PurposeThe purpose of this study was to assess the causes and possible solutions for patient dissatisfaction after the implantation of presbyopia-correcting intraocular lenses (IOLs).MethodsThis study was a retrospective review of clinical records. All patients who were seen between January 2009 and December 2013 whose primary reason for consultation was dissatisfaction with visual performance after presbyopia-correcting IOL implantation were included in the study. A single treating physician, who determined the most probable cause of dissatisfaction, decided which interventions to pursue following the initial consultation.ResultsData from 74 eyes of 49 patients were analyzed. The most common cause for complaint was blurry or foggy vision both for distance and near (68%). Complaints were most frequently attributed to residual refractive error (57%) and dry eye (35%). The most common interventions pursued were treatment of refractive error with glasses or contact lenses (46%) and treatment for dry eye (24%). Corneal laser vision correction was done in 8% of eyes; 7% required an IOL exchange. After the interventions, 45% of patients had completed resolution of symptoms, 23% of patients were partially satisfied with the results, and 32% remained completely dissatisfied with the final results.ConclusionThe most identifiable causes of dissatisfaction after presbyopia-correcting IOL implantation are residual refractive error and dry eye. Most patients can be managed with conservative treatment, though a significant number of patients remained unsatisfied despite multiple measures.

Purpose: To evaluate the epidemiology of persistent post-surgical pain (PPP) manifesting as dry eye (DE)-like symptoms 6 months after surgery. Methods: The single-center study population included 119 individuals whose cataract surgeries were performed by a single surgeon at the Bascom Palmer Eye Institute and who agreed to participate in a phone survey six months after surgery. Patients were divided into two groups: PPP group was defined as those with a Dry Eye Questionnaire-5 (DEQ5) score≥6 and without PPP (WoPPP) as those with DEQ5 score<6 at six months after cataract surgery. Results: The mean age of the study population was 73±8.0 years; 55% (n=66) were female. PPP was present in 34% (n=41) of individuals six months after surgery. Factors associated with an increased risk of PPP were female gender (Odds ratio (OR)=2.68, 95% confidence interval (CI)=1.20–6.00, p=0.01), autoimmune disorder (OR=13.2,CI=1.53–114,p=0.007), non-ocular chronic pain disorder (OR=4.29,CI=1.01–18.1,p=0.06), antihistamine use (OR=6.22,CI=2.17–17.8,p=0.0003), anti-reflux medication use (OR=2.42,CI=1.04–5.66,p=0.04), antidepressant use (OR=3.17,CI=1.31–7.68,p=0.01), anxiolytic use (OR=3.38,CI=1.11–10.3,p=0.03), and anti-insomnia medication use (OR=5.28,CI=0.98–28.5,p=0.047). PPP patients also reported more frequent artificial tears use (p<0.0001), higher ocular pain levels (p<0.0001), and greater neuropathic ocular pain symptoms, including burning (p=0.001), wind sensitivity (p=0.001), and light sensitivity (p<0.0001). Conclusions: PPP in the form of persistent dry eye-like symptoms is present in approximately 34% of individuals six months after cataract surgery. The frequency of PPP after cataract surgery is comparable with that of other surgeries including laser refractive surgery, dental implants, and genitourinary procedures.

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Purpose Stenotrophomonas maltophilia, an uncommon cause of infectious keratitis, is difficult to treat due to its resistance to multiple antibiotics. The purpose of this study is to describe the clinical features, antibiotic susceptibility profile, and outcomes of S. maltophilia keratitis. Methods A retrospective review of records from 1987–2014 identified 26 eyes of 26 patients who were treated at the Bascom Palmer Eye Institute for a S. maltophilia corneal ulcer. Clinical data was analyzed as to predisposing factors, clinical presentation, antibiotic susceptibility, treatment selection and clinical outcomes. Results Median age at presentation was 64.9 years (range, 16.0 – 97.7). Twelve patients were using topical corticosteroids, 8 patients had a history of penetrating keratoplasty and 9 were contact lens wearers. All patients received topical antibiotics, two required a therapeutic penetrating keratoplasty, and one was enucleated. At presentation, 57.7% (15/26) of the patients had visual acuity 20/400 or worse. At the final visit only 30.4% (7/23) of the patients had visual acuity worse than 20/400, while 65.2% (15/23) of the patients were at 20/100 or better. Almost all isolates (25/26, 96.2%) were susceptible to fluoroquinolones and 77.3% (17/22) of them to polymyxin B/trimethoprim. Only 33.3% (5/15) of the tested isolates were susceptible to aminoglycosides and 58.3% (7/12) to cephalosporins. Conclusion Infectious keratitis due to S. maltophilia presents a treatment challenge due to its resistance to aminoglycosides and cephalosporins, which are typically used for empiric broad-spectrum gram-negative coverage as fortified solutions. Fluoroquinolones and polymyxin B/trimethoprim should be considered instead in cases of S. maltophilia infection.

Purpureocillium keratitis can have devastating consequences to visual function and even lead to enucleation. Physicians should make every effort to arrive at an earlier microbiological diagnosis, as this is associated with better outcomes and less need for surgical intervention. The first line use of voriconazole is recommended, and steroid use should be avoided, as their previous use is associated with worse visual outcomes.