Comparison of changes in blood pressure in phacoemulsification cataract surgery performed via topical and peribulbar anaesthesia: A cohort study.

Background: The purpose of study was to compare the changes in blood pressure in patients undergoing phacoemulsification cataract surgery under topical and peribulbar anaesthesia during preoperative, intraoperative and postoperative period. Methods: In this prospective cohort study, 240 patients undergoing phacoemulsification were divided into topical (Group 1) and peribulbar (Group 2) equally. Proparacaine 0.5% drops were used for topical anaesthesia, and Inj lignocaine with Inj bupivacaine were used to give peribulbar anaesthesia. Preoperative blood pressure was taken 30 min before surgery with automated sphygmomanometer. Intraoperative blood pressure was taken during phacoemulsification, and postoperative blood pressure was taken 1 h after surgery. Outcomes assessed were systolic, diastolic and mean blood pressure. Results: Systolic blood pressure in Group 1 was significantly increased in the intraoperative phase, whereas it was significantly decreased in Group 2 in the intraoperative phase. Diastolic and mean blood pressure in Group 1 showed no significant change, whereas in Group 2, both showed significant reduction in intraoperative and postoperative phases. Conclusion: The increase in intraoperative systolic blood pressure in topical group could be due to discomfort from microscope light, iris manipulation, irrigation and aspiration during surgery. The decrease in intraoperative systolic and diastolic blood pressure in peribulbar group could be due to systemic absorption of local anaesthetic. The mean preoperative systolic blood pressure was also higher in the topical group, which could be due to anxiety or stress under topical anaesthesia. The changes in blood pressure need to be observed so that timely intervention can be made to achieve favourable postoperative outcome.

Photodynamic therapy in the treatment of circumscribed choroidal hemangioma: Current perspectives.

Photodynamic therapy (PDT) using verteporfin Visudyne®(Novartis International AG, Basel, Switzerland) is widely used to treat various chorio-retinal diseases. PDT targets choroidal vascular abnormalities and induces selective occlusion of vessels. PDT was originally used in combination with full-dose verteporfin to treat neovascular age-related macular degeneration. Currently, the clinical targets of PDT have shifted to other chorioretinal conditions such as central serous chorioretinopathy, polypoidal choroidal vasculopathy and choroidal hemangioma. Clinical studies have also facilitated the optimization of treatment outcomes in choroidal hemangiomas through changes in protocols including the introduction of reduced treatment settings; such as PDT with half-dose verteporfin and half-fluence PDT. Here, we review various evolving trends in clinical application of PDT and its use for choroidal hemangiomas from a practical perspective.

Half-fluence photodynamic therapy in peripapillary circumscribed choroidal haemangiomas.

PURPOSE: To evaluate the safety and efficacy of half-fluence photodynamic therapy (PDT) as treatment for symptomatic peripapillary circumscribed choroidal haemangiomas (CCHs). METHODS: In this prospective, interventional case series; 11 patients with symptomatic peripapillary CCHs presenting to a single centre were treated with half-fluence PDT using verteporfin 6 mg/m2 with fluence of 25 mJ/cm2 (standard is 50 mJ/cm2) and other standard settings. Patients were evaluated at baseline, four weeks, twelve weeks and twenty-four weeks post-PDT treatment with best corrected visual acuity (BCVA), ultrasonography, spectral domain optical coherence tomography (SD-OCT), visual evoked potential and angiographic studies. RESULTS: Eleven patients with peripapillary CCHs received half-fluence PDT. The BCVA significantly improved to 0.558 ± 0.118 at four weeks post-treatment (P = 0.014), to 0.494 ± 0.114 at twelve weeks (P = 0.006) and 0.441 ± 0.125 at twenty-four weeks (P = 0.007) from baseline levels of 1.017 ± 0.075 on log MAR scales. Similar improvement was observed in central macular thickness (CMT) of 78.50 ± 13.73 µm (P = 0.001) at four weeks; 114.70 ± 27.73 µm (P = 0.003) at twelve weeks and 174.60 ± 23.13 µm (P = 0.001) at twenty-four weeks post-treatment. A single session of re-treatment was required in 18% (n = 2) of patients which also showed complete resolution at last follow-up. No complications were observed without any significant change in retinal nerve fibre layer (RNFL) thickness at six months follow-up. CONCLUSIONS: Half-fluence PDT can be an effective and safe treatment option for peripapillary CCHs which results in both anatomical and functional improvements with no observable complications.

Subthreshold micropulse laser for adult onset Coats' associated exudative maculopathy.

PURPOSE: To report subthreshold micropulse laser as novel treatment modality for exudative maculopathy associated with adult Coats' disease. METHODS: A 27-year old, young male presented with exudative maculopathy in adult onset Coat's disease with profound diminution of vision. Spectral domain-optical coherence tomogram (SD-OCT) revealed macular oedema with significant subfoveal hard exudates with massive subretinal exudations temporal to macula. He was planned for anti-VEGF injection to treat macular oedema in order to preserve vision but developed conjunctivitis which made any interventional procedure impossible. Patient was managed with subthreshold micro pulse laser using 532 nm green laser. RESULTS: Patient had significant improvement in vision, resolution of macular oedema as well as hard exudate without any adverse effects on fovea. CONCLUSION: Novel treatment approach in form of subthreshold micro pulse laser could be an alternative treatment modality for exudative maculopathy associated with adult onset Coat's disease, especially in cases where other available interventional treatment options are not possible.

