Mean Postoperative Visual Acuity Research Articles

Efficacy of inverted inner limiting membrane flap technique for macular holes of ≤400 μm: A systematic review and meta-analysis.

To evaluate the efficacy of inverted internal limiting membrane (ILM) flap technique in full-thickness macular holes (MHs) with a size of ≤400 μm compared to the ILM peeling technique. Related literatures that compared inverted ILM flap and ILM peeling in MHs ≤ 400 μm were reviewed by searching electronic databases including Pubmed, EMbase, ClinicalTrials.gov, and Cochrane Library up to April 2023. The primary outcome measure was hole closure rate, and the secondary outcome measures were the mean postoperative best-corrected visual acuity (BCVA), retinal sensitivity, and outer status of the retinal layers, including the external limiting membrane and ellipsoid zone. The quality of the articles was assessed according to the revised version of the Cochrane risk-of-bias tool for randomized trials or the Newcastle-Ottawa scale. In the case of heterogeneity, a sensitivity analysis was conducted, and publication bias was visually evaluated using a funnel plot. This review included six studies with 610 eyes for the primary outcome and 385 eyes for the secondary outcomes, which were two randomized control trials and four retrospective studies. Pooled data revealed that the overall MH closure rate was 99.4% in the inverted ILM flap group and 96.2% in the ILM peeling group, without significant difference between the two groups (odds ratio = 3.91; 95% confidence interval, 0.82~18.69; P = 0.09). The inverted ILM flap technique did not have a favorable effect on the BCVA, retinal sensitivity, or recovery of the outer retinal layers. These results were consistent with those of the subgroup analysis of the different follow-up periods. No significant publication bias was observed. In eyes with MHs of ≤400 μm, both techniques demonstrated excellent surgical outcomes without significant differences. Therefore, surgical techniques can be selected according to surgeon preferences.

Fusion-Flanged Intrascleral Intraocular Lens Fixation Technique: Simple, Safe, Efficient.

To develop a new, sutureless intrascleral intraocular lens (IOL) fixation technique based on the Yamane double-needle and Canabrava 4-flanged techniques. The Fusion-Flanged technique involves using a 7-0 polypropylene suture loop threaded through the eyelets of the IOL. Afterward, both ends of the suture are passed outside the eye through a 27-gauge needle. This technique creates a single flange by joining the 2 suture ends through handheld cautery, and this flange is then embedded into the scleral tunnel to securely fix the IOL in place. This technique was performed on a total of 7 aphakic patients. Four of them had encountered complications following manual small incision cataract surgery, while the remaining 3 experienced complications after phacoemulsification. The results indicated a significant improvement in visual acuity, with mean preoperative and postoperative corrected distance visual acuities of 0.77 ± 0.11 and 0.27 ± 0.08 (logarithm of the minimum angle of resolution [logMAR] units), respectively. The Fusion-Flanged intrascleral IOL fixation technique offers improvements in simplicity, safety, and the overall efficiency when compared to existing sutureless intrascleral fixation techniques. Notably, this technique is versatile and can be applied to both non-foldable and foldable IOLs.

Microsurgical Vitrectomy with Pars Plana Incision for the Removal of Posterior Segment Intraocular Foreign Bodies.

This study describes a pars plana incision surgical technique combined with 23 or 25-gauge vitrectomy in the management of intraocular foreign bodies (IOFBs) and to assess its anatomical and functional results. Sixteen patients with ocular trauma complicated with IOFB were enrolled in our study. The mean preoperative visual acuity was 2.01 ± 0.55 LogMAR, and the mean postoperative visual acuity at the final visit was improved to 0.91 ± 0.58 LogMAR (p < 0.001). Until the last follow-up, all IOFBs were successfully removed and anatomic success was obtained. Complications, such as endophthalmitis, silicone oil-dependent, and ocular hypotonia, were not observed. Microsurgical vitrectomy with modified pars plana incision is a safe and effective procedure in the treatment of retained IOFB, especially associated with transparent lens and posterior segment injury.

Nonpenetrating Foldable Intrastromal Keratoprosthesis: A Review of the Literature.

