Per Montan

Prophylactic intracameral cefuroxime: Evaluation of safety and kinetics in cataract surgery

Purpose: To evaluate the safety and kinetics of prophylactic intracameral cefuroxime in cataract surgery. Setting: Department of Ophthalmology, St. Eriks Hospital, Stockholm, Sweden. Methods: In a nonrandomized observer‐masked best‐case trial, the visual rehabilitation and the evolution of laser flare intensity and corneal endothelial cell density after cataract surgery were assessed in 45 patients receiving intracameral cefuroxime and in 45 control patients. Immunoglobulin E‐mediated sensitivity was evaluated using a skin prick test to cefuroxime in a screening program comprising all cataract patients operated on in 1997. Intracameral concentrations of cefuroxime in samples retrieved 30 seconds (n = 10) and 1 hour (n = 9) postoperatively were evaluated in an observer‐masked fashion with a microbiological assay. Results: Intracameral cefuroxime did not have a statistically significant effect on postoperative visual acuity, induced laser flare intensity, or endothelial cell loss compared with nonadministration of intracameral antibiotic prophylaxis. Three positive skin prick tests to cefuroxime were found in the 5813 screened cataract patients. The median aqueous humor concentration of cefuroxime at 30 seconds was 2742 mg/L, declining to 756 mg/L 1 hour after drug instillation. Conclusions: Intracameral cefuroxime 1 mg appears safe in terms of local toxicity. Immunoglobulin E‐mediated allergy to cefuroxime is rare in the cataract population. The treatment achieved high aqueous concentrations even 1 hour after surgery.

Endophthalmitis after cataract surgery: risk factors relating to technique and events of the operation and patient history: a retrospective case-control study.

OBJECTIVE This study aimed to investigate the relationship between postoperative endophthalmitis and current changes in the cataract operative technique. DESIGN A retrospective case-control study. PARTICIPANTS The 22,091 cataract operations performed from 1990 through 1993 at St Eriks Hospital formed the basis for this investigation. In a random fashion, 220 control subjects were selected to be compared with the endophthalmitis cases. MAIN OUTCOME MEASURES Numerous variables pertaining to the cataract extraction procedure and to the ocular and general health of patients with cataracts were analyzed regarding the development of postoperative intraocular infection. Patient age, presence of diabetes or immunosuppression, type of cataract extraction and intraocular lens (IOL), and intraoperative or postoperative complications were the principal variables assessed. RESULTS Fifty-seven patients with endophthalmitis were diagnosed, resulting in an overall frequency of 0.26%. Immunosuppressive treatment (P = 0.019), wound abnormality (P = 0.03), and the use of IOLs without a heparinized surface (P = 0.0023) were the only significant risk factors found in a logistic regression model. CONCLUSIONS The results suggest that cataract operating practice may alter the risk for endophthalmitis in that implanting a heparinized IOL and creating a tight section both seem to provide protection against this dreaded complication. Regarding patient history, an increased susceptibility was found among subjects treated with immunosuppressants. Designing a prophylactic protocol that protects against endophthalmitis more efficiently than did the study prophylaxis of 20 mg of subconjunctival gentamicin, is important not only for this patient subgroup but also for the cataract operated population at large.

Eosinophil cationic protein in tears in allergic conjunctivitis.

AIMS/BACKGROUND--Eosinophil cationic protein (ECP) is a quantifiable product secreted by activated eosinophils. The aim of this study was to assess the degree of eosinophil activity in different clinical stages of various forms of allergic conjunctivitis. METHODS--Tears were collected in glass capillary tubes from 14 subjects with seasonal allergic conjunctivitis (SAC), 23 subjects with vernal keratoconjunctivitis (VKC), 16 subjects with atopic keratoconjunctivitis (AKC), 10 subjects with giant papillary conjunctivitis (GPC), and 16 healthy control subjects. The samples were analysed in duplicate with a radio-immunoassay for ECP. RESULTS--Statistically significant differences were evident between healthy controls and allergic subjects (p < 0.001). Subjects with AKC and VKC had significantly higher tear ECP values than subjects with GPC and SAC. In addition, there was a significant correlation between ECP values and disease severity in all disorders. CONCLUSION--The data suggest a particular pathogenic role of the eosinophil in VKC and AKC, and a less pronounced but still important eosinophil involvement in the disease processes of GPC and SAC.

Aiming for emmetropia after cataract surgery: Swedish National Cataract Register study

