Background Though Limbal Relaxing Incisions (LRI) were used widely to correct pre-existing corneal astigmatism during cataract surgery, they have been replaced recently with the more expensive methods like the use of toric Intra Ocular Lenses (IOL) and femtosecond during cataract surgery. We conducted our study to re-evaluate the role of (LRI) in correcting pre-existing moderate corneal astigmatism during cataract surgery in settings where other options are neither available nor affordable. Methods Retrospective analysis of all consecutive cases of LRI performed by a single surgeon at the time of cataract surgery to correct moderate corneal astigmatism (1.5-3D) in a community hospital over a period of 6 months. Corneal astigmatism, uncorrected distance visual acuity (UDVA) and best corrected distance visual acuity (CDVA) were recorded pre-operatively, 4 weeks and 3 months post-operatively. Data on age, intraocular lens (IOL) power, predictive refraction and post-operative spherical equivalent was also collected and analyzed. The number and position of LRI was determined based on the pre-existing corneal astigmatism using online calculator. Results 29 eyes of 25 patients with the mean age of 73.6 years (range: 46 to 90 years) and corneal astigmatism between 1.5 to 3D were included. Statistically significant reduction in the mean corneal astigmatism was recorded from 2.05 ± 0.45D preoperatively to 0.85 ± 0.56D postoperatively (P < 0.0001). All eyes showed reduction in astigmatism; 83% of eyes had < 1.0D post-operatively and 66% of eyes had < 0.75D. UDVA of 6/9 or better was recorded in 80% of eyes post-operatively (CDVA of 6/9 or better in 100%). The spherical equivalent was within 1.0D of the predictive refraction postoperatively in nearly all eyes (97%) and within 0.5D in 86% of the eyes. There were no peri-operative or post-operative complications were recorded in any case. Conclusion Combining LRI and cataract surgery to address moderate degrees of corneal astigmatism is a safe, reliable and predictable option especially in areas where more expensive methods such as toric IOL or excimer laser are not available or affordable. LRI has no significant effect on the spherical equivalent and is an excellent tool in reducing patient’s spectacle dependence.
Sir,The biological bandage contact lens: a novel technique for using the amniotic membrane in the treatment of persistent corneal epithelial defectsWe read with interest the article entitled 'Amniotic membrane in ophthalmology: indications and limitations' by Rahman et al, 1 in which the authors provide a comprehensive review of the use of amniotic membrane (AM) transplantation in ocular surface reconstruction.In the article the authors describe a new method of using the AM, retaining it in the eye with a conformer.We would like to describe an alternative method, which we have found to be very well tolerated by the patient. TechniqueThe AM is obtained from Tissue Services, National Blood Services (Liverpool, UK, L24 8RB) as a 2 Â 2 or 3 Â 3 cm 2 sheet on nitrocellulose mounting paper in transport medium frozen at À40 1C. The AM is provided stromal side down and the overlap reflected onto the reverse of the paper.The amnion is allowed to thaw and is rinsed according to the supplier's instructions. The mounting paper is taped flat onto a suitable surface (eg, a plastic kidney dish), having first peeled the AM from the corners to allow this (Figure 1a). A Flieringa ring, of an appropriate size to fit comfortably into the patient's fornices, is selected and placed on the uppermost, epithelial surface of the amnion. The peripheral amnion is lifted and placed at the centre of the ring. The amnion is then sutured in position with one running 7/O Vicryl suture (Figure 1b).
We report a one stage management of a Giant Divided Naevus of the eyelids with excellent cosmetic results.
Purpose. This study was aimed at describing our experience in congenital cataract surgery in a developing Country. Methods. A retrospective study was conducted in Amman, Jordan. The patients who were diagnosed with congenital cataract and underwent the surgery were included in the study. It was decided to use an intraocular lens if the corneal diameter was more than 10 millimeters. Results. The findings revealed that around 13 of the patients did not have any visual axis opacification, indicating that they were aphakic. Visual axis opacification was seen in 8 out of the total sample of participants. Eleven patients with obvious opacification of the visual axis were found to be pseudophakic after at least two procedures and were thus cleared. It was necessary to do a second surgery to rectify the visual axis opacification induced by pseudophakia, which was putting the patient’s ability to recuperate at danger. Three of them (or 12 percent) exhibited visual axis opacification, which is a rare occurrence. The intraocular lenses used in the remaining 24 patients were constructed of hydrophilic plastic. Conclusion. Patients are less prone to have visual axis opacification while implanted by hydrophobic intraocular lenses is something they should consider.
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