Purpose:
To assess Photo Activated Chromophore for Infective Keratitis-Cross Linking (PACK-CXL) and its efficacy as a treatment modality in managing microbial keratitis.
Methods:
Single Centre prospective interventional study in infectious keratitis. A total of eleven patients were taken who had corneal thickness (CT) more than 400µm. PACK-CXL was performed according to Dresden’s protocol. The response was assessed by slit lamp examination, BCVA and AS-OCT at the time of complete healing.
Results:
The mean visual acuity at presentation was 1.207logMAR (0.3-3) which improved to mean value of 0.53logMAR (0.3-1). Mean time taken for complete epithelization was 17.45 days (14- 30 days) and that for complete healing was 33.72 days (21- 60 days). Mean CT at the baseline was 650.5± 108µm which reduced on consecutive follow up visits. There was reduction in the symptoms in nine patients except in two. One case reported increase in symptoms with worsening increase in endoexudates and hypopyon, and the other developed drug toxicity due to topical medications.
Conclusion:
Patients who underwent PACK-CXL showed good and early healing, good remodelling of cornea and improved visual acuity. The recalcitrant cases became responders to the same medications after PACK-CXL. Thus, PACK-CXL works well for both fungal and bacterial keratitis.
Introduction:To study the effect of excision of double headed monocular pterygium on astigmatism. Materials and Methods: 8 Patients of DMP presenting from January 2016 to December 2017 were treated with excision of pterygium followed by conjunctival autograft. Preoperative and postoperative astigmatism was measured by keratometry. Observation: The change between preoperative and postoperative day 45 astigmatism was found to be extremely significant (p=0.0003). Conclusion: DMP must be dealt with utmost care, owing to it's higher impact in change of astigmatism.
Tarsorrhaphy has always been advised for management of persistent epithelial defects, but it is losing it's importance in present era. Materials and Methods: It was a prospective interventional study. Twenty-one patients of persistent epithelial defects presented over a period of two years at a tertiary hospital. They underwent tarsorrhaphy, along with medical management. All patients were followed up for a minimum period of two months. Observation: Eighty-five percent of patients with PED resolved with tarsorrhaphy alone. Rest three patients which failed to heal, underwent amniotic membrane transplantation at 4 th week as add-on procedure, following which they resolved. Discussion: Tarsorrhaphy helps in healing of PED by decreasing the interpalpebral fissure and retaining the tears and medicines in cul-de-sac. It also decreases the windshield wiper effect of eyelid margins. Conclusion: Tarsorrhaphy should always be considered as first modality for treating the PED.
This study aimed to report the surgical outcomes of autologous Simple limbal epithelial transplantation (SLET) performed for unilateral limbal stem cell deficiency (LSCD) following chemical injury. This was single centre prospective case series of patients who developed unilateral LSCD after chemical injury and underwent SLET between December 2018 and September 2019 with follow up of 3-6 months. Primary outcome was restoration of completely epithelized avascular corneal surface. The secondary outcome was percentage of eyes which gained vision. This study included 5 eyes of 5 patients with follow up of 3-6 months. Stable corneal surface was obtained clinically in 4 cases out of 5 and visual acuity gain seen in 3 patients. The factors associated with failure of vision improvement were time of chemical injury (during childhood), duration of injury to SLET procedure and previous history of surgical procedure. Complications seen are haemorrhage under hAM, focal recurrence, symblepharon, keratitis and loss of explants post operatively.Autologous SLET is an effective and safe modality for the treatment of unilateral LSCD. It causes stabilization of ocular surface and also facilitates visual improvement. In a developing country like India, with limited facilities in the healthcare system, auto-SLET is a boon for patients with unilateral LSCD.
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