ABSTRACT: To evaluate the efficacy of intracameral phenylephrine (IPH) administered as prophylaxis against intraoperative floppy iris syndrome (IFIS) and to analyze the ability of IPH to reverse IFIS.
Prospective, multicenter, randomized, comparative case series of fellow eyes.
Forty-two patients receiving tamsulosin who underwent cataract surgery between January and April 2011.
Phacoemulsification was performed by 2 experienced surgeons at 2 surgical sites (Complexo Hospitalario Universitario Orense and Complexo Hospitalario Universitario A Coruña). One eye of each patient was randomized to receive 0.6 ml of nonpreserved bisulfite-free IPH 1.5% (group 1) or balanced saline solution (group 2) at the start of surgery. If significant miosis or iris prolapse occurred, IPH was injected during phacoemulsification in group 2. No changes were performed in the surgeon's standard fluidic parameters or viscoelastic preferences. Routine topical mydriatics were instilled before surgery. Intraoperative iris billowing and prolapse and pupil size were recorded and videotaped. Surgical complications; adverse events; pre- and postoperative pulse rate and blood pressure; and final best-corrected visual acuity (BCVA), intraocular pressure (IOP), and endothelial cell count (ECC) were recorded.
Incidence of IFIS and change in pupil size after IPH administration in those eyes of group 2 requiring IPH because of significant miosis or iris prolapse.
Signs of IFIS were observed in 88.09% of eyes in group 2. No signs of IFS were noted in group 1 (P < 0.001). Significant miosis, iris prolapse, or both occurred in 54.76% of eyes in group 2, although the condition was successfully reverted with IPH, with a significant increase in pupil size after IPH administration (from 4.77±0.88 mm to 6.68±0.93 mm; P=0.000). No intraoperative complications occurred. No significant differences in ECC, BCVA, or IOP were detected between IPH-treated and nontreated eyes. Blood pressure/pulse rate did not differ significantly from preoperative values in IPH-treated cases.
Intracameral phenylephrine is a highly efficient measure for prophylaxis against IFIS. Moreover, the drug can reverse IFIS, restoring iris rigidity and causing the pupil to return to its preoperative size.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Ophthalmology 06/2012; 119(10):2053-8. · 5.45 Impact Factor
ABSTRACT: To evaluate the incidence, culture results, risk factors, treatment strategies, and visual outcomes of infectious keratitis after surface ablation.
Multicenter study in Spain.
The medical records of patients who had surface ablation between January 2003 and December 2009 were reviewed to identify cases of infectious keratitis. The incidence, risk factors, clinical course, days to diagnosis, medical and surgical treatment, and visual outcome were recorded. Main outcome measures were incidence of infectious keratitis after surface ablation, culture results, response to treatment, and visual outcomes.
The study reviewed the records of 9794 patients (18,651 eyes). Infectious keratitis after surface ablation was diagnosed in 39 eyes of 38 patients. The onset of infection was early (within 7 days after surgery) in 28 cases (71.79%). Cultures were positive in 13 of 27 cases in which samples were taken. The most frequently isolated microorganism was Staphylococcus species (9 cases). The final corrected distance visual acuity (CDVA) was 20/20 or better in 23 cases (58.97%), 20/40 or better in 36 cases (92.30%), and worse than 20/40 in 3 cases (7.69%).
The incidence of infectious keratitis after surface ablation was 0.20%. Infectious keratitis is a potentially vision-threatening complication. Prompt and aggressive management with an intensive regimen of fortified antibiotic agents is strongly recommended. Proper management can preserve useful vision in most cases.
No author has a financial or proprietary interest in any material or method mentioned.
Journal of cataract and refractive surgery 08/2011; 37(10):1822-31. · 2.75 Impact Factor
Ophthalmology 02/2011; 118(2):425-425.e1. · 5.45 Impact Factor
ABSTRACT: To evaluate the characteristics of and risk factors for spontaneous late in-the-bag intraocular lens (IOL) dislocation and to analyze the outcomes of surgical correction.
Department of Ophthalmology, Complejo Hospitalario Orense, Orense, Spain.
In this retrospective single-surgeon interventional case series, the surgical database of a referral center was searched for cases of late spontaneous in-the-bag IOL dislocation between 2005 and 2009. The main outcome measures were interval between surgery and dislocation, dislocation site and grade, IOL type, associated capsular tension ring (CTR), predisposing factors, surgical technique to correct dislocation, preoperative and postoperative corrected distance visual acuity (CDVA), and surgical complications.
Pseudoexfoliation was the main risk factor for in-the-bag IOL dislocation (66.66% of 45 cases identified). A CTR was present in the capsular bag in 8 cases. Dislocation was corrected by repositioning using scleral fixation (20 cases) or iris suturing (1 case), IOL exchange for an anterior chamber IOL (AC IOL) (19 cases) or iris-claw IOL (4 cases), or (3) anterior capsulotomy (1 case). The mean CDVA improved significantly postoperatively (P = .0001); it was 20/40 or better in 28 eyes (62.22%) and 20/25 or better in 10 eyes (22.22%). There was no significant difference in postoperative CDVA between scleral-fixated IOLs and AC IOLs (P = .316).
Pseudoexfoliation was the main risk factor for in-the-bag IOL dislocation. The presence of a CTR in the bag did not prevent dislocation. Satisfactory results were achieved with a low rate of complications using different surgical techniques to correct IOL position.
No author has a financial or proprietary interest in any material or method mentioned.
