Brown discoloration of acrylic hydrophobic intraocular lens.

OBJECTIVE: We report a case series of brown discoloration of Abbott Medical Optics, USA, acrylic intraocular lens (IOLs; AABOO, ZCBOO, and ZMBOO) after cataract operation. DESIGN: Retrospective case series. PARTICIPANTS: Patients with brown discoloration of their IOLs postoperatively during the period from March 2013 to October 2013 at the Singapore National Eye Centre were consecutively identified. METHODS: Distance best-corrected visual acuity (BCVA), intraocular pressure, slit-lamp examination, colour fundus photographs, flare meter reading, endothelial cell count, dilated fundus examination, as well as colour discrimination test on the Lanthony D 15 Hue test were performed. RESULTS: Sixteen eyes of 14 patients were found to have evenly brown discoloration of varying degrees of acrylic IOL postphacoemulsification. This included 11 AABOO IOLs, 3 ZCBOO IOLs, and 2 ZMBOO IOLs. All had uneventful surgery except one who required anterior vitrectomy for posterior capsule rupture. One patient had uneventful operation but subsequently developed pigment dispersion glaucoma with tunnel vision and required a trabeculectomy. Mean time from operation to reporting date was 143 days (range 1-327 days). Pre- and postoperative month 6 BCVA was logMAR 0.54 and logMAR 0.13, respectively. None of the patients had loss of lines of BCVA. The desaturated Lanthony D 15 Hue test was abnormal in 8 out of the 16 eyes. None required IOL explantation. CONCLUSIONS: Varying degrees of brown discoloration may occur in today's modern hydrophobic acrylic IOLs.

Ocular Biometrics of Myopic Eyes With Narrow Angles.

PURPOSE: The purpose of this study was to compare the ocular biometrics between myopic patients with and without narrow angles. METHODS: Patients with a stable myopic refraction (myopia worse than -1.00 D spherical equivalent) were prospectively recruited. Angle status was assessed using gonioscopy and biometric measurements were performed using an anterior segment optical coherence tomography and an IOLMaster. RESULTS: A total of 29 patients (58 eyes) were enrolled with 13 patients (26 eyes) classified as having narrow angles and 16 patients (32 eyes) classified as having open angles. Baseline demographics of age, sex, and ethnicity did not differ significantly between the 2 groups. The patients with narrow angles were on average older than those with open angles but the difference did not reach statistical significance (P=0.12). The central anterior chamber depth was significantly less in the eyes with narrow angles (P=0.05). However, the average lens thickness, although greater in the eyes with narrow angles, did not reach statistical significance (P=0.10). Refractive error, axial lengths, and iris thicknesses did not differ significantly between the 2 groups (P=0.32, 0.47, 0.15). CONCLUSIONS: Narrow angles can occur in myopic eyes. Routine gonioscopy is therefore recommended for all patients regardless of refractive error.

Retinal vascular caliber between eyes with asymmetric glaucoma.

PURPOSE: To compare differences in retinal arterial and venular caliber (RAC and RVC respectively) between fellow eyes with glaucoma of asymmetric severity. METHODS: We included subjects with bilateral primary glaucoma that had vertical cup-disc ratios (VCDR) >0.2 between both eyes, or visual field (VF) mean deviation (MD) >6.0 decibels (dB) between both eyes. RESULTS: Among 158 subjects, the average RAC in glaucoma eyes was 131.5 ± 17.8 µm vs 141.6 ± 18.8 µm in fellow eyes with mild disease (p < 0.001). RVCs in glaucoma eyes were 201.0 ± 21.4 µm vs 211.7 ± 25.3 µm in fellow eyes with mild disease (p < 0.001). This relationship held in clustered linear regression models adjusted for age, gender, vascular risk factors, visual acuity, axial length, and intraocular pressure, with RVCs narrower in eyes with worse disease vs mild disease. Eyes with worse disease had greater VCDR (0.9 ± 0.1 vs 0.7 ± 0.1, p < 0.001), and worse VF MD (-18.5 ± 8.6 vs -6.6 ± 5.6, p < 0.001). CONCLUSION: In glaucoma with asymmetric severity between fellow eyes, retinal vascular caliber is less in the eye with more severe disease.

Prevalence of dengue maculopathy in patients hospitalized for dengue fever.

