The Wounded Healer Sharmila Devi Vadivelu TNOA Journal of Ophthalmic Science and Research 2019 57(2):103-104

Surgically induced astigmatism in manual small-incision cataract surgery: A comparative study between superotemporal and temporal scleral incisions Machireddy R Sekharreddy, Venkatesh Sugantharaj, Shruti Prabhat Hegde TNOA Journal of Ophthalmic Science and Research 2019 57(2):105-108 Purpose: The purpose of this study is to compare the surgically induced astigmatism between superotemporal and temporal approaches in manual small-incision cataract surgery (MSICS). Materials and Methods: This was a prospective, hospital-based, interventional study with two groups each consisting of 50 patients. Patients in Group A underwent superotemporal MSICS and those in Group B underwent temporal MSICS. Statistical analyses of the results obtained were done with the SPSS software version 20, and data sets were compared using an independent sample t-test. Results: Astigmatism induced by superotemporal incision was 0.8032 ± 0.322 D, whereas astigmatism induced by temporal incision was 0.3826 ± 0.142 D with the difference being statistically significant. Both the groups showed significant improvement in postoperative uncorrected visual acuity. Conclusions: This study showed that the temporal MSICS induces lesser astigmatism as compared to the superotemporal approach. However, unaided postoperative visual acuity was comparable and good in both the groups.

Topical nepafenac in the treatment of center involving diabetic macular edema TP Vignesh TNOA Journal of Ophthalmic Science and Research 2019 57(2):109-112 Purpose: To assess the efficacy of topical nepafenac 0.1% in the treatment of center-involving diabetic macular edema (DME). Design: A prospective, interventional case series. Methods: Fourteen eyes of thirteen patients with center-involving DME were included in the study, and they were administered topical nepafenac eye drops 0.1% thrice daily, for 6 months. Vision and foveal thickness were recorded at the baseline and 2nd, 4th, and 6th month follow-up visits. Results: The mean baseline and final LogMAR visual acuity were 0.35 and 0.18, respectively, and the mean baseline and final foveal thickness were 463.4 μm and 291.8 μm, respectively, both showing a statistically significant improvement (P < 0.05). Conclusion: Topical nepafenac is effective in the treatment of center-involving DME in this small case series; however, a large randomized study is warranted.

A study on the safety and efficacy of posterior chamber phakic intraocular lens (refractive implantable lens) in high myopia Sivaviganesh Subramanian, Sharmila Devi Vadivelu, M Ananda Babu, B Meenakshi, Jiz Mary Santhosh TNOA Journal of Ophthalmic Science and Research 2019 57(2):113-117 Background: Myopia is the most common refractive error worldwide causing visual impairment in children and adults. The prevalence of high myopia varies with age and ethnicity. High myopia has been found to be visually debilitating and affects day-to-day activities of the individual. Aim: This study aimed to analyze the efficacy and visual outcomes of posterior chamber phakic intraocular lens-refractive implantable lens (RIL) in high-myopia patients. Methods: This prospective study was conducted in a tertiary care center during February 2017–February 2018. Results: This study included 50 eyes of 34 patients, which showed 82% of eyes had uncorrected visual acuity equal or better than preoperative best-corrected visual acuity and 52% eyes had visual acuity of 6/6. No incidence of cataract was observed in this study. Conclusion: Refractive results after RIL implantation are found to be safe and satisfactory and has favorable visual outcome.

Subthreshold micropulse yellow laser in the treatment of central serous chorioretinopathy TP Vignesh TNOA Journal of Ophthalmic Science and Research 2019 57(2):118-121 Purpose: The objective was to study the safety and efficacy of subthreshold micropulse yellow laser in the treatment of central serous chorioretinopathy (CSCR). Materials and Methods: This is a retrospective interventional case series in a tertiary eye care center. Patients diagnosed to have CSCR were treated with subthreshold micropulse yellow laser, over the leaks identified by fundus fluorescein angiography. Subretinal fluid (SRF) level was measured by optical coherence tomography at baseline and the follow-up visits at 1, 3, and 6 months. Results: Twelve eyes of 12 patients were included, and there was a statistically significant improvement in visual acuity as well as reduction in SRF level between baseline and the follow-up visits. Conclusion: There was a beneficial effect of subthreshold micropulse yellow laser in the treatment of CSCR in this study, with complete resolution of SRF in ten out of 12 eyes (83.3%). However, a larger study is warranted.

