Missed retinal breaks in rhegmatogenous retinal detachment

AIM： To evaluate the causes and associations of missed retinal breaks（MRBs） and posterior vitreous detachment（PVD） in patients with rhegmatogenous retinal detachment（RRD）.METHODS： Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and191 patients were included for analysis of PVD,depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations.RESULTS： Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs（P =0.033） with the odds of missing a retinal break being1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy（PVR） and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae,pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD.Traumatic RRDs were rarely associated with PVD. CONCLUSION： Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD.

The Indian retinopathy of prematurity society:a baby step towards tackling the retinopathy of prematurity epidemic in India

Background:India leads all nations in the number of preterms born annually.With over 3.5 million infants,a reducing infant mortality rate and an expanding base of rural neonatal intensive care units,the number of infants requiring retinopathy of prematurity(ROP)screening has dramatically increased.The number of ROP specialists in the country is currently inadequate.Leading ROP specialists of the country initiated the Indian ROP(IROP)society to address these challenges.Methods:In 2016,the IROP society was conceived and registered as a professional body with a mission to prevent needless blindness from ROP by promoting standards of excellence.A national online membership drive was carried out.The data collected in this survey was analyzed to collate information on past training,practice patterns,ease of screening and treatment,use of wide-field imaging and willingness to be certified.Results:Of the 113 members at the time of submission,67.3%were male.88.5%were formally trained for ROP and 85.8%were vitreo-retinal specialists.Of the practicing members,96%were“comfortable”with screening and 86%with ROP treatment and this correlated with training(P=0.001 and P=0.002 respectively).Only 25.7%performed vitreous surgery for ROP.Wide field imaging was used by 33%of members in their practice and 52%of those who did not,wanted to use it in the future.Members who used imaging performed more number of laser treatments than those who did not(P=0.008).Laser was the preferred modality of treatment for 98%of members.A majority of the members(92.5%)were willing to be audited.Conclusions:The IROP society is a novel platform for ROP specialists to collaborate.The society has setup short,mid and long-term goals to make ROP care more accessible and affordable with appropriate use of technology.

Posterior segment nucleotomy for dislocated sclerotic cataractous lens using chandelier endoilluminator and sharp tipped chopper

· AIM: To describe a new surgical technique for managing dislocated sclerotic cataractous lens.· METHODS: Six patients with advanced posteriorly dislocated cataracts were operated at a tertiary care centre and analyzed retrospectively. After standard 3 port23 G pars plana vitrectomy and perfluorocarbon liquid(PFCL) injection, the dislocated white cataract was held with occlusion using phaco fragmatome and then chopped into smaller pieces with a sharp tipped chopper using 25 G chandelier endoilluminator. Each piece was emulsified individually. Following aspiration of PFCL,Fluid Air Exchange was done in all the cases and surgery completed uneventfully.·RESULTS: Best corrected visual acuity(BCVA) in all the patients was better than 6/12 after one month of follow up. No serious complications were noted till minimum 6mo of follow up.·CONCLUSION: Four port posterior segment nucleotomy with a chandelier endoilluminator, fragmatome and a chopper appears to be a safe, easy and effective procedure for managing dislocated sclerotic cataractous nuclei. Ultrasonic energy used and adverse thermal effects of the fragmatome on the sclera may be lesser.

Combined pars plana vitrectomy and suture less scleral fixation of foldable intraocular lens:single surgery visual rehabilitation of dislocated lens/intraocular lens

Background:To evaluate efficacy and safety of combined pars plana vitrectomy(PPV)and scleral fixated intraocular lens(SFIOL)surgery as a single procedure.Methods:Retrospective interventional case series done at a tertiary eye care center in Northern India.Eleven patients who underwent combined PPV and SFIOL surgery were included and analyzed retrospectively.Results:Mean age of the patients was 43.36±15.12 years(range,22-64 years).Eight were male.Mean baseline best corrected visual acuity(BCVA)was 0.78±0.63 logMAR units while the mean post-operative BCVA at 6 months follow-up was 0.37±0.29 logMAR units,the visual gain being statistically significant(P=0.021).None of the patients had a drop in BCVA with nine patients having final BCVA better than 0.48 logMAR units.Choroidal detachment(CD)was the only notable complication,seen in three patients.Other complications included two cases of intraoperative retinal breaks,a case each of reversible corneal edema,ocular hypertension and cystoid macular edema.Conclusions:Combined PPV and SFIOL is an efficacious procedure for managing IOL/lens dislocation and aphakia in a single surgery.There may be short-term reversible complications with no impact on final visual gain.

Preferred practice guidelines for retinopathy of prematurity screening during the COVID-19 pandemic

Retinopathy of prematurity(ROP)is the leading cause of preventable infant blindness in the world and predominantly affects babies who are born low birth weight and premature.India has the largest number of surviving preterm births born annually.ROP blindness can be largely prevented if there is a robust screening program which detects treatment requiring disease in time.ROP treatment must be provided within 48 h of reaching this threshold of treatment making it a relative emergency.During the severe acute respiratory syndromecoronavirus disease 2019 pandemic in 2020 ROP screening was disrupted throughout the world due to lockdowns and restriction of movement of these infants,their families,specialists and healthcare workers.The Indian ROP Society issued guidelines for ROP screening and treatment in March 2020,which was aimed at preserving the chain-of-care despite the potential limitations and hazards during the(ongoing)pandemic.This preferred practice guideline is summarized in this manuscript.

Rescue with intravitreal bevacizumab in aggressive posterior retinopathy of prematurity poorly responsive to laser treatment

Successful management of a case of aggressive posterior retinopathy of prematurity(APROP)poorly responsive to laser therapy with intravitreal bevacizumab(IVB)is discussed.IVB is useful as rescue therapy in such cases,if given within the correct window period post laser therapy.

Iridofundal colobomas may lower severity of retinopathy of prematurity

We report a case where unilateral iridofundal coloboma(IFC)was observed with asymmetric retinopathy of prematurity(ROP).Associated ocular abnormalities with IFC are present in nearly 15%of the cases;however its implications on course of ROP have not been reported thus far.IFC,damaging in its own respect,may be protective against disease progression in ROP.