Early Visual Rehabilitation Research Articles

EFFECT OF SUPEROTEMPORAL CLEAR CORNEAL INCISION ON PRE EXISTING ASTIGMATISM AFTER PHACOEMUSIFICATION SURGERY

Background: Historically, patients undergoing cataract surgery were at an increased risk of developing surgically induced astigmatism with the advent of modern methods of cataract surgery, the focus shifted towards smaller sized incisions and minimally invasive surgery. Smaller incision produces less post-operative change in astigmatism and early visual rehabilitation as compared to larger incisions. This study was conducted to evaluate and compare the difference between pre and post op corneal astigmatism among patients undergoing phacoemulsification surgery, for cataract, via a superotemporal clear corneal incision. Methods: This was a longitudinal study that enrolled 85 patients between the ages of 40 and 90 years at Ophthalmology Department, Jinnah International Hospital, Abbottabad. Patients were divided into 2 groups according to their pre exiting astigmatism. Group A, With the Rule (WTR), astigmatism and Group B, Against the Rule (ATR) astigmatism. Astigmatism was measured and compared pre operatively, and on day 1, day 7 and day 30 post operatively via auto kerato-refractometer. Results: The mean astigmatism in patients in Group A (WTR astigmatism) preoperatively was 0.76 Diopters, whereas patients in Group B (ATR astigmatism) had a mean pre operative astigmatism of 0.68 Diopters. Mean astigmatism post operatively at day 30 was 0.86 Diopters for Group A, and 1.02 Diopters for Group B. Only 2 out of 36 patients in Group A had a shift to ATR astigmatism, whereas 4 out of 49 patients in Group B had a shift to WTR astigmatism by post op day 30. Conclusion: Superotemporal clear corneal incision is a relatively stable and effective site for incision during phacoemulsification surgery, and causes negligible change in pre operative astigmatism.

Compression sutures: A rescue to failed intracameral gas injection in massive non-resolving corneal hydrops of long duration in advanced pellucid marginal corneal degeneration (PMCD)

To describe the application of full-thickness compression corneal sutures along with intracameral gas injection in a case of non-resolving long-duration hydrops of pellucid marginal corneal degeneration with a large Descemet membrane (DM) tear. Corneal hydrops is a complication of conditions such as keratoconus (KC), pellucid marginal corneal degeneration (PMCD), and keratoglobus. Intracameral gas injection in the form of sulfur hexafluoride (SF6) or perfluoro propane (C3F8) has been known to shorten the recovery period by tamponading the break. The application of corneal sutures to approximate the widely separated ends of the DM tear may also be performed. All these are management options described for acute hydrops. We report two cases of application of full-thickness compression corneal sutures along with intracameral gas injection in a case of non-resolving long-duration hydrops of more than 2 months duration in PMCD with a large DM tear. Full-thickness corneal compression sutures and intracameral gas injection can restore the imperviousness of posterior stroma after hydrops. This technique is safe and effective for faster resolution of corneal edema post hydrops and early visual rehabilitation.

Retinitis Pigmentosa in Awka, Nigeria: A Survey Study

Background: Retinitis pigmentosa which causes irreversible blindness and affects all gender is usually inherited.
 Objectives: To describe the incidence and pattern of retinitis pigmentosa at the Eye Unit of Chukwuemeka Odumegwu Ojukwu University Teaching Hospital Awka, Nigeria.
 Materials and Methods: The case files of all the new patients seen at the Eye Unit of the Chukwuemeka Odumegwu Ojukwu University Teaching Hospital Awka between January 2014 to December 2021 were reviewed. Those with clinical diagnosis of Retinitis Pigmentosa were selected and information bordering on age, sex, occupation, disease duration. associated morbidity and fundus findings were extracted and analyzed using descriptive statistics.
 Results: Out of the 5461 new patients seen at the Eye Clinic within the study period, 29(0.5%) were diagnosed of Retinitis Pigmentosa. Of the 29 patients 18 (62.1%) were males and 11(37.9%) females, with male to female ratio of 1.6:1. The age range was 7 years to 69 years. Thirteen patients (44.8%) were between 16 years and 44 years. Median age was 33 years while the mean age was 34. 8+15. 2 years. Nine (31.0%) patients were students. The most common complaints of the patients were poor vision, 27(93.1%) and refractive error 8(27.68). Seven patients (24.18) were blind at presentation while retinal pigmentation was the most frequent fundus finding 29 (100%).
 Conclusion: Retinitis Pigmentosa is a cause of visual impairment and blindness which reduces the quality of life of affected persons. Early diagnosis and visual rehabilitation should be encouraged.

