Surendra Basti - Academia.edu (original) (raw)

Papers by Surendra Basti

Research paper thumbnail of Results of Bilateral Cataract Extraction with Posterior Chamber Intraocular Lens Implantation in Children

Ophthalmology, 1997

A retrospective study was undertaken to evaluate long-term anatomic and visual outcomes in eyes o... more A retrospective study was undertaken to evaluate long-term anatomic and visual outcomes in eyes of children who underwent bilateral intraocular lens implantation. The study design was a review of medical records of 24 children operated on for bilateral cataracts and posterior chamber-intraocular lenses. Twenty-four children operated on for bilateral cataracts by 1 surgeon between February 1980 and February 1995 were studied. Cataract extraction with bilateral posterior chamber-intraocular lens implantation was performed. Best-corrected visual acuity, visual acuity without correction, intraocular pressure, manifest refraction, and any intraoperative or postoperative complications were measured. At last follow-up (mean follow-up, 50.8 months; range, 10-149 months), the intraocular lens was in good position and the intraocular pressure was normal without medication in all eyes. Four years after surgery, 79.2% (19 of 24) of first eyes achieved a best-corrected visual acuity of 20/40 or better compared to 66.7% (16 of 24) of second eyes. No eye had any loss in best-corrected visual acuity. In first eyes of 3- to 8-year olds at the time of surgery, 73.3% (11 of 15) achieved a spherical equivalent within 2 diopters of the intended at 4 years after surgery compared to 80% of second eyes. In the 9- to 18-year-old group, 88.9% (8 of 9) of first eyes and 100% of second eyes achieved a spherical equivalent within 2 diopters of the intended at 4 years after surgery. Intraoperative and postoperative complications were minimal. Long-term anatomic and visual results have been gratifying in this series of patients with bilateral implants.

Research paper thumbnail of The SERIES clinic: an interdisciplinary approach to the management of toxicities of EGFR inhibitors

The journal of supportive oncology, 2006

Page 1. 236 www.SupportiveOncology.net THE JOURNAL OF SUPPORTIVE ONCOLOGY J Support Oncol 2006;4:... more Page 1. 236 www.SupportiveOncology.net THE JOURNAL OF SUPPORTIVE ONCOLOGY J Support Oncol 2006;4:236–238 © 2006 Elsevier Inc. All rights reserved. HOW WE DO IT options with the patient, erlotinib was initiated at 150 mg daily as a single agent. ...

Research paper thumbnail of NCCN Task Force Report: Management of dermatologic and other toxicities associated with EGFR inhibition in patients with cancer

Journal of the National Comprehensive Cancer Network : JNCCN, 2009

This NCCN Task Force Report describes the management of dermatologic and ocular toxicities that o... more This NCCN Task Force Report describes the management of dermatologic and ocular toxicities that occur in patients treated with epidermal growth factor receptor (EGFR) inhibitors. Task force members are from NCCN member institutions and include oncologists, dermatologists, an ophthalmologist, and a mid-level oncology provider. This report describes commonly used therapies that the task force agreed are appropriate standards of care for dermatologic and ophthalmologic toxicities associated with EGFR inhibitors, which generally are supported only by anecdotal evidence. Few recommendations are evidence based; however, some commonly used therapies have data supporting their use. Conclusions from completed clinical trials are generally limited by the small numbers of patients enrolled. The information in this report is based on available published data on treating toxicities associated with EGFR inhibitors, data from treatment of clinically similar toxicities from different etiologies, an...

Research paper thumbnail of Posterior capsule dehiscence during phacoemulsification and manual extracapsular cataract extraction: comparison of outcomes

Journal of cataract and refractive surgery, 2003

To compare the intraoperative behavior and postoperative outcomes of posterior capsule dehiscence... more To compare the intraoperative behavior and postoperative outcomes of posterior capsule dehiscence during phacoemulsification and during manual extracapsular cataract extraction (ECCE). L.V. Prasad Eye Institute, Hyderabad, India. This study was a retrospective chart review of consecutive cases of posterior capsule dehiscence over 2 years in patients having phacoemulsification or manual ECCE. A chi-square test was used for statistical comparison of the results in the 2 groups. In the 127 eyes with posterior capsule dehiscence, the incidence of vitreous prolapse was comparable between the 2 groups (phacoemulsification, 61.6%; ECCE, 62.7%). In the phacoemulsification group, vitreous prolapse occurred more frequently if nuclear fragments were present at the time of posterior capsule dehiscence than if they were present during cortex removal (P =.05). Posterior dislocation of nuclear fragments occurred in 4 eyes in the phacoemulsification group. Increased anterior uveitis in the early po...

