Trends in contact lens microbial keratitis 1999 to 2015: a retrospective clinical review.

IMPORTANCE: Contact lens microbial keratitis (CLMK) is the most common cause of microbial keratitis in our community. BACKGROUND: Define the trend in rate of CLMK and define patient demographics/culture results that may have a predictive value in patients with CLMK. DESIGN: Retrospective review of clinical records of patients with MK. PARTICIPANTS: All patients with positive corneal scraping between 1999 and 2015 at the Princess Alexandra Hospital, Brisbane, Queensland identified through local microbiology database. METHODS: Trend in CLMK tested with chi-squared test of peak 3 years vs other years and Poisson regression of interrupted time series. Patient characteristics predictive of CLMK were defined by creating a polynomial regression model by stepwise variable selection. MAIN OUTCOME MEASURES: Yearly rate of CLMK. RESULTS: Records of 895 episodes of MK were included. The most common: risk factor was contact lens wear (324, 36.2%), isolated organism was Pseudomonas aeruginosa (P. aeruginosa 181, 55.9%) and treatment was monotherapy with a fluoroquinolone 172, 53%). CLMK was most common between 2009 and 2011 (49.5% vs other years 32%, P < 0.001). Poisson regression of the interrupted time series showed there was a significant decrease in the rate over time after 2010 (P < 0.001). Independent factors predictive of CLMK in multivariate regression were young age (15-49 years) and corneal culture positive for P. aeruginosa CONCLUSIONS AND RELEVANCE: The rate of CLMK in our community ranged between 32% and 50% and the rate of disease appears to have peaked during 2009 to 2011 and subsequently declined.

Outcomes of toric supplementary intraocular lenses for residual astigmatic refractive error in pseudophakic eyes.

PURPOSE: To evaluate rotational stability and visual and refractive outcomes of supplementary toric IOLs (Sulcoflex Toric 653T, Rayner Intraocular Lenses Ltd) for residual astigmatic refractive error in pseudophakic eyes. METHODS: A retrospective interventional case series was conducted in a single surgeon practice. Charts of patients who had Sulcoflex Toric supplementary IOLs inserted between June 2009 and September 2015 were reviewed. Outcomes were compared between eyes with and without prior corneal transplant. Patients with at least 3-months follow-up were included. RESULTS: In 51 eyes, mean UDVA improved from 20/86 to 20/43 (p = 0.002), though UDVA was better in eyes without corneal grafts (20/31) than eyes with (20/62). The proportion of eyes achieving 20/20 UDVA was 43%, 61% and 17% overall, in eyes with prior graft and in eyes with no prior graft, respectively. Sixty-four percentage achieved a spherical equivalent of within 0.5D of target (84% no graft, 34% prior graft). Fifty-three percentage of eyes achieved a cylinder of within 0.5D of target (no graft: 73%, prior graft: 0%). Mean lens rotation was 8.23° on day 1, and mean maximal rotation during follow-up was 17.63°. Sixty-two percentage of IOLs required repositioning. Of those that required repositioning, this was conducted a mean of 2.3 times. The mean final IOL rotation (following repositioning if required) was 6.17°. CONCLUSION: Sulcoflex Toric supplementary IOLs result in good visual and refractive outcomes in eyes with no prior corneal graft. However, outcomes are sub-optimal in eyes with prior corneal transplantation, and the majority of lenses require repositioning.

Current status and future prospects for cultured limbal tissue transplants in Australia and New Zealand.

Cultured limbal tissue transplants have become widely used over the last decade as a treatment for limbal stem cell deficiency (LSCD). While the number of patients afflicted with LSCD in Australia and New Zealand is considered to be relatively low, the impact of this disease on quality of life is so severe that the potential efficacy of cultured transplants has necessitated investigation. We presently review the basic biology and experimental strategies associated with the use of cultured limbal tissue transplants in Australia and New Zealand. In doing so, we aim to encourage informed discussion on the issues required to advance the use of cultured limbal transplants in Australia and New Zealand. Moreover, we propose that a collaborative network could be established to maintain access to the technology in conjunction with a number of other existing and emerging treatments for eye diseases.

