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Articles from Namrata Sharma
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Intralenticular changes in eyes with mature senile cataract on modified posterior segment optical coherence tomography
Read Full ArticlePurpose: To study the morphological changes within mature senile cataracts on modified posterior segment optical coherence tomography (OCT). Methods: A cross-sectional observational study recruiting patients of mature cataracts admitted for elective cataract surgery in tertiary eye care. A modified OCT imaging of the lens was done and lenticular findings were noted by a single observer. Corresponding slit-lamp biomicroscopic findings and intraoperative experiences were also noted by a second observer and respective surgeons. Results: Forty-four eyes of 44 patients were included. The mean age of patients was 65 ± 5.7 years. The intralenticular findings were uniform in groups of eyes, and ...
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Intraoperative Optical Coherence Tomography Guided Ocular Surgeries: Critical Analysis of Clinical Role and Future Perspectives
Read Full ArticleIntraoperative imaging of ocular tissues for diagnostic and therapeutic applications has gained immense admiration in recent years. The real time cross-sectional imaging, as well as three and four dimensional reconstruction abilities of intraoperative optical coherence tomography (iOCT), has enhanced our knowledge on many fronts in surgical maneuvers. In this review, we discuss the iOCT discovered constructive knowledge in the cornea, cataract, refractive, glaucoma, pediatric ocular, and various retinal conditions. The practical utility with decision modifying aspects along the specified ocular tissues and with respect to specific ocular entities have been narrated. Moreover, limitations and future directions have also been emphasized ...
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Role of Microscope-Intraoperative Optical Coherence Tomography in paediatric keratoplasty: A comparative Study
Read Full ArticlePurpose To evaluate role of Microscope-Integrated Intraoperative Optical Coherence Tomography (i-OCT) in paediatric keratoplasty. Design Combined prospective and retrospective, comparative, interventional study Setting Dr Rajendra Prasad Centre for Ophthalmic Sciences, India Methods Seventy-five children aged ≤16 years planned for keratoplasty were divided into two groups and compared for intraoperative course and postoperative outcome. In Group-1 (prospective group, n=56), pre-operative anterior segment visualization was performed clinically, with ultrasound biomicroscopy (UBM) and i-OCT and keratoplasty was commenced under i-OCT microscope. In Group-2 (retrospective group, n=19), conventional microscope was employed during keratoplasty. Results In Group-1, i-OCT, UBM and clinical examination detected ...
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Intraoperative Optical Coherence Tomography in Anterior Segment Surgery
Read Full ArticleIntraoperative optical coherence tomography (iOCT) enables real-time visualization of ocular structures during surgery and enhances our understanding of intraoperative dynamics. iOCT aids in decision making during various anterior segment surgeries, and its efficacy and feasibility in anterior lamellar keratoplasty and endothelial keratoplasty is well established. The landmark DISCOVER study observed that iOCT altered the surgeon decision in 38% of cases undergoing lamellar keratoplasty and provided guidance regarding the need for secondary surgical intervention. iOCT also finds an application in phacoemulsification wherein it helps to assess corneal incisions, intralenticular pressure, and posterior capsule integrity during nuclear emulsification. iOCT aids in the ...
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Evaluation of the signs of deficient posterior capsule in posterior polar cataracts using anterior segment optical coherence tomography
Read Full ArticlePurpose: To systematically observe and analyze the signs of deficient posterior capsule in posterior polar cataracts. Design: Ambispective observational study. Participants: Cases with posterior polar cataracts. Methods: Eyes with diagnosed posterior polar cataracts were imaged on anterior segment optical coherence tomography. A detailed assessment was performed to note the morphology of the posterior opacity, posterior capsule, and the common patterns to indicate their abnormality. In addition, generalized observation of the morphology was also performed with respect to intraoperative surgical experiences. Results: A total of 101 eyes were included. The average patient age was 52.85 ± 10.72 years. The posterior ...
