Clinical study using a new phacoemulsification system with surgical intraocular pressure control.

PURPOSE: To compare cumulative dissipated energy (CDE), aspiration fluid used, and aspiration time during phacoemulsification cataract extraction using 2 surgical configurations. SETTING: Two clinical sites in the United States and 1 in Spain. DESIGN: Prospective randomized clinical case series. METHODS: For each patient, the first eye having surgery was randomized to the active-fluidics configuration (Centurion Vision System with Active Fluidics, 0.9 mm 45-degree Intrepid Balanced tip, and 0.9 mm Intrepid Ultra infusion sleeve) or the gravity-fluidics configuration (Infiniti Vision System with gravity fluidics, 0.9 mm 45-degree Mini-Flared Kelman tip, and 0.9 mm Ultra infusion sleeve). Second-eye surgery was completed within 14 days after first-eye surgery using the alternate configuration. The CDE, aspiration fluid used, and aspiration time were compared between configurations, and adverse events were summarized. RESULTS: Patient demographics and cataract characteristics were similar between configurations (100 per group). The CDE was significantly lower with the active-fluidics configuration than with the gravity-fluidics configuration (mean ± standard error, 4.32 ± 0.28 percent-seconds) (P < .001). The active-fluidics configuration used significantly less aspiration fluid than the gravity-fluidics configuration (mean 46.56 ± 1.39 mL versus 52.68 ± 1.40 mL) (P < .001) and required significantly shorter aspiration time (mean 151.9 ± 4.1 seconds versus 167.6 ± 4.1 seconds) (P < .001). No serious ocular adverse events related to the study devices or device deficiencies were observed. CONCLUSION: Significantly less CDE, aspiration fluid used, and aspiration time were observed with the active-fluidics configuration than with the gravity-fluidics configuration, showing improved surgical efficiency. FINANCIAL DISCLOSURES: Drs. Solomon and Cionni are consultants to Alcon Research, Ltd., and received compensation for conduct of the study. Dr. Lorente received compensation for clinical work in the study. Mr. Fanney is an employee of Alcon Research, Ltd.

Traumatic endophthalmitis caused by Nocardia kruczakiae in a patient with traumatic eye injury.

BACKGROUND: We describe a case of traumatic ocular endophthalmitis caused by Nocardia kruczakiae after vegetable trauma in an immunocompetent child. FINDINGS: A 5-year-old boy suffered from a trauma with a palm tree leaflet. Two months later, he was diagnosed with traumatic infectious uveitis and intumescent cataract with anterior capsule rupture. Intensive treatment with systemic and topical vancomycin, ceftazidime and methylprednisolone began. After 1 month, he underwent phacoemulsification with intraocular lens implantation (IOL). After some episodes of reactivation, he was diagnosed with traumatic nocardial endophthalmitis from aqueous humour samples. Several operations and specific antibiotic therapy resolved the infection. CONCLUSIONS: In cases of traumatic endophthalmitis and several recurrences, it is extremely useful to make an etiologic diagnosis in order to treat the patient with specific antibiotics.

Frequency of pseudoexfoliation among patients scheduled for cataract surgery.