Research paper thumbnail of Intraoperative reverse pupillary block during femtosecond laser–assisted cataract surgery in a patient with phacomorphic angle closure

Journal of Cataract & Refractive Surgery, 2014

We report a patient with phacomorphic angle closure having femtosecond laser-assisted cataract su... more We report a patient with phacomorphic angle closure having femtosecond laser-assisted cataract surgery. A staged procedure was followed to achieve mydriasis and deepen the anterior chamber with bisulfate-free epinephrine (epi-Shugarcaine) and an ophthalmic viscosurgical device (OVD) prior to the femtosecond procedure. After the femtosecond laser was docked, the patient complained of discomfort in her eye and intraoperative optical coherence tomography imaging revealed a reverse pupillary block configuration. Software modifications were required to complete the procedure, following which partial OVD removal and anterior tenting of the pupil margin relieved the reverse pupillary block. In the fellow eye, intracameral bisulfate-free epinephrine alone was injected above and below the iris plane for intraoperative mydriasis and to deepen the anterior chamber, which prevented a reverse pupillary block. Neither author has a financial or proprietary interest in any material or method mentioned.

Research paper thumbnail of Autosomal dominant zonular cataract with sutural opacities is as- sociated with a splice mutation in the βA3/A1-crystallin gene

Congenital cataracts constitute a morphologically and genetically heterogeneous group of diseases... more Congenital cataracts constitute a morphologically and genetically heterogeneous group of diseases that are a major cause of childhood blindness. Different loci for hereditary congenital cataracts have been mapped to chromosomes 1, 2, 16, and 17q24. We report linkage of a gene causing a unique form of autosomal dominant zonular cataracts with Y-sutural opacities to chromosome 17q11-12 in a three-generation family exhibiting a maximum lod score of 3.9 at D17S805. Multipoint analysis gave a 1-lod confidence interval of 17 cM. This interval is bounded by the markers D17S799 and D1 7S798, a region that would encompass a number of candidate genes including that coding for PA3/A1-crystallin.

Research paper thumbnail of Customizing femtosecond laser–assisted cataract surgery in a patient with a traumatic corneal scar and cataract

Journal of Cataract & Refractive Surgery, 2014

Research paper thumbnail of Unusual intermediate-term outcome in three cases of limbal autograft transplantation

Ophthalmology, 1999

OBJECTIVE: To report an unusual intermediate-term outcome after limbal autograft transplantation ... more OBJECTIVE: To report an unusual intermediate-term outcome after limbal autograft transplantation for unilateral, severe chemical burns. DESIGN: Case reports of three consecutive cases. PARTICIPANTS: Three patients with a history of chemical burns. The ...

Research paper thumbnail of Chapter 5 Limbal Stem Cells

International Review of Cell and Molecular Biology, 2009

Corneal opacification due to limbal stem cell deficiency (LSCD) is an important cause for ocular ... more Corneal opacification due to limbal stem cell deficiency (LSCD) is an important cause for ocular morbidity, resulting from a number of intrinsic and extrinsic factors. While the extrinsic factors include conditions such as chemical or thermal injuries, intrinsic include dysfunction, or reduction in the number of stem cells either due to pathological changes in autoimmune diseases or secondary to certain clinical conditions such as diabetes, dry eye disorders, or multiple previous eye surgeries. LSCD is characterized by a classic triad of signs-conjunctivalization, neovascularization and decrease in vision. With the increasing knowledge of limbal stem cells, the treatment of this condition has evolved from simple debridement to use of biological materials, direct transplantation of the healthy limbal tissue from the contralateral eye, or allogenic source to the use of cultivated limbal epithelial sheets. This chapter provides an update on the disease pathology, various treatment methodologies, with specific emphasis on the fast developing field of cell therapy and tissue engineering.

