Bruno Zuberbuhler

Rotational stability of the AcrySof SA60TT toric intraocular lenses: A cohort study

BackgroundTo evaluate the rotational stability of the three types of AcrySof SA60TT toric intraocular lenses (Alcon, Switzerland) in cataract surgery after the first postoperative week.MethodsA retrospective study of 44 eyes in 33 patients. All patients underwent similar uncomplicated phacoemulsification cataract surgery. Seven eyes with corneal astigmatism of less than 1.5 D were implanted with the AcrySof SA60T3 intraocular lens. Seventeen eyes with astigmatism between 1.5 D and 2.25 D received the SA60T4 intraocular lens, and 20 eyes with more than 2.25 D of corneal astigmatism received the SA60T5 intraocular lens. Intraoperatively, the axis of the toric lens was aligned to the steepest axis of the corneal astigmatism. Main outcome measure was the postoperative position of the lens, assessed at 1 week and 3 months, using a specially designed angle measuring eyepiece for the slit lamp.ResultsThere was no significant difference in the rotational stability of the three types of toric intraocular lenses. Overall, the postoperative rotation was within 5 degrees in 95% and within 2 degrees in 68% of eyes. The mean absolute rotation was 2.2 ± 2.2 degrees. No lens showed more than 9 degrees of rotation, and no lens required secondary repositioning. There was no trend for either clockwise or anti-clockwise rotation. The surgical procedure did not change the corneal astigmatism.ConclusionOnce placed to its position, each of the three types of the AcrySof SA60TT toric intraocular lenses demonstrate rotational stability in the capsular bag.

Retinal straylight and complaint scores 18 months after implantation of the AcrySof monofocal and ReSTOR diffractive intraocular lenses.

PURPOSE To evaluate retinal straylight and patient complaint scores 18 months after implantation with the AcrySof ReSTOR diffractive multifocal intraocular lens (IOL) (Alcon Laboratories Inc). METHODS Retinal straylight was measured with the C-Quant (Oculus Optikgeräte GmbH) system in 40 eyes implanted with the AcrySof ReSTOR IOL (SA60D3) and in 40 eyes implanted with the AcrySof SA60AT monofocal IOL. Complaint scores were assessed by a questionnaire in both groups of patients at three different lighting conditions--day light, dimmed light, and at night. RESULTS Seventy-five percent of eyes (30/40) of the ReSTOR group and 80% of eyes (32/40) of the SA60AT control group showed a retinal straylight value within or better than the normal range. No statistically significant differences between groups were found (P = .790). Patients of the ReSTOR group showed significantly more complaint scores at all assessed lighting conditions: increasing factors were 1.53, 2.02, and 2.66, for day light, dimmed light, and night, respectively (P < .0001). Comparing the amount of straylight, the multifocal group had 20% more straylight, albeit not significant at the 1% level. CONCLUSIONS The AcrySof ReSTOR IOL showed similar retinal straylight values compared to the monofocal IOL. Subjectively, patients with the diffractive IOL claimed significantly more glare for all light conditions, especially at night.

Phacoemulsification in eyes with extreme axial myopia

PURPOSE: To determine the outcomes of phacoemulsification of age‐related cataract in eyes with extreme axial myopia. SETTING: Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. METHODS: This consecutive case series of eyes with an axial length (AL) greater than 30.0 mm was identified retrospectively. Surgical procedure details, complications, and refractive outcome were recorded. The incidence of postoperative retinal detachment (RD) was assessed in a subgroup of eyes without previous RD or vitrectomy. RESULTS: One hundred seventy‐seven eyes (124 patients) were identified from a dataset of 6882 cataract procedures; 21 eyes had previous RD or vitrectomy. Intraoperative complications were posterior capsule tear (5 eyes, 2.8%), zonular dehiscence (3 eyes, 1.7%), and anterior capsule tear (2 eyes, 1.1%). At a median follow‐up of 25.4 months, 2 (1.3%) of 156 eyes without previous RD or vitrectomy developed RD. The median biometry prediction error in the 156 eyes (88.1%) with an intraocular lens (IOL) was 0.88 diopter (D) (range 0.00 to 5.75 D); 83 eyes (53.2%) were within ±1.00 D. The median biometry prediction error was greater in the 61 eyes that received a negative‐power IOL (1.38 D) than in the 95 eyes that received a plano or positive‐power IOL (0.68 D) (P<.001). CONCLUSIONS: The incidence of complications after phacoemulsification in eyes with extreme axial myopia was similar to that in previously reported unselected case series. The refractive outcome showed a hyperopic error that increased with AL, an effect that was primarily the result of the eyes that received a negative‐power IOL.

Acute Dacryocystitis in a 2-Year Old Child Caused by Pantoea

A previously healthy 23-month-old girl was admitted for the management of an acute unilateral dacryocystitis following accidental contact with dog faeces. No periocular trauma was reported. Microbiological investigation showed a multiresistant strain of Pantoea species to be the responsible pathogen. The infection responded to a course of oral Clindamycin and Ciprofloxacin, in combination with Chloramphenicol eye drops. This is the first report of an acute dacryocystitis sustained by this microorganism.