To review the literature focusing on the clinical outcomes of KeraKlear (KK) (KeraMed), a foldable intrastromal keratoprosthesis. We searched 6 databases using 4 keywords: KeraKlear, Foldable Keratoprosthesis, Intrastromal Keratoprosthesis, and Non-penetrating Keratoprosthesis. Included studies had to be conducted in vivo on humans, published until January 3, 2023, and had to investigate the implantation of the KK. Eyes were considered at high risk of keratoprosthesis retention failure whenever there was an active inflammatory ocular surface disorder or in case of previous KK failure. We aimed at recording the postoperative complications, rate of prosthesis retention, and mean improvements in visual acuity. We identified 144 publications, 6 of which (38 eyes) met the inclusion criteria. No randomized controlled trials were found, and some studies had significant limitations regarding sample size and follow-up duration. With a mean follow-up of 28 ± 18.8 months, postoperative complications of any kind occurred between 0% and 50% and 24% had an implant extrusion/needed a reoperation. The mean postoperative visual acuity improvement on the last follow-up was -0.83 ± 0.27 LogMAR, that is, -0.57 ± 0.3 for high-risk and -1.03 ± 0.25 for low-risk eyes, whereas 1 year after implantation, 50% of the prostheses were retained in the former and 81% in the latter group. None of the eyes developed glaucoma, endophthalmitis, or expulsive hemorrhages; none had to be eviscerated/enucleated. Despite the limited quality and quantity of evidence, the available literature seems to suggest the KK to be a valuable tool in the treatment of complicated corneal disorders. Because in many parts of the world, the access to corneal transplantation is limited, this prosthesis could represent a valid alternative.

Refractive Status after Phacoemulsification with Biometry Done by Haigis and SRK-T Formulae in Myopic Patients

Background: Optimum refractive outcome is the key indicator for assessing the success of cataract surgery. Accurate biometric calculation of IOL is an important contributor of post-operative refractive status. There are several formulae for calculation of IOL power depending on axial length of eyes. Haigis is the formula of choice for calculating IOL power in myopic patients, whereas, SRK-T is a versatile formula irrespective of axial length. For IOL power calculation by Haigis formula needs expensive instrument. On the other hand, biometry by SRK-T formula can be done by less expensive and easily available instrument. Objective: To assess and compare post-operative refractive status after phacoemulsification where biometry done by Haigis and SRK-T formulae. Methods: This prospective observational study was conducted over 60 diagnosed patients of cataract with axial length more than 24 mm attending in the cataract clinic of NIO&amp;H for phacoemulsification. Patients were selected based on specific selection criteria. Selected patients underwent detail ophthalmic and systemic examination as well as relevant investigation. Biometric calculation of IOL power was done by a single skilled technician by using Haigis formula (group A) in 30 patients and SRK-T formula (group B) in 30 patients. Visual acuity was assessed by LogMAR unit after 4 weeks of surgery and compared between two groups, p value ≤0.05 was considered as significant. Results: Mean age of the study subjects were 57.7±6.0 (SD) years in group A and 57.27±5.48 (SD) years in group B. In group A 14(46.7%) were male and 16(53.3%) were female and in group B 16(53.3%) were male and 14(46.7%) were female. Mean axial length was 25.05±0.45 (SD) mm in group A and 24.88±0.32 (SD) mm in group B. Mean IOL power was 18.23±0.76 (SD) diopter in group A and 18.23±0.65 (SD) diopter in group B. Post-operative mean visual acuity was 0.19±0.26 (SD) LogMAR unit in group A and 0.18 ±0.27 (SD) LogMAR unit in group B. Regarding post-operative refractive status of the study subjects, in group A, out of 30 patients 14(46.7%) were emmetropic, 7(23.3%) were myopic, 5(16.7%) were hypermetropic and the rest 4(13.3%) patients had astigmatism and in group B, out of 30 patients 16(53.3%) were emmetropic, 5(16.7%) were myopic, 4(13.3%) were hypermetropic and the rest 5(16.7%) patients had astigmatism. Conclusion: Quantitative assessment and statistical analysis shows there was no significant difference in post-operative refractive status and mean visual acuity between two groups. J.Natl.Inst.Ophthalmol.2023;6(1): 42-47

Outcomes of Pre-Descemet Endothelial Keratoplasty for Failed Therapeutic Penetrating Keratoplasty.

