Management of traumatic haemorrhage in the Berger's space of a 4-year-old child.

We are reporting an unusual case of haemorrhage in the Berger's space after an episode of blunt ocular trauma in an eye of a 4-year-old boy, who enjoyed premorbid normal vision. A secondary posterior subcapsular cataract developed as a complication of the haemorrhage after 6 months of observation. Surgery comprised cataract extraction, removal of a residual retrolenticular haematoma via opening of posterior continuous curvilinear capsulorhexis (CCC), anterior vitrectomy and placement of an intraocular lens. This yielded a reasonable visual outcome. Complete spontaneous resolution of haemorrhage in the Berger's space is unlikely and may cause secondary cataracts in children. We suggest early intervention in such conditions in order to prevent the development of amblyopia.

Successful Treatment of Lasiodiplodia theobromae Keratitis - Assessing the Role of Voriconazole.

PURPOSE: The aim of this paper is to report the successful management of the first case of Lasiodiplodia theobromae keratitis in Hong Kong. METHODS: We conducted a case report. RESULTS: A 43-year-old Chinese male with a history of diabetes developed left eye keratitis after a trauma during tree felling. Fungal keratitis was diagnosed using a confocal microscope on day 1, and L. theobromae was confirmed from the culture. He was given oral voriconazole, topical natamycin, and topical and intracameral amphotericin B. The patient's condition improved after the initial treatment. However, there was a slow progression to descemetocele formation and impending perforation due to corneal melting. Penetrating keratoplasty was performed at 8 weeks after presentation. Final visual recovery was good with no recurrence of infection. The cornea remained clear. CONCLUSIONS: We report the first case of L. theobromae keratitis in Hong Kong, and it is the only case so far that involved the use of oral voriconazole in the combination therapy. Early recognition with the aid of confocal microscopy allowed the early start of treatment. The use of newer antifungal voriconazole topically and orally combined with topical amphotericin B appeared to be useful in the eradication of the fungus and prevention of recurrence. Intracameral antifungals might have improved the clinical management.

Multicenter study of descemet membrane endothelial keratoplasty: first case series of 18 surgeons.

IMPORTANCE: Surgeons starting to perform Descemet membrane endothelial keratoplasty (DMEK) should be informed about the learning curve and experience of others. OBJECTIVE: To document the clinical outcome of standardized "no-touch" DMEK and its complications during the learning curves of experienced surgeons. DESIGN, SETTING, AND PARTICIPANTS: Retrospective multicenter study. A total of 431 eyes from 401 patients with Fuchs endothelial dystrophy (68.2%) and bullous keratopathy (31.8%) underwent DMEK performed by 18 surgeons in 11 countries. EXPOSURES: Descemet membrane endothelial keratoplasty. MAIN OUTCOMES AND MEASURES: Best-corrected visual acuity (BCVA), endothelial cell density, and intraoperative and postoperative complications. RESULTS: Of 275 eyes available for BCVA pooled analysis, BCVA improved in 258 eyes (93.8%), remained unchanged in 12 (4.4%), and deteriorated in 5 (1.8%). Two hundred seventeen eyes (78.9%) reached a BCVA of at least 20/40 (≥0.5), 117 (42.5%) at least 20/25 (≥0.8), and 61 (22.2%) at least 20/20 (≥1.0). Eyes with at least 6 months of follow-up (n = 176) reached similar BCVA outcomes. Mean (SD) decrease in endothelial cell density at 6 months was 47% (20%) (n = 133 [P = .02]). Intraoperative complications were rare, including difficulties in inserting, unfolding, or positioning of the graft (1.2%) and intraoperative hemorrhage (0.5%). The main postoperative complication was graft detachment (34.6%); 20.4% underwent a single rebubbling procedure, occasionally requiring a second (2.6%) and a third rebubbling (0.7%), and 17.6% underwent a second keratoplasty. CONCLUSIONS AND RELEVANCE: Our multicenter study showed that the standardized no-touch DMEK technique was feasible in most hands. The main challenges for surgeons starting to perform the procedure may be (1) to decide whether graft preparation is outsourced or performed during surgery, (2) to limit the number of graft detachments and secondary procedures, and (3) to obtain organ cultured donor corneal tissue.

Shallow ablations in phototherapeutic keratectomy: long-term follow-up.

PURPOSE: To evaluate the long-term efficacy and safety of shallow ablations in phototherapeutic keratectomy (PTK) in patients with recurrent corneal erosions. SETTING: Department of Ophthalmology, Tuen Mun Hospital, Hong Kong, China. METHODS: A retrospective analysis of 13 consecutive eyes with recurrent corneal erosions treated by PTK from 1997 to 1999 was performed. All eyes failed to respond to conventional treatments, and all eyes had corneal erosions involving the visual axis. Outcome measures included number of recurrences, change in best corrected visual acuity (BCVA) and spherical equivalent (SE), and complications arising from the laser treatment. RESULTS: Indications for PTK were recurrent corneal erosions secondary to minor abrasive trauma (9 eyes) and map-dot-fingerprint corneal dystrophy (4 eyes). The mean ablation depth was 4.6 microm (range 3.4 to 5.8 microm). Mean postoperative follow-up was 49.5 months (range 24 to 68 months). The overall success rate after only 1 treatment was 84.6%. Eleven of 13 eyes had a preserved or improved BCVA, while 2 eyes showed deterioration of 1 line on Snellen testing. Seven of 13 patients had no change in SE; the rest had a change of less than +/-0.50 diopters. There were no major complications. CONCLUSIONS: The comparable success rate after a single treatment suggests that PTK may still be effective at a shallower depth than previously considered. Shallow ablations may have lower chances of complications associated with deeper ablations. Further studies involving a larger number of subjects are warranted.

Intraocular lens power calculation formulas in Chinese eyes with high axial myopia.

PURPOSE: To compare the accuracy of intraocular lens (IOL) power calculation formulas in Chinese eyes with high axial myopia. SETTINGS: Department of Ophthalmology, Tuen Mun Hospital, Hong Kong, China. METHODS: This retrospective study reviewed 125 Chinese patients with high myopia and axial lengths (ALs) longer than 25.0 mm who had cataract surgery during the year 2000. Eyes with pathology or operative complications affecting the refractive status and those with missing data were excluded. In each case, the power of the implanted IOL was used to calculate the predicted postoperative refractive error by 4 IOL power calculation formulas: SRK II, SRK/T, Holladay 1, and Hoffer Q. The predictive accuracy of the formulas was analyzed by comparing the difference between the "actual" and "predicted" postoperative refractive errors. The Student t test was used for statistical analysis. The performance of the formulas in subcategories of long AL was also tested. RESULTS: One hundred twenty-five eyes (110 patients) were studied. Thirty-seven eyes (29.6%) were excluded. The Hoffer Q, Holladay 1, and SRK/T formulas showed a slight tendency toward resultant hyperopia, with a mean of +0.36 diopters (D), +0.53 D, and +0.74 D, respectively. The SRK II caused the largest hyperopic error, with a mean of +1.47 D. All 4 formulas caused a refractive error shift toward myopia in the subcategories of AL >28.0 mm, minus-power IOL, and extracapsular cataract extraction (ECCE). CONCLUSIONS: In Chinese eyes with high axial myopia with an AL longer than 25.0 mm, the 4 formulas caused a slight postoperative hyperopic refractive error that was less in eyes with a minus-power IOL or an AL longer than 28.0 mm and in those that had ECCE. The Hoffer Q formula provided the best predictive result, and Holladay 1 and SRK/T were comparable in IOL power calculation. The SRK II was the least accurate in all subgroups.