In vivo confocal microscopy: qualitative investigation of the conjunctival and corneal surface in open angle glaucomatous patients undergoing the XEN-Gel implant, trabeculectomy or medical therapy.

PURPOSE: Assessing the quality of the ocular surface by in vivo scanning laser confocal microscopy (IVCM) in primary open angle glaucoma (POAG) patients treated by Xen 45 Gel Stent, medical therapy and trabeculectomy. METHODS: Retrospective, single-center, single-masked, comparative study including 60 eyes of 30 patients (mean age 61.16 ± 10 years) affected by POAG. Eyes were divided into 3 groups: Group 1 eyes underwent the Xen 45 Gel Stent procedure, Group 2 eyes were under medical therapy, Group 3 eyes were surgically treated by trabeculectomy. All patients underwent HRT II IVCM analysis of cornea, limbus, conjunctiva, sub-tenionian space and sclera. RESULTS: The Xen 45 Gel stent, if properly positioned in the sub-conjunctival space preserves goblet cells and limits ocular surface inflammation. Regular corneal epithelial cells with micro-cysts, and normo-reflective sub-epithelial nerve plexus are documented by IVCM. In sub Tenon's implants an alternative lamellar intra-scleral filtration is detectable. Combined surgical procedures show a noticeable number of inflammatory cells with rare micro-cysts. Post-trabeculectomy inflammatory reaction is more evident than Xen 45 Gel Stent associated surgical procedures, but less than medical therapy where a conspicuous presence of Langerhans cells, peri-neural infiltrates, marked loss of goblet cells and fibrosis is visible. CONCLUSION: Ocular surface inflammation was more notable in topical therapy than after trabeculectomy, which itself causes more inflammation than XEN Gel stents.

Contrast sensitivity evaluation of aspheric and spherical intraocular lenses 2 years after implantation.

PURPOSE: To compare the quality of vision with aspheric and spherical intraocular lenses (IOLs) in pseudophakic patients after long-term follow-up. METHODS: Two hundred eyes of 100 patients with bilateral cataracts were randomly assigned to receive spherical (Acrysof SN60AT [Alcon Laboratories Inc] or Sensar AR40e [Advanced Medical Optics Inc]) or aspheric IOLs (Acrysof SN60WF [Alcon] or Tecnis Z9000 [Advanced Medical Optics]). Ophthalmologic examination, including best spectacle-corrected visual acuity (BSCVA), pupil size, ocular dominance, contrast sensitivity under mesopic and photopic conditions, and wavefront analysis, was performed 2 months and 1 and 2 years after surgery. RESULTS: No statistically significant differences among the four groups in terms of age, pupil diameter, postoperative BSCVA, comeal spherical aberration, and posterior capsular opacification were noted. At all followup examinations, contrast sensitivity results showed no significant differences between the two aspheric IOLs at all spatial frequencies. Under photopic conditions, significant differences (P<.05) between spherical and aspheric IOLs were detected for spatial frequencies of 12 and 18 cycles per degree (cpd) at 2 months and 2 years and 12 cpd at 1 year. Under mesopic conditions, significant differences (P<.05) were detected between spherical and aspheric IOLs for all spatial frequencies at 2 months; all spatial frequencies except 18 cpd at 1 year; and spatial frequencies of 3, 12, and 18 cpd at 2 years. In addition, aspheric IOLs had statistical reductions in total spherical aberration at all follow-up examinations (P<.01). CONCLUSIONS: This study confirms that implantation of a modified aspheric IOL improves functional visual performance at 2 years postoperative.

Phacoemulsificator and sterile drapes contamination during cataract surgery: a microbiological study.

PURPOSE: To determine the microbial contamination of the irrigating fluids at the time of phacoemulsification after the use of topical povidone-iodine and antibiotics prophylaxis. METHODS: A total of 119 patients undergoing cataract surgery were enrolled in this prospective study. All patients received 5 mg/mL levofloxacin starting from the day prior to surgery and topical and 5% povidone-iodine drops starting from 30 minutes before the surgery. At the end of each surgery, 2 samples of drainage liquids were sterilely collected from the drainage bags (DBL) and from the peristaltic pump single-cassettes (PCL) of the phacoemulsification machine. Search for aerobic and anaerobic bacteria and fungi was performed. RESULTS: Seventy-five patients (31.5%) revealed a growth of at least one microbial species (53 DBL and 22 PCL, 44.5% vs 18.5%; p<0.001). Sixty-six patients (55.5%) had at least one positive intraoperative solution. Overall, 111 microbial strains were collected: 82 (74%) Gram-positive bacteria, 20 (18%) fungi, and 9 (8%) Gram-negative bacteria. Thirteen staphylococcal isolates from PCL, compared with 52 out of DBL (11% vs 43.7%, p<0.001), fungi were essentially isolated from PCL. No significant correlation was found between microbial isolation and risk factors. No postsurgical infective complication occurred in the follow-up. CONCLUSIONS: Evaluation of intraoperative fluids can provide evidence on sources or vehicles of postsurgical infections. Antibiotic prophylaxis and topical povidone-iodine can significantly contribute to minimize the risk of endophthalmitis.

In vivo confocal microscopy and anterior segment optical coherence tomography in a case of alternaria keratitis.

PURPOSE: To report a case of Alternaria alternata keratitis analyzed with in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (OCT). METHODS: A 68-year-old man with unilateral keratitis was evaluated using IVCM (Heidelberg Retina Tomograph II; Heidelberg, Germany) and anterior segment OCT (Visante OCT; Carl Zeiss Meditec, Dublin, CA). RESULTS: IVCM demonstrated the presence of small, round, hyperreflective cells surrounded by hyporeflective irregular areas and highly reflective dendritic shaped cells at the level of the epithelium. Stromal examination revealed many hypereflective filamentous structures, and some hyporeflective perpendicular lines and hyperreflective oval bodies were clearly visible along the filaments. Anterior segment OCT examination demonstrated a thickened cornea due to diffuse edema and an irregular corneal surface corresponding to the ulcer. There were hyperreflective areas beneath the epithelium representing the infiltrate. Microbiological examination of corneal scrapings demonstrated the presence of Alternaria alternata. After 1 month of antifungal treatment, IVCM demonstrated a significant reduction of the inflammatory cells and a hyperreflective scar-like tissue. Branching hyphal infiltrates were no longer present. OCT also documented the healing process and the complete recovery of the central and peripheral stromal thickness. CONCLUSIONS: IVCM and anterior segment OCT could be useful for the early diagnosis and treatment of fungal keratitis.