PURPOSE: To assess and analyze refractive outcome after cataract surgery in Sweden from 2008 though 2010. SETTING: Swedish cataract surgery units participating in outcome registration of National Cataract Register. DESIGN: Cohort study. METHODS: Planned and actual postoperative refractions were analyzed for cataract procedures and preoperative and postoperative corneal astigmatism for procedures performed in 2008 though 2010. Induced astigmatism was calculated with Naeser and Behrens polar coordinates. RESULTS: Postoperative refraction was analyzed for 17 056 procedures and corneal astigmatism for 7448 procedures. Emmetropia was targeted in 78.1% of eyes and achieved in 52.7%; 43.0% had less than 1.00 diopter (D) of astigmatism. “Reading myopia” of −3.5 to −1.6 D was targeted in 7.0% of eyes and achieved in 7.8%. Planned hyperopia greater than 1.0 D or myopia greater than −3.5 D was rare. The mean absolute biometry prediction error was 0.402 D ± 0.338 (SD) in all eyes; however, astigmatic eyes and eyes planned for myopia or hyperopia had higher biometry prediction errors. Younger patients were more often astigmatic and planned for a more myopic outcome. Preoperatively, one third of eyes had more than 1.0 D of corneal astigmatism; postoperatively this figure was largely unaltered. The mean induced astigmatism was 0.525 ± 0.804 D in all eyes. CONCLUSIONS: Emmetropia (spherical equivalent −0.5 to +0.5 D and <1.0 D astigmatism) is the goal in most cataract cases but was reached in only 55% of eyes planned for emmetropia. Factors precluding emmetropia included remaining corneal astigmatism and biometry prediction errors in astigmatic and ametropic eyes. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Decreasing rate of capsule complications in cataract surgery: eight-year study of incidence, risk factors, and data validity by the Swedish National Cataract Register.

PURPOSE: To define the incidence of capsule complication and its risk factors in Sweden over an 8‐year period. SETTING: Fifty‐two ophthalmic surgery units in Sweden. DESIGN: Database study. METHODS: Data were collected prospectively in the Swedish National Cataract Register (NCR) from 2002 through 2009. The NCR contains 97.3% of the total number of cataract extractions in Sweden over the 8‐year study period. One mandatory variable in the register is capsule complications during surgery. As a means to validate the accuracy of register data on capsule complications, a randomly selected sample of 2400 registrations was compared with corresponding medical records. RESULTS: The analyses were based on 602 553 cataract extractions reported to the NCR. A capsule complication was reported in 12 574 cataract extractions, corresponding to a frequency of 2.09%. The incidence of this complication consistently decreased each year from 2002 to 2006, after which it stabilized. Poor corrected distance visual acuity in the surgical eye (≤ 0.1), the occurrence of glaucoma, diabetic retinopathy, and age were among the parameters significantly related to a capsule complication. Some of these parameters also decreased over time. However, even after adjusting for this, there was an obvious decrease in capsule complications over time. The validity test showed a certain underreporting of capsule complications to the registry, but it was not significant and did not change over time. CONCLUSION: The incidence of capsule complications decreased over time. This may be partly the result of fewer risk factors and of better surgical quality. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

No apparent association between periocular and ocular microcolonization and the degree of inflammation in patients with atopic keratoconjunctivitis

Background The cause of the chronic inflammation in atopic keratoconjunctivitis (AKC), the ocular manifestation of atopic eczema/dermatitis syndrome, is largely unknown.

The outcome of cataract surgery measured with the Catquest-9SF.

Purpose:  The purpose of this study was to use the Catquest‐9SF to measure cataract surgery outcomes, and to use Rasch analysis to test the psychometric properties of this questionnaire, including its validity and responsiveness.

IgE, IgE Receptors, and other Immunocytochemical Markers in Atopic and Nonatopic Patients with Vernal Keratoconjunctivitis

BACKGROUND Vernal keratoconjunctivitis (VKC) often is associated with atopy but a considerable part of the patients lack evidence of specific hypersensitivity. An immunocytochemical study was undertaken with the aim of detecting possible differences in the tissue inflammatory response between atopic and nonatopic subjects with VKC. METHODS Conjunctival biopsy specimens from six atopic and three nonatopic subjects with VKC (age range, 7-17 years) and eight healthy control subjects (age range, 3-15 years) were analyzed with a panel of monoclonal and polyclonal antibodies. RESULTS No distinct differences in cell counts between atopic and nonatopic subjects with VKC were observed. Vernal keratoconjunctivitis specimens as a whole showed higher counts than control specimens for CD3+, CD4+, HLA-DR+, CD38+, EG2+, CD68+, IgE+, FC epsilon RI+, IgA+, IgG+, and IgM+ cells in the substantia propria; and for CD1a+, IgE+, and EG2+ cells in the epithelium. CONCLUSIONS Because the number of cells expressing CD4, EG2, IgE, and the high-affinity receptor for IgE, all of which are considered relevant in infiltrates of allergic conditions, were similar in atopic and nonatopic subjects, the authors conclude that the role of allergen-specific IgE sensitization in the pathogenesis of VKC remains unclear.

Sustained eosinophil cationic protein release into tears after a single high‐dose conjunctival allergen challenge

Background The appearance of eosinophils is a hallmark sign of the allergic late‐phase response (LPR). Eosinophil cationic protein (ECP), a readily measurable product released from activated eosinophils, has so far not been evaluated in the ocular LPR.

Similar T helper Th2‐like cytokine mRNA expression in vernal keratoconjunctivitis regardless of atopic constitution

Background: Many patients with vernal keratoconjunctivitis (VKC), a severe chronic allergic eye disease in children, exhibit IgE‐sensitization, but about 40% of cases lack this immunologic trait. As a disease factor in VKC, IgE is thus not fully understood. The aim of this study was to investigate whether there are any differences in the conjunctival cytokine messenger (m)RNA pattern related to IgE‐sensitization in children suffering from VKC.