Cataract Surgery in Patients with Keratoconus: Pearls and Pitfalls.

BACKGROUND: Keratoconus (KC) is a common ectatic disorder resulting in progressive corneal thinning and irregular astigmatism. It has been observed that patients affected by KC are more likely to develop lens opacities earlier compared to non-keratoconic patients. OBJECTIVE: Intraocular lens (IOL) selection and refractive outcome prediction are among a number of factors that can make cataract surgery in keratoconic patients challenging. Accurate biometry is often difficult to obtain due to unreliable K measurements and lack of dedicated biometric formulae. The use of toric IOLs has also been investigated. CONCLUSIONS: Determining the stage of KC, pre-operative patient counselling and the preferred method of refractive correction are all crucial to obtain successful postoperative outcomes and good patient satisfaction. The use of toric IOLs can achieve good results only in selected low-grade keratoconic eyes.

Mean intraocular pressure and progression based on corneal thickness in patients with ocular hypertension.

PURPOSE: To determine the incidence of glaucomatous progression at mean intraocular pressure (IOP) levels in patients with ocular hypertension (OHT). METHODS: A retrospective, multicentre, cohort analysis of 230 OHT patients with 5 years of follow-up evaluated for risk factors associated with progressive optic disc and visual field loss to determine the incidence of glaucomatous progression. RESULTS: Forty percent of patients with IOPs > or = 24 mmHg, 18% of patients with IOPs of 21-23 mmHg, 11% of patients with IOPs with 18-20 mmHg, and 3% of patients with IOPs of < or = 17 mmHg progressed to glaucoma. The mean IOP was 19.8+/-2.4 mmHg in the stable group and 21.7+/-2.6 mmHg in the progressed group (P=0.0004). The highest average peak IOP was 23.4+/-4.0 mmHg in the stable group and 25.2+/-3.1 mmHg in the progressed group (P=0.006). Based on the pachymetry values for central corneal thickness, patients with thinner corneas more often progressed to glaucoma (P<0.0001). A multivariant regression analysis to determine risk factors for progression was positive primarily for higher peak IOPs, older age, male gender, argon laser trabeculoplasty, visual acuity > or = 20/50, and no topical medical therapy or beta-blocker therapy prior to the study. CONCLUSIONS: IOP reduction within the normal range over 5 years of follow-up reduces the chance of progression to primary open-angle glaucoma in OHT patients.

Patients presenting to an Ophthalmic Emergency Department after 5pm.

We analysed the attendance after 5pm at the Ophthalmic Accident and Emergency department of Royal Victoria Eye and Ear Hospital, Dublin over a period of 34 days. 345 patients attended, 203 (73%) were considered non urgent by the duty ophthalmologist. 12 (3.4%) required immediate admission. 245 (71%) self referred without an accompanying letter. There is a disproportionate amount of non emergency presentations to the RVEEH ophthalmic emergency department that leads to long waiting times and inefficient use of resources. By implementing a multifaceted educational and publicity programme and by improving access to daytime ophthalmic services we will eliminate the need for patients to attend our A&E with non-acute complaints after 5 pm. A new Accident and Emergency department policy is required to prevent inappropriate use of the service after 5 pm.

Toxoplasmosis after a simultaneous pancreas and kidney transplantation.

We report the case of a simultaneous kidney and pancreas transplant recipient who presented with vague neurologic symptoms 21 months following the surgery. Computed tomography, magnetic resonance imaging, and fundoscopy findings were normal. Serology titers for antitoxoplasmic antibodies were increased. This was an atypical presentation of toxoplasmosis in a simultaneous kidney and pancreas transplant patient.