Visual field defects and retinal nerve fiber imaging in patients with obstructive sleep apnea syndrome and in healthy controls.

BACKGROUND: To assess the retinal sensitivity in obstructive sleep apnea hypopnea syndrome (OSAHS) patients evaluated with standard automated perimetry (SAP). And to correlate the functional SAP results with structural parameters obtained with optical coherence tomography (OCT). METHODS: This prospective, observational, case-control study consisted of 63 eyes of 63 OSAHS patients (mean age 51.7 ± 12.7 years, best corrected visual acuity ≥20/25, refractive error less than three spherical or two cylindrical diopters, and intraocular pressure < 21 mmHg) who were enrolled and compared with 38 eyes of 38 age-matched controls. Peripapillary retinal nerve fiber layer (RNFL) thickness was measured by Stratus OCT and SAP sensitivities and indices were explored with Humphrey Field Analyzer perimeter. Correlations between functional and structural parameters were calculated, as well as the relationship between ophthalmologic and systemic indices in OSAHS patients. RESULTS: OSAHS patients showed a significant reduction of the sensitivity for superior visual field division (p = 0.034, t-student test). When dividing the OSAHS group in accordance with the severity of the disease, nasal peripapillary RNFL thickness was significantly lower in severe OSAHS than that in controls and mild-moderate cases (p = 0.031 and p = 0.016 respectively, Mann-Whitney U test). There were no differences between groups for SAP parameters. We found no correlation between structural and functional variables. The central visual field sensitivity of the SAP revealed a poor Pearson correlation with the apnea-hipopnea index (0.284, p = 0.024). CONCLUSIONS: Retinal sensitivity show minor differences between healthy subjects and OSAHS. Functional deterioration in OSAHS patients is not easy to demonstrate with visual field examination.

A Rabbit Model of Acanthamoeba Keratitis: Use of Infected Soft Contact Lenses After Corneal Epithelium Debridement With a Diamond Burr.

Purpose: To develop a rabbit model of Acanthamoeba keratitis (AK) as the best method to reproduce the natural course of this disease. Methods: To induce AK, infected contact lenses (1000 amoebae/mm2, 90% trophozoites) were placed over the previously debrided corneal surface, in combination with a temporary tarsorrhaphy. Environmental and clinical strains of Acanthamoeba spp. (genotype T4) were used. Three groups (1L, n = 32; 2L-21d, n = 5; 2L-3d, n = 23) were established according to the number of contact lenses used (1L, 1 lens; 2L-21d and 2L-3d, 2 lenses) and the placement day of these (1L, day 1; 2L-21d, days 1 and 21; 2L-3d, days 1 and 3). The infection was quantified by a clinical score system and confirmed using corneal cytology and culture, polymerase chain reaction and histopathologic analysis. Results: The infection rate obtained was high (1L, 87.5%; 2L-21d, 100%; 2L-3d, 82.6%), although no clinical signs were observed in the 50% of the infected animals in group 1L. Among groups, group 2L-3d showed more cases of moderate and severe infection. Among strains, no statistically significant differences were found in the infection rate. In the control eyes, cross infection was confirmed when a sterile contact lens was placed in the previously debrided corneas but not if the eye remained intact. Conclusions: The combination of two infected contact lenses after corneal debridement seems to be an alternative model, clinically and histopathologically similar to its human counterpart, to induce the different AK stages and reproduce the course of the disease in rabbits.

Computational Simulation of Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment: On the Effect of the Band Size on the Myopization.

A finite element model (FE) of the eye including cornea, sclera, crystalline lens, and ciliary body was created to analyze the influence of the silicone encircling bandwidth and the tightness degree on the myopia induced by scleral buckling (SB) procedure for rhegmatogenous retinal detachment. Intraocular pressure (IOP) was applied to the reference geometry of the FE model and then SB surgery was simulated with encircling bandwidths of 1, 2, and 2.5 mm. Different levels of tightening and three values of IOP were applied. The anterior segment resulted as unaffected by the surgery. The highest value of Cauchy stress appeared in the surroundings of the implant, whereas no increment of stress was observed either in anterior segment or in the optic nerve head. The initial IOP did not appear to play any role in the induced myopia. The wider the band, the greater the induced myopia: 0.44, 0.88, and 1.07 diopters (D) for the 1, 2, and 2.5 mm bandwidth, respectively. Therefore, patients become more myopic with a wider encircling element. The proposed simulations allow determining the effect of the bandwidth or the tightness degree on the axial lengthening, thus predicting the myopic increment caused by the encircling surgery.

