Visual satisfaction and spectacle independence with monofocal intraocular lens with enhanced intermediate vision and trifocal intraocular lenses in the prepresbyopic age group patients with cataracts.

AIM: This aims to study visual satisfaction and spectacle independence in prepresbyopic age patients with cataracts after the implantation of either monofocal intraocular lens (IOL) with enhanced intermediate vision or trifocal IOL. SETTING: Private practice. MATERIALS AND METHODS: This prospective, observational case study was conducted on patients in the prepresbyopic age group with cataracts. Patients were allocated to one of the two groups. Thirteen patients (26 eyes) received monofocal IOL with enhanced intermediate vision (intermediate vision group), and 12 patients (24 eyes) received diffractive multifocal IOLs (trifocal group). Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity, Uncorrected intermediate visual acuity (UIVA) and uncorrected near visual acuity (UNVA) values, defocus curves, and contrast sensitivities (CS) of the two groups were compared 3 months' postsurgery. Their spectacle independence and visual satisfaction were also assessed. RESULTS: The study patients were aged 35-45 years and comprised 14 males and 11 females. No significant difference was observed in UDVA (intermediate vision group: 0.02 ± 0.01, trifocal group: 0.02 ± 0.01; P = 0.22) and UIVA (intermediate vision group: 0.20 ± 0.10, trifocal group: 0.19 ± 0.10; P = 0.12). However, a statistically significant difference was observed between the groups in terms of UNVA (intermediate vision group: 0.32 ± 0.10, trifocal group: 0.80 ± 0.10; P = 0.01). The mean CS in monofocal IOL with enhanced intermediate vision and trifocal groups were 1.577 ± 0.3 and 1.550 ± 0.2, respectively (P = 0.40). None of the patients experienced photic phenomena. In total, 10 of 13 patients in the monofocal IOL with enhanced intermediate vision group required spectacle correction for near visual acuity in the range of +1.00 to +2.00 D. CONCLUSION: This study found that there was no significant difference in distance and intermediate vision between the two groups. However, the trifocal group had better uncorrected near vision compared to the monofocal group that had enhanced intermediate vision. The conclusion is that using trifocal IOLs for both eyes provided complete independence from wearing glasses. In addition, no visual disturbances were observed after implanting the new-generation trifocal IOLs.

Peripapillary nerve fiber layer in patients with iron deficiency anemia: A cross-sectional study in a tertiary eye care center in Central India.

AIMS: The aim of this study is to evaluate the effect of iron-deficiency anemia (IDA) on peripapillary retinal nerve fiber layer (RNFL) thickness using spectral-domain optical coherence tomography (SD-OCT). SETTINGS: The study was conducted at tertiary eye care center in Central India. DESIGN: This study was a prospective, cross-sectional, case-control, and observational study. MATERIALS AND METHODS: In the present study, 58 eyes of patients with IDA were compared with 58 eyes of healthy individuals. All individuals underwent a thorough hematological, clinical, and ophthalmic examination, followed by peripapillary RNFL analysis using SD-OCT. RESULTS: A total of 116 eyes were included in the study. The average RNFL thickness (RNFLT) in the cases was 97.26 ± 5.96, and 102.32 ± 6.26 (P = 0.005) in controls. There was a significant RNFL loss in the temporal (66.76 ± 6.1, P = 0.02), superior (119.66 ± 10.47, P = 0.01), nasal (73.59 ± 9.52, P = 0.003), and inferior (129.05 ± 10.96, P = 0.001) quadrants in the cases and controls. Serum hemoglobin, iron, ferritin, total iron-binding capacity, and transferrin saturation were lower in the cases (P < 0.05). A positive correlation was observed between average RNFLT and hemoglobin (r = 0.321), iron (r = 0.122), ferritin (r = 0.152), and transferrin (r = 0.190) levels. CONCLUSIONS: In patients with IDA, RNFLT was decreased in all quadrants compared to normal healthy individuals. The inferior and nasal RNFL showed a significant decrease in thickness. The presence of myopia, glaucoma, and diabetic and hypertensive retinopathy can exert an additive effect in the thinning of RNFLs and cause significant visual loss; hence, the correction of anemia is essential. There is a pressing need to raise public and health professional awareness of these problems and their prevention, diagnosis, and management.

