Justesenmcculloch7788

A 36-year-old man was referred back to our clinic after an uneventful laser in situ keratomileusis (LASIK) surgery 6 months previously, with a chief complaint of declining vision in the left eye for the last several months. His pertinent ocular history prior to the LASIK surgery was significant for episodic left eye irritation and inflammation of the superior part of the left cornea secondary to contact lens-induced keratopathy, according to his optometrist.This was a femtosecond-assisted LASIK surgery using the WaveLight FS200 femtosecond laser (Alcon) with the Allegretto EX500 excimer laser (Alcon) for attempted correction of -4.50 diopter (D) of myopia in both eyes under an 8.8 mm flap with a thickness of 100 μm. The uncorrected distance visual acuity (UDVA) was 20/15 in both eyes for the first 2 weeks; at the 1-month follow-up visit, a well-demarcated, wavelike plaque of coarse, thickened corneal epithelium along the superior aspect of the cornea was noted. The UDVA had declined to 20/30 in the left eye. y specific ocular exposure. He is a barbeque enthusiast and brews his own alcohol but denies any thermal or direct injury to either eye. His mother had recently told him that he might have had battery acid exposure when he was very young, before age 10, but never required medical attention.What is the most likely diagnosis? What medical or surgical interventions would you recommend for this patient? What is the prognosis for this patient?Contradictory results of postoperative steroid application in photorefractive keratectomy (PRK) led to a meta-analysis of the existing data to achieve a definite conclusion on the optimum dosage and duration of corticosteroid therapy after PRK. The overall pooled unstandardized mean difference (PUMD) of the corneal haze score was -0.20 (95% CI, -0.29 to -0.12). In subgroup analysis, the PUMD of the corneal haze score was statistically significant in 2 subgroups, -0.57 (-0.85 to -0.30) for 3 to 6 months postoperatively and -0.13 (-0.23 to -0.04) for ≤ 3 months postoperatively. Analysis of the PUMD of postoperative spherical equivalent in participants with low to moderate myopia (≥-6.00 D) and high myopia ( less then -6.00 D) showed positive effects of steroids on prevention of myopia regression. In conclusion, long-term topical steroid application after PRK seems unnecessary in low and moderate myopia. New randomized clinical trials using current technologies are recommended for postoperative treatments.PURPOSE To determine the incidence of clinically significant pseudophakic cystoid macular edema (CSPME) after phacoemulsification using the bag-in-the-lens intraocular lens (BIL IOL) implantation technique and to examine the influence of associated risk factors, both ocular and systemic. SETTING Monocentric, Antwerp University Hospital, Belgium. DESIGN Retrospective. METHODS This study included 1 077 first-operated eyes of 1 077 adults who underwent phaco-emulsification cataract surgery using the BIL IOL implantation technique between January 2013 and December 2015. RESULTS The 3-month incidence of CSPME in the subgroup without risk factors was 0% (95% CI, 0.0-0.0). The 3-month incidence of CSPME in the subgroup with risk factors was 2.8% (95% CI, 1.3-4.3). The 3-month incidence of CSPME in the total group of 1077 patients was 1.4% (95% CI, 0.6-2.1). The risk factors most significantly associated with CSPME included diabetes (hazard ratio [HR] 5.37; 95% CI, 1.5-19.3; P = .019), exudative age-related macular degeneration (HR 121; 95% CI, 36.1-409; P less then .001), and macular traction (HR 6.47; 95% CI, 1.9-22.1; P less then .009). CONCLUSIONS The incidence of CSPME was zero in eyes without risk factors. The incidence was consistent with previous reports in the literature regarding the lens-in-the-bag IOL implantation technique in eyes with risk factors. This indicates that the BIL IOL implantation technique is a safe procedure and does not confer a higher risk for developing cystoid macular edema after cataract surgery compared with the lens-in-the-bag IOL implantation technique, despite the requirement of a primary posterior continuous curvilinear capsulorhexis.PURPOSE To evaluate morphological characteristics and intraoperative dynamics of different types of white cataract using intraoperative optical coherence tomography (iOCT). SETTING Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. DESIGN Prospective interventional study. METHODS Fifty eyes with white cataract undergoing phacoemulsification were evaluated. Irinotecan price The primary outcome measure was the classification of white cataract based on morphology and intraoperative dynamics on iOCT. The secondary outcome measure was rhexis-related complications. RESULTS Four types of white cataract were identified based on iOCT-type I (9 eyes), type II (3 eyes), type III (24 eyes), and type IV (14 eyes). Type I had regularly arranged lamellar cortical fibers, type II had continuous hyperreflective bands of cortical fibers with intralenticular clefts, type III had intralenticular clefts combined with areas of homogenous ground-glass appearance, and type IV had homogenous ground-glass appearance of the anterior lens cortex. Capsulorhexis in type I cataract was uneventful. In type II cataract, cortical bulge was observed in the anterior chamber on creating the initial nick, indicating raised intralenticular pressure (ILP) with an imminent risk of rhexis extension. A bimanual irrigation/aspiration was performed until lowering of ILP was observed on iOCT. In types III and IV, fluid release was observed on initiation of rhexis leading to partial (type III) or complete (type IV) lowering of ILP, with a mild-moderate risk of capsulorhexis extension. A continuous curvilinear capsulorhexis was achieved in all cases, with no case of posterior capsular tear or vitreous loss. CONCLUSIONS Intraoperative OCT helped elucidate intraoperative dynamics of the spectrum of white cataracts and facilitates completion of capsulorhexis.PURPOSE To compare the use of topical dilation drops vs topical drops with the addition of intracameral epinephrine in resident-performed cataract surgery and the effects on pupil expansion device (PED) use, surgical costs, and surgical times. SETTING Iowa City Veterans Affairs Medical Center, Iowa City, Iowa, USA. DESIGN Retrospective chart review. METHODS Resident-performed primary cataract surgical cases using topical dilation drops only or drops with the addition of intracameral epinephrine were analyzed for PED use, surgical time, and costs in all patients and in patients with a history of tamsulosin use. RESULTS In the topical group, PEDs were used in 31.1% of cases compared with 13.5% of cases in the intracameral group (P less then .0001). History of tamsulosin use was noted in about one third of cases in both groups. For patients with a history of tamsulosin use, PED use decreased from 52.7% in the topical cases to 17.9% in the intracameral group (P less then .0001). Surgical times were on average 7.