Cataract Surgery in Short Eyes, Including Nanophthalmos: Visual Outcomes, Complications and Refractive Results.

BACKGROUND: To report the visual outcomes, complications and refractive results of phacoemulsification surgery and intraocular lens implantation in a large series of adult patients with short and nanophthalmic eyes. METHODS: The records of all patients with axial length <21.0 mm undergoing phacoemulsification with intraocular lens implantation at an adult teaching hospital were retrospectively reviewed. The main outcome measures were corrected distance visual acuity and refraction at 90 days after surgery and intra- and postoperative complications occurring during the follow-up period. RESULTS: A total of 71 eyes of 51 patients (median age 71 years, interquartile range 62-75.5) were included. Surgery resulted in an improvement in corrected distance visual acuity in 53 eyes (74.6%) (95% confidence interval, logMAR 0.11-0.29) and was logMAR 0.30 or better in 47 eyes (66.2%). Worsening of corrected distance visual acuity occurred in 9 eyes (12.7%). Median postoperative refractive error was -0.75 dioptres. SRK/T and Kane formula were more accurate in predicting postoperative refraction than Barrett Universal II and Hoffer Q when based on mean absolute error (P < 0.005). Complications occurred in 18 eyes (25.4%). The most frequent complications were iris prolapse, Descemet's membrane and/or endothelial trauma, transient severe corneal edema and cystoid macular edema. There was no statistically significant difference in complication rates between senior surgeons and senior trainees (P = 0.66). CONCLUSION: Cataract surgery in short and nanophthalmic eyes is challenging with a higher complication rate than routine cataract surgery, but frequently results in good visual outcomes. Postoperative refractive outcomes are more difficult to predict in this cohort.

The diagnosis and management of temporal arteritis.

Temporal arteritis (TA), or giant cell arteritis, is a systemic autoimmune vasculitis affecting patients over 50 years of age. It can cause rapid, irreversible bilateral vision loss in older adults and is therefore considered an ophthalmological emergency. Many of the symptoms and signs of TA can be vague, non-specific and gradual in onset, often leading to a delayed or inaccurate diagnosis. As such, it is important for a wide variety of primary optometrists and health practitioners to maintain a robust understanding of the clinical presentation, key investigations and time-sensitive management of this disease, as early initiation of treatment for TA can be vision- and life-saving.

Neurosyphilis presenting as visually asymptomatic bilateral optic perineuritis.

A 39-year-old Caucasian man presented with headaches and retro-orbital pain but normal vision. Bilateral optic nerve swelling was found on funduscopy though optic nerve function and computed perimetry were normal and there was no relative afferent pupillary defect. CT venogram and MRI were unremarkable. Cerebrospinal fluid (CSF) opening pressure was normal on lumbar puncture and Treponema pallidum antibodies and T. pallidum particle agglutination test were positive on CSF analysis. He tested negative for HIV. Symptoms rapidly resolved with 2 weeks of intravenous benzylpenicillin. At 1 month follow-up, the right optic nerve swelling had reduced while the left optic nerve swelling had increased; his vision remained unaffected and he was symptom free and continued to have no objective evidence of optic nerve dysfunction.

Acute myopic shift in a patient with systemic lupus erythematosus.

PURPOSE: To describe a rare case of acute, transient myopic shift occurring as a feature of a flare of systemic lupus erythematosus. OBSERVATIONS: A 22-year-old Indigenous Australian woman with diagnosed systemic lupus erythematosus was admitted with blurry vision and periorbital oedema. She had a refractive error of -7.50 DS in the right eye and -3.50 DS in the left eye and cotton wool spots throughout the posterior poles of the retina of each eye. Treatment with intravenous and oral steroids resulted in rapid resolution of myopia and improvement in visual acuity. CONCLUSIONS AND IMPORTANCE: Systemic lupus erythematosus disproportionately affects more indigenous than non-indigenous Australians with greater disease burden and severity. This case describes a rare manifestation of this disease.