The Role of Postoperative Bandage Contact Lens in Patients Undergoing Fasanella-Servat Ptosis Repair.

PURPOSE: To determine whether a bandage contact lens (BCL) improves patient comfort in the postoperative period in patients undergoing ptosis repair using the Fasanella-Servat technique, compared with no BCL. METHODS: In this prospective, randomized, double-masked, comparison study, all patients had bilateral Fasanella-Servat surgery. A total of 30 patients were randomized to receive a BCL in one eye and no BCL in the other eye. Patient discomfort was measured as the primary outcome using the Eye Sensation Scale. Blurred vision was measured as a secondary outcome using selected questions from the Ocular Surface Disease Index. The surgeries were performed by 2 surgeons (J.T.H and R.S.A). Outcomes were measured one week following the procedure. RESULTS: Patients reported significantly less discomfort in the eye receiving a BCL, with only 13.3% ranking discomfort as "moderate" or "severe," compared with the eye not receiving BCL, where 63.3% of patients rated discomfort as "moderate" or "severe" (p < 0.001). There was no significant difference in patient-reported blurred vision between the 2 groups (p = 0.520). CONCLUSIONS: The use of a bandage contact lens after Fasanella-Servat procedure for ptosis repair is recommended as it improves patient comfort. In addition, it has no detrimental effect on patient-reported blurring of vision.

Observations on the management of Coats' disease: less is more.

BACKGROUND: In this article we share our experience of treating various severities of Coats' disease and focus on optimal therapy for advanced disease. METHODS: Retrospective chart review of 10 patients treated with varied techniques including intraocular surgery, cryopexy and/or laser photocoagulation. RESULTS: Nine patients were male. At presentation the average age was 4.6 years (range 21 months-7 years), the average number of retinal quadrants involved with telangiectasia was 2.7 (range 1-4, median 3), eight of the 10 patients had retinal detachment, six of these being total, and all patients had macular involvement with either exudate or fibrosis. Average follow-up was 2.3 years (range 1-4.5 years). The best visual outcomes were observed in patients who presented with less severe disease. For example, the only four patients to maintain ambulatory vision all presented without total retinal detachment, two or fewer quadrants of retinal telangiectasia and a visual acuity better than light perception. No patient developed secondary angle closure glaucoma, and all patients have kept a cosmetically acceptable eye. CONCLUSION: In this limited series, visual outcomes in the setting of advanced Coats' disease are largely dependent on disease severity and visual status at the time of presentation. Minimally invasive surgery with vitreous infusion through the pars plana, combined with external drainage of subretinal fluid together with cryotherapy and/or laser photocoagulation is sufficient to effect retinal re-attachment and prevent loss of the eye.

Localized topical steroid use and central serous retinopathy.

OBJECTIVES: The link between topical steroid use and central serous retinopathy (CSR) is poorly understood as there are a limited number of reported cases, with most cases typically occurring in patients using oral or inhaled steroids. CSR is a common retinal disease that can cause loss of vision as a result of accumulated subretinal fluid leading to localized serous retinal detachments. CSR is associated with systemic steroid use. The objective of this case series and the review was to further understand the relationship between localized topical steroid use and CSR. METHODS: The medical charts of two patients who developed CSR after using topical steroids were reviewed. RESULTS: These cases demonstrate that CSR is associated with consistent topical steroid use to even limited areas of the body. These cases are unique, as other published cases describe patients who used topical steroids either on multiple or larger areas of the body. CONCLUSION: It is critical that dermatologists are aware of this association, and refer patients who develop ocular symptoms after using topical steroids to ophthalmology.

Ultrasound biomicroscopic analysis of iris profile changes with accommodation in pigmentary glaucoma and relationship to age.

PURPOSE: To examine the effect of accommodation on iris profile in pigmentary glaucoma and its relationship to age. DESIGN: Interventional case series. METHODS: We measured change in iris profile with accommodation in 92 eyes of 92 patients with pigmentary glaucoma. RESULTS: Mean age was 42 years. Mean change in posterior iris excursion from nonaccommodated to accommodated state was 144.5 microm. (P < .001). Age was plotted against iris excursion with an estimated least-squares regression line. The estimated Pearson correlation coefficient was -0.60, (P < .001). Patients younger than 42 years of age had a mean change in excursion of 209.2 microm compared with 79.8 microm for those patients older than 42 years. (P < .001) CONCLUSION: This study found that there is a significant increase in posterior iris bowing in the accommodated state. Increasing age is associated with decreased posterior iris deviation. These findings add evidence to the theory of accommodation-induced reverse pupillary block in pigmentary glaucoma.

Triaging herpes zoster ophthalmicus patients in the emergency department: do all patients require referral?

OBJECTIVES: The objective was to assess the predictive value of clinical signs and symptoms of herpes zoster ophthalmicus (HZO) for development of moderate to severe eye disease. METHODS: This was a prospective cohort multicenter study of 54 patients referred to the ophthalmology service after presenting to the emergency department (ED) or primary care clinic with a zosteriform rash of less than 10 days' duration. Upon referral to ophthalmology, easily assessable clinical signs and symptoms were documented. A complete ocular exam was then performed. Patients were followed for 2 months. RESULTS: Twenty-three patients (43%) developed moderate to severe disease as defined by corneal or intraocular involvement. Eye redness and rash in the supratrochlear nerve distribution had a statistically significant association with clinically relevant eye disease. All 23 patients who developed moderate to severe eye disease presented with a red eye. Hutchinson's sign (nasociliary nerve involvement) was not predictive of clinically relevant eye disease. CONCLUSIONS: Eye redness was 100% sensitive for predicting moderate to severe eye disease in this sample of patients and should necessitate immediate referral for ophthalmologic assessment. Patients lacking eye redness, even with a positive Hutchinson's sign, may not require immediate specialist consultation. All patients not being referred require careful instructions to seek further care should they develop any concerning eye symptoms such as redness, pain, photophobia, or visual disturbance.