- Email: [email protected]
Microbial keratitis at extremes of age
suture lysis or eyes undergoing LSL ⬍10 days after surgery.—Michael D. Wagoner
tonometry, and to evaluate the influence of central corneal thickness (CCT) and corneal curvature. A clear correlation between dynamic contour tonometry and Goldmann applanation tonometry was found (r ⫽ 0.693, P ⬍ .001). Dynamic contour tonometry generally resulted in higher IOP measurement (mean difference ⫹ 1.8 mm Hg, mean difference ⫹ 2.34 mm Hg). Unlike dynamic contour tonometry, Goldmann applanation tonometry was remarkably affected by central corneal thickness, which partially explained the disagreement in IOP measurements by the two techniques. Neither method was significantly influenced by corneal curvature. The authors conclude that dynamic contour tonometry is a reliable method for IOP measurement, which unlike Goldmann applanation tonometry is not influenced by corneal thickness. In clinical practice, advantages from dynamic contour tonometry can be expected for cooperative patients, outpatients, and patients with sufficient bilateral ocular fixation, whereas Goldmann applanation tonometry measurements are more reliable in cases of patients with inadequate cooperation, poor vision, or nystagmus.—Michael D. Wagoner
*J. Caprioli, Glaucoma Division, Jules Stein Eye Institute, University of California at Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095; e-mail: [email protected]
●
Microbial keratitis at extremes of age. Parmar P,* Salman A, Kalavathy CM, Kaliamurthy J, Thomas PA, Jesudasan AN. Cornea 2006;25:153–158.
T
HE AUTHORS CONDUCTED A PROSPECTIVE, NONRAN-
domized, analytical clinical study of all patients presenting with microbial keratitis and undergoing microbiological workup. The patients were evaluated using a dedicated corneal ulcer protocol. They performed a comparative analysis of the microbiological profile, predisposing factors, clinical presentation, response to treatment, and final visual outcome in (1) a pediatric group of patients 16 years of age or younger (26 eyes); (2) an elderly group of patients 65 years of age or older (55 eyes); and (3) a control group between 17 and 64 years of age (188 eyes). The elderly and control groups had a similar incidence of bacterial and fungal keratitis, but the pediatric group had a significantly lower incidence of fungal keratitis (P ⫽ .001). Trauma was the most common predisposing factor in all three groups. Elderly patients tended to present with a higher incidence of central ulcers (P ⫽ .04), severe ulcers (P ⫽ .04), and poor visual acuity (P ⫽ .003) compared to the control group. The percentage of ulcers healing with medications alone was significantly more in the pediatric group (P ⫽ .004), while the incidence of poor visual outcome was greater in the elderly group (P ⫽ .006) compared to the control group. The authors conclude that pediatric patients have a better chance for resolution of microbial keratitis with medical therapy alone compared to the general population, while elderly patients with microbial keratitis tend to present with severe, central corneal ulcers that have a poor visual outcome.—Michael D. Wagoner
*E. Schneider, Department of Ophthalmology, University of Wuerzburg, Josef-Schneider-Strasse 11, 97080 Wuerzburg, Germany; e-mail: evelin. [email protected]
●
Retinal detachment in myopic eyes after phakic intraocular lens implantation. Ruiz-Moreno J, Montero J, de la Vega C, Alio JL, Zapater P. J Refract Surg 2006;22: 247–252.
T
*P. Parmar, Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirapalli 620 001 (Tamil Nadu), India; e-mail: [email protected]
●
Intraocular pressure measurement-comparison of dynamic contour tonometry and Golmann applanation tonometry. Schneider E,* Grehn F. J Glaucoma 2006;15: 2– 6.
A
PROSPECTIVE STUDY IN 100 PATIENTS WITHOUT
glaucoma was performed in order to compare intraocular pressure (IOP) measurement using dynamic contour tonometry (DCT, Pascal tonometer, Swiss Microtechnology AG, Port, Switzerland) and Goldmann applanation 204
AMERICAN JOURNAL
HIS RETROSPECTIVE, NONCOMPARATIVE, INTERVEN-
tional case series analyzed the risk of retinal detachment in highly myopic eyes that underwent implantation of phakic intraocular lenses (PIOLs). In a series of 522 consecutive highly myopic eyes (323 patients), with a mean age of 32.1 ⫾ 7.3 years (range, 18 to 52 years), a mean spherical refractive error of ⫺18.1 ⫾ 5.0 diopters (D) (range, ⫺7.0 to ⫺38.0 D), and a mean follow-up of 60.4 ⫾ 39.1 months (range, 12 to 145 months), 15 (2.9%) developed retinal detachment after PIOL implantation. The mean time between surgery and retinal detachment was 24.4 ⫾ 24.4 months (range, 1 to 92 months). By Kaplan-Meier analysis, the risk for retinal detachment after PIOL was 0.57% at three months, 1.64% at 12 months, 2.73% at 36 months, and 4.06% at 92 to 145 months. There was a statistically significant difference in the axial length of eyes that developed retinal detachment after PIOL and those that did not (30.65 ⫾ 1.97 vs 29.51 ⫾ 2.20, respectively; P ⫽ .028). The authors conclude that there is a greater risk of retinal detachment after PIOL in eyes with an axial length ⬎ 30.24 mm.—Michael D. Wagoner *Division de Oftalmologia, Univesidad Miguel Hernandez, Campus de San Juan, 03550 Alicante, Spain; e-mail: [email protected] OF
OPHTHALMOLOGY
JULY 2006
tonometry, and to evaluate the influence of central corneal thickness (CCT) and corneal curvature. A clear correlation between dynamic contour tonometry and Goldmann applanation tonometry was found (r ⫽ 0.693, P ⬍ .001). Dynamic contour tonometry generally resulted in higher IOP measurement (mean difference ⫹ 1.8 mm Hg, mean difference ⫹ 2.34 mm Hg). Unlike dynamic contour tonometry, Goldmann applanation tonometry was remarkably affected by central corneal thickness, which partially explained the disagreement in IOP measurements by the two techniques. Neither method was significantly influenced by corneal curvature. The authors conclude that dynamic contour tonometry is a reliable method for IOP measurement, which unlike Goldmann applanation tonometry is not influenced by corneal thickness. In clinical practice, advantages from dynamic contour tonometry can be expected for cooperative patients, outpatients, and patients with sufficient bilateral ocular fixation, whereas Goldmann applanation tonometry measurements are more reliable in cases of patients with inadequate cooperation, poor vision, or nystagmus.—Michael D. Wagoner
*J. Caprioli, Glaucoma Division, Jules Stein Eye Institute, University of California at Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095; e-mail: [email protected]
●
Microbial keratitis at extremes of age. Parmar P,* Salman A, Kalavathy CM, Kaliamurthy J, Thomas PA, Jesudasan AN. Cornea 2006;25:153–158.