Retinal nerve fiber layer and macular thickness in patients with schizophrenia: Influence of recent illness episodes.

Optical coherence tomography (OCT) has been recently used to investigate neuropsychiatric disorders. We aimed to study retinal OCT measures of patients with schizophrenia with respect to healthy controls, and to evaluate possible differences between recent illness episode (RIE) and non-recent illness episode (NRIE) patients. Thirty schizophrenia patients were classified as RIE (n=10) or NRIE (n=20), and compared with 30 matched controls. Statistical analyses included linear mixed-effects models to study the association between OCT measures and group membership. Multivariate models were used to control for potential confounders. In the adjusted linear mixed-effects regression model, patients had a significantly thinner retinal nerve fiber layer (RNFL) in overall measurements, and in the nasal, superior and inferior quadrants. Macular inner ring thickness and macular volume were also significantly smaller in patients than controls. Compared with controls, in the adjusted model only NRIE (but not RIE) patients had significantly reduced RNFL overall measures, superior RNFL, nasal RNFL, macular volume, and macular inner ring thickness. No significant correlation was found between illness duration and retinal measurements after controlling for age. In conclusion, retinal parameters observed using OCT in schizophrenia patients could be related to clinical status and merit attention as potential state biomarkers of the disorder.

CHOROIDAL THICKNESS AND VOLUME IN A HEALTHY PEDIATRIC POPULATION AND ITS RELATIONSHIP WITH AGE, AXIAL LENGTH, AMETROPIA, AND SEX.

PURPOSE: To evaluate choroidal thickness (CT) and volume in healthy pediatric individuals using enhanced depth imaging spectral domain optical coherence tomography (SD-OCT), as well as its association with age, sex, axial length (AL), and refractive error. METHODS: Ninety-three eyes from 93 healthy pediatric individuals were examined. An Early Treatment Diabetic Retinopathy Study grid was applied to analyze CT and volume map in each of its nine sectors. RESULTS: The mean subfoveal CT and volume were 314.22 ± 55.48 µm and 0.25 ± 0.04 mm, respectively. The nasal CT and volume of both the inner and the outer rings were significantly lower than the temporal area of the same ring and lower than the subfoveal choroidal thickness. A significant negative correlation between the subfoveal CT and AL (r = -0.250, P = 0.015) and a significant positive correlation between the subfoveal CT and refractive error (r = 0.238, P = 0.006) were found. The estimation of the variation in the subfoveal CT in relationship to the AL was -13.55 µm per millimeter. The variation in the subfoveal CT with refractive error was 7.52 µm per diopter. The estimation of the variation in the total choroidal volume related to the AL and ametropia was, respectively, -0.2354 mm per millimeter and 0.1412 mm per diopter. CONCLUSION: Healthy pediatric subjects exhibit choroidal differences in refractive error and AL. In the study population, CT and volume show an increase with age after adjusting for AL.

Branch retinal vein occlusion and vitreovascular traction: a preliminary spectral domain OCT case-control study.

