Tape Splint Tarsorrhaphy for Persistent Corneal Epithelial Defects.

PURPOSE: To report outcomes of tape splint tarsorrhaphy (TST) for persistent corneal epithelial defects (PCED). DESIGN: Retrospective, interventional case series. METHODS: The study population was consecutive patients with a PCED (14 days or longer) treated at a tertiary cornea clinic with TST. Patients with a corneal epithelial defect that did not respond to treatment with a bandage contact lens were included. Patients with a follow-up time of less than 3 months were excluded. Time to PCED resolution was the main outcome measure. RESULTS: Thirty-four eyes of 33 patients (mean age 62.9 ± 17.8 years; range, 27-90 years) were included in this study. The main etiologies of the PCED were post keratoplasty (n = 15), herpes simplex virus (n = 4), superficial keratectomy (n = 3), neurotrophic cornea (n = 4), fungal keratitis (n = 2), exposure keratopathy (n = 2), failed graft (n = 1), peripheral ulcerative keratitis (n = 1), rosacea (n = 1), and stitch abscess (n = 1). Mean ± SD time from PCED presentation to TST was 58.9 ± 106.3 days (range, 14-390 days). The mean ± SD area of the PCED was 25.1 ± 15.7 mm2 (range, 0.50-42.0 mm2). After TST, resolution of the PCED was achieved in 29/34 eyes (85.3%) without the need for additional interventions within 22.5 ± 24.3 days (range, 2-105 days). The mean ± SD logMAR best-corrected visual acuity improved significantly from 1.11 ± 0.41 to 0.83 ± 0.70 (P = .02). There were no complications attributed to TST and 2 patients elected to discontinue due to discomfort. CONCLUSIONS: TST achieved resolution of PCEDs secondary to various etiologies in 85.3% of eyes, with significant improvement in vision demonstrated. This simple, inexpensive, noninvasive technique may be considered for patients with PCEDs.

Pediatric orbital cellulitis in the Haemophilus influenzae vaccine era.

PURPOSE: To evaluate the microbiology of pediatric orbital cellulitis in blood cultures and abscess drainage cultures following the introduction of the Haemophilus influenzae serotype b (Hib) vaccine. METHODS: The medical records of all pediatrics patients (aged <18 years) at a tertiary pediatric hospital during the period January 2000 to July 2011 with a computed tomography orbital imaging querying "orbital cellulitis," "periorbital cellulitis," "preseptal cellulitis," or "post-septal cellulitis" were retrospectively reviewed. The records, microbiology, and radiology of these patients were reviewed to assess the rates and complications of H. influenzae orbital cellulitis, including bacteremia and meningitis. RESULTS: A total of 149 patients were diagnosed with preseptal or orbital cellulitis, of whom 101 (mean age, 7.2 ± 4.0) had true orbital cellulitis. No patients grew H. influenzae from blood cultures. Of the 101 patients, 30 (29.7%) required surgical drainage and had abscess drainage fluid sent for microbiology. Of these, 18 (64.3%) had a positive culture: 4 (13.3%) grew H. influenzae from their abscess drainage fluid samples; 1 grew H. influenzae alone; and 3 had mixed growth that included H. influenzae. The patients positive for H. influenzae were significantly older and had significantly larger abscesses. CONCLUSIONS: Although there were no cases of H. influenzae bacteremia or meningitis in our cases of orbital cellulitis, abscess drainage fluid microbiology indicated that H. influenzae remains a cause of orbital cellulitis. H. influenzae abscess volume was significantly larger than other bacterial abscesses and was associated with abscesses of mixed bacterial growth in older children.

The effect of adding orbital computed tomography findings to the Chandler criteria for classifying pediatric orbital cellulitis in predicting which patients will require surgical intervention.

