Genetic association of IL1B gene variants with primary glaucoma in a North Indian Punjabi cohort: An original study and meta-analysis.

Interleukin (IL) 1B is an important candidate gene in glaucoma pathogenesis as it affects the survival of retinal ganglion cells (RGCs). In the present study, -511T/C and +3953C/T polymorphisms in the IL1B were assessed as genetic risk factors for primary open angle (POAG) and angle closure glaucoma (PACG) in a North Indian Punjabi cohort comprising 867 samples (POAG cases = 307; PACG cases = 133 and controls = 427). Genetic association, diplotype and linkage disequilibrium (LD) analyses were performed. Corrections for confounding variables and multiple testing were applied. An updated meta-analysis was also performed. Pooled OR with 95% CI was calculated for dominant, over dominant, and recessive models. Level of heterozygosity among studies was tested using I2 statistic with fixed or random effect model based on the extent of heterogeneity. For -511T > C polymorphism, a positive association was observed with PACG under dominant (p = 0.038; OR = 0.65; pcorr = 0.011; OR = 0.55) and over dominant models (p = 0.010; OR = 0.59; pcorr = 0.001; OR = 0.46). Significant association of +3953C > T was also observed with POAG under dominant (p = 0.011; OR = 1.46; pcorr = 0.018; OR = 1.48) and PACG under recessive models (p < 0.0001; OR = 4.47; pcorr<0.0001; OR = 4.06). While C-C diplotype provided protection against primary glaucoma (0.67-fold; p = 0.0004), T-T and T-C diplotypes predisposed individuals to higher risk (1.31-fold; p = 0.030 and 1.36-fold; p = 0.022 respectively). In meta-analysis, a significant association between +3453 C>T and POAG was observed under dominant (pooled OR = 1.33, p = 0.0046) and over dominant (pooled OR = 1.25; p = 0.0269) models with overall heterogeneity of 15% and 0% respectively. The study provides strong evidence of IL1B variants in modifying genetic susceptibility to primary glaucoma in the targeted North Indian Punjabi population. Replication of the present findings in other populations, and functional studies are warranted to further assess the relevance of IL1B variants in the pathogenesis of primary glaucoma.

Suggestive evidence of genetic association of -572G > C polymorphism with primary open angle glaucoma in a North Indian Punjabi population.

BACKGROUND: IL6 is an important candidate gene implicated in the pathogenesis of glaucoma. The present study assessed the genetic association of -174G > C and -572G > C polymorphisms in the IL6 promoter region with primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) in a north Indian Punjabi cohort. METHODS: 910 subjects (313 POAG, 148 PACG cases and 449 controls) were recruited. Genotyping was done by TaqMan assays. Genetic association was tested under different genetic models using Plink. Diplotype and linkage disequilibrium (LD) analysis was done through Haploview. Association of clinical parameters with the genotypes was assessed by one-way ANOVA. Adjustment for potential confounding variables was done by binary logistic regression. IL6 levels were measured in POAG patients and controls. RESULTS: 572G > C variant showed marginal difference in genotype frequency between pooled cases and POAG subgroup with respect to controls (p = 0.042; OR = 1.33; and p = 0.041; OR = 1.37). The GC genotype conferred 1.37-fold protection under codominant model in POAG cases (p = 0.034, OR = 1.37, 95% CI = 1.02-1.85; pcorr = 0.025, OR = 1.45, 95% CI = 1.04-2.02). The mean value for IOP was elevated among cases having 'CC' genotype at the -572G > C locus (p = 0.037). Lower levels of IL6 were detected in POAG patients in plasma samples (p = 0.0001). CONCLUSION: The study reports suggestive evidence for -572G > C variant in IL6 in affecting genetic susceptibility to POAG in the targeted North Indian Punjabi cohort. A correlation of IL6 levels in aqueous humor (AH) and systemic circulation in POAG was observed, the functional and diagnostic relevance of which may be further investigated.

