Purpose: To compare the outcomes of vitreoretinal surgery in patients with primary and recurrent rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) on 3 dimensional digitally assisted visualization system (3D-DAVS) and conventional analogue microscope (CAM). Methods: 68 patients with primary (50) and recurrent (18) RRD with PVR > C1 were included. One group underwent surgery on 3D-DAVS while the other on CAM. The parameters studied included detachment rate, best-corrected visual acuity (BCVA), duration of surgery, mean endo-illumination levels of 23 G (Gauge) micro incision vitrectomy system (MIVS) and microscope and satisfaction of surgeon and observers based on a framed questionnaire. The mean duration of follow up was three months. Results: 68 eyes of 68 patients with median age 52.5 (range 18–68) years were included. 50 had primary RRD and 18 had recurrent RRD. Detachment rate at the end of three months was comparable in both groups of primary ( P > 0.99) and recurrent ( P = 0.21) RRD. Mean duration of surgery in minutes for 3D DAVS and CAM group was 61.8 (±22.07) and 58.04 (±12.33), respectively, in primary RRD and 37.22 (±10.27) and 36.55 (±5.92), respectively, in recurrent RRD group. Mean endo-illumination in 3D DAVS (14.5%) group was half of that in CAM (34.17%) group. Surgeon and observer satisfaction scores were significantly higher for 3D DAVS group. Conclusion: 3D DAVS is a safe and effective modality or performing VR surgery in RRD with PVR. 3D DAVS allows lower endo-illumination levels provides superior surgeon ergonomics and offers better learning opportunities to the trainees.

Purpose: To evaluate morphological characteristics and intraoperative dynamics of posterior polar cataract (PPC) using intraoperative optical coherence tomography (iOCT). Setting: Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. Design: Prospective interventional study. Methods: Forty eyes with PPC undergoing phacoemulsification were evaluated. Primary outcome measure was morphology of PPC and intraoperative dynamics of posterior capsule (PC). Secondary outcome measure was PC rent, which was retrospectively compared with 72 PPC cases that underwent non–iOCT-guided surgery. Results: Of the 40 eyes evaluated, 3 morphological variants of PPC were observed: type I (19/40 [47.5%]) characterized by intact PC and clearance between PC and opacity, type II (12/40 [30%]) with intact PC in periphery of opacity, shadowing, and inability to detect PC in the center, and type III (9/40 [22.5%]) with dense opacity, extensive shadowing, and inability to delineate PC. In addition to hydrodelineation, hydrodissection was performed in all cases of type I PPC. In types II and III PPC, only hydrodelineation was performed. No case with type I opacity developed PC dehiscence. Three cases (7.5%) with types II (1 eye) and III (2 eyes) PPC developed PC dehiscence during aspiration of epinuclear cushion. Intraocular lens was implanted in all cases in the bag or sulcus. There was no significant difference in PC dehiscence between iOCT-guided and non–iOCT-guided surgery (P = .7). Conclusions: iOCT-guided surgery helps to elucidate intraoperative dynamics in PPC and assess real-time PC integrity. It characterizes high-risk morphological features, enables safe hydrodissection in a subset of PPC, but does not decrease the incidence of PC dehiscence.

No abstract

A 58-year-old woman presented to us with sudden onset diminution of vision for 10 days following trauma while using mobile phone. Patient had a history of posterior iris claw implantation 3 years ago. On examination, the patient was aphakic and intraocular lens (IOL) was seen enclaved on nasal side and disenclaved on temporal side on ultrasound biomicroscopy. Patient underwent surgery for re-enclavation of temporal haptic by lifting the IOL using 23-gauge pars plana trocar. Patient had a postoperative uncorrected visual acuity of 6/9 and best-corrected visual acuity of 6/6 with refraction. Re-enclavation of partially disenclaved posterior iris claw lens is a minimally invasive technique to restore visual acuity in such cases.

Purpose: The study sought to describe the clinical presentation pattern of pediatric cataracts and factors leading to delay in surgery at a tertiary care center in North India. Methods: A cross-sectional, interview-based study was conducted from January 2020 to October 2020, that included pediatric patients <12 years, with unilateral or bilateral congenital or developmental cataract. A pre-validated questionnaire was used to record data. The parameters recorded were age at first symptoms, age at diagnosis of cataract, age at surgery, laterality of cataract, first symptom, first family member noticing the abnormality, the morphology of cataract, association of perinatal complications, family history, systemic diseases, and cause (s) of delay in surgery. Results: A total of 89 patients were included. The mean age of subjects was 4.75(±3.51) years. A white pupil was the most common symptom (64.04%) and appeared in infancy in 30.3% of cases. Parents first detected the problem in 60.67%, and the pediatrician was the first medical contact in 11.23% of cases. The median (IQR) delay period between diagnosis of cataract and cataract surgery was 4 (3–6) months, the major causes were long GA waiting (30.33%), and delay due to systemic ill health (14.61%). Conclusion: Parental education on cataract detection is recommended to help in the timely detection and hence, improved outcomes of pediatric cataract surgery. Pediatricians, consulted for any systemic illness, have the role of the second most important contact in the detection of pediatric cataract.