Microperimetry in Children’s Practice

Child health is a global health priority. The program “Elimination of Eliminable Blindness in the World of Vision-2020” gives the fourth place to the problems of pediatric ophthalmopathology and creates targeted programs for their elimination. The introduction of modern equipment in the clinical practice of pediatric ophthalmologists has expanded the boundaries of traditional diagnostics. Microperimetry is an innovative, quantitative, non-invasive diagnostic study aimed at assessing the functional ability of the retina in strict correlation with morphology. Along with the assessment of light sensitivity, the device allows you to measure fixation parameters, which serves as a reliable criterion for its stability and indirectly reflects the functional organization of central vision. In this regard, the literature review presents the results of domestic and foreign researchers who used microperimetric testing as the main or additional research method for diseases of various etiologies, such as hereditary retinal diseases, amblyopia, and nystagmus. Most authors have demonstrated the high diagnostic significance of this method, the ability to assess photosensitivity of the retina, the detection of fixation disorders, such as eccentricity and instability, even in pediatric patients. The use of microperimetry as a new method of treatment for these diseases has also been shown. Visual rehabilitation based on biofeedback provided by this device has shown high efficiency in diseases of the central region. More research remains to be done to determine future potential applications of this technology, in particular in pediatric practice, and to develop the potential of microperimetry as a tool for the visual rehabilitation of patients.

A COMPARATIVE PROSPECTIVE STUDY OF EFFICACY AND VISUAL OUTCOME OF PHACOEMULSIFICATION AND SICS IN NORTH INDIAN POPULATION IN AND AROUND LUCKNOW.

PURPOSE: To evaluate efcacy and visual outcome of manual small incision cataract surgery (SICS) and phacoemulsication. METHODS: A prospective, interventional, observational, follow up study was conducted on 120 patients with clinically signicant senile cataract undergoing cataract surgery by either SICS or phacoemulsication, at a tertiary eye care centre in Lucknow. The follow up evaluations were carried out at post-operative day st rd th 1, 1 week, 3 week and 6 week. RESULTS: On rst postoperative day, there was signicantly better visual outcome with phacoemulsication than SICS (p = 0.005) with 80% patients in SICS group and 90% patients in phacoemulsication group, th had best corrected visual acuity (BCVA) better than equal to 6/18. However at 6 week, nal visual recovery was similar in both the groups (BCVA 6/18 in 96.7% in SICS group and 100% in phacoemulsication group) with no statistically signicant difference. There was no signicant difference in overall per operative and post operative complications between SICS and phacoemulsication. SICS and phacoemulsication did not show signicant difference in surgery induced astigmatism (SIA) with SIA of 0.733D and 0.775D in SICS and phacoemulsication group respectively. CONCLUSIONS: Phacoemulsication is superior to SICS in terms of early visual rehabilitation. But there is no signicant difference in nal visual outcome and complication rates between the two techniques.

Comprehensive Management of Congenital Cataract in Dizygotic Twin Babies

Introduction: One of the leading causes of infant blindness is cataract. The prevalence of congenital cataract has been estimated in the range between 1 and 15 per 10.000 children globally. Congenital cataract in twin babies is a rare case. This case will report the outcome of comprehensive management of congenital cataract in dizygotic twin babies. Case presentation: Eight months old dizygotic twin babies came to our clinic with the primary complaint of whitish appearance in the pupil of both eyes since birth. They were born aterm with cesarean delivery. The birth weight was 2.700 g and 3.100 g respectively. They were the fourth and fifth children in the family. There was no family history of congenital cataract. The visual acuity of both eyes was positive response to light stimuli. The cataract was bilateral and dense on both babies. Fundus reflex and TORCH examinations were negative. Ultrasonography (USG) of the retina was normal on both babies. Conclusions: Isolated congenital cataract in twin babies is an unusual condition that should be treated comprehensively. Congenital cataract may cause deprivation amblyopia, refractive amblyopia, and permanent vision impairment. Early diagnosis and quick treatment, such as surgical timing and visual rehabilitation, are critical to perform successful management. Comprehensive care is required to monitor the visual result of cataract surgery.

Possibilities of scleral lenses for visual rehabilitation of patients with corneal scars

Purpose. To analyze the efficacy and safety of SCL in patients with corneal cicatricial changes and other concomitant conditions. Material and мethods. The study included 19 patients (20 eyes) with cicatricial deformity of the cornea of various etiology, who were fitted with scleral contact lenses. Results and discussions. The use of SCL is possible in post-traumatic pathology, such as corneoscleral scars with or without aphakia, as well as after keratitis with an outcome in cicatricial deformity, cicatricial changes after a burn. A significant increase in visual acuity compared with spectacle correction has been proven. Depending on the topography of the scar, it is possible to select scleral lenses such as Oblate and Prolate, as well as with different versions of the support zone: both toric and quadratic. Conclusion. Scleral lenses can be successfully used for optical correction in patients with cicatricial changes in the cornea and other concomitant post-traumatic conditions of ineffectiveness of other methods of visual rehabilitation. Key words: cornea, lenses, vision correction, contact lenses, visual rehabilitation, scleral lenses, corneal scars, post-traumatic astigmatism, aphakia, keratitis, toric lenses, quadratic lenses, astigmatism, irregular cornea, regular cornea, regular astigmatism, irregular cornea, irregular astigmatism, prolate, oblate.

