Outcomes of intravitreal anti-VEGF injections and panretinal photocoagulation in preretinal hemorrhage secondary to proliferative diabetic retinopathy involving the fovea

PURPOSE

To evaluate the outcome of intravitreal anti-vascular endothelial growth factor (VEGF) injections and panretinal photocoagulation (PRP) in fovea involving preretinal hemorrhage (PRH) secondary to proliferative diabetic retinopathy (PDR).

METHODS

Retrospective non-comparative cross-sectional series of patients diagnosed with fovea involving PRH secondary to PDR at our institute from March 2019 to October 2021 who were treated with combination treatments of intravitreal anti-VEGF and PRP and have completed a minimum 6-month follow-up. The primary outcome measure was serial changes in the visual acuity (VA) and PRH regression from the fovea. Secondary outcome measures were the quantitative assessment of the size of PRH, its association with VA improvement and time to regression, and the proportion of patients who underwent surgery for poor response.

RESULTS

In total, 22 eyes of 21 patients showed regression of PRH from the foveal center at 33.6 days, and complete regression was seen at 140.7 days. The average number of anti-VEGF injections required for clearance of PRH from the fovea was 1.6. Mean LogMAR visual acuity improved from 0.54 at baseline to 0.32 at 4 weeks and 0.18 at 6 months ( P < 0.01). Three eyes (13.6%) required vitrectomy surgery during follow-up. The mean area of PRH as measured by Image J analysis was 14.78 mm 2 at baseline, 8.97 mm 2 at 4 weeks, and 1.25 mm 2 at 3 months ( P < 0.01). No statistically significant difference was seen between the size of PRH and PRH clearance time and VA improvement. No systemic side effects were observed following the intravitreal injections during follow-up.

CONCLUSION

Intravitreal anti-VEGF injections and PRP were found to be effective and safe treatment methods for fovea involving PRH secondary to PDR. Long-term studies are warranted to assess the long-term efficacy.

Impact of COVID-19-related lockdown on retinal disorders treated with intravitreal injections

PURPOSE

To study functional changes in vision and morphological changes on optical coherence tomography (OCT) scans in patients where intravitreal therapy (IVT) with injections has been delayed due to COVID-19 pandemic lockdown.

METHODS

Retrospective cross-sectional study included 77 eyes with the diagnosis of exudative age-related macular degeneration (eAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO), regularly receiving IVT with anti-vascular endothelial growth factor (Anti-VEGF) injections or dexamethasone implant and were not able to receive the injections as intended due to lockdown. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), and qualitative morphological features on OCT were analyzed pre- and post-therapy break off.

RESULTS

The mean duration of IVT break-off was 57 days. Mean BCVA logarithm of minimum angle of resolution (logMAR) worsened from 0.33 (20/42) to 0.35 (40/44) (P = 0.02) and mean CFT increased from 297.90 μm to 402.16 μm (P < 0.01), from pretherapy break-off to return visit. Worsening of the visual acuity was seen across all the three disease cohorts, significantly more in the eyes with eAMD.

CONCLUSION

Marginal decline in the visual acuity and worsening of the OCT features were observed as a result of delay in the IVT injections of DME, eAMD and RVO patients.

Comparison of wide-field swept source optical coherence tomography angiography and fundus autofluorescence in tubercular serpiginous-like choroiditis

Purpose:

To evaluate the potential clinical utility of wide-field swept source optical coherence tomography angiography (SS-OCTA) using a prototype device compared to a wide-field fundus autofluorescence (FAF) for analysis of the disease activity in eyes with tubercular serpiginous-like choroiditis (TBSLC).

Methods:

Using a prototype SS-OCTA device (PLEX Elite, Carl Zeiss Meditec, Dublin, CA), 17 eyes of 12 consecutive patients with TBSLC were imaged and multiple 12 mm × 12 mm OCTA scans were captured, which were montaged to create wide-field montage OCTA images scans. A wide- FAF (Eidon, CenterVue, Padova, Italy) was performed in the same sitting. Two masked graders independently analyzed OCTA and FAF images for the presence of choroidal lesions, recorded the number of lesions identifiable, and provided a subjective grading for the activity of individual lesion, which were then compared.

