4-Flanged intrascleral fixation of an intraocular lens through the dialing hole

The high prevalence of mature, hypermature, and traumatic cataracts in developing countries, combined with the limited availability of surgical resources and skill by anterior segment surgeons to manage the resultant aphakia, leaves the patient needlessly blind. Relying on posterior segment surgeons, expensive surgical setup, and appropriate lenses for aphakia management limits the number of patients receiving a secondary intraocular lens (IOL). Utilizing the well-acknowledged flanging technique and the readily available polymethyl methacrylate (PMMA) lenses with dialing holes in their optic, a hammock can be created through the dialing holes using a 7-0 polypropylene suture on a straight needle. This 4-flanged scleral fixation through the dialing hole of an IOL makes scleral fixation of PMMA lens possible by even anterior segment surgeons without requiring any specialized equipment or scleral fixated lens with eyelet. This technique was successfully performed in a series of 103 cases with no incidence of IOL decentration.

Retrospective analysis of the role of anterior segment optical coherence tomography and outcomes of cataract surgery in posterior polar cataract

Purpose: To evaluate the visual and surgical outcomes of cataract surgery in patients with posterior polar cataract (PPC) and to evaluate the benefits of preoperative anterior segment optical coherence tomography (AS?OCT). Methods: This was a retrospective, single?center study. Case records of patients diagnosed with PPC who underwent cataract surgery either by phacoemulsification or manual small?incision cataract surgery (MSICS) from January to December 2019 were analyzed. Data collected include demographic details, preoperative best corrected visual acuity (BCVA), AS?OCT, type of cataract surgery, intraoperative and postoperative complications, and visual outcome at 1?month follow?up. Results: One hundred patients were included in the study. Preoperative posterior capsular defect was noted on AS?OCT in 14 patients (14%). Seventy?eight underwent phacoemulsification and 22 underwent MSICS. Intraoperatively, posterior capsular rupture (PCR) was seen in 13 patients (13%) and cortex drop was noted in one among them (1%). Out of 13 PCRs, 12 were found to have posterior capsular dehiscence preoperatively in AS?OCT. The sensitivity of AS?OCT for detecting posterior capsule dehiscence was 92.3% and specificity was 97.7%. The positive predictive value and negative predictive value were 85.7% and 98.8%, respectively. There was no significant difference in the incidence of PCR between phacoemulsification and MSICS (P = 0.475). The mean BCVA at 1 month was found to be better with phacoemulsification than MSICS (P = 0.004). Conclusion: Preoperative AS?OCT has excellent specificity and negative predictive value in identifying posterior capsular dehiscence. It thus helps to plan the surgery and counsel patients appropriately. Both phacoemulsification and MSICS provide good visual outcome with similar complication rates.

Changes in emergency glaucoma care during the COVID-19 pandemic in South India

Purpose: To assess the differences in the pattern of presentation of glaucoma emergency conditions during the various phases of pandemic?related travel restrictions: first wave?related lockdown, unlock period, and the second wave?related lockdown. Methods: The number of new emergency glaucoma conditions, the various diagnoses, and the total number of all new glaucoma patients presenting to the glaucoma services at five tertiary eye care centers in south India from 24th March 2020 to 30th June 2021 were collected from the electronic medical records and were analyzed. The data were compared with the corresponding time period in the year 2019. Results: In total, 620 patients presented with an emergency glaucoma diagnosis during the first wave?related lockdown as against 1337 during the same period in 2019 (P < 0.0001). During the unlock period, 2659 such patients visited the hospital compared with 2122 in 2019 (P = 0.0145). During the second wave?related lockdown, there were 351 emergency patients compared with 526 patients in 2019 (P < 0.0001). Lens?induced glaucomas (50.4%) and neovascular glaucoma (20.6%) were the most common diagnoses during the first wave?related lockdown. During the unlock period, there was a greater proportion of neovascular glaucoma (P = 0.0123). The second wave?related lockdown had a greater proportion of phacolytic glaucomas (P = 0.005) and acute primary angle closure (P = 0.0397) patients. Conclusion: The study demonstrates that emergency glaucoma care was grossly underutilized by the people during the lockdowns. Trivial conditions like cataracts or retinal vascular diseases if not treated appropriately may progress to become emergencies in the future.

Clinical and demographic profile of patients less than 40 years of age presenting to glaucoma services at a tertiary care eye hospital in South India

Purpose: To study the clinical and demographic profile of patients less than 40 years of age presenting to glaucoma services including the reasons for referral. Methods: Patients in the age group of 5 to 39 years, visiting the glaucoma clinic, who were either suspected to have glaucoma or who had been newly/previously diagnosed with glaucoma were included in the study. After informed written consent, basic demographic details of the participants including age, gender, education, socioeconomic status, and family history were obtained. A comprehensive ophthalmological evaluation was performed by glaucoma specialists. Results: The proportion of glaucoma in the study population (n = 384) was found to be 31.25%, and the incidence of glaucoma among new patients was found to be 11.9%. Among all glaucomas (n = 120), 44.2% of patients had secondary glaucomas, 27.5% had primary glaucomas, and 28.3% had congenital glaucomas. Also, 67.3% of all glaucoma patients were males. Newly diagnosed glaucoma patients presented with a mean intraocular pressure (IOP) of 32.9 mmHg and mild–moderate disc damage with a mean cup?disc ratio of 0.65. Nearly one?third of them had a presenting visual acuity worse than 5/60. The most common reason for referral was raised IOP. Univariate and multivariate analysis revealed that the odds of developing glaucoma were less in females (P = 0.04) and in patients with a higher standard of living index (P < 0.001). Conclusion: One?third of the patients had glaucoma and another one?third were suspects. Secondary glaucomas are more common than primary/congenital glaucomas. A comprehensive eye evaluation is a must, especially in those with predisposing factors.

