Nocardia arthritidis scleritis: A case report.

Purpose: This report describes a case and management of a 69-year-old female with infectious scleritis found to be caused by Nocardia arthritidis species. Observations: Our patient presented with severe constant pain in the left eye (OS) following cataract surgery. She had a pertinent past medical history significant for renal transplantation (on oral tacrolimus, mycophenolate, and prednisone). Slit lamp examination OS (1 month after cataract surgery) demonstrated 3+ injection temporally accompanied by scleral thickening and multiloculated abscesses with purulent drainage from small conjunctival erosions. The abscesses were debrided and sent for gram stain and culture. The patient was treated with repeated subconjunctival injections of antibiotics and an antifungal; topical amphotericin, vancomycin, and amikacin; and oral trimethoprim-sulfamethoxazole (double strength). Two separate gram stains with cultures confirmed the diagnosis and species identification. The patient responded well to repeat subconjunctival injections early on in addition to the prescribed regimen, remaining free of disease at the last follow-up (12 months following presentation). Conclusions and Importance: This unique case demonstrates infectious scleritis caused by an uncommon Nocardia species (N. arthritidis) that was successfully treated with similar strategies used for other reported Nocardia species. As Nocardia scleritis can lead to adverse outcomes if not treated promptly and properly, it should be considered on the differential diagnoses in an immunocompromised patient who presents with acute ocular symptoms after any recent ocular surgery.

Intraocular lens power calculation after two different successive corneal refractive surgeries.

Purpose: To report two challenging intraocular lens power calculation cases with patients each underwent different successive corneal refractive surgeries, respectively. Observations: Biometry data, including the Back to Front corneal radii ratio (B/F ratio), were collected by Lenstar, IOL Master, and Pentacam AXL for Case 1 (received radial keratotomy (RK) and photorefractive keratectomy (PRK)) and Case 2 (received RK and laser-assisted in situ keratomileusis (LASIK)). The IOL power calculation was determined by several methods, including Shammas, Haigis-L, and Barrett True-K, which are available in the American Society of Cataract and Refractive Surgery online calculator and Pentacam AXL. The Barrett True-K (no history, post-RK) was more accurate in Case 1 (increased B/F ratio), whereas the Shammas, Haigis-L, and Barrett True-K (no history, post-LASIK/PRK) were more accurate in Case 2 (decreased B/F ratio). Conclusion and importance: The B/F ratio may be a factor to be considered when selecting the IOL power calculation formula for patients who undergo two different corneal refractive surgeries. The further study focusing on this issue should be performed to clarify the results in the future.

Monovisión con láser de excímeros en pacientes présbitas / Monovision with Excimer laser surgery in presbyopic patients

OBJETIVO: Describir los resultados refractivos obtenidos mediante la cirugía con láser de excímeros en pacientes présbitas hipermétropes y miopes con monovisión. MÉTODOS: Se realizó un estudio descriptivo, longitudinal prospectivo, con 60 pacientes, 18 miopes y 42 hipermétropes sometidos a cirugía con láser de excímeros para corregir la presbicia con el método de la monovisión en el Servicio de Córnea y Cirugía Refractiva del Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período comprendido entre febrero del 2009 y febrero del 2010. Las variables utilizadas fueron: agudeza visual con corrección preoperatoria y posoperatoria y sin ellas (lejos y cerca), y equivalentes esféricos. Para presentar la información se utilizó la media y desviación estándar de ambas. RESULTADOS: En el preoperatorio se observó que la agudeza visual promedio mejoraba de un valor de 0,1 y 0,3 sin corrección para miopes e hipermétropes, respectivamente a 0,94 y 0,97 de agudeza visual binocular sin corrección para estos mismos grupos en el posoperatorio, lo cual corrige de esta manera equivalentes esféricos promedios de -4,63 dioptrías y +2,21 dioptrías en cada grupo. La agudeza visual cercana promedio para ambos grupos fue de Jeager 1 - 2 y los equivalentes esféricos promedios alcanzados para visión lejana fueron de -0,02 ± 0,27 dioptrías para miopes y +0,09 ± 0,34 dioptrías para hipermétropes; en visión cercana, o sea, en el ojo no dominante fue de -1,7 ± 0,22 dioptrías para el primer grupo y de -1,4 ± 0,38 dioptrías para el segundo grupo. CONCLUSIONES: Se halló mejoría de la agudeza visual sin corrección tanto para la visión lejana como para la cercana después de la cirugía. Los equivalentes esféricos fueron ampliamente modificados para ambos grupos tanto en los ojos dominantes como en los no dominantes para facilitar el resultado visual en ambas distancias con la precisión en los resultados visuales antes previstos que caracterizan a la cirugía con láser de excímeros

