"Stamp the tunnel"- Innovative tool - for perfection in manual small incision cataract surgery.

BACKGROUND: Manual small incision cataract surgery (SICS) is a cost-effective and safe procedure offering comparable outcomes to phacoemulsification. It holds significance for outreach and economically disadvantaged patients in developing countries, while also being important for complex cataracts in developed nations. The SICS technique revolves around a three planar self-sealing sclero corneal tunnel (SCT), a critical element for rapid and suture-less healing. The tunnel's components include the incision, side pocket, internal entry, and depth each affecting astigmatism and successful nucleus delivery.[1-3] Various incision types are explored, with the frown incision yielding minimal astigmatism but posing challenges.[2,4] Inappropriate SCT leads on to high induced astigmatism, post op hypotony, and chances of infection. PURPOSE: This video introduces "Tunnel stamp" which is a novel device designed to guide the incision length, internal entry line, and side pocket accuracy thus making a perfect SCT particularly for novice surgeons, who often encounter intraoperative and postoperative complications due to inappropriate SCT. The device is produced through 3D printing with thermoplastic polyurethane (TPU), an easily available and economically feasible material. The prototype's practicality is demonstrated through successful wet lab trials on goat eyes and subsequently on human eyes. The device is aligned using a limbus-matching step and a sterilized marker pen. SYNOPSIS: This device has unique advantage to take care of the three aspects of SCT, that is, incision, side pocket, and internal entry. One can have custom-made guarded knife to perform scleral groove in optimum depth, which is another important dimension of SCT. Future developments involve creating the tunnel stamp in transparent flexible silicon to enhance alignment accuracy. Given the diversity of cataract types, multiple sizes of the device are envisioned to accommodate nucleus size variability and different stages of cataract development. To aid novice surgeons, two variations of incision guides (straight and frown) are proposed for immature and harder cataracts reducing induced astigmatism. HIGHLIGHTS: Overall, this innovative tunnel stamp aims to enhance SICS outcomes, enabling more precise and consistent SCT creation while addressing challenges posed by various cataract types and surgeon experience levels. VIDEO LINK: https://youtu.be/yzV-UC4jwPg.

Assessment of parental awareness about pediatric visual problems by Knowledge-Attitude-Practice survey in South India.

Purpose: To find out parents' knowledge, attitude, and treatment practice (KAP) toward pediatric eye problems and to assess the effect of demographic factors such as gender, age, educational status, and number of children on KAP. Methods: A cross-sectional descriptive study was conducted in a hospital setting. Two hundred parents were randomly selected for the questionnaire. All parents had children who were included in Systematic Pediatric Eye Care Through Sibling Screening Strategies (SPECSSS) study. A survey with 15 questions on KAP of pediatric eye diseases was prepared and administered to parents coming to a tertiary eye hospital with varied experience and education qualifications. Results: The mean age of 200 patients was 9.6 (3.4) years, with the majority of them male (n = 110; 55.0%). The majority of the children (n = 91, 45.5%) were between the age group of 6-10 years. Knowledge of visual problems among parents was of a good grade in 9% only. The attitude of the parents toward the visual problem was positive at 17%, and the responses regarding the practice were of excellent grade at 46.5% and good at 26.5%. Analysis suggests that the level of knowledge and practice were not significantly associated with the demographic factors (p > 0.05). The positive attitude toward the visual problems of the children was associated with education of the parents (p < 0.05) and the father occupation (p < 0.05). Conclusion: Knowledge about pediatric eye diseases was poor among parents and it was significantly affected by education and occupation of parents. The parents have positive attitude toward enhancing their attitude in treatment.

Single-arm tool for assessment of anomalous head posture.

