RESUMO
Double free-flaps are necessary when tissue cover cannot be sufficed with a single flap. The other factors to be considered when using two free flaps for resurfacing of distal limb defects are the availability of more than one recipient vessel, the risk of distal limb ischaemia and the donor site morbidity of double flap harvest. If these factors are adequately addressed, double free-flaps can be safely executed for resurfacing distal limb defects with minimal morbidity. We report the simultaneous harvest and transfer of the anterolateral and anteromedial thigh flaps inset and vascularised as double free-flaps to resurface a large bimalleolar defect in a 14-year-old boy with no additional morbidity as compared to that of a single free tissue transfer.
RESUMO
PURPOSE: To evaluate the prediction accuracy of various intraocular lens (IOL) power calculation formulas on American Society of Cataract and Refractive Surgery (ASCRS) calculator and Barrett True-K total keratometry (TK) in eyes with previous laser refractive surgery for myopia. METHODS: This retrospective study included eyes with history of myopic laser refractive surgery, which have undergone clear or cataractous lens extraction by phacoemulsification followed by IOL implantation. Those who underwent uneventful crystalline lens extraction were included. Eyes with any complication of refractive surgery or those with eventful lens extraction procedure and those who were lost to follow-up were excluded. Formulas compared were Wang-Koch-Maloney, Shammas, Haigis-L, Barrett True-K no-history formula, ASCRS average power, ASCRS maximum power on the ASCRS post-refractive calculator and the IOLMaster 700 Barrett True-K TK. Prediction error was calculated as the difference between the implanted IOL power and the predicted power by various formulae available on ASCRS online calculator. RESULTS: Forty post-myopic laser-refractive surgery eyes of 26 patients were included. Friedman's test revealed that Shammas formula, Barrett True-K, and ASCRS maximum power were significantly different from all other formulas (P < 0.00001 for each). Median absolute error (MedAE) was the least for Shammas and Barrett True-K TK formulas (0.28 [0.14, 0.36] and 0.28 [0.21, 0.39], respectively) and the highest for Wang-Koch-Maloney (1.29 [0.97, 1.61]). Shammas formula had the least variance (0.14), while Wang-Koch-Maloney formula had the maximum variance (2.66). CONCLUSION: In post-myopic laser refractive surgery eyes, Shammas formula and Barrett True-K TK no-history formula on ASCRS calculator are more accurate in predicting IOL powers.
Assuntos
Lentes Intraoculares , Óptica e Fotônica , Refração Ocular , Humanos , Estudos Retrospectivos , Feminino , Masculino , Refração Ocular/fisiologia , Pessoa de Meia-Idade , Miopia/cirurgia , Miopia/fisiopatologia , Miopia/diagnóstico , Sociedades Médicas , Facoemulsificação , Biometria/métodos , Acuidade Visual , Estados Unidos/epidemiologia , Adulto , Seguimentos , Idoso , Reprodutibilidade dos TestesRESUMO
PURPOSE: To compare the ease of visualization and comfort of the surgeon during phacoemulsification surgery using NGENUITY® 3D (NG) visualization system and standard operating microscope (SOM). METHODS: In this prospective, randomized, single-blind, single-center study, patients undergoing phacoemulsification surgery by one of the five surgeons were randomly assigned to two groups based on the visualization modality-NG and SOM. Ease of visualization and comfort of the surgeon was assessed using a 27-parameter in-house Surgeon Comfort Score questionnaire. RESULTS: A total of 224 phacoemulsification with intraocular lens implantations were performed in senile immature cataract (SIMC, n = 174) and mature cataract patients (MC, n = 50). Surgeon's ease of visualization (4.92-5.00) and hand-eye coordination score (4.97-5.00) were comparable between the NG- and SOM-groups. Postoperative neck discomfort was lower in both the groups, with a relatively lower discomfort in the NG-group (score: 1.04 vs 1.56). The Spearman rank correlation coefficient (r) between illumination of the operation theatre room and the surgical field revealed a weak negative correlation for most of the patients in the NG-group, and a positive correlation for patients in the SOM-group. No correlation was obtained between brightness of the surgical field and comfort with the surgical field brightness. CONCLUSIONS: Similar ease of visualization was experienced by the surgeons using NG- and SOM-system. Neck discomfort postsurgery was numerically lower in the NG-group, although not significant. Additionally, the NG-system permitted the safe performance of phacoemulsification using a lower surgical field illumination.