OBJECTIVES: To describe the refractive results achieved with Excimer laser surgery in presbyopic patients, both hyperopic and myopic, with monovision. METHODS: A prospective, longitudinal and descriptive study was performed on 60 presbyopic patients, 18 myopic and 42 hyperopic, who underwent Excimer laser surgery to correct presbyopia based on the monovision method at the Corneal and Refractive Surgery Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from February 2009 to February 2010. The variables used were pre- and post-operative visual acuity with correction, visual acuity without binocular correction, both near and distant, and spheral equivalents. For presenting this information, the mean and standard deviation were used for all variables. RESULTS: In the preoperative phase, it was observed that average visual acuity improved from 0,1 and 0,3 for myopic and hyperopic patients without correction, to 0,94 and 0,97 binocular visual acuity without correction for the same groups in the postoperative phase, thus correcting their average spherical equivalent of 4,63 D and +2,21 D respectively. Average near visual acuity for both groups was Jeager (J) 1 - 2 and average spheral equivalents reached for distant vision were 0,02 ± 0, 27 D for myopic and +0.09 ± 0,34 D for hyperopic patients. For near vision, i.e. in the non- dominant eye, the spheral equivalent values were 1.7 ± 0,22 D for myopic and 1.4 ± 0,38 D for hyperopic patients. CONCLUSIONS: After surgery both myopic and hyperopic patients experienced improvement in their visual acuity without correction for distant as well as for near vision. Spheral equivalents were widely modified in both groups for the dominant and non-dominant eyes, in order to facilitate the final visual result in both distances with the foreseen precision in the visual results that characterizes the Excimer laser surgery

Monovisión con láser de excímeros en pacientes présbitas / Monovision with Excimer laser surgery in presbyopic patients

OBJETIVO: Describir los resultados refractivos obtenidos mediante la cirugía con láser de excímeros en pacientes présbitas hipermétropes y miopes con monovisión. MÉTODOS: Se realizó un estudio descriptivo, longitudinal prospectivo, con 60 pacientes, 18 miopes y 42 hipermétropes sometidos a cirugía con láser de excímeros para corregir la presbicia con el método de la monovisión en el Servicio de Córnea y Cirugía Refractiva del Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período comprendido entre febrero del 2009 y febrero del 2010. Las variables utilizadas fueron: agudeza visual con corrección preoperatoria y posoperatoria y sin ellas (lejos y cerca), y equivalentes esféricos. Para presentar la información se utilizó la media y desviación estándar de ambas. RESULTADOS: En el preoperatorio se observó que la agudeza visual promedio mejoraba de un valor de 0,1 y 0,3 sin corrección para miopes e hipermétropes, respectivamente a 0,94 y 0,97 de agudeza visual binocular sin corrección para estos mismos grupos en el posoperatorio, lo cual corrige de esta manera equivalentes esféricos promedios de -4,63 dioptrías y +2,21 dioptrías en cada grupo. La agudeza visual cercana promedio para ambos grupos fue de Jeager 1 - 2 y los equivalentes esféricos promedios alcanzados para visión lejana fueron de -0,02 ± 0,27 dioptrías para miopes y +0,09 ± 0,34 dioptrías para hipermétropes; en visión cercana, o sea, en el ojo no dominante fue de -1,7 ± 0,22 dioptrías para el primer grupo y de -1,4 ± 0,38 dioptrías para el segundo grupo. CONCLUSIONES: Se halló mejoría de la agudeza visual sin corrección tanto para la visión lejana como para la cercana después de la cirugía. Los equivalentes esféricos fueron ampliamente modificados para ambos grupos tanto en los ojos dominantes como en los no dominantes para facilitar el resultado visual en ambas distancias con la precisión en los resultados visuales antes previstos que caracterizan a la cirugía con láser de excímeros(AU)

OBJECTIVES: To describe the refractive results achieved with Excimer laser surgery in presbyopic patients, both hyperopic and myopic, with monovision. METHODS: A prospective, longitudinal and descriptive study was performed on 60 presbyopic patients, 18 myopic and 42 hyperopic, who underwent Excimer laser surgery to correct presbyopia based on the monovision method at the Corneal and Refractive Surgery Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from February 2009 to February 2010. The variables used were pre- and post-operative visual acuity with correction, visual acuity without binocular correction, both near and distant, and spheral equivalents. For presenting this information, the mean and standard deviation were used for all variables. RESULTS: In the preoperative phase, it was observed that average visual acuity improved from 0,1 and 0,3 for myopic and hyperopic patients without correction, to 0,94 and 0,97 binocular visual acuity without correction for the same groups in the postoperative phase, thus correcting their average spherical equivalent of 4,63 D and +2,21 D respectively. Average near visual acuity for both groups was Jeager (J) 1 - 2 and average spheral equivalents reached for distant vision were 0,02 ± 0, 27 D for myopic and +0.09 ± 0,34 D for hyperopic patients. For near vision, i.e. in the non- dominant eye, the spheral equivalent values were 1.7 ± 0,22 D for myopic and 1.4 ± 0,38 D for hyperopic patients. CONCLUSIONS: After surgery both myopic and hyperopic patients experienced improvement in their visual acuity without correction for distant as well as for near vision. Spheral equivalents were widely modified in both groups for the dominant and non-dominant eyes, in order to facilitate the final visual result in both distances with the foreseen precision in the visual results that characterizes the Excimer laser surgery(AU)