Comparison of Surgically-induced Astigmatism using Topography and Keratometry in Patients undergoing Phacoemulsification and Small Incision Cataract Surgery: A Prospective Interventional Study

Introduction: Topographic measurement of corneal astigmatism is the current standard of care because, in addition to measuring corneal astigmatism, it identifies irregular astigmatism, which may limit optimum surgical results. The present study focuses on the use of topography to measure Surgically Induced Astigmatism (SIA), which is not a routine practice in most institutions, and compares it with keratometry values of corneal astigmatism. The present study highlights the accuracy of topography in the measurement of astigmatism, with its additional benefits being the measurement of irregular astigmatism and assessment of tear film status. Aim: To compare SIA using topography and keratometry in patients undergoing phacoemulsification and Small Incision Cataract Surgery (SICS). Materials and Methods: The present study was a prospective, interventional study conducted in the Ophthalmology Department of Bharti Vidyapeeth (deemed to be University) Medical College and Hospital, Sangli, Maharashtra, India for 18 months (November 2019 to April 2021). A total of 100 cases (100 eyes) with cataracts were randomly divided into Group-A (n=50) and Group-B (n=50), respectively, underwent Phacoemulsification and SICS. Before the surgery, the astigmatism of each patient was noted by both topography and keratometry. On the 45th postoperative day, patients’ Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA), automated keratometry readings, and corneal topography readings were taken, based on which SIA was calculated by SIA calculator version 2.0. The mean SIA in both groups was calculated and compared. An unpaired t-test was used to compare the mean of different variables in the two groups, Group-A and Group-B. A p-value of <0.05 was considered statistically significant. Results: The majority of cases were in the age group of 61- 70 years, with 23 (46%) cases in Group-A and 27 (54%) in Group-B. In the study, the mean SIA by keratometry in Group-A was 0.43±0.02D and in Group-B was 1.24±0.04D (p<0.0001), and the mean SIA by topography in Group-A was 0.49±0.02D and in Group-B was 1.28±0.03D (p<0.0001), indicating that phacoemulsification causes less SIA compared to SICS. Upon comparing the mean SIA calculated by keratometry and topography in both study groups, it was found that p<0.02 in Group-A and p<0.4 in Group-B, suggesting that both p-values are not significant. This indicates that both keratometry and topography will give similar results and can be used for determining SIA. Conclusion: The study showed that phacoemulsification produces less mean SIA compared to SICS, leading to better visual outcomes and early visual rehabilitation in contrast to the SICS group. The present study also concluded that both keratometry and corneal topography can be used for the calculation of SIA as both give similar results, although topography remains an important tool in the calculation of Intraocular Lens (IOL) power in patients with corneal pathologies and post-refractive surgeries.

Complications of laser in situ keratomileusis (LASIK)

Laser-in-situ-keratomileusis (LASIK) is one of the most commonly done refractive surgeries round the globe. It has become a popular technique of refractive surgery because of lower postoperative discomfort, early visual rehabilitation and decreased post-operative haze. This review journal aims to give a brief outline about intra and postoperative complications of LASIK, clinical presentation and management guidelines for these complications. Intraoperative complications include free cap, buttonhole flap, flap tear, decentered ablation, interface debris and femtosecond laser related complications like vertical gas breakthrough and opaque bubble layer. Postoperative complications include flap striae, epithelial ingrowth, diffuse lamellar keratitis, residual refractive error, refractive regression and many more. The knowledge about these complications help the surgeon in early identification and timely intervention for achieving optimal visual outcome.

