Phakic anterior chamber lenses in very high myopia: an 18-month follow up.

BACKGROUND: To evaluate the efficacy and tolerance of two different foldable anterior chamber phakic intraocular lenses for high myopia. DESIGN: A prospective interventional case series at the Eye Clinic, Kartal Training and Research Hospital, Istanbul, Turkey. PARTICIPANTS: Sixty-two eyes of 31 patients received iris-claw lens (group 1) (Artiflex AC 401, Ophtec), and 43 eyes of 22 patients received angle-supported lens (group 2) (I-Care, Corneal). METHODS: The mean preoperative spherical equivalents for group 1 and group 2 were -12.13 D and -18.95 D, respectively. Endothelial cell density was measured at day 1 and at 1, 3, 6, 12 and 18 months for follow ups. MAIN OUTCOME MEASURES: Percentage change in endothelial cell density and improvement in visual acuity. RESULTS: At the 18-months follow up, uncorrected visual acuity improved to logMAR 0.37 ± 0.23 from 1.60 ± 0.10 in group 1, and logMAR 0.47 ± 0.14 from 0.70 ± 0.20 in group 2; best spectacle corrected visual acuity improved to logMAR 0.23 ± 0.22 from logMAR 0.36 ± 0.14) in group 1, and logMAR 0.29 ± 0.18 from logMAR 0.50 ± 0.20) in group 2 (P<0.001, in both groups). Mean decreased endothelial cell density was 241 cells/mm(2) (8.61%) and 223 cells/mm(2) (8.42%) at 18 months follow up in group 1 and 2, respectively (P=0.17) but significant in comparison to preoperative values for both groups (P<0.001). CONCLUSIONS: Although both iris-claw and angle-supported lenses offer good refractive outcomes significant endothelial cell density was observed at 18 months follow up.

Acute-onset endophthalmitis after cataract surgery: success of initial therapy, visual outcomes, and related factors.

PURPOSE: To evaluate the success of initial treatment and the factors influencing the outcome in acute-onset endophthalmitis after cataract surgery. METHODS: We retrospectively reviewed the medical records of all patients with acute postoperative endophthalmitis between 2000 and 2007. We performed pars plana vitrectomy (PPV) to all eyes with initial visual acuity of light perception. Eyes with visual acuity of hand motions or better underwent either intraocular antibiotic injection (IOAI) or PPV. Eyes that did not give a good clinical response to initial therapy within 60 hours underwent a second procedure. The main outcome measure was the rate of early reintervention after PPV and IOAI. RESULTS: We evaluated 88 eyes of 88 patients. Thirty-seven patients underwent PPV and 51 patients underwent IOAI alone. Six of 37 (16.2%) patients required 1 or more procedures within 60 hours of the initial procedure in the PPV group. Twenty-eight of 51 eyes (54.9%) in the IOAI group underwent PPV within 60 hours. The rate of response to primary PPV was significantly higher than to primary IOAI (P < 0.001). Gram-negative organisms composed 35.1% of the isolates. CONCLUSION: Pars plana vitrectomy may be preferable to IOAI in postoperative endophthalmitis since the rate of early reintervention is lower with initial PPV.

Association between ocular dominance and refraction.

PURPOSE: To investigate the association between ocular dominance and refraction. METHODS: A retrospective study of the cycloplegic refraction of 2453 consecutive patients with a mean age of 46 +/- 12 years (range: 18 to 79 years) was performed. One thousand one hundred fifty-seven (47%) patients were men and 1296 (53%) were women. Patients who had previous eye surgery, ocular disease, or > 2 lines of best spectacle-corrected visual acuity (BSCVA) difference between eyes were excluded. Motor ocular dominance was determined using the hole-in-the-card test. RESULTS: The right and left eyes were dominant in 67% (1650) and 33% (803) of patients, respectively. Males had a higher right eye dominance (70%) than females (65%) (P = .0168) with a mean cycloplegic spherical equivalent refracton (SE) of -2.12 diopters (D) and -2.38 D, respectively. This higher rate of right eye dominance in males was seen at all levels of SE refractive error. Mean BSCVA was 20/19 in both right and left eyes (P>.05) with a mean SE of -2.25 +/- 3.63 D and -2.26 +/- 3.66 D in the right and left eyes, respectively. Neither mean SE difference nor BSCVA difference between eyes was found to correlate with motor eye dominance. CONCLUSIONS: Gender appears to be a factor when testing ocular dominance but not SE refractive error. The hole-in-the-card dominance test is a method that is easy to perform for both patients and clinicians.

Isolates and antibiotic sensitivity of eighty culture-proven endophthalmitis cases from Istanbul.

PURPOSE: To investigate the spectrum of organisms causing endophthalmitis and their sensitivity to commonly used antimicrobial agents. METHODS: Medical records of 80 consecutive patients treated at Beyoglu Eye Hospital for endophthalmitis from January 2001 to April 2006 were reviewed. Specimens were obtained from either the vitreous (93%, 81/87) or anterior chamber (7%, 6/87) during pars plana vitrectomy or vitreous tap, and were inoculated into blood culture bottles. A Kirby-Bauer disk diffusion test was performed to determine antibiotic susceptibility. The outcome measures included isolates identified and antibiotic sensitivity of the specimens. RESULTS: Fifty-six of 87 (64.4%) isolates were Gram-positive organisms, 29 (33.3%) were Gram-negative organisms, and 2 (2.3%) were fungi. The most common organism group identified was coagulase-negative staphylococci in 26.4% (23/87). While vancomycin was active against all Gram-positive isolates tested (100%), ceftazidime had the highest susceptibility rate (100%) for Gram-negative organisms isolated. CONCLUSIONS: Although coagulase-negative micrococci predominated in this series, a high isolation rate for Gram-negative organisms was obtained. High susceptibility rates for ofloxacin make it an alternative to ceftazidime and vancomycin in both Gram-negative- and Gram-positive-derived endophthalmitis, respectively. Studies with larger series and additional antibiotics are needed to confirm these findings.

