A survey of ocular diseases in an isolated rural Haitian community: a retrospective evaluation.

PURPOSE: To report the prevalence and incidence of ophthalmic pathology from a small, rural town in Haiti and to determine the leading causes of blindness in this population. DESIGN: Retrospective study from 2002 to 2009. Data collected include visual acuity, intraocular pressure, and ocular and family history. METHOD: The study was conducted in a single center--Hospital de Lascahobas, Lascahobas, Haiti. Patients were natives of Lascahobas and the surrounding areas. Treatments were dispensed as indicated or warranted. RESULTS: A total of 3702 patients were seen and examined: 51.52% were male and 49.48% were female. Ages ranged from 6 months to 92 years (mean, 48.69 SD +/- 49.94). Uncorrected refractive error was the most common diagnosis (53.27%), followed by presbyopia (43.76%), hyperopia (34.03%), and myopia (22.21%). A total 981 patients (26.50%) were diagnosed with cataract. Three hundred twenty-three (32.93%) cataract surgeries were performed. The overall postoperative complications rate was 9.29%. A total of 706 patients (19.07%) were diagnosed with glaucoma: 23.65% were glaucoma suspect and 76.35% were diagnosed with open-angle glaucoma (POAG). Of those diagnosed with POAG, 35.06% had end-stage (absolute) glaucoma. The mean age at diagnosis was 52.56 SD +/- 8.2 years. The mean intraocular pressure was 24.07 and 25.60 mm Hg, and the mean cup to disc ratio of the right eye (OD) and the left eye (OS), respectively, was 0.67 and 0.72. CONCLUSIONS: Glaucoma was the most common cause for blindness. The most common cause of correctable vision loss was uncorrected refractive error followed by cataract. Providing constant eye care in this region will most likely decrease the incidence of correctable and permanent vision loss.

Ketorolac tromethamine LS 0.4% versus nepafenac 0.1% in patients having cataract surgery. Prospective randomized double-masked clinical trial.

PURPOSE: To compare the clinical, subjective, and objective outcomes of the use of 2 topical nonsteroidal antiinflammatory drugs--ketorolac tromethamine LS 0.4% (Acular) and nepafenac 0.1% (Nevanac)--in patients having cataract surgery. SETTING: Single-center private practice, Las Vegas, Nevada, USA. METHODS: One hundred eighty-three patients (193 eyes) with visually significant cataract were recruited for the study. Consenting patients were randomized to a standard regimen of Acular, gatifloxacin 0.3% (Zymar), and prednisolone acetate 1% (Pred Forte) (ketorolac group) or Nevanac, moxifloxacin hydrochloride 0.5% (Vigamox), and prednisolone acetate (Econopred) (nepafenac group). Analysis included subjective complaints (burning, itching, foreign-body sensation, pain level after surgery) and objective findings (visual function, degree of inflammation in the anterior segment, complications). RESULTS: The ketorolac group consisted of 94 patients (100 eyes) and the nepafenac group, 89 patients (93 eyes). The between-group differences in visual outcomes and anterior chamber inflammation were not statistically significant (mean P = .33). There was a higher incidence of posterior capsule opacification in the nepafenac group (P = 0.019). Patient satisfaction, patient compliance, and postoperative pain control were statistically significantly better in the ketorolac group (P = .022, P = .023, and P = .025, respectively). CONCLUSION: Ketorolac tromethamine was statistically significantly better than nepafenac in terms of patient satisfaction, compliance, and postoperative pain control.

Bilateral diffuse melanocytic proliferation associated with ovarian carcinoma and metastatic malignant amelanotic melanoma.

PURPOSE: To report a case of metastatic malignant amelanotic melanoma to the skin from a patient diagnosed with bilateral diffuse uveal melanocytic proliferation (BDUMP). This dermatological finding is a unique phenomenon associated with BDUMP. DESIGN: Retrospective case report. METHODS: We studied the case of a 66-year-old Caucasian woman with gradual onset of blurred vision in her right eye followed by her left eye. She had previously been diagnosed with ovarian carcinoma, and findings of funduscopic examinations were consistent with BDUMP. Metastatic examination revealed no evidence of liver involvement. Clinical and histopathological examinations of both enucleated eyes were consistent with BDUMP. RESULTS: The hematoxylin and eosin, S-100, and HMB-45 stains were consistent with metastatic malignant amelanotic melanoma to the skin. CONCLUSIONS: Although believed to have a low potential for metastasis, patients should be monitored and evaluated regularly to detect any new lesions not associated with their primary inciting carcinoma.

Treatment Paradigm After Uncomplicated Cataract Surgery: A Prospective Evaluation.

PURPOSE: To compare 3 clinical variables, namely, visual recovery, anterior chamber inflammation, and macular edema, between 2 different regimens after uncomplicated cataract surgery. DESIGN: Prospective, randomized, single-blind study at a single center, private, teaching practice in Las Vegas, NV. METHODS: Patients randomized to group I (nonsteroidal anti-inflammatory drugs, n = 113) received besifloxacin ophthalmic suspension 0.6% and bromfenac 0.09%, whereas those randomized to group II (steroid, n = 109) received besifloxacin ophthalmic suspension 0.6% and prednisolone acetate 1%.Preoperative evaluation included a baseline macular optical coherence tomography. Postoperative data collected included visual acuity, direct visual anterior segment cell and flare counts, and macular optical coherence tomographies. Foveal thickness and total macular volume were used to assess the presence of cystoid macular edema. RESULTS: Visual recovery was statistically insignificant with P values at 0.7, 0.10, 0.2, and 0.7 at 1 day, 1 week, 1 month, and 2 months, respectively.The degree of anterior segment inflammation was not statistically significant (P = 0.8) between the studied populations.The foveal thickness (1 week, P = 0.8; 1 month, P = 0.2; 2 months, P = 0.2) and total macular volume (1 week, P = 0.7; 1 month, P = 0.1; 2 months, P = 0.2) were not statistically significant between the groups, and the observed power were 0.902 and 0.666, respectively. CONCLUSIONS: This study demonstrated that bromfenac was equally efficacious when compared with a potent topical steroid in restoring visual function, decreasing and resolving anterior chamber inflammation, and preventing the development of macular edema.

Alloplant implant: a novel biomaterial in the management of recalcitrant glaucoma.

In North America, management of glaucoma includes observation, medical therapy, laser surgery, and ab-externa ocular surgery.[1] Although management of glaucoma in Russia does not differ greatly from that in the West, Russia has a unique biomaterial, Alloplant. Figure 1. (click image to zoom) Various Alloplant biomaterials for ophthalmic surgery. Courtesy of the Alloplant Web site: http://www.alloplant.ru/index2_eng.php?page=3&pagel2=3. This unique biomaterial has been documented in Russian literature not only to lower intraocular pressure (IOP) but also to have the potential to induce normal tissue regeneration (allowing for restoration of normal eye physiology), decrease inflammatory response, prevent or minimize scarring, and stimulate regeneration of natural host tissues.