Four-point fixation technique for sutured posterior chamber intraocular lenses.

Transscleral suture fixation of posterior chamber lenses is a popular recent alternative for avoiding the potential complications of anterior chamber lenses and in the absence of sufficient iris support for an anterior chamber lens. If a posterior chamber lens is fixated by only two points in the ciliary sulcus, the lens may tilt relative to the visual axis, causing clinically significant and possibly uncorrectable astigmatism. Described methods of three- or four-point fixation are technically more difficult and can result in an improperly centered lens. A method is described herein that allows stable four-point fixation with precise lens placement using only two sutures. This method also allows the suture knot to be buried in the eye without the use of scleral flaps.

Late onset endophthalmitis associated with filtering blebs.

A consecutive series of 71 cases of late onset endophthalmitis (defined as onset of symptoms at least 2 weeks after surgery) were reviewed to determine the association of this entity with glaucoma surgery filtering blebs and to identify any predisposing factors. Sixteen cases were associated with filtering blebs and two with inadvertent blebs following cataract surgery. Onset of endophthalmitis ranged from 24 days to 20 years after surgery (mean, 6.9 years). Possible contributing factors included trauma, vitreous wicks, and bleb leak. Twelve cases were culture-positive, with 5 cases of Staphylococcus epidermidis; 2, Staphylococcus aureus; 4, Streptococcus; and 1, Pseudomonas. There were no cases of Hemophilus. The more virulent organisms were generally associated with a poor visual outcome. The organisms recovered in this series were similar to those found in postoperative endophthalmitis not associated with filtering blebs.

Pars planitis presenting with vitreous hemorrhage.

A 31-year-old woman complained of a sudden, painless decrease in vision of the right eye. Ophthalmic examination demonstrated a vitreous hemorrhage in the right eye secondary to peripheral neovascularization. The left eye demonstrated findings consistent with pars planitis. Before this episode, vision was good in both eyes. Although rare, vitreous hemorrhage can occur in the setting of pars planitis and may be a presenting symptom. Pars planitis should be considered in the differential diagnosis of young patients with vitreous hemorrhage.

Prevalence and association of asteroid hyalosis with systemic diseases.

We performed a cross-sectional study of 12,205 patients, which identified 101 patients (0.83%) with asteroid hyalosis. These patients were examined for associated systemic and ocular conditions. Diabetes mellitus was found in 29 of the patients with asteroid hyalosis (29%), as compared to ten of 101 (10%) control subjects (P = .0007). An increased prevalence of systemic arterial hypertension (61 of 101 [60%] patients with asteroid hyalosis compared with 29 of 101 [29%] control subjects; P = .0001) and atherosclerotic vascular disease (30 of 101 [30%] patients with asteroid hyalosis compared with 13 of 101 [13%] control subjects; P = .006) was also discovered in the asteroid hyalosis group. Additionally, patients with asteroid hyalosis were found to be more hyperopic than control subjects (P = .009).