Intrachoroidal cavitation in myopic eyes.

PURPOSE: To determine the incidence and characteristics of intrachoroidal cavitation (ICC) in the eyes with high myopia. METHODS: In this retrospective, non-interventional, comparative study, we analysed the case records of 108 eyes with and without pathological myopia (PM). PM was defined as having a refractive error (spherical equivalent) of ≥ - 6.0 D or axial length ≥ 26 mm. The presence of other features like posterior vitreous detachment, myopic traction maculopathy, posterior staphyloma, focal/patchy chorioretinal atrophy (CRA), choroidal neovascularisation and retinoschisis was looked for on OCT. The association of these features with ICC was analysed using statistical tests. RESULTS: In this study, 38 out of 68 eyes with PM and 4 out of 40 eyes with non-PM showed the bowing of the posterior sclera and the presence of ICC. On statistical analysis with Chi-square test and multiple variable linear regression analysis tests, it was identified that the presence of focal/patchy CRA (p = 0.005) and intrascleral vessels (p = 0.018) in and around the cavitation was important features noted in eyes with ICC. The OCT features of macular and peripapillary ICC were similar. The transudation of fluid from the dilated intrascleral vessels in and around the ICC could be one other mechanism responsible for the development of ICC. CONCLUSION: ICC is seen in 55.8% of highly myopic eyes with the presence of focal CRA or myopic conus and/or presence of intrascleral vessels near the cavitation. These findings suggest that patchy atrophy affects the scleral contour within posterior staphyloma beyond the funduscopically identified patchy atrophy by ICC. The presence of intrascleral vessels could also contribute to the ICC development. Eyes with patchy CRA or myopic conus needs to be checked on further follow-up visits for the development of macular or peripapillary ICC.

Presenile cataract and its risk factors: A case control study.

PURPOSE: Early onset opacification of the lens (cataract) has been observed to be on the rise globally. This study was conducted to determine the various types of presenile cataract and to determine the probable risk factors associated with the occurrence of presenile cataract. MATERIALS AND METHODS: Patients in the age group of 18-40 years attending the Out-Patient Clinic of the Ophthalmology Department who were found to have presenile cataract were recruited as cases. An equal number of consecutive patients of the same age group were included in the control group. Those who gave consent to participate in the study were interviewed through a preformed questionnaire and underwent a complete ocular examination and set of blood investigations. The type of cataract was noted, data obtained were compiled, and examination and investigations done were documented and analyzed using frequency distribution and Chi-squared test. RESULTS: In total, 90 cases and 90 controls that fulfilled the inclusion criteria were recruited. Most common type of cataract was found to be posterior subcapsular cataract. Presenile cataract was observed to be significantly associated with tobacco intake (P = 0.035), hypercholesterolemia (P = 0.002), fuel exposure (P = 0.004), and lower socioeconomic status (P = <0.001). CONCLUSIONS: Tobacco chewing, hypercholesterolemia, and excessive fuel exposure are risk factors for early development of cataract.

Efficacy of Phacotrabeculectomy Alone versus Phacotrabeculectomy Augmented with Autologous Anterior Capsule Implantation Beneath the Sclera Flap.

PURPOSE: To evaluate the efficacy of autologous anterior lens capsule (ALC) in phacotrabeculectomy. MATERIAL AND METHODS: In this prospective, randomized case control study, after obtaining institutional ethical clearance and informed consent, 88 eyes posted for phacotrabeculectomy were divided into ALC and non-ALC groups. Combined phacoemulsification, with posterior chamber intraocular lens implantation and trabeculectomy, was performed in both groups. Anterior lens capsule transplantation was done in the first group beneath the sclera flap. Follow-up of three months was carried out and the morphology of bleb, intraocular pressure (IOP), requirement for additional medications, and complications were compared between the two groups. RESULT: Statistical difference favoring the ALC group was seen in IOP reduction (p < 0.05) at each follow-up, qualified success rate and failure rate at the three-month follow-up (p = 0.006), but no difference in bleb morphology was seen. CONCLUSION: ALC implantation is beneficial in maintaining filtration in a combined surgery with minimal complications.

Comparative Evaluation of Corneal Endothelium in Diabetic Patients Undergoing Phacoemulsification.

PURPOSE: To determine if phacoemulsification with intraocular lens implantation has a greater impact on the corneal endothelium of type 2 diabetic patients as compared to nondiabetics. MATERIALS AND METHODS: This study compared the endothelial status in 60 diabetics with good glycemic control and 60 nondiabetics before and after uneventful phacoemulsification. Central corneal endothelial cell density, percentage hexagonality and percentage coefficient of variation (%CV) were measured using a specular microscope. RESULTS: Data were age and sex matched. Diabetics showed significantly higher loss in endothelial cell count as compared to nondiabetics. At the end of 3 months, there was a decline of 157 endothelial cell (standard deviation [SD] 90) in the diabetic group and 121 (SD 50) in the control group. This was statistically significant (P = 0.008). Furthermore, the diabetics showed a slower recovery trend in the endothelial healing response as evidenced by lower change in the %CV. The change in %CV was 4.5 in the control group and 3.1 in diabetic group which was statistically significant (P = 0.016). Significant correlation was found between energy used and change in endothelial count as well as %CV in nondiabetics only. CONCLUSION: In spite of good glycemic control, diabetics have significantly more endothelial damage in comparison to nondiabetics with similar nuclear grading and phaco energy used. This warrants a more careful use of phaco energy in diabetics.

Comparative Evaluation of Corneal Endothelium in Patients with Diabetes Undergoing Phacoemulsification.

PURPOSE: The purpose of this study is to determine if phacoemulsification with posterior chamber foldable intraocular lens implantation has a greater impact on the corneal endothelium of type 2 diabetic patients as compared to nondiabetic controls. MATERIALS AND METHODS: This study compared the corneal endothelial status in sixty patients with diabetes with good glycemic control and sixty nondiabetic controls before and after (1 week, 1 month, 2 month, and 3 month) uneventful phacoemulsification. Central corneal endothelial cell density, percentage hexagonality, and coefficient of variation were measured using a noncontact specular microscope. Central corneal thickness was taken as a surrogate marker for endothelium functional status. RESULTS: Data were age and sex matched. Patients with diabetes showed significantly higher loss in endothelial cell count as compared to nondiabetic controls. Furthermore, the patients with diabetes showed a slower recovery trend in the endothelial healing response as evidenced by lower change in the coefficient of variation. Significant correlation was found between energy used and change in endothelial count as well as coefficient of variation in nondiabetics only. CONCLUSION: In spite of good glycemic control, patients with diabetes have significantly more endothelial damage in comparison to nondiabetic controls with similar nuclear grading and phaco energy used. This warrants a more careful use of phaco energy in patient with diabetes.