Maximizing surgical safety: Approaches to prevent intraoperative complications in manual small incision cataract surgery (MSICS).

BACKGROUND: In manual small incision cataract surgery (MSICS), the occurrence of intraoperative complications is a recognized concern that can impact both surgical outcomes and patient safety. MSICS is widely practiced as a cost-effective alternative for cataract extraction, especially in resource-limited settings where access to phacoemulsification may be limited. However, it is important to acknowledge that MSICS is not entirely risk-free. Complications during the surgery can arise due to factors such as surgeon experience, surgical technique, instrument handling, and patient-specific anatomical variations. Common complications encountered in MSICS include posterior capsule rupture, corneal burns, iris trauma, wound-related issues, vitreous loss, and anterior chamber hemorrhage. It is crucial for surgeons to have a comprehensive understanding of the background and potential risks associated with these complications. This knowledge allows them to proactively implement preventive strategies, optimize surgical outcomes, and prioritize patient safety during MSICS procedures. Ongoing efforts in the field of cataract surgery aim to improve outcomes by advancing surgical techniques, refining equipment, and enhancing postoperative care. Through research and innovation, the goal is to minimize complications and achieve optimal visual outcomes for individuals undergoing cataract surgery. PURPOSE: This video discusses the possible complications and provides practical strategies to minimize the same at each step of the MSICS procedure. SYNOPSIS: The video demonstrates the potential complications that can occur intraoperatively during MSICS and highlights the significance of careful technique and practical strategies for prevention. HIGHLIGHTS: In resource-poor settings, MSICS is widely used as the predominant technique for cataract surgeries. Despite being a cost-effective alternative, MSICS offers comparable visual outcomes to phacoemulsification with low complication rates. This video emphasizes the importance of proactive measures and careful technique in preventing complications, thereby improving patient safety and outcomes in MSICS. VIDEO LINK: https://youtu.be/hOAMJpC67C0.

Prognostic factors for visual outcome after surgical repair of limbal corneal laceration at a tertiary eye care center in South India.

Purpose: To determine the factors affecting the visual outcome after surgical repair of limbal corneal lacerations at a tertiary eye care center in South India. Methods: A retrospective analysis of patients diagnosed with limbal tears between 2011 and 2021 was conducted. Demographic information such as age, gender, cause of injury, and size of the laceration was recorded. Comprehensive ocular examination was performed, including gentle B scan evaluation whenever not contraindicated for detailed posterior segment evaluation. Only those cases with a minimum follow-up of one year were included. Postoperative best-corrected visual acuity, intraocular pressure (IOP), cornea clarity, and integrity of the wound at last follow-up were noted. Results: Out of the 20 patients, 15 (75%) were males and 5 (25%) were females. The mean age was 42.6 ± 22.4 years. All 20 patients had a penetrating injury, with four (20%) injured by a stick, two (10%) by an iron rod, three (15%) due to road traffic accident (RTA), three (15%) by glass, and eight (40%) with other nonspecific objects [two (10%) with needle, two (10%) with elastic rope, two (10%) with bangle, and two (10%) with metal]. The average time between the injury and the surgery was 48 hours (2 days). Four (20%) patients underwent a second surgery within a week of repair. After limbal tear repair, at final follow-up at 3 years, 7 (35%) had VA worse than 20/800, 3 (15%) had VA between 20/100 and 20/800, and 10 (50%) achieved VA better than 20/80. Conclusion: Preoperative visual acuity (VA), mode of injury, and size of wound affect the final visual outcome after surgical repair of limbal corneal laceration. Preoperative VA and mode of injury were statistically significant even in the multivariate analysis.

Incidence of re-surgery after manual small-incision cataract surgery at a tertiary eye-care center in South India.