Assuntos
Catarata , Facoemulsificação , Cirurgiões , Humanos , Imageamento Tridimensional , Microcirurgia , Estudos Prospectivos , Método Simples-CegoRESUMO
PURPOSE: To compare the accuracy of nine conventional and newer-generation formulae in calculating intraocular lens power in eyes with axial myopia. SETTING: Tertiary eye care center, Bengaluru, India. DESIGN: Retrospective cross-sectional, comparative study conducted in India. METHODS: Patients undergoing uneventful phacoemulsification in eyes with axial length >26 mm were included. Preoperative biometry was done using Lenstar LS 900 (Haag-Streit AG, Switzerland). Single eye of patients undergoing bilateral implantation was randomly selected. Optimized lens constants were used to calculate the predicted postoperative refraction of each formula, which was then compared with the actual refractive outcomes to give the prediction errors, following which subgroup analysis was performed. The Kane formula, Barrett universal II, Emmetropia Verifying Optical (EVO) 2.0, Hill Radial Basis Function (Hill RBF) 3.0, Olsen formula, along with Wang Koch-adjusted four formulae, that is, Sanders Retzlaff Kraff/Theoretical (SRK/T), Holladay 1, Haigis, and Hoffer Q formula, were compared for intraocular lens power calculations. RESULTS: One hundred and sixty-five eyes that fulfilled all the inclusion criteria were studied. Hill RBF 3.0 had the lowest mean and median absolute prediction errors (0.355 and 0.275, respectively) compared to all formulas. In subgroup analysis (26-28, >28-30, and >30 mm), significant difference was seen only in extremely long eyes (>30 mm). The Hill RBF 3.0 formula generated the maximum percentage of eyes with refractive errors within ±0.25, ±0.5, ±0.75, and ±1 D (46%, 76.2%, 89.9%, and 95.8%, respectively). CONCLUSION: This is the first study evaluating all the formulas exclusively in the myopic eyes. Hill RBF 3 was found to be superior in accuracy to all other formulas.
Assuntos
Lentes Intraoculares , Miopia , Humanos , Estudos Transversais , Olho , Miopia/diagnóstico , Miopia/cirurgia , Estudos RetrospectivosRESUMO
Rationale: Reconstruction of soft tissue defects in the facial region have always been challenging. Appropriate selection of flaps will result in minimal morbidity and restore the tissue form without compromising function. Patient Concerns: During reconstruction in the facial region, patients desire to have minimal visible scar and functions of the jaw bone. Diagnosis: The article discusses a case of right space infection with soft tissue loss in the submandibular region. Treatment: The fascial spaces were explored and the odontogenic foci of infection were removed. The soft tissue defect in the submandibular region was resurfaced using the temporoparietal fasciocutaneous flap. Outcomes: The flap was well settled, and facial contours were maintained with reasonable facial symmetry. Take-away Lessons: Surgical skill in the management of soft tissue defects in the fascial region demands sound knowledge of the facial region, selection of the flap and meticulous execution of the surgical plan.
RESUMO
PURPOSE: To compare time and resource-saving with integration of digital cataract workflow to the existing workflow in high-volume cataract surgery clinics. SETTING: L V Prasad Eye Institute, Hyderabad, India (Site 1) and Narayana Nethralaya, Bengaluru, India (Site 2). DESIGN: Prospective, time-and-motion. METHODS: The total time to complete each step (preoperative measurements, surgical planning, and surgical procedures) of the cataract workflow, number of data fields entered, and support staff required for both workflows were recorded. All study measurements were determined first for existing EMR cataract workflow followed by digital workflow (integrated data management system with data reviewer, surgical planner, and data transfer to OR) at both sites. RESULTS: A total of 85 (Site 1, 44; Site 2, 41) cataract workflows were analyzed. The integration of digital workflow into the site's existing EMR workflow reduced the mean time for preoperative measurements by 25.3% (P = .006), surgical planning by 55.1% (P = .008), and surgical procedures by 22.6% (P = .002). The mean±SD overall time for the surgery was significantly shorter in the digital group (887.3±103.3 vs 1271.3±300.7 seconds; P < .0001). For both sites, the number of data fields recorded and the number of support staff needed was significantly lesser for the digital workflow (P < .0001, for both). CONCLUSIONS: Integration of digital workflow significantly reduced the overall cataract surgery time, variability of overall time, number of data fields recorded, and resource utilization. Complete digitalization has important implications for improving the efficiency and standardization of cataract surgery workflow.
