Identifying the real cause of the fusarium outbreak

Sandhya Iyer, Sonal Tuli and Ryan Wagoner from the Department of Ophthalmology, University of Florida, USA, conducted a retrospective review of records of consecutive patients diagnosed with fungal keratitis at their institution between January 1999 and June 2006.

A total of 84 patients were diagnosed with fungal keratitis during this period. The average age of subjects was 48 years and 64% were male. Up until 2004, the major risk factors were trauma (51%) and contact lens use (40%), however, after 2005, contact lens use (52%) overtook trauma (29%). The percentage of fungal ulcers caused by the use of non-therapeutic contact lenses increased from 21%, between 1999 and 2001, to 32% between 2002 and 2004 and then to 45% in 2005 and 2006. Fusarium was the most commonly identified genus (86%), followed by Candida (14%), Curvularia (12%) and Aspergillus (12%).

The authors concluded that contact lenses have become a major risk factor for fungal keratitis, steadily increasing even before the fusarium outbreak in 2006. However, good visual outcomes can be achieved with aggressive dual topical antifungal therapy.

Are robots the future of ophthalmic surgery?

The success of robotic ocular microsurgery in porcine models is such that the technology warrants consideration for evaluation in human trials, according to a report published in January 2007 issue of the British Journal of Ophthalmology.

Professor A. Tsirbas and colleagues from the Jules Stein Eye Institute and the David Geffen School of Medicine at UCLA, California, USA, used a da Vinci surgical robot to perform ocular microsurgery to repair a corneal laceration in a porcine model. The harvested porcine eyes were placed in an anatomical position, using foam heads, on a standard operating table. A video scope and two, 360°-rotating, 8 mm wrested-end effector instruments were placed over the eye with three robotic arms. Surgeons performed the actual procedures while at a robotic system console that was located at the opposite side of the operating theatre. Each surgeon placed three 10-0 sutures, each were documented with still and video photography.

The surgery was successful in each case and the robotic system provided good visualization, in addition to controlled placement of the sutures. The authors believe that the success of the technology warrants its evaluation in human trials.