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To compare the visual outcomes and intraoperative complications between phacoemulsification and manual small-incision cataract surgery (MSICS) in cases of posterior polar cataract (PPC).A retrospective study was carried out involving 142 patients (164 eyes) with PPC who underwent cataract surgery between January and December 2017. Data collected include the demographic details, preoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), type of cataract, intraocular pressure, anterior and posterior segment findings, type of surgery performed, intraoperative complications, postoperative UCVA on the first day, UCVA and BCVA at 1 month after surgery, complications, and resurgery details.In total, 90 patients (107 eyes) underwent phacoemulsification, and 52 patients (57 eyes) underwent MSICS. There was no significant difference in the mean age, sex, and type of PPC between the two groups (P = 0.326, 0.852, and 0.220, respectively). Patients who underwent phacoemulsification had significantly better preoperative BCVA (P = 0.002). The BCVA on first postoperative day and 1 month after surgery was better in the phacoemulsification group than in the MSICS group (Plt; 0.001 and 0.002, respectively). The overall incidence of posterior capsular rupture (PCR) was 11.6%, which included the 10.3% in phacoemulsification and 14.0% in MSICS. There was, however, no significant difference in the rates of PCR between the two groups (P = 0.506).Phacoemulsification delivered better postoperative visual outcomes than MSICS in PPC patients, whereas the complication rates were similar between the two groups.

Among 20 million cataract surgeries being performed worldwide every year, approximately 5% are being complicated by posterior capsule rent or zonular dialysis. Intraocular lens (IOL) implantation in such cases with intraoperative complications is quite challenging. Our next course of action is to place the IOL in the ciliary sulcus, however, there is a risk of IOL drop into the vitreous in cases of inadequate support. We have described a novel idea of using a suture material through the dialling hole of a three-piece rigid IOL which can be used as a leash to reduce the risk of IOL drop during implantation in such cases. This technique could also be used during sutureless scleral fixated IOL and retro-pupillary iris claw lens implantation. We found that in 90 consecutive patients where this technique was used, there was no incidence of IOL drop or retinal detachment.

This chapter attempts to study the groundwater quality of abandoned Sangramgarh colliery area using the weighted arithmetic water quality index method and heavy metal pollution index method. The present study also draws attention toward the seasonal changes of some water parameters and groundwater level of the study area. Scarcity of clean and potable drinking water is one of the most serious issues in this study area. The result of hydrochemical analysis shows the water quality rating as per weighted arithmetic water quality index method is 59.58, which indicates poor water quality of the groundwater, and it also shows near-neutral to alkaline conditions of the groundwater in abandoned Sangramgarh colliery area. Land filling materials, huge overburden dumps, mine waste and heavy metal leaching during the rainy season contaminate the groundwater and deteriorate drinking water quality, which is a serious human health issue. Therefore, a periodic assessment of groundwater quality is necessary in order to ascertain the quality for human consumption purpose and to take better planning for sustainable management of groundwater.

Purpose To determine whether preoperative assessment of posterior capsule integrity using anterior segment optical coherence tomography (AS-OCT) can predict posterior capsule dehiscence in patients with posterior polar cataract having phacoemulsification. Setting Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India. Design Prospective observational study. Methods Patients with posterior polar cataract who had phacoemulsification between October 2012 and November 2013 were included in the study. Preoperative AS-OCT imaging was performed to assess the integrity of the posterior capsule. Anterior segment OCT images of the posterior capsule were graded as “intact” or “dehiscent.” Phacoemulsification was performed by the same surgeon who was masked from the AS-OCT findings. The integrity of the posterior capsule was evaluated by the surgeon intraoperatively. Results The study comprised 64 eyes of 62 patients. Preoperative AS-OCT showed 8 eyes (12.5%) to have probable posterior capsule dehiscence and 56 eyes (87.5%) to have intact posterior capsules. Intraoperatively, the surgeon noted posterior capsule dehiscence in 5 eyes (7.8%) and an intact posterior capsule in 59 eyes (92.2%). The sensitivity and specificity of AS-OCT for detecting posterior capsule dehiscence was 100% and 94.92%, respectively. The negative predictive value of AS-OCT was 100%. Conclusion Anterior segment OCT with its high negative predictive value can be used successfully to predict the risk for posterior capsule rupture during phacoemulsification in eyes with posterior polar cataract.

