Keratoconus in Asian eyes at a tertiary eye care facility.

BACKGROUND: The purpose of this study was to assess the demographic variables, age at diagnosis, keratometry and slitlamp signs in keratoconus. METHODS: Thirty-one patients with 61 keratoconic eyes were selected provided they met one of two criteria: 1. They had an irregular corneal surface, Vogt's striae, Fleischer's ring or apical sub-epithelial corneal scarring characteristic of keratoconus; 2. Corneal topography revealed an average simulated keratometry of more than 45.2 D, central corneal power higher than 47.2 D or infero-superior asymmetry greater than 1.4 D. The main outcome measures were demographic variables, age at diagnosis, disease severity on keratometry and biomicroscopic signs. RESULTS: The patients' mean age at presentation was 20.2 +/- 6.4 years. Based on average keratometry values, 67.2 per cent of eyes had severe and 32.8 per cent had moderate keratoconus. Eyes with severe keratoconus presented at a younger average age (18.8 +/- 5.35 years) than moderate keratoconus (23.69 +/- 8.07 years). Thirty-eight eyes (92.5 per cent) with severe and 13 eyes (65 per cent) with moderate keratoconus demonstrated biomicroscopic signs of keratoconus. Twenty eyes (32.7 per cent) demonstrated apical sub-epithelial cornea scarring and 95 per cent of these eyes had severe keratoconus. CONCLUSIONS: The majority of keratoconic eyes in Asian-Indian patients demonstrate the severe stage of the disease by the second decade.

Neural network approach to classify infective keratitis.

PURPOSE: Infective keratitis is a major sight-threatening condition in developing countries like India. An early diagnosis of infective keratitis is critical to its treatment. Epidemiological trends, morphological features of corneal ulceration and presence of other risk factors often dictate choice of initial treatment. This work assesses the usefulness of classification of infective keratitis by artificial neural network (ANN). METHODS: Forty input variables from each of the sixty-three known bacterial or fungal ulcers provided the basis for training a three layer feed-forward neural network. The trained neural network classified another set of forty-three corneal ulcers. RESULTS: Trained artificial neural network could classify correctly all sixty-three cornea ulcers in the training set. In the test set, the artificial neural network correctly classified 39 out of 43 cornea ulcers. Specificity for bacterial and fungal categories was 76.47% and 100% respectively. Accuracy of classification by neural network was 90.7% and compared significantly better than clinicians' prediction of 62.8% (p < 0.01). CONCLUSION: ANN has the potential to help clinicians classify corneal ulcers more accurately.

Anterior and posterior capsulorhexis in pediatric cataract surgery with or without trypan blue dye: randomized prospective clinical study.

PURPOSE: To evaluate the clinical efficacy of trypan blue 0.1% dye (Blurhex) in creating a complete anterior and posterior capsulorhexis during pediatric cataract surgery. SETTING: Tertiary eyecare center, Postgraduate Institute of Medical Education and Research, Chandigarh, India. METHODS: In a prospective randomized study, an anterior (ACCC) and posterior (PCCC) continuous curvilinear capsulorhexis were performed in pediatric patients. In Group 1 (n = 19), the ACCC and PCCC were created without use of trypan blue dye. In Group 2 (n = 23), intracameral trypan blue dye was used to stain the anterior and posterior capsules. RESULTS: In Group 1, 14 eyes (73.6%) had a complete ACCC and 10 (52.6%) had a complete PCCC. In Group 2, 21 eyes (91.3%) had a complete ACCC and 19 (82.6%) had a complete PCCC. CONCLUSION: In cases of pediatric cataract, staining the anterior and posterior capsules with trypan blue 0.1% allowed recognition of capsule flaps and facilitated the creation of complete ACCCs and PCCCs.

Phacoemulsification and intraocular lens implantation in an Alport's syndrome patient with bilateral anterior and posterior lenticonus.

We report a case of intraocular lens (IOL) implantation with a continuous curvilinear capsulorhexis and phacoemulsification in a 30-year-old man manifesting anterior and posterior lenticonus. The surgery was uneventful and on follow-up, the IOL was well centered in the bag.

Indications and outcome of optical partial thickness lamellar keratoplasty.

PURPOSE: To review the indications and outcome of optical partial thickness lamellar keratoplasty (LKP) over a 22-year period. METHODS: The study is a retrospective review of 138 eyes of 126 patients. Snellen visual acuity, preoperative clinical condition, and postoperative clinical status were assessed. RESULTS: Postoperative follow-up ranged from 1 month to 174 months (average, 34.5). In descending order of frequency, climatic droplet keratopathy, infectious keratitis scar, and band-shaped keratopathy were the most common indications for surgery. Follow-up records were available for 130 eyes; 93% of grafts remained transparent. One hundred eyes (80%) preoperative measured Snellen acuity of 6/60 or less. Postoperatively, only 20 eyes (13.4%) were assessed as worse than 6/60. Mean best-corrected visual acuity postoperative was 0.58 +/- 0.24. Twenty-two eyes (16.9%) demonstrated postoperative visual acuity of better than 6/12. Complications included presumed rejection in two eyes, nonhealing epithelial defect in two eyes, and graft infection in seven eyes. CONCLUSION: Vision gain following LKP is generally moderate (visual acuity, 6/18-6/12) in the majority of eyes (61.5%). Vision-threatening complications are low (6.9%). There is scope for reducing complications like postoperative infections and improving visual gain through deep lamellar keratoplasty.