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ABSTRACT: PURPOSE:: To report the varied presentation and management of cryptophthalmos and further categorize grades of the congenital symblepharon variant based on the severity of the defect. METHODS:: The records of 34 eyes of 25 patients with cryptophthalmos who sought treatment at the authors' tertiary eye care center over a period of 22 years were analyzed. RESULTS:: Of the 34 eyes, 25 belonged to the congenital symblepharon variant, which could distinctively be further classified in medial/mild (4), moderate (9), and severe (11) subgroups and the surgical management for each has been outlined. The associated corneal and facial anomalies have also been highlighted along with their management modalities when indicated. CONCLUSIONS:: Although a rare clinical entity, this is the largest series of cryptophthalmos reported so far with a proposed classification scheme for the congenital symblepharon variant.
Ophthalmic plastic and reconstructive surgery 04/2013; · 0.69 Impact Factor
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Cornea 06/2012; 31(9):1092. · 1.73 Impact Factor
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ABSTRACT: PURPOSE: To analyze the outcome (functional and anatomic) of eyes that underwent tenonplasty as the primary globe-saving procedure in severe ocular chemical injuries (grade V-VI Dua's classification). METHODS: The records of patients who underwent tenonplasty for associated scleral ischemia in severe chemical burns in our institute between October 2005 and June 2011 were analyzed retrospectively. Out of 31 eyes that underwent tenonplasty, 21 belonged to grade V and VI of Dua's classification with diffuse scleral ischemia for which a four-quadrant tenonplasty was performed and only these 21 eyes were included for further analysis. The time to presentation following chemical injury, the need for revision surgeries, the time to complete epithelization, the procedures performed for ocular surface reconstruction and for visual rehabilitation and their outcome, both functional and anatomic, were analyzed. RESULTS: Of the 21 eyes of 13 patients, four were unilateral and nine were bilateral cases of chemical injury. The mean time to presentation following chemical injury was 14.61 days. Tenonplasty with amniotic membrane transplantation (AMT) was performed as the primary surgery. Revision tenonplasty was required in six eyes (seven procedures), the mean time to complete epithelization of the ocular surface was 5.4 ± 4.03 months. Of the 21 eyes, three lost perception of light following phthisis, evisceration for corneal infection, and uncontrolled glaucoma. Eighteen of 21 eyes were salvaged anatomically, of which ten eyes of 13 patients underwent surgery for visual rehabilitation. Among the unilateral cases, two eyes underwent ex vivo limbal stem cell transplant (LSCT) with or without keratoplasty for further visual rehabilitation. Among the patients with bilateral burns, visual rehabilitative procedure was performed in only one eye. Modified osteo-odonto-keratoprosthesis (MOOKP) was performed in five eyes, Boston type 1 keratoprosthesis in two eyes, and penetrating keratoplasty with keratolimbal allograft with systemic immunosuppression in one eye. One patient with bilateral injury is awaiting Boston keratoprosthesis type 1 for one eye. Of these eight eyes (bilateral injuries), all achieved a BCVA of 20/200 or better over a mean follow-up period of 27.37 ± 14.5 months following visual rehabilitative procedure. CONCLUSIONS: Tenonplasty has a globe-saving role in eyes with severe chemical injuries with associated scleral ischemia, by accelerating the healing process. Further on, these eyes can undergo visual rehabilitative procedures and our results highlight the feasibility of achieving a good functional outcome following anatomical stability. The role of tenonplasty to salvage the eye in the initial management of chemical injury, the need for multiple surgeries, close follow-up, and monitoring of intraocular pressure prior to and after procedures for visual rehabilitation cannot be underemphasized.
Albrecht von Graæes Archiv für Ophthalmologie 05/2012; · 2.17 Impact Factor
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ABSTRACT: To analyze the visual outcome of Boston keratoprosthesis for keratopathy in silicone oil-filled eyes.
Retrospective chart review of patients with silicone oil-induced keratopathy undergoing Boston keratoprosthesis between January 2008 and June 2010 was performed. Patients received Boston keratoprosthesis as the primary procedure or after a failed penetrating keratoplasty because of silicone oil-induced keratopathy after assessing possible visual potential. Silicone oil had to be retained in all eyes because of persistent ocular hypotony.