Conjunctivitis due to Neisseria sicca: a case report.

We report the first case, in Medline-based literature, of conjunctivitis caused by gram negative diplococcus, Neisseria sicca. Although it is not widely accepted as such, isolation from cultures of repeated eye swab samples suggests that N. sicca may be a pathogen in conjunctival infections. Positive culture for this organism should not be readily dismissed. Such conjunctivitis responded favorably to treatment with netilmicin eye drops.

Kill rates of preserved and preservative-free topical 8-methoxy fluoroquinolones against various strains of Staphylococcus.

PURPOSE: To assess the kill rates of preserved and preservative-free 8-methoxy fluoroquinolones and benzalkonium chloride (BAC) against isolates of Staphylococcus aureus and coagulase-negative Staphylococcus (CNS) species. SETTING: Bascom Palmer Eye Institute, Miami, Florida, USA. METHODS: Ocular and standard isolates of S aureus and CNS were inoculated with saline, 0.005% BAC, gatifloxacin 0.3% containing 0.005% BAC (Zymar), or BAC-free moxifloxacin 0.5% (Vigamox) at 37 degrees C. Bacterial viability was assessed after 15 minutes, 30 minutes, and 60 minutes. RESULTS: Thirteen isolates of S. aureus and 5 isolates of CNS were used. The mean initial load of bacterial inoculum was 5.45 log colony-forming units (CFU)/mL +/- 0.37 (SD). Saline did not affect the density of staphylococci; BAC significantly decreased the staphylococci count to a mean of 3.80 +/- 0.32 log CFU/mL at 60 minutes (P<.05). Gatifloxacin 0.3% reduced the number of staphylococci significantly more than moxifloxacin 0.5% at 15 minutes (mean 0.47 +/- 1.12 log CFU/mL versus 4.55 +/- 0.60 log CFU/mL), 30 minutes (mean 0.07 +/- 0.31 log CFU/mL versus 3.82 +/- 1.07 log CFU/mL), and 60 minutes (mean 0.00 +/- 0.00 log CFU/mL versus 2.75 +/- 1.29 log CFU/mL) (P<.005). Gatifloxacin 0.3% completely eradicated most S. aureus (10/13) and CNS (3/5) isolates at 15 minutes; moxifloxacin 0.5% did not achieve complete kill in any S. aureus isolate (13/13) or in most CNS isolates (4/5) at 60 minutes. CONCLUSION: The commercial formulation of gatifloxacin 0.3% containing BAC 0.005% completely eradicated staphylococcal isolates more rapidly than the BAC-free formulation of moxifloxacin 0.5% or BAC 0.005% alone.

Comparative outcomes of pars plana vitrectomy in acute postoperative endophthalmitis with 25-gauge and 20-gauge techniques.

PURPOSE: To evaluate the safety and outcomes of 25-gauge pars plana vitrectomy (PPV) in the treatment of postoperative endophthalmitis and compare it with 20-gauge PPV. METHODS: The medical records of all patients diagnosed with acute endophthalmitis following cataract surgery who underwent PPV between December 2000 and December 2007 were reviewed. Main outcome measures included final visual acuity (VA), additional interventions, and both intraoperative and postoperative complications. RESULTS: Records of 70 eyes of 70 patients with a condition diagnosed as postoperative endophthalmitis were evaluated. Fifty-eight eyes underwent 20-gauge PPV (group 1), and 12 eyes underwent 25-gauge PPV (group 2). Mean follow-up time for group 1 was 9.6 +/- 8.8 months, and for group 2, 7.9 +/- 12.7 months (P = 0.57). Median VA at presentation was hand motion in both groups. The differences between the two groups in frequencies of visual outcome levels of 20/800 and 20/100 were significant in favor of group 2 (20/800, P = 0.006; 20/100, P = 0.01). In group 2, fewer additional interventions were required, and postoperative complications tended to be less frequent. CONCLUSIONS: Twenty-five-gauge PPV seems to be safe and effective in the management of postoperative endophthalmitis. This sutureless technique may have some advantages over 20-gauge surgery, but controlled studies are needed to confirm the results.

The use of blood culture bottles in endophthalmitis.

PURPOSE: To study the use of blood culture bottles for culturing vitreous specimens in acute-onset postoperative infectious endophthalmitis cases. METHODS: Forty-eight eyes of 48 patients with mean age of 66.4 +/- 14.7 years with postoperative endophthalmitis that occurred within 6 weeks after ocular surgery, presenting from June 2001 to January 2005, were retrospectively studied. Vitreous fluid specimens of these patients were cultured in blood culture bottles. The measured outcome is the yield of positive culture. RESULTS: Vitreous specimens yielded positive in 34 of 48 (70.8%) eyes with blood culture bottles. The most common organism isolated was Staphylococcus epidermidis in 17.6% (6/34) of cases. CONCLUSION: The direct inoculation of vitreous specimens into the blood culture bottles is easy to perform, with a high yield positive rate (70.8%). It may be an alternative to conventional culture media for culturing vitreous specimen in infectious endophthalmitis especially in clinics or hospitals that are unable to have adequate microbiology laboratory facilities.