Purpose: To evaluate a new surgical technique (“prick and print”) for harvesting shaped donor corneal grafts in cases with perforated peripheral ulcerative keratitis (PUK). Methods: We conducted a retrospective case series at a tertiary center. Medical records of 13 patients with perforated PUK, who underwent tectonic eccentric keratoplasty using the stenciling-based prick and print technique during the past 1 year, were reviewed. All patients (15 eyes of 13 patients) received grafts of varying sizes and shapes (14 crescentic and 1 biconvex). Factors evaluated were tectonic integrity, graft apposition, and complications, if any. Surgical success was defined as maintenance of corneal integrity and healing of PUK. Results: Mean age of patients was 40.6 ± 19.4 years. Mean follow-up was 10 months. We achieved surgical success in 80% (12/15 eyes) of cases. Two eyes had graft infection, and regrafting (large circular graft) was performed for both. One eye developed new-site PUK, which was managed medically, and the graft remained viable tectonically. After surgery, 9 eyes achieved a best-corrected visual acuity of logarithm of the minimum angle of resolution +0.3 or better. No cases had graft rejection or peripheral anterior synechiae by final follow-up. Conclusions: The stenciling-based prick and print technique for making shaped donor corneal grafts may offer a simple, easy-to-learn surgical technique that can be used to make any shape or pattern of donor corneal grafts without involving the optical center, even in extensive peripheral corneal lesions.
Purpose: To report a case of central retinal artery occlusion after Descemet membrane reposition by intracameral air. Methods: An otherwise healthy 60-year-old woman presented with white mature cataract in her left eye. Ocular exam of both eyes was within normal limits. After an uneventful topical phacoemulsification, a moderate-grade striate keratopathy and non-planar Descemet membrane detachment was noted on first postoperative day, which was confirmed on anterior segment optical coherence tomography. The Descemet membrane was repositioned within 24 h of cataract extraction by intracameral air tamponade (pneumatic descematopexy) under topical anesthesia, and partial air release was done after 2 h. The patient was evaluated for decreased immediate postoperative vision of perception of light. Results: After pneumatic descematopexy, the stromal edema relatively cleared. The intraocular pressure before releasing the intracameral air was 38 mmHg and antiglaucoma medication was started. Dilated fundus exam showed retinal pallor and a cherry-red spot over the macula. A diagnosis of central retinal artery occlusion was confirmed, and thorough systemic workup was done. Systemic investigations were within normal limits. The patient was managed conservatively, but the final visual acuity remained at 1/60. Conclusion: Central retinal artery occlusion is not a reported complication after pneumatic descematopexy for Descemet membrane detachment management. The possible mechanism could be sudden increase in intraocular pressure due to pupil block by air, and thus, ocular surgeries with use of intracameral air for prolonged duration warrants close monitoring of intraocular pressure and its subsequent management.
Purpose: This study was conducted to examine microbiological profile with their antibiotic sensitivity in cases of bacterial keratitis in north and central India to ensure appropriate use of antibiotics. Methods: The microbiology laboratory records of 228 patients with culture-proven bacterial keratitis from 1 st January to 31 st December 2019 were analyzed. Cultured bacterial isolates were subjected to antimicrobial susceptibility testing to antibiotics commonly used in the treatment of corneal ulcer. Chi-squared or Fisher’s exact test were applied to check the significance of difference between the susceptibility levels of antibiotics. Results: The prevalence of Staphylococcus aureus and Pseudomonas aeruginosa –induced keratitis was higher in northern India, whereas that by Streptococcus pneumoniae was more prevalent in central India. In central India, 100% of S. pneumoniae isolates were found to be sensitive to ceftriaxone compared to 79% in northern India ( P = 0.017). In comparison to 67% of isolates from north India, 15% of S. aureus isolates from central India were found to be sensitive to ofloxacin ( P = 0.009). Similarly, 23% of isolates from central India were found sensitive to amikacin compared to 65% of isolates from north India ( P = 0.012). P. aeruginosa isolates from central India were found to be sensitive to ceftazidime in 63% of cases compared to 21% of isolates from north India ( P = 0.034). Conclusion: Prevalence of bacteria and their susceptibility to antibiotics are not uniform across geography. Vancomycin remained the most effective drug in all gram-positive coccal infections. S . aureus susceptibility to amikacin was significantly greater in north India. P . aeruginosa showed less susceptibility as compared to previous reports.
A 32-year-old man presented with bilateral diminution of vision for 10 years. Visual acuity was light perception in both eyes with inaccurate projection in the oculus dextrus(OD) and accurate projection in the in oculus sinister (OS). Intraocular pressure was 6 and 12 mm Hg in the OD and OS, respectively. Slit-lamp examination revealed the presence of leucomatous corneal opacification with microcornea in oculus uterque (OU). Both eyes had a dislocated nucleus in the vitreous cavity on ultrasound B-scan with advanced cupping in the right eye. Ultrasound biomicroscopy revealed ciliary body atrophy in the OD and preserved ciliary processes (two quadrants) in the OS. In view of a partially preserved ciliary body function and a potential for gaining useful vision, we planned surgical intervention in the left eye. Deep anterior lamellar keratoplasty with pars planavitrectomy (PPV) and phacofragmentation of the nucleus was done. Donor lamellar graft was sutured after completion of PPV and nucleus fragmentation. The patient regained useful ambulatory vision postoperatively with clear corneal graft.
Purpose: To evaluate the efficacy of releasable single suture (RS) for conjunctival autograft (CAG) and to compare it with sutureless gluefree (SG) technique in pterygium surgery. Methods: We conducted a retrospective comparative study on patients with primary pterygium who underwent CAG. In 150 patients, CAG was additionally secured by a single 10-0 nylon releasable suture (RS) which was released on the first postoperative day. In 47 patients, no suture was applied, and CAG was allowed to stick to the scleral bed by autologous fibrin only (SG group). The duration of surgery and size of CAG (in mm2) was noted in both groups. All patients completed one year of follow-up. Factors that were studied included graft stability, patient comfort, complications, and recurrence. Results: The mean age of patients in RS and SG groups was 39.6 ± 11.8 and 47.3 ± 13.8 years, respectively. The mean duration of surgery was 4.84 ± 1.34 min in RS group and 4.90 ± 1.42 min in SG group (P = 0.001). The size of CAG used in both groups was comparable with more stability in RS group postoperatively. Graft retraction rate in RS group was 5.3% (1 mm retraction in CAG more than 36 mm2) with no event of graft loss. The graft loss occurred in 6.3% of eyes in SG group. The recurrence rate in RS group was 4%, while in SG group it was 6.3% (P = 0.4). Conclusion: RS, by augmenting the autologous blood mechanism, may offer an easy-to-learn option for pterygium surgery with good stability even in large-sized CAGs.
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