Comparison of keratometry using SS-OCT and dual Scheimpflug-Placido imaging in postmyopic corneal refractive surgery eyes.

PURPOSE: To compare simulated (SimK) and total (True-K) keratometry and corneal astigmatism values between the IOLMaster 700 (IOLM) and Galilei G4 (G4) devices in postmyopic laser refractive surgery eyes. SETTING: Methodist Eye Associates, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas. DESIGN: Retrospective cohort study. METHODS: A chart review was conducted on patients with prior myopic laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK), undergoing phacoemulsification at a single institution from May 2019 through January 2022, who underwent imaging with both the IOLM and G4. Exclusion criteria were prior radial keratotomy, keratoectatic diseases, and inability to obtain a reliable image. Mean, flat, and steep SimK and True-K (TK from the IOLM and TCP IOL from the G4) values and astigmatism magnitude were compared. RESULTS: 50 eyes of 50 patients were included. The mean difference in SimK and True-K between devices (IOLM - G4) was -0.04 (95% CI -0.13 to 0.06; P > .05) diopters (D) and 1.14 (95% CI 1.02 to 1.25; P < .05) D, respectively. The IOLM measured steeper True-K values than the G4. There were no statistically significant differences between devices for all other SimK values, whereas for True-K there were significant differences in flat K and steep K ( P < .05), but not astigmatism magnitude. CONCLUSIONS: Despite an overall good correlation in postmyopic laser refractive surgery eyes in keratometry and astigmatism measurements, there is a significant difference in True-K, with the IOLM measuring steeper values by about 1.0 D compared with the G4, similar to prior studies on nonrefractive surgery eyes.

Comparison of Simulated and True Keratometry Measurements Using Swept-Source Optical Coherence Tomography and Dual Scheimpflug-Placido Imaging.

PURPOSE: To compare simulated and total keratometry and corneal astigmatism values between the IOLMaster 700 and Galilei G4 devices. METHODS: A retrospective chart review was conducted for all patients undergoing phacoemulsification by a single surgeon (RTP) from March through September 2020 and who underwent imaging with both the IOLMaster 700 and Galilei G4. Exclusion criteria were prior corneal surgery, keratectatic diseases and inability to obtain a reliable image during image acquisition. Mean, flat, and steep keratometry values as well as astigmatism magnitude were compared. RESULTS: A total of 200 eyes of 100 patients were included. Intraclass correlation coefficients (ICC) were moderate or high for all variables. Mean difference ± SD in SimK and TrueK between devices (G4-IOLM) was 0.05 ± 0.318 diopters and -1.1156 ± 0.438 diopters, respectively (p < 0.05 for both). The IOLM measured steeper TrueK value than the G4. For SimK, there was a statistically significant difference between devices only for mean keratometry (K), whereas for TrueK, there were significant differences in flat K, steep K, and mean K. Astigmatism analysis revealed a difference in mean (±SD) SimK of 0.07 (±0.57) D at 94 degrees and in mean TrueK of 0.04 (±0.85) D at 108 degrees. CONCLUSION: Though there is overall good correlation between the IOLMaster 700 and Galilei G4 in SimK and astigmatism measurements, there is a significant difference in TrueK measurements, with the IOLM measuring steeper values by about 1.0 diopter as compared to the G4.

Orbital Compartment Syndrome After High-speed Air-Gasoline Blast Injury.

Orbital compartment syndrome is an ophthalmologic emergency that requires timely surgical intervention. The authors present a rare case of orbital compartment syndrome in a 30-year-old male injured by forceful entry of air-gasoline mixture into the orbit, secondary to inadvertent firing of the piston from running mechanical diagnostics on an automobile internal combustion engine. Orbital CT revealed extensive orbital emphysema with both pre- and postseptal involvement and diffuse chemical cellulitis. Serial exams revealed rapid deterioration of vision with elevated intraocular pressure and development of eyelid, corneal, and orbital edema; a relative afferent pupillary defect and optic nerve hypoperfusion. He was started on intravenous steroids and underwent an emergent lateral canthotomy with cantholysis, which temporarily reduced the intraocular pressure. However, a second rapid increase in soft tissue swelling resulted in another episode of ocular hypertension and compressive optic neuropathy, requiring emergent orbital bony decompression, which was followed by decreased intraocular and orbital pressure. The patient later developed progressive corneal opacification indicating delayed chemical injury. This was managed with a 10-day course of aggressive topical and systemic antiinflammatory agents with significant improvement in visual acuity. At last follow up, the vision was 20/30 and the corneal and eyelid edema had cleared.

Twist and out intraocular lens removal.

