Prediction Error Stabilization and Long-Term Standard Results with a Monofocal Intraocular Lens.

The aim of this study was to assess the stability and differences between objective (O-Rx) and subjective (S-Rx) refraction for the assessment of the prediction error (PE). A secondary aim was to report the results of a monofocal intraocular lens (IOL). 100 subjects were included for whom S-Rx and O-Rx were obtained for all visits, and for visual performance, posterior capsular opacification incidence and Nd:YAG rates at 12 months. Either S-Rx and O-Rx showed a hyperopic shift from 1 to 6 months (p < 0.05) and stabilization after 6 months. S-Rx was related with the axial length (rho = -0.29, p = 0.007), obtaining a major tendency towards hyperopia in short eyes implanted with high-power IOLs. O-Rx showed a myopic shift in comparison to S-Rx (p < 0.05). This resulted in a decrease of the number of eyes in ±0.50 D and ±1.00 D from 79 to 67% and from 94 to 90%, respectively. The median (interquartile range) uncorrected and corrected visual acuities were 0.1 (0.29) and 0 (0.12) logMAR, respectively, and seven eyes required Nd:YAG capsulotomy at 12 months. Some caution should be taken in PE studies in which O-Rx is used or S-Rx is measured in a 1-month follow-up. Constant optimization should be conducted for this IOL after S-Rx stabilization.

Scanning electron microscopy assessment of the Descemet membrane interface during DMEK graft preparation.

We set out to determine microscopic characteristics of the Descemet membrane interface during Descemet membrane endothelial keratoplasty (DMEK) graft preparation. Ten corneas were partially prepared, preserving half of the Descemet membrane attached to the stroma to enable visualisation of the Descemet-stroma interface. This tissue was prepared for viewing with a scanning electron microscope. The Descemet-stroma interface was categorised into three regions: centre, mid-periphery and periphery. We classified adhesions in these regions as either minor thread-like adhesions or major bridge-like adhesions with stromal detachments. We found a region-specific differentiation of the Descemet-stroma morphology. The presence of minor (P = 0,0001) and major (P = 0,0001) adhesions at the explored regions of the Descemet-stroma interface were found to be statistically significant. Fibrotic linear adhesions were predominant in the centre and mid-periphery, whereas the larger bridge-like adhesions were found mainly in the periphery. In addition, we observed a positive correlation between the size of the adhesions and the presence of ruptures in the underlying stromal bed. Viewing of the Descemet-stroma interface with electron microscopy reveals morphological differences between the centre of a graft and its periphery. These findings are of potential clinical relevance in terms of developing a better understanding of tissue behaviour during graft preparation.

Endophthalmitis caused by Fusarium: An emerging problem in patients with corneal trauma. A case series.

BACKGROUND: Although fortunately very rare in countries with a temperate climate, certain factors, such as clinical or pharmacological immunosuppression, may cause Fusarium-related fungal infections to become an emerging problem. Moreover, Fusarium is one of the most important etiological agents in exogenous endophthalmitis, which is often favored by the disruption of the epithelial barriers. AIMS: The aim of this series of clinical cases is to identify characteristic clinical findings that may allow an early diagnosis and more efficient management of this ophthalmologic emergency. METHODS: Three cases of endophthalmitis due to Fusarium solani and Fusarium oxysporum, diagnosed in 2009, 2010, and 2014 in patients from two different health regions belonging to the same health system and separated by around 43 miles, are presented. The Fusarium isolates were initially identified microscopically and the species subsequently confirmed by sequencing the elongation factor alpha (EFα) and internal transcribed spacers (ITS). Susceptibility to antifungal agents was determined using the EUCAST broth dilution method. RESULTS: Evolution was poor as two of the three patients progressed to phthisis bulbi despite surgical measures and broad-spectrum antifungal antibiotic therapy. CONCLUSIONS: It is essential to rapidly instigate multidisciplinary measures to combat suspected endophthalmitis due to Fusarium given the poor prognosis of this type of infection.

Endophthalmitis caused by Fusarium: An emerging problem in patients with corneal trauma. A case series / Endoftalmitis por Fusarium: un problema emergente en pacientes con traumatismo corneal. Serie de casos

Background: Although fortunately very rare in countries with a temperate climate, certain factors, such as clinical or pharmacological immunosuppression, may cause Fusarium-related fungal infections to become an emerging problem. Moreover, Fusarium is one of the most important etiological agents in exogenous endophthalmitis, which is often favored by the disruption of the epithelial barriers. Aims: The aim of this series of clinical cases is to identify characteristic clinical findings that may allow an early diagnosis and more efficient management of this ophthalmologic emergency. Methods: Three cases of endophthalmitis due to Fusarium solani and Fusarium oxysporum, diagnosed in 2009, 2010, and 2014 in patients from two different health regions belonging to the same health system and separated by around 43 miles, are presented. The Fusarium isolates were initially identified microscopically and the species subsequently confirmed by sequencing the elongation factor alpha (EFalfa) and internal transcribed spacers (ITS). Susceptibility to antifungal agents was determined using the EUCAST broth dilution method. Results: Evolution was poor as two of the three patients progressed to phthisis bulbi despite surgical measures and broad-spectrum antifungal antibiotic therapy. Conclusions: It is essential to rapidly instigate multidisciplinary measures to combat suspected endophthalmitis due to Fusarium given the poor prognosis of this type of infection

Antecedentes: Afortunadamente, las infecciones por Fusarium son poco frecuentes en países de clima templado; sin embargo, determinados factores como la inmunodepresión clínica o farmacológica, pueden convertirlas en un problema emergente. Fusarium es uno de los microrganismos etiológicos más importantes de la endoftalmitis exógena, favorecida habitualmente por una rotura de las barreras epiteliales. Objetivos: En esta serie de casos clínicos queremos identificar hallazgos clínicos característicos que puedan establecer un diagnóstico temprano y un tratamiento más eficiente de esta urgencia oftalmológica. Métodos: Se presentan tres casos de endoftalmitis por Fusarium solani y Fusarium oxysporum que se produjeron en los años 2009, 2010 y 2014, en pacientes de dos áreas de salud diferentes, pero pertenecientes al mismo sistema sanitario, las cuales distan 43 millas una de la otra. Las cepas aisladas de Fusarium se identificaron inicialmente por microscopia y su identidad se confirmó posteriormente mediante secuenciación del factor de elongación alfa (EFalfa) y de la región codificadora espaciadora interna (ITS). La sensibilidad a los antifúngicos se llevó a cabo por el método de dilución en caldo del EUCAST. Resultados: Se produjo una mala evolución, ya que dos de los tres pacientes evolucionaron haca la atrofia ocular a pesar de las medidas quirúrgicas y el tratamiento antibiótico y antifúngico de amplio espectro. Conclusiones: Es importante actuar rápidamente con medidas multidisciplinarias ante la sospecha de una endoftalmitis por Fusarium por el mal pronóstico de este tipo de infecciones