Eye Donation: Knowledge, Beliefs, Awareness, and Willingness Among Ambulance Drivers in Central India.

Aim: To determine the awareness about and willingness to donate eyes among ambulance drivers in Central India. Design: Prospective, observational, noncomparative, and cross-sectional survey study. Setting: Tertiary eye care center in Central India. Methods: The present study used a structured questionnaire distributed to ambulance drivers during the eye donation fortnight (August 25-September 8, 2022). The questionnaire comprised four domains: awareness, knowledge beliefs, and willingness to donate eyes. The collected data were entered into an Excel sheet and analyzed using SPSS software. Results: Forty-seven ambulance drivers participated in the study. All participants were men. The results showed that 48.9% (n = 23) of the ambulance drivers had completed elementary or middle school education. Furthermore, 27 (57%) participants were aware of eye donation; however, only 14 (29.7%) realized its importance. The source of information was mobile phones (n = 20, 42.6%). The common reason for the nondonation of eyes was lack of awareness (n = 14 29.7%). Thirty-five (74.5%) ambulance drivers were willing to donate their eyes, and the most common reason was the gratification derived from helping blind people. Conclusion: The study revealed the need to improve awareness and knowledge about eye donation among the participants. Arranging short sessions round the year, addressing the myths associated with eye donation, and sharing motivational stories may help create awareness. Display of information and booklets on eye donation in the ambulance is likely to help in obtaining more corneas for transplantation.

Study of the relationship between serum lipid levels and primary open-angle glaucoma.

Purpose: To determine the association between serum lipid levels and primary open-angle glaucoma (POAG). Methods: In this case-control study, 50 patients with POAG documented by clinical tests using standard ophthalmologic equipment and 50 age-matched controls were investigated. Twelve-hour fasting serum lipid profiles, including total cholesterol, serum triglycerides, low-density lipoproteins (LDLs), and high-density lipoproteins (HDLs), were compared between the cases and controls. Results: The mean age of cases and controls was 62.84 ± 9.68 and 60.12 ± 8.65, respectively (P = 0.65). High total cholesterol levels (>200 mg/dl) were found in 23 cases (46%) and 8 controls (16%); high serum triglyceride levels (>150 mg/dl) were found in 24 cases (48%) and 7 controls (14%); high LDL levels (130 mg/dl) were found in 28 cases (56%) and 9 controls (18%); and low HDL levels (<40 mg/dl) were found in 38 cases (76%) and 30 controls (60%). The mean total cholesterol levels were 205.24 ± 36.90 mg/dl in cases and 177.68 ± 22.56 mg/dl in controls (P < 0.001); the mean serum triglyceride levels were 150.42 ± 49.55 mg/dl and 130.84 ± 23.16 mg/dl, respectively (P = 0.013); and the mean LDL levels were 139.50 ± 31.03 mg/dl and 114.96 ± 17.73 mg/dl, respectively (P < 0.001). The mean cholesterol, triglyceride, and LDL levels were significantly higher in cases than in controls (P < 0.05). Conclusion: The present study shows that higher proportion of POAG patients have dyslipidemia compared to age-matched controls. Though these findings need to be replicated by others. This study opens new vistas for further studies, such as lowering dyslipidemia, lowering the intra-ocular pressure and incidence of POAG, and whether the use of statins to reduce dyslipidemia affects the progression of POAG.

Evaluation of posterior capsular opacification and neodymium-doped yttrium aluminum garnet capsulotomy rates in patients with hydrophilic intraocular lens implantation with and without ocular viscoelastic device.

