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PurposeComparative evaluation of ‘flap on’ and ‘flap off’ techniques of Epi-LASIK in low-to-moderate myopia.MethodsSixteen eyes of eight consecutive patients with myopia 6 D were selected for this prospective, randomized, comparative, interventional case series. Epi-LASIK surgery was performed in all eyes. In one eye of each patient, the epithelial flap was retained after excimer laser ablation (flap on). In the fellow eye, the epithelial flap was discarded (flap off) after ablation. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), spherical equivalent (SEQ), postoperative pain score, time to epithelization, and corneal haze were recorded on postoperative visits.ResultsThe mean preoperative SEQ in the two groups was −3.61±1.32 D (flap on) and −3.49±1.86 D (flap off; P=0.752). The mean follow-up period was 8.5±4.9 months. The mean pain score was comparable on all postoperative days except the second postoperative day when the group with flap off had a lesser mean pain score (P=0.053).Time for epithelial healing was 3.63±0.52 days in cases with flap off and 4.13±0.64 days in cases with flap on (P=0.113). Eyes with flap off had a better UCVA on the first postoperative day (0.19±0.11 logMAR) compared with eyes with flap on (0.41±0.28logMAR; P=0.032). There was no significant difference in UCVA, BSCVA, SEQ, contrast sensitivity, corneal haze, and higher order aberrations at any other postoperative visit.ConclusionsThere is no difference between flap on and flap off techniques of Epi-LASIK with regards to overall outcome of surgery. [ABSTRACT FROM AUTHOR]

PurposeTo describe a surgical technique as an alternative to allograft corneal transplantation for management of cases with cataract and corneal opacity.MethodsSeven eyes of seven patients with adherent leucomas and cataract underwent phacoemulsification with intraocular lens (IOL) implantation. An automated vitrector was used to release the adherent leucoma and create an optical iridectomy at the start of surgery. Phacoemulsification with IOL implantation was performed in all eyes. The release of the iris adherence along with creation of an optical iridectomy improved visualization during phacoemulsification.ResultsPhacoemulsification and IOL implantation could be performed successfully in all seven eyes. The median best-corrected visual acuity (BCVA) improved from 1/60 (range: (light perception) 6/36) preoperatively to 6/18 (range: 6/36–6/12) at last follow-up (average: 41 days).ConclusionsThis surgical technique is a viable option in cases with partial corneal opacification with coexisting cataract.Eye (2009) 23, 1345–1348; doi:10.1038/eye.2008.283; published online 14 November 2008 [ABSTRACT FROM AUTHOR]

PurposeTo study the outcome of therapy for acute endothelial graft rejection with an intravenous (i.v.) pulse of dexamethasone vs methylprednisolone, in addition to topical corticosteroids.MethodsRecords of 98 eyes of 99 patients treated for endothelial graft rejection with a single i.v. pulse of dexamethasone or methylprednisolone in addition to topical steroids, between January 1999 and June 2004, were retrospectively reviewed. Baseline characteristics such as surgery-rejection interval, time taken to consult after onset of symptoms, history of failed grafts, extent of stromal vascularization, best-corrected visual acuity (BCVA) and corneal thickness at the time of presentation were noted. Main outcome measures following treatment for rejection included improvement in BCVA, change in corneal thickness, and reversal of graft rejection.ResultsFifty-one patients were treated with i.v. methylprednisolone and 47 with i.v. dexamethasone, in addition to topical steroids. Both groups were found to be comparable with respect to baseline parameters, that is, time taken to present, history of failed grafts, extent of stromal vascularization, BCVA, and graft thickness. Graft rejection could be successfully reversed in 72.3% cases in the dexamethasone group and 49% in the methylprednisolone group (P=0.018). A significant improvement in visual acuity was recorded following treatment in both groups, with a better outcome in the dexamethasone group (P=0.012). Post-treatment pachymetry values were lower than pretreatment values in both groups, with significantly lower final pachymetry in the dexamethasone group (P=0.017). No adverse effects were observed.ConclusionI.v. pulse therapy with dexamethasone may be used as an effective alternative to methylprednisolone in reversing acute endothelial graft rejection.Eye (2009) 23, 635–639; doi:10.1038/eye.2008.25; published online 22 February 2008 [ABSTRACT FROM AUTHOR]

