Bilateral endophthalmitis after bilateral sequential phacoemulsification.

An 81-year-old woman had uneventful bilateral sequential phacoemulsification using a separate sterile technique for each eye. Despite this, early culture-positive postoperative endophthalmitis developed. Management included bilateral intravitreal antibiotic agents, and the patient achieved an excellent visual outcome. To our knowledge, this is the third reported case of bilateral endophthalmitis after bilateral sequential phacoemulsification and the first reported case in which a separate sterile technique was used in each eye.

An evaluation of intracameral mydriasis for routine cataract surgery.

BACKGROUND: Intracameral Mydrane might facilitate a more streamlined cataract service and improve the patient experience. There is limited 'real-world' evidence of its use in a UK setting. METHODS: As part of a local evaluation of cataract surgery using intracameral Mydrane (group 2; n=60), data were collected on intraoperative pupil size and postoperative visual acuity (VA), as well as the rate of mechanical pupil dilation, intraoperative floppy iris syndrome (IFIS) and complications. Preoperative and theatre turnaround time was recorded and patients completed a validated measure of satisfaction postoperatively. Data were compared with a previous cohort subjected to the existing standard regime of preoperative topical mydriatics (group 1; n=60). RESULTS: Postoperative VA was comparable between groups (0.09±0.16 vs 0.08±0.15; p=0.59). Pupil size in group 2 was 7.0±1.0 mm prior to capsulorhexis and 6.5±0.29 mm after cortical aspiration, with a smaller pupil in patients on alpha-antagonists (4.7±1.1 mm; p=0.004) at this later time point. Comparing group 2 with group 1, preoperative waiting was less (87 vs 146 min; p<0.0001) and satisfaction was higher (76.0±11.2 vs 66.3±8.6; p<0.0001), although theatre turnaround time was longer (25 min vs 22 min). CONCLUSION: Intracameral mydriasis was clinically effective in most patients undergoing cataract surgery and might be associated with an improved patient experience and a more streamlined preoperative flow. Mydrane represents a licensed alternative to the off-label use of other intracameral mydriatic agents, but was not judged to be a cost-effective intervention for routine use in this particular setting.

Ruby laser for the treatment of trichiasis.

Trichiasis, the misdirection of eyelashes arising from their normal sites of origin, may cause discomfort, corneal abrasions, ulceration and scarring. The therapies currently used for this condition have a variety of success rates and complications. In this report we describe epilation using a ruby laser to treat ten patients (11 lids). In six patients laser treatment was completely successful in achieving alopecia, in three patients the treatment was partly successful, and one patient was lost to follow up. In all cases ruby laser treatment was well tolerated, and there were no reported complications; thus, ruby laser treatment can be a viable and well-tolerated option for the relief of the symptoms of trichiasis.