Outbreak of fungal endophthalmitis due to Fusarium oxysporum following cataract surgery.

Outbreak of exogenous Fusarium endophthalmitis after cataract surgery was evaluated. Twenty patients developed postoperative endophthalmitis. In 19 eyes, pars plana vitrectomy (PPV) was performed, in 14 cases (74 %) with primary intraocular lens explantation. In one case, the PPV was not performed because of poor general condition of the patient. Symptoms of endophthalmitis (damaged vision, iritis, tyndallization in anterior chamber, hypopyon) occurred at intervals of 16-79 days (mean 31.3 days). Fungal etiology was documented in 12 eyes (60 %). Fusarium oxysporum was evidenced by culture and/or microscopy and confirmed by PCR and sequencing analysis. Eighteen (90 %) patients were treated with oral voriconazole (400 mg/day) for a period of 4-6 weeks. The final visual acuity was 6/15 in 1 case (5 %), 6/60 and worse in 17 eyes (85 %), and in 2 cases (10 %), enucleation had to be performed. Viscoelastic filling material was suggested the most likely source of infection. Endophthalmitis caused by Fusarium spp. are a potentially big threat for patients with serious impact on vision. Successful management of the infection is highly dependent on early diagnosis including species identification and antifungal susceptibility testing, and on aggressive and long-term treatment.

LASIK for myopia and astigmatism using the SCHWIND AMARIS excimer laser: an international multicenter trial.

PURPOSE: To assess the efficacy, predictability, and safety of LASIK for the surgical correction of low to moderate myopia with astigmatism using the SCHWIND AMARIS excimer laser. METHODS: Six international study sites enrolled 358 eyes with a manifest refraction spherical equivalent (MRSE) from -0.50 to -7.38 diopters (D) (mean sphere: -3.13+/-1.58 D) with up to -5.00 D of astigmatism (mean: -0.69+/-0.67 D). All eyes underwent treatment with the nonwavefront-guided aspheric algorithm of the SCHWIND AMARIS excimer laser. All eyes were targeted for emmetropia. Refractive outcomes and corneal higher order aberrations were analyzed pre- and postoperatively. Visual quality was assessed using photopic and mesopic contrast sensitivity. Six-month postoperative outcomes are reported. RESULTS: At 6 months postoperative, the MRSE for all eyes was -0.21+/-0.20 D, and 96% (343/358) of eyes had MRSE within +/-0.50 D. Uncorrected visual acuity was 20/20 or better in 98% (351/358) of eyes, and no eyes lost 2 or more lines of best spectacle-corrected visual acuity. The total corneal higher order aberrations root-mean-square increased by 0.09 microm, spherical aberration increased by 0.08 microm, and coma increased by 0.04 microm postoperatively. Photopic and mesopic contrast sensitivity did not change 6 months postoperatively. CONCLUSIONS: Treatment of myopia with astigmatism using the SCHWIND AMARIS excimer laser is safe, efficacious, predictable, and maintains visual quality.

Transient branch retinal artery occlusion in a 15-year-old girl and review of the literature.

BACKGROUND: Retinal artery occlusion is an extremely rare diagnosis in the pediatric population and the etiology with risk factors of retinal artery occlusion are poorly understood in younger individuals. METHODS AND RESULTS: This case report a rare case of transient branch retinal artery occlusion (BRAO) in a healthy young girl. A fifteen-year-old girl presented with painless decreased vision in her right eye. Fundus examination revealed in the right eye intensive edema of the part of superior half of the retina, but the vessels were absolutely normal. She was hospitalized for diagnosis and treatment. A thorough workup was performed to determine any etiologic factor. Her physical examination was normal, but from anamnesis has been found that patient began use oral contraception at the time of occurrence eye problems. The condition is evaluated as transient branch retinal artery occlusion by the course of the disease. The paper includes the review of the literature also. CONCLUSION: Though retinal arterial obstruction is rare in the pediatric population, this case highlights the importance of including this in the differential diagnosis of acute vision loss.

Penetrating keratoplasty for iatrogenic keratoconus after repeat myopic laser in situ keratomileusis: histologic findings and literature review.

We report a patient with a sufficiently thick cornea (593 microm) and no topographic signs of keratoconus preoperatively who developed iatrogenic keratoconus 2 months after repeat laser in situ keratomileusis (-4.00 -1.00 x 20) performed 5 months after the primary procedure (-10.50 -1.00 x 55). After penetrating keratoplasty, macrophotography showed severe multidirectional "macrostriae" of the stromal bed. On histologic evaluation, excessive thinning of the residual stromal bed to a minimum of 75 microm in the valleys and a maximum of 200 microm at the peaks of the macrostriae were documented. The flap thickness was 225 microm in the center. The thicker-than-intended flap (160 microm) is thought to be the cause of the severe complication of the LASIK procedure.

Effect of photorefractive keratectomy and laser in situ keratomileusis in high myopia on logMAR visual acuity and contrast sensitivity.

PURPOSE: To compare effect of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) on contrast sensitivity (CS) and best corrected visual acuity (BCVA) in high myopia. METHODS: 38 myopes (PRK) and 31 patients (LASIK) were examined before and 1, 3, 6, and 12 months postoperatively. Mean preoperative spherical equivalent was -8.0 +/- 1.7D (PRK) and -9.2 +/- 2.1D (LASIK). CS was tested on a computerized system of the Contrast Sensitivity 8010 Type at 6 spatial frequencies (0.74 and 29.55 c/deg), BCVA was measured on logMAR charts. RESULTS: At 12 months postoperatively, mean spherical equivalent was -0.6 +/- 1.0D (PRK) and -1.0 +/- 0.8D (LASIK). Postoperative values of CS were significantly higher in the PRK group, except for spatial frequencies of 3.69 and 7.39 c/deg up to 3 months postoperatively. The initial significant decrease of BCVA lasted up to 6 months after PRK. In the LASIK group BCVA was not significantly different from its preoperative level at the 3-months follow-up. CONCLUSIONS: The significant improvement of CS after PRK suggest that PRK can improve quality of vision in eyes with high myopia. Although recovery of BCVA after LASIK was faster than after PRK, there may be a persistent decrease in CS.