Sunil Ganekal

Purpose: To evaluate the results of parsplana lensectomy in the management of cataract with severely compromised or abnormal corneal endothelium. Materials and Methods: Retrospective interventional case study comprised 22 patients (9 women, 13 men; 22 eyes) with severely abnormal corneal endothelium ut still had transparent cornea. Of which 14 had history of penetrating keratoplasty, 6 had history of trabeculectomy and 2 were diagnosed with Fuch’s endothelial dystrophy. Postoperative est corrected visual acuity (BCVA), mean density of corneal endothelial cell and other complications were analyzed. Results: Mean follow-up period was 17.2 months (ranging from 6 to 31 months). Postoperative BCVA were found to be 6/60 or below in 2 patients, 6/60-6/18 in 7 patients and 6/18-6/12 in 7 patients and 6/12 or better in 6 patients. BCVA improved in all patients after surgery, except in one patient with Fuch’s endothelial dystrophy BCVA turned worse again about five months after surgery and eventually patient developed bullous keratopathy. The mean density of corneal endothelial cells was 1018± 84/ mm (range 844/ mm to 1176/ mm) before operation and 981±93/ mm (range 853 to 1211/ mm) after operation. No significant difference in the density of corneal endothelial cells was found among the patients before and after operation (P=0.43). Conclusions: Pars plana lensectomy is able to decrease surgically-induced corneal endothelial damage and is safe in the management of cataract with severely compromised corneal endothelium.   Keywords: Cataract, Compromised cornea, Parsplana lensectomy.

Purpose: To study the correlation between choroidal vascularity index, flow pattern and neovascular activity in treatment naive eyes of age related macular degeneration. Materials and Methods: Cross-sectional analysis of 46 treatment naive eyes diagnosed with exudative age related macular degeneration. All patients underwent spectral domain optical coherence tomography, fluorescein angiography, indocyanine green angiography and OCTA. The Choroidal Vascularity Index (CVI) and OCTA vascular features at initial and last visit were analyzed after anti vascular endothelial growth factor (VEGF) treatment. These changes were correlated with the disease activity on SD-OCT and OCTA. Results: Mean age was 66.34 ± 7.2 years. Mean sub foveal choroidal thickness was 215.39±102.378 µm at baseline and 198.42±101.049 µm at 3 months (p=0.07). The mean CVI was 63.73±5.28% at baseline & 64.59±4.87% at 3 months (p=0.754). Pattern of network on OCTA was sea-fan in 20(43.5%), medusa head in 8(17.4%), indistinct in 18(39.1%) at baseline and sea-fan in 6(13%), medusa head in 6(13%), indistinct in 28(60.9%) and mixed in 6(13%) at 3 months. The signs of activity on OCT changes after 3 months (p =0.001).On OCTA 36 eyes had active network at baseline & 34 eyes had inactive network at the last follow up (p=0.001). Conclusion: Choroidal vascularity Index showed no correlation with various patterns of CNV and showed no significant change with anti VEGF treatment. Post treatment network patterns showed no significant correlation with the OCT activity even though the OCTA showed an active network.   Keywords: ­ OCT angiography, Choroidal neovascular activity, AMD.

Purpose: To correlate UBM and clinical findings in patients with closed globe injury. Materials and Methods: Prospective observational study of 75 patients, ? 12 years of age presenting to ophthalmic outpatient department within one week of sustaining closed globe injury. Patients with seriously ill polytrauma and open globe injuries were excluded from the study. Comprehensive ophthalmic examination including Visual acuity assessment, slit lamp examination, fundus examination and IOP measurement. Gonioscopy and UBM examination was done in all patients on presentation except for patients with hyphema (UBM and gonioscopy done at 4 weeks to prevent rebleed). Results: Mean age of the patients was 31.4 ±8 years, most common external findings included lid ecchymosis (47%), subconjunctival hemorrhage (93%). The common anterior segment finding included traumatic iritis (87%), traumatic hyphema (61%) and traumatic cataract in 27% of patients. Clinical evidence of zonular dialysis was seen in 13% of patients. UBM was able to detect zonular defects in 62% patients (P=0.008). Most of the patients (57%) had zonular dialysis less than 3 clock hours on UBM examination. UBM confirmed the presence of other clinical findings like iridodialysis, cyclodialysis. Conclusion: UBM is a safe and effective adjunctive tool for clinical assessment and management of ocular trauma. It can diagnose subtle zonular dialysis and other anterior segment changes following blunt trauma. UBM should be an integral part of ophthalmic examination especially in patients requiring surgical intervention after closed globe injury.   Keywords: Closed globe injury, UBM, Anterior segment assessment.