Recurrent post-operative endophthalmitis caused by Sphingomonas paucimobilis despite vitrectomy - a case and review of the literature.

Over the past 20 years, scattered reports have emerged about a low virulence, gram negative bacillus, Sphingomonas paucimobilis, causing unpredictable clinical presentations of endophthalmitis. Previous reports have characterised the organism as being resistant to aggressive treatment and prone to recurrence up to several months later, with few warning signs of any residual infection. We report a case of a 75 year-old male who returned 10 days after a left eye cataract surgery with an atypical, indolent endophthalmitis. He was treated with broad-spectrum intravitreal antibiotics and vitrectomy, and despite initial improvement, the patient suffered a recurrence after 2 weeks, necessitating successive rounds of intravitreal antibiotics. While our patient was able to achieve an excellent final visual acuity of 6/9, there are several cases in the literature reporting similar cases with much worse visual outcomes. Further research is required to elucidate early warning signs that may indicate a recurrence of S. paucimobilis infection, and the underlying mechanism by which it is resistant to standard endophthalmitis therapy. Alongside this case, we review and summarise the literature on postoperative endophthalmitis involving this organism.

Outcomes of a Toric Monofocal Piggyback Intraocular Lens for Residual Astigmatic Refractive Error in Pseudophakic Eyes.

PURPOSE/AIM: To evaluate the visual outcomes, refractive outcomes and rotational stability of a toric piggyback intraocular lens (1stQ AddOn, GmbH, Mannheim, Germany) for astigmatic refractive error in pseudophakic eyes. MATERIALS AND METHODS: Visual and refractive outcomes were assessed based on the standard graphs for reporting refractive surgery outcomes. Rotational stability was assessed according to the Intraocular Lens (IOL) standards of the International Organisation for Standards. RESULTS: Twenty-two eyes of 17 patients (age: 65.1 ± 9.3 years) underwent toric piggyback IOL insertion. After a minimum follow-up of 3 months, 18 eyes (82%) achieved an uncorrected distance visual acuity (UDVA) of 0.00 logMAR (20/20) or better and all eyes achieved 0.1 logMAR (20/25). Mean UDVA improved from 0.27 ± 0.03 to 0.12 ± 0.03 and 0.04 ± 0.04 at one and 3 months (all p < .05). Nineteen eyes (86%) achieved an UDVA at least equal to the pre-operative corrected distance visual acuity (CDVA). No eyes lost more than one line of CDVA. All eyes achieved within 0.5D of target spherical equivalent (SE). In 18 eyes (82%), the residual astigmatism magnitude was 0.5D or less. The mean absolute difference between the target axis and the achieved axis 1 and 3 months postoperatively was 2.5° ± 2.7° and 3.2° ± 3.3°, respectively. The final IOL orientation was within 10 degrees of target axis in 19 of 22 (86.4%) eyes, within 20 degrees in 21 of 22 (95.2%) eyes and within 30 degrees in 22 of 22 (100%) eyes. IOL rotational repositioning was required in two eyes (9.1%). CONCLUSIONS: In this cohort of patients, the 1stQ AddOn toric monofocal piggyback IOL resulted in very good visual and refractive outcomes and showed reasonable rotational stability. This IOL appears to be an effective treatment option for residual astigmatic refractive error in pseudophakic eyes.

Clinical factors associated with positive corneal culture in suspected microbial keratitis.

