Physical Incompatibility between Vancomycin and Viscoelastic Mimicking Acute Endophthalmitis: The First Report.

This is the first documentation of vancomycin precipitation with viscoelastic in the anterior chamber of the eye. A 34-year-old white male underwent uneventful penetrating keratoplasty. Intracameral instillation of 1 mg/0.1 mL of vancomycin followed no attempts of meticulous viscoelastic irrigation. Six hours later thick white material in the anterior chamber was sedimented. The following criteria excluded the diagnosis of endophthalmitis and TASS: clear and transparent anterior chamber and vitreous body, the absence of ciliary injection and corneal oedema, and unremarkable laboratory tests' results. This iatrogenic complication mimicking endophthalmitis does not require any specific management and should be acknowledged in guidelines for prevention and treatment of endophthalmitis. The objective of this paper is to alert colleagues to this iatrogenic complication of vancomycin mimicking endophthalmitis. Whether this condition should be labelled as positive or negative demands further investigation. As vancomycin is a time-dependent antibiotic, it is possible that this precipitate could serve as a slowly releasing drug depot and viscoelastic as a vehicle for precipitation. This being the case, investigation is needed to analyse its potential to precipitate with another dispersive and cohesive viscoelasticity.

Sub-Bowman keratomileusis compared with photorefractive keratectomy--contralateral eye study.

The aim of this study was to compare two different refractive surgery approaches in correction of myopia with or without astigmatism. In patients where one eye underwent sub-Bowman keratomileusis (SBK) and the other eye photorefractive keratectomy (PRK), the objective and subjective results were retrospectively compared during the six-month follow-up. Eighty four patients (168 eyes) were involved in this retrospective contralateral study. The mean preoperative spherical refraction was -3.88 diopters (D) and the mean cylinder was -0.82 D for all eyes. Each patient underwent SBK on one eye and PRK on the contralateral eye. The eyes in the PRK group underwent mechanical epithelial removal, which was followed by laser treatment. Mitomycin C 0.02% was used for 15 seconds if ablation was deeper than 50 microns. In the SBK group, the intended 100-microm corneal flap was created with IntraLase femtosecond laser. All eyes underwent customized wavefront guided laser ablation using a VISX Star S4 IR excimer laser. Preoperative and postoperative outcome measures included best spectacle-corrected visual acuity, uncorrected visual acuity, corneal topography, contrast visual acuity, and anterior optical coherence tomography imaging. Patients were asked to complete subjective satisfaction questionnaires at each visit. Through the first 3 months of follow up, the SBK eyes demonstrated clinically and statistically better visual results than PRK eyes, between 3 and 6 months the results in the two groups began to equalize, and after 6 months of follow up there were no clinical and statistical differences between the SBK and PRK groups. SBK seems to be more practical for the patient with less pain, faster visual recovery, fewer medications, and overall superior experience.

Eye drops preservative as the cause of corneal band keratopathy in long-term pilocarpine hydrochloride treatment.

The aim is to present a patient with severe bilateral corneal complications after long-term antiglaucoma treatment with 1% pilocarpine hydrochloride (Pilokarpin, Pliva, Zagreb, Croatia) and its management. A patient with narrow-angle glaucoma treated with 1% topical pilocarpine hydrochloride eye drops for the last twenty years complained of impaired vision, intermittent visual haloes and eye redness. Ophthalmologic examination showed bilateral band keratopathy, peripheral laser iridotomy, medicamentous myosis, brown nuclear cataract, and synchysis scintillans of his right eye. Band keratopathy was thought to have resulted from the presence of the preservative phenylmercuric nitrate in the pilocarpine hydrochloride eye drops. Treatment of the patient consisted of two separate procedures for both eyes, i.e. phaco trabeculectomy and six months later corneal procedure including abrasion of corneal epithelium followed by removal of the superficial stromal calcium deposits by means of a 3.75% ethylenediaminetetraacetic (EDTA) solution. After phaco trabeculectomy, visual acuity was 0.8 on both eyes. Bilateral visual improvement with visual acuity 1.0 was recorded after corneal treatment with EDTA. In conclusion, one must be aware of preservative complications in long-term topical use, such as band keratopathy that can be visually incapacitating. Surgical treatment using EDTA is safe and effective treatment for band keratopathy.

Cosmetic applications of botulinum toxin in oculofacial region.

