Triaging herpes zoster ophthalmicus patients in the emergency department: do all patients require referral?

OBJECTIVES: The objective was to assess the predictive value of clinical signs and symptoms of herpes zoster ophthalmicus (HZO) for development of moderate to severe eye disease. METHODS: This was a prospective cohort multicenter study of 54 patients referred to the ophthalmology service after presenting to the emergency department (ED) or primary care clinic with a zosteriform rash of less than 10 days' duration. Upon referral to ophthalmology, easily assessable clinical signs and symptoms were documented. A complete ocular exam was then performed. Patients were followed for 2 months. RESULTS: Twenty-three patients (43%) developed moderate to severe disease as defined by corneal or intraocular involvement. Eye redness and rash in the supratrochlear nerve distribution had a statistically significant association with clinically relevant eye disease. All 23 patients who developed moderate to severe eye disease presented with a red eye. Hutchinson's sign (nasociliary nerve involvement) was not predictive of clinically relevant eye disease. CONCLUSIONS: Eye redness was 100% sensitive for predicting moderate to severe eye disease in this sample of patients and should necessitate immediate referral for ophthalmologic assessment. Patients lacking eye redness, even with a positive Hutchinson's sign, may not require immediate specialist consultation. All patients not being referred require careful instructions to seek further care should they develop any concerning eye symptoms such as redness, pain, photophobia, or visual disturbance.

The SuperCrescent diamond knife: an innovative blade for glaucoma surgery.

Diamond blades have been used extensively in cataract surgery but their routine use in glaucoma surgery has been limited owing to the lack of controlled sharpness. The SuperCrescent knife is an ultrathin (100 µm) diamond blade that is an innovative modification of conventional blade design. Its pentium faceted trapezoidal design along with the square front surface area affords better control during dissection and has been used with success in both traditional trabeculectomies and nonpenetrating glaucoma procedures.

Capsular tension rings: update on endocapsular support devices.

Endocapsular support devices, such as the capsular tension ring, and other newer scleral-fixated devices have become increasingly important in the management of compromised zonules during cataract surgery. Cataract removal in patients with significant zonulopathy presents many challenges with increase risk of intraoperative and postoperative complications. The original capsular tension ring was the beginning of a progressive evolution in the management of zonular weakness. Newer devices, which permit scleral-suture fixation, include the modified capsular tension ring and the capsular tension segment.

Capsular tension rings and related devices: current concepts.

PURPOSE OF REVIEW: To discuss current designs, indications, contraindications and controversies pertaining to capsular tension devices. RECENT FINDINGS: Capsular tension rings and other newer endocapsular support devices have become increasingly important in the management of zonular weakness during cataract extraction. They have been found to improve both intraoperative support during phacoemulsification and postoperative intraocular lens centration. Since the introduction of the original capsular tension rings in 1991, there has been a progressive evolution of this device to help deal with profound zonular weakness. These newer devices, which permit scleral-suture fixation, include the modified capsular tension ring and the capsular tension segment. SUMMARY: Continual advances in capsular tension device technology have allowed for increased safety and efficacy in performing cataract surgery in patients with zonular weakness with newer devices being evolved to manage more profound cases.

Phacoemulsification and intraocular lens implantation in nanophthalmic eyes: report of a medium-size series.

PURPOSE: To evaluate the outcomes in nanophthalmic eyes that had phacoemulsification and intraocular lens (IOL) implantation. SETTING: Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. METHODS: Six nanophthalmic eyes of 4 patients had uneventful phacoemulsification and posterior chamber IOL implantation with a retrobulbar or peribulbar block. All operations were performed by 1 surgeon. Patients ranged in age from 41 to 70 years. RESULTS: The visual acuity remained stable or improved in all 6 eyes. Glaucoma control was maintained or improved in 5 eyes. CONCLUSION: The results indicate that small-incision cataract surgery, although challenging, is safe and diminishes the need for prophylactic sclerotomies in these high-risk eyes.