Purpose: To study the effect of intraocular lens (IOL) implantation with and without ocular viscoelastic device (OVD) on posterior capsular opacification (PCO) in eyes with phacoemulsification. Methods: This prospective, comparative, and randomized case series included 70 patients (140 eyes) with senile cataracts scheduled for phacoemulsification and IOL implantation in a tertiary eye c are center. One eye of each patient was randomized to one of the two groups, namely, control and OVD. After phacoemulsification, the IOL was placed in the capsular bag under balanced salt solution (BSS) in the control group, whereas the IOL was placed under OVD in the OVD group. PCO was analyzed by an independent observer at 6, 12, and 18 months under slit-lamp illumination. Results: The mean age of the participants in the two groups was 61.2 (±9.9) years. Of the total participants, 68 (48.5%) were men and 72 (51.5%) were women. The mean keratometry (K1, K2) values of the OVD (44.26 ± 1.43, 44.93 ± 1.66) and control (44.51 ± 1.74, 44.69 ± 1.49) groups were similar. The mean IOL powers of the control and OVD groups were 21.25 (±1.94) and 21.53 (±1.86), respectively (P = 0.463). The mean best-corrected visual acuity (BCVA) of the control group at 6-, 12-, and 18-month follow-ups were 0.622 (±0.253), 0.315 (±0.203), and 0.063 (±0.163), respectively, whereas those of the OVD group were 0.592 (±0.253), 0.336 (±0.169), and 0.066 (±0.118), respectively (P = 0.922). None of the patients had postoperative raised intraocular pressure (IOP), uveitis, or endophthalmitis. Three and four eyes in the control and OVD groups, respectively, required neodymium-doped yttrium aluminum garnet (ND: YAG) capsulotomy at study termination (P = 0.999). Conclusion: The hydroimplantation technique of the placement of hydrophilic IOL did not reduce the PCO rate in the 18-month follow-up period. The ND: YAG capsulotomy rate did not differ between the groups.

Incidence and risk factors for vitreous loss in residents performing manual small-incision cataract surgery.

AIM: To assess the incidence of vitreous loss and associated risk factors in residents performing manual small-incision cataract surgery (MSICS). METHODS: The present retrospective record review study was performed on 490 patients who underwent MSICS performed between November 2018 and December 2019 by 7 third-year postgraduate residents. The study group comprised of patients having intraoperative vitreous prolapse. All the surgeries were performed under supervision of a trained assistant. RESULTS: The mean age of the participants at the time of surgery was 68.42±2.05y. Of the 490 patients, 250 patients were male, and 240 patients were female (P=0.23). A total of 215 (43.9%) eyes had mature white cataract, 185 (37.8%) eyes had brown cataract, and 90 (18.3%) eyes had immature senile cataract. The incidence of intraoperative vitreous loss among residents was 2% (10/490). Vitreous loss occurred during hydrodissection [1/10 (10%)], nucleus delivery [3/10 (30%)], irrigation and aspiration [5/10 (50%)], and intraocular lens insertion [1/10 (10%)]. Multivariate stepwise Logistic regression analysis confirmed immature senile cataract [odds ratio (OR)=3.99; P=0.02], irrigation and aspiration of cortical material (OR=3.07; P=0.03), and anterior capsular extension (OR=3.22, P=0.03) as independent risk factors for vitreous loss. CONCLUSION: Immature senile cataract, irrigation and aspiration of cortical material, and anterior capsular extension are independent risk factors for vitreous loss. Our findings may serve as a guide for future trainers or residents learning MSICS.

Comparison of intraocular lens power calculation in simultaneous and sequential pterygium and cataract surgery.

Objective: To evaluate the effect of pterygium excision on intraocular lens (IOL) power and refraction. Methods: The present study was carried out on patients with combined cataract and pterygium excision (combined group) and pterygium surgery first and cataract surgery after one month (sequential group). Parameters such as mean keratometry (K) values, axial length, IOL power, and corneal astigmatism were compared pre and postoperatively in the combined and sequential groups. Results: 70 eyes of 70 patients were included in the present study. The mean age of the participants in the combined group was 70.46±10.12, whereas that in the sequential group was 68.68±11.22 (p=0.243). The mean horizontal length of the pterygium in the combined group was 2.64±0.17 mm and 2.57±0.17 mm in the sequential group. The mean postoperative K values (p=0.03) and IOL power (p=0.04) in the combined group were significantly higher than the preoperative values. The estimated postoperative refractive error in the combined group was -0.50±1.00 D and 0.25±0.5 D in the sequential group (p=0.04). On the other hand, the postoperative refraction in the sequential group was predictable. Corneal visibility was diminished on the nasal side in almost all the patients in the combined group as compared to the sequential group. Conclusion: The postoperative refraction errors were positively correlated with the length of pterygium in the combined group. The unpredictability of these errors recommends sequential surgery in cases with concurrent pterygium and cataract.

