Cytomegalovirus as a cause of recurrent corneal endotheliitis in the Canadian population.

OBJECTIVE: To report the clinical manifestations, response to antiviral treatment, and long-term visual outcomes of cytomegalovirus endotheliitis in a Canadian population. DESIGN: Retrospective case series. PARTICIPANTS: A total of 9 eyes of 7 patients referred to a cornea subspecialty clinic in a major Canadian centre with corneal endotheliitis. METHODS: A retrospective review of all patients presenting with corneal endotheliitis to 1 corneal surgeon was completed. Patients underwent anterior chamber biopsy with positive cytomegalovirus polymerase chain reaction. All patients received systemic valganciclovir for a minimum of 3 months. Primary outcomes included visual acuity, intraocular pressure control, medication dependence, and corneal status. RESULTS: The average follow-up was 76.4 ± 11.8 months. Two patients had bilateral disease. Corneal manifestations included linear, disciform, and circinate patterns of endotheliitis. Best-corrected visual acuity improved from a mean of 0.48 ± 0.19 logMAR at presentation to 0.24 ± 0.11 logMAR at last follow-up. Intraocular pressure decreased from a peak of 35 ± 3.1 mm Hg to 14.2 ± 4.3 mm Hg. Antiglaucoma medications were reduced from 2.6 ± 0.45 to 0.89 ± 0.29 agents. Two eyes required endothelial transplantation. Valganciclovir therapy was well tolerated by all patients; at the time of last follow-up, all patients were stable on low-dose valganciclovir at an average dose of 1395 mg per week. CONCLUSIONS: Cytomegalovirus is an uncommon but clinically significant cause of corneal endotheliitis that must be considered in the differential diagnosis of corneal endotheliitis, even in the immunocompetent population. Our results support prior findings that this entity responds robustly to oral valganciclovir and demonstrate for the first time the efficacy of chronic low-dose antiviral maintenance therapy.

Canadian Opinions on Refractive Surgery and Approaches to Presbyopia Correction.

PURPOSE: To explore the opinions of Canadian ophthalmologists on refractive and presbyopia-correcting surgeries. METHODS: We distributed an online survey to the Canadian Ophthalmological Society members, covering laser refractive surgery (LRS), femtosecond laser-assisted cataract surgery (FLACS), lenticular refractive surgery (lenRS) that includes cataract refractive surgery (CRS) with premium intraocular lens (IOL) implantation, and presbyopia correction. RESULTS: There were 68 (7.6%) total respondents. Most respondents would not consider LRS (62.5%) nor FLACS (73.9%) for themselves. Male sex and performance of LRS or FLACS was significantly associated with consideration of these procedures for self. Most respondents (59.3%) would consider lenRS for themselves. The top method of personal presbyopia correction was spectacles, chosen by 52.5%. CONCLUSIONS: When surveying the wide body of Canadian ophthalmologists, most respondents preferred spectacle correction of presbyopia and would consider lenRS, but not LRS or FLACS for themselves. Surgeons performing these procedures were more likely to consider them for self.

Opinions on corrective refractive surgery.

OBJECTIVE: To investigate public perception that ophthalmologists are hesitant to undergo refractive surgery by determining the personal opinions of ophthalmologists on different surgical options. DESIGN: Prospective cross-sectional survey. PARTICIPANTS: Members of the American Society of Cataract and Refractive Surgery electronic mailing list. METHODS: An online survey administered from July to August 2014. RESULTS: There were 396 (5.7%) respondents: 204 (51.5%) would undergo laser refractive surgery (LRS) and 192 (48.5%) would not. Of the 228 (57.6%) with refractive error, 121 (53.1%) would have LRS, with 83 (36.4%) already having had the procedure done. Top reasons against LRS include existing contraindications, worry about intolerable side effects, and worry about complications. 179 (45.3%) would undergo lenticular refractive surgery (lenRS), with 22 (12.3%) having already had this done. Among those who said yes, most preferred a monofocal intraocular lens (IOL; 59 [33.0%]), whereas those who said no thought Toric IOLs to be superior (82 [38.0%]). 184 (46.6%) would undergo femtosecond laser-assisted cataract surgery (FLACS); the main reason against FLACS was concern regarding efficacy, followed by safety. Pearson χ2 analysis found that younger age and higher number of LRS procedures performed were associated with increased willingness to undergo LRS. Furthermore, willingness to undergo LRS was positively correlated with willingness to undergo lenRS. CONCLUSIONS: Ophthalmologists indeed are willing to undergo corrective refractive procedures. There is an approximately 50-50 divide on whether or not they would undergo LRS. Slightly less than half of ophthalmologists would personally undergo lenticular surgery, which includes cataract refractive surgery and FLACS.

Oral pilocarpine for the treatment of keratoconjunctivitis sicca with central corneal irregularity.

A 31-year-old female physician with bilateral myopia had unilateral myopic laser in situ keratomileusis in the right eye. The patient was overcorrected with the initial treatment and had 2 subsequent hyperopic treatments, resulting in central corneal irregularity. During the course of treatment, the patient was diagnosed with Sjögren's syndrome with marked keratoconjunctivitis sicca. The patient had anisometropia, aniseikonia, and monocular diplopia and was unable to tolerate contact lenses. Oral pilocarpine (Salagen) was prescribed, which improved salivation, lacrimation, and keratoconjunctivitis sicca. The patient was able to tolerate rigid gas-permeable contact lenses to achieve 20/20 visual acuity in both eyes and regain binocular vision.

Unfolder lens injection system with acrylic intraocular lenses: retrospective study.

PURPOSE: To examine the efficacy of using the Unfolder Sapphire series system (Allergan) for implanting acrylic intraocular lenses (IOLs) with a 6.0 mm optic (Sensar AR40, Allergan). SETTING: Ambulatory day-surgery center. METHODS: Phacoemulsification was performed using topical anesthesia. The Unfolder injection system was used to insert a Sensar AR40 acrylic IOL. Data on complications and the success of implantation were collected retrospectively. RESULTS: Two hundred two consecutive patients having implantation of the Sensar IOL with the Unfolder system were examined. Three problems related to the Unfolder injector were identified. Another patient required an anterior vitrectomy, sulcus IOL implantation with the Unfolder, and optic capture; the complication was not related to the Unfolder system. Sulcus implantation was relatively easy with the Unfolder. CONCLUSION: Implantation of the Sensar AR40 IOL with the Unfolder system was easy to perform, and no serious complications occurred.