Abdel H Taguri

Sensitivity and specificity of frequency-doubling technology, tendency-oriented perimetry, and Humphrey Swedish interactive threshold algorithm-fast perimetry in a glaucoma practice.

PURPOSE To evaluate the sensitivity and specificity of the screening mode of the Humphrey-Welch Allyn frequency-doubling technology (FDT), Octopus tendency-oriented perimetry (TOP), and the Humphrey Swedish Interactive Threshold Algorithm (SITA)-fast (HSF) in patients with glaucoma. DESIGN A comparative consecutive case series. METHODS This was a prospective study which took place in the glaucoma unit of an academic department of ophthalmology. One eye of 70 consecutive glaucoma patients and 28 age-matched normal subjects was studied. Eyes were examined with the program C-20 of FDT, G1-TOP, and 24-2 HSF in one visit and in random order. The gold standard for glaucoma was presence of a typical glaucomatous optic disk appearance on stereoscopic examination, which was judged by a glaucoma expert. The sensitivity and specificity, positive and negative predictive value, and receiver operating characteristic (ROC) curves of two algorithms for the FDT screening test, two algorithms for TOP, and three algorithms for HSF, as defined before the start of this study, were evaluated. The time required for each test was also analyzed. RESULTS Values for area under the ROC curve ranged from 82.5%-93.9%. The largest area (93.9%) under the ROC curve was obtained with the FDT criteria, defining abnormality as presence of at least one abnormal location. Mean test time was 1.08 +/- 0.28 minutes, 2.31 +/- 0.28 minutes, and 4.14 +/- 0.57 minutes for the FDT, TOP, and HSF, respectively. The difference in testing time was statistically significant (P <.0001). CONCLUSIONS The C-20 FDT, G1-TOP, and 24-2 HSF appear to be useful tools to diagnose glaucoma. The test C-20 FDT and G1-TOP take approximately 1/4 and 1/2 of the time taken by 24 to 2 HSF.

Bilateral panuveitis: a possible association with Kikuchi-Fujimoto disease

PURPOSE To report a case of necrotizing lymphadenitis caused by Kikuchi-Fujimoto disease, which developed bilateral panuveitis. METHODS A 16-year-old Chinese female with histologically proven Kikuchi-Fujimoto disease developed bilateral panuveitis 2 years after the onset of lymphadenopathy. RESULTS Bilateral panuveitis was successfully treated with topical steroid. Serologic investigations were positive for Epstein-Barr virus antibodies and antinuclear antibodies, but no evidence of systemic disease or other causes of ocular inflammation was found. CONCLUSION Kikuchi-Fujimoto disease may be associated with intraocular inflammation.

Marginal keratitis: an uncommon form of topical dorzolamide allergy

PURPOSE To report a case of marginal keratitis resulting from topical dorzolamide hypersensitivity. METHOD Case report. RESULTS A 68-year-old woman presented with bilateral marginal keratitis 2 weeks after commencing bilateral topical dorzolamide. One week after discontinuation of topical dorzolamide, the patient was asymptomatic with complete resolution of corneal infiltrates. CONCLUSIONS Topical dorzolamide may cause a hypersensitivity reaction in the form of marginal keratitis. Discontinuation of the offending medication should result in complete resolution.

Foreign body reaction with delayed extrusion of ganciclovir implant in a patient with immune recovery vitritis syndrome

PURPOSE To report a case of delayed extrusion of primary ganciclovir implants in a patient with immune recovery vitritis syndrome. METHOD Interventional case report. A 54-year-old HIV positive male patient with immune recovery vitritis syndrome had spontaneous extrusion of bilateral ganciclovir devices 4 years after primary implantation. RESULT The extruded ganciclovir implants were removed from both eyes, and removal was complicated by vitreous hemorrhage in one eye. Histopathological examination of the extruded implant, LE, showed marked inflammation and evidence of foreign body reaction. CONCLUSION Excess inflammation in eyes with immune recovery vitritis syndrome may trigger a foreign body reaction that results in a delayed extrusion of primary ganciclovir implants. The site of ganciclovir implants in patients with immune recovery vitritis syndrome should be regularly inspected for eroding struts to prevent secondary endophthalmitis.

Delayed opacification of a PMMA intraocular lens.