T
HE AUTHORS CONDUCTED A PROSPECTIVE, NONRAN-
domized, analytical clinical study of all patients presenting with microbial keratitis and undergoing microbiological workup. The patients were evaluated using a dedicated corneal ulcer protocol. They performed a comparative analysis of the microbiological profile, predisposing factors, clinical presentation, response to treatment, and final visual outcome in (1) a pediatric group of patients 16 years of age or younger (26 eyes); (2) an elderly group of patients 65 years of age or older (55 eyes); and (3) a control group between 17 and 64 years of age (188 eyes). The elderly and control groups had a similar incidence of bacterial and fungal keratitis, but the pediatric group had a significantly lower incidence of fungal keratitis (P ⫽ .001). Trauma was the most common predisposing factor in all three groups. Elderly patients tended to present with a higher incidence of central ulcers (P ⫽ .04), severe ulcers (P ⫽ .04), and poor visual acuity (P ⫽ .003) compared to the control group. The percentage of ulcers healing with medications alone was significantly more in the pediatric group (P ⫽ .004), while the incidence of poor visual outcome was greater in the elderly group (P ⫽ .006) compared to the control group. The authors conclude that pediatric patients have a better chance for resolution of microbial keratitis with medical therapy alone compared to the general population, while elderly patients with microbial keratitis tend to present with severe, central corneal ulcers that have a poor visual outcome.—Michael D. Wagoner
*E. Schneider, Department of Ophthalmology, University of Wuerzburg, Josef-Schneider-Strasse 11, 97080 Wuerzburg, Germany; e-mail: evelin. [email protected]
●
Retinal detachment in myopic eyes after phakic intraocular lens implantation. Ruiz-Moreno J, Montero J, de la Vega C, Alio JL, Zapater P. J Refract Surg 2006;22: 247–252.
T
*P. Parmar, Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirapalli 620 001 (Tamil Nadu), India; e-mail: [email protected]
●
Intraocular pressure measurement-comparison of dynamic contour tonometry and Golmann applanation tonometry. Schneider E,* Grehn F. J Glaucoma 2006;15: 2– 6.
A
PROSPECTIVE STUDY IN 100 PATIENTS WITHOUT
glaucoma was performed in order to compare intraocular pressure (IOP) measurement using dynamic contour tonometry (DCT, Pascal tonometer, Swiss Microtechnology AG, Port, Switzerland) and Goldmann applanation 204
AMERICAN JOURNAL
HIS RETROSPECTIVE, NONCOMPARATIVE, INTERVEN-
tional case series analyzed the risk of retinal detachment in highly myopic eyes that underwent implantation of phakic intraocular lenses (PIOLs). In a series of 522 consecutive highly myopic eyes (323 patients), with a mean age of 32.1 ⫾ 7.3 years (range, 18 to 52 years), a mean spherical refractive error of ⫺18.1 ⫾ 5.0 diopters (D) (range, ⫺7.0 to ⫺38.0 D), and a mean follow-up of 60.4 ⫾ 39.1 months (range, 12 to 145 months), 15 (2.9%) developed retinal detachment after PIOL implantation. The mean time between surgery and retinal detachment was 24.4 ⫾ 24.4 months (range, 1 to 92 months). By Kaplan-Meier analysis, the risk for retinal detachment after PIOL was 0.57% at three months, 1.64% at 12 months, 2.73% at 36 months, and 4.06% at 92 to 145 months. There was a statistically significant difference in the axial length of eyes that developed retinal detachment after PIOL and those that did not (30.65 ⫾ 1.97 vs 29.51 ⫾ 2.20, respectively; P ⫽ .028). The authors conclude that there is a greater risk of retinal detachment after PIOL in eyes with an axial length ⬎ 30.24 mm.—Michael D. Wagoner *Division de Oftalmologia, Univesidad Miguel Hernandez, Campus de San Juan, 03550 Alicante, Spain; e-mail: [email protected] OF
OPHTHALMOLOGY
JULY 2006