Visual Rehabilitation Research Articles

Comparative Analysis of the Clinical Outcomes of Two Toric Presbyopia-Correcting Intraocular Lenses.

To evaluate and compare the clinical outcomes of two toric presbyopia-correcting intraocular lenses (IOLs). Non-randomized prospective comparative study including 86 eyes of 51 patients (age 43-83years) that underwent cataract surgery with implantation of one of the following two IOLs: TECNIS Toric Synergy (Johnson & Johnson Vision) (Synergy group) or AT LISA tri toric 939MP (Carl Zeiss Meditec) (ATLISA group). Visual and refractive outcomes were evaluated during a 6-month follow-up. At 6months after surgery, all eyes achieved uncorrected distance visual acuity 20/25 or better in both groups, whereas 96.2% and 100% of eyes achieved uncorrected near visual acuity (UNVA) 20/25 or better in the ATLISA and Synergy groups, respectively. All eyes achieved postoperative mesopic UNVA 20/30 or better in both IOL groups; 96.2% and 100% of eyes had a manifest cylinder ≤ 0.50 D at 6months in ATLISA and Synergy groups, respectively. Mean magnitude of error was 0.04 ± 0.20 and - 0.04 ± 0.09 D in ATLISA and Synergy groups, respectively (p = 0.05). In the defocus curve, significant differences were found between IOL groups for most of distance-corrected visual acuities, except those corresponding to defocus of 0 D (p = 0.268) and - 1 D (p = 0.361). The two toric presbyopia-correcting IOLs evaluated provide an efficacious astigmatic correction combined with a successful distance, intermediate and near visual rehabilitation. The visual performance seems to be better for most visual demands with the TECNIS Toric Synergy IOL, especially for distances closer than 40cm.

Clinical features of three-layer’s impairment of capillary plexuses’ perfusion at follow-up in patients with Purcher retinopathy and Purcher-like retinopathy

In Purcher retinopathy and Purcher-like retinopathy, ischemic lesions occur at the level of all three retina capillary plexuses. Recognition of characteristic ischemic patterns by optical coherence tomography helps to predict the degree of visual functions’ recovery. The aim of this study is to present clinical cases of patients with Purcher retinopathy and Purcher-like retinopathy and to observe the dynamics of visual rehabilitation of patients with retinal vascular conditions. Two patients with complaints of central vision loss and skotomata in the visual field were examined. The complex of multimodal visualization included fundus photoregistration with fundus camera, optical coherence tomography and optical coherence tomography-angiography, and microperimetry. Paracentral acute middle maculopathy and acute macular neuroretinopathy are the manifestations of the same ischemic process on different levels of retinal vascular plexuses. The “diffuse” pattern damages in paracentral acute middle maculopathy lead to more permanent structural and functional impairments opposed to the “skip” pattern. The optical coherence tomography allows to predict the possibilities of visual and functional rehabilitation in patients with ischemic damage of retinal vessels.

Quality assurance in corneal transplants: Donor cornea assessment and oversight

The cornea is the most frequently transplanted human tissue, and corneal transplantation represents the most successful allogeneic transplant worldwide. In order to obtain good surgical outcome and visual rehabilitation and to ensure the safety of the recipient, accurate screening of donors and donor tissues is necessary throughout the process. This mitigates the risks of transmission to the recipient, including infectious diseases and environmental contaminants, and ensures high optical and functional quality of the tissues. The process can be divided into 3 stages: (1) donor evaluation and selection before tissue harvest performed by the retrieval team, (2) tissue analysis during the storage phase conducted by the eye bank technicians after the retrieval, and, (3) tissue quality checks undertaken by the surgeons in the operating room before transplantation. Although process improvements over the years have greatly enhanced safety, quality, and outcome of the corneal transplants, a lack of standardization between centers during certain phases of the process still remains, and may impact on the quality and number of transplanted corneas. Here we detail the donor screening process for the retrieval teams, eye bank operators. and ophthalmic surgeons and examine the limitations associated with each of these stages.

