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Introduction: Intermittent exotropia (IXT) is commonly seen in areas with more sunlight, females and Asians. Surgical alignment is recommended to improve binocular function, but a high recurrence rate has been reported. This study aimed to assess the stability of ocular alignment and factors contributing to exodrift post-surgery for IXT over 6-month follow-up. Methods: We retrospectively reviewed the medical records of patients with IXT who underwent unilateral recess resect procedures and attended follow-up examinations for at least six months post-surgery. A significant exodrift was defined as exodrift of more than 10PD at distance and near. Ocular deviation, binocularity, and stereopsis at one and six-month post-operative visits were studied to assess the incidence of exodrift post-surgery and the probable factors causing such drift. Results: Of the 50 patients studied, 26 (52%) were males, 42 (84%) were <20 years. The median age at surgery was 10 years (range 6-14), and the median preoperative angle of deviation was 37 PD. Majority of patients (62%) had exodrift within six months of surgery, and about a quarter of the study population had significant exodrift >10 PD. No clinical factors were found to contribute significantly to exodrift in this study.16 (61.5%) patients attained near and distance BSV post-surgery (p-value: <0.001). Six (12%) and 10 (20%) patients with subnormal near and distance stereopsis, respectively, attained normal stereopsis post-surgery. Conclusion: Over half of the patients operated for IXT had some Exodrift, and one-fourth had significant exodrift within six months post-surgery. Despite improved BSV, many patients failed to attain normal stereopsis with just motor alignment.
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PURPOSE: To contribute evidence about the effectiveness of dichoptic therapy in patients with mild to moderate amblyopia. METHODS: A retrospective study was conducted in patients enrolled for dichoptic therapy on the Bynocs AmblyGo platform (Kanohi Eye Pvt Ltd) from January to August 2023. Data collected included logarithm of the minimum angle of resolution best corrected visual acuity, anterior and posterior segment examination, fixation pattern, dynamic and cycloplegic refraction, orthoptic evaluation, and number of dichoptic therapy sessions. Visual acuity, binocularity, and stereopsis before and after therapy were analyzed. RESULTS: Of 59 patients (median age: 11 years, range: 5 to 30 years) enrolled, 34 (57.6%) had anisometropic amblyopia, 12 (20.3%) had ametropic amblyopia, 10 (17.0%) had strabismic amblyopia, and 3 (5.1%) had deprivation amblyopia. All 6 (10.2%) and 15 (22.4%) patients who had no binocular single vision for near and distance before therapy, respectively, attained normal binocular single vision on completion, except one who suppressed at distance. Twenty-one (75.0%) had improved near stereopsis, and 21 (60.0%) had improved distance stereopsis. Of 74 eyes treated, 61 (82.4%) had improved visual acuity and 73 (98.6%) improved in at least one tested parameter. A majority of these eyes had residual amblyopia after occlusion therapy. CONCLUSIONS: Dichoptic therapy improves visual acuity, binocularity, and stereoacuity in patients with amblyopia, including those older than 8 years, especially in partial deprivation, ametropic, and anisometropic amblyopia. {J Pediatr Ophthalmol Strabismus. 20XX;XX(X):XX-XX.].
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This article reports a novel surgical technique in the management of soft posterior polar cataracts. This technique avoids hydro procedures, trenching, and chopping. Viscodissection is avoided or minimal, and polar opacity is removed last. These modifications minimize the risk of intraoperative complications.