Clinical assessment of corneal complications of manual small incision cataract surgery at tertiary care centre

: To assess corneal complications and visual outcome of manual small incision cataract surgery.: This study comprises of 227 patients in a tertiary care centre in Kolar district, who underwent MSICS were examined for corneal complications and visual outcome postoperatively on Day 1, 1 week, and at the end of 6 week also visual acuity (VA) assessment, anterior segment evaluation with slit lamp biomicroscopy, posterior segment evaluation using indirect ophthalmoscopy, and keratometry was done.227 participants were included in the study, of whom 138 (61%) were female and 89 (39%) were male. The maximum number of patients being in the age group of 61-70 (42.7%). OCTET grading was done for corneal edema patients and on post op Day 1, total 62 patients who had corneal edema in the study were graded according to OCTET classification, and 6 patients (9.6%) had grade 1, 17 patients (27.4%) had grade 2 and 39 patients (63%) had grade 3. At the end of 6 week postoperatively, 45 patients had clear cornea, and 5 patients (8%) had grade 1, 6 patients (9.5%) had grade 2, and 7 patients (11.1%) had grade 3, and 82.3% of patients had VA of 6/6 to 6/9 followed by 11% had 6/12 to 6/18 and 6.6% had 6/24 to 6/36.: Small incision cataract surgery is most cost-effective surgery if corneal endothelium is protected during surgery and will have early visual rehabilitation.

Auro-Keratoprosthesis for Visual Rehabilitation in Ocular Graft Versus Host Disease

Abstract A 36-year-old male presented with right eye graft melt post-penetrating keratoplasty (PK) for Aspergillus infection. The patient had a history of acute lymphocytic leukemia and had undergone a bone marrow transplant. He developed ocular graft versus host disease (GVHD) in both eyes and tissue adhesive application had to be performed for bilateral corneal melt. The right eye developed fungal keratitis, necessitating therapeutic keratoplasty. At presentation, the visual acuity was perception of light with an accurate projection of rays in the right eye and finger counting at 1 m in the left eye. An anterior chamber tap showed no organism on culture. Considering the non-ambulatory state of the patient and the need for early visual rehabilitation due to deteriorating mental well-being, a keratoprosthesis (KPro) surgery with amniotic membrane grafting was performed in the right eye. By post-operative day 20, the patient achieved a best-corrected visual acuity of 20/20. A PK was later performed in the other eye. It is conventionally believed that KPro is the last resort for bilateral corneal blindness and is commonly performed after multiple PK grafts have failed. However, this case highlights another indication of KPro in ocular GVHD; the rehabilitation of vision when PK will not work. In addition, this case illustrates the difference in the long-term outcomes between the two eyes, one that underwent early KPro surgery and the other that underwent early PK in ocular GVHD.

Visual outcome after manual small-incision cataract surgery by viscoexpression technique.

