Ophthalmology
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Randomized Controlled Trial Comparative Study Clinical Trial
Outpatient topical use of povidone-iodine in preparing the eye for surgery.
Povidone-iodine 5% solution placed on the eye immediately before ophthalmic surgery within the preoperative preparation significantly reduces the conjunctival bacterial flora. In 40 patients undergoing ophthalmic surgery, the authors compared the outpatient use of povidone-iodine for 3 days before surgery with a 3-day course of a combination antibiotic ophthalmic solution (Neosporin) placed on the other eye. ⋯ Cultures taken after preparation but before commencement of surgery showed a further reduction for both regimens, but more for eyes previously treated with the antibiotic (P less than 0.02). To minimize the conjunctival bacterial flora before surgery, the authors continue to recommend instillation of a broad-spectrum antibiotic for 3 days before surgery, followed by application of povidone-iodine solution to the eye immediately before surgery within the preoperative preparation.
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The authors report 19 cases of exogenous fungal endophthalmitis managed between 1969 and 1986. These developed after ocular surgery (5 cases), after trauma (6 cases), by intraocular spread from fungal keratitis (4 cases), after therapeutic keratoplasty for keratitis (3 cases), and by spontaneous infection of a filtration bleb (1 case). The diagnosis of endophthalmitis was made from 3 days to 4 months after surgery or trauma. ⋯ Fusarium (6 cases) and Acremonium (3 cases) accounted for approximately one half of the isolates. Forty-two percent of the patients recovered 20/400 or better acuity (3 of 5 postoperative cases, 4 of 6 trauma cases, and 1 of 4 keratitis cases). The clinical and microbiologic features of these cases are presented, and recommendations for management are offered.
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Diabetic retinopathy was assessed in a population-based study of 2708 diabetic persons in southern Wisconsin. The retinopathy levels as determined by ophthalmoscopy and by the grading of stereoscopic fundus photographs were compared in the eyes of 1949 persons. Ophthalmoscopy was performed by an ophthalmologist and a specially trained optometrist and ophthalmic technician. ⋯ Ophthalmoscopy was more likely to disagree with fundus photography grading in eyes with less severe forms of retinopathy and in patients examined early in the study. Other factors found to influence the degree of agreement were age, visual acuity, and duration of diabetes. It is concluded that with proper training ophthalmoscopy can be an acceptable alternative to fundus photography in certain situations.
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A review of 36 cases of von Hippel-Lindau disease underscores the important role of the ophthalmologist in evaluating this phakomatosis. Retinal angiomatosis occurred in almost two-thirds of those affected, was usually diagnosed before other target organs, and frequently led to decreased visual acuity. Common non-ophthalmic manifestations included cerebellar (69%), medullary (11%) and spinal (8%) hemangioblastoma, renal cell carcinoma (22%), and polycythemia (17%). ⋯ For the surveillance of suspected von Hippel-Lindau victims, a detailed family history and retinal examination is recommended. Essential laboratory tests include a complete blood count and computed tomography of the head, upper cervical region, and abdomen. Periodic pre-symptomatic screening is imperative for follow-up investigation of affected individuals to determine possible additional occult manifestations and of non-affected family members at risk to von Hippel-Lindau disease.