George M. Bohigian

Case-control study of endophthalmitis after cataract surgery comparing scleral tunnel and clear corneal wounds.

PURPOSEnTo study the possible association between clear corneal incision with or without placement of a suture during cataract extraction and postoperative endophthalmitis.nnnDESIGNnRetrospective, comparative, case-controlled study.nnnMETHODSnThirty-eight patients treated for culture-positive, acute post-cataract surgery endophthalmitis, and 371 randomly selected control patients who underwent uncomplicated cataract surgery in the referring community were studied. Incision type and use of suture during cataract surgery of endophthalmitis patients were compared with the controls. The data were analyzed using logistic regression methods.nnnRESULTSnOf the 38 patients with endophthalmitis, 17 patients (45%) had clear corneal incisions and 21 patients (55%) had a scleral tunnel incision. In 371 controls, 76 patients (20%) had clear corneal incisions and 295 patients (80%) had scleral tunnel incisions. Clear corneal incision was associated with a threefold greater risk of endophthalmitis than was scleral tunnel incision (Odds Ratio, 3.36, 95% Confidence Interval = 1.67 to 6.78). The type of incision was significant (chi(2) = 11.53, P =.0007); a clear corneal incision was more frequently associated with endophthalmitis. A subgroup analysis revealed that the presence or absence of a suture was not significant (chi(2) = 1.31, P =.2524).nnnCONCLUSIONSnIn this retrospective, case-controlled study, clear corneal incisions were found to be a statistically significant risk factor for acute post-cataract surgery endophthalmitis when compared with scleral tunnel incisions.

Factors Associated With a Poor Visual Result in Endophthalmitis

In a retrospective study of 82 cases of endophthalmitis treated between 1976 and 1982 at Barnes Hospital-Washington University, St. Louis, Missouri, 51 (62%) cases were culture-proven. Forty-nine (60%) were associated with cataract extraction, 16 cases (20%) were associated with trauma, and 17 cases (20%) were associated with other events. Sixty-four patients (78%) had undergone neither anterior chamber nor vitreous paracentesis before referral. Seventeen of the 51 culture-proven cases were initially thought to be sterile inflammatory responses and not infectious by the referring ophthalmologist. A poor visual result (visual acuity of less than 20/400) was associated with positive cultures, accidental trauma, virulent organisms, poor initial visual acuity, or a combination of these.

Complications of Retained Nuclear Fragments in the Anterior Chamber After Phacoemulsification With Posterior Chamber Lens Implant

PURPOSEnWe report two cases in which retained nuclear fragments in the anterior chamber after phacoemulsification and posterior chamber lens implant resulted in intraocular complications.nnnMETHODSnCase reports.nnnRESULTSnIn two eyes of two patients, retained nuclear fragments resulted in minimal anterior chamber reaction but substantial corneal edema and reduced visual acuity. Topical anti-inflammatory medications did not alter the postoperative course. Improvement occurred only when the nuclear fragments were surgically removed.nnnCONCLUSIONSnRetained nuclear fragments in the anterior chamber can cause corneal edema and reduced vision that may be reversed by removing the fragments.

Management of Infections Associated with Soft Contact Lens

This study suggests that there is a higher incidence of infectious corneal ulcers with soft contact lenses than with hard contact lenses. Pseudomonas aeruginosa was the most commonly identified organism associated with soft contact lens corneal ulcers. Early and aggressive management can improve the prognosis of this disease. A plan of therapy and management is recommended and discussed.

An Ancient Eye Test—Using the Stars

Vision testing in ancient times was as important as it is today. The predominant vision testing in some cultures was the recognition and identification of constellations and celestial bodies of the night sky. A common ancient naked eye test used the double star of the Big Dipper in the constellation Ursa Major or the Big Bear. The second star from the end of the handle of the Big Dipper is an optical double star. The ability to perceive this separation of these two stars, Mizar and Alcor, was considered a test of good vision and was called the test or presently the Arab Eye Test. This article is the first report of the correlation of this ancient eye test to the 20/20 line in the current Snellen visual acuity test. This article describes the astronomy, origin, history, and the practicality of this test and how it correlates with the present day Snellen visual acuity test.

Francis I. Proctor, MD and his wife Elizabeth C. Proctor: Their lives and legacy

The Francis I. Proctor Foundation for Research in Ophthalmology is internationally recognized for its research in the fields of ocular inflammatory and infectious diseases. Although the name of one of its founders, Francis I. Proctor, MD (1864–1936) is memorialized, the legacy of his wife, Elizabeth C. Proctor (1882–1975) is not as well known. They were both full partners in this endeavor. Francis, a successful and wealthy ophthalmologist, retired to Santa Fe, New Mexico. After their marriage, they became interested in the problem of blinding trachoma, then an endemic problem on the Native American Indian reservations. The couple selected Phillips Thygeson, MD (1903–2002), a young ophthalmologist with an interest in infectious diseases, as their lead investigator. Using their own funds, the Proctors paid for Thygeson and themselves to study trachoma in Egypt, and then establish a trachoma research laboratory in Arizona where the causative agent of trachoma was identified. Not only did the Proctors fund these studies, they also studied bacteriology so they could help in the laboratory themselves. After Francis’ death, Elizabeth endowed the Foundation in 1947 and continued to support it. She also established the Proctor Medal for The Association for Research in Vision and Ophthalmology.