Indian Journal of Ophthalmology最新文献

{"title":"Clinical associations for the development of malignant glaucoma following intraocular surgery.","authors":"Shantha Balekudaru, Amit Pandey, Parveen Rewri, R George, Lingam Vijaya, Mani Baskaran","doi":"10.4103/IJO.IJO_1609_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_1609_24","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the factors associated with malignant glaucoma (MG) following intraocular surgery.</p><p><strong>Design: </strong>Retrospective case-control study.</p><p><strong>Setting: </strong>Institutional.</p><p><strong>Study population: </strong>A total of 40 eyes with MG and 80 controls were included.</p><p><strong>Methods: </strong>A total of 40 patients who developed malignant glaucoma following intraocular surgery between January 1995 and December 2013 were compared with 80 age- and gender-matched controls who underwent surgery during the study period.</p><p><strong>Main outcome measures: </strong>The associated factors for the development of malignant glaucoma following intraocular surgery.</p><p><strong>Results: </strong>Diagnosis in cases included primary angle closure glaucoma (PACG: 31 [77.5%]), primary open-angle glaucoma (POAG: 2 [5%]), pseudoexfoliation glaucoma (PXFG: 4 [10%]); in controls included PACG 44 (55%) and POAG 36 (45%), (P < 0.001). Trabeculectomy was performed in 24 cases (50%) and 28 (35%) controls, phaco-trabeculectomy in 14 cases (35%) and 52 eyes (65%) in controls, and cataract surgery in 2 cases (5%) (P = 0.004). Factors associated on univariate analysis included PACG (odds ratio [OR]: 12.68, 95% confidence interval [CI]; 2.84, 56.62, P < 0.001, synechial angle closure > 180° (OR: 10.1, 95% CI: 2.87, 35.44, P < 0.001, higher preoperative IOP > 22 mmHg (OR: 5.32, 95% CI: 2.64, 10.73, P < 0.001), trabeculectomy (OR: 3.05, 95% CI: 1.36, 6.83, P = 0.007) and axial length < 22 mm (OR: 6.80, 95% CI: 2.51, 18.46, P < 0.001. The use of postoperative cycloplegics was protective on univariate analysis (OR: 0.268, 95% CI: 0.12, 0.596), P < 0.001). Preoperative IOP > 22 mmHg (2.85, 95% CI: 1.11, 7.31, P = 0.02), and trabeculectomy (OR: 4.09, 95% CI: 1.48, 11.3, P = 0.007) remained significant on multivariate analysis.</p><p><strong>Conclusion: </strong>PACG eyes with higher preoperative IOP and eyes undergoing trabeculectomy surgery alone, increased the likelihood of developing MG.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 Suppl 2","pages":"S240-S243"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current perspectives in tackling glaucoma blindness.","authors":"Shibal Bhartiya, Parul Ichhpujani, Meenakshi Wadhwani","doi":"10.4103/IJO.IJO_3280_23","DOIUrl":"https://doi.org/10.4103/IJO.IJO_3280_23","url":null,"abstract":"<p><p>As a major reason for irreversible vision loss, glaucoma is a significant public health concern. Its multifactorial nature demands a nuanced understanding of its pathophysiology, risk factors, and management. An understanding, and continuous refinement, of diagnostic and therapeutic modalities, including pharmacological interventions, novel methods of drug delivery, and surgical techniques (including minimally invasive glaucoma surgeries) are critical. The advent of personalized medicine, genetic profiling, and innovative biomarkers for identifying susceptible individuals and tailoring treatment strategies may help prevent blindness and improve patient outcomes. Evaluation of the impact of lifestyle modifications and holistic approaches and integration of telemedicine and artificial intelligence in glaucoma management may revolutionize current glaucoma practice. In addressing the global challenge of glaucoma blindness, this narrative review highlights ongoing initiatives, public health policies, and community-based interventions. This includes raising awareness, enhancing early detection programs, and access to care, particularly in underserved populations.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 Suppl 2","pages":"S189-S196"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"SYRI\" - A hands-on teaching model for SYRInging of nasolacrimal duct.","authors":"Akash R Khiyani, Preeti Mohanty","doi":"10.4103/IJO.IJO_1548_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_1548_24","url":null,"abstract":"<p><strong>Background: </strong>Nasolacrimal duct (NLD) screening is a standard before cataract surgery. Lacrimal sac pressure and syringing rules out NLD obstructions.