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Microscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization
Read Full ArticlePurpose: To assess the utility of microscope-integrated intraoperative optical coherence tomography (Mi-OCT) for performing Descemet membrane endothelial keratoplasty (DMEK) in corneas with poor visualization. Methods: It is a prospective interventional case series that included 25 consecutive cases of corneal decompensation with poor visualization that underwent Mi-OCT-guided DMEK at a tertiary eye care centre. The main outcome measures were graft attachment on day 3 and requirement for re-bubbling. Results: The etiology for corneal decompensation was pseudophakic bullous keratopathy (n=17), Fuchs endothelial corneal dystrophy (n=4), failed graft (n=2), iridocorneal endothelial syndrome (n=1) and failed Descemet stripping automated endothelial ...
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Intraoperative optical coherence tomography-guided release of lenticulo-corneal adhesion and lens aspiration in anterior dislocation of lens with corneal edema
Read Full ArticlePurpose: To describe the outcome of microscope integrated optical coherence tomography (MiOCT) guided removal of lenticulo-corneal adhesion and intralenticular lens aspiration (ILLA) in cases with anterior dislocation of the crystalline lens and corneal edema. Methods: MiOCT-guided ILLA was performed in three eyes of two cases of homocystinuria with spontaneous anterior dislocation of lens and corneal edema. Lenticulo-corneal adhesion was noted intraoperatively, which was not apparent pre-operatively. The lenticulo-corneal adhesion could be successfully peeled using intravitreal forceps and viscodissection with visco-dispersive viscoelastic under the guidance of MiOCT. Results: In all cases, the lenticulo-corneal adhesion could be successfully removed without any complication ...
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Assessment of optic edge and the posterior capsule junction on optical coherence tomography
Read Full ArticleAfter cataract surgery, a frequent challenge faced by the anterior segment surgeon is posterior capsule opacification (PCO). Therefore, it is necessary to tackle this intraoperatively by thoroughly removing the lens capsule epithelial cells. 1 A square-edged intraocular lens (IOL) optic has also been shown to reduce the occurrence of PCO. 1 Determining the actual changes along the square edges of the IOL and the capsule junction is important in understanding why PCO develops.
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Assessment of posterior capsular integrity on optical coherence tomography
Read Full ArticleThe integrity of posterior capsule is of paramount importance to cataract surgeon. Careful preoperative assessment is routinely performed to avoid undesirable intraoperative complications. Routine slit-lamp-based assessment provides a detailed understanding of the posterior capsule, provided that lens matter is optically clear to an acceptable extent. However, the presence of opacity along the posterior capsule with a hidden defect such as posterior polar cataract may pose a challenge to decipher the intactness of the capsule. 1 Under such circumstances, noninvasive imaging modalities, such as anterior segment optical coherence tomography (OCT), is at surgeons rescue during the preoperative period. Therefore, here we ...
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Intralenticular changes on optical coherence tomography in eyes with mature brown cataract
Read Full ArticleWe modified the posterior segment optical coherence tomography (OCT) process to image anterior segment structures by keeping a 20.0 diopter lens along its aperture (Figure 1, A ). We were measuring the central corneal thickness using this technique and we noticed some empty pockets within the anterior lens matter. We discuss these findings in 2 cases.
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Intraoperative assessment of corneal injuries using microscope-integrated optical coherence tomography
Read Full ArticleA 2-year-old male child presented to the ocular emergency following penetrating injury with a metallic foreign body. Clinical examination revealed a nasal corneal perforation with iris tissue prolapse [ [Figure 1] , yellow arrow ]. To further delineate the extent of the corneal perforation and associated anterior segment changes, integrated optical coherence tomography (iOCT) was used. It showed corneal wound gaping for entire corneal thickness from the paracentral region to the periphery of the cornea. Within the gaping, prolapsing hyperreflective tissue was made out in continuity with the iris tissue onto the surface of the epithelium, suggestive of iris tissue [Figure 2] a ...