RESUMO
PURPOSE: To assess the effect of change in ocular spherical aberration (SA) with adaptive optics on visual acuity (VA) at different defocus after implantation of extended depth-of-focus (EDOF) and enhanced monofocal intraocular lenses (IOLs). SETTINGS: Narayana Nethralaya Eye Hospital, Bangalore, India. DESIGN: Prospective, longitudinal, observational. METHODS: 80 eyes (40 patients) that had cataract surgery were included in the study. 40 eyes were implanted with Eyhance EDOF IOLs and the remaining with Vivity EDOF IOLs. Baseline ocular aberrations were measured with a visual adaptive optics aberrometer, then the optimal SA was determined by increasing it in steps of -0.01 µm up to -0.1 µm until the maximum improvement in near distance VA was observed for a given eye. Then the defocus curve for each eye was measured after modifying the ocular SA by magnitude equal to optimal SA. RESULTS: Most of the eyes accepted a negative induced SA of -0.05 µm (Eyhance group: 67.6%; Vivity group, 45.2%). In the Eyhance group (dominant eyes), VA improved at -2 diopters (D) ( P < .02) only and degraded at 0 D, +0.5 D, and +1 D defocus ( P < .05). In the Vivity group, the VA remained unchanged at all defocus ( P > .05). In the Eyhance group (nondominant eyes), VA improved at -3.5 D defocus only and degraded at +1.5 D and +2 D defocus ( P < .05). In the Vivity group, VA improved at -2.5 D defocus ( P < .05) only. CONCLUSIONS: A negative induced SA of -0.05 µm in implanted eyes was optimal for a slight improvement in distance-corrected near and intermediate VA without any significant decrease in baseline distance-corrected VA.
Assuntos
Lentes Intraoculares , Facoemulsificação , Humanos , Percepção de Profundidade , Índia , Satisfação do Paciente , Estudos Prospectivos , Desenho de Prótese , Refração Ocular , Acuidade Visual , Estudos LongitudinaisRESUMO
Purpose: To evaluate the accuracy of intraocular lens (IOL) power prediction of the formulas available on the American Society of Cataract and Refractive Surgery (ASCRS) post-refractive calculator in eyes with prior radial keratotomy (RK) for myopia. Methods: This retrospective study included 25 eyes of 18 patients whose status was post-RK for treatment of myopia, which had undergone cataract extraction with IOL implantation. Prediction error was calculated as the difference between implanted IOL power and predicted power by various formulae available on ASCRS post-refractive calculator. The formulas compared were Humphrey Atlas method, IOLMaster/Lenstar method, Barrett True-K no-history formula, ASCRS Average power, and ASCRS Maximum power on ASCRS post-refractive calculator. Results: Median absolute errors were the least for Barrett True-K and ASCRS Maximum power, that is, 0.56 (0.25, 1.04) and 0.56 (0.25, 1.06) D, respectively, and that of Atlas method was 1.60 (0.85, 2.28) D. Median arithmetic errors were positive for Atlas, Barrett True-K, ASCRS Average (0.86 [-0.17, 1.61], 0.14 [-0.22 to 0.54], and 0.23 [-0.054, 0.76] D, respectively) and negative for IOLMaster/Lenstar method and ASCRS Maximum power (-0.02 [-0.46 to 0.38] and - 0.48 [-1.06 to - 0.22] D, respectively). Multiple comparison analysis of Friedman's test revealed that Atlas formula was significantly different from IOLMaster/Lenstar, Barrett True-K, and ASCRS Maximum power; ASCRS Maximum power was significantly different from all others (P < 0.00001). Conclusion: In post-RK eyes, Barrett True-K no-history formula and ASCRS Maximum power given by the ASCRS calculator were more accurate than other available formulas, with ASCRS Maximum leading to more myopic outcomes when compared to others.