AIMS: Determine demographic and clinical characteristics associated with positive culture in suspected microbial keratitis. METHODS: Retrospective audit of patients that had corneal scrapings between October 1999-September 2004 at Princess Alexandra Hospital. Clinical information was gathered from medical records, smear and culture results from the local microbiology database. Univariate and multivariate analyses of variables associated with positive cultures and calculation of population attributable risk percentage (PAR). RESULTS: Univariate analysis showed that positive cultures were associated with patients over 60 years (81% vs 55%; p < 0.001), presenting visual acuity (VA) of 6/24 or worse (74% vs 57%; p = 0.012) or contact lens-related keratitis (CLK 77% vs 62%; p = 0.08). Analysis of patients' clinical presentation showed that positive culture was associated with a central epithelial defect (74% vs 57%; p = 0.012), anterior chamber reaction of 2 + cells or worse (73% vs 56%; p = 0.03), an epithelial defect of 2 mm or more in diameter (71% vs 50%; p = 0.006) or no prior treatment with antibiotics (68% vs 56%; p = 0.053). Multivariate analysis showed the independent variables associated with positive cultures were VA of 6/24 or worse on presentation, contact lens-related keratitis, age greater than 60 years, an anterior chamber reaction of 2 + cells or worse and no prior treatment with antibiotics. The factor with the highest attributable risk (PAR%) for a positive corneal scraping was VA of 6/24 or worse on presentation (21%). CONCLUSIONS: In this series positive cultures were associated with poor presenting VA contact lens keratitis (CLK), older age, anterior chamber reaction and no prior treatment with antibiotics.

Patient Expectation, Satisfaction and Clinical Outcomes with a New Multifocal Intraocular Lens.

PURPOSE: To report patient expectations, visual performance and satisfaction with AcrySof IQ PanOptix multifocal intraocular lens in a heterogeneous patient group. Additionally, determine if identifiable pre-operative characteristics can predict post-operative satisfaction. METHODS: Data were prospectively collected for 67 consecutive patients (134 eyes) who underwent bilateral Panoptix implantation in a private ophthalmology clinic. A pre-operative questionnaire was completed regarding vision satisfaction, visual phenomena and expectations. Routine clinical parameters were collected 1 month and follow-up questionnaire administered 3 months post-operatively. RESULTS: Post-operative unaided distance vision was 20/20 (0.01 ± 0.10) and binocular near vision 20/25-2 (N5; 0.14 ± 0.06). Patients satisfied with vision increased from 6% (n=4) unaided and 48% (n=32) aided pre-operatively to 94% (n=63) unaided post-operatively (p<0.001). There was marked increase in frequency of halo from 14% (n=9) to 69% (n=46; p<0.001) but no corresponding increase in how bothersome this symptom was (p=0.193) nor the frequency of other visual phenomena. Worse post-operative vision and fluctuating vision were associated with lower post-operative satisfaction. There was no difference in satisfaction or residual astigmatism in those implanted with toric lenses. A total of 96% (n=64) of patients were spectacle-free at 3-months and would recommend this procedure to others. CONCLUSION: This study supports the trend towards increased patient expectations of multifocal intraocular lenses, matched by excellent visual outcomes and satisfaction. Visual phenomena may be less troubling with new multifocal lenses than previously reported. A pre-operative questionnaire may be a useful education tool but could not isolate pre-operative characteristics that predict post-operative satisfaction.

Microbial keratitis in a tertiary centre in Queensland, Australia (1999-2015).

Clinical relevance: Keratitis is common and studies of blindness throughout the world have found that corneal disease is the second most common cause of blindness.Background: Microbial keratitis a bacterial, fungal, or protozoan disease of the cornea, characterised by a corneal infiltrate with an overlying epithelial defect and associated anterior chamber reaction.Methods: Patients were identified through the hospital pathology database and a retrospective chart review of all patients with a positive corneal culture between 1999 and 2015 at Princess Alexandra Hospital was carried out.Results: There were 895 records from 779 patients included and additional 107 records excluded. The average age of the included patients was 58.9 years (SD 21.0). Males made up 498 (55.6%) of the included patients. Contact lens microbial keratitis (CLMK) was the most common risk factor for MK and was significantly more common in younger patients. CLMK was significantly associated with cultures positive for Pseudomonas aeruginosa (p < 0.001) while MK secondary to ocular surface disease and prior ocular surgery were more commonly associated with gram-positive organisms (p < 0.001). Monotherapy with a fluoroquinolone was the most common treatment for patients with MK. Good outcomes were seen in 57% of patients.Conclusion: In this patient group, contact lens wear was the most common risk factor for MK. Pseudomonas aeruginosa was the most common isolate.

