Daraius Shroff

Endophthalmitis caused by Enterococcus faecalis: a case series.

Background: To profile the etiology, clinical features, visual and anatomical outcomes in eyes diagnosed with Enterococcus faecalis endophthalmitis. Methods: A single (tertiary care) center, Retrospective interventional case series. Clinical and microbiological records of 26 consecutive eyes with culture positive E. faecalis endophthalmitis treated at a tertiary referral ophthalmic hospital in south India from 1st January 1995 to September 2007 were reviewed and analyzed. Results: Of the twenty-six eyes, 12 were of postsurgical etiology, 11 cases were posttraumatic while 3 were of endogenous causes. Two eyes had an intraocular foreign body. Initial mean visual acuity was 3.19 logMAR (range: 0.77–4). All cases were treated with vitrectomy and intravitreal injections. Six cases developed retinal detachment after initial surgery, but only 30.7% eyes had a poor anatomical outcome (8 patients out of 26). All cases except one were sensitive to Vancomycin. Final mean visual acuity was 2.12 logMAR (range: 0.17–4). Paired ‘t’ test showed statistically significant (P = 0.008) good visual outcome (better than or equal to 3/60). Conclusions: Surgery (12 of 26 eyes) and trauma (11 of 26 eyes) were the commonest causes of E. faecalis endophthalmitis. Our results indicate that early surgical intervention can lead to a good functional outcome despite the virulent nature of the organism. Since almost all the cases were sensitive to Vancomycin, it may be considered as a first line drug in the management of such eyes.

Peters plus syndrome

A 10-year-old boy, issue of unrelated parents presented with visual impairment, short stature and mental retardation. The presence of a Peters’ anomaly, mental retardation, disproportionate short stature, skeletal abnormalities and distinctive facial features (broad forehead, telecanthus, cupid bow shaped upper lip) established the diagnosis of Peters’ plus syndrome. Analysis of his genomic DNA revealed a homozygous deletion in the β1,3-galactosyltransferase-like gene (B3GALTL), a recently identified gene.

Bilateral periorbital necrotizing fasciitis following exposure to Holi colors: A case report

Holi festival is celebrated in India traditionally by applying colors on one another. Various ocular adverse effects of these colors have been reported including conjunctivitis and corneal abrasion. We report a case of bilateral periorbital necrotizing fasciitis, following exposure to Holi colors. General physicians might encounter more such cases after exposure to Holi colors. In India, these colors are prepared on a small scale and lack any quality checks. Use of such toxic colors should be discouraged, and all doctors should caution people against using synthetic dyes. This case report highlights the need to put manufacturing of Holi colors under guidelines of the Food and Drug Cosmetic Act and the Bureau of Indian Standards.

Chemo-paralysis for the removal of a live intraocular worm in ocular angiostrongyliasis.

Angiostrongylus cantonensis is also called the rodent lung worm. It was first discovered in 1935 by Chen in Rattus rattus, in Canton, China. The rodent is the definitive host while infected mollusks, snails and crabs act as the intermediate hosts. Humans are infected by the 3rd stage larvae, either by eating undercooked intermediate hosts or by consuming vegetables. 1 It is a delicate nematode reported in Asia Pacific region most commonly in South‐east Asia and has been reported from Taiwan, Thailand, Indonesia, Vietnam and Sri Lanka. 2 Anterior chamber angiostrogyliasis is extremely rare, and no previous case of ocular angiostrogyliasis from India could be found on Medline search. We report a new technique in the removal of the actively motile thread‐like worm by paralysing it with intracameral preservative free lidocaine, which aids in the easy removal of the intact worm.

Macular infarction after enterococcus faecalis endophthalmitis.

PURPOSE To describe a case of macular infarction occurring after Enterococcus faecalis endophthalmitis in a patient who had undergone cataract surgery. METHODS A 74-year-old woman who underwent uneventful phacoemulsification with intraocular lens implantation developed E. faecalis endophthalmitis on the second postoperative day. Management included repeated intravitreal antibiotic treatment, vitrectomy, and intraocular lens explantation. RESULTS One week after intraocular inflammation subsided, macular infarction was noted clinically, which was confirmed by fundus fluorescein angiography. Visual acuity did not improve beyond 1/60 by Snellen chart testing. CONCLUSION Posterior segment involvement, including optic atrophy, macular hole formation, and tractional retinal detachment, has been reported clinically as a complication of E. faecalis endophthalmitis. Macular infarction could be another sight-threatening complication of endophthalmitis due to E. faecalis.

In vivo microscopy of Best's Vitelliform Macular Dystrophy: optical coherence tomography study of combined stage III and IV lesions

A 35‐year‐old man presented with decreased vision in both eyes. Fundus biomicroscopy of the right eye revealed a pseudohypopyon along with an area of hyperpigmentation and scarring at the macula (combined stage III and IVb Bests Vitelliform Macular Dystrophy [BVMD]). The left eye showed the presence of a pseudohypopyon along with macular atrophy (combined stage III and IVa). On optical coherence tomography both eyes had a neurosensory retinal detachment with an optically clear subretinal zone, an accumulation of material between neurosensory retina and the retinal pigment epithelium corresponding to the pseudohypopyon and subfoveal photoreceptor atrophy. We document on optical coherence tomography the transition of BVMD from stage III to IV (in the form of the combined stage). These new findings may be considered unique for this stage of BVMD, and would help in a further understanding of the disease as it passes through its various stages.

