Evaluation of visual outcomes with toric intraocular lens implantation using digital marker during cataract surgery.

Objectives: To assess the visual improvement and mean residual astigmatism in patients who underwent cataract surgery with toric intraocular lens. METHODS: The retrospective, observational study was conducted at the Department of Ophthalmology, Aga Khan University Hospital, Karachi, and comprised data from January 1, 2018, to December 31, 2020, related to adult patients who had regular astigmatism of at least 0.75D and underwent cataract surgery with toric intraocular lens implantation using a digital marker. The patients were followed up on post-operative days 1, 7, 30, 90 and 180. Along with age, the degree of astigmatism was noted. The visual acuity was calculated pre- and post-operatively. The mean residual astigmatism was then noted for all patients post-operatively. Data was analysed using SPSS 22. RESULTS: The sample comprised 240 eyes of 177 patients; 99(55.9%) males and 78(44.1%) females. The mean age of the sample was 62.5±10.6 years. The mean unaided visual acuity improved post-operatively from 0.57±0.38 to 0.07±0.22 at 90 days. At the 30-day follow-up, mean residual astigmatism had reduced from 1.52±0.84 to 0.01±0.09 (p<0.001). The mean intraocular lens rotation from the intended axis was 0.73°±0.92° on day 30. CONCLUSIONS: Toric intraocular lens implantation using a digital marker could effectively reduce the post-operative cylinder, and improve the unaided visual acuity following cataract surgery.

Efficacy and safety of intravitreal injection of triamcinolone-moxifloxacin after cataract surgery in a low to middle income country - a one-year audit.

OBJECTIVE: To evaluate the safety and efficacy of intravitreal injection of triamcinolone and moxifloxacin regime administered immediately following cataract surgery. METHODS: The retrospective study was conducted from January to June 2021 at a tertiary care referral centre in Karachi and comprised record of all patients who underwent dropless cataract surgery from April 2018 to June 2019. Data included slit lamp examination, dilated fundal exam, uncorrected visual acuity, best corrected visual acuity, and intraocular pressure. Cataract assessment and anterior chamber reaction were graded according to the World Health Organisation cataract grouping system. Efficacy of the regime was defined as the ability to prevent postoperative endophthalmitis. Stratification analysis was done to note if gender has any role in terms of effectiveness. Data was analysed using Microsoft Excel version 16.0 and IBM SPSS version 27. RESULTS: Of 240 eyes of 161 patients analysed, 114(47.5%) were of men who had a mean age of 57.89±14.32 years, and 126(52.5%) were of females with a mean age of 58.02±10.85 years. Overall, 2(1.75%) male subjects and 1(0.8%) female subject developed breakthrough inflammation within one week of the procedure. They were treated with anti-inflammatory drops and in 1(33%) of the cases antibiotic drop for 1 week. At day 90, no patient had residual inflammation or new onset inflammation. Also, 15(6.25%) patients developed raised intraocular pressure from day 7 to day 30. Most cases 10(66.7%) resolved within 1 week of using intraocular pressure-lowering drops. No patient developed endophthalmitis postoperatively. CONCLUSIONS: Dropless cataract regime was found to be an effective and safe alternative that was easy to administer.

Choroidal neovascularization secondary to Best vitelliform macular dystrophy detected by optical coherence tomography angiography.

Best vitelliform macular dystrophy (VMD) is a hereditary condition that causes childhood-onset macular dystrophy. In rare cases, VMD is accompanied by formation of a choroidal neovascular membrane (CNVM). We report a case of CNVM secondary to Best VMD in a 10-year-old boy that was detected using optical coherence tomography angiography, a new noninvasive diagnostic modality that detects motion contrast in repeated B-scans to identify blood flow within vessels.

Topiramate induced sudden loss of vision.

The case of a 20 year old female presenting with overnight acute loss of vision is reported. The patient was recently started on topiramate (Hitop) for her recurrent migraine and developed sudden loss of vision due to acute myopia. Topiramate was discontinued and the patient's vision returned to normal. Delayed and incorrect treatment may result in permanent vision loss, secondary to angle closure glaucoma; therefore it is imperative that prescribing physicians are aware of this rare but serious ocular emergency.

Correlation between corneal and scleral thickness in glaucoma.

PURPOSE: To assess the correlation between central corneal thickness (CCT) and anterior scleral thickness (ST) in patients of primary open-angle glaucoma (POAG), normal tension glaucoma (NTG), and ocular hypertension (OHT). PATIENTS AND METHODS: Consecutive patients with OHT, POAG, NTG, and normal individuals were recruited. CCT was measured by ultrasonic pachymetry, whereas ST was measured using ultrasonic biomicroscopy at the temporal quadrant, 2 mm posterior to the scleral spur. Investigators were masked to the diagnosis and CCT/ ultrasonic biomicroscopy data. Correlation between mean CCT and ST was analyzed. RESULTS: One hundred and twenty-four subjects (31 with OHT, 31 with POAG, 31 with NTG, and 31 normal individuals) were enrolled. The CCT (OHT 548.06+/-30.45 microm; POAG 519.39+/-42.95 microm; NTG 505.81+/-27.23 microm; controls 529.90+/-43.40 microm) was found to be thicker in patients with OHT than POAG (P=0.004) or NTG (P<0.01). There was also a difference in CCT between NTG and control eyes (P=0.012). The ST (OHT 755.03+/-69.58 microm; POAG 738.45+/-66.83 microm; NTG 708.74+/-71.58 microm; controls 724.45+/-73.27 microm) was thicker in the OHT group than in NTG patients (P=0.012). No significant difference in ST was found among other groups. Among subgroups, the correlation between CCT and ST was found only among the patients with NTG (r=0.440, P=0.013). However, no correlation was seen between CCT and ST in patients with OHT, POAG, and controls. CONCLUSIONS: There is a correlation between CCT and ST among the NTG group but no correlation was seen among OHT, POAG, and controls.