PURPOSE: To assess the effect of adding orbital computerized tomography (CT) findings to the Chandler criteria for classifying pediatric orbital cellulitis in predicting which patients will require surgical intervention. METHODS: The medical records of patients with orbital CT at a tertiary pediatric hospital from January 2000 to March 2011 were reviewed retrospectively. CT images of cases with radiology report of postseptal orbital involvement were further reviewed by a neuroradiologist. RESULTS: Of 101 cases of orbital cellulitis, 71 (mean age, 7.1 ± 4.0) were successfully managed with systemic antibiotics alone; 30 patients (mean age, 7.2 ± 4.3) required surgical intervention. Bony destruction on CT was significantly associated with surgical intervention (P = 0.02), and the size of the subperiosteal abscess (SPA) was significantly correlated with management outcome. Patients who were managed with systemic antibiotics alone had a mean SPA volume of 2.1 ± 2.4 mL; those who had undergone surgical intervention had a mean SPA volume of 14.3 mL ± 16.8 mL (P < 0.0001). If SPA volume is <3.8 mL, then the probability of surgery is 12%; if SPA is >3.8 mL, the probability of surgery is 71% (P < 0.0001). CONCLUSIONS: Adding radiological characteristics such as presence of bony destruction on CT and size of SPA to the Chandler orbital cellulitis classification scheme increases the ability to more accurately predict which patients will require surgical intervention.

Clopidogrel therapy in ophthalmic procedures: a survey of subspecialty ophthalmologists and review of current guidelines.

OBJECTIVE: To assess the knowledge and practice of subspecialty ophthalmologists with respect to perioperative clopidogrel therapy in ophthalmic procedures. DESIGN: Mail survey composed of 5 questions. PARTICIPANTS: Fifteen subspecialty ophthalmologists (3 in each of the fields of surgical retina, anterior segment, oculoplastics, strabismus, and glaucoma) in 3 academic centers in Toronto, Ontario. METHODS: Study parcipants completed an anonymous mail survey consisting of multiple-choice and short-answer questions. We studied participants' knowledge about and clinical practices regarding the use of clopidogrel in the perioperative period of specified ophthalmic procedures. We evalutated perceived risks of halting clopidogrel indicated for both primary and secondary prevention of cardiovascular events, as well as clinical decisions regarding clopidogrel in the perioperative period of specified ophthalmic procedures. RESULTS: There was marked variability and relative lack of knowledge by subspecialty ophthalmologists in the management of clopidogrel in the perioperative period. Only 1 respondent identified coronary stent thrombosis or restenosis as a potential and life-threatening risk of halting clopidogrel therapy in these patients. CONCLUSIONS: In patients with coronary stents, the risks of halting clopidogrel therapy in the perioperative period are potentially life-threatening and include stent thrombosis and myocardial infarction. Ophthalmic surgeons should pay close attention to the indications for clopidogrel therapy in their patients and should enlist appropriate collaboration with their colleagues in cardiology to minimize risks to their patients.

Retinopathy in sickle cell trait: does it exist?

BACKGROUND: Patients with sickle cell trait and concomitant systemic disease are known to be at risk for proliferative retinopathy. However, there are reports of retinopathy in patients with sickle cell trait without systemic disease. There are no population-based studies addressing the risk of sickle cell retinopathy in this group. We performed a study to clarify the relation between sickle cell trait and retinopathy in healthy subjects. METHODS: We reviewed the medical records of 100 children with sickle cell disease who attended the Sickle Cell Clinic at the Hospital for Sick Children, Toronto. We then contacted 200 parents with sickle cell trait, of whom 32 agreed to participate in the study. All participants were proven to have hemoglobin AS status with prior hemoglobin electrophoresis. An ophthalmologic history was obtained, and a complete ophthalmologic examination was performed. We defined sickle cell retinopathy as any salmon patch hemorrhages, iridescent spots, black sunbursts, retinal neovascularization or retinal detachment. The evaluation also included attempts to identify the more subtle signs of sickle cell retinopathy, such as optic nerve head vascular changes, vascular tortuosity, macular changes (e.g., microaneurysms and vascular loops) and peripheral arteriovenous anastamoses. Blood samples were obtained for complete blood count, reticulocyte count and smear. RESULTS: We found no cases of sickle cell retinopathy among the 32 subjects. Ten of 30 subjects had a high reticulocyte count (greater than 120 x 10(9)/L); however, there were no associated eye findings in this subgroup. INTERPRETATION: Our results indicate that there is no increased risk of retinopathy in healthy people with sickle cell trait.