New technologies for eye care practitioners

Keywords: orthoptics, optometry, visual rehabilitation, visual therapy.In the 1920s, Mary Maddox opened a vision rehabilitation center in London, being considered the first orthoptist (an unknown profession in Spain, whose competences fall on Optics‐Optometry). Her father, Ernest E. Maddox, an ophthalmologist, had developed various instruments to investigate binocular vision. The new discipline seeks to improve the binocular state of the patient, affected by symptomatic tropias or phorias, through exercises that train eye movements, ductions, versions, vergences, fixations and saccades. Amblyopia, on the other hand, is still treated by occlusion of the fellow eye, following practices that began in the 18th century (George L. de Buffon).During the 20th century, orthoptic specialists used different instruments, which have survived to this day, for the diagnosis and treatment of deviations. Perhaps the most advanced of them is the synoptophore, capable of determining objective and subjective deviations, the presence of normal or abnormal correspondences, and the presence of suppression scotoma. The synoptophore is also used in rehabilitation, together with the aperture rule, vectograms or the Brock string. However, in the case of tropias and during the 20th century, orthoptic therapy occupies a very marginal place compared to the surgical solution. The Hubel and Wiesel experiments in the 60s and 70s were interpreted restrictively, rooting concepts such as the so‐called critical period, which discouraged any attempt to treat amblyopia beyond occlusion, particularly in adulthood.However, research carried out from the second half of the 20th century to nowadays provides evidence of the usefulness of vision rehabilitation in the treatment of strabismus and non‐strabismus visual dysfunctions, and in the recovery of amblyopia in adulthood. Basic research led by Dennis M. Levi of the University of California at Berkeley and Robert F. Hess of McGill University, as well as clinical research by the Paediatric Eye Disease Investigator Group, PEDIG, are good examples.New technologies based on computers are currently renewing and revitalizing orthoptic practice, both in diagnosis and treatment. Eye‐trackers combined or not with Virtual Reality allow (a) to record eye movements accurately and objectively, and to identify visual behaviour and deficits, and (b) to train those movements, providing positive feedback to the patient. Screens have evolved from conventional models, later 3D and finally Virtual Reality, allowing dynamic exercises and avoiding other limitations, such as postural ones. Software algorithms adapt the difficulty of the exercises to patient's performance, record therapy compliance, and store the results in the cloud for remote control of home therapy. In addition, gamification techniques allow increasing the patient's motivation and adherence to treatment. These improvements are essential in perceptual learning, the paradigm of the new visual rehabilitation model.

Case series of spontaneous bilateral absorbed cataracts running in a family

There are only a handful of case reports and studies available regarding spontaneously absorbed cataracts and their management, including the surgical techniques and results following the management. In our study, on retrospective analysis, after a thorough search of the concerned literature, we encountered a series of cases of bilateral spontaneous absorbed cataracts running in a family with no such documentation. This retrospective study included 11 patients (aged between 3 and 65 years and of either sex) of the same family having bilateral absorbed cataracts. All patients underwent best-corrected visual acuity (BCVA); a thorough eye examination; rubella titer estimation; intraocular lens (IOL) power calculation; lens aspiration with or without posterior capsulotomy, anterior vitrectomy (AV), or IOL implantation; and visual rehabilitation. All patients had bilateral absorbed cataracts, which were acquired in an autosomal dominant pattern. Preoperative BCVA distance: 22 eyes had either counting fingers close to the face or counting fingers at 1–2 feet. The presence of high-frequency mixed bilateral nystagmus was noted in four patients. Anterior continuous curvilinear capsulorhexis was possible. Cortical aspiration was uneventful. In the capsular bag, implantation was possible in the majority of cases. No postoperative inflammation was noted, and the IOL was well-centered in all patients. To the best of our knowledge, this is the first study to report a case series of bilateral absorbed cataracts running in an Indian family with no syndromic association, no history of mental retardation, or infection. Anatomic disorganization of the absorbed lens makes surgery in such cases challenging. By using appropriate surgical methods and good visual rehabilitation, satisfactory surgical and visual outcomes can be achieved.