Intrastromal keratoplasty with intracorneal ring segments implantation as an independent method of visual rehabilitation in patients with keratoconus

Purpose. To assess the possibility of using intrastromal keratoplasty with intracorneal ring segments implantation as an independent technique to achieve visual rehabilitation in patients with keratoconus of the stages I and II. Material and methods. There were examined and operated 14 eyes (10 patients) with keratoconus of the stages I and II (classification by Izmailova SB, 2014). Patients were divided into two groups depending on the keratoconus stage. All patients underwent intrastromal keratoplasty with intracorneal ring segments implantation using the femtosecond technology. The on average follow-up was 5.7 months. Results. In the first group: the average UCVA value increased with from 0.31±0.21 to 0.81±0.31 (p<0.05); the BCVA increased from 0.89±0.08 to 0.94±0.10 (p>0.05); the spherical component of refraction decreased from 0.96±1.25 to 0.08±0.20 (p<0.05); the cylindrical component of refraction decreased from 4.25±1.73 to 0.50±1.22 (p<0.05). In the second group: UCVA increased from 0.51±0.40 to 0.61±0.28 (p<0.05); the BCVA increased from 0.70±0.17 to 0.81±0.26 (p>0.05); the spherical component of refraction decreased from 4.88±2,61±0.53±0.63 (p<0.05); the cylindrical component of refraction decreased from 2.69±1.65 to 1.41±1.02 (p<0.05). Conclusion. 1. After implantation of intracorneal ring segments, both in patients with I and in patients with the II stage of keratoconus, there was an increase in the UCVA and BCVA, as well as a significant reduction in maximal keratometry and coma, which provides the improving of the quality of vision. 2. In all cases the UCVA and BCVA that were obtained after the treatment reached a sufficiently high level to ensure the possibility of performing their professional functions, without resorting to additional surgical treatment techniques. That characterizes this method as an independent and sufficient to achieve high visual acuity in patients with I and II stages of keratoconus. Key words: keratoconus, corneal intrastromal segments, femtosecond laser, visual rehabilitation.

Keratoconus Diagnostic and Treatment Algorithms Based on Machine-Learning Methods

The accurate diagnosis of keratoconus, especially in its early stages of development, allows one to utilise timely and proper treatment strategies for slowing the progression of the disease and provide visual rehabilitation. Various keratometry indices and classifications for quantifying the severity of keratoconus have been developed. Today, many of them involve the use of the latest methods of computer processing and data analysis. The main purpose of this work was to develop a machine-learning-based algorithm to precisely determine the stage of keratoconus, allowing optimal management of patients with this disease. A multicentre retrospective study was carried out to obtain a database of patients with keratoconus and to use machine-learning techniques such as principal component analysis and clustering. The created program allows for us to distinguish between a normal state; preclinical keratoconus; and stages 1, 2, 3 and 4 of the disease, with an accuracy in terms of the AUC of 0.95 to 1.00 based on keratotopographer readings, relative to the adapted Amsler–Krumeich algorithm. The predicted stage and additional diagnostic criteria were then used to create a standardised keratoconus management algorithm. We also developed a web-based interface for the algorithm, providing us the opportunity to use the software in a clinical environment.

Sutureless Tectonic Mini-Descemet's Stripping Automated Endothelial Keratoplasty (“mini-DSAEK”) for the management of corneal perforations

Purpose To report the outcomes of a new technique, pull-through sutureless ‘mini-DSAEK’, to manage corneal perforations secondary to different aetiologies including trauma, neurotrophic ulcer following penetrating keratoplasty (PK), herpes simplex keratitis and microbial keratitis. Methods In this retrospective case series, we report the clinical outcomes of five cases of sutureless tectonic mini-DSAEK performed in patients presenting with large corneal perforations to Southend University Hospital between November 2019 and October 2020. One corneal perforation was sufficiently peripheral for the tectonic mini-DSAEK graft to be successfully positioned outside of the central visual axis. Four corneal perforations were central or paracentral for which the tectonic grafts involved the visual axis. Results Anterior chambers remained deep and formed with no evidence of leak in all subsequent follow ups in all patients representing 100% tectonic success. All tectonic grafts remained attached except one partially detached graft. One patient underwent uneventful phacoemulsification with intraocular lens implant 8 months after the primary intervention with excellent visual outcome. Two patients underwent two-piece mushroom PK and one patient underwent triple procedure (cataract extraction + intraocular lens + PK) for visual rehabilitation 2–6 months after the primary intervention with good visual outcome. Conclusion Sutureless tectonic pull-through mini-DSAEK is a useful technique in the management of corneal perforations, with a number of advantages compared with conventional techniques.