Ophthalmic referrals from emergency wards-a study of cases referred for urgent eye care (The R.E.S.C.U.E Study).

OBJECTIVE: To characterize emergency department (ED) referrals in order to identify the most common pathologies, compare accuracy of diagnosis, and measure correlation of visual acuity (VA) and intraocular pressure (IOP) measurements between the ED and ophthalmology setting. DESIGN, SETTING, AND PARTICIPANTS: Retrospective chart review of consecutive patients referred for an ocular emergency after hours to a tertiary care emergency eye clinic in Hamilton, Ontario, between February 17, 2015, and May 3, 2015 (n = 288). METHODS: Variables extracted from the patients' charts included date of referral, age, sex, eye(s) under examination, VA at the time of referral, IOP at the time of the referral, site of referral, the referring physician's provisional diagnosis, VA at the time of the ophthalmologist consultation, IOP at the time of the ophthalmologist consultation, number of days between referral and ophthalmic consultation, and the ophthalmologist's diagnosis. RESULTS: Agreement between ED provisional diagnosis and ophthalmology was good at 79.4% when classified according to anatomic location of pathology. A strong correlation was found between VA measurements in the ED and ophthalmology setting (p < 0.001). IOP measurement was infrequently checked in ED and a significant difference existed between ER physician and ophthalmologist measurements (p = 0.010) where ophthalmology reported lower IOP. CONCLUSIONS: The 5 highest volume diagnoses in descending order were posterior vitreous detachment/vitreous syneresis, corneal abrasion, keratitis, anterior uveitis, and retinal tear/detachment. Visual acuity measurements in ED are reliable. IOP is infrequently checked in the ED and more unreliable when measured over 20 mm Hg.

Cataract surgery with toric intraocular lens for correction of high corneal astigmatism.

OBJECTIVE: To analyze the outcomes of cataract surgery with high-power toric intraocular lens (IOL) implantation in patients with high corneal astigmatism. DESIGN: Retrospective case series. PARTICIPANTS: Twelve eyes of 9 patients. METHODS: Patients with idiopathic, pathologic, or postsurgical corneal astigmatism and a visually significant cataract were included in the study. Cataract extraction with implantation of a custom-made high-power toric IOL was performed on all patients. Outcomes included uncorrected and best corrected distance visual acuity (UDVA and BCDVA), manifest refraction, and mean and steepest keratometry. Analysis of astigmatic vectors was also performed. RESULTS: The mean follow-up time was 3.75 months. At the last follow-up visit, there was a significant improvement of UDVA (1 ± 0.64 vs 0.39 ± 0.21 logMAR; p < 0.05), cylindrical refraction (-4.72 ± 1.13 vs -1.81 ± 1.10 D; p < 0.01), and refractive spherical equivalent (-4.56 ± 5.58 vs -0.36 ± 1.19 D; p < 0.05). The BCDVA improvement did not reach statistical significance. Astigmatism on the target axis was reduced by an average of 5 D (p < 0.01). CONCLUSIONS: Cataract surgery with implantation of a high-power toric IOL was safe and effective in correcting high values of corneal astigmatism.

Secondary intraocular lens interventions: predisposing factors, indications and coincident procedures.

To evaluate the predisposing factors, indications and coincident procedures in patients requiring a secondary intraocular lens (IOL)-related intervention. We reviewed data on 183 consecutive secondary IOL-related procedures. Information collected included demographics, predisposing factors, IOL status, indication for surgery, coincident procedures, and final IOL location and fixation method. Of the 183 procedures performed, 73 were secondary IOL implantations, 68 were IOL exchanges and 42 were IOL repositionings. Predisposing factors were found in 88.6 % of the cases, the most common being complicated cataract surgery (39.8 %) followed by trauma (20.2 %). The most common indications for surgery in the anterior chamber IOL and posterior chamber IOL groups were pseudophakic bullous keratopathy ± failed graft (77.2 %) and subluxated IOL (57.53 %), respectively. A malpositioned or subluxated lens was found in 47.86 % of all pseudophakic eyes. A simultaneous procedure was performed in 67 % of cases, anterior vitrectomy being the most common (43.7 %), followed by keratoplasty (35 %). Secondary IOL-related interventions were associated with predisposing factors, complicated cataract surgery being the most common. Patients implanted with anterior chamber IOLs seemed to have a more complicated course requiring more complex secondary surgeries and associated procedures.