Non-contact Ultra-widefield Imaging in Lasered Retinopathy of Prematurity

To the Editor: Retinopathy of prematurity (ROP) still remains a challenging condition to detect, image, document and treat. Documentation has become necessary in recent times due to advancement in telemedicine, newer treatment modalities like intravitreal anti-VEGF injections [1] and medicolegal implications. It is important to note that despite advancements in imaging modalities, indirect ophthalmoscopy with scleral depression remains the gold standard for retinal evaluation in ROP management. Currently used Retcam® (Clarity Medical Systems, Inc., Pleasanton, CA) became commercially available in 1997. Retcam utilizes a contact lens with a fiberoptic cable light source connected to a computer monitor for retinal imaging. Its shortcomings include relatively limited field of view (130 degrees) [2] and being a contact system, would be avoided in the immediate post intravitreal injection period to minimize chances of infections. Optos® 200Tx scanning laser ophthalmoscope (Optos PLC, Dunfermline, Scotland) is a recently introduced noncontact ultra wide field (UWF) retinal imaging system. Optos utilizes the optics of an ellipsoid mirror, which has two focal points to create images of the peripheral retina, thereby capturing up to 200 degrees of retina in a single image [3]. Limitations of this modality include high cost of equipment and the need for the operator to be trained in its use. Due to its large size, it is not easy to transport the Optos, unlike the Retcam which is a portable device and can easily be manoeuvred into pediatric nurseries for screening purpose. Patel et al. evaluated its role in ROP babies elegantly using the Bflying baby^ position [4]. We present retinal images from a premature infant born at 27 wk who underwent laser for ROP stage 3 in zone 2. At 38 wk while the right eye shows well regressed disease (Fig. 1), the left eye shows skip areas with preretinal hemorrhage (Fig. 2) for which laser augmentation was done. We believe this to be the first report of UWF non-contact imaging for ROP from the Indian subcontinent with this new imaging modality.

Spontaneous closure of a posttraumatic scleral fistula in an atypical choroidal coloboma.

BACKGROUND Scleral fistulas have been reported to occur in choroidal colobomas, and their repair has been described in the literature. Spontaneous closure of a posttraumatic fistula has not been reported. PURPOSE To describe the occurrence of posttraumatic scleral fistula formation and its spontaneous closure in an eye with an atypical choroidal coloboma. METHODS Interventional case report. RESULTS Spontaneous closure of the posttraumatic scleral fistula was noted at 1-month follow-up. This was documented clinically and confirmed by B-scan ultrasound. CONCLUSION Scleral fistula formation can occur at the base of a choroidal coloboma after blunt injury, and this can close spontaneously over a period of time.

Excyclotorsion in Congenital Fibrosis of Extraocular Muscles

The authors report marked bilateral excyclotorsion contributing to loss of binocularity and leading to ipsilateral head tilt in a patient with congenital fibrosis of the extraocular muscles type 1. Neuroimaging revealed bilateral hypoplastic superior recti and levator palpebrae superioris muscles. Postoperatively, head tilt was relieved and excyclotorsion was reduced. Assessment of torsion may influence surgical strategies and outcome in patients with congenital fibrosis of the extraocular muscles.

Hybrid 20/23-G pars plana vitrectomy in endophthalmitis and trauma: a strategic approach

Purpose: To assess the safety and efficacy of hybrid vitreous surgery combining active 23-G ports with a sutured 20-G 6-mm infusion cannula for performing vitrectomy in endophthalmitis and trauma. Methods: This is a retrospective analysis of 10 eyes with endophthalmitis and 10 eyes with trauma requiring vitreous surgery, having corneal clarity suitable for vitrectomy and best-corrected visual acuity (BCVA) greater than or equal to light perception. All patients underwent hybrid 20/23-G vitrectomy. Intraoperative notes were analyzed for peroperative complications. The BCVA and retinal status at 3 months were analyzed. Results: In the endophthalmitis group, patients ranged from 5 to 85 years of age and showed varied etiologies. Retinal detachment was present in 5 eyes, which received silicone oil tamponade. Mean preoperative logMAR visual acuity (VA) was 2.29 ± 0.45, which improved to 1.10 ± 0.72 at 3 months postoperatively (p<0.001). Trauma cases ranged from 21 to 75 years of age. Retinal detachment was present in 9 out of 10 eyes, all of which received silicone oil tamponade. Preoperative logMAR VA was 2.26 ± 0.71, which improved to 1.33 ± 0.50 postoperatively (p<0.001). At 3 months postsurgery, the retina was attached in all eyes in both groups. Conclusions: The longer sutured 20-G cannula was easier to visualize through fibrin, exudates, and hemorrhage and did not slip out or enter the suprachoroidal space in any of our cases. The 23-G active ports and vitrectomy cutter enhanced safety and efficacy. Hybrid vitrectomy enabled safe surgery in these difficult cases.