PURPOSE:The purpose of the study is to develop a novel nomogram and validate with a retrospective comparative study for manual astigmatic keratotomy (MAK) with the assistance of intraoperative aberrometry (Optiwave Refractive Analysis [ORA]) and digital eye tracking (VERION) in mild astigmatic correction enhancement.SETTING:The study was conducted in Honolulu, Hawaii.DESIGN:This was a single-surgeon comparative study with retrospective data collection.METHODS:Sixty consecutive adult cataract surgery cases with regular astigmatism of 1.25 D or less were included for study from April 2016 to April 2017. VERION was used preoperatively in all cases. MAK was performed before phacoemulsification according to the surgeon's own nomogram. ORA then was utilized to obtain the axis and remaining cylinder power after phacoemulsification and intraocular lens implant implantation. MAK extension was performed for eyes with 1 D or more of remaining cylinder. Extensions were carried out slowly and slightly until the amount of cylinder was 1½ D or less under ORA. The mean degrees of extension plus the original MAK plan were calculated to develop the new nomogram. Sixty consecutive similar cases by the same surgeon using the surgeon's nomogram without using ORA/VERION for enhancement were reviewed from April 2015 to April 2016 for comparison. All patients included in this study signed the consent form.RESULTS:Using Alpins vector analysis for comparison, the proportion of patients with cylinder <0.5 D 3 months postoperatively was 87% in the ORA/VERION group compared to 70% in the non-ORA/VERION group (P < 0.05). Better than 20/25 best-corrected visual acuity was achieved more in the ORA/VERION group compared to non-ORA/VERION group.CONCLUSIONS:This novel nomogram developed by the surgeon may have better outcomes than the old surgeon's own nomogram. Further prospective control study is needed to validate the efficacy. If validated, those surgeons who do not have ORA/VERION can hopefully use this nomogram with greater success.
PurposeUpper eyelid ptosis has different etiologies in children and adults. In children, the common causes include orbital cellulitis, congenital ptosis, Cranial Nerve (CN) III palsy, and Horner's syndrome. The purpose of this report is to discuss an unusual presentation of ptosis.ObservationsWe describe a case of a 9-year-old boy with left-sided ptosis with no apparent clinical signs of orbital or preseptal infection. Magnetic resonance imaging (MRI) revealed pansinusitis and contralateral otitis media with direct extension into the superior aspect of the left orbit affecting the levator palpebrae superioris muscle.Conclusions and importanceThis finding on imaging disclosed the etiology of an otherwise unexplained case of upper lid ptosis.
A 74-year-old male underwent uncomplicated cataract surgery of the right eye one month prior. His postoperative visual acuity was 20/20. He had LenSx assisted cataract surgery without complication. The preoperative medications included Besifloxacin 0.6% eye drops twice daily for three days with postoperative eye drops including the same antibiotic for six weeks following surgery. Intraoperatively, the surgeon himself prepped and draped the eye in the usual sterile ophthalmic fashion with povidone-iodine drops for 3 minutes along with meticulously scrubbing the lids and lashes with povidone-iodine solution. Profuse irrigation in the eye was done before the incision.One month after surgery, the patient presented with sudden mild discomfort, mild conjunctival injection, and decreased vision in the right eye. He denied trauma, recent surgery or hospitalization, fever, chills, or any other systemically infectious symptoms. He had a past medical history of hypertension, atrial fibrillation, coronary artery disease, myocardial infarction in 1999, and hypothyroidism. The past surgical history revealed that he had a pulmonary vein ablation in 2011, implantable cardioverter defibrillator in 2004, coronary artery stent in 1999, and appendectomy in 1963.His complete medication list included enalapril, levothyroxine, metoprolol, warfarin, simvastatin, etodolac, and furosemide. His eye drops included Besifloxacin 0.6% twice daily, difluprednate 0.05% twice daily, and bromfenac 0.075% twice daily all to the right eye. The patient's social history revealed that he was a retired police officer and is a black belt in karate. He was a former everyday cigarette smoker until quitting in 1990. He drank approximately 6 bottles of beer and 6 shots of whiskey per week.On the day of presentation, ocular examination showed his best corrected visual acuity to be 20/60 in the right eye and 20/30 in the left eye. Intraocular pressure was 9 mmHg in the right eye and 11 mmHg in the left eye. Slit lamp exam of the right eye revealed the following. There was mild conjunctival injection. There was mild corneal edema with Descemet's membrane folds. The anterior chamber showed about ten percent of layered hypopyon inferiorly with fibrin as shown in Figure 1. The posterior chamber intraocular lens was in good position. The fundus revealed vitreous haze with vitreous cells as shown in Figure 2. ManagementImmediate pars plana vitrectomy was performed. A vitreous specimen was collected and sent for culture. Intravitreal antibiotics were administered and the patient was placed on an intensive regimen of topical steroids. On the first day postoperative visit, the patient revealed that he had dental implant three days prior. He did not take the preoperative oral antibiotics prior to the dental procedure as instructed by his dentist. Consequently, he was given oral clindamycin following the procedure. Meanwhile, the vitreous culture grew 1+ Staphylococcus epidermidis that was sensitive to vancomycin and clindamycin but resistant to penicillin and oxacilli...
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