Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

Endophthalmitis is a severe inflammation of the anterior or posterior (or both) chambers of the eye that may be sterile or associated with infection. It is a potentially vision-threatening complication of cataract surgery. Prophylactic measures for endophthalmitis are targeted against various sources of infection

High-Resolution Optical Coherence Tomography as an Adjunctive Tool in the Diagnosis of Corneal and Conjunctival Pathology

To evaluate the use of a commercially available, high-resolution, spectral-domain optical coherence tomography (HR-OCT) device in the diagnosis of corneal and conjunctival pathologies, with a focus on malignant lesions. Eighty-two eyes of 71 patients were enrolled in this prospective case series, including 10 normal eyes, 21 with ocular surface squamous neoplasia (OSSN), 24 with a pterygium or pingueculum, 3 with lymphoma, 18 with pigmented conjunctival lesions (nevus, flat melanosis, or melanoma), and 6 with Salzmann nodular degeneration. Subjects were imaged using photography and HR-OCT (RTVue, Optovue, Fremont, CA). When clinically indicated, surgery was performed and histopathologic specimens were correlated with OCT images. HR-OCT was useful in differentiating among various lesions based on optical signs. Specifically, in OSSN, HR-OCT findings included epithelial thickening and hyper-reflectivity, whereas pterygia and pinguecula showed a subepithelial mass under thinner epithelium. In lymphoma, a hypo-reflective, homogenous subepithelial mass was observed. Differentiating between pigmented lesions with HR-OCT was more difficult, but certain characteristics could be identified. Eyes with nevi and melanoma both displayed intensely hyper-reflective basal epithelial layers and discrete subepithelial lesions, but could be differentiated by the presence of cysts in nevi and intense shadowing of sublesional tissue in most melanomas. We found that a commercially available HR-OCT was a useful noninvasive adjunctive tool in the diagnosis of ocular surface lesions

Evidence for contamination with C. trachomatis in the household environment of children with active Trachoma: A cross-sectional study in Kongwa, Tanzania.

BackgroundTrachoma, a conjunctivitis caused by repeated infections with Chlamydia trachomatis, remains a significant cause of blindness worldwide. While mass treatments with azithromycin decreases disease and infection, re-emergence occurs, indicating that elimination may require other sustainable interventions. Environmental changes largely focus on facial hygiene and latrines, but further work to identify other possible transmission targets are needed. We sought to determine, in a cross-sectional survey of households of children with active trachoma, if we could detect the presence of Chlamydia trachomatis on household objects and on family members based on sleeping and caretaking patterns.MethodsIn five villages in Kongwa, Tanzania, children ResultsOf 80 visited households, 13 (16%) had at least one swab from environmental sources positive for C. trachomatis DNA. A positive environmental swab was associated with the presence of ocular infection in the index child (Odds Ratio = 22.0, p = .007), the presence of an infant ConclusionsC. trachomatis DNA is present in the environment of children with active trachoma, especially in households with an ocular infection. Specific findings also suggest that washing hands, clothing, and bedding may be important

Prospective cohort study investigating frequency and risk factors for acute pain 1 day after refractive surgery

Background/aims To examine demographic and clinical factors associated with ocular pain 1 day after refractive surgery.Methods Prospective study of individuals undergoing refractive surgery. Participants rated their ocular pain on a 0–10 numerical rating scale (NRS) presurgery and 1 day after surgery. Presurgery, participants completed questionnaires on demographics, comorbidities, medications and dry eye and ocular pain symptoms; and an anaesthetised Schirmer test was performed. Acute ocular pain 1 day after surgery was defined as an NRS score of worst pain since surgery ≥3 and this group was compared with individuals with NRS scores<3.Results 251 individuals underwent refractive surgery (89% laser-assisted in situ keratomileusis, n=222; 11% PRK, n=29). Mean age was 35±8 years (range 19 to 60); 60% (n=150) self-identified as female, 80% (n=203) as White, and 36% (n=89) as Hispanic. Thirteen (5%) individuals reported ocular pain (NRS ≥3) prior to surgery and 67% (n=168) reported ocular pain 1 day after surgery (nine individuals had pain at both time points). Factors that were associated with pain 1 day after surgery included Hispanic ethnicity (adjusted relative risk (aRR) 1.42, 95% CI 1.21 to 1.68, p<0.001) and the presence of eye pain presurgery (aRR 1.10, 95% CI 1.02 to 1.18, p=0.02).Conclusion A majority of individuals report moderate or greater pain within 24 hours of refractive surgery. Hispanic ethnicity and eye pain prior to surgery were associated with self-reported acute postsurgical pain