Association of TGFB -509C>T promoter polymorphism with primary angle closure glaucoma in a North Indian Punjabi cohort.

PURPOSE: Transforming growth factor beta (TGFB) is an important candidate gene implicated in glaucoma pathogenesis because it affects retinal ganglionic cell survival. The present study assessed the genetic association of -509C > T variant in the TGFB promoter region with primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) in a North Indian Punjabi population. METHOD: A total of 867 subjects (307 POAG, 133 PACG cases and 427 controls) were recruited from the targeted population. Genotyping was done by PCR-RFLP method and the data was analyzed using PLINK software (v1.07). Logistic regression under different genetic models was applied and genotype phenotype correlation was assessed by one-way ANOVA. RESULT: A statistically significant difference in the frequency of heterozygotes among PACG cases (53.16%) and controls (30.07%) (p = 0.0002) was observed. Genetic model analysis revealed that mutant "TT" genotype conferred 2-fold risk towards PACG development under recessive model (p = 0.0019) while dominant model and co-dominant model provided 0.62 and 0.37 fold protection against PACG (p = 0.025 and p = 0.0001, respectively). Data segregation based on sex revealed a strong protective effect of heterozygous 'CT' genotype against progression of PACG among females (p = 0.002, OR = 0.37, 95% CI = 0.19-0.70), but conferred 2.14-fold risk among female POAG subjects (p = 0.013). CONCLUSION: The study revealed a strong genetic association of -509C > T variant in TGFB with PACG in females. There is a need to replicate the results in a larger PACG cohort in other populations and further assess the contribution of sex specific factors in modifying genetic susceptibility to PACG.

Genetic association between CDKN2B/CDKN2B-AS1 gene polymorphisms with primary glaucoma in a North Indian cohort: an original study and an updated meta-analysis.

BACKGROUND: Variants in CDKN2B/CDKN2B-AS1 have been reported to modulate glaucoma risk in several GWAS across different populations. CDKN2B/CDKN2A encodes tumor suppressor proteins p16INK4A/p15INK4B which influences cell proliferation/senescence in RGCs, the degeneration of which is a risk factor for glaucoma. CDKN2B-AS1 codes a long non-coding RNA in antisense direction and is involved in influencing nearby CDKN2A/CDKN2B via regulatory mechanisms. METHODS: Current study investigated four SNPs (rs2157719, rs3217992, rs4977756, rs1063192) of aforementioned genes in a case-control study in a North Indian cohort. Genotyping was done with Taqman chemistry. In addition, an updated meta-analysis was performed. RESULTS: Two SNPs, rs3217992 and rs2157719 were found to be significantly associated with the disease. The frequency of 'T' allele of rs3217992 was significantly lower in cases (POAG/PACG) [p = 0.045; OR = 0.80(CI = 0.65-0.99) and p = 0.024; OR = 0.73(CI = 0.55-0.96)], respectively than in controls. Genetic model analysis revealed that TT + CT genotype confers 0.73-fold protection against POAG [p = 0.047; OR = 0.73(CI = 0.54-0.99)] and trend assumed additive model gives 0.53 times higher protection against PACG progression. However the association of rs3217992 with POAG and PACG did not remain significant after Bonferroni correction. For rs2157719, the 'C' allele was found to be less prevalent among cases (POAG/PACG) with respect to controls. Cochran Armitage trend test assuming additive model revealed 0.77 and 0.64-fold protection against POAG and PACG respectively. Bonferroni correction (pcorr = 0.003) was applied and the association of rs2157719 remained significant in PACG cases but not among POAG cases (p = 0.024). The 'CC' genotype also confers protection against primary glaucoma (POAG/PACG) among males and female subjects. The frequency rs1063192 and rs4977756 did not vary significantly among subjects, however the haplotype 'CATA' was found to be associated with increased glaucoma risk. An updated meta-analysis conducted on pooled studies on POAG cases and controls revealed significant association between rs1063192, rs2157719, rs4977756 and POAG except rs3217992. CONCLUSION: The study concludes significant association between INK4 variants and primary glaucoma in the targeted North Indian Punjabi cohort. We believe that deep-sequencing of INK4 locus may help in identifying novel variants modifying susceptibility to glaucoma. Functional studies can further delineate the role of CDKN2B and CDKN2B-AS1 in primary glaucoma for therapeutic intervention.