Incidence of Non-Traumatic Subconjunctival Hemorrhage in an Indian Rural Population.

PURPOSE: To determine the incidence of non-traumatic subconjunctival hemorrhage (NTSH) in Indian rural population and analyze the associated risk factors. METHODS: The study included patients diagnosed having subconjunctival hemorrhage (SCH) who attended the out-patient department (OPD) of ophthalmology. Demographic characteristics of subjects included age, gender, medical and ocular history, and location of hemorrhage. RESULTS: The incidence rate of NTSH in this study was 3.07 per 1000 patients per year attending OPD. The men to women ratio for NTSH was 1.26 (95% CI). The commonest site of presentation was nasal side (n=36, 51.4%). Right eye (n= 37, 54.3%) was affected more than the left eye (n=28, 40%). The analysis showed 24 patients (34.3%) did not have any etiological factor attributable to SCH. Conjunctivochalasis (CCH) was associated in 15 patients (21.4%). An antiplatelet agent was associated with SCH in 7 patients (10%). Other factors associated with SCH were hypertension, leukemia, and anemia (n=6, 8.6%). CONCLUSION: This study indicates that NTSH occurs in 3 out of 1000 individuals per year in the rural population presenting to the OPD. Nasal conjunctiva was commonly involved. CCH was associated with 15 patients. Use of antiplatelet agents, hypertension and blood disorders are associated with the risk of NTSH. Patients presenting for the first time with NTSH should be screened for systemic etiological factors.

Clear lens extraction for patients who are unfit for laser-assisted in situ keratomileusis and implantable contact lenses in central Indian population.

PURPOSE: The purpose of this study is to establish the safety of clear lens extraction (CLE) for the correction of high myopia in patients unfit for implantable contact lenses (ICLs) and laser in situ keratomileusis in the central Indian population. METHODS: In this retrospective observational study performed at a tertiary care centre, medical records of the patients who had undergone CLE with implantation of intraocular lens (IOL) to treat high myopia were retrieved. Details of the demographic profile, surgical procedure, complications, power, and type of IOLs implanted were recorded. RESULTS: The average postoperative follow-up period was 64.1 ± 4.2 months. The average postoperative spherical power was -1.4 ± 0.6 D, which was much lower than the preoperative spectacle power -15 ± 4.4 D. There was improvement in the postoperative visual acuity (0.4 ± 0.2 logMAR) from the preoperative distant uncorrected visual acuity (0.8 ± 0.2 logMAR). No significant change in intraocular pressure (IOP) was observed. The postoperative average anterior chamber depth (ACD) (2.66 ± 0.1 mm) was significantly deeper than the preoperative ACD (2.61 ± 0.1 mm) P = 0.00. Barrage laser was required for lattice degeneration in one patient before CLE and in two patients during follow-up. Two patients (8.7%) required Nd:YAG capsulotomy for posterior capsular opacification. None of the patients had corneal decompensation, retinal detachment, or endophthalmitis. CONCLUSION: CLE with implantation of IOL is the safe procedure for correcting high myopia in patients who are unfit for ICL. None of the patient had eye loss in the follow-up period of 5 years. The low incidence of complications can be attributable to the closed chamber lens removal and implantation of IOL and prophylactic retinal treatment.

Intraoperative Evaluation of Phacoemulsification Cataract Surgery with and without the Use of Ophthalmic Viscosurgical Devices.

