Abstract: Implications of Upper Eyelid Ptosis and Blepharodermatochalasis on Fixed Horizontal Forehead Lines (original) (raw)
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Late-onset bleb infections: Prevalence and risk factors
Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2009
The purpose of this study was to determine the rate and course of blebitis/late endophthalmitis 5-10 years post-filtration surgery and to evaluate risk factors. Design: Retrospective chart review. Participants: Three hundred fifty consecutive patients undergoing filtration surgery from January 1, 1996, to December 31, 2001, by a single surgeon. Five hundred twenty-one surgeries were evaluated. Methods: Data recorded included patient demographics, systemic disease(s), glaucoma type, left or right eye, date of surgery, last follow-up date, surgical procedure details, postoperative antimetabolite injections, bleb manipulations, bleb leaks and treatment, date of infection, type of infection, pre-and postinfection visual acuity, intraocular pressure (preinfection, during, and postinfection), treatment, and functionality of the bleb after infection. Statistical analysis used for assessment of risk factors included Fisher's exact test and the Student's t test analysis. Results: There were a total of 5 bleb-related infections (0.96%), 4 blebitis and 1 endophthalmitis, occurring at a mean of 31.3 months after surgery. Three occurred in blacks and 2 in Caucasians. The mean age at surgery for the infected group was 53.5 years compared with 64.7 years for those with no infection. Mitomycin C was used in 4 of the 5 cases compared with in 52% of controls. Four underwent suture lysis. Bleb leaks occurred in 4 cases. The bleb remained functional and vision unchanged in the 4 blebitis cases; however, the endophthalmitis case lost vision and had uncontrolled pressure following the infection. Conclusions: We report a 0.96% bleb infection rate with a 5.3-year mean follow-up. Bleb leak, black race, and bleb manipulation were risk factors for infection. Objet : Établissement du taux et des suites de la blébite, endophtalmie tardive 5 à 10 ans après une chirurgie de filtration, et évaluation des facteurs de risque. Nature : Examen rétrospectif des dossiers. Participants : Trois cent cinquante patients consécutifs ayant subi une chirurgie de filtration entre le 1 er janvier 1996 et le 31 décembre 2001, par le même chirurgien. Cinq cent vingt et une chirurgies ont été évaluées. Méthodes : Les données comprenaient la démographie des patients, les maladies systémiques, les types de glaucome, l'oeil droit ou gauche, la date de la chirurgie, la date du dernier suivi, les détails de la procédure chirurgicale, les injections d'antimétabolites post-opératoires, les manipulations de la bulle, fuites de la bulle et traitement, la date de l'infection, le genre d'infection, l'acuité visuelle avant et après l'infection, la pression intraoculaire (avant, pendant et après l'infection), le traitement et la fonctionnalité de la bulle après l'infection. L'analyse statistique utilisée pour l'évaluation des facteurs de risque comprenait le test d'exactitude de Fisher et l'analyse des tests t des étudiants. Résultats : En tout, 5 infections de la bulle (0,96 %), 4 blébites et 1 endophtalmie survenues en moyenne 31,3 mois après l'opération. Trois ont affecté des noirs et 2, des blancs. L'âge moyen du groupe infecté au moment de la chirurgie était de 53,5 ans, comparativement à 64,7 ans pour ceux qui n'avaient pas l'infection. La mitomycine C a été utilisée dans 4 cas sur 5, comparativement à 52 % chez les cas témoins. Quatre ont subi une suturolyse. Quatre ont eu une fuite de la bulle. La bulle est demeurée fonctionnelle et la vision inchangée dans les quatre cas de blébite; cependant, le cas d'endophtalmie a perdu la vision et eu une pression incontrôlée après l'infection. Conclusions : Nous faisons état d'un taux de 0,96 % d'infection de la bulle avec un suivi de 5,3 années en moyenne.
Journal of Health Sciences and Medicine
Aim: To compare the predisposing factors, surgical interventions, length of hospital stay (LOHS), and treatment outcomes of culture-positive (CP) versus culture-negative (CN) severe infectious keratitis (IK) resulting in hospitalization in a tertiary referral clinic. Material and Method: We retrospectively reviewed the medical and microbiological records of 287 patients clinically diagnosed with severe keratitis over a 4-year period. Results: Of 287 study participants, 141 (49.1%) had positive CP results. The most common ocular risk factor was a previous ocular surgery (45.6%), and keratoplasty was the first among these ocular surgeries (90.8%). Staphylococcus epidermidis (22.7%) was the most commonly isolated microorganism followed by fungi (17.7%). The initial and final visual acuities did not differ significantly between the CP and CN groups. Major and minor surgical interventions did not significantly differ between the groups (p=0.05). The rates of clear corneal graft in the CP...
