Patrick Mk Tam

Topical 0.03% tacrolimus ointment in the management of ocular surface inflammation in chronic GVHD.

Topical 0.03% tacrolimus ointment in the management of ocular surface inflammation in chronic GVHD

Prospective study on the safety and efficacy of combined conjunctival rotational autograft with intraoperative 0.02% mitomycin C in primary pterygium excision.

Purpose: To describe the novel use of combined conjunctival rotational autograft (CRA) and intraoperative 0.02% mitomycin C (MMC) in the treatment of primary pterygium and to evaluate its safety and efficacy. Methods: Prospective interventional case series comparing with historical controls was conducted. Patients with primary pterygium underwent pterygium excision, MMC was applied to the scleral bed after the surface conjunctiva was harvested, and the CRA was sutured back with a 180-degree rotation. Patients were followed for a minimum of 1 year. Results: Sixty-seven eyes from 67 patients participated in the study, of which 31 (46.3%) were men and 36 (53.7%) were women. The mean age was 58 ± 10.6 years, (range 36-79 years). There were 2 recurrences (3%), one occurring at month 3 and the other at month 9. Compared with historical controls, CRA-MMC resulted in significantly fewer recurrences than MMC alone (P = 0.005) when adjusted for age and was equally effective when compared with limbal-conjunctival autografts. The main postoperative problem was graft injection, which was noted in 41 eyes (61%) at 1 year. Conclusions: To the best of our knowledge, this was the first study on the combined use of CRA and MMC in the treatment of primary pterygium. CRA with MMC was found to be effective in the prevention of recurrence. Although injection remained as a cosmetic concern, it was a safe alternative to limbal-conjunctival autograft in cases where mobilizing autologous conjunctival tissue would not be feasible.

Randomized controlled trial on the safety of intracameral cephalosporins in cataract surgery.

Objective: To compare the safety profiles of intracameral cephalosporins in cataract surgery. Patients and methods: In this controlled trial, 129 patients were randomized to one of four groups to receive 1 mg of one of three cephalosporins – cefazolin, cefuroxime, or ceftazidime, or normal saline – given intracamerally during cataract surgery. Central endothelial cell density (ECD) and retinal center point thickness (CPT) were determined by specular microscopy and ocular coherence tomography, respectively, before and at 3 months after surgery. Results: There were no statistical significant differences in the changes of ECD and CPT between eyes receiving intracameral cephalosporin and control. Conclusion: The use of intracameral cefazolin, cefuroxime, or ceftazidime (1 mg in 0.1-mL solution) at the time of cataract surgery had no significant effect on ECD and CPT postoperatively.

Adjunctive antibiotics in the treatment of acute bacterial endophthalmitis following cataract surgery

Ghazi NG & Green WR (2002): Pathology and pathogenesis of retinal detachment. Eye (Lond) 16: 411–421. Maier MM et al. (2011): Sutureless encircling band clinical experience]. Klin Monbl Augenheilkd 228: 473–476. Ramulu PY, Do DV, Corcoran KJ, Corcoran SL, Robin AL (2010): Use of retinal procedures in medicare beneficiaries from 1997 to 2007. Arch Ophthalmol 128: 1335–1340. Ricci B & Ricci F (2001): Octyl 2-cyanoacrylate tissue adhesive in experimental scleral buckling. Acta Ophthalmol Scand 79: 506–508. Ross WH & Lavina A (2008): Pneumatic retinopexy, scleral buckling, and vitrectomy surgery in the management of pseudophakic retinal detachments. Can J Ophthalmol 43: 65–72.

Tsukamurella: an unrecognized mimic of atypical mycobacterial keratitis? The first case report.