Background/Objectives: To compare the visual acuity outcomes after surgical treatment of epiretinal membranes (ERM) in cases with and without ectopic inner foveal layers (EIFL).  Methods : A total of 100 eyes of 98 patients with idiopathic ERM were retrospectively staged according to the newer OCT classification and divided into two groups on the basis of presence or absence of EIFL. The two groups were evaluated for various parameters including visual acuity, thickness of the EIFL, re-appearance of the foveal contour, outer retinal changes and complications before and after ERM peeling. Correlation analysis was done using chi square test and p-values were obtained for corresponding variables. Results: Of 100 eyes with ERM, 20% had stage 1, 29% had stage 2, 42% had stage3 & 9% had stage 4 disease. VA was worse in eyes with EIFL as compared those without it. Correlation of VA with EIFL thickness however was not significant. Surgical removal of ERM didn’t alter EIFL frequency though the thickness decreased. New EIFL appeared in 4% eyes and 35% demonstrated thickened fovea after surgery. Anatomical reappearance of foveal contour was poorer in eyes with EIFL. Outer retinal changes were more common in non EIFL eyes. Lamellar holes and nontractional cysts were more common in EIFL eyes. Conclusion: EIFL is a significant prognostic tool to predict the visual outcome of surgery in cases of Epiretinal membrane. EIFL eyes did not regain foveal contour, had less outer retinal damage but were associated with poorer visual outcomes.   Keywords: Epiretinal membrane, Ectopic inner foveal layer.

Purpose: To study the retinal nerve fiber layer (RNFL) thickness in pediatric age group and its correlation with age, gender, refractive error and axial length Materials and Methods: Prospective observational study of 200 eyes of 100 children aged between 5-18 years presenting to the ophthalmic department. All children underwent detailed ophthalmic evaluation and SD OCT examination for RNFL thickness, Standard RNFL assessment protocol was used. Mean RNFL thickness in micrometers along the whole circle circumference, four quadrants, 12’o clock hours were obtained. RNFL measurements included average/full circle thickness — RNFL-FC (360ºmeasure), temporal quadrant thickness, RNFL-T, superior quadrant thickness, RNFL-S, nasal quadrant thickness, RNFL-N, inferior quadrant thickness, RNFL-I. Results: Mean age was 13.3 ± 2.4 years. The refractive error in spherical equivalent was -0.28 ± 0.91 dioptre (SE). The mean axial length was 23.1 ± 0.7mm. The mean global RNFL thickness (RNFL-FC) was 97.0 ± 8.8mm (range 79.4 -114.6). RNFL thickness was maximum in the inferior quadrant (RNFL-I) 126 ± 13.7mm followed in order by superior (RNFL-S) 126 ± 16.3mm, nasal (RNFL-N) 70.5 ± 12.3mm and temporal (RNFL-T) 63.4± 9.2mm, in both the sexes. For every increase in one diopter of spherical equivalent of refractive error the mean RNFL increased by 3.77 microns and there was a reduction in mean RNFL thickness by 4.86 micron for every 1mm increase in axial length. Conclusion: RNFL varied minimally with gender. Positive correlation was seen with refractive error while inverse or negative correlation was seen with axial length and age. RNFL measurements could serve as reference for further studies on pediatric glaucoma or other optic nerve head pathologies. Keywords: RNFL thickness, Paediatric age group, Optical coherence tomography.