Results:

The total number of lesions identified on FAF were 282 (posterior pole lesions, n = 129 and peripheral lesions n = 153) and on wide-field SS-OCTA were 230 (posterior pole lesions, n = 108 and peripheral lesions n = 122). Active choroidal lesions were comparable on the two machines (n = 28 on FAF and n = 28 on SS-OCTA, respectively); whereas numerous healed lesions were identified on FAF (n = 219) as compared to SS-OCTA (n = 170). There was good correlation among the devices for healed lesions (Pearson correlation, r = 0.82) and active lesions (r = 0.88).

Conclusion:

There was good correlation between FAF and wide-field SS-OCTA for detection of disease activity in TBSLC; however, FAF depicted greater number of healed lesions compared to wide-field SS-OCTA.

Quantification of retinal microvasculature and neurodegeneration changes in branch retinal vein occlusion after resolution of cystoid macular edema on optical coherence tomography angiography

Purpose

To compare foveal avascular zone (FAZ) area and circularity, ganglion cell layer (GCL) thickness, retinal perfusion density (PD), and vessel density (VD) in eyes with branch retinal vein occlusion (BRVO) after resolution of cystoid macular edema (CME) to fellow control eyes and to correlate these parameters with visual acuity (VA).

Methods

SD-OCTA scans (Zeiss Angioplex; Carl Zeiss Meditec Version 10) obtained on 32 eyes with BRVO after resolution of the CME with their fellow eyes used as controls were retrospectively evaluated. Parameters analyzed were FAZ size and circularity, PD, and VD in the superficial capillary plexus measured in the Early Treatment Diabetic Retinopathy Study (ETDRS) grid pattern using the automated algorithm. GCL thickness was generated from the Macular Cube 512 × 218 protocol. VA measured on the same day as OCTA examination was recorded.

Results

The mean FAZ area was greater (P = 0.01) in BRVO eyes (0.239 ± 0.108 mm²) when compared with fellow eyes (0.290 ± 0.127 mm²). The FAZ was more irregular in BRVO eyes compared with fellow eyes (circularity index = 64.6 ± 12.8% vs 71.1 ± 10.8%, respectively, P= 0.03). GCL thickness was lower in BRVO eyes compared with control eyes (67.19 ± 27.71 vs 77.79 ± 6.41 respectively, P= 0.006). The mean VD and PD were significantly lower in the ETDRS outer ring in BRVO eyes (P = 0.04 and 0.038, respectively). On comparison of the affected quadrant with the unaffected quadrant in BRVO eyes, the affected quadrant had a lower outer PD (P = 0.04), outer VD (P = 0.04), and GCL thickness (P = 0.02). There was no significant correlation of VA with FAZ, VD, or GCL thickness (P >0.05).

Conclusion

FAZ is more irregular and enlarged, and GCL is thinner, in eyes with BRVO after resolution of CME especially in the affected quadrant suggesting neuronal degeneration as a sequela of BRVO. Both perfusion and VD are reduced in the quadrant affected by the BRVO demonstrating regional quantitative differences in the retinal microvasculature. These parameters may prove useful in monitoring the disease progression and treatment response.

To compare intralesional and oral propranolol for treating periorbital and eyelid capillary hemangiomas

Purpose:

A pilot randomized control trial to compare the efficacy and side effects of intralesional and oral propranolol in periorbital and eyelid capillary hemangiomas.

Methods:

Twenty patients were prospectively randomized to two groups of ten each. Group 1 was initiated on oral propranolol 1 mg/kg/day titrated to final dose of 3 mg/kg/day over 1 week which was continued for 6 months and then tapered over 1 week; Group 2 received 3 doses of direct intralesional propranolol hydrochloride 1 mg/ml; 0.2 ml/cm 4–6 weeks apart. Hemangioma area and corneal astigmatism were measured.

Results:

Within each group at 6 months there was a significant reduction in area (group 1: 83.48 ± 11.67%, P = 0.0019; group 2: 67.78 ± 21.71%, P = 0.0019) and improvement in astigmatism (pre, post: group 1: 2.98D @ 179.8°, 1.13D @ 179.8°, P = 0.0045; group 2: 1.62D @ 90.16°, 0.75D @ 179.9°, P = 0.0001). There was no difference in area reduction (P = 0.056), change in appearance (P = 0.085), ptosis (P = 0.23) and side effects (lethargy, poor feeding; P = 0.171) between the two groups.

Conclusion:

Efficacy and side effects with intralesional propranolol are comparable to oral propranolol for periorbital and eyelid lesions.

