Agricultural Trauma Causing Open Fractures: Is Antibiotic Coverage Against Anaerobic Organisms Indicated?

OBJECTIVE: To compare deep infection rate and causative organisms in open fractures of the lower extremity from agricultural trauma with similar injuries in nonagricultural trauma. DESIGN: Retrospective. SETTING: Two tertiary care institutions. METHODS: Open lower extremity fractures sustained between 2003 and 2018 caused by agriculture-related trauma in adult patients were reviewed. A nonagriculture open fracture control group (NAG) was identified for comparison. Patient demographics and injury characteristics were assessed. Outcomes included occurrence of deep infection and causative organisms. RESULTS: One hundred seventy-eight patients were identified in the agriculture (AG) (n = 89) and control (NAG) (n = 89) groups. Among patients with agricultural injury, farm machinery was the most common mechanism in 69 (77.5%) of them. Open injuries of the foot (38.2%) and tibial shaft injuries (25.8%) were the most common in the AG and NAG groups, respectively. Deep infection was seen in 21% of patients in the AG group compared with 10% in the NAG group (P < 0.05). In the AG group, anaerobic infection occurred in 44% of patients with deep infection compared with 9.1% in the NAG group (P < 0.05). The most common anaerobic organisms included enterococci, Pseudomonas aeruginosa, and Clostridium perfringens. CONCLUSIONS: This study supports that open fractures due to agricultural trauma have a high infection rate, with anaerobic infection occurring at higher rates than in injuries due to nonagricultural trauma. Prophylactic treatment with antibiotics directed against anaerobes is indicated in these injuries. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Hyperopic shift in refraction associated with implantation of the single-piece Collamer intraocular lens.

PURPOSE: To describe reports of refractive hyperopic shift over time following intraocular lens (IOL) implantation, discuss possible etiologies, and suggest preventive and therapeutic treatments. SETTING: Multiple U.S. ophthalmic surgical centers; data collection at Staar Surgical, Monrovia, California, USA. METHODS: Forty cases displaying a progressive hyperopic shift in refraction after implantation of the single-piece Collamer IOL (Staar Surgical) were reported to the manufacturer out of 160 000 that have been implanted since its commercial introduction in April 2000. A retrospective data analysis of these 40 cases was performed; parameters included the mean refractive change over time, presence of capsular fibrosis, IOL displacement, and outcomes of secondary treatments. Individual case examples are presented. RESULTS: The mean refractive shift was 1.81 diopters (D) (range 0.25 to 3.75 D) with 5 cases (14%) demonstrating a hyperopic shift greater than 3.0 D. In 38 of the 40 cases, some combination of the following were reported: posterior displacement of the IOL, capsule fibrosis, and/or relief of the condition by performance of a radial or circumferential anterior neodymium:YAG capsulotomy to relieve capsule tension. The use of a small (less than 5.5 mm) capsulorhexis was also associated with cases showing the hyperopic shift. CONCLUSION: The most likely etiology was the development of anterior capsule fibrosis, sometimes exacerbated by a small capsulorhexis, which could cause the IOL to move posteriorly, resulting in a hyperopic change in refraction. Previous in vitro testing by the manufacturer ruled out a change in the refractive power of the IOL in the eye as a cause of this phenomenon.