Patrick Gooi

Comparison of the incidence of opacification of Hydroview hydrogel intraocular lenses with the ophthalmic viscosurgical device used during surgery.

PURPOSE: To determine the effect of intraoperative ophthalmic viscosurgical devices (OVDs) on late opacification of the Hydroview hydrogel intraocular lens (IOL) (Bausch & Lomb Surgical). SETTING: Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada. METHODS: A retrospective study of 949 cases of Hydroview IOL implantations from February 1998 to September 2000 was conducted. Of the 949 implantations, 462 were performed by 1 surgeon (J.H.S.) using Viscoat (sodium chondroitin sulfate 4.0%–sodium hyaluronate 3.0%) and 487 were performed by a second surgeon (W.A.N.) using Biolon (sodium hyaluronate 1.0%). Surgical techniques were identical with the exception of surgeon OVD preference. The number of IOLs opacifying and requiring explantation was determined in each group. RESULTS: Seventy‐one Hydroview IOLs had surface calcification deposits that presented a mean of 39 months postoperatively. Twenty‐two IOLs opacified sufficiently to warrant a recommendation of IOL explantation; 20 IOLs were explanted, and 2 surgeries were cancelled due to death or disability. In all cases of opacification, Viscoat had been used intraoperatively. This represented a 15.4% incidence of opacification in the Viscoat group, with 31.0% cases severe enough to warrant a recommendation of explantation. CONCLUSION: The results suggest that the intraoperative use of Viscoat has a facilitating role in the development of late calcification and opacification of the Hydroview IOL.

Acanthamoeba keratitis: persistent organisms without inflammation after 1 year of topical chlorhexidine.

Purpose: To report a non-contact lens wearer with persistent Acanthamoeba organisms in the cornea after being treated with medical therapy that included topical chlorhexidine as 1 agent for 1 year. Methods: A 53-year-old man with Acanthamoeba keratitis was treated with medical therapy for >1 year, followed by a penetrating keratoplasty. Results: Histopathologic examination of the keratoplasty specimen revealed viable-appearing Acanthamoeba cysts and trophozoites within the deep corneal stroma in a focus of corneal scarring. Conclusions: The use of chlorhexidine as 1 agent in the medical management of Acanthamoeba keratitis may not eradicate the organisms.

Temporal arteritis: a dilemma in clinical and pathological diagnosis.

CAN J OPHTHALMOL—VOL. 43, NO. 1, 2008 119 went laser photocoagulation and the hemorrhage resolved. For the next several years, she complained of occasional transient blurring, particularly OS, but no microhyphema was identified. In 1990, a left microhyphema was seen emanating from a tuft at the pupillary border at 1 o’clock. Visual acuity was 20/20 OD and 20/50 OS, with normal pressures. Photocoagulation was refused. The hemorrhage resolved spontaneously, as did a similar episode in 1996. In 2004, she presented with a 20% spontaneous left hyphema, although no active bleeding was identified. Visual acuity was 20/80. Intraocular pressure of 24 was treated with a topical beta-blocker. Photocoagulation was again refused. The patient died shortly thereafter and no autopsy was performed. Iris vascular tufts, also known as iris neovascular tufts, microhemangiomas, or Cobb’s tufts, were described by Fechner in 1958 in a single case report.2 Cobb presented a series of 44 patients.3 Histopathology describes a collection of small, thin-walled blood vessels at the pupillary border.4 The prevalence of these lesions is unknown, but Sellman examined 2000 patients and found lesions in 3.5 Angiography revealed more lesions, suggesting that clinical inspection alone underestimates their true prevalence. It is similarly difficult to estimate the incidence of hyphema, as case reports are few. Recurrent hemorrhages have rarely been reported. Associations with diabetes mellitus and myotonic dystrophy have been suggested.3,6 Tufts have also been reported in the presence of cutaneous hemangiomas, orbital hemangioma, and Sturge-Weber syndrome.7–9 Most patients reported are older than 50 years. Iris vascular tufts must be included in the differential diagnosis of spontaneous hyphema. Iris angiography, as in the first case, may be helpful. Observation is often warranted, as bleeding is uncommon and recurrent episodes are rare. Argon laser photocoagulation, as in the second case, may not prevent rebleeding.10

A Novel Combination Point-of-View (POV) Action Camera Recording to Capture the Surgical Field and Instrument Ergonomics in Oculoplastic Surgery.