Subject(s)
Cataract , Phacoemulsification , Humans , Phacoemulsification/methods , Visual AcuityABSTRACT
Background: Pupil distortion and aphakia are common complications that follow blunt injury of the eye globe, surgical complications, and iris coloboma. Patients with these two complications complain of severe glare and photophobia even after successful intraocular lens (IOL) implantation like scleral fixation of intraocular lens (SFIOL) due to irregular pupil. To overcome this, we prefer to do pupilloplasty along with IOL implantation. Purpose: In this video, we demonstrate iris fixation of IOL using four-throw pupilloplasty; thus with one surgical technique, both pupilloplasty and iris fixation are done. Synopsis: The technique of an IOL implantation without capsular support can be challenging. There are different techniques, such as iris claw, iris fixation, and scleral fixation. Permanent mydriasis or distorted pupil can be a disabling condition, even after successful vision gain, due to photophobia. So pupilloplasty is nowadays preferred along with IOL implantation. Usually after IOL implantation, iris cerclage or pupilloplasty is done. We combined both steps with one technique: iris fixation with four-throw pupilloplasty. This technique can be used for iris coloboma with weak zonules and surgical iridectomy with aphakia cases where the pupil is irregular. Highlights: The video highlights the steps of four-throw pupilloplasty technique which is also used for fixating the IOL to the iris (iris fixation). This can give an excellent outcome in aphakia with distorted pupil using a single technique approach. Video Link: https://youtu.be/TEa54A5kg2I.
Subject(s)
Aphakia , Coloboma , Iris Diseases , Lenses, Intraocular , Humans , Aphakia/surgery , Coloboma/surgery , Iris Diseases/surgery , Lens Implantation, Intraocular/methods , Photophobia , Sclera/surgeryABSTRACT
Purpose: To analyze the hesitancy and motivational factors related to coronavirus disease 2019 (COVID-19) vaccination among patients visiting for eye care. Methods: A telephonic survey was conducted using validated questionnaires consisting of 36 questions in five sections from July 1 to July 31, 2021. Patients visiting six tertiary centers and one secondary center of our eye hospitals were interviewed over their phones, and their responses were entered onto the Google forms. The responses were recorded as demographics, health status, awareness about vaccination, factors contributing to hesitancy or acceptance to vaccinate, and general perception about the vaccine. Results: A total of 5033 patients were surveyed. The mean age was 49.0 ± 14.2 years. A total of 563 (11.2%) patients gave a history of symptoms or were tested positive for COVID-19; 2225 (44.2%) patients were already COVID-19 vaccinated. Around 2883 (56%) patients were aware of getting infection despite vaccination, and 4092 (81.3%) perceived vaccination should be compulsory. The main reason for vaccination hesitancy was the fear of side effects (n = 487, 17.3%). The fear of getting infected was the most common reason for vaccination (n = 911, 40.9%). Factors associated with a lower proportion of vaccinated individuals included younger age (P < 0.001), female gender (P < 0.001), lower education (P < 0.001), lower income (P < 0.001), and rural residence (P = 0.33). Conclusion: Creating awareness about the minor side effects and reassurance can allay an individual's fears. The fear associated with the rapid spread of infection and associated mortality needs to be utilized to increase vaccination acceptance. A targeted approach toward groups with poor uptake of vaccination is necessary.
Subject(s)
COVID-19 , Vaccines , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Female , Health Knowledge, Attitudes, Practice , Hospitals , Humans , Middle Aged , Patient Acceptance of Health Care , Surveys and Questionnaires , VaccinationABSTRACT
The authors describe a novel technique of performing retinoscopy assisted with a smartphone (gimbalscope). We found this technique of digital retinoscopy to be useful for demonstrating and documenting retinoscopic reflexes and in addition as an easy teaching tool. This technical report explains the assembly of our smartphone-assisted retinoscope and provides examples of the range of normal and abnormal reflexes that can be captured.
Subject(s)
Retinoscopes , Retinoscopy , Humans , Refraction, Ocular , SmartphoneABSTRACT
This case series describes the ocular and retinal manifestations of rare eye diseases in systemic syndromes. This observational case series consists of five patients with varied ophthalmic manifestations and documentation of imaging in rare pediatric and adult retinopathies. Two patients had Kearns Sayre syndrome (KSS) based on the classical triad of external ophthalmoplegia, pigmentary retinopathy, and onset before 20 years of age. In one patient of KSS, the mitochondrial retinopathy was seen in an asymmetric pattern, and the second patient presented with KSS after being mis-diagnosed as myasthenia gravis elsewhere. A case of Senior Loken syndrome in pediatric age is described in this series with varied ophthalmic manifestations ranging from retinitis pigmentosa to orbital abscess. This series also enlightens features of Hallervorden Spatz syndrome presenting with bull's eye maculopathy and a case of spino-cerebellar ataxia type 7 presenting with pigmentary retinopathy.
