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Purpose: To analyze the visual outcome in patients with traumatic optic neuropathy (TON) with respect to different treatment modalities, to study the correlation of initial visual loss with the final visual outcome, and to find out the predictor of final visual outcome in patients with indirect TON. Methods: A retrospective analysis of 36 eyes with TON was done. Data on clinical profile, including demographics, mode of trauma, best corrected visual acuity (BCVA), pupillary reflex examination, and anterior and posterior segment examination, was collected. Presence and location of orbital and cranial fractures were identified from computed tomography scan. Visual outcomes following steroid therapy, optic nerve (ON) decompression, and in untreated patients were analyzed. Pre? and post?treatment BCVA were divided into three groups based on logarithm of the minimum angle of resolution (logMAR) as follows: group A: 3, group B: 2.9–1.3, and group C<1.3. BCVA values at follow?up visits were taken as the primary outcome measure. Association between various risk factors and final visual outcome in patients with indirect TON was also analyzed. Results: Out of 34 patients whose 36 eyes were studied, three (8.8%) patients were females and 31 (91.2%) patients were males. Most common mode of trauma was road traffic accident (RTA; 91.2%), which was followed by fall (8.8%) and assault (2.9%). Pre? and post?treatment BCVA values of 36 eyes were compared, and improvement in BCVA after treatment was found to be statistically significant. Also, 28.6% of patients with presenting BCVA of no light perception showed improvement compared to 94.1% and 100% in groups B and C, respectively. Orbital wall fractures were seen in 80.5% (n = 29) of the patients, with lateral wall fracture being the most common (58.3%) followed by medial wall (33.3%), roof (27.7%), floor (27.7%), and optic strut (5%). Conclusion: Baseline BCVA had significant association with final vision improvement. Lateral wall fracture was the most common fracture associated with indirect TON. Patients treated with high?dose corticosteroids, irrespective of the time of presentation, had a better visual outcome
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Purpose: The aim of this study was to determine the predisposing risk factors, clinical characteristics, microbiological profile, and visual and functional treatment outcome of microbial keratitis including viral keratitis in children. Methods: A prospective study was carried out in a tertiary care institute over a period of 18 months on 73 pediatric patients. Data collected was analyzed for demographics of the patient population, causative organisms, and management outcome in terms of visual and functional outcome. Results: Patients in the age group from 1 month to 16 years were included, with a mean age of 10.81 years. Trauma was the commonest risk factor (40.9%), with unidentified foreign body fall being the most common (32.3%). No predisposing factors were identified in 50% of cases. Also, 36.8% of eyes were culture positive, with bacterial isolates in 17.9% and fungus in 82.1%. Moreover, 7.1% eyes were culture positive for Streptococcus pneumoniae and Pseudomonas aeruginosa each. Fusarium species (67.8%) was the commonest fungal pathogen, followed by Aspergillus species (10.7%). Also, 11.8% were clinically diagnosed as viral keratitis. No growth was found in 63.2% of patients. Treatment with broad?spectrum antibiotics/antifungals was administered in all cases. At the final follow?up, 87.8% achieved a best corrected visual acuity (BCVA) of 6/12 or better. Therapeutic penetrating keratoplasty (TPK) was required by 2.6% of eyes. Conclusion: Trauma was the major cause for pediatric keratitis. Majority of the eyes responded well to medical treatment, with only two eyes needing TPK. Early diagnosis and prompt management helped majority of the eyes to achieve a good visual acuity after the resolution of keratitis.