PURPOSE: The purpose of this study was to compare the efficacy and safety of cataract surgery by the phacoemulsification technique with and without the use of ophthalmic viscosurgical devices (OVDs). SETTING: This study was conducted at a tertiary eye care center in a rural area of Central India. DESIGN: This was a prospective, randomized, observational study. METHODS: In this study, 220 patients underwent phacoemulsification for cataract surgery with OVDs (OVD group) or without OVDs (BSS group) (n = 110 in each group). Patients with operable, nuclear Grade 2-4 cataracts were included in the study. The study was conducted from June 2017 to September 2018. The frequency of intraoperative complications, surgical time, and ease of the surgical procedure (easy, difficult, or very difficult) were recorded. RESULTS: There was no statistically significant difference in the nuclear opalescence, axial length, and intraocular lens (IOL) power between the two groups. Capsulorhexis extension was seen in two eyes in the OVD group and none of the eyes in the BSS group. The problems that occurred during IOL implantation included flip (OVD group, 2; BSS group, 1), haptic breakage (OVD group, 1; BSS group, 1), sulcus implantation (OVD group, 0; BSS group, 2), and stuck haptic (OVD group, 1; BSS group, 3). The total surgical time was almost equal in the two groups (OVD group, 9.2 min ± 3; BSS group, 9.5 min ± 3.5; P = 0.521). None of the patients had iris trauma or posterior capsular rupture. CONCLUSIONS: OVD-less phacoemulsification surgery is a safe and effective technique for treating age-related cataracts that requires no additional instrumentation and saves the cost of the OVD.

Ocular Trauma in Pediatric Age Group at a Tertiary Eye Care Center in Central Maharashtra, India.

PURPOSE: To study the demographic profile and visual outcome in pediatric ocular trauma. STUDY DESIGN: Prospective and interventional study. SETTING: Tertiary eye care center in central Maharashtra. MATERIALS AND METHODS: The study included all children of age group 15 years and younger sustaining eye injuries and presented to the outpatient department or emergency services. The duration of the study was 1 year. A detailed medical history was obtained. Demographic profile was noted. A detailed ocular examination included visual acuity, slit-lamp biomicroscopy, and fundus examination. All patients were followed up to 6 months. RESULTS: Out of 350 children examined, 66 (18.9%) had ocular trauma. The mean age at presentation was 8.33 ± 4.03 years. Children aged 6-10 years (39.3%) were most commonly affected followed by children from 11 to 15 years (36.1%). There were no significant differences between rural (54.1%) and urban (45.9%) children. Most (63.9%) had open and 24.6% had closed globe injuries. Perforating injuries to the cornea (n=29, 47.5%) was the most common injury. Sports-related injuries were common (n= 18) followed by wooden stick- (n = 14) and firecracker-related (n = 11) injuries. In the open and closed globe injuries, 36 (92.3%) and 5 (33.3%) patients, respectively, required immediate surgical intervention. CONCLUSION: Sports-related activities were a common cause of ocular trauma in the pediatric age group in the central region of Maharashtra. We propose setting of rapid action ocular trauma team to prevent blindness occurring due to trauma.

Frequency of Corneal Astigmatism in Patients Presenting for Senile Cataract Surgery at a Teaching Hospital in Indian Rural Population.

PURPOSE: The aim of this study was to assess prevalence of corneal astigmatism before cataract surgery in old age in Indian rural population. DESIGN: Prospective, cross-sectional, and observational study. METHODS: Keratometric values were measured with an auto refractokeratometer in patients presenting for cataract surgery between January 2017 and May 2018. The demographic profiles of patients were recorded. Axial length and intraocular lens power were measured. Data were analyzed in SPSS software. RESULTS: This study included 1000 eyes of 880 patients with a mean age of 65.1 ±â€Š10.12 years. The mean astigmatism was 0.89 ±â€Š0.63 D. A total of 179 eyes (17.9%) had astigmatism between 1.00 and 1.49 D; 34 eyes (3.4%) had astigmatism between 2.00 and 2.5 D; and 20 eyes (2%) had astigmatism >3 D. Overall, 325 eyes (32.5%) had astigmatism >1.00 D. Against the rule astigmatism was seen in 44.6% cases, oblique astigmatism was seen in 32% cases, and with the rule astigmatism was seen in 20.7% cases. Against the rule astigmatism increased with age and reached a maximum between 60 and 69 years. Male eyes had flatter corneal curvature than female eyes. The mean axial length was 25.59 mm, and the mean intraocular lens power was 21.05 ±â€Š1.0D. CONCLUSIONS: We found that 32.5% patients had corneal astigmatism >1 D and may benefit from toric intraocular lenses implantation. The results of this analysis provide normative data for the hospital to plan for correction of corneal astigmatism in patients undergoing cataract surgery.

Multiquadrant versus single quadrant cortical cleaving hydrodissection during phacoemulsification of age related cataract.