Research paper thumbnail of Results of a Prospective Evaluation of Three Methods of Management of Pediatric Cataracts

Ophthalmology, 1996

Although a variety of approaches to manage cataracts in children have been studied, no consensus ... more Although a variety of approaches to manage cataracts in children have been studied, no consensus exists on the optimum approach. The authors, there fore, conducted a prospective, nonrandomized, consecutive study to evaluate three most commonly adopted methods of management of pediatric cataracts.

Research paper thumbnail of When may the posterior capsule be preserved in pediatric intraocular lens surgery?

Ophthalmology, 2002

To refine indications for primary posterior capsulotomy (PPC) in conjunction with posterior chamb... more To refine indications for primary posterior capsulotomy (PPC) in conjunction with posterior chamber intraocular lens (PCIOL) implantation for cataract in childhood. Noncomparative case series. Patients 1 to 13 years old who underwent cataract extraction with intent to preserve the posterior lens capsule and PCIOL implantation between January 1992 and December 1998 at a pediatric hospital. Medical records were reviewed to determine the frequency and timing of posterior capsule opacification (PCO) after PCIOL surgery with preservation of an intact posterior capsule. Comparison of pseudophakic PCO rates for groups defined by age and several possible risk factors. Assessment of safety and efficacy for PPC with anterior vitrectomy performed through a limbal incision in cases where the posterior capsule could not be preserved. Need for neodymium:yttrium-aluminum-garnet laser capsulotomy or surgical membranectomy to treat PCO. PCO occurred in 40% of 30 eyes with intact posterior capsule. Mean follow-up duration was 22 months for eyes that had PCO develop and 24 months for those in which the posterior capsule remained clear. Laser capsulotomy was required for 64% of 14 eyes in the 1- to 6-year-old age range but for only 19% of 16 in the 6- to 13-year-old range (P < 0.05). Mean time from surgery to PCO was 7 months for the younger group and 13 months for the older group. A need for repeated capsulotomy (one eye) or membranectomy with anterior vitrectomy (two eyes) was found only in the younger age group. There was no association of PCO with trauma history, cataract type, residual lens cortex, IOL position, or postoperative fibrin clot. Final vision was possibly compromised as a result of PCO in one eye with amblyopia. None of 24 eyes in which PPC with anterior vitrectomy was performed out of intraoperative necessity before primary PCIOL implantation had secondary opacification develop. No reduction in postoperative vision was attributable to PPC. PPC seems to be advisable for children less than 6 years old when cataract extraction with PCIOL implantation is performed. Preservation of the posterior capsule remains appropriate for older children with pseudophakia.

Research paper thumbnail of Intraoperative vertical gas breakthrough during clear corneal incision creation with the femtosecond cataract laser

Journal of Cataract & Refractive Surgery, 2014

We report the occurrence and management of intraoperative vertical gas breakthrough during clear ... more We report the occurrence and management of intraoperative vertical gas breakthrough during clear corneal incision creation with the femtosecond laser (Catalys) in 2 patients. Both eyes were managed by creation of a keratome incision, and the surgery was completed uneventfully. There were no postoperative complications. We believe that wound architecture and corneal clarity in the area of wound creation predispose to the occurrence of vertical gas breakthrough. Careful inspection of wound integrity can provide clues to an incomplete wound. Neither author has a financial or proprietary interest in any material or method mentioned.

Research paper thumbnail of Incomplete capsulotomy using femtosecond laser with a pupil expansion device

Journal of Cataract & Refractive Surgery, 2014

Research paper thumbnail of Use of preservative-free lidocaine for cataract surgery in a patient allergic to “caines”

Journal of Cataract & Refractive Surgery, 2005

Although many patients have been labeled allergic to local anesthetics (LAs), true allergic react... more Although many patients have been labeled allergic to local anesthetics (LAs), true allergic reactions to LAs are rare. An 81-year-old woman with a history of procaine (Novocaine) allergy presented for cataract surgery. Skin testing showed sensitivity to amide and ester LAs. Further testing with preservative-free lidocaine was negative, suggesting the patient was allergic to ester LAs and preservatives found in amide anesthetic preparations. Cataract extraction was subsequently and uneventfully performed in both eyes with topical anesthesia using preservative-free lidocaine. Refract Surg 2005; 31:848-850 ª 2005 ASCRS and ESCRS

