Jeffrey L. Shakin

Treatment of Experimental Methicillin-resistant Staphylococcus epidermidis Endophthalmitis with intravitreal Vancomycin

Endophthalmitis remains a dreaded complication of intraocular surgery and penetrating eye trauma. Subconjunctival, topical, and systemic antibiotics have been largely ineffective in the treatment of endophthalmitis, whereas intravitreal antibiotics have proved efficacious. Methicillin-resistant Staphylococcus epidermidis has become an important pathogen in many infections, including endophthalmitis. Toxicity, clearance, and efficacy of intravitreal vancomycin were evaluated in the treatment of experimental methicillin-resistant S. epidermidis endophthalmitis. No evidence of retinal toxicity was found and therapeutic levels were demonstrated six days after injection. The treated rabbit eyes showed a marked beneficial effect when compared to the untreated eyes. If experience confirms the safety of intravitreal vancomycin in human eyes, vancomycin should be considered the drug of choice for methicillin-resistant S. epidermidis endophthalmitis.

Recurrent Subretinal Neovascularization

A retrospective analysis of a consecutive series of patients treated with krypton red laser (KRL) photocoagulation for subretinal neovascularization (SRN) secondary to drusen-related macular degeneration (DMD) was carried out to investigate the frequency and nature of recurrent neovascularization (recurrence). A classification of various types of recurrences based on the clinical and fluorescein angiographic features and the onset of their appearance in the postoperative course was used in this study. Patient, fundus, and membrane variables were examined in search of relevant high risk factors predisposing to recurrences. The membranes proximity to the fovea and its relative lack of pigmentation were individual factors which were associated with a high risk of recurrence (P less than 0.05 for distance and P = 0.005 for color). Multivariate analysis also indicated that a greater distance from the fovea (P less than 0.05) and a darker color (P = 0.002) were favorable features to the primary membrane, reducing the probability of a recurrence. Overall, 39% of the patients experienced recurrences (23% of the patients had treatable recurrences and 16% had non-treatable recurrences extending under the center of the fovea). The membranes recurred predominantly at the margin of the photocoagulation burn. The recurrences were also noted relatively early in the postoperative course, 65% within two months after photocoagulation of the primary membrane. The fluorescein angiographic and clinical nature of these membranes and the visual effect of retreatment are also discussed in the paper.

Krypton red laser photocoagulation of the ocular fundus.

The theoretical rationale, the histopathologic evidence, and the preliminary clinical studies related to krypton red laser (KRL) photocoagulation of the ocular fundus are reviewed. The authors report on their experience with currently available laser systems using this wavelength (647.1 nm) for photocoagulation of retinal vascular proliferative diseases and chorioretinal diseases associated with exudative manifestations. A histopathologic and clinical comparison of argon blue-green laser (ABGL), the pure argon green laser (AGL), and the krypton yellow laser (KYL), with reference to photocoagulation treatment of the ocular fundus is also discussed.

Krypton Red Laser Photocoagulation for Subretinal Neovascularization

A series of 75 well-defined, consecutive patients with subretinal neovascularization secondary to a variety of macular diseases were treated with krypton red laser (KRL) photocoagulation and are reported on prospectively. Two thirds of the patients had subretinal neovascularization secondary to involutional (senile) macular degeneration. Most patients had clinical and/or fluorescein angiographic manifestations of neovascularization that posed a poor visual prognosis. The technique of treatment using the krypton red wavelength, as well as special considerations in the pre- and post-operative management, are reviewed. The results suggest that this wavelength is effective in the successful, anatomic elimination of subretinal neovascularization and improvement of the visual status with certain potential advantages compared to conventional argon blue-green laser (ABGL) radiation. Since this clinical study is void of randomization and controls, no absolute conclusions can be made with regard to the effectiveness of this form of treatment compared to other laser treatments or to the natural course of the macular diseases themselves. However, the results of this study are extremely encouraging, warranting further investigation.

Perfluoropropane Gas, Modified Panretinal Photocoagulation and Vitrectomy in the Management of Severe PVR

Proliferative vitreoretinopathy (PVR) complicates between 5 and 10% of retinal reattachment procedures for rhegmatogenous retinal detachments. While early stages may be managed successfully with standard scleral buckling surgery, the more severe forms require vitreoretinal techniques for adequate treatment. In addition, silicone oil, long-acting perfluoropropane gases, panretinal endophotocoagulation, and intravitreal medications have been utilized in the treatment of severe PVR with varying degrees of success.