Slit lamp examination during COVID-19: Where should the protective barrier be?

PURPOSE: The aim of this study was to describe a poly-vinyl chloride air condition (PVC AC) curtain shield placed at the intervening space between the chin rest and the illuminating and optical arm of the slit lamp microscope (distal barrier) instead of the present position at the oculars (proximal barrier) to guard against severe acute respiratory syndrome Coronavirus 2. This experimental study was done to validate and compare the protection offered by the conventional breath shields and the one described by us in a simulated environment. METHODS: In this experimental study, 12 puffs of fine mist were sprayed over a period of 1 minute using "magenta-colored dye" and "cyan-colored dye" for analyzing proximal barrier and distal barrier respectively. To access the amount of contamination of the slit lamp, caused by sprayed "magenta" and "cyan" colored dye, we covered the entire slit lamp with appropriately sized white-colored cotton sheet. The stained sheets were individually photographed and then the images were first cropped, then color threshold adjusted and then converted to binary and finally fraction of surface area stained was calculated using the ImageJ software. (Pn Surface Area magenta fraction (%) during analysis of "proximal barrier" and Pn Surface Area cyan fraction (%) during the analysis of "distal barrier", where Pn refers to various parts of slit lamp. RESULTS: The entire surface area of the cloth covering the slit lamp was 9912.45 cm2. The surface area of the cloth which was stained when using the "proximal barrier" was 567.50 cm2 whereas when using the "distal barrier" was 222.93 cm2. When using proximal barrier, 97.71% of the staining was present on the slit lamp base, viewing arm, illumination arm and the pivot of the slit lamp. While using the distal breath shield no parts of the viewing arm, illumination arm, the pivot or the mechanical base with joystick were stained. CONCLUSION: The novel PVC AC curtain shield provides better barrier against the simulated contaminated stream of patient's breath directed towards the working parts of the slit lamp as compared to conventional slit lamp oculars mounted breath shields.

Genetic association of -1562C>T polymorphism in the MMP9 gene with primary glaucoma in a north Indian population.

MMP (Matrix metalloproteinase) 9 is reported to affect glaucoma pathogenesis by altering intraocular pressure (IOP) through its role in remodeling the extracellular matrix (ECM) in the trabecular meshwork. A genetic variant at the promoter region in the MMP9 gene (-1562C>T) has a putative role in regulating its transcription rate and hence can affect genetic predisposition to primary glaucoma. The present study examined the association of -1562C>T promoter polymorphism in the MMP9 gene with Primary Open Angle Glaucoma (POAG) and Primary Angle Closure Glaucoma (PACG) in a north Indian population. A total of 729 subjects (POAG = 224, PACG = 138 and 367 controls) were recruited for the study. Genotyping for the promoter sequence variant was done with PCR-RFLP method. Genotypic and allelic frequency distribution of the POAG and PACG data sets were compared to that of controls by chi-square test and genetic association was tested under different genetic models as implemented under PLINK. Statistically significant difference was observed in the genotype frequencies between PACG cases and controls (p = 0.030). However, in the POAG cases, this difference was only borderline (p = 0.052). Genetic model analysis, under the dominant model revealed 1.6 and 1.4 fold increased susceptibility to PACG and POAG (p = 0.012, p = 0.032) respectively. A higher frequency of CT genotype was observed in PACG as well as POAG males as compared to female subjects. According to the dominant model, CT+TT genotype conferred 1.8 fold higher risk of developing PACG among male patients as compared to the control group (p = 0.048, OR = 1.87;1.00-3.50). Current findings suggest significant association of MMP9 -1562C>T polymorphism with primary glaucoma in the targeted north Indian population and warrant further replication of the findings in other populations.

