Interventions and Outcomes in Patients with Infectious Pseudomonas scleritis: A 10-Year Perspective.

Purpose: To identify interventional factors associated with improved visual results and faster time to resolution for patients with Pseudomonas scleritis. Methods: Retrospective study analyzing inciting factors, therapeutic modalities, and outcomes of patients with Pseudomonas scleritis. Results: A total of 24 patients were analyzed; 22 were treated as outpatients. All had resolution of infection and 58% (n = 14) maintained ≥20/200 vision. Medical therapy included topical and oral antibiotics; seven received additional subconjunctival injections; two were admitted for IV antibiotics. Patients presenting with ≥20/200 vision were more likely to maintain this level of vision (n = 8, 80%) compared to those presenting with severe vision loss (n = 5, 36%) (p = 0.04). A similar proportion of patients who received (n = 8, 61%) and did not receive (n = 5, 39%) oral steroids achieved 20/200 vision or better once infection resolved, p = 1.0. Conclusions: Pseudomonas scleritis can be successfully managed in the outpatient setting. Oral steroids do not appear harmful in the treatment of this disease.

Revision blepharoplasty.

This article is designed to offer a deeper understanding of complications that can occur with blepharoplasty and to highlight the realm of surgical and nonsurgical therapeutic interventions for revision.

Descemet stripping automated endothelial keratoplasty tissue preparation with femtosecond laser and contact lens.

PURPOSE: To report a novel method of preparing planar Descemet stripping automated endothelial keratoplasty (DSAEK) tissue using a femtosecond laser with a hyperopic soft contact lens (Hyp-SCL). METHODS: DSAEK tissue was prepared from 11 cadaveric porcine eyes. A femtosecond laser was used to create 400-microm flaps, with or without a Hyp-SCL, after which the eyes were imaged with anterior segment optical coherence tomography. The ratio of the mean central thickness (C) to the mean peripheral thickness (P) was calculated using the flap tool. RESULTS: Eleven eyes were cut (5 without, 5 with, and 1 without and with a Hyp-SCL). In all corneas, the cut interfaces were visualized by anterior segment optical coherence tomography. The mean C:P ratio of the flap made without a Hyp-SCL was 0.998 (range 0.968-1.03, SD = 0.254) compared with 0.904 (range 0.851-0.985, SD = 0.509) with a Hyp-SCL (P = 0.001), demonstrating that a cut made with a Hyp-SCL created a flap that was significantly more concave than that created without a Hyp-SCL, resulting in a more planar DSAEK graft. However, the C:P ratios calculated for DSAEK tissue made without (mean 0.998, range 0.965-1.02, SD = 0.0195) and with (mean 1.02, range 0.986-1.05, SD = 0.0250) a Hyp-SCL did not show significance (P = 0.07). CONCLUSIONS: Combining a femtosecond laser and a Hyp-SCL may aid in the creation of planar donor tissue for DSAEK. Clinically, this could reduce the amount of postoperative hyperopic shift, although further human corneal studies are warranted.