Purpose: To study the incidence of re-surgery after manual small-incision cataract surgery (MSICS) at a tertiary eye-care center in South India and to compare the re-surgery rate between trainees and experts. Methods: A retrospective study was conducted at a tertiary eye-care center in Andhra Pradesh state of South India, which included 19,515 patients who underwent MSICS between 2012 and 2022 with 369 eyes of 369 patients who underwent re-surgery within 1 week of primary surgery. Factors included demographic data, type of re-surgery, that is, wound re-suturing, IOL repositioning, cortical wash, as well as anterior chamber (AC) wash. Results: 19,515 eyes from the year 2012-2022 were analyzed. Most of the patients undergoing re-surgery belonged to the age group of 61-70 years (40.3%). Wound re-suturing was the more frequently performed re-surgery (47.6%). Wound re-suturing rates were comparable between the trainees and experts, whereas IOL repositioning, cortical wash, and AC wash were higher in the cases performed by trainees though statistically not significant. Conclusion: Careful pre-operative assessment, training under supervision, and other measures can be taken to reduce the re-surgery rates. Timely diagnosis and early treatment can give better outcomes and prevent devastating complications like endophthalmitis.

Changing trend in the morphology of cataracts at a tertiary eye care centre in South India due to COVID-19-pandemic related national lockdown.

Purpose: To study the changing trends in the morphology of cataracts at a tertiary eye care center in South India due to COVID-19 pandemic-related national lockdown. Methods: A retrospective study conducted at a tertiary eye care center in Andhra Pradesh state of South India, which included 1724 patients (1753 eyes) who underwent cataract surgery at our center during April 2019-July 2019 (1298 eyes of 1271 patients) and April 2020-July 2020 (455 eyes of 453 patients). Factors studied included preoperative lens status, associated phacodonesis or subluxation, pupil size, other eye lens status, associated retinal problems, glaucoma, and complications during surgery. Postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal clarity, intraocular pressure (IOP), and disc status at postoperative day 1, 1 week, and 1-month visits were compared. Results: A significantly lower proportion of nuclear sclerosis (decreased from 83.2% in last year before lockdown to 55.2% during lockdown) and significantly higher proportions of mature, brown, or black cataract and phacomorphic, phacolytic, or Morgagnian cataract (increased from 15.5% in last year before lockdown to 43.8% during lockdown) were observed. The proportion of small-incision cataract surgery decreased significantly (from 63.2% to 57.4%), whereas the proportion of phacoemulsification increased significantly (from 35.9% to 41.5%) during lockdown as compared to last year. A significantly higher proportion of eyes with small pupils and association with retinal pathology were also observed during the lockdown. Conclusion: During the national lockdown, there was a shift from nuclear sclerosis grade toward mature, brown, black grade of cataracts. In addition, the proportion of small-incision cataract surgery decreased significantly whereas the proportion of phacoemulsification increased significantly during the lockdown. More number of cataracts with small pupils and associated retinal pathology were observed during the lockdown.

Penetrating injury of the cornea by a barbed fish hook and its surgical management by "Cut-it out technique".

Fishing is a worldwide pastime enjoyed by millions of people. Ocular fishing injuries though uncommon may cause potentially devastating ocular trauma. We report a rare case of penetrating injury of the cornea by a barbed fish hook and its successful surgical management by "cut-it out technique". We are discussing the various techniques available for removal of fish hooks. The hook can be successfully removed with minimal trauma to ocular structures by understanding the structure of the fish hook and by employing the appropriate method of extraction.

Visual outcomes of sterile corneal infiltrates after photorefractive keratectomy.

PURPOSE: Sterile infiltrates following laser refractive surgery is an uncommon complication. This study was undertaken to analyze the visual outcomes of sterile infiltrates following photorefractive keratectomy (PRK). METHODS: This retrospective study included 14 eyes that developed sterile infiltrates following PRK out of a total of 6280 eyes that underwent PRK between 2014 and 2017. Medical records of these patients, including patient demographics, characteristics of the infiltrate, presenting visual acuity, and treatment outcomes were recorded and analyzed. RESULTS: The incidence of sterile corneal infiltrates post-PRK in our study was 0.22% (14/6280). The mean age of the patients was 27.42 ± 4.87 years. The uncorrected visual acuity (UCVA) at presentation was 0.49 ± 0.13 log MAR units. The mean size of the infiltrate was 3.22 ± 2.85 mm2. All cases were successfully managed medically with topical steroids. The mean UCVA and best-corrected visual acuity (BCVA) at the last follow-up visit were 0.08 ± 0.08 and 0.05 ± 0.07 log MAR units, respectively. The mean time taken for resolution of the infiltrate was 8.91 ± 4.57 days. CONCLUSION: Sterile infiltrates following PRK can be effectively treated with aggressive topical steroids. The outcome is generally favorable and does not require surgical intervention if treatment is instituted early.