Research paper thumbnail of Heparin-surface-modified intraocular lenses in pediatric cataract surgery: Prospective randomized study

Journal of Cataract & Refractive Surgery, 1999

To evaluate the performance of heparin-surface-modified (HSM) intraocular lenses (IOLs) in pediat... more To evaluate the performance of heparin-surface-modified (HSM) intraocular lenses (IOLs) in pediatric eyes after cataract surgery. L.V. Prasad Eye Institute, Hyderabad, India. This prospective, randomized, double-masked, controlled clinical trial comprised 90 children aged 2 to 14 years with cataract. The patients were consecutively randomized to receive an HSM (Group 1) or an unmodified (Group 2) poly(methyl methacrylate) (PMMA) IOL. Extracapsular cataract extraction (ECCE) with IOL implantation was performed in children 8 years and older and ECCE with primary posterior capsulotomy, anterior vitrectomy, and IOL implantation in children younger than 8 years. Outcome parameters were inflammatory cell deposits on the IOL surface, posterior synechias, and anterior chamber reaction. Follow-up data were available for 73, 70, 60, and 68 patients at 1 week, 1 month, 3 months, and 6 months, respectively. Significantly fewer cell deposits were noted in Group 1 at 1, 3, and 6 months (P < .001). Synechia formation and anterior chamber reaction were comparable in the 2 groups. The lower incidence of inflammatory cell deposit formation in eyes with HSM PMMA IOLs indicates that these IOLs have greater bicompatibility than unmodified IOLs in pediatric cataract surgery.

Research paper thumbnail of Acute suprachoroidal hemorrhage during clear corneal phacoemulsification using topical and intracameral anesthesia

Journal of Cataract & Refractive Surgery, 2003

Shallowing of the anterior chamber and hardening of the eye occurred just before commencement of ... more Shallowing of the anterior chamber and hardening of the eye occurred just before commencement of irrigation/aspiration of cortex in an 80-year-old man having temporal clear corneal cataract surgery under topical and intracameral anesthesia. Nucleus removal had been completed and was uneventful. Intraoperative fundus examination with the indirect ophthalmoscope disclosed a choroidal hemorrhage. The wound was immediately closed with sutures, and intravenous mannitol was administered. The hemorrhage remained localized. The red reflex remained unchanged at all times, and there was no prolapse of intraocular contents. A high index of suspicion is critical to the early diagnosis and management of choroidal hemorrhage.

Research paper thumbnail of Predictive formula for calculating the probability of LASIK enhancement

Journal of Cataract & Refractive Surgery, 2004

Purpose: To develop a formula to predict a patient's need for laser in situ keratomileusis (LASIK... more Purpose: To develop a formula to predict a patient's need for laser in situ keratomileusis (LASIK) enhancement.

Research paper thumbnail of Posterior capsule dehiscence during phacoemulsification and manual extracapsular cataract extraction: comparison of outcomes

Journal of Cataract & Refractive Surgery, 2003

To compare the intraoperative behavior and postoperative outcomes of posterior capsule dehiscence... more To compare the intraoperative behavior and postoperative outcomes of posterior capsule dehiscence during phacoemulsification and during manual extracapsular cataract extraction (ECCE).

Research paper thumbnail of Capsular bag distension after optic captureof a sulcus-fixated intraocular lens

Journal of Cataract & Refractive Surgery, 1999

Capsular bag distension from occlusion of the circular anterior capsule opening by the intraocula... more Capsular bag distension from occlusion of the circular anterior capsule opening by the intraocular lens (IOL) optic is a rare complication of capsulorhexis. The nature and source of fluid remain unclear. We report a case of capsular bag distension in an eye with an optic-captured, all-poly(methyl methacrylate), sulcus-fixated IOL. The fluid behind the IOL optic was visible on the first postoperative day and resolved spontaneously by the sixth postoperative week. We believe that retained viscoelastic material in the capsular bag was a major contributor to the fluid.

Research paper thumbnail of Silicone oil adhesion to intraocular lenses: An experimental study comparing various biomaterials

Journal of Cataract & Refractive Surgery, 1997

To perform an in vitro experimental study comparing the degree of adherence of silicone oil to va... more To perform an in vitro experimental study comparing the degree of adherence of silicone oil to various rigid and foldable intraocular lens (IOL) designs and to the human lens capsule.

