Radiation-associated lens changes in the cardiac catheterization laboratory: Results from the IC-CATARACT (CATaracts Attributed to RAdiation in the CaTh lab) study.

OBJECTIVE: To examine the relationship between occupational exposure to ionizing radiation and the prevalence of lens changes in interventional cardiologists (ICs) and catheterization laboratory ("cath-lab") staff. BACKGROUND: Exposure to ionizing radiation is associated with the development of lens opacities. ICs and cath-lab staff can receive high doses of ionizing radiation without protection, and may thus be at risk for lens opacity formation. METHODS: We conducted a cross-sectional study at an interventional cardiology conference. Study participants completed a questionnaire pertaining to occupational exposure to radiation and potential confounders for the development of cataracts, followed by slit-lamp examination and grading of lens findings. RESULTS: A total of 117 attendees participated in the study, including 99 (85%; 49 ± 11 years-old; 82% male) with occupational exposure to ionizing radiation and 18 (15%; 39 ± 12 years-old; 61% male) unexposed controls. The prevalence of overall cortical and posterior subcapsular lens changes (including subclinical findings) was higher in exposed participants compared with controls (47 vs. 17%, P = 0.015). Occupational exposure and age over 60 were independent predictors of lens changes (odds ratio [95% CI]: 6.07 [1.38-43.45] and 7.72 [1.60-43.34], respectively). The prevalence of frank opacities was low and similar between the two groups (14 vs. 6%, P = 0.461). Most lens findings consisted of subclinical changes in the periphery of the lens without impact on visual acuity. CONCLUSIONS: Compared with unexposed controls, ICs and cath-lab staff had a higher prevalence of lens changes that may be attributable to ionizing radiation exposure. While most of these changes were subclinical, they are important due to the potential to progress to clinical symptoms, highlighting the importance of minimizing staff radiation exposure.

Anterior stromal puncture in the treatment of loose epithelium after LASIK.

PURPOSE: To describe anterior stromal puncture, with or without a bandage contact lens, as a means to treat LASIK epithelial defects and potentially reduce the likelihood of secondary diffuse lamellar keratitis (DLK). METHODS: Six eyes of five LASIK patients had their microkeratome pass complicated by loose epithelium, central in one case. After repositioning the flap, a 25-gauge needle on a tuberculin syringe was used to puncture the anterior corneal stroma to just beneath Bowman's layer in the affected area of irregular epithelium. A bandage contact lens was placed on two eyes, including the one with loose epithelium centrally. RESULTS: Normal appearance of the corneal epithelium was noted by postoperative day 1; no eye developed DLK or significant epithelial ingrowth postoperatively. All eyes achieved > or = 20/20 vision. CONCLUSIONS: By obviating, in select cases, the need for bandage contact lenses, anterior stromal puncture could increase patient comfort and remove a potential source of infection.

Recurrence of Fuchs marginal keratitis within a lamellar graft.

We report a case of Fuchs marginal keratitis with a recurrence and spontaneous perforation on the lamellar graft. A constellation of marginal corneal infiltrates and stromal thinning under a pseudopterygium characterize this condition. Two years after an initial lamellar keratoplasty, the pathology recurred within the graft. A repeat lamellar keratoplasty was performed, this time combined with a conjunctival autograft.

Diode-laser-induced cataract and iris atrophy as a complication of eyelid hair removal.

PURPOSE: To caution about ocular risks of dermatologic diode laser, including cataract formation and iris atrophy. DESIGN: Observational case report. METHODS: A 63-year-old woman underwent diode epilation in the upper eyelid area without protective eye shields and experienced a sharp ocular pain during treatment of her left eye. She later presented with decreased vision in that eye and sensitivity to light. RESULTS: Iris atrophy and a nuclear cataract were seen on examination. In the absence of any such observations at previous eye examinations and of any contributory ocular history, these findings were attributed to the diode laser treatment. CONCLUSION: Diode laser epilation in the upper eyelid region could entail risks for intraocular structures, including cataractogenesis and iris atrophy.

Bilateral dislocation of in-the-bag posterior chamber intraocular lenses in a patient with intermediate uveitis.

We present a case of bilateral dislocation of in-the-bag intraocular lenses (IOLs) in a patient with intermediate uveitis. The IOLs dislocated into the vitreous cavity 24 and 41 months postoperatively. A complete pars plana vitrectomy with sutured posterior chamber IOL implantation was performed after each dislocation. The final visual acuity was 20/20(-) in each eye.