Eyeworld

EW NEWS & OPINION September 2015 17 The Folden* Femto Double-Ended Dissector 3360 Scherer Drive, Suite B, St. Petersburg, FL 33716 800-637-4346 • Tel: 727-209-2244 • Fax: 727-341-8123 Email: Info@RheinMedical.com • Website: www.RheinMedical.com *Developed In Coordination With David Folden, M.D. Lamentation, Michelangelo ACBF 1360 Rev.A 8-10144 Folden Femto Double-Ended Dissector, 0.7mm & 1.2mm • Clear Corneal Incisions (CCIS): The 1.2mm End Provides Easy Entry Into Standard Small Incisions As Well As Sub-2.0mm Micro-Incisions. The 0.7mm End Provides Ample Clearance For Entry Into The Paracentesis. • Arcuate Incisions (AIS): Arcuate Incisions For Astigmatism Are Opened Quickly And Cleanly Down To Their Base Without Risk Of Perforation. The Polished Semi- Blunted Leading Tip Glides Smoothly Along The Base Of The Arcuate Incision, While The Sharp Edge Provides Smooth Opening Of Stromal Tissue Bridges And Maintains Clean Epithelial Edges. Fewer Surface Abrasions Result In Less Foreign Body Sensation And Improved Patient Comfort Postoperatively. The Folden Femto Dissector Is A Single Instrument Designed For Smooth Opening Of All Femtosecond Laser – Created Corneal Incisions During Cataract Surgery. The Double-Ended Instrument Measures 0.7mm At One End, And 1.2mm At The Other. The Polished, Semi-Blunted Leading Tip Allows For "Scoring" Of The Epithelium And Provides Easy, Glided Entry Into The Femtosecond Laser – Created Corneal Incision. The Unique Sharp Edge Design Cleanly Separates Residual Tissue Bridges And Stromal Adhesions That Provide Resistance To Entry Using Standard Instruments. Please Watch The Video Or Contact 727-209-2244 For More Information. Come See Us at AAO, Booth 2514 Intracameral vancomycin toxicity by Richard S. Hoffman, MD, chair, ASCRS Cataract Clinical Committee I n response to a recent article in Ophthalmology 1 regarding the possible association of intracameral vancomycin and hemorrhagic occlusive retinal vasculitis (HORV), the ASCRS Executive Committee requested that the ASCRS Cataract Clinical Committee (CCC) poll its committee members to determine their use of intracameral vancomycin and any known reports of this potentially serious complication other than the rare scattered reports published in the literature. The Ophthalmology article discussed the findings of 11 eyes that experienced severe HORV and found that this exceedingly rare condition could represent a delayed immune reaction. Although the cause was unknown, all eyes that developed HORV had been treated prophylactically following uncomplicated cataract surgery with intracameral vancomycin, suggesting a possible association with this antibiotic. Of the 11 CCC members who responded to the poll, most were currently not using intracameral vancomycin and all respondents had not seen or heard of this complication from anyone in their community who may be using intracameral vancomycin. One surgeon had been using intracameral vancomycin in his practice since 1994 and stated that he has had no events of vasculitis in more than 40,000 cases. He also practices in an area where another high volume surgeon has used it in more than 300,000 cases, and he was not aware of that surgeon having any issues. Two other members had been using vancomycin in the irrigating solution in tens of thousands of cases without any vascular events. Considering that this is an exceedingly rare complication that is likely an immunologic rather than a toxic reaction, the CCC feels that no further intervention is warranted. Recommendations in the Ophthalmology article to place 3 weeks between bilateral cataract surgeries utilizing prophylactic intracameral vancomycin seem somewhat excessive considering the rarity of the condition. Whether intracameral vancomycin should be avoided in individuals with an autoimmune disease (an association found in the eyes developing HORV) is a question that could not be adequately answered; however, considering the number of individuals who have autoimmune diseases who have probably received intracameral vancomycin and not developed HORV, we believe it is safe to state that no special precautions need to be taken in these individuals. Currently, 37% of ASCRS members who are administering prophylactic intracameral antibiotics following cataract surgery are using vancomycin. Vancomycin (1 mg/0.1 ml) has been found to remain in the anterior chamber exceeding its MIC for endophthalmitis-causing gram positive bacteria (94% of endophthalmitis organisms) for 24–33 hours. 2 In addition, it covers methicillin resistant Staphylococcus aureus (MRSA) that may not be susceptible to other commonly used intracameral antibiotics. Despite the lack of reported encounters of HORV among CCC members, ASCRS is considering starting a data registry so that ASCRS members can report any suspected cases of HORV and any assumed associations. EW References 1. Witkin AJ, Shah AR, Engstrom RE, et al. Postoperative hemorrhagic occlusive retinal vasculitis: expanding the clinical spectrum and possible association with vancomycin. Ophthalmology 2015;122:1438–1451. 2. Murphy CC, Nicholson S, Quah SA, et al. Pharmacokinetics of vancomycin following intracameral bolus injection in patients undergoing phacoemulsification cataract surgery. Br J Ophthalmol 2007;91:1350–1353.

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