OBJECTIVE: Branch retinal vein occlusion (BRVO) typically occurs at an arteriovenous (AV) crossing site. Although the pathogenesis is unclear, vitreovascular traction might have a significant role in some BRVO cases. The purpose of present study was to determine the incidence of vitreoretinal traction at the obstruction site in patients diagnosed with BRVO. METHODS: In this prospective observational case­control study, 32 consecutive BRVO patients were studied with spectral-domain optical coherence tomography (SD-OCT) to detect the presence of vitreovascular traction or vitreous adherence at the occlusion site. RESULTS: SD-OCT directed to the occlusion site revealed a vitreovascular traction at this point in eight eyes (25 %). Fourteen eyes (43.75 %) were associated with an adherence of posterior hyaloids without signs of retinal traction, whereas ten eyes (31.25 %) had neither vitreoretinal adherence nor vitreous traction. Regarding either the same vessel segment of the fellow eye, none of the cases revealed vitreovascular traction in the correspondent AV crossing site; 12 cases (37.5 %) presented vitreoretinal adherence; and the remaining 20 cases (62.5 %) showed neither traction nor adhesion. Thus, vitreovascular traction in the occlusion site was significantly associated with BRVO (p = 0.024, chi-squared test). B-scan ultrasonography showed that the posterior vitreous cortex remains more frequently attached in eyes with BRVO compared to unaffected fellow eyes (p = 0.041, chi-squared test). CONCLUSIONS: A common firm vitreous adhesion at the obstruction site is reported herein, pointing out the possible role of vitreovascular traction in the etiology of some cases of BRVO. Likewise, although not all BRVO cases can be explained by this pathogenic mechanism, an attached posterior vitreous cortex might be a cofactor in the origin of this entity.

Retinal alterations in mild cognitive impairment and Alzheimer's disease: an optical coherence tomography study.

Retinal nerve fiber layer thickness (RNFL) measured by means of Optical Coherence Tomography (OCT) has been used as a marker not only of ophthalmologic diseases but also of neurodegenerative diseases such as Alzheimer's disease (AD) and mild cognitive impairment (MCI). The purpose of this work was to demonstrate that patients with amnestic MCI show an intermediate RNFL thickness between normality and AD, and a macular volume and thickness as well. In a cross-sectional study we consecutively recruited 18 patients with AD, 21 with MCI, and 41 healthy controls. OCT was performed in all of them to measure circumpapillary RNFL thickness in µm, as well as macular volume and thickness. In the analysis of variance we saw that RNFL was thinner in MCI patients compared with controls, and it was also thinner in AD patients compared with MCI patients and controls. With regard to the macular measurements in mm(3), MCI patients had the greatest macular volume in comparison with AD patients and controls. In turn the controls had greater macular volume than AD patients. The decreased RNFL thickness in MCI and AD patients suggests loss of retinal neurons and their axons. The increased thickness and macular volume have never been reported before in aMCI. This finding could be explained by inflammation and/or gliosis in early stages of AD. OCT could be a useful marker of AD for early detection and monitoring progression.

Assessment of corneal biomechanical properties and intraocular pressure in myopic spanish healthy population.

Purpose. To examine biomechanical parameters of the cornea in myopic eyes and their relationship with the degree of myopia in a western healthy population. Methods. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann correlated intraocular pressure (IOP), and corneal compensated IOP (IOPcc) were measured using the ocular response analyzer (ORA) in 312 eyes of 177 Spanish subjects aged between 20 and 56 years. Refraction was expressed as spherical equivalent (SE), which ranged from 0 to -16.50 diopters (D) (mean: -3.88 ± 2.90 D). Subjects were divided into four groups according to their refractive status: group 1 or control group: emmetropia (-0.50 ≤ SE < 0.50); group 2: low myopia (-0.75 ≤ SE < 3.00 D); group 3: moderate myopia (-3.00 ≤ SE ≤ -6.00 D); and group 3: high myopia (SE greater than -6.00 D). We analyzed the relationship between corneal biomechanics measured with ORA and SE. Results. CH in the emmetropia, low myopia, moderate myopia, and high myopia groups was 11.13 ± 0.98, 11.49 ± 1.25, 10.52 ± 1.54, and 10.35 ± 1.33 mmHg, respectively. CH in the highly myopic group was significantly lower than that in the emmetropic group (P = 0.07) and low myopic group (P = 0.035); however, there were no differences with the moderate myopic group (P = 0.872). There were no statistically significant differences regarding IOP among the four groups (P > 0.05); nevertheless, IOPcc was significantly higher in the moderately myopic (15.47 ± 2.47 mmHg) and highly myopic (16.14 ± 2.59 mmHg) groups than in the emmetropia (15.15 ± 2.06 mmHg) and low myopia groups (14.53 ± 2.37 mmHg). No correlation between age and the measured parameters was found. CH and IOPcc were weakly but significantly correlated with SE (r = 0.171, P = 0.002 and r = -0.131, P = 0.021, resp.). Conclusions. Present study showed only a very weak, but significant, correlation between CH and refractive error, with CH being lower in both moderately and highly myopic eyes than that in the emmetropic and low myopic eyes. These changes in biomechanical properties of the cornea may have an impact on IOP measurement, increasing the risk of glaucoma.

