PubMed Health⌕ Search

Biomedical subjects

Abhay R Vasavada

Publications and source records attributed to Abhay R Vasavada.

10 recordsLinked to original sources
PubMed2003

Randomized, clinical trial of multiquadrant hydrodissection in pediatric cataract surgery.

PURPOSE: Evaluate efficacy of multiquadrant cortical-cleaving hydrodissection in pediatric cataract surgery. DESIGN: Randomized multicenter clinical trial. METHODS: Surgery performed at Iladevi Cataract & IOL Research Center (57 eyes, 42 patients) and Postgraduate Institute of Medical Education and Research (23 eyes, 17 patients). Study population comprised 59 consecutive patients (80 eyes) 12 years old and younger undergoing cataract aspiration. The intervention procedure involving envelope randomization was used to assign patients to multiquadrant cortical-cleaving hydrodissection (HY) (40 eyes), or no hydrodissection (HN) (40 eyes). The main outcome measures were as follows: (1) lens-substance removal time and volume of fluid used and (2) ease of lens substance removal. Presence or absence of residual fibers on the posterior capsule was recorded. RESULTS: The mean +/- standard deviation lens substance removal time was significantly less in the HY group (156.1 +/- 86.8 seconds) than in HN group (210.7 +/- 73.8 seconds; P =.003). Fluid used for lens substance removal was significantly less in the HY (91.0 +/- 47.5 ml) than in the HN group (156.9 +/- 87.2 ml; P <.001). In the HY group, lens substance removal was ranked as easy in 36 eyes (90.0%), average in 2 eyes (5.0%), and difficult in 2 eyes (5.0%). In the HN group, removal was easy in 19 eyes (47.5%), average in 12 eyes (30.0%), difficult in 5 eyes (12.5%), and very difficult in 4 (10.0%) eyes (P =.0005). Residual cortical fibers on the posterior capsule were noted in 12.5% of the HY group and 22.5% of HN group, but the difference was not statistically significant (P =.2). CONCLUSIONS: Multiquadrant cortical-cleaving hydrodissection decreases lens substance removal time, lessens fluid volume used for lens substance removal, and facilitates lens substance removal in pediatric cataract surgery.

Cataract↗
PubMed2003

Corticocapsular adhesions and their effect during cataract surgery.

PURPOSE: To identify the types of corticocapsular adhesions by their preoperative clinical appearance and evaluate the difficulties they pose during cataract surgery. SETTING: Iladevi Cataract & IOL Research Center, Ahmedabad, India. METHODS: Seventy-six eyes with age-related senile cataract scheduled for phacoemulsification were identified as having corticocapsular adhesions. Preoperatively, the eyes were assessed at the slitlamp to determine the type of corticocapsular adhesions present. During surgery, the surgeon graded nucleus rotation after single-site cortical-cleaving hydrodissection as easy, difficult, or not possible. Additional multiquadrant-focal hydrodissection was performed. The surgeon's impressions of the presence of corticocapsular adhesions and visualization of the furry surface of the epinucleus were noted. RESULTS: Corticocapsular adhesions were confirmed in 86.84% of eyes. Equatorial corticocapsular adhesions alone or in combination were present in 72 eyes (94.74%) eyes, anterior corticocapsular adhesions in 40 (52.74%), and posterior corticocapsular adhesions in 42 (56.26%). Rotation of nucleus was not possible in 47.37% eyes, difficult in 39.47%, and easy in 13.16%. CONCLUSIONS: The surgeon should perform a thorough preoperative slitlamp evaluation in extreme gaze with a fully dilated pupil. Equatorial corticocapsular adhesions, which were present in most eyes, made nucleus rotation difficult. Additional multiquadrant and focal cortical-cleaving hydrodissection helped separate the adhesions and achieve successful rotation.

Cataract↗
PubMed2003

Management of bilateral anterior dislocation of a lens in a child with Marfan's syndrome.

A 13-year-old boy with Marfan's syndrome presented with bilateral, acute, complete anterior dislocation of the crystalline lens. The lens substance was aspirated intracapsularly after 2 linear capsulotomies were created. The empty capsular bag was removed from the eye as a vitrectome was used to severe the adhesions between the capsule and vitreous face through 1 paracentesis and a forceps was used to pull the capsule through the other paracentesis. Aphakia was corrected by glasses and contact lenses. Two years after surgery, the best corrected visual acuity was 20/32 in both eyes.

