Comparative analysis of outcomes of two (popular) techniques of haptic exteriorization in scleral fixation intra-ocular lens surgery - A retrospective study.

PURPOSE: To compare the visual outcomes and complication rates between the extra-ocular needle-guided haptic insertion technique (XNIT) and the conventional handshake (HS) technique of scleral fixation intra-ocular lens (SFIOL). METHODS: In this retrospective study, we retrieved data of those patients who had undergone SFIOL surgery from January 2018 to May 2022 at our institute for aphakia following either a complicated cataract surgery or an ocular trauma and had a minimum follow-up of 3 months. RESULTS: Of the 156 eyes, the HS technique was done in 80 eyes and the remaining 76 eyes with XNIT. At 3 months follow-up visit, there was no significant difference in the median best corrected visual acuity (BCVA) ( P = 0.988) and uncorrected visual acuity (UCVA) ( P = 0.765) between the two techniques. There was no statistically significant difference between pre-operative median BCVA and post-operative UCVA in XNIT ( P = 0.961) and the HS technique ( P = 0.831) at 3 months follow-up visit. The complication rates between the two techniques were minimal and comparable. The most common post-operative complication was corneal edema. The incidence of cystoid macular edema was slightly more in the XNIT group but not statistically significant ( P = 0.05). Two patients in the HS group developed retinal detachment, which settled after repeat surgery. CONCLUSION: The newer XNIT technique was found to be as safe and effective as compared to the conventional HS technique.

S-FIX: A sutured way of doing sutureless SFIOL surgeries beyond X-NIT!

BACKGROUND: The video describes a technique in scleral fixation intraocular lens (SFIOL) surgery that is very simple and easily reproducible by any novice surgeon. PURPOSE: This technique may serve as a simple option for tucking the haptic of a multipiece IOL into the sclera without the need for the scleral flap, scleral pocket, forceps, glue, or flange. SYNOPSIS: The two most crucial steps in scleral fixation intraocular lens (SFIOL) surgery are 1) the exteriorization of the haptic, and 2) the fixation of the exteriorized haptic. The first half of the video describes the steps of our previously published technique of extraocular needle-guided haptic insertion technique (X-NIT), which simplifies the exteriorization step by shifting the intraocular hand-shake maneuver to an extraocular site. The second half describes a novel suture-guided haptic fixation (S-FIX) device, which simplifies the fixation step. S-FIX has three components: 1) a 380-micron spatulated needle, 2) a 5-o nylon suture thread, and 3) a polyimide tube. There are four steps involved in S-FIX: 1) docking of the exteriorized haptic into the polyimide tube, 2) pushing the docked polyimide tube into the eye, 3) suture bite starting from the point of sclerotomy, and 4) pulling the suture thread. As the suture thread is being pulled, the haptic along with the polyimide tube comes out and the haptic gets fixed into the narrow suture track. HIGHLIGHTS: The technique enhances the overall safety in SFIOL surgeries by avoiding haptic slips during exteriorization and fixation steps. Most anterior segment and novice surgeons do not perform SFIOL surgeries due to fear of fall of IOL. VIDEO LINK: https://youtu.be/ZoJBiw2SNaU.

Suprachoroidal hemorrhage following sutureless scleral-fixated intraocular lens - A case series.

Suprachoroidal hemorrhage (SH) is a rare complication of scleral-fixated intraocular lens (SFIOL). In this series, we report three cases of sutureless SFIOL who developed SH postoperatively. Details of surgery, treatment, and outcome were analyzed. Two cases had limited SH which resolved with conservative treatment and had optimum visual recovery. One case developed massive SH needing surgical drainage, with final best-corrected visual acuity of 6/18 due to a persistent retinal fold. SH can be a potential complication while creating scleral grooves for haptic fixation. The use of a bent needle instead of a straight microvitreoretinal knife while creating scleral grooves might reduce the risk of SH in sutureless SFIOL surgeries.

Bilateral Occlusive Vasculitis Associated with Retinitis Pigmentosa - A Case Report.

