Reduced corneal endothelial cell density after toxic anterior segment syndrome (TASS) caused by inadvertent intraocular ointment migration: A case report.

INTRODUCTION AND IMPORTANCE: Toxic anterior segment syndrome (TASS) is an acute sterile inflammation of the anterior segment which may occur after surgery. This case presents endothelial cell density (ECD) loss due to months of TASS caused by intraocular migration of ocular ointment. The chronicity of this case and the clinical consequences are rare in the literature. CASE PRESENTATION: A Colombian 71-year-old man developed TASS secondary to intraocular ointment migration after uneventful cataract surgery with phacoemulsification and intraocular lens placement in the capsular bag. The main complaint for the patient was a chronic red eye, no pain or visual disturbance were reported, rheumatologic diseases were discarded. It was documented the presence of intraocular ointment in the anterior chamber, over the iris and in the anterior chamber angle. The ECD was reduced secondary to TASS and the long-term presence of ointment moving in the anterior chamber, so it had to be removed. CLINICAL DISCUSSION: It is important to avoid using ocular ointment after intraocular surgeries to avoid the risk of ointment migration into the anterior chamber. Intraocular ointments should be removed promptly to reduce ECD loss as documented in the present case report in which after ointment elimination ECD remains stable for 7 years. CONCLUSION: Topical ointments should not be used after routine cataract surgery because of the risk of intraocular ointment migration and subsequent risk of developing TASS and reduced ECD.

Ten years of intraoperative floppy iris syndrome in the era of α-blockers.

INTRODUCTION: The use of alpha-1 receptor antagonists in the treatment of benign prostatic hyperplasia (BPH) has created a problem in ophthalmic surgery, the so-called intraoperative floppy iris syndrome (IFIS). This consists of a billowing iris, insufficient pupillary dilation with progressive intraoperative miosis, and protrusion of iris tissue through the tunnel and side port incision that are made for access to the anterior chamber during surgery. IFIS presents particular difficulties in cataract surgery which is carried out through the pupil with manipulations in the immediate vicinity of the iris. The complications range from poor visibility of the operative field to iris damage with the surgical instruments and to rupture of the posterior capsule, with loss of lens material into the vitreous body. MATERIAL AND METHODS: A comprehensive literature review was performed using MEDLINE with MeSH terms and keywords 'benign prostatic hyperplasia', 'intraoperative floppy iris syndrome', 'adrenergic alpha-antagonist' and 'cataract surgery'. In addition, reference lists from identified publications were reviewed to identify reports and studies of interest from 2001 to 2017. RESULTS: The A total of 95% of experienced ophthalmologic surgeons reported that systematic treatment with tamsulosin represents a challenging surgical condition increasing the risk of complications. Alpha-blockers are commonly prescribed, with 1,079,505 packages of tamsulosin prescribed each month in 2014 in Austria. Dose modification may be one way to reduce the risk of IFIS. A lower incidence of IFIS was reported in patients on tamsulosin in Japan, but the recommended dosage was lower than that used in Europe and the US (0.2 mg vs. 0.4 mg). CONCLUSIONS: We showed that not all patients taking tamsulosin experience IFIS. Moreover, larger investigations with a prospective design are needed, including studies to monitor the pre- and post-therapeutic ophthalmologic changes under tamsulosin, as well as urodynamic improvements resulting from this therapy.

Influence of phacoemulsification combined with limbal relaxing incisions for preoperative astigmatism on corneal high-order aberrations / 中华实验眼科杂志

Background phacoemulsification combined with limbal relaxing incision (LRI) is reported to be effective for the management of coexisting cataract astigmatism,but the influence of after phacoemulsification with LRI on corneal high-order aberration is still rarely reported.Objective This study was to evaluate the effect of cataract surgery with LRI for preoperative astigmatism or on corneal high-order aberration.Methods A selfcontrolled serial cases observational study was designed.A total of 35 cataractous eyes of 35 patients with astigmatism ≥ 1.0 D before cataract surgery were enrolled in Tianjin Medical University Eye Hospital from August 2014 to April 2015 under the informed consent of patients.LRIs were performed on the eyes during the phacoemulsification and IOL implantation.The uncorrected visual acuity (UCVA),BCVA and optometry were recorded before operation and 1 day,1 week,1 month,3 months after operation.Pentacam was employed to measure the maximal and minimal diopters,astigmatism and high-order aberrations within 3 mm of the anterior corneal surface at above-mentioned time points.All the results were compared among different time points.The optometry outcomes and the anterior corneal surface astigmatism change were analyzed using vector analysis method.Results The UCVA was 0.34 ±0.22,0.38 ± 0.25,0.43±0.27,0.42±0.28 in 1 day,1 week,1 month and 3 months after operation,which was significantly higher than 0.08 ±0.09 before operation;and the BCVA was 0.54 ± 0.27,0.64 ± 0.29,0.67 ± 0.29,0.71 ± 0.32 in 1 day,1 week,1 month and 3 months after operation,showing a significant increase in comparison with 0.22±0.51 before operation(F=54.457,P=0.000;F =62.653,P =0.000).The refractive cylindrical error and corneal astigmatism were significantly decreased after operation in comparison with before operation (F =31.061,P =0.000;F =113.043,P=0.000).High order aberrations (HOA) at postoperative 1 day,1 week,1 month,3 months were all higher than those in preoperation (F =11.189,P =0.000) under the 4 mm pupil diameter.Compared with preoperation,the vertical coma,secondary vertical coma and three leaf clover were significantly increased(all at P＜0.05),but the horizontal coma and primary spherical aberration were not significantly changed (all at P＞0.05) under the 6 mm pupil diameter.Conclusions Phacoemulsification combined with LRI can reduce the corneal astigmatism effectively and steadily,and the increase of corneal aberrations does not affect visual acuity.

