Refractive and visual outcome of toric intraocular lens implantation following cataract surgery.

PURPOSE: To evaluate the refractive and visual outcome of toric IOL implantation for correction of pre-existing corneal astigmatism following cataract surgery. MATERIALS AND METHODS: In this retrospective study, 56 eyes of 30 patients who underwent implantation of toric IOL following regular phacoemulsification were divided into two groups based on the types of toric IOL implanted: group 1 patients received Acrysof toric (Alcon) and group 2 patients received AT-Torbi (Zeiss Meditech) IOLs. Pre-and post-operative corneal and refractive astigmatisms, and post-operative distance vision were investigated. Statistical analysis was carried out using the paired student t-test when necessary. Factors affecting the success of toric IOL implantation are discussed and recommendations are made to optimize the outcome. RESULTS: The mean age of all patients was 75.56 � 9.87 years. No statistical difference was observed between pre-and post-operative corneal astigmatism (p = 0.819). Postoperative refractive astigmatism was significantly less in both groups (Group 1: p = 0.0014; Group 2: p= less than0.00001). The best-corrected distance visual acuity was 6/12 or better in 95 % of group 1 and 100 % of group 2 patients. CONCLUSION: Toric IOL implantation is a viable and highly predictable method of correcting the corneal astigmatism. It allows correction without compromising the integrity of the cornea. Careful selection of the patient, accurate keratometry and precise alignment of the cylindrical axes are some of the factors to be considered for a superior outcome.

Profile of pediatric ocular trauma in mid western hilly region of Nepal.

INTRODUCTION: Majority of blinding ocular injuries can be prevented. OBJECTIVE: To describe the epidemiology of ocular trauma in children. MATERIAL AND METHODS: A retrospective review of medical records of the patients aged below 16 years who attended the Himalaya Eye Hospital, Pokhara with history of ocular injury. RESULTS: Of 6,829 pediatric patients, 554 (8.1 %) had ocular trauma. The ocular trauma was more prevalent (38.1 %) in the age group of 5 - 10 years followed by 10-15 years (16.6 %). The boys (62 % vs 38 %) were more prone to ocular trauma than girls (RR = 1.7 and 95 % CI = 1.41 - 2.02). Of 554 ocular injuries, 32 (5.8 %) were open globe injuries. Sub-conjunctival hemorrhage was the commonest presenting finding in 96 (17.3 %) subjects. Forty-seven (8.5 %) of them attended the hospital after 15 days of injury. Home was the most common place for trauma (n =204, 36.8%), followed by playground (n = 140, 25.3 %). CONCLUSION: Children between the ages of 5-10 years are most vulnerable to ocular trauma.Home is the commonest place for ocular injury followed by playground. By adopting some common safety factors or by reducing the ocular injury risks factor, ocular trauma can be greatly reduced.

Intraocular lens tilt and decentration: a concern for contemporary IOL designs.

PURPOSE: To review published studies reporting the posterior chamber intraocular lens tilt and decentration after surgically uneventful implantation. Potential influences of normally occurring misalignment of modern designs of IOL on the optical performances are discussed. MATERIALS AND METHODS: Published theoretical and clinical studies in relation to primarily implanted posterior chamber intraocular lenses and reports relating to more recent development of intraocular lens technologies were reviewed. RESULTS: Capsulotomy type and integrity, ocular pathology, fixation position of the haptics are some of the important factors causing the misalignment. On an average, a 2-3 degrees tilt and a 0.2 -0.3 mm decentration are common, and which remain clinically unnoticed for any design of IOL. However, theoretical studies predict deterioration of retinal image quality particularly with customized wavefront correcting IOLs. More than a 10 degrees tilt and above 1 mm decentration are occasionally reported even with modern cataract surgery in about 10 % of pseudophakic population. CONCLUSIONS: The rate and extent of the complication have lowered substantially concomitant with developments in surgical techniques and IOL designs. While emerging designs of modern IOLs offer improved quality of postoperative vision, optimum performance is vastly influenced by the position of the device in the eye. Therefore, additional precision in alignment of modern designs of IOL may be warranted.