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Ritu Nagpal, Chetan Shakkarwal, Rinky Agarwal, Rahul Kumar Bafna, Prafulla Kumar Maharana, Namrata Sharma Cataract, Cornea & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Namrata SharmaCataract, Cornea & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaTel +91-11-26593144Email namrata.sharma@gmail.comPurpose: To quantitatively analyze the dimensions of the gap between the intraocular lens (IOL) and the posterior capsule using microscope-integrated optical coherence tomography (MIOCT).Setting: Institutional.Design: Prospective, interventional.Methods: A total of 105 eyes of 105 consecutive patients planned for phacoemulsification with IOL implantation were enrolled. At the end of surgery, the gap between the IOL and the posterior capsule (IOL-PC gap) was measured using MIOCT (RESCAN). The same gap was reassessed at 1 week follow-up visit using the Visante-OCT system. The cases were sub-grouped based on the grade of cataract, IOL material, size and design and were analyzed to look for any difference in the IOL-PC gap both intraoperatively and postoperatively.Results: The IOL-PC gap could be successfully measured intra-operatively in all cases, using the RESCAN. The mean gap at the end of phacoemulsification was 385.08± 264.58 μm, and at one week follow up this was 120.83± 95.13 μm.Conclusion: MIOCT may be successfully used to quantify the dimensions of the gap between the IOL and the posterior capsule. It can be used as a potential tool to further understand the dynamics of the IOL-PC space and to assess the impact of various IOL and non-IOL parameters implicated in the causation of posterior capsule opacification.Keywords: cataract surgery, intraocular lens-posterior capsule gap, microscope-integrated optical coherence tomography, spectral domain optical coherence tomography, RESCAN

Purpose: To compare the corneal biomechanical parameters, visual outcome, and epithelial remodeling after small-incision lenticule extraction (SMILE) and photorefractive keratectomy (PRK) for low to moderate myopia., Design: Prospective, interventional, randomized, comparative study., Methods: Eighty eyes of 40 patients undergoing bilateral SMILE or PRK for low to moderate myopia (<-5 D SE) were included. They were divided into two groups based on the planned refractive surgery. Visual acuity, corneal biomechanics using Corvis-ST, epithelial mapping via anterior segment optical coherence tomography, and higher-order aberrations were recorded both preoperatively and postoperatively at 6 months and compared., Results: At 6 months follow-up, the corrected distance visual acuity as well as the postoperative spherical equivalent of both the groups were comparable ( P = 0.13 and P = 0.32, respectively). The biomechanical parameters like deformation amplitude ratio ( P < 0.01), inverse concave radius ( P = 0.006), integrated ratio ( P < 0.01), stress-strain index ( P < 0.01), Ambrosio's relational thickness (ArTH) ( P < 0.01), and corneal biomechanical index-laser vision correction ( P = 0.02) were altered more in the SMILE group than in the PRK group, while the biomechanically corrected intraocular pressure ( P = 0.16) was comparable. Epithelial remodeling ( P = 0.59), higher-order aberrations ( P = 0.53), and stromal keratocyte loss ( P = 0.16) in both the groups were comparable., Conclusion: Both SMILE and PRK are comparably effective procedures for correction of low to moderate myopia in terms of visual outcomes; however, the corneal biomechanical stability in PRK is superior than that in SMILE., (Copyright © 2024 Indian Journal of Ophthalmology.)

Purpose: To evaluate the clinical outcomes of preloaded toric intraocular lens (IOLs) implantation in eyes undergoing phacoemulsification., Methods: This prospective study included 51 eyes of 51 patients with visually significant cataracts and corneal astigmatism ranging between 0.75 and 5.50 D. All patients underwent phacoemulsification with SupraPhob toric intraocular lens implantation under topical anesthesia. The main outcome measures were uncorrected distance visual acuity (UDVA), residual refractive cylinder, spherical equivalent, and IOL stability at 3 months follow-up., Results: At 3 months, 49% (25/51) of patients had UDVA equal to or better than 20/25 with 100% of eyes achieving better than 20/40. Mean logMAR UDVA improved from 1.02 ± 0.39, preoperatively to 0.11 ± 0.10 at 3 months follow-up (P < 0.001, Wilcoxon signed-rank test). The mean refractive cylinder improved from - 1.56 ± 1.25 D preoperatively to - 0.12 ± 0.31 D at 3 months follow-up (P < 0.001) while the mean spherical equivalent value changed from - 1.93 ± 3.71D preoperatively to - 0.16 ± 0.27D (P = 0.0013). The mean root mean square value for higher order aberrations was 0.30 ± 0.18 μm while the average contrast sensitivity value (Pelli-Robson chart) was 1.56 ± 0.10 log unit, at the final follow-up. The mean IOL rotation at 3 weeks was 1.7 ± 1.61 degrees, which did not change significantly at 3 months (P = 0.988) follow-up. There were no intraoperative or postoperative complications., Conclusion: SupraPhob toric IOL implantation is an effective method for addressing preexisting corneal astigmatism in eyes undergoing phacoemulsification with good rotational stability., Competing Interests: None

Purpose: To describe a novel modification of tuck-in Tenon's patch graft (TPG) using temporary horizontal mattress sutures and fibrin glue to hitch the graft in the management of corneal perforations., Design: Ambispective interventional case series., Methods: Modified technique of autologous TPG was used to seal corneal perforations measuring 3-5 mm, using horizontal mattress sutures to hitch the graft in a lamellar pocket, followed by application of fibrin glue. The horizontal mattress sutures were removed after the reformation of the anterior chamber. The primary outcome measure was a well formed anterior chamber in the post-operative period and the secondary outcome was epithelization time., Results: The surgery was performed in 22 eyes. The mean age was 43.86 ± 16.02 (26-66) years, with 14 males and eight females. The etiologies of corneal perforation included dry eye (n = 10), neurotrophic keratitis (n = 6), trauma (n = 2), chemical injury (n = 2) and exposure (n = 2). The mean size of the perforation with the thinned-out area was 4.3 mm (range 3-5 mm). The mean duration of epithelialization was 14.31 ± 2.63 days (7-21 days). No intraoperative complications were observed. All eyes had a well-formed anterior chamber in the immediate postoperative period. Postoperatively, two eyes had graft pseudoectasia due to a thick graft and supra tenon haemorrhage each; one eye each had graft thinning with the formation of pseudopterygium and graft melting., Conclusion: Tenon's patch graft, along with the use of temporary horizontal mattress sutures and fibrin glue, is an effective modification of the technique for managing corneal perforations measuring 3-5 mm.