PURPOSE: To assess the frequency of pseudoexfoliation syndrome (PXF) in patients scheduled for cataract surgery and to evaluate its association with pupil dilation, lens nucleus hardness, intraocular pressure (IOP), glaucoma, age, and sex. SETTING: Ourense University Hospital, Ourense, Spain. DESIGN: Cross-sectional study. METHODS: This study evaluated eyes scheduled for cataract surgery between January 2013 and July 2013. Pseudoexfoliation was diagnosed in phakic eyes that showed central and/or peripheral white deposits on the lens surface, pupillary margin, or both. Dilated pupils were evaluated with a portable pupil chart. Nucleus hardness was assessed according to the Lens Opacities Classification System III. Diagnosis of glaucoma was based on International Society Geographical and Epidemiological Ophthalmology criteria. RESULTS: Of the 1763 eyes (1093 patients) evaluated, 381 (21.6%) were diagnosed with PXF. The frequency of PXF increased with age from 6.0% in people between 50 year and 60 years to 31.66% in those older than 80 years. In PXF eyes, nuclear cataracts were significantly harder than in non-PXF eyes (P < .001). The mean IOP was significantly higher in PXF eyes than in non-PXF eyes (P = .002). The frequency of glaucoma was higher in PXF eyes (17.4%) than in non-PXF eyes (9.4%), with a statistically significant difference (P < .001). In PXF eyes, the pupil was significantly smaller than in non-PXF eyes (P < .001). CONCLUSIONS: The frequency of PXF was high in the study population and increased with age. Eyes with PXF were associated with significantly harder nuclear cataracts, smaller pupils, and glaucoma. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Bilateral and simultaneous central retinal vein occlusion in a patient with obstructive sleep apnea syndrome.

PURPOSE: To describe a case of bilateral and simultaneous central retinal vein occlusion (RVO) in a young patient diagnosed with obstructive sleep apnea syndrome (OSAS). CASE REPORT: A 38-year-old man with morbid obesity and daytime sleepiness presented with a history of bilateral vision loss. His visual acuity (VA) was hand movements, and fundus examination (FE) revealed bilateral central RVO. General medical examination revealed untreated hypertension and type II respiratory failure. Laboratory tests for thrombophilia showed increased hematocrit (59%) and high levels of fibrinogen and C-reactive protein. Other causes of congenital and acquired hypercoagulability were ruled out. Pathologic polysomnography led to the diagnosis of OSAS. The patient was treated with antihypertensive drugs and continuous positive air pressure. In addition, he received intravitreal ranibizumab. At 10 months after presentation, his VA was no light perception in the right eye and hand movements in the left eye. FE revealed bilateral retinal and optic nerve atrophy, and the occurrence of a nonarteritic anterior ischemic neuropathy in the right eye was considered.

Prevalence of open angle glaucoma in vitrectomized eyes: a cross-sectional study.

PURPOSE: Primarily to assess and compare the prevalence of open-angle glaucoma (OAG) in previously vitrectomized and nonvitrectomized eyes at our institution. Secondarily to assess and compare the prevalence of OAG in eyes those were phakic and pseudophakic/aphakic at the time of vitrectomy. METHODS: A cross-sectional prevalence study was designed. Patients who underwent pars plana vitrectomy at our institution from January 2006 to December 2011 and had not been diagnosed with OAG before the surgical procedure were contacted by phone. Those patients who agreed to participate were invited to the University Hospital of Ourense (Spain) for a comprehensive ophthalmic assessment, including Perkins tonometry, gonioscopy, examination of the optic disk, and a spectral-domain optical coherence tomography scan of the optic nerve head. The definition of OAG was based on standardized criteria, modified versions of the Rotterdam Study, and those published by Foster et al. RESULTS: Among 472 eligible patients, 182 responded and agreed to participate in our study. Of these, 26 were excluded. Finally, 312 eyes of 156 patients were included in the analysis. Fifteen vitrectomized (8.9%) and 3 nonvitrectomized (2%) eyes were diagnosed with OAG. This difference was statistically significant (P = 0.02, chi-square test). Differences in the prevalence of OAG between eyes those were phakic and pseudophakic/aphakic at the time of vitrectomy were not statistically significant (P = 0.48, chi-square test). CONCLUSION: Our study supports the hypothesis of an increased risk of OAG after vitrectomy. Prevalence of OAG in vitrectomized eyes was significantly higher compared with nonvitrectomized ones. However, we were not able to demonstrate significant difference in the prevalence of OAG between eyes those were phakic or aphakic/pseudophakic at the time of vitrectomy.

Intracameral phenylephrine 1.5% for prophylaxis against intraoperative floppy iris syndrome: prospective, randomized fellow eye study.