PURPOSE: To report a case of bilateral occlusive vasculitis associated with retinitis pigmentosa (RP). METHOD: Case report. CASE REPORT: A 34-year male presented with blurred vision in left eye (OS) for two weeks and right eye (OD) for one day. He had night blindness for five years. His best corrected visual acuity (BCVA) was OD 20/63 and OS 20/200. Ophthalmoscopy revealed bilateral RP with OD inflammatory central retinal vein occlusion (CRVO) and OS occlusive vasculitis with bilateral macular edema. Presumed intraocular tuberculosis (IOTB) was suspected based on clinical features, positive Mantoux and high-resolution computed tomography chest findings. Oral steroids and antitubercular therapy (ATT) were started. OD received six intravitreal ranibizumab injections. At his 7-month follow-up, BCVA improved, OD 20/40 and OS 20/80. CONCLUSION: RP rarely can be associated with presumed IOTB. Oral steroids with ATT are helpful; however, in inflammatory CRVO, intravitreal ranibizumab can give good results.

A novel device for safe exteriorization of haptic in scleral fixation intraocular lens surgery.

The aim of this study was to describe a novel device that has been designed to facilitate anterior segment and novice surgeons to perform extraocular needle-guided haptic insertion technique (X-NIT) for scleral fixation intraocular lens surgery (SFIOL). We performed SFIOL surgery using X-NIT device in 21 eyes of 21 patients. The mean preoperative best-corrected visual acuity (BCVA) was 0.5 ± 0.2 logarithm of minimum angle of resolution (log MAR), which improved by one or more lines postoperatively in all eyes. There were no intraoperative complications. Postoperatively, we noted minimal corneal edema in one patient and dispersed vitreous hemorrhage in one patient. The sharpness and angulation of the needle and the haptic holding ability of silicone stopper were found to be satisfactory. The X-NIT device may potentially improve the safety of SFIOL procedures by minimizing intraocular maneuvers.

A modified air-assisted silicone oil removal from the anterior chamber.

Silicone oil (SO) is a commonly used tamponading agent in retinal detachment surgeries. Inadvertent anterior migration of SO and complete anterior chamber (AC) oil fill in an aphakic or pseudophakic eye is occasionally encountered. This can cause secondary glaucoma with very high intraocular pressure and pain. In this scenario, an urgent silicone oil removal (SOR) is warranted. Since SO is buoyant, in the supine position, it tends to rise anteriorly. Hence, removal of SO trapped in the AC will invariably lead to further migration of oil from the posterior segment into the AC to replace the volume removed. Simultaneous replacement of AC volume is necessary to prevent this. We describe a modified technique of partial SOR that employs air to prevent recurrent migration of SO into AC.

Can preoperative anterior segment optical coherence tomography predict posterior capsule rupture during phacoemulsification in patients with posterior polar cataract?

PURPOSE: To determine whether preoperative assessment of posterior capsule integrity using anterior segment optical coherence tomography (AS-OCT) can predict posterior capsule dehiscence in patients with posterior polar cataract having phacoemulsification. SETTING: Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India. DESIGN: Prospective observational study. METHODS: Patients with posterior polar cataract who had phacoemulsification between October 2012 and November 2013 were included in the study. Preoperative AS-OCT imaging was performed to assess the integrity of the posterior capsule. Anterior segment OCT images of the posterior capsule were graded as "intact" or "dehiscent." Phacoemulsification was performed by the same surgeon who was masked from the AS-OCT findings. The integrity of the posterior capsule was evaluated by the surgeon intraoperatively. RESULTS: The study comprised 64 eyes of 62 patients. Preoperative AS-OCT showed 8 eyes (12.5%) to have probable posterior capsule dehiscence and 56 eyes (87.5%) to have intact posterior capsules. Intraoperatively, the surgeon noted posterior capsule dehiscence in 5 eyes (7.8%) and an intact posterior capsule in 59 eyes (92.2%). The sensitivity and specificity of AS-OCT for detecting posterior capsule dehiscence was 100% and 94.92%, respectively. The negative predictive value of AS-OCT was 100%. CONCLUSION: Anterior segment OCT with its high negative predictive value can be used successfully to predict the risk for posterior capsule rupture during phacoemulsification in eyes with posterior polar cataract.

Ocular infections caused by Scedosporium apiospermum: A case series.