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Purpose: To analyze intraoperative difficulties and visual and surgical outcomes following pediatric cataract surgery. Methods: This five?year retrospective study (2014�19) included 138 eyes (85 children) with cataract aged between 12 months and 18 years (either sex). All children had undergone best?corrected visual acuity (BCVA), anterior and posterior segment evaluation, intraocular lens (IOL) power calculation, superior manual?small?incision cataract surgery (MSICS) with or without posterior capsulotomy/anterior vitrectomy and IOL implantation under general or local anesthesia, visual rehabilitation, and had been followed up for a minimum period of 12 months. Results: The mean age was 111.27 � 4.84 months. Preoperative BCVA distance: 113 (81.88%)eyes had BCVA < 6/60; near BCVA: 114 (82.6%) eyes had ?N36. At last postoperative follow?up (mean: 20.98 � 13.08 months): distant BCVA? ?6/60 had been recorded in 120 (86.96%) eyes; near BCVA? >N36 in 123 (89.13%) eyes. Improvement in BCVA was statistically significant. Intraoperative scleral tunnel difficulties were seen in three eyes (thin flap in two, and buttonhole in one eye); in the majority of the eyes 113 (81.88%), IOL was placed in the bag. Twenty eyes had early postoperative inflammation. At last follow?up: posterior capsular opacity was recorded in six eyes, IOL decenteration in two eyes, secondary glaucoma in six eyes, and severe amblyopia in 36 (26.09%) eyes. The mean myopic shift was ? 1.11 � 0.89 D and was statistically significant. Conclusion: Superior MSICS as a treatment for pediatric cataract has minimal intraoperative complications and satisfactory visual and surgical outcomes.
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Purpose: Owing to the paucity of literature on Indian children with periventricular leukomalacia (PVL), this retrospective study aimed to describe the visual and associated developmental abnormalities in a series of affected children attending a tertiary level eye care facility. Methods: Children with radiologically confirmed PVL who attended the Pediatric Department of a tertiary eye hospital were included and underwent a detailed ocular and general developmental assessment. Results: Of the 75 children, the mean age was 2.3 years, the mean follow?up was 3.1 years, 68% were males and 43% were born preterm. Grade I PVL was identified in 13 children (17%), Grade 2 PVL in 39 (52%), and Grade 3 PVL in 23 (31%). Premies with ?2 kg (72.5%) and term babies with >2 kg (75%) had a greater association of PVL occurrence with a preponderance to severe PVL; 46% of the children were visually impaired which was significantly higher in the children with Grade 3 PVL (74%) than those with Grade 2 PVL (15%). Strabismus was common (80%) with a change in deviation over time. Seventy?one percent of the children had a refractive error, frequently myopic astigmatism. All the children except two had a delay in one or more general developmental milestones. Conclusion: PVL occurrence is observed both in the babies born at term and premies, resulting in significant ocular and systemic morbidities. We recommend a system in place for early identification and referral to initiate an early intervention program which goes a long way toward improving the quality of life in these children
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BACKGROUND: PCO occurs commonly postoperatively followingcataract extraction in children, obscuring vision as did the initialcataract. It may require a second surgical procedure when it is dense.It is expected that this results in restoration of vision and it is importantto ascertain that this is the case as well as to examine any significantchanges in refraction thereafter.M ETHODS: A retrospective observational study extractingdemographic and clinical information from case notes of patients whohad membranectomy and/or capsule polishing between October 2017and September 2018.RESULTS: 57 eyes of 51 patients were enrolled. There was a 2:1male: female ratio. Mean age at cataract surgery was 6.33 ï±3.59yearswhilst that for PCO surgery was 9.68 ï±3.89years. Postoperativevisual acuity (by WHO definition) was good (between 6/6 and 6/18)in 33.3%, compared to 8.8% preoperatively. Whereas presenting visualacuity was poor (<6/60) in 61.4% preoperatively, this reduced to30% postoperatively. Visual outcome was influenced by age at cataractsurgery, age at PCO surgery, interval between cataract and PCO surgeryand type of cataract. Children >8 years of age at time of PCO surgeryhad a greater proportion of good post-operative best corrected visualacuity (BCVA) (52.6%), whilst 75% of children younger than 8yearsat time of surgery turned out with poor BCVA after surgery.Developmental cataracts proportionately had the best outcome ofvisual acuity. There was a range of refractive shift of +0.25D to 5.25D with a mean myopic shift of 1.51D following membranectomy. CONCLUSION: There was a good proportion of children withsignificant improvement in visual acuity on the short term,and a mildmyopic shift following membranectomy.