Clinical applications of Scheimpflug imaging in cataract surgery

Since the Scheimpflug principle was first described over a century ago, there has been a great interest among ophthalmologists for the use of Scheimpflug camera in anterior segment imaging. Scheimpflug imaging has since advanced significantly and modern day instruments provide comprehensive imaging and topographic data of the anterior segment. In this article the clinical applications and limitations of Scheimpflug imaging in modern cataract surgery patients are discussed. This article reviews recent work on assessment of lens transparency for cataract grading and integrity, using preoperative lens density measurements to help predict phacoemulsification parameters, its utility in challenging situations like capsular bag distension syndrome and traumatic cataract and assessment of density of the posterior capsule for objectively quantifying posterior-capsule opacification.

Quantitative analysis of anterior chamber following peripheral laser iridotomy using Pentacam in eyes with primary angle closure

Purpose. To quantify the effects of laser peripheral iridotomy (LPI) on peripheral anterior chamber depth (PACD), central internal anterior chamber depth (CACD), and anterior chamber volume (ACV) using Rotating Scheimpflug Imaging System, i.e., Pentacam, on Asian Indian eyes. Methods and Materials. This was an institutional, prospective, nonrandomized, interventional study. Sixty-eight eyes of 68 consecutive patients with primary angle closure were enrolled. Pentacam scanned the anterior ocular segment with the 25-image acquisition scan protocol and PACD, CACD, and ACV values were obtained. The PACD was measured in nasal, temporal, superior, and inferior meridian at 4 mm and 8 mm circles. Nd:YAG laser iridotomy was performed. Preiridotomy, immediate postiridotomy, 1 week and 1 month postiridotomy data for PACD, CACD, and ACV were acquired. The t test and repeated-measures analysis of variance (ANOVA) and one-way ANOVA were used for statistical significance. Results. Pre-LPI ACV increased immediately after iridotomy (28.4 mm3; p=0.001), at 1 week (15.9 mm3; p=0.001), and at 1 month post-LPI (19.8 mm3; p=0.00). There was no change in CACD (p>0.05). Significant PACD deepening was observed at 4 mm and 8 mm in all meridians (p<0.001) at all visits. Conclusions. Laser peripheral iridotomy significantly increased the PACD and ACV. Extent of the LPI-induced PACD increase was enhanced with increasing distance from the optical axis.

Comparison of Scheimpflug imaging and spectral domain anterior segment optical coherence tomography for detection of narrow anterior chamber angles

PURPOSE

To compare the performance of anterior chamber volume (ACV) and anterior chamber depth (ACD) obtained using Scheimpflug imaging with angle opening distance (AOD500) and trabecular-iris space area (TISA500) obtained using spectral domain anterior segment optical coherence tomography (SD-ASOCT) in detecting narrow angles classified using gonioscopy.

METHODS

In this prospective, cross-sectional observational study, 265 eyes of 265 consecutive patients underwent sequential Scheimpflug imaging, SD-ASOCT imaging, and gonioscopy. Correlations between gonioscopy grading, ACV, ACD, AOD500, and TISA500 were evaluated. Area under receiver operating characteristic curve (AUC), sensitivity, specificity, and likelihood ratios (LRs) were calculated to assess the performance of ACV, ACD, AOD500, and TISA500 in detecting narrow angles (defined as Shaffer grade ≤1 in all quadrants). SD-ASOCT images were obtained at the nasal and temporal quadrants only.

RESULTS

Twenty-eight eyes (10.6%) were classified as narrow angles on gonioscopy. ACV correlated with gonioscopy grading (P<0.001) for temporal (r=0.204), superior (r=0.251), nasal (r=0.213), and inferior (r=0.236) quadrants. ACV correlated with TISA500 for nasal (r=0.135, P=0.029) and temporal (P=0.160, P=0.009) quadrants and also with AOD500 for nasal (r=0.498, P<0.001) and temporal (r=0.517, P<0.001) quadrants. For detection of narrow angles, ACV (AUC=0.935; 95% confidence interval (CI) =0.898-0.961) performed similar to ACD (AUC=0.88, P=0.06) and significantly better than AOD500 nasal (AUC=0.761, P=0.001), AOD500 temporal (AUC=0.808, P<0.001), TISA500 nasal (AUC=0.756, P<0.001), and TISA500 temporal (AUC=0.738, P<0.001). Using a cutoff of 113 mm(3), ACV had 90% sensitivity and 88% specificity for detecting narrow angles. Positive and negative LRs for ACV were 8.63 (95% CI=7.4-10.0) and 0.11 (95% CI=0.03-0.4), respectively.

