Survey of meticillin-resistant Staphylococcus aureus policies in UK eye departments.

The purpose of this study was to investigate meticillin-resistant Staphylococcus aureus (MRSA) screening and decolonisation practices for patients undergoing routine cataract surgery in ophthalmology departments across the UK. A postal questionnaire survey of all ophthalmology departments in the UK was carried out, with 75 of 152 (49.3%) questionnaires returned. Sixty-three percent of units had a departmental MRSA policy. Preoperative MRSA screening was performed in 50 (66.7%) units, three of which screened all preoperative patients and the remainder performed selective screening. The proportion of patients screened for MRSA ranged from 0 to 100%, with a median of 2% and a mean of 9.9% (95% confidence interval: 3.5-16.2%). Overall, 65.3% of respondents felt that their departmental policy was reasonable, although there was considerable dissatisfaction and confusion, with comments identifying lack of evidence and the need for guidelines applicable to day-case cataract surgery. The survey demonstrates significant inconsistencies in preoperative MRSA screening practice in ophthalmology departments throughout the UK. Current recommendations from the Department of Health suggest that day-case ophthalmology patients do not require routine screening, although the implication appears that high risk patients continue to do so. Further investigation is required to ascertain the scientific validity of these recommendations.

LASIK for post penetrating keratoplasty astigmatism and myopia.

AIMS: To report the results of a series of patients who were treated with LASIK to correct post penetrating keratoplasty ametropia. METHODS: 26 eyes of 24 patients underwent LASIK to correct astigmatism and myopia after corneal transplantation; 14 eyes also received arcuate cuts in the stromal bed at the time of surgery. The mean preoperative spherical equivalent was -5.20D and the mean preoperative astigmatism was 8.67D. RESULTS: The results of 25 eyes are reported. The mean 1 month values for spherical equivalent and astigmatism were -0.24D and 2.48D respectively. 18 eyes have been followed up for 6 months or more. The final follow up results for these eyes are -1.91D and 2.92D for spherical equivalent and astigmatism. The patients undergoing arcuate cuts were less myopic but had greater astigmatism than those not. The patients receiving arcuate cuts had a greater target induced astigmatism, surgically induced astigmatism, and astigmatism correction index than those eyes that did not. One eye suffered a surgical complication. No eyes lost more than one line of BSCVA and all eyes gained between 0 and 6 lines UCVA. CONCLUSIONS: LASIK after penetrating keratoplasty is a relatively safe and effective procedure. It reduces both the spherical error and the cylindrical component of the ametropia. Correction of high astigmatism may be augmented by performing arcuate cuts in the stromal bed.

Staphylococcal infection under a LASIK flap.

PURPOSE: To report a staphylococcal infection under a laser in situ keratomileusis (LASIK) flap and to discuss the management of this rare and potentially devastating complication. METHODS: A patient was referred to our practice having had bilateral LASIK. She was found to have abscesses under the left corneal flap. Staphylococcus aureus was identified as the infecting organism by corneal scrape and treated with appropriate antibiotics. The cornea improved, and then the abscess recurred. The abscess was again scraped and intensive treatment reinstituted. RESULTS: After successful treatment, the patient recovered excellent visual acuity with only a minimal astigmatic error. CONCLUSION: The possible reasons for the apparent improvement and then recurrence of the abscess are discussed. The management of this case including the need for corneal scrape and antibiotic prophylaxis is discussed in relation to previously reported cases.

Toric laser in situ keratomileusis for myopic astigmatism using an ablatable mask.

BACKGROUND: To assess the results of toric laser in situ keratomileusis (LASIK) correction of myopic astigmatism. METHODS: A prospective study was performed over a 20 week period for consecutive patients treated for myopic astigmatism. Spectacle-corrected visual acuity, uncorrected visual acuity, spectacle refraction, videokeratography, and complications were recorded. Vector analysis was performed by the ASSORT program. RESULTS: Sixty-five eyes of 42 patients underwent toric LASIK with a Summit Technologies Apex Plus excimer laser. Mean preoperative spherical equivalent refraction at the spectacle plane was -6.24 +/- 2.42 D (range, -1.63 to -14.63 D) and mean pre-operative refractive cylinder magnitude was 1.99 +/- 1.35 D (range, 0.75 to 7.00 D); mean attempted refractive cylinder correction was 1.90 +/- 1.00 D. Six months after LASIK (43 eyes followed), mean spherical equivalent refraction at the spectacle plane was -0.40 +/- 0.55 D and 31 eyes (72.1%) were within +/- 0.50 D of emmetropia. At 6 months, mean refractive cylinder magnitude was 0.74 +/- 0.70 D, mean surgically induced astigmatism was 1.46 +/- 0.86 D, mean absolute angle of error was 10.33 degrees, mean astigmatic correction index was 0.93 +/- 0.36 D, and mean index of success was 0.46 +/- 0.39. Uncorrected visual acuity was 6/12 or better in 34 eyes (79.1%) and 6/6 in 15 eyes (35%); spectacle- corrected visual acuity was 6/9 or better in 41 eyes (95.35%). Six eyes (14.0%) lost 1 line of spectacle-corrected visual acuity at 6 months and one eye (2.3%) lost 2 lines. Ten eyes (23.3%) gained 1 line at 6 months. CONCLUSION: Toric LASIK with an ablatable mask using the Summit Apex Plus excimer laser is a safe and relatively accurate procedure for the correction of myopic astigmatism.

Ophthalmologists with conjunctivitis: are they fit to work?

