Extensive bone formation in a painful blind eye.

Osseous metaplasia may occur in phthisis bulbi, usually caused by long-standing retinal detachment, ocular trauma, or inflammation. However, extensive intraocular bone formation is a rare phenomenon. We report a case with long-standing phthisis bulbi demonstrating subretinal extensive bone formation. Results of histopathologic examination revealed extensive bone formation overlying the choroid with accompanying bone marrow without hematopoiesis.

Does Cataract Surgery Simulation Correlate with Real-life Experience?

OBJECTIVES: To evaluate the correlation of cataract surgical simulator and real-life surgical experience and its contribution to surgical training. MATERIALS AND METHODS: Sixteen doctors in our department were divided into three groups based on their surgical experience. After being familiarized with the device, the participants were evaluated while performing the navigation, forceps, bimanual practice, anti-tremor and capsulorhexis stages. The capsulorhexis stage was repeated five times. Participants were also assessed while performing capsulorhexis again with their non-dominant hand. The influence of repetition and surgical experience on the recorded points was evaluated. P values below 0.05 were considered statistically significant. RESULTS: There was correlation between the participants' surgical experience and their scores in the capsulorhexis module. Their dominant hand was more successful than the non-dominant hand in capsulorhexis (p=0.004). Capsulorhexis scores increased with repetition (p=0.001). CONCLUSION: Results achieved with the cataract surgery simulation device correlate with surgical experience. The increase in performance upon repeated practice indicates that the simulator supports surgical training.

Corneal Collagen Crosslinking Treatment in a Case with Pneumococcal Keratitis.

Bacterial keratitis is a serious ocular infectious disease that can threaten vision. The disease generally progresses rapidly and can lead to corneal scar, stromal abscess formation, perforation, and dissemination to adjacent tissues if not treated properly. Recent studies showed that corneal collagen crosslinking (CCC) using ultraviolet-A/riboflavin is effective in the treatment of bacterial keratitis refractory to topical antibiotic treatment. In addition to being bactericidal, CCC also decreases risk of perforation by strengthening the corneal collagen structure. Herein, we report a male patient with Streptococcus pneumonia keratitis 6 months after a keratoplasty procedure, which did not respond to fortified topical antibiotic therapy and was treated successfully with riboflavin/ultraviolet-A CCC. His pain decreased remarkably in a few days. The corneal epithelial defect healed and infiltration regressed within 2 weeks after CCC. His vision improved significantly from hand movement to 20/400. CCC might be used as adjuvant treatment in bacterial keratitis refractory to medical treatment.

Correlation of Corneal Endothelial Cell Density with Corneal Tomographic Parameters in Eyes with Keratoconus.

OBJECTIVES: To examine changes in corneal endothelial cell density (ECD) in different stages of keratoconus and evaluate its correlation with corneal tomographic parameters. MATERIALS AND METHODS: Two hundred six patients with keratoconus were enrolled in the study. Corneal topography was performed by Sirius (CSO, Italy), which has a rotating Scheimpflug camera and a Placido disc topographer. Automatic endothelial analysis was done with the non-contact endothelial microscope (20x probe) of Confoscan-4 (NIDEK, Japan). The eyes were classified into stages based on steepest keratometric value as follows: mild <45 D; moderate 45-52 D; severe >52 D and according to thinnest cornea thickness (TCT) as <400 µm, 400-450 µm, and >450 µm. Tomographic and endothelial cell parameters were compared among the groups using Kruskal-Wallis test and the correlations between them were analyzed using Spearman correlation. RESULTS: The study included 391 eyes of 100 male (24.29±7.7 years, range 11-47 years) and 106 female (26.26±7.5 years, range 13-45 years) patients (p=0.07). Mean ECD values were 2628±262 cells/mm2, 2541.9±260.4 cells/mm2, and 2414.6±384.3 cells/mm2 in mild, moderate, and severe keratoconus, respectively (p<0.001) and 2592.3±277 cells/mm2, 2502±307 cells/mm2 and 2348±296 cells/mm2 in corneas with TCT values >450 µm, 400-450 µm, and <400 µm, respectively (p<0.001). ECD showed significant negative correlation with keratometric and elevation parameters and positive correlation with pachymetric parameters (p<0.05). CONCLUSION: As endothelial cell numbers seem to decrease with the progression of keratoconus, specular/confocal microscopy screening should be carried out, especially in eyes with advanced stages and corneas with TCT <400 µm.

Safety of prophylactic intracameral moxifloxacin use in cataract surgery.

PURPOSE: To evaluate posterior and anterior segment safety of an intracameral injection of moxifloxacin as prophylaxis for endophthalmitis in cataract surgery. METHODS: In this study, 60 eyes of 60 patients were included. In the first group, only 5% povidine iodine drop was administrated to 30 patients at the end of the surgery, while 30 patients were treated with intracameral moxifloxacin (250 µg/0.050 mL) additionally in the second group. Visual acuity, intraocular pressure, corneal pachymetry, corneal clarity, and edema and retinal thickness were evaluated preoperatively and for day 3 postoperatively for each group and were compared. RESULTS: Mean preoperative visual acuity was 0.7 ± 0.9 LogMAR in both groups 1 and 2, while mean postoperative visual acuity was 0.05 ± 1.00 LogMAR in both groups. Preoperative and postoperative intraocular pressure averaged 13.2 ± 2.0 and 13.2 ± 2.1 mmHg, respectively, in the first group, while preoperative and postoperative intraocular pressure was 14.9 ± 2.1 and 14.3 ± 2.0, respectively, in the second group. Preoperative and postoperative visual acuity changes and intraocular pressure changes were not significantly different between 2 groups. There was no single case of corneal edema. In the first group, preoperative pachymetry was 523 ± 44 and postoperative pachmetry was 536 ± 45 µm, while in the second group preoperative pachymetry was 527 ± 43 and postoperative pachymetry was 543 ± 42 µm. Preoperative and postoperative pachymetry changes were not significantly different between 2 groups. Mean preoperative macular thickness in the first group was 188 ± 7.73 µm, while it was measured as 189 ± 7.75 µm postoperatively. In the second group, mean preoperative macular thickness was 188 ± 8.89 µm, while it was 189 ± 9.61 µm postoperatively. Preoperative and postoperative optical coherence tomography (OCT) measure changes were not significantly different between the 2 groups. No study-related adverse events were noted. CONCLUSION: There was no increased safety risk associated with a 250 µm/0.050 mL intracameral injection of moxifloxacin, which appears to be safe in the prophylaxis of endophthalmitis after cataract surgery.