Globally, cataracts have remained the major cause of blindness. Cataract accounts for 62.6% of blindness affecting 9-12 million people. The only treatment for cataracts is surgical removal of cataracts. The surgical procedures include phacoemulsification and extracapsular cataract extraction (ECCE). In India, there is a huge backlog of cataract patients. Phacoemulsification is preferred nowadays for early visual rehabilitation, but in developing countries like ours, where facilities are not widely available, small-incision cataract surgery (SICS) is a cost-effective alternative as no machine is required. Also, it provides early visual rehabilitation as it is sutureless when compared to ECCE. So, manual SICS has emerged as a substitute for phacoemulsification and ECCE. The aim of the study was to evaluate the visual acuity and surgically induced astigmatism in patients more than 40 years of age, undergoing manual SICS with nucleus management by viscoexpression technique. This was a prospective study that included 50 patients over the age of 40 years undergoing manual SICS at a tertiary health-care center in North India by viscoexpression technique. Only those patients whose functional visual disability could be attributed to cataracts were included in the study. Preoperative and postoperative astigmatism were analyzed in the first, fourth, and sixth weeks. Fifty patients who were undergoing manual SICS were analyzed. Preoperative best-corrected visual acuity (BCVA) and astigmatism were compared to postoperative BCVA and astigmatism. Of 50 patients, 48 (96%) patients were able to gain good vision after 6 weeks. This study showed early visual rehabilitation with less surgically induced astigmatism following manual SICS by viscoexpression technique.

Retinitis pigmentosa in Usher syndrome in India: Electronic medical records driven big data analytics: Report III

Purpose:To describe the clinical presentation and demographic distribution of retinitis pigmentosa (RP) in patients with Usher syndrome (USH).Methods: This is a cross-sectional observational hospital-based study including patients presenting between March 2012 and October 2020. In total, 401 patients with a clinical diagnosis of USH and RP in at least one eye were included as cases. The data were retrieved from the electronic medical record database. For better analysis, all 401 patients were reclassified into three subtypes (type 1, type 2, and type 3) based on the USH criteria.Results: In total, there were 401 patients with USH and RP, with a hospital-based prevalence rate of 0.02% or 2/10,000 population. Further, 353/401 patients were subclassified, with 121 patients in type 1, 146 patients in type 2, and 86 patients in the type 3 USH group. The median age at presentation was 27 years (IQR: 17.5–38) years. There were 246 (61.35%) males and 155 (38.65%) females. Males were more commonly affected in all three subtypes. Defective night vision was the predominant presenting feature in all types of USH (type 1: 43 (35.54%), type 2: 68 (46.58%), and type 3: 40 (46.51%) followed by defective peripheral vision. Patients with type 2 USH had more eyes with severe visual impairment.Conclusion: RP in USH is commonly bilateral and predominantly affects males in all subtypes. Patients with USH and RP will have more affection of peripheral vision than central vision. The key message of our study is early visual and hearing rehabilitation in USH patients with prompt referral to otolaryngologists from ophthalmologists and vice versa.

Comparison of Surgically Induced Astigmatism L-Shaped vs Straight Incisions in Manual Small Incision Cataract Surgery

Aims and objective: To compare surgically induced astigmatism(SIA) in L-shaped vs straight incision in manual small incision cataract surgery(SICS). Material method: 60 patients aged 35 years and above with uncomplicated cataract with nuclear sclerosis of any grade were included in the study who were divided into 2 groups randomly. 30 patients underwent SICS with straight scleral incision and 30 with L-shaped incision. Data was analyzed using SPSS version 15.0 statistical analysis and calculations were performed using SIA calculator version 2.1. Results: The SIA (surgically induced astigmatism) was 1.14 ± 0.44D, 0.81 ± 0.40D, 0.61 ± 0.33 D on 1st post-operative day, 4 weeks and 6 weeks respectively in straight incision group and the SIA was 0.79 ± 0.36D, 0.33 ± 0.31D, 0.15 ± 0.18D on 1st post-operative day, 4 weeks and 6 weeks respectively in L-shaped incision group. Conclusion: L-shaped incision technique induces less amount of SIA as compared to straight incision and the difference is statistically significant. Also, L-shaped incision maintains better anterior chamber stability and leads to early visual rehabilitation. In poor and developing countries where still majority of cases are being operated by manual SICS, achieving emmetropia or minimal refractive errors should be the goal.