Subject(s)
Kearns-Sayre Syndrome , Ophthalmoplegia , Retinal Diseases , Retinitis Pigmentosa , Adult , Child , Face , Humans , Kearns-Sayre Syndrome/complications , Kearns-Sayre Syndrome/diagnosis , Rare Diseases , Retinal Diseases/diagnosis , Retinal Diseases/etiology , Retinitis Pigmentosa/diagnosisABSTRACT
The emergence of smartphone-based imaging devices has been a boon in the field of ophthalmology, especially in obtaining high-quality ocular images. They can be specialized and utilized for imaging-specific regions of the eye. Among the multitude of applications of smartphone-based imaging, one of the upcoming major use is to image the microbiological world. Previous few reports have described attaching magnifying lenses of various types to the smartphone camera and transforming it into a microscope for imaging fungal hyphae and ocular surface parasites. We describe a novel technique of attaching the smartphone-based intraocular lens microscope (IOLSCOPE) to the slit lamp, thereby utilizing the slit lamp joystick for moving the smartphone over the concerned slide specimen to make it steady and obtain images of high resolution. This innovative do-it-yourself novel modification is especially useful in peripheral centers, vision centers, and local clinics for immediate screening and identification of microbial pathogens such as fungi and ocular surface parasites.
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Lenses, Intraocular , Slit Lamp , Humans , Microscopy , Slit Lamp Microscopy , SmartphoneABSTRACT
Phacoemulsification is routinely performed with the patient lying supine on the surgical table with his or her head flat and facing the overhead microscope. This routine technique can be a challenge in medical conditions such as kyphosis, scoliosis, orthopnea, Meniere's disease, and CNS abnormality. Some cardiovascular and respiratory conditions make the patients breathless when they lie down, whereas other neurological and spinal problem patients are also equally uncomfortable. The only reasonable solution to conduct surgery on a patient who cannot lie down flat on the operating table is to position them face to face in a sitting position. We describe an innovative phacoemulsification technique in a sitting position called "phacosit" in an 80-year-old wheelchair-bound female patient who was denied cataract surgery by other eye surgeons owing to her medical condition.
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Cataract , Phacoemulsification , Aged, 80 and over , Cataract/complications , Female , Humans , Lens Implantation, Intraocular/methods , Male , Patient Positioning/methods , Phacoemulsification/methods , Sitting PositionABSTRACT
ABSTRACT: Demodex is an important pathogen causing eyelid and eyelash diseases. This article describes a quick, efficient, cost-effective office-based imaging of demodex with the help of an intraocular lens (IOL) and smartphone-aided innovated tool. Eyelid photography of a 56-year-old man with suspected demodex infestation was obtained using a 20-diopter (D) IOL over the smartphone camera called as Anterior Segment Photography using IOL (ASPI). A video or photograph of the epilated eyelash was taken using four 30-D IOLs attached to the smartphone camera to form an optical system called IOLSCOPE, which clearly detected the demodex parasite. The importance of ASPI and IOLSCOPE for the rapid office-based diagnosis of demodex pathogen in peripheral health centers devoid of slitlamp and microscopes has been emphasized here.
