Decrease in complications during cataract surgery with the use of a silicone-tipped irrigation/aspiration instrument.

PURPOSE: To compare rates of vitreous loss during cataract surgery when a silicone-tipped irrigation/aspiration (I/A) instrument is used for cortex removal as opposed to a metal tip. SETTING: Parkland Memorial Hospital, Dallas, Texas, USA. METHODS: A retrospective chart review of all patients who had cataract extraction by phacoemulsification by third-year ophthalmology residents between September 2000 and February 2004 was conducted. A silicone-tipped I/A instrument was used to remove cortex for all surgeries beginning in September 2002, whereas a metal I/A tip was used previously. RESULTS: Of the 1072 cases performed with a metal I/A tip, there were 13 cases of vitreous loss during cortex removal (rate 1.2%) and 26% of all vitreous loss during that time occurred during cortex removal. Of the 805 cases performed with a silicone I/A tip, there was a single case (0.1%) of vitreous loss during cortex removal (P=.004); only 4% of all vitreous loss during that time occurred during cortex removal (P=.011). CONCLUSION: The overall incidence of vitreous loss during cortex removal and the ratio of vitreous loss during cortex removal to all cases of vitreous loss were significantly decreased using the silicone-tipped I/A instrument.

Utility of red amsler grid screening in a rheumatology clinic.

OBJECTIVE: To ascertain the false positive rate of red Amsler grid screening in an outpatient rheumatologic setting. METHODS: Red Amsler grid screening was performed on 170 consecutive patients presenting with rheumatoid arthritis or systemic lupus erythematosus. Patients with abnormal screening results were referred for ophthalmologic evaluation and formal visual field testing. RESULTS: Nineteen patients identified scotomata on red Amsler grid. Despite numerous recall attempts, only 9 of the 19 patients with scotomata presented for ophthalmologic evaluation. The positive predictive value was 5-58%. Roughly 6-11% of all patients screened had a false positive screening test. CONCLUSION: While red Amsler grid screening may allow rheumatologists to identify patients who are more likely to have hydroxychloroquine ocular toxicity, an abnormal red Amsler grid screening is in itself an unreliable predictor of toxicity.