Unilateral simultaneous optic nerve and choroidal infiltration - unusual presentation of metastatic disease in breast carcinoma.

Breast carcinoma metastasis can involve any ocular structures, but involvement of the optic nerve is extremely rare. Choroidal metastasis is usually multifocal as well as bilateral and occurs late. We report an unusual initial presentation of metastasis from breast cancer; unilateral infiltrative optic neuropathy with concurrent choroid metastatic deposits in an adequately treated middle-aged female. Our present case, wherein for the first time in the literature, we illustrated unilateral infiltrative optic neuropathy and choroidal metastatic deposits secondary to breast carcinoma, will increase our knowledge about the various potential ocular presentations of this relatively common malignant disease.

Mini-Simple Limbal Epithelial Transplantation Versus Conjunctival Autograft Fixation With Fibrin Glue After Pterygium Excision: A Randomized Controlled Trial.

PURPOSE: To compare the outcomes between mini-simple limbal epithelial transplantation (mini-SLET) and conjunctival autograft (CAG) fixation with fibrin glue after excision of pterygium. METHODS: Ninety-two eyes with primary nasal pterygium were prospectively randomized into a CAG control arm and a mini-SLET study arm. Follow-up examinations were set at the first and third day, at weeks 1, 2, and 4, and at the third and sixth month after surgery. The primary outcome measure was the recurrence rate at 1, 3, and 6 months after surgery, whereas the secondary outcome measures were the intraoperative time, postoperative symptoms, and other complications. RESULTS: Eighty-two eyes completed the 6-month follow-up interval. Of the 42 eyes that underwent CAG, 4 (9.5%) exhibited recurrences, whereas only 1 of the 40 eyes (2.5%) treated with mini-SLET had recurrence (P = 0.358). The time taken for surgery in the study group (21.4 minutes) was greater as compared to the control group (15.1 minutes) (P < 0.001). The postoperative median symptom (foreign body sensation, lacrimation, pain, and irritation) score in the CAG group was significantly more for all symptoms on day 1 and day 3; however, on day 7, it was significantly more for pain and irritation only. Except dellen formation (1 in each group), both groups exhibited different other complications, although less in the study group. CONCLUSIONS: The study group exhibited a positive trend of less recurrence with reduced postoperative symptoms and other complications. More similar studies are required in future to validate the results.

ALK negative inflammatory myofibroblastic tumor of the orbit: a masquerading entity.

Inflammatory myofibroblastic tumor is a biologically distinct neoplasm of intermediate grade, which can affect every possible tissue of the human body. It is a 'masquerading tumor' as the presenting complaints vary with the affected site. Occurrence of this tumor as an orbital mass is rare and is challenging for both the clinician as well as the pathologist, due to a varied number of lesions sharing a similar picture clinically and histologically. We discuss a rare case of inflammatory myofibroblastic tumor presenting as an orbital mass and the importance of immunohistochemistry in arriving at the diagnosis, which helps dictate the treatment and prognosis of the patient.

Effect of 0.5 mm larger donor corneal size on intraocular pressure following penetrating keratoplasty.

BACKGROUND: Glaucoma can develop after penetrating keratoplasty resulting in irreversible loss of vision. The incidence of post-penetrating keratoplasty glaucoma varies from 31% in the early postoperative period to 29% after three months. Various factors are responsible for the rise of intraocular pressure (IOP). This study was carried out to evaluate the effect of 0.5 mm larger donor corneal size on IOP following penetrating keratoplasty. METHODS: Patients were divided into two groups: group I was phakic and group II consisted of aphakic and pseudophakic patients. The same surgical technique was used for obtaining and suturing the donor graft. The viscoelastics and the postoperative regime also remained the same in all cases. IOP was measured by the rebound tonometer. RESULTS: The incidence of postoperative raised IOP in the first seven days in the phakic group was found to range from 16 mmHg to 25 mmHg and IOP in the aphakic/pseudophakic group ranged from 16 mmHg to 42 mmHg. The IOP in the phakic group after three weeks of surgery was around 12.3 mmHg and that in the pseudophakic/aphakic group was 14.8 mmHg-16.2 mmHg. In aphakic patients, IOP was controlled in the first six months with eyedrops Timolol 0.5% and tablet acetazolamide which was given only for short periods. IOP settled to < 12 mmHg with timolol 0.5% after six months. In the pseudophakic patients, IOP became normal by six months. These were inclusive of patients who had undergone anterior reconstruction and/or vitrectomy. CONCLUSION: The study proves that keeping the donor corneal size 0.5 mm larger does not affect IOP and that aphakia itself is a factor responsible for rise of IOP due to anterior chamber angle compression.