Stenotrophomonas maltophilia endophthalmitis following keratoplasty.

Endophthalmitis is among the most sight-threatening infections in ophthalmology practice. Many microorganisms causing endophthalmitis have been reported. Stenotrophomonas maltophilia is among the rare causes of endophthalmitis and has been reported after cataract surgery, intravitreal injections and ocular trauma. We report a case of S. maltophilia endophthalmitis after keratoplasty, which is a rare entity, in a 63-year-old female patient.

Comparison of Pain between First and Second Operated Eyelids after Upper Eyelid Blepharoplasty.

PURPOSE: To evaluate and compare intraoperative pain during upper eyelid blepharoplasty (UEB) between on first and second operated eyelids. METHODS: In this cross-sectional observational study, the patients were divided into two groups, with group 1 representing 40 patients whose surgery was first started on the right and group 2 representing the other 40 patients who started surgery on the left first. UEB was performed to all patients by the same surgeon under the same and equal amount of local anesthesia. Degree of pain felt during surgery on first and second operated eyelid was evaluated with the visual analoge scale (VAS) and Wong-Baker Facial Pain Expression Scale (WBFPES) of all patients immediately after surgery and was compared using paired t-test. RESULTS: There were 20 female and 20 male patients in both groups. In group 1, the VAS value was 2.8 ± 1.5 and WBFPES value was 2.7 ± 1.6 UEB in the first operated eyelid; the VAS value was 4.1 ± 1.8 and WBFPES value was 3.9 ± 1.8 UEB in the second operated eyelid. A significant difference was found between pains felt during first and second operated eyelid UEB regarding VAS and WBFPES values in group 1 (p = 0.003 and p = 0.002, respectively). In group 2, the VAS value was 1.9 ± 1.0 and WBFPES value was 2.0 ± 1.0 UEB in the first operated eyelid; the VAS value was 3.0 ± 1.5 and WBFPES value was 2.8 ± 1.6 UEB in the second operated eyelid. A significant difference was found between pains felt during first operated and second operated eyelid UEB regarding VAS and WBFPES values in group 2 (p = 0.009 and p = 0.005, respectively). CONCLUSIONS: To the best of our knowledge, this study is the first to evaluate which eyelid is more painful during surgery in UEB. Patients tend to feel more pain during surgery on the second operated eyelid. Therefore, surgeons should consider using local anesthetics with more volume or longer duration in the second operating eyelid in light of this information and patients should be given detailed information about pain.

Contact Lens Compliance With Ophthalmologists and Other Health Professionals.

PURPOSE: To assess the compliance with contact lens (CL) use among ophthalmologists and other health professionals, and to identify the main noncompliant behaviors. METHODS: A cross-sectional, comparative study was designed for soft CL wearers. Twenty-five ophthalmologists, 24 medical doctors other than ophthalmologists, 20 nurses (health professionals), and 52 lay people (members of the public) subjects were included in the interview. The compliance rate for each behavior were determined and compared. Users were asked to rate their subjective use to calculate self-evaluation scores. RESULTS: The compliance rate was found to be the highest among ophthalmologists; however, the difference was not significant (P=0.083). Although the level of compliance was not associated with the subjects' age, duration of lens wear, or wearing days per week (P>0.05), an association was found with the number of wearing hours per day (P=0.010). Increased wearing hours per day was found to increase the rate of poor compliance (P=0.010). Significant differences were found between the groups in storing lenses in fresh solution, lens wearing time according to the ophthalmologist recommendation, and follow-up visits according to ophthalmologist recommendation (P<0.001, P=0.036, P=0.001, respectively). Self-evaluation scores among ophthalmologists, health professionals, and the lay people were 7.56±0.86, 7.59±1.29, and 7.67±1.60, respectively, and no significant differences existed between the groups (P=0.930). CONCLUSION: No differences were evident between the groups in terms of good compliance with CL wear and care practices. As this result shows that compliance with CL wear and care practices is not only related to the level of knowledge, different methods should be developed to increase compliance.

The Effect of Corneal Epithelium on Corneal Curvature in Patients with Keratoconus.

OBJECTIVE: To investigate the effects of corneal epithelium on corneal curvature in patients with keratoconus. DESIGN: This is a prospective, nonrandomized study. PARTICIPANTS: Fifty-nine eyes of 47 patients diagnosed as keratoconus and for whom corneal collagen crosslinking (CXL) was recruited in this study. METHODS: This study is a single-center clinical trial. Pregnancy, lactation, connective tissue disease, corneal thickness below 350 µm, severe dry eyes, or scar of corneal surgery were exclusion criteria. Before and during CXL procedure after removing the corneal epithelium, maximum values of corneal apical curvature, simulated keratometry 1 (Sim-K1), simulated keratometry 2 (Sim-K2), temporal and inferior curvature values, all of which are 1.5 mm from the corneal center, were calculated. These values before and after removal of epithelium were compared statistically. RESULTS: Mean age of patients was 23.30 ± 5.5 (12-38) years. Twenty-eight (59%) were male while 19 (41%) were female. Mean values measured before and after removing the corneal epithelium were: apical curvature; 59.19 ± 7.2 (47.06-82.40) diopter (D) and 61.70 ± 8.8 (49.19-92.66) D (p = 0.001), SimK1; 47.57 ± 4.3 (39.14-64.57) D and 48.23 ± 4.3 (41.89-66.70) D (p = 0.001), SimK2; 52.04 ± 5.3 (43.56-69.34) D and 53.34 ± 5.6 (43.73-70.89) D (p = 0.001), inferior curvature; 53,85 ± 5.2 (43.47-76.56) D and 55.05 ± 5.8 (44.56-81.93) D (p = 0.002), temporal curvature 49.49 ± 5.1 (41.50-71.03) D and 51.53 ± 5.4 (41.58-73.34) D (p = 0.001), respectively. CONCLUSIONS: In keratoconus patients during CXL treatment, after removing the corneal epithelium, more steepness is detected in the curvature of the steeper area of the cornea. When evaluating patients with keratoconus, the masking effect of corneal epithelium on values of curvature should be taken into consideration.