Ultrasonic pachymeter: a little different role.

BACKGROUND: Ultrasonic pachymeter, though primarily used in refractive surgery and in glaucoma evaluation, can evaluate and compare the change in corneal thickness following extracapsular cataract extraction (ECCE), small incision cataract surgery (SICS) and phacoemulsification. METHOD: Six hundred patients were included in study. Patients were divided into three groups. Group 1 (200 eyes), group 2 (200 eyes) and group 3 (200 eyes) underwent ECCE, SICS, and phacoemulsification, respectively. Corneal thickness was evaluated pre-operatively and postoperatively on day 1, day 2, day 7, day 15, and day 30 by ultrasonic pachymetry. RESULTS: Mean pre-operative corneal thickness in central, superior, inferior, nasal, and temporal quadrants is 525.35 ± 32.34 µm, 592.23 ± 35.39 µm, 595.66 ± 31.68 µm, 589.29 ± 38.07 µm, and 581.19 ± 42.31 µm, respectively. Postoperatively, a highly significant (P<0.01) increase in central corneal thickness was observed up to day 15 in ECCE, day 7 in SICS whereas it was up to day 2 in phacoemulsification. In superior quadrant, it is up to day 15 in ECCE and SICS whereas it is up to day 7 in phacoemulsification. In inferior quadrant, it was up to day 2 in all three techniques. In temporal quadrant, it is up to day 7 in ECCE and up to day 2 in SICS and phacoemulsification. In nasal quadrant, a highly significant (P<0.01) increase in corneal thickness was observed up to day 7 in ECCE and SICS whereas it was up to day 2 in phacoemulsification. CONCLUSION: Normal central corneal thickness is 525.35 ± 32.44 µm. At midperiphery, inferior cornea has maximum corneal thickness followed by superior, temporal, and nasal cornea. Postoperatively, pre-operative value of corneal thickness and visual rehabilitation is achieved earliest in phacoemulsifiaction followed by SICS and ECCE.

The efficacy of Ahmed glaucoma valve drainage devices in cases of adult refractory glaucoma in Indian eyes.

AIM: To evaluate the efficacy of Ahmed glaucoma valve (AGV) drainage devices in cases of adult refractory glaucoma in Indian eyes. SETTINGS AND DESIGN: Retrospective interventional case series study. MATERIALS AND METHODS: Fifty two eyes of 32 patients of refractory glaucoma in the age group of 35 to 60 years who underwent AGV implantation with or without concomitant procedures from January 2003 to Jan 2007 were studied. Of these, 46 eyes (88%) had undergone filtering surgery earlier whereas remaining eyes underwent primary AGV implantation following failure of maximal medical therapy. The follow up ranged between 12 months to 48 months RESULTS: Eighteen eyes (35%) had undergone phacoemulsification with AGV implantation, penetrating keratoplasty (PK) with AGV and intraocular lens (IOL) implantation in 13 eyes (25%), AGV over preexisting IOL in eight eyes (15%). AGV implantation alone was done in six (11%) eyes. Anterior chamber (AC) reconstruction with secondary IOL and AGV was performed in the remaining eyes. The mean intra ocular pressure (IOP) decreased from 36.3 +/- 15.7 mm Hg to 19.6 +/- 9.2 mm Hg. Complete success as per criteria was achieved in 46 eyes (88%). None of the eyes had failure to maintain IOP control following AGV. CONCLUSION: The AGV resulted in effective and sustained control of IOP in cases of adult refractory glaucoma in intermediate follow up.

Comparative analysis of endothelial cell loss following phacoemulsification in pupils of different sizes.

PURPOSE: To compare Endothelial cell(EC) loss following Phacoemulsification (PKE) in pupils of different sizes. METHODS: A prospective double masked observational study in which a total of 150 eyes of 150 patients between 50 & 70 years of age with senile cataract of nuclear sclerosis grade II were enrolled. Patients were allocated into three groups of 50 eyes each in Group A (pupil size <5 mm), Group B (pupil size 5-7 mm) and Group C (pupil size >7 mm). Pupillary size was measured by determining the height of slit on slit-lamp biomicroscope examination. PKE was done by the same expert surgeon using vertical chop technique and a foldable intraocular lens was implanted in the capsular bag. Corneal EC count and pachymetry were performed twice and average of 2 readings was taken for the purpose of this study. Measurements were taken preoperatively and postoperatively on day 1, day 7 and day 30. RESULTS: The mean EC count loss on postoperative day 1 in Group A was 19.45%, Group B 14.89%, Group C 10.19% with statistical significant difference between Group A and Group B, as also Group A and Group C. The difference was not significant between Group B and Group C, though there was a fall in EC count in Group C as well. Increase in corneal thickness on postoperative day 1 in group A was 5.43%, Group B 3.55%, Group C 2.14% with statistical significant difference between Group A and Group B, as also Group A and Group C with no difference in Group B and Group C. CONCLUSION: PKE done in eyes with maximal pupillary dilatation of <5 mm causes a greater EC loss and results in thicker corneas postoperatively as compared to eyes with pupillary dilatation of >5 mm at the end of one month.