Journal of cataract and refractive surgery 08/2010; 36(8):1270-82. · 2.75 Impact Factor
ABSTRACT: To investigate the incidence, culture results, risk factors, and visual outcomes of infectious keratitis after LASIK, and examine treatment strategies.
We included 107 613 patients who underwent LASIK at Clínica Baviera (Instituto Oftalmológico Europeo, Spain) from September 2002 to May 2008.
The medical records of post-LASIK patients (204 586 eyes) were reviewed to identify cases of infectious keratitis. Incidence, risk factors, clinical course, days to diagnosis, medical and surgical treatment, and final visual outcomes were recorded.
Incidence of post-LASIK infectious keratitis, culture results, response to treatment, and visual outcome.
Post-LASIK infectious keratitis was diagnosed in 72 eyes from 63 patients. Onset of infection was early (within 7 days after surgery) in 62.5% of cases. Cultures were positive in 21 of 54 cases in which samples were taken. The most frequently isolated microorganism was Staphylococcus epidermidis (9 cases). Immediate flap lifting and irrigation with antibiotics was performed in 54 eyes; late flap lifting was subsequently required in 10 out of 18 cases initially treated with topical antibiotics alone. One case required flap amputation owing to flap necrosis. Final best spectacle-corrected visual acuity (BSCVA) was >or=20/20 in 38 cases (52.7%) and >or=20/40 in 67 cases (93.05%); final BSCVA was <20/40 in 5 cases (6.94%).
The incidence of post-LASIK infectious keratitis was 0.035% per procedure. Infectious keratitis after LASIK is a potentially vision-threatening complication. The appearance of infections in asymptomatic patients highlights the need for a proper schedule of follow-up appointments. Prompt and aggressive management of this LASIK complication with early flap lifting, scraping, culture, and irrigation with antibiotics is strongly recommended. Proper management can result in preserving useful vision.
The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Ophthalmology 12/2009; 117(2):232-8.e1-4. · 5.45 Impact Factor
Journal of refractive surgery (Thorofare, N.J.: 1995) 10/2009; 25(10):844-5. · 2.54 Impact Factor
British Journal of Ophthalmology 06/2007; 91(5):699. · 2.90 Impact Factor
ABSTRACT: To report epithelial perilenticular opacity as a new complication of intracorneal inlay implantation for the correction of hyperopia.
Prospective observational case series.
Eleven eyes of 7 patients underwent intracorneal inlay implantation for the correction of hyperopia.
Intracorneal inlays were implanted onto the stromal bed by using a microkeratome cut to create an inferior hinged corneal flap.
Postoperative complication occurrence of intracorneal perilenticular opacity, microbiological laboratory analysis, histopathological analysis, and confocal microscopy study.
Of 11 implanted eyes, 5 showed diffuse perilenticular opacity of varying intensity that was unresponsive to steroid use following intracorneal inlay implantation. All patients had moderate to severe loss of best-corrected visual acuity. The inlays showed deposits at the edge and on the surface. Confocal microscopy in all eyes produced images compatible with the confocal morphologic features of epithelial cells. Explantation of inlays was performed in 5 eyes. The histopathologic study showed the presence of epithelial cells, and microbiological analysis and cultures were negative for bacteria, fungi, and mycobacteria.
Epithelial perilenticular opacity is a new and serious complication in patients with intracorneal inlay implantation for the correction of hyperopia.
Archives of Ophthalmology 11/2004; 122(10):1441-6. · 3.71 Impact Factor
ABSTRACT: To study the quality of the cut created by 3 microkeratomes from 2 different generations using corneal confocal microscopy.
Department of Refractive Surgery, Instituto Oftalmológico de Alicante, Alicante, Spain.
Two different studies were conducted: Study 1 and Study 2. Study 1 was a prospective analysis using confocal microscopy examination data from 2 reference groups: Group A (control) with 20 nonoperated eyes of 20 healthy volunteers, and Group B with 50 eyes of 30 patients operated on with the Bausch & Lomb Automated Corneal Shaper (ACS) microkeratome. Study 2 was a prospective randomized double-masked study in which 40 eyes of 20 patients underwent myopic laser in situ keratomileusis by 1 surgeon. The right and left eyes of each patient were randomly and alternatively assigned to Group C, flap made with the Hansatome microkeratome, or Group D, flap made with the Moria M2. Immediately after surgery, the microscopic appearance of the cut was subjectively evaluated by the surgeon. One month postoperatively, flap thickness, particle density, and the subclinical confocal wound healing opacity (WHO) index were evaluated with the corneal confocal microscope.
Surgeon handling comfort was nearly the same with the Hansatome as with the M2 (P =.540). However, the apparent quality of the resulting flap was better with the M2 microkeratome (P =.041). The depth of the cuts made by the 3 microkeratomes were significantly different (P<.001), with the ACS flaps being thinner than the flaps made with the Hansatome or the M2. Particle density at the interface was significantly poorer in the eyes operated on with the ACS, but in these cases the WHO index was significantly greater (P<.001 in both cases).
Confocal microscopy is a very useful tool to evaluate the quality of the cut made by different microkeratomes. Overall, the predictability in flap thickness and the apparent quality of the cut made by the Moria M2 microkeratome are better than those obtained with the Hansatome or the ACS. The thin flap made by the ACS microkeratome produced a significantly greater WHO index than the thicker flaps created with the other 2 microkeratomes.
Journal of Cataract [?] Refractive Surgery 06/2004; 30(6):1300-9. · 2.26 Impact Factor