Morphological variations influencing the outcomes in posterior polar cataract.

Purpose: To study the intraoperative complications and postoperative clinical outcomes in different types of posterior polar cataract (PPC) following phacoemulsification, based on morphological classification. Methods: All consecutive patients with PPC who underwent phacoemulsification during the study period from 2016 to 2019 were included and sub-grouped based on the morphological characteristics according to Daljit Singh's classification. Intraoperative complications such as posterior capsular rupture (PCR), vitreous loss, nucleus drop, and Postoperative best-corrected visual acuity (BCVA) at day 1 and day 30 were documented. Results: A total of 388 eyes of 380 patients were included. Eighty nine (22.9%) eyes belonged to type 1, 135 (34.8%) belonged to type 2, 8 (2.1%) belonged to type 3, and 156 (40.2%) belonged to type 4. Thirty-five (9.3%) eyes had intraoperative PCR, with vitreous loss in 21 (60%) eyes, and nucleus/cortex drop in 5 (1.3%) eyes. Six (75%) eyes of type 3, 14 (10.04%) eyes of type 2, 12 (17.7%) eyes of type 4, and 3 (3.4%) eyes of type 1 PPC had PCR. PCR occurred more during the emulsification of the nucleus (18 cases, 51.4%). A significant correlation was seen between intraoperative PCR and type of PPC with a higher incidence in type 3 (P < 0.001). BCVA was found to be significantly worse on day 1 among patients with PCR compared to those who did not and improved well by day 30. Conclusion: PPC morphology is significantly co-related with the occurrence of PCR, emphasizing the need for careful grading of posterior polar cataracts in predicting the risk of intraoperative complications.

Factors associated with postoperative visual outcome in acute endophthalmitis after cataract surgery-a cross-sectional, analytical study.

Purpose: To identify predictors of visual outcome in patients with acute endophthalmitis following cataract surgery. Methods: This cross-sectional study included consecutive patients with acute endophthalmitis following cataract surgery at our tertiary care center between January 2017 and June 2018. Baseline demographic details, surgical details, and treatment offered were extracted from the medical record, and patients were followed for 3 months after diagnosis and treatment for endophthalmitis. A good outcome was defined as visual acuity of greater than 6/12; a poor outcome, visual acuity of less than 6/60 on 3-month follow-up. The factors associated with these outcomes were analyzed. Results: A total of 60 patients were included, of whom 32 (53%) had good visual outcome, and 11 (18%) had poor visual outcome. On univariate analysis, factors associated with good outcome were younger age at surgery, male sex, diabetes, absence of hypopyon, and absence of fibrillary membrane over the intraocular lens (IOL). Poor visual acuity at presentation, inability to visualize the optic disc on indirect ophthalmoscopy, and negative microbiological culture were associated with poor visual outcome. Stepwise logistic regression analysis showed that absent hypopyon (OR = 19.50; 95% CI, 2.87-132.14) and absent fibrillary membrane over the IOL (OR =15.0; 95% CI, 2.34-96.89) were independent factors for good visual outcome. Negative microbiological culture (OR = 18.67; 95% CI, 2.32-150.13) was the only independent factor associated with poor visual outcome. Conclusions: The clinical findings at presentation and microbiological profile play an important role in determining the outcome in patients with acute post-cataract surgery endophthalmitis.

A new normal with cataract surgery during COVID-19 pandemic.

Cataract is the second leading cause of preventable blindness on the globe. Several programs across the country have been running efficiently to increase the cataract surgical rates and decrease blindness due to cataract. The current COVID-19 pandemic has led to a complete halt of these programs and thus accumulating all the elective cataract procedures. At present with the better understanding of the safety precautions among the health care workers and general population the Government of India (GoI) has given clearance for functioning of eye care facilities. In order to facilitate smooth functioning of every clinic, in this paper, we prepared preferred practice pattern based on consensus discussions between leading ophthalmologists in India including representatives from major governmental and private institutions as well as the All India Ophthalmological Society leadership. These guidelines will be applicable to all practice settings including tertiary institutions, corporate and group practices and individual eye clinics. The guidelines include triage, use of personal protective equipment, precautions to be taken in the OPD and operating room as well for elective cataract screening and surgery. These guidelines have been prepared based on current situation but are expected to evolve over a period of time based on the ongoing pandemic and guidelines from GoI.

Herniation of the anterior lens capsule.

Herniation of the anterior lens capsule is a rare abnormality in which the capsule bulges forward in the pupillary area. This herniation can be mistaken for an anterior lenticonus where both the capsule and the cortex bulge forward. The exact pathology behind this finding is still unclear. We report the clinical, ultrasound biomicroscopy (UBM) and histopathological findings of a case of herniation of the anterior lens capsule. UBM helped to differentiate this entity from anterior lenticonus. Light microscopy revealed capsular splitting suggestive of capsular delamination and collection of fluid (aqueous) in the area of herniation giving it a characteristic appearance.