Purpose: To report the clinical profile, management, and long-term anatomical and visual acuity (VA) outcomes of pediatric macula-off rhegmatogenous retinal detachment (RRD) secondary to familial exudative vitreoretinopathy (FEVR). Methods: This was a prospective, interventional study of 14 eyes of 13 children aged ≤18 years with macula-off FEVR-RRD. The primary outcomes were anatomical reattachment and VA changes. Results: The mean (±SD) age of the study population was 12.14 (±3.23) years (range 6–18 years) with a male preponderance (M:F – 10:3). Of the 14 eyes, 10 underwent vitrectomy with silicone oil injection, while four underwent scleral buckling surgery. Significant improvement in VA was noted at a mean (±SD) follow-up duration of 3.32 (±1.34) years, with the mean (±SD) LogMAR VA improving from 1.42 (±0.48) (Snellen equivalent 2/60; range from 6/36 to counting finger close to face [CFCF]) to 0.6 (±0.31) (Snellen equivalent 6/24; range 6/9–6/36) ( P < 0.00001) at the final visit. Successful anatomical reattachment was achieved in 13/14 eyes (92.85%). Screening of the other eye and family members was performed for FEVR and treated with laser photocoagulation when deemed necessary (7/10 contralateral eye; 12/20 siblings; 0/24 parents). Conclusion: To conclude, RRD may arise in eyes with FEVR at a young age and with a male predilection in Indian population. Timely surgical intervention by scleral buckling procedure or vitrectomy, based on the patient profile, can achieve excellent anatomical and VA outcomes. Careful clinical and angiographic screening of the other eye and family members is vital.
Purpose: To compare the self-sealing ability of temporal clear corneal incisions for phacoemulsification using conventional stromal hydration (CH) with two modified methods: the anterior stromal pocket hydration (ASPH) and the modified stromal pocket hydration (MASH). Methods: Patients undergoing routine phacoemulsification surgeries were randomized to receive the CH, ASPH, and MASH ( n = 30 eyes in each group). In the ASPH, an anterior stromal pocket was created superficial and parallel while in the MASH; it was superficial and perpendicular to the plane of the main incision. The primary outcome measure was wound leakage assessed after applying firm downward pressure on the posterior lip of the main corneal incision, simulating eye rubbing. Results: On application of pressure to the posterior lip, leakage was seen from 19 eyes (63%) in the CH group, while this was seen in only two eyes (7%) each in the ASPH and MASH groups ( P < 0.001). The likelihood of wound leak after applying pressure to the posterior lip reduced by 86% in the ASPH and MASH groups compared to CH (Odds ratio = 0.14, 95% CI = 0.05 – 0.35, P < 0.001). The mean surgically induced astigmatism was 0.18 ± 0.14D and there were no differences in SIA across the three groups ( P = 0.42). More eyes in the ASPH required conversion to CH ( n = 4, 13%) due to difficulty in localizing the pocket compared to MASH ( n = 0, P = 0.03) Conclusion: Both, the ASPH and MASH techniques reduce the risk of wound leakage and do not induce astigmatism. The MASH technique makes it easier to consistently localize the pocket.
Purpose: The purpose of this study is to find incidence of negative dysphotopsia (ND) in eyes undergoing clear corneal phacoemulsification and identify its causes including corneal wound hydration and type of intraocular lens (IOL). Methods: In this randomized clinical trial, consenting adult patients undergoing phacoemulsification were randomized to receive a hydrophobic (Alcon Acrysof ® SN60WF) or a hydrophilic acrylic IOL (CT Asphina ® 603P, Carl Zeiss Meditec) in a 1:1 ratio. At time of surgery, eyes were again randomized in 1:1 fashion to receive stromal wound hydration or not ( n = 80 each in four groups). Primary outcome measure was the incidence of ND between eyes receiving stromal hydration versus no hydration. Those with ND were observed for 5 years after surgery. Results: Of the 320 eyes, 29 (9.06%) reported ND of which 24 (83%) were transient. Eyes with wound hydration had significantly higher proportion of ND ( n = 21/160, 13%) compared to no hydration ( n = 8/160, 5%) ( P = 0.01). Additionally, eyes with wound hydration were three times more likely to experience ND (odds ratio = 3.29, 95% CI = 1.3–8.2, P = 0.01). Majority of eyes (20/21, 95%) with ND after hydration had it transiently while half (4/8, 50%) of those with ND without wound hydration had it persistently at 6 weeks ( P < 0.001) and continued to experience ND for 5 years but did not request intervention. Conclusion: ND occurred in 9% cases with majority being transient. Corneal wound hydration led to significant higher likelihood of experiencing transient ND. Those with persistent ND for more than 6 weeks (1.5%) continue to experience ND for at least 5 years.
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