RESUMEN
PURPOSE: To report a series of patients who developed corneal toxicity after exposure to aquarium coral palytoxin. DESIGN: Multicenter retrospective case series. METHODS: Retrospective review. RESULTS: Seven patients presented with corneal findings ranging from superficial punctate epitheliopathy to bilateral corneal melt with subsequent perforation. Among those with mild corneal findings, resolution was achieved with topical steroids and lubrication, whereas some patients who developed progressive corneal melt required therapeutic penetrating keratoplasty. The history in all patients revealed exposure to aquarium zoanthid corals shortly before disease onset. A review of the literature revealed that there are few prior reports of coral-associated corneal toxicity and that some species of coral secrete a substance known as palytoxin, a potent vasoconstrictor that inhibits the membranous sodium-potassium ATPase pump across cell types and can cause rapid death if inhaled or ingested. CONCLUSIONS: This is the largest case series to date demonstrating patients with aquarium coral palytoxin-associated corneal toxicity, and is the first to provide details of related histopathologic findings. Similar to other forms of toxic keratoconjunctivitis, a detailed history and careful clinical assessment are required, as well as timely removal of the offending agent from the patients' ocular milieu and environment. Mild ocular surface and corneal disease may be treated effectively with aggressive topical steroid therapy and lubrication. Given the potential severity of ocular as well as systemic adverse effects, there should be increased awareness of this entity among eye care professionals, aquarium enthusiasts, and the general public.
Asunto(s)
Acrilamidas/efectos adversos , Antozoos/química , Queratitis/inducido químicamente , Adulto , Anciano , Animales , Venenos de Cnidarios , Femenino , Humanos , Queratitis/diagnóstico , Queratitis/cirugía , Queratoplastia Penetrante , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
PURPOSE OF REVIEW: The purpose of this study is to provide a summary of current trends and recent developments in postoperative care after cataract surgery. RECENT FINDINGS: There is new evidence challenging the routine use of a protective eye shield after uncomplicated cataract surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in decreasing the risk of cystoid macular edema (CME) in high-risk eyes, but must be used with caution in patients with prior corneal disease. Pre-existing ocular comorbidities can have significant effects on postoperative outcomes. Management of postoperative visual expectations can be challenging in patients receiving newer advanced technology intraocular lenses (IOLs). SUMMARY: Key practices such as restrictions on activities, prophylactic regimens against infection and inflammation, appropriate follow-up with adjustments for individual risk factors and management of complications, and continuing care until visual rehabilitation is complete are advised to optimize visual outcome for patients after cataract surgery.