PURPOSE: To evaluate and compare single and multiquadrant hydrodissection in age related cataract. DESIGN: Prospective, observational case series. METHODS: In this study, 220 patients were consecutively assigned to either single (n = 110) or multiquadrant (n = 110) hydrodissection during phacoemulsification. Patients having operable cataract in the nuclear grade of 1-3 of Lens Opacities Classification System III were included in the study. After hydrodissection of the nucleus nuclei were not rotated. Parameters assessed were amount of balanced salt solution (BSS) required to accomplish the hydrodissection, nucleus emulsification time (NET), and cortical aspiration time (CAT). Ease in nucleus rotation during chopping of the nucleus, cortical aspiration (easy, difficult, or very difficult) and intraoperative surgical complications were qualitatively assessed. RESULTS: Average amount of BSS required in multiquadrant hydrodissection was 1.7 ml (±0.9), which was more than double the single quadrant group 0.71(±0.17), p = 0.001. No statistically significant differences were observed between the two studied groups with respect to the following parameters: mean NET (single quadrant 277 sec ±â€¯95.5, multiquadrant 267 sec ±â€¯98.8, p = 0.379), CAT (single quadrant 75.7 sec ±â€¯31.2, multiquadrant 73.4sec ±â€¯33.9p = 0.301), and total fluid required (single quadrant 154 ml ±â€¯64.9, multiquadrant 157 ml ±â€¯66.4p = 0.708).Almost equal number of patients in both the groups had easy rotation of the nucleus (single quadrant: n = 105, 95.45% and multiquadrant n = 103, 93.64%) and cortical aspiration (n = 102, 92.72% both the groups). Three patients in multiquadrant group had posterior capsular rupture during hydrodissection. CONCLUSIONS: A single quadrant hydrodissection is sufficient for the efficient removal of nucleus and cortex.

Long-term results of trypan blue dye irrigation in the capsular bag to prevent posterior capsule opacification: A randomized trial.

PURPOSE: To study the effect of capsular bag irrigation of trypan blue dye (0.06%) on posterior capsular opacification (PCO) in eyes undergoing phacoemulsification. METHODS: This was a randomized, trial conducted at a tertiary eye care center in central India. The study included 50 patients (100 eyes) with senile cataracts who were scheduled for phacoemulsification and intraocular lens (IOL) implantation and were willing to undergo bilateral cataract surgery. One eye of each patient was randomized to one of two groups. The dye group received 0.2 ml of trypan blue injected in the capsular bag after cortical cleanup under air. The control group (other eye of the same patient) received 0.2 ml of balanced salt solution injected in a similar manner. PCO in the central 3 mm area of IOL optic was analyzed by a masked observer using an evaluation of PCO software computer analysis system at 6, 12, 24, and 36 months. RESULTS: The average age of patients was 62.05 ± 6.22 in the dye group and 64.92 ± 7.16 years in the control group. The mean PCO score at 6 months was significantly lower in the dye group (0.10 ± 0.15) than in the control group (0.22 ± 0.30). There were no significant differences in the PCO scores between the two groups from 12 to 36 months. At the end of 3 years, eight eyes in the dye group and seven in the control group required YAG capsulotomy (P = 0.21). CONCLUSION: Capsular bag irrigation of trypan blue dye decreased the PCO score at 6 months, but it had no effect at 36 months.

Evaluation of Topical Lignocaine Jelly 2% for Recurrent Pterygium Surgery with Glue-free Autologous Conjunctival Graft.

AIM: This study aims to evaluate the efficacy of lignocaine 2% jelly as a topical anesthesia in recurrent pterygium surgery with glue-free conjunctival limbal autograft. MATERIALS AND METHODS: A prospective, nonrandomized, observational study, comprising of 51 patients (51 eyes) having recurrent pterygium, was conducted at a tertiary eye care center in central India. Pterygium excision with glue-free autologous conjunctival grafting was done under 2% lignocaine jelly. The visual analog scale was utilized to record the intra- and post-operative pain score. Patient comfort, intraoperative painful sensations perceived by the patient, supplemental anesthesia, complications, and surgeon discomfort were noted. Anesthetist also noted vital parameters and any intravenous drugs required. RESULTS: No difference in intra- and post-operative pain score (P = 0.24) was observed in the patients. Zero score, i.e. no pain was noticed in 30 patients (58.8%) patients. The average surgical time was 29.20 min (+1.11). The average surgeon discomfort score was 0.18 + 0.51. Inadvertent eye movement was seen in 3 patients (5.9%). Lid squeeze was noted in 45 patients (88.2%) during placement of lid speculum. Forty-eight patients (94.1%) gave preference to the topical anesthesia of 2% lignocaine jelly compared to the previous mode of anesthesia. CONCLUSION: Pterygium surgery with glue-free autogenous conjunctival grafting can be performed successfully by preoperative local application of 2% lignocaine jelly. The ease of application, lack of toxicity and sufficient effect to complete the surgery make it an efficient alternative to injectable anesthetics.