The aim of this study was to analyze the outcomes of pre-Descemet endothelial keratoplasty (PDEK) for failed therapeutic penetrating keratoplasty. This was a retrospective, interventional study that involved 12 eyes of 12 patients with failed therapeutic penetrating keratoplasty that underwent PDEK. All cases had a minimum follow-up of 12 months. The main outcome measures were best-corrected visual acuity, graft clarity, endothelial cell density loss, and graft survival. Corneal clarity was graded on a scale from 0 to 4, where grade 4 denoted an absolutely clear cornea and grade 0 denoted a totally opaque cornea. Three cases underwent PDEK, 6 cases PDEK with phacoemulsification, and 3 cases underwent PDEK with pupilloplasty. The mean follow-up period for all cases was 18.5 ± 4.9 months. The mean preoperative and postoperative best-corrected visual acuity (in Snellen decimal equivalent) was 0.02 ± 0.01 and 0.54 ± 0.17, respectively, at the last follow-up. Postoperatively, corneal clarity grade 4 was present in 9 eyes, grade 3 in 2 eyes, and grade 2 in 1 eye. Mild subepithelial haze was noted in 2 eyes. The percentage of endothelial cell density loss was 28.2% ± 10.6%. No correlation was observed between the postoperative graft clarity and preoperative specular count (r = -0.021, P = 0.512). Rebubbling was performed for 1 eye that developed partial graft detachment in the first postoperative week. One patient had an episode of rejection that was managed with systemic and topical steroids. In patients with failed therapeutic penetrating keratoplasty, PDEK can be a useful alternative for visual rehabilitation as it demonstrates favorable visual outcomes with a good graft survival rate.

Early-Onset Myopia and Retinal Detachment without Typical Microcoria or Severe Proteinuria due to a Novel LAMB2 Variant

To describe the ocular and renal features, as well as outcomes of retinal detachment repair, in patients with a novel, homozygous laminin β-2 (LAMB2) pathogenic variant. Single-center retrospective chart review of patients with a homozygous variant, c.619T>C p.(Ser207Pro), in the LAMB2 gene. Eleven patients (22 eyes) from 4 families. Demographic data and ocular findings were recorded. Patients were recalled for a detailed renal evaluation. Ocular features, renal features, and outcomes of retinal detachment repair. The mean age at presentation was 6.0 (range, 1-26) years. None of the study eyes had microcoria, and none of the patients had nephrotic-range proteinuria. The mean refraction and axial length were-7.9 diopters (range,-4.0 to-12.0 diopters) and 25.3 (range, 22.7-27.7) mm, respectively. Eleven eyes (50%) had cataract at presentation. Fifteen eyes had a clear view to the fundus and all showed tessellated myopic fundus, avascular peripheral retina evident clinically or on fluorescein angiography, and rudimentary fovea. Optic disc pallor was observed in 10 eyes (66.7%). Straightened retinal vessels, abnormal vascular emanation (situs inversus) from the optic disc, supernumerary vascular branching at the optic disc, and vascular tortuosity were observed in 10 (66.7%), 2 (13.4%), 2 (13.4%), and 2 (13.4%) eyes, respectively. Discrete areas of punched-out chorioretinal atrophy were observed in 4 (26.7%) eyes. Spectral-domain OCT showed retinal and choroidal thinning in 13 eyes (86.7%), retinoschisis temporal to the fovea in 2 eyes (13.4%), and rudimentary fovea in 15 eyes (100%). Among the 22 eyes, 14 eyes (63.6%) developed rhegmatogenous retinal detachment (RRD), mostly during childhood, of which 5 patients had bilateral RRD. Eight eyes were operated on and 6 (75%) achieved retinal reattachment at the last follow-up. The mean preoperative visual acuity was 20/300 and the mean postoperative visual acuity at the last follow-up was 20/400. This study describes a distinct phenotype of LAMB2-related disease with a novel, homozygous LAMB2 variant, and further expands the spectrum of ophthalmic and renal features, and the molecular genetic basis, of LAMB2-related disease. Because the typical microcoria and nephrotic-range proteinuria might be absent, the retinal features can guide the diagnosis. The authors have no proprietary or commercial interest in any materials discussed in this article.

Evaluation of Visual Outcomes and 3-Month Refractive Stability of a New Hydrophobic Acrylic Intraocular Lens.

