Prevention, diagnosis, and management of acute postoperative bacterial endophthalmitis

This distillation of the peer-reviewed scientific literature on infection after cataract surgery summarizes background material on epidemiology, etiology, and pathogenesis, describes the roles of surgical technique and antibiotic prophylaxis in prevention, and discusses diagnostic and therapeutic interventions in cases of suspected endophthalmitis

Therapeutic visual rehabilitation in a patient with high hyperopia and flat cornea years after radial keratotomy

A 51-year-old man was referred for refractive surgery evaluation. Spectacle dependence and poor visual quality in both eyes was his chief complaint. He cannot tolerate contact lenses. Corrected distance visual acuity (CDVA) was 20/40 in both eyes. Manifest refraction was +5.25 -2.25 @ 90 (20/40) in the right eye and +6.25 -2.25 @ 105 (20/40) in the left eye. The patient had a history of radial keratotomy (RK) almost 30 years ago in both eyes and at the slitlamp presented 8 RK incisions, proportionally spaced between one another. All incisions were closed, and there were no relevant signs of scarring. The patient denied any history of ocular trauma, systemic disease, or medications. Corneal topography with different technologies revealed an irregular pattern with marked central flattening in both eyes, with some points below 30 diopters (D) (Supplemental Figures 1 and 2, available at http://links.lww.com/JRS/A862 and http://links.lww.com/JRS/A863, respectively). There were no signs of cataract, and fundus examination was normal. Optical coherence tomography (OCT) of the right eye revealed a more homogeneous thickness pattern, little variation between the thinnest and thickest areas, and adequate transparency (Figure 1JOURNAL/jcrs/04.03/02158034-202306000-00018/figure1/v/2023-05-31T172126Z/r/image-tiff). In the left eye, there is wide variability between the thinnest and thickest stromal points, with annular thinning and central thickening (Figure 2JOURNAL/jcrs/04.03/02158034-202306000-00018/figure2/v/2023-05-31T172126Z/r/image-tiff). Both eyes show marked epithelial irregularity. Considering this patient's current ocular status, how would you reach visual rehabilitation? Because he is contact lens intolerant, would you consider surface ablation, for example, photorefractive keratectomy (PRK) with mitomycin-C (MMC)? If that were the case, would you think of an optimized or a topography-guided (TG) treatment? Would you immediately consider a corneal transplant option? Would you instead consider a more conservative approach? Which one and why

Complex karyotype in one patient with small cell variant of T-prolymphocytic leukemia. Analysis by G-banding and comparative genomic hybridization

On the basis of two sedimentary records from the central Sea of Okhotsk, we reconstruct the closely coupled glacial/interglacial changes in terrigenous flux, marine productivity, and sea ice coverage over the past 1.1 Myr. The correspondance of our sedimentary records to the China loess grain size record ( China loess particle timescale, CHILOPARTS) suggests that environmental changes in both the Sea of Okhotsk area and in SE Asia were closely related via the Siberian atmospheric high-pressure cell. During full glacial times our records point to a strong Siberian High causing northerly wind directions, the extension of the sea ice cover, and a reduced Amur River discharge. Deglacial maxima of terrigenous flux were succeeded by or synchronous to high-productivity events. Marine productivity was strengthened during glacial terminations because of an effective nutrient utilization at times of enhanced water column stratification and high nutrient supply from fluvial runoff and sea ice thawing. During interglacials, SE monsoonal winds prevailed, analogous to today's summer situation of a pronounced Mongolian Heat Low and a strong Hawaiian High. Strong freshwater discharge induced by high precipitation rates in the Amur drainage area and a seasonally reduced and mobile sea ice cover favored marine productivity ( although being considerably lower than during the terminations) and a lowered flux of ice-rafted detritus

Visual fields in patients with multifocal intraocular lens implants and monovision:an exploratory study

PurposeTo assess the difference in binocular visual fields (VFs) in patients who underwent bilateral cataract surgery with either multifocal (MF; Tecnis ZM900, AMO) intraocular lenses (IOLs) or monofocal IOLs with powers adjusted to give monovision (MV; Akreos AO, Bausch&Lomb).SettingSt George's & Moorfields Eye Hospital, London.MethodsProspective exploratory study. Binocular Esterman VFs (Humphrey Field Analyser II) were compared between 10 participants with MV and 16 participants with MF IOLs. The dominant eye in MV participants had 0 to 0.50DS and the non-dominant eye had between 1.0DS and 1.5DS. Best-corrected Snellen visual acuity for all 52 eyes was six out of nine or better. The main outcome measure was Esterman Efficiency Score. Incidence of suboptimal VF results (≥1 Unseen LocationsULs) and mean testing times in the two groups were compared.ResultsThere was no statistically significant difference in the incidence of suboptimal VF results in these two groups (P=0.662). Test durations in the two groups were not significantly different (P=0.650). However, 310 MV plots (33) had markedly suboptimal right hemi-fields (distance-dominant eye) compared with 015 MF plots. Additionally, the MV group accounted for 79 of total ULs (2029) and all these ULs were distributed in areas outside or bordering the true binocular VFs.ConclusionsAll included VFs met the UK driving standards criteria. The pattern of VF defects encountered in the MV group is of interest because the majority of ULs (1320; 65) corresponded to the monocular VFs of the distance-dominant eye. © 2010 Macmillan Publishers Limited. All rights reserved