OBJECTIVE: Dengue fever causes numerous systemic manifestations, including maculopathy, with loss of vision. This study sought to determine the prevalence of dengue maculopathy in patients hospitalized with dengue fever. DESIGN: Cross-sectional observational study in which consecutive patients hospitalized with dengue fever during a dengue epidemic were enrolled over a 3-week period. PARTICIPANTS: Patients hospitalized in 2 general hospitals in Singapore with dengue fever. TESTING: Patients completed a standardized questionnaire and underwent tests for near and distance visual acuity (VA), Amsler grid testing, dilated retinal examination, serum complements C3 and C4, and urinary microalbumin. MAIN OUTCOME MEASURES: Dengue maculopathy found on retinal examination. RESULTS: One hundred ninety-seven patients were enrolled, of whom 119 (60.4%) were male and 78 (39.6%) female. The patients ranged between 12 and 67 years old (mean, 32.65). One hundred sixty of 197 patients had positive dengue immunoglobulin M serology. Dengue maculopathy was detected in 27 eyes of 16 of the seropositive patients, giving a prevalence of 10% (95% confidence interval, 6.03%-15.40%). None of the patients who were dengue immunoglobulin M negative had dengue maculopathy. Dengue maculopathy eyes were more likely to have distance acuity worse than logarithm of the minimal angle of resolution 0.15 (Snellen 6/9 or worse) (P = 0.005) and abnormalities on Amsler grid testing (P = 0.001), with a greater proportion of these patients having visual complaints (P = 0.002) and lower mean complement C3 levels (P = 0.008) as compared with patients without maculopathy. Logistic regression analysis showed Amsler grid abnormalities to be the most consistent factor associated with dengue-related maculopathy (P<0.001), with a hazard ratio of 8.669; sensitivity, 29.6%; and specificity, 95.4%. CONCLUSION: The prevalence of dengue maculopathy among patients hospitalized for dengue fever is 10% in our series. Amsler grid abnormalities, reduced distance VA, and the presence of visual symptoms are associated with dengue maculopathy. Low complement C3 levels in these patients suggest that this is an immune-mediated disease.

Nodular scleritis and Sweet's syndrome.

The authors report a case of nodular scleritis in Sweet's syndrome. The patient was a 40-year-old Malay woman with a history of Sweet's syndrome presented with a 6-day history of a red and painful right eye associated with blurred vision. Clinical examination revealed nodular scleritis of the right eye which was deemed secondary to Sweet's syndrome after investigations for other systemic diseases were negative. The patient demonstrated good response to systemic corticosteroid therapy with complete resolution of scleritis in the right eye. However, her inflammatory skin condition worsened each time the systemic corticosteroids were tapered so colchicine and dapsone were added to treat the dermatologic disease. Ocular manifestations are uncommon in Sweet's syndrome but it is important to diagnose and treat them. This will prevent ocular morbidity and ensure a good clinical outcome.

Sympathetic ophthalmia in Singapore: new trends in an old disease.

BACKGROUND: Sympathetic ophthalmia (SO) is an uncommon uveitic condition that occurs after injury to the uvea of one eye and may occur after accidental ocular trauma or ocular surgery. We sought to investigate the common causes of SO in Singapore and the demographic profile as well as the final visual acuity after treatment in these patients. METHODS: This was a retrospective, non-comparative case series in which patients with SO were identified from the Singapore National Eye Centre uveitis database in the period between 1993 and 2003. The patients' case records were examined for a history of ocular trauma or surgery and subsequent development of bilateral or contralateral uveitis consistent with SO or histopathological evidence of SO in enucleated eyes. The medical records of these patients were reviewed for details of the inciting event, presentation, treatment, and visual acuity. RESULTS: A total of ten patients (six men and four women) were diagnosed with SO in the period of study. SO occurred after accidental trauma in three patients and following ocular surgery in seven. Vitreoretinal surgery was responsible for four of these cases, and diode laser cyclophotoablation for another two, whereas neodymium:yttrium-aluminium-garnet (Nd:YAG) laser cyclotherapy was the cause in the last patient. Overall, six of ten patients underwent at least one vitreoretinal procedure. Four of the patients had a final visual acuity of 6/15 or better, whereas five had a visual acuity of 6/30 or worse. Good final visual acuity appeared to be associated with early initiation of immunosuppressive therapy. CONCLUSION: In this series, ocular surgery, especially vitreoretinal surgery, had overtaken non-surgical trauma as the major cause of SO. A good outcome was possible in most cases if an early diagnosis was made and immunosuppressive treatment started promptly.

Infectious keratitis associated with daily disposable contact lenses.

PURPOSE: To report two cases of infectious keratitis associated with the use of daily disposable soft contact lenses. METHOD: Two case reports of individuals who developed infectious keratitis while wearing daily disposable soft contact lenses are presented. RESULTS: The first case is that of a 34-year-old woman who had been using daily disposable soft contact lenses for 18 months before she developed a corneal ulcer in her left eye. The cultures grew Pseudomonas aeruginosa, and she was treated successfully with fortified topical antibiotics. The second case describes a 30-year-old woman who had been using conventional soft contact lenses for 5 years before switching to daily disposable soft contact lenses 3 months before presentation. She was found to have a corneal ulcer in her left eye that grew Staphylococcus aureus on cultures, and she responded to topical antibiotic treatment. CONCLUSIONS: Although daily disposable soft contact lenses theoretically have a lower risk of infectious keratitis compared with other lens wear regimens, reports have shown that at least some risk remains. These lenses should be prescribed and used with great care to minimize contact lens-related infectious keratitis.