Comparison of clinical outcomes between femtosecond laser-assisted cataract surgery versus conventional phacoemulsification in vitrectomized eyes - A prospective interventional study.

PURPOSE: To compare the clinical outcomes and surgical safety between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS) in vitrectomized eyes. METHODS: A prospective interventional comparative study was conducted at a tertiary eye care center. Sixty consecutive cases requiring cataract surgery following pars plana vitrectomy were allocated into Group 1 ( n = 30), who underwent FLACS with intraocular lens implantation, and Group 2 ( n = 30), who underwent CPCS with intraocular lens implantation, and followed up for 3 months. Primary outcome measures were intraoperative ultrasonic cumulative dissipated energy (CDE) and intraoperative and postoperative complications. The secondary outcome measures were postoperative changes in endothelial cell count (ECC) and central corneal thickness (CCT). RESULTS: Baseline corrected distance visual acuity (CDVA), ECC, and CCT were comparable. Intraoperative CDE was significantly less in the FLACS group (8.11 vs. 15.83 percentage seconds; P = 0.012) with no intraoperative complication in either group. The postoperative CDVA was comparable between the groups with a trend toward earlier visual recovery in the FLACS group. The postoperative day (POD) 1 endothelial cell loss was higher in the CPCS group (7.54% vs. 2.05%), with the mean endothelial cell density being significantly higher in the FLACS group throughout the follow-up period ( P < 0.05). POD-1 corneal edema was higher in the CPCS group compared to FLACS with no significant difference on follow-up. Intraoperative migration of silicone oil to the anterior chamber was observed in 40% versus 0% in the CPCS versus FLACS groups, respectively. CONCLUSION: FLACS can be safely performed in post-vitrectomy eyes with lesser intraoperative ultrasonic energy used, postoperative endothelial cell loss, and change in CCT compared to CPCS.

Effect of intraoperative optical coherence tomography on anatomic and cosmetic results of intrastromal tattooing.

PURPOSE: The aim of the study was to evaluate the effect of intraoperative optical coherence tomography (i-OCT) on anatomic and cosmetic outcomes of intrastromal keratopigmentation (i-KTP) performed by novice lamellar corneal surgeons. METHODS: Thirty patients presenting with unilaterally disfiguring corneal scar and nil visual prognosis were subjected to i-OCT-guided intrastromal tattooing with rotring ink, by ophthalmology residents undergoing training in corneal surgeries at our center, who were later asked for a subjective feedback and mean stromal depth dissected was measured objectively. All patients were followed up for 9 months after surgery, and the subjective satisfaction of the patient, an independent observer, and surgeon was graded as poor, good, and excellent. RESULTS: The mean age of the patients was 29.53 ± 13.82 years (8-56 years). The most common cause of corneal opacity was healed keratitis with (6/30) or without (3/30) adherent leukoma, trauma-induced ocular disfigurement (7/30), and bullous keratopathy (6/30). All residents reported that feed-back images on i-OCT were "helpful" in all eyes and "very helpful" in eyes with corneal thinning, stromal scarring, adherent leukoma, bullous keratopathy, and hypotony. The mean depth of lamellar dissection was 51.16% ±4.62% of preoperative corneal thickness. The cosmetic results as perceived by the patient, an independent observer, and the surgeon were excellent and good in 23 and 7, 26 and 4, and 20 and 10 patients, respectively. CONCLUSION: I-KTP may be employed as a primary method of cosmetic correction of unsightly corneal scars. Centers equipped with i-OCT may employ this tool for teaching i-KTP to their ophthalmology residents for better surgical results with minimal complications.

Scleral tunnel with conjunctival autograft for rescue management of extruded haptic: Surgical technique and review of literature.

Extrusion of haptic is a rare complication after intra-scleral haptic fixation of intraocular lens (SF-IOL). Various techniques described for its management such as autologous scleral patch, cauterization of exposed haptic, reattempting the glued IOL and IOL explant have their own limitations. Presently, we describe a simple rescue technique for management of such situations. In this method, after performing localized conjunctival peritomy, 2 mm long partial-thickness scleral tunnel is fashioned with an angled 20-guage microvitreoretinal blade 1.5 mm away from the limbus in line with pre-existing defective scleral flap underneath which the exposed haptic is tucked securely. Following this, conjunctival autograft (CAG) with fibrin glue application is undertaken to combat conjunctival fibrosis. In three patients, where this technique was performed, had well-tucked haptic and maintained visual acuity with no complications at 3-months follow-up. This technique is a useful method of tucking extruded haptic after SFIOL in eyes subjected to multiple previous surgeries.