Prevalence and Factors Related to Visual Impairments in Children With Bilateral Cataract Following Surgery and the Potential Need for Education and Rehabilitation Services

Introduction Pediatric cataract is still a major cause for childhood visual impairment. The goal of our study was to analyze the prevalence of children with impaired vision (6/15 or worse) after surgery for bilateral cataract, to evaluate factors associated with it and to emphasize the importance for visual rehabilitation including the use of visual aids, educational measures, and social worker services. Methods Retrospective analysis of medical records from children who underwent surgery for cataract up to age 6 years, with a follow-up of at least 4 years. Clinical characteristics retrieved from medical records included visual acuity, presence of nystagmus and/or strabismus, age at surgery, intraocular lens (IOL) implantation, and others. Results Fifty-five children were included in the study. Follow-up ranged from 4 to 13 years (Mdn = 6.8). Visual impairment was found in 15/24 (62.5%) of children operated on before the age of 6 months (group 1), and in 7/31 (22.5%) n those operated after the age of 6 months (group 2; p = .019). Thirty-eight of the 55 children had a primary IOL implantation; nystagmus and microphthalmos were also associated with higher rates of visual impairment. Discussion Despite early and modern surgery, long-term visual outcome remains poor in children undergoing bilateral cataract surgery at young age. When discussing visual prognosis with parents, it is important to recognize factors associated with visual impairment, such as need for surgery before age 6 months, nystagmus and microphthalmos, as well as the importance for early visual rehabilitation services when needed. Implications for Practitioners Our study aims to highlight the high number of children left with visual impairment and blindness following modern and timely treatment for early cataract. Early referral for visual rehabilitation will optimize quality of life in these children and will probably allow a wider range of opportunities as adults.

Ocular trauma

Background: According to the WHO, ocular injury results in 19 million people to become unilateral blind and 1.6 million to become bilateral blind. Ocular trauma constitutes a major part of preventable blindness. The following study was done to identify the demographic profile of the patients and nature of ocular trauma for developing acceptable methods for better management and early visual rehabilitation of patients. Aim: The aim was to study various demographic patterns and manifestations of ocular injuries. Methods: This hospital-based prospective study was carried out in the Department of Ophthalmology. One hundred cases of ocular trauma were included, and written consents were obtained. A detailed history specific to age, occupation, time of injury, type of object causing injury, and socioeconomic status of the patient was obtained through prestructured pretested pro forma. A detailed ocular examination along with a systemic examination was carried out. Results: In the present study, 24% of the cases were in the age group of 40–50 years. Sixty-five percent of the population was male. Thirty-one percent of the population presented within 24 h of trauma, 61% within 3 days, and 25% presented after 7 days. Ninety-five percent of the patients had unilateral trauma and 5% had bilateral trauma. Sixty-two percent of the patients had suffered from road traffic accidents, 25% had work-related trauma, whereas, in 13% of cases, trauma was at home. Blunt objects, foreign bodies, and sharp objects were the top three causes of trauma, accounting for 26%, 23%, and 15% of trauma cases, respectively; it was found that the anterior segment was involved in 74% of cases, the posterior segment in 4% of cases, and combined injury was in 22% of the cases. Conclusion: Most of the eye injuries can be prevented by educating people on various modes of ocular trauma, the need for early treatment, and importance of wearing safety eye gear. This study highlights on the epidemiology of ocular trauma as well as various preventive strategies.

A COMPARATIVE PROSPECTIVE STUDY OF EFFICACY AND VISUAL OUTCOME OF PHACOEMULSIFICATION AND SICS IN NORTH INDIAN POPULATION IN AND AROUND LUCKNOW.