Development of a prediction formula of Parkinson disease severity by optical coherence tomography.

The aims of this study were to assess the peripapillary retinal nerve fiber layer (RNFL) thickness in patients with Parkinson's disease (PD), to determine its correlation with disease severity, and to define a simple biomarker for predicting clinical severity. One hundred two eyes from 52 patients affected by PD were compared with 97 eyes from 50 age-comparable controls. In all patients, peripapillary RNFL thickness was measured by optical coherence tomography (OCT). We used the Unified Parkinson's Disease Rating Scale (UPDRS) total score and measured responses in the on medication state. Eyes from patients with PD had a statistically significant decrease in average peripapillary RNFL thickness compared with control eyes (P < 0.001). This reduction was observed in every quadrant (inferior, superior, nasal [P < 0.001], and temporal [P = 0.017]) in patients with PD. Furthermore, a strong inverse correlation was found between the PD severity measured according to the UPDRS score and the average peripapillary RNFL thickness (r = -0.615; P < 0.001) and PD duration (r = -0.303; P = 0.002). From these results, we defined a regression equation that predicts the UPDRS score from the above-mentioned variables: UPDRS = 81.6 + 29.6 * log PD duration (years) - 0.6 * RFNL thickness (µm). We observed that, as the evolution and severity of PD progress, the peripapillary RNFL layer thickness, as evaluated by OCT, gradually diminishes. These results suggest that the average peripapillary RNFL thickness measured by OCT might be useful as a biomarker to detect the early onset and progression of PD.

Retinal and optic nerve evaluation by optical coherence tomography in adults with obstructive sleep apnea-hypopnea syndrome (OSAHS).

OBJECTIVE: To assess the peripapillary retinal nerve fiber layer (RNFL) thickness, optic nerve head (ONH) morphologic parameters, and macular thickness and volume in patients affected by obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: This prospective, observational case-control study consisted of 96 eyes of 50 OSAHS patients (mean age of 50.9 ± 12.4 years, best-corrected visual acuity ≥ 20/20, refractive error less than 3 spherocylindrical diopters, and intraocular pressure <21 mmHg) who were enrolled and compared with 64 eyes of 33 age-matched controls. Peripapillary RNFL thickness, ONH parameters, macular thickness and volume were measured by optical coherence tomography (OCT). RESULTS: OSAHS patients showed a significant reduction of the nasal quadrant RNFL thickness (74.7 ± 15.8 µm) compared with those values observed in control patients (81.1 ± 16.6 µm, p=0.047, Student's t-test). No differences in peripapillary RNFL thickness were observed when dividing the OSAHS group in accordance with disease severity. Vertical integrated rim area (VIRA) (0.67 ± 0.41 mm(3) in OSAHS vs 0.55 ± 0.29 mm(3) in controls; p=0.043, Student's t-test), horizontal integrated rim width (HIRW) (1.87 ± 0.31 mm(2) in OSAHS vs 1.8 ± 0.25 mm(2) in controls; p=0.039, Student's t-test) and disc area (2.74 ± 0.62 mm(2) in OSAHS vs 2.48 ± 0.42 mm(2) in controls; p=0.002, Student's t-test) showed significant differences, all of them being higher in the OSAHS group. Severe OSAHS had significant higher disc area (2.8 ± 0.7 mm(2)) than controls (2.5 ± 0.4 mm(2); p=0.016, ANOVA test). Temporal inner macular thickness was significantly higher in mild-moderate OSAHS patients (270 ± 12 µm) than in severe OSAHS patients (260 ± 19 µm; p=0.021, ANOVA test). CONCLUSIONS: OSAHS patients showed decreased peripapillary nasal RNFL thickness, and increased ONH area and volume parameters when they were evaluated by OCT. These findings suggest that neuronal degeneration might be present in the retina of OSAHS patients, as previously observed in some neurodegenerative disorders.

