Comparative analysis of outcomes following topography-guided laser in situ keratomileusis using manifest refraction versus a new topographic analysis algorithm

Purpose: To compare the visual outcomes following topography-guided laser in situ keratomileusis (LASIK) treatment using manifest refraction versus a new topography analysis software. Methods: A prospective, randomized, observer-masked contralateral study was conducted in the refractive services of a tertiary eye care hospital in South India. Analysis of visual outcomes, corneal higher-order aberrations, and contrast sensitivity were performed at 3 months postoperative visit following uneventful topography-guided LASIK using the Wavelight EX500. One eye was treated with the Contoura platform using manifest refraction (Contoura), while the contralateral eye was treated using an ablation profile planned by the Phorcides Analytic Engine (Phorcides). Results: Sixty eyes of 30 patients were included in the study. At 3 months postoperative visit, the uncorrected distance visual acuity (UDVA) in the Contoura and Phorcides groups was logarithm of the minimal angle of resolution (logMAR) 0.04 ± 0.07 and logMAR 0.06 ± 0.1, respectively (P = 0.483). Postoperative manifest refractive spherical error (MRSE) was 0.12 ± 0.22 and − 0.06 ± 0.20 D in the Contoura and Phorcides groups, respectively (P = 0.338). Although higher number of eyes demonstrated a gain in one or more lines of corrected distance visual acuity (CDVA) in the Contoura group (16.6% vs. 6.6%), the difference was not statistically significant (P = 0.361). Vector analysis (Alpins criteria) for postoperative cylinder, contrast sensitivity measurement, and corneal higher-order aberration profile showed no significant difference between the two groups at 3 months postoperative visit (P = 0.213, 0.514, and 0.332, respectively). Conclusion: Quantitative and qualitative visual outcomes with the Phorcides Analytic Software were similar to the Contoura treatment using manifest refraction

Visual outcomes of patients bilaterally implanted with the extended range of vision intraocular lens: A prospective study

Purpose: The aim of this study was to analyze the objective and subjective visual outcomes of patients bilaterally implanted with the extended range of vision intraocular lens (EROV IOL), the Tecnis Symfony. Methods: This was a prospective interventional case series conducted at a tertiary eye care hospital in South India. The study included patients with bilateral implantation of EROV IOLs. The uncorrected and corrected visual acuity for distance, intermediate, and near vision was recorded at 6 weeks and 6 months' postoperative visit. A subjective questionnaire was administered to assess spectacle independence, photic phenomenon, and overall satisfaction. All data were recorded using Microsoft Excel worksheet. The analyses were performed using SPSS for windows software. Results: Our study included fifty patients with bilateral implantation of EROV IOLs. The mean age was 59.84 ± 11.68 years. The mean uncorrected binocular distance, intermediate, and near visual acuity (in standard decimal equivalent) was 0.89,0.99 and 0.99 respectively, at 6 months' postoperative visit. Ninety-six percent of the patients did not require spectacles for distance and 98% of the patients were free from spectacles for intermediate and near vision. 94% of our patients perceived no or minimal photic phenomena such as glare and halos. The mean subjective patient satisfaction score (out of 10) for distance, intermediate, and near was 9, 10, and 9, respectively. Conclusion: The EROV IOLs demonstrated high levels of spectacle independence for distance, intermediate, and near vision. The incidence of photic phenomena observed was minimal with a high level of patient satisfaction

Comparative analysis of safety and efficacy of photorefractive keratectomy versus photorefractive keratectomy combined with crosslinking

Gitansha Shreyas Sachdev, Shreyas Ramamurthy, Ramamurthy Dandapani Refractive Services, The Eye Foundation, Coimbatore, India Purpose: To assess the safety, efficacy, and refractive predictability of half-fluence accelerated corneal collagen crosslinking (CXL) applied concurrently with photorefractive keratectomy (PRK), and compare the results to standard PRK.Setting: Refractive Services, The Eye Foundation, Coimbatore, India.Design: Interventional comparative case series.Methods: Patients seeking refractive correction for myopia or myopic astigmatism were included in the study. Photorefractive keratectomy with concurrent half-fluence crosslinking (PRK Xtra) was performed in eyes with borderline suspicious tomography (not amounting to forme fruste keratoconus) or low pachymetry between 450 and 474 µm with an otherwise unremarkable corneal tomography. Eyes with normal corneal tomography and thickness between 475 and 500 µm underwent standard PRK. The minimum follow-up period was 1 year. Results: In total, 109 eyes underwent PRK Xtra (Group A) and 118 eyes underwent PRK alone (Group B). The preoperative MRSE was −3.64 D and −3.38 D in Groups A and B, respectively (P=0.28). Group A had a significantly higher number of eyes with thinner corneas (P<0.01) and corneal tomographic abnormalities (P=0.02). At 1 year follow-up, 96.3% of eyes in group A as against 99.1% of eyes in group B achieved a best corrected distance visual acuity (CDVA) of 20/20 or better. No iatrogenic ectasia or hyperopic shift secondary to progressive flattening was noted in the PRK Xtra group. No significant difference in incidence of haze was noted.Conclusion: PRK Xtra showed comparable safety, efficacy, and stability to PRK in eyes with thinner pachymetry and tomographic abnormalities. Combining crosslinking with PRK in suspicious tomographies augurs for safe and predictable outcomes. Keywords: photorefractive keratectomy, PRK, corneal collagen crosslinking, CXL, PRK Xtr