PURPOSE: To evaluate the efficacy of intracameral phenylephrine (IPH) administered as prophylaxis against intraoperative floppy iris syndrome (IFIS) and to analyze the ability of IPH to reverse IFIS. DESIGN: Prospective, multicenter, randomized, comparative case series of fellow eyes. PARTICIPANTS: Forty-two patients receiving tamsulosin who underwent cataract surgery between January and April 2011. METHODS: Phacoemulsification was performed by 2 experienced surgeons at 2 surgical sites (Complexo Hospitalario Universitario Orense and Complexo Hospitalario Universitario A Coruña). One eye of each patient was randomized to receive 0.6 ml of nonpreserved bisulfite-free IPH 1.5% (group 1) or balanced saline solution (group 2) at the start of surgery. If significant miosis or iris prolapse occurred, IPH was injected during phacoemulsification in group 2. No changes were performed in the surgeon's standard fluidic parameters or viscoelastic preferences. Routine topical mydriatics were instilled before surgery. Intraoperative iris billowing and prolapse and pupil size were recorded and videotaped. Surgical complications; adverse events; pre- and postoperative pulse rate and blood pressure; and final best-corrected visual acuity (BCVA), intraocular pressure (IOP), and endothelial cell count (ECC) were recorded. MAIN OUTCOME MEASURES: Incidence of IFIS and change in pupil size after IPH administration in those eyes of group 2 requiring IPH because of significant miosis or iris prolapse. RESULTS: Signs of IFIS were observed in 88.09% of eyes in group 2. No signs of IFS were noted in group 1 (P < 0.001). Significant miosis, iris prolapse, or both occurred in 54.76% of eyes in group 2, although the condition was successfully reverted with IPH, with a significant increase in pupil size after IPH administration (from 4.77±0.88 mm to 6.68±0.93 mm; P=0.000). No intraoperative complications occurred. No significant differences in ECC, BCVA, or IOP were detected between IPH-treated and nontreated eyes. Blood pressure/pulse rate did not differ significantly from preoperative values in IPH-treated cases. CONCLUSIONS: Intracameral phenylephrine is a highly efficient measure for prophylaxis against IFIS. Moreover, the drug can reverse IFIS, restoring iris rigidity and causing the pupil to return to its preoperative size.

Management of late spontaneous in-the-bag intraocular lens dislocation: Retrospective analysis of 45 cases.

PURPOSE: To evaluate the characteristics of and risk factors for spontaneous late in-the-bag intraocular lens (IOL) dislocation and to analyze the outcomes of surgical correction. SETTING: Department of Ophthalmology, Complejo Hospitalario Orense, Orense, Spain. METHODS: In this retrospective single-surgeon interventional case series, the surgical database of a referral center was searched for cases of late spontaneous in-the-bag IOL dislocation between 2005 and 2009. The main outcome measures were interval between surgery and dislocation, dislocation site and grade, IOL type, associated capsular tension ring (CTR), predisposing factors, surgical technique to correct dislocation, preoperative and postoperative corrected distance visual acuity (CDVA), and surgical complications. RESULTS: Pseudoexfoliation was the main risk factor for in-the-bag IOL dislocation (66.66% of 45 cases identified). A CTR was present in the capsular bag in 8 cases. Dislocation was corrected by repositioning using scleral fixation (20 cases) or iris suturing (1 case), IOL exchange for an anterior chamber IOL (AC IOL) (19 cases) or iris-claw IOL (4 cases), or (3) anterior capsulotomy (1 case). The mean CDVA improved significantly postoperatively (P = .0001); it was 20/40 or better in 28 eyes (62.22%) and 20/25 or better in 10 eyes (22.22%). There was no significant difference in postoperative CDVA between scleral-fixated IOLs and AC IOLs (P = .316). CONCLUSIONS: Pseudoexfoliation was the main risk factor for in-the-bag IOL dislocation. The presence of a CTR in the bag did not prevent dislocation. Satisfactory results were achieved with a low rate of complications using different surgical techniques to correct IOL position. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.