Assuntos
Catarata , Ceratotomia Radial , Lentes Intraoculares , Miopia , Procedimentos Cirúrgicos Refrativos , Humanos , Estudos Retrospectivos , Miopia/diagnóstico , Miopia/cirurgiaRESUMO
Purpose: To compare post-operative pain perception using bandage contact lens (BCL) stored at 2-8°C (Cold BCL, CL-BCL) or room temperature (23 - 25°C, RT-BCL) after photorefractive keratectomy (PRK) or corneal collagen-crosslinking (CXL) and determine status of nociception associated factors. Methods: In this prospective interventional study, 56 patients undergoing PRK for refractive correction and 100 keratoconus (KC) undergoing CXL were recruited following approval from the institutional ethics committee with informed consent. Patients undergoing bilateral PRK received RT-BCL on one eye and CL-BCL on the other. Pain was graded by Wong-Baker scoring on the first post-operative day (PoD1). Expression of transient receptor potential channels (TRPV1, TRPA1, TRPM8), calcitonin gene-related peptide (CGRP) and IL-6 was measured in cellular content from used BCLs collected on PoD1. Equal number of KC patients received RT-BCL or CL-BCL post-CXL. Pain was graded by Wong-Baker scoring on PoD1. Results: Pain scores on PoD1 were significantly (P < 0.0001) reduced in subjects receiving CL-BCL (Mean ± SD: 2.6 ± 2.1) compared to RT-BCL (6.0 ± 2.4) post-PRK. 80.4% of subjects reported reduced pain scores with CL-BCL. 19.6% reported no change or increased pain scores with CL-BCL. TRPM8 expression was significantly (P < 0.05) increased in BCL of subjects reporting reduced pain with CL-BCL compared to those who did not. Pain scores on PoD1 were significantly (P < 0.0001) reduced in subjects receiving CL-BCL (3.2 ± 2.1) compared to RT-BCL (7.2 ± 1.8) post-CXL. Conclusion: The simple approach of using a cold BCL post-operatively substantially reduced pain perception and could overcome post-operative pain-related limited acceptance of PRK/CXL.
Assuntos
Lentes de Contato , Ceratocone , Ceratectomia Fotorrefrativa , Humanos , Acuidade Visual , Estudos Prospectivos , Ceratocone/diagnóstico , Ceratocone/cirurgia , Bandagens , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/prevenção & controle , Percepção da Dor , Colágeno/farmacologia , Colágeno/metabolismo , Reagentes de Ligações Cruzadas/uso terapêutico , Fármacos Fotossensibilizantes/uso terapêuticoRESUMO
Purpose: The purpose of this study was to identify and analyze the clinical and ocular surface risk factors influencing the progression of keratoconus (KC) using an artificial intelligence (AI) model. Methods: This was a prospective analysis in which 450 KC patients were included. We used the random forest (RF) classifier model from our previous study (which evaluated longitudinal changes in tomographic parameters to predict "progression" and "no progression") to classify these patients. Clinical and ocular surface risk factors were determined through a questionnaire, which included presence of eye rubbing, duration of indoor activity, usage of lubricants and immunomodulator topical medications, duration of computer use, hormonal disturbances, use of hand sanitizers, immunoglobulin E (IgE), and vitamins D and B12 from blood investigations. An AI model was then built to assess whether these risk factors were linked to the future progression versus no progression of KC. The area under the curve (AUC) and other metrics were evaluated. Results: The tomographic AI model classified 322 eyes as progression and 128 eyes as no progression. Also, 76% of the cases that were classified as progression (from tomographic changes) were correctly predicted as progression and 67% of cases that were classified as no progression were predicted as no progression based on clinical risk factors at the first visit. IgE had the highest information gain, followed by presence of systemic allergies, vitamin D, and eye rubbing. The clinical risk factors AI model achieved an AUC of 0.812. Conclusion: This study demonstrated the importance of using AI for risk stratification and profiling of patients based on clinical risk factors, which could impact the progression in KC eyes and help manage them better.
