Surgical peripheral iridotomy creation during intraocular surgery by intraocular diathermy probe—a novel technique

A novel technique for the creation of surgical iridotomies using a bipolar diathermic probe is described. In a cohort comprising 19 eyes of 18 patients, a 100% patency rate was achieved, with no intra- or postoperative complications.

Multifocal Femto-PresbyLASIK in Pseudophakic Eyes

Background: Presbyopia treatment in pseudophakic patients with a monofocal IOL is challenging. This study investigates the refractive results of femto-PresbyLASIK and analyzes presbyopia treatment in pseudophakic eyes. Methods: 14 patients with 28 pseudophakic eyes were treated with femto-PresbyLASIK. The dominant eye was targeted at a distance and the non-dominant eye at −0.5 D. The presbyopic algorithm creates a steepness in the cornea center by using an excimer laser that leads to corneal multifocality. Results: 6 months after surgery a refraction of −0.11 ± 0.13 D (p = 0.001), an uncorrected distance visual acuity of 0.05 ± 1.0 logMAR (p < 0.001) and an uncorrected near visual acuity of 0.15 ± 0.89 logMAR (p = 0.001) were achieved in the dominant eye. For the non-dominant eye, the refraction was −0.28 ± 0.22 D (p = 0.002), the uncorrected distance of visual acuity was 0.1 ± 1.49 logMAR, and the uncorrected near visual acuity was 0.11 ± 0.80 logMAR (p < 0.001). Spherical aberrations (Z400) were reduced by 0.21–0.3 µm in 32% of eyes, and by 0.31–0.4 µm in 26% of eyes. Conclusion: By steepening the central cornea while maintaining spherical aberrations within acceptable limits, PresbyLASIK created a corneal multifocality that safely improved near vision in both eyes. Thus, femto-PresbyLASIK can be used to treat presbyopia in pseudophakic eyes without performing intraocular surgery.

Intraocular pressure and pupil diameter in healthy cats anesthetized with isoflurane and pre-medicated with isolated acepromazine or in combination with tramadol

ABSTRACT The objective of this study was to determine changes on intraocular pressure (IOP) and pupil diameter (PD) in healthy cats anesthetized with isoflurane, and premedicated with acepromazine alone or in combination with tramadol. Thirty cats were allocated in two groups (n=15/each) and were treated with acepromazine (AG) or acepromazine/tramadol (ATG). PD and IOP were assessed before and following 30 (PM1), and 40 minutes (PM2) of treatments. Anesthesia was induced with propofol, and IOP and DP were recorded (A10) at 10 minute intervals until the end of anesthesia (A40). IOP decreased in AG and ATG, when comparing baseline with PM1. IOP decreased only in AG, in comparisons between baseline and PM2. During anesthesia, IOP did not change within and between groups. Comparisons between baseline with those recorded at PM1 and 2 showed that PD increased in the ATG. During anesthesia, PD decreased significantly in AG and ATG. Both protocols maintained the IOP within the reference range to perform corneal or intraocular surgery in healthy cats but did not sustain pre-anesthetic pupil dilation observed in ATG.

Endophthalmitis Panorama in The Jerusalem Area

Purpose: The spectrum of microbial infections and the pattern of their susceptibility is variable among communities. Researching this data will lead to the establishment of the most appropriate national management strategies. The purpose of this study was to analyze the epidemiological, clinical, microbial spectrum and antibiotic susceptibility of endophthalmitis cases in a tertiary referral center in Jerusalem.Methods: Retrospective review of medical charts of patients presenting with endophthalmitis over a 12-year-period.Results: Included were 74 eyes of 70 patients (males 56%). Mean age±SD at presentation was 60±19.5 years. Exogenous endophthalmitis accounted for 78% of cases; of which, 62% followed an intraocular surgery, 21% occurred after intravitreal injections, 10% followed infectious keratitis and 7% were post-traumatic. Endogenous cases were predominantly observed in diabetic patients. Microbial isolates were identified in 44 samples. Of them, gram-positive bacteria were the predominant microorganisms detected in 33 samples (75%); Staphylococcus epidermidis and Enterococcus faecalis were the most commonly detected pathogens. Mean presenting±SD LogMAR visual acuity (VA) was 2.38±1.21 and it improved at last follow-up to 1.7±1.37 (p=0.004, paired t-test). Cases secondary to gram-positive microbes were associated with improved VA during the follow-up while cases secondary to gram-negative microbes was correlated with poor final VA (p=0.046, r2=0.4). There was no evidence of bacterial resistance in the antibiograms for either vancomycin, ceftazidime, ceftriaxone or amikacin.Conclusions: Intraocular surgery remains the most common event preceding endophthalmitis with coagulase-negative staphylococci being the most frequently detected microorganisms. The microbial spectrum of endophthalmitis is similar to that in the western world.