To determine the refractive stability of a new hydrophobic acrylic intraocular lens (IOL) when implanted bilaterally. This was a prospective, evaluator masked, single surgeon study of 58 eyes of 29 patients. Patients were bilaterally implanted with the Clareon monofocal IOL (CNA0T0, Alcon Vision LLC). Refractive stability was evaluated between 1 and 3 months postoperatively. At 3 months postoperatively, data were also collected for binocular uncorrected and distance corrected visual acuities at distance (4 m) and intermediate (80 cm and 66 cm) and binocular defocus curve. Postoperative refraction was statistically equivalent between 1 and 3 months postoperatively (p < 0.001). Mean postoperative uncorrected distance visual acuity was -0.01 ± 0.10 logMAR, and mean corrected distance visual acuity was -0.04 ± 0.06 logMAR. Mean postoperative uncorrected intermediate visual acuity was 0.16 ± 0.13 logMAR and 0.24 ± 0.14 logMAR at 80 cm and 66 cm, respectively. With distance correction in place, mean visual acuity at 80cm and 60cm was 0.16 ± 0.13 logMAR and 0.23 ± 0.14 logMAR, respectively. The Clareon monofocal IOL can provide stable refraction, excellent distance vision, and functional intermediate vision postoperatively.

Four-Point Flange Intrascleral Fixation With Double Suture Through the Dislocated Plate-Haptic Trifocal Intraocular Lens

To describe a technique for the replacement of dislocation of plate-haptic trifocal intraocular lens (IOL) through double-suture four-point flange intrascleral fixation. Retrospective, interventional, noncomparative, case series METHODS: A total of 7 eyes of 7 patients with a dislocated plate-haptic trifocal IOL were enrolled for four-point flange intrascleral fixation with double 7-0 polypropylene suture. Preoperative and postoperative visual acuity, operating time, refractive results, postoperative IOL tilt and decentration, intra-operative and postoperative complications were recorded. The mean postoperative uncorrected distance visual acuity (UDVA) was 0.05 ± 0.06 logMAR. The mean postoperative uncorrected intermediate visual acuity (UIVA) at 80 cm was 0.09 ± 0.06 logMAR and the mean postoperative uncorrected near visual acuity (UNVA) at 40 cm was 0.06 ± 0.07 logMAR. The mean postoperative residual spherical equivalent values were - 0.27 ± 0.39 D. VF-14 questionnaire showed that no difficulty was found in >80% of subjects for all of the tasks. The mean surgical time was 16.23 ± 5.64 minutes. The mean tilt of IOL was 3.74 ± 1.31° and the mean decentration of the IOL was 0.18 ± 0.09 mm. No important complications appeared. The authors have described the technique of four-point flange intrascleral fixation for plate-haptic trifocal IOL.

Clinical Outcomes of Toric Intraocular Lenses in Patients with Fuchs Endothelial Corneal Dystrophy.

Implantation of toric intraocular lenses (IOLs) in patients with Fuchs endothelial corneal dystrophy (FECD) is still considered relatively contraindicated, without sufficient clinical evidence. Therefore, this study was designed to evaluate the results of toric IOL implantation in patients with FECD. A retrospective case-control study of 28 eyes of FECD patients and 84 eyes of healthy control patients who received toric IOLs during routine cataract surgery was performed. The outcome measures were uncorrected and corrected distance visual acuity, spherical equivalent, and refractive residual astigmatism. The mean postoperative uncorrected and corrected distance visual acuity in the FECD eyes compared to the control eyes were 0.15 ± 0.14 vs. 0.13 ± 0.17, respectively (P = 0.32), and 0.05 ± 0.08 vs. 0.06 ± 0.10, respectively (P = 0.95). The spherical equivalent in the FECD eyes compared to the control eyes was -0.29 ± 0.43 vs. -0.21 ± 0.50, respectively (P = 0.19). The preoperative corneal centroid astigmatism in the FECD eyes compared to the control eyes was 0.85D@93° ± 2.42° vs. 0.23D@68° ± 2.50°, respectively (P = 0.43), and the mean preoperative corneal astigmatism magnitude was 2.26 ± 1.1D vs. 2.28 ± 1.03D, respectively (P = 0.82). A trend toward higher postoperative refractive centroid astigmatism was found in the FECD eyes compared with the control eyes: 0.24D@28° ± 0.57° vs. 0.03D@127° ± 0.53°, respectively (P = 0.09). However, the mean refractive astigmatism magnitude was similar in FECD eyes and the healthy control eyes: 0.52 ± 0.31D vs. 0.42 ± 0.31D, respectively (P = 0.44) (D diopters). The postoperative refractive astigmatism (both centroid astigmatism and mean magnitude astigmatism) was no higher than 0.52D in both groups. Therefore, FECD patients without corneal edema can be considered for toric IOLs.

