Faculty Bibliography

PURPOSE: To determine the relationship between untoward events noted during phacoemulsification surgery associated with aberrant infusion misdirection and their causal relationship to current infusion sleeve design. SETTING: The New York Eye & Ear Infirmary of Mt. Sinai, New York, New York, USA. DESIGN: Retrospective case reports and experimental study. METHODS: Observations of live cataract surgery were documented with high-definition videography using 3 commercial phacoemulsification platforms. Laboratory studies using a Photron MC2 high-speed camera and the Kitaro cataract surgical system were used to simulate surgical maneuvers and assess flow patterns and visualize the dynamics of fluid movement in the anterior chamber. Color-flow Doppler ultrasound studies were used to demonstrate the effect of infusion fluid on the iris during surgery. RESULTS: Misdirected infusion and floppy-iris leaflets were determined to be secondary to a fulcrum effect at the corneal wound that constrained movement of the standard silicone sleeves. The phacoemulsification needles could therefore decenter independently of the infusion sleeve, attenuating infusion volume down 1 side of the sleeve and, as a result, obstructing fluid exiting the ipsilateral port. CONCLUSIONS: Untoward events associated with aberrant fluid infusion during phacoemulsification surgery were secondary to a fulcrum effect at the corneal wound. Complications included misdirected infusion that facilitated the transport of retained nuclear fragments to the vitreous, inconsistent lens followability during phacoemulsification, and exaggerated movements of the iris particularly consistent with intraoperative floppy-iris syndrome and pseudoexfoliation. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Wearing contact lenses has been identified as a risk factor for the development of eye conditions such as giant papillary conjunctivitis and keratitis. We hypothesized that wearing contact lenses is associated with changes in the ocular microbiota. We compared the bacterial communities of the conjunctiva and skin under the eye from 58 subjects and analyzed samples from 20 subjects (9 lens wearers and 11 non-lens wearers) taken at 3 time points using a 16S rRNA gene-based sequencing technique (V4 region; Illumina MiSeq). We found that using anesthetic eye drops before sampling decreases the detected ocular microbiota diversity. Compared to those from non-lens wearers, dry conjunctival swabs from lens wearers had more variable and skin-like bacterial community structures (UniFrac;P value = <0.001), with higher abundances ofMethylobacterium,Lactobacillus,Acinetobacter, andPseudomonasand lower abundances ofHaemophilus,Streptococcus,Staphylococcus, andCorynebacterium(linear discriminant analysis [LDA] score = >3.0). The results indicate that wearing contact lenses alters the microbial structure of the ocular conjunctiva, making it more similar to that of the skin microbiota. Further research is needed to determine whether the microbiome structure provides less protection from ocular infections. IMPORTANCE: As in other body sites (i.e., the gut, skin, and mouth), the eye has a normal community of bacteria which are expected to confer resistance that provides protection from invaders. However, the eye microbiome has been largely neglected and is relevant to eye health and understanding eye diseases and to discovery of its functions. This report of a baseline study shows differences in the eye microbiome of contact lens wearers in relation to those of non-lens wearers and has the potential to help future studies explore novel insights into a possible role of the microbiome in the increased risk for eye infections in contact lens wearers.

We report the case of a 34-year-old man who had uncomplicated cataract surgery in his left eye. Medical history was significant for atopic dermatitis, requiring oral immunosuppressive medications. Two days after the surgery, the patient presented with pain, photophobia, decreased vision, and a small corneal abrasion. On postoperative day 5, the patient returned with left upper lid vesicular lesions and 2 corneal dendrites. Corrected vision was 20/100 OS, with intraocular pressure of 18 mm Hg and 1+ pigmented cells in the anterior chamber. Cultures of the lid lesions revealed herpes simplex virus (HSV) type 1. The patient was placed on oral acyclovir 800 mg 5 times a day. By day 8, the dendrites had resolved, and by day 15, the lid lesions healed over. HSV keratitis is an uncommon complication after cataract surgery. Ophthalmologists should be aware of the possibility of developing HSV keratitis even after the most routine cataract extraction

PURPOSE: To describe the use of ultrasound biomicroscopy (UBM) to image retained nuclear fragments posterior to the iris plane after uncomplicated phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation in two patients. DESIGN: Interventional case report. METHODS: Two patients presented with an iris elevation after uncomplicated phacoemulsification and lens implantation. RESULTS: Visual acuity was 20/20 in the first patient and 20/30 in the second. There was no anterior chamber inflammation in either eye. UBM revealed a small, retained nuclear fragment between the iris pigment epithelium and the anterior lens capsule, causing localized anterior iris displacement in both patients. The PCIOL was within the capsular bag, and the iris root and ciliary body were normal in both patients. CONCLUSION: UBM can demonstrate retained lens fragments within the posterior chamber