A review of paediatric cataract surgery techniques and practices: Past, present and future

Background: The management of paediatric cataract has always been unique, challenging and complex for ophthalmologists. The pursuit of expertise to enhance outcomes for affected children has driven the scientific and ophthalmic community, from the years preceding Christ to the present-day 21st century, to refine surgical techniques for visual restoration in these children. Methods: This is a review article looking into the evolution, historical progression and advancement of cataract surgical techniques in children through extensive online literature search utilising internet search engines, journals, textbooks, PubMed, Cross-references, ResearchGate, Medscape and Web of Science. Search terms used included “history of Paediatric Cataract Surgery,” “Paediatric cataract surgical techniques,” “Couching,” “Discission,” “Irrigation & Aspiration’, ‘Phacoemulsification’, ‘Femtolaser’, Visual rehabilitation and Optic capture”. Results: The management of paediatric cataract has witnessed remarkable transformation over the years. The historical context illustrates a continuous dedication towards improving visual outcome. Refined techniques have culminated in diverse array of methods and practices used to take care of unique or specific challenges encountered in the care of paediatric cataracts. Conclusion: This article highlights the various methods employed to achieve the goal of visual restoration in paediatric cataract cases by considering factors such as the age of the child, the extent and impact of cataract and advancements in technology. Therefore, it provides insight into the ongoing efforts to enhance the quality of life for children affected by cataract.

Challenging course of endophthalmitis with corneal ulcer following cataract surgery: successful management and visual rehabilitation

Challenging course of endophthalmitis with corneal ulcer following cataract surgery: successful management and visual rehabilitation

Pediatric corneal transplantation: techniques, challenges, and outcomes.

Pediatric corneal transplant is a highly demanding and technically challenging procedure for the cornea surgeon in today's era. These cases pose unique challenges in clinical and surgical management. The indications of pediatric corneal transplant can be therapeutic, tectonic, optical, and cosmetic. Pediatric patients undergoing corneal transplants are at a high risk of graft infection, failure, rejection, dehiscence, and amblyopia due to young age, robust immune system, increased incidence of trauma, and compliance issues. The other factors contributing to graft failure can be allograft rejection, secondary glaucoma, corneal vascularization, multiple surgeries, vitreous prolapse, and lack of treatment compliance. A successful corneal transplant in children depends on meticulous preoperative evaluation, uneventful surgery, the expertise of a corneal surgeon, and regular and timely postoperative follow-up. Therapeutic and optical penetrating keratoplasty are the most commonly performed transplants in children. However, with the advancements in surgical technique and management protocol, the current focus has shifted toward lamellar keratoplasty. Lamellar keratoplasty offers early visual recovery and potentially fewer complications. Visual rehabilitation through corneal transplant in otherwise blind eyes can be a boon for the children. Recently, keratoprostheses have been promising in children with multiple graft failures. The current review gives insights into epidemiology, etiology, indications, clinical characteristics, investigations, management options, recent advances, and the future of pediatric corneal transplants. As surgical techniques continue to grow and comprehension of pediatric corneal transplants is improving, we can safeguard these eyes with the best possible anatomical and functional outcomes.

Ectopia Lentis in Three Successive Generations: A Case Series Study

Aim: To describe the clinical profiles of patients of three successive generations of a Bangladeshi family affected by familial ectopia lentis. Methods: A case series study was conducted in a tertiary eye hospital in Bangladesh from 2015 to 2019. We evaluated twentythree people of the same family of three successive generations. Among them, thirteen patients were affected by familial ectopia lentis. Several patients from all three generations underwent elaborate general examinations to rule out systemic and metabolic disorders. Results: Among thirteen patients, eleven had bilateral Ectopia lentis. Among six adult patients, three had bilateral cataracts. ICCE was done on one patient from 2nd generation (pedigree 7) in another eye hospital. The other two patients (Pedigree-2 and 9) were blind; among seven child patients, four developed cataracts. One was visually significant and underwent PPL with AVT (Pedigree-14). Visual rehabilitation was done with aphakic glass. The other three children had cataracts but not in the pupillary area - not visually significant. No systemic associations were found except one who was suspected of Marfan syndrome. Conclusions: Not only many patients in one family but also the occurrence in three generations is exceptional for Ectopia Lentis Syndrome. The autosomal recessive mode was found in other studies, but this family pedigree analysis favoured an autosomal dominant inheritance. Emphasis is needed on the importance of regular follow-up and management.

