Anthony Maloof

Selective and specific targeting of lens epithelial cells during cataract surgery using sealed-capsule irrigation

We describe the technique of sealed capsule irrigation, which aims to reduce posterior capsule opacification and better control lens epithelial cell activity.

Medpor porous polyethylene implants in orbital blowout fracture repair.

Purpose Various materials are used in orbital blowout fracture repair. We describe a series of patients with orbital blowout fractures that were repaired using porous polyethylene (Medpor) sheets.Methods A non-comparative interventional case series is described of 30 blowout fractures of 30 patients aged 7-60 years (median 29 years) who underwent orbital blowout fracture repair with Medpor sheets. The mean follow-up was 19.1 months (minimum 5 months). The indication for surgery in 6 cases was non-resolving diplopia. The remaining 24 cases had surgery for enophthalmos. Ten cases underwent primary or secondary hydroxyapatite orbital implantation at the same time as orbital floor blowout fracture repair. Data were collected on postoperative motility and diplopia, enophthalmos, cosmesis, complications and re-operations.Results In no case was diplopia worsened by blowout fracture repair. Where surgery was performed for the correction of enophthalmos, late surgery did not compromise the surgical results. There were no intraoperative complications. The one major complication was a case of recurrent implant infections leading to implant removal. There were 3 minor postoperative complications: 2 cases of postoperative infraorbital anaesthesia and one case of a palpable titanium screw. Re-operations were performed for pre-existent diplopia, lid laxity, socket abnormalities and mid-facial deformities. None of these arose from the blowout fracture repair.Conclusions The study suggests that in orbital blowout fracture repair Medpor implants are safe and effective with few complications. Late surgery for enophthalmos is technically more difficult but is not associated with poorer functional or cosmetic results.

The maximal Hughes procedure.

Purpose To describe the use of oblique medial and lateral periosteal flaps with the Hughes tarsoconjunctival flap for the repair of maximal defects of the lower eyelid. Methods A small prospective case series of eight patients requiring lower eyelid reconstruction following with maximal defect of the lower eyelid. The patients underwent a Hughes tarsoconjunctival advancement combined with oblique medial and lateral periosteal flaps, and were assessed for aesthetic outcome and surgical complications. Results All patients had uncomplicated surgery. Outcomes assessed included corneal protection, eye closure, lower eyelid retraction, complications, and patient satisfaction. Eyelid contour and protection was excellent in all patients. Postoperatively, one patient had mild lower eyelid retraction, and in a second patient, medial ectropion with mild lower eyelid retraction developed that required subsequent revision. Conclusions The maximal Hughes procedure is a safe and effective procedure that may be performed with patients under local anesthesia and may avoid the need for more extensive techniques for surgical repair of maximal defects of the lower eyelid.

Endocrine mucin-producing sweat gland carcinoma: report of a case and review of the literature

Abstract:  Mucinous carcinoma of skin (MCS) is an uncommon adnexal tumor of disputed differentiation. In 1995, Rahilly et al. reported a case of MCS with neuroendocrine differentiation (E‐MCS). 1 Since that report, seven additional cases have been published. Here, we report on a case of E‐MCS and discuss the differential diagnoses.

Water-mediated lysis of lens epithelial cells attached to lens capsule

Purpose: To investigate the effect of distilled deionized water (DDW) on lens epithelial cells (LECs) attached to the lens capsule. Setting: Wound Healing Research Laboratory, Center for Vision Research, Westmead Hospital, Sydney, NSW, Australia. Methods: Anterior capsulotomy specimens taken during routine cataract surgery were divided in half. One half was immersed in DDW and the other half in culture medium (control) for 1 to 5 minutes and photographed at intervals by phase‐contrast microscopy. In further experiments, the capsules were exposed to DDW for 1 or 2 minutes and placed in culture for 1 week to determine whether LECs survive treatment and are capable of repopulating the lens capsule. Results: Distilled‐deionized water induced marked swelling of the cytoplasm within 60 seconds of treatment. At 120 seconds, there was disruption of the plasma membranes, with few intact cells remaining. In the control capsules, confluent monolayers of LECs covered the entire capsule surface with a halo of LECs growing on the surrounding plastic well. Viable LECs were observed in 1 of 3 capsules treated for 1 minute with DDW. These did not reach confluence or grow off the capsule onto the surrounding well. No viable LECs were seen on capsules exposed to DDW for 2 minutes. Conclusions: Short exposure of LECs to DDW induced extensive and rapid cell lysis. Distilled‐deonized water may be a useful agent for instillation in the capsular bag during sealed‐capsule irrigation to prevent posterior capsule opacification.