Infectious Keratitis in 204 586 LASIK Procedures
Ophthalmology, 2010
PURPOSE: To investigate the incidence, culture results, risk factors, and visual outcomes of infectious keratitis after LASIK, and examine treatment strategies. DESIGN: Retrospective study. PARTICIPANTS: We included 107 613 patients who underwent LASIK at Clínica Baviera (Instituto Oftalmológico Europeo, Spain) from September 2002 to May 2008. METHODS: The medical records of post-LASIK patients (204 586 eyes) were reviewed to identify cases of infectious keratitis. Incidence, risk factors, clinical course, days to diagnosis, medical and surgical treatment, and final visual outcomes were recorded. MAIN OUTCOME MEASURES: Incidence of post-LASIK infectious keratitis, culture results, response to treatment, and visual outcome. RESULTS: Post-LASIK infectious keratitis was diagnosed in 72 eyes from 63 patients. Onset of infection was early (within 7 days after surgery) in 62.5% of cases. Cultures were positive in 21 of 54 cases in which samples were taken. The most frequently isolated microorganism was Staphylococcus epidermidis (9 cases). Immediate flap lifting and irrigation with antibiotics was performed in 54 eyes; late flap lifting was subsequently required in 10 out of 18 cases initially treated with topical antibiotics alone. One case required flap amputation owing to flap necrosis. Final best spectacle-corrected visual acuity (BSCVA) was >or=20/20 in 38 cases (52.7%) and >or=20/40 in 67 cases (93.05%); final BSCVA was <20/40 in 5 cases (6.94%). CONCLUSIONS: The incidence of post-LASIK infectious keratitis was 0.035% per procedure. Infectious keratitis after LASIK is a potentially vision-threatening complication. The appearance of infections in asymptomatic patients highlights the need for a proper schedule of follow-up appointments. Prompt and aggressive management of this LASIK complication with early flap lifting, scraping, culture, and irrigation with antibiotics is strongly recommended. Proper management can result in preserving useful vision.
Cornea, 2009
To identify the risk factors for, and to report the microbiological findings and clinical outcomes of, severe microbial keratitis (MK). Methods: This was a retrospective study of all cases of presumed MK admitted to a tertiary referral center over a 2-year period (September 2001 to August 2003). Data recorded included demographic data, details relating to possible risk factors, results of microbiological studies, clinical findings at presentation, and clinical and visual outcomes. Results: Ninety patients were admitted with a diagnosis of presumed MK during the study period. The mean age of patients was 45 6 32 years, and the male to female ratio was 47:43 (52.2%:47.7%). Predisposing risk factors for MK included contact lens wear (37; 41.1%), anterior segment disease (19; 21.1%), ocular trauma (13; 14.4%), systemic disease (5; 5.6%), and previous ocular surgery (1; 1.1%). Cultured organisms included gram-negative bacteria (17; 51.5%), gram-positive bacteria (11, 33.3%), acanthamoeba (2; 6.1%), and fungi (1; 3%). Visual acuity improved significantly after treatment [mean best-corrected visual acuity (6standard deviation) at presentation: 0.76 (60.11); mean bestcorrected visual acuity at last follow-up: 0.24 (60.07); P , 0.001]. Secondary surgical procedures were required in 18 (20%) cases, and these included punctal cautery (1; 1.1%), tissue glue repair of corneal perforation (2; 2.2%), tarsorrhaphy (9; 9.9%), Botulinum toxininduced ptosis (1; 1.1%), penetrating keratoplasty (3; 3.3%), and evisceration (2; 2.2%). Conclusions: Contact lens wear remains a significant risk factor for severe MK. MK remains a threat to vision and to the eye, but the majority of cases respond to prompt and appropriate antimicrobial therapy.
EPIDEMIOLOGICAL AND MICROBIOLOGICAL PROFILE OF PATIENT'S HAVING MICROBIAL KERATITIS
National Journal of Community Medicine, 2014
Background: Microbial keratitis is common potentially sight threatening ocular infection that may be caused by bacteria, fungi or virus. Epidemiological and microbiological profile of corneal ulceration have been found vary with patient population, health of cornea, geographical location and climate tends to vary over times. Methods: The present cross-sectional study was conducted 3 on patients having microbial keratitis. Detailed history taking include duration of symptoms, predisposing factors, history of trauma, traumatic agents, associated ocular conditions, other systemic disease, treatment received prior to presentation, visual acuity at the time of presentation and all clinical findings were collected. Detailed ocular examination, using standard technique, corneal scraping were also taken under aseptic conditions from each ulcer. Results: In our study, 51 cases belonged to low socio-economic group of which 21 cases (41%) of bacterial keratitis, 15 cases (29%) of fungal keratitis , 11 cases (21%) of viral keratitis and 4 cases (8%) of Mixed (bacterial + fungal ) keratitis. A total 15 bacterial pathogens were isolated from the 64 eyes which yielded only bacterial growth in culture. Out of which 4(16%) were staphylococcus aureus, 4(16%) pseudomonas,3(12%) were streptococcus,2(8%) were staphylococcus epidermis. A total of 17 viral keratitis 9(53%) were recurrent cases. Conclusion: Trauma is most common predisposing factor responsible for microbial keratitis. Direct microscopic examination of corneal scraping is key tool for rapid diagnosing and institution of antimicrobial therapy.
