Jesse Pelletier

Surgical and refractive outcomes of cataract surgery with toric intraocular lens implantation at a resident-teaching institution.

PURPOSE: To evaluate the refractive and surgical outcomes of cataract surgery with toric intraocular lens (IOL) implantation performed at a teaching institution. SETTING: Miami Veterans Affairs Medical Center, Miami, Florida, USA. DESIGN: Retrospective case series. METHODS: All data were obtained by a retrospective chart review and entered into a standard computerized database for analysis. Main outcome measures included refractive and surgical outcomes after Acrysof toric IOL placement, including the deviation from the expected spherical and cylindrical correction and the incidence of ocular complications. RESULTS: The study comprised 94 eyes (80 patients). The mean deviation from the anticipated spherical correction (94 eyes) was +0.06 diopter (D) ± 0.8 (range −2.6 D to +3.6 D), with 80% of eyes achieving a spherical equivalent within ±1.00 D of the target refraction. The postoperative refractive cylinder was significantly reduced from baseline, with 79% of eyes having at least a 0.50 D improvement in astigmatism after surgery (P<.0005). The mean deviation from the anticipated refractive cylinder (85 eyes) was −0.48 ± 1.2 D (range −5.0 to +2.8 D). The IOL was placed in an incorrect position in 2 patients, requiring a reoperation with IOL rotation into the proper axis. The mean follow‐up was 7 months (range 1 to 28 months). CONCLUSION: The added complexity associated with toric IOL placement resulted in spherical and astigmatic improvements without compromising patient safety beyond a level inherent in resident‐based cataract surgery. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

In vitro efficacy of a povidone-iodine 0.4% and dexamethasone 0.1% suspension against ocular pathogens

PURPOSE: To assess the efficacy of a povidone–iodine 0.4%–dexamethasone 0.1% suspension against bacterial, fungal, and Acanthamoeba clinical isolates. SETTING: Bascom Palmer Eye Institute, McKnight Research Building, Miami, Florida, USA. DESIGN: Experimental study. METHODS: One hundred milliliters of 104 colony‐forming units/mL of ocular isolates of methicillin‐resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Serratia marcescens, Candida albicans, Fusarium solani, and Acanthamoeba castellanii were inoculated into 100 μL of a povidone–iodine 0.4%–dexamethasone 0.1% suspension in a 96‐well microtiter plate incubated at room temperature. Organism viability was assessed at 15, 30, and 60 seconds by removing 10 μL aliquots and streaking onto a 5.0% sheep blood agar plate (fungi and bacteria) and agar‐agar (Acanthamoeba) using a 0.001 calibrated loop. The plates were then incubated at 35°C and monitored for up to 7 days. Isolates were inoculated into 200 μL of trypticase soy broth as controls. The number of colonies was counted and compared with controls to determine the kill rate. RESULTS: A 99.9% kill was observed for MRSA, P aeruginosa, S marcescens, and C albicans after 15 seconds of exposure and for F solani after 60 seconds. Acanthamoeba castellanii cyst viability was not inhibited by exposure to the povidone–iodine and dexamethasone suspension. Organism growth was achieved on all control broth. CONCLUSIONS: Povidone–iodine 0.4%–dexamethasone 0.1% suspension killed all bacterial and candida isolates within 15 seconds of exposure. It killed Fusarium isolates at 60 seconds but was ineffective against Acanthamoeba cysts. Financial Disclosure: Drs. Pelletier and Miller have no financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Brevundimonas vesicularis keratitis after laser in situ keratomileusis

A 45-year-old woman developed a corneal infiltrate 14 months after laser in situ keratomileusis (LASIK) enhancement in the left eye. The LASIK flap was lifted, scraped, and irrigated with fortified vancomycin and ceftazidime. Scraped samples were cultured and grew Brevundimonas vesicularis. The patient remained on topical ceftazidime until improvement was noted and was then switched to topical levofloxacin. The keratitis resolved on antibiotic agents with strong gram-negative coverage and a steroid. To our knowledge, this is the first report of a B vesicularis ocular infection.

Agreement Between Pentacam and IOLMaster in Patients Undergoing Toric IOL Implantation

PURPOSE To investigate inter-device agreement between the Pentacam (Optikgerate GmbH, Wetzlar, Germany) and IOLMaster (Carl Zeiss Meditec, Jena, Germany) in measuring corneal power, cylinder, and axis of astigmatism. METHODS Retrospective case series reviewing the status of eyes after toric IOL implantation to evaluate inter-device agreement in measuring corneal power, cylinder, and axis of astigmatism. RESULTS Forty-nine eyes from 41 patients were evaluated. Agreement for corneal power and cylinder were deemed good and moderate, with 95% limits of agreement of -1.02 to +1.13 and -1.37 to +1.09 diopters (D), respectively. Agreement for axis of astigmatism was only fair, with a mean absolute difference of 8.9 degrees (range: 0.3 to 37.7 degrees, standard deviation: 8.79 degrees). Thirty percent of eyes had a 10-degree or greater difference in axis measurements, and 13% of eyes had a 20-degree or greater difference in measurements. Analysis by multivariate logistic regression showed higher cylinder powers associated with discrepant corneal power measurements (odds ratio: 3.46, P = .02), and increasing age was associated with discrepant axis measurements (odds ratio: 1.09, P = .03). Overall, there was no significant difference in accuracy predicting postoperative spherical equivalent refraction. CONCLUSIONS Pentacam and IOLMaster agree well for corneal power but less so for cylinder and axis of astigmatism and thus cannot be used interchangeably.