Combined cataract and vitreoretinal surgery

Combined cataract surgery and vitrectomy is a surgical technique used to address both cataract and vitreoretinal disorders. With the advances in surgical tools, simultaneous removal of cataract associated with vitreoretinal disorders is gaining popularity. This technique offers several advantages over separate surgeries, including reduced surgical time and anaesthesia exposure, as well as quicker visual rehabilitation. However, the optimal timing and approach for combined cataract surgery and vitrectomy remain controversial.Indications for combined cataract surgery and vitrectomy include various vitreoretinal conditions, such as retinal detachment, diabetic retinopathy, macular holes, and epiretinal membranes. The timing of surgery depends on the severity of the cataract and the vitreoretinal pathology, as well as the surgeon's preference. The most common surgical techniques include phacoemulsification with posterior chamber intraocular lens implantation, followed by pars plana vitrectomy. The filling of the vitreous cavity is possible with several types of tamponades, such as different gases, but in extreme cases even with silicone oil. After gas tamponade, proper positioning of the patient is of great importance.Complications associated with combined cataract surgery and vitrectomy include posterior capsule rupture, intraocular lens dislocation, postoperative inflammation, and intraocular pressure elevation. However, the overall complication rate is low, and the visual outcomes are generally favourable.In conclusion, combined cataract surgery and vitrectomy is a useful technique for managing various vitreoretinal conditions. Proper patient selection, careful surgical planning, and close postoperative monitoring are critical for achieving optimal outcomes.

Outcome Measures of In-Office Optometric Visual Rehabilitation Intervention on Oculomotor Function, Visual Processing Skills, and Reading Efficiency Scores in Children with Formally Identified Academic Difficulties

Oculomotor dysfunction (OMD) and visual information processing (VIP) deficits are often seen in children with reading difficulties. Prior published evidence has shown statistically significant correlations between several metrics, in particular vergence facility and reading efficiency at baseline within an office-based vision therapy (OBVT) setting supported by home vision therapy (HVT). However, data on the effects of OBVT on OMD, VIP deficits, and reading performance is currently lacking. The purpose of this study is to investigate whether vision therapy improves VIP deficits in children diagnosed specifically with a dyseidetic based reading problem with confirmed concurrent oculomotor dysfunction.

Cataract surgery in AMD patients

Cataract and age‐related macular degeneration (AMD) are leading causes of visual loss and they occur in the similar age group, thus co‐existence of both diseases is real clinical problem and challenge. Theoretical mechanisms considered to be involved in possible relations between cataract surgery and AMD progression include blue light toxicity and the role of post‐operative inflammation. None of these mechanisms was found to play a role in clinical conditions. Some earlier a recent population‐based studies reported an increased risk of late AMD after cataract surgery; however, this was not confirmed by recent cross‐sectional studies (clinical‐based) from South Korea and Australia. Systematic reviews and meta‐analyses reported a moderate quality of evidence to suggest that VA was better by approximately 7 letters in eyes with AMD that underwent cataract surgery vs. eyes with AMD that did not undergo cataract surgery for up to 12 months after surgery and the same quality of evidence did not find an increased risk of progression to exudative AMD for at least 12 months after surgery. The risks and possible advantages of cataract surgery in visual rehabilitation of wet and dry AMD patients will be discussed.

Rehabilitating homonymous visual field deficits: white matter markers of recovery-stage 1 registered report.

