An 81-year-old woman had uneventful bilateral sequential phacoemulsification using a separate sterile technique for each eye. Despite this, early culture-positive postoperative endophthalmitis developed. Management included bilateral intravitreal antibiotic agents, and the patient achieved an excellent visual outcome. To our knowledge, this is the third reported case of bilateral endophthalmitis after bilateral sequential phacoemulsification and the first reported case in which a separate sterile technique was used in each eye.
Non-mydriatic retinal photography with later interpretation of the photographs was assessed as a screening method for the detection of diabetic retinopathy; when compared with an ophthalmologist's clinical assessment in a random group of 62 diabetic patients it was accurate (false negative 6-8%, false positive 2%) and sensitive (sensitivity 96%, specificity 98%). The assessment of further management required based on analysis of the photographs was 96-5% in agreement with the further management suggested by the ophthalmologist after direct clinical assessment ofthe patient.If this technique were used to screen patients in a typical diabetic clinic the predicted positive accuracy rate would be 84% and the predicted negative accuracy rate 99 5%.
Intracameral mydriasis was clinically effective in most patients undergoing cataract surgery and might be associated with an improved patient experience and a more streamlined preoperative flow. Mydrane represents a licensed alternative to the off-label use of other intracameral mydriatic agents, but was not judged to be a cost-effective intervention for routine use in this particular setting.
Hypromeliose can be used as a viscoelastic substance during cataract surgery. Two-groups of patients, one group operated on using hypromeliose, the other using sodium hyaluronate as a viscoelastic substance were followed up 2-6 months postoperatively. A total of 16.7% of the eyes operated on using hypromeliose developed a non-reactive semidilated pupil whereas none ofthe eyes from the control group developed this phenomenon. However, it has been noted in our practice that some pupils of eyes operated on with hypromellose 2% used as the viscoelastic substance developed abnormalities in pupil reaction; a number of patients developed a fixed, semi-dilated pupil postoperatively (Figs 1 and 2) resulting in glare, poor quality of vision, as well as cosmetic embarrassment. We have since stopped using hypromellose as a result of these complications. This paper presents a retrospective study comparing the incidence of pupil abnormality in eyes operated on using hypromellose as viscoelastic with a consecutive batch of similar operations performed prospectively by the same surgeon (RCH) using sodium hyaluronate (Healon).Although to our knowledge, there has been no report on the effect of intraocular use of hypromellose on pupil mobility in the ophthalmic literature to date, we were so concerned by our clinical findings that we did not consider it ethical to perform a prospective study using hypromellose. Subjects and methodsFigure I Non-reactive, semidilated pupil in one ofthe eyes operated on using hypromellose 2% as viscoelastic.
SUMMARY Twenty-eight patients with either the acquired immune deficiency syndrome (AIDS) or persistent generalised lymphadenopathy (PGL) were studied prospectively as outpatients for up to one year. Six patients had fundal cotton wool spots at some stage of their follow-up and all six suffered opportunistic infections associated with AIDS. We suggest that ocular abnormalities may be prognostic for opportunistic infection in AIDS and discuss the wide range of ophthalmic complications consequent to HIV infection.The human immunodeficiency virus type III (HIV) is now implicated as the cause of the acquired immune deficiency syndrome (AIDS) and of related disorders, such as persistent generalised lymphadenopathy (PGL).'-" A recent study of AIDS and AIDS risk patients by both membrane immunofluorescence and competitive radioimmunoassay showed that 97% of AIDS patients were seropositive for antibodies to HIV, as were 89% of patients with PGL, 17% of symptomless homosexual men, 34% of haemophiliacs receiving pooled clotting factors, and 1-5% of intravenous drug abusers. None of more than 1000 unselected blood donors were seropositive.6AIDS is a severe disorder of immunoregulation found in previously healthy subjects and occurs most commonly in homosexual males, bisexuals, haemophiliacs, and intravenous drug abusers.7-9 Patients may develop opportunistic infections, Kaposi's sarcoma, Pneumocystis carindi pneumonia, and a form of presenile dementia due to HIV related
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