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Humans , Child , Outcome Assessment, Health Care , Posterior Capsule of the Lens , Cataract , Capsule Opacification , Tertiary Care CentersABSTRACT
Paediatric ocular trauma is one of the most common causes of preventable visual morbidity in children. One third vision loss occurs in the first decade of life, which is crucial stage for visual development. We wanted to evaluate the final visual outcome of paediatric ocular trauma and determine the various aetiological factors contributing to ocular trauma.METHODSProspective data regarding age, sex, visual acuity, etiological factors of 100 children who visited the emergency in the department of ophthalmology was collected. Children below 18 years of age were included. Children who could not cooperate or lost to follow-up were excluded from the study. Chi square test was done. P values were considered statistically significant at 0.01% level.RESULTSOf the 100 cases, closed globe injury accounted for 69% and the sex ratio was 3.2:1.48 children had visual acuity > 6/12, 18 had visual acuity 6/18 – 6/36, and 3 children had no perception of light (NOPL).CONCLUSIONSPaediatric ocular trauma is a major cause of the non-congenital unilateral blindness. Such injuries cannot always be prevented, but by identifying the underlying aetiological factor of serious injuries, it may be possible to determine the most effective method of reducing the incidence of visually challenging trauma. Although prognosis is mainly dependent on the extent of injury, choice of appropriate management can favourably affect the visual outcome.
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AIM: To evaluate and compare macular thickness changes after uneventful Phacoemulsification and Manual Small Incision Cataract Surgery in correlation with visual acuity. METHOD: Study was conducted on 250 cataract patients they were equally divided into Group A and Group B. Group A patients underwent Phacoemulsification and Group B underwent MSICS. In both groups macular thickness using OCTand Best Corrected Visual Acuity (BCVA) was recorded preoperatively and postoperatively at 1 day, 1, 3, 6 weeks, 3 and 6 months. Macular thickness changes were evaluated and compared with visual acuity. RESULTS: Macular thickness continued to increase from 1 week to 6 months postoperatively which was statistically significant. No correlation found between increased macular thickness and BCVA. CONCLUSION: Increase in macular thickness remained subclinical and there was no impact of increased macular thickness on the final visual outcome.
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Introduction: Cataract is the most frequently performed surgery in the world. The beginner cataract surgeon at our institute is first trained in extra capsular cataract extraction followed by training in manual small incision cataract surgery. Once trained in these two surgical arts, the surgeon is then step wise graduated to doing phacoemulsification. We designed a study to compare the major surgical complications and visual outcome of Phacoemulsification versus MSICS performed by resident doctors at our centre. Aim: The aim of the study was to compare the visual outcome and major surgical complications of Phacoemulsification versus Manual Small Incision Cataract Surgery (MSICS) performed by resident doctors at our Western Regional Institute of Ophthalmology. Methods: 253 eyes of 203 patients with visually significant cataract presenting to our outpatient department wer enrolled. The study was carried out at our Regional Institute of Ophthalmology. The study design is a prospective, non-randomized cohort study. Informed consent for cataract surgery was taken from every patient. The data of consecutive resident phacoemulsification and manual small incision cataract surgeries done from December 2017 to February 2018 was analyzed. Phacoemulsification was done by post Master of Surgery JR4. MSICS was done by JR3 and JR2. Results: Both the surgeries in all the three resident groups had good visual outcome. The rate of major surgical complications was 3.70%for JR4 performing phacoemulsification,2.6%and 5.74% for JR3 and JR2 respectively performing MSICS. The overall major surgical complication rate for MSICS was 4.52%. Conclusion: We conclude that Phacoemulsification and MSICS can be taught to resident doctors with good visual results and a comparable rate of major surgical complications. The beginner resident surgeon graduates comfortably from MSICS to phacoemulsification with low complication rates and good visual results.