Outcome of deep anterior lamellar keratoplasty patients with intraoperative Descemet's membrane perforation: A retrospective cross-sectional study

Purpose: To evaluate functional and anatomical outcome in patients undergoing deep anterior lamellar keratoplasty (DALK) with intraoperative Descemet's membrane (DM) perforation (macro and micro). Methods: A retrospective cross sectional study (January 2009 to December 2015) of sixteen eyes of sixteen patients which included nine patients of advanced keratoconus (KC), two patients with paracentral DM scarring post hydrops, KC with Bowman's membrane scarring, macular corneal dystrophy and one patient of advanced Pellucid Marginal Degeneration (PMD). All underwent DALK with intraoperative DM perforation. Big bubble technique was attempted in all except in the two patients with post hydrops DM scar. Preoperative and postoperative best corrected visual acuity (BCVA), astigmatism and endothelial count (EC) were compared. Results: Postoperative BCVA and astigmatism were found to be better and statistically significant ('p value' 0.00 and 0.003 respectively). BCVA preoperative and postoperative was 1.07± 0.3 and 0.28 ± 0.09 in LogMAR respectively and astigmatism pre and postoperative 4.14 ± 1.5 D and 2.7 ± 0.97 D respectively. Percentage decrease in EC at sixth postoperative week was 7.48% and at sixth month and 1 year postoperative was 15.1%. Two patients developed postoperative double anterior chamber and two patients developed pupillary block glaucoma and all were successfully managed. Conclusion: Not all patients of intraoperative DM perforation (including macro perforation) needs to be converted to penetrating keratoplasty. DALK can be successfully done if the perforation is identified early and managed adequately. This is the only known study which has shown a large series of successful DALK even with macro perforations

Complications in deep anterior lamellar keratoplasty – A retrospective cross sectional interventional analysis in a large series

AIM: To analyse complications in patients managed with deep anterior lamellar keratoplasty (DALK) for diseases of anterior corneal stroma. MATERIALS AND METHODS: This was a retrospective analysis of all the patients who underwent DALK in a tertiary care center in South India from 2010 to 2021. A total of 484 eyes in 378 patients were included in the study. Patients who underwent DALK for advanced keratoconus, keratoconus with Bowman's membrane scar, healed hydrops, macular corneal opacity, macular corneal dystrophy, granular corneal dystrophy, spheroidal degeneration, pellucid marginal degeneration, post-LASIK ectasia, descemetocele, postcollagen cross-linking aborted melt and dense scar, and postradial keratotomy were included in the study. The patients were followed up for 17.6±9.4 months(1–10years). RESULTS: Complications noted in the surgery were intraoperatively Descemet's membrane perforation in 32 eyes (6.6%), postoperatively secondary glaucoma in 16 eyes (3.31%), cataract in 7 eyes (1.45%), suture-related complications in 5 eyes (1.03%), graft rejection in 3 eyes (0.61%), traumatic dehiscence in 2 eyes (0.41%), filamentary keratitis in 2 eyes (0.41%), interface infiltrate in 1 eye (0.21%), and recurrence of disease in 4 eyes (8.77%) out of 57 eyes with corneal dystrophy. CONCLUSION: DALK as an alternative to penetrating keratoplasty for anterior corneal stromal diseases has proven to be better time and again. It has become an automatic choice for diseases of anterior cornea requiring keratoplasty. Complications occurring at any stage of surgery can be identified and managed effectively resulting in optimal outcome. This article compiles complications post DALK

Tuck in versus cauterisation of graft edge in pterygium management: A comparative retrospective interventional analysis

