Nada Jiraskova

Delayed-onset Pseudomonas stutzeri endophthalmitis after uncomplicated cataract surgery

Abstract An 88‐year‐old woman had uneventful extracapsular cataract extraction with posterior chamber intraocular lens (IOL) implantation her right eye. Seven weeks later, an anterior vitrectomy with removal of the IOL was performed because of endophthalmitis resistant to topical and systemic amoxicillin, cephalosporin, aminoglycoside, and steroids. Microbiological examination of the vitreous biopsy, capsule, and anterior chamber fluid disclosed Pseudomonas stutzeri gram‐negative nonfermentative bacteria sensitive to tetracycline, ceftazidime, gentamicin, ofloxacin, and piperacillin. Pseudomonas stutzeri should be considered in the treatment of delayed‐onset endophthalmitis.

Phacoemulsification parameters: series 20000 Legacy Versus Legacy with AdvanTec software and NeoSoniX handpiece.

Purpose: To examine the differences in average phaco power and effective phaco time (EPT) and evaluate the clinical results with the standard Series 20000® Legacy® system (Alcon) and the Legacy with AdvanTec® software and the NeoSoniX® handpiece (Alcon). Setting: Department of Ophthalmology, University Hospital, Hradec Králové, Czech Republic. Methods: The mean phaco power and EPT in 240 eyes of 240 consecutive patients having cataract surgery by a single surgeon using the standard Legacy 20000 system were retrospectively compared with results in 240 eyes of 240 consecutive patients operated on by the same surgeon using the Legacy with AdvanTec software and the NeoSoniX handpiece. Statistical analysis was performed using the Kruskal‐Wallis 1‐way analysis of variance. All chi‐square (&khgr;2) values are approximations. Results: The EPT and mean phaco power were less in the AdvanTec–NeoSoniX group than in the standard Legacy 20000 group in all cases. The mean EPT was 56.9 seconds ± 29.5 (SD) in the standard Legacy 20000 group and 4.2 ± 3.8 seconds in the AdvanTec–NeoSoniX group. The mean phaco power was 19.2% ± 6.2% and 5.1% ± 2.5%, respectively. The difference between groups was statistically significant in EPT (age ≥90 years, &khgr;2 = 4.5, P = .034; age <90 years, &khgr;2>57, P<.00005) and in mean phaco power (&khgr;2 = 4.58 and P = .032 and &khgr;2>44 and P<.00005, respectively). No trace of corneal striae or edema was observed in 92% eyes on the first postoperative day. The best corrected visual acuity was 20/25 or better in 60% of cases. Conclusions: The Legacy system with AdvanTec software and the NeoSoniX handpiece significantly reduced the mean EPT and phaco power. This low‐power technology minimizes intraoperative damage to ocular structures and maximizes the level and rapidity of visual rehabilitation.

Comparison of the effect of AquaLase and NeoSoniX phacoemulsification on the corneal endothelium

PURPOSE: To compare the extent of corneal endothelial cell loss and pachymetry changes in 2 age‐based groups of patients who had cataract removal by AquaLase (Alcon) phacoemulsification in 1 eye and NeoSoniX (Alcon) phacoemulsification in the contralateral eye. SETTING: Department of Ophthalmology, University Hospital, Hradec Králové, Czech Republic. METHODS: This prospective clinical study comprised 28 patients younger than 80 years (Group A) and 28 patients 80 years or older (Group B) with bilateral cataract having lens removal using AquaLase in the right eye and NeoSoniX in the left eye. The nuclei were graded clinically on the basis of hardness. The endothelial cell count (ECC), pachymetry, and best corrected visual acuity (BCVA) were evaluated preoperatively and postoperatively. The mean ECC and pachymetry values (±SD) were calculated in each group, with differences between right and left eyes analyzed using the paired t test. RESULTS: In Group A, the differences in the postoperative changes in ECC and pachymetry between AquaLase and NeoSoniX were not statistically significant. In Group B, there were statistically significant differences in postoperative changes in ECC and pachymetry, with the results better in the AquaLase eyes. The BCVA immediately after surgery was better than preoperatively in all eyes. CONCLUSION: The results suggest that AquaLase cataract extraction is safe for the endothelium, even in older patients with harder cataracts and a lower ECC count preoperatively.

Anterior chamber migration of dexamethasone intravitreal implant (Ozurdex®) through basal iridectomy (Ando) in a pseudophakic patient.

Purpose Intravitreal implantation of dexamethasone implant (Ozurdex®) is being widely used for the treatment of macular edema (ME) after branch or central retinal vein occlusion, diabetic ME, and persistent ME associated with uveitis or Irvine-Gass syndrome. We describe a complication: migration of the dexamethasone implant into the anterior chamber through basal iridectomy (Ando) in a pseudophakic patient with development of corneal edema and secondary high intraocular pressure. Methods This is a case report of migration of Ozurdex® through basal iridectomy in a pseudophakic patient with iris claw lens. Conclusions Pseudophakic patients, with a history of vitrectomy, even those with a basal iridectomy (Ando), are at high risk for migration of the Ozurdex® into the anterior chamber and development of corneal edema.