The Success Rate of Glaucoma Drainage Device Revision.

We report the survival of surgical revision to glaucoma drainage devices for several indications in a large cohort of patients, with an overall success rate of 45% at 36 months. To evaluate the outcomes of surgical revision for complications of glaucoma drainage devices. Three hundred thirty-five eyes of 318 patients who underwent tube revision or removal at University of California Los Angeles (UCLA) Jules Stein Eye Institute between 1997 and 2019 were included. The pre-defined primary outcome measure was surgical success of the initial revision, defined as resolution of the condition with no additional revisions required, no functionally significant change in vision, and no instances of intraocular pressure > 21mmHg at 2 consecutive visits postoperatively. Kaplan-Meier survival analysis was applied to evaluate survival at 36 months based on these criteria. The Wilcoxon paired test was used to compare mean preoperative and postoperative intraocular pressure, medication usage, and visual acuity. Overall, survival of revised tubes at 36 months was 45%. The 4 most common indications for revision were exposure of the implant (42% of all revisions), occlusion (14%), corneal failure or threat of failure (12%), and hypotony (11%). Survival at 36 months for each of these indications was 44%, 45%, 52%, and 37%, respectively. These results suggest that eyes with glaucomatous damage with long-term glaucoma drainage device complications can still have a reasonably successful outcome when a revision is performed. However, with substantial rates of vision loss and a frequent need for additional revisions to manage complications, managing patient expectations for success and making them aware of the likelihood of additional surgeries or failure is important.

Comparison of Visual Outcomes between Phacoemulsification and Small Incision Cataract Surgery

Background: Globally, it is approximated that there are around 100 million cases of cataracts resulting in visual acuity of less than 6/60, and this number is expected to increase to approximately three to four times more for cases causing acuity of less than 6/18. Small incision cataract surgery is distinguished by its ability to provide early wound stability, reduce post-operative inflammation, eliminate suture-related complications, necessitate fewer post-operative visits, and have a milder impact on the corneal endothelium. This approach can be applied to all types of cataracts, unlike phacoemulsification, where careful case selection is particularly crucial, especially for less experienced surgeons. Objective: The objective of this study is to compare the visual outcome between Phacoemulsification and Small Incision Cataract surgery. Method: An experimental interventional study was conducted concurrently at Kulsoom Bai Valika Social Security Hospital and Sindh Govt. Qatar Hospital from January 2022 to January 2023. During this study, Phacoemulsification and Small Incision Cataract Surgery (SICS) procedures were performed. The research received approval from the relevant authorities at both hospitals. The study included a total of 200 participants, with one group undergoing SICS and the other group undergoing phacoemulsification, each consisting of 100 patients. To assess the relationship between the two procedures, a statistical analysis employing either the Chi-square or Fischer's test was conducted, and for LogMAR Mann-Whitney test with a P-value of 0.05 was deemed statistically significant. Results: The age difference between the two groups was found to be statistically insignificant, with a p-value of 0.158. The mean age for the SICS group was 54.96 ± 11 years, while the mean age for the Phacoemulsification group was 57.3 ± 12 years. In terms of gender distribution, the SICS group consisted of 47 females and 53 males out of 100 participants, while the Phacoemulsification group had 45 females and 55 males out of 100 participants. The results indicate that there was no significant difference in the mean best-corrected visual acuity (BCVA) between both groups, with a p-value of 0.36. In the Phacoemulsification and SICS groups, 86 and 83 patients out of 100, respectively, achieved a BCVA of 6/6-6/12 [LogMAR (0-0.3)]. Conclusion: The postoperative mean visual acuity in both the SICS and Phacoemulsification groups was found to be similar. Nevertheless, it's noteworthy that the SICS procedure offers significant cost-effectiveness and can be a viable option for cataract treatment, enabling economically disadvantaged patients to achieve excellent vision.

