Seroprevalence, risk associations, and cost analysis of screening for viral infections among patients of cataract surgery.

PURPOSE: The purpose of this study was to estimate the prevalence of blood-borne viral infections (triple H: HBV-hepatitis B virus, HCV-hepatitis C virus, and HIV-human immunodeficiency virus) among cataract patients, sought possible risk associations and discuss feasibility of universal preoperative screening. METHODS: This prospective, cross-sectional study enrolled consecutive patients of senile cataract. They were screened by immunoassay-based rapid diagnostic card tests for blood-borne viral infections. Positive cases were confirmed with confirmatory ELISA tests. Seropositive patients were enquired about the exposure to possible risk associations for acquiring these infections. Cost of card test per patient was calculated. RESULTS: The prevalence of seropositivity for triple H viral infections (HBV, HCV, and HIV) among patients of senile cataract was 5.9% (95% confidence interval [CI]: 5.3-6.6), and HCV was most common viral infection. The dental extraction was most common (54%; 95% CI:48-60) possible risk association. The total cost of primary screening per patient for triple H infections(HBV, HCV, and HIV) was $0.93. CONCLUSION: The prevalence of blood-borne viral infection among cataract patients is high in this area. Awareness of the prevalence of blood-borne viral infections in service area, along with knowledge of rate of accidental exposure and risk of transmission would help to understand cost-effectiveness of universal preoperative screening before cataract surgery.

Development of computerized color vision testing as a replacement for Martin Lantern.

BACKGROUND: Development and standardization of computerized color vision testing as a replacement for Martin Lantern test. Non-randomized comparative trial. METHODS: All candidates of SSB, Allahabad, reporting for SMB underwent color vision testing at the eye dept by computerized eye test and currently available tests. RESULTS: All candidates were subjected to Ishihara chart testing and those found to be CP III were subjected to the confirmatory test on Martin Lantern and the Software. Candidates requiring CP I standards for eligibility were tested on the same on Martin Lantern and on the new software method. On comparison between the Standard Martin Lantern and the Software, the results were consistent and comparable with 82 patients testing CP I on the Martin Lantern and 81 on the software. Of the CP III patients, 253 tested positive on the Standard lantern test as compared to 251 on the software and of the CP IV group, 147 tested positive on the Standard lantern and 149 by the software method. CONCLUSION: It was found that the software replicated the existing Martin Lantern accurately and consistently. The Martin Lantern Software can be used as a replacement for existing old Lanterns which are not in production since the early 20th century.

Comparison of Phaconit Rollable IOL with Acrylic Foldable IOL.

BACKGROUND: Phaconit or ultra micro incision phacoemulsification cataract surgery involves phacoemulsification through a 0.9 millimetre sleeveless phaco tip and irrigating chopper followed by implantation of a rollable intraocular lens. The procedure leads to negligible astigmatism and faster visual recovery as compared to phacoemulsification with a foldable intraocular lens. METHODS: This prospective study analysed 80 cases of sub millimetre phaconit surgery with implantation of rollable intraocular lenses(IOL) in 40 cases and acrylic foldable IOL in the remaining 40 cases. Evaluation of efficacy and adaptability of procedure, equipment settings, operative constraints, postoperative complications, keratometric and topographic evaluation of induced astigmatism with visual outcome and patient's rehabilitation were studied. RESULTS: The intraoperative complications were surge/ chamber collapse in 16 (20%), iris chaffing in one and corneal burns in two cases. All cases had an induced astigmatism of less than or equal to ± 0.25 D in four to six weeks after rollable IOL and ± 0.5 D to ± 0.75 D after acrylic IOL implantation. All patients had best-corrected visual acuity of 6/6 by third post operative day. CONCLUSION: Phaconit with rollable IOL is a perfect blend of surgical skill, application of technology and ultra thin IOL.

Manual Small Incision Cataract Surgery: Experience at a Military Hospital.