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Eyelashes , Lenses, Intraocular , Eyelashes/parasitology , Humans , Male , Middle Aged , Photography , Slit Lamp Microscopy , SmartphoneABSTRACT
PURPOSE: To report the outcomes of sutureless intrascleral fixation of a 3-piece intraocular lens in the ciliary sulcus, in a large cohort of patients with aphakia of various aetiology METHODS: Retrospective, non-comparative, single centre interventional study of 250 aphakic eyes of various causes, which underwent sutureless and glueless intrascleral fixation of 3-piece intraocular lens (IOL). All patients were required to have at least 3 months of follow up post procedure to be included in the study. Anatomical and functional outcomes obtained were statistically analysed for significance. RESULTS: A total of 250 eyes of 246 patients were included in the study population. The average age was 56.5 years ± 16.4 (range 6-86 years). The mean best-corrected visual acuity (BCVA) significantly improved from 0.74 ± 0.6 logMAR (approx. Snellen equivalent 20/110) to 0.48 ± 0.36 logMAR (approx. Snellen equivalent 20/60), (p < 0.001) following surgery. Early postoperative complication (<2 weeks) included hypotony (n = 10, 4%), ocular hypertension (n = 38,15.2%) and vitreous haemorrhage (n = 50, 20%). Late complications included retinal detachment (n = 14, 5.6%%), cystoid macular oedema (n = 24, 9.6%), scleral erosion (n = 1, 0.4%), haptic extrusion to subconjunctival space (n = 3, 1.2%) and IOL subluxation or dislocation (n = 5, 2%) CONCLUSION: This cost-effective and easier technique of sutureless scleral fixated 3-piece IOL implantation provided good visual acuity outcomes in a large cohort of patients and was well tolerated.
Subject(s)
Aphakia, Postcataract , Lenses, Intraocular , Humans , Child , Adolescent , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Lens Implantation, Intraocular/methods , Aphakia, Postcataract/etiology , Retrospective Studies , Lenses, Intraocular/adverse effects , Sclera/surgeryABSTRACT
PURPOSE: We aimed to study the success of prism in regard to diplopia resolution score and associated factors in patients presenting with symptomatic diplopia arising from various etiologies. METHODS: In this descriptive, retrospective study diplopia resolution among 31 patients who were prescribed prism were analyzed. RESULTS: Fifty-four patients were evaluated for diplopia and 31 were included for the study done over 3 years. The mean follow-up was 15 months. Esotropia, exotropia, and hypertropia were seen in 39%, 51%, and 19.4% of patients, respectively. Furthermore, 71% received Fresnel prism and 29% were given ground glass prism. The mean prism power prescribed was 13.3 PD. 87% had complete resolution of diplopia; 96.8% continued usage of prism. High success rates were seen among patients with decompensated strabismus, sixth and fourth nerve palsy. Horizontal prism and oblique prism in the form of Fresnel prism yielded complete resolution of diplopia (P = 0.028). There was no association between the success of prism and etiology (P 0.058), history of trauma (P = 0.212), and type of deviation (P = 0.387). The study showed that oblique Fresnel prism can be considered for combined deviation. CONCLUSION: Our study showed prism to be effective in alleviating diplopia over a varied range of etiologies.
Subject(s)
Esotropia , Strabismus , Trochlear Nerve Diseases , Diplopia/diagnosis , Diplopia/etiology , Diplopia/therapy , Esotropia/complications , Humans , Oculomotor Muscles , Retrospective Studies , Strabismus/complications , Strabismus/therapy , Vision, Binocular/physiologyABSTRACT
PURPOSE: To evaluate the use of smartphone-based innovative tools named Anterior segment photography with intraocular lens (ASPI) and smartphone based intraocular lens microscope (IOLSCOPE) to demonstrate, treat, and diagnose the patients of ophthalmomyiasis caused by Oestrus ovis. METHODS: A retrospective interventional case series of six patients infested with O. ovis presenting in a rural health center with symptoms of burning, itching, watering, and foreign body sensation diagnosed with ophthalmomyiasis. Diagnosis and treatment were performed using an innovative imaging technique that is, an optical system formed by intraocular lens (IOL) and smartphone. RESULTS: The smartphone-based ASPI clearly detected and removed the moving larvae from the ocular surface, followed by microbiological diagnosis of O.ovis larvae with the help of an IOLSCOPE. CONCLUSION: The importance of ASPI and IOLSCOPE for the management of ophthalmomyiasis in peripheral health centers devoid of slitlamp and microscopes has been emphasized here.
