Clinical outcomes of topography-guided versus wavefront-optimized LASIK for correction of myopia and compound myopic astigmatism.

PURPOSE: To compare the safety, efficacy, and visual outcomes of topography-guided (TG) LASIK ablation versus advanced ablation algorithm (AAA) on Zeiss Mel 90 on virgin eyes. SETTING: A tertiary care hospital in north India. DESIGN: A retrospective comparative study. METHODS: Case sheets of 30 patients who underwent TG LASIK and 45 patients who underwent AAA LASIK between January 2021 and September 2022 were retrieved and reviewed. The TG group included 60 eyes of 30 patients, and the AAA group included age- and sex-matched 90 eyes of 45 patients. Both groups were compared for visual outcomes, residual refraction, and root-mean-square higher-order aberrations (rms HOA) at 1 week, 1 month, 3 months, and 6 months postoperatively and using unpaired t -test and Mann-Whitney U test. RESULTS: The mean preoperative spherical equivalent in the TG group and AAA group was - 3.12 (1.67) and - 3.19 (1.61), respectively. The safety and efficacy of the treatment were 100% in both groups. The postoperative increase in rms HOA was comparable in both groups ( P = 0.55). The ablation duration was significantly longer in topo-guided LASIK ( P = 0.001). CONCLUSION: AAA LASIK on MEL 90 is comparable to topography-guided LASIK for the management of low myopia and myopic astigmatism.

Visual axis opacification after pediatric cataract surgery - An analysis of morphology and etiology.

PURPOSE: To investigate the morphological types and delineate the clinical and surgical variables associated with VAO in children undergoing pediatric cataract surgery. METHODS: We included 33 eyes of 28 children who developed clinically significant visual axis opacification (VAO) after congenital or developmental cataract surgery. All eyes underwent a comprehensive examination under anesthesia followed by a membranectomy to clear the visual axis. We classified VAO into three subgroups: fibrotic, proliferative, and combined morphologies. We reviewed and analyzed the retrospective data and the findings during membranectomy to identify the etiological variables associated with various morphologies of VAO. RESULTS: The median age at primary surgery was 7 (2-96) months. The median interval from primary surgery to the first documentation of VAO was 6 (1-22) months. Younger children developed VAO sooner than older children. VAO was fibrotic in 11 eyes (33%), proliferative in 18 eyes (54.5%), and combined in four eyes (12.12%). Most children with fibrotic VAO belonged to economically disadvantaged sections of society ( P = 0.04). CONCLUSION: Lower age at primary surgery was the predominant risk factor for the development of VAO. Besides primary posterior capsulotomy and adequate anterior vitrectomy, a strict adherence to anti- inflammatory measures and follow up in necessary to prevent the occurrence of VAO. A close follow-up facilitates early detection and management, which can prevent the onset of visually impairing amblyopia.

Bimanual phacoemulsification for subluxated cataractous lens.

Bimanual phacoemulsification has been established as a safe and efficacious means of nuclear emulsification in the past. This case report presents the use of this technique in a man in his early forties, who had subluxated cataractous lenses in both eyes. The technique allowed for effective nuclear emulsification within a closed chamber, providing better control over intraocular events. The report emphasizes the safety and effectiveness of bimanual phacoemulsification in cataract extraction, even in challenging cases like a subluxated lens.

Drying behaviour of nanofluid sessile droplets on self-affine vis-à-vis corrugated nanorough surfaces.

In recent years, evaporative self-assembly of sessile droplets has gained considerable attention owing to its wide applicability in many areas. While the phenomenon is well studied for smooth and isotropically rough (self-affine) surfaces, investigations comparing the outcomes on self-affine vis-à-vis corrugated surfaces remains to be done. In this experimental work, we compare the wetting and evaporation dynamics of nano-colloidal microlitre droplets on self-affine and corrugated nanorough surfaces having identical roughnesses and interface properties. The coupled influence of particle size, concentration, and surface structuring has been explored. Differences in wettability and evaporation dynamics are observed, which are explained via the interaction between wetting fluid and anisotropic surface roughness. Our findings exhibit different temporal behaviour of contact radius and angle in the evaporation process of the droplets. Further, the corrugated surface exhibits anisotropic wettability with a monotonic change in droplet shape as evaporation proceeds, finally giving rise to irregular dried patterns. The scaled rim width and crack spacing of the particulate deposits are examined. Our results can inspire fabrication of surfaces that can facilitate direction-dependent droplet motion for specific applications.