Comparison of surgeon comfort assessment during phacoemulsification using bilateral topical anesthesia versus ipsilateral topical anesthesia: a randomized controlled study.

AIM: To evaluate the effectiveness of bilateral use of topical anesthetic eye drops during phacoemulsification procedure as compared to use in one eye only. METHODS: This is a prospective double-blind randomized case study of 180 cases undergoing phacoemulsification under topical anesthesia using 0.5% proparacaine: Group 1 consisting of patients who had topical anesthetic eye drop instilled into the operating eye only and Group 2 consisting of patients who had both their eyes anesthetized using topical anesthetic eye drops. Phacoemulsification was done using standard surgical technique. Main parameters evaluated included number of intra-operative patient counseling score (IPCS), surgical comfort score (SCS), total phacoemulsification procedure time (TPPT) and total operation time (TOPT). RESULTS: A comparison of mean value of various variables between Group 1 (60; 33.3% cases) and Group 2 (120; 66.7% cases) using "t" test revealed that there was a statistically significant difference for mean SCS (78.38 ± 10.31 vs. 85.05 ± 8.70; p = 0.00), mean IPCS (12.60 ± 3.11 vs. 6.63 ± 1.74; p = 0.00) and mean TOPT (418.88 ± 89.59 vs. 341.64 ± 79.51; p = 0.00), respectively. However, no statistically significant difference existed for mean TPPT (143.57 ± 87.96 vs. 152.96 ± 78.99; p = 0.48). CONCLUSION: Simultaneous instillation of topical anesthetic eye drops in both the eyes, i.e., operating eye and the fellow eye as against practice of instilling topical anesthetic eye drop in the operating eye only, helps in decreasing the total surgical time by primarily shortening the durations of pre- and post-ultrasonic periods of surgery where effective globe stabilization is wanted. This is achieved by better patient compliance, which in turn enhances surgeon's comfort during phacoemulsification surgery.

Penetrating keratoplasty for perforated corneal ulcers under topical anesthesia.

PURPOSE: To evaluate the structural and functional outcomes of eyes with perforated corneal ulcers undergoing penetrating keratoplasty (PKP) under topical anesthesia. METHODS: A prospective analysis of 17 consecutive cases that underwent PKP under topical anesthesia, where infiltrative anesthesia was contraindicated or general anesthesia could not be given for medical reasons or was not available for logistical reasons. RESULTS: Seventeen eyes of 15 patients with a mean age of 47.3 ± 16.2 years underwent a PKP for treating perforated corneal ulcers under topical anesthesia. Perforation involved the pupillary zone in 13 (76.5%) cases. Preoperatively, 8 patients (47.1%) were phakic, 8 (47.1%) were pseudophakic, and 1 (5.9%) was aphakic. The PKP was completed successfully in all the eyes. An anterior capsular tear occurred in 3 eyes (17.6%). A posterior chamber intraocular implant was put in 1 eye, and 2 eyes were found to be aphakic. The patients reported mild to moderate discomfort and tolerated the procedure well. At the final follow-up, 10 patients had clear grafts (58.8%), and 7 patients (41.2%) had partially clear grafts. The best-corrected visual acuity was better than 6/18 in 10 eyes and between 6/60 and 6/24 in 7 eyes. CONCLUSIONS: PKP can be performed successfully under topical anesthesia in cooperative patients who have perforated corneal ulcers.

Iris-fixated intraocular lens implantation to correct moderate to high myopia in Asian-Indian eyes: five-year results.

