Acanthamoeba keratitis cluster: an increase in Acanthamoeba keratitis in Australia.

BACKGROUND: This study was undertaken in response to an increase in the number of patients treated for Acanthamoeba keratitis at a tertiary referral hospital in Brisbane, Australia. Incidence and patient characteristics were investigated over a 4-year period. METHODS: A retrospective consecutive case series study was performed on patients with Acanthamoeba keratitis presenting to the Princess Alexandra Hospital between January 2003 and March 2007. RESULTS: Nine cases of Acanthamoeba keratitis were identified over 12 months from March 2006 to March 2007 compared with four cases over the previous 37 months from January 2003 to February 2006. This was an increase from 0.07 cases per 1000 outpatient visits to 0.42 per 1000 (P = 0.003). Of the 13 cases, 11 patients used soft contact lenses of which two used monthly extended overnight wear silicone hydrogel lenses. Of the five patients who specified the type of contact lens solution they had used, three reported using AMO Complete Moistureplus Multipurpose solution, one reported using the AMO Complete Comfortplus Multipurpose solution and one was unsure which type of AMO Complete solution they were using. CONCLUSIONS: There has been a significant increase in incidence of cases of Acanthamoeba keratitis presenting to our institution. The type of contact lens solution and the use of silicon hydrogel lenses combined with extended overnight wear may play a role; however, the significance is unclear given the small numbers for analysis. Further study of incidence and patient characteristics is warranted to identify risk factors and causes for the rising incidence.

Treatment and outcomes of malignant melanoma of the eyelid: a review of 29 cases in Australia.

PURPOSE: To review the treatment and outcomes of malignant melanoma (MM) of the eyelid skin. DESIGN: Retrospective case series review. PARTICIPANTS: All consecutive patients who had MM arising from eyelid skin treated by 2 regional tertiary referral oculoplastic surgeons were included. METHODS: Patient charts were reviewed to collect information on the main outcome measures. MAIN OUTCOME MEASURES: Demographics, clinical and histological features of the lesion, treatment, and outcomes. RESULTS: Twenty-nine patients between 22 and 88 years old (mean, 65) were included. The most common site of MM occurrence was the lower eyelid. Seventeen cases arose in an area of pigmentation, 4 arose de novo, and 8 were of unknown origin. The most common histopathological types were lentigo maligna melanoma (19 cases), followed by superficial spreading MM (8 cases). Fourteen patients had in situ disease and therefore had no Breslow thickness. Another 7 patients had Breslow thickness of <0.76 mm. Thirteen patients had Clark level II or higher. According to the American Joint Committee on Cancer staging system for cutaneous melanoma, 14 patients were clinically stage 0 and 6 patients were stage IA, with thickness < or = 1 mm and no ulceration. Treatment included wide excision in all cases, one of which underwent anterior exenteration. Pathological techniques used included mapped serial excision with standard or overnight paraffin sections or Mohs' micrographic surgery. Most patients had a good outcome, although 2 died of the disease. Five patients had local recurrence, and 4 had distant metastases. Median postoperative follow-up was 3 years (range, 1 month-9 years, 9 months). CONCLUSIONS: Lentigo maligna melanoma compared with other forms of MM was relatively more common in the periocular region than in other body locations. Our pathologists preferred paraffin sections to frozen section for accurate assessment of melanocytic atypia and margin status. Initial wide excision margins of 10 mm from the macroscopic edge of the tumor are suggested, as histological margins may be less than this. Margin control by mapped serial excision or a modified Mohs' micrographic surgery using paraffin sections is a useful technique to ensure complete excision and minimization of local recurrence.

Rates of posterior capsule rupture during cataract surgery among different races in Singapore.

INTRODUCTION: The aim of this study was to determine if racial differences exist in the rate of posterior capsule rupture (PCR) during cataract surgery in Singapore. MATERIALS AND METHODS: All intraoperative complications during cataract surgery were prospectively reported as part of a clinical audit programme. A retrospective review of all patients who sustained a PCR during cataract surgery between July 1995 and December 1998 was performed. RESULTS: Of 8230 consecutive eyes which underwent cataract surgery, 6951 (84.5%) were Chinese, 597 (7.3%) were Malay, 524 (6.4%) were Indian, and 158 (1.9%) were of other races. The overall incidence of PCR was 1.9%. The PCR rates were 1.8% [125 of 6951; 95% confidence interval (CI), 1.49 to 2.11] in Chinese, 2.0% (12 of 597; 95% CI, 1.01 to 3.57) in Malay, 2.7% (14 of 524; 95% CI, 1.13 to 3.56) in Indian, and 2.5% (4 of 158; 95% CI, 0.00 to 4.98) in other races. There was no statistical difference between the PCR rates (P = 0.62, chi-square test). CONCLUSION: Racial differences in Singapore do not have an effect on the rates of PCR during cataract surgery.

Short-term outcomes in eyes with posterior capsule rupture during cataract surgery.

PURPOSE: To determine the short-term outcomes in eyes with posterior capsule rupture (PCR) during cataract surgery. SETTING: The Eye Institute, National Healthcare Group, Tan Tock Seng Hospital, Singapore, Singapore. METHODS: All intraoperative complications during cataract surgery were reported prospectively as part of a clinical audit program. The clinical charts of all patients who had PCR during cataract surgery from July 1995 to December 1998 were retrospectively reviewed. RESULTS: Posterior capsule rupture occurred in 155 (1.9%) of 8230 consecutive eyes that had extracapsular cataract extraction (ECCE) or phacoemulsification. Thirteen cases were excluded from analysis for missing data or insufficient follow-up. Of the remaining 142 eyes, 100 (70.4%) achieved a best corrected visual acuity (BCVA) of 6/12 or better between 6 weeks and 3 months postoperatively. Excluding 27 eyes with preexisting ocular pathology contributing to impaired vision, 87.0% achieved a BCVA of 6/12 or better. Fifteen eyes (13.0%) failed to achieve that acuity because of cystoid macular edema (CME) (2 eyes), posterior capsule opacification (2 eyes), endophthalmitis (1 eye), glaucoma (1 eye), retinal detachment (1 eye), CME, central retinal artery occlusion, and vitreous hemorrhage (1 eye) or unknown reasons (7 eyes). Risk factors for a poor visual outcome included older age, presence of coexisting ocular pathology, ECCE, implantation of an anterior chamber intraocular lens, and vitreous loss requiring anterior vitrectomy. CONCLUSIONS: Most eyes with PCR achieved a good BCVA in the early postoperative period.

Nanophthalmic cataract extraction.

Nanophthalmos is a rare ophthalmic condition with potential sight-threatening complications. In addition, nanophthalmic eyes have a high incidence of intraoperative and postoperative complications, including uveal effusion and retinal detachment. Prophylactic measures to prevent these complications may be used. The case is presented where cataract extraction for a nanophthalmic eye was performed from a posterior approach in combination with a pars plana vitrectomy and gas procedure. To the authors' knowledge, this method of cataract extraction has not been reported before for this condition.