Acute mountain sickness and retinal evaluation by optical coherence tomography.

PURPOSE: Acute mountain sickness (AMS), the commonest form of altitude illness, might represent early-stage high altitude cerebral edema (HACE). Optical coherence tomography (OCT) was used to evaluate optic nerve head (ONH) consequences following a sojourn to extreme altitude. METHODS: This prospective study included 4 high-altitude expeditions in Himalayas. Twenty-four eyes of 12 healthy male climbers underwent baseline and postexpedition complete ophthalmic evaluation, including OCT to measure the peripapillary retinal nerve fiber layer (RNFL) thickness, ONH parameters, and macular thickness and volume. Lake Louise Scoring (LLS) self-report questionnaire was used to estimate AMS severity. RESULTS: All mountaineers experienced symptoms of AMS (LLS: 5.1±1.1, range 4.0-7.0). Average peripapillary RNFL thickness showed a significant increase in postexpedition examination (94±23 µm, 47-115), compared with baseline values (89±19 µm, range 45-114) (p=0.034). Superior (p=0.036) and temporal (p=0.010) quadrants also showed an increased RNFL thickness following exposure to high altitude. Vertical integrated rim area (VIRA) was significantly higher in postexpedition examination (0.71±0.43 mm(3), 0.14-1.50) than in baseline examination (0.51±0.26 mm(3), 0.11-1.00) (p=0.002). Horizontal integrated rim width was significantly higher in postexpedition examination (1.90±0.32 mm(2), range 1.37-2.34) than in baseline examination (1.77±0.27 mm(2), 1.27-2.08) (p=0.004). There was no correlation between LLS and OCT parameters (p>0.05). CONCLUSIONS: In climbers with AMS, OCT was able to detect subtle increases in the peripapillary RNFL thickness and in some ONH measurements, even in absence of HACE and papilledema. These changes might be a sensitive parameter in physiologic acclimatization and in the pathogenesis of AMS.

Two cases of accidental dislocation of the silicone sleeve of an extrusion cannula into the vitreous cavity.

BACKGROUND: Fluid-air exchange during vitreoretinal surgery is often used as a tool for subretinal fluid endodrainage. Soft-tipped flexible extrusion cannulas are commonly used to aspirate the posterior subretinal fluid. METHODS: This is an observational two-case series describing two patients who underwent 20-G pars plana vitrectomy complicated by the accidental fall of the silicone sleeve of a soft-tipped extrusion cannula into the vitreous cavity. In the first case, the cannula had inadvertently been subjected to sterilization process. RESULTS: While withdrawing the soft-tipped extrusion cannula from the eye, following internal drainage of transvitreal and subretinal fluid, the loose silicone sleeve probably got entangled at the inner lip of the sclerotomy and finally fell on the retinal surface. In both cases, the silicone sleeve was held and removed with an intraocular forceps. CONCLUSIONS: This rare complication has been reported in the literature only once previously. Sterilization of disposable subretinal fluid cannulas is not advisable because of the risk of dislocation of the silicone sleeve into the eye. Besides this, it is important to check the integrity of the silicone sleeve before and after surgery.

Evaluation of in vitro efficacy of combined riboflavin and ultraviolet a for Acanthamoeba isolates.

PURPOSE: To evaluate in vitro the amoebicidal effects of riboflavin and ultraviolet A (UVA) collagen cross-linking. DESIGN: Experimental study, laboratory investigation. METHODS: Two different strains of Acanthamoeba species were tested identically. Four treatment groups were considered: group 1 consisted of 0.1% riboflavin and 30-minute UVA irradiation; group 2 consisted of 0.1% riboflavin and 60-minute UVA irradiation; group 3 consisted of no riboflavin and no UVA exposure; group 4 consisted of 0.1% riboflavin and no UVA exposure. The application of UVA was performed under the parameters used for in vivo corneal collagen cross-linking. RESULTS: In all cases, cysts and trophozoites were detected 24 hours after treatment at a radial distance from the center of the seeding point more than 5 mm, indicating that the amoebae were viable. All treated and untreated groups of amoebae from the 2 strains exhibited growth (radii of 14 to 15 mm in groups 1, 3, and 4; radius of 12 mm in group 2). The final morphologic features of the 2 strains of trophozoites that received treatment were similar to those of the initial seeding group and the untreated control group. CONCLUSIONS: The results obtained in our study show that a single dose (30 or 60 minutes) of cross-linking cannot achieve eradication in the 2 different Acanthamoeba strains examined. However, in vitro results do not always indicate in vivo efficacy, so future studies should test the validity of this treatment for Acanthamoeba keratitis.