Assuntos
Ceratocone , Humanos , Ceratocone/diagnóstico , Ceratocone/epidemiologia , Córnea , Topografia da Córnea/métodos , Inteligência Artificial , Fatores de Risco , Imunoglobulina E , DemografiaRESUMO
Background: Glomus because of their small size in fingers presents difficulty in clear visualization in the operation theater and requires magnifying techniques. Because of the dearth of infrastructure in many hospitals, the excision of these is done with either no or inadequate magnification. Magnetic resonance imaging (MRI) has become the gold standard investigation as glomus tumors can be visualized on radiology very clearly. The reason for recurrence given in the literature is access to tumors by the type of surgical approach for clear visualization, but high magnification being the most important, as the size of glomus is very small has no or limited mention in the literature. Being in a tertiary care hospital, we have analyzed the role of high magnification in the excision of glomus and its impact on recurrence as the end outcome. Aim: To understand the role of intraoperative high magnification using operative microscope and its advantages in the surgical clearance of glomus tumor of fingers. Settings and Design: Retrospective record review. Materials and Methods: Thirteen cases of glomus tumor in the phalanges over a period of 7 years were operated under operative microscope with a magnification ranging from 10× to 12.5×; data and mean follow-up to 5.5 years have been analyzed. Results: Age ranged from 24 to 72 years; all the glomus tumors were in the distal phalanx. Three cases had bony erosion on MRI scan. We had an equal distribution of three cases each in the thumb, ring, and middle finger. Conclusions: (1) High magnification with operative microscope is essential during the excision of glomus tumor especially in the distal phalanx in order to prevent recurrence; (2) advantages of high magnification are clear delineation with complete tumor excision, with meticulous repair of nail bed.
RESUMO
Purpose: To assess real-world clinical outcomes and safety of the Clareon® intraocular lens (IOL) and AutonoMe® automated preloaded delivery system in an Indian population. Patients and methods: This was a prospective, single-arm, multicenter, 12-month clinical study in patients aged ≥20 years with unilateral or bilateral cataracts. Surgery was performed by phacoemulsification followed by implantation of the Clareon monofocal IOL (CNA0T0). Monocular best-corrected distance visual acuity (BCDVA) and uncorrected distance visual acuity (UCDVA) were assessed at 1 week and 1, 6, and 12 months after implantation. Posterior capsular opacification (PCO), surface haze, and glistenings were evaluated at all visits. Surgeons' satisfaction with automated injector system was also evaluated using a questionnaire. Safety was assessed by monitoring adverse events (AEs). Results: A total of 151 eyes received the CNA0T0 IOL. Mean ± SD monocular BCDVA improved from 0.53±0.44 logMAR preoperatively to 0.00±0.08 logMAR at week 1 and -0.03±0.08 logMAR at 12 months after implantation. At 12 months, 137/137 (100%) of eyes achieved BCDVA of 0.3 logMAR or better. Mean ± SD monocular UCDVA was 0.78±0.40 logMAR preoperatively, 0.11±0.15 logMAR at week 1, and 0.08±0.13 logMAR at 12 months after implantation. At 12 months, 132/137 (96%) eyes achieved UCDVA of 0.3 logMAR or better. Serious intraoperative AEs were posterior capsule rupture (n=1) and ciliary zonular dehiscence (n=1). Surgeons reported that the automated preloaded device was more intuitive compared with other push- or screw-style preloaded injector systems. None of the eyes in this study presented surface haze; all were graded as 0 glistenings at all visits. No clinically significant PCO or neodymium-doped yttrium aluminum garnet (Nd:YAG) capsulotomies were reported. Conclusion: The hydrophobic IOL preloaded in an automated injector system provided good visual and refractive outcomes, as well as no surface haze and grade 0 glistenings. None of the patients required Nd:YAG capsulotomy.
RESUMO
Purpose: To determine the causes of severe visual impairment and blindness in children in schools for the blind in the city of Bangalore, Karnataka and to determine the error of inclusion and exclusion from these schools. Methods: This was a cross-sectional study. Children in four schools for the blind were subjected to a detailed ophthalmic evaluation. The World Health Organization Program for Prevention of Blindness low-vision form was used to collect data. To know the educational background of children with visual disability of 40% or more (best-corrected visual acuity of ≤6/24 in the better eye), not in schools for the blind, we collected data by telephonic conversation after procuring their phone numbers from our low-vision clinic. Results: One-hundred-seventy-eight children were examined. The major site of anomaly causing blindness in 31% of children was optic nerve, followed by retina (24%), cornea (23%), and whole globe (22%). Avoidable blindness was 35.42%. Thirteen percent of the children with no visual disability were incorrectly enrolled in blind schools. We were able to contact 92 children with a visual disability of ≥40%. Seventy-eight children (84.78%) attended regular schools; these schools were bereft of a specially trained teacher to look after the needs of the blind. Conclusion: Avoidable blindness is still a cause for concern. Children should undergo eye-examination before being enrolled in schools for the blind to avoid errors of inclusion. Though integrated education for children with vision disability is a good approach, it requires teachers trained in teaching skills particular to blindness. Education for the visually impaired in India needs a major revision.
