Spontaneous resolution of a traumatic cataract caused by an intralenticular foreign body.

A 49-year-old man presented with an intralenticular metal foreign body incurred while he was sawing wood. The metal chard had violated the lens capsule and was lodged in the cortex of the lens. It was removed using a lens-preservation technique during open-globe repair. Subsequently, a dense posterior cortical cataract developed, which spontaneously resolved over the ensuing months. The cataract had a cruciate configuration with wave-like disruption of the stromal lamellae. To our knowledge, this is the first case of spontaneous resolution of a cataract after capsule violation by an intralenticular foreign body. The unique appearance of the cataract and its unusual resolution led to a new theory of lens injury by shockwave.

Zernike versus Fourier treatment tables for myopic patients having CustomVue wavefront laser in situ keratomileusis with the S4 excimer laser.

PURPOSE: To compare the efficacy, predictability, and safety of Zernike-based versus Fourier-based treatment tables in myopic eyes 1 year after CustomVue wavefront laser in situ keratomileusis (LASIK) using the S4 excimer laser (Visx). SETTING: Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA. METHODS: A prospective analysis of 32 eyes of 16 patients with myopia who had CustomVue LASIK with the S4 excimer laser was conducted using Zernike or Fourier treatment tables. Mean spherical equivalent (SE), uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and higher wavefront analyses were determined. RESULTS: The mean postoperative SE was -0.27 diopter (D) +/- 0.41 (SD) in Zernike-treated eyes and -0.20 +/- 0.29 D in Fourier-treated eyes. Twenty-eight of 32 eyes were available for analysis. Ninety-two percent of eyes in the Zernike group and all eyes in the Fourier group had 20/20 or better acuity (P = .85). Seventy-nine percent and 92%, respectively, were within +/-0.50 D of emmetropia (P = .68). All eyes in the Zernike group and 93% of eyes in the Fourier group had no change or gained at least 1 Snellen line of BSCVA (P = .85). Mean higher-order aberration values (mum) in the Zernike group and Fourier group were as follows: total root mean square, 0.91 and 0.99, (P = 0.95); defocus, 0.71 and 0.74, (P = 0.98); astigmatism, 0.15 and 0.31, (P = 0.81); coma, 0.21 and 0.20, (P = 0.99); trefoil, 0.11 and 0.11, (P = 1); and spherical aberration, 0.17 and 0.30, (P = 0.85), respectively. CONCLUSIONS: Myopic eyes that had CustomVue LASIK had better visual outcomes in the Fourier group than in the Zernike group. Higher-order wavefront aberration results were similar between the 2 groups.

Topographic centration of ablation after LASIK for myopia using the CustomVue VISX S4 excimer laser.

PURPOSE: To determine the ablation centration, efficacy, predictability, and safety of CustomVue LASIK using the VISX S4 excimer laser for the treatment of myopia and myopic astigmatism. METHODS: A retrospective review of 20 myopic eyes of 12 patients treated with LASIK CustomVue VISX S4 was conducted. Corneal topography was used to determine ablation centration. Primary outcome variables including manifest refraction, best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), and complications were evaluated at 3 months postoperatively. RESULTS: Mean decentration (from ablation zone to entrance pupil) was 0.23 +/- 0.08 mm at 3 months postoperatively. No eyes were decentered > 0.5 mm. Preoperatively, the mean spherical equivalent refraction was -4.81 +/- 11.39 diopters (D) (range: -6.75 to -2.25 D). At 3 months postoperatively, mean spherical equivalent refraction was -0.63 +/- 0.25 D (range: -2.00 to 0.25 D). Nineteen (95%) of 20 eyes had UCVA of 20/40 and 16 (80%) of 20 eyes had UCVA of 20/20 at 3 months postoperatively. Fourteen (70%) eyes were within +/- 0.50 D and 18 (90%) eyes were within +/- 1.00 D of emmetropia. No eye lost > 1 line of BSCVA. CONCLUSIONS: Wavefront-guided LASIK using the CustomVue VISX S4 for myopic eyes results in minimal decentration ablation and effective, predictable, and safe visual outcomes.

Endophthalmitis prophylaxis.

The prevalence of postoperative endophthalmitis following cataract surgery appears to be increasing with the popularity of clear cornea incision. As a result, endophthalmitis prophylaxis will play and increasingly important role as the number of clear cornea cataract surgeries increases. In this article, the authors examine and critically evaluate techniques used to prevent endophthalmitis including proper preoperative patient preparation, application of povidone-iodine, and use of broad-spectrum antibiotics (topical, intracameral, and subconjunctival injection).

Posterior pole tumor update.

This chapter focuses on the diagnosis and management of choroidal melanoma in light of recent findings from the COMS. Retinoblastoma is emphasized to describe recent trends in primary treatment away from EBRT and toward chemoreduction with local therapy. In addition, vascular and glial tumors of the retina and tumors of the retinal pigment epithelium are described because of the association between these lesions and systemic disease. Recent advances in treatment and genetic testing for these diseases are discussed. Finally, ocular metastasis, intraocular lymphoid tumors, and intraocular leukemia are included because of their importance in determining systemic treatment and prognosis. The chapter gives an overview of important posterior pole tumors and highlights recent developments in the management of each intraocular disease process.