Bilateral cataract surgery: A controlled clinical trial

Purpose  To evaluate the efficacy and safety of simultaneous bilateral cataract surgery with respect to patient satisfaction, outcomes, and complication rates. Methods  We conducted a prospective study of consecutive patients who had simultaneous bilateral cataract surgery on the same day or separate bilateral cataract surgery with an interval of 2 days between operations. The changes in refraction, visual acuity, degree of anisometropia, and complication rates were compared between the simultaneous bilateral cataract surgery and separate bilateral cataract surgery groups. Patient satisfaction was assessed with a questionnaire. Results  Ninety-four patients who had simultaneous bilateral cataract surgery and 100 patients who had separate bilateral cataract surgery were enrolled in this study. The preoperative best-corrected visual acuity (logMAR) was 0.31 ± 0.17 in the simultaneous bilateral cataract surgery group and 0.29 ± 0.16 in the separate bilateral cataract surgery group, and it improved postoperatively to 0.11 ± 0.12 in the simultaneous bilateral cataract surgery group and to 0.10 ± 0.11 in the separate bilateral cataract surgery group. There was no significant difference between the two groups (P = 0.061). In addition, 96.8% of eyes in the simultaneous bilateral cataract surgery group and 97.0% of eyes in the separate bilateral cataract surgery group were within 1.0 diopters of the mean absolute error, and there were no sight-threatening intraoperative or postoperative complications in the two groups. Conclusions  Simultaneous bilateral cataract surgery may be an effective and safe bilateral cataract surgery option with a high degree of patient satisfaction.     

Bilateral infectious keratitis after a laser in situ keratomileusis enhancement procedure

We report a case of bilateral infectious keratitis occurring as a complication of bilateral simultaneous laser in situ keratomileusis enhancement procedures. Corneal scraping from the interface of both eyes grew Staphylococcus aureus. The infection cleared after treatment with fortified cefazolin, fortified gentamicin, and ciprofloxacin eyedrops. The patient was left with bilateral paracentral corneal scars. When bilateral surgery is performed, bilateral infection may occur as a rare complication.     

Sudden bilateral vision loss in a COVID-19 patient: A case report

We present a Coronavirus disease 2019 (COVID-19) patient who developed sudden bilateral vision loss after a bilateral occipital ischemic stroke and without a history of stroke risk factors. An 84-year-old man was admitted to the emergency room with bilateral sudden vision loss while receiving Favipiravir treatment for 5 days following a COVID-19 diagnosis. The patient had no history of stroke risk factors, such as hypertension, diabetes mellitus, coronary artery disease, or arrhythmia. Diffusion magnetic resonance imaging of the patient revealed acute ischemia in the bilateral posterior occipital lobe and bilateral cerebellar hemisphere. We conclude that COVID-19 may rarely cause bilateral ischemic stroke presented only in the form of vision loss.     

鼻咽癌长期放射治疗后双眼缺血综合征1例

目的：报道1例因接受放射治疗后出现双侧颈总动脉完全闭塞和双眼缺血综合征(ocular ischemic syndrome,OIS)的患者。 方法：病例报告。1例57岁男性患者主诉左眼一过性黑矇伴有眼部和眶周疼痛6mo,诊断为双侧OIS,依次给予双侧全视网膜光凝(panretinal photocoagulation,PRP)、白内障手术、颈动脉内膜剥脱术和Ahmed青光眼阀植入术。 结果：经过PRP和白内障超声乳化手术治疗,双侧眼部病情稳定。但患者行双侧颈动脉内膜剥脱术后出现眼压升高,视力降至指数。 结论：鼻咽癌放射治疗后出现的双侧颈总动脉完全闭塞和双眼OIS的治疗比较困难,预后不佳。     

Simultaneous,Bilateral Ophthalmoplegia as the Presenting Sign of Paediatric Multiple Sclerosis: Case Report and Discussion of the Differential Diagnosis

An 11-year-old female developed bilateral oculomotor nerve palsies without pupillary involvement and bilateral optic neuropathy as the presenting signs of paediatric multiple sclerosis (MS). Although ocular mono-neuropathies have been reported, this is the first bilateral mono-neuropathy reported in a paediatric patient due to MS. The differential diagnosis and evaluation for bilateral ophthalmoplegia are discussed in detail.     

Bilateral Pseudomonas aeruginosa endophthalmitis following bilateral simultaneous cataract surgery

A bilateral simultaneous cataract surgery (BSCS) was performed on a 67-year-old man. The surgeon had not changed the surgical settings in between the two procedures for the two eyes. The patient developed fulminant bilateral endophthalmitis a day following the BSCS. Intravitreal culture grew Pseudomonas aeruginosa . The source of infection was not found. Immediate bilateral vitrectomy and intravitreal, subconjunctival, topical and systemic antibiotic did not save the eyes. Patient ended up with bilateral visual loss.     