PURPOSE: To compare and evaluate surgical outcome between tuck in and cauterisation in the management of primary pterygium. MATERIALS AND METHODS: Two groups of 56 eyes and 58 eyes with primary pterygium underwent pterygium excision with conjunctival autograft fixation by tucking in alone (Group 1) and with cauterization (Group 2), respectively. A retrospective comparative analysis was done between the two groups. RESULTS: This study included a total of 114 eyes in the final analysis. The recurrence was noted in 3 eyes in Group 1 (5.35%), whereas only 1 eye (1.72%) in Group 2. Other complications included graft edema in 25 eyes (44.64%), in Group 1 and 29 eyes (50%) in Group 2, subconjunctival hemorrhage seen in 28 eyes (50%) in Group 1 and 32 eyes (55.17%) in Group 2, graft retraction observed in 28 eyes (50%) in Group 1 and 13 eyes (22.4%) in Group 2, granuloma formation was seen only in one patient (1.72%) in Group 2, graft loss was observed in four patients (7.14%) in Group 1 and 2 patients (3.44%) in Group 2. CONCLUSION: Graft fixation in pterygium surgery using low-cost procedures with tuck in or cauterization proves to be tolerable, safe and successful method. An additional step of fixing the graft to the cut conjunctival margin using bipolar cautery proves to be safer

Visual outcomes of early enhancement following small incision lenticule extraction versus laser in situ keratomileusis

Purpose: To compare visual outcomes of early enhancement following small incision lenticule extraction (SMILE) versus laser in situ keratomileusis (LASIK). Methods: Retrospective analysis of eyes (patients operated in the setting of a tertiary eye care hospital between 2014 and 2020) requiring early enhancement (within one year of primary surgery) was conducted. Stability of refractive error, corneal tomography, and anterior segment Optical Coherence Tomography (AS-OCT) for epithelial thickness was performed. The correction post regression was done using photorefractive keratectomy and flap lift in eyes, wherein the primary procedure was SMILE and LASIK, respectively. Pre- and post enhancement corrected and uncorrected distance visual acuity (CDVA and UDVA), mean refractive spherical equivalent (MRSE), and cylinder were analyzed. IBM SPSS statistical software. Results: In total, 6350 and 8176 eyes post SMILE and LASIK, respectively, were analyzed. Of these, 32 eyes of 26 patients (0.5%) post SMILE and 36 eyes of 32 patients (0.44%) post-LASIK required enhancement. Post enhancement (flap lift in LASIK, and PRK in SMILE group) UDVA was logMAR 0.02 ± 0.05 and 0.09 ± 0.16 (P = 0.009), respectively. There was no significant difference between the refractive sphere (P = 0.33) and MRSE (P = 0.09). In total, 62.5% of the eyes in the SMILE group and 80.5% in the LASIK group had a UDVA of 20/20 or better (P = 0.04). Conclusion: PRK post SMILE demonstrated comparable results to flap lift post LASIK and is a safe and effective approach for early enhancement post SMILE

Concomitant use of conjunctival tissue graft from the pterygium itself without rotation in pterygium surgery: A full circle in conjunctival autografting

Purpose: The aim of this study is to describe a modified technique of using conjunctival tissue from the pterygium itself without any rotation of graft for the primary pterygium in eyes with glaucoma filtering bleb, glaucoma suspects, and in primary double-head pterygium using fibrin glue. Methods: In this retrospective, noncomparative, interventional case series, 98 eyes of 98 patients with primary pterygium operated between July 2011 to July 2016 were included. They underwent this technique from the pterygium tissue itself. There was no rotation of this graft, and it was adhered to the bare scleral defect with fibrin glue. Histopathological analysis of pterygium tissue was done to look for morphology and thickness of this thin conjunctival tissue obtained from pterygium tissue itself. The primary outcome measure was recurrence rate. Other outcome measures studied was graft retraction and graft edema. Results: The mean age was 52 ± 10.04 years. Mean follow-up was 14 ± 8.24 months. The only significant complication was recurrence rate of 4.08% (4 eyes out of 98). The most come secondary outcome was graft edema, 52.04% (51 eyes out of 98) which resolved without any intervention. Other outcome such as graft retraction, 32.65% was also recorded. Conclusion: Conjunctival tissue from the pterygium tissue itself without actual rotation appears to be a successful technique with lower recurrence rate for treating primary pterygium in eyes with glaucoma filtering bleb, glaucoma suspects, and in primary double-head pterygium