PurposeTo study the risk factors for the occurrence of cylindrical prediction error (PE) after laser in situkeratomileusis (LASIK) for myopia and myopic astigmatism.MethodsThe study was a nested case–control study. Five hundred eyes of 252 consecutive patients who underwent LASIK for myopia and myopic astigmatism on the Chiron Technolas 217C laser and completed 6 months of follow-up. There were 435 controls and 65 cases based on the postoperative refractive cylindrical PE. The probable risk factors studied included preoperative sphere and cylinder, keratometry, pachymetry, suction ring used, flap thickness, hinge centeration, optic zone, ablation depth, and intraoperative complications.ResultsBy univariate analysis, the cylindrical PE was found to be associated with preoperative spherical equivalent higher than −6 D (χ2=10.83; P=0.001), preoperative sphere higher than −6 D (χ2=6.15, P=0.013), preoperative cylinder more than −0.75 D (χ2=6.61; P-value=0.010), and an optic zone less than 5.5 mm (χ2=19.3; P=0.001). Risk factors for postoperative astigmatism by stepwise multivariate logistic regression analysis were an optic zone of less than 5.5 mm with an odds ratio (OR) of 2.81 (95% confidence interval (CI)=1.62–4.86) and preoperative cylinder more than −0.75 D with an OR of 1.60 (95% CI=0.92–2.77).ConclusionPostoperative astigmatism (as indicated by the cylindrical PE) is more likely to occur with an optic zone of less than 5.5 mm and a higher preoperative cylindrical error.Eye (2008) 22, 332–339; doi:10.1038/sj.eye.6702545; published online 25 August 2006 [ABSTRACT FROM AUTHOR]

PurposeEvaluation of on axis phacoemulsification surgery through temporal incision using nondominant hand with surgeon sitting at the head end, inpatients with against-the-rule astigmatism.MethodsEighty eyes of 80 patients who underwent phacoemulsification through a temporal clear corneal tunnel for age-related cataract and against-the-rule astigmatism were enrolled and divided into four equal groups. In Group 1A, the surgeon was sitting at the head end for the left eye performing surgery with the left hand (nondominant hand). In group 1B, the surgeon was seated at the temporal side and surgery was performed in the left eye with dominant right hand. In group 2A, the surgeon was sitting at the head end for the right eye and performed surgery holding the phacoemulsification hand piece in his right hand. In group 2B, the surgeon sat on the temporal side of the right eye and performed phacoemulsification with his right hand. The patients were followed up on day 7, 1 month, and 3 months. Parameters evaluated included average phaco power, effective phaco time, uncorrected and best-corrected visual acuity, keratometry, intraocular pressure, surgically induced astigmatism, pachymetry, and endothelial cell counts.ResultsThe phaco time and phaco power among the four groups were comparable (phaco time: P=0.368; phaco power: P=0.294). The four groups were also comparable on parameters like surgically induced astigmatism (P=0.674), change in postoperative keratometric astigmatism (P=0.584), endothelial cell loss (0.921), change in ultrasonic pachymetry (P=0.476), and intraocular pressure (P=0.942). No intraoperative or postoperative complications were observed in any of the groups. The mean uncorrected visual acuity at 3 months in group 1 was 0.723±0.21; in group 2 it was 0.756±0.21; in group 3 it was 0.748±0.22, and in group 4 it was 0.732±0.23. The best-corrected visual acuity was 0.96±0.10, 0.97±0.11, 0.95±0.13, and 0.96±0.10 in the four groups at 3 months.ConclusionPhacoemulsification surgery can be successfully performed with nondominant hand with a good surgical outcome. The technique gives an alternative approach where surgeon does not have to shift the position to perform on-axis phacoemulsification.Eye (2007) 21, 1037–1040; doi:10.1038/sj.eye.6702390; published online 12 May 2006 [ABSTRACT FROM AUTHOR]

PURPOSE:To evaluate the outcome of penetrating keratoplasty in patients with bilateral corneal blindness. METHODS:Bilaterally blind patients who had undergone optical penetrating keratoplasty (PK) were evaluated on optical and refractive parameters and presence of complications if any. The results at 3 months, 6 months, and 1 year were compared with age-matched and indication-matched unilaterally blind controls. RESULTS:The most common indication for surgery in both the groups was the presence of a corneoiridic scar. Best corrected visual acuity of?6/18 was seen in five (16.66%) patients in the study group and in 11 (36.66%) patients in the control group (P=0.14). In all, 15 (50%) grafts in the study group and six (20%) in the control group failed (P=0.03). The most common cause of failure was graft infection (40%) in the study group and post-PK glaucoma (20%) in the control group. The percentage of graft rejection as a cause of graft failure was the same in both the groups. A composite socioeconomic status scale based on family literacy and income suggested that 70%of the cases in the study group and 30%in the control group belonged to the low socioeconomic group (P=0.004). CONCLUSION:The outcome of optical penetrating keratoplasty in patients with bilaterally blinding corneal disease is poorer than those who are unilaterally blind. Low socioeconomic status may be a contributing factor for the poor outcome.Eye (2005) 19, 451-454. doi:10.1038/sj.eye.6701534 Published online 20 August 2004 [ABSTRACT FROM AUTHOR]