[1] However, lacrimal syringing is invasive and risks iatrogenic injury to the lacrimal drainage system (LDS).[2].</p><p><strong>Purpose: </strong>Practice model for lacrimal syringing and understanding outflow obstructions.</p><p><strong>Synopsis: </strong>The model included an inner functional part and an outer mechanical part. Two circular apertures were first made in the ink dropper (lacrimal sac) and two hollow silicone tubing of 10 mm length were glued to the apertures (upper and lower canaliculi). The tubing were bent using pins for the horizontal and vertical canaliculi. Silicone liquid was then poured into 3D-printed mould with LDS model kept inside and was left for 3-4 h. The inner model was modified by fitting small silicone balls, and obstructions were created at various levels such as lower, upper, common canaliculus, and NLD. In normal LDS, when the fluorescein dye passed through one of the tubing, it exited at the NLD opening. If the dye regurgitated through the same tubing, it suggested same canalicular block. Regurgitation from the opposite tubing suggested either a common canalicular block or an NLD obstruction. The model presents a commendable representation of the NLD system; however, it does exhibit some limitations. Notably, the absence of eyelid margins hinders the precise localization of stenotic puncta and the effective utilization of punctum dilators. In addition, the model cannot replicate the lateral pulling of the eyelid, which is crucial for effective probing procedure.</p><p><strong>Highlights: </strong>Our Do it yourself (DIY) syringing model called \"SYRI\" is a cost-effective way to practice syringing, enhancing the understanding of canalicular and NLD blocks. While not meant for probing, its repeated use improves proficiency in syringing, benefiting patient care. The model is easily replicated and can serve as foundation for teaching complex surgeries like dacryocystorhinostomy.</p><p><strong>Video link: </strong>https://youtu.be/xbKl33-W0VA.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 3","pages":"464"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-point flanged optic piercing intrascleral fixation of multifocal intraocular lenses.","authors":"Youngsub Eom, Hyun Sun Jeon, Seong-Jae Kim, Dong Hyun Kim, Jong Suk Song, Dooho Brian Kim","doi":"10.4103/IJO.IJO_1960_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_1960_24","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the feasibility of a three-point flanged optic piercing intrascleral fixation technique for replacing a dislocated multifocal intraocular lens (IOL).</p><p><strong>Design: </strong>Retrospective cross-sectional study.</p><p><strong>Methods: </strong>In total, 13 eyes from 13 patients with a dislocated single-piece C-loop or double C-loop diffractive multifocal IOL were enrolled to undergo dislocated multifocal IOL replacement through three-point flanged optic piercing 120 degrees apart intrascleral fixation using 7-0 polypropylene sutures at 2.5 mm posterior to the limbus. Preoperative and postoperative uncorrected distance visual acuity (UDVA), postoperative uncorrected intermediate visual acuity (UIVA) at 66 cm, uncorrected near visual acuity (UNVA) at 40 cm, residual refractive errors, and the amount of IOL decentration were evaluated.</p><p><strong>Results: </strong>There were six multifocal IOLs and seven multifocal toric IOLs. There was a notable improvement in visual acuity, with the mean UDVA improving from 0.79 ± 0.72 logMAR preoperatively to 0.06 ± 0.08 logMAR postoperatively (P = 0.004). The mean postoperative UIVA and UNVA were 0.04 ± 0.05 and 0.10 ± 0.12 logMAR, respectively. The mean residual refractive sphere, cylinder, and spherical equivalent were -0.04 ± 0.48 D, -0.29 ± 0.25 CD, and -0.18 ± 0.47 D, respectively. The mean residual cylinder was -0.25 ± 0.25 CD in eyes with multifocal toric IOL fixation. The mean amount of IOL decentration was 0.22 ± 0.05 mm.</p><p><strong>Conclusion: </strong>The three-point flanged optic piercing intrascleral fixation technique for dislocated multifocal IOLs could provide good distance, intermediate, and near vision alongside excellent IOL centration.