This case highlights the postoperative management of a patient with hypotony who masqueraded as wound leak following manual small-incision cataract surgery (MSICS). A 66-year-old male patient underwent uneventful MSICS in the left eye. He developed postoperative hypotony following surgery. B-scan revealed a small peripheral shallow serous choroidal detachment. There was a mild conjunctival retraction which masqueraded as postoperative wound leak. Postoperative hypotony resolved after conservative management.

Purpose To compare reduction in intraocular pressure (IOP) and change in anterior chamber angle configuration between eyes undergoing phacoemulsification versus those undergoing manual small-incision cataract surgery (MSICS). Design Prospective, randomized, double-masked, parallel assignment clinical trial. Participants Five hundred eyes of 500 participants 40 to 70 years of age with normal IOP, gonioscopically open angles, and age-related cataract. Methods Eyes underwent phacoemulsification or MSICS after a 1:1 randomization and allocation code. Best-corrected vision, IOP, comprehensive slit-lamp evaluation, and anterior segment (AS) optical coherence tomography (OCT) were performed at baseline and at 1, 3, and 6 months follow-up. Main outcome measures Change in IOP (ΔIOP) and AS OCT parameters between baseline and 6 months after surgery. Results Six months, similar IOP reduction was observed in eyes undergoing phacoemulsification (ΔIOP = 2.7±2.9 mmHg) and MSICS (ΔIOP = 2.6±2.6 mmHg; P = 0.70). Widening of the angle opening distance (AOD) 500 μm from the scleral spur (median ΔAOD500 = 103 μm; interquartile range = 39-179 μm) was also similar in both groups (P = 0.28). Multivariate linear regression analysis showed that eyes with higher baseline IOP experienced significantly greater reduction in IOP at 6 months (ΔIOP = 0.46-mmHg reduction for every 1-mmHg increment in baseline IOP; 95% confidence interval [CI], 0.4-0.5 mmHg; P Conclusions Both phacoemulsification and MSICS led to significant and similar IOP reductions 6 months after surgery, and both surgeries produced similar changes in anterior chamber and angle parameters. Higher baseline IOP was associated with greater IOP reduction; IOP reduction also can be attributed partly to changes in angle and anterior chamber configuration, although these parameters were unable to predict significantly predict IOP drop at 6 months.

Pseudoexfoliation Syndrome (PXFS) is considered a systemic disorder with significant ocular manifestations ranging from corneal decompensation, non-dilating pupil, zonular weakness, subluxated lens, and glaucoma. PXFS may lead to increased complications during routine cataract surgery. Zonular dialysis is a common complication during or after cataract surgery in such patients. However, not all patients with pseudoexfoliation are at a higher risk. We hypothesize that there is an inverse correlation between the maximum pupillary dilation and the degree of zonular disintegration. Available evidence supporting the hypothesis is discussed. We propose a new clinical classification for predicting the zonular strength based on the maximum pupillary dilation so that it can serve as a guide to identify PXFS patients who are at high risk of complications during or after cataract surgery.

Purpose The primary output of hospital-based cancer registries is data on cancer stage and treatment-based survival that can be used to evaluate patient care, but because there are many challenges in obtaining follow-up details, a separate study on patterns of care and patterns of survival for patients at selected sites was initiated under the National Cancer Registry Programme of India. This article presents the results for cervical cancer. Patients and Methods A standardized patient information form was used to record patient information, and data were entered into a central repository—the National Centre for Disease Informatics and Research. The study patients were from 12 institutions and were diagnosed between January 1, 2006, and December 31, 2008. Patterns of treatment were assessed for 7,336 patients, and patterns of survival were determined for 2,669 patients from six institutions, at least 70% of whom had data regarding follow-up as of December 31, 2012. Results Of 7,336 patients, 55.5% received optimal radiotherapy (RT). In all, 80.9% of patients had locally advanced cancers (stage IIB to IVA), 51.1% received RT alone, and 44.4% received concurrent chemoradiation (RTCT). In 1,753 patients with locally advanced cancers, significantly better survival was observed with RTCT than with RT alone (5-year cumulative survival, 70.2% v 47.3%; hazard ratio, 0.48; 95% CI, 0.41 to 0.56). Conclusion A conservative estimate indicates that, on an annual basis, 38,771 patients with cervical cancers in India alone do not get the benefit of RTCT and thus they have poorer survival. There is a need to reiterate the National Cancer Institute's alert that advised supplementing chemotherapy to radiation for locally advanced cancer of the cervix in the context of the developing world, where 84.3% of cancers of the cervix occur.