Outcomes of rebubbling for graft detachment after Descemet's stripping endothelial keratoplasty or Descemet's stripping automated endothelial keratoplasty.

Purpose: To study the outcomes of rebubbling for graft detachment after Descemet's stripping endothelial keratoplasty (DSEK) or Descemet's stripping automated endothelial keratoplasty (DSAEK). Methods: From 2260 eyes that underwent DSEK or DSAEK from July 2008 to June 2015, 80 eyes of 80 patients developed graft detachment and were retrospectively reviewed. Host-related, surgery-related and donor-related factors that have a bearing on graft adhesion were looked at retrospectively, and eventual outcomes after rebubbling procedure were studied. Results: Successful attachment was observed in 77 (96.25%) eyes and clear grafts were achieved in 55 (68.75%) eyes, while 25 (31.25%) eyes had graft failure. The uncorrected and best-corrected distance visual acuities significantly improved from 1 month to 3 months post-operatively and remained stable till 12 months of follow-up. Three lenticules that failed to attach with the first rebubbling procedure underwent a second rebubbling, two underwent a repeat DSEK with good outcomes and four underwent penetrating keratoplasty. On evaluating possible risk factors for graft failure, lower donor endothelial cell density was found to be a significant factor (P = 0.03). The median graft survival following rebubbling was 30 months. Conclusion: Rebubbling procedure in detached grafts after DSEK or DSAEK can reattach the lenticule in 96% of eyes in immediate post-operative period and the majority of the grafts remained clear on long-term follow-up with a median graft survival period of 2.5 years.

The sting of a honey bee: An unusual subconjunctival foreign body.

Ocular foreign bodies (FBs) are often encountered in clinical practices. However, there are cases in which the presence of the FB is difficult to diagnose based on mere history taking and/or clinical examination. We herein present a case of unusual subconjunctival foreign body in the form of the sting of a honey bee in a 63-year-old farmer. This was removed from the superior forniceal subconjunctival space in toto with forceps under a microscope in the operation theater. This case emphasizes the need to elicit a complete history and a careful ocular examination with double eversion of the eyelid to avoid missing any foreign body lodged in the fornices and subconjunctival space in patients who complained of foreign body sensation.

Visual outcome and complications of various techniques of secondary intraocular lens.

BACKGROUND/AIMS: The purpose of this study was to compare and evaluate the visual outcome and complications of various techniques of secondary intraocular lens (IOL) (i.e., anterior chamber IOL [ACIOL], suture-fixated posterior chamber IOL [PCIOL], and glue-fixated PCIOL). STUDY DESIGN AND SETTING: This was a randomized, prospective, interventional, comparative, clinical trial study. SUBJECTS AND METHODS: Patients of either sex having aphakia and lacking posterior capsular support were included in the study, and patients having corneal or scleral pathology, optic atrophy, uncontrolled glaucoma, retinal detachment, and other retinal pathology were excluded from the study. The patients were divided into three groups after comprehensive ophthalmological examination - Group A (secondary ACIOL) included 44 patients, Group B (secondary scleral-fixated sutured PCIOL) included 32 patients, and Group C (fibrin glue-fixated sutured PCIOL) included 34 patients. RESULTS: A total of 110 patients were included in this study, of which 59 (53.63%) were males and 51 (46.37%) were females. The best-corrected visual acuity (VA) after 6 weeks was in the range of 20/60-20/40 in 36.4% of Group A and 40.6% of Group B patients. In Group C, 52.9% of patients had best-corrected VA in the range of 20/30-20/20. The overall complications were less in glued PCIOL group. CONCLUSION: It can be concluded that fibrin glue-assisted PCIOL implantation provides better visual outcome with minimal complications in eyes with deficient capsular support.