Foldable acrylic posterior chamber intraocular lenses (PC IOLs) can be removed via a variety of methods. In this technique, the PC IOL is freed from its position in the capsular bag or sulcus space and raised into the anterior chamber. The IOL is manipulated such that a haptic is externalized through a 2.2 mm corneal incision. A spatula is inserted through a paracentesis incision and placed above the PC IOL. Straight forceps are inserted through the main incision and the haptic/optic junction closest to the paracentesis is grasped with the hand completely supinated. The hand is then pronated while rolling the PC IOL around the forceps using the spatula to guide the PC IOL and guard the cornea. The forceps are then retracted through the main wound, enveloped by the PC IOL, thereby removing an acrylic PC IOL in its entirety using standard intraocular instruments through a 2.2 mm incision.

Shewanella algae keratitis.

A 75-year-old male with a right eye history of chronic dry eye syndrome, glaucoma status post tube shunt, and Fuchs dystrophy status post Descemet stripping endothelial keratoplasty followed by penetrating keratoplasty (PKP) presented with a 2.7 × 4.2 mm corneal ulcer, culture positive for Shewanella algae and Klebsiella oxytoca. A topical antibiotic regimen of gentamicin 14 mg/mL and vancomycin 50 mg/mL was administered according to culture sensitivities. There was concurrent use of loteprednol 0.5% (Lotemax Gel, Bausch and Lomb, Rochester, NY, USA) and later addition of erythromycin 0.5% ointment. The corneal ulcer improved with antibiotic therapy but was complicated by poor patient follow-up. Descemetocele formation prompted PKP in the right eye. The graft was successful and visual acuity improved from a low of light perception to maximum of 20/200 Snellen.

Antibiotic Resistance Rates by Geographic Region Among Ocular Pathogens Collected During the ARMOR Surveillance Study.

INTRODUCTION: The Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR) study is an ongoing nationwide surveillance program that surveys in vitro antibiotic resistance rates and trends among ocular bacterial pathogens. We report resistance rates by geographic region for isolates collected from 2009 through 2016. METHODS: Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa isolates from ocular infections were collected at clinical centers across the US and categorized by geographic region based on state. Minimum inhibitory concentrations (MICs) for various antibiotics were determined at a central laboratory, and isolates were classified as susceptible or resistant based on established breakpoints. Geographic differences in methicillin resistance among staphylococci were evaluated by χ2 test with multiple comparisons, whereas geographic differences in mean percentage antibiotic resistance were evaluated by one-way analyses of variance and Tukey's test. RESULTS: Overall, 4829 isolates (Midwest, 1886; West, 1167; Northeast, 1143; South, 633) were evaluated. Across all regions, azithromycin resistance was high among S. aureus (49.4-67.8%), CoNS (61.0-62.8%), and S. pneumoniae (22.3-48.7%), whereas fluoroquinolone resistance ranged from 26.1% to 47.8% among S. aureus and CoNS. Across all regions, all staphylococci were susceptible to vancomycin; besifloxacin MICs were similar to those of vancomycin. Geographic differences were observed for overall mean resistance among S. aureus, S. pneumoniae, and P. aeruginosa isolates (p ≤ 0.005); no regional differences were found among CoNS and H. influenzae isolates. Methicillin resistance in particular was higher among S. aureus isolates from the South and CoNS isolates from the Midwest (p ≤ 0.006). CONCLUSION: This analysis of bacterial isolates from the ARMOR study demonstrated geographic variation in resistance rates among ocular isolates, with greater in vitro resistance apparent in the South and Midwest for some organisms. These data may inform clinicians in selecting appropriate treatment options for ocular infections. FUNDING: Bausch & Lomb, Inc.

Monocular Clinical Outcomes and Range of Near Vision following Cataract Surgery with Implantation of an Extended Depth of Focus Intraocular Lens.

IMPORTANCE: A full range of near and intermediate vision has not been clinically evaluated for the Symfony extended depth of focus intraocular lens (EDOF IOL). BACKGROUND: To evaluate the monocular range of near visual acuity with an EDOF IOL. DESIGN: Retrospective case series. PARTICIPANTS: Consecutive patients of a single surgeon from January 2017 through March 2018. METHODS: Phacoemulsification with implantation of an EDOF IOL. MAIN OUTCOME MEASURES: Uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), distance-corrected near visual acuity (DCNVA), range of DCNVA, and optimal near focal length. RESULTS: Seventy-six eyes of 48 patients (34 or 71% female, mean age: 68 years) were included with a mean follow-up of 68 days. Mean values were as follows: logarithm of the minimum angle of resolution (logMAR) UDVA 0.02 ± 0.09, logMAR UNVA 0.12 ± 0.09 at a mean distance of 51 cm, logMAR CDVA -0.05 ± 0.07, logMAR DCNVA 0.08 ± 0.07 at a mean distance of 51 cm, and a spherical equivalent of -0.16 diopters ±0.35. Percentage of eyes achieving DCNVA of 20/30 were 84% at 36 cm, 92% at 41 cm, 99% at 51 cm, 93% at 61 cm, and 74% at 71 cm. DCNVA of 20/40 or better was achieved in nearly 100% of eyes over a range of 35 cm. CONCLUSIONS AND RELEVANCE: The Symfony EDOF IOL achieved excellent distance visual acuity while providing a 35 cm range of near visual acuity at levels useful for many tasks in nearly all patients.

