Siep’s test: A novel test for checking wound integrity in small-incision cataract surgery

Purpose:This study was conducted to ensure the integrity of surgery wounds.Methods:This was a randomized prospective trial of 300 patients who underwent small-incision cataract surgery (SICS) at our hospital over a one-year period. We used 2–3 drops of 5% povidone-iodine at the end of each case, not only to disclose any wound leaks but also to sterilize the surface of the eye.Results:Three hundred patients underwent SICS. One hundred ten patients had postoperative wound leak in SICS due to surgical complications. Premature entry comprising 75% (83 cases), followed by floppy iris syndrome comprising 20% (22 cases) and 5% (6 cases) comprising pseudoexfoliation (PXF) syndrome. There was a drop in the number of re-surgeries from 12 to 3 cases since we started implementing this technique.Conclusion:The simple procedure is very handy and economical in identifying the leak and can reduce further complications such as endophthalmitis and re-surgeries. Among residents, this can be a boon where povidone-iodine acts as a riverbank for the outflow of aqueous, outlining the speed, location, and quantity of the leak. Siep’s test plays an important role in identifying any postoperative wound leaks and also sterilizing the eye surface post surgery.     

Corneal endothelial protection during manual small-incision cataract surgery: A narrative review

Cataract causes bilateral blindness in 20 million people globally, the vast majority of whom live in developing countries. Manual small-incision cataract surgery (MSICS) has emerged as an efficient and economical alternative to phacoemulsification, giving comparable results in terms of final visual gain. One of the important determinants of postoperative visual gain is the status of the corneal endothelium. Multiple factors such as corneal distortion, irrigation solution turbulence, mechanical trauma by instruments, nuclear fragments, intraocular lens contact, and free oxygen radicals, all have been implicated in causing corneal damage during cataract surgery. MSICS with posterior chamber intraocular lens implantation has been reported to cause an endothelial cell loss of 15.83%, which is comparable with other modes of cataract surgery like extracapsular cataract extraction and phacoemulsification. Thorough preoperative assessment of endothelial status and taking necessary steps for endothelial protection during surgery can decrease the endothelial cell loss and overall burden of pseudophakic bullous keratopathy. In addition to surgical techniques, the type of irrigating solutions, ocular viscoelastic devices, intracameral dyes, and drugs all affect the endothelial cell status. This review presents a summary of available literature on the protection of endothelial cells during different steps of MSICS. This is especially relevant for developing countries where large-scale MSICS cataract surgeries are performed to decrease the cataract blindness burden.     

Evaluation of scleral incisions and their effects on corneal curvature in manual small-incision cataract surgery

Purpose:Incisions in cataract surgery can be modified in various ways in terms of size, shape, and axis to reduce or tailor astigmatism. This study was conducted to examine the effect of site (superior vs, temporal) and shape (frown vs. V-shaped, chevron) of scleral incisions for cataract surgery on corneal curvature.Methods:The prospective study was carried out on 200 consecutive patients with senile cataract and who were planned for surgery at a tertiary eye hospital in north India. The placement of the incision was decided by the steeper corneal meridian—whether superior or temporal—and then patients of these two groups were randomized for frown and V-shaped incision; in this way, four groups of 50 patients each were formed. Follow-up was done on day 1, at 2 weeks, 4 weeks, 8 weeks, and 12 weeks. At each follow-up, post-operative keratometry with routine postoperative examination was done. The results were statistically analyzed by using student’s t-test, Chi-squared test, and the Pearson correlation coefficient.Results:In all the four groups, the difference of preoperative astigmatism and surgically-induced astigmatism was statistically highly significant. The analysis of uncorrected visual acuity (UCVA) was statistically significant (P < 0.05) on postoperative day 1 and at 2, 4, and 12 postoperative weeks; it was statistically insignificant (P > 0.05) at postoperative week 8.Conclusion:Temporal incisions result in lesser postoperative surgically induced astigmatism (SIA) than superior incisions. Chevron incisions result in minimal change in corneal curvature. This effect can be utilized to tailor the postoperative astigmatism.     

Comparison of different endophthalmitis prophylactic measures in cataract surgery - An analysis of 2.4 lakh cases

Purpose:To compare different endophthalmitis prophylaxis methods adopted in cataract surgery (manual small-incision cataract surgery and phacoemulsification) between the years 2013 and 2021 in the community eye care section of a tertiary eye care hospital in South India and report their outcomes.Methods:All cataract surgeries performed from January 2013 to December 2021 (2,46,874 surgeries) at a single center were included in this retrospective study. The different endophthalmitis rates with each regimen were analyzed and evaluated.Results:70,081 surgeries were performed from January 2013 to February 2015, where Tobramycin was added to Balanced Salt Solution (BSS) (Group A). From March 2015 to January 2017, 63,245 surgeries were performed when intracameral Moxifloxacin was given (Group B). From February 2017 to December 2021, 1,13,548 surgeries were performed were Amikacin was added to BSS (Group C). In total, 42 cases of postoperative endophthalmitis were reported during the study period (0.02%). There was no significant difference in the endophthalmitis rates between groups A and B (P = 0.4152); however, there was a significant decrease in endophthalmitis rates in group C when compared with group A (P = 0.04) and group B (P = 0.006).Conclusion:There was a significant reduction in the rates of endophthalmitis following the addition of amikacin in irrigating BSS. Nocardia was one of the predominant organisms isolated from these endophthalmitis patients. This is the first single-center study to report a comparative analysis of different endophthalmitis prophylactic measures in a community eye care set up with a high incidence of Nocardia endophthalmitis prevented with amikacin in BSS irrigating solution.     