Traumatic Superior Oblique Palsies

The differences in the clinical and diagnostic characteristics of 33 consecutive traumatic unilateral (21 patients, 62% ) and bilateral (12 patients, 38%) superior oblique palsies were studied. The unilateral palsies had a large hypertropia in primary postion, more vertical than torsional diplopia, a compensatory head tilt to obtain fusion, and a positive Bielschowsky head tilt test. In contrast, the bilateral palsies had small hypertropias in primary gaze that alternated on right and left gaze, a large V-pattern esotropia with excyclotorsion that was frequently bilateral, and a compensatory head position with fusion in upgaze. The results of the study indicate that a V-pattern in excess of 25 prism diopters, an excyclotorsion of greater than 10 degrees, or head trauma severe enough to cause loss of consciousness should also signal bilateral involvement. Torsional diplopia was present in only 20% of unilateral palsies vs 75% of bilateral palsies. The Bielschowsky head tilt test was diagnostic in 100% of the patients with unilateral palsy and 83% of the patients with bilateral palsy. It was undiagnostic in the supine position in all patients. Spontaneous resolution occurred in 65% of the unilateral palsies but in only 25% of the bilateral palsies. Surgical correction was successful in relieving persistent symptoms.     

Long-Term Results of Simultaneous Bilateral External Dacryocystorhinostomy in Cases with Bilateral Dacryostenosis

ABSTRACT

Objectives: To evaluate the long-term results of simultaneous bilateral external dacryocystorhinostomy (EX-DCR) in cases with bilateral dacryostenosis. Methods: Thirty-four eyes of 17 consecutive patients with a history of bilateral epiphora were included in the study between 2007 and 2011. Demographic information, etiology of the obstruction, history of lacrimal surgery, type of anesthesia, duration of surgery, incidence of postoperative nasal bleeding and infection, surgical outcomes, and duration of follow-up were recorded. During the lacrimal irrigation, there was not any passage noticed in the patients’ eyes. The post-operative follow-up was 13 to 44 months (mean 33.6 months). Results: Of 17 patients undergoing simultaneous bilateral EX-DCR with a mean age of 42.8 years, one of the patients had a history of bilateral unsuccessful DCR performed in a different center. One patient had previously failed bilateral probing before undergoing bilateral EX-DCR. This latter patient was a four-month-old baby with bilateral dacryoceles. Bicanalicular silicone intubation was performed in 15 eyes of 10 patients that had a canalicular problem or fibrotic lacrimal sac. It has been discerned that complaints about epiphora disappeared in 33 of the eyes (97%) and that the passage was open during the lacrimal irrigation. One eye with a history of unsuccessful dacryocystorhinostomy failed to respond positively to our operation. Conclusions: In our study, high success rates of simultaneous bilateral EX-DCR were found in both children and adult patients with bilateral dacryostenosis during a long-term follow-up. We believe that simultaneous bilateral dacryocystorhinostomy has medical, social, and economic advantages.     

Meesmann corneal dystrophy associated with epithelial basement membrane and posterior polymorphous corneal dystrophies

PURPOSE: To report a rare case of bilateral and symmetric Meesmann corneal dystrophy concurrent with bilateral epithelial basement membrane dystrophy and bilateral but asymmetric posterior polymorphous corneal dystrophy in a patient of Armenian origin. METHODS: Complete ophthalmologic examination was performed on a 6-year-old boy from Armenia who was diagnosed with bilateral symmetric Meesmann corneal dystrophy combined with bilateral epithelial basement membrane dystrophy and bilateral but asymmetric posterior polymorphous corneal dystrophy. This case was observed and treated for 24 years. RESULTS: On slit-lamp biomicroscopy, the patient showed bilateral multiple intraepithelial cystic lesions, bilateral irregularly shaped grayish-white opacities in the superficial corneal epithelium, and bilateral but asymmetric transparent vesicles surrounded by gray halos at the level of the Descemet membrane and the endothelium. CONCLUSIONS: This case is reported because of the unusual occurrence of Meesmann corneal dystrophy with other corneal dystrophies.     

Simultaneous,Bilateral Ophthalmoplegia as the Presenting Sign of Paediatric Multiple Sclerosis: Case Report and Discussion of the Differential Diagnosis

Abstract

An 11-year-old female developed bilateral oculomotor nerve palsies without pupillary involvement and bilateral optic neuropathy as the presenting signs of paediatric multiple sclerosis (MS). Although ocular mono-neuropathies have been reported, this is the first bilateral mono-neuropathy reported in a paediatric patient due to MS. The differential diagnosis and evaluation for bilateral ophthalmoplegia are discussed in detail.     