Background: Anomalous head posture (AHP) measurement is crucial in the management of nystagmus and incomitant strabismus and also during follow-up assessments. The types of AHP include chin posture, head tilt, and face turn. Goniometer is a low-cost tool widely used to measure head posture. This has two arms: one reference arm and one measuring arm. The drawback of this device is that the examiner has to maintain the reference arm exactly parallel or perpendicular to the floor and the other arm has to align the AHP. Since not all the examiners are comfortable in aligning both the arms simultaneously, the measurements obtained by a goniometer end up being less accurate. A device named cervical range of motion (CROM) is more reliable but expensive. There is an iOS application created for the purpose of head posture assessment, but an iPhone is expensive. Purpose: To demonstrate a low-cost, innovative, reliable single-arm tool (SAT) for assessment of AHP. Synopsis: A clinometer is a device that is used to measure the heights of buildings. In this device, the gravitational force of the earth determines the reference line. We have modified a clinometer into a SAT by incorporating a long plastic arm to it, which is used to measure head tilt and chin up/down measurements. For the purpose of face-turn measurement, we modified a compass for direction into another type of SAT by fitting a yoke dial and a long plastic arm to measure face turn. Here, the principle is to have the line of direction as a reference. The direction of the patient's seating arrangement is determined and taken as the reference direction. The amount of the patient's face turn is measured by finding out the angle between reference direction and direction of the nose. Highlights: This video shows the method of making SAT in a do-it-yourself manner and also demonstrates the method of measuring AHP. SAT is a reliable and low-cost device. Online Video Link: https://youtu.be/UwoHARok85c.

Technique of using Cionni capsular tension ring in the management of of ectopia lentis cases.

BACKGROUND: Ectopia lentis is a condition that compromises vision in childhood by inducing either double vision or aphakic visual axis. Correction of lens status is of prime importance to prevent amblyopia or sensory strabismus. PURPOSE: Placing an intraocular lens (IOL) in the bag in such cases will maintain aqueous vitreous barrier but it is a difficult task.This video demonstrates the method of placing modified Cionni capsular tension ring (CTR) and placement of IOL in children. SYNOPSIS: This video shows the management of multiple cases of ectopia lentis with more than 180 degree subluxation. Making intact rhexis is crucial and technically difficult in such cases. The way of making a proper capsulorhexis is shown. After making capsulorhexis, all the cases were managed with single loop Cionni CTR. Cionni CTR has a loop with a anterior offset of 0.4 mm to override the anterior capsule. It has two designs - right and left design, based on the position of islet in the CTR. Since the offset of the hook is tiny, there are high chances to flip the Cionni CTR. If the Cionni CTR is placed in a flipped manner, it would not give effective pull of the bag, when fixated to sclera. And also, it could be traumatic to explant and place in correct manner. Hence it is vital to place the Cionni CTR in correct orientation, so that anterior offset will orient anteriorly. This video gives guidance to the viewers about the correct way of placing different designs of Cionni CTR in different types of subluxation.Timing of passing sutures through sclera may be done either before or after placing the Cionni CTR in the bag. Both the ways are demonstrated in different cases. HIGHLIGHTS: Different technique of doing Cionni CTR fixation with IOL placement are demonstrated. Surgeons who wish to try this procedure can choose the option that they feel comfortable with. We conclude that choice of Cionni CTR design and technique of placement depends on surgeon's choice and not based on the type of subluxation. VIDEO LINK: https://youtu.be/zbdpP0lhykw.

Novel device to contain aerosols during phacoemulsification.

We herein describe a novel device to contain droplets and aerosols during phacoemulsification. We modified the silicon phaco test chamber into an aerosol containment chamber (ACC) by shortening the chamber and making a pear-shaped opening at one aspect of its tip. The ACC was fitted over phaco tip such that 4-5 mm of phaco tip and sleeve was exposed. When the phaco tip and irrigation port are inside the anterior chamber during phacoemulsification, the portion of the modified chamber remains around the clear corneal tunnel in an enclosing manner that contains aerosols and droplets.

Acute comitant esotropia in a very young child due to combined mechanism: A case report.

We report a case of esotropia with high hyperopia in a 3-year-old female child. She was initially treated with hyperopic correction and noted to have residual esotropia, which was diagnosed as partial accommodative esotropia. Later when she presented with headache, she was diagnosed to have an intracranial tumour. To our surprise, after neurosurgical excision of tumour, her non-accommodative component of the esotropia resolved over 1 year implying that the intracranial lesion was an additional causative factor for this acute onset Accommodative esotropia. The child attained Orthophoria with the same hyperopic correction.