Comparative Efficacy and Safety of Standard Versus Accelerated Corneal Crosslinking for Keratoconus: 1-Year Outcomes From the Save Sight Keratoconus Registry Study.

PURPOSE: The aim of this study was to compare the efficacy and safety of standard [Ultraviolet (UV) light power: 3 mW/cm2, duration: 30 minutes] versus accelerated (UV power: 9 mW/cm2, duration: 10 minutes) corneal crosslinking (CXL) for stabilizing keratoconus. METHODS: A total of 684 eyes (555 patients; mean age ± SD, 25.0 ± 7.9 years; women, 30.6%) from 24 international sites with epithelium-off CXL for keratoconus had follow-up data at 1-year and met the inclusion criteria. Two hundred sixty-six eyes (228 patients) had undergone standard CXL, and 418 eyes (327 patients) had undergone accelerated CXL. The outcome measures included changes in visual acuity, keratometry, minimum corneal thickness, and frequency of adverse events. The outcomes were compared using mixed-effects regression models adjusted for age, sex, visual acuity, keratometry, pachymetry, doctor, practice, and eye laterality. RESULTS: The adjusted mean changes (95% confidence interval) in outcomes were similar in standard and accelerated CXL in visual acuity [6.5 (2.0, 11.1) versus 5.5 (0.4, 10.6) logMAR letters, respectively], Kmax [-0.9 (-1.4, -0.3) D versus -1.2 (-1.9, -0.4) D, respectively], K2 [-0.4 (-0.9, 0.2) D versus -0.4 (-1.1, 0.3), D respectively], or minimum corneal thickness [-13.3 (-20.3, -6.3) µm versus -16.6 (-24.5, -8.6) µm, respectively] (all P > 0.05). The frequency of adverse events at the 12-month visit was also similar between the CXL groups (standard, 8.3% vs. accelerated, 5.5%; P = 0.21). CONCLUSIONS: This real-world observational study found that both standard and accelerated CXL were similarly safe and effective in stabilizing keratoconus at 1-year postsurgery in the real-world setting. The findings support the adoption of accelerated CXL for time and convenience.

Aciclovir-resistant herpes keratitis.

Herpes simplex virus (HSV) keratitis is a common cause of ocular morbidity. Resistance to aciclovir is probably under recognized. We describe three cases of aciclovir-resistant herpes simplex virus keratitis treated with systemic foscarnet and present a review of the pharmacological options available to manage this condition.

Comparison of the AcrySof SA60 spherical intraocular lens and the AcrySof Toric SN60T3 intraocular lens outcomes in patients with low amounts of corneal astigmatism.

BACKGROUND: Toric intraocular lenses (IOLs) have been reported to be an effective method of reducing postoperative refractive astigmatism and spectacle dependence following cataract surgery. This study compares a series of patients with low corneal astigmatism implanted with either the AcrySof SA60 spherical IOL or the AcrySof Toric SN60T3 IOL in a quantitative fashion to establish the merit of toric IOLs in these cases. METHODS: A retrospective chart audit was undertaken of 12 patients receiving the AcrySof Toric SN60T3 IOL (1.5 DC, Alcon, Fort Worth) and 10 patients receiving the AcrySof SA60 IOL (Alcon, Fort Worth). Preoperative corneal astigmatism and postoperative refractive astigmatism were recorded and converted into a non-signed Astigmatic Power Vector for statistical analysis. Postoperative vision (uncorrected visual acuity, UCVA) was also recorded for both groups. A statistical analysis was performed to examine for differences in outcomes between groups. RESULTS: The mean magnitude of the preoperative corneal Astigmatic Power Vector was not significantly different between the groups. The mean magnitude of the postoperative refractive vector was significantly smaller in the AcrySof Toric group. The mean UCVA was significantly better in the AcrySof Toric group compared with the AcrySof group. CONCLUSION: The AcrySof Toric IOL provides a significant improvement in postoperative astigmatism and UCVA when compared statistically with its spherical counterpart for patients with low degrees of corneal astigmatism.