Orbital leiomyosarcoma after retinoblastoma

Patients with the inherited, bilateral form of retinoblastoma have an increased incidence of osteogenic sarcoma such that the mortality from the secondary tumor exceeds that of the initial bilateral retinoblastoma. We report a 29-year-old male survivor of bilateral retinoblastomas originally diagnosed at 8 months of age, whose treatment eventually included bilateral enucleation, bilateral orbital radiation, and systemic chemotherapy. At age 26, a tumor removed from his right maxillary sinus was diagnosed as fibroma. At age 29, he developed an inferior orbital mass that extended into the right maxillary sinus. A biopsy and comparison with the previous maxillary sinus mass revealed both lesions to be leiomyosarcoma. Both light and electron microscopy supported the diagnosis. The patient has survived treatment with orbital exenteration and maxillectomy combined with postoperative radiation to the right orbital-maxillary area. This appears to be the fourth case of leiomyosarcoma in the third decade of life in a male patient with a previously irradiated orbit after enucleation for bilateral retinoblastoma. Leiomyosarcoma appears to be another orbital tumor associated with bilateral retinoblastoma.     

Simultaneous bilateral retinal detachment following coronary artery bypass graft: case report

PURPOSE: To present an unusual case of simultaneous bilateral retinal detachment (RD) following a coronary artery bypass graft in a patient with acute myocardial infarction (AMI). METHODS: A 78-year-old man was first seen for bilateral sudden visual loss after surgical treatment of AMI. The patient underwent ultrasound biomicroscopy (UBM) and ocular B-scan echographic examination. RESULTS: The ocular assessment showed a bilateral seclusion of the pupil with bombe of the iris, an anterior chamber without cells or flare, and hypotonia. The evaluation of the visual acuity revealed no light perception in the right eye (RE) and uncertain light perception in the left eye (LE). The UBM analysis of the anterior segment confirmed the presence of bilateral pupillary block due to the seclusion of the pupil and a peripheral serous choroidal detachment involving the RE. The echographic B-scan analysis of the posterior segment showed a bilateral closed funnel-shaped RD and confirmed the presence of the peripheral flat serous choroidal detachment in RE. CONCLUSIONS: The cause for simultaneous bilateral RD remained unclear. It may have been a consequence of a persistent choroidal detachment with multiple swelling and 'kissing' of retinal surface. The increased venous pressure caused by congestive heart failure due to AMI could have caused a bilateral uveal effusion. Alternatively, the absence of retinal tears, the presence of a closed funnel-shaped morphology, and seclusion of the pupils allowed us to suspect an exudative pathogenetic mechanism due to a previous unrecognized ocular inflammatory state.     

Simultaneous bilateral cataract extraction--a retrospective study

BACKGROUND: In patients with bilateral cataracts and contraindications for local anaesthesia a simultaneous bilateral cataract extraction under general anaesthesia is worth considering. PATIENTS AND METHODS: The retrospective study includes all 19 patients (aged 58 to 94 years, mean age 81.5 years) who underwent simultaneous bilateral cataract extraction at our hospital in a period of two years. While the majority of patients had bilateral phacoemulsification, five eyes of three patients underwent planned extracapsular cataract extraction. The preoperative ophthalmic and anaesthetic data and the perioperative and postoperative follow-up data are evaluated. Additionally patient satisfaction and financial aspects are investigated (coverage of the second eye surgery by health-insurance). RESULTS: In none of the 19 patients did severe complications occur. The majority of patients showed a fast visual rehabilitation with a striking improvement in their quality of life. The majority of eyes (20/38; 52.6 %) achieved a visual acuity of 20/30 or better. The analysis of financial aspects disclosed disadvantages for the hospital. Conclusions: Simultaneous bilateral cataract extraction can be considered as a safe and effective method for a selective group of patients with bilateral cataracts.     

双侧上斜肌麻痹的分类及其临床特点

目的 :讨论一种合理的双侧上斜肌麻痹分类方法 ,加强对隐蔽型双侧上斜肌麻痹的认识。方法 :回顾总结了 48例双侧上斜肌麻痹病人 ,按WilliamE .Scott的分类法对其临床特点进行分析。结果 :双侧上斜肌麻痹具有与单侧麻痹相似的体征 ,根据眼球运动特点进行的双侧上斜肌麻痹分类 ,与手术治疗有着重要关系 ,尤其对于隐蔽型双侧上斜肌麻痹 ,术前即可准确估计预后。结论 :双侧上斜肌麻痹的正确诊断和分类对正确治疗具有重要意义 ,隐蔽型应引起临床医生的重视     

Isolated bilateral lateral geniculate infarction producing bow-tie visual field defects

CASE REPORT: We examined a unique case of stroke in a 29-year-old woman. Magnetic resonance imaging revealed isolated bilateral acute infarctions of the lateral geniculate bodies (LGB). Visual field testing demonstrated incongruous but homonymous bilateral visual field loss in a bow-tie configuration. COMMENTS: Isolated bilateral damage to the LGB is a rare event. Literature review has revealed only 4 previous incidents of bilateral damage to both LGB. We present a literature review and a case of bilateral LGB infarction producing visual field defects suggestive of bilateral lateral choroidal artery involvement in an individual with classic migraine.     