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A safe technique for entry incisions and closure in stage 5 retinopathy of prematurity (ROP) surgery is being described. Three 23G clear corneal incisions are made which allow for safe and snug entry of 25G calibrated infusion and 25G instruments for performing lensectomy, membrane removal and vitrectomy. At the end of surgery, air is injected and corneal entries are hydrated for sutureless closure. The technique was performed in 50 eyes of 36 children with stage 5 ROP. The hybrid technique ensured safe entry and exit with stable anterior chamber during surgery. None of the cases developed retinal breaks during surgical entry nor had any complications such as hypotony, flat anterior chamber, hyphaema or corneal edema in post operative period. Clear corneal entry using 23G incisions for 25G instrument access is a safe and effective technique for performing lensectomy and vitrectomy with sutureless closure in cases with stage 5 ROP.
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Purpose: To evaluate vision-related quality of life in children treated for retinopathy of prematurity. Methods: Cross sectional observational study of 54 treated ROP babies 2–7 years of age. The study excluded babies with chronic pediatric conditions and babies of parents suffering from mental illness. Detailed examination including visual acuity was done for all. Two versions of CVFQ questionnaire for children under 3 and above 3 years of age were posed to parents in this study. CVFQ contains six subscales: General health, vision health, competence, personality, family impact, and treatment difficulty. The scores ranged from 0 (worst score) to 1 (best score). Results: The study included 54 children with mean birth weight was 1194 grams, mean gestation age 30 weeks. The age, gender, birth weight, and gestational age didn't affect the overall quality of life (P > 0.05). The severity of ROP (stage 4 and 5) had poorer CVFQ scores (personality and family impact subscales). Competence and personality scores were significantly lower in zone I disease. The quality of life especially general vision, competence, personality, and treatment difficulty subscales had significantly lower values in ROP with higher clock hour involvement (P < 0.05). With myopia after ROP treatment, only personality subscale was significantly affected (P 0.02). Mean CVFQ score including the family impact and treatment difficulty subscale score was also significantly lower in amblyopic and anisometropic children (P value < 0.05). Family impact subscale and overall quality of life was significantly lower in children with strabismus than children without strabismus (P 0.001). Conclusion: ROP has negative effect on the vision-related quality of life of children and their parents. The overall quality of life worsened with the increase in the severity of disease and the occurrence of ocular sequelae of ROP. The vision of the baby may not be the only cause of low scores in the quality of life questionnaire in ROP.
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Introduction: There were many studies where computerusers were surveyed and symptoms were attributed to use ofcomputer but as the symptoms of patients were not alwaysvisible, many people using VDT didn’t attribute computerfor symptoms of VDTS. This Study spread awareness aboutVDTS among the outdoor patients and office staff workersat Tertiary hospital.In this study, we have screened computerusers for ocular complaints along with risk factors andassociation between them.Material and Methods: This present study was carried outamong the outdoor patients who uses computer for at leastone year and presenting with eye complaints at TertiaryCare Centre and office staff of Medical Institute in Karad,Maharastra, India, where the uses of computers required,during the period of November 2016 to May 2018.180Office staff worker and OPD patients, 25-50 years of age,were surveyed. All the participants were subjected to routineclinical examination. After ocular examination, subjects wereasked to respond to a predefined questionnaireResults: Eyestrain, Dryness and Redness were majorcomplaints in male while headache and burning were infemales.Conclusion: Factors like working hours on a computer,whether they were using spectacles or not, their distance fromthe computer screen, the level of the eyes, type of monitor, thebrightness adjustment, use of an antiglare screen, rule of 20-20-20 and the habit of taking breaks contributed to differentocular complaints
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@#Paediatric cataract surgery is challenging with reported post-operative visual acuity (VA) of 0.3LogMar or better varying between 33% to 68% of patients. OBJECTIVE: The aim is to document the post-operative refraction, VA and complications of non-traumatic pediatric cataract surgery performed in a tertiary referral center in Malaysia.