PURPOSE: To evaluate efcacy and visual outcome of manual small incision cataract surgery (SICS) and phacoemulsication. METHODS: A prospective, interventional, observational, follow up study was conducted on 120 patients with clinically signicant senile cataract undergoing cataract surgery by either SICS or phacoemulsication, at a tertiary eye care centre in Lucknow. The follow up evaluations were carried out at post-operative day st rd th 1, 1 week, 3 week and 6 week. RESULTS: On rst postoperative day, there was signicantly better visual outcome with phacoemulsication than SICS (p = 0.005) with 80% patients in SICS group and 90% patients in phacoemulsication group, th had best corrected visual acuity (BCVA) better than equal to 6/18. However at 6 week, nal visual recovery was similar in both the groups (BCVA 6/18 in 96.7% in SICS group and 100% in phacoemulsication group) with no statistically signicant difference. There was no signicant difference in overall per operative and post operative complications between SICS and phacoemulsication. SICS and phacoemulsication did not show signicant difference in surgery induced astigmatism (SIA) with SIA of 0.733D and 0.775D in SICS and phacoemulsication group respectively. CONCLUSIONS: Phacoemulsication is superior to SICS in terms of early visual rehabilitation. But there is no signicant difference in nal visual outcome and complication rates between the two techniques.

Early corneal pachymetry maps after cataract surgery and influence of 3D digital visualization system in minimizing corneal oedema.

To describe the early topography of corneal swelling occurring after cataract surgery and to evaluate the impact of the three-dimensional (3D) digital visualization system in minimizing corneal oedema. Prospective observational, single-centre, consecutive case series of 134 patients undergoing cataract surgery performed by the same surgeon, with either 3D or conventional visualization systems. Eyes were assigned to two groups based on their anterior chamber depth (group ACD ≤3 mm and group ACD >3 mm). Optical coherence tomography was performed to evaluate postoperative corneal swelling. Three corneal swelling profiles were identified on the first postoperative day type 1, limited corneal oedema near peripheral corneal incisions; type 2, dome-shaped corneal swelling spreading from the principal corneal incision and reaching the paracentral cornea; type 3, continuous oedema spreading from the principal incision to central cornea, with a generalized oedema predominating in the upper part of the cornea. On the first day after surgery, in group ACD ≤3 mm, visual acuity was significantly better in patients undergoing surgery with 3D visualization (0.023 vs 0.072 logMar, p = 0.014) with reduced central corneal thickening 17.3 µm (±3.2) in comparison with conventional visualization 44.0 µm (±9.3) (p = 0.0082). In group ACD >3 mm, no significant association was found between the use of the 3D system and pachymetry changes and early visual rehabilitation. On day 21 after surgery, no significant differences in corneal pachymetry values were observed between the two surgical approaches in both groups. We describe early postoperative corneal map profiles providing insight into the pathogenesis of postoperative corneal swelling and possible prevention strategies. By improving visualization of the narrow surgical space in patients with shallow anterior chambers, the 3D system could help to minimize postoperative corneal oedema.

Comparison of Surgically Induced Astigmatism and Visual Outcome in 5.5 mm and 4.5 mm Superior Scleral Incision in Small-Incision Cataract Surgery

Background: Comparative study of visual outcome and astigmatism between manual small-incision cataract surgery (MSICS) done through a 5.5 mm and 4.5 mm superior scleral incision. Aim: The aim of this study is to compare the visual outcome and astigmatism in manual small-incision cataract with superior scleral incision size of 4.5 mm and 5.5 mm. Settings and Design: This is a hospital-based, prospective, case–control observational study of 6-month duration; 110 eyes of 110 patients with cataract attending the ophthalmology outpatient department/inpatient department at Acharya Vinoba Bhave Rural Hospital were selected for the study after taking the inclusion and exclusion criteria into consideration. Informed consent was obtained from all participants after approval by the institutional ethical committee of the college. Materials and Methods: After enrollment, the patients were divided into two groups, one which underwent cataract extraction by MSICS with 4.5 mm superior scleral incision and the other which underwent cataract extraction by MSICS with 5.5 mm superior scleral incision. All surgeries were done by the same surgeon under the same setting and visual outcome and astigmatism were studied and compared between the two groups. Statistical Analysis Used: Statistical analysis was carried out using descriptive and inferential statistics using Chi-square test and Student's unpaired t-test and software used in the analysis was SPSS 17.0 version and GraphPad 6.0 version and P < 0.05 is considered a level of statistical significance. Results: Surgically induced astigmatism (SIA) in MSICS with 4.5 mm superior scleral incision was comparatively less as compared to that in patients in whom 5.5 mm incision was used. Conclusions: In the present study, we found that MSICS with 4.5 mm scleral incision has a better visual prognosis for cataract extraction as compared to conventional extracapsular cataract extraction in terms of better and early visual rehabilitation and lesser SIA.

