Visual axis opacification after pediatric cataract surgery - An analysis of morphology and etiology

PURPOSE

To investigate the morphological types and delineate the clinical and surgical variables associated with VAO in children undergoing pediatric cataract surgery.

METHODS

We included 33 eyes of 28 children who developed clinically significant visual axis opacification (VAO) after congenital or developmental cataract surgery. All eyes underwent a comprehensive examination under anesthesia followed by a membranectomy to clear the visual axis. We classified VAO into three subgroups: fibrotic, proliferative, and combined morphologies. We reviewed and analyzed the retrospective data and the findings during membranectomy to identify the etiological variables associated with various morphologies of VAO.

RESULTS

The median age at primary surgery was 7 (2-96) months. The median interval from primary surgery to the first documentation of VAO was 6 (1-22) months. Younger children developed VAO sooner than older children. VAO was fibrotic in 11 eyes (33%), proliferative in 18 eyes (54.5%), and combined in four eyes (12.12%). Most children with fibrotic VAO belonged to economically disadvantaged sections of society (P = 0.04).

CONCLUSION

Lower age at primary surgery was the predominant risk factor for the development of VAO. Besides primary posterior capsulotomy and adequate anterior vitrectomy, a strict adherence to anti- inflammatory measures and follow up in necessary to prevent the occurrence of VAO. A close follow-up facilitates early detection and management, which can prevent the onset of visually impairing amblyopia.

Bimanual phacoemulsification for subluxated cataractous lens

Bimanual phacoemulsification has been established as a safe and efficacious means of nuclear emulsification in the past. This case report presents the use of this technique in a man in his early forties, who had subluxated cataractous lenses in both eyes. The technique allowed for effective nuclear emulsification within a closed chamber, providing better control over intraocular events. The report emphasizes the safety and effectiveness of bimanual phacoemulsification in cataract extraction, even in challenging cases like a subluxated lens.

Drying behaviour of nanofluid sessile droplets on self-affine vis-à-vis corrugated nanorough surfaces

In recent years, evaporative self-assembly of sessile droplets has gained considerable attention owing to its wide applicability in many areas. While the phenomenon is well studied for smooth and isotropically rough (self-affine) surfaces, investigations comparing the outcomes on self-affine vis-à-vis corrugated surfaces remains to be done. In this experimental work, we compare the wetting and evaporation dynamics of nano-colloidal microlitre droplets on self-affine and corrugated nanorough surfaces having identical roughnesses and interface properties. The coupled influence of particle size, concentration, and surface structuring has been explored. Differences in wettability and evaporation dynamics are observed, which are explained via the interaction between wetting fluid and anisotropic surface roughness. Our findings exhibit different temporal behaviour of contact radius and angle in the evaporation process of the droplets. Further, the corrugated surface exhibits anisotropic wettability with a monotonic change in droplet shape as evaporation proceeds, finally giving rise to irregular dried patterns. The scaled rim width and crack spacing of the particulate deposits are examined. Our results can inspire fabrication of surfaces that can facilitate direction-dependent droplet motion for specific applications.

A pilot randomized clinical trial comparing muscle transplant versus hang back recession in extra-large angle exotropia

PURPOSE

For extra-large angle exotropia (>60 prism diopters, PD), single-setting surgical alternatives are scarce; frequently, more than two muscle or two eye procedures are indicated. To evaluate the viability of single eye surgery, a current randomized comparative trial is undertaken.

METHODS

Twenty adult patients with extra-large angle exotropia underwent a thorough orthoptic evaluation before being divided into two groups at random. Ten patients in group 1 underwent medial rectus resection (5.5-7.5 mm), followed by transplant-aided lateral rectus recession (effective length: 4-5.5 mm) (9 mm). In group two, ten different patients underwent medial rectus resection (5.5-7 mm), but this time, the lateral rectus recession (9 mm) was aided with a hang-back suture (5-7 mm). The two procedures were compared at baseline and six months post-operatively.

RESULTS

There was no significant difference in the groups' median ages (P = .95). In groups one and two, the median corrections achieved were 81.00 (79.50-85.50) PD and 81.00 (79.75-86.50) PD, respectively. The differences in corrections were statistically insignificant (p = .99). In all patients, abduction limitation was frequently noted in the immediate post-operative period, which improved over time. In each group, there were two patients (>90 prisms) with residual deviation of at least 30 PD, for which the contralateral eyes were operated.