Surgical versus Medical Treatment of Ocular Surface Squamous Neoplasia

PURPOSE: The objective of this study was to compare the cost associated with surgical versus interferon (IFNα2b) treatment for ocular surface squamous neoplasia (OSSN). DESIGN: A matched, case-control study. PARTICIPANTS: Ninety-eight patients with OSSN; 49 of whom were treated surgically and 49 of whom were treated medically. METHODS: Patients with OSSN treated with IFNα2b were matched to surgery patients based on age and date of treatment initiation. Financial cost to the patient was calculated using two different methods (hospital billing and Medicare allowable charges) and compared between the two groups. These fees included physician fees (clinic, pathology, anesthesia, and surgery), facility fees (clinic, pathology, and operating room), and medication costs. Time invested by patients was calculated in terms of number of visits to the hospital and compared between the two groups. Parking costs, transportation, caregiver wages, and lost wages were not considered in our analysis. MAIN OUTCOME MEASURES: Number of clinic visits and cost of therapy as represented by both hospital charges and Medicare allowable charges. RESULTS: When considering cost in terms of time, the medical group had an average of 2 more actual and imputed number of visits over 1 year compared to the surgical group. Cost as represented by hospital charges was higher in the surgical group (mean $17,598, SD$7,624) when compared to the IFNα2b group (mean $4,986, SD$2,040). However, cost between the two groups was comparable when calculated based on Medicare allowable charges (surgical group: mean $3,528, SD$1,610; medical group: mean $2,831, SD$1,082; P = 1.00). The highest cost category in the surgical group was the excisional biopsy (Hospital billing $17,598; Medicare allowable$3,528) while the highest cost in the medical group was interferon ($1,172 for drops, average 8.0 bottles;$370 for injections, average 5.4 injections). CONCLUSION: Our data in this group of patients previously demonstrated equal efficacy of surgical versus medical treatment. Here, for the first time, we consider costs of therapy and found that medical treatment involved slightly more office visits whereas surgical treatment could be more or equally costly depending on insurance coverage

Surgical versus Medical Treatment of Ocular Surface Squamous Neoplasia

PURPOSE: Treatment for ocular surface squamous neoplasia (OSSN) has historically been surgery, but non-surgical interventions are increasingly employed. Treatment with interferon is efficacious, but evidence is needed regarding recurrence and complication rates in comparison to surgery. The objective of this study is to compare the recurrence and complication rates of surgical versus interferon treatment for OSSN. DESIGN: A matched, case-control study. PARTICIPANTS: Ninety eight patients with OSSN, 49 of whom were treated with interferon alpha 2b (IFNα2b) therapy and 49 of whom were treated with surgical intervention. METHODS: Patients with OSSN were treated with surgery versus IFNα2b therapy, either in topical or injection form. Median follow up after lesion resolution for the IFNα2b group was 21 months (range 0–173 months) and for the surgery group was 24 months (range 0.9–108 months). MAIN OUTCOME MEASURE: The primary outcome measure for the study was the rate of recurrence of OSSN in each of the treatment groups. Recurrence rates were evaluated using Kaplan-Meier survival analysis. RESULTS: Mean patient age and gender were similar between the groups. There was a trend toward higher clinical American Joint Committee on Cancer tumor grade in the IFNα2b group. Despite this, the number of recurrences was equal at 3 per group. The one year recurrence rate was 5% in the surgery group versus 3% in the IFNα2b group (p=0.80). There was no statistically significant difference in the recurrence rate between the surgically and medically treated groups. Non-limbal location was a risk factor for recurrence (hazard ratio 8.96), in the entire study population. In patients treated successfully, the side effects of the two treatments were similar, with mild discomfort seen in the majority of patients in both groups. There was no limbal stem cell deficiency, symblephara, or diplopia noted in either group. Two patients were excluded from the IFNα2b group due to intolerance to the medication. CONCLUSION: No difference in the recurrence rate of OSSN was found between surgical versus IFNα2b therapy

Management of conjunctival malignant melanoma: a review and update

Conjunctival malignant melanoma is a pigmented lesion of the ocular surface. It is an uncommon but potentially devastating tumor that may invade the local tissues of the eye, spread systemically through lymphatic drainage and hematogenous spread, and recur in spite of treatment. Despite its severity, the rarity of available cases has limited the evidence for diagnosis and management. This review will provide an overview of the epidemiology, presentation, diagnosis, management, and surveillance of conjunctival melanoma, with an emphasis on recent advances in biological therapies to treat this disease