A survey of intraocular lens explantation : A retrospective analysis of 23 IOLs explanted during 2005

PURPOSE To evaluate the indications, lens styles, perioperative findings, and results of intraocular lens (IOL) explantation or exchange performed in the authors department in 2005. METHODS The retrospective analysis comprised 22 patients (23 eyes). Twenty-one eyes had previous phacoemulsification and IOL implantation, one eye secondary aphakic IOL, and one eye phakic IOL implantation. The indications for IOL explantation/exchange and perioperative complications were evaluated. The best-corrected visual acuity (BCVA) before and after surgery was compared. RESULTS Time from initial surgery to explantation/exchange varied from 1 to 121 months, median value was 46 months. The IOLs were explanted using local anesthesia and in 21 eyes replaced with new lens. Indications for IOL removal were opacification of the IOL in 12 eyes, malposition of the IOL in 5 eyes, postoperative refractive error in 2 eyes, recurrent toxic anterior segment syndrome in 1 eye, pseudophakic dysphotopsia in 1 eye, endothelial cell loss in phakic anterior chamber IOL in 1 eye, and visual discomfort with intraocular telescopic lens in 1 eye. The mean BCVA (decimal scale) before and after IOL explantation/exchange was 0.5620.279 and 0.6270.276, respectively. There was no significant difference in visual acuity before and after IOL exchange (Wilcoxon test). CONCLUSIONS The most frequent indications for IOL explantation/exchange were opacification of the IOL and IOL malposition. Surgeries were uneventful in most cases. Final visual results have been largely good. Long-term follow-up of patients with various types of IOLs should be maintained.

Using corneal confocal microscopy to track changes in the corneal layers of dry eye patients after autologous serum treatment

In vivo corneal confocal microscopy allows the examination of each layer of the cornea in detail and the identification of pathological changes at the cellular level. The purpose of this study was to identify the possible effects of a three‐month treatment with autologous serum eye‐drops in different corneal layers of patients with severe dry eye disease using corneal confocal microscopy.

Microincision 25G pars plana vitrectomy with peeling of the inner limiting membrane and air tamponade in idiopathic macular hole.

Purpose To evaluate the success of a mini-invasive technique for operation of idiopathic macular hole (IMH). Methods We retrospectively examined 29 patients (30 eyes) in whom 25-G pars plana vitrectomy (PPV), peeling of the inner limiting membrane (ILM), and application of air tamponade were performed. The group of the patients included 7 males and 22 females (76%), age range 57-79 years (median 70). The follow-up period was 3-47 months (median 17). Results Pars plana vitrectomy was indicated only in the stages of full-thickness macular hole. Prior to operation, 13 eyes (43%) were in stage 2, 15 eyes (50%) in stage 3, and 2 eyes (7%) in stage 4. The IMH healed in 28 eyes after operation. Persistence of IMH occurred in 2 eyes (7%). After subsequent reoperation with extension of the peeling zone of the ILM and gas tamponade (with 10% C3F8), these macular holes also healed (100%). Prior to carrying out PPV, best-corrected visual acuity (BCVA) ranged between 20/40 and 20/500 (median 20/125). At the end of the follow-up period, BCVA was improved to 20/40 (median). The change in the final BCVA compared to the initial visual acuity was statistically significant (p = 0.008; Wilcoxon). Conclusions The 25-G PPV with peeling of the ILM and air tamponade is an effective technique and presents no increased risks in comparison with routine procedures. The main benefit of the intervention is its good tolerance by the patient, particularly with respect to painfulness and postoperative irritation.

The natural evolution of idiophatic epimacular membrane

BACKGROUND AND AIMS Epiretinal membrane (ERM) refers to a semi-translucent tissue layer found on the inner surface of the retina especially in older people. Surgical treatment remains controversial, optimal timing for such treatment is difficult to determine and data on the natural evolution of this disorder are limited. In this study we evaluated the natural course of idiopathic epimacular membrane in 49 patients (53 eyes). MATERIALS AND METHODS Retrospective evaluation of a group of 49 patients (53 eyes) with idiopathic epimacular membrane confirmed by biomicroscopy, photography and optical coherence tomography (OCT). RESULTS Patient age ranged from 51-85 years (median 72). The average follow-up was 21.3 months (± 14). Between the initial and final best corrected visual acuity (BCVA) there was no statistically significant difference although there was a significant tendency to decrease in BCVA (Spearman P=0.05) during the follow-up. Initial BCVA correlated with initial central retinal thickness (CRT), final CRT, final volume, and age. The final BCVA significantly correlated with all parameters measured. CONCLUSION BCVA during follow-up tended to decrease: difference of starting BCVA and final BCVA values depending on the time of monitoring is significant. This we attribute to a slow gradual progression of macular changes. But, initial and final BCVA measurements were not substantially different at the end. Thus, in the absence of any clear signs of ERM progression, we can safely postpone the decision whether to perform PPV.

Transient branch retinal artery occlusion in a 15-year-old girl and review of the literature.

BACKGROUND Retinal artery occlusion is an extremely rare diagnosis in the pediatric population and the etiology with risk factors of retinal artery occlusion are poorly understood in younger individuals. METHODS AND RESULTS This case report a rare case of transient branch retinal artery occlusion (BRAO) in a healthy young girl. A fifteen-year-old girl presented with painless decreased vision in her right eye. Fundus examination revealed in the right eye intensive edema of the part of superior half of the retina, but the vessels were absolutely normal. She was hospitalized for diagnosis and treatment. A thorough workup was performed to determine any etiologic factor. Her physical examination was normal, but from anamnesis has been found that patient began use oral contraception at the time of occurrence eye problems. The condition is evaluated as transient branch retinal artery occlusion by the course of the disease. The paper includes the review of the literature also. CONCLUSION Though retinal arterial obstruction is rare in the pediatric population, this case highlights the importance of including this in the differential diagnosis of acute vision loss.

Migration of emboli in the retinal artery: case report

Branch retinal artery occlusion (BRAO) is a prevalent vascular occlusive disorder of the eye. In transient BRAO, an embolus temporarily blocks the vessel and then moves on resulting in recovery of blood circulation. In this case, we have documented migration of the embolus with recovery of perfusion of the retina and improvement of visual acuity in a patient with transient BRAO. Early diagnosis and fast action are important in the case of patients with retinal artery occlusion.