CONCLUSIONS

The hang-back recession was as successful as muscle transplant procedure in correcting 80-90 PD of exotropia with notable clinical benefits and ease.

Anthropometry of deep-set eyes with respect to difficulty in docking during femtosecond laser procedures

Purpose

To identify the facial anthropometric parameters that predict the difficulty during femtosecond (FS) laser.

Methods: This was a

single-center observational study was conducted on participants between the ages 18 and 30 years who were planned for FS-LASIK (femtosecond laser-assisted laser in situ keratomileusis) or SMILE (small incision lenticule extraction) at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India. The front and side-facing images of the participants were analyzed using Image J software to measure different anthropometric parameters. The nasal bridge index, facial convexity, and other parameters were measured. The difficulty faced by the surgeon during docking was recorded for each subject. The data were analyzed on Stata 14.

Results

A total of 97 subjects were included. The mean age was 24 (±7) years. Twenty-three (23.71%) subjects were females while the rest were males. Difficulty in docking was seen in 1 (4.34%) female and 14 (19%) males. The mean nasal bridge index was 92.58 (±4.01) in subjects with deep-set eyes and 89.72 (±4.30) in normal subjects. The mean total facial convexity was 129.28 (±4.24) in deep-set eyes, and 140.23 (±4.74) in normal subjects.

Conclusion

Total facial convexity appeared as the most important feature, with the value being less than 133° in most subjects with unfavorable facial anthropometry.

North India Childhood Cataract Study - The real scenario and causes of surgical delay of pediatric cataract

Purpose:

The study sought to describe the clinical presentation pattern of pediatric cataracts and factors leading to delay in surgery at a tertiary care center in North India.

Methods:

A cross-sectional, interview-based study was conducted from January 2020 to October 2020, that included pediatric patients <12 years, with unilateral or bilateral congenital or developmental cataract. A pre-validated questionnaire was used to record data. The parameters recorded were age at first symptoms, age at diagnosis of cataract, age at surgery, laterality of cataract, first symptom, first family member noticing the abnormality, the morphology of cataract, association of perinatal complications, family history, systemic diseases, and cause (s) of delay in surgery.

Results:

A total of 89 patients were included. The mean age of subjects was 4.75(±3.51) years. A white pupil was the most common symptom (64.04%) and appeared in infancy in 30.3% of cases. Parents first detected the problem in 60.67%, and the pediatrician was the first medical contact in 11.23% of cases. The median (IQR) delay period between diagnosis of cataract and cataract surgery was 4 (3–6) months, the major causes were long GA waiting (30.33%), and delay due to systemic ill health (14.61%).

Conclusion:

Parental education on cataract detection is recommended to help in the timely detection and hence, improved outcomes of pediatric cataract surgery. Pediatricians, consulted for any systemic illness, have the role of the second most important contact in the detection of pediatric cataract.

Variability in human external ear anthropometry- Anthropological and forensic applications

The human auricle has attracted the attention of forensic scientists since a long for its unique morphological characteristics. In modern times, these unique features can be captured by CCTV cameras, which may be extremely useful during the identification process in a criminal investigation. Unique morphological characteristics such as Darwin's tubercle, shape, and size of the ear, different morphological features of the helix, tragus, lobule, etc. are frequently used in the identification and individualization process. The human ear was not only accessi-ble for its morphological and morphometric variations, but also its existing bilateral, sex, and population differences. The present study was conducted on 140 individuals (71 males and 69 females) aged between 18 and 30 years. The data were collected from the colleges of Nahan city of Sirmaur district in Himachal Pradesh state of North India. Various anthropometric measurements were taken independently on the left and right ear of each individual with the help of a pair of sliding calipers using a standard method. These linear measurements were physiognomic ear length, physiognomic ear breadth, ear length above tragus, distance from tragus to antihelix, distance from tragus to the helix, lobule height, and lobule width. Auricular index, lobular index, and lobular ear index were calculated from the aforementioned measurements. Further, an independent t-test/ Mann Witney U test and paired sample t-test/ Wilcoxon Signed Rank test were applied for the evaluation of sex differences and bilateral differences in the human ear, respectively. For the prediction of sexual dimorphism, discriminant function analysis was applied. Physiognomic ear length, physiognomic ear breadth, ear length above tragus, distances from tragus to antihelix (left ear only), and tragus to helix exhibited significant sex differences on both sides (p<0.05). Significant bilateral differences (p<0.05) were reported for all the measurements of the ear in males except for lobule height, whereas, significant side differences (p<0.05) were shown for ear length above tragus, distance from tragus to helix, and lobule width among females. The discriminant function model showed 82.10% accuracy for determining sexual dimorphism. The study highlighted sexual dimorphism and bilateral differences in ear morphometry in a north Indian population and provided a database of anthropometric variables in the human ear for forensic and anthropological uses.