The objective of this review was to analyze and compare the efficacy and safety of botulinum toxin for cosmetic oculofacial use, published in articles during the last two decades. Article searches for relevant data were conducted in 2009 for the last two decades. Controlled studies showed statistically significant improvement in glabellar, frontal, and lateral canthal wrinkles after botulinum toxin therapy. Standardized documentation using clinical examinations and grading by the patient and physician supports the efficacy ofbotulinum toxin in the treatment of dynamic wrinkles in the glabellar region, frontal region, and lateral canthal area. Complications and unwanted effects associated with the treatment were rare and temporary. Botulinum toxin is safe and efficacious in the treatment ofglabellar, frontal and lateral canthal wrinkles. Additional studies are required to assess the efficacy of botulinum toxin for other cosmetic indications. All available data suggest that the possible side effects are infrequent and completely resolved in short term after botulinum therapy. Future research is needed to determine the ideal efficacious dose and concentration for each anatomic area. The use of botulinum toxin in conjunction with laser resurfacing treatment, facial surgical procedures, facial fillers, and other treatment modalities requires further study.

[Ophthalmological causes of headache]. / Okularni uzroci glavobolje.

Ophthalmologic causes of headache represent a very complex and extensive problem, and very often differential diagnostic problem too. Many various reasons of headache can be caused by ophthalmologic diseases like those of anterior and posterior eye segments, acute and subacute angle closed glaucoma and orbital diseases. Headache can be caused by no or poor correction of the refraction anomalies. Ophthalmologic causes of headache are quite frequently connected with conditions that affect other body systems apart from the eyes, nervous and/or vascular system in particular. Although ophthalmologic examination very provides the clue in patients with headache, the diagnostic and therapeutic approach to the problem has to be interdisciplinary.

Full-thickeness anterior blepharotomy and transpalpebral fat decompression in Graves' orbitopathy.

A chief morbidity of Graves eye disease is eyelid retraction and exophthalmus. Transpalpebral orbital fat removal accomplished with full thickness anterior blepharotomy was performed in 4 patients (5 orbits). Preoperative and postoperative ocular exposure symptoms, visual acuity, upper eyelid retraction and proptosis were evaluated. In all 5 operated orbits preoperative symptoms resolved; good results were achieved from the functional and cosmetic point of view. Full-thickness anterior blepharotomy combined with fat decompression is a safe and effective surgery for patients with upper eyelid retraction and exophthalmus due to enlarged orbital fat compartment.

Clinical importance of the lens opacities classification system III (LOCS III) in phacoemulsification.

The aim of this study was to compare the correlation of features of cataracts graded by the Lens Opacities Classification System, version III (LOCS III) with recorded operative characteristics during the phacoemulsification. The retrospective study included 245 cases operated on by a single surgeon from October 2003 to March 2004. The cataract was graded at the biomicroscope using the 4 grading scales of the lens opacities classification system, version III (LOCS III); nuclear opalescence (NO), nuclear color (CO), cortical cataract (C) and posterior subcapsular cataract (P). We recorded 2 intraoperative characteristics: machine measured phacoemulsification time, and average machine power. The machine recorded phacoemulsification time and average power correlated positively with the estimated nuclear color (NC) scale and nuclear opaclescence (NO) scale. Grading within categories of cortical cataract (C) and posterior subcapsular cataract (P) did not correlate with any of the operative variables. Exponentially, greater phacoemulsification energy was required as NC and NO increased. LOCS III grading system enables the surgeon to anticipate potential pitfalls and to adapt the operative technique to the individual patient.

Comparison of visual evoked potentials, automated perimetry and frequency-doubling perimetry in early detection of glaucomatous visual field loss.

The present study compares frequency-doubling perimetry (FDP), automated perimetry (AP) and visual evoked potentials (VEP) for their ability to diagnose early glaucoma. In present study 224 patients of Clinic for Eye Diseases, Clinical Hospital "Sestre Milosrdnice" that had diagnosis of open angle glaucoma and glaucomatous visual field loss proven by automated static perimetry on only one eye were performing all three tests. Visual evoked potentials, automated perimetry and frequency-doubling perimetry were performed four times in each patient with six months period in between testing. Significant difference was proven between frequency-doubling perimetry and automated perimetry in favor for FDP in early detection of glaucomatous field loss. There was no significant difference between FDP and VEP neither between VEP and AP measurements. The results of this study indicate that frequency-doubling perimetry is significantly better method for early detection of glaucomatous visual field loss than automated static perimetry.