Bacterial Keratitis in Toronto: A 16-Year Review of the Microorganisms Isolated and the Resistance Patterns Observed.

PURPOSE: To review the incidence, distribution, current trends, and resistance patterns of bacterial keratitis isolates in Toronto over the past 16 years. METHODS: Microbiology records of suspected bacterial keratitis that underwent a diagnostic corneal scraping and cultures from January 1, 2000, through December 31, 2015, were retrospectively reviewed. The distribution of the main isolated pathogens and in vitro laboratory minimum inhibitory concentration testing results were used to identify resistance patterns. RESULTS: A total of 2330 corneal scrapings were taken over 16 years. A pathogen was recovered in 1335 samples (57.3%), with bacterial keratitis accounting for 1189 of the positive cultures (86.0% of all isolates). The total number of gram-positive and gram-negative isolates was 963 and 324, respectively. Coagulase-negative Staphylococcus and Pseudomonas aeruginosa were the most common gram-positive and gram-negative bacteria isolates, respectively. A decreasing trend in the number of isolates in gram-positive bacteria (P = 0.01), specifically among Staphylococcus aureus (P < 0.0001) and Streptococcus species (P = 0.005), was identified. When analyzing the susceptibilities of gram-positive and gram-negative isolates, an increasing trend in antibiotic resistance was observed in erythromycin (P = 0.018), ceftazidime (P = 0.046), and piperacillin/tazobactam (P = 0.005). The susceptibility of tested gram-positive microorganisms to vancomycin was 99.6%. CONCLUSIONS: There has been a decreasing trend in the number of isolates in gram-positive microorganisms over the past 16 years. An increasing trend in resistance for various antibiotics against gram-negative and gram-positive isolates was identified. High susceptibility to vancomycin reinforced the empirical use of fortified tobramycin and vancomycin in the initial management of severe bacterial keratitis.

Evisceration for the management of ocular trauma.

Despite the eye being surrounded by orbital bones and protective mechanisms such as the blink reflex, it is vulnerable to trauma. The two key issues to consider when presented with a case of ocular trauma are the visual potential of the eye and the risk of sympathetic ophthalmia. The Ocular Trauma Score can be used to assess the visual potential of the injured eye. Surgical management may be either repair or removal of the eye (evisceration or enucleation). Herein we describe a case of ocular trauma and the decision-making process in the management of the injury.

Calcification of hydrophilic acrylic intraocular lenses in combined phacovitrectomy surgery.

UNLABELLED: Two cases of postoperative intraocular lens (IOL) calcification in patients implanted with the Akreos Adapt IOL at the time of combined phacovitrectomy are described, along with clinical review of all patients implanted with this IOL type at our institution between November 2006 and September 2008. The IOLs explanted from the 2 cases were examined using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). The SEM of the explanted IOLs showed crystalline anterior surface and subsurface deposits; by EDX, the deposits showed high concentrations of calcium and phosphorous, consistent with calcium apatite. Twenty patients (20 eyes) attended for cohort review, and none showed IOL opacification. The reason calcification occurred in the 2 cases remains unknown, but clinicians should be aware of this potential complication. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Postoperative rotation of a 3-piece loop-haptic acrylic intraocular lens.

PURPOSE: To assess the rotational stability of the AcrySof MA60BM acrylic intraocular lens (IOL) with and without aspiration of residual lens epithelial cells (LECs). SETTING: Stoke Mandeville Hospital, Aylesbury, United Kingdom. METHODS: Routine phacoemulsification was performed with (Group A) or without (Group B) aspiration of residual LECs (random allocation). The baseline position of the IOL was determined from a video frame acquired at the conclusion of surgery. Postoperative IOL position was documented using digital retroillumination images at 2 weeks and 3 months. Early IOL rotation (surgery to 2 weeks postoperatively) was graded as mild (<10 degrees), moderate (10 to 30 degrees), or severe (>30 degrees) by semiobjective comparison of the images. Late IOL rotation (2 weeks to 3 months) was measured more precisely using purpose-designed software. RESULTS: Group A had incomplete aspiration of residual LECs. The only between-group demographic difference was significantly more men in Group A than in Group B (P<.05). There were no cases of severe early IOL rotation. Mild and moderate early rotation occurred in 91.5% of eyes and 8.5% of eyes, respectively. The mean late rotation was 0.03 degrees +/- 3.06 (SD) (range 7.8 to -8.7 degrees). Aspiration of residual LECs made no statistical difference in early or late rotation (P>.05). Between 2 weeks and 3 months, counterclockwise rotation occurred in 50% of all cases. CONCLUSIONS: Postoperative rotation of the loop-haptic IOL was stable; LEC clearance did not adversely affect performance. The tendency toward counterclockwise rotation would not preclude good performance of a toric model of the IOL.

Treatment of vasoproliferative tumors with photodynamic therapy.

A 46-year-old woman presented with a peripheral vasoproliferative tumor. The tumor was treated with one session of photodynamic therapy with 6 mg/m2 body surface area of verteporfin and a dose of 100 J/cm2 delivered in 83 seconds. At the 10-month follow-up examination, involution of the vasoproliferative tumor was seen with improvement of best-corrected visual acuity to 20/80. Photodynamic therapy is an effective treatment option in cases of exudative vasoproliferative tumors. Great variability exists in the parameters used to treat vasoproliferative tumors.