Spontaneously resolving descemet's membrane detachment caused by an ophthalmic viscosurgical device during cataract surgery.

We present a case of a central Descemet's membrane detachment (DMD) induced by an Ophthalmic Viscosurgical Device during phacoemulsification surgery that resolved spontaneously, leaving a best spectacle corrected visual acuity of 20/20. The detachment was monitored with serial anterior segment optical coherence tomography images. Most cases of central DMD reported in the literature have been managed surgically to facilitate rapid visual recovery and minimize the risk of scarring. Our case adds to the literature in providing an alternative management strategy where surgical intervention may not be possible.

The floppy iris syndrome - what urologists and ophthalmologists need to know.

INTRODUCTION: Benign prostatic hyperplasia (BPH) and cataract formation are common in older people. Medical management of symptomatic BPH is often preferred to surgical treatment as surgery increases the risk of morbidities, whereas, surgery is the main form of treatment to restore sight in patient with cataract. The clinical treatment of BPH is either alpha-1 adrenergic antagonist alone or combination of alpha reductase inhibitor and alpha adrenergic receptor (AR) antagonist. There are four alpha-AR antagonists currently available to treat BPH. The uroselective alpha-blocker tamsulosin is the most commonly used drug among all. Studies showed that the majority of the patients who develop intraoperative floppy iris syndrome (IFIS) were on tamsulosin. Women are more likely to develop cataract than men and some recent studies showed that tamsulosin is effective in treating female lower urinary tract symptoms and thereby can cause IFIS during cataract surgery. EVIDENCE ACQUISITION: We performed a critical review of the published articles and abstracts on association of IFIS with alpha-blockers and other medications as well as other medical conditions. EVIDENCE SYNTHESIS: Tamsulosin is the most common cause of formation of IFIS. However, not all patients given tamsulosin develop IFIS and cases have been reported without any tamsulosin treatment. CONCLUSION: Tamsulosin is a recognized cause to impede mydriasis and lead to IFIS during cataract surgery. Urologist should collaborate with their ophthalmology colleagues and general practitioner during prescribing tamsulosin in patients with history of cataract or waiting for planned cataract surgery. The increasing life expectancy and growth of older people will increase the number of men and women who suffer from lower urinary tract symptoms as well as cataract. Therefore, further research and studies are required to properly understand the relation of alpha blockers and IFIS.

Benign prostatic hyperplasia: clinical treatment can complicate cataract surgery

PURPOSE: To investigate the effects of alpha-1 adrenergic receptor antagonists for the treatment of benign prostatic hyperplasia (BPH) regarding potential risks of complications in the setting of cataract surgery. AIM: To address recommendations, optimal control therapy, voiding symptoms and safety within the setting of cataract surgery. MATERIALS AND METHODS: A comprehensive literature review was performed using MEDLINE with MeSH terms and keywords "benign prostatic hyperplasia", "intraoperative floppy iris syndrome", "adrenergic alpha-antagonist" and "cataract surgery". In addition, reference lists from identified publications were reviewed to identify reports and studies of interest from 2001 to 2009. RESULTS: The first report of intraoperative floppy iris syndrome (IFIS) was observed during cataract surgery in patients taking systemic alpha-1 AR antagonists in 2005. It has been most commonly seen related to use of tamsulosin. Changes of medication and washout periods of up to 2 weeks have been attempted to reduce the risk of complications in the setting of cataract surgery. CONCLUSION: Patients under clinical treatment for BPH should be informed about potential risks of this drug class so that it can be discuss with their healthcare providers, in particular urologist and ophthalmologist, prior to cataract surgery.

Intraocular Lens implantation in cataract with high myopia / 眼科

Extracapsular cataract extraction (ECCE) with primary posterior chamber intraocular lens (IOL) implantation was performed on 31 cases (38 eyes)of cataract with high myopia of axial length over 26mm and preoperative retinal visual acuity of ≥0.5. They were followed up for 3～26 months. Postoperative visual acuity s. c. was ≥0.5 in 65.8％ of the eyes and visual acuity c.c. was ≥0.5 in 92.1％ and 1.0～1.5 in 52.6％ of the eyes. The results showed that it was fairly possible for cataract patients with high myopia to obtain normal vision after ECCE and IOL implantation when the preoperative retinal acuity was ≥0.5. The calculation of lens power and surgical procedures were described, and the indications for the operation and the managements of complications were discussed as well.