Vacuum-assisted cortex removal - A novel change to the tradition

In developing countries, manual small-incision cataract surgery (MSICS) has surfaced as the cost-effective alternative to phacoemulsification. The Simcoe irrigation-aspiration cannula was developed nearly 40 years ago and is still the most frequently employed tool for cortex aspiration. Although it stands unsurpassed, here we attempt to introduce an addition to the existing Simcoe cannula to achieve a dynamic and controlled vacuum with the added advantage of less physical strain and an effective volume of aspiration. The vacuum-assisted cortex removal device is based on a simple spring action mechanism, where the relaxation of the spring pushes the plunger up and thereby generates a controlled vacuum

Comparison of the outcomes of phacoemulsification and manual small-incision cataract surgery in posterior polar cataract - A retrospective study

Purpose: To compare the visual outcomes and intraoperative complications between phacoemulsification and manual small-incision cataract surgery (MSICS) in cases of posterior polar cataract (PPC). Methods: A retrospective study was carried out involving 142 patients (164 eyes) with PPC who underwent cataract surgery between January and December 2017. Data collected include the demographic details, preoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), type of cataract, intraocular pressure, anterior and posterior segment findings, type of surgery performed, intraoperative complications, postoperative UCVA on the first day, UCVA and BCVA at 1 month after surgery, complications, and resurgery details. Results: In total, 90 patients (107 eyes) underwent phacoemulsification, and 52 patients (57 eyes) underwent MSICS. There was no significant difference in the mean age, sex, and type of PPC between the two groups (P = 0.326, 0.852, and 0.220, respectively). Patients who underwent phacoemulsification had significantly better preoperative BCVA (P = 0.002). The BCVA on first postoperative day and 1 month after surgery was better in the phacoemulsification group than in the MSICS group (P < 0.001 and 0.002, respectively). The overall incidence of posterior capsular rupture (PCR) was 11.6%, which included the 10.3% in phacoemulsification and 14.0% in MSICS. There was, however, no significant difference in the rates of PCR between the two groups (P = 0.506). Conclusion: Phacoemulsification delivered better postoperative visual outcomes than MSICS in PPC patients, whereas the complication rates were similar between the two groups.

Short-term surgical outcomes of twin-site combined phaco-emulsification and mitomycin-C augmented trabeculectomy in pseudo-exfoliation glaucoma versus primary open-angle glaucoma

Purpose: To compare the short?term outcomes of combined phaco?emulsification with posterior chamber intra?ocular lens and mitomycin augmented trabeculectomy in patients with pseudo?exfoliation glaucoma (PXFG) versus primary open?angle glaucoma (POAG). Methods: A total of 144 eyes of 144 patients were enrolled in this prospective interventional comparative study, 72 each of which had PXFG and POAG, respectively. All patients underwent twin?site combined phaco?trabeculectomy at a tertiary eye center in India between December 2017 and December 2018 and were followed up for a period of 12 months. The main outcome measures were intra?ocular pressure (IOP), best corrected visual acuity (BCVA), total surgical time, rate of intra?operative and post?operative complications, and the number of ocular hypotensive medications needed. Success rates were determined via Kaplan–Meier survival analysis. Results: The mean age was 63.9 ± 7.9 years in the POAG group and 66.4 ± 6.8 years in the PXFG group (P ? 0.04). The baseline BCVA, IOP, and cup?disc ratio were comparable between two groups. Intra?operative complications and post?operative outcomes were comparable between the two groups. There was a significant drop in anti?glaucoma medications in both groups. Six patients, three (4.2%) in each group, were lost to follow?up after 6 months. Three patients (4.2%) in PXFG needed additional glaucoma intervention for controlling IOP, one patient needed a non?valved glaucoma drainage device, and two patients required diode cyclo?photocoagulation within the follow?up period. Conclusion: Patients with PXFG had a longer surgical time than POAG. Similar success and complication rates were observed following combined twin?site phaco?trabeculectomy in both POAG and PXFG at 1 year. Combined glaucoma surgery resulted in good IOP control, improvement in BCVA, and lower requirement of ocular hypotensives in both the groups.

Artificial intelligence in glaucoma

Background: Artificial Intelligence (AI) is an area of computer science that encompasses the creation of intelligent machines that work and react like humans. It deals with the development algorithms that seek to simulate human brain and also mimic cognitive functions typically associated with the human mind such as learning and problem solving. Purpose: Do we need artificial intelligence in Glaucoma? Glaucoma is the second most common cause of blindness in the world. Its prevalence was over 60 million in 2010 and over 80 million by 2020. It is so common, yet so easily overlooked. More importantly, about 50% of patients in developed countries and 90% in developing countries are unaware of having glaucoma. Early detection can delay the progression of glaucoma. Hence the time is ripe to advovate glaucoma screening. Synopsis: The application of AI in ophthalmology mainly concentrates on the diseases with a high incidence, such as diabetic retinopathy, age-related macular degeneration, glaucoma, retinopathy of prematurity, age-related or congenital cataract etc AI involves mainly 1. machine learning that are algorithms with the ability to learn without being explicitly programmed and 2. deep learning in which artificial neural networks adapt and learn from vast amounts of data. But there are limitations to screening - such as disparity between ophthalmologist:patient ratio and also the availability of the specialty services. The large amount of data acquired from patients makes it nearly impossible for ophthalmologists to screen them with equal efficacy and consistency. Highlights: AI in glaucoma aims at including factors such as clinical data, genomic data, life style behaviors, risk factors, and medical history to predict the risk of developing glaucoma, help customise the most appropriate management protocol for a given patient, and estimate prognosis and surgical success.