Of the 8 eyes that underwent surgery, anatomic retention and visual improvement were noted in 7 eyes (87.5%). The visual acuity improved to 20/200 or better in 6 eyes (66.67%). Repeated corneal melt necessitated the removal of the prosthesis with corneal transplant in 1 eye. Membranectomy was performed twice for retroprosthetic membrane in 1 eye.
Boston keratoprosthesis seems to be a viable option for visual rehabilitation in postvitrectomized eyes with a decrease in vision due to retained silicone oil-induced keratopathy.
Cornea 06/2011; 30(10):1083-7. · 1.73 Impact Factor
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ABSTRACT: To study the results of the modified osteo-odonto keratoprosthesis (MOOKP) surgery in bilateral end-stage ocular surface disorders.
The MOOKP surgery is performed as a routine in 3 stages. Stage 1A involves removal of the iris and anterior vitrectomy with a corneal transplant if indicated. Stage 1B + 1C usually performed simultaneously involves harvesting the buccal mucosa and transplanting it onto the ocular surface along with fashioning of the osteo-odonto alveolar lamina. Stage 2 involves transplanting the osteo-odonto alveolar lamina to the eye 3 months later.
The MOOKP surgery was completed in 50 eyes of 47 patients with a mean follow-up of 15.38 months (range: 1-54 months). Anatomic success was achieved in 96% of the eyes. Functional success of visual acuity > or = 20/60 was noted in 66% of eyes. Complications included oroantral fistula (6%), trophic mucosal alterations (8%), lamina exposure (central 6% and peripheral 8%), mucous membrane overgrowth (2%), hypotony (2%), expulsion of optic cylinder (4%), endophthalmitis (2%), glaucoma (20%), sterile vitritis (6%), and retinal detachment (2%).
MOOKP is the keratoprosthesis of choice in bilateral end-stage ocular surface disorders in the Indian subcontinent. Complications do occur and have to be recognized and treated early.
Cornea 05/2010; 29(7):771-6. · 1.73 Impact Factor
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ABSTRACT: Modified osteo-odonto-keratoprosthesis (MOOKP) forms the treatment of choice for corneal blindness in the end stage of bilateral ocular surface disorders. The hostile ocular environment encountered in severe bilateral chemical or physical injuries and Stevens-Johnson syndrome are very common among the Indian population, and other less common but serious autoimmune disorders also affecting the ocular surface result in dry eyes. In some of these diseases, such as Sjögren syndrome, pemphigoid, graft-versus-host diseases, and trachoma, conventional penetrating keratoplasty and limbal allografting are almost impractical. The resilience offered by the MOOKP procedure in these eyes along with the good image resolution from the rigid optical cylinder is responsible for its long-term success. The indications, contraindications, preoperative assessment, surgical techniques, postoperative follow-up, comparative results, and complications are described in detail. Case illustrations, indicating postoperative improvement in the quality of life, signify the value of the otherwise time-consuming and surgically demanding procedure.
Techniques in Ophthalmology 02/2010; 8(1):1-9.
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ABSTRACT: PURPOSE:: To study the efficacy of mucous membrane grafting as a surgical technique to address lid margin keratinization, an important cause for chronic blink- related microtrauma in Stevens Johnson Syndrome (SJS). METHODS:: The keratinized strip of conjunctiva along the lid margin was excised and replaced by lip mucous membrane using fibrin glue in 54 eyes of 31 patients with lid margin keratinization following SJS. This was a retrospective case series carried out between April 2005 and November 2006. RESULTS:: In 50 of 54 eyes (92.6%), there was improvement or stabilization in patient comfort, conjunctival hyperemia, ocular surface staining characteristics, and best corrected visual acuity over a mean follow-up period of 6 months. CONCLUSION:: The authors describe the method of mucous membrane grafting for addressing lid margin keratinization, one of the important causes for persistent inflammation in SJS. This procedure not only improves patient comfort and visual acuity by reducing surface inflammation, but also possibly prevents further deterioration of ocular surface in SJS.
Cornea 12/2009; · 1.73 Impact Factor
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ABSTRACT: The purpose of this study was to describe the challenges in preoperative evaluation, complexity of surgical maneuvers, and intricacies of postoperative management in eyes with Pintucci biointegrable keratoprosthesis requiring vitreoretinal intervention. Ocular surface disorders like Stevens-Johnson syndrome, chemical burns, and ocular cicatrical pemphigoid render the eye inamenable to penetrating keratoplasty. Hence, permanent keratoprosthesis is used for visual rehabilitation in such eyes. Management of vitreoretinal complications in such eyes is a challenging situation because of the difficult approach, limited visibility and maneuverability, and meticulous postoperative care.
