Early surgical debridement in the management of infectious scleritis after pterygium excision.

PURPOSE: The purpose of this study was to report outcomes of infectious scleritis after pterygium surgery, managed with antibiotic therapies and early scleral debridement. METHODS: Retrospective chart review of 13 consecutive cases of infectious scleritis after pterygium excision between 1999 and 2009 was conducted. Collected data included prior medical and surgical history, latency period between pterygium surgery and presentation of infectious scleritis, culture and histopathologic findings, antibiotic regimen, length of hospital stay, visual acuity before and after treatment, and complications. RESULTS: Median follow-up was at 14 months. Twelve patients underwent prompt surgical debridement after infectious scleritis diagnosis (median, 2.5 days). Debridement was delayed in one patient. Median hospital stay was 3 days. Best-corrected visual acuity improved in ten patients, remained stable in one patient, and decreased in two patients following treatment. Complications included scleral thinning requiring scleral patch graft (1/13), glaucoma (3/13), and progression to phthisis bulbi (1/13). No patients required enucleation. CONCLUSIONS: In contrast to the generally poor outcomes in the literature, early surgical debridement of pterygium-associated infectious scleritis appears to offer improved prognosis.

Between-grader repeatability of tear meniscus measurements using Fourier-domain OCT in patients with dry eye.

BACKGROUND AND OBJECTIVE: To examine the between-grader repeatability of height, depth, and cross-sectional area measurements of the lower tear meniscus, using a Fourier-domain optical coherence tomography (OCT) system. PATIENTS AND METHODS: A total of 16 patients with dry eye had the lower tear meniscus of the right eye imaged twice in rapid succession. The tear meniscus height, depth, and cross-sectional area were measured by two masked graders using computer calipers. The between-grader variability, calculated using the pooled coefficient of variation (CV%), assessed the repeatability of the measurements. RESULTS: The between-grader CV% was 12.1%, 15.7%, and 19.5% for height, depth, and area, respectively. The between-image variability was 17.1%, 13.4%, and 35.4% for height, depth, and area, respectively. The overall intraclass correlation was 99%. There was no systematic bias between the two graders. CONCLUSION: Fourier-domain OCT demonstrates good between-grader and between-image repeatability in measuring the height, depth, and cross-sectional area of the tear meniscus in patients with dry eye. Measurement variability was primarily due to the difference between images rather than graders.

The early flat anterior chamber after trabeculectomy: a randomized, prospective study of 3 methods of management.

PURPOSE: To evaluate prospectively 3 different approaches to the management of a flat anterior chamber (FAC) because of overfiltration in the early postoperative period after trabeculectomy. MATERIALS AND METHODS: Thirty-six eyes diagnosed with a FAC with total iridocorneal touch, but no lenticular touch (grade II) because of overfiltration in the first 14 days after trabeculectomy were randomized prospectively into 3 groups: group 1--anterior chamber reformation with viscoelastic substance; group 2--anterior chamber reformation with balanced salt solution and concurrent drainage of choroidal effusion; and group 3--pharmacologic therapy with atropine, phenylephrine, and in select cases oral acetazolamide. Outcome measures were visual acuity, amount of intraocular pressure (IOP) reduction, and achievement of predetermined target IOP. RESULTS: Treatment group 2 had a greater number of eyes with acuity decline of two or more lines relative to group 3 (P=0.04). Group 1 had more eyes with acuity decline of two or more lines relative to group 3, but this was not significant (P>0.05). CONCLUSIONS: For grade II FACs because of overfiltration in the early postoperative period after trabeculectomy, reformation of the anterior chamber with drainage of choroidal effusion may be associated with greater long-term trabeculectomy success, but is associated with greater visual acuity loss relative to medicinal therapy alone. Reformation with viscoelastic resulted in a trend toward lowest final IOP in comparison to medicinal therapy alone.

Oral niacin can increase intraocular pressure.

The intraocular pressure of a 73-year-old man with a history of primary open-angle glaucoma had been approximately 21 and 17 mm Hg in the right and left eyes, respectively, while taking latanoprost 0.005% and dorzolamide hydrochloride 2%. When taking 500 mg of oral niacin (also known as vitamin B3 or nicotinic acid), his intraocular pressure increased to 37 and 27 mm Hg in the right and left eyes, respectively, on one occasion. On reexamination, the intraocular pressure had increased to 28 and 23 mm Hg in the right and left eyes, respectively. Each time the niacin was stopped, the intraocular pressure decreased to the original levels.

Post-peripheral iridotomy inflammation in patients with dark pigmentation.

A retrospective chart review of four patients who had Nd:YAG peripheral iridotomy performed for narrow anterior chamber angle and subsequently developed marked inflammation after tapering anti-inflammatory steroids. These cases were possibly predisposed to this reaction by the heavy pigmentation of their irides based on race, their use of latanoprost, or the conjunction of these factors.

The amount of intraocular pressure rise during pharmacological pupillary dilatation is an indicator of the likelihood of future progression of glaucoma.

AIM: To determine if there is a relationship between the amount of increase in IOP following dilatation with a cycloplegic agent and the future course of glaucoma. METHOD: A retrospective chart review of 100 eyes from 55 subjects with open-angle glaucoma who had had IOP measured before and after pharmacological pupillary dilatation was performed to establish the rate of progression of glaucoma, based on serial evaluation of the visual fields using the glaucoma staging system 2 (GSS 2), and optic discs using the disc damage likelihood scale (DDLS). Progressive visual field loss was defined as an increase of two or more stages with the GSS 2 and progressive deterioration of the disc was defined as an increase of two or more stages with the DDLS. Mean follow-up time was 7.2 years. RESULTS: A total of 26 eyes showed glaucomatous progression. The likelihood of progression of glaucoma was related to the amount of IOP increase after pharmacological pupillary dilatation. For every 1 mmHg increase in IOP, the odds of progression increased 24% (p = 0.008). The likelihood of progression of glaucoma, however, was not related to the baseline IOP, which was 20.63 mmHg (SD = 4.59 mmHg) in those showing deterioration of disc or field and 19.72 mmHg (SD = 5.32 mmHg) in those not worsening according to our definition. CONCLUSION: In patients with open-angle glaucoma, the amount of increase in IOP caused by pharmacological pupillary dilatation is related to the likelihood of future progression of glaucoma.