Molluscum Contagiosum Viral Infection Treated With a Dilute Povidone-Iodine/Dimethylsulfoxide Preparation.

IntroductionMolluscum contagiosum is a viral infection of the skin that is spread from direct contact, either via person to person by touching affected lesions or innocuously via fomites. The condition is often socially stigmatizing, motivating patients to seek treatment. There are many anecdotal remedies, but none have been overwhelmingly effective in controlled clinical trials.Case ReportA 16-year-old girl presented with approximately 75 lesions on her inner thighs as a result of friction from an athletic uniform. She tried over-the-counter antibiotic ointment and topical steroids for several weeks without improvement, and was concerned at the rate of spread of the lesions, along with the social implications.ConclusionThe topical povidone-iodine/dimethylsulfoxide system is very effective in eradicating molluscum contagiosum. This novel combination warrants further investigation in randomized, controlled trials to further elucidate its clinical utility.

Rosacea Blepharoconjunctivitis Treated with a Novel Preparation of Dilute Povidone Iodine and Dimethylsulfoxide: a Case Report and Review of the Literature

IntroductionPovidone iodine (PVP-I) 10% aqueous solution is a commonly utilized anti-septic employed for sterilization of the ocular surface prior to interventional procedures. Dimethylsulfoxide (DMSO) is a well-known skin penetration agent scarcely utilized in ophthalmic drug formulations. We describe here a low-dose formulation of 1% PVP-I (w/w) in a gel containing DMSO for use in the setting of recalcitrant rosacea blepharoconjunctivitis. A review of the ocular uses of dimethylsulfoxide is also presented.Case reportA 78-year-old male presented with chronic, long-standing blepharitis involving both the anterior and posterior lid margins. Posterior lid and skin inflammatory changes were consistent with ocular rosacea. Previous oral and topical therapies had been largely ineffective at controlling his condition.ConclusionThe topical PVP-I/DMSO system was effective in abating the signs and symptoms of rosacea blepharoconjunctivitis. Further investigation of this novel agent is warranted.

Chemotherapy-associated paronychia treated with 2% povidone–iodine: a series of cases

Background Nail changes are known to occur during the use of chemotherapy for a variety of malignancies, particularly those treated with taxanes and EGFR inhibitors. There are currently no actively recruiting prospective clinical trials investigating potential treatments. There are also no US Food and Drug Administration-approved medical treatments for chemotherapy-associated paronychia and no consensus on the best way to treat these common chemotherapy-induced events. Methods A retrospective review of all cases presenting to a single dermatology private practice from June 2016 to January 2017 identified nine patients with chemotherapy-associated paronychia seeking treatment. Each patient was prescribed a topical solution comprised of 2% povidone–iodine in a dimethylsulfoxide vehicle that was prepared by a licensed compounding pharmacy. Patients were seen at 3 week and 6 week follow-up visits. Results All 9/9 patients demonstrated complete or partial resolution. The number of nails involved for each patient ranged from 4–12. There were a total of 58 nails affected in the case series, and 44/58 (76%) resolved overall. The treatment was well tolerated. Conclusion The topical povidone–iodine/dimethylsufoxide solution described is very effective in alleviating the signs and symptoms of paronychia associated with chemotherapy. This novel combination warrants further investigation in randomized, controlled trials to further elucidate its clinical utility.

Demodex Blepharitis Treated with a Novel Dilute Povidone-Iodine and DMSO System: A Case Report

IntroductionPovidone-iodine aqueous solution is an antiseptic commonly used in ophthalmology for treatment of the ocular surface. Dimethylsulfoxide (DMSO) is a well-known skin penetration enhancer that is scarcely utilized in ophthalmic drug formulations. We describe here a low-dose formulation of 0.25% PVP-I in a gel containing DMSO for the treatment of Demodex blepharitis.Case ReportA 95-year-old female presented with chronic blepharitis involving both the anterior and posterior eyelid margins. The anterior eyelid margins demonstrated pathognomonic features consistent with Demodex infection, and this diagnosis was confirmed with microscopy. Previous traditional therapies had been ineffective at controlling her signs and symptoms.ConclusionThe topical PVP-I/DMSO system was effective at treating the signs and symptoms of Demodex blepharitis. Further investigation of the novel agent is warranted.