Traumatic endophthalmitis caused by Nocardia kruczakiae in a patient with traumatic eye injury.

BACKGROUND: We describe a case of traumatic ocular endophthalmitis caused by Nocardia kruczakiae after vegetable trauma in an immunocompetent child. FINDINGS: A 5-year-old boy suffered from a trauma with a palm tree leaflet. Two months later, he was diagnosed with traumatic infectious uveitis and intumescent cataract with anterior capsule rupture. Intensive treatment with systemic and topical vancomycin, ceftazidime and methylprednisolone began. After 1 month, he underwent phacoemulsification with intraocular lens implantation (IOL). After some episodes of reactivation, he was diagnosed with traumatic nocardial endophthalmitis from aqueous humour samples. Several operations and specific antibiotic therapy resolved the infection. CONCLUSIONS: In cases of traumatic endophthalmitis and several recurrences, it is extremely useful to make an etiologic diagnosis in order to treat the patient with specific antibiotics.

Frequency of pseudoexfoliation among patients scheduled for cataract surgery.

PURPOSE: To assess the frequency of pseudoexfoliation syndrome (PXF) in patients scheduled for cataract surgery and to evaluate its association with pupil dilation, lens nucleus hardness, intraocular pressure (IOP), glaucoma, age, and sex. SETTING: Ourense University Hospital, Ourense, Spain. DESIGN: Cross-sectional study. METHODS: This study evaluated eyes scheduled for cataract surgery between January 2013 and July 2013. Pseudoexfoliation was diagnosed in phakic eyes that showed central and/or peripheral white deposits on the lens surface, pupillary margin, or both. Dilated pupils were evaluated with a portable pupil chart. Nucleus hardness was assessed according to the Lens Opacities Classification System III. Diagnosis of glaucoma was based on International Society Geographical and Epidemiological Ophthalmology criteria. RESULTS: Of the 1763 eyes (1093 patients) evaluated, 381 (21.6%) were diagnosed with PXF. The frequency of PXF increased with age from 6.0% in people between 50 year and 60 years to 31.66% in those older than 80 years. In PXF eyes, nuclear cataracts were significantly harder than in non-PXF eyes (P < .001). The mean IOP was significantly higher in PXF eyes than in non-PXF eyes (P = .002). The frequency of glaucoma was higher in PXF eyes (17.4%) than in non-PXF eyes (9.4%), with a statistically significant difference (P < .001). In PXF eyes, the pupil was significantly smaller than in non-PXF eyes (P < .001). CONCLUSIONS: The frequency of PXF was high in the study population and increased with age. Eyes with PXF were associated with significantly harder nuclear cataracts, smaller pupils, and glaucoma. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Intracameral phenylephrine 1.5% for prophylaxis against intraoperative floppy iris syndrome: prospective, randomized fellow eye study.

PURPOSE: To evaluate the efficacy of intracameral phenylephrine (IPH) administered as prophylaxis against intraoperative floppy iris syndrome (IFIS) and to analyze the ability of IPH to reverse IFIS. DESIGN: Prospective, multicenter, randomized, comparative case series of fellow eyes. PARTICIPANTS: Forty-two patients receiving tamsulosin who underwent cataract surgery between January and April 2011. METHODS: Phacoemulsification was performed by 2 experienced surgeons at 2 surgical sites (Complexo Hospitalario Universitario Orense and Complexo Hospitalario Universitario A Coruña). One eye of each patient was randomized to receive 0.6 ml of nonpreserved bisulfite-free IPH 1.5% (group 1) or balanced saline solution (group 2) at the start of surgery. If significant miosis or iris prolapse occurred, IPH was injected during phacoemulsification in group 2. No changes were performed in the surgeon's standard fluidic parameters or viscoelastic preferences. Routine topical mydriatics were instilled before surgery. Intraoperative iris billowing and prolapse and pupil size were recorded and videotaped. Surgical complications; adverse events; pre- and postoperative pulse rate and blood pressure; and final best-corrected visual acuity (BCVA), intraocular pressure (IOP), and endothelial cell count (ECC) were recorded. MAIN OUTCOME MEASURES: Incidence of IFIS and change in pupil size after IPH administration in those eyes of group 2 requiring IPH because of significant miosis or iris prolapse. RESULTS: Signs of IFIS were observed in 88.09% of eyes in group 2. No signs of IFS were noted in group 1 (P < 0.001). Significant miosis, iris prolapse, or both occurred in 54.76% of eyes in group 2, although the condition was successfully reverted with IPH, with a significant increase in pupil size after IPH administration (from 4.77±0.88 mm to 6.68±0.93 mm; P=0.000). No intraoperative complications occurred. No significant differences in ECC, BCVA, or IOP were detected between IPH-treated and nontreated eyes. Blood pressure/pulse rate did not differ significantly from preoperative values in IPH-treated cases. CONCLUSIONS: Intracameral phenylephrine is a highly efficient measure for prophylaxis against IFIS. Moreover, the drug can reverse IFIS, restoring iris rigidity and causing the pupil to return to its preoperative size.

Management of late spontaneous in-the-bag intraocular lens dislocation: Retrospective analysis of 45 cases.

PURPOSE: To evaluate the characteristics of and risk factors for spontaneous late in-the-bag intraocular lens (IOL) dislocation and to analyze the outcomes of surgical correction. SETTING: Department of Ophthalmology, Complejo Hospitalario Orense, Orense, Spain. METHODS: In this retrospective single-surgeon interventional case series, the surgical database of a referral center was searched for cases of late spontaneous in-the-bag IOL dislocation between 2005 and 2009. The main outcome measures were interval between surgery and dislocation, dislocation site and grade, IOL type, associated capsular tension ring (CTR), predisposing factors, surgical technique to correct dislocation, preoperative and postoperative corrected distance visual acuity (CDVA), and surgical complications. RESULTS: Pseudoexfoliation was the main risk factor for in-the-bag IOL dislocation (66.66% of 45 cases identified). A CTR was present in the capsular bag in 8 cases. Dislocation was corrected by repositioning using scleral fixation (20 cases) or iris suturing (1 case), IOL exchange for an anterior chamber IOL (AC IOL) (19 cases) or iris-claw IOL (4 cases), or (3) anterior capsulotomy (1 case). The mean CDVA improved significantly postoperatively (P = .0001); it was 20/40 or better in 28 eyes (62.22%) and 20/25 or better in 10 eyes (22.22%). There was no significant difference in postoperative CDVA between scleral-fixated IOLs and AC IOLs (P = .316). CONCLUSIONS: Pseudoexfoliation was the main risk factor for in-the-bag IOL dislocation. The presence of a CTR in the bag did not prevent dislocation. Satisfactory results were achieved with a low rate of complications using different surgical techniques to correct IOL position. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.