Jagjit S Gilhotra

Divergence in the lived experience of people with macular degeneration.

Purpose The aim of this study was to understand people’s experience with age-related macular degeneration (AMD) in light of new treatment successes. Methods An interpretive qualitative methodology was used to facilitate understanding of the experience of people with AMD. Rich in-depth data were collected using focus groups and individual interviews. Thematic analysis of the data occurred through the processes of line-by-line coding, aggregation, and theme development using the NVivo 10 software. Results A total of 4 focus groups and 16 individual interviews were conducted with 34 people (median age = 81 years; range = 56 to 102 years; 19 females) with AMD. Four major themes arose from the narratives of the participants: cautious optimism, enduring, adaptation, and profound loss. Cautious optimism resonated for participants who had received successful treatment and stabilization of AMD. Enduring emerged as participants with exudative AMD described an ongoing need for invasive and frequent treatments (anti–vascular endothelial growth factor injections) that maintained their vision. Adaptation was evident in the narratives of all participants and was directly related to the physical and psychological limitations that were a consequence of visual disability. Profound loss encompassed both physical and emotional aspects of deteriorating vision and was most evident in patients for whom treatment had failed or had not been considered appropriate for their disease. Conclusions The findings of this study shed new light on the influence of underlying pathology, disease trajectory, and success of new treatments on quality of life of people living with AMD. Optimism toward maintaining vision in the presence of exudative AMD was described by participants, moderated by ongoing caution and a need for endurance of frequent and often problematic intravitreal treatments. These findings add a deeper understanding of this complex and life-changing experience.

Hip-implant related chorio-retinal cobalt toxicity.

A 39-year-old female with elevated serum cobalt levels from her bilateral hip prostheses presented with a 3-week history of blurred vision in her left eye. Optical coherence tomography revealed patchy degeneration of the photoreceptor-retinal pigment epithelium (RPE) complex. The lesions were hypofluorescent on indocyanine green angiography. We postulate that this is a case of implant-related chorio-retinal cobalt toxicity.

Dynamic focal retinal arteriolar vasospasm in migraine.

A 48-year-old man presented following an episode of sudden onset simultaneous inferior altitudinal visual loss in his left eye and visual obscuration with shimmering in the inferonasal quadrant of the right eye. Clinical examination demonstrated left superior hemiretinal artery occlusion and an area of focal dynamic spasm along the right superior temporal branch retinal artery, the arteriolar spastic cycle was about 2 sec in duration. Hematological (including complete blood count, thrombophilia screen, vasculitic screen and serum magnesium), carotid, and cardiac investigations were normal. He was given acetazolamide 500 mg orally, timolol maleate 0.5% eye drops once daily and sublingual amyl-nitrate 0.8 mg, and maintained on felodipine 10 mg/day and aspirin 100 mg/day. The area of focal arteriolar spasm in the right eye resolved over two months. To our knowledge there are no prior reports of photographically documented dynamic focal retinal vascular spasm on a MEDLINE and PUBMED search.

Biochemical analysis of the living human vitreous.

To date, our understanding of the biochemical composition of the living human vitreous relies on extrapolations from animal or human post‐mortem studies.

Desferrioxamine-related ocular toxicity: A case report

A 29-year-old lady receiving repeated blood transfusions for β thalassemia since childhood, presented with rapidly deteriorating symptoms of night blindness and peripheral visual field loss. She was recently commenced on high-dose intravenous desferrioxamine for reducing the systemic iron overload. Clinical and investigative findings were consistent with desferrioxamine-related pigmentary retinopathy and optic neuropathy. Recovery was partial following cessation of desferrioxamine. This report highlights the ocular side-effects of desferrioxamine mesylate and the need to be vigilant in patients on high doses of desferrioxamine.

Pilot randomized trial of a nanopulse retinal laser versus conventional photocoagulation for the treatment of diabetic macular oedema

Background:  To assess the efficacy of a new nanopulse laser, retinal regeneration therapy for the treatment of diabetic macular oedema.

Aqueous Chlorhexidine for Intravitreal Injection Antisepsis: A Case Series and Review of the Literature

PURPOSE To determine the incidence of endophthalmitis in a large clinical series using aqueous chlorhexidine for antisepsis before intravitreal injection and to review the ophthalmic literature regarding chlorhexidine efficacy and safety. DESIGN Multicenter retrospective case series. PARTICIPANTS All patients receiving intravitreal injections from 7 retinal specialists. METHODS An audit of intravitreal injections performed by retinal specialists who exclusively used aqueous chlorhexidine 0.05% or 0.1% for prophylaxis of infective endophthalmitis was undertaken. The incidence of endophthalmitis was determined from August 1, 2011, to February 28, 2015. A literature review was performed to critically appraise the ocular safety and efficacy of aqueous chlorhexidine. MAIN OUTCOME MEASURES Incidence of endophthalmitis after intravitreal injections. RESULTS A total of 40 535 intravitreal injections were performed by 7 retinal specialists across 3 centers. Chlorhexidine was well tolerated, and only 1 patient with a suspected allergic reaction was noted. Three cases of endophthalmitis were identified with 1 culture-positive case. The 0.0074% (1 in 13 512) per-injection rate of endophthalmitis in this series compares favorably with previous series in which povidone-iodine has been used. CONCLUSIONS Aqueous chlorhexidine was associated with a low rate of postinjection endophthalmitis and was well tolerated by patients.

Retrospective study of an as required dosing regimen of intravitreal bevacizumab in neovascular age-related macular degeneration in an Australian population.

Purpose:  To investigate the efficacy of intravitreal bevacizumab for the treatment of neovascular age‐related macular degeneration (AMD) using an as required dosing regimen.

Pseudohypopyon following intravitreal triamcinolone acetonide injection in a phakic eye

mented transfer of microorganisms from the donor cornea to the recipient. In a systematic review Wilhelmus and Hassan found that endophthalmitis occurred 12 (95% CI 5–29) times more often among recipients of a culturepositive donor cornea. Although donor button contamination is a reality, Wiffen et al. as well as Everts et al. found a poor correlation between positive donor corneal rim cultures and risk of postoperative infection. However, isolation of the same organism with identical susceptibility from both recipients as well as from the donor corneoscleral rim suggests with reasonable certainty that the source of infection in the cases described in this report was the donor cornea. Because both the patients were operated on different days, it cannot be due to surgical factors. The contamination of storage media could be considered a possibility; however, none of the other cases operated using donor corneas stored in media from the same batch had any evidence of infection. Another factor worth considering is the antibiotic in corneal storage media. Currently, all commercially available corneal storage media contain gentamicin either alone or along with streptomycin to prevent multiplication of bacteria during storage. However, these antibiotics might not be effective against resistant organisms. This is particularly likely to occur in hospital-acquired infections. Both cases described in here received corneas from a donor who not only had metastatic carcinoma but also frequently visited hospitals for chemotherapy. We speculate that premortem prolonged hospitalization and/or treatment with immunosuppressive drugs may affect microbial colonization of the ocular surface and influence the ability of established eye bank techniques to adequately decontaminate corneal tissue. Therefore, pre-mortem medical conditions and treatment sequelae must be considered in eye donor screening. In summary, although a positive donor rim culture has poor predictive value for postoperative infection, this case report documents with reasonable certainty the transmission of infection from contaminated donor corneas to recipients.

A rare case of endogenous Streptococcus group C endophthalmitis associated with cellulitis

Sir, Group C Streptococci are part of the human flora1 and rarely cause opportunistic infections. Here we report a case of endophthalmitis presumably caused by a cellulitis of the arm.