Cataract surgery outcomes in pediatric patients with systemic comorbidities.

The aim of the study was to evaluate the outcomes of cataract surgery in patients of the pediatric age group with systemic comorbidities. Medical records of 54 eyes (30 patients) of the pediatric age group with systemic comorbidities who had undergone cataract surgery in a tertiary-care center were reviewed. The following parameters were recorded: systemic comorbidity; toxoplasmosis, rubella, cytomegalovirus, herpes simplex, HIV (TORCH) profile, best spectacle-corrected visual acuity (BSCVA), strabismus, nystagmus, and cataract morphology. Thirty patients with a mean age of 55 months (9 months-14 years) were included. On average, every child was seen by three physicians, and the mean duration between the first visit to a physician and presentation to our center was 2.23 ± 0.67 years. The various causes for delay in referral include multiple referrals due to a lack of general anesthesia services in 78% of cases, a long waiting list at the referral hospital in 35% of cases, and a lack of awareness at the primary-care physician level in 50% of cases. The mean BSCVA at presentation was 1.4 logMAR (0.3 to 3 logMAR). The most common cataract morphology was that of zonular cataract (31.48%; 17/54). Strabismus and abnormal eye movements were observed in 27.7% (15/54) and 33.3% (18/54) of eyes, respectively. Various systemic associations were periventricular leukomalacia (12/30), Down's syndrome (6/30), seizure disorder (6/30), cardiac valvular anomalies (6/30), Marfan's syndrome (4/30), hypothyroidism (4/30), rubella (3/20), cytomegalovirus (3/20), cerebral palsy (2/30), nephrotic syndrome (2/30), Type 1 diabetes mellitus (1/30), microcephaly (1/30), cryptogenic West syndrome (1/30), congenital rubella syndrome (1/30), and Tourette syndrome (1/30). The mean postoperative corrected distance visual acuity (CDVA) at 2-year follow-up improved to 1.0 logMAR (0 to 3 logMAR). No postoperative complications were reported at the final follow-up. Around 70% of the parents reported improvement in their child's psychomotor skills. Intellectually impaired pediatric patients with cataract should be operated upon whenever there is a presence of infrastructure, and unnecessary delay in surgery should be avoided by referring the patient to higher centers. Even though objective improvement in visual acuity was suboptimal, there was definitely an improvement in the psychomotor skills of the patients.

Combined Cataract and Corneal Transplantation Surgery Without Viscosurgical Devices.

The most common complications after performing the triple Descemet's stripping automated endothelial keratoplasty (DSAEK), which combines the cataract phacoemulsification, intraocular lens implantation and DSAEK procedure, are detachment or decentration of the donor lamella and postoperative interface haze. One reason for this is the retained viscoelastic used during surgery. This study aimed to describe triple DSAEK procedure without the usage of viscoelastic and to discuss its potential benefits on surgical outcomes. The surgical procedures and outcomes of patients with Fuchs' dystrophy and lens opacification who underwent the triple DSAEK were retrospectively reviewed. The surgical procedure was described, and postoperative complications were studied. The study included 10 eyes of 10 patients. Capsulorhexis and IOL implantation performed in locally potentiated anesthesia compared to general anesthesia did not significantly differ (P > 0,05). The mean preoperative best-corrected visual acuity was 0.75 LogMar. The mean postoperative best-corrected visual acuity was 0.2 LogMar. The central graft thickness before surgery was 129.6 μm and 6 months after surgery was 114.2 μm. Successful attachment of the donor lamellae was observed in all 10 patients. None of the patients had postoperative interface haze or any other possible viscoelastic caused complication. Although viscoelastic can facilitate certain aspects of the triple DSAEK procedure, we conclude that this procedure can be performed completely without its use. If performed by a trained surgeon, the procedure can be feasible without the complications of donor lamella detachment, decentration, or interface haze.