Unilateral tacrolimus-associated optic neuropathy after liver transplantation.

BACKGROUND: Tacrolimus has been associated with several ocular adverse effects, such as optic neuropathy. METHODOLOGY/PRINCIPAL FINDINGS: A 56-year-old woman noted sudden, severe, painless visual loss in her left eye. She had undergone liver transplantation for alcoholic related cirrhosis 6 months before. Her chronic immunosuppressive regimen consisted of prednisone and tacrolimus at dosage of 1.5 mg orally once daily. Consequently, the patient developed a left optic neuropathy. CONCLUSION/SIGNIFICANCE: We report the first case of unilateral optic neuropathy associated with oral tacrolimus medication. Surgeons and ophthalmologists must evaluate ocular symptoms in the post-transplantation period, and suspicion should be maintained even if unilaterality or asymmetry of symptoms against a toxic etiology.

Topical tacrolimus ointment for treatment of intractable atopic keratoconjunctivitis: a case report and review of the literature.

PURPOSE: To report the utility of tacrolimus 0.03% dermatologic ointment (Protopic) in a case of refractory atopic keratoconjunctivitis with giant papillae. A review of the medical literature is presented. METHODS: A 32-year-old man with a long-standing history of severe atopic disease was referred to our department because of bilateral intense eye pain, itching, photophobia, and epiphora. Biomicroscopy examination showed conjunctival hyperemia, superficial punctata keratitis, and tarsal giant papillae. This patient had undergone previous treatment with systemic and topical steroids, antihistamines, topical antihistamine/mast cell stabilizer drops, cyclosporine A, and even surgical resection-cryopexy of giant papillae-without success. RESULTS: The patient was started on tacrolimus 0.03% ointment treatment of the conjunctival fornix twice daily. After 2 months, the patient experienced resolution of his clinical symptoms with a significant decrease in papillae size. No side effects were reported. Treatment was continued for 1 month and gradually reduced with increasingly wide intervals between applications. Eight months after treatment, there were no signs of reactivation, and the patient remains asymptomatic. CONCLUSIONS: Application of tacrolimus 0.03% dermatologic ointment into the lower fornix seems to constitute an interesting alternative treatment for atopic keratoconjunctivitis that is refractory to traditional treatment.

Keratitis after Implantation of Intrastromal Corneal Rings with Spontaneous Extrusion of the Segment.

PURPOSE: To report a case of bacterial keratitis in a patient with a history of intrastromal corneal ring segments (INTACS®) implantation to correct keratoconus. METHODS: The patient's history, clinical presentation, pathological analysis and therapeutic management were reviewed. RESULTS: A 36-year-old-man was referred to our department due to decreased vision and intense pain in his left eye, 40 days after INTACS® implantation for keratoconus. Slit-lamp examination revealed epithelial defects and stromal infiltrates in the lower channel without evidence of the inferior ring. The anterior chamber also showed a significant fibrin reaction to hypopyon. A low-tension suture was removed at the site of the incision. Microbiological study of the conjunctival swab was positive for Staphylococcus epidermidis, but the corneal culture was sterile. The patient was treated with topical fortified and systemic antibiotics. The infection slowly resolved, leaving opacity at the inferior segment site. CONCLUSIONS: Infectious keratitis following INTACS implantation is an infrequent complication that can have important consequences without suitable and early therapeutic management.

Multifocal intraocular lenses for unilateral cataract in children.