Adolescent↗
PubMed2003

Quality-of-life and visual function assessment after phacoemulsification in an urban indian population.

PURPOSE: To assess patients' quality of life (QoL) and overall visual function (VF) after phacoemulsification with intraocular lens (IOL) implantation in an urban Indian population. SETTING: Iladevi Cataract & IOL Research Center, Ahmedabad, India. METHODS: This prospective study comprised 300 patients with a mean age of 60.8 years +/- 9.2 (SD) who were evaluated preoperatively for visual acuity, QoL, VF, and demographic information. Postoperative evaluations included the same parameters with the addition of patient satisfaction. Also analyzed was the impact on the resumption of routine daily activities and professional work after phacoemulsification. Patients were divided into 2 categories: driving and nondriving. They were also categorized by profession and type and density of cataract. The relationship of patients' characteristics and QoL versus VF was determined by an analysis of variance and 99% confidence intervals. Effect sizes (change/difference / the standard deviation at baseline) were computed for intergroup longitudinal changes and intergroup differences. RESULTS: Correlation analysis showed a highly significant positive correlation between logMAR scores with VF and QoL. Overall, VF changed more significantly than QoL in effect size on all subscales. Postoperatively, 13% of respondents reported difficulty performing routine work; 40% resumed their daily activities within 1 week and 55%, within 1 month. More than 42% resumed professional activities within 1 week after surgery; 53% took 1 week to 1 month. Eight-six percent were fully satisfied with the results of cataract surgery. Overall, 88% reported that VF and QoL were "a lot better" and 10% responded little they were "a little better" than before surgery. CONCLUSIONS: Improvement in health-related QoL and VF occurred within 3 months of cataract extraction. The speed of visual acuity recovery after phacoemulsification matched the improvement across health-related QoL functions, resulting in rapid recovery of the patients' functional independence and health status.

Activities of Daily Living↗
PubMed2003

Step-down technique.

From the beginning of nuclear fragment removal to the end, we progressively reduce all the parameters, ie, energy, vacuum, and aspiration flow rate, in a step-by-step manner proportionate to the posterior capsule exposure. This promotes adaptation of various parameters to the appropriate stages of surgery and allows the trainee and expert surgeon to perform posterior plane phacoemulsification. We recommend this technique for emulsification of dense as well as optimum-grade cataracts.

Drainage↗
PubMed2003

Phacoemulsification in subluxated cataract.

PURPOSE: To evaluate the outcome of phacoemulsification in eyes with subluxated cataract. MATERIALS AND METHODS: This retrospective study comprised 22 eyes of 20 consecutive patients with subluxated cataracts of varying aetiology operated between March 1998 and March 2001. Detailed preoperative assessment included visual acuity (VA), slitlamp examination, presence of vitreous in anterior chamber extent of subluxation, intraocular pressure (IOP) and detailed fundus examination. Phacoemulsification was done to retain the natural bag support and all patients had acrylic foldable Acrysof IOL implantation either in-the-bag or by scleral fixation. Postoperative observations included best-corrected visual acuity (BCVA), IOP, pupillary reaction and the IOL position. RESULTS: The aetiology of the subluxation was traumatic in 11 patients and non-traumatic in 9 patients. Fifteen were males and 5 were females. Mean follow-up was 11.7 +/- 9.71 months (range 4-39). The average age was 39.15 +/- 16.33 (range 5-74). A 2-port anterior chamber vitrectomy was performed in 6 eyes (27.2%). Capsule tension ring (CTR) was implanted in 15 eyes (68.18%). Twelve eyes (54.5%) had in-the-bag implants, while 5 (22.72%) had scleral fixation. The remaining 5 eyes (22.72%) had one haptic in-the-bag and another sutured to sclera. No major intraoperative complications were noted. Twelve eyes (54.5%) had clinically and geometrically well centered IOLs while 9 eyes (40.9%) had geometrically decentered IOLs. One patient was lost to follow-up. Fifteen eyes (55.55%) had postoperative BCVA of 6/12 - 6/6 while 2 eyes (7.40%) had BCVA of 6/18. The remaining 4 eyes (14.81%) had less than 6/24 BCVA due to pre-existing posterior segment pathology. Postoperative complications included rise in IOP in 1 eye (4.54%), pupillary capture of the IOL optic in 2 eyes (9.09%); the same 2 eyes (9.09%) required redialing of IOL. One eye (4.54%) had to undergo refixation (one haptic was fixed to sclera) year after cataract surgery. Postoperative retinal detachment was noticed in one patient after a month of phacoemulsification. CONCLUSION: In subluxated cataracts it is essential to have appropriate parameters depending on the grade of cataract. This contributes to a safe and predictable outcome in subluxated cataract surgery.

