Modified corneal incisions in intraoperative floppy iris syndrome (IFIS)-prone patients.

BACKGROUND: We aimed to report a simple technique that involves modified anterior (to the limbus) elongated corneal incisions in order to reduce the incidence and severity of intraoperative floppy iris syndrome (IFIS) and related complications. METHODS: This was a retrospective study of phacoemulsification cataract surgeries performed by a single surgeon on patients receiving tamsulosin or alfuzosin between 1 January 2009 and 31 July 2012 at Meir Medical Center, Kfar-Sava, Israel. We recorded preoperative gender, age, α-antagonist medication, coexisting pseudoexfoliation (PXF), and intraoperative use of ophthalmic viscosurgical devices (OVDs), pupil size, complications, IFIS grading and the need for additional operative strategies to manage IFIS. Elongated corneal incisions were performed approximately 1 mm anterior to the limbus. RESULTS: Ninety-three eyes of 81 men were included. Mean age was 76.5 years (range 55 to 96 years). Forty-seven eyes (40 patients) had documented use of alfuzosin and 45 eyes (40 patients) of tamsulosin. One patient received both. The overall rate of IFIS was 22.6 % (n = 21). Eyes of patients who were treated with alfuzosin had a milder grading (p < 0.001) and an overall lower percentage of IFIS compared to tamsulosin (4.26 % versus 42.22 % respectively, p < 0.001). No additional strategies were used to manage IFIS during surgery. No intraoperative complications occurred. CONCLUSION: Anterior elongated incisions are simple and efficient in preventing IFIS, exempting the surgeon from the use of additional expensive devices or materials in most cases. They do not limit the surgeon to one strategy, and therefore, if necessary, another may be applied at any given time.

The effect of gatifloxacin 0.3% or moxifloxacin 0.5% on corneal healing, ocular tolerability and toxicity following pterygium surgery.

PURPOSE: To compare the rate of corneal epithelial healing and ocular tolerability following pterygium surgery between gatifloxacin and moxifloxacin. METHODS: In this double masked, prospective, controlled study 40 patients were randomized to receive prophylactic topical gatifloxacin 0.3% or moxifloxacin 0.5% following pterygium surgery. Patients were examined on days 1, 3, 7 and 21 post-operatively or until complete corneal epithelial healing. The primary outcome measure was the area of corneal epithelial defect during the post-operative period. Patients graded post-operative ocular pain, foreign body sensation, tearing, general burning sensation and burning sensation post-antibiotic drops instillation on a scale of 1-5. Conjunctival hyperemia and superficial punctate keratopathy (SPK) were measured on a scale of 0-3. RESULTS: No significant differences between groups were found in terms of corneal epithelial defect percentage over time (p = 0.989) and there was no significant difference between groups on each of the post-operative days. No significant differences were noted in terms of post-operative ocular pain, foreign body sensation, tearing, general burning sensation, burning sensation post-antibiotic drops instillation, conjunctival hyperemia and SPK. CONCLUSIONS: Gatifloxacin and moxifloxacin showed equivalent results in terms of corneal epithelial healing and ocular tolerability following pterygium surgery. This study suggests that there was no apparent added epithelial toxicity due to the presence of benzalkonium chloride in the gatifloxacin preparation when compared to moxifloxacin.

Establishment of a Registry to Monitor Trends in Cataract Surgical Procedures and Outcomes in Israel, 1990-2014.

BACKGROUND: Cataract extraction is the most commonly performed ophthalmic surgical procedure. There is no registry for documenting cataract surgical procedures and the overall risk of its complications overtime in Israel. OBJECTIVES: To present trends in the number and type of selected parameters associated with cataract surgical procedures in Israel between 1990 and 2014. METHODS: Questionnaires had been sent annually to all surgical centers in which cataract surgery was performed in Israel during the study period. The trends that were investigated included annual rates, surgical sites, surgical techniques, use of an intraocular lens (IOL), and type and rates of postoperative endophthalmitis (POE). RESULTS: A total of 812,112 cataract surgical procedures were reported during the 25 year study period. Responses to the questionnaire increased from 75% in 1990 to 100% in 2006 onwards. The annual number of reported cataract surgical procedures increased from 16,841 (3.5 per 1000) in 1990 to 57,419 in 2014 (6.9 per 1000), representing an increase of 197%. There was a shift from performing the surgery in the public health system to private medical centers. The surgical technique changed from predominantly manual extracapsular cataract extraction (56% in 1999) to predominantly phacoemulsification (98.7% in 2014). POE rates decreased from 0.25% in 2002 to 0.028% in 2014. CONCLUSIONS: There was a continuous increase in the rate of surgical cataract procedures, and more were performed in private medical facilities. There was also a major shift towards advanced cataract procedures and a decreased rate of POE.

Slit-lamp exophthalmometry, a novel technique.

PURPOSE: Exophthalmometry is clinically important for diagnoses, follow-up, and treatment decision-making. Through the years, several drawbacks and sources of error have been described when using Hertel and other exophthalmometers. METHODS: We describe a simple method of non-touch slit-lamp exophthalmometry. Comparing the results between Hertel and slit-lamp exophthalmometry on 60 patients with proptosis showed no statistically significant differences in the two methods. RESULTS: A total of 60 consecutive patients with proptosis were included. Thirty-six cases (60 %) were women. Their mean age was 55.6 ± 16.4 (median 57.5, range 20-87) years. Only 5 % of the measurements had more than 2 mm difference between the two techniques. There were no significant differences in the measurements between the two methods. Intra-correlation coefficient is 0.96 for right side and 0.956 for lest side. The Bland-Altman plot revealed good agreement. CONCLUSIONS: Slit-lamp exophthalmometry offers a simple, easily available, and reliable non-touch technique that does not require an exophthalmometer.