A relatively simple and inexpensive technique to train surgeons in phacoemulsification using a goat's eye integrated with a human cataractous nucleus is described. The goat's eye is placed on a bed of cotton within the lumen of a cylindrical container. This is then mounted on a rectangular thermocol so that the limbus is presented at the surgical field. After making a clear corneal entry with a keratome, the trainer makes a 5-5.5 mm continuous curvilinear capsulorhexis in the anterior lens capsule, creates a crater of adequate depth in the cortex and inserts the human nucleus within this crater in the goat's capsular bag. The surgical wound is sutured, and the goat's eye is ready for training. Creating the capsulorhexis with precision and making the crater of adequate depth to snugly accommodate the human nucleus are the most important steps to prevent excessive wobbling of the nucleus while training.

Femtosecond laser-assisted cataract surgery was performed in a patient with high myopia, who had undergone posterior chamber phakic intraocular lens surgery (Implantable Collamer Lens, ICL). During docking the machine erroneously focused the laser on the anterior surface of ICL and laser for lens fragmentation was also defocused, which were correctly positioned before laser delivery. During laser application for capsulotomy, air bubbles were entrapped under the ICL prohibiting lens fragmentation. One must be careful during focusing the laser in eyes with ICL. Additionally, gas bubbles under the ICL may lead to difficulties in completion of nuclear disassembly.

To compare reduction in intraocular pressure (IOP) and change in anterior chamber angle configuration between eyes undergoing phacoemulsification versus those undergoing manual small-incision cataract surgery (MSICS).Prospective, randomized, double-masked, parallel assignment clinical trial.Five hundred eyes of 500 participants 40 to 70 years of age with normal IOP, gonioscopically open angles, and age-related cataract.Eyes underwent phacoemulsification or MSICS after a 1:1 randomization and allocation code. Best-corrected vision, IOP, comprehensive slit-lamp evaluation, and anterior segment (AS) optical coherence tomography (OCT) were performed at baseline and at 1, 3, and 6 months follow-up.Change in IOP (ΔIOP) and AS OCT parameters between baseline and 6 months after surgery.Six months, similar IOP reduction was observed in eyes undergoing phacoemulsification (ΔIOP = 2.7±2.9 mmHg) and MSICS (ΔIOP = 2.6±2.6 mmHg; P = 0.70). Widening of the angle opening distance (AOD) 500 μm from the scleral spur (median ΔAOD500 = 103 μm; interquartile range = 39-179 μm) was also similar in both groups (P = 0.28). Multivariate linear regression analysis showed that eyes with higher baseline IOP experienced significantly greater reduction in IOP at 6 months (ΔIOP = 0.46-mmHg reduction for every 1-mmHg increment in baseline IOP; 95% confidence interval [CI], 0.4-0.5 mmHg; P0.001). After adjusting for covariates, the magnitude of widening of AOD500 was not associated significantly with reduction in IOP (1.33-mmHg reduction for every 1-mm increment in AOD500; P = 0.07). Baseline AOD500 (β = -0.60-mm change/1-mm increment of baseline AOD; 95% CI, -0.67 to -0.53 mm) and anterior chamber depth (β = 0.07-mm change/1-mm increment of baseline anterior chamber depth; 95% CI, 0.04-0.1 mm) were significant predictors of AOD500 widening at 6 months.Both phacoemulsification and MSICS led to significant and similar IOP reductions 6 months after surgery, and both surgeries produced similar changes in anterior chamber and angle parameters. Higher baseline IOP was associated with greater IOP reduction; IOP reduction also can be attributed partly to changes in angle and anterior chamber configuration, although these parameters were unable to predict significantly predict IOP drop at 6 months.