Research paper thumbnail of Results of Bilateral Cataract Extraction with Posterior Chamber Intraocular Lens Implantation in Children

Ophthalmology, 1997

A retrospective study was undertaken to evaluate long-term anatomic and visual outcomes in eyes o... more A retrospective study was undertaken to evaluate long-term anatomic and visual outcomes in eyes of children who underwent bilateral intraocular lens implantation. The study design was a review of medical records of 24 children operated on for bilateral cataracts and posterior chamber-intraocular lenses. Twenty-four children operated on for bilateral cataracts by 1 surgeon between February 1980 and February 1995 were studied. Cataract extraction with bilateral posterior chamber-intraocular lens implantation was performed. Best-corrected visual acuity, visual acuity without correction, intraocular pressure, manifest refraction, and any intraoperative or postoperative complications were measured. At last follow-up (mean follow-up, 50.8 months; range, 10-149 months), the intraocular lens was in good position and the intraocular pressure was normal without medication in all eyes. Four years after surgery, 79.2% (19 of 24) of first eyes achieved a best-corrected visual acuity of 20/40 or better compared to 66.7% (16 of 24) of second eyes. No eye had any loss in best-corrected visual acuity. In first eyes of 3- to 8-year olds at the time of surgery, 73.3% (11 of 15) achieved a spherical equivalent within 2 diopters of the intended at 4 years after surgery compared to 80% of second eyes. In the 9- to 18-year-old group, 88.9% (8 of 9) of first eyes and 100% of second eyes achieved a spherical equivalent within 2 diopters of the intended at 4 years after surgery. Intraoperative and postoperative complications were minimal. Long-term anatomic and visual results have been gratifying in this series of patients with bilateral implants.

Research paper thumbnail of The SERIES clinic: an interdisciplinary approach to the management of toxicities of EGFR inhibitors

The journal of supportive oncology, 2006

Page 1. 236 www.SupportiveOncology.net THE JOURNAL OF SUPPORTIVE ONCOLOGY J Support Oncol 2006;4:... more Page 1. 236 www.SupportiveOncology.net THE JOURNAL OF SUPPORTIVE ONCOLOGY J Support Oncol 2006;4:236–238 © 2006 Elsevier Inc. All rights reserved. HOW WE DO IT options with the patient, erlotinib was initiated at 150 mg daily as a single agent. ...

Research paper thumbnail of NCCN Task Force Report: Management of dermatologic and other toxicities associated with EGFR inhibition in patients with cancer

Journal of the National Comprehensive Cancer Network : JNCCN, 2009

This NCCN Task Force Report describes the management of dermatologic and ocular toxicities that o... more This NCCN Task Force Report describes the management of dermatologic and ocular toxicities that occur in patients treated with epidermal growth factor receptor (EGFR) inhibitors. Task force members are from NCCN member institutions and include oncologists, dermatologists, an ophthalmologist, and a mid-level oncology provider. This report describes commonly used therapies that the task force agreed are appropriate standards of care for dermatologic and ophthalmologic toxicities associated with EGFR inhibitors, which generally are supported only by anecdotal evidence. Few recommendations are evidence based; however, some commonly used therapies have data supporting their use. Conclusions from completed clinical trials are generally limited by the small numbers of patients enrolled. The information in this report is based on available published data on treating toxicities associated with EGFR inhibitors, data from treatment of clinically similar toxicities from different etiologies, an...

Research paper thumbnail of Posterior capsule dehiscence during phacoemulsification and manual extracapsular cataract extraction: comparison of outcomes

Journal of cataract and refractive surgery, 2003

To compare the intraoperative behavior and postoperative outcomes of posterior capsule dehiscence... more To compare the intraoperative behavior and postoperative outcomes of posterior capsule dehiscence during phacoemulsification and during manual extracapsular cataract extraction (ECCE). L.V. Prasad Eye Institute, Hyderabad, India. This study was a retrospective chart review of consecutive cases of posterior capsule dehiscence over 2 years in patients having phacoemulsification or manual ECCE. A chi-square test was used for statistical comparison of the results in the 2 groups. In the 127 eyes with posterior capsule dehiscence, the incidence of vitreous prolapse was comparable between the 2 groups (phacoemulsification, 61.6%; ECCE, 62.7%). In the phacoemulsification group, vitreous prolapse occurred more frequently if nuclear fragments were present at the time of posterior capsule dehiscence than if they were present during cortex removal (P =.05). Posterior dislocation of nuclear fragments occurred in 4 eyes in the phacoemulsification group. Increased anterior uveitis in the early po...