CONCLUSIONS

ACV measurements using Scheimpflug imaging outperformed AOD500 and TISA500 using SD-ASOCT for detecting narrow angles.

Posterior corneal elevation after LASIK with three flap techniques as measured by Pentacam

PURPOSE

To evaluate and compare posterior corneal changes using elevation data obtained from Pentacam (Oculus Optikgeräte GmbH) Scheimpflug imaging in eyes undergoing LASIK with three different modes of flap creation: IntraLase femtosecond laser FS60 (Abbott Medical Optics) (femtosecond group), Amadeus (Ziemer Group AG) mechanical microkeratome (keratome group), or flap formation using 20% alcohol laser epithelial keratomileusis (LASEK) (LASEK group).

METHODS

Ninety myopic patients (90 eyes) undergoing refractive surgery were recruited. The change in posterior corneal elevation at 21 predetermined points in the central 5-mm area was measured using exported elevation data from the Pentacam before LASIK and 18 months postoperative and was compared among and within three modes of flap creation.

RESULTS

Mean change in posterior elevation in the central 5-mm area was 5.13±4.16 μm for the femtosecond group, 5.78±4.42 μm for the keratome group, and 6.68±4.72 μm for the LASEK group and was similar among groups (P=.59). Change in posterior elevation before and after LASIK was not significant within any group (P=.342, P=.232, and P=.321 for the femtosecond, keratome, and LASEK groups, respectively). Preoperative spherical equivalent, central corneal thickness, ablation depth, and estimated residual bed thickness did not correlate with change in posterior corneal elevation for the femtosecond, keratome, or LASEK groups (P>.05).

CONCLUSIONS

Using Pentacam elevation data, there were no significant changes in posterior corneal elevation following LASIK among or within the three methods of flap creation. At 18 months after LASIK, the posterior corneal surface is not displaced anteriorly significantly and is equally stable using these three surgical techniques.

Correlation of nuclear cataract lens density using Scheimpflug images with Lens Opacities Classification System III and visual function

PURPOSE

To calculate the average lens density (ALD) and nuclear lens density (NLD) using Scheimpflug images and to determine their correlation with logarithmic minimal angle resolution (logMAR) best-corrected visual acuity (BCVA), contrast sensitivity (CS), and lens grading based on the Lens Opacities Classification System (LOCS) III.

DESIGN

Cross-sectional observational study.

PARTICIPANTS

One hundred ten patients with age-related nuclear cataract.

METHODS

The logMAR BCVA was recorded using Early Treatment Diabetic Retinopathy Study charts and photopic contrast-sensitivity using CSV-1000LV (Vector Vision, Greeneville, OH). Fifty Scheimpflug images (Pentacam, Oculus, Germany) covering 360 degrees of the lens were obtained for 1 eye of each patient after dilation. All Scheimpflug images were exported to ImageJ software (NIH, Bethesda, MD) for analysis wherein the ALD and NLD (using a mask applied to the lens nuclear area) were calculated in pixel-intensity units. Repeatability was determined using coefficient of variation (CoV) and intraclass correlation coefficient (ICC). Lens opacity on slit-lamp images was graded using LOCS III for nuclear opalescence (NO) and nuclear color (NC).

MAIN OUTCOME MEASURES

We evaluated ALD and NLD on Scheimpflug images and their correlation with NO and NC LOCS III grading, BCVA, and photopic CS.

RESULTS

The ICC for ALD and NLD were 0.983 and 0.99, respectively; the CoV were 3.92+/-1.76% and 2.57+/-0.74%, respectively. The ALD correlated with NO (r = .774; P<0.001), NC (r = .732; P<0.001), BCVA (r = 0.696; P<0.001), and CS at 3 cycles per degree CPD (P = 0.011), 6, 12, and 18 CPD (P<0.001). The NLD correlated with NO (r = .859; P<0.001), NC (r = .81; P<0.001), BCVA (r = .760; P<0.001), CS at 3 CPD (P = 0.002), 6, 12, and 18 CPD (P<0.001). The NLD had a significantly stronger correlation with BCVA (P<0.05), NO (P<0.01), NC (P<0.01), and CS at 6 CPD (P<0.01) and 12 CPD (P<0.005) compared with ALD.

