Reasons for declining corneal refractive laser correction for refractive candidates in Southern India.

PURPOSE: To analyze the reasons for declining corneal refractive laser correction procedures in patients presenting to tertiary eye care centers in Tamil Nadu, Southern India, and review the literature. METHODS: Retrospective case records of subjects presenting from January 2019 to December 2021 for refractive surgery workup were analyzed. Demographic details and refractive parameters of patients rejected for corneal refractive laser corrections (CRLC) were documented and reviewed. RESULTS: A total of 2358 patients presented for refractive surgery evaluation during the study period, and out of them, 395 patients (16.8%) were not considered ideal candidates for undergoing CRLC. The common reasons for rejecting the patients were unfit topography (n = 110, 27.8%), unstable refraction over a one-year duration (n = 9, 2.27%), low corneal thickness (n = 85, 21.5%), keratoconus (n = 5, 12.9%), and other ocular and systemic disorders (n = 48, 12.1%). CONCLUSION: There was a marked change in magnitude and rationalization for not performing either laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy in our study. The reasons are unfit topography, keratoconus, and systemic disorders, which were diagnosed during pre-LASIK screening workup, being the most common cause for rejecting patients for corneal refractive corrections.

Preferred practice of cataract surgery in brown cataract: A questionnaire-based survey among Indian ophthalmic surgeons.

Purpose: To determine the most preferred method of operating brown cataracts among ophthalmologists in India. Methods: A cross-sectional, questionnaire-based study was conducted among ophthalmologists all over India through electronic and social media from May 1 to June 15, 2022. All single, voluntary entries within the stipulated time period were accepted for analysis. Results: A total of 230 ophthalmologists participated in the study among which 198 (86%) preferred Manual small-incision cataract surgery (mSICS) as the first option. This was preferred due to the high risk of complications associated (40, 33.6%) as well as endothelial damage due to increased Phaco power (53, 47.9%). The majority of the surgeons (162, 70.4%) preferred a superior tunnel for SICS, and 51.7% (119) performed continuous curvilinear capsulorhexis in 100% of their cases. The most common complication encountered was posterior capsular rupture (PCR) (66%), followed by zonular dialysis (ZD) (18.7%), whole bag removal (8.3%), and Descemet's membrane detachment (7%). Conclusion: Despite diverse recent new modalities of Femto Laser assisted cataract surgery (FLACS). Phakonit, and Smart Intraocular Lens (IOLs), the majority of ophthalmologists still find the manual small-incision cataract surgery (mSICS) procedure a safe surgery for mature brown cataracts.

"Outcomes of optical penetrating keratoplasty with the large sized donor for failed therapeutic grafts for infectious keratitis from the tertiary eye care center, South India".

PURPOSE: To evaluate the preoperative risk factors, complications, and postoperative outcomes following regraft with the large-sized donor for failed therapeutic grafts. METHODS: In this retrospective interventional case series, patients who underwent optical penetrating keratoplasty for failed therapeutic keratoplasty (TPK) from 2010 till 2019 were studied at the Cornea clinic, Tertiary eye care center, with a maximum follow-up period of 3 years within the study period. Demographic patterns, preoperative risk factors, graft survival, visual outcomes, and complications were reviewed from the electronic medical records. RESULTS: A total of 77 eyes of 77 patients underwent optical penetrating keratoplasty, with the mean age of 46.18 ± 12.56 years. The median interval between the two procedures was 10.29 months (IQR: 9.0-15.5) and a mean follow-up of 31.27 months. Non-healing fungal keratitis (n = 48) was the most common indication for TPK. The mean size of the donor used was 10 mm (IOR: 9.5-11 mm). The presence of Peripheral anterior synechiae (p < 0.001) and deep limbal vessels (p = 0.011) showed a significant association with the graft outcomes. Four eyes (5%) developed graft reinfection, one patient (1.2%) underwent evisceration, 28 eyes (39%) had graft rejection; among them, 11 eyes (14.28%) resolved with treatment, and in 17 eyes (22.07%), graft failed. Forty-seven eyes (61%) had secondary glaucoma, of which in 32 eyes (68.08%), intraocular pressure was controlled with anti-glaucoma medications; fifteen eyes (31.19%) needed surgery. The graft's cumulative success rate was 83.1% at six months, 58.4% at one year, and 35.1% at three years. CONCLUSION: We conclude that despite the high complication rate following optical penetrating keratoplasty for failed therapeutic grafts, the visual and clinical outcomes are satisfactory for such high-risk grafts. Hence, it is imperative to venture surgical intervention to salvage these eyes.

Descemet Membrane Endothelial Transfer (DMET) in Pseudophakic Bullous Keratopathy After DSEK-A Case Report and Review of Literature.

PURPOSE: The purpose of this study was to report a Descemet membrane endothelial transfer (DMET) in a patient with pseudophakic bullous keratopathy (PBK) who developed graft dislocation after manual Descemet stripping endothelial keratoplasty. METHODS: A 60-year-old man presented with defective vision in the left eye; after Descemet stripping endothelial keratoplasty, graft dislocation was noted 1 month after surgery. RESULTS: Corneal clarity was improving slowly over 3 months without any secondary surgical intervention. The mechanism of DMET and the review of literature were enunciated. CONCLUSIONS: DMET occurs commonly in eyes with Fuch endothelial dystrophy and rarely in patients with PBK. The mechanism of DMET in PBK probably occurs because of migration of the donor endothelial cells from partially attached Descemet stripping endothelial keratoplasty grafts to the host stroma, in contrast to Fuch endothelial dystrophy, where the endothelial cells from the periphery migrate to the center. Hence, waiting for spontaneous corneal clarity is pivotal because of DMET even in patients with PBK for at least 3 months.