Factors Predisposing to Rhegmatogenous Retinal Detachment in a Tertiary Care Hospital of Pakistan

Purpose: To find out the factors predisposing to rhegmatogenous retinal detachment. Study Design: Descriptive cross sectional study. Place and Duration of Study: Liaquat National Hospital, Karachi, from October 2017 to April 2018. Methods: After approval from ethical review committee 117 patients presenting with Rhegmatogenous retinal detachment (RRD) were included in the study. A detailed history was taken including previous surgery and trauma. Complete ocular examination was performed including dilated fundus examination. Data was analyzed using SPSS version 21. Mean and standard deviation were computed for quantitative variable i.e. age and frequency. Percentages were calculated for qualitative variables i.e. gender, eye involved, lattice degeneration, trauma and intraocular surgery. Stratification was done with regards to age, gender, eye involved to see the effect of these modifiers on individual factor (lattice degeneration, trauma, intraocular surgery) by using chi square test and considering p value ≤ 0.05 as significant. Results: There were 117 patients including 91 males and 26 females. Sixty four were right eyes and fifty three were left eyes. Mean age was 37.30 ± 8.97 years. Lattice Degeneration was observed in 29.1% patents, Trauma was 37.6% and intraocular surgery was observed in 33.3% patients. There was a significant association of age with trauma (p = 0.045) and intraocular surgery (p = 0.001), which had statistically significant association with RRD. Conclusion: Intraocular surgery, trauma were significantly associated with age and RRD. However, although lattice degeneration is an established risk factors for Rhegmatogenous retinal detachment it was not associated with increased age. Key Words: Rhegmatogenous Retinal Detachment, Lattice Degeneration, Trauma, Intraocular Surgery.

Adverse Cardiovascular Effects of Phenylephrine Eye Drops Combined With Intravenous Atropine

Background: Phenylephrine and atropine can cause serious adverse effects when applied in combination. We investigated the effect of phenylephrine eye drops combined with intravenous atropine on the cardiovascular system in patients under general anesthesia undergoing intraocular surgery.Methods: The effects of the drugs were observed through clinical study. Thirteen patients undergoing intraocular surgery under general anesthesia were observed in this study; all were injected intravenously with atropine due to the oculocardiac reflex during surgery. To study the combination of drugs, an in vivo study was performed on rats. Seventy-two standard deviation rats that received phenylephrine eye drops and intravenous atropine treatment under general anesthesia were assessed, of which 18 treated with these drugs simultaneously were administered normal saline, neostigmine or esmolol. Blood pressure and heart rate were recorded and analyzed.Findings: The age of the patients ranged from seven to 14 years old with an average age of 10.7 years old, and 11 patients were male. In patients, 5% phenylephrine eye drops combined with intravenous atropine led to a significant heart rate increase and the increase lasted 20 min. The significant increase in diastolic blood pressure and systolic blood pressure lasted for 15 and 25 min, respectively. From five to 25 min after intravenous atropine treatment, the systolic blood pressure and diastolic blood pressure were both more than 20% higher than that at baseline. In rats, the changes in blood pressure and heart rate were independent of the phenylephrine and atropine administration sequence but were related to the administration time interval. The neostigmine group showed a significant decrease in blood pressure after the increase from the administration of phenylephrine and atropine.Interpretation: Phenylephrine eye drops combined with intravenous atropine have obvious cardiovascular effects that can be reversed by neostigmine. This drug combination should be used carefully for ophthalmic surgery, especially in patients with cardio-cerebrovascular diseases.