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Purpose: The aim of this study was to study the effect of wet-laboratory training on the surgical outcome of resident performed manual small-incision cataract surgery (MSICS). Methods: We conducted a retrospective, comparative observational study on resident performed MSICS in our institute. We collected data of 464 patients of which Group A had 232 cases performed by residents without prior wet-laboratory training and Group B had 232 resident performed cases after adequate skill training in the wet laboratory. The demographics, type of cataract, intraoperative, postoperative complications, and immediate visual outcome were compared between the two groups. Results: The age, sex, and type of cataract were similar in both groups of residents. The frequency of intraoperative complications was higher in Group A (23.7%) than in Group B (15.08%) (P = 0.019). The occurrence of posterior capsule (PC) rupture and vitreous loss showed a statistically significant difference, with Group A showing a high rate of 14.3% PC rent and vitreous loss while only 6.9% (P = 0.01) had this complication in Group B. The postoperative visual outcome also was better in Group B than in Group A, with 62.06% of patients in Group B, having a postoperative day 1 vision of better than 6/18 as compared to only 38.36% in Group A. Conclusion: The wet-laboratory training is an effective method of improving the skills of the ophthalmology residents in MSICS. The reduction of complications will improve the quality of surgery and improve the postoperative visual outcome.
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Purpose: The purpose of this study is to study the clinical features, visual outcome, management, and ocular complications of ocular injury, following trauma with tennis or cricket ball. Methods: A prospective, noncomparative case study of patients having injury with tennis/cricket ball while playing cricket was conducted between January 2013 and April 2016. Seventy-six eyes of 76 patients were studied. Presenting vision, age, gender, time since injury, general and ocular examination, intraocular pressure, indirect ophthalmoscopy, B scan, and X-ray/computed tomography scan findings were noted. Patients were managed medically or surgically as per the need and followed up at least for 6 months. Results: Seventy-six eyes of 76 patients were studied. All cases were male, except two. Majority (80.2%) were <25 years. Median presenting visual acuity (VA) was 6/36 and median final VA was 6/18. Significant findings in the decreasing order of frequency were sphincter tear (26.3%), retinal detachment (23.6%), angle recession (18.4%), choroidal rupture (17.1%), and Berlin's edema (15.7%). Most of the cases (69.7%) were managed medically. Only 30.2% cases needed surgical intervention. Final visual outcome in our study was depended on initial VA (P = 0.000). It was also correlating with presenting clinical feature (P = 0.010) and type of intervention (medical/surgical) (P = 0.001). Conclusion: Cricket-related ocular injury generally has a poor prognosis with most cases being closed globe injury; retinal detachment is the most common vision-threatening presentation. In spite of being a common event, cricket-related injury is sparingly documented and hence needs further studies for proper documentation, prognostication, and formulation of definitive management plan.
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@#AIM:Analysis of visual prognosis and correlative factors in patients with branch retinal artery occlusion(BRAO). <p>METHODS: Retrospective medical record review of 68 eyes of 68 patients with BRAO seen at Fushun Ophthalmology Hospital from June 2015 and June 2017. Demographic and clinical characteristics were recorded, including gender, age, race, eye involved, and best-corrected visual acuity(BCVA), spectral domain optical coherence tomography(SD-OCT)and optical coherence tomography angiography(OCTA, OptoVue). The OCTA retinal blood flow imaging scan mode was performed, the scanning region in the macular area were 3mm×3mm. the patients were followed up for 6mo.<p>RESULTS: On presentation, 69% of eyes with BRAO had BCVA of 0.5 or better, 24% of moderate visual impairment(0.1-0.4)and 7% of severe visual impairment(<0.1). At the 6-month visit, the percentage of eyes with slight, moderate and severe visual impairment was 75%, 19% and 6% respectively. The presenting BCVA(<i>r</i>=0.776, <i>P</i><0.001), the integrity of superficial foveal capillary arcade(<i>r</i>=-0.003, <i>P</i><0.001), the integrity of deep foveal capillary arcade(<i>r</i>=-0.003, <i>P</i><0.001), the density of superficial retinal capillary plexuses(<i>r</i>=-0.034, <i>P</i>=0.029)and the density of deep retinal capillary plexuses(<i>r</i>=-0.014, <i>P</i>=0.012)were found to be statistically significant with regard to visual outcome. Male, age, duration of symptoms, macular retinal thickness, area of macular involvement(superior or inferior)and presence or absence of emboli were not found to be statistically significant with regard to follow-up BCVA(<i>r</i>=0.273, 0.01, 0, 0.082, 0.41, 0.109, all <i>P</i>>0.05). <p>CONCLUSION: The integrity of foveal capillary arcade, the density of retinal capillary plexuses and the presenting BCVA are dosely associated with visual outcome of patients with branch retinal artery occlusion.
