We report a severe anaphylactic reaction that occurred about 5 minutes after 1.0 mg of cefuroxime was injected into the anterior chamber after routine phacoemulsification and intraocular lens implantation. The patient was known to be allergic to penicillin. Immediate action was taken, and the patient recovered well. The presence of staff trained in resuscitation was essential in this case and raises questions about the trend to perform routine topical anesthesia cataract surgery without an anesthesiologist in the operating room.

We measured Snellen visual acuity under standard and glare conditions using the Allergan Humphrey 570 autorefractor in 46 pseudophakes (46 eyes) undergoing Neodymium-YAG laser posterior capsulotomy before and after treatment. All the patients studied had a best corrected vision of at least 6/12 but complained of visual disability and had clinically observable posterior capsule opacification. The patients did not have other known causes of glare disability. Following posterior capsulotomy, 30 (65%) patients showed an improvement in standard Snellen visual acuity and 44 (97%) an improvement in Snellen visual acuity under glare conditions. This difference was statistically significant (p < 0.001). Of the 16 patients whose standard Snellen visual acuity did not improve after posterior capsulotomy, 14 showed a reduction in glare disability. Glare testing was clinically useful in evaluating pseudophakes with posterior capsule opacification who complained of visual disability in spite of good Snellen visual acuity under standard testing conditions.

PURPOSE: To assess the effectiveness of optical and ultrasonic pachymetry when examining corneas of patients before and after laser in situ keratomileusis (LASIK). METHODS: We conducted a prospective study of 25 patients (50 eyes) who had LASIK for myopia or myopic astigmatism (mean spherical equivalent refraction -4.80 ± 3.60 D; range -1.75 to -12.00 D). Corneal thickness was measured using 1) conventional ultrasonic pachymetry (20 MHz probe) in the central cornea, 2) ASL confocal microscopy (CMTF analysis), 3) Orbscan II Analyzer, and 4) ultrasound biomicroscopy (UBM) (50 MHz probe) preoperatively and 3 months postoperatively. RESULTS: Preoperative pachymetry values measured with the Orbscan II Analyzer (551.3 ± 27.3 µm) were almost identical to those measured with the 20 MHz ultrasonic probe (553.7 ± 25.7 µm; t-test P=.652). The mean preoperative pachymetry for UBM was 566.7 ± 38.8 µm and for CMTF was 553.2 ± 15.5 µm. The optic and ultrasonic system measurements differed in operated eyes; 20 MHz ultrasonic pachymetry yielded an average 478.7 ± 23.5 µm and the UBM, 482.4 ± 40.3 µm. These measurements differed from the Orbscan II (Tukey test; P=.023) measurement of 461.1 ± 37.5 µm but not from the confocal microscopy measurement of 475.2 ± 41.8 µm. UBM registered greater values that were more variable than those obtained with ultrasonic pachymetry. CONCLUSIONS: In non-operated eyes, corneal thickness was similar using conventional ultrasound, Orbscan II, or confocal techniques, with ultrasound biomicroscopy giving thicker readings. [J Refract Surg 2004;20:29-34]

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METHODSAll the refractions, clinical as well as on the autorefractor, were carried out without the use of mydriatics. Clinical refraction, streak retinoscopy followed by subjective verification, was carried out by two of the authors (PSR, KM) to achieve the best possible visual acuity. Autorefraction was performed to obtain a series of three readings by a different examiner (AEL). The 'standard' refractive value in the AR printout data (categorised into reliable and less reliable data) was then compared with the result of clinical refraction for degree of agreement. STATISTICAL ANALYSISThe statistical significance of the difference between the less reliable (indicated by the 'reliability mark') and reliable autorefractive data was evaluated using two tests: (1) X2 test on the number of eyes in the two groups within 0-51 D of spherical equivalence, spherical power, or cylindrical power and within 110 in cylindrical axis as determined by clinical refraction; and (2)