23-Guage Vitrectomy with Internal Gas Tamponade for the Management of Rhegmatogenous Retinal Detachment

Purpose: To find out functional and anatomical outcomes of 23-G pars plana vitrectomy (PPV) with gas tamponade (C3F8/SF6) for Rhegmatogenous Retinal Detachment (RRD). Study Design: Quasi Experimental Study. Place and Duration of Study: Liaquat National Hospital Karachi Ophthalmology department, from October 2020 to April 2021. Methods: Fifty-five eyes of 55 patients with RRD were included in the study by convenient sampling. The patients underwent 23-G PPV with gas tamponade under general anesthesia. Anatomical and functional results were evaluated in the form of retinal attachment and change in the best corrected visual acuity (BCVA). Frequency of complications were also assessed. An average follow up period was 6 months. Results: Out of 55 patients, 32.7% were males and 67.3% were females. Mean age of the patients was 49.14 ± 17.11 years ranging from 17 years to 79 years. Four quadrants were involved in 36.4% of the patients. Among 55 eyes, 40% were phakic and 60% were pseudophakic. Only 4 (7.3%) patients needed redo procedure. Mean pre-operative and post-operative visual acuity was 2.52 ± 0.67 and 0.80 ± 0.66 with a significant mean difference of 1.71. Anatomical success was seen in 92.7% of patients. Conclusion: Anatomical success and improvement in the best corrected visual acuity (BCVA) is achievable with 23-G PPV with expansible gas used as internal tamponade in the treatment of RRD.

THREE-DIMENSIONAL QUANTIFICATION OF INTRARETINAL CYSTOID SPACES ASSOCIATED WITH FULL-THICKNESS MACULAR HOLE.

To evaluate intraretinal cystoid spaces in patients with idiopathic macular hole (MH). Retrospective cohort study included consecutive patients with full-thickness MH who underwent successful MH surgery and 12 months of follow-up. Custom software was applied to preoperative optical coherence tomography scans to generate fluid volume. Inner fluid volume was defined as cystoid spaces in the inner nuclear layer, and outer fluid volume was defined as cystoid spaces in Henle fiber layer of the outer nuclear layer. Thirty-nine eyes from 39 participants were included. Postoperative 12-month visual acuity correlated with both inner fluid volume and minimum MH size (both P < 0.05) but not outer fluid volume. Inner fluid volume positively correlated with minimum MH size ( P = 0.0003). After accounting for minimum MH size with multivariable analysis, inner fluid volume effect on VA remained significant ( P = 0.025). After dividing inner fluid volume into tertiles, mean baseline visual acuity was 20/50 in eyes with small inner fluid volume, and was 20/125 in eyes with large inner fluid volume ( P = 0.0039). Mean postoperative 12-month visual acuity was 20/20 in eyes with small inner fluid volume compared with 20/32 in eyes with large inner fluid volume ( P = 0.019). Increased inner fluid volume was associated with worse postoperative VA.

Selective Endothelialectomy in Peters Anomaly: A Novel Surgical Technique and Its Clinical Outcomes in Children.

This study describes the surgical outcomes of selective endothelialectomy in Peters anomaly (SEPA), a relatively new technique to manage Peters anomaly (PA). This study included 34 eyes of 28 children who had a visually significant posterior corneal defect due to PA and underwent SEPA between 2012 and 2019. A selective endothelialectomy from the posterior corneal defect was performed while preserving Descemet membrane. The primary outcome measure was the resolution of corneal opacification. The secondary outcome measures were functional vision, complications, and risk factors for failure. At a mean postoperative follow-up of 0.96 ± 0.20 years, 29 eyes (85.3%) maintained a successful outcome. Mean preoperative and postoperative best-corrected visual acuities were 2.55 ± 0.13 and 1.78 ± 0.13 ( P < 0.0001), respectively. Ambulatory functional visual improvement was seen in 97%, and 23% attained vision ranging between 20/190 and 20/50. Corneal opacification failed to clear in 5 eyes (15%). Risk factors associated with surgical failure were female sex ( P = 0.006), disease severity ( P < 0.0001), glaucoma ( P = 0.001), and additional interventions after SEPA ( P = 0.002). In multivariate analysis, only disease severity (ie, a type 2 PA) was a significant risk factor for the failure of SEPA. There were no sight-threatening complications. SEPA is a safe and effective technique in select cases of posterior corneal defect due to PA. SEPA could be a potential surgical alternative to pediatric keratoplasty or optical iridectomy in children with central corneal opacification smaller than 7 mm due to PA.

