Neil Sharma

Zoledronic Acid Infusion and Orbital Inflammatory Disease

A 57-year-old man presented with a 4-day history of increasing orbital pain and swelling in the right eye. A diagnosis of orbital inflammatory disease due to bisphosphonate infusion was made.

Patient perceptions of second eye clear corneal cataract surgery using assisted topical anaesthesia

AimTo assess patient recall of intraoperative pain, anxiety, fear, and sensory (visual and auditory) perceptions during second eye clear corneal cataract surgery using assisted topical anaesthesia (ATA), in comparison with first eye cataract surgery using the same technique.MethodsThis prospective, consecutive, observational study was conducted in a free-standing dedicated ophthalmic day surgery centre. A voluntary questionnaire was distributed to 129 consecutive patients who underwent clear corneal cataract surgery using ATA. Two patients had to be converted to block anaesthesia, and were excluded.Patients were asked to rate intraoperative pain, anxiety, and fear using a visual analogue scale (VAS), and recollection of intraoperative visual and auditory perceptions. Results were analysed using the Mann–Whitney U and Spearman correlation tests.ResultsThere were 70/127 (55%) patients undergoing first eye cataract surgery and 57/127 (45%) undergoing second eye surgery. There was no significant difference in mean pain, anxiety, and fear scores between those undergoing the second eye operation compared with those undergoing their first eye operation. Similarly, there was no significant difference in sensory perceptions between the two cohorts. Overall, there was a small but significant positive correlation between recall of visual and auditory perceptions and combined pain, fear, and anxiety scores (r=0.33, P=0.0002).ConclusionThere was no significant difference in levels of intraoperative pain, anxiety, fear, and sensory perceptions experienced by patients between the first eye and second eye surgeries. We recommend that preoperative counselling for a patients second eye be as comprehensive as for the first eye surgery.

THE LENGTH OF SUPERFICIAL TEMPORAL ARTERY BIOPSIES

Background:  To compare temporal artery biopsy specimen lengths from a tertiary care and a community hospital in New South Wales to recommended clinical guidelines in suspected giant cell arteritis.

Laser corneal biofilm disruption for infectious crystalline keratopathy

Crystalline keratopathy can be successfully treated by the Nd:YAG laser. We present two cases of crystalline keratopathy managed this way. A 36‐year‐old female contact lens wearer presented with crystalline keratopathy following recent treatment with topical steroids and antibiotics for a corneal abscess. In this case crystalline keratopathy developed despite the intensive topical antibiotic treatment. A 55‐year‐old man with a history of acne rosacea, chronic myelomonocytic leukaemia, asthma and Crohns disease presented with crystalline keratopathy following an episode of infectious keratitis. Treatment with the Nd:YAG laser to the area of involvement was instituted in both cases. Noticeable resolution occurred within days, with subsequent full recovery. No side‐effects from the use of the Nd:YAG laser were noted. There have been only two cases previously reported using this treatment modality.

Corneal perforation and intraocular lens prolapse in Serratia marcescens endophthalmitis.

A 72‐year‐old lady was referred with bacterial endophthalmitis secondary to complicated left cataract extraction. The organism was identified as Serratia marcescens. Despite aggressive treatment the eye continued to deteriorate with corneal perforation and prolapse of the intraocular contents.

Comment on a new ocular trauma score in pediatric penetrating eye injuries

Sir, We read with interest Acar et als1 article on their newly proposed paediatric penetrating ocular trauma score (POTS). The authors have designed POTS to be used specifically in paediatric penetrating injuries to prognosticate for future visual acuity (VA) rather than using the more widely recognised but non-specific ocular trauma score (OTS) designed by Kuhn et al2 as part of the United States Eye Injury Registry. We appreciate that the authors felt that the age of the patient and location of the wound were important prognostic factors and so included them in the scoring system. The authors decided to downscale the amount of points scored for initial VA due to problems that were inherently present when trying to obtain an accurate VA in children, especially those with a significant injury. They identified that the POTS was statistically significant in predicting final VA. As the article stands, the authors have not demonstrated any reasons why POTS should be used instead of OTS for paediatric penetrating injuries. VA still needs to be obtained to enter into the POTS system. We therefore suggest two ways in which POTS could be more rigorously tested to demonstrate any benefit. First, the POTS could be calculated without using the VA score. As the authors pointed out, the relationship between initial VA and final VA is statistically significant. It would be interesting to see whether POTS without any VA inclusion gives a statistically significant result or whether it is purely the initial VA prognostic factor that makes POTS statistically significant in predicting final VA. Second, the authors could apply the OTS to their data and compare the two scores directly to identify any benefit of one over the other. Unless a clear benefit of POTS over OTS can be demonstrated, there would be no reason to use POTS preferentially. As the authors demonstrated in their study, VA can usually be obtained in all but the very youngest children, and so it may be that VA is the most important factor and can be used as a stand-alone predictor of final VA.

Re: 'Fellow eye effect of unilateral intravitreal bevacizumab injection in eyes with diabetic macular edema'.

Re: ‘Fellow eye effect of unilateral intravitreal bevacizumab injection in eyes with diabetic macular edema’

Culture-proven Aspergillus fumigatus infection in a primary hydroxyapatite orbital implant.

Hydroxyapatite orbital implants are widely used in enucleation surgery. Infection in this setting is an uncommon but severe complication. Herein a patient with a 3‐year history of chronic socket discharge, orbital discomfort, conjunctival breakdown and implant exposure after enucleation and implantation of a hydroxyapatite sphere 7 years previously is reported. Repeated attempts at covering the exposed implant failed. Eventually the implant was removed, and Aspergillus fumigatus was cultured from the explanted material. This is the second reported case of Aspergillus infection of a hydroxyapatite orbital implant, and the first case where fungal cultures were positive.

Length of temporal artery biopsies

Giant cell arteritis is a systemic inflammatory vasculitis of large‐sized and medium‐sized arteries. Superficial temporal artery biopsy of at least 20 mm has traditionally been the standard length for histopathology to accurately diagnose giant cell arteritis. Recent studies suggest than a post‐fixation superficial temporal artery biopsy length of 7 to 10 mm is adequate for diagnosing giant cell arteritis.

Longitudinal sectioning of temporal artery biopsy specimens

Sir, Despite increasing interest in the use of various imaging modalities such as ultrasound, magnetic resonance imaging, and positron-emission tomography, temporal artery biopsy remains the gold standard in the diagnosis of giant cell arteritis (GCA).1 Given that GCA can lead to profound irreversible blindness and other devastating complications, every effort must be made to ensure a correct diagnosis is made in each and every case.