Complications and clinical outcomes of intraocular lens exchange in patients with calcified hydrogel lenses.

PURPOSE: To evaluate the outcomes of intraocular lens (IOL) exchange in patients with calcified hydrogel IOLs. SETTING: Ophthalmology departments of 2 university hospitals in Hong Kong, China. METHODS: Fifteen patients developed loss of vision resulting from calcification of hydrogel IOLs. The calcified IOLs were explanted and replaced with new IOLs. The best corrected visual acuity before and after surgery was measured and compared. RESULTS: The mean visual acuity was 0.03 (range 0.01 to 0.20) before IOL exchange and 0.20 (range 0.01 to 0.50) 3 months after; the difference was significant (P <.001). Acuity improved approximately 5 Snellen lines. Complications included posterior capsule rupture in 2 patients and zonular dehiscence in 3 patients; the secondary IOL was placed in the anterior chamber or ciliary sulcus in these patients. Three patients required cutting of the haptics before the calcified IOL could be removed. CONCLUSION: Intraocular lens exchange was an effective treatment in patients with calcified hydrogel IOLs.

Randomized double-masked controlled trial comparing pain scores with and without the use of supplementary 2% lidocaine gel in LASIK.

PURPOSE: To compare pain scores with and without supplementary topical 2% lidocaine gel in patients undergoing simultaneous bilateral laser-assisted in situ keratomileusis (LASIK) under topical anesthesia using 0.5% proparacaine eye drops. DESIGN: Randomized double-masked placebo-controlled trial. METHODS: Fifty-one Chinese subjects (102 eyes, with 51 eyes in each arm) were included. One eye was randomly allocated to have supplementary 2% lidocaine gel while the other eye received carbomer gel as control, in addition to topical 0.5% proparacaine. The pain scores for each eye during microkeratome flap creation, during laser ablation, and at 15, 30, and 45 minutes after LASIK were assessed. An overall pain score of the LASIK procedure was also obtained. Primary outcome measures were pain scores during and after LASIK. Secondary outcomes included need for additional topical anesthesia, patient cooperation score, and duration and complications of surgery. RESULTS: In the 2% lidocaine gel-treated group, the pain scores were significantly lower during microkeratome flap creation and laser ablation, and postoperatively at 30 and 45 minutes (P<.05 for all). Patients in the lidocaine gel group required less additional topical anesthesia (P=.0004) and were more cooperative (P=.019) as compared to the carbomer gel group. No surgical or postoperative complications were observed. CONCLUSIONS: The use of supplementary 2% lidocaine gel in LASIK is effective in lowering the pain experienced during and up to 45 minutes after LASIK.

Clinical features and outcomes of Fusarium keratitis associated with contact lens wear.

PURPOSE: To describe the clinical features and outcomes among contact lens wearers with Fusarium keratitis. METHODS: A retrospective observational review of all cases of culture-proven Fusarium keratitis among contact lens wearers from three hospitals in Hong Kong Island were included. The clinical features, hygiene habits, and clinical outcomes were reviewed. RESULTS: Sixteen patients (17 eyes) were diagnosed with Fusarium keratitis associated with contact lens wear. One patient had bilateral involvement. Six patients had a central lesion; four had paraxial lesions; one had paraxial and peripheral lesions; and the rest had peripheral lesions. Ten (62.5%) patients reported using ReNu multipurpose cleaning solution. Most patients had poor contact lens hygiene habits. One patient required systemic antifungal treatment. No surgical intervention was required in any of the patients. CONCLUSIONS: The clinical features of Fusarium keratitis in contact lens wearers can be variable. Although fungal infection is reported rarely, clinicians should maintain a high index of suspicion for it when examining patients with contact lens-associated microbial keratitis. Education on proper contact lens care should be reinforced. Early and appropriate treatment may lead to satisfactory visual outcomes.

Recent pattern of contact lens-related keratitis in Hong Kong.

PURPOSE: To describe the changing pattern of clinical features and microbiology of contact lens-associated microbial keratitis in Hong Kong. METHODS: This is a retrospective observational case series of patients diagnosed with contact lens-associated microbial keratitis between July 2004 and April 2005 and between July 2005 and April 2006. Patients who wore contact lenses solely for the correction of refractive error and who were seen at Queen Mary Hospital were included in the study. The clinical characteristics, microbiology, and visual outcomes were compared. RESULTS: There were 14 cases between July 2004 and April 2005. Most cases had an axial lesion (eight) or paraxial lesions (four). Corneal scrapings were positive in seven (50%) patients, among whom six showed Pseudomonas aeruginosa and one showed Serratia marcescens as the pathogens. Contact lens storage cases yielded polymicrobial growth in two cases. For the more recent cohort, Fusarium species had been identified as the dominant pathogen, and most (60%) contact lens storage cases showed polymicrobial growth. CONCLUSIONS: There has been an increased number of cases of contact lens-associated fungal keratitis recently. Fusarium species and polymicrobial growth are becoming more dominant.