RESUMEN
OBJECTIVE: Zonular dialysis (ZD), referred to as the presence of a deficient zonular support for the lenticular capsule, might be the result of several causes and be detected only at the time of cataract surgery. The aim of this study was to evaluate pre-, intra-, and postoperative features of eyes with ZD regardless of the etiology detected during cataract surgery. METHODS: A single-centre retrospective observational cohort study was performed at Moorfields Eye Hospital (NHS Foundation Trust, London, U.K.) to identify patients who underwent cataract surgery whose procedure was intraoperatively described as being complicated by ZD between January 1, 2014, and August 22, 2019. Patient characteristics, intraoperative clinical findings, visual and refractive outcomes, and postoperative complications were recorded. RESULTS: ZD was identified intraoperatively in 447 eyes. In most cases (213 of 223; 96.8%), patients underwent a phacoemulsification procedure, not requiring any conversion to intracapsular or extracapsular extraction technique. Intraoperative complications increased to 46.2% (103 of 223), with no significant correlation with ZD width. Capsular tension rings (CTRs) were implanted in 43.4% of patients (97 of 223). The use of CTRs correlated with better postoperative visual and refractive outcomes. CONCLUSIONS: ZD is a serious complication of cataract surgery requiring prompt intraoperative diagnosis and proper management. While it tends to worsen cataract surgery outcomes, the implantation of CTRs during the surgical procedure seems to be associated with better postoperative visual and refractive results.
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Extracción de Catarata , Catarata , Facoemulsificación , Humanos , Estudios Retrospectivos , Agudeza Visual , Diálisis Renal/efectos adversos , Extracción de Catarata/efectos adversos , Facoemulsificación/métodos , Complicaciones Posoperatorias/etiología , Catarata/complicaciones , Derivación y Consulta , Reino UnidoRESUMEN
PURPOSE: Thygeson's superficial punctate keratitis (TSPK) is a chronic and recurrent corneal epitheliopathy. Although first described more than 70 years ago, the precise etiological mechanism and optimal treatment approach for TSPK has not been established. In this paper, we present an up-to date review of the literature and propose a step-by-step management protocol. METHOD: A literature search was done on PubMed using keywords including Thygeson's superficial punctate keratitis, punctate keratitis, etiology, management, and treatment. The literature was reviewed and reported. RESULTS: The main findings of this review include a summary of the main theories behind the cause TSPK; although topical corticosteroids remain the treatment of choice, long-term risks associated with these agents and recent studies have revealed immunomodulatory agents as promising treatment adjuvants or alternatives for TSPK; surgical interventions such as PRK/PTK have been utilized in selected refractory cases; finally we propose a treatment protocol based the best available evidence and clinical experience. CONCLUSION: Although the clinical features of TSPK have been well described, the specific cause of TSPK remains inconclusive. Mechanisms proposed including viral infection, immune-mediated, and immune responses to viral infection but require further investigation. More prospective randomized clinical trials comparing efficacy of corticosteroids, tacrolimus, and cyclosporine A (CSA) are required. More evidence is required for surgical interventions such as PRK/PTK.
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Opacidad de la Córnea , Queratitis , Corticoesteroides/uso terapéutico , Córnea , Humanos , Queratitis/diagnóstico , Queratitis/tratamiento farmacológico , Estudios ProspectivosRESUMEN
Giant fornix syndrome (GFS) was first described as a cause for a relapsing mucopurulent conjunctivitis. Predominantly elderly patients have enlarged superior fornices from superior aponeurosis dehiscence that permits the accumulation of protein coagulum that is colonised by bacteria. Established treatment includes the use of intensive topical antibiotic and corticosteroid. We describe a case of a 98-year-old woman with GFS who did not respond to several weeks of intensive (two hourly) treatment with topical prednisolone 1% drops and chloramphenicol. Subsequent additional regular sweeping of the fornices with cotton buds and topical medication did not improve her symptoms but which resolved with manual coagulum debridement and application of 10% povidone-iodine. This treatment offers an effective treatment option of GFS cases, which do not respond to intensive topical corticosteroids and chloramphenicol.
