Surgical Antimicrobial Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Eye Surgery: A RAND/UCLA Appropriateness Method Consensus Study.

Ocular surgery encompasses a wide range of procedures, including surgery of the tear ducts, eyelid, cornea and conjunctiva, lens, ocular muscle, and vitreoretinal and iris surgery. Operations are also performed for the removal of tumors, repairs of ocular trauma and, finally, corneal transplantation. Antibiotic prophylaxis for the prevention of surgical site infections (SSIs) in ocular surgery is a complex field in which shared lines of action are absent. In light of the scarcity of shared evidence in the use of ocular antimicrobial prophylaxis for the pediatric population, this consensus document aims to provide clinicians with a series of recommendations on antimicrobial prophylaxis for patients of neonatal and pediatric age undergoing eye surgery. The following scenarios are considered: (1) intraocular surgery; (2) extraocular surgery; (3) ocular trauma; (4) ocular neoplasm; (5) ocular surface transplantations; (6) corneal grafts. This work has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies and represents, in our opinion, the most complete and up-to-date collection of recommendations regarding clinical actions in the peri-operative environment in eye surgery. The application of uniform and shared protocols aims to improve surgical practice, through the standardization of procedures, with a consequent reduction of SSIs, also limiting the phenomenon of antimicrobial resistance.

Supporting IOL'S in a Deficient Capsular Environment: The Tale of No "Tails".

PURPOSE: To evaluate the efficacy and safety of the following three distinct surgical procedures for secondary IOL implantation without capsular support: Iris-claw lens, flanged transscleral fixated IOLs (Yamane technique), and sutureless transscleral hook IOL fixation (Carlevale IOL). MATERIALS AND METHODS: In this retrospective comparative study, three different sutureless IOL implantation techniques were compared in patients without any capsular support. Visual acuity and outcomes were analyzed in 24 eyes of 23 patients (14 male and 9 female). Study included 13 iris-claw lenses (Artisan Ophtec), 6 flanged transscleral fixated IOLs (Yamane technique using a MA60MA Alcon Inc IOL), and 5 transscleral Carlevale IOLS (Carlevale IOL, Soleko, Italy). RESULTS: logMAR mean best-corrected visual acuity (BCVA) improved from 0.49 ± 0.19 to 0.19 ± 0.10 at three months after surgery (p < 0.05). Postoperative BCVA was similar in all three groups, and no intergroup difference was noted. Three eyes (12.5%) had a raised IOP >25 mmHg, 2 eyes (8%) presented a subluxated/dislocated IOL, 4 eyes (16%) had corneal edema longer than 7 days, 3 eyes (12.5%) had irregular pupil profile, 2 eyes (8%) had vitreous hemorrhage, 7 eyes had (29%) corneal astigmatism over 3 diopters, and one patient (4%) developed cystoid macular edema (CME). CONCLUSIONS: All three surgical procedures can be considered adequate to correct aphakia in patients without capsular support with significant improvement in visual acuity and low complication.

Treatment of keratoconus by topography-guided customized photorefractive keratectomy: two-year follow-up study.

PURPOSE: To evaluate the outcome of treatment of mild to moderate keratoconus with photorefractive keratectomy (PRK) and computed videokeratography for customized ablation of the superficial corneal layers. METHODS: Eighteen nonconsecutive patients with bilateral keratoconus (Krumeich classification, grade 2) were examined. Both eyes were treated in 7 patients and 1 eye in 11 patients. Eight contralateral eyes served as controls. Photorefractive keratectomy was performed with the Zeiss MEL 70 excimer laser using the topographically supported customized ablation program. We evaluated changes in keratoconus topography data at 6 (25 eyes), 12 (25 eyes), and 24 (22 eyes) months after treatment (mean follow-up: 22.56 +/- 3.97 months) and versus control eyes. Changes in visual acuity and manifest refraction (spherical equivalent and cylindrical component) were also evaluated during follow-up. RESULTS: The mean keratoconus index, keratoconus severity index, keratoconus apex, keratoconus predictor index, opposite sector index, and differential sector index were significantly lower (all P < .0001) 24 months after treatment versus baseline data. Keratoconus topography parameters were significantly worse in control eyes 24 months after study onset versus baseline. Mean uncorrected visual acuity (P < .0001) and best spectacle-corrected visual acuity (P < .05) were significantly increased 24 months after surgery. CONCLUSIONS: Customized photorefractive surgery improved videokeratography indices and clinical data in patients affected by grade 2 keratoconus.