Research paper thumbnail of Intraoperative reverse pupillary block during femtosecond laser–assisted cataract surgery in a patient with phacomorphic angle closure

Journal of Cataract & Refractive Surgery, 2014

We report a patient with phacomorphic angle closure having femtosecond laser-assisted cataract su... more We report a patient with phacomorphic angle closure having femtosecond laser-assisted cataract surgery. A staged procedure was followed to achieve mydriasis and deepen the anterior chamber with bisulfate-free epinephrine (epi-Shugarcaine) and an ophthalmic viscosurgical device (OVD) prior to the femtosecond procedure. After the femtosecond laser was docked, the patient complained of discomfort in her eye and intraoperative optical coherence tomography imaging revealed a reverse pupillary block configuration. Software modifications were required to complete the procedure, following which partial OVD removal and anterior tenting of the pupil margin relieved the reverse pupillary block. In the fellow eye, intracameral bisulfate-free epinephrine alone was injected above and below the iris plane for intraoperative mydriasis and to deepen the anterior chamber, which prevented a reverse pupillary block. Neither author has a financial or proprietary interest in any material or method mentioned.

Research paper thumbnail of Autosomal dominant zonular cataract with sutural opacities is as- sociated with a splice mutation in the βA3/A1-crystallin gene

Congenital cataracts constitute a morphologically and genetically heterogeneous group of diseases... more Congenital cataracts constitute a morphologically and genetically heterogeneous group of diseases that are a major cause of childhood blindness. Different loci for hereditary congenital cataracts have been mapped to chromosomes 1, 2, 16, and 17q24. We report linkage of a gene causing a unique form of autosomal dominant zonular cataracts with Y-sutural opacities to chromosome 17q11-12 in a three-generation family exhibiting a maximum lod score of 3.9 at D17S805. Multipoint analysis gave a 1-lod confidence interval of 17 cM. This interval is bounded by the markers D17S799 and D1 7S798, a region that would encompass a number of candidate genes including that coding for PA3/A1-crystallin.

Research paper thumbnail of Customizing femtosecond laser–assisted cataract surgery in a patient with a traumatic corneal scar and cataract

Journal of Cataract & Refractive Surgery, 2014

Research paper thumbnail of Unusual intermediate-term outcome in three cases of limbal autograft transplantation

Ophthalmology, 1999

OBJECTIVE: To report an unusual intermediate-term outcome after limbal autograft transplantation ... more OBJECTIVE: To report an unusual intermediate-term outcome after limbal autograft transplantation for unilateral, severe chemical burns. DESIGN: Case reports of three consecutive cases. PARTICIPANTS: Three patients with a history of chemical burns. The ...

Research paper thumbnail of Chapter 5 Limbal Stem Cells

International Review of Cell and Molecular Biology, 2009

Corneal opacification due to limbal stem cell deficiency (LSCD) is an important cause for ocular ... more Corneal opacification due to limbal stem cell deficiency (LSCD) is an important cause for ocular morbidity, resulting from a number of intrinsic and extrinsic factors. While the extrinsic factors include conditions such as chemical or thermal injuries, intrinsic include dysfunction, or reduction in the number of stem cells either due to pathological changes in autoimmune diseases or secondary to certain clinical conditions such as diabetes, dry eye disorders, or multiple previous eye surgeries. LSCD is characterized by a classic triad of signs-conjunctivalization, neovascularization and decrease in vision. With the increasing knowledge of limbal stem cells, the treatment of this condition has evolved from simple debridement to use of biological materials, direct transplantation of the healthy limbal tissue from the contralateral eye, or allogenic source to the use of cultivated limbal epithelial sheets. This chapter provides an update on the disease pathology, various treatment methodologies, with specific emphasis on the fast developing field of cell therapy and tissue engineering.