The aim of our retrospective study is to report a case series of ocular infections caused by a rare fungus, Scedosporium apiospermum, in a South Indian population. Thirteen cases of culture-positive S. apiospermum infections diagnosed between January 2011 and March 2016 were included in this study. The parameters evaluated were predisposing factors, treatment and final clinical outcome. The most common mode of presentation was keratitis (84.6%) followed by sclerokeratitis (15.3%). The predisposing factors involved were unspecified foreign body injury (30.7%), organic matter injury (15.3%), uncontrolled diabetes (7.6%), and recent manual small-incision cataract surgery (7.6%). Five cases (38.46%) had no predisposing factor. Of the 11 keratitis cases, nine (69.2%) responded well to combination medical therapy while one case (7.6%) required therapeutic keratoplasty. One case was lost to follow-up. Both cases which presented with sclerokeratitis showed no response to medico-surgical treatment progressing to panophthalmitis and evisceration.

Macular Hole Secondary to Polypoidal Choroidal Vasculopathy.

We report a case of polypoidal choroidal vasculopathy (PCV) presented with massive submacular hemorrhage (SMH) and macular hole (MH). Spectral domain optical coherence tomography confirmed the presence of MH along with SMH and also revealed an extrafoveal-notched pigment epithelium detachment (PED) suggestive of PCV. Urgent pneumatic displacement with perfluoropropane (C3F8) was done. Indocyanine green angiography done 3 weeks later showed polyps in the superonasal macula corresponding to PED. Extrafoveal polyps were treated with laser photocoagulation. Inverted flap MH surgery was planned but the patient was lost to follow-up.

Optical coherence tomography and fundus autofluorescence findings in presumed congenital simple retinal pigment epithelium hamartoma.

Aim: Presumed congenital simple retinal pigment epithelium hamartoma is a rare benign lesion of the macula that mimics congenital hypertrophy of the retinal pigment epithelium (RPE) and combined hamartoma of the retina and the RPE; newer imaging modalities can help in diagnosis. We report three patients with presumed congenital simple RPE hamartoma, and describe the enhanced-depth imaging optical coherence tomography (EDI-OCT) and fundus autofluorescence (FAF) findings. Methods: Two patients were asymptomatic; one had an intraocular foreign body in addition to the hamartoma. All had a similar jet black, elevated lesion in the macula, sparing the fovea. EDI-OCT showed a characteristic hyperreflective layer with complete optical shadowing of the deeper layers; FAF showed pronounced hypoautofluorescence of the lesion. Conclusion: Multimodal imaging with FAF and EDI-OCT can help to differentiate simple RPE hamartoma from similar RPE lesions, and may serve as a useful adjunct to clinical diagnosis of this rare tumor. We present the second largest series of presumed congenital simple RPE hamartoma, and - to the best of our knowledge - the first report of FAF findings of this tumor.

Extraocular needle- guided haptic insertion technique of scleral fixation intraocular lens surgeries (X-NIT).

The most challenging step in sutureless scleral fixation of intraocular lens (SFIOL) is exteriorization of haptics. The conventional handshake technique has a learning curve since it involves intraocular handing over of haptics from one forceps to another. Here, we describe "extraocular needle-guided haptic insertion technique" (X-NIT), a novel technique of exteriorizing haptics that totally eliminates intraocular manipulations. This method involves sequential introduction of two bent 26-gauge needles through the sclera (pars plicata zone) into the eye which are brought out through a sclerocorneal wound. The intraocular lens haptics are threaded through these needles and exteriorized. Nineteen consecutive patients underwent surgery by this technique. There were no intraoperative complications. The mean best-corrected visual acuity (BCVA) of these patients at 1-month follow-up was 0.5 ± 0.3 (logarithm of the minimum angle of resolution) with 18 of 19 eyes showing one or more lines of improvement in BCVA. X-NIT is a safe, easy, cost-effective, and highly reproducible technique, especially for beginners.

A Modified Perfluoro-n-octane-Assisted Autologous Internal Limiting Membrane Transplant for Failed Macular Hole Reintervention: A Case Series.

The authors describe a modified perfluoro-n-octane (PFO)-assisted autologous internal limiting membrane (ILM) transplantation technique for macular hole (MH) reintervention and present results from a series of 11 patients. The authors harvested a free ILM flap and transplanted it into the MH under a PFO bubble. The time at which PFO is injected, the extent of coverage of PFO, and the sequence of fluid-air exchange (FAE) are crucial to overcome previously described technical difficulties of relieving the flap from forceps, stabilizing the flap into the MH, and prevention of flap dislodgement during FAE. A successful U-shaped closure was observed in 10 of 11 cases (90.9%). One case (9.1%) showed flat open closure. The postoperative visual gain was statistically significant (P = .01). [Ophthalmic Surg Lasers Imaging Retina. 2017;48:416-420.].