PURPOSE: To establish current opinion as to whether ophthalmologists with conjunctivitis are fit to work. METHODS: One hundred and sixty ophthalmology units in the United Kingdom were sent a postal survey enquiring about work practices when an ophthalmologist contracts conjunctivitis. RESULTS: One hundred and five replies were received. Twenty-nine per cent of respondents said the ophthalmologist should stay off work while 7% said he or she should continue as usual. There was no concordance as to whether viral or bacterial conjunctivitis posed a greater problem. There is evidence that ophthalmologists have been implicated in the spread of epidemics of viral conjunctivitis but also reports of ophthalmologists who have continued to work with no reported spread of infection. CONCLUSION: In view of the lack of consensus the authors are unable to recommend evidence-based clinical guidelines, but would suggest that use of modern diagnostic laboratory techniques may help in making the decision as to whether to continue at work or not.

Contrast sensitivity after implantation of diffractive bifocal and monofocal intraocular lenses.

PURPOSE: To compare contrast sensitivity (CS) after implantation of a diffractive bifocal intraocular lens (IOL) and a monofocal IOL of similar design. SETTING: Seven European centers. METHODS: In this randomized, prospective study, CS was tested 5 months after cataract and IOL implantation surgery in 115 patients with a diffractive bifocal IOL and 106 patients with a monofocal IOL. It was also tested in a subgroup of 38 patients who had bilateral implantation of a diffractive bifocal IOL. Contrast sensitivity was tested using the Vision Contrast Test System (VCTS). RESULTS: In patients with a best corrected visual acuity (BCVA) of 1.0 or better, the CS at all spatial frequencies (1.5 to 18 cycles/degree), both at distance and near, was slightly lower in the bifocal IOL group than in the monofocal group. Mean values were within the normal range. In patients with a BCVA of less than 1.0, the CS was lower and the difference between the bifocal and monofocal groups was less. In patients with bilateral bifocal IOLs, CS was better when tested bilaterally than when testing the better eye alone. Pupil size affected the results to a small degree. Contrast sensitivity appeared to improve over time after implantation of a diffractive bifocal IOL. CONCLUSIONS: In patients with cataract and no other eye pathology, the diffractive bifocal IOL with slightly reduce the CS at all spatial frequencies. In those with reduced visual acuity after cataract surgery, CS will be reduced accordingly. In this situation, the reduction from the diffractive bifocal optic would be minor.

Comparison of a diffractive bifocal and a monofocal intraocular lens.

PURPOSE: To compare a Pharmacia diffractive bifocal intraocular lens (IOL) with a monofocal lens of the same design without the diffractive grating. SETTING: Multicenter study. METHODS: This randomized, prospective study comprised 70 patients with a monofocal IOL and 79 with a diffractive bifocal IOL. Follow-up was 5 to 6 months. Near and distance visual acuities, contract sensitivity, patient satisfaction, and spectacle use were evaluated. RESULTS: All patients achieved a best corrected visual acuity of 0.5 or better; 80% in the monofocal and 71% in the bifocal group had a best corrected visual acuity of 1.0 or better. Without correction, 93% of the bifocal and 9% of the monofocal group could read J3 or better. With distance correction, 99% and 4%, respectively, could read J3 or better. Contrast sensitivity was slightly lower in the bifocal group at distance and near for all spatial frequencies. In the bifocal group, 46% never used spectacles for near tasks. Overall satisfaction was rated good by 86% of the monofocal and 85% of the bifocal group. CONCLUSIONS: The diffractive bifocal IOL performed well at distance and near. Patients who no longer require spectacles will benefit significantly from a bifocal IOL, but many with a bifocal IOL in one eye will require spectacles for the fellow eye.

Decentration of photorefractive keratectomy ablation zones after excimer laser surgery for myopia.

PURPOSE: To devise a method for measuring excimer laser photorefractive keratectomy (PRK) ablation zone decentration. SETTING: Excimer Laser Clinic, Sunderland Eye Infirmary, Sunderland Tyne and Wear, England. METHODS: Fifty-three eyes of 53 consecutive patients having PRK for a spherical myopic refractive error were studied. Preoperative and postoperative corneal topographic maps and differential subtraction maps were produced for each cornea. Using these maps, the distance between ablation zone centers and pupil centers was measured. All measurements were repeated by a second observer. RESULTS: Mean ablation zone decentration was 0.46 mm from the pupil center; 69% of cases decentered 0.50 mm or less. The difference between the two independent measurements was 0.05 +/- 0.06 mm (mean +/- SD). A trend toward superonasal displacement was noted. CONCLUSION: This simple method of measuring zone decentration can be used to compare the refractive results of PRK with those of other procedures.

Corneal tattooing revisited: excimer laser in the treatment of unsightly leucomata.

BACKGROUND: Corneal tattooing, a procedure first used by Galen in the treatment of unsightly leucomata, has in recent times received relatively little attention due to major advances in intraocular and corneal surgery. Resurrection of the technique, however, may be reasonably considered in 'high risk' cases of leucomata or leucocoria where corneal transplantation would lead to rejection and failure, or, in eyes with no visual potential, where removal of cosmetically unacceptable dense, white cataracts carries an unreasonable risk of phthisis bulbi or sympathetic ophthalmitis. METHODS: Corneal tattooing requires the accurate and limited removal of corneal epithelium to act as the tattoo bed and unfortunately, if removal of the epithelium exceeds, or goes beyond the circumference of, the chosen area, a ragged cosmetically less pleasing 'pupil' is created. The excimer laser appears to be an ideal tool to create a perfectly circular corneal bed to improve upon older techniques. CONCLUSION: We report, for the first time, an updated, simple and improved technique for successful corneal tattooing using excimer laser technology.