Postoperative Morganella morganii endophthalmitis associated with subclinical urinary tract infection

We report a case of Morganella morganii acute endophthalmitis following clear corneal phacoemulsification cataract surgery in which a coincident asymptomatic chronic urinary tract infection was detected postoperatively. Morganella morganii is a gram-negative bacillus that inhabits the gastrointestinal tract and is part of the normal fecal flora. It is an opportunistic pathogen usually encountered in postoperative and nosocomial settings, causing urinary tract and wound infections. Chronic urinary tract infection may be a risk factor for postoperative endophthalmitis. A dipstick urinalysis before elective cataract surgery in elderly patients with a history of recurrent urinary tract infections may be considered.

Age-related maculopathy and cataract surgery outcomes: visual acuity and health-related quality of life

PurposeTo assess visual acuity (VA) and health-related quality of life (HRQoL) outcomes in patients with and without age-related maculopathy (ARM) after cataract surgery.MethodsPatients aged 60+ years who had undergone cataract surgery at the Westmead Hospital during 2001–2003 were re-examined 1–3 years after surgery. Tests included VA and assessment of visual- and HRQoL using standardised questionnaires (VF-14, SF-12). Preoperative comorbidity data were collected from medical records. Poor surgical outcomes (VA<6/12; no VA improvement; lowest quintile of VF-14, SF-12 scores) were compared in patients with and without ARM, adjusting for age, sex, preoperative systemic comorbidities, ocular comorbidities and surgical or postoperative complications.ResultsOf 622 surviving patients, 454 (73%) were followed up for a mean period of 2.8 years. Similar proportions with VA≥6/12 were observed in patients with (80.2%) and without (88.8%) pre-existing ARM. Preoperative early ARM was only associated with slightly lower mean VF-14 scores (87.64 with vs92.58 without ARM, P=0.01). Increasing age and preoperative ocular comorbidities were associated with all poor outcomes measured. Low SF-12 scores were associated with preoperative systemic comorbidities.ConclusionOur study documents favourable cataract surgical outcomes 1–3 years after cataract surgery in patients with preoperative ARM.

Systemic and ocular comorbidity of cataract surgical patients in a western Sydney public hospital

Background: This study aimed to assess the frequency of major systemic and ocular comorbidities among cataract surgical patients attending a large general public hospital.

Deep lamellar keratoplasty for pellucid marginal degeneration: review of management options for corneal perforation.

Purpose: To report a case of unilateral corneal perforation associated with pellucid marginal degeneration (PMD) and rapid onset and progression of PMD in the second eye. Both eyes underwent subsequent successful management with deep anterior lamellar keratoplasty (DALK). Methods: Case presentation with corneal topographic correlation, along with the relevant literature pertaining to surgical techniques used in PMD. Results: DALK was undertaken in both eyes with stable improvement in visual outcome and no rejection episode. Conclusions: DALK is a useful surgical alternative in the management of PMD. The technique provides useful visual rehabilitation in patients with PMD even in the presence of previous corneal perforation.

Mycobacterium hemophilum infection presenting as filamentary keratopathy in an immunocompromised adult.

Purpose: To report a case of Mycobacterium hemophilum of the eye. Methods: Case report with pathologic correlation. A 55-year-old Malaysian man with a 3-year history of graft-versus-host disease presented with dry eye and keratopathy. Results: The diagnosis was not initially evident, despite biopsy specimens of the conjunctiva. Definitive diagnosis was made after dermatology consultation suggested a histoid variant of lepromatous leprosy, prompting Ziehl-Neelsen staining of the initial and subsequent conjunctival biopsies with subsequent polymerase chain reaction testing. Anti-M. hemophilum treatment resulted in prompt resolution of ocular signs. Conclusions: Mycobacterium hemophilum is a rare condition, affecting mainly immunocompromised patients. Although filamentary keratopathy has been described as common manifestations of leprosy, to date, no ocular manifestations of M. hemophilum have been described. Conjoint management with infectious disease and clinical microbiology is imperative to ensure accurate diagnosis and appropriate early intervention. The effect of systemic immunosuppression is relevant in such patients.