Neeraj Israni

Background: In LASIK (laser in situ keratomileusis), a hinged corneal flap is made, which enables the flap to be lifted and the excimer laser to be applied to the stromal bed. If the hinge of the corneal flap detaches from the cornea, the flap is called a free cap. A free cap is a rare intra-operative complication of LASIK most commonly associated with the use of a microkeratome on corneas with flat keratometry, which predisposes to a small flap diameter. Free caps are preventable and treatable. Rarely does the complication lead to a severe or permanent decrease in visual acuity. Purpose: As free caps are avoidable, prevention is critical. Our video gives some tips and tricks on how to avoid a free flap and also focuses on how to manage a cut through a free flap. Synopsis: If a free cap is created, the surgeon must decide whether to continue with excimer laser ablation or to abort the procedure. When to abort: If the stromal bed is irregular, the flap is replaced without applying la...

PURPOSE The aim of this study was to assess the visual, topographic, and aberrometric outcomes of a novel tissue sparing technique, topography-guided removal of epithelium, and stroma in keratoconus (TRESK) along with accelerated collagen cross-linking (CXL), 1 month after Intacs insertion. DESIGN Prospective interventional study. METHODS Fourty-eight eyes (45 patients) with keratoconus underwent femto-assisted Intacs insertion. After 1 month, TRESK and CXL (9 mW/cm2 for 10 minutes) was done. TRESK is a decentered trans-PTK (phototherapeutic keratectomy) with center and area of ablation at the location of the steepest tangential anterior curvature and area of the cone respectively. Total ablation (epithelium plus stroma) was limited to 75 μm. Postoperative measurements were performed 1 month after Intacs, 6 weeks after Intacs followed by TRESK/CXL, and at the final visit 12 months after Intacs followed by TRESK/CXL. RESULTS For all eyes studied, uncorrected distance visual acuity and corrected distance visual acuity (CDVA) (logMAR) improved from preoperative means of 1.05 ± 0.05 and 0.31 ± 0.03 logMAR to postoperative means of 0.52 ± 0.05 (P < 0.001) and 0.20 ± 0.02 logMAR (P = 0.009), respectively. The mean preoperative sphere, cylinder and mean refractive spherical equivalent decreased from -4.52 ± 0.98 D, -4.81 ± 0.25 D, -6.93 ± 0.99 D to -0.77 ± 0.53 D (P = 0.029), -3.13 ± 0.24 D (P = 0.002), and -2.34 ± 0.53 D (P = 0.021), respectively with a mean keratometric flattening of 5.06D (P < .0001) at the final visit. In total, 2.08% of the eyes lost 1 Snellen line of CDVA. Sixty eight percent and 27% of the eyes gained 2 Snellen lines or more of uncorrected distance visual acuity and CDVA, respectively. CONCLUSIONS Simultaneous TRESK with CXL done 1 month after Intacs insertion (I-TRESK) in keratoconus eyes provided significant visual gain with refractive and topographic improvement. This novel procedure involving customized PTK before CXL is safe, easy to plan and perform, and provides good outcomes.

Background: Drug Utilization Provides Prescribing Behaviors of Prescriber. Rational Prescribing plays a crucial role in reducing the Ocular disease burden in Ophthalmogy Practices. Aim: The Study aim was to analyze the patterns of drugs Prescribed Ophthalmology OPD patients. Methods: The study was an observational study completed over a period of 9 months, from March 2014 to Nov 2014.The Study was conducted in Department of Ophthalmology, MGM Medical College & Hospital Navi Mumbai. A questionnaire was specifically designed factoring patients’ demographical profile, diagnosis of disease, Drug regimen. Results: A total 246 prescriptions of patients were analyzed who visited Ophthalmology OPD Department.The total 495 drugs were prescribed. Average number of drug prescribed was 2.01. Maximum Patients were diagnosed with Cataract (25.03%) followed by Conjunctivitis (10.49%), Meibomitis (7.88%), Glaucoma (10.03%), Allergic eye (15.12%), Blephritis (7.85%), Foreign body in eye (4.91%), Dry...

Sir, We have read with keen interest the article entitled, “To assess surgical outcomes of combined femtosecond laser‐assisted cataract surgery with 25‐gauge vitrectomy surgery at a tertiary eye care center” by Kelkar et al.[1] Although the article has enlightened us, we have a few queries regarding the same. 1. Why was a posterior capsulotomy done in all cases? Was it because of intraoperative view issue? Was it to prevent postoperative opacification with necessity of a yttrium aluminum garnet capsulotomy? If an aspheric hydrophobic lens was used in all cases, the incidence of posterior capsular opacification would be low in any case.[2] Second, the incidence of neovascularization of iris increases with an open capsule and hence a posterior capsulotomy should have been avoided in the diabetic vitrectomy cases at least.[3] None of the patients had a Grade 4 cataract. A competent phacoemulsification surgeon would have had no difficulty in doing cataract surgery in any of these cases. In any case, the authors have mentioned that they did away with nucleus softening procedures in cataract less than Grade 4 nuclear sclerosis, which in effect includes all the patients [Table 2]. Hence, we gather that the only procedure, which was done consistently, was a femto rhexis. In our experience, the rhexis does not play such an important role in combined cataract surgery and vitrectomy to merit such a complex and expensive procedure.