ABSTRACT
We report 2 cases of toxic anterior segment syndrome (TASS) resulting from impurities in generic trypan blue that was administered intracamerally to improve visualization of the capsule. Histology of the corneal buttons revealed foci of inflammatory response and complete loss of endothelial cells. Cell culture analysis showed that the generic trypan blue was approximately twice as toxic to the endothelium as a proprietary trypan blue. Ophthalmologists should be aware that any substance administered intraocularly can be a source of complications, and they should know the source of all material used in surgery.
Subject(s)
Coloring Agents/adverse effects , Corneal Edema/chemically induced , Drugs, Generic , Endothelium, Corneal/drug effects , Endotoxins/adverse effects , Trypan Blue/adverse effects , Uveitis, Anterior/chemically induced , Aorta, Thoracic/cytology , Cell Survival , Cells, Cultured , Coloring Agents/toxicity , Corneal Edema/diagnosis , Endothelium, Corneal/pathology , Endothelium, Vascular/drug effects , Endothelium, Vascular/pathology , Endotoxins/toxicity , Female , Humans , Lens Capsule, Crystalline/pathology , Lens Implantation, Intraocular , Male , Middle Aged , Phacoemulsification , Trypan Blue/toxicity , Uveitis, Anterior/diagnosisABSTRACT
PURPOSE: To report the incidence of postoperative endophthalmitis in a series of patients who had cataract surgery with intraocular lens (IOL) implantation and to apply guidelines toward the prevention of postoperative endophthalmitis. SETTING: The Buzard Eye Institute for Corneal, Refractive and Cataract Surgery, Las Vegas, Nevada, USA. METHODS: In this prospective institutional study, 5,131 cataract surgery cases with IOL implantation were performed from 1998 to 2002 by 1 surgeon at a single institute. The surgeon used a blue-line incision at the superior location, povidone- iodine prophylaxis, and postoperative injection of subconjunctival antibiotics. The incidence of endophthalmitis in the study was compared with the general incidence in the United States (range 0.07% to 0.13%) and in published studies (range 0.02% to 0.57%). RESULTS: The 5,131 cases were followed for a mean of 2 years (range 3 months to 4 years). The mean patient age was 69.6 years +/- 10.9 (SD). No case of endophthalmitis occurred. The zero incidence of endophthalmitis was below the general incidence in the United States and in published studies. CONCLUSIONS: The findings suggest that the absence of postoperative endophthalmitis may be related to 4 factors: povidone-iodine prophylaxis, meticulous draping of the eyes, operative technique (blue-line incision), and postoperative injection of subconjunctival antibiotics.
Subject(s)
Cataract Extraction , Endophthalmitis/prevention & control , Lens Implantation, Intraocular , Postoperative Complications/prevention & control , Aged , Anti-Infective Agents/administration & dosage , Endophthalmitis/epidemiology , Humans , Incidence , Ophthalmologic Surgical Procedures/instrumentation , Povidone-Iodine/administration & dosage , Practice Guidelines as Topic , Prospective Studies , Surgical Equipment , United States/epidemiologyABSTRACT
PURPOSE: To evaluate the safety, efficacy, and predictability of excimer laser in situ keratomileusis (LASIK) to correct residual myopia and astigmatism after penetrating keratoplasty (PKP). SETTING: Buzard Eye Institute, Las Vegas, Nevada, USA. METHODS: Twenty-six eyes had LASIK at least 1 year after PKP. All eyes were followed for at least 6 months after LASIK; 22 eyes were followed for 12 months. Sutures were removed at a mean of 13 months post PKP. Laser in situ keratomileusis was performed with the Chiron Automated Corneal Shaper microkeratome (Bausch & Lomb) and the Visx Star excimer laser. Before LASIK, the mean spherical equivalent (SE) was -4.94 diopters (D) +/- 2.79 (SD) and the mean astigmatism was 2.71 +/- 2.33 D; all eyes had regular astigmatism or slightly decentered, irregular astigmatism. RESULTS: At the last follow-up, the mean postoperative uncorrected visual acuity (UCVA) was 20/30, the mean SE was -0.35 +/- 0.65 D, and the mean residual astigmatism was 1.06 +/- 0.67 D. Eighty-six percent of patients had an SE within +/-1.00 D of emmetropia and a UCVA of 20/40 or better. Ten eyes (39%) had 1 or more enhancements, which were performed a mean of 6 months after the primary LASIK. Significant complications such as wound dehiscence, epithelial ingrowth, and corneal decompensation did not occur. At the last follow-up, 18% of patients lost 1 line of best corrected visual acuity and 27% gained 1 line. CONCLUSION: Laser in situ keratomileusis appeared to be a reliable and safe procedure to correct residual myopia and astigmatism after PKP.