BACKGROUND: Small incision cataract surgery came into practice with the advent of phacoemulsification. However, manual small incision cataract surgery (SICS) is a useful alternative for those who do not have access to phacoemulsification machine. METHOD: A total of 69 cases of cataract were undertaken for manual incision cataract surgery and intra ocular lens (IOL) implantation using 6mm straight incision. The surgical technique and postoperative results are compared with the results of phacoemulsification and IOL implantation. RESULT: Average postoperative astigmatism was ± 0.75 dioptres. Postoperative uncorrected visual acuity (UCVA) of 6/18 or better was observed in 51(71.9%) cases after first week of the surgery. CONCLUSION: The study concludes that both phacoemulsification and small incision cataract surgery with intraocular lens (IOL) implantation are effective methods. However SICS with IOL implantation is a useful alternative in the absence of phacoemulsification machine.

AC/PC Intraocular Lens Exchange with Penetrating Keratoplasty in Pseudophakic Bullous Keratopathy.

BACKGROUND: Evaluation of penetrating keratoplasty in cases of pseudophakic bullous keratopathy with AC/PC IOL exchange. METHODS: This retrospective study included 120 cases of pseudophakic bullous keratopathy managed over 9 years at three tertiary care eye centres followed up for 4 years. Cases were taken up for penetrating keratoplasty along within adjuvant procedures like IOL explantation and Secondary Posterior Chamber IOL implantation over the frill of posterior capsule. RESULTS: Lens exchange with Penetrating Keratoplasty (PK) was done in 93 and PK without lens exchange in 27 cases. 25% required systemic steroids for 2-3 weeks. Re-grafting was performed in 5% and 85% attained moderate visual acuity. CONCLUSION: Intra ocular lens exchange and Posterior chamber IOL are suitable for penetrating keratoplasty in terms of optical clarity, graft survival and visual outcome.

Phacotrabeculectomy Versus Conventional Combined Technique in Coexisting Glaucoma and Cataract.

BACKGROUND: To evaluate and compare efficacy and outcome after single site phacotrabeculectomy and conventional combined surgery in cases of coexisting primary open angle glaucoma and cataract. METHODS: This prospective study on fifty patients of concurrent primary open angle glaucoma and cataract, who had undergone combined surgery as single site phacotrabeculectomy or conventional single site trabeculectomy with extracapsular lens extraction with IOL implantation in 25 cases each. Evaluation was based on operative and postoperative complications, control of IOP and visual outcome. The follow up period ranged between twelve months to eighteen months. RESULTS: The mean medically controlled preoperative intraocular pressure was 22 mm of Hg (Range 18 to 35 mm of Hg) by applanation method of tonometry. The range of postoperative intra-ocular pressure after one year was 11 to 22 mm of Hg in first and 14 to 26 mm Hg in second group. Failure to maintain optimum postoperative IOP without Beta-blocker was more frequent after conventional combined procedure. There was no significant difference in incidence and pattern of postoperative complications. CONCLUSION: Phacotrabeculectomy provides effective and sustained visual recovery and adequate control of intraocular pressure as compare to conventional combined procedure.

PENETRATING KERATOPLASTY IN HIGH RISK CASES.

Penetrating Keratoplasty in high risk cases like paediatric patients, complicated cases of pseudophakic bullous keratopathy, or in patients with highly vascularized corneal opacities have been a challenge for opthalmologists because of the poor outcome. 101 patients with such high risk indications underwent penetrating keratoplasty. Some of them also underwent concurrent procedures like PC IOL implantation or vitrectomy. The patients' follow up period ranged from six months to four years. The results were evaluated. Good quality donor material, good intraoperative tissue handling, aggressive and meticulous postoperative management contributed to gratifying results. However chemical injuries and patients with dry eyes continued to have a bad prognosis and keratoplasty in these cases proved to be unrewarding.

MANAGEMENT OF CONCURRENT GLAUCOMA AND CATARACT BY PHACOTRABECULECTOMY TECHNIQUE: AN EFFECTIVE ALTERNATIVE APPROACH.

30 cases of open angle glaucoma with cataract who underwent phacoemulsification, PMMA phaco profile IOL implantation and trabeculectomy through same incision were critically evaluated. The mean controlled, preoperative intra ocular pressure was 20 mm of Hg (range 18 to 35 mm of Hg) by aplanation method. Mean post operative pressure after 12 months was 13 mm of Hg (range 11 to 22 mm of Hg) intra operative hyphaema, post operative uveitis were noted problems. Periodic, post operative optic disc and field evaluation remained static in 66% cases. Visual acuity of 6/12 or better was achieved in 60% cases. Failure to restore glaucoma control without medication was seen in 13.3% cases after 9-12 months. The combined phacotrabeculectomy is an effective single step technique of managing concurrent glaucoma with cataract.