CONCLUSIONS

Repeatable 360 degrees lens density measurements were obtained using Scheimpflug imaging. A stronger correlation was observed between NLD and LOCS III grading, BCVA, and photopic CS than with ALD. The NLD is an objective and repeatable method for assessment of lens density, which could be helpful in longitudinal studies monitoring nuclear cataracts.

Scheimpflug imaging of pediatric posterior capsule rupture

We report a case of an 11-year-old boy who presented two days after blunt trauma to the left eye with a slingshot. On examination his best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/400 in the left eye. Slit-lamp examination of the left eye revealed a Vossius ring, traumatic cataract, traumatic posterior capsule tear (PCT). The contour of the posterior capsule bulge corresponded to the edges of the PCT. Rotating Scheimpflug imaging (Pentacam 70700:Oculus, Wetzlar Germany) confirmed the traumatic cataract in the region of the PCT visualized as increased lens density at the cortex-vitreous interface. The extent of the PCT in the greatest and least dimensions was documented before and after intraocular lens (IOL) implantation. Intra-operatively, the PCT was evident and phaco-emulsification with an IOL implant was performed. Postoperatively, his BCVA improved to 20/20 in the left eye with a well-centered in-the-bag IOL as found on slit-lamp and Scheimpflug images.

Artificial neural network-based glaucoma diagnosis using retinal nerve fiber layer analysis

PURPOSE

To develop, train, and test an artificial neural network (ANN) for differentiating among normal subjects, primary open angle glaucoma (POAG) suspects, and persons with POAG in Asian-Indian eyes using inputs from clinical parameters, optical coherence tomography (OCT), visual fields, and GDx nerve fiber analyzer.

METHODS

One hundred eyes were classified using optic disc examination and perimetry into normal (n=35), POAG suspects (n=30), and POAG (n=35). EasyNN-plus simulator was used to develop an ANN model with inputs including age, sex, myopia, intraocular pressure (IOP), optic nerve head, and retinal nerve fiber layer (RNFL) parameters on OCT, Octopus 30-2 full threshold visual field, and GDx parameters.

RESULTS

With two outputs (POAG or normal), specificity was 80% and sensitivity was 93.3%. Ninety percent of POAG suspects were labeled as abnormal in this analysis. ANN assigned the highest importance to Smax/Imax RNFL on OCT followed by cup-area (OCT) and other RNFL parameters (OCT) for two outputs. With three outputs (normal, POAG, and POAG suspect), ANN gave an overall classification rate of 65%, specificity of 60%, and sensitivity of 71.4% with a target error rate of the training set at 1%. The parameters for three outputs, in decreasing order of relative importance, were Savg, vertical cup-disc ratio, cup-volume, and cup-area on OCT.

CONCLUSIONS

An ANN taking varied diagnostic imaging inputs was able to separate POAG eyes from normal subjects and POAG suspects. The network had reasonable sensitivity with three outputs; however, it had a tendency to mislabel POAG suspects as POAG.

Unilateral electric cataract: Scheimpflug imaging and review of the literature

A 22-year-old man presented with diminution of vision in the left eye 1 month after sustaining an injury from a high-voltage electric current to the left side of his head. Slitlamp examination and Scheimpflug imaging confirmed the typical anterior subcapsular lenticular opacities in the left eye and also documented early anterior subcapsular vacuoles in the right eye. Based on history, the electric shock wound, and the typical appearance of the opacities, an electric cataract was diagnosed. The difference in lens density between the 2 eyes was also documented. The best corrected visual acuity (BCVA) was 20/20 in the right eye and counting fingers at 1 foot in the left eye. Phacoaspiration and posterior chamber intraocular lens implantation were performed in the left eye. Postoperatively, the BCVA improved to 20/20. The developmental mechanisms of these opacities after exposure to an electric current and the role of Scheimpflug imaging in assessing the earliest subclinical manifestations of electric cataract injuries are discussed.

Repeatability of corneal parameters with Pentacam after laser in situ keratomileusis

AIM

To investigate the coefficient of repeatability (CR) for corneal parameters evaluated with Pentacam after laser in situ keratomileusis (LASIK) in myopic eyes.