Adolescent↗
PubMed2002

Effect of hydrodissection on intraoperative performance: randomized study.

PURPOSE: To evaluate the effect of hydrodissection on intraoperative performance during phacoemulsification of age-related nuclear cataracts. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India, and Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: In a prospective study, 86 eyes were randomly assigned to have multiquadrant hydrodissection (+HD, n = 48) or no hydrodissection (-HD, n = 38) during phacoemulsification of a grade 1 to 3 nuclear cataract. Excluded were patients with grade 4 or 5 nuclear sclerosis, a poorly dilating pupil, or associated ocular/systemic disease. Parameters assessed were nucleus and cortex removal time, the amount of fluid used for cortex removal, and the total amount of fluid used. The ease of nucleus rotation and cortical cleanup was also evaluated and graded subjectively as very easy, difficult, or very difficult. Data were analyzed using the Student t test and the chi-square test. RESULTS: The mean nucleus removal time was 355 seconds +/- 237 (SD) and 474 +/- 212 seconds in the +HD and -HD groups, respectively (P =.09). The mean cortex removal time was significantly less in the +HD group than in the -HD group (79 +/- 51 seconds and 220 +/- 222 seconds, respectively) (P =.007). Significantly less fluid (43%) was used for cortex removal in the +HD group than in the -HD group (mean 70 +/- 45 mL and 123 +/- 82 mL, respectively) (P =.013), and significantly less total fluid (35%) was used in the +HD group (312 +/- 132 mL and 422 +/- 80 mL, respectively) (P =.002). Nucleus rotation was easy in all eyes in the +HD group; 68.43% of eyes in the -HD group failed to achieve rotation (P =.001). Cortex removal was very easy in 52.08% of eyes in the +HD group and easy in 47.90%; it was easy in 52.63% in the -HD group, difficult in 36.84%, and very difficult in 10.52%. CONCLUSION: The use of multiquadrant cortical-cleaving hydrodissection made removal of the lens nucleus and cortex easier and faster during phacoemulsification of age-related nuclear cataracts.

Dissection↗
PubMed2002

Cell response to AcrySof intraocular lenses in an Indian population.

PURPOSE: To evaluate the quantitative cytological response to AcrySof (Alcon) intraocular lenses (IOLs) in an Indian population by studying the incidence, fate, progression, and severity of cell deposits after uneventful phacoemulsification. SETTING: Iladevi Cataract & IOL Research Center, Ahmedabad, India. METHOD: This clinical prospective study comprised 64 eyes of 64 healthy patients with senile cataract and no other ocular pathology having phacoemulsification and implantation of an AcrySof IOL. The eyes were observed for cell deposits. One week and 1, 3, 6, 12, and 15 months postoperatively, specular reflex was obtained by slitlamp biomicroscopy under x 20 magnification to record the incidence, progression, morbidity, and severity of small and large (including giant) cells on the IOLs. RESULTS: The highest incidence of small cells was 18.7%. The cell deposits appeared at 1 week, peaked at 1 month, and were gone after 6 months. The severity was never more than grade 2 (5 to 10 cells). The highest incidence of large cells, including giant cells, was 23.4%. The deposits appeared at 1 month, peaked at 3 months, and were gone after 12 months. The severity was never more than grade 2 (3 to 5 cells). The highest incidence of giant cells was 6.2%. The deposits appeared at 3 months and were gone by 15 months. Severity was never more than grade 1 (2 cells). No IOL had cell deposits at the last follow-up (mean 14 months +/- 3.25 [SD]). CONCLUSIONS: The incidence, and especially the severity, of cell deposits in the Indian population was low. All cell types, including giant cells, disappeared within 12 months. This could reflect the biocompatibility of the AcrySof IOL and the appropriate surgical technique.

Acrylic Resins↗