A pilot randomized clinical trial comparing muscle transplant versus hang back recession in extra-large angle exotropia.

PURPOSE: For extra-large angle exotropia (>60 prism diopters, PD), single-setting surgical alternatives are scarce; frequently, more than two muscle or two eye procedures are indicated. To evaluate the viability of single eye surgery, a current randomized comparative trial is undertaken. METHODS: Twenty adult patients with extra-large angle exotropia underwent a thorough orthoptic evaluation before being divided into two groups at random. Ten patients in group 1 underwent medial rectus resection (5.5-7.5 mm), followed by transplant-aided lateral rectus recession (effective length: 4-5.5 mm) (9 mm). In group two, ten different patients underwent medial rectus resection (5.5-7 mm), but this time, the lateral rectus recession (9 mm) was aided with a hang-back suture (5-7 mm). The two procedures were compared at baseline and six months post-operatively. RESULTS: There was no significant difference in the groups' median ages (P = .95). In groups one and two, the median corrections achieved were 81.00 (79.50-85.50) PD and 81.00 (79.75-86.50) PD, respectively. The differences in corrections were statistically insignificant (p = .99). In all patients, abduction limitation was frequently noted in the immediate post-operative period, which improved over time. In each group, there were two patients (>90 prisms) with residual deviation of at least 30 PD, for which the contralateral eyes were operated. CONCLUSIONS: The hang-back recession was as successful as muscle transplant procedure in correcting 80-90 PD of exotropia with notable clinical benefits and ease.

Anthropometry of deep-set eyes with respect to difficulty in docking during femtosecond laser procedures.

Purpose: To identify the facial anthropometric parameters that predict the difficulty during femtosecond (FS) laser. Methods: This was a: single-center observational study was conducted on participants between the ages 18 and 30 years who were planned for FS-LASIK (femtosecond laser-assisted laser in situ keratomileusis) or SMILE (small incision lenticule extraction) at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India. The front and side-facing images of the participants were analyzed using Image J software to measure different anthropometric parameters. The nasal bridge index, facial convexity, and other parameters were measured. The difficulty faced by the surgeon during docking was recorded for each subject. The data were analyzed on Stata 14. Results: A total of 97 subjects were included. The mean age was 24 (±7) years. Twenty-three (23.71%) subjects were females while the rest were males. Difficulty in docking was seen in 1 (4.34%) female and 14 (19%) males. The mean nasal bridge index was 92.58 (±4.01) in subjects with deep-set eyes and 89.72 (±4.30) in normal subjects. The mean total facial convexity was 129.28 (±4.24) in deep-set eyes, and 140.23 (±4.74) in normal subjects. Conclusion: Total facial convexity appeared as the most important feature, with the value being less than 133° in most subjects with unfavorable facial anthropometry.

North India Childhood Cataract Study - The real scenario and causes of surgical delay of pediatric cataract.

Purpose: The study sought to describe the clinical presentation pattern of pediatric cataracts and factors leading to delay in surgery at a tertiary care center in North India. Methods: A cross-sectional, interview-based study was conducted from January 2020 to October 2020, that included pediatric patients <12 years, with unilateral or bilateral congenital or developmental cataract. A pre-validated questionnaire was used to record data. The parameters recorded were age at first symptoms, age at diagnosis of cataract, age at surgery, laterality of cataract, first symptom, first family member noticing the abnormality, the morphology of cataract, association of perinatal complications, family history, systemic diseases, and cause (s) of delay in surgery. Results: A total of 89 patients were included. The mean age of subjects was 4.75(±3.51) years. A white pupil was the most common symptom (64.04%) and appeared in infancy in 30.3% of cases. Parents first detected the problem in 60.67%, and the pediatrician was the first medical contact in 11.23% of cases. The median (IQR) delay period between diagnosis of cataract and cataract surgery was 4 (3-6) months, the major causes were long GA waiting (30.33%), and delay due to systemic ill health (14.61%). Conclusion: Parental education on cataract detection is recommended to help in the timely detection and hence, improved outcomes of pediatric cataract surgery. Pediatricians, consulted for any systemic illness, have the role of the second most important contact in the detection of pediatric cataract.