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Intraoperative optical coherence tomography-guided scleral suture passage while performing surgery on extraocular muscles
Read Full ArticleSir, Microscope-integrated intraoperative optical coherence tomography (iOCT, 2 mm depth penetration) helps in achieving the optimal results by providing the real-time images of tissue manipulation during the surgery. The iOCT is of great value while performing lamellar corneal surgeries, cataract surgeries, and intraocular lens implantation surgery. [1] , [2] It has also been noted to provide an advantage during placement of the glaucoma drainage devices in cadaveric eyes and needling of the blebs. [3] , [4] Pasricha et al . described the four-dimensional visualizations of the muscle and the scleral wound while passing the scleral sutures. [5] A 45-year-old male patient with alternate ...
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Spectral Domain Anterior Segment Optical Coherence Tomography in Fungal Keratitis
Read Full ArticlePurpose: To evaluate the use of spectral domain anterior segment optical coherence tomography (SD-ASOCT) in fungal keratitis . Methods: Fifty eyes of 50 patients with fungal keratitis were recruited. Serial ASOCT was performed on days 0, 7, 14, 21, 28, 42, and 56. Corneal thickness (CT) in the infiltrate area, infiltrate thickness (IT), and infiltrate width were measured at each follow-up. The presence of any specific feature on ASOCT was evaluated. Results: Mean CT and IT at presentation were 650.5 ± 108 μm and 401.1 ± 91 μm, which reduced significantly at each follow-up [on days 7, 14, 28, and 42 ...
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Ocular toxicity due to colours used during Holi celebration in India: Correlation of clinical findings with the anterior segment OCT
Read Full ArticlePurpose: To correlate the anatomical extent of ocular surface toxicity due to colours using anterior segment optical coherence tomography with the clinical findings. Methods: Patients presenting to our emergency department with ocular colour toxicity during the Holi festival celebrations from 2 nd March 2018 to 5 th March 2018 were assessed for any adnexal, conjunctival, corneal and anterior chamber findings, as well as findings on anterior segment optical coherence tomography (ASOCT). Results: A total of 21 patients were observed. The average age was 23 years with 16 patients being male (76.19%). Bilateral ocular involvement was more common (in 13 ...
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Continuous intraoperative optical coherence tomography-guided shield ulcer debridement with tuck in multilayered amniotic membrane transplantation
Read Full ArticlePurpose: The aim of this study is to describe a modified surgical technique of continuous intraoperative optical coherence tomography (iOCT)-guided shield ulcer debridement with tuck-in multilayered Amniotic membrane transplantation (ML AMT) in vernal keratoconjunctivitis (VKC) with shield ulcer with plaque. Methods: Seven eyes of seven patients presenting with VKC with shield ulcer with plaque were enrolled in this prospective case series and planned for shield ulcer debridement with ML AMT. Debridement of the ulcer base with double-layered AMT was done under the continuous guidance of iOCT. The main outcome measure was the time for complete reepithelialization. Statistical analysis was ...
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Intraoperative Optical Coherence Tomography–Guided Management of Cap–Lenticule Adhesion During SMILE
Read Full ArticlePURPOSE: To report successful lenticule extraction using intraoperative optical coherence tomography (OCT) in a case of cap–lenticule adhesion during small incision lenticule extraction (SMILE). METHODS: Case report. RESULTS: A 22-year-old patient with a refractive error of −5.00 −0.50 × 120° and −5.00 −0.75 × 60° in the right and left eyes, respectively, was scheduled for SMILE. The lenticule was created using the VisuMax femtosecond laser system (Carl Zeiss Meditec, Jena, Germany). The surgeon experienced difficulty while extracting the lenticule in the right eye. The patient was immediately shifted under the surgical microscope integrated with intraoperative OCT. The ...
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Rescuing the host Descemets membrane in full-thickness traumatic wound dehiscence in deep anterior lamellar keratoplasty: intraoperative optical coherence tomography (iOCT)-guided technique
Read Full ArticleOptimal visual recovery following full-thickness traumatic wound dehiscence in a case of operated deep anterior lamellar keratoplasty (DALK) is rarely seen. Here we report a case of 22-year-old male patient presented to our casualty department with complaint of sudden-onset diminution of vision in his right eye following blunt trauma of 1 day duration. DALK had been performed 11 months ago for advanced keratoconus in the same eye. Best-corrected visual acuity (BCVA) in the right eye was hand movement close to face with accurate projection of rays and in the left eye was 20/20. Slit-lamp examination showed the presence of ...