PURPOSE: To evaluate the efficacy, safety, predictability, and stability of iris-fixated phakic intraocular lenses (pIOLs) to correct high myopia in an Asian-Indian population. SETTING: Tertiary eyecare center. DESIGN: Interventional case series. METHODS: Eyes with myopia from -5.5 to -24.0 diopters (D) had pIOL implantation and were examined postoperatively at 1 day, 1 week, 1, 3, and 6 months, and yearly for 5 years. Parameters evaluated were postoperative uncorrected (UDVA) and corrected (CDVA) distance visual acuities, predictability, efficacy, stability of mean spherical equivalent (SE), and endothelial cell loss. RESULTS: The study enrolled 85 eyes (44 patients). The mean CDVA improved from 6/10 preoperatively to 6/7 postoperatively and the mean UDVA, from 6/319 to 6/9. Postoperatively, the mean SE was -0.63 ± 0.55 D. Of the 51 eyes completing a 4-year follow-up; 19 (37.3%) had a mean SE of 0.50 D or less and 37 (72.5%) had a mean SE of 1.00 D or less. The CDVA improved 1 line or more in 35 eyes (68.6%); 14 eyes (27.5%) had postoperative CDVA similar to the preoperative CDVA. At 4 years, the safety index was 1.46 and the efficacy index, 0.96. Thirty-six eyes (70.6%) had a postoperative UDVA better than the preoperative CDVA. The mean endothelial cell loss at 1, 3, 6, 12, 24, 36, and 48 months was 4.3%, 5.7%, 7.1%, 7.6%, 8.7%, 9.2%, 11.07%, and 12.4% respectively. Twenty eyes (23.5%) had reenclavation for spontaneous or traumatic disenclavation. CONCLUSION: Postsurgical refractive outcomes of iris-fixated pIOL implantation for myopia were fairly predictable and stable in an Asian-Indian population. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Structural and functional salvaging of eyes with anterior staphyloma using cyclodialysis with penetrating keratoplasty.

PURPOSE: To evaluate the efficacy of a novel technique of anterior segment reconstruction and cyclodialysis in patients with anterior staphyloma. METHODS: A prospective case series of 8 consecutive patients who underwent anterior segment restoration with penetrating keratoplasty and cyclodialysis was analyzed. The main parameters evaluated were structural success of the graft, improvement in visual acuity, and intraocular pressure. RESULTS: The globe could be salvaged in all the cases, and 75% (6 of 8) of the cases had clear graft at 6-month follow-up. Best-corrected visual acuity (BCVA) ranged from hand motion close to face to 6/12. None of the patients developed glaucoma during the follow-up period. CONCLUSIONS: Intraoperative creation of a cyclodialysis cleft can aid in adequate postoperative intraocular pressure (IOP) control and hence decrease the likelihood of graft failure because of raised IOP in eyes predisposed to development of postkeratoplasty glaucoma.

Intrascleral reverse pocket approach of transconjunctival transscleral sulcus fixation of intraocular lens in eyes with ocular trauma.

PURPOSE: To evaluate the efficacy of a novel technique of intrascleral reverse pocket approach of transconjunctival transscleral (TC-TS) sulcus fixation of intraocular lens (IOL) implants in posttraumatic eyes. METHOD: A prospective case series of 12 patients who had ocular trauma underwent TC-TS fixation of intraocular implants (including posterior chamber IOLs, rigid or foldable and capsular tension ring) were examined for any intraoperative complications, postoperative best-corrected visual acuity (BCVA), status of conjunctiva, and other potential complications. RESULTS: Twelve eyes of 12 patients (8 men and 4 women) with a mean follow-up of 14.5±7.25 months were included in the analysis. In no case was any intraoperative deroofing of the tunnel or buttonholing of the conjunctiva performed. The mean final BCVA (in Snellen Equivalent [SE]) showed significant improvement from preoperative levels (0.48±0.29 SE vs. 0.65±0.19 SE, respectively; P=0.049). One case showed a single line drop in the BCVA at final follow-up. Another case had a dispersed vitreous hemorrhage in the immediate postoperative period that cleared in 3 weeks' time. One eye demonstrated a clinically detectable IOL tilt, which was corrected by astigmatic prescription in the spectacle glass. None of the cases exhibited postoperative suture knot erosion or breakage of polypropylene sutures until the last follow-up. CONCLUSIONS: The technique of intrascleral reverse pocket approach of TC-TS fixation is a successful method of sulcus fixation, which can obviate the need for conjunctival peritomy, thus helping in salvaging the conjunctiva for any future trabeculectomy in posttraumatic eyes predisposed to developing glaucoma.

