Anterior segment optical coherence tomography for identifying muscle status in strabismus surgery

Dear Sir,Anterior segment optical coherence tomography(AS-OCT)finds very few indications in the domain of strabismus surgery.Current applications remain restricted to determining limbus-muscle insertion distance and anterior segment changes after strabismus surgery.We discuss two cases of operated strabismus surgery where AS-OCT

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.

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.

Delayed presentation of intracameral graphite foreign body in a child: school trauma

We report a case of large graphite foreign body(FB) in the anterior chamber of eye of a 4-yearold child,incurred during unsupervised play.Despite delayed presentation,the eye had few signs of resolved inflammation which allowed safe extraction of the FB bimanually through limbus.School play,especially in young children,should be under supervision and free of sharp objects.Graphite is inert while inside the eye,and even large pieces can be well tolerated for long time in absence of infection.

Bilateral lens subluxation in a case of Behcet's disease related uveitis

Ocular inflammation accompanying the pediatric Behcet's disease(BD)is characterized by a relapsing and complicated course,often resulting in blindness due to severe bilateral affection(1).Ectopia lentis(EL)is an important association of multiple ocular and systemic syndromes,with favorable visual outcomes if managed ideally(2).We discuss a unique case presenting with a combination of these entities。

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.

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.