Damage to the primary visual cortex (V1) or its afferent white matter tracts results in loss of vision in the contralateral visual field that can present as homonymous visual field deficits. Recent evidence suggests that visual training in the blind field can partially reverse blindness at trained locations. However, the efficacy of visual training to improve vision is highly variable across subjects, and the reasons for this are poorly understood. It is likely that variance in residual functional or structural neural circuitry following the insult may underlie the variation among patients. Many patients with visual field deficits retain residual visual processing in their blind field, termed 'blindsight', despite a lack of awareness. Previous research indicates that an intact structural and functional connection between the dorsal lateral geniculate nucleus (dLGN) and the human extrastriate visual motion-processing area (hMT+) is necessary for blindsight to occur. We therefore predict that changes in this white matter pathway will underlie improvements in motion discrimination training. Twenty stroke survivors with unilateral, homonymous field defects from retro-geniculate brain lesions will complete 6 months of motion discrimination training at home. Visual training will involve performing two daily sessions of a motion discrimination task, at two non-overlapping locations in the blind field, at least 5 days per week. Motion discrimination and integration thresholds, Humphrey perimetry and structural and diffusion-weighted MRI will be collected pre- and post-training. Changes in fractional anisotropy will be analysed in two visual tracts: (i) between the ipsilesional dLGN and hMT+ and (ii) between the ipsilesional dLGN and V1. The (non-visual) tract between the ventral posterior lateral nucleus of the thalamus (VPL) and the primary somatosensory cortex (S1) will be analysed as a control. Tractographic changes will be compared to improvements in motion discrimination and Humphrey perimetry-derived metrics. We predict that (i) improved motion discrimination performance will be directly related to increased fractional anisotropy in the pathway between ipsilesional dLGN and hMT+ and (ii) improvements in Humphrey perimetry will be related to increased fractional anisotropy in the dLGN-V1 pathway. There should be no relationship between behavioural measures and changes in fractional anisotropy in the VPL-S1 pathway. This study has the potential to lead to greater understanding of the white matter microstructure of pathways underlying the behavioural outcomes resulting from visual training in retro-geniculate strokes. Understanding the neural mechanisms that underlie visual rehabilitation is fundamental to the development of more targeted and thus effective treatments for this underserved patient population.

Options for contact correction after keratoplasty

Keratoplasty is a radical surgical method for treating various corneal pathologies. Today, there are many types of keratoplasty, each aiming to restore the integrity and transparency of the cornea. However, keratoplasty-induced ametropia often prevents achieving high visual acuity and makes impossible the use of conventional optical correction methods such as glasses or soft and traditional rigid contact lenses. In this regard, the use of scleral contact lenses is the most optimal method for optical correction of postoperative refractive anomalies, ensuring successful visual rehabilitation and preventing the need for additional keratorefractive interventions.

Biomarkers in retinal detachment surgery. How can we improve visual outcomes

Rhegmatogenous retinal detachment (RRD) is associated with separation of the neurosensory retina from the RPE, leading to visual field defect and potential reduction of central vision. Despite significant improvement in primary and final reattachment rate exceeding 90% and 98% respectively, functional outcomes are still difficult to predict and vary widely. In cases with macular involvement several factors have been implicated in the final visual recovery. These biomarkers are either related to individual risk factors (e.g., duration of symptoms, age, high myopia, and concomitant retinal disease),or to peri and postoperative factors (time to surgery, type of surgery, day of the week, experience of surgeon, positioning before and after surgery, and follow‐up management). With the availability of high‐resolution imaging modalities additional biomarkers have emerged, facilitating further more accurate prediction of visual outcome. Incorporating retinal detachment biomarkers into the daily clinical practice is essential to provide more effective patient counselling and potentially modify the visual rehabilitation process.

Comparison of Corneal Endothelial Cell Loss during Manual Small-incision Cataract Surgery using Visco-expression versus Irrigating Wire Vectis-assisted Nucleus Removal: A Prospective Randomised Study

