Survey of practice preference pattern in antibiotic prophylaxis against endophthalmitis after cataract surgery in Singapore.

To determine practice preference of prophylaxis against post-cataract surgery endophthalmitis in Singapore. Prospective nationwide survey of all registered ophthalmologists through telephone, e-mail or postal questionnaires. A response rate of 76.6% was obtained from 121 out of 158 eligible ophthalmologists. Awareness of the recommendations made by the European Society of Cataract and refractive surgeons (ESCRS) endophthalmitis study was noticed in 98 (81.0%) respondents. Out of the 121 respondents, 85 (70.2%) do not use intracameral antibiotic prophylaxis. Of the 36 respondents using intracameral antibiotics, 34 (94.4%) used cefazolin. The reasons cited for not adopting intracameral antibiotic prophylaxis included financial costs, the relatively low risk of endophthalmitis after cataract surgery, the burden of dilution and the fear of toxic anterior segment syndrome. More than half (65, 53.7%) of respondents would use intracameral antibiotic prophylaxis if it were available commercially. The most commonly practiced prophylaxis (94, 77.7%) was preoperative topical antibiotics. The majority of ophthalmologists in Singapore have not adopted the use of intracameral antibiotics, with most preferring the use of pre- and postoperative prophylactic topical antibiotics, despite knowledge of the ESCRS endophthalmitis study.

Outcomes of the Haigis-L formula for calculating intraocular lens power in Asian eyes after refractive surgery.

PURPOSE: To report outcomes using the Haigis-L formula to calculate intraocular lens (IOL) power in Asian eyes with long axial lengths (ALs) that had previous myopic laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK). SETTING: Singapore National Eye Centre, Singapore. DESIGN: Retrospective case series. METHODS: Patients with ALs greater than 25.0 mm and previous myopic LASIK or PRK who had phacoemulsification were analyzed. The emmetropic IOL power was back-calculated using the 1-month postoperative manifest refraction and compared with the emmetropic IOL power calculated with the Haigis-L formula. The primary outcome measure was the mean arithmetic prediction error, defined as the difference between the actual postoperative refractive error and the intended formula-derived refractive target. RESULTS: Sixty-two eyes (52 patients) were analyzed. The mean arithmetic prediction error was -0.44 diopter (D) ± 0.98 (SD) and the mean absolute error, 0.87 ± 0.62 D. The mean arithmetic prediction error was -0.52 ± 0.96 D in eyes with an AL less than 27.0 mm and -0.36 ± 1.00 D in eyes with an AL of 27.0 mm or greater (P = .463). The predictability of being within ±0.50 D and ±1.00 D of target was 35.7% and 63.1%, respectively, overall; 31.6% and 60.5%, respectively, in eyes with an AL less than 27.0 mm; and 39.1% and 65.2%, respectively, in eyes with an AL of 27.0 mm or greater (P = .772). CONCLUSION: The Haigis-L formula was acceptably accurate in predicting and achieving target outcomes after phacoemulsification in Asian eyes with a long AL that had previous myopic LASIK or PRK. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Cystoid macular edema in acute presentation of central retinal artery occlusion.

A seventy-six-year-old lady with poor vision of the left eye due to previous retinal detachment presented with acute visual loss of her right eye secondary to central retinal artery occlusion. Clinical examination showed a pale right optic disc, macular edema, and a cherry red spot. Optical coherence tomography done four hours after onset showed right acute cystoid macular edema and diffuse inner retinal thickening. Subsequent treatment with intravenous carbonic anhydrase inhibitor resulted in some visual improvement. Central retinal artery occlusion has been known to produce diffuse intraretinal edema instead of cystoids changes. We would like to discuss a case of acute cystoid macular edema in acute central retinal artery occlusion.

Comparison of outcomes of lamellar keratoplasty and penetrating keratoplasty in keratoconus.

PURPOSE: To compare outcomes after penetrating keratoplasty (PK) and two techniques of deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. DESIGN: Retrospective cohort study. METHODS: One hundred and twenty-five corneal transplantations comprising 100 PK and 25 DALK procedures for keratoconus at the Singapore National Eye Centre from April 1992 through December 2006 were included. DALK was performed with the modified Anwar technique (descemetic or DALKa group) in 14 eyes and manual lamellar keratoplasty (predescemetic or DALKm group) was performed in 11 eyes. RESULTS: At 12 months, the DALKa and PK groups achieved a logarithm of the minimum angle of resolution mean best spectacle-corrected visual acuity (BSCVA) of 0.15 and 0.27, respectively (P = .26), whereas the mean BSCVA of the DALKm group was 0.41 compared with the PK group (P = .12). Significance level was achieved between the DALKa and DALKm groups (P = .013). There was no significant difference in the mean spherical equivalent (P = .72) and astigmatism (P = .88) between the PK and DALK groups. The DALK group had a significantly lower incidence of complications compared with PK cases, including allograft rejection and glaucoma. Graft survival rate of both the PK and DALKa groups was 100%, whereas that of the DALKm group was 73% at 3 years after surgery (P = .000 between PK and DALKm groups). CONCLUSIONS: Visual acuity outcomes of the DALKa technique are comparable with those of PK for keratoconus, whereas DALK surgery results in fewer postoperative complications than PK. DALKa is emerging as a preferred choice among the lamellar techniques for better optical outcome. Further studies are required to provide long-term analysis of these results.