Comparison between opposite clear corneal incision versus toric intraocular lens in correcting astigmatism.

PURPOSE: To compare the visual outcomes and efficacy of opposite clear corneal incision (OCCI) and toric intraocular lens (IOL) implantation in correcting preexisting astigmatism (PEA) in patients undergoing phacoemulsification. METHODS: This prospective interventional comparative study was conducted between June 2022 and January 2023 in patients having cataract with PEA undergoing phacoemulsification. Patients were divided into two groups - group A underwent phacoemulsification with OCCI and group B underwent phacoemulsification with toric IOL implantation. Uncorrected distance visual acuity (UDVA), manifest refractive cylinder, and corneal astigmatism using corneal tomography were measured preoperatively and at 6 weeks postoperatively. The eyes were categorized into three groups with PEA ranging from 1 to 1.5 D, 1.6 to 2 D, and 2.1 to 3 D. Depending upon the white-to-white corneal diameter, the eyes were also categorized into four groups with corneal diameter ranging from 10.5 to 10.9 mm, 11 to 11.4 mm, 11.5 to 11.9 mm, and 12 to 12.4 mm. RESULTS: Sixty eyes of 60 patients were studied. At postoperative 6 weeks, 83.3% (25 eyes) in the OCCI group and 96.7% (29 eyes) in the toric IOL group achieved UDVA of 6/9 or better. No statistically significant difference was noted between the groups (P = 0.37). The reduction in mean corneal astigmatism was 0.63 ± 0.37 D in the OCCI group and 0.15 ± 0.12 D in the toric IOL group (P < 0.001). The residual mean refractive cylinder was 0.60 ± 0.38 D in the OCCI group and 0.05 ± 0.15 D in the toric IOL group at 6 weeks (P = 0.007). CONCLUSION: Both OCCI and toric IOL are effective in correcting PEA. However, in a resource-limited setting, OCCI is a better alternative surgical option for correcting astigmatism of 1-1.5 D during phacoemulsification without requiring additional skills or instruments.

Outcomes of refractive implantable lens implantation after deep anterior lamellar keratoplasty.

Purpose: To assess the refractive outcomes and effect on endothelial cell density of refractive implantable lens (RIL) implantation following deep anterior lamellar keratoplasty (DALK). Methods: A retrospective study was conducted on 10 eyes of 10 patients who had undergone DALK and subsequently underwent toric RIL implantation. The patients were followed up over a period of 1 year. The parameters compared were uncorrected and best corrected visual acuity, spherical and cylindrical acceptance, mean refractive spherical equivalent, and endothelial cell counts. Results: There was a significant improvement (P < 0.05) from preoperatively to 1 month postoperatively in the mean log of minimum angle of resolution (logMAR) uncorrected distance visual acuity (UCVA; 1.1 ± 0.1 to 0.3 ± 0.1), spherical refraction (5.4 ± 3.8 to 0.3 ± 0.1 D), cylindrical refraction (5.4 ± 3.2 to 0.8 ± 0.7 D), and MRSE (7.4 ± 3.5 to 0.5 ± 0.4 D). Three patients achieved spectacle independence for distance vision with a residual MRSE less than 1 D in the other cases. A stable refraction was maintained up to 1 year follow-up in all cases. There was a 2.3% mean decline in endothelial cell counts at 1 year of follow-up. No intraoperative or postoperative complications were seen in any case up to 1 year of follow-up. Conclusion: RIL implantation is an effective and safe procedure for the correction of high ametropia post-DALK.

Comparison of different endophthalmitis prophylactic measures in cataract surgery - An analysis of 2.4 lakh cases.

Purpose: To compare different endophthalmitis prophylaxis methods adopted in cataract surgery (manual small-incision cataract surgery and phacoemulsification) between the years 2013 and 2021 in the community eye care section of a tertiary eye care hospital in South India and report their outcomes. Methods: All cataract surgeries performed from January 2013 to December 2021 (2,46,874 surgeries) at a single center were included in this retrospective study. The different endophthalmitis rates with each regimen were analyzed and evaluated. Results: 70,081 surgeries were performed from January 2013 to February 2015, where Tobramycin was added to Balanced Salt Solution (BSS) (Group A). From March 2015 to January 2017, 63,245 surgeries were performed when intracameral Moxifloxacin was given (Group B). From February 2017 to December 2021, 1,13,548 surgeries were performed were Amikacin was added to BSS (Group C). In total, 42 cases of postoperative endophthalmitis were reported during the study period (0.02%). There was no significant difference in the endophthalmitis rates between groups A and B (P = 0.4152); however, there was a significant decrease in endophthalmitis rates in group C when compared with group A (P = 0.04) and group B (P = 0.006). Conclusion: There was a significant reduction in the rates of endophthalmitis following the addition of amikacin in irrigating BSS. Nocardia was one of the predominant organisms isolated from these endophthalmitis patients. This is the first single-center study to report a comparative analysis of different endophthalmitis prophylactic measures in a community eye care set up with a high incidence of Nocardia endophthalmitis prevented with amikacin in BSS irrigating solution.

Evaluation of retinal nerve fiber layer, ganglion cell layer, and optic nerve head morphological parameters in patients with obstructive sleep apnea and comparison with normal population.

PURPOSE: To compare the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and optic nerve head (ONH) morphological parameters between obstructive sleep apnea (OSA) patients and age-matched controls using spectral domain optical coherence tomography (SD-OCT). METHODS: This case control study was conducted in a multi-specialty tertiary care hospital from 2014 to 2016. Patients diagnosed to have OSA by overnight polysomnography were included in the study. Fifty eyes of 25 OSA patients with clinically normal optic disc were compared with 50 eyes of age-matched controls. The study population underwent detailed ophthalmological evaluation including SD-OCT. RESULTS: There was significant thinning of the superior, inferior, and average RNFL in the OSA group when compared to controls. GCL analysis also showed a significant thinning of the six sectors as well as average and minimum ganglion cell layer + inner plexiform layer in OSA patients. The optic nerve head rim area was significantly decreased in OSA patients when compared to controls. CONCLUSION: OSA patients even with clinically normal optic disc showed significant decrease in the RNFL thickness, GCL thickness, and rim area when compared to age-matched controls. Hence, these patients constitute a high-risk population who need to be regularly screened and followed up for ocular co-morbidities.