Preclinical safety and stability study of a next generation telescope prosthesis for end-stage macular degeneration.

BACKGROUND: To assess the surgical procedure, safety and stability of a next generation injectable telescope prosthesis in a rabbit model. METHODS: After removal of the crystalline lenses of eight New Zealand White rabbits, the next generation device was randomly implanted in one eye, and the available telescope prosthesis (Normal device) was implanted in the fellow eye. Operative parameters (incision, capsulorrhexis size and operative time), intraoperative and postoperative complications rates, endothelial cell density changes and the distance between the corneal endothelium and the telescope (central clearance distance) were measured and compared between the groups. RESULTS: Incision size and capsulorrhexis size were smaller, and operative time was shorter in the next generation group in comparison with the Normal group. No difference was found in the intraoperative and postoperative complication rates between the groups. Endothelial cell density loss observed in the next generation group was less than the loss in the Normal group, but the difference was not significant statistically. The central clearance distance was significantly larger in the next generation group in comparison with the Normal group (P = 0.001). CONCLUSIONS: The next generation telescope was implanted through a smaller incision, with a shorter surgical time and a larger central clearance distance in the rabbit eyes, in comparison with the Normal group. The next generation device may allow reduced trauma to the corneal endothelium, better control during surgery and induce less astigmatism while preserving the optical advantages of the Food and Drug Administration-approved telescope prosthesis.

Giant cobblestone-like papillae during isotretinoin therapy.

PURPOSE: To report a case of giant cobblestone-like papillae that appeared during oral isotretinoin therapy. DESIGN: Case report. METHODS: A 14-year-old boy presented with bilateral eye itching for 1 week. Bilateral upper palpebral conjunctival cobblestone-like papillae, superficial punctate keratitis, and shield ulcer in the left cornea were seen. At the time, he was treated with oral isotretinoin for 6 months. RESULTS: Following cessation of isotretinoin, the ulcer and SPK healed, and the papillae disappeared completely after an 8-week course. CONCLUSION: Giant cobblestone-like papillae and corneal shield ulcer may be considered as a probable isotretinoin-induced ocular adverse event.

Treatment of total exudative retinal detachment due to central retinal vein occlusion by intravitreal bevacizumab in a patient with p-ANCA vasculitis.

OBJECTIVE: To report on the use of intravitreal bevacizumab (an anti-vascular endothelial growth factor [VEGF] monoclonal antibody) as treatment of diffuse exudative retinal detachment due to ischemic central retinal vein occlusion (CRVO). DESIGN: Interventional case report. PATIENT: A 27-year old woman on peritoneal dialysis because of end stage renal failure (ESRF) due to perinuclear antineutrophil cytoplasmic antibody (p-ANCA) associated vasculitis presented with acute unilateral blurred vision. Visual acuity (VA) rapidly deteriorated. Examination revealed the development of total bullous exudative retinal detachment following ischemic CRVO. INTERVENTION: Two intravitreal injections of bevacizumab (2.5 mg/0.1ml) were administered followed by panretinal laser photocoagulation. MAIN OUTCOME MEASURES: VA, retinal detachment, and changes in macular edema. RESULTS: Prompt significant resolution of exudative retinal detachment with a corresponding gradual improvement of VA from light perception to finger counting. At follow-up examination after 8-months, the retina remained attached. CONCLUSION: Intravitreal bevacizumab proved to be a useful treatment modality in diffuse exudative retinal detachment due to CRVO.

[Optic disc drusen and acute vision loss].

Optic disc drusen (ODD) are calcified nodules within the optic nerve head. These are products of degenerated retinal ganglion cells axoplasmic transport, also known as hyaline or colloid bodies. They are mainly encountered as an incidental benign finding, or as a benign cause of swollen discs (in the differential diagnosis of papilledema). The majority of the patients are asymptomatic, and a slowly progressive sub-clinical visual field loss is found in about 80% of the patients. However, acute painless symptomatic visual field loss, occasionally massive, is rare. This is a case history of 4 patients who developed acute painless visual field loss which was attributed to optic disc drusen. The clinical features and proposed ischemic pathophysiology of acute vision loss and ODD are discussed.

[Exercise induced hyponatremia].

A normal water-electrolyte balance is essential for normal function of body systems during physical activity. During recent years, awareness of the importance of drinking amongst athletes and Israeli Defense Force (IDF) soldiers, in particular, has been highlighted. A large number of athletes tend to drink prior to, during and after their exercise in order to enhance physical abilities and to prevent heat casualties and dehydration. However, excessive water consumption combined with sweat induced electrolytes loss during physical activity, may cause hyponatremia in extreme cases. Recently, several cases of exercise induced hyponatremia were reported in the IDF, resulting from improper water consumption. In this article, we describe a clinical case of exercise-induced hyponatremia in a soldier and a review of the literature, including the etiology, clinical characterization and recommended treatment. Moreover, water consumption recommendations with regard to physical activity are presented. The application of such recommendations may prevent future events of exercise-induced hyponatremia.