Faculty Bibliography

PURPOSE: To report a case of late failure of a posterior segment placed Ahmed valve in a uveitic eye with a corneal graft and a minimally invasive, ab interno approach in restoring valve function, pressure control, and preservation of vision. DESIGN: Case report. METHODS: A 25 gauge trans-conjunctival 3-port pars plana vitrectomy was performed to inspect and clean the ostium of the Ahmed valve of any vitreous debris. The Ahmed valve was not disturbed externally and conjunctival dissection was not performed. A 27-gauge blunt cannula was introduced through the vitrector site and used to cannulate the tube and flush it with balanced salt solution. A bleb was immediately re-established and all instruments were removed requiring no sutures. RESULTS: Intraocular pressure returned to target levels and a filtration bleb was re-established. Corneal graft clarity was restored with resolution of preoperative microcystic edema. Postoperative inflammation was minimal and vision was restored. CONCLUSIONS: A nonfunctioning tube shunt residing in the vitreous cavity may be revised ab interno without disturbing the shunt placement or the conjunctiva under which it resides to re-establish filtration.

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 assess the safety of neodymium:YAG (Nd:YAG) laser lens ablation in a rabbit model prior to human investigation. METHODS: The Nd:YAG laser lens ablation probe was inserted into the anterior chamber of 14 New Zealand white rabbit eyes and Nd:YAG laser lens ablation was simulated, exposing the eyes to energy significantly higher than that used in previous experimental Nd:YAG lens ablation of the human crystalline lens. After the procedure, the rabbits were killed at 1 hour, 1 day, or 1 week and the eyes evaluated by specular microscopy, ultrasonic pachymetry, and light microscopy. RESULTS: There was no statistically significant difference in the postoperative endothelial cell counts or ultrasonic pachymetry of study eyes and control (unoperated) eyes. Light microscopy revealed no apparent damage to the cornea, trabecular meshwork, or retina of the study eyes. CONCLUSIONS: the Nd:YAG laser lens ablation device appears to be a safe method of cataract removal in this animal model. Further study is needed to determine the safety and efficacy of this device for cataract removal in humans

We examined the effects of contact lens wear on corneal topography following penetrating keratoplasty (PK). We present the long-term follow-up of 23 eyes of 22 patients who underwent PK and rigid gas permeable contact lens fitting. Computerized corneal topography, manual keratometry, and refraction were conducted prior to contact lens fitting and then at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year post-fitting. At least 6 months follow up was obtained for 23 eyes of 22 patients, and at least 12 months follow-up was obtained for 18 eyes of 17 patients. Seventy four percent of the eyes were stable (+/- 1.00 D) by manual keratometry, computerized corneal topography, and refraction (both spherical equivalent and cylinder). Those patients who changed showed a trend toward a small decrease in refractive cylinder and spherical equivalent. Measurements obtained from both computerized corneal topography and manual keratometry showed a small but significant amount of flattening (P < 0.003 and P < 0.04, respectively)

BACKGROUND: Treating traumatic corneal abrasions is a common problem for the ophthalmologist. Traditional management has been the use of a pressure patch. Three different therapeutic modalities were evaluated for their efficacy in treating traumatic corneal abrasions. METHODS: Forty-seven consecutive patients with traumatic corneal abrasions were randomized prospectively in a single-masked, controlled clinical trial which compared the efficacy of (1) pressure patching, (2) a bandage contact lens, and (3) a bandage contact lens with a topical nonsteroidal anti-inflammatory drug (0.5% ketorolac tromethamine). RESULTS: There was no significant difference in the healing time of the three groups. However, psychometric analysis showed a significant decrease in pain in the group that received a bandage contact lens with a topical nonsteroidal anti-inflammatory drug. There was a significant difference in the ability to return to normal activities in both contact lens groups compared with the pressure-patch group. There was no significant difference among the three groups with respect to photophobia, redness, ocular irritation, headache, or tearing. CONCLUSION: Use of a bandage contact lens significantly shortens the time required for a patient to return to normal activities. Moreover, addition of a nonsteroidal anti-inflammatory drug to a treatment regimen significantly decreases the pain associated with traumatic corneal abrasions. Use of a bandage contact lens with a topical nonsteroidal anti-inflammatory may prove to be an effective adjunct in treating traumatic corneal abrasions

In the more than 25 years since the development of ultrasound phacoemulsification, enormous change has occurred in cataract surgery. One of the latest and most significant changes in cataract surgery has been the development of devices that utilize laser energy for the removal of cataracts. Both ultraviolet (excimer) and infrared wavelengths have been studied, but in 1994, we have seen significant progress only with the infrared wavelengths. The lack of progress in the devices utilizing ultraviolet wavelengths are due to concerns with safety. Two infrared laser devices, one developed by Dodick and the other developed by Colvard have been used successfully for the removal of cataracts under Investigational Device Exemptions from the Food and Drug Administration. These developments have brought us a step closer to realizing the dream of laser cataract surgery

Since the development of ultrasound phacoemulsification more than 25 years ago, cataract surgery has changed dramatically. One of the major changes in cataract surgery has been the research into the use of laser for the removal of cataracts. To date, both ultraviolet and infrared wavelengths have been studied, with the infrared showing more promise. The ultraviolet end of the spectrum has shown promise, but concerns with safety have hindered its progress. An infrared laser device developed by Dodick has been used successfully for the removal of cataracts under an Investigational Device Exemption from the Food and Drug Administration and a second infrared laser developed by Colvard should be approved soon. These developments have brought us a step closer to realizing the dream of laser cataract surgery

In a prospective study 155 consecutive patients undergoing penetrating keratoplasty were examined for postoperative increase in intraocular pressure to determine the frequency and duration of intraocular pressure spikes, risk factors, and response to treatment. Patients were maintained on preoperative glaucoma medications except miotics. Additional medications to lower intraocular pressure perioperatively were not given. Intraocular pressure was measured two to five hours, one day, and one week postoperatively. An intraocular pressure of 30 mm Hg or greater was considered an increase in pressure and was treated according to a standardized protocol. The results were analyzed by procedure as well as by variables commonly perceived to be associated with intraocular pressure increase (history of glaucoma, use of hyaluronate, lysis of the synechiae, or vitrectomy at the time of the operation). Overall, intraocular pressure increases in the early postoperative period occurred in 18 of 155 patients (12%). Pressure increases occurred in ten of 48 patients (21%) with a history of glaucoma; five of 24 patients (21%) undergoing combined penetrating keratoplasty, extracapsular cataract extraction, and posterior chamber intraocular lens implantation; and ten of 43 patients (23%) undergoing vitrectomy at the time of penetrating keratoplasty