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Eye Diseases , Smartphone , Animals , Humans , Retrospective Studies , Sheep , Slit Lamp , Slit Lamp MicroscopyABSTRACT
A 59-year old man with very large exotropia and bilateral limitation of adduction, underwent bilateral true muscle transplantation, involving the sutured transfer of resected segment of medial rectus (MR) onto the distal end of lateral rectus (LR), prior to recession of the thus elongated LR muscle. Following this he was left with mild residual exotropia and improved adduction, which has remained stable for 6 months following surgery.
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Exotropia , Exotropia/surgery , Follow-Up Studies , Humans , Male , Middle Aged , Oculomotor Muscles/surgery , Ophthalmologic Surgical Procedures , Retrospective Studies , Treatment Outcome , Vision, BinocularABSTRACT
Surgical skill of the surgeon can be improved by surgical simulation. Especially in ophthalmology, it is impossible to use real human/non-human primate eyes for ophthalmology surgery practice. However, surgical practice is most important for ophthalmologist. The retina laser surgery is one of the ophthalmology surgeries and it requires more surgical practice for surgeons to use the laser beam precisely to coagulate and fuse small areas of tissue. Dealing with the prospect of vision reduction or vision loss presents a peculiar problem and that can be highly stressful and frustrating for both doctors and patients. In this regard, training for indirect ophthalmoscopy and retinal photocoagulation is undergone using model eyes instead of real eyes. Properties and functioning of an existing model eye are huge and they differ from real human eye such as casings are completely rigid and focusing of retinal fundus is not completely covered. Therefore, this research concentrates to develop a model eye that assimilates close to the human eye by focussing on the maximum viewing area that is not done at the moment. Finally, the design and development of re-engineered model eye for retina laser is fabricated by additive manufacturing. Compared to existing plastic model eye, viewing area and viewing angle of the re-engineered model eye is increased by 16.66% and 6.14%, respectively. Due to design modifications and elimination of the insert, it can be reduced by 18.99% and 13.95% of height and weight of the top casing respectively. Developed re-engineered model eye will improve the surgical and diagnostic skill of the surgeon and increase their confidence and proficiency. It also augments the effective use of essential ophthalmic instruments. Additionally, it can reduce the surgical error and meet the existing demand of actual eyes for surgical practices.
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Ophthalmology , Retina , Animals , Humans , Lasers , Light , Retina/surgeryABSTRACT
We wish to assess effectiveness of using topical anesthesia without sedation in single-stage adjustable strabismus surgery (SSASS). Sixteen consecutive adults with diplopia and those willing to undergo SSASS, participated in a prospective study between September 2018-August 2019. They underwent detailed ophthalmic evaluation, ocular alignment measurement by prism cover test (PCT), and sensory evaluation. Subsequently they underwent SSASS under topical anesthesia (2% lidocaine gel). Surgery was performed using conventional technique; ocular alignment was then reassessed in sitting position by alternate cover test using prisms, for which with Snellen's chart was used as distance target and Lang's fixation stick as near target. Absence of diplopia was considered the end point of measurement. Any adjustment, if required, was performed intraoperatively, after recleaning the operative area with povidone iodine and redraping the eye. Participants were reassessed 1 day, 1 month, and 3-month after procedure, ocular deviation, and presence or absence of diplopia was documented. Fifteen males and one female patient participated in the study. Mean age of the study population was 31.29 years (range 19-65 years). Of these, 62.5% of patients required intraoperative modification of planned surgical dose. Patients with esotropia, vertical deviations, and combined deviations obtained surgical success, which remained stable till 3-month review. Patients with exotropia had initial surgical success rates of 100% immediately following surgery (day 1 postoperative evaluation), but it decreased to 83.33% and 66.67% during one and 3-months follow-up visits. In this study all patients tolerated the procedure well, without systemic adverse occurrence, including vasovagal reflex and without the need for additional anesthesia. SSASS is a good option in patients with diplopia and variable ocular deviations. Topical anesthesia allows intraoperative adjustment of surgical dosing, with aim of orthophoria or relief from diplopia, leading to satisfactory results. Postoperative drift may occur in exotropia. Case selection and preoperative counseling are necessary for cooperation during surgery, under topical anesthesia.