Research paper thumbnail of Results of a Prospective Evaluation of Three Methods of Management of Pediatric Cataracts

Ophthalmology, 1996

Although a variety of approaches to manage cataracts in children have been studied, no consensus ... more Although a variety of approaches to manage cataracts in children have been studied, no consensus exists on the optimum approach. The authors, there fore, conducted a prospective, nonrandomized, consecutive study to evaluate three most commonly adopted methods of management of pediatric cataracts.

Research paper thumbnail of When may the posterior capsule be preserved in pediatric intraocular lens surgery?

Ophthalmology, 2002

To refine indications for primary posterior capsulotomy (PPC) in conjunction with posterior chamb... more To refine indications for primary posterior capsulotomy (PPC) in conjunction with posterior chamber intraocular lens (PCIOL) implantation for cataract in childhood. Noncomparative case series. Patients 1 to 13 years old who underwent cataract extraction with intent to preserve the posterior lens capsule and PCIOL implantation between January 1992 and December 1998 at a pediatric hospital. Medical records were reviewed to determine the frequency and timing of posterior capsule opacification (PCO) after PCIOL surgery with preservation of an intact posterior capsule. Comparison of pseudophakic PCO rates for groups defined by age and several possible risk factors. Assessment of safety and efficacy for PPC with anterior vitrectomy performed through a limbal incision in cases where the posterior capsule could not be preserved. Need for neodymium:yttrium-aluminum-garnet laser capsulotomy or surgical membranectomy to treat PCO. PCO occurred in 40% of 30 eyes with intact posterior capsule. Mean follow-up duration was 22 months for eyes that had PCO develop and 24 months for those in which the posterior capsule remained clear. Laser capsulotomy was required for 64% of 14 eyes in the 1- to 6-year-old age range but for only 19% of 16 in the 6- to 13-year-old range (P < 0.05). Mean time from surgery to PCO was 7 months for the younger group and 13 months for the older group. A need for repeated capsulotomy (one eye) or membranectomy with anterior vitrectomy (two eyes) was found only in the younger age group. There was no association of PCO with trauma history, cataract type, residual lens cortex, IOL position, or postoperative fibrin clot. Final vision was possibly compromised as a result of PCO in one eye with amblyopia. None of 24 eyes in which PPC with anterior vitrectomy was performed out of intraoperative necessity before primary PCIOL implantation had secondary opacification develop. No reduction in postoperative vision was attributable to PPC. PPC seems to be advisable for children less than 6 years old when cataract extraction with PCIOL implantation is performed. Preservation of the posterior capsule remains appropriate for older children with pseudophakia.

Research paper thumbnail of Intraoperative vertical gas breakthrough during clear corneal incision creation with the femtosecond cataract laser

Journal of Cataract & Refractive Surgery, 2014

We report the occurrence and management of intraoperative vertical gas breakthrough during clear ... more We report the occurrence and management of intraoperative vertical gas breakthrough during clear corneal incision creation with the femtosecond laser (Catalys) in 2 patients. Both eyes were managed by creation of a keratome incision, and the surgery was completed uneventfully. There were no postoperative complications. We believe that wound architecture and corneal clarity in the area of wound creation predispose to the occurrence of vertical gas breakthrough. Careful inspection of wound integrity can provide clues to an incomplete wound. Neither author has a financial or proprietary interest in any material or method mentioned.

Research paper thumbnail of Incomplete capsulotomy using femtosecond laser with a pupil expansion device

Journal of Cataract & Refractive Surgery, 2014

Research paper thumbnail of Use of preservative-free lidocaine for cataract surgery in a patient allergic to “caines”

Journal of Cataract & Refractive Surgery, 2005

Although many patients have been labeled allergic to local anesthetics (LAs), true allergic react... more Although many patients have been labeled allergic to local anesthetics (LAs), true allergic reactions to LAs are rare. An 81-year-old woman with a history of procaine (Novocaine) allergy presented for cataract surgery. Skin testing showed sensitivity to amide and ester LAs. Further testing with preservative-free lidocaine was negative, suggesting the patient was allergic to ester LAs and preservatives found in amide anesthetic preparations. Cataract extraction was subsequently and uneventfully performed in both eyes with topical anesthesia using preservative-free lidocaine. Refract Surg 2005; 31:848-850 ª 2005 ASCRS and ESCRS

Research paper thumbnail of Heparin-surface-modified intraocular lenses in pediatric cataract surgery: Prospective randomized study