Ultrasound biomicroscopy-guided assessment of acute corneal hydrops.

OBJECTIVE: To analyze the morphologic features of acute hydrops and treatment success using ultrasound biomicroscopy (UBM). DESIGN: Prospective interventional case series. PARTICIPANTS: Fourteen patients (14 eyes) affected by keratoconus with acute corneal hydrops. INTERVENTION: Patients with acute hydrops were treated with intracameral injection of 0.15 ml of 14% perfluoropropane (C3F8) gas. MAIN OUTCOME MEASURES: The parameters evaluated on UBM included the location and length of the Descemet's membrane (DM) tear and corneal thickness at the central corneal thickness at the area overlying the DM tear (CT0), corneal thickness 2.5 mm from the central point (CT2.5), and peripheral corneal thickness 2.0 mm from the scleral spur toward the corneal side (CT(P)). The ratio of CT2.5 to CT0 was calculated to obtain the hydrops resolving index (HyRI). RESULTS: The DM tear was visualized with UBM in all cases and slit-lamp microscopy in 9 of 14 eyes. The mean length of DM tears at presentation was 1.74 ± 0.77 µm. Patients with zone 3 corneal edema had a longer DM tear compared with patients with zone 2 corneal edema (1.27 ± 0.55 vs 2.02 ± 0.79 µm, respectively, P = 0.09). Significant positive correlations were seen between DM tear length and CT2.5 and CT(p) (r = 0.790, P = 0.020 and r = 0.766, P = 0.027, respectively). An intracameral gas bubble was seen abutting the edges of the tear in all cases. At the 6-week follow-up, the apposition of the DM and the overlying stroma occurred in all eyes, and resolution of epithelial edema and intrastromal cysts were seen in 11 of 13 cases (84.6%) and 12 of 13 cases (92.3%). The mean values of CT0, CT2.5, and CT(p) at presentation were 2359.69 ± 582.26 µm, 1911.15 ± 502.60 µm, and 1156.46 ± 275.77 µm, respectively, which decreased to 398.15 ± 31.65 µm (P = 0.0), 453.46 ± 68.45 µm (P = 0.0), and 638.00 ± 62.17 µm (P = 0.0), respectively. The mean HyRI showed a significant increase from 0.80 ± 0.05 at the time of presentation to 1.13 ± 0.12 (P = 0.03) at 3 months follow-up. CONCLUSIONS: Ultrasound biomicroscopy is a useful tool for quantitative and qualitative study of the morphologic features of acute hydrops. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Spontaneous wound dehiscence after early suture removal after deep anterior lamellar keratoplasty.

PURPOSE: To describe a case of spontaneous wound dehiscence (WD) after complete suture removal in a patient with macular dystrophy who underwent deep anterior lamellar keratoplasty (DALK). METHODS: A 47-year-old man with macular corneal dystrophy underwent DALK. Intraoperative Descemet membrane perforation was noted. The postoperative period was complicated by corneal edema and high astigmatism. Videokeratography-guided suture removal was carried out, and all sutures were removed by the end of 5 months after which the patient developed spontaneous 270° WD within 6 days. Visual acuity at the time of presentation in the affected eye was counting fingers, anterior chamber was formed, and intraocular pressure was normal. The wound was resutured with 17 interrupted sutures using 10-0 monofilament nylon under topical anesthesia. RESULTS: Three months after resuturing, the best-corrected visual acuity was 6/9, and the graft-host junction was well apposed. CONCLUSIONS: A spontaneous WD can be seen after complete removal of nonabsorbable suture during early months after DALK. Timely management can give good visual results.