Comparative analysis of the post-operative anti-inflammatory effect of topical 0.1% dexamethasone sodium eye drops, topical 1% prednisolone acetate eye drops and difluprednate 0.05% topical eye drops after small incision cataract surgery at a tertiary eye care institute in India

Background & Objectives: Comparative analysis of the post-operative anti-inflammatory effect of topical 0.1% dexamethasone sodium eye drops, topical 1% prednisolone acetate eye drops and difluprednate 0.05% topical eye drops after small incision cataract surgery at a tertiary eye care institute in India. Materials and Methods: The current study was a prospective randomised control study conducted from June 2019 to January 2021 at a tertiary eye care institute in India after taking due clearance from the institutional ethical committee. 300 eyes of 215 patients were enrolled into the study and divided into three groups consisting of 100 eyes in each group. Group A patients received topical Dexamethasone 0.1% eye drops, group B & C received Prednisolone acetate 1% and difluprednate 0.05% eye drops respectively. Level of significance was kept at p Results: Baseline IOP values between the three groups did not show any statistical significance. Significant difference in the analgesia was observed in the difluprednate 0.05% group. AC cells & flare was decreased by around the 7th day of treatment in difluprednate and prednisolone acetate eye drops treated groups. Conclusion: To conclude our study opines that, dexamethasone is non-inferior and equally efficacious to prednisolone and difluprednate in the management of post cataract surgery inflammation. Although difluprednate 0.05% provides superior analgesia and early clearance of AC cells & flare, which may further aid in early visual rehabilitation and recovery. Keywords: Difluprednate, Prednisolone, AC cells, Flare, IOP.

An overview of complications of MSICS

Introduction: Taking into consideration the wide spectrum of complications that follow MSICS and their influence on visual outcome, a sincere effort has been made in this study to critically analyze the incidence and the nature of various intraoperative, early and late post-operative complications among the total number of cataract extraction carried out. Materials and Methods: A Prospective observational study of 500 cases that had undergone MSICS after a thorough preoperative ocular evaluation including detailed history and clinical examination and these cases were studied for a period of 2 years and all the intraoperative, early and late post-operative complications were noted. Results: The commonest intraoperative complications were premature entry with iris prolapse (5%) followed by zonular dialysis (3%), commonest early post operative complications were SK (20%) and corneal edema (17%) and the commonest late post operative complications were PCO(18%) followed by astigmatism in 9% of the cases. Conclusion: SICS gives best corrected postoperative visual acuity of 6/6 or 6/9 in a greater proportion of patients and it has all the inherent advantages of the sutureless cataract surgery in terms of universal applicability, greater wound stability, lesser complications and early visual rehabilitation. Keywords: Cataract surgery, Complications of MSICS, MSICS, Phacoemulsification.

