Faculty Bibliography

PURPOSE: To assess commonly used cataract surgery bacterial endophthalmitis prophylaxis techniques based on a systematic literature review and evidence rating. CLINICAL RELEVANCE: Prophylactic techniques to decrease the risk of bacterial endophthalmitis related to cataract surgery are commonly used, but the evidence justifying their use is unclear. LITERATURE REVIEWED: A MEDLINE search of the literature published in English or with English abstracts from 1966 to 2000 was performed using various combinations of relevant key words. Eighty-eight peer-reviewed papers were identified and judged worthy of review on the basis of predefined criteria. RESULTS: No prophylactic technique received the highest of three possible clinical recommendations (A, crucial to clinical outcome). Preoperative povidone-iodine preparation received the intermediate clinical recommendation (B, moderately important to clinical outcome). All other reported prophylactic interventions, including postoperative subconjunctival antibiotic injection, preoperative lash trimming, preoperative saline irrigation, preoperative topical antibiotics, antibiotic-containing irrigating solutions, and the use of intraoperative heparin, received the lowest clinical recommendation (C, possibly relevant but not definitely related to clinical outcome) based on weak and often conflicting evidence justifying their use. CONCLUSIONS: With regard to bacterial endophthalmitis prophylaxis in cataract surgery, current literature most strongly supports the use of preoperative povidone-iodine antisepsis

PURPOSE: To present a case of anterior scarring in an epikeratophakia lenticule and its partially successful treatment with the excimer laser. METHODS: Excimer laser phototherapeutic keratectomy (PTK) was used to reduce corneal scarring in an epikeratophakia lenticule. RESULTS: Visual acuity improved after two sessions of PTK. CONCLUSIONS: PTK is an alternative to epikeratophakia lenticule removal

PURPOSE: To report the recurrence of presumed post-viral conjunctivitis subepithelial corneal opacities after excimer laser phototherapeutic keratectomy (PTK). METHOD: Case report. RESULTS: A 33-year-old ophthalmic technician developed recurrence of opacities after treatment of presumed post-viral keratitis subepithelial corneal opacities with the excimer laser. CONCLUSIONS: Post-viral keratitis subepithelial corneal opacities may recur after removal by excimer laser PTK. Recurrence of these opacities in anterior corneal stroma previously unaffected by opacities before laser treatment suggests the presence of viral antigen in deeper corneal tissue than that occupied by the original subepithelial opacities. The recurrence also suggests likely routes of corneal antibody penetration in the formation of these opacities. Intensive topical steroid treatment may play a role by increasing the depth of viral particle penetration into corneal stroma