Technique of re-enclavation of post-traumatic disenclaved haptic of posterior iris claw lens in a vitrectomised eye

A 58-year-old woman presented to us with sudden onset diminution of vision for 10 days following trauma while using mobile phone. Patient had a history of posterior iris claw implantation 3 years ago. On examination, the patient was aphakic and intraocular lens (IOL) was seen enclaved on nasal side and disenclaved on temporal side on ultrasound biomicroscopy. Patient underwent surgery for re-enclavation of temporal haptic by lifting the IOL using 23-gauge pars plana trocar. Patient had a postoperative uncorrected visual acuity of 6/9 and best-corrected visual acuity of 6/6 with refraction. Re-enclavation of partially disenclaved posterior iris claw lens is a minimally invasive technique to restore visual acuity in such cases.

Elucidating intraoperative dynamics and safety in posterior polar cataract with intraoperative OCT-guided phacoemulsification

PURPOSE

To evaluate morphological characteristics and intraoperative dynamics of posterior polar cataract (PPC) using intraoperative optical coherence tomography (iOCT).

SETTING

Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

DESIGN

Prospective interventional study.

METHODS

Forty eyes with PPC undergoing phacoemulsification were evaluated. Primary outcome measure was morphology of PPC and intraoperative dynamics of posterior capsule (PC). Secondary outcome measure was PC rent, which was retrospectively compared with 72 PPC cases that underwent non-iOCT-guided surgery.

RESULTS

Of the 40 eyes evaluated, 3 morphological variants of PPC were observed: type I (19/40 [47.5%]) characterized by intact PC and clearance between PC and opacity, type II (12/40 [30%]) with intact PC in periphery of opacity, shadowing, and inability to detect PC in the center, and type III (9/40 [22.5%]) with dense opacity, extensive shadowing, and inability to delineate PC. In addition to hydrodelineation, hydrodissection was performed in all cases of type I PPC. In types II and III PPC, only hydrodelineation was performed. No case with type I opacity developed PC dehiscence. Three cases (7.5%) with types II (1 eye) and III (2 eyes) PPC developed PC dehiscence during aspiration of epinuclear cushion. Intraocular lens was implanted in all cases in the bag or sulcus. There was no significant difference in PC dehiscence between iOCT-guided and non-iOCT-guided surgery (P = .7).

CONCLUSIONS

iOCT-guided surgery helps to elucidate intraoperative dynamics in PPC and assess real-time PC integrity. It characterizes high-risk morphological features, enables safe hydrodissection in a subset of PPC, but does not decrease the incidence of PC dehiscence.

Optic disc pit with multiquadrant peripapillary retinoschisis and choroidal coloboma

An 18-year-old man presented with decreased vision in the right eye (OD) noticed for 1 month. On examination, OD best-corrected visual acuity was 3/60 and the left eye (OS) was 6/6 with intraocular pressure of 12 mm Hg in both the eyes (OU). OD fundus revealed an inferior optic-disc-pit with macular-retinoschisis and an inferior choroidal coloboma. OS fundus was normal. On swept-source optical coherence tomography (SSOCT) radial scans, peripapillary-retinoschisis was seen not only in the macular region but in all the four quadrants. To the best of our knowledge, no such case has been reported of optic disc pit with multiquadrant peripapillary retinoschisis and choroidal coloboma coexisting in the same eye. SSOCT radial scans can help detect subclinical retinoschisis as in this case.