A study on evaluation of eyelid trauma in a tertiary care center A Anuradha, Malarvizhi Raman, Jaya Jarika TNOA Journal of Ophthalmic Science and Research 2019 57(2):122-127 Aim: This study aims to evaluate traumatic eyelid injuries and assess functional outcome following treatment. Materials and Methods: A prospective study of 30 cases of lid injury was conducted at Orbit and Oculoplasty Department, Regional Institute of Ophthalmology and Government Ophthalmic Institute, Egmore, Chennai, Tamil Nadu, for 12 months from February 01, 2017, to February 01, 2018. Data collected were entered into Excel Spreadsheet and analyzed using STATA statistical software package release 11. Results: The incidence of lid injuries was more in males (63%) compared to females (37%). The most common mode of injury of the eyelid was accidental fall (36.7%) and assault (23.3%). Majority of the cases presented within 6 h of injury. Full-thickness involvement was seen in 20 patients (66.7%). Involvement of the eyelid margin was seen in 18 patients (60%) and was managed by three-layer margin suturing canalicular involvement in 8 cases (26.7%) underwent monocanalicular stent placement. About 40% of patients complained of epiphora and were not satisfied with cosmetic results. Conclusion: This study reveals that young adult males, most of whom were workers, were more prone to eyelid injuries. Timely meticulous management of the eyelid injury with minimal debridement of the wound and tension-free suturing gives better cosmetic outcome. Epiphora, notching of lid margin, or ectropion was the most common complication postoperatively.

Outcome of early and late vitrectomy for retinal detachment associated with von Hippel–Lindau-related retinal capillary hemangioma Karthik Kumar, Piyush Kohli, Naresh Babu, Soumya Jena, Kim Ramasamy TNOA Journal of Ophthalmic Science and Research 2019 57(2):128-131 Aim: The aim of this study was to report the outcome of early and late vitrectomy for retinal detachment-associated with von Hippel–Lindau (VHL)-related retinal capillary hemangioma (RCH). Materials and Methods: Records of patients diagnosed with VHL-related RCH, from 2016 to 2018, were retrospectively analyzed for patients' age, gender, family history, systemic disorders, previous treatment taken, clinical characteristics of RCH, associated complications, timing of surgery, and surgical outcome. The treatment of RCH depends on its location, size, and clinical expressions. Results: Twenty-one eyes of 15 patients with a median age of 40 years (range, 22–65 years) were seen. Nine patients had central nervous system hemangioblastomas, eight had associated renal complications (four – renal cell carcinoma and four – multiple renal cysts), four had pancreatic cysts, while one had testicular cyst and pheochromocytoma each. Four eyes presented with no perception of light. Eight eyes presented with retinal detachment (RD). Four eyes underwent a combination treatment, four underwent cryotherapy, five underwent laser, and two underwent transpupillary thermotherapy, while four underwent intravitreal bevacizumab. Of eight eyes with tractional RD (TRD), four presented with no perception of light (NPL) . The other four eyes underwent surgery. Of the eyes that underwent surgery, two underwent early vitrectomy for extramacular TRD, whereas the other two underwent surgery in late stage. The two eyes that underwent early vitrectomy gained best-corrected visual acuity (BCVA) of 20/20, and the retina was attached in single surgery. The other two eyes that underwent surgery at an advanced stage had to undergo multiple surgeries and gained BCVA <10/200. Conclusion: Early vitrectomy is a safe and effective modality of treatment for VHL-related RCH complicated with TRD.

Coexistent cataract and glaucoma – Causes and management Seshadri J Saikumar, Manju Anup, Abhilash Nair, Namitha R Mathew TNOA Journal of Ophthalmic Science and Research 2019 57(2):132-138 The optimal management of a glaucoma patient with cataract has always been a vexing issue. The prime concern has been to adequately control glaucoma while providing visual improvement and decreasing complications due to surgery. Advances in microsurgery techniques have improved surgical outcomes in recent years. However, numerous options exist and the management of an individual patient need to be personalized based on patient needs and surgical proficiency. This article aims to enlighten the reader regarding apt options in dealing with such individuals.

Immunosuppressives and biologicals in uveitis: The way forward – Current concepts Karpagam Damodaran, Sudharshan Sridharan TNOA Journal of Ophthalmic Science and Research 2019 57(2):139-145 Uveitis constitutes a sight-threatening group of diseases, which includes infectious and noninfectious entities. In this review, we consider the current evidence base for treatments in noninfectious uveitis including immunosuppressives and biologicals. Future treatment will require a better understanding of the mechanisms involved in autoimmune diseases and better delivery systems in order to provide targeted treatment with minimal side effects.

Expert corner - diabetic retinopathy R Kim, Atul Kumar, Rajiv Raman, Raja Narayanan, Manish Nagpal, Paisan Ruamviboonsuk, VG Madanagopalan TNOA Journal of Ophthalmic Science and Research 2019 57(2):146-151 Diabetic retinopathy (DR) continues to be a challenge both to clinicians and patients. The systemic variables involved, local mediators implicated, and the coexistence of other ocular conditions such as cataract requires careful planning and delivery of treatment. With the advent of antivascular endothelial growth factor agents, there has been a paradigm shift in the management of DR. Nevertheless, other treatment options such as retinal laser therapy, intravitreal steroids, and vitreoretinal surgery are equally important in selected clinical scenarios. We have a stellar panel of experts who are world-renowned experts in the field of DR. For the benefit of our readers, they distill the essence of evidence-based medicine and share their expertise with particular focus on real-world scenarios in DR.