Clinical characteristics and surgical outcomes of phacoemulsification in true exfoliation syndrome.

PURPOSE: To review the clinical characteristics and surgical outcomes of patients with true exfoliation syndrome of the lens capsule having phacoemulsification cataract surgery. SETTING: Hong Kong Eye Hospital, Kowloon, Hong Kong. DESIGN: Case series. METHODS: Eyes of patients with true exfoliation syndrome diagnosed clinically or intraoperatively had standard phacoemulsification and intraocular lens (IOL) implantation. The anterior capsules removed during capsulorhexis were sent for histological confirmation. RESULTS: Twenty-four eyes of 18 patients were included. All eyes were confirmed to have true exfoliation syndrome by histological examination of the anterior lens capsule. Seven eyes (29.2%) had preexisting chronic glaucoma; 5 (20.8%) had laser iridotomy before the diagnosis. During phacoemulsification, all eyes had a continuous curvilinear capsulorhexis without complications. Trypan blue staining was used during capsulorhexis in 11 eyes (45.8%). Posterior capsule rupture occurred during lens chopping in 1 eye (4.2%). No loose zonular fibers or radial extension of capsulorhexis occurred. Capsular bag IOL implantation was successfully performed in all cases except the 1 with a posterior capsule rupture, in which an anterior chamber IOL was implanted. CONCLUSIONS: Phacoemulsification was safely performed in eyes with true exfoliation syndrome. Trypan blue staining can be used to facilitate capsulorhexis creation. Ultrasound biomicroscopy or anterior segment optical coherence tomography may be useful in preoperative assessment of such cases. The disease may be associated with glaucoma and laser iridotomy.

Extent and predictors of microbial hand contamination in a tertiary care ophthalmic outpatient practice.

PURPOSE: To measure the extent of microbial hand contamination among ophthalmologists during routine clinic practice and examine its association with hand cleansing practices and beliefs, glove use, and patient load. METHODS: This was a single-masked analysis of resident and transient flora of ophthalmologists before and after patient examination and after handwashing by agar imprints of the dominant hand. Standardized questionnaires were used to collect information concerning subjects' hand cleansing practices and patient load. RESULTS: Of the 108 cultures, 107 (99.1%) were culture positive, yielding 15 separate organisms. Gram-negative bacilli were the most common transient flora, followed by Gram-positive cocci and fungi. Thirty-five (97.2%) ophthalmologists were culture positive for at least one resident and 8 (22.2%) ophthalmologists were culture positive for at least one transient organism, before patient contact. Regression models showed alcohol-based hand rub use, transient and resident floral load before patient contact, and patient load collectively accounted for 58.7% of the variance in resident floral load after patient contact. Use of alcohol-based hand rubs was associated with a mean resident floral reduction of 324.4 CFUs (95% confidence interval [CI] = 185.4 to 463.5; P < 0.01) and 31.6 CFUs (95% CI = 1.2 to 62.0; P < 0.05) after patient contact and handwashing, respectively. Handwashing with chlorhexidine was a significant predictor for transient floral load after handwashing (unstandardized beta = -17.2; 95% CI = -10.2 to -24.2; P < 0.01). CONCLUSIONS: The extent of contamination with pathogenic organisms after contact with eye outpatients, who have traditionally been perceived as relatively "clean," was of concern. Previously identified risk factors for hand contamination in inpatient settings, such as patient load, only explained a small proportion of variance in microbial load in the ophthalmic outpatient setting.

Retained presumed intraocular cotton fiber after cataract operation: long-term follow-up with in vivo confocal microscopy.

PURPOSE: To evaluate the long-term clinical outcomes in eyes with retained presumed intraocular cotton fibers after cataract surgery. SETTING: Hong Kong Eye Hospital, Hong Kong, The People's Republic of China. METHODS: A retrospective review of 19 eyes with retained presumed intraocular cotton fibers after cataract surgery was performed. Outcome measures were fiber-related complications. In vivo confocal microscopy was performed in eyes with entrapped cotton fibers at the wound site. RESULTS: The duration of retained presumed cotton fibers ranged from 5 to 110 months (mean 42.3 months). No complications were noted in any of these eyes, including endophthalmitis, persistent uveitis, or corneal endothelial cell loss. In vivo confocal microscopy in eyes with entrapped fibers at the wound site showed normal corneal endothelium morphology with no keratocyte activation or inflammatory response. CONCLUSIONS: Retained presumed fibers after cataract operations are more common than anticipated. In contrast to other organic foreign bodies, these retained fibers appear to be well tolerated. Conservative treatment can be adopted for these fibers as these pose minimal toxicity to the eye.