PURPOSE: To evaluate the implantation of apodized diffractive multifocal intraocular lenses (IOLs) in children with unilateral cataract. SETTING: Ophthalmology Service, Hospital Clínico Lozano Blesa, Zaragoza, Spain. DESIGN: Prospective clinical study. METHODS: Five children between 4 and 6 years of age with unilateral cataract had cataract extraction and implantation of an apodized diffractive multifocal IOL (AcrySof Restor SN60D3). Phacoaspiration was accompanied by posterior capsulorhexis followed by an anterior vitrectomy. Uncorrected distance (UDVA), corrected distance (CDVA), and corrected near (CNVA) visual acuities; binocular function using the Worth 4-dot test and the TNO stereotest; and subjective symptoms such as glare and halos were evaluated over 21 months of follow-up. RESULTS: At the final follow-up visit, the mean UDVA was 0.45 ± 0.149 logMAR and the mean CDVA was 0.30 ± 0.06 logMAR with 20/32 in 3 eyes, 20/50 in 1 eye, and 20/63 in 1 eye. The mean CNVA was 0.10 ± 0.05 logMAR (about 20/25) with J1 in 2 eyes, J2 in 1 eye, J3 in 1 eye, and J4 in 1 eye. The stereoacuity was 120 seconds of arc (arcsec) in 2 patients, 240 arcsec in 1 patient, 1980 arcsec in 1 patient, and nonexistent in 1 patient. The Worth 4-dot test showed that 4 patients had fusion. None of the 5 patients complained about halos or glare. No IOL decentration was observed in any patient. CONCLUSION: Implantation of an apodized multifocal IOL seems to be a satisfactory alternative to monofocal pseudophakia in children with unilateral cataract.

Acute postoperative endophthalmitis caused by Gemella morbillorum.

PURPOSE: We present a case of Gemella morbillorum endophthalmitis after uneventful cataract surgery. METHODS: A 78-year-old woman developed progressive blurring of vision, hypopyon, and vitritis in the precocious postoperatory following cataract surgery. Pars plana vitrectomy and intraocular lens explantation were performed followed by intravitreal injection of vancomycin and ceftazidime. Postoperatively, the patient was given hourly topical fortified vancomycin according to antimicrobial susceptibility testing. At the final follow-up visit 6 months after the initial procedure, visual acuity was 20/50 and no signs or symptoms of endophthalmitis were observed. RESULTS: The undiluted vitreous samples and explanted lens were analyzed. Cultures revealed the growth of G morbillorum, an infrequent opportunistic pathogen. CONCLUSIONS: To date, this is the second reported case of postoperative endophthalmitis by this species. Although endophthalmitis is rare, ophthalmologists should be alert to the possibility of patients having endophthalmitis caused by G morbillorum. Especially, it is necessary to be cautious with surgery in patients with recent infections. A review of the medical literature of this rare ocular infection is presented.

Effect of limbal relaxing incisions during phacoemulsification surgery based on nomogram review and numerical simulation.

PURPOSE: To determine the effect of the parameters related to limbal incisions (length, depth, optical zone, and so on) by revision of different nomograms and analyzing the outcomes of numerical simulation of incisions with a biomechanical model of the cornea. METHODS: The Cristóbal nomogram was developed based on our experience on the performance of relaxing incisions to correct astigmatism. A numerical model of the eye was used to analyze the effect induced by variation of each parameter compiled in nomograms. The biomechanical properties remained invariable for all cases. Different incisions were simulated to study the influence of each parameter, being one varied while the others remain constant, under equal biomechanical conditions, ignoring the human factor. RESULTS: Quantitatively, simulation of incisions of 45, 60, and 90 degrees; optical zone of 10 mm; and depth of 90% of the thickness induced astigmatic changes of 1.2, 1.4, and 1.9 diopters (D). Paired incisions at 7.5-mm optical zone and 90-degree length induced astigmatic changes of 0.7, 2.6, and 4.4 D for 40%, 75%, and 90% depth, respectively. Paired incisions of 90-degree length and 90% depth for 10- and 7.5-mm optical zones induced 1.9 and 4.4 D, respectively. Qualitatively, the results confirm the guidelines compiled in nomograms. CONCLUSIONS: The revision of some nomograms for limbal incisions to correct astigmatism, compared with the outcomes of numerical simulation, leads to common guidelines. Numerical simulation supplies theoretical outcomes that the clinician can take into account to decide the values of the parameters for the surgery, in addition to their clinical experience.