Technique of re-enclavation of post-traumatic disenclaved haptic of posterior iris claw lens in a vitrectomised eye.

A 58-year-old woman presented to us with sudden onset diminution of vision for 10 days following trauma while using mobile phone. Patient had a history of posterior iris claw implantation 3 years ago. On examination, the patient was aphakic and intraocular lens (IOL) was seen enclaved on nasal side and disenclaved on temporal side on ultrasound biomicroscopy. Patient underwent surgery for re-enclavation of temporal haptic by lifting the IOL using 23-gauge pars plana trocar. Patient had a postoperative uncorrected visual acuity of 6/9 and best-corrected visual acuity of 6/6 with refraction. Re-enclavation of partially disenclaved posterior iris claw lens is a minimally invasive technique to restore visual acuity in such cases.

Optic disc pit with multiquadrant peripapillary retinoschisis and choroidal coloboma.

An 18-year-old man presented with decreased vision in the right eye (OD) noticed for 1 month. On examination, OD best-corrected visual acuity was 3/60 and the left eye (OS) was 6/6 with intraocular pressure of 12 mm Hg in both the eyes (OU). OD fundus revealed an inferior optic-disc-pit with macular-retinoschisis and an inferior choroidal coloboma. OS fundus was normal. On swept-source optical coherence tomography (SSOCT) radial scans, peripapillary-retinoschisis was seen not only in the macular region but in all the four quadrants. To the best of our knowledge, no such case has been reported of optic disc pit with multiquadrant peripapillary retinoschisis and choroidal coloboma coexisting in the same eye. SSOCT radial scans can help detect subclinical retinoschisis as in this case.

Heads-up 3D viewing system in rhegmatogenous retinal detachment with proliferative vitreoretinopathy - A prospective randomized trial.

Purpose: To compare the outcomes of vitreoretinal surgery in patients with primary and recurrent rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) on 3 dimensional digitally assisted visualization system (3D-DAVS) and conventional analogue microscope (CAM). Methods: 68 patients with primary (50) and recurrent (18) RRD with PVR > C1 were included. One group underwent surgery on 3D-DAVS while the other on CAM. The parameters studied included detachment rate, best-corrected visual acuity (BCVA), duration of surgery, mean endo-illumination levels of 23 G (Gauge) micro incision vitrectomy system (MIVS) and microscope and satisfaction of surgeon and observers based on a framed questionnaire. The mean duration of follow up was three months. Results: 68 eyes of 68 patients with median age 52.5 (range 18-68) years were included. 50 had primary RRD and 18 had recurrent RRD. Detachment rate at the end of three months was comparable in both groups of primary (P > 0.99) and recurrent (P = 0.21) RRD. Mean duration of surgery in minutes for 3D DAVS and CAM group was 61.8 (±22.07) and 58.04 (±12.33), respectively, in primary RRD and 37.22 (±10.27) and 36.55 (±5.92), respectively, in recurrent RRD group. Mean endo-illumination in 3D DAVS (14.5%) group was half of that in CAM (34.17%) group. Surgeon and observer satisfaction scores were significantly higher for 3D DAVS group. Conclusion: 3D DAVS is a safe and effective modality or performing VR surgery in RRD with PVR. 3D DAVS allows lower endo-illumination levels provides superior surgeon ergonomics and offers better learning opportunities to the trainees.

Femtosecond laser-assisted refractive capsulorhexis - Precise capsulotomy with accurate toric intraocular lens alignment.

Femtosecond laser-assisted cataract surgery with refractive capsulorhexis and toric intraocular lens (IOL) implantation was performed in 14 eyes with senile cataract and a preexisting regular corneal astigmatism of 1.5 D or more. Intraoperatively, the accuracy of the capsular rim marks was confirmed using the digital overlay of CALLISTO Eye and Z Align (Carl Zeiss Meditec, Germany). Postoperatively, the mean deviation from target axis of implantation was 2.07° ± 1.49°. Refractive capsulorhexis combines the advantages of a femtosecond laser capsulotomy with a one-step visual guide for intraoperative toric IOL alignment as well as postoperative assessment of rotational stability.