Descemet membrane detachment during foldable intraocular lens implantation.

PURPOSE: Descemet membrane detachment (DMD) during phacoemulsification is a well-known complication. Although most of the DMDs resolve on their own, some may require surgical intervention in the form of intracameral injection of air or isoexpansive gas. We report the occurrence and subsequent management of a patient with DMD caused by the leading haptic of a foldable intraocular lens (IOL) during its insertion. METHODS: A 50-year-old woman underwent coaxial phacoemulsification for age-related cataract in her right eye. Descemet membrane detachment was noted during the insertion of the foldable posterior chamber IOL through a temporal 2.2-mm incision. Corneal edema did not resolve by the third postoperative day. Scheimpflug photography demonstrated a complete separation between the posterior stroma and DM along the entirety of the cornea. Surgical intervention was performed on the fourth postoperative day, which involved creation of stab incisions into the pre-Descemet space along with intracameral air injection. RESULTS: Successful apposition of the DM followed by clearing of corneal edema was observed within 1 week. CONCLUSIONS: Our case report highlights the potential complication of DM detachment during insertion of foldable IOL. We performed stab incisions in the pre-DM space to achieve quick and successful repositioning of the detached DM with favorable results.

Impact of early rise of intraocular pressure on visual outcome following diabetic vitrectomy.

OBJECTIVE: The objective was to study the incidence and risk factors for an early rise in intraocular pressure (IOP) following pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) and to correlate its impact on visual outcome. MATERIALS AND METHODS: This was a longitudinal prospective study. IOP and best corrected visual acuity (BCVA) for 73 cases of PDR (52 males and 21 females) who underwent PPV were recorded at day 1, week 1, and months 1, 3, and 6. Risk factors for the early IOP rise, defined as IOP ≥ 30 mmHg at day 1, were evaluated using cross-tabulation and the t-test. RESULTS: Mean IOP at day 1 was 21.8 ± 9.8 mmHg with 15 cases (20.5%) having an early rise in IOP. Risk factors for the early IOP rise included intraoperative fibrovascular frond removal (P = 0.003), lens removal (P = 0.043), and intraoperative vitreous bleed (P = 0.008). The early rise in IOP was also associated with consistently raised IOP (P = 0.02), defined as IOP > 21 mmHg during first three consecutive follow-up visits. Further, difference in BCVA at 6 months among the two groups, i.e., with and without an early IOP rise was statistically significant (3.11 ± 1.52 logMAR vs. 2.11 ± 1.49 logMAR; P = 0.025). CONCLUSION: An early rise in IOP is a significant risk factor which compromises the visual outcome of patients undergoing diabetic vitrectomy.

Outcomes of reenclavation of subluxated iris-fixated phakic intraocular lenses: comparison with primary surgery outcomes.

PURPOSE: To study the outcomes of successful reenclavation of subluxated iris-fixated phakic intraocular lenses (pIOLs). SETTING: Tertiary eyecare referral center. METHODS: Interventional case series comprised eyes with a subluxated Verisyse pIOL that had successful reenclavation of 1 haptic. A comparison of outcomes between primary pIOL implantation surgery and subsequent reenclavation was performed. The parameters were uncorrected (UDVA) and corrected (CDVA) distance visual acuity and the quantitative endothelial changes preoperatively and postoperatively at 1 week and 1, 3, and 6 months. RESULTS: Nine eyes of 6 patients were evaluated. Disenclavation was spontaneous in 6 eyes (66.6%) and posttraumatic in 3 eyes (33.3%). The mean UDVA and CDVA at 6 months were comparable between primary surgery and reenclavation. The subluxation and subsequent reenclavation did not cause statistically significant endothelial cell loss; endothelial cell loss after reenclavation was comparable to that after primary surgery (P = .953). CONCLUSION: Successful subluxation of iris-fixated pIOLs did not cause significant damage to the ocular structures or lead to serious complications.