Supplemental nutrition for retinal health: Evidence based analysis of commercial preparations in India

Purpose: Antioxidants have been lately postulated as supportive and prophylactic supplements for various retinal disorders, especially age?related macular degeneration (AMD). Forty?eight brands of such supplements containing lutein and zeaxanthin are available in India. The aim of the study was to assess the market leaders in supplements for ophthalmology in view of AREDS recommendations. Methods: Descriptive review of top?selling supplements for eye health were compared to the contents of the AREDS?recommended levels. Results: None of the top 10 selling brands had exact or near similar composition as recommended in the AREDS?2 study, which is the most widely accepted level?1 evidence in AMD prevention. Conclusion: Physicians prescribing these antioxidants, especially for the prevention of advanced AMD, should be vigilant and aware of the contents of the prescribed brands.

Experience with the Pascal® photocoagulator: An analysis of over 1200 laser procedures with regard to parameter refinement.

Aim: To systematically refine and recommend parameter settings of spot size, power, and treatment duration using the Pascal® photocoagulator, a multi-spot, semi-automated, short-duration laser system. Materials and Methods: A retrospective consecutive series with 752 Caucasian eyes and 1242 laser procedures over two years were grouped into, (1) 374 macular focal / grid photocoagulation (FP), (2), 666 panretinal photocoagulation (PRP), and (3) 202 barrage photocoagulation (BP). Parameters for power, duration, spot number, and spot size were recorded for every group. Results: Power parameters for all groups showed a non-gaussian distribution; FP group, median 190 mW, range 100 – 950 mW, and PRP group, median 800 mW, range 100 – 2000 mW. On subgroup comparison, for similar spot size, as treatment duration decreased, the power required increased, albeit in a much lesser proportion than that given by energy = power × time. Most frequently used patterns were single spot (89% of cases) in FP, 5 × 5 box (72%) in PRP, and 2 × 2 box (78%) in BP. Spot diameters as high as ≈ 700 μm on retina were given in the PRP group. Single session PRP was attempted in six eyes with a median spot count of 3500. Conclusion: Overall, due to the small duration of its pulse, the Pascal® photocoagulator tends to use higher powers, although much lower cumulative energies, than those used in a conventional laser. The consequent lesser heat dissipation, especially lateral, can allow one to use relatively larger spot sizes and give more closely spaced burns, without incurring significant side effects.

Use of capsular tension ring in phacoemulsification. Indications and technique.

The capsular tension ring (CTR) was originally introduced to reinforce the zonule in eyes with zonular dehiscence and to prevent capsular phimosis in eyes at risk for postoperative capsular shrinkage. Since then, other designs and applications have been developed and described. Modified CTRs with shields can be used in eyes with iris coloboma. A CTR with loops is intended for scleral fixation. Studies are underway to determine if the presence of the CTR helps avoid or limit capsular opacification. A number of different insertion techniques with the aid of manipulators, injectors and traction sutures have been described. We have developed a technique that is particularly effective in cases of zonular dehiscence due to its low solicitation to the damaged bag.