Eyeworld

EW INTERNATIONAL 66 April 2015 by Matt Young EyeWorld Contributing Writer Troubleshooting interesting problems at international conference Head massage IOL rotation, crosslinking conundrum, and calculation issues discussed in posters T he 2015 All India Oph- thalmological Conference (AIOC) in New Delhi in February testified to some of the world's interesting re- cent ocular phenomenon, challeng- es, and surgical tips, particularly in the scientific poster section. Ocular issues via head massage, crosslinking induced microbial keratitis, and how to pinpoint a defective toric IOL were poster topics of considerable interest, among others. The head massage that went awry A 25-year-old man decided to have a facial massage before getting mar- ried. "His face and eyes were thor- oughly rubbed and massaged with cream," said Maneck Nicholson, MD, Narayana Nethralaya Eye Hospital, Bangalore, India, and colleagues. Having had a toric ICL im- planted prior to the massage, soon after the massage the patient com- plained of vision loss. While he had achieved 6/6 vision in both OD and OS (i.e., 20/20 vision), his vision now was 6/36 (i.e., 20/120, OD) and 6/24 (i.e., 20/80, OS). Upon examination, it was seen that the toric ICL had significantly rotated in both eyes. Investigations included use of corneal topography, wavefront aberrometry, manifest refraction, macular and anterior segment OCT, a dilated fundus examination, and ultrasound biometry. Objective and subjective measurements of visual acuity were employed, and a thorough patient history was taken. Rerotation surgery was per- formed to rotate the ICLs back to their previously planned position, and visual acuity improvement was demonstrated after this additional surgery. "[A] sudden drop in vision in toric ICLs needs to be investigat- ed thoroughly; a detailed history should be taken and examination done," Dr. Nicholson said. Dr. Nicholson also noted that visual quality assessment is benefi- cial in such cases, and "rerotation surgery should be done with utmost care to achieve predictable out- comes." The crosslinking conundrum Luci Kaweri, MD, Narayana Nethralaya Eye Hospital, and col- leagues, retrospectively analyzed 2,350 patients who underwent corneal crosslinking (CXL) during a 7-year period for keratoconus. Four eyes developed moxiflox- acin-resistant Staphylococcus aureus (MXRSA) after the treatment. In other words, the 4 eyes (0.0017%) had corneal infiltrates. Gram stain- ing and culture determined that MXRSA was the problem agent. "The incidence of infectious keratitis is a rare complication," Dr. Kaweri reported. "All patients were treated with fortified antibiotic eye drops, [after] which keratitis resolved over a 6-week period with scarring. MXRSA is a potential organism for causing post-CXL keratitis and should be identified early and treated aggressively with fortified antibiotics." This also poses an interesting issue, Dr. Kaweri said. Some studies have pointed to the successful treatment of infec- tious keratitis with CXL. It has been shown in peer-reviewed research to, for example, successfully treat advanced non-resolving microbial keratitis. It also has been used to manage advanced infectious keratitis with corneal melt. But this poster also suggests MXRSA can occur after CXL. It did so in 4 patients (with bronchial asth- ma, eczema, and 2 cases of vernal catarrh). Other peer-reviewed research has found isolated cases of infectious keratitis occurring after CXL. Organ- isms causing such infection have been noted to include herpes sim- plex, E. coli, Acanthamoeba, Staphylo- coccus epidermidis, and others. The case of the defective toric Goyal Rajat, MS, GSVM Medical College, Kanpur, Uttar Pradesh, India, and colleagues found a way to thoroughly check the possibility of a defective toric IOL prior to expla- nation. "A meticulous preoperative evaluation and calculation is the key to successful cataract extraction with toric IOL implant," Dr. Rajat reported. Dr. Rajat analyzed a 55-year- old patient with a grade II nuclear sclerosis with posterior subcapsular cataract in the right eye. Preoperative data for the right eye included the following: best corrected visual acuity of 4/60, IOP 12 mm Hg, axial length 25.01 mm, IOL power +16.5, with keratometry readings performed as well. Calculation details for the toric IOL included: 4.5 D at 86 degrees T he 73rd annual conference of the All India Ophthalmological Society (AIOS) offered attendees a varied program, from sessions on ophthalmic innovations to "Industry for You" talks, catering to both general and comprehensive ophthalmologists from India and around the world. The 2015 All India Ophthalmological Conference (AIOC) of the AIOS was held in New Delhi, India, from Feb. 5–8. This year's conference, chaired by Jeewan S. Titiyal, MD (chairman, organizing committee), and Lalit Verma, MD (chairman, scientific committee), received an overwhelming number of submissions: 549 instruction courses, 1,699 free papers/posters, and 258 videos on a wide range of subject areas, which were used in the conference's video sessions, simulated surgery skills transfer sessions, as well as e-posters and as physical poster boards for one-on-one interactions. EW Humayun's Tomb in New Delhi, India About the AIOC

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