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PURPOSE: To report the French refractive surgeons' real-life practices for preventing infection after corneal refractive surgery (photorefractive keratotomy [PRK], laser in situ keratomileusis [LASIK], and small-incision lenticule extraction). SETTING: France. DESIGN: Anonymous practice survey. METHODS: The questionnaire was sent in a single email invitation to 400 declared refractive surgeons. The following information was recorded between December 2019 and April 2020, before the coronavirus pandemic: demographics data, preoperative evaluation and preparation of the patient, surgical management, immediate and postoperative protocol, and infections reported after corneal refractive surgery. RESULTS: Eighty-three of 400 surgeons (20.75%) responded to the questionnaire; 55 (66.0%) performed more than 50 corneal refractive surgeries a year, and 25 (30.1%) performed more than 200 procedures a year. Thirty-six (43.4%) surgeons wore 3 protective items, 37 (44.6%) 2, 5 (6.0%) 1, and 5 (6.0%) zero. Seventy-seven (92.8%) surgeons used povidone-iodine for skin area disinfection and 54 (65%) for conjunctival fornix disinfection. The contact time of povidone-iodine was less than 3 minutes for 71 (85.0%) surgeons. Twenty surgeons (24.1%) reported at least 1 postrefractive surgery infection. Twenty percent of surgeons who wore sterile gloves for PRK reported postoperative infections compared with 62.5% for those who did not (P = .008). These figures were, respectively, 8.7% and 66.7% for the use of sterile gloves during LASIK (P = .002); 8.9% of surgeons who wore surgical masks for LASIK reported postoperative infections compared with 50.0% for those who did not (P = .01). CONCLUSIONS: Practices are variable among French refractive surgeons. Wearing a surgical mask and sterile gloves during corneal refractive surgery appears to be advisable.
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Control de Infecciones/métodos , Queratomileusis por Láser In Situ/efectos adversos , Miopía , Queratectomía Fotorrefractiva/efectos adversos , Complicaciones Posoperatorias/prevención & control , Infección de la Herida Quirúrgica/prevención & control , Francia/epidemiología , Humanos , Láseres de Excímeros , Miopía/cirugía , Pautas de la Práctica en Medicina , Encuestas y CuestionariosRESUMEN
UNLABELLED: We report the clinical features and management of a patient with severe bilateral infectious keratitis developing after simultaneous bilateral small-incision lenticule extraction. A 39-year-old man was referred to our emergency department 2 days after a small-incision lenticule extraction procedure for moderate myopia. He reported decreased vision, photophobia, and pain bilaterally. Visual acuity was counting fingers in the right eye and hand motion in the left eye. Slitlamp examination showed multiple white corneal infiltrates at the corneal cap-stromal bed interface. The interface was first rinsed with povidone-iodine 10.0% and then with vancomycin (50 mg/mL). Fortified antibiotics eyedrops administration was initiated. Cultures showed Streptococcus pneumonia. Anterior segment spectral-domain optical coherence tomography scans were performed daily. Once the infection was controlled 4 days later, corticosteroids eyedrops were begun. Three months postoperatively, the patient had a corrected distance visual acuity of 20/32 in the right eye and 20/25 in the left eye. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.
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Queratitis/etiología , Miopía/cirugía , Infección de la Herida Quirúrgica/etiología , Adulto , Sustancia Propia , Humanos , Masculino , Tomografía de Coherencia Óptica , Agudeza VisualRESUMEN
PURPOSE: To report long-term results of Artisan phakic intraocular lens (pIOL) to correct myopia and to propose a model predicting endothelial cell loss after pIOL implantation. SETTING: Quinze-Vingts National Ophthalmology Hospital, Paris, France. DESIGN: Retrospective, interventional case series. METHODS: Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and central endothelial cell count (ECC) were determined before and at yearly intervals up to 5 years after pIOL implantation. Linear model analysis was performed to present a model that describes endothelial cell loss as a linear decrease and an additional decrease depending on postoperative loss. RESULTS: A total of 49 patients (68 eyes) implanted with pIOLs from January 2000 to January 2009 were evaluated. The mean preoperative and final spherical equivalent (SE) were -13 ± 4.10 and -0.75 ± 0.74 diopters (D), respectively. The mean preoperative and final central ECC were 2629 ± 366 and 2250 ± 454 cells/mm(2), respectively. There were no intraoperative complications for any of the eyes. One eye required surgery for repositioning the pIOL, and 1 eye required pIOL exchange for postoperative refractive error. The model predicted that for patients with preoperative ECC of 3000, 2500, and 2000 cells/mm(2), a critical ECC of 1500 cells/mm(2) will be reached at 39, 28, and 15 years after implantation, respectively. CONCLUSIONS: Implantation of the pIOL was an effective and stable procedure after 5 years of follow-up. The presented model predicted EC loss after pIOL implantation, which can assist ophthalmologists in patient selection and follow-up. FINANCIAL DISCLOSURE: The authors report no conflict of interest.
