Vision Science and Eye Health Journal

Safety of Phacoemulsification with Gradual Hydro Dissection on Posterior Polar Cataract

Ahda Firstaputra Parmono — 2024-07-16

Introduction: Phacoemulsification has been a procedure of choice for treating cataractous lenses and restoring visual function. Posterior polar cataract have been one of many cases in which phaco surgeons should be careful and aware for more to perform phacoemulsification. One hydrodissection procedure is safe to perform as an alternative to hydrodileniation during phacoemulsification for posterior cataract. It is called gradual hydrodissection. Methods: This study performed a quasi-experimental pre-post study that tested the safety of gradual hydrodissection in phacoemulsification in 50 eyes of 50 patients. The safety parameter used in this study includes the incidence of posterior capsule rupture and nucleus drop during phacoemulsification until surgery is finished. Descriptive statistics were used to summarize the characteristics of the study participants, such as age, sex, race, eye laterality, and previous intraocular surgery. A paired student’s t-test was conducted to compare preoperative and postoperative values for visual acuity and intraocular pressure. The P <0.05 was considered the level of statistical significance. Results: There was no complication of the posterior capsule during the hydrodissection procedure. There was a statistically significant difference in visual acuity and intraocular pressure before and after surgery by P value <0.001. All of the phacoemulsification studies were considered uneventful and successful. Conclusions: Gradual hydrodissection may be safe to be performed in phacoemulsification for posterior polar cataract.

Intraocular Lens (IOL) Exchange Procedure in Refractive Surprise After Ten Years of Cataract Surgery

Rizna Audina — 2024-07-21

Introduction: Postoperative refractive surprises may manifest following cataract surgery. A residual refraction difference of > 2.0 D after cataract surgery was considered a refractive surprise. Treating refractive error after cataract surgery includes non-surgical and surgical options. The objective is to report clinical outcomes of intraocular lens (IOL) exchange with ciliary sulcus placement technique to manage refractive surprise. Case Presentation: A female patient aged 70 years reported experiencing blurred vision in her right eye (RE) for the past two years. History of RE cataract surgery ten years ago, however, she only had control 1-2 times after surgery. After that, the patient underwent cataract surgery on the left eye (LE), and then she complained that her RE was getting blurry. Her RE's visual acuity (VA) was 1/60 with best corrected visual acuity (BCVA) S-8.00 C-1.00 X100° to 6/10, and her LE was 7/10 with BCVA C-0.75 X60° to 10/10. The anterior segment examination of the RE was a 3-piece sulcus intraocular lens with complete continuous curvilinear capsulorhexis (CCC) intact anterior capsule, posterior capsule rupture, and the LE was in the bag IOL. Ultrasound examination of the RE revealed posterior staphyloma. She was diagnosed with OD refractive surprise, pseudophakia, posterior staphyloma, and OS pseudophakia. She underwent IOL exchange surgery on her RE. Post-operatively, the visual acuity of the RE was 7/45 using the Snellen chart. Three months post-op, the BCVA of RE was 10/10. Conclusions: In well-prepared cataract surgery, unexpected refractive outcomes such as a refractive surprise can be prevented. IOL exchange with ciliary sulcus placement technique is a treatment option for refractive surprise associated with posterior capsule rupture, and it has a good outcome.

Bilateral Subconjunctival Hemorrhage (SCH) Following Delivery

Ronik Harsono Kamal — 2024-07-24

Introduction: Subconjunctival hemorrhage (SCH) occurs when blood enters from the conjunctival or episcleral blood vessels into the subconjunctival space. SCH is classified as traumatic and non-traumatic (NTSCH). Microvascular diseases and increased intraabdominal pressure are associated with NTSCH; consequently, SCH can develop after vaginal delivery. However, reports regarding postpartum SCH are still scarce. This study aims to enhance awareness and comprehension of postpartum SCHs rather than minimize their significance. Case Presentation: A 17-year-old female presented with bilateral redness in both eyes one day post-delivery with no other ocular complaints. There were no complications in pregnancy and labor. The patient had no medical history of anticoagulant usage, trauma, hypertension, or blood disorders. Ophthalmic examination revealed visual acuity 20/20 on both eyes and bilateral subconjunctival hemorrhage, while other examinations were unremarkable. Treatment included a cold compress for 24 hours, followed by warm compresses every two hours on both eyes. Pharmacological therapy included artificial tears and naphazoline eye drops. Conclusions: Increased intra-abdominal pressure during labor can contribute to SCHs. While spontaneous resolution is common, accurate differentiation of SCH etiology is crucial for effective management. Obstetricians and ophthalmologists must collaborate to identify risk factors early, including routine eye screenings during the perinatal period, to enhance patient comfort and safety. Furthermore, additional research endeavors and investigations are necessary to deepen our understanding of the frequency and risk factors associated with postpartum SCHs and to develop effective prevention and treatment measures.

Late Onset Corneal Haze Post Photorefractive Keratectomy

Emeralda Brilian Agnia — 2024-08-02

Introduction: Photorefractive keratectomy (PRK) is a surface ablation procedure to correct refractive errors. Regardless of the safety and efficacy, corneal haze may occur after PRK, and it remains one of the most feared complications because it can impair good visual outcomes. Case Presentation: A 20-year-old woman complained of blurred vision in her right eye (RE) after undergoing PRK elsewhere six months before admission with a history of refraction of S-12.75 C-1.75 x 10° preoperatively and S-0.75 postoperatively. Six-month postoperative uncorrected visual acuity (UCVA) was 0.01, best corrected visual acuity (BCVA) was 0.5 with S-7.00 C-0.75 x 50°. A slit lamp examination revealed grade three corneal haze. Anterior optical coherence tomography (OCT) showed the hyperreflective area with 132 μm deep into the stroma. The patient underwent phototherapeutic keratectomy (PTK) and mitomycin-C (MMC) treatment to a depth of 50 μm Ø6.5mm transition zone 0.5 mm. Two months later, UCVA was 0.2, BCVA was 0.63 with S-2.50 C-0.50 x 90°, and slit lamp examination revealed no haze remaining. Conclusions: This case illustrates the potential risk for corneal haze development, mainly when PRK is performed at greater treatment depths. However, with phototherapeutic keratectomy and mitomycin-C treatment, an excellent visual outcome and vision restoration can be obtained.