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Introduction: Microbial keratitis (MK) is an important cause for corneal blindness and understanding its risk factors enable us to improve management and minimise its complications. Methods: In this retrospective case review, medical records of all patients treated for MK from 2006 to 2013 was analysed to know the socio-demography, preceding risk factors, clinical characteristics, causative organisms and final visual outcome. Results: A total of 174 patients (180 eyes) were included in this study. Identifiable ocular risk factors included contact lens (CL) usage (85, 47.2%), ocular trauma (50, 27.8%), ocular surface disease (21, 11.6%), steroid use (6, 3.3%) and immuno-compromy (19, 10.5%). Association factors for presenting uncorrected visual acuity (UCVA) were age group (p=0.013), size (p<0.001), location (p<0.001) and hypopyon (p<0.001). The predictors for final best spectacle-corrected visual acuity (BSCVA) were age group (p<0.001), nationality (p=0.020), occupation (p<0.001), CL use (p<0.001), ocular surface disease (p=0.048), size (p<0.001) and location (p<0.044), hospitalisation duration (p=0.002) and presenting UCVA (p<0.001). Conclusions: Contact lens was the most frequent predisposing risk factor for microbial keratitis, followed by ocular trauma. Understanding the association factors for presenting vision and predictors for final vision may help in the patients’ management and improve eventual outcome of microbial keratitis.
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Background: The aim of this study was to assess the surgical outcomes of combined femtosecond laser‑assisted cataract surgery (FLACS) with 25‑gauge vitrectomy surgery. Materials and Methods: A retrospective analysis of 45 patients who underwent combined FLACS with 25‑gauge vitrectomy surgery. Results: A total number of 45 eyes of 45 patients were treated with a mean age of 63.27 years (range 45–75). The mean follow‑up was 3 months (range 3–12 months). The mean preoperative best‑corrected visual acuity was 1.47 ± 0.86. The mean postoperative vision was 0.36 ± 0.36 and 0.275 ± 0.184 at a paired t‑test revealed a statistically significant improvement in visual acuity at 1 month (P < 0.001) and 3 months (P < 0.001). The most common indication for surgery was full‑thickness macular hole (51.1%), vitreous hemorrhage (24.4%), followed by epiretinal membrane (17.7%) and rhegmatogenous retinal detachment (4.4%). Conclusion: Combining FLACS with vitrectomy may be a step toward achieving better outcomes when combined CS and vitrectomy is performed.
