Novel technique of pupillary dilation during retinal detachment surgery in an eye with iris claw lens.

Iris fixated intraocular lens (IOLs) have been used for Aphakia and capsular bag instability. The IOLs cause a postoperative non dilating pupil in most cases. We encountered such a case which presented with rhegmatogenous retinal detachment. We describe a novel technique of operating for retinal reattachment in such a case using iris hooks passing in the potential plane between the IOL optic and the iris. The technique had advantages of obviating the need for IOL explantation, associated large corneal entry wound, allowing silicone oil tamponade by retaining an IOL-iris diaphragm, early visual rehabilitation, reduced surgical time, and avoiding multiple surgeries.

532 nm versus 810 nm subthreshold micropulse laser in treatment of non-resolving central serous chorioretinopathy: A randomized controlled trial.

Background: The relative efficacy of 532 nm subthreshold micropulse laser in comparison to the 810 nm subthreshold micropulse laser, in the treatment of central serous chorioretinopathy is not known. Methods: This randomized controlled trial included 99 eyes each in groups A and B. Key inclusion criteria were: (i) vision loss for minimum three months due to persistent central serous chorioretinopathy; (ii) focal leaks (upto two leaks) on fundus fluorescein angiography. Key exclusion criteria were: (i) history of prior treatment for central serous chorioretinopathy; (ii) absence of any leak/ presence of diffuse leaks/ >2 leaks on fundus fluorescein angiography; (iii) chronic central serous chorioretinopathy. All eyes were treated with subthreshold micropulse laser (group A: 532 nm green laser; group B: 810 nm diode laser). Best-corrected visual acuity, autofluorescence, spectral domain optical coherence tomography, and fundus fluorescein angiography, were evaluated at baseline and at 1, 3, and 6 months. Laser was repeated in nor-responders at 3 months. Results: There was a statistically significant improvement in BCVA in both groups six months post laser. Between the two groups, a comparable proportion of eyes showed complete resolution of subretinal fluid at one month, three months and at six months. No adverse effect of laser was observed in either group. Conclusion: Both 532 nm STMP laser and 810 nm STMP laser have comparable structural and functional outcomes in the treatment of non-resolving CSC. There are no adverse effects related to either of the two wavelengths.

Posterior polar cataract: Minimizing risks.

BACKGROUND: Comparing surgical outcomes of management of posterior polar cataract, a congenital cataract, which is difficult to manage surgically and has been associated with poor surgical outcomes. METHODS: 46 eyes of 38 patients with posterior polar cataract underwent phacoemulsification and PCIOL implantation. RESULTS: In a prospective analytical study, 46 eyes of 38 patients with posterior polar cataracts underwent surgery at a zonal hospital of the armed forces. The posterior polar cataract incidence was 1.23 per 1000 with confidence interval (CI) of 0.0012. Of the 46 eyes operated, 6 had a posterior capsular rupture (PCR) (13.04%). The PCR incidence in normal cataracts is reported at approx. 1.1%, whereas, various studies have reported incidence of 6-36% in posterior polar cataracts. 41 eyes achieved a visual acuity of 6/12 or better (89.13%) and 39 eyes of 6/9 or better (84.78%). 4 patients had amblyopia (8.6%), Two patients developed macular edema (4.34%). Mean follow-up was 7 months (range 3-11 months). There was no case of nucleus drop or retinal detachment. CONCLUSION: Posterior polar cataracts are a surgical challenge. With controlled surgery, well defined techniques, a good surgical outcome can be achieved with reduced incidence of PCR.

Comparison of anatomical and functional outcomes of vitrectomy with internal limiting membrane peeling in recalcitrant diabetic macular edema with and without traction in Indian patients.

PURPOSE: To study and compare the outcomes of pars plana vitrectomy (PPV) with the internal limiting membrane (ILM) peeling in the eyes with recalcitrant diabetic macular edema (DME) with and without vitreomacular traction. METHODS: A comparative prospective interventional study was undertaken in which group 1 included 45 eyes of 45 patients with DME with vitreomacular tractional component and group 2 included 45 eyes of 45 patients with recalcitrant DME without a tractional component. Both groups underwent standard PPV with ILM peeling. All the patients were followed up for a minimum of 6 months. The parameters evaluated were changes in the best-corrected visual acuity (BCVA), central macular thickness (CMT), multifocal electroretinogram (mfERG) parameters, and occurrence of any intraoperative/postoperative surgical complication. RESULTS: The mean CMT improved significantly from 540.6 and 490.2 µm at the baseline to 292.5 and 270.6 µm at 6 months in groups 1 and 2, respectively (P < 0.001). The mean BCVA logMAR improved from 0.78 ± 0.21 to 0.62 ± 0.22 in group 1 and 0.84 ± 0.19 to 0.65 ± 0.21 in group 2 at 6 months follow-up which was not statistically significant. The improvement in the mfERG was seen in group 2 as a significant increase in P1 wave amplitude in ring 2 (2-5°) (P < 0.004) and a significant decrease in P 1 wave implicit time in ring 1 (central 2°) (P < 0.001). None of the eyes suffered from the loss of BCVA or any major surgical complication in either group. CONCLUSION: PPV in recalcitrant DME provides good anatomical outcomes and the results are comparable in DME with and without a tractional component.