Assuntos
Baixa Visão , Pessoas com Deficiência Visual , Cegueira/epidemiologia , Cegueira/etiologia , Cegueira/prevenção & controle , Criança , Estudos Transversais , Humanos , Índia/epidemiologia , Instituições Acadêmicas , Baixa Visão/epidemiologiaRESUMO
PURPOSE: To evaluate the effectiveness and safety of a presbyopia-correcting trifocal intraocular lens (IOL), AcrySof® IQ PanOptix® (TFNT00), in an Indian population. PATIENTS AND METHODS: This prospective, multicenter, observational, single-arm, post-marketing study included 67 patients undergoing cataract surgery with bilateral implantation of TFNT00 across five Indian sites. Postoperative outcomes were assessed at 3 months after second eye surgery. Effectiveness outcomes included: mean binocular and monocular visual acuity (VA) at distance (4 m), intermediate (60 cm), and near (40 cm); binocular defocus curve; manifest refraction; and subjective symptom questionnaire evaluation. Safety outcomes included the rate of ocular adverse events and mesopic contrast sensitivity. RESULTS: Mean binocular and monocular distance-corrected and uncorrected VAs of 0.1 logMAR or better (approximately 20/25 Snellen) were achieved at distance, intermediate, and near. Overall, ≥70% of patients achieved binocular 0.1 logMAR vision or better across all distances. TFNT00 maintained a mean VA of 0.1 logMAR or better at the defocus range of +0.5 diopters (D) to -2.5 D (200 cm to 40 cm). The subjective symptom questionnaire-assessed frequency of halo visual disturbances was low at Month 3; halos were reported "none of the time" to "only some of the time" in 86.6% of patients. The large majority of patients (98.5%) were "satisfied" or "very satisfied" with their near, intermediate, and distance vision at Month 3, and ≥94.0% of patients reported spectacle independence for tasks at all distances. The adverse event rate was low; no patients discontinued due to an adverse event. CONCLUSION: TFNT00 provided a continuous range of vision of 20/25 or better for distance to near and performed effectively at an intermediate functional distance of 60 cm, resulting in high levels of spectacle independence and patient satisfaction. TFNT00 demonstrated a good safety profile and a low post-operative frequency of halo visual disturbances.
RESUMO
PURPOSE: To compare the repeatability of ocular biometry measured with the LENSTAR LS 900, IOLMaster 700, and Anterion and its impact on predicted intraocular lens (IOL) power. SETTING: Tertiary eye-care facility in South India. DESIGN: Prospective, observational, cross-sectional study. METHODS: Eyes diagnosed with cataract had 3 consecutive scans on each biometers. The repeatability was assessed using the within-subject standard deviation (Sw), test-retest repeatability, and coefficient of variation (CoV). The agreement was evaluated with the intraclass correlation (ICC). The IOL power was calculated with the Barrett Universal II formula. RESULTS: The study comprised 127 eyes of 76 patients. The repeatability of all parameters for a given device were excellent (ICC >0.9, low CoV and Sw). The agreement of the parameters between the biometers was very good (range from 0.93 to 0.99). The predicted IOL power differed statistically between the devices (P < .05), but the difference was clinically insignificant between the 3 biometers (ICC >0.99 for repeat calculation of IOL power). CONCLUSIONS: All the biometers included in the study had good to excellent repeatability of biometry parameters. The agreement of the predicted IOL power was excellent between the 3 optical biometers.
