Santosh Kumar

Abstract

Aim/Purpose: To determine the role of anterior segment optical coherence topography (AS-OCT) pre- operatively to detect pre-existing weakness of the posterior capsule in patient of posterior polar cataract (PPC) effecting outcomes during phacoemulsification. Materials and Methods: A prospective observational study was done in 26 eyes with clinically diagnosed PPC who underwent phacoemulsification between November 2018 to December 2019. AS-OCT was done preoperatively to detect pre existing dehiscence of posterior capsule in patient of PPC. The images obtained by AS-OCT were divided into either intact or dehiscent. Integrity of posterior capsule was also observed during operation by surgeon. Results: In 26 eyes, dehiscence of posterior capsule was detected in 4 eyes (15.4%) by AS-OCT pre operatively, of posterior capsule in 3 eyes (11.5%) and intact posterior capsule in 23 eyes (88.5%). Rupture of posterior capsule occurred in 4 eyes during phacoemulsification. 3 out of 4 eyes who had rupture, had dehiscence of posterior capsule that was noted by AS-OCT and also intraoperatively while 1 eye was detected to have intact posterior capsule. The sensitivity of AS-OCT was 75% for detecting posterior capsule dehiscence and specificity was 95.65%. Conclusion: AS-OCT can be used preoperatively to identify posterior polar cataract that are at risk of posterior capsule rupture. This provides preoperative information to surgeon and helps in proper counselling of patients about the prognosis.   Keywords: Posterior polar cataract, Anterior segment optical coherence tomography, Phacoemulsification, Cataract complication, Posterior capsular rupture.

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Abstract

Purpose: To study the efficacy of air descemetopexy in the management of various types of descemet membrane detachment (DMD). Materials and Methods: After ethical committee approval, clinical data of 40 patients during the period of December 2017 to December 2018, who developed DMD after cataract surgery were analysed. Results: Majority of patients (n= 32, 80%) had severe generalized corneal edema, n = 4 had moderated corneal edema & n = 4 had localized mild corneal edema. Only air was sufficient to reattach DMD in majority of the patients (n=36, 90% cases), only 4 patients who had very large dmd failed to attach by air. In these patients repeat descemetopexy by 14% C3F8 gas was done which lead to attachment of descemet membrane with improvement of visual acuity in 3 cases. Complications due to increase intraocular pressure were noted with these gases. Conclusion: Air descemetopexy is a safe & efficacious option for DMD repair in most of the cases and it is associated with less postop complications. Keywords: Descemetopexy, Descemet membrane detachment (DMD).

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Abstract

Objective: To study evolution of cataract surgery (from ECCE to manual small incision cataract surgery to phaco-emulsification) in relation to ease of surgery and visual outcome in eye camps in northern India. Design: Cross-sectional study Materials and Methods: The study included 780 patients who underwent cataract surgery following screening of 4763 patients at community screening camps. Patients underwent ECCE (Extra-capsular cataract extraction), SICS (small?incision cataract surgery) and phaco-emulsification with intraocular lens implantation under local anaesthesia at the base hospital. Patients were followed up on 1st day, 1st week, 6th week, 3rd month, and 6th month postoperatively. Postoperative complications and visual outcome were recorded. Main Outcome Measures: Visual outcome and complications in patients undergoing surgery Results: Among the 4763 patients seen in OPD, almost two-third of patients were between 41 to 70 years of age and approximately half (52.82%) of patients were females. Cataract (53.52%), refractive error (16.75%) and corneal scarring (8.34%) were among leading causes of ocular morbidity.Out off 780 patients selected for cataract surgery, most were between 40-60 years of age(82%) and 52.5% were females.82% of patients were from lower socio-economic class. Complication rate was more in ECCE with PCIOL group and less in Phaco-emulsification with PCIOL group. Best corrected visual acuity at 6 weeks follow up was better in SICS and phaco-emulsification group while average numbers of follow up visits were less in these two groups as compared to other two groups. Conclusion: Our study reflects the efficacy of the base hospital approach and also adopting newer surgical approaches at base camps gives easily visual rehabilitation, better visual outcomes and compliance, and lesser complications compared to older methods. Phaco-emulsification and small incision cataract surgery are safer than conventional ECCE surgery. Keywords: Base hospital, Extra-capsular cataract extraction, Phaco-emulsification, Small?incision cataract surgery.

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