Introduction: Age-related cataract is the leading cause of curable blindness in India, and Manual Small-Incision Cataract Surgery (MSICS) is a machine-independent and cost-effective alternative to phacoemulsification for handling this significant burden. In every cataract surgery, some endothelial cell loss is inevitable. Therefore, the present study was conducted to compare endothelial cell loss in the two most commonly practiced methods of nucleus delivery in MSICS. Aim: To compare and analyse endothelial cell loss during MSICS using viscoelastic/viscoexpression-assisted nucleus removal versus irrigating wire vectis-assisted nucleus removal. Materials and Methods: A prospective randomised interventional study was conducted at the Regional Institute of Ophthalmology, Postgraduate Institute of Medical Sciences (PGIMS) Rohtak, Haryana, India. The study duration was three years, from May 2018 to May 2021. A total of 250 patients with uncomplicated senile cataract over 40 years of age, with nuclear sclerosis of grade 2 or higher and “with the rule” astigmatism, were included in the study. The patients were randomly divided into Group A and Group B (125 each), who underwent MSICS using visco-expression (Group A) versus irrigating wire vectis-assisted (Group B) nucleus removal. Visual Acuity (VA), keratometry, astigmatism, pachymetry, and Endothelial Cell Density (ECD) were recorded in every patient preoperatively and postoperatively on day 1 and day 40. The Shapiro-wilk test was used to assess the normality of the data, and student’s t-test was performed to identify significant differences in continuous factors between the two groups. Chi-square test was used to find the association between factors and techniques, with a p-value <0.05 considered statistically significant. Results: The mean age of the patients was 68.5±9.4 years (range 52-89 years) with a significant male preponderance. The mean LogMAR visual acuity on Postoperative Day (POD)-1 was 0.3±0.1 for Group A, while for Group B, it was 0.5±0.2, showing a statistically significant difference (p=0.004). However, on day 40, visual acuity was comparable in both groups, with Group A (0.1±0.2) and Group B (0.1±0.1), and no significant difference (p=0.09). On POD-1, the percentage change in Endothelial Cell Density (ECD) was 4.2% in Group A and 10.6% in Group B, with a statistically significant difference (p=0.0017). On day 40, it was 2.1% and 4.8% in Group A and Group B, respectively, also showing a statistically significant difference (p=0.003). On postoperative day 40, the mean Surgically Induced Astigmatism (SIA) in Group A and Group B was 0.67±0.24 and 0.74±0.41, respectively, but this difference was statistically insignificant (p=0.074). Intra and postoperative complications such as hyphema, iridodialysis, and corneal oedema were more common in Group B than Group A. Conclusion: The study concludes that there was a statistically significant endothelial cell loss in the irrigating wire vectisassisted nucleus delivery method compared to the viscoexpression of the nucleus during MSICS. The present method also showed delayed visual rehabilitation and a higher risk of intra and postoperative complications. Therefore, viscoexpression of the nucleus should be the preferred method of nucleus delivery in every MSICS where feasible.

Comparative analysis of clinical and functional parameters in patients with stable stage II-III keratoconus after implantation of corneal segments and fitting of scleral rigid contact lenses

This study compares the effect of implantation of intrastromal corneal ring segment (ICRS) and fitting of individual scleral rigid contact lenses (RCLs) on visual functions in patients with stage II-III KC after previously performed corneal collagen cross-linking. The Helmholtz National Medical Research Center of Eye Diseases examined and treated 34 patients (69 eyes) aged 18 to 33 years with stage II-III KC. The study included patients who had previously undergone standard corneal collagen cross-linking. Depending on the type of optical correction, the patients were divided into two groups: patients in group 1 underwent ICRS implantation using a femtosecond laser; patients in group 2 were fitted with individual scleral RCLs. Improvement in clinical and functional parameters was observed in both groups. A higher clinical and functional result was achieved in group 2. For patients with stable stage II-III KC, it is advisable to recommend fitting of individual scleral RCLs for visual rehabilitation.

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.

Outcomes of hemi-Descemet membrane endothelial keratoplasty and phacoemulsification for the treatment of primary Fuchs' endothelial corneal dystrophy combined with cataract

This study evaluates the long-term results of surgical treatment of patients with Fuchs' endothelial corneal dystrophy and cataract. The study included 24 patients (24 eyes) with primary Fuchs' endothelial corneal dystrophy and cataract, who underwent cataract phacoemulsification with IOL implantation and of Descemet's membrane endothelial keratoplasty with a semicircular graft (hemi-DMEK). The effect of treatment was assessed by best corrected visual acuity (BCVA), central corneal thickness (CCT) and endothelial cell density (ECD). In total, surgical treatment involved 14 donor corneas that were divided in half during the preparation and isolation of the Descemet's membrane (DM). By month 12 after the surgery an increase in visual functions and graft transparency were observed in 23 patients (23 eyes) out of 24. Repeated keratoplasty was required in one case due to fibrosis of the posterior layers of recipient's corneal stroma. At 12 months postoperatively, the study group showed an increase in BCVA from 0.16±0.1 to 0.75±20, a decrease in CCT from 650.9±4.5 μm to 519.6±43.9, and a decreased in ECD from 2850.5±84.7 cells/mm2 up to 1285.5±277.2 cells/mm2. Thus, the loss of endothelial cells at one year after surgery amounted to 54.9%. The developed method for transplantation of a semicircular DM fragment provides a tissue-saving approach to endothelial keratoplasty, and considering the high percentage of transparent engraftment of grafts and complete visual rehabilitation, it can be recommended in the treatment of patients with cataract and Fuchs' endothelial corneal dystrophy.

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.