Assuntos
Lentes Intraoculares , Comprimento Axial do Olho , Biometria , Estudos Transversais , Humanos , Índia , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
Refractive surgery has evolved from being a therapeutic correction of high refractive errors to a cosmetic correction. The expectations associated with such a surgery are enormous and one has to anticipate all possible complications and side-effects that come with the procedure and prepare accordingly. The most common amongst these is post-refractive surgery dry eye of which Meibomian gland dysfunction is a commonly associated cause. We present an understanding of various diagnostic imaging modalities that can be used for evaluating meibomian glands which can also serve as a visual aid for patient understanding. We also describe various common conditions which can silently cause changes in the gland architecture and function which are to be considered and evaluated for.
Assuntos
Síndromes do Olho Seco , Doenças Palpebrais , Disfunção da Glândula Tarsal , Cirurgiões , Síndromes do Olho Seco/diagnóstico , Humanos , Glândulas Tarsais/diagnóstico por imagem , LágrimasRESUMO
Recent advances in the diagnosis and treatment of ectatic corneal disease have mandated a more modern staging system. The new Belin ABCD keratoconus staging system incorporates anterior and posterior curvature centered on the thinnest point of the cornea, thinnest pachymetry values and distance visual acuity in grades from 0-4. By including posterior curvature and thickness measurements based on the thinnest point, as opposed to apical, the new staging system better reflects anatomical changes seen in keratoconus and other ectatic diseases.
Assuntos
Ceratocone , Córnea , Paquimetria Corneana , Topografia da Córnea , Dilatação Patológica , Humanos , Ceratocone/diagnóstico , Acuidade VisualRESUMO
PURPOSE: To evaluate the relation of the tear film on the quality of vision comparing parameters in normal patients to those having dry eye disease. METHODS: 50 normal and 50 eyes with dry eye disease (DED) were included in the study. Patients were screened for dry eye with Schirmer's test, tear break up time, ocular surface staining, and assessment of meibomian gland disease. Their quality of vision was assessed using the Optical quality analysis system (OQAS). The results of dry eye evaluation were correlated with the parameters on the OQAS especially the mean objective scatter index (OSI). RESULTS: Patients with dry eye and unstable tear film were found to have a significantly worse quality of vision and optical scatter (P < 0.05). They were also noted to have fluctuation of vision between blinks. CONCLUSION: Tear film optics can have an important bearing on the quality of vision and quality of life. A detailed assessment preoperatively will help improve surgical outcomes and patient satisfaction.
Assuntos
Síndromes do Olho Seco , Lacerações , Piscadela , Síndromes do Olho Seco/diagnóstico , Humanos , Qualidade de Vida , LágrimasRESUMO
Ocular trauma can range from trivial to significant, with varying implications on the visual acuity and prognosis. A 32-year-old woman presented with complaints of blurring of vision following blunt ocular trauma with a previous history of having undergone implantable phakic contact lens (IPCL V2.0) implantation 2 years back. The corrected distance visual acuity (CDVA) was 20/20 in the right eye and 20/30 in the left eye. Slit-lamp examination revealed a prolapse of inferonasal IPCL footplate into the anterior chamber with pupillary entrapment. No corneal endothelial touch was noted. Immediate repositioning of the IPCL was performed and the patient regained a CDVA of 20/20 in the left eye, postoperatively. Traumatic dislocation of IPCL is a rare occurrence, which can be successfully managed by prompt surgery, thus avoiding further complications like corneal endothelial decompensation.
Assuntos
Lentes de Contato , Traumatismos Oculares , Lentes Intraoculares , Lentes Intraoculares Fácicas , Adulto , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/etiologia , Traumatismos Oculares/cirurgia , Feminino , Humanos , Implante de Lente Intraocular , Acuidade VisualRESUMO
Electrical injuries are among the most devastating of burn injuries. High-voltage electrical injuries result in extensive deep tissue damage and are associated with multiple complications, long-term morbidity, and a high mortality rate. We describe the case of a 16-year-old male cable operator who suffered high-voltage electric injury of left upper limb and anterior abdominal wall. Despite the exit wound causing transection of the ileum, the patient did not have any contamination of the peritoneal cavity as both ends of the bowel were sealed off due to electro-thermal energy. His management included multiple operative procedures, including intestinal resection and anastomosis, debridement, abdominal wall flap-based reconstruction, fasciotomies, split skin grafting, and left hand above elbow amputation.