Search

Author(s): Rajesh Sinha (corresponding author) [1]; Juhi Daga [2]; Pranita Sahay [3]; Vinay Gupta [1]; Tushar Agarwal [1]; Namrata Sharma [1]; Prafulla K Maharana [1]; Sudarshan K Khokhar [1]; Jeewan [...], Purpose: To compare the visual outcomes of implantable Collamer lens (ICL) with small incision lenticule extraction (SMILE) in cases of moderate-high myopia. Methods: A prospective comparative study was conducted on 60 eyes of 30 patients with moderate-high myopia (-3D to -8D with astigmatism ≤1 D) at a tertiary eye care center. Patients underwent either SMILE or ICL in both eyes and had a postoperative follow-up of 1 year. Results: The manifest refractive spherical equivalent was -5.22 ± 1.05 D and -5.4 ± 1.17 D in the SMILE and ICL groups, respectively (P = 0.53). The mean sphere and cylinder were comparable between the groups. The mean uncorrected visual acuity improved from 1.18 ± 0.19 logMAR to 0.03 ± 0.07 logMAR in SMILE and 1.14 ± 0.25 logMAR to 0.011 ± 0.04 logMAR in the ICL group. The efficacy for SMILE was 83.3% and that for ICL was 93.3%. Safety and predictability (±0.5D) for both was 100%. A significant increase was observed in ocular aberration with a decrease in modular transfer function in the eyes that underwent SMILE, whereas no significant change in the eyes that underwent ICL. A significant difference was observed in all parameters of ocular aberration except corneal trefoil, corneal astigmatism, and PSF between the two groups at the final follow-up. The contrast sensitivity at final follow-up was higher in ICL cases when compared to SMILE. The quality of vision (QoV) score suggested a better QoV with ICL; however, the difference was not statistically significant. Conclusion: Both SMILE and ICL are safe in patients with moderate-high myopia. The efficacy, contrast sensitivity, and postoperative ocular aberration profile are better in cases undergoing ICL. Keywords: Higher order aberrations, ICL, implantable Collamer lens, moderate myopia, refractive surgery, small incision lenticule extraction, SMILE

Author(s): Deepali Singhal (corresponding author) [1]; Prafulla K Maharana [2] Corneal perforation can develop due to trauma, inflammatory, and infective causes. Early management leads to timely healing, amenable to optical [...], We describe the hybrid technique of tuck-in Tenon's patch graft (TPG) and tissue adhesive bandaged contact lens (TABCL) for large corneal perforations (>5 mm) with intact surrounding stroma. Management of large corneal perforation is often challenging, and urgent availability of donor cornea might be difficult; Tenon patch alone does not provide tectonic support; hence, this hybrid technique can be used safely in large perforations. This involves freshening the perforation edges, creating a 360[sup.0] stromal pocket, harvesting a Tenon's graft 1 mm oversized, tucking into the pocket, and suturing. Then areas of leakage were noted, and only those areas were supplemented with minimal cyanoacrylate glue (CG) at the graft edges. This technique was used in two eyes, one with a large corneal perforation and intact surrounding stroma and the other with 4 mm corneal fistula post healed keratitis with a failed primary TPG alone, and led to epithelialization and a smooth corneal surface at 6 weeks. The advantages include autologous tissue, cost-effective, easily available, minimal post-operative inflammation, vascularization, and surface irregularity. Keywords: Corneal perforation, glue, microbial keratitis, Tenon patch graft

Author(s): Manumuraleekrishna [1]; Mohamed Ibrahime Asif [1]; Prafulla Kumar Maharana [1]; Ritu Nagpal [1]; Tushar Agarwal [1]; Rajesh Sinha [1]; Jeewan Singh Titiyal [1]; Namrata Sharma (corresponding author) [1] Introduction [...], Purpose: To compare the changes encountered in corneal biomechanics and aberration profile following accelerated corneal collagen cross-linking (CXL) using hypo-osmolar and iso-osmolar riboflavin in corneal thicknesses of 400 microns, respectively. Methods: This is a prospective, interventional, comparative study involving 100 eyes of 75 patients with progressive keratoconus. Eyes were divided into two groups based on corneal thickness: group 1 included eyes with a corneal thickness of 400 microns who underwent iso-osmolar CXL. Corneal biomechanical and aberration profiles were evaluated and compared between groups. Results: In group 1, all higher-order aberrations (HOA) except secondary astigmatism significantly decreased from baseline; however, in group 2, only coma and trefoil decreased. The corneal resistance factor and corneal hysteresis significantly improved in both groups, which was significantly greater in group 2 than in group 1. The change in inverse radius, deformation amplitude, and tomographic biomechanical index was significantly improved in group 2 as compared to group 1. Conclusion: Improvement in corrected distance visual acuity and decrease in HOA were significantly better in the hypo-osmolar CXL group; however, the improvement in biomechanical strength of the cornea was significantly better in the iso-osmolar group. Keywords: Accelerated collagen cross-linking, corneal biomechanics, higher-order aberration, hypo-osmolar riboflavin, iso-osmolar riboflavin, keratoconus