Scleral- fixated intraocular lens implantation in microspherophakia.

Background: In microspherophakia, abnormal laxity of the lenticular zonules leads to development of a spherical lens and possible subluxation. We evaluated long-term results of lens removal with scleral-fi xated intraocular lens (SFIOL) implantation in microspherophakia. Materials and Methods: Case series. SF IOLs were implanted in four consecutive patients with bilateral microspherophakia (eight eyes [three with pupillary block and secondary glaucoma who underwent immediate surgery and fi ve with only subluxation who underwent elective surgery]). Post-operative best-corrected visual acuity (BCVA), intraocular pressure (IOP) and lens position were evaluated periodically from day 1 to 18 months. Results: All patients were females (mean age 28 ± 7.03 years). In group 1 eyes (three eyes that presented with pupillary block), the mean BCVA improved from 0.008 decimals (preoperative) to 0.50 decimals (fi nal post-operative visit); in group 2 eyes (the other fi ve eyes), the mean BCVA improved from 0.12 ± 0.21 decimals to 0.73 ± 0.14 decimals. The preoperative mean IOP (54.53 ± 7.33 mmHg) in group 1 eyes was signifi cantly (P = 0.03) higher than that (16 ± 4.30 mm Hg) in group 2 eyes. At fi nal post-operative visit, the mean IOP (11.67 ± 2.88 mmHg) in group 1 eyes was not signifi cantly diff erent from that in group 2 eyes (13.0 ± 3.08 mmHg). All SFIOLs were well- centred at the fi nal visit. None of the patients encountered any peroperative or postoperative complications. Conclusions: SFIOLs may be an option for surgical management of microspherophakia.

Bilateral Pseudomonas keratitis without predisposing factors.

Bilateral keratitis usually occurs in predisposed individuals such as contact lens wearers, those suffering from malnutrition and immunodeficiency or patients undergoing bilateral refractive corneal surgery. We report a 30-year-old man without any obvious predisposing factors who presented with complaints of pain and decreased vision in both eyes. Examination revealed corneal ulcers in both eyes, which on microbiological culture grew Pseudomonas aeruginosa. The patient underwent a therapeutic keratoplasty in the right eye while the left eye was managed medically. Bilateral Pseudomonas keratitis can develop in the absence of any obvious predisposing factors.

Is ultrasonography essential before surgery in eyes with advanced cataracts?

BACKGROUND: Ultrasonography is an important tool for evaluating the posterior segment in eyes with opaque media. AIM: To study the incidence of posterior segment pathology in eyes with advanced cataract and to see whether certain features could be used as predictors for an abnormal posterior segment on ultrasound. SETTING: Tertiary care hospital in South India. METHODS AND MATERIALS: In this prospective study conducted over a 6-month period, all eyes with dense cataracts precluding visualization of fundus underwent assessment with ultrasound. Presence of certain patient and ocular "risk" factors believed to be associated with a higher incidence of abnormal posterior segment on ultrasound were looked for and the odds ratio (OR) for posterior segment pathology in these eyes was calculated. RESULTS: Of the 418 eyes assessed, 36 eyes (8.6%) had evidence of posterior segment pathology on ultrasound. Retinal detachment (17 eyes; 4.1%) was the most frequent abnormality detected. Among patient features, diabetes mellitus (OR= 4.9, P= 0.003) and age below 50 years (OR= 15.4, P= 0.001) were associated with a high incidence of abnormal ultrasound scans. In ocular features, posterior synechiae (OR= 20.2, P= 0.000), iris coloboma (OR= 34.6, P= 0.000), inaccurate projection of rays (OR= 15.1, P= 0.002), elevated intraocular pressure (OR= 15.1, P= 0.004) and keratic precipitates (OR= 22.4, P= 0.004) were associated with high incidence of posterior segment pathology. Only four eyes (1.5%) without these features had abnormal posterior segment on ultrasonography. CONCLUSIONS: Certain patient and ocular features are indicative of a high risk for posterior segment pathology and such patients should be evaluated by ultrasonography prior to cataract surgery. In the absence of these risk factors, the likelihood of detecting abnormalities on preoperative ultrasonography in eyes with advanced cataracts is miniscule.