Ocular pseudoexfoliation (PEX) syndrome may be associated with systemic vascular diseases, which might suggest a broader health significance of PEX, although previous reports are conflicting.To determine whether prespecified vascular risk factors and cardiac abnormalities are more common among patients with PEX than among control individuals without PEX.This cross-sectional analysis of patients recruited into the Aravind Pseudoexfoliation study included South Indian patients older than 40 years with or without PEX who required cataract surgery. Surgical procedures were performed at 4 tertiary Aravind eye hospitals in Tamil Nadu, India, from December 2, 2010, through March 26, 2012. Nine hundred thirty patients with PEX and 476 non-PEX controls underwent detailed ocular examinations, including specific ocular features reflecting PEX. Patients also underwent evaluation for multiple systemic potential cardiovascular diseases and their risk factors. The data collection for this analysis on systemic vascular diseases started on December 2, 2010, and ended on April 30, 2014. This study analysis was specified in the study protocol.Five cardiovascular outcomes compared between patients with and without PEX included blood glucose, cholesterol, and homocysteine levels; blood pressure; and cardiac morbidity (defined by electrocardiographic [ECG] abnormalities).The study analysis included 930 patients in the PEX group and 476 in the non-PEX group. The mean (SD) ages of patients in the PEX and non-PEX groups were 64.8 (6.8) and 59.9 (7.3) years (P .001), respectively. More patients in the PEX group were men (470 [50.5%] vs 460 women [49.5%]) than in the non-PEX group (201 [42.2%] vs 275 women [57.8%]; P .001). In multivariable analyses adjusting for age and sex, higher systolic blood pressure values were noted for the PEX group (difference [Δ], 4.0 mm Hg; 95% CI, 1.7-6.2 mm Hg; P = .001). Also, patients in the PEX group were more likely to demonstrate an ECG abnormality than in the non-PEX group (odds ratio, 1.64; 95% CI, 1.04-2.60; P = .03). Pseudoexfoliation was not observed to be associated with a higher level of blood glucose (Δ, 6.2 mg/dL; 95% CI, -2.0 to 14.3 mg/dL; P = .14), serum cholesterol (Δ, -0.6 mg/dL; 95% CI, -5.1 to 4.0 mg/dL; P = .81), or serum homocysteine level (Δ, 0.004 mg/L; 95% CI, -0.12 to 0.14; P = .96).Of the 5 cardiovascular outcomes examined in South Indian patients requiring cataract surgery, PEX was associated with higher systolic blood pressure and more frequent ECG abnormalities but not with higher blood glucose, serum cholesterol, or serum homocysteine levels. Patients with PEX are more likely to require attention to blood pressure and cardiac morbidity.

This study examined the prognostic significance of candidate tumor suppressor genes (TSGs) PHD finger protein-2 (PHF2), Fanconi anaemia complementation group C (FANCC) and human homologue of Drosophila patched gene (PTCH1), in head and neck squamous cell carcinoma (HNSCC) treated primarily with surgery, or surgery followed by adjuvant radiotherapy.Eighty-four patients with HNSCC were followed-up for recurrence/death for up to five years after diagnosis. Molecular alterations (deletion/methylation) of TSGs and human papilloma virus (HPV) status were determined in previous studies of our group. Statistical analyses of correlation of genetic alterations with treatment response and survival were carried out.Alterations of FANCC and PTCH1 were significantly associated with locoregional recurrence/death. In the surgery with adjuvant radiotherapy-group (n=56), patients showing alterations in FANCC and in PTCH1 were seven- and six-times, respectively, more likely to have locoregional recurrence compared to those with no alterations. In addition, the presence of alterations of both FANCC and PTCH1 had remarkable prognostic significance.FANCC and PTCH1 alterations might be used as molecular markers for prognosis and to develop strategies for effective treatment planning.

Background: Capsulorhexis in intumescent mature cataract has high chance of peripheral extension. This paper aims at describing a modified “C- rhexis technique”, with the unique mechanism of “simultaneously acting unidirectional vector forces” for virtually eliminating the risk of peripheral extension. Methods: Retrospective analyses of patients who were diagnosed to have intumescent mature cataract and underwent surgical intervention by a single surgeon using the modified “C-rhexis technique” were included. Results: A total of 125 eyes were included. None of the eyes experienced any capsular tag or peripheral extension of rhexis. Conclusion: In the nutshell, the “C-rhexis” virtually eliminates the risk of peripheral extension of capsulorhexis due to its unique “simultaneously acting unidirectional vector forces”. It can be easily mastered, creates an adequate size rhexis in first attempt, does not require expensive instruments and can be advocated in both MSICS and phacoemulsification. Keywords: C-rhexis1, Intumescent cataract2, Rhexis extension3, Uni-directional vector4