Pediatric Microbial Keratitis in Queensland, Australia (2005 to 2015).

PURPOSE: To estimate the incidence and define the demographic and microbiological profile of pediatric microbial keratitis (MK) in Queensland, Australia. METHODS: This is a retrospective study based on the multicenter database of all patients with positive corneal scrapes in Queensland, Australia, between 2005 and 2015. Pathology organizations in Queensland were identified by online and local directory search and were requested to provide digital records of the corneal scrapes, including patient demographics and culture and antibiotic sensitivity results. Patient demographics, yearly incidence (based on state population data), cultured organisms, and antibiotic sensitivities in MK in patients 16 years old or younger with keratitis were reported and compared with adults. RESULTS: Pediatric cases comprised 125 cases of a total 3182 (3.9%) included in the database. The yearly incidence of MK in children was estimated to be 0.11 cases per 10,000 people 16 years old or younger (95% confidence interval, 0.086-0.134), which was significantly lower than the estimated incidence in people older than 16 years (0.82 per 10,000 people; 95% confidence interval, 0.72-0.92; P < 0.0001). The average age of pediatric patients was 9.2 years (SD 5.5). Culture results showed Gram-positive organisms were the most common causative organisms (84%; 67.2%), Pseudomonas aeruginosa was the most common single organism (24%; 19.2%), and fungal recovery was low (4%; 3.2%). Cultures positive for Streptococcus pneumoniae (17%; 13.6%; P < 0.001) and bacteria sensitive to all recorded antibiotics (96.8%; P < 0.001) were significantly more common in children. CONCLUSIONS: MK in pediatric patients is less common than in adults. Although Streptococcus pneumoniae was more common in children, P. aeruginosa was the most common isolate.

Queensland Microbial Keratitis Database: 2005-2015.

AIMS: To estimate the incidence of culture-positive microbial keratitis in Queensland and analyse trends in the organisms and their sensitivities cultured from corneal scrapes, especially low-incidence organisms. METHODS: Retrospective multicentre case series of all positive corneal scrapes in Queensland, Australia between 2005 and 2015. Pathology organisations in Queensland were identified by online and local directory search and agreed to participate. Digital records of scrapes provided patient demographics and culture and susceptibility results. Trends in the incidence, organisms and sensitivities were monitored with linear regression. The yearly incidence of microbial keratitis was estimated from the Queensland population. RESULTS: The included corneal scrapes totalled 3182, while 1006 were excluded. The included scrapes yielded 4111 organisms. Pseudomonas aeruginosa was the most common single isolate (729, 17.7%), although Gram-positive organisms were more common overall (2737, 66.6%). Fungal organisms were cultured in 6% of cases, while Acanthamoeba comprised only 1% of records. Bacterial organisms were sensitive to all recorded antibiotics in 89% of all isolates and none of the reported antibiotics showed a decreasing trend in susceptibility. The incidence of protozoal isolation decreased over time (p=0.055). Cultures positive for yeasts showed a linear increase in incidence (p=0.045) while moulds showed a spike in incidence in 2010-2012 (p=0.0008). CONCLUSION: The estimated incidence of microbial keratitis was 0.66 cases per 10 000 people, the rate of antibiotic susceptibility is high and stable, the incidence of keratitis secondary to protozoa is likely to be decreasing while the incidence of keratitis culturing yeast is increasing.

High-Dose Steroid Treatment of Bacterial Keratitis.

