Effect of fluidics on corneal endothelial cell density, central corneal thickness, and central macular thickness after phacoemulsification with torsional ultrasound

Aim: To study the relative effects of high and low fluidic parameters on endothelial cell density (ECD), central corneal thickness (CCT), and central macular thickness (CMT) after phacoemulsification with torsional ultrasound. Settings and Design: Prospective, randomized clinical trial based on a tertiary eye hospital. Subjects and Methods: The study included 65 patients in each group. Patients were randomized to either the high or the low flow group using a computerized random number table. The study was patient and examiner masked. All patients underwent phacoemulsification with torsional ultrasound. Visual acuity, ECD, CCT, and CMT were measured for all patients preoperatively at 2 weeks and 6 weeks postoperatively. Statistical Analysis Used: The Shapiro–Wilks test was used to assess the normality of the data. Mann–Whitney U-test with the P value set at 0.05 was used to compare the two groups. Results: Cumulative dissipated energy was significantly higher in the low flow group (16.44 ± 9.07 vs. 11.74 ± 6.68; P = 0.002). No statistically significant difference was noted between the two groups in the ECD, CCT, CMT, or corrected distance visual acuity at the end of 6 weeks. Conclusions: No significant difference was noted in the postoperative outcome between high and low flow groups. Parameters can be modified to suit the surgeon's preference, as both high and low flow parameters were found to have comparable postoperative outcomes

Do platelets have a role in the pathogenesis of aggressive posterior retinopathy of prematurity?

PURPOSE: The purpose of this study was to report the possible role of thrombocytopenia in the pathogenesis of aggressive posterior retinopathy of prematurity (APROP). METHODS: The index case described in this study showed spontaneous resolution of APROP with plus disease within 3 days of correcting thrombocytopenia and did not require laser treatment. The retrospective cohort of nine consecutive Asian Indian infants with APROP with similar stage and plus disease as the index case was studied. The mean platelet count of these infants before laser treatment was compared with 21 age- and birth weight-matched control subjects. Correlation of platelet count with APROP is discussed. RESULTS: The mean birth weight of the 10 cases with APROP was 1,030 g (+/-178 g), and the mean period of gestation was 29.4 weeks (+/-2.0 weeks). The mean platelet count of the cases was 82,870/mm3 (+/-58,702/mm3) and that of the control subjects was 178,285 +/- 57,051/mm3 (P = 0.0002). Five of the 10 cases (50%) and 1 of the 21 control subjects (4.8%) had a platelet count of <100,000/mm3 (P = 0.007). In all, 19.4% of infants had culture-proven sepsis. There was no correlation between sepsis and thrombocytopenia in our cohort (P = 0.567). CONCLUSION: The role of low platelets in the etiopathogenesis of APROP has not been previously elucidated. Our study shows that a platelet count of <100,000 was associated with severe disease. Recently, platelets have been reported to play a key role in angiogenic regulatory protein delivery. It is possible that premature infants who develop retinopathy of prematurity in the setting of low platelet counts may lack the function of either delivering the optimal level or incompletely scavenging the excess of vascular endothelial growth factor A present in APROP. The spontaneous resolution of disease in our index case with platelet correction alone needs additional studies to correlate the timing and magnitude of correction that may play a role

Topiramate-induced acute angle closure with severe panuveitis: A challenging case report

A 36-year-old female presented with the complaints of pain, photophobia, redness, and sudden diminution of vision in both the eyes following topiramate for migraine treatment. On examination, there was panuveitis with angle-closure glaucoma in both the eyes with fibrinous exudate with pigments in the anterior chamber of the left eye. B scan revealed increased choroidal thickness in both the eyes. Serial anterior segment optical coherence tomography scans were done in the left eye to demonstrate the gradual resolution of the fibrin material from the anterior chamber. There was complete resolution of inflammation in both eyes following discontinuation of topiramate and treatment with systemic and topical steroids. There was an improvement in visual acuity in the left eye following complicated cataract surgery

Endothelial cell study in a case of Werner′s syndrome undergoing phacoemulsification and Yettrium-Aluminum-Garnet laser capsulotomy

Werner′s syndrome (WS) is a rare autosomal recessive disorder with multisystem manifestations of premature aging from the second decade of life. Cataract is one of the features of WS. Cataract surgery is complicated with postoperative wound dehiscence and bullous keratopathy when the surgery is done by intracapsular or conventional extracapsular method. We report the short-term result of phacoemulsification and Neodymimum Yettrium-Aluminum-Garnet laser (Nd YAG) capsulotomy in a case of WS with bilateral cataracts. Postoperatively and post capsulotomy, there was no change in the endothelial cell morphology. There was an 8.6% decrease in endothelial cell count at the end of 15 months postoperatively and 11 months post YAG capsulotomy. This decrease is within the acceptable range of cell loss after phacoemulsification and YAG capsulotomy. To the best of our knowledge, this is the first reported case of YAG laser capsulotomy in WS

Toric implantable collamer lens for keratoconus

Keratoconus is a progressive non-inflammatory thinning of the cornea that induces myopia and irregular astigmatism and decreases the quality of vision due to monocular diplopia, halos, or ghost images. Keratoconus patients unfit for corneal procedures and intolerant to refractive correction by spectacles or contact lenses have been implanted toric posterior chamber phakic intraocular lenses (PC pIOLs) alone or combined with other surgical procedures to correct the refractive errors associated with keratoconus as an off label procedure with special informed consent from the patients. Several reports attest to the safety and efficacy of the procedure, though the associated corneal higher order aberrations would have an impact on the final visual quality