To study the existing system of surgical safety for cataract surgery at tertiary care ophthalmic centre to implement WHO surgical safety checklist

Background: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, named after the first President of India, was established on the 10th of March, 1967 as a National centre for ophthalmic science, to provide state of the art patient care, expand human resources for medical education and undertake research to find solutions to eye health problems of national importance. Average numbers of cataract surgeries performed per month are 700 to 1000.Methods: Anticipating implementation in 50% cases hundred cases of cataract surgery were observed to study the existing system of surgical safety followed at Dr. R.P. Center and gap analysis done, against the WHO surgical safety checklist for cataract surgery. Modified WHO surgical safety checklist for cataract surgery was developed and implemented in the centre. Barriers in implementation of surgical safety checklist were also identified, and remedial measures suggested.Results: Significant improvement was noticed in all the parameters after introduction of modified checklist.  The additional points which were added in modified surgical safety checklist were implemented in almost all the cases by the nursing staff. Overall mean compliance percentage before implementation of modified surgical safety check list at Dr. R.P.C was 37%±10.1 (P=0.001).  While after introduction of modified surgical safety check list the mean compliance has improved to 62.7%±10.3, Wilcoxon rank sum test/Independent test is applied for each domain.Conclusions: Cataract procedure is the most common surgical procedure performed in the population in India. High volume and high turnover increase the potential for errors. Compliance to surgical safety check list before intervention was 32%. After intervention in form of a focus group discussion and introduction of modified surgical safety check list has resulted in increase in the compliance rate to 67%. This study revealed that changes or additional work is not happily accepted by the staff. After six months of intervention of modified surgical safety checklist compliance rate was still high, this suggests that constant supervision and monitoring by senior staff can sustain the compliance rate.

Contact lens rehabilitation following repaired corneal perforations

BACKGROUND: Visual outcome following repair of post-traumatic corneal perforation may not be optimal due to presence of irregular keratometric astigmatism. We performed a study to evaluate and compare rigid gas permeable contact lens and spectacles in visual rehabilitation following perforating corneal injuries. METHOD: Eyes that had undergone repair for corneal perforating injuries with or without lens aspiration were fitted rigid gas permeable contact lenses. The fitting pattern and the improvement in visual acuity by contact lens over spectacle correction were noted. RESULTS: Forty eyes of 40 patients that had undergone surgical repair of posttraumatic corneal perforations were fitted rigid gas permeable contact lenses for visual rehabilitation. Twenty-four eyes (60%) required aphakic contact lenses. The best corrected visual acuity (BCVA) of ≥ 6/18 in the snellen's acuity chart was seen in 10 (25%) eyes with spectacle correction and 37 (92.5%) eyes with the use of contact lens (p < 0.001). The best-corrected visual acuity with spectacles was 0.20 ± 0.13 while the same with contact lens was 0.58 ± 0.26. All the patients showed an improvement of ≥ 2 lines over spectacles in the snellen's acuity chart with contact lens. CONCLUSION: Rigid gas permeable contact lenses are better means of rehabilitation in eyes that have an irregular cornea due to scars caused by perforating corneal injuries

The comparative study of applanation and optical coherence biometry methods for the intra ocular lens power calculation

Purpose: To compare applanation biometry (A-Scan) and optical coherence biometry (AL-Scan) methods for IOL power calculation based on Axial Length and post operative refractive outcome. Methodology: Prospective and Interventional Randomized Comparative Study, Sample size of 400, studied under two sub groups, for Axial Length readings and IOL power calculation by A-Scan (Biomedix) and AL-Scan (Nidek). Keratometry readings are taken only by AL-Scan.Results: Mean ± St. dev. of A.L. measured by App. Biometry was low (22.79 ± 0.9 mm) than Opt. Coh. Biometry (23.16 ± 0.78 mm) to be significant (P= .0001). Mean ± St. dev. IOL power was higher (21.75 ± 2.1D) than App. Biometry (20.88 ± 1.59 D) to be significant (P= 0.0001). Mean ± St. dev. of refractive status for Myopia is higher -0.97 ± 0.53 by App. Biometry than Opt. Coh. Biometry -0.5 ± 0.19, to be significant (P= 0.0001) and Mean ± St.dev. for Hyperopia is higher 0.98 ± 0.59 by App. Biometry than Opt. Coh. Biometry 0.46 ± 0.18, to be significant (P= 0.0001). Bland–Altman plots showed perfect agreement between both methods regarding A.L. and calculated IOL power. Further subgroup analysis revealed a statistically significant difference in different age groups and types of cataract for Posterior Sub capsular cataract alone and Nuclear Sclerosis with Posterior Sub capsular cataract (P= 0.001). Conclusion: There is significant difference between App. and Opt. Coh. Biometry; however, certain situations of Cataract is demanding mandatory role of App. Biometry

Postage stamp multiple anterior capsulorhexisotomies in pediatric cataract surgery

BACKGROUND: Capsule related complications are common following pediatric cataract surgery. We report a new technique of multiple anterior capsulorhexisotomies after lens aspiration and intraocular lens (IOL) implantation. METHODS: After performing automated lens aspiration, an IOL was implanted into the capsular bag. A bent 26 gauge needle was introduced through one side port and multiple small cuts were made in one half of the circumference of the anterior capsular rim by making a radial movement of the needle tip centripetally over the margin of the anterior capsular rim. The needle was again introduced through the other side port and multiple similar cuts were made in the other half thereby creating nearly 20 – 30 cuts at the margin of the anterior capsular rim. RESULTS: The mean size of the primary capsulorhexis was 4.33 ± 0.20 mm. A uniform enlargement of the capsulorhexis could be performed in all the eyes without peripheral extension in any of the eyes. There was no damage to the posterior capsule and no scratch mark on the IOL. In one eye, the primary capsulorhexis was slightly eccentric, though it was covering the IOL optic all around. The rhexisotomies in this eye were limited to the capsular rim that was overlapping more on the IOL optic (sectoral anterior capsulorhexisotomies). CONCLUSION: The technique of postage stamp anterior capsulorhexisotomies is a feasible technique in pediatric cataracts