Study of visual functions with multifocal versus monofocal intraocular lenses after phacoemulsification in patients with age-related cataract

Early visual rehabilitation and targeting emmetropia using small incisions and foldable IOLs is the main objective of modern cataract surgery, the so termed ‘refractive cataract surgery’. This current single-center prospective study assessed the clinical outcomes and thus patient satisfaction of multifocal IOLs over monofocal IOLs. To study visual functions with a refractive –diffractive type multifocal versus monofocal intraocular lenses after phacoemulsification in patients with age related cataract. 40 patients undergoing phacoemulsification for decreased vision due to age related cataract were randomly divided into 2 groups. Patients in group 1 underwent multifocal IOL [refractive –diffractive type] implantation and patients in group 2 underwent confocal IOL implantation. Postoperatively, patients were followed up for 90 days and assessed for unaided visual acuity for distance, intermediate and near vision, contrast sensitivity using Pelli-robson chart. At the end of the study, uncorrected visual acuity for distance (UDVA) was 6/9 in 65% patients in group 1 while 50% had uncorrected visual acuity of 6/9 in group 2. Uncorrected intermediate visual acuity (UIVA) in group 1 was N10 or better in 55% patients while in group 2, 75% patients had N24. Uncorrected near visual acuity (UNVA) in group 1 was N6 in 35% patients and N8 in 35% while in group 2, 75% patients had N18 vision, A paramount statistical difference was seen in the two groups.(p=0.001). The mean contrast sensitivity in group 1 was 2.04+/-0.23 and group 2 was 2.20+/-0.07(although statistically significant but within normal limits). None of the patients in any group had any significant complaint of glare or haloes. Mutifocal IOLs decrease the spectacle dependence of patients without compromising the subjective visual functions

A clinical study of corneal complications of cataract surgery

Background: In this study we investigate the incidence of corneal complications of extra capsular cataract extraction (ECCE) and manual small incision cataract surgery (SICS). We study the various etiological factors leading to these complications and also to highlight various prophylactic intra and post-operative measures to reduce these complications.Methods: Cataract surgery was conducted on 100 patients at Meenakshi Medical College Hospital and Research Institute. Patients were randomly divided into two groups. Group A of 50 patients were subjected to ECCE with posterior chamber intraocular lenses (PCIOL) and group B of 50 patients to small incision cataract surgery with PCIOL.Results: On the first post-operative day, 5 post-operative cases developed corneal edema (10%) in ECCE and 4 cases (8%) in SICS. Striate keratitis developed in 4 cases of ECCE (8%) and 3 SICS (6%). Nearly 62% patients who underwent ECCE accepted cylinder between 0.25-0.75 D while there were 52% cases in SICS.Conclusions: In this study we conclude that with various advances in cataract surgery the incidence of corneal complication have reduced and have helped in early visual rehabilitation and minimization of post-operative astigmatism by careful selection of incision type and location for MSICS.

CAUSES OF VISUAL HANDICAP AMONGST PATIENTS ATTENDING OUTPATIENT DEPARTMENT OF A TERTIARY CARE CENTER FOR VISUAL HANDICAP CERTIFICATE

PURPOSE- To analyse various ocular diseases leading to permanent visual handicap in a district based on visual handicap certification issued by ophthalmologist at tertiary care center after verification of the domicile of the person. METHOD – This is a retrospective analysis of patients attending outpatient department of tertiary care center for visual handicap certification. It was done over the period of one year with total recruitment of 311 patients. All patients were examined for best corrected visual acuity according to Snellen’s chart, anterior and posterior segment examination. Ultrasonography and/or Optical Coherence Tomography and/or electroretinography / visual evoked potential was done in selected cases. After diagnosis, percentage of blindness was determined according to the categories of visual disability and blindness certificate was issued. RESULT- Maximum of the certified visually disabled individuals are of 21- 30 years (73 patients, 23.47%). 212 patients were males and 99 were females. Visual disability of 100% was seen in 258 cases. Retinitis Pigmentosa was the most common cause seen in 67(21.54%) cases. Other major causes include congenital ocular malformation(16.40%) optic atrophy(13.83%), phthisis bulbi (8.68%), corneal opacities(8.36%), glaucoma(6.75%). CONCLUSION- The burden of the blindness can be decreased by public educationand genetic counselling regarding common and preventable causes of blindness, as early diagnosis, treatment and visual rehabilitation can help to improve visual outcome and ultimately visual handicap in the society for the better future.