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Pérdida de Celulas Endoteliales de la Córnea/diagnóstico , Iris/cirugía , Implantación de Lentes Intraoculares/métodos , Miopía/cirugía , Lentes Intraoculares Fáquicas , Adulto , Recuento de Células , Endotelio Corneal/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Teóricos , Estudios Retrospectivos , Agudeza Visual/fisiología , Adulto JovenRESUMEN
PURPOSE: To investigate the features of corneal epithelial basement membrane dystrophy using spectral-domain optical coherence tomography (SD OCT) and to examine the reliability of SD OCT in distinguishing epithelial basement membrane dystrophy from the normal cornea. DESIGN: Diagnostic test study. METHODS: Forty-five individuals with epithelial basement membrane dystrophy and 45 age- and sex-matched controls with normal corneas were examined, and SD OCT scans of their corneas were performed. In vivo confocal microscopy was performed to confirm or rule out the diagnosis of epithelial basement membrane dystrophy. The structural corneal changes occurring in eyes with epithelial basement membrane dystrophy based on SD OCT findings were described. RESULTS: Epithelial abnormalities were observed in 86 of 87 eyes with epithelial basement membrane dystrophy (45 patients) on SD OCT scans. The 2 main features were the presence of an irregular and thickened epithelial basement membrane duplicating or insinuating into the corneal epithelium layer, or both, and the presence of hyperreflective dots. In some cases, we detected hyporeflective spaces between the corneal epithelial layer and the Bowman layer similar to a corneal epithelial detachment. This corneal epithelial detachment sometimes was associated with a cleavage with a stair-step appearance within the corneal epithelial layer. We found a perfect correlation between in vivo confocal microscopy and SD OCT findings in the diagnosis of epithelial basement membrane dystrophy (κ = 0.98). CONCLUSIONS: SD OCT provides an accurate assessment of the structural changes occurring in eyes with epithelial basement membrane dystrophy. These changes, visible on SD OCT scans, are easily detectable and permit an accurate diagnosis, especially in patients with no biomicroscopically visible corneal changes.
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Síndrome de Cogan/diagnóstico , Tomografía de Coherencia Óptica , Adulto , Anciano , Membrana Basal/patología , Epitelio Corneal/patología , Femenino , Análisis de Fourier , Humanos , Masculino , Microscopía Confocal , Persona de Mediana Edad , Estudios Prospectivos , Agudeza Visual/fisiología , Adulto JovenRESUMEN
PURPOSE: To perform VHF digital ultrasound scanning and analysis of a case of high-myopic undercorrection in an eye that had undergone multiple surgical interventions for the correction of an initial refraction of -12.00 diopters (D). METHODS: A 49-year-old woman was evaluated after undergoing three surgical interventions for correction of an initial refraction of -12.00 D in the left eye. Automated lamellar keratoplasty (ALK) was followed by arcuate keratotomy (for induced astigmatism) and surface photorefractive keratectomy (PRK). The residual ametropia on presentation was -6.75 -3.50 x 95 degrees. VHF digital ultrasound scanning and analysis was performed. RESULTS: On ultrasound, the ALK interface was clearly visible. Residual stromal thickness beneath the cap was at least 275 microm. The absence of Bowman's layer indicated the region of PRK. New stroma and nascent stromal layers were differentiated within the flap. Neo stromal deposition and central epithelial hyperplasia were determined to be responsible for the myopic shift, as opposed to biomechanical changes. CONCLUSIONS: In this case, refraction, slit-lamp examination, and topography were unable to provide a diagnosis for regression following multiple corneal refractive procedures. By providing layered anatomical mapping, VHF digital ultrasound scanning was able to exclude a diagnosis of ectasia and provide anatomical diagnostic information to explain the clinical observations.
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Córnea/diagnóstico por imagen , Miopía/diagnóstico por imagen , Queratectomía Fotorrefractiva , Astigmatismo/diagnóstico por imagen , Astigmatismo/etiología , Astigmatismo/cirugía , Topografía de la Córnea , Trasplante de Córnea , Femenino , Humanos , Imagenología Tridimensional , Láseres de Excímeros , Persona de Mediana Edad , Miopía/etiología , Miopía/cirugía , Reoperación , UltrasonografíaRESUMEN
PURPOSE: To analyze the features of retinal detachment (RD) occurring after cataract surgery performed by Kelman phacoemulsification (KPE) and to identify any potential correlations between KPE intraoperative complications and the features of RD (incidence apart) as well as the final visual outcome. DESIGN: Interventional consecutive case series. METHODS: Retrospective review of 114 eyes of 114 consecutive patients with RD occurring after KPE and followed for 6 months or more after surgery. RESULTS: Removal of posteriorly dislocated lens fragments during KPE by pars plana vitrectomy (PPV) was associated with a significantly shorter time interval between KPE and RD (3.89 vs. 15.7 months, P =.0044). Once RD occurred, no other statistically significant correlation between its features or the final visual outcome and KPE intraoperative complications (posterior capsular rupture, vitreous loss, posteriorly dislocated lens fragments) was detected. The overall anatomic reattachment rate was 94%. Only redetachment associated with the development of proliferative vitreoretinopathy (PVR) was significantly correlated with ultimate anatomic failure (P =.0036). A best-corrected visual acuity of 20/60 or better was achieved in 58 out of 114 eyes (51%). Three variables were independently correlated with visual results: more extensive RD (P =.0001), redetachment associated with the development of PVR (P =.0029), and failure to identify retinal breaks (P =.0114). CONCLUSIONS: Posterior capsular rupture and vitreous loss during KPE do not seem to affect the features (incidence apart) or the final visual outcome of RD occurring afterwards, except for a shorter time interval between KPE and RD in eyes that underwent PPV to remove posteriorly dislocated lens fragments.