Eye, 2021
Corneal opacity is the 5th leading cause of blindness and visual impairment globally, affecting ~6 million of the world population. In addition, it is responsible for 1.5–2.0 million new cases of monocular blindness per year, highlighting an ongoing uncurbed burden on human health. Among all aetiologies such as infection, trauma, inflammation, degeneration and nutritional deficiency, infectious keratitis (IK) represents the leading cause of corneal blindness in both developed and developing countries, with an estimated incidence ranging from 2.5 to 799 per 100,000 population-year. IK can be caused by a wide range of microorganisms, including bacteria, fungi, virus, parasites and polymicrobial infection. Subject to the geographical and temporal variations, bacteria and fungi have been shown to be the most common causative microorganisms for corneal infection. Although viral andAcanthamoebakeratitis are less common, they represent important causes for corneal blindness in the develope...
Multinational Comparison of Prophylactic Antibiotic Use for Eyelid Surgery
JAMA ophthalmology, 2015
Antibiotic stewardship is important in controlling resistance, adverse reactions, and cost. The literature regarding antibiotic use for eyelid surgery is lacking. To determine standard care and assess factors influencing antibiotic prescribing practices for eyelid surgery. A survey study was conducted from February 2, 2014, to March 24, 2014. The survey was distributed to 2397 oculoplastic surgeons in private and academic oculoplastic surgery practices in 43 countries. All surgeons were members of ophthalmic plastic and reconstructive surgery societies. Data were analyzed by geographic location. Linear regression was performed to quantify contributions to rates of prescribing postoperative antibiotics for routine eyelid surgical procedures. Rates of prescribing prophylactic intravenous, oral, and topical antibiotics as well as factors that influence surgeons' prescribing practices. A total of 782 responses were received from 2397 surgeons (average response rate, 36.7%; 2.5% marg...
Infections following laser in situ keratomileusis: An Integration of the Published Literature
Survey of Ophthalmology, 2004
Infections occurring after laser in situ keratomileusis (LASIK) surgery are uncommon, but the number of reports have steadily increased in recent years. This systematic, comprehensive review and analysis of the published literature has been performed in order to develop an integrative perspective on these infections. We have stratified the data by potential associations, microbiology, treatment, and the degree of visual loss, using Fisher's exact tests and Student's t-tests for analysis. In this review, we found that Gram-positive bacteria and mycobacterium were the most common causative organisms. Type of postoperative antibiotic and steroid use was not associated with particular infecting organisms or severity of visual loss. Gram-positive infections were more likely to present less than 7 days after LASIK, and they were associated with pain, discharge, epithelial defects, and anterior chamber reactions. Fungal infections were associated with redness and tearing on presentation. Mycobacterial infections were more likely to present 10 or more days after LASIK surgery. Moderate or severe visual reductions in visual acuity occurred in 49.4% of eyes. Severe reductions in visual acuity were significantly more associated with fungal infections. Flap lift and repositioning peformed within 3 days of symptom onset may be associated with better visual outcome. (Surv Ophthalmol 49:269-280, 2004. Ć 2004 Elsevier Inc. All rights reserved.)
Journal of Nepal Medical Association
Introduction: Keratitis, an ocular emergency, requires rapid and accurate treatment to prevent vision impairment. Wet mount direct microscopy examination of corneal scraping smear using gram and 10% potassium hydroxide stain helps in early diagnosis and treatment. The main objective of this study was to find out the prevalence of positive microbiological stains of corneal scrapings among patients with keratitis in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in the Department of Ophthalmic Pathology and Laboratory Medicine from January, 2018 to December, 2019. Data collection was done after taking ethical approval from the Institutional Review Committee of the hospital (Reference number: BEH-IRC-35/A). All corneal smear samples received in this department were included in this study. Case records with incomplete data were excluded. Whole sampling was done. The data were analyzed using Statistical Package for the Social Sciences version 22.0. Poi...