Comparison of Anterior Chamber Depth Measurements from the Galilei Dual Scheimpflug Analyzer with IOLMaster.

Purpose. To compare anterior chamber depth (ACD), representing the distance between the anterior corneal surface and anterior lens surface measurements between the Galilei Dual Scheimpflug Analyzer and the IOLMaster. Methods. A retrospective review of 65 individual patient eyes with normal anterior segments, and no prior ocular surgery was performed. Patients underwent ACD measurements with both devices during the same session by a trained examiner. Interdevice agreement was evaluated using paired two-tailed t-tests, Pearson correlation coefficient, and Bland-Altman analysis. Results. The mean ± standard deviation (SD) ACD for the Galilei and IOLMaster was 3.37 ± 0.36 mm (range from 2.62 to 4.13) and 3.25 ± 0.38 mm (range from 2.34 to 3.92), respectively (Pearson correlation coefficient = 0.96). ACD mean difference was 0.12 mm (P < 0.0001); 95% limits of agreement was from -0.09 to 0.34. The Galilei measured slightly longer ACD values than the IOLMaster. There was no relationship between axial length and interdevice difference. Conclusion. ACD measurements correlate well between the Galilei and IOLMaster, with Galilei values on average 0.12 mm longer than the IOLMaster.

Brevundimonas diminuta keratitis.

PURPOSE: To report the first documented case of keratitis secondary to the gram-negative bacillus Brevundimonas diminuta. METHODS: A 66-year-old woman with an ocular history of bilateral soft contact lens wear presented with a large, 6×9-mm, culture-positive Pseudomonas aeruginosa-induced corneal ulcer. After weeks of therapy, she developed secondary keratitis. Repeat cultures grew a rare, gram-negative bacillus, B. diminuta. RESULTS: Targeted therapy followed by adjustments based on repeat bacterial cultures with sensitivities resulted in slow resolution of the ulcer. After months of therapy, the cornea recovered leaving only a minimal corneal scar. Visual acuity improved from a low of Hand Motions to a final 20/40. CONCLUSIONS: This is the first reported case of ocular infection with B. diminuta. This case demonstrates the need to be aware of potential rare secondary infections in corneas compromised by an initial infection and to adjust pharmacotherapy based on sensitivities and clinical signs.

Sudden corneal edema due to retained lens nuclear fragment presenting 8.5 years after cataract surgery.

A 79-year-old woman presented with a 1-week history of sudden onset of decreased vision, pain, and redness in the right eye. Ocular history included uneventful cataract surgery in both eyes more than 8 years prior to presentation. Slitlamp examination revealed significant corneal edema and mild iritis. Gonioscopy revealed a retained lens nuclear fragment in the inferior angle. Surgical removal of the fragment improved the patient's condition. The retained nuclear fragment presumably lodged behind the iris at the time of the initial surgery and spontaneously moved forward more than 8 years later. To our knowledge, this is the longest reported delay between phacoemulsification and presentation of a retained nuclear fragment. Before this case, retained nuclear fragments had been associated with complications within a year of surgery only. We recommend gonioscopy in cases of sudden-onset corneal edema extending to the inferior limbus in patients with a history of phacoemulsification.

Tent-shaped retinal detachments in retinopathy of prematurity.

BACKGROUND: Most retinal detachments associated with retinopathy of prematurity (ROP) are radial, segmental, or circumferential with cicatricial extraretinal fibrovascular proliferation (EFP) at the apex of the detachment. This report describes peculiar tent-shaped retinal detachments that developed among eyes with ROP. METHODS: An observational case series consisting of 9 patients and 13 eyes with tent-shaped retinal detachments. Their morphology, clinical baseline, surgical course, and final retinal status were extracted from medical records. RESULTS: Eight had simple tent-shaped retinal detachments, three had a double tent-shaped retinal detachment, one had a chevron-based retinal detachment, and one had a star-shaped retinal detachment. Each case had a disk based stalk that extended to the apex of the traction retinal detachment and continued anteriorly; 12 stalks inserted in the retrolental space and 1 terminated in the mid vitreous. Six eyes were stage 4A, two eyes were stage 4B, and five eyes were stage 5. Vitrectomy surgery was performed on 11 eyes. Surgery resulted in retinal attachment in nine eyes, and two retinas remained detached. CONCLUSION: Tent-shaped retinal detachments are seen in patients with ROP. A stalk should be sought in evaluation of these eyes. Vitreous surgery focused on relieving this traction is often successful.

Pop-and-chop nucleofractis.

Horizontal chopping is effective for endocapsular nucleofractis. We describe pop and chop, a variant of chopping that enables an easy first crack and initial segment removal. It involves partial extracapsular prolapse of the nucleus prior to the initial chop. It is particularly useful when hydrodissection results in partial prolapse of the lens nucleus so that it is wedged into the anterior capsule opening. It is also helpful when beginning surgeons are learning phaco chop.