PURPOSE: To describe the usage patterns of steroids in bacterial keratitis and to analyze the effect of steroids on patients' visual outcomes. METHODS: This was a single-center retrospective review of patients with culture-positive bacterial keratitis treated between 1999 and 2015 at Princess Alexandra Hospital (Brisbane, Australia). Patients with culture-positive bacterial keratitis were identified through the Queensland Pathology Database, and clinical information was gathered through a subsequent medical record review. High-dose steroid treatment was classified as 6 or more drops of a steroid a day started within 7 days of corneal scraping. The outcome of a patient's episode of keratitis was classified as good if their final visual acuity was 6/12 or better; poor if it was 6/60 or worse or required a corneal transplant, otherwise it was classified as average. Microbiological and clinical variables' association with outcomes was evaluated in univariate analyses. Variables significant at P < 0.1 were examined in a multivariate ordinal logistic regression analysis created with forward variable selection with forced inclusion of steroid treatment (high, regular, low dose, and none). RESULTS: A total of 328 patients were included from the 1002 reviewed charts. Of these patients, 164 (50.0%) were treated with steroids. Factors significantly associated with outcomes in the multivariate model were high-dose steroid treatment, visual acuity on presentation, age group, cause of keratitis, infiltrate size, and location. The odds ratio of better outcomes with high-dose steroids was 5.49 (confidence interval, 1.6-19.0, P = 0.007). CONCLUSIONS: High-dose steroid treatment is significantly associated with better visual outcomes in patients with culture-positive bacterial keratitis in this case series.

Calcification of hydrophilic acrylic intraocular lenses following secondary surgical procedures in the anterior and posterior segments.

AIMS: To report 15 cases of intraocular lens (IOL) calcification following intraocular surgery and to identify common risk factors. METHODS: A retrospective case review of patients with IOL calcification reported from the Royal Victorian Eye and Ear Hospital, Melbourne, Australia, and six surgeons in private practice in the Australian states of Victoria, New South Wales and Queensland. RESULTS: 15 cases of IOL calcification were identified. Eight cases were in hydrophilic acrylic IOLs and seven in hydrophilic acrylic IOLs with hydrophobic surface properties. Five cases occurred following intraocular injection of gas during endothelial keratoplasties. Two cases occurred following pars plana vitrectomy where gas was used. The remaining eight cases did not involve the injection of any intraocular gas; six cases were following trabeculectomy surgery, and two cases were after insertion of a 'piggyback' sulcus IOL. In each case, the calcification had a characteristic pattern, being centrally placed in the pupillary zone, mainly affecting the anterior lens surface. CONCLUSION: The aetiology of IOL calcification is not fully understood, although there are known risk factors such as using hydrophilic acrylic materials and the use of intraocular gas. Surgical consideration of a patient's ocular comorbidities before IOL implantation is an important tool to mitigate some of this risk.

Risk factors and causative organisms in microbial keratitis.

