Whats Next

Sep
2006

Viva: Ecko Unltd. Kids

Recommending LASIK to another person is not necessarily a sign of a patient’s own satisfaction with LASIK outcomes, finds a multi-site survey of patients in Scranton, Pa., Pittsburgh and Los Angeles.

Investigators mailed questionnaires on symptoms and satisfaction after LASIK to 2,100 patients. All had undergone LASIK or their last LASIK enhancement procedure at least six months before completing the survey. Accounting for patients lost for reasons such as undeliverable address and surveys returned after the deadline, a total of 604 patients were included in the analyses.
The mean age of the 604 patients was 43±10.6 years. Women made up 63 percent of the sample. The mean spherical equivalent preop refractive error was 4.99±3.14 D. Just over 30 percent of the patients were corrected to produce monovision; 421 had bilateral LASIK; 184 had only one eye treated. The mean time between the patient’s LASIK procedure and completion of the questionnaire was 1.55±0.58 years.

Of the 604 patients included in the analyses, 586 would recommend LASIK to a friend; 434 of these answered the open-ended question, “Why or why not?” Investigators sorted these answers into 16 different categories. The top answer, written by 179 patients (42 percent) was, “No more spectacles/contact lenses.” (See table for remainder of responses.)

Thirty-five patients reported they were dissatisfied with their post-LASIK vision. However, 20 of them (57 percent) reported they would still recommend LASIK to a friend. It was only these subjects who reported “LASIK helps others but not me” on the survey. Investigators suggest that because a high number of unsatisfied patients would still recommend the procedure to a friend, the question, “Would you recommend LASIK to a friend?” is not a good measurement of visual function nor a valid measure of satisfaction after LASIK.
(J Cataract Refract Surg 2004;30:1861-1866)
Bailey MD, Mitchell GL, Dhaliwal DK, Boxer Wachler BS, Olson MD, Shovlin JP, Pascucci SE, Zadnik K

Alone or in Combination, Gatifloxacin Proves Effective
Topical gatifloxacin 0.3%, alone or in combination, may be an effective therapy against Mycobacterium chelonae keratitis, say researchers in Baltimore who have studied it in an animal model.

Researchers inoculated the midstroma of the right eye of 35 adult white rabbits with a 100-µg suspension containing 106 organisms of M chelonae. By day four, mycobacterial keratitis developed in all 35 rabbits. The infection was allowed to proceed for five days before initiation of antibiotic therapy.

Before inoculation, the rabbits had been sorted into one of five treatment groups to receive one of the following antibiotic regimens:

(1) 3 mg/mL of gatifloxacin
(2) 3 mg/mL of ciprofloxacin
(3) a combination of 50 mg/mL of fortified amikacin and 10 mg/mL of clarithromycin
(4) a triple combination of topical
3 mg/mL of gatifloxacin, 50 mg/mL of fortified amikacin and 10 mg/mL of clarithromycin
(5) 0.9% balanced salt solution as a control.

From the fifth day after inoculation, one of these topical antibiotic regimens was applied to the affected right eyes hourly for 12 hours. The animals were then destroyed, corneal buttons removed, and the material prepared in culture and incubated for six days.

Quantitative culture results revealed that regimen 1 (0.3% gatifloxacin) and regimen 4 (the triple combination therapy) significantly reduced the number of M chelonae compared with the control (both P<.001).

Triple combination therapy with gatifloxacin, amikacin and clarithromycin resulted in a more favorable result in reduction of bacterial colonies than monotherapy with 0.3% gatifloxacin, but there was no statistical significance.
There was no significant difference observed between control eyes (regimen 5) and those treated with regimen 2 or regimen 3.
(Arch Ophthalmol. 2004;122:1166-1169)
Hyon J-Y, Joo M-J, Hose S, Sinha D, Dick J, O’Brien T

Prep Work Can Beat Endophthalmitis
Findings of a prospective investigational study conducted in Nevada suggest that the absence of postop endophthalmitis may be related to four factors: povidone-iodine prophylaxis, meticulous draping of the eyes, operative technique and postop subconjunctival injection of antibiotics.The investigators cite studies pointing to the patient’s ocular flora or microorganisms that have colonized the surface eye structures (eyelids and conjunctiva) as the usual causes of infection.

The study comprised 5,131 consecutive cataract surgery cases with IOL implantation between 1998 and 2002 by one surgeon at a single institution. The mean patient age was 69.6±10.9 years. The mean follow-up was two years. Ten minutes was the mean surgical time, with a mean 0.6 minutes of phaco time.

No prophylactic antibiotic drops were given preoperatively. The surgeon used a blue-line incision at the superior location. At the conclusion of the case, patients were given subconjunctival injections of 0.25 mL betamethasone, 0.25 mL lidocaine 2% with epinephrine, 0.25 mL genta-micin and 0.25 mL cephazolin.

There were no cases of endophthalmitis. Complications included posterior capsule rupture (0.10 percent) and perforated sclera from the retrobulbar block (0.02 percent). No eye had wound leak through the primary cataract incision (flat or shallow anterior chamber) postoperatively.

The zero incidence of endophthalmitis in this series is below the general incidence in the United States (0.07 to 0.13 percent) and in published studies (0.02 to 0.57 percent). 
(J Cataract Refract Surg 2004; 30:1953-1959)
Buzard K, Liapis S

 

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