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1.  Contact lens rehabilitation following repaired corneal perforations 
BMC Ophthalmology  2006;6:11.
Background
Visual outcome following repair of post-traumatic corneal perforation may not be optimal due to presence of irregular keratometric astigmatism. We performed a study to evaluate and compare rigid gas permeable contact lens and spectacles in visual rehabilitation following perforating corneal injuries.
Method
Eyes that had undergone repair for corneal perforating injuries with or without lens aspiration were fitted rigid gas permeable contact lenses. The fitting pattern and the improvement in visual acuity by contact lens over spectacle correction were noted.
Results
Forty eyes of 40 patients that had undergone surgical repair of posttraumatic corneal perforations were fitted rigid gas permeable contact lenses for visual rehabilitation. Twenty-four eyes (60%) required aphakic contact lenses. The best corrected visual acuity (BCVA) of ≥ 6/18 in the snellen's acuity chart was seen in 10 (25%) eyes with spectacle correction and 37 (92.5%) eyes with the use of contact lens (p < 0.001). The best-corrected visual acuity with spectacles was 0.20 ± 0.13 while the same with contact lens was 0.58 ± 0.26. All the patients showed an improvement of ≥ 2 lines over spectacles in the snellen's acuity chart with contact lens.
Conclusion
Rigid gas permeable contact lenses are better means of rehabilitation in eyes that have an irregular cornea due to scars caused by perforating corneal injuries.
doi:10.1186/1471-2415-6-11
PMCID: PMC1421434  PMID: 16536877
2.  Indications and outcome of repeat penetrating keratoplasty in India 
BMC Ophthalmology  2005;5:26.
Background
Repeat penetrating keratoplasty is quite often required as there is high chance of failure of the primary graft particularly in the developing world. We planned a study to analyze the indications and outcome of repeat penetrating keratoplasty in a tertiary care centre in India.
Methods
A retrospective analysis of all the patients who underwent repeat penetrating keratoplasty, between January 1999 and December 2001 was performed. The parameters evaluated were indication for the primary penetrating keratoplasty, causes of failure of the previous graft, and final visual outcome and clarity of the repeat corneal grafts.
Results
Of fifty-three eyes of 50 patients with repeat penetrating keratoplasty (three patients underwent bilateral corneal regrafts), 37 eyes had undergone one regraft each, 14 eyes two regrafts and two eyes had three regrafts. The follow-up of the patients ranged from one to three years. The most common primary etiologic diagnosis was vascularized corneal scars (66%), of which the scars related to infection were most common (68.5%). Twenty-eight regrafts (52.8%) remained clear at a mean follow-up of 1.54 ± 0.68 years, of which 25 were single regrafts (89.3%). The commonest cause of failure of regraft was infection to the corneal graft (recurrence of herpetic infection in 9 eyes and perforated graft ulcers in 3 eyes). Three (18.6%) of the 16 eyes with multiple corneal regrafts achieved a BCVA of 6/60. Overall, only five eyes (all with single regraft) achieved a BCVA of 6/18 or better at the end of follow-up.
Conclusion
Graft infection is the leading cause of failure of repeat keratoplasty in this part of the world. Prognosis for visual recovery and graft survival is worse in eyes undergoing multiple regrafts.
doi:10.1186/1471-2415-5-26
PMCID: PMC1291374  PMID: 16262912
3.  Comparative evaluation of efficacy and safety of ophthalmic viscosurgical devices in phacoemulsification [ISRCTN34957881] 
BMC Ophthalmology  2005;5:17.
Background
Various ophthalmic viscosurgical devices (OVD) are used to perform phacoemulsification and other intraocular surgeries. We performed a study to compare the efficacy and safety of three ophthalmic viscosurgical devices that are routinely used in phacoemulsification.
Methods
Fifty-six patients of immature senile cataract with hard nucleus (grade 3 and 4) who underwent phacoemulsification were included. Depending upon the type of OVD, patients were randomly allocated into three groups; group 1 (n = 19), Viscoat® was used; group 2 (n = 19), Healon GV® was used; group 3 (n = 18), Healon 5® was used. Parameters evaluated were uncorrected and best corrected visual acuity, specular microscopy, intraocular pressure and pachymetry both preoperatively and postoperatively on day 1, 1 week, 1 month and 3 months and development of any complication both intraoperative and postoperative were also noted.
Results
The mean increase in central corneal thickness was 15.17% (group 1); 17.26% (group 2) and 16.21% (group 3) on first postoperative day and was comparable in the three groups. The density of endothelial cells decreased postoperatively (day 1) by 12.54% (group 1), 13.76% (group 2) and 13.06% (group 3) and was comparable. The mean preoperative intraocular pressure in groups 1, 2 and 3 were 13.3 ± 2.0, 14.0 ± 2.2 and 13.2 ± 3.2 mmHg respectively, which changed to 16.0 ± 4.7, 12.2 ± 4.7 and 12.3 ± 4.8 respectively on first postoperative day and the change in intraocular pressure was significantly higher in group 1 (1 vs 2 & 1 vs 3; p = 0.02; oneway ANOVA).
Conclusion
Viscoat®, Healon GV® and Healon 5® give comparable results in terms of efficacy and safety in performing phacoemulsification.
doi:10.1186/1471-2415-5-17
PMCID: PMC1180454  PMID: 16018819
ophthalmic viscosurgical device; phacoemulsification; corneal endothelium
4.  Postage stamp multiple anterior capsulorhexisotomies in pediatric cataract surgery 
BMC Ophthalmology  2005;5:3.
Background
Capsule related complications are common following pediatric cataract surgery. We report a new technique of multiple anterior capsulorhexisotomies after lens aspiration and intraocular lens (IOL) implantation.
Methods
After performing automated lens aspiration, an IOL was implanted into the capsular bag. A bent 26 gauge needle was introduced through one side port and multiple small cuts were made in one half of the circumference of the anterior capsular rim by making a radial movement of the needle tip centripetally over the margin of the anterior capsular rim. The needle was again introduced through the other side port and multiple similar cuts were made in the other half thereby creating nearly 20 – 30 cuts at the margin of the anterior capsular rim.
Results
The mean size of the primary capsulorhexis was 4.33 ± 0.20 mm. A uniform enlargement of the capsulorhexis could be performed in all the eyes without peripheral extension in any of the eyes. There was no damage to the posterior capsule and no scratch mark on the IOL. In one eye, the primary capsulorhexis was slightly eccentric, though it was covering the IOL optic all around. The rhexisotomies in this eye were limited to the capsular rim that was overlapping more on the IOL optic (sectoral anterior capsulorhexisotomies).
Conclusion
The technique of postage stamp anterior capsulorhexisotomies is a feasible technique in pediatric cataracts.
doi:10.1186/1471-2415-5-3
PMCID: PMC554985  PMID: 15752433
postage stamp capsulotomy; anterior capsulorhexis; pediatric cataract

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