Severe and recurrent interface hemorrhage after endothelial keratoplasty.

PURPOSE: To report the occurrence and management of recurrent hemorrhage after Descemet stripping endothelial keratoplasty (DSEK) in a patient with pseudophakic bullous keratopathy. METHODS: An 84-year-old Chinese woman on two oral antiplatelet drugs underwent DSEK in her left eye. Preoperative best-corrected visual acuity was 20/30 OD and 14/200 OS. Intraoperative bleeding was noted from the iris root. Surgery was completed uneventfully, and interface was thoroughly irrigated in the end. Slit lamp examination on the first postoperative day showed a dense interface hemorrhage and an intraocular pressure of 24 mm Hg. Repeat interface irrigation was carried out on postoperative day 4, but the hemorrhage appeared again on the following day. Donor lenticule was well apposed to the corneal stroma, and visual acuity was hand motions in the operated eye. No further surgical interventions were performed. Corticosteroid eye drops were continued four times a day in the operated eye, and the patient was advised weekly follow-up. RESULTS: Over the next 4 weeks, the interface blood gradually started to clear from the central cornea. At the end of 4 months postoperatively, the interface hemorrhage disappeared completely. A final best-corrected visual acuity of 20/80 was achieved. Specular microscopy revealed an endothelial cell density of 1375 cells/mm2. CONCLUSIONS: Interface hemorrhage is a known complication after DSEK surgery. Recurrent hemorrhage may be expected in patients on oral antiplatelet treatment. In cases without associated graft dislocation, conservative management can still result in good visual outcome.

Randomized controlled trial on the safety of intracameral cephalosporins in cataract surgery.

OBJECTIVE: To compare the safety profiles of intracameral cephalosporins in cataract surgery. PATIENTS AND METHODS: In this controlled trial, 129 patients were randomized to one of four groups to receive 1 mg of one of three cephalosporins - cefazolin, cefuroxime, or ceftazidime, or normal saline - given intracamerally during cataract surgery. Central endothelial cell density (ECD) and retinal center point thickness (CPT) were determined by specular microscopy and ocular coherence tomography, respectively, before and at 3 months after surgery. RESULTS: There were no statistical significant differences in the changes of ECD and CPT between eyes receiving intracameral cephalosporin and control. CONCLUSION: The use of intracameral cefazolin, cefuroxime, or ceftazidime (1 mg in 0.1-mL solution) at the time of cataract surgery had no significant effect on ECD and CPT postoperatively.

Oral moxifloxacin and topical amikacin for Mycobacterium abscessus keratitis after laser in situ keratomileusis.

We report a case of Mycobacterium abscessus keratitis after elective laser in situ keratomileusis in a 19-year-old woman. The infection started 3 weeks after uneventful surgery, and the patient received multiple antimicrobial treatments without response. A corneal scrape isolate showed an acid-fast bacterium that was subsequently confirmed by culture to be M abscessus. Prompt treatment of oral moxifloxacin 400 mg twice daily and hourly topical amikacin 2.5% was started. Recovery occurred within the first week of treatment, with complete resolution 3 weeks after presentation. The final uncorrected distance visual acuity was 6/9. We comment on other reports of post-LASIK keratitis caused by M abscessus, the in vitro sensitivity to antibiotic agents described in the literature, and the use of oral moxifloxacin as a potential good alternative treatment based on its good ocular bioavailability, which in our case allowed resolution without the need for surgical intervention.

Antiviral selection in the management of acute retinal necrosis.

There is no consensus on the optimal antiviral regimen in the management of acute retinal necrosis, a disease caused by herpetic viruses with devastating consequences for the eye. The current gold standard is based on retrospective case series. Because the incidence of disease is low, few well-designed, randomized trials have evaluated treatment dosage and duration. Newer oral antiviral agents are emerging as alternatives to high-dose intravenous acyclovir, avoiding the need for inpatient intravenous treatment. Drug resistance is uncommon but may also be difficult to identify. Antiviral drugs have few side effects, but special attention needs to be paid to patients who have underlying renal disease, are pregnant or are immunocompromised.

Tsukamurella: an unrecognized mimic of atypical mycobacterial keratitis? The first case report.

PURPOSE: The purpose of this study was to report on Tsukamurella as a mimic of atypical mycobacterial infection. METHODS: We report a patient who had received repeated corneal grafts with culture-proven Tsukamurella keratitis. RESULTS: A slow-progressing corneal abscess that initially developed adjacent to a corneal stitch responded poorly to empiric antibiotic treatment. A preliminary culture report revealed fast-growing mycobacterial species. Treatment adjustments successfully controlled the disease. A final diagnosis of Tsukamurella was subsequently made on the basis of cultures. CONCLUSIONS: Tsukamurella exhibits laboratory similarities to mycobacteria and should be considered in the differential of atypical infection of the ocular surface.

Prospective study on the safety and efficacy of combined conjunctival rotational autograft with intraoperative 0.02% mitomycin C in primary pterygium excision.

PURPOSE: To describe the novel use of combined conjunctival rotational autograft (CRA) and intraoperative 0.02% mitomycin C (MMC) in the treatment of primary pterygium and to evaluate its safety and efficacy. METHODS: Prospective interventional case series comparing with historical controls was conducted. Patients with primary pterygium underwent pterygium excision, MMC was applied to the scleral bed after the surface conjunctiva was harvested, and the CRA was sutured back with a 180-degree rotation. Patients were followed for a minimum of 1 year. RESULTS: Sixty-seven eyes from 67 patients participated in the study, of which 31 (46.3%) were men and 36 (53.7%) were women. The mean age was 58 +/- 10.6 years, (range 36-79 years). There were 2 recurrences (3%), one occurring at month 3 and the other at month 9. Compared with historical controls, CRA-MMC resulted in significantly fewer recurrences than MMC alone (P = 0.005) when adjusted for age and was equally effective when compared with limbal-conjunctival autografts. The main postoperative problem was graft injection, which was noted in 41 eyes (61%) at 1 year. CONCLUSIONS: To the best of our knowledge, this was the first study on the combined use of CRA and MMC in the treatment of primary pterygium. CRA with MMC was found to be effective in the prevention of recurrence. Although injection remained as a cosmetic concern, it was a safe alternative to limbal-conjunctival autograft in cases where mobilizing autologous conjunctival tissue would not be feasible.