Five patients (mean age: 18 years) with Pintucci biointegrable keratoprosthesis who underwent surgical intervention for vitreoretinal disorders between 2003 and 2008 were evaluated. All patients underwent pars plana vitrectomy with adjunct procedures and intraocular tamponade.
Retinal reattachment was achieved in all cases. Mean best corrected visual acuity improved from 20/10,000 to 20/1,200. Mean duration of follow-up was 108 days.
Vitreoretinal surgery in eyes with Pintucci biointegrable keratoprosthesis is a highly challenging situation that requires intricate planning and an integrated approach. However, it can result in good anatomical and functional outcomes.
Retina (Philadelphia, Pa.) 10/2009; 30(2):287-93. · 2.93 Impact Factor
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ABSTRACT: PURPOSE: To describe the preoperative characteristics, intraoperative details, management, and postoperative in patients with bilateral epithelial defects after laser in situ keratomileusis (LASIK). METHODS: Retrospective non-comparative case series. RESULTS: Six patients with bilateral epithelial defects after LAISK were part of a cohort of 605 patients undergoing bilateral LASIK at our center from December 2001 to April 2003. The mean age of the patients (5M:1F) was 28.5 7.9 years, and the average pretreatment myopic spherical equivalent (SE) refraction was 7.3 0.7 D (-4, -12.25D). An epithelial flap was present in 6 eyes and an epithelial defect with a mean diameter of 3 mm (2mm, 6mm) was seen in 6 eyes. In four patients the epithelial disturbance was bilaterally similar. All defects occurred in the inferior cornea and the epithelial flaps had the hinge positioned superiorly. None of the patients had ocular or systemic risk factors that could have resulted in this complication. A bandage contact lens was used in 6 eyes. At last follow-up of 5.5 9.5 months (0.25, 21 months), unaided visual acuity was 6/9 or better in 10 eyes. Best spectacle-corrected visual acuity (BSCVA) was maintained in 8 eyes, while 4 eyes lost one line of BSCVA. Recurrent corneal erosions were not reported in the follow-up period. CONCLUSIONS: These patients represent a hitherto unrecognised group of individuals who appear to have a subclinical weakness of adhesion of the corneal epithelium to the underlying structures, which is not evident on clinical examination. This results in bilateral epithelial disturbances after LASIK. Appropriate management results in satisfactory clinical outcomes. Other options for treatment of the fellow eye of such patients include the use of a different microkeratome, release of suction during the reverse pass of the Hansatome microkeratome, and photorefractive keratectomy if the refractive error is low.
Indian Journal of Ophthalmology. 01/2005;
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ABSTRACT: The tear ascorbate owing to its high concentration, functions as an effective antioxidant against the oxidative damage of cornea. Contact lens wearers (CLW) are prone to oxidative stress due to the lens-induced hypoxic conditions. A pilot study was done to compare the tear ascorbic acid level and the total antioxidant capacity give as in normal and CLW.
In this study 21 CLW (Mean age 23 +/- 3 years ; M-2, F-19), who were daily wear users, with duration of wear not more than four years, along with age-matched 28 controls (Mean age 28 +/- 3 ; M-15, F-13) were recruited in the study for collection of reflex tears using Schirmer's strip. Ascorbic acid in tears was determined using high-performance liquid chromatography (HPLC), total antioxidant capacity (TAC) and total protein assay by spectrophotometric analysis.
CLW showed no significant change in the tear ascorbic acid levels (0.4 +/- 0.26 mM) compared to the control subjects (0.61 +/- 0.59 mM). The amount of ascorbic acid in tears did not correlate with the TAC or the total protein of the tears. The mean TAC in CLW was 0.69 +/- 0.16 mM, with a total protein of 1.35 +/- 0.46 mg/ml while in controls it was 0.7 +/- 0.18 mM and 1.21 +/- 0.47 mg/ml respectively.
Soft contact lens wear did not show any significant change in tear ascorbic acid, TAC and total protein levels compared to controls.
Indian Journal of Ophthalmology 57(4):289-92. · 1.02 Impact Factor
