Results and safety profile of trainee cataract surgeons in a community setting in East Africa.

Purpose: To evaluate the results and safety profile of assistant medical officer ophthalmologists (AMO-O) performing cataract surgery in the last stage of their surgical training, before their appointment to local communities.

Methods: We retrospectively analyzed the records of patients who underwent cataract surgery by AMO-Os at Dar es Salaam, Comprehensive Community Based Rehabilitation for Tanzania Disability Hospital between September 2008 and June 2011. Surgical options were either extracapsular cataract extraction (ECCE) or manual small incision cataract surgery (MSICS), both with polymethylmethacrylate intraocular lens implantation.

Misdirected aqueous flow in rhegmatogenous retinal detachment: a pathophysiology update.

It is widely accepted that the origin of subretinal fluid in rhegmatogenous retinal detachment (RRD) is liquid vitreous and that posterior vitreous detachment (PVD) and associated retinal tears are caused by vitreoretinal traction from intra-ocular currents, contraction of collagen fibers, and gravity. These explanations, however, are incomplete. We present a new synthesis of experimental and clinical evidence, updating understanding of fundamental pathophysiological processes in RRD.

Corneal collagen cross-linking for ectasia after LASIK and photorefractive keratectomy: long-term results.

Purpose: To report the long-term results of corneal collagen cross-linking (CXL) in ectasia after LASIK and photorefractive keratectomy (PRK).

Design: Retrospective, interventional cases series.

Participants: Twenty-six eyes of 26 patients (18 male, 8 female) with postoperative ectasia after LASIK (23 eyes) and PRK (3 eyes) were included with a mean age of 35 ± 9 years at the time of treatment and a mean follow-up of 25 months (range, 12-62 months).

Phacolytic glaucoma: are there 2 forms?

We report a case of acute phacolytic glaucoma in which only protein was present in the anterior chamber without macrophages. We propose that this study represents a type of phacolytic glaucoma characterized by a hyperacute presentation caused by rapid leakage of degenerated lens proteins into the aqueous humor as opposed to a second type with a more gradual onset and with phacolytic macrophages in the aqueous humor resulting from an immunologic response to liquefied lens proteins. Thus, 2 forms, perhaps at ends of a spectrum of clinical manifestations of phacolytic glaucoma, may exist with distinct characteristics and pathophysiology.

Are ocular injection anesthetic blocks obsolete? Indications and guidelines.

Purpose Of Review: In this era of topical anesthesia for ocular surgery, anesthetic ocular blocks are still important when profound anesthesia and akinesia are required. Although injection ocular blocks, retrobulbar and peribulbar anesthesia, have been supplanted for most ocular surgery in many centers by sub-Tenon's irrigation block because of its superior safety profile, still worldwide, injection blocks remain popular.

Recent Findings: We present here the results of a survey of the literature published over the last 5 years to assess current international preferences for ocular anesthesia injection blocks.

Topiramate-induced acute bilateral angle closure and myopia: pathophysiology and treatment controversies.

Purpose: To discuss the unusual features of topiramate-induced acute angle closure glaucoma, its pathophysiologic mechanisms, and treatment controversies, and to report the first anterior segment optical coherence tomography (OCT) of this condition.

Methods: Literature review and case report with OCT findings.

Results: Topiramate-induced angle closure is usually bilateral and associated with acute myopia; the ocular pressure is often not very highly elevated.

Postoperative IOP is related to intrascleral bleb height in eyes with clinically flat blebs following deep sclerectomy with collagen implant and mitomycin.

Aim: To investigate the relationship between intrascleral bleb height and intraocular pressure (IOP) following deep sclerectomy with collagen implant (DSCI) and mitomycin C (MMC) in eyes with clinically flat blebs.

Methods: The records of 25 eyes of 22 consecutive patients presenting with clinically flat blebs following DSCI with MMC for primary or secondary open angle glaucoma were reviewed. Anterior segment optical coherence tomography (AS-OCT) scans were used to evaluate postoperative intrascleral bleb height and its relation to IOP control.

Pediatric ocular rosacea.

A case of severe pediatric ocular rosacea was effectively treated after 2.5 years of misdiagnosis. A high index of suspicion should be maintained in children with ocular surface disease, with or without dermatologic rosacea, to correctly diagnose ocular rosacea and avoid morbidity and complications.

Posterior-assisted levitation in cataract surgery.

Purpose Of Review: Posterior-assisted levitation (PAL) is a surgical maneuver for dealing with rupture of the posterior capsule or zonular dehiscence with threatened or actual subluxation of the nucleus or entire lens into the vitreous during phacoemulsification. PAL is often unknown or overlooked, especially by young or inexperienced surgeons.

Recent Findings: The advantages of PAL are, first, that it often enables completion of phacoemulsification and intraocular lens placement without conversion to an open eye with nuclear expression and second, it prevents luxation of nucleus, nuclear fragments, or the lens into the vitreous avoiding the necessity for trans pars plana vitrectomy (TPPV)-lensectomy.

Perceptual distortion in homonymous paracentral scotomas.

Background: Cortical remapping after peripheral or central visual deafferentation alters visual perception, but it is unclear whether such a phenomenon impinges on areas remote from a scotoma. To investigate this question, we studied variations of perceptual spatial distortion in the visual field of patients with homonymous paracentral scotoma.

Methods: Two patients with right inferior homonymous paracentral scotoma were asked to describe their perception of a series of figures showing two isometric vertical lines symmetrically located on either side of a fixation point.

Feigned visual loss misdiagnosed as occult traumatic optic neuropathy: diagnostic guidelines and medical-legal issues.

The medical-legal problem of occult traumatic optic neuropathy diagnosed in patients who actually have feigned visual loss (malingering) is reviewed along with guidelines for suspecting and differentiating feigned visual loss from true traumatic optic neuropathy. We explain why we feel the term occult optic neuropathy is inappropriate and misleading, and the medical-legal consequences of this misdiagnosis are discussed.

Outflow facility in isolated porcine eyes after creation of an intrascleral canal by injection of stabilized hyaluronic acid.

Purpose: To investigate outflow facility in isolated porcine eyes after creation of an intrascleral canal by injection of stabilized, nonanimal, hyaluronic acid gel (NASHA; Q-Med AB, Uppsala, Sweden).

Methods: Outflow facility of 60 porcine eyes was measured after creation of an intrascleral canal into the anterior chamber by injection of NASHA gel using six different combinations of needle size (21, 23, and 27 gauge) and canal length (4.6 mm).