Successful treatment of methicillin-resistant Staphylococcus aureus infection associated with Jones tube using vancomycin eye drops and rifampicin.

OBJECTIVE: Complications associated with the lacrimal Lester Jones tube have been reported. The infections associated with the tube and proper treatment are not well known. The authors have introduced a successful treatment regimen for persistent methicillin-resistant Staphylococcus aureus (MRSA) periocular infection associated with the lacrimal Lester Jones tube without tube removal. DESIGN: Retrospective case series. PARTICIPANTS: Six patients with MRSA infection associated with the Lester Jones tube without tube removal. METHODS: Four patients had improper tube position with total regurgitation and 2 patients had relative normal tube position with a partial to normal passage, but the tube tip irritated the nasal mucosa wound persistently. In all 6 cases, development of a biofilm on the tube was observed. All cultures were positive for MRSA. RESULTS: All patients were prescribed a combination therapy of topical ocular vancomycin and oral rifampicin before or after the dislocated tube reposition. Periocular symptoms resolved within 1 week, and the biofilm on the tube was gradually reduced during combination therapy. Signs of recurrence of infection were not noted during the follow-up visits. CONCLUSION: Patients showing infection signs associated with the Jones tube need to be examined before complete removal of the infected tube. Medical treatment with vancomycin eye drops combined with oral rifampicin for persistent MRSA infection associated with the Lester Jones tube produced a successful result. Removal of the biofilm on the tube at follow-up visits is important to prevent micro-organisms from dispersing around the tissue. If the Jones tube is dislocated, repositioning is highly recommended to prevent periocular MRSA infection recurrence.

Simplified Correction of Ischemic Index in Diabetic Retinopathy Evaluated by Ultra-widefield Fluorescein Angiography

PURPOSE: To develop a novel, simplified method for correcting the ischemic index of nonperfused areas in diabetic retinopathy (DR). METHODS: We performed a retrospective review of 103 eyes with naive DR that underwent ultra-widefield angiography (UWFA) over a year. UWFAs were graded according to the quantity of retinal non-perfusion, and uncorrected ischemic index (UII) and corrected ischemic index (CII) were calculated using a simplified, novel method. RESULTS: The average differences between UII and CII in the non-proliferative DR group and the proliferative DR group were 0.7 +/- 0.9% in the 50% CII group, respectively. A CII >25% was critical for determining DR progression (p < 0.001). CONCLUSIONS: Distortion created by UWFA needs to be corrected because the difference between UII and CII in DR increases with the ischemic index.

Simplified Correction of Ischemic Index in Diabetic Retinopathy Evaluated by Ultra-widefield Fluorescein Angiography

PURPOSE: To develop a novel, simplified method for correcting the ischemic index of nonperfused areas in diabetic retinopathy (DR). METHODS: We performed a retrospective review of 103 eyes with naive DR that underwent ultra-widefield angiography (UWFA) over a year. UWFAs were graded according to the quantity of retinal non-perfusion, and uncorrected ischemic index (UII) and corrected ischemic index (CII) were calculated using a simplified, novel method. RESULTS: The average differences between UII and CII in the non-proliferative DR group and the proliferative DR group were 0.7 +/- 0.9% in the 50% CII group, respectively. A CII >25% was critical for determining DR progression (p < 0.001). CONCLUSIONS: Distortion created by UWFA needs to be corrected because the difference between UII and CII in DR increases with the ischemic index.

Delayed-Onset Interface Fluid Syndrome after LASIK Surgery in Traumatic Hyphema

A 50-year-old female was referred to our clinic with visual disturbance, hyphema and increased intraocular pressure (IOP) in her right eye 7 days after experiencing blunt trauma in that eye. She had undergone uncomplicated laser in situ keratomileusis (LASIK) on both eyes 10 years earlier. At initial examination, the best corrected visual acuity (BCVA) in her right eye was counting fingers at 2 feet with no correction. Central Goldmann applanation tonometry (GAT) showed an IOP of 7 mm Hg. Peripheral digital tonometry showed the IOPs in her right eye superiorly, nasally, temporally, and inferiorly were 36 mm Hg, 35 mm Hg, 34.5 mm Hg and 36.5 mm Hg, respectively. Slit-lamp examination showed diffuse epithelial and stromal edema and a blood clot 1 mm in height in the anterior chamber. Spectral domain scanning laser ophthalmoscope/optical coherence tomography (SD-SLO/OCT) images showed a pocket of fluid between the LASIK flap and the underlying stroma. The patient was started on anti-inflammatory agent and IOP lowering agents. After 15 days of treatment, IOP measured with GAT was 10 mm Hg, slit-lamp examination showed that epithelial and stromal edema had disappeared, and OCT showed no fluid between the corneal flap and stroma.

The Recovery of Optical Quality after Laser Vision Correction

PURPOSE: To evaluate the optical quality after laser in situ keratomileusis (LASIK) or serial photorefractive keratectomy (PRK) using a double-pass system and to follow the recovery of optical quality after laser vision correction. METHODS: This study measured the visual acuity, manifest refraction and optical quality before and one day, one week, one month, and three months after laser vision correction. Optical quality parameters including the modulation transfer function, Strehl ratio and intraocular scattering were evaluated with a double-pass system. RESULTS: This study included 51 eyes that underwent LASIK and 57 that underwent PRK. The optical quality three months post-surgery did not differ significantly between these laser vision correction techniques. Furthermore, the preoperative and postoperative optical quality did not differ significantly in either group. Optical quality recovered within one week after LASIK but took between one and three months to recover after PRK. The optical quality of patients in the PRK group seemed to recover slightly more slowly than their uncorrected distance visual acuity. CONCLUSIONS: Optical quality recovers to the preoperative level after laser vision correction, so laser vision correction is efficacious for correcting myopia. The double-pass system is a useful tool for clinical assessment of optical quality.