Jacob J. Yunker

Incidence Of Acute Onset Endophthalmitis Following Intravitreal Bevacizumab (avastin) Injection

Purpose: To report the incidence of acute endophthalmitis as a complication of intravitreal bevacizumab (Avastin) (IVB) injection in a tertiary vitreoretinal group practice. Methods: A retrospective chart review of 5,233 consecutive eyes that underwent IVB injection at Retina Consultants of Alabama (RCA) from October 1, 2005, to August 31, 2007, was performed to identify cases of acute endophthalmitis. Results: During the 23-month study interval, the overall incidence rate of postinjection endophthalmitis was 0.019% (1/5,233). In the single case of acute endophthalmitis, bacterial cultures revealed coagulase-negative Staphylococcus (CNS) species. Visual acuity after treatment for endophthalmitis was improved (baseline 4/400) to 20/400 at two months after the initial IVB injection. Conclusions: Acute endophthalmitis is a rare potential complication of IVB. Prophylaxis with topical povidone-iodine and adherence to aseptic technique minimizes the risk of postinjection infection. Summary Statement: A retrospective review of 5,233 consecutive intravitreal injections of bevacizumab (Avastin) revealed only a single case of acute endophthalmitis. Adherence to aseptic technique and the use of povidone-iodine prophylaxis minimizes the risk of postinjection intraocular infection.

Intravitreal bevacizumab (Avastin) prevention of panretinal photocoagulation-induced complications in patients with severe proliferative diabetic retinopathy.

Purpose: To evaluate the efficacy of intravitreal injection of bevacizumab (Avastin) (IVA) in preventing panretinal photocoagulation (PRP)-induced macular thickening and visual dysfunction in eyes with severe proliferative diabetic retinopathy. Methods: A retrospective review of 60 consecutive eyes (30 patients) with severe proliferative diabetic retinopathy whose visual acuity was 20/30 or better (<0.18 in logarithm of the minimum angle of resolution acuity) and average foveal thickness (FT) was 280 &mgr;m or less, and whose retinopathy was bilateral and symmetrical, was performed. In all eyes, PRP was performed in two sessions. In the interventional group, 1.25 mg of IVA was injected to each eye 1 week before initiation of PRP. Foveal thickness was measured by optical coherence tomography before treatment, and the clinical course was monitored by best corrected visual acuity (BCVA) and FT for 24 weeks after beginning PRP. Results: Before treatment, mean BCVA and FT was 0.073 ± 0.071 &mgr;m and 278.8 ± 29.5 &mgr;m in the IVA-injected group and 0.069 ± 0.076 &mgr;m and 273.5 ± 27.7 &mgr;m in the control group, respectively. After the IVA injection and PRP completion, FT in the IVA-injected eyes was significantly decreased, with a mean FT of 257.2 &mgr;m at 12 weeks and 264.3 &mgr;m at 24 weeks. In the control group, FT increased dramatically and reached 307.3 &mgr;m at 12 weeks and 298.2 &mgr;m at 24 weeks. The difference in final FT between groups was significant (P = 0.001). Best corrected visual acuity in the control group decreased with time to 0.149 ± 0.113 at 24 weeks; in contrast, BCVA in the IVA-injected eyes improved over time to 0.039 ± 0.054 at 24 weeks. This difference in BCVA was statistically significant (P≤0.0001). Seven eyes (23.3%) in the control group had worse vision by ≥2 lines and increased FT by ≥50 &mgr;m at 24 weeks, whereas none of the eyes in the IVA group had either worse vision or a significant increase in FT (P = 0.011). Conclusions: A single IVA injection given before standard PRP may be beneficial in preventing PRP-induced visual dysfunction and foveal thickening in eyes with severe proliferative diabetic retinopathy and good vision.

Incidence of endophthalmitis following 20-gauge and 25-gauge vitrectomy.

Incidence of Endophthalmitis Following 20-Gauge and 25-Gauge Vitrectomy The 25-gauge transconjunctival sutureless pars plana vitrectomy (PPV) system enables sutureless three-port PPV without the need for conjunctival peritomies, decreases mean operative times, decreases surgically-induced trauma at sclerotomy sites, and reduces postsurgical patient discomfort.1 Decreased traumatic conjunctival and scleral manipulation with less postoperative inflammation, as well as less induced corneal astigmatism, allows for more rapid postoperative visual recovery. The self-sealing nature of the incisions in sutureless transconjunctival vitrectomy surgery, however, does pose theoretical concerns for possible increased risk of hypotony, vitreous incarceration, and postoperative intraocular infection.2–4 Postoperative endophthalmitis following ophthalmic surgery remains rare with an incidence of approximately 0.1%.5–7 Endophthalmitis following 20-gauge PPV has been reported as 0.07% by Cohen et al7 in their 10-year survey published in 1995. Although cases of endophthalmitis have been reported after 25-gauge transconjunctival sutureless PPV,2–4 the exact incidence was unknown until two very recent series were published.8,9 Scott et al8 and Kunimoto and Kaiser9 both reported an increased rate of endophthalmitis following 25-gauge PPV compared with 20gauge PPV. The purpose of the current study was to examine the incidence of endophthalmitis following 25-gauge transconjunctival sutureless PPV in a large, single institution, single surgical location, consecutive case series. Methods

Statin use and ocular inflammatory disease risk

BackgroundThis study aims to evaluate the effect of oral statin medication use on the subsequent development of ocular inflammatory disease (OID). A retrospective nested case–control study was carried out on patient records from the Birmingham Veterans Affairs Medical Center. All male patients with a new diagnosis of OID over a 5-year period were included. Ten control subjects (without OID) were age-matched to each OID case. Prescription files of all subjects were queried for statin use. Information on selected comorbid medical conditions was also obtained. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for risk of OID development in the context of statin use, controlling for comorbid conditions.ResultsNinety-two incident cases of OID were identified. A trend toward a reduction in the risk of new OID development was found in patients that used statins compared to those that did not (OR 0.50, 95% CI 0.20 to 1.23, p = 0.13). The longer the duration of statin use, the greater is the effect.ConclusionsUse of oral statins may be associated with a reduced risk for the development of OID. This reduced risk increases with increasing duration of use. Larger clinical studies would be required to definitively establish the effectiveness of statins in lowering the incidence of OID.