Purpose: The purpose of this study was to report on Tsukamurella as a mimic of atypical mycobacterial infection. Methods: We report a patient who had received repeated corneal grafts with culture-proven Tsukamurella keratitis. Results: A slow-progressing corneal abscess that initially developed adjacent to a corneal stitch responded poorly to empiric antibiotic treatment. A preliminary culture report revealed fast-growing mycobacterial species. Treatment adjustments successfully controlled the disease. A final diagnosis of Tsukamurella was subsequently made on the basis of cultures. Conclusions: Tsukamurella exhibits laboratory similarities to mycobacteria and should be considered in the differential of atypical infection of the ocular surface.

Case of post Descemet stripping endothelial keratoplasty retrocorneal fibrous membrane.

Descemet stripping endothelial keratoplasty (DSEK) has been gaining interest as an alternative to standard penetrating keratoplasty (PK). However, it presents a new set of challenges to corneal surgeons. The main complications include donor tissue perforation and detachment and primary graft failure. We present a patient with post DSEK retrocorneal fibrous membrane (RCFM) formation (confirmed by anterior segment optical coherence tomography) and review the literature on the associations for its formation.

Oral moxifloxacin and topical amikacin for Mycobacterium abscessus keratitis after laser in situ keratomileusis

We report a case of Mycobacterium abscessus keratitis after elective laser in situ keratomileusis in a 19-year-old woman. The infection started 3 weeks after uneventful surgery, and the patient received multiple antimicrobial treatments without response. A corneal scrape isolate showed an acid-fast bacterium that was subsequently confirmed by culture to be M abscessus. Prompt treatment of oral moxifloxacin 400 mg twice daily and hourly topical amikacin 2.5% was started. Recovery occurred within the first week of treatment, with complete resolution 3 weeks after presentation. The final uncorrected distance visual acuity was 6/9. We comment on other reports of post-LASIK keratitis caused by M abscessus, the in vitro sensitivity to antibiotic agents described in the literature, and the use of oral moxifloxacin as a potential good alternative treatment based on its good ocular bioavailability, which in our case allowed resolution without the need for surgical intervention.

Ophthalmology for diagnosis of sarcoidosis

3 21 (51·2%) had a positive conjunctival biopsy. Spaide and colleagues 4 also demonstrated that conjunctival biopsy was positive in 40·4% of cases in a prospective observation of 47 patients. It is important to note that simple manoeuvres, such as bilateral and multiple levels of conjunctival sampling, may improve diagnostic accuracy. 3,4 Given that as many as 54·1% of patients with sarcoidosis will have ocular abnormality, it is worthwhile to refer suspected cases for ophthal- mological assessment and to consider

Ocular complications of drugs used in rheumatic disease

Systemically administered medications have long been known to produce detectable ophthalmic signs. Some of these are benign, asymptomatic phenomena that do not require screening or regular follow-up, such as the vortex keratopathy characteristic of amiodarone use, but other medications are potentially toxic to the eye and can damage vision. Ocular toxicity is an established side-effect of several of the immunosuppressive medications in routine use in rheumatological disease, including hydroxychloroqine, but corticosteroids can also cause ocular side-effects in the form of cataract and raised intraocular pressure. Ocular side-effects often occur in a dose-related and reversible manner, but some toxicity reactions are idiosyncratic, irreversible or may progress despite cessation of treatment.

Efficacy of topical cyclosporine A in the treatment of severe trachomatous dry eye: comment

changes in myotonic dystrophy. Clinical and follow-up evaluation. Retina 1993; 13: 129–35. 3. Bando H, Ikuno Y, Choi JS et al. Ultrastructure of internal limiting membrane in myopic foveoschisis. Am J Ophthalmol 2005; 139: 197–99. 4. Ikuno Y, Gomi F, Tano Y. Potent retinal arteriolar traction as a possible cause of myopic foveoschisis. Am J Ophthalmol 2005; 139: 462–67. 5. Garreston BR, Pollack JS, Ruby AJ et al. Vitrectomy for a symptomatic lamellar macular hole. Ophthalmology 2008; 115: 884–86.