In recent years, several forms of intraocular lens (IOL) opacification have been reported. Hydrophilic acrylic IOLs have been explanted for granulations within their optics, which are thought to be calcific in nature. Central haziness has been noted in early-generation silicone IOLs and more recently in the Hydroview IOL. In addition, surface calcification has been seen in hydrophilic and hydrophobic acrylic IOLs. Opacification of IOLs made of poly (methyl methacrylate) (PMMA), however, is less common. We recently reviewed a 79-year-old man complaining of gradual loss of vision in both eyes and metamorphopsia in the right eye. The patient had had successful small-incision extracapsular cataract surgery in the right eye with implantation of a 3-piece Domilens IOL (PMMA optic) 8 years earlier, followed by a similar procedure using an identical IOL 4 years later. The procedures were uneventful, and there was no report of intraoperative IOL damage. On discharge, visual acuity was limited to 6/12 N8 in both eyes due to coexisting age-related macular degeneration (ARMD) but no IOL abnormality was noted. Our examination revealed a deterioration of visual acuity to 6/24 N18 in the right eye and 1/60 N48 in the left eye with concomitant worsening of the ARMD in both eyes. More surprisingly, discrete white areas of snowflake-like opacification were seen within the substance of the IOL in the left eye. A diffuse central haziness was also noted within the IOL optic (Figure 1, left). The older, identical IOL in the right eye was clear (Figure 1, right). There was no significant posterior capsule opacification in either eye. Serum calcium was checked and found to be normal. We did not think the patient would significantly benefit from IOL explantation as the ARMD in the left eye was particularly advanced. We reported this case to the suppliers of the Domilens PMMA IOL, but they have not yet replied. Trivedi et al. recently described similar snowflake opacification within the substance of PMMA IOLs.

Iris prolapse in small incision cataract surgery

Iris prolapse is a rare complication after small incision cataract surgery. We looked at the possible operative and perioperative factors that might have contributed to this complication in 2 of our patients and in another 10 patients identified through a national questionnaire survey. The details of 12 cases of iris prolapse following small incision cataract surgery are presented. Since iris prolapse may occur in small incision cataract surgery, notably in the presence of certain predisposing factors, extra diligence is required in wound construction and closure in high-risk patients.

Traumatic cataract from asymptomatic nonmetallic foreign body

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Delayed reappearance of a dislocated lens

Intravitreal dislocation of a posterior chamber intraocular lens (PC IOL) is usually precipitated by perioperative damage to the posterior lens capsule and the zonules. The dislocated lens can be repositioned or explanted through a pars plana or limbal approach, with simultaneous or secondary lens implantation. However, it is also possible for a second anterior chamber IOL (AC IOL) to be successfully implanted in the presence of a stable posteriorly dislocated lens. Instability of the dislocated lens may result in significant visual disturbances. The presence of an AC IOL is likely to complicate management of the dislocated PC IOL, and a posterior segment approach is often required. We recently explanted a posteriorly dislocated PC IOL in the presence of a second AC IOL. The patient was a 57-year-old man with a history of repeated head trauma. In 1995, he had retinal detachment surgery in his left eye followed by extracapsular cataract extraction with PC IOL implantation. The IOL was a Pearce tripod lens type with 2 small inferior haptics and a single, large, superior, limb-like haptic (Figure 1 insert). The patient presented to our clinic complaining of pain and blurred vision following further blunt trauma to his left eye. The injury resulted in a posterior capsule rupture and anterior displacement of the lens, with dislocation of its superior haptic into the anterior chamber. The lens flipped over into the inferior vitreous cavity as the superior haptic was disentangled after pupil dilation. The inferior 2 haptics remained anchored to the remains of the capsular bag, preventing total dislocation of the lens into the posterior vitreous and acting as a hinge that resulted in repeated reappearance of the superior haptic in the anterior chamber. Eventually, the lens settled into the inferior vitreous cavity with no further visual disturbance. A second AC IOL (Iolab) was implanted and a peripheral iridectomy performed; the dislocated lens, however, was left undisturbed. The postoperative period was uneventful; visual acuity improved to 6/18. However, 6 months later, the patient presented with a week’s history of deteriorating vision and a dull aching pain in the left eye. This was due to the reappearance of the posteriorly dislocated PC IOL in the pupillary area, with the superior haptic entrapped in the anterior chamber, inducing a high refractive error and elevated intraocular pressure (Figure 1). Another surgical procedure was done, and the dislocated lens was successfully removed through a 7.0 mm limbal incision without disturbing the AC IOL. After acuity in the left eye recovered to 6/18, the patient sustained further ocular trauma, resulting in a traumatic macular hole with subsequent deterioration of acuity to 6/36. The AC IOL, however, remained undisturbed.