Ocular microbiology trends in Edmonton, Alberta: a 10-year review.

OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) has been recognized as an increasingly common cause of nosocomial infections since the 1980s.(1) Reports of ocular infections due to MRSA are composed primarily of case reports. But a recent report from the United States suggests that ocular infections due to MRSA are about to become more common than methicillin-sensitive S. aureus (MSSA).(2) However, this observation is not consistent with anecdotal experience at the University of Alberta. The purpose of this study is to evaluate the ocular microbiology trends in a tertiary care eye center in Canada. METHODS: Cross-sectional study using a computer search of the DynaLIFE(DX) Diagnostic Laboratory Services database for all positive ocular microbiology cultures and in vitro antibiotic susceptibilities performed in the Edmonton area. RESULTS: Over a 10-year period, between 2000 and 2010, 6.4% of S. aureus isolates were MRSA; there were 2030 MSSA and 129 MRSA isolates, including 46 MSSA and 4 MRSA isolates from deep eye cultures. The prevalence of MRSA over the total number of S. aureus isolates, regardless of specimen source, steadily increased in the 10-year period, from 0.5% in 2002 to 12.6% in 2010. Gram-positive cocci were the most common organisms to cause ocular infections (82.6%). In vitro susceptibility of ocular MSSA and MRSA samples demonstrated 100% sensitivity to vancomycin. CONCLUSIONS: The prevalence of MRSA ocular infections, although still uncommon, appears to be increasing in Edmonton, Alberta.

Can preoperative anterior chamber angle width predict magnitude of intraocular pressure change after cataract surgery?

OBJECTIVE: To determine whether preoperative anterior chamber angle width, captured by anterior segment optical coherence tomography (AS-OCT), can be a predictor of intraocular pressure (IOP) change following cataract surgery. DESIGN: Prospective comparative observational study. PARTICIPANTS: Fifty-three eyes of 53 patients awaiting cataract surgery were included. METHODS: Measurement of anterior chamber angle width and IOP using AS-OCT and Goldmann's applanation tonometry, respectively, were performed before and 6 months after phacoemulsification and intraocular lens implantation. Preoperative and postoperative measurements were compared using paired t test. The prediction rule defined success as > or =20% IOP reduction from the baseline preoperative IOP measurement. Multivariate regression analysis was performed to assess the association of postoperative IOP with independent variables, including age, sex, systemic hypertension, diabetes mellitus, glaucoma, and preoperative anterior chamber angle width. RESULTS: Data were collected from 32 females and 21 males with visually significant cataract. Mean age was 73.3 (SD 8.2) years. Mean IOP dropped from 15.1 (SD 3.1) mm Hg to 12.8 (SD 2.5) mm Hg (p < 0.0001) after cataract extraction. Mean anterior chamber angle width increased from 24.7 degrees (SD 7.1 degrees ) to 38.1 degrees (SD 6.0 degrees ) after surgery (p < 0.001). Multivariate regression analysis did not identify preoperative variables to be significantly associated with > or =20% postoperative IOP reduction. CONCLUSIONS: Cataract surgery results in significant and sustained mean reductions in IOP and concurrent increases in anterior chamber angle width for a period of at least 6 months after surgery. However, measurements of the preoperative anterior chamber angle width did not predict the IOP-lowering effect of cataract surgery.

Canadian ophthalmology residency training: an evaluation of resident satisfaction and comparison with international standards.

OBJECTIVE: To evaluate the adequacy of Canadian ophthalmology residency programs in achieving the competencies outlined by the International Council of Ophthalmology (ICO) and to assess residents' satisfaction with their training programs. PARTICIPANTS: Canadian residents enrolled in the final 2 years of English and French ophthalmology programs, as well as recent graduates from 2005 to 2008. METHODS: Graduates and eligible residents were invited to participate in the 43-item survey during the autumn of 2008. Data were categorized by demographic variables, and basic statistics were done. RESULTS: Of the 99 individuals surveyed, 40 (40%) responded, representing 26 current residents and 14 graduates. The vast majority (85%) of respondents were satisfied with their residency program. Clinic-based training was generally rated satisfactorily; however, respondents reported insufficient exposure to low-vision rehabilitation (77.5%), refraction and glasses prescription (65%), and neuro-ophthalmology (45%). Respondents were similarly satisfied with their surgical experiences, most of them (>60%) rating case volume, complexity, and variety as satisfactory or better. However, many stated that they had insufficient exposure to extracapsular cataract extraction (72.5%), refractive surgery (72.5%), and orbital surgery (57.5%). Of the graduates surveyed, all passed their Royal College licensing examinations on the first attempt and felt that residency adequately prepared them for the examinations. They reported insufficient training in certain nonclinical areas, such as practice management, and staffing and administration skills. CONCLUSIONS: Canadian ophthalmology residents express high levels of satisfaction with their residency training programs. Although most programs appear to adequately address most ICO core objectives, certain curriculum modifications are required.