. The UBM HI-scan ultrasound biomicroscope (Optikon, Italy) was used. Results. The reduction of the capsule bag of the lens was accompanied by a significant decrease in the diameter of the anterior capsulotomy opening, IOL decentration and its displacement towards the posterior pole of the eye, stretching or damage to the zonula ciliaris, and an increase in the CB thickness. In 2 cases, ruptures of the CB and its separation from the place of attachment to the radix iridis were recorded. Conclusion. UBM is an effective assessment method for CS, which allows us to study the state of the capsule bag of the lens and CB, evaluate the effectiveness of laser treatment and predict the risks associated with a high probability of complications. Key words: capsular contraction syndrome, anterior capsule, lens, laser, UBM, ciliary body.

1 Neurosurgery for severe OCD: the past, present and future

Obsessive compulsive disorder (OCD) is a common disorder thought to have a prevalence of 1-2%. The majority of patients are helped by treatments such as exposure and response prevention therapy and medication. A significant minority fail to benefit from optimal treatment and are severely disabled with respect to everyday function.Such patients may be candidates for a neurosurgical approach. This talk will trace the development of neurosurgery for severe OCD beginning with leucotomy/lobotomy which was practiced in the early part of the 20th Century and left an unfavourable legacy. Advancements in neurosurgery have allowed techniques such as anterior cingulotomy and anterior capsulotomy to be practiced at present and will be compared. Deep brain stimulation for severe OCD was introduced as an alternative to ablation neurosurgery but the optimal target for electrode placement remains under debate and will be discussed with reference to a study directly comparing DBS of two emerging targets within the same patients. Finally, methods of target refinement will be discussed which may improve patients outcome in the near future.

Rescue Anterior Capsulotomy after Failure of Nucleus Accumbens Deep Brain Stimulation in Anorexia Nervosa: A Case Report

Anorexia nervosa (AN) is a highly disabling mental disorder with high rates of morbidity and mortality. Few psychological treatments and pharmacotherapy are proven to be effective for adult AN. Two invasive stereotactic neurosurgical interventions, deep brain stimulation (DBS) and anterior capsulotomy, are now commonly used as investigational approaches for the treatment of AN. Here, we report the long-term safety and efficacy of rescue bilateral anterior capsulotomy after the failure of bilateral nucleus accumbens (NAcc)-DBS in an 18-year-old female patient with life-threatening and treatment-resistant restricting subtype AN. Improvements in the neuropsychiatric assessment were not documented 6 months after the NAcc-DBS. Rescue bilateral anterior capsulotomy was proposed and performed, resulting in a long-lasting restoration of body weight and a significant and sustained remission in AN core symptoms. The DBS pulse generator was exhausted 2 years after capsulotomy and removed 3 years postoperatively. No relapse was reported at the last follow-up (7 years after the first intervention). From this case, we suggest that capsulotomy could be a rescue treatment for patients with treatment-resistant AN after NAcc-DBS failure. Further well-controlled studies are warranted to validate our findings.