Justin H. Townsend

Culture-positive endophthalmitis after open globe injuries with and without retained intraocular foreign bodies

BACKGROUND AND OBJECTIVE To report the visual and anatomical outcomes and microbiologic spectrum of culture-positive endophthalmitis in open globe injuries (OGIs) with or without intraocular foreign