[Managing complications in intraoperative floppy iris syndrome]. / Komplikationsmanagement beim "intraoperative floppy iris syndrome"

The intraoperative floppy iris syndrome (IFIS) describes an ophthalmologically relevant phenomenon which is observed after systemic intake of alpha blockers for treatment of benign prostate hyperplasia. This leads to an increase in intraoperative complications in cataract surgery characterized by a flaccid iris which billows in response to currents with a tendency to prolapse towards the area of surgery. This results in damage to the iris by the instruments used or posterior capsule rupture with loss of lens material. We describe the preoperative and intraoperative measures and techniques to deal with this challenging situation in order to minimize development of IFIS and reduce the complication rate.

[Counterfeiting of eye drops?: a laboratory study of antibiotic eye drops purchased in two African countries]. / Counterfeiting von Augentropfen? : Eine Untersuchung von Antibiotikapräparaten aus 2 Ländern Afrikas.

INTRODUCTION: Counterfeit drugs are often ineffective and are considered a problem with an immense risk potential especially in the treatment of infectious diseases. Emerging and developing countries are particularly affected. Little is known about the extent of counterfeit antibiotic drugs used in eye care. In the present study we investigated antibiotic eye drops purchased in two African countries with respect to the active substance and its concentration in the sample. METHODS: A total of 33 antibiotic eye drops purchased in Kenya and the Democratic Republic of Congo were tested. The bottles were labeled to contain one of the following substances: the quinolones ciprofloxacin, levofloxacin and ofloxacin and the aminoglycosides gentamicin and tobramycin. Imported quality products as well as cheaper generic drugs were tested. Fluoroquinolones were determined by high pressure liquid chromatography (HPLC) and quantified by fluorescence measurement and aminoglycosides were tested by using a fluorescence polarization immunoassay. RESULTS: All samples were found to contain the declared drug. Nine samples (27%) showed an under-concentration by 10% or less and ten (30%) showed an increased concentration of 10% or more than indicated on the label. 75% of the original drugs but only 12% of the generic drugs had measured concentrations within the standard advisory ranges of ± 5% from the nominal value. CONCLUSION: Our results provide no evidence for significant criminal counterfeiting of eye drops in the studied countries. The frequent deviation from the stated concentration in the generic samples is cause for concern and justifies further investigation.

[Cataract surgery outcomes by temporal small incision techniques with and without phacoemulsification. Results of a prospective study from Kenya]. / Katarakt-Operationsergebnisse durch temporale Kleinschnitttechniken mit und ohne Phakoemulsifikation. Ergebnisse einer prospektiven Studie aus Kenia.

BACKGROUND: The present outcomes of cataract surgery in Africa do not meet the recommendations of the World Health Organization. Superior manual small incision cataract surgery (SICS) is the operation of choice in many developing countries. However, there is good evidence that temporal incisions are more stable and cause less surgically induced astigmatism (SIA). METHODS: In a prospective, non-randomized study in an anterior segment clinic in the southeastern part of Kenya, 405 eyes were operated on using either temporal phacoemulsification (n = 288) or temporal SICS (n = 117) with implantation of a rigid intraocular lens (IOL). The main outcome variables were preexisting corneal astigmatism, SIA, visual outcomes and complication rates. RESULTS: Preoperatively, the mean astigmatism in all eyes was 1.1 diopters (D) ranging from 0 to 6.28 D. Against-the-rule astigmatism (ATR) (mean 1.18 D) was most common with 60.4%. After 8 weeks following surgery the mean SIA was 1.13 D (SD ±0.63 D) at 92° for phacoemulsification and 1.11 D (SD ±0.56 D) at 102° for SICS. Of the eyes 89.6% reached a best corrected visual acuity (BCVA) ≥ 0.3 and 82.7% reached this visual acuity also uncorrected. The main reasons for not reaching BCVA ≥ 0.3 were ocular comorbidities. CONCLUSIONS: In the population studied most patients had preexisting ATR astigmatism and a switch to routine temporal incisions appeared beneficial. The World Health Organization recommends that poor (BCVA below 0.1) or borderline (BCVA below 0.3) outcomes after cataract surgery should not be more than 10-20%. This goal has been achieved in this study with the techniques presented.

[Complication cascade after hyperopic LASIK]. / Komplikationskaskade nach hyperoper LASIK.

This report concerns the case of a 28-year-old female patient who was treated with topical steroids for 2 years following complicated hyperopic LASIK surgery with a re-treatment including a re-lift of the flap. A steroid-induced rise in the intraocular pressure (IOP) was subsequently observed on the treated eye, together with a glaucomatous subtotal destruction of the optic nerve, resulting in a residual vision of 1/15. An erroneously low IOP measurement, which was probably the reason for the delay in detecting steroid-induced glaucoma, has been reported in several cases concerning LASIK patients. The reason for the unusually severe course in the case in question can only be presumed, namely a possible accumulation of fluid at the interface or altered biomechanics following hyperopic LASIK surgery. The need for a thorough postoperative examination following refractive surgery must be emphasized. This case shows a cascade of complications following hyperopic LASIK surgery resulting in the functional blindness of one eye.

Minimal cross-infection risk through Icare rebound tonometer probes: a useful tool for IOP-screenings in developing countries.

AIMS: Recently, a new rebound tonometer has been introduced into the market, which might be useful for glaucoma screenings in developing countries. Disposable probes, that are potentially reusable, are recommended by the manufacturer. Our study aimed to address the question of microbial transmission risks if the probes are reused. METHODS: IOP measurements were obtained from 100 healthy eyes. The used probes were inoculated on broth and culture media. In addition, 10 probes were analyzed using environmental scanning electron microscopy in saturated hydrogen-steam atmosphere after usage and wipe disinfection technique with Sekusept 4% solution or Isopropanol 70%. RESULTS: No bacterial or fungal growth could be detected in any of the inoculated agar plates or broth tubes. No microorganisms, clumps of cells, or single intact epithelium cells were detected in any of the probes using environmental scanning electron microscopy. Cell debris was detected on seven probes; three probes were completely free of any residual cell elements. CONCLUSION: Transmission of possibly infective material through reused probes is significantly less than for reusable Goldmann probes if the same sterilization protocols are applied. Re-usage of the probes appears safe and is helpful in avoiding unnecessary costs.

[Biometry in cataract camps. Experiences from north Kenya]. / Biometrie in Katarakt-Camps. Erfahrungen aus Nordkenia.

BACKGROUND: Biometry has the potential to improve refractive outcomes of cataract surgery in developing countries. However, the procedure is difficult to carry out in remote areas. PATIENTS AND METHODS: The feasibility of automated biometry using portable devices was assessed in an eye camp in a remote Kenyan community and reasons for failure were documented. PC-IOLs in the range of 17-27 dioptres (dpt) were implanted and a model was created to predict spherical refractive error if a standard 22 dpt lens had been used. RESULTS: In 104 out of 131 eyes (80%) biometry was possible. Failure to obtain K-readings in eyes with coexisting corneal pathology was the main limiting factor. The calculated mean IOL strength to achieve emmetropia was 21.56 dpt with a SD=1.96 (min: 14.78 dpt, max: 27.24 dpt). If 22 dpt lenses had been implanted around 20% would have had an error of more than 2 dpt and 7% an error of more than 3 dpt. CONCLUSION: Biometry is a challenging procedure in remote areas where comorbidities are common. However, without biometry and implantation of different IOL powers poor refractive outcome can be expected in around 20% of patients.