Late postoperative capsular block syndrome: entrapment of liquefied after-cataract by capsular bend.

We report a case of capsular bend-related entrapment of liquefied after-cataract that resulted in late postoperative capsular block syndrome in a 56-year-old man. Slitlamp examination showed a capsular bend formation at the square edge of the optic. Superiorly, leakage in the capsular bend resulted in fluid extending into Soemmering's ring, although communication with the anterior chamber was limited by the capsular bend. Fluid was seen between the lens and posterior capsule.

What is the direct cost of treatment of acute primary angle closure glaucoma? The Singapore model.

AIM: To estimate the cost of management of acute primary angle closure glaucoma in Singapore. METHODS: In this cost analysis using retrospective data, the authors performed a MEDLINE search of published papers on acute primary angle closure glaucoma (APACG) in Singapore. Using information from published data, clinical management pathways were constructed and clinical outcomes identified. For each management path, costs of medical treatment, hospitalization, clinic charges, investigations, laser treatment and surgery were identified and accounted over a 5-year treatment period, using year 2002 rates. RESULTS: Given that, in Singapore, APACG affects 12.2 per 100,000 per year (95% confidence interval [CI], 10.5-13.9) in those aged 30 and older, each annual cohort would need to pay 261,741.78 US dollars (95%CI: US$225 310.90-298 265.10) or 287,560.26 US dollars (95%CI: 247,274.04-330,624.84 US dollars), if inclusive of cataract surgery, over 5 years after the episode of APACG. In this period, individuals would have to commit between 879.45 US dollars and 2576.39 US dollars, depending on the complexity of disease and accompanying cataract surgery. CONCLUSION: Acute primary angle closure glaucoma produces a substantial financial burden on society as well as on the individuals.

Unusual morphology in orthokeratology contact lens-related cornea ulcer.

PURPOSE: To report a case of unusual ulcer morphology in orthokeratology-related corneal ulcer. METHODS: A single observational case report of a 14-year-old Chinese female myope with a 1.5-month experience wearing overnight B.E. orthokeratology (Capricornia) lenses and presenting with a right stellate-shaped central cornea abscess. Cornea scrapings for Gram stains, culture, and antibiotic sensitivity were performed. The patient was prescribed hourly fortified cefazolin and gentamicin drops. RESULTS: Pseudomonas aeruginosa grew on blood and chocolate agar cultures. The ulcer was successfully treated with antibiotics and reepithelialized over 5 days. There was a residual central corneal scar. The refraction changed from -4.25 sphere OD and -1.75 -1.75 x160 OS to -3.50 -1.50 x160 OD and -1.50 -1.75 x165, giving a visual acuity of 20/ 25 OD and 20/20 OS. CONCLUSIONS: A flatter fit of orthokeratology lenses may be associated with unusual cornea ulcer morphology.

Calcium channel blockers as first line treatment for broad complex tachycardia with right bundle branch block: ingenuity or folly?

OBJECTIVE: To study the response of regular broad-complex tachycardia (BCT) demonstrating right bundle branch block (RBBB) to treatment in the Emergency department (ED). METHODS: Retrospective chart review of management of patients with BCT, RBBB without a history of ischaemic heart disease. A diagnosis of ventricular tachycardia (VT) was made if the ECG showed features such as atrioventricular dissociation, capture or fusion beats or if VT was demonstrated during electrophysiological studies (EPS). RESULTS: A total of 25 patients were eligible. Nineteen patients were given intravenous (IV) calcium channel blockers (either verapamil or diltiazem), as first line treatment. Of these, 18 converted to sinus rhythm and the other one patient subsequently converted with amiodarone. The remaining six patients were given IV adenosine (n=3), lignocaine (n=2) or amiodarone (n=1) as first line treatment but none of them were converted. Of these, four of them converted with IV calcium channel blockers eventually. Of the other two patients, who were both given lignocaine initially, one deteriorated haemodynamically with the use of verapamil and required synchronised cardioversion to convert. The other patient did not respond to amiodarone and synchronised cardioversion but was subsequently converted with verapamil. The difference between the success rate of calcium channel blockers and other anti-arrhythmics is statistically significant (P<0.01 by Fischer's exact method). Fourteen cases had diagnoses of VT, including the two patients given lignocaine. Five cases were found to have supraventricular tachycardia with aberrant conduction. Six cases did not have confirmed diagnoses. CONCLUSION: In patients presenting with BCT and RBBB but without underlying ischaemic heart disease, there is evidence to suggest that calcium channel blockers could effectively be used as the treatment of choice.