St. Luke's Cataract and Laser Institute

BackgroundTo evaluate how smoking affects the time to disease quiescence and time to disease recurrence in patients with ocular inflammation.MethodsA retrospective cohort study of patients with ocular inflammation who were followed longitudinally and had smoking information available in the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study database.ResultsAmong 2676 patients with active ocular inflammation, smokers were more likely to have bilateral ocular disease and poorer visual acuity on presentation compared with non-smokers and previous smokers. In a multivariate analysis, there was no statistically significant difference in the time to disease quiescence between groups. However, the median time to recurrence of ocular inflammation was statistically significantly longer for non-smokers (9.4 months) and for previous smokers (10.7 months) than for current smokers (7.8 months) (p=0.02). The RR of ocular inflammation recurrence was higher for smokers than for non-smokers (adjusted HR=1.19, 95% CI 1.03 to 1.37) and tended towards significance in previous smokers (adjusted HR=1.11, 95% CI 0.93 to 1.35).ConclusionsSmoking was associated with an increased likelihood of bilateral ocular inflammation and reduced vision upon presentation, and an increased risk of recurrence compared with not smoking. These results suggest that patients with ocular inflammation should be counselled to stop smoking as part of routine management.

The piggyback method of implanting two intraocular lenses in one eye has been successfully expanded to address pseudophakic refractive error in normal eyes and eyes that have undergone post-penetrating keratoplasty. Piggyback implantation has been combined with the use of newly available minus-power lenses to provide appropriate power for a cataract patient with keratoconus, as well as to correct pseudophakic myopia. The phenomenon of increased depth of focus in piggybacks may be explained by a contact zone between the lenses. The late complication of inter-lenticular cellular growth with resultant hyperopic shift, opacification, and loss of vision has recently become a concern.

Retrobulbar and peribulbar anesthesia remain the principle means of ophthalmic anesthesia. Methods, needles, and medications continue to vary in the search for what works best, and that is a very individual preference as is seen by the literature over the past year. The increased role of nonsteroidal anti-inflammatory drugs is discussed, along with prophylactic antibiotic use.