PurposeTo evaluate a new technique of ‘Layer by Layer’ phacoemulsification in eyes with posterior polar cataract with pre-existing posterior capsular rent (PCR).MethodsLayer by layer phacoemulsification was performed in eight eyes of eight patients of posterior polar cataract with pre-existing posterior capsular rent. All the patients had evidence of a posterior capsular defect showing presence of iridescent refractile lens particles in vitreous with onion skinning of central dense plaque.ResultsThe mean age of the patients was 43.75±2.5 years and six patients were men. All the eyes had vertical posterior capsular defect irrespective of the site of entry of phaco probe. Vitrectomy was not required in any of the eyes. Single piece foldable acrylic intraocular lens was implanted in the bag in all the eyes. The mean preoperative best corrected visual acuity was 0.14±0.05, which improved to 0.77±0.27.ConclusionOur technique of ‘Layer by layer’ phacoemulsification is an effective and safe technique for the management of posterior polar cataract with pre-existing PCR.Eye (2008) 22, 1008–1010; doi:10.1038/sj.eye.6702795; published online 6 April 2007 [ABSTRACT FROM AUTHOR]

A response by J. S. Titiyal and colleagues to a letter to the editor about their article on dye-assisted small incision cataract surgery technique is presented.

Background This study aimed to compare the clinical outcomes of a heparin surface-modified (HSM) hydrophobic acrylic foldable intraocular lens (IOL) (CT LUCIA 601PY) and non-heparin-modified hydrophobic acrylic foldable IOL (AcrySof IQ SN60WF) in diabetic patients undergoing phacoemulsification. Methodology This randomized, single-surgeon, double-masked controlled trial was conducted at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. In this randomized controlled trial, 100 eyes of 100 diabetic patients with or without mild-to-moderate diabetic retinopathy were enrolled (HSM IOL, n = 50; non-HSM IOL, n = 50). Outcome measures were aqueous flare, visual acuity, and anterior chamber depth (ACD). These were measured preoperatively as well as one day, one week, one month, three months, six months, and one year postoperatively. Results The HSM IOL group had significantly lower anterior chamber aqueous flare values (photon count/ms) than the non-HSM IOL group on postoperative day one (9.97 ± 5.2 vs. 17.56 ± 11.3, p < 0.001), postoperative week one (11.47 ± 7.78 vs. 17.06 ± 9.4, p = 0.02), and postoperative month three (7.7 ± 4.1 vs. 12.5 ± 5.6, p = 0.004) of phacoemulsification. The corrected distance visual acuity (CDVA) was significantly better in the HSM IOL group on postoperative day one (uncorrected distance visual acuity: p = 0.022; CDVA; p = 0.005), but there was no significant difference at any other follow-ups. ACD was significantly longer in the HSM IOL group at all follow-ups. Conclusions The implantation of HSM IOL resulted in significantly lower inflammatory reactions in the early postoperative period in diabetics., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Kumari et al.)

Purpose: To compare the equivalence of gatifloxacin 0.3% with a combination of fortified cefazolin sodium 5% and tobramycin sulfate 1.3% eye drops in the treatment of nonperforated bacterial corneal ulcers., Methods: In randomized, controlled, equivalence clinical trials, microbiologically proven cases of nonperforated bacterial corneal ulcers were enrolled and were allocated randomly to one of the 2 treatment groups. Group A was given combination therapy (fortified cefazolin sodium 5% and tobramycin sulfate 1.3%) and group B was given monotherapy (gatifloxacin 0.3%). The primary outcome measure was the percentage of corneal ulcers that healed at 3 months of follow-up., Results: Out of 204 patients enrolled, 103 patients were randomized to group A, whereas 101 patients were randomized to group B. The mean ± SD of ulcer size in groups A and B were 4.35 ± 1.36 and 4.18 ± 1.31 mm, respectively (P = 0.376). The most common bacterial isolate was coagulase-negative Staphylococcus (51.5% in group A and 45.5% in group B). Worsening of the ulcer was seen in 27.2% (28/103) of the cases in group A and in 21.8% (22/101) of the cases in group B. The percentage healing difference was calculated to be 5.4% (90% confidence interval, -4.5 to 15.3). No serious events attributable to therapy were reported in any group., Conclusions: Using the prespecified definition of equivalence of ±20%, this trial found evidence that gatifloxacin monotherapy was equivalent to combination therapy with cefazolin and tobramycin for the treatment of nonperforated bacterial corneal ulcers.