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Background: Pterygium is a triangular fibrovascular, subepithelial in growth of degenerative bulbar conjunctival tissue encroaching over the limbus onto the cornea located commonly horizontally in inter palpebral fissure on either nasal or temporal side of cornea or sometimes on both sides. Aim and objectives: To study the efficacy of amniotic membrane grafting in prevention of recurrence, to know the complications associated with amniotic membrane grafting, and to assess the visual prognosis. Materials and methods: This was a prospective observational study for a period of 1 year, a total of 70 pterygia of 70 patients were studied, and who attended the outpatient department. Each patient was totally evaluated by complete history, total ocular and systemic examination with necessary investigations. They were diagnosed as various grades of pterygia, depending on the extent of cornea involved. Results: This study group consisted of 70 patients; the patients were followed up for 6 months. Out of which 24 (34.28%) were male patients and 46 (65.71%) were female patients. Highest prevalence of pterygium was seen in age group of 31-40 years. 20 eyes (28.57%), followed by 41-50 years 18 eyes (25.57%), followed by 20-30 years 17 eyes (24.28%), followed by 51-60 years 10 eyes and 61 years 5 eyes (7.14%). Commonest presenting symptom was foreign body sensation, redness, watering followed by fleshy growth and defective vision. There were no cases with complaints of diplopia. Out of 70 operated cases, 39 (55.71%) were right eye and 31 (44.28%) were left eye. Out of 70 patients, 68 cases had only nasal pterygium (97.14%), 1 case had double pterygia (1.42%), 1 case (1.42%) had only temporal pterygium. During post-operative follow up, 1 case of granuloma, B. Dharma Raju, M. Venu Madhav, D. Sindhu. Clinical study of efficacy of amniotic membrane grafting in the management of pterygium. IAIM, 2016; 3(7): 87-92. Page 88 1 case graft retraction with foreign body sensation, 2 cases of loose suture with graft dislodgement were noticed. During the follow-up period of this study, pterygium recurred in 3 patients. The average duration of recurrence was 2.3 months. The average age of the patient with recurrence was 30 years. More recurrence in GII and GIII pterygia were noticed in this study. Out of 70 patients, best corrected visual acuity remained stable in 21 cases (30%), improved in 49 cases (70%). The post-operative cosmesis was graded as good in 58 (87%) cases, as fair in 7 (10%) cases and as poor in 5 (2.85%) cases. Conclusion: AMT is a safe and effective procedure in the management of pterygium. AMT is a better method with regard to visual outcome, improvement of astigmatism, incidence of recurrence and complications.
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Cataract, the leading cause of blindness in the world, is treated with surgery, and is the most common eye surgery performed. A PubMed search was done to review the spectrum of practice of cataract surgeries in Asian countries. Coverage for surgeries varied in different countries which depends mainly on the surgical facilities available in the region or country. Outreach programs, free surgeries and reimbursement of transport influence this. The cost of cataract surgery depends on type of cataract operation, government/private hospital, and facilities provided in the hospital, day care/in patient surgery, and economic status of people in the region/country. Phaco surgery was more expensive than extracapsular cataract extraction (ECCE) and manual small incision cataract surgery (SICS). Intracapsular cataract extraction (ICCE) was cheaper than ECCE in India. Local anaesthesia (retrobulbar, peribulbar, subtenon and topical) is used compared to general anaesthesia. Pain was more in topical compared to regional anaesthesia though no pain was reported for phacoemulsification under topical. Several manouveres have been utilised in difficult cases to optimise the outcomes. These include invention and modification of instruments, phacodynamic settings and surgical techniques. Specific regimes for pupillary dilatation have been recommended. In Diabetics, trenching was difficult. Elimination of cotton balls reduced fibres in the anterior chamber. Innovations in intraocular lenses (IOL) are glued IOL, Artisan iris fixated IOL, intrascleral fixation of IOL with Y sutures. Visual outcomes varied based on techniques of surgeries and types of IOLs used. The advancement of techniques and instrumentation has benefited patients with cataracts by improving outcomes.
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PURPOSE: To investigate changes in the clinical manifestations of ocular injuries induced by power lawn mowers. METHODS: In a retrospective study of 172 patients with ocular injuries induced by power lawn mowers in 2006, 2010, and 2014. Best corrected visual acuity (BCVA) at the time of presentation and 6 months after trauma, age, sex and seasonal distribution were analyzed. We assessed the degree of injury using slit lamp biomicroscopy, fundus examination, and computed tomography and analyzed the prognoses according to open/closed injury and, anterior/posterior segment injury. All patients underwent medical or surgical treatment, and the factors affecting final BCVA were analyzed. RESULTS: The ratio of closed injuries increased significantly (p = 0.027), as did the ratio of corneal erosion (p = 0.020), and, the ratio of corneal laceration decreased significantly (p = 0.014) over time. In the multivariate analysis, initial BCVA was the only risk factor of poor visual outcome in both open and closed injuries. CONCLUSIONS: The proportion of open globe injury has decreased over time. In contrast, the proportion of simple injuries such as corneal erosion has increased in ocular injuries induced by power lawn mowers. Lower initial visual acuity was the only risk factor of poor visual outcome in both open and closed injuries.