Endogenous Bacterial Endophthalmitis

Endogenous bacterial endophthalmitis (EBE) is due to the haematogenous spread of bacteria into the eye.

Corneal limbal marking in the treatment of myopic astigmatism with the excimer laser.

PURPOSE To determine whether preoperative marking of the limbal cornea improves treatment of myopic astigmatism with the excimer laser. METHODS Retrospective study on 108 eyes with myopic astigmatism that underwent LASIK or laser epithelial keratomileusis (LASEK) with the Technolas 217 (Bausch & Lomb) excimer laser. Preoperative limbal marking was performed in 47 eyes (marked group). The 12-month results were used for refractive and visual analysis. RESULTS The achieved cylinder reduction, spherical reduction, and refractive predictability were similar for the marked and unmarked groups in the overall study collective, in the LASIK and LASEK subgroup analysis, and in a higher astigmatism (> 1.25 diopters) subgroup analysis. Limbal marking showed no influence on the refractive results, and vector analysis showed no significant difference in angle of error among groups. CONCLUSIONS Corneal limbal marking failed to improve the refractive outcome in LASIK and LASEK for myopic astigmatism.

Silicone tube stenting in endonasal dacryocystorhinostomy

We read with interest the recent article from Dr Saeed [1]. The author achieved a remarkable 100 % of success rate following endoscopic dacryocystorhinostomy (EN-DCR) without employing silicone tube stenting. However, he did not report whether they were all primary cases. In fact, whereas avoiding stenting is in line with more recent evidence [2, 3], silicone tubes are often employed in revision DCR [4]. The intended purpose of the article was to propose guidelines as to when employ or not the adjuvant procedure. In particular, the author suggested considering tube stenting for patients with stenosed lacrimal puncti (‘‘second of the clinical criteria’’). In this respect, it has to be highlighted that silicone tubes would not have effect on it, and other procedures such as punctoplasty are to be employed. A nasolacrimal duct obstruction gives indication for DCR, which creates a direct bypass between the lacrimal sac and the nasal cavity, whereas conjunctivorhinostomy must be considered in case of more proximal obstructions [5]. When assessing the effect of any additional procedure or adjuvant on the surgical success rate in EN-DCR, the osteotomy size represents a fundamental factor as it can influence the success rate [4, 6]. Therefore, we would stimulate Dr Saeed to provide some information in that respect. Finally, we would challenge him to agree that proper clinical investigation should be always performed to ascertain the existence of complete lacrimal drainage system and locate the site of obstruction. Probing the lacrimal canaliculi and, particularly, syringing is essential. Easily, a low obstruction is manifested by the fluid regurgitating through the upper punctum and the absence of fluid passed into the nasopharynx. Whereas it is acceptable avoiding instrumental investigations, which could better confirm the diagnosis and exclude the presence of neoplastic etiology, we query why the author considered the simple clinical assessment not required.

Prophylaxis of pseudophakic endophthalmitis

Prophylaxis of pseudophakic endophthalmitis We congratulate Tan et al. for reporting on their experience with antibiotic prophylaxis of pseudophakic endophthalmitis in an Asian population. Given the ethical concerns regarding future randomized trials on this subject, only large retrospective case series can confute or confirm the positive effect of intracameral cephalosporins for pseudophakic endophthalmitis prophylaxis thatwasestablishedby theEuropeanSocietyofCataract & Refractive Surgeons (ESCRS) endophthalmitis prophylaxis study. In Tan et al.s study, of 50177 eyes having cataract surgery, 20638 received intracameral cefazolin. Theauthors founda significantly favorable effect of the intracameral cefazolin bolus over the subconjunctival cefazolin, in line with the results of a similar study. Commendably, the rate of endophthalmitis, already low in the control group (first series), became extremely low in the treated groupdless than 0.01%. For a better understanding of the findings and to enable comparison with the available clinical evidence, the timeframe from surgery should be stated. The study enrolled only eyes with “recent” ocular surgery without quantifying the time from surgery. We remind Tan et al. that a 3-month interval from surgery was the timeframe in the ESCRS study. Wealsoquerytherationale for thesimultaneousadministration of cefazolin and gentamicin. With the spectrum being similar and the safety issues related to gentamicin administered subconjunctivally, as done in the Tan et al. study, is it justifiable to routinely add aminoglycosides only to cover for the very rare Pseudomonas cases? It would be helpful to know whether the authors saw any case of retinal toxicity in their large case series. Besides the absence of information on whether the samples were from aqueous or vitreous taps, we noted that 43% of cultures were negative for bacterial growth, which reinforces the recommendation to use a molecular biology technique for endophthalmitis specimens, as previously suggested.