Journal of Cataract & Refractive Surgery, 1999

To evaluate the performance of heparin-surface-modified (HSM) intraocular lenses (IOLs) in pediat... more To evaluate the performance of heparin-surface-modified (HSM) intraocular lenses (IOLs) in pediatric eyes after cataract surgery. L.V. Prasad Eye Institute, Hyderabad, India. This prospective, randomized, double-masked, controlled clinical trial comprised 90 children aged 2 to 14 years with cataract. The patients were consecutively randomized to receive an HSM (Group 1) or an unmodified (Group 2) poly(methyl methacrylate) (PMMA) IOL. Extracapsular cataract extraction (ECCE) with IOL implantation was performed in children 8 years and older and ECCE with primary posterior capsulotomy, anterior vitrectomy, and IOL implantation in children younger than 8 years. Outcome parameters were inflammatory cell deposits on the IOL surface, posterior synechias, and anterior chamber reaction. Follow-up data were available for 73, 70, 60, and 68 patients at 1 week, 1 month, 3 months, and 6 months, respectively. Significantly fewer cell deposits were noted in Group 1 at 1, 3, and 6 months (P < .001). Synechia formation and anterior chamber reaction were comparable in the 2 groups. The lower incidence of inflammatory cell deposit formation in eyes with HSM PMMA IOLs indicates that these IOLs have greater bicompatibility than unmodified IOLs in pediatric cataract surgery.

Research paper thumbnail of Acute suprachoroidal hemorrhage during clear corneal phacoemulsification using topical and intracameral anesthesia

Journal of Cataract & Refractive Surgery, 2003

Shallowing of the anterior chamber and hardening of the eye occurred just before commencement of ... more Shallowing of the anterior chamber and hardening of the eye occurred just before commencement of irrigation/aspiration of cortex in an 80-year-old man having temporal clear corneal cataract surgery under topical and intracameral anesthesia. Nucleus removal had been completed and was uneventful. Intraoperative fundus examination with the indirect ophthalmoscope disclosed a choroidal hemorrhage. The wound was immediately closed with sutures, and intravenous mannitol was administered. The hemorrhage remained localized. The red reflex remained unchanged at all times, and there was no prolapse of intraocular contents. A high index of suspicion is critical to the early diagnosis and management of choroidal hemorrhage.

Research paper thumbnail of Predictive formula for calculating the probability of LASIK enhancement

Journal of Cataract & Refractive Surgery, 2004

Purpose: To develop a formula to predict a patient's need for laser in situ keratomileusis (LASIK... more Purpose: To develop a formula to predict a patient's need for laser in situ keratomileusis (LASIK) enhancement.

Research paper thumbnail of Posterior capsule dehiscence during phacoemulsification and manual extracapsular cataract extraction: comparison of outcomes

Journal of Cataract & Refractive Surgery, 2003

To compare the intraoperative behavior and postoperative outcomes of posterior capsule dehiscence... more To compare the intraoperative behavior and postoperative outcomes of posterior capsule dehiscence during phacoemulsification and during manual extracapsular cataract extraction (ECCE).

Research paper thumbnail of Capsular bag distension after optic captureof a sulcus-fixated intraocular lens

Journal of Cataract & Refractive Surgery, 1999

Capsular bag distension from occlusion of the circular anterior capsule opening by the intraocula... more Capsular bag distension from occlusion of the circular anterior capsule opening by the intraocular lens (IOL) optic is a rare complication of capsulorhexis. The nature and source of fluid remain unclear. We report a case of capsular bag distension in an eye with an optic-captured, all-poly(methyl methacrylate), sulcus-fixated IOL. The fluid behind the IOL optic was visible on the first postoperative day and resolved spontaneously by the sixth postoperative week. We believe that retained viscoelastic material in the capsular bag was a major contributor to the fluid.

Research paper thumbnail of Silicone oil adhesion to intraocular lenses: An experimental study comparing various biomaterials

Journal of Cataract & Refractive Surgery, 1997

To perform an in vitro experimental study comparing the degree of adherence of silicone oil to va... more To perform an in vitro experimental study comparing the degree of adherence of silicone oil to various rigid and foldable intraocular lens (IOL) designs and to the human lens capsule.