Purpose: The aim of this study was to report three cases of stromal rejection after deep anterior lamellar keratoplasty using big bubble technique in keratoconus., Methods: Deep anterior lamellar keratoplasty was performed in 3 cases of keratoconus (11-19 years of age) using the "big bubble" technique. All of them presented 4 to 19 months after uneventful surgeries with variable decrease of vision (1/200-20/200) along with foreign body sensation, mild pain, and corneal edema. Suture infiltrates were present in all eyes. Ultrasound pachymetry showed variable increase in central corneal thickness (711-894 μm). These patients with stromal rejection were administered pulse intravenous methylprednisolone, 500 mg in 150 mL of 5% dextrose and were started on 1% prednisolone acetate eye drops 1 hourly, moxifloxacin hydrochloride 0.5% 4 times a day along with homatropine 2% eye drops 4 times a day., Results: Complete recovery of the stromal rejections was attained with clear graft and recovery of visual acuity (≥20/40) in all eyes. Central corneal thickness returned to prerejection values in all the eyes after 7 days. There was no significant change in specular count., Conclusions: Deep anterior lamellar keratoplasty does not eliminate the risk of stromal rejection. Suture-related factors in the form of suture infiltrates and loose suture are an important risk factor for graft rejection. Graft rejection if treated promptly is reversible.

Corneal scrapings were collected from a case of keratitis and microbiological investigations done. Coagulase-negative Staphylococcus (Staphylococcus epidermidis) was identified on culture, and antibiotic susceptibility tests were performed. Treatment was started with topical cefazolin sulfate 5% and gatifloxacin 0.3%; this was subsequently changed to vancomycin 5% and tobramycin sulfate 1.3% based on the sensitivity pattern. The isolates of this bacterium were susceptible to vancomycin, tobramycin, and gentamicin, and resistance was present against moxifloxacin, gatifloxacin, ciprofloxacin, and cefazolin. The case highlights the occurrence of keratitis caused by coagulase-negative Staphylococcus that is resistant to treatment with moxifloxacin.

Purpose: To evaluate the visual performance of rigid gas permeable (RGP) contact lenses in patients with nebular and nebulo-macular corneal opacity and correlate the improvement in visual acuity with other visual parameters., Methods: In a prospective study, visual performance of RGP contact lenses was evaluated in eyes with corneal opacity involving the pupillary area. The baseline visual acuity and other visual parameters with glasses were compared with those recorded with RGP contact lenses. The visual functions evaluated were visual acuity, contrast sensitivity, glare acuity, and mesopic vision. Binocular status with RGP contact lenses was assessed. All patients were followed up for 3 months., Results: Twenty-eight eyes (26 patients) with nebular or nebulo-macular corneal opacity were included in this study. All eyes (100%) achieved significantly better visual performance with RGP contact lenses than with glasses (P< 0.0020). Visual acuity of 6/9 or better was achieved in 50% of patients with RGP contact lenses compared to none with glasses. RGP contact lenses improved the visual acuity by 0.27 decimals over the baseline value with glasses, butthe improvement for mesopic vision and glare acuity was significantly lower at 0.15 and 0.06 decimals respectively. Similarly, contrast sensitivity did not improve to the same extent as visual acuity. Stereopsis was present only in patients with best corrected visual acuity of 6/9 or better with RGP lenses., Conclusion: RGP contact lenses improved the visual acuity and other visual performance in patients with reduced vision due to nebular or nebulo-macular corneal opacity. However, contrast sensitivity, glare acuity, and mesopic vision did not improve to the same extent as visual acuity.

Purpose: To review the causes, clinical features, course, histopathological and biochemical changes, diagnosis, andtreatmentof neurotrophic keratopathy., Methods: We reviewed the literature on neurotrophic keratopathy., Results and Conclusions: Neurotrophic keratopathy is a clinical entity which involves all degrees of degenerative corneal and conjunctival changes secondary to loss of sensory function in the nasociliary branch of the trigeminal nerve with or without decreased tear production. One of the commonest causes of loss of corneal sensation is herpes virus infection. The clinical course of neurotrophic keratopathy varies considerably. The corneal epithelium becomes diseased and breakdown occurs even in the absence of dessication, infection, and trauma. This stage, if not treated aggressively with ocular lubricants, tarsorrhaphy, or a bandage soft contact lens, will result in stromal lysis with or without perforation. Depending on the size and location of corneal perforation, procedures like the application of cyanoacrylate glue, penetrating keratoplasty, or conjunctival flap may be required.