IMPACT OF FELLOWSHIP TRAINING ON SURGICAL PRODUCTIVITY IN OPHTHALMOLOGY

Objectives:To assess whether Surgical productivity is affected by fellowship training by comparing differences in Visual acuity and complication rates at 3 month and 1 year of fellowship training. Design: Retrospective case series. Settings: Sankara Eye Hospital Ludhiana, Panjab, India. Methods: Cataract operations performed by a single fellow doctor from March 2021 through March 2022 at Sankara Eye Hospital, Ludhiana formed the basis for this investigation. In a random fashion, 40 subjects who had undergone manual Small incision cataract surgery (MSICS) were selected and divided into 2 groups. Group 1 was operated at 3rd month (March-April 2021) of fellowship training and Group 2 was operated after 1 year (March-April 2022) of training. Cataract surgeries were analyzed for risk factors, comorbidities, and intraoperative and postoperative complications. The main outcome measures were postoperative Best corrected distance visual acuity (BCVA), which were correlated with preoperative demographics. Results: The mean visual acuity improved signicantly after surgery in all patients (P &lt; .001) compared to baseline. 16(80%) patients in Group 1 and 18(90%) of Group 2 achieved a postoperative CDVAof 20/40 or better (P&lt; .001). Visual outcome was comparable in both groups. The mean postoperative visual acuity did not vary by trainee year and the rate PC tear(5%) during surgery declined as fellow resident progressed in training (P&lt; .05). Conclusion: Despite more complicated cataracts and advanced comorbidities, fellow-performed cataract surgery in a tertiary-care county hospital system achieved comparable visual outcomes similar to those found at start.

Study of endothelial cell loss in small incision cataract surgery (SICS)

Purpose: To evaluate the density of the central corneal endothelial cell before and after a small incision cataract surgery with posterior chamber intraocular lens implantation and also determine the association between endothelial cell loss and post-operative visual acuity. Methods: A total of 205 eyes of 205 patients undergoing SICS were included in surgery. Patients underwent complete ophthalmic evaluation and endothelial cell density was measured with TOPCON SP1P specular microscope preoperatively and postoperatively day 7 and at 1 month. Results: The majority of the patients were in the age group 61-70 years. The mean endothelial cell count pre operatively was 2689.65 cells/mm2, post operatively on 7th day 2433.27 cells/mm2 and at 1 month was 2367.01 cells/ mm2. At 1 month postoperative mean visual acuity between 20/30-20/70. Conclusion: There is 11.21% endothelial cell count after SICS, which is comparable with other modes of cataract surgery like extracapsular cataract extraction and phacoemulsification.

Outcomes of chronic angle-closure glaucoma treated by phacoemulsification and endocyclophotocoagulation with or without endoscopically goniosynechialysis

To investigate the surgical outcomes of patients with chronic angle-closure glaucoma (CACG) treated with phacoemulsification (phaco)/endocyclophotocoagulation (ECP) with and without endoscopic goniosynechialysis (E-GSL). A retrospective, nonrandomized, comparative case series was conducted. Patients with CACG who underwent phaco in combination with either ECP alone (ECP group) or GSL with ECP (E-GSL group) from 2018 to 2019 were followed for 12mo and reviewed. Clinical features and outcomes were identified and analyzed. The ECP and E-GSL groups were matched in age and baseline intraocular pressure (IOP). Changes in IOP, mean of visual acuity (VA), peripheral anterior synechiae (PAS) formation, and the number of glaucoma medications was examined. The ECP group included 32 eyes of 27 patients, and the E-GSL group included 32 eyes of 26 patients. The preoperative baseline IOP was 22.18±6.48 mm Hg in the ECP group and 22.95±6.71 mm Hg in the E-GSL group (P=0.644). The mean IOP reduction was 26.2% in the ECP group and 41.6% in the E-GSL group at 12mo. The mean postoperative VA (logMAR units) at 12mo was 0.47 in the ECP group and 0.36 in the E-GSL group. The reduction in PAS formation and the number of glaucoma medications was also higher in the ECP group than E-GSL group at 12mo. The phaco/ECP and phaco/E-GSL groups both achieve a significant reduction in IOP without complications associated with traditional glaucoma filtration surgeries.