Architectural analysis of subconjunctival oblique limbus incision techniques in manual cataract extraction surgery by optical coherence tomography imaging

The purpose was to assess the profile of subconjunctival oblique limbus incision (SCOLI) design by using anterior-segment optical coherence tomography (AS-OCT) and try to emphasize the proper technique of wound construction. The structural dimensions and integrity of the wound were acquired from the patients, who had undergone manual small-incision cataract surgery with SCOLI techniques, using a Canon OCT anterior-segment imaging system on the first postoperative day. The use of AS-OCT allowed for an in vivo evaluation of SCOLI in high definition. The radial OCT scan image showed three staggered incisions, including conjunctiva incision, scleral entrance, and inner corneal lip. A tangential scan demonstrated that the internal lip is parallel to the curvature of the peripheral cornea. The en face image showed an asymmetric 4 arc-shaped configuration rather than a symmetrical one. In conclusion, AS-OCT could be used to analyze SCOLI to determine optimal wound construction and geometry. The results of this study indicated that an asymmetric 4 arc-shaped limbus tunnel incision was superior to the conventional linear equivalent in stability and nucleus delivery.     

Safety and efficacy of Aurolab aqueous drainage implant in refractory glaucoma: A prospective study

Purpose:This study was conducted to assess the intraocular pressure (IOP) control and postoperative complications following a non-valved glaucoma drainage device (GDD) surgery in refractory glaucoma.Methods:This was a prospective interventional study conducted on patients with glaucoma refractory to maximal medications or failed surgical treatment who underwent Aurolab aqueous drainage implant (AADI; Aurolabs, India) surgery. Primary outcome measures were IOP control, postoperative complications, and reduction in the number of antiglaucoma medications (AGM).Results:Thirty-four eyes were analyzed and the mean follow-up was 16.06 ± 5.63 months. The preoperative median (Q1, Q3) IOP was 31 mmHg (28, 36.5) which decreased to 12 mmHg (12, 14) at 6 months postoperatively. The median (Q1, Q3) number of AGMs decreased from 3 (3, 4) to 0 (0, 1). Significant complications like implant extrusion and tube exposure were noted in two eyes. The total success and failure rates at 6 months were 91.1% and 8.8%, respectively.Conclusion:AADI is effective in achieving target IOP and significantly reduces the use of AGMs with good safety in the short term. Long-term follow-up studies are needed to assess long-term IOP control and cost-effectiveness.     

单中心儿童肾肿瘤SCMC WT-99方案临床报告

目的改善儿童肾母细胞瘤预后。方法对1998年10月至2007年12月住院明确诊断为肾母细胞瘤及肾肉瘤患儿,采用外科手术、内科化疗、选择性放疗,病理科、影像学科协作诊断综合治疗的上海儿中心WT-99方案。按方案中条件根据分期及其他危险因素进行分组,并按分组给予不同药物组合和强度的化疗。Ⅰ期及Ⅱ期病理分型预后良好型不放疗。估计手术不能完全切除时给予2个疗程术前化疗。结果全组54例,年龄3个月至13岁。病理分类预后良好型39例,预后不良型4例,透明细胞肉瘤5例,横纹肌肉瘤样1例,分型困难或未分化型5例。临床结合病理分期为Ⅰ期19例,Ⅱ期7例,Ⅲ期19例,Ⅳ7例,Ⅴ期2例。54例中获完全缓解51例(94.4%),3例初治失败。缓解后复发9例。随访1～104个月,中位31.5个月,估计5年无病生存率(EFS)和总生存率(SR)分别为75.7%和83.9%。结论多专业联合诊断治疗工作模式及儿中心WT-99方案对儿童肾母细胞瘤有效。     

Correction of Hypercortisolemia with an Improved Cognitive Function and Muscle Mass after Transsphenoidal Surgery in an Older Patient with Cushing's Disease

Cushing''s disease causes numerous metabolic disorders, cognitive decline, and sarcopenia, leading to deterioration of the general health in older individuals. Cushing''s disease can be treated with transsphenoidal surgery, but thus far, surgery has often been avoided in older patients. We herein report an older woman with Cushing''s disease whose cognitive impairment and sarcopenia improved after transsphenoidal surgery. Although cognitive impairment and sarcopenia in most older patients show resistance to treatment, our case indicates that normalization of the cortisol level by transsphenoidal surgery can be effective in improving the cognitive impairment and muscle mass loss caused by Cushing''s disease.