Success Rate of Conventional Dacryocystorhinostomy in Post-acute Dacryocystitis Compared to Endonasal Dacryocystorhinostomy in Acute Dacryocystitis.

PURPOSE: To determine the success rate of conventional dacryocystorhinostomy (DCR) and endoscopic DCR performed in patients with acute dacryocystitis. METHODS: Records of patients with acute dacryocystitis and operated during 2007-2008 were reviewed. Patients who completed a follow-up of 60 months were included in our study. Demographic characteristics, surgery types, success rate, and follow-up periods were recorded. Success was defined as the elimination of epiphora, absence of dacryocystitis, and negative syringing test result (i.e., unrestricted flow of irrigated saline to the nose). RESULTS: A total of 67 patients were operated during the period. Fifty-seven patients completed the follow-up of 60 months. The mean age in the conventional and endoscopic groups was 39.5 ± 8.5 and 39.5 ± 8.4 years, respectively. The participants included 33 female and 24 male patients. Endoscopic DCR was performed in 28 (endoscopic group) and conventional DCR (conventional group) in 29 patients. Conventional DCR was performed after subsidence of the acute attack, which took an average of 10 days (range, 9-19 days). After a period of 60 months, patency on syringing and resolution of epiphora was documented in 26 patients in the conventional group (success rate, 89.7%) and 23 patients in the endonasal group (success rate, 82.1%) (P = 0.654). CONCLUSION: The success rates of conventional and endonasal DCR during a follow-up period of five years in patients with acute dacryocystitis are almost similar.

Postoperative posterior capsular striae and the posterior capsular opacification in patients implanted with two types of intraocular lens material.

AIM: To evaluate the incidence of postoperative posterior capsular striae (PCS) and its influence on posterior capsular opacification (PCO) in patients implanted with two types of lens material. SETTING: Tertiary eye care center in central rural India. STUDY DESIGN: A prospective, observational, nonrandomized study. MATERIALS AND METHODS: The study included 1247 patients having age-related cataract scheduled for removal by phacoemulsification technique and implantation of hydrophilic or hydrophobic intraocular lens (IOL). Demographic profile, nuclear grading, axial length, and IOL power were noted. Details of PCS were noted on the 1st postoperative day in patients with clear cornea. Postoperative follow-up was ensured to study the status of PCS and development of PCO. RESULTS: The overall incidence of PCS was 19.8% (247 out of 1247 eyes). Out of 1247 patients, 641 patients (51.4%) had hydrophilic IOL implantation and 201 eyes had PCS (31.4%) and 606 patients (48.6%) had hydrophobic IOL implantation and 46 eyes had PCS (7.6%), P = 0.04. Three and more striae were seen in 119 eyes (119/641, 18.6%) in hydrophilic group and 4 eyes (4/606, 0.66%) in hydrophobic group. Sixty-two eyes (62/201, 30.9%) in hydrophilic group with multiple PCS were reported with persistent striae after 6 months of surgery. Two eyes in hydrophobic group had persistent striae even after 3 years of follow-up. Evaluation of PCO score of the hydrophilic group was 0.6 whereas of the hydrophobic group was 0.1 (P = 0.04). Ten patients of the hydrophilic group only required neodymium-doped yttrium aluminum garnet (ND: YAG) laser capsulotomy. CONCLUSION: The incidence of PCS was higher in hydrophilic than hydrophobic IOLs. Multiple PCS persisting in patients beyond 6 months after operation should be followed up for early development of PCO, particularly in patients implanted with hydrophilic IOL.