Heads-up 3D viewing system in rhegmatogenous retinal detachment with proliferative vitreoretinopathy - A prospective randomized trial

Purpose:

To compare the outcomes of vitreoretinal surgery in patients with primary and recurrent rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) on 3 dimensional digitally assisted visualization system (3D-DAVS) and conventional analogue microscope (CAM).

Methods:

68 patients with primary (50) and recurrent (18) RRD with PVR > C1 were included. One group underwent surgery on 3D-DAVS while the other on CAM. The parameters studied included detachment rate, best-corrected visual acuity (BCVA), duration of surgery, mean endo-illumination levels of 23 G (Gauge) micro incision vitrectomy system (MIVS) and microscope and satisfaction of surgeon and observers based on a framed questionnaire. The mean duration of follow up was three months.

Results:

68 eyes of 68 patients with median age 52.5 (range 18–68) years were included. 50 had primary RRD and 18 had recurrent RRD. Detachment rate at the end of three months was comparable in both groups of primary (P > 0.99) and recurrent (P = 0.21) RRD. Mean duration of surgery in minutes for 3D DAVS and CAM group was 61.8 (±22.07) and 58.04 (±12.33), respectively, in primary RRD and 37.22 (±10.27) and 36.55 (±5.92), respectively, in recurrent RRD group. Mean endo-illumination in 3D DAVS (14.5%) group was half of that in CAM (34.17%) group. Surgeon and observer satisfaction scores were significantly higher for 3D DAVS group.

Conclusion:

3D DAVS is a safe and effective modality or performing VR surgery in RRD with PVR. 3D DAVS allows lower endo-illumination levels provides superior surgeon ergonomics and offers better learning opportunities to the trainees.

Femtosecond laser-assisted refractive capsulorhexis - Precise capsulotomy with accurate toric intraocular lens alignment

Femtosecond laser-assisted cataract surgery with refractive capsulorhexis and toric intraocular lens (IOL) implantation was performed in 14 eyes with senile cataract and a preexisting regular corneal astigmatism of 1.5 D or more. Intraoperatively, the accuracy of the capsular rim marks was confirmed using the digital overlay of CALLISTO Eye and Z Align (Carl Zeiss Meditec, Germany). Postoperatively, the mean deviation from target axis of implantation was 2.07° ± 1.49°. Refractive capsulorhexis combines the advantages of a femtosecond laser capsulotomy with a one-step visual guide for intraoperative toric IOL alignment as well as postoperative assessment of rotational stability.

Assessment of sodium status in large ruminants by measuring the sodium-to-potassium ratio in muzzle secretions

OBJECTIVE

To develop a simple diagnostic test to assess sodium status in large ruminants on the basis of the sodium-to-potassium ratio (Na:K) and to determine its relevance.

ANIMALS

7 buffalo heifers and 21 lactating, pregnant, and nonpregnant dairy cows and heifers.

PROCEDURE

Buffalo heifers were subjected in 2 experiments to variable dietary sodium intake or sodium depletion and changes in sodium and potassium concentrations; Na:K was simultaneously monitored in various body fluids to study its value for indicating sodium status. Validity of the muzzle secretion test was assessed.

RESULTS

Muzzle secretion and urinary Na:K and sodium concentration, but not serum electrolyte concentrations, reflected the sodium status of buffalo heifers in response to the widely variable intake of sodium (0.03 to 0.16% of dry matter [DM]). Progressive sodium depletion during an 11-day period, using saliva deprivation caused reciprocal changes in sodium and potassium concentrations in saliva and muzzle secretion, but not in urine. Decreasing urine sodium concentration was associated with decreasing urine potassium concentration. Saliva, urine, and muzzle secretion Na:K closely reflected the degree of sodium deficit.

CONCLUSIONS AND CLINICAL RELEVANCE

Buffaloes or dairy cows maintained on optimal sodium intake had muzzle secretion and urine Na:K > 0.30. Muzzle secretion or urine Na:K < 0.20 or < 0.10, respectively, was indicative of sodium deficiency. Analysis of muzzle secretion Na:K, and to a large extent urine Na:K, may be used as a convenient diagnostic tool to assess sodium status in large ruminants. It has accuracy similar to that of saliva Na:K.