Primary Intraocular Lens Implantation in Pediatrie Uveitis: A Comparison of 2 Populations. Nemet AY, Raz J, Sachs D, et al. Arch Ophthalmol 2007;125:354-360.
Objective: To evaluate the visual outcome and postoperative complications of cataract surgery with posterior chamber intraocular lens implantation in children with uveitis.
Methods: This retrospective, interventional case series included three medical centers and involved cataract surgery and intraocular lens implantation in pediatrie patients with a history of uveitis. Aggressive preoperative and postoperative systemic and topical anti-inflammatory treatment was instituted. The main outcome measures included postoperative inflammation, complications, and visual outcome.
Results: Children with juvenile rheumatoid arthritis (JRA)-associated uveitis underwent cataract surgery at an earlier age, had a lower preoperative visual acuity, and had more severe uveitic complications when first seen compared with children who had non-JRA-associated uveitis. Visual acuity improved by 2 or more lines in all patients, and in 13 eyes the final visual acuity was 20/40 or better. Postoperative complications included elevated intraocular pressure, posterior and anterior capsular opacities, and macular dysfunction.
Conclusions: Compared with those who have non-JRA-associated uveitis, children with JRA-associated uveitis tend to have more severe manifestations of disease when first seen and after surgery; however, there is no significant difference between these groups for postoperative course or complications. Intraocular lens implantation, including smallincision, foldable intraocular lenses, is well tolerated when combined with aggressive medical treatment to control inflammation. Intraocular lens implantation is not contraindicated in those with pediatrie uveitis, including uveitis associated with JRA.
Reproducibility of and Effect of Magnification on Optical Coherence Tomography Measurements in Children. Wang XY, Huynh SC, Burlutsky G, et al. Am J Ophthalmol 2007;?43:484-488. Purpose: To determine the reproducibility of optical coherence tomography (OCT) measurements of macular thickness, peripapillary nerve fiber layer (NFL) thickness, and optic disk parameters and to investigate the effect of axial length and refractive error on these measurements in children with healthy eyes.
Methods: This study examined 2,353 year 7 students (75-3% response) from a random cluster sample of 21 secondary schools across Sydney. A consecutive subsample of 120 children had OCT performed by a single operator, which was repeated with a brief rest between the two sessions. Scans of the NFL, macula, and optic disk were performed.
Results: Intersubject variability of measurements of macular thickness, NFL thickness, and optic disk parameters assessed using intraclass correlation coefficients accounted for greater than 85%, greater than 62%, and greater than 38% of total variability of measurements, respectively. Corresponding coefficients of variability were less than 5%, less than 8%, and less than 13%. Magnification effects attributable to axial length and refractive error on the measurement of these parameters were statistically not significant.
Conclusion: OCT demonstrated reproducible measurements of macular and NFL thickness. Measurements of most optic disk parameters were also reproducible. Magnification attributable to axial length and refractive error had minimal impact on measurements of macular and NFL thickness.
Endophthalmitis After Uncomplicated Cataract Surgery With the Use of Fourth-Generation FIuoroquinolones: A Retrospective Observational Case Series. Moshirfar M, Feiz V, Vitale AT, et al. Ophthalmology 2007;114:686-691.
Objective: To estimate the rate of acute endophthalmitis after uncomplicated cataract surgery in patients treated before and after surgery with one of two different fourth-generation fluoroquinolone ophthalmic drops for surgical prophylaxis.
Methods: This was a retrospective, observational case series that included 20,013 patients from 9 cataract surgery centers in 7 states in the United States. Patients who had undergone uncomplicated phacoemulsification who received preoperative and postoperative topical fourth-generation fluoroquinolones for surgical prophylaxis between March 2003 and July 2005 were included in the study. The files of patients in whom acute endophthalmitis developed were reviewed and analyzed.
Results: During the study period, the participating surgeons performed 20,013 uncomplicated surgeries. Of these, 16,209 patients (81%) received topical gatifloxacin and 3,804 patients (19%) were treated with topical moxifloxacin as anti-infective prophylaxis. A total of 14 patients experienced endophthalmitis. The overall rate of endophthalmitis was 0.07%. There were 9 patients with endophthalmitis in the gatifloxacin group and 5 in the moxifloxacin group. The rate of endophthalmitis in the gatifloxacin group was 0.06% and the rate in the moxifloxacin group was 0.1%. The difference in the rate of endophthalmitis between the two groups was not statistically significant. In 10 of the patients, vitreous culture results were positive. Coagulase-negative staphylococci, followed by streptococci, species were the most commonly isolated organisms in the culture-positive patients.
Conclusion: The overall rate of endophthalmitis after uncomplicated cataract surgery in patients treated with topical fourth-generation fluoroquinolones as anti-infective prophylaxis was 0.07%. This rate was within the range reported in the literature. The difference in the observed rate of postoperative endophthalmitis in patients treated with moxifloxacin versus gatifloxacin was not statistically significant.