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Antiinfecciosos Locales/uso terapéutico , Conjuntivitis Bacteriana/diagnóstico , Soluciones Oftálmicas/uso terapéutico , Povidona Yodada/uso terapéutico , Infecciones Estafilocócicas/diagnóstico , Anciano de 80 o más Años , Antiinfecciosos Locales/administración & dosificación , Conjuntivitis Bacteriana/tratamiento farmacológico , Conjuntivitis Bacteriana/microbiología , Desbridamiento , Diagnóstico Diferencial , Esquema de Medicación , Femenino , Humanos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Soluciones Oftálmicas/administración & dosificación , Povidona Yodada/administración & dosificación , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiologíaRESUMEN
PURPOSE: To describe a case of acute glaucoma after cyanoacrylate gluing for a nontraumatic central corneal perforation. METHODS: A 55-year-old woman with history of rheumatoid arthritis and severe dry eye presented to emergency with a right central corneal perforation. She was treated successfully with the use cyanoacrylate glue patch but iridocorneal adhesions remained. The next day she presented with ocular pain, headaches, and vomiting. On examination she had shallow anterior chamber (AC) with no aqueous leakage but her intraocular pressure (IOP) was 56 mm Hg measured with rebound tonometry. An anterior segment optical coherence tomography scan showed a 360 degrees central iris adhesion with shallow AC. Topical and oral treatment for acute glaucoma was given that decreased her IOP. She then underwent urgent surgery to release the iridocorneal adhesions and restore aqueous flow that was achieved without replacing the glue patch. RESULTS: One day postoperatively her right eye was comfortable and her IOP measurement remained within normal limits. The AC was deep with no iridocorneal adhesions. CONCLUSIONS: Close monitoring of the IOP is recommendable in central corneal perforations with iris adhesions managed with cyanoacrylate glue due to the potential developing of aqueous blockage.
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Humor Acuoso/efectos de los fármacos , Perforación Corneal/tratamiento farmacológico , Cianoacrilatos/efectos adversos , Glaucoma/etiología , Enfermedad Aguda , Cianoacrilatos/uso terapéutico , Femenino , Cirugía Filtrante , Glaucoma/diagnóstico , Glaucoma/fisiopatología , Glaucoma/cirugía , Humanos , Presión Intraocular/fisiología , Persona de Mediana Edad , Tomografía de Coherencia Óptica , Tonometría OcularRESUMEN
PURPOSE: To assess the outcomes of small optical zone (OZ) ablations used in conjunction with large transition zones (TZ) and a highly aspheric treatment profile. METHODS: Interventional case series of 39 consecutive patients with myopia or myopic astigmatism. Patient data included pre and postoperative refraction and visual acuities, laser treatment settings and pre and postoperative corneal topography as well as questionnaire responses about the use of glasses and the quality of vision postoperatively. RESULTS: The mean preoperative spherical equivalent was -4.50±2.11 dioptres (D) and the mean OZ and TZ diameters were 4.5±0.5mm and 8.1±0.4mm, respectively. The mean patient age was 40.7±10.4 years. Manifest spherical refraction was within ±0.5D in 87% of patients (±1.0D in 99%) and cylindrical refraction within 0.5D in 79% (≤1.0D in 95%). The need to wear distance glasses postoperatively was associated with dissatisfaction with the quality of daytime vision (p=0.05) and unhappiness with night vision was associated with symptoms of halos (p=0.03) and starbursts (p=0.02). The proportion of patients reporting symptoms of dysphotopsias included: ghosting 0%; glare 2%; halos 10%; and starbursts 15%. There was a significant difference in the measured mean effective OZ diameter (4.8±0.3mm) compared to the mean programmed OZ (4.5±0.5mm, p=0.00). CONCLUSIONS: Small ablation zones, when used in conjunction with a large diameter TZ, do not lead to a greater incidence of unwanted visual phenomena over that reported by many studies with larger OZs.
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Astigmatismo/diagnóstico , Astigmatismo/cirugía , Cirugía Laser de Córnea/métodos , Miopía/diagnóstico , Miopía/cirugía , Satisfacción del Paciente , Agudeza Visual , Adulto , Anciano , Astigmatismo/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Miopía/complicaciones , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: To measure the ease of use and performance of the Optyse lens-free ophthalmoscope compared with the standard Keeler pocket ophthalmoscope, and to assess its suitability as an inexpensive ophthalmoscope for medical students. DESIGN: Randomized cross-over study. PARTICIPANTS: Twenty second-year medical students, 10 as ophthalmoscopists ('observers') and 10 as 'patients'. METHODS: Students used both ophthalmoscopes to examine the optic disc in each eye of 10 'patients'. They were randomized as to the order in which they were used. A Consultant ophthalmologist was used as the gold standard. MAIN OUTCOME MEASURES: Main outcome measures were accuracy in estimating vertical cup:disc ratio (VCDR), ease of use (EOU) for each examination, and overall ease of use (OEOU). RESULTS: Of 400 attempted eye examinations, sufficient visualization was achieved in 220 cases to allow a VCDR estimation: 107/200 VCDR estimates with the Optyse and 113/200 with the Keeler. Accuracy of VCDR estimates was better with the Optyse by the equivalent of 0.05 VCDR (P = 0.002). There was no significant difference in EOU or OEOU between the two ophthalmoscopes. EOU for 400 examinations: median (IQR) of 6 (3-8) for Optyse versus 6 (3-8) for Keeler (P = 0.648). OEOU for 20 scores: median (IQR) of 6.5 (2-9) for Optyse versus 5.5 (3-8) for Keeler (P = 0.21). CONCLUSION: Medical students found the Optyse and Keeler pocket ophthalmoscopes to be of similar ease of use and performed slightly better with the Optyse when estimating VCDR. The lens-free Optyse ophthalmoscope is a reasonable alternative to the standard Keeler pocket ophthalmoscope.