Management of anterior segment penetrating injuries with traumatic cataract by Pentagon approach in paediatric age group: constraints and outcome.

PURPOSE: To evaluate the efficacy of multiple combined procedure (Pentagon approach) as single-step secondary repair in cases of extensive keratolenticular trauma in paediatric age group. METHODS: Retrospective evaluation of 18 patients of penetrating injuries with sclerokeratolenticular trauma, who underwent multiple procedure as single-step secondary repair by a single team of two surgeons during a 4 year period. Surgical procedure included reconstruction of anterior segment, synechiolysis, excision of membrane, lensectomy, open sky vitrectomy, PC IOL implantation over frill and penetrating keratoplasty. Meticulous antiamblyopia measures were applied in all cases. RESULTS: Extensive vasoproliferative membrane, complicated cataract and anterior vitreous condensation were significant intra-operative hurdles. Moderate uveitis, secondary glaucoma, persistent epithelial defects were problems noted. Eleven (61.22%) patients attained good visual outcome. Regrafting was required in remaining cases due to delayed graft failure. CONCLUSION: Despite being a highly complex technique, Pentagon approach provides effective management profile in terms of graft success and functional outcome, especially in keratolenticular trauma, in children.

RETINAL VASCULITIS and ITS MANAGEMENT IN SERVING SOLDIERS - LONG TERM FOLLOW UP STUDY.

200 eyes of 110 male serving military personnel showing retinal vasculitis in various stages were managed with institution of steroids, ATT, photocoagulation, cryoablation and vitreo retinal surgery as indicated in a span of 78 months. 156 eyes showing evidence of vasoproliferation responded favourably to laser photocoagulation. Over all 80% of the patients showed good functional recovery with combined modalities of management thereby obviating recurrent morbidity and invalidation in trained combatant manpower in wage earning age group. Cases with complicated retinal vasculitis had to be treated in a sophisticated retina centre having facilities for Fluorescein angiography, laser and vitreo-retinal surgery.

OUR EXPERIENCE WITH LASER PHOTOCOAGULATION IN DIABETIC MACULAR OEDEMA.

Diabetic macular oedema, focal or diffuse, is primarily responsible for visual loss in cases of diabetic retinopathy. When to start photocoagulation in such cases has often been debatable. Over a 3 year period, 80 eyes of 80 patients were subjected to argon green macular grid photocoagulation in a randomized clinical study keeping the other eye (80 eyes) as controls in patients with diabetic macular oedema. It was observed that in 5 per cent of such eyes the vision did improve while in 6.3 per cent of patients deterioration of vision was present as compared to 16.3 per cent in control group. It is concluded that laser photocoagulation has a definite role in arresting the progression of diabetic maculopathy and early intervention should be resorted to in case of clinically significant macular oedema.

OUR EXPERIENCE OF IOL IMPLANTATION IN PAEDIATRIC AGE GROUP.

Forty eyes of 35 patients in paediatric age group suffering from congenital/traumatic cataracts were operated. Posterior chamber intra ocular lens (PC IOL) implantation was carried out and followed for four years. Twenty one eyes (52.5%) showed visual recovery of 6/18 or better. Forward thrust was the commonest per operative complication. Uveitis and pupillary distortion were the common post operative complications. PC IOL implantation appears to be safe and promising procedure.

OUR EXPERIENCE IN PC IOL IMPLANTATION IN CASES OF POSTERIOR CAPSULAR BREAKS.

We implanted posterior chamber intra ocular lenses (PC IOL) in 107 eyes with posterior capsular breaks. Left over posterior capsular frill at the periphery was used to hold and support the PC IOL. After a median follow up of 2.5 years, 96.9% of the patients who developed per operative posterior capsular break and 67.56% who had pre-existing capsular breaks achieved 6/12 or better visual acuity. Remaining 32.44% of the patients with pre-existing capsular break due to previous surgical intervention or trauma achieved 6/18 or worse visual acuity.