James G. Diamond

Uveitis: Effect of Vitrectomy Combined with Lensectomy

Combined lensectomy-vitrectomy was performed on 25 eyes in 20 patients with cataracta complicata associated with uveitis from various etiologies. Postoperative follow-up averaged 15 months, with visual improvement in 24 of the 25 eyes. Primary cause of postoperative decreased vision was cystoid macular edema. Operative complications included retinal detachment and choroidal ischemia. The technique employed and the effect of lensectomy-vitrectomy on decreasing the number and severity of recurrent attacks of uveitis are discussed.

Surgical wound defects associated with endophthalmitis

Twenty-five consecutive cases of culture-proven postsurgical endophthalmitis were evaluated. Patients underwent wound revision and pars plana vitrectomy with intravitreal antibiotic and steroid infusion (gentamicin 8 micrograms/cc, clindamycin 9 micrograms/cc, dexamethasone 8 micrograms/cc) and injection (gentamicin 100 micrograms plus clindamycin 200 micrograms [and amphotericin 5 micrograms in one case] and dexamethasone 800 to 1000 micrograms). Twenty cases demonstrated wound defects (eg, wound gape/malapposition, abscess/tissue necrosis, suture dehiscence, leak, vitreous wick). Culture-proven isolates included both gram negative and positive bacteria and fungi. Visual acuity improved in 18 of the 20 (90%) gram positive cases. Ten of the 17 (59%) patients in the Staphylococcus epidermidis subgroup achieved a visual acuity of 20/50 or better. Surgical wound defects are frequently associated with culture-proven endophthalmitis. When vitrectomy is included as part of the treatment regimen, we recommend meticulous inspection and closure of any defective surgical wounds associated with endophalmitis.

Endophthalmitis Therapy-Reply

In Reply. —In response to the letter by Drs Baum and Barza, it is imperative that a general misunderstanding of the article be initially cleared. The supposition that my systematic approach to the management of bacterial endophthalmitis consists primarily of a single intravitreal injection is grossly misrepresented. Such misunderstanding undoubtedly results from a previous general preoccupation in the microbiological basis for initial therapy. The article clearly describes a combination of factors including time of onset, predisposing cause, echographic findings, and initial Grams stain to form a basis on which treatment is instituted. When this information is combined with recent inroads into intravitreal antibiotics and vitrectomy, a new method of management results. Staphylococcus aureus and, particularly, S epidermidis , if treated early, are generally amenable to noninvasive ocular therapy. When other organisms are present, however, the success rate in therapy is severely tested. It was my objective to present to the practitioner

Current Concepts of the Vitreous, Including Vitrectomy

This text joins several similar publications on a most exciting topic. The text is structured from presentations at a tutorial conference in New Orleans on the vitreous in April 1975. Its list of contributors (13) includes men foremost in the field. Its topics follow the nostalgic format in relation to the vitreous: anatomy, pathology, operative loss, instrumentation, and associated disease states. An exact listing of the table of contents can be found in the American Journal of Ophthalmology (82:332, 1976). While the editing is well done, the material has been the subject of other publications and presentations. Here the title of Current Concepts falls short of its claim. This fact is never more noticeable than in the two chapters (one quarter of the printed text) on the operative loss of the vitreous associated with cataract surgery. The major portion of this material is derived from previous publications by the same

Advances in Uveal Surgery, Vitreous Surgery, and the Treatment of Endophthalmitis

As its title implies, this book gives an up-to-date presentation of three particularly controversial inroads in ophthalmology. A simplistic review of classical background material preceding each section sets the stage for the introduction of the pioneering efforts of Dr Peyman and his many associates. Multiple diagrammatic representations of surgical devices and techniques, coupled with ample photomicrographs, tables, and in-depth bibliographies, encompass a major portion of the text. The initial chapter on uveal surgery highlights a full-thickness eye wall resection technique for choroidal melanoma. Improved instrumentation for retinal biopsy and iridocyclochoroidectomy are also introduced. The second section deals with techniques, complications, and some short-term results of vitreous surgery, with particular emphasis on the Peyman vitrophage and lens fragmenter. The treatment of endophthalmitis is covered in the third section. There is a brief but complete description of the dosage, routes of administration, and ocular penetration of the major drugs used in