PURPOSE: To establish the risk factors, causative organisms, levels of antibiotic resistance, patient demographics, clinical presentations, and clinical outcomes of microbial keratitis at a tertiary hospital in Australia. METHODS: Patients who had a corneal scraping for culture over a 5-year period were identified through the local microbiology database, and a retrospective audit of their medical records was carried out. Clinical information was gathered from medical records, and smear, culture, and antibiotic resistance results were from the microbiology database. An index of disease severity was calculated for each patient from scores for the magnitude of the epithelial defect and anterior-chamber reaction and the location of the lesion. Associations between risk factors for keratitis and variables such as patient demographics, causative organism and antibiotic resistance, disease severity, and outcome were analyzed by using analysis of variance and chi tests with appropriate correction for multiple comparisons. RESULTS: Two hundred fifty-three cases of microbial keratitis in 231 patients were included. Sixty percent of patients were men, and there was a bimodal distribution in the age of presentation. Common risk factors for keratitis were contact lens wear (53; 22%), ocular surface disease (45; 18%), ocular trauma (41; 16%), and prior ocular surgery (28; 11%). Gram stains were positive in 33%, with a sensitivity of 53% and specificity of 89%. Cultures of corneal scrapings were positive in 65% of cases, and Pseudomonas aeruginosa (44; 17%), coagulase-negative staphylococci (22; 9%), Staphylococcus aureus (19; 8%), and fungi (7; 3%) were commonly recovered. P. aeruginosa was more common than other culture results in contact lens-related cases (55% vs. 0%-23%; P < 0.001), and S. aureus was more common than other culture results in ocular surgery-related cases (29% vs. 0%-21%; P < 0.001). Patients with keratitis related to prior ocular surface disease had more severe keratitis at the time of scraping (P = 0.037). Cultures positive for Fusarium, P. aeruginosa, and other Gram-negative organisms had statistically significantly more severe keratitis at the time of scraping, whereas patients with negative cultures had milder keratitis (P = 0.030). Only 2% of all bacterial isolates were resistant to ciprofloxacin, 20% of Gram-positive isolates were resistant to cephalothin, and no Gram-negative isolates were resistant to gentamicin. CONCLUSIONS: In this series, the most common risk factor for keratitis was contact lens wear and the most commonly isolated organism was P. aeruginosa.

A longitudinal study of trends in keratitis in Australia.

PURPOSE: To analyze the changes in risk factors, corneal culture results, antibiotic resistance, treatment, and clinical outcomes of patients with keratitis presenting to a major public hospital in Australia over a 5-year period. METHODS: A retrospective audit of all patients who had a corneal scraping between October 1999 and September 2004 at the Princess Alexandra Hospital. Clinical information was gathered from medical records and smear and culture results from the local microbiology database. The trends over time in patient demographics, keratitis risk factors, corneal culture results, antibiotic resistance, treatment, and clinical outcomes were analyzed by using linear regression. By using a moving average, we analyzed differences in the rate of culture of each causative organism for each month of the year with linear regression from the month of highest presentation. The mean of maximum temperatures on the days of presentation between different groups of organisms was compared. RESULTS: The proportion of patients presenting with keratitis related to contact lens wear increased significantly (12%-29%; P = 0.04) and with keratitis related to ocular surgery decreased significantly (18%-8%; P = 0.009) through the study. Antibiotic resistance of cultured bacteria to cephalothin increased significantly (2%-12%; P = 0.02), whereas resistance to ciprofloxacin and gentamicin remained at a low level throughout the study. There was significant variation in the monthly recovery of Pseudomonas aeruginosa (P = 0.04) and fungi (P = 0.02), which were cultured more frequently in summer months, whereas Streptococcus pneumoniae (P = 0.04) was more common in winter months than in other times of the year. Treatment with fluoroquinolones increased significantly (14%-40%; P = 0.002) through the study, and the rate of good outcomes also increased significantly (42%-72%; P = 0.02). CONCLUSIONS: In this series, keratitis related to contact lens wear became more frequent, whereas keratitis related to prior ocular surgery became less frequent. Different organism groups showed significant seasonal variations in their presentation, and bacterial resistance to cephalothin increased significantly.

Calcification of hydrophilic acrylic intraocular lenses associated with intracameral air injection following DMEK.

UNLABELLED: We present 2 cases of localized calcification on the anterior surface/subsurface of hydrophilic acrylic intraocular lenses (IOLs) following procedures involving intracameral injection of air. Although this phenomenon has been reported in hydrophilic acrylic IOLs, to our knowledge it has not been reported in the IOLs described in our cases, one a sulcus-fixated supplementary IOL and the other a hydrophilic acrylic IOL with a hydrophobic surface. Centralized opacity of the IOLs was first noted months after Descemet membrane endothelial keratoplasty had been performed in both cases; explantation was required. Laboratory analysis of the IOLs confirmed calcification of the anterior surfaces in a localized pattern in the area of the capsulorhexis or pupil. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.