Purpose:To evaluate a novel combination head-mounted/chest-mounted point-of-view recording system for oculoplastic surgical procedures. Methods:The point-of-view head camera captures the surgical field, while the point-of-view chest camera captures a wide field of view to record instrument ergonomics. Various methods of recording were trialed. Results:The head camera with a narrow field of view was better for recording fine details of the surgical field. The chest camera recording a wide field of view was optimal for recording hand positions. Stereoscopic recording of the instrument ergonomics was helpful in relaying the relative positions of the surgeon’s hands and instruments. Conclusions:Point-of-view cameras are cost–effective means of recording oculoplastics procedures. The authors feel simultaneously recording the surgeon’s ergonomics and the corresponding instrument movements within the surgical field, from the “surgeons view”, will augment surgical education.

Histologic and ultrastructural findings in a case of traumatic graft failure in deep lamellar endothelial keratoplasty: a clinicopathologic case report.

Purpose: Few complications have been reported for deep lamellar endothelial keratoplasty (DLEK). Endothelial graft failure has rarely been disclosed as a complication. Although the histopathologic and ultrastructural analysis of a failed DLEK graft has been previously described, we are not aware of any reports of these features in a case of traumatic endothelial graft failure. Methods: We report a case of an 85-year-old man with Fuchs endothelial dystrophy who underwent DLEK for corneal decompensation after cataract extraction and intraocular lens implantation. The graft had dislocated by the fourth postoperative day and was repositioned the following day. Penetrating keratoplasty was performed 3 months later for gradually progressive intractable corneal edema. The excised cornea underwent histochemical, immunohistochemical, and ultrastructural analysis. Results: Marked endothelial loss resulting in corneal decompensation was diagnosed histopathologically. The graft-host interface line showed no substantial findings for the following histochemical and immunohistochemical stains: colloidal iron, alcian blue (pH 2.5), vimentin, epithelial membrane antigen (EMA), smooth muscle actin (SMA), anti-cytokeratin CAM 5.2, high-molecular-weight keratin, anti-cytokeratin AE1/AE3, and collagen 3. The cornea showed ultrastructural changes similar to, but more pronounced than, those observed in corneas after laser in situ keratomileusis. Conclusions: This is the second described case of endothelial graft failure after DLEK. Histochemical and ultrastructural analysis revealed that the DLEK-operated cornea contained irregularities that may interfere with optical performance.

Sinonasal undifferentiated carcinoma with a frozen globe.

A 42-year-old previously healthy woman presented with a 5-week history of headache, facial numbness, proptosis, motility restriction, and visual loss. CT showed soft-tissue infiltration involving the posterior ethmoids, pterygopalatine fossa, and posterior inferior orbit. Histopathologic analysis of a biopsy specimen disclosed a highly aggressive and undifferentiated neoplasm with an immunophenotype and ultrastructural features consistent with an epithelial origin, which was most consistent with a diagnosis of sinonasal indifferentiated carcinoma. The tumor was unresectable and the patient was started on a course of radiation and chemotherapy.

Cadaver corneoscleral model for angle surgery training

PURPOSE To assess a new training model (Tackdriver) for new-generation microinvasive glaucoma surgeries (MIGS). SETTING Resident training centers in Canada. DESIGN Evaluation of technology. METHODS Human cadaver corneoscleral rims recovered after Descemet-stripping endothelial keratoplasty or not suitable for transplantation were acquired from an eye bank. The tissue was fixated with a single tack through the center of the cornea, which was inverted in a concave fashion. A water-based medical lubricant was used for placement of a goniolens after visualization of the anterior chamber and the trabecular meshwork. Microbypass stent (iStent) insertion and gonioscopy-assisted transluminal trabeculotomy (GATT) were practiced on this model. The model was qualitatively assessed for ease of preparation, accuracy of surgical simulation, and the number and variety of MIGS procedures that can be performed. RESULTS Efficient high-volume training was performed for microbypass stent insertion using first-generation and second-generation microbypass stents. The GATT procedure was also performed as a final step in a titratable fashion in 90-, 180-, or 270-degree segments or a complete 360-degree treatment. The model simulated bimanual angle surgery with good fidelity. CONCLUSIONS The training model allowed for high-volume bimanual MIGS training for techniques such as microbypass stent insertion and removal as well as GATT. Preparation was relatively simple, efficient, and cost-effective compared with other models. Inverting the specimen allowed the trainee to practice MIGS techniques independent of the tissues corneal clarity. Other MIGS techniques and angle training procedures can be adopted to this model.