Enucleación bilateral por panoftalmitis endógena polimicrobiana fulminante

The case is presented of a 62 year-old woman with a rapid, progressive bilateral decrease in visual acuity and panuveitis with orbital cellulitis. She was also in poor general condition, with emesis and fever. Septicaemia due to Klebsiella pneumoniae and bilateral endogenous panophthalmitis were diagnosed. The ocular infection quickly progressed to sclerokeratitis and bilateral perforation despite broad spectrum systemic antibiotic management, and eventually the patient required bilateral enucleation. Microbiological cultures of the surgical pieces identified Klebsiella pneumoniae and Candida magnoliae.To our knowledge, this is the third published case that required bilateral enucleation or evisceration due to endogenous panophthalmitis, and the first case of endogenous ocular infection caused by Candida magnoliae.     

Bilateral central retinal vein occlusion associated with moderate acute rejection of a cardiac graft

We report a case of bilateral central retinal vein occlusion following moderate acute rejection of a cardiac transplant. A 27-year-old man was admitted for sudden bilateral decreased vision due to bilateral central retinal vein occlusion. Visual acuity was 20/63 in the right eye and 20/25 in the left eye. This patient had undergone a heart transplant 6 months before and had presented with moderate acute rejection for a few days. The moderate acute rejection phenomenon includes inflammatory lymphocyte infiltrates, reflecting persistent immune response activation. Moderate acute rejection of a cardiac transplant graft might cause a bilateral central retinal vein occlusion.     

Encephalomyelitis and bilateral optic perineuritis after influenza vaccination

We report the case of one patient suffering from headache, urinary retention, bilateral optic disc swelling and a mild bilateral visual defect after influenza vaccination. The presumptive diagnosis was encephalomyelitis with bilateral optic perineuritis caused by influenza vaccination. We stress on the interest to search for this aetiology in unexplained optic neuropathy.     

单纯与双内直肌后徙联合Faden术矫正集合过强型内斜视的比较分析

目的 比较单纯双内直肌后徙与双内直肌后徙联合Faden术在矫正集合过强型内斜视中的作用。方法 28例集合过强型内斜视,远近斜视角相差在15△以上,AC/A值〈6,看近斜视角为45～80△,看远25～45△,一组12例行单纯双内直肌后徙,另一组16例行双内直肌后徙联合Faden术。结果 12例行单纯双内直肌后徙组中9例视近仍残余＞10△内斜视。16例行双内直肌后徙联合Faden术组14例视近时基本正位,2例视近仍残余＞10△内斜视,2例视远过矫。结论 双内直肌后徙联合Faden术较单纯双内直肌后徙可有效矫正集合过强型内斜视,但需要注意防止过矫。     

Simultaneous bilateral cataract surgery: Financial differences among nations and jurisdictions

PURPOSE: To identify and measure financial pressures surrounding unilateral and simultaneous bilateral cataract surgery in Canada and other Western nations to understand financial factors that may affect simultaneous bilateral cataract surgery. SETTING: Eye Foundation of Canada, York Finch Eye Associates, Humber River Regional Hospital, University of Toronto, Toronto, Ontario, Canada. METHODS: Schedules of physician benefits from 4 Canadian provinces and public and private sectors in the United States were applied to a consistent template for unilateral and simultaneous bilateral cataract surgery. Well-known surgeons from the United Kingdom, Australia, Japan, and Israel provided additional information. The data were analyzed for similarities and differences to identify financial factors that may influence surgeons and anesthesiologists regarding simultaneous bilateral cataract surgery. RESULTS: Simultaneous bilateral cataract surgery yielded approximately 15% greater efficiency in the number of daily operations. Ophthalmologists' surgical fees were variably discounted for the second cataract surgery, up to 100% in some jurisdictions. Financial incentive issues were compounded by widely differing reimbursement schemes across regions. Anesthesiologists were generally reimbursed for simultaneous bilateral cataract surgery through additional time units of pay, not for additional surgical complexity. Simultaneous bilateral cataract surgery led to greater administrative, laboratory, and nursing efficiencies for institutions with minimal increases in overall complexity. CONCLUSIONS: Results show that discounting second-eye cataract surgery in simultaneous bilateral cataract surgery was a financial deterrent. Although increased efficiency was a slight incentive to ophthalmologists and surgical centers, anesthesiologists experienced significant financial disincentives.