DESIGN AND SETTING

Prospective, non-interventional, non-comparative study in an institutional setup.

MATERIALS AND METHODS

Forty eyes of 40 consecutive subjects who had undergone LASIK for myopia were assessed with the Scheimpflug system (Pentacam 70700: Oculus, Wetzlar Germany). The mean of five consecutive measurements of all the corneal parameters was recorded and CR was calculated as standard deviation of the difference from the mean of these repeat measurements divided by the mean response. The statistical significance of the CR was calculated for these parameters at 5% significance level.

RESULTS

The best CR was observed for the periphery of the anterior corneal curvature (0.18%) and the least for the horizontal meridian of the posterior corneal curvature (1.29%). Despite being significantly different ( P < 0.001), both the measurements were highly repeatable in post-LASIK eyes. The central, apical and minimal corneal thickness had a CR of 1%, 0.78% and 0.77% respectively. These were equally repeatable ( P> 0.323). The CR of the mean radius of curvature of the anterior cornea (0.29%) was significantly better ( P < 0.001) than the posterior corneal curvature (0.57%).

CONCLUSION

The CR for the post-LASIK cornea with Pentacam was the best for the anterior corneal curvature. Significantly, Pentacam has a high degree of repeatability for the posterior corneal curvature, which has a potential for early detection of keratectasia in these eyes. Post-LASIK pachymetry with Pentacam also showed excellent repeatability.

In vivo fluorescein staining of SI-30NB silicone intraocular lens

We report a case of a 48-year-old pseudophakic woman who presented 3 weeks after Heidelberg retinal angiography using intravenous sodium fluorescein 2%. Bilateral retinal vasculitis with severe retinal ischemia and extensive capillary dropouts had been diagnosed. Anterior segment examination revealed green staining on the silicone optic of the 3-piece SI-30NB intraocular lens (IOL) (AMO), with no cell or flare in the aqueous humor. The anterior and posterior capsules were not stained. The patient did not report dark vision, double vision, or altered color vision. The anterior and posterior IOL surfaces demonstrated an autofluorescence at the time of fundus photography, which persisted to the 6-week examination although there were no symptoms. This is suggestive of deposits of sodium fluorescein on the IOL surface following angiography.

Scheimpflug imaging in late Capsular Bag Distention syndrome after phacoemulsification

PURPOSE

To describe two cases of late Capsular Bag Distention syndrome (CBDS) and posterior capsular opacification (PCO) as documented on Pentacam.

DESIGN

Case series.

METHODS

A 55-year-old male and a 72-year-old female presented three years after phacoemulsification and intraocular lens (IOL) implantation with a complaint of decreased vision. Scheimpflug imaging was done using Pentacam. Patients underwent Nd:YAG capsulotomy for PCO, and postcapsulotomy capsular bag dynamics were imaged on Pentacam.

RESULTS

Three years after phacoemulsification, patients presented with blurred vision and posterior bowing of opacified posterior capsule. Anterior capsular opening was apparently sealed by lens optic, and space between IOL and opacified posterior capsule was filled with turbid fluid. Nd:YAG laser capsulotomy was done. All findings, including collapse of distended bag, were precisely documented on Scheimpflug images.

CONCLUSIONS

Pentacam Scheimpflug imaging is a useful technique to diagnose and document the presence and progress of CBDS and PCO.

Role of scheimpflug imaging in traumatic intralenticular foreign body

PURPOSE

The role of Pentacam Scheimpflug imaging in evaluation of penetrating eye injury and intralenticular foreign body (ILFB).

DESIGN

Interventional case report.

METHODS

A 35-year-old male presented to our clinical practice with penetrating eye injury and endophthalmitis. Scheimpflug imaging helped localize the intralenticular foreign body (ILFB). It confirmed the posterior capsule to be intact. He underwent phacoemulsification, foreign body removal, and intraocular lens (IOL) implant. Postoperatively, IOL was imaged with Pentacam Scheimpflug imaging.

RESULTS

Scheimpflug imaging allowed us to confirm the presence and exact location of ILFB and its relation to the intact posterior capsule as well as the postoperative IOL positioning. This helped in better planning of management of traumatic cataract with ILFB.

CONCLUSIONS

Pentacam is a potential tool for accurate localization of foreign bodies lodged in the lens and provides an objective basis for better patient counseling and surgical planning.