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Microscope-integrated intraoperative optical coherence tomography-guided small-incision lenticule extraction: New surgical technique
Read Full ArticleWe describe the surgical technique of microscope-integrated intraoperative optical coherence tomography (OCT)-guided small-incision lenticule extraction. The technique enables manual tracking of surgical instruments and identification of the desired dissection plane. It also helps discern the relation between the dissector and the intrastromal lenticule. The dissection plane becomes hyperreflective on dissection, ensuring complete separation of the intrastromal lenticule from the overlying and underlying stroma. Inadvertent posterior plane entry, cap–lenticule adhesion, incomplete separation of the lenticule, creation of a false plane, and lenticule remnants may be recognized intraoperatively so corrective steps can be taken immediately. In cases with a hazy ...
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Continuous intraoperative OCT guided management of post-deep anterior lamellar keratoplasty descemet’s membrane detachment
Read Full ArticleContinuous intraoperative optical coherence tomography (iOCT) integrated into the operating microscope is a new modification in the current operating microscope to aid in the surgical procedures involving both the anterior and the posterior segment. This helps in intraoperative planning, modification of the surgical steps if required and confirmation of the surgical endpoint in the operating room itself. iOCT was used for the successful management of descemet’s membrane detachment (DMD) following deep anterior lamellar keratoplasty (DALK) with intracameral injection of 20% Sulphur hexafluoride. The gas was injected under direct visualization through the microscope with continuous real time monitoring of the ...
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Evaluation of Time to Donor Lenticule Apposition Using Intraoperative Optical Coherence Tomography in Descemet Stripping Automated Endothelial Keratoplasty
Read Full ArticlePurpose: To evaluate the time to donor lenticule apposition in cases of Descemet stripping automated endothelial keratoplasty (DSAEK) using microscope-integrated intraoperative optical coherence tomography (iOCT). Methods: Thirty eyes of 27 patients planned to undergo Descemet stripping automated endothelial keratoplasty were enrolled in this prospective study. In group I (n = 10), continuous intracameral positive pressure was maintained for 8 minutes. In group II (n = 10) and group III (n = 10), external corneal massage was initiated simultaneously with positive intracameral air pressure. The external corneal massage was continued till complete resolution of interface fluid; the positive intracameral pressure was maintained for 8 ...
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Anterior Segment Optical Coherence Tomography-Guided Management Algorithm for Descemet Membrane Detachment After Intraocular Surgery
Read Full ArticlePurpose: To evaluate the role of anterior segment optical coherence tomography (ASOCT) in the detection and management of Descemet membrane detachment (DMD) in cases of persistent corneal edema after intraocular surgery. An ASOCT-guided new algorithm for the management of such DMDs is described. Methods: Thirty-seven consecutive cases of persistent corneal edema of more than 2-week duration after intraocular surgery were included. All cases referred had no response to medical therapy. ASOCT was performed in all eyes. DMDs that were in the superior half of the cornea with a planar configuration alone were managed using intracameral air, and those with scrolled ...
Mentions: University of Melbourne -
Intrastromal fluid drainage with air tamponade: anterior segment optical coherence tomography guided technique for the management of acute corneal hydrops
Read Full ArticleAims To describe a new technique of corneal stab incision with intracameral air injection for management of patients with acute corneal hydrops. Methods Five patients with acute corneal hydrops with large Descemet's membrane (DM) detachment and multiple stromal clefts underwent the procedure. The technique entailed anterior segment optical coherence tomography guided intrastromal fluid drainage through multiple corneal stromal venting incisions along with anterior chamber air tamponade. The time taken for the DM to reattach, resolution of corneal oedema and the best-corrected visual acuity (BCVA) were assessed postoperatively. Results Five patients (age range, 10–25 years) with large DM detachment ...
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