Purpose To compare the outcomes of phacoemulsification with either a 2.5-mm clear corneal incision and a foldable intraocular lens (IOL) or a 5-mm sclerocorneal tunnel incision and a rigid polymethyl methacrylate (PMMA) IOL. Methods In a prospective, randomised clinical trial of phacoemulsification cataract surgery, 1200 patients received either a foldable hydrophilic acrylic IOL through a 2.5-mm corneal incision or an inexpensive rigid PMMA IOL via a 5-mm sclerocorneal tunnel. Intra-and post-operative data and visual acuity at discharge, 6 weeks, and 1 year follow-up were analysed.Results At 1 year after surgery, 996 (83.0%) patients were followed up with an uncorrected visual acuity of 6/18 or better in 90.3% of the foldable and 94.3% in the rigid IOL group (risk ratio (RR) 0.96, 95% confidence intervals (CI) 0.92-0.99). Poor outcome (best-corrected acuity 6/60 or worse) occurred in 1.0% and 0.4%, respectively (RR 4.28,). The surgical cost of consumables and overall surgical time were similar in both groups; however, the cost of the foldable IOL was eight times higher than the PMMA IOL. Posterior capsule opacification was more common in the rigid IOL group at 12 months (36.1% vs 23.3%); however, this did not affect postoperative vision. Conclusion In the hands of experienced cataract surgeons, phacoemulsification with implantation of a foldable or a rigid IOL gives excellent results. Using an inexpensive rigid PMMA IOL will make phacoemulsification more affordable for poor patients in low-and middle-income countries.

Introduction: Post-operative astigmatism is one of the most important causes for diminution of vision after trabeculectomy. Objective: To evaluate the induced corneal astigmatism following trabeculectomy with the use of 8-0 silk suture. Materials and methods: A prospective interventional study was done including 100 consecutive eyes of 84 patients who underwent trabeculectomy with the use of 8-0 silk suture. The postoperative induced astigmatism on the 1 st post-operative day, 3 rd week and after 6 months was determined. Statistics: Vector analysis was performed on the data using a computerized method for calculating the surgically induced astigmatism (SIA) for each eye at every time point postoperatively. In order to analyze group changes, we also performed vector decomposition which gave us a mathematical expression of the changes in astigmatism "with the rule" (WTR) or "against the rule" (ATR). Results: The mean age of all the patients was 53.31 11.39 years. The mean 1 st post-operative surgically induced astigmatism (SIA) was 2.73 D ( 99 degree ) which reduced to 0.41 D ( 58 degree) at the 3 rd week and 0.43 ( 21 degree) at 6 months. The mean WTR astigmatism was 4.46 D and ART astigmatism was 1.42 D on the 1 st post-operative day which was significantly high ( p<0.0001). At the 3 rd week and 6 months WTR astigmatism ( 1.40 D and 1.08D ) and ATR astigmatism (1.27 D and 1.10 D) showed no significant changes (p=0.69,0.97 respectively. Conclusion: Trabeculectomy with the use of 8/0 silk sutures showed significantly high 1 st post-operative day SIA which nevertheless perished fast to a minimum amount at just 3 weeks.

A 45-year-old male farmer presented with blunt ocular trauma by cow horn in the left eye three days back. He had undergone manual small incision cataract surgery with posterior chamber intraocular lens implantation five years back with good postoperative gain of vision. At presentation his vision was hand motion close to face. Slit lamp examination revealed full chamber hyphema (Figure 1A) and anterior chamber details were not clear. On down gaze, posterior chamber intraocular lens was seen in the superior subconjunctival space (Figure 1B). Intraoperatively, subconjunctival scleral rupture was noted at the site of cataract incision. The single-piece rigid polymethylmethacrylate intraocular lens with intact haptic was removed, hyphema drained, surgical iridectomy of prolapsed iris done, the anterior chamber reformed and the wound resutured. A secondary intraocular lens implantation was performed later. This case highlights a rare presentation of blunt ocular trauma. Figure 1: A) Posttraumatic full chamber hyphema. B) Dislocated intraocular lens in superior subconjunctival space.