Corneal Toxicity Associated With Aquarium Coral Palytoxin.

PURPOSE: To report a series of patients who developed corneal toxicity after exposure to aquarium coral palytoxin. DESIGN: Multicenter retrospective case series. METHODS: Retrospective review. RESULTS: Seven patients presented with corneal findings ranging from superficial punctate epitheliopathy to bilateral corneal melt with subsequent perforation. Among those with mild corneal findings, resolution was achieved with topical steroids and lubrication, whereas some patients who developed progressive corneal melt required therapeutic penetrating keratoplasty. The history in all patients revealed exposure to aquarium zoanthid corals shortly before disease onset. A review of the literature revealed that there are few prior reports of coral-associated corneal toxicity and that some species of coral secrete a substance known as palytoxin, a potent vasoconstrictor that inhibits the membranous sodium-potassium ATPase pump across cell types and can cause rapid death if inhaled or ingested. CONCLUSIONS: This is the largest case series to date demonstrating patients with aquarium coral palytoxin-associated corneal toxicity, and is the first to provide details of related histopathologic findings. Similar to other forms of toxic keratoconjunctivitis, a detailed history and careful clinical assessment are required, as well as timely removal of the offending agent from the patients' ocular milieu and environment. Mild ocular surface and corneal disease may be treated effectively with aggressive topical steroid therapy and lubrication. Given the potential severity of ocular as well as systemic adverse effects, there should be increased awareness of this entity among eye care professionals, aquarium enthusiasts, and the general public.

Obtaining Lissamine Green 1% Solution for Clinical Use.

PURPOSE: With new compounding pharmacy laws, the only economically feasible approach to using lissamine is through dye-impregnated strips. This research aims to determine the concentration of lissamine that can be obtained using a single commercially available lissamine strip. With the optimal vital staining requiring 1% concentration of lissamine, we sought to obtain this concentration using supplies in an ordinary ophthalmology clinic. METHODS: A standard curve was generated using compounded lissamine green 1% solution. Serial dilutions were made with 3 different diluents and measured using a spectrophotometer at a wavelength of 633 µm. Combinations of the number of strips, amount of solvent, and absorption time were performed to obtain a 1% solution. Cost analyses were performed to select the most economical method. RESULTS: Single lissamine strips wetted with any of the diluents produced 0.17% ± 0.05% (95% confidence interval) lissamine solution, a 5-fold weaker concentration than the optimal for vital staining. Combinations of 4 strips in 200 µL (4 drops) for 1 minute and 2 strips in 200 µL for 5 minutes were found to reach concentrations of 1%. Cost analysis showed that the 2 strip/4 drops/5 minutes method costs $0.67 and the 4 strips/4 drops/1 minute method $1.27. CONCLUSIONS: Use of a single lissamine strip leads to suboptimal concentrations for vital staining. With only the addition of disposable microcentrifuge tubes to the clinical setting, ophthalmologists can make 1% solutions of lissamine. This solution is both more economical and in compliance with both state and national compounding laws.

Postoperative care in cataract surgery.

PURPOSE OF REVIEW: The purpose of this study is to provide a summary of current trends and recent developments in postoperative care after cataract surgery. RECENT FINDINGS: There is new evidence challenging the routine use of a protective eye shield after uncomplicated cataract surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in decreasing the risk of cystoid macular edema (CME) in high-risk eyes, but must be used with caution in patients with prior corneal disease. Pre-existing ocular comorbidities can have significant effects on postoperative outcomes. Management of postoperative visual expectations can be challenging in patients receiving newer advanced technology intraocular lenses (IOLs). SUMMARY: Key practices such as restrictions on activities, prophylactic regimens against infection and inflammation, appropriate follow-up with adjustments for individual risk factors and management of complications, and continuing care until visual rehabilitation is complete are advised to optimize visual outcome for patients after cataract surgery.

Check-up time: a closer look at physical symptoms in occupational health research.

In order to advance research on stress-related symptoms in occupational health psychology, our study examined three ways to measure physical symptoms-by asking about symptom frequency, interference with daily activities and whether a doctor was seen for each symptom. We used exploratory factor analysis and item response theory to gain greater insight into these measures and compared how symptoms measured along these dimensions predicted other stress-related outcomes in the workplace. Among the main findings of our study are the following: (1) symptoms may be categorized as those that occur as a response to acute events and those that reflect more chronic stress; (2) individuals appear to have a relatively low threshold for reporting that acute symptoms (e.g. heart pounding) interfere with daily activities; and (3) specific symptom (acute, chronic)-response format (frequency, interference) combinations uniquely predicted other strain variables in conceptually meaningful ways. Recommendations for the assessment of physical symptoms are provided.