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 3","pages":"455-461"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical mycobacterial keratitis: Clinical outcome in nonrefractive surgery cases.","authors":"Kshyanaprava Priyadarshini, Smruti Rekha Priyadarshini, Srikant Kumar Sahu, Himansu Sekhar Behera, Sujata Das","doi":"10.4103/IJO.IJO_3338_23","DOIUrl":"10.4103/IJO.IJO_3338_23","url":null,"abstract":"<p><strong>Purpose: </strong>To identify the predisposing factors, clinico-microbiological profiles, and treatment responses in patients with atypical mycobacterial keratitis.</p><p><strong>Methods: </strong>The study retrospectively analyzed patients who presented at a tertiary eyecare center in eastern India with atypical mycobacterial keratitis between 2008 and 2021. The diagnostic criteria included cases positive for acid-fast bacilli on Ziehl-Nielsen stain or culture. The antibiotic susceptibility pattern was observed, and treatment was initiated accordingly.</p><p><strong>Results: </strong>Out of the 29 cases, ocular predisposing factors were present in 62.1% with an antecedent history of trauma, and vegetative matter was the most common risk factor. There was no predisposing association with systemic conditions in any case. A long lag time was observed between the onset of corneal infection and presentation in 79.3% of cases, with the average time being 43.7 days. Clinical signs mimicked fungal keratitis in most cases. Typical cracked windshield appearance was only observed in two cases. Two patients presented with clinical pictures like peripheral ulcerative keratitis. Topical amikacin was used as treatment in 28 cases. Based on disk diffusion assay, 28 (96.5%) isolates were sensitive to amikacin. Twelve (41.3%) were sensitive to vancomycin, six (20.6%) to gatifloxacin, six (20.6%) to ciprofloxacin, and four (13.7%) to moxifloxacin. Twelve participants showed good final visual acuity posttreatment, which improved to over two lines of Snellen's visual acuity chart (44.5%).</p><p><strong>Conclusion: </strong>Atypical mycobacteria keratitis may not present with classically described clinical features. The duration of presentation, clinical presentation, special microbiological stains, targeted therapy, and antibiotic susceptibility patterns are the key to successfully managing these intractable infections and obtaining favorable outcomes.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":" ","pages":"404-407"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of micropulse in pediatric eyes with refractory glaucoma.","authors":"Raajaraajeshwari Sivasubramanian, Kumar Siddharth, Vijayalakshmi A Senthilkumar, Iswarya Mani, Sharmila Rajendrababu","doi":"10.4103/IJO.IJO_1066_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_1066_24","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the safety and efficacy of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in pediatric eyes with refractory glaucoma.</p><p><strong>Design: </strong>Hospital-based prospective interventional study.</p><p><strong>Methods: </strong>Patients less than 18 years of age, receiving MP-TSCPC between December 1, 2022 and May 31, 2023 with at least three follow-ups within 6 months period, were included in the study. Post-laser evaluation was done at day 1, 1 month, 3 months, and 6 months. Success outcomes were calculated at 1, 3, and 6 months follow-up.</p><p><strong>Results: </strong>A total of 23 eyes of 23 patients were included in the study. Mean intraocular pressure (IOP) lowering agents (P = 0.041) had significant change compared to the baseline value; however, the change was insignificant when eyes requiring additional IOP-lowering surgeries during the follow-up period were excluded. There was a significant reduction in IOP at each follow-up visit compared to the baseline (P = 0.000014). Two (8.6%) eyes required additional intervention within 1-month follow-up, another six eyes (26%) between 1-3 months, and three eyes (13%) between 3-6 months of MP-TSCPC. Total success was highest at 56.5% (13 eyes) at 1-month follow-up and at least 34.7% (8 eyes) at 6-month follow-up. No major complications were reported in our study.</p><p><strong>Conclusion: </strong>MP-TSCPC was found to be safe and effective in pediatric population. However, we observed a gradual reduction in the success with time, and thus, it can be individualized to patients with high risk for incisional surgery or those requiring immediate IOP reduction.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 Suppl 2","pages":"S227-S231"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on: Nonpenetrating deep sclerectomy in advanced open-angle glaucoma.","authors":"Smita Narayanan","doi":"10.4103/IJO.IJO_2387_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_2387_24","url":null,"abstract":"","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 Suppl 2","pages":"S219-S220"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cataract surgical coverage in Indian population aged 50 years and above.","authors":"Praveen Vashist, S Sarath, Vivek Gupta, Noopur Gupta, Suraj S Senjam, Pallavi Shukla, Sumit Grover, B R Shamanna, Rajshekhar Vemparala, Meenakshi Wadhwani, Amit Bhardwaj, Jeewan S Titiyal","doi":"10.4103/IJO.IJO_1398_24","DOIUrl":"10.4103/IJO.IJO_1398_24","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives of the study were to obtain the current estimates of cataract surgical coverage (CSC) at varying thresholds of vision and gender variations across districts in diverse Indian populations aged ≥50 years.</p><p><strong>Methods: </strong>Data collected from the national blindness survey from 31 Indian districts between 2015 and 2019 were analyzed. CSC at varying thresholds of presenting visual acuity <3/60, <6/60, and <6/18 were estimated along with gender variations across districts in population ≥50 years of age.</p><p><strong>Results: </strong>The survey coverage was 93.5%, with 85,135 participants examined. The overall CSC at best corrected visual acuity (BCVA) <3/60, <6/60, and <6/18 in the Indian population was 93.3% (95% confidence interval [CI]: 91.5-94.7), 88.9% (95% CI: 86.5-90.9), and 72.6% (95% CI: 69.1-75.9), respectively. CSC was highest in the north and lowest in the northeast administrative zone at all BCVA cut-offs. Khera district had the highest CSC at BCVA <3/60 (99.1%) and <6/60 (97.9%), whereas Kapurthala district had the highest CSC at <6/18 (88%). Nalbari district had the lowest CSC at BCVA <3/60 (78%) and <6/60 (70.2%), and Nayagarh had the lowest CSC at <6/18 (45.6%). Overall, males had higher CSC than females. Gender variation was highest in Thoubal at BCVA <3/60 (18.7%) and <6/60 (19.2%). At BCVA <6/18, gender variation was highest in Thrissur (15.9%), with males (85.5%) found to have 15.9% higher CSC than females (69.6%).</p><p><strong>Conclusions: </strong>CSC improved for 3/60 and 6/60 cut-offs, but remained low for 6/18 BCVA cut-off in India, with district- and gender-based inequities that need health system interventions.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":" ","pages":"347-351"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closed globe refixation of the IOL-bag complex with the ab-externo 8-exit-4-point fixation technique.","authors":"Ayushi Choudhary, Gaurang Sehgal, Chaitra Jayadev, Nagesha C Krishnappa","doi":"10.4103/IJO.IJO_1316_24","DOIUrl":"10.4103/IJO.IJO_1316_24","url":null,"abstract":"<p><p>Intraocular lens (IOL) dislocation is not an uncommon complication and often requires surgical intervention, depending on the status of capsular bag support. Conventionally, posterior dislocation of a foldable IOL or the IOL-bag complex warrants their removal as foldable IOLs are not ideal for sulcus placement. The technique presented here describes using quadrilateral sutures to refix looped haptic IOLs at the ciliary sulcus with or without a bag complex. The haptic loops act as eyelets, and 4-side suture placement helps in good centration, avoiding lens tilt. The closed globe maneuver causes minimal ocular trauma and helps in faster postoperative recovery.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":" ","pages":"442-445"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on: Understanding IOL optic-posterior capsule dynamics.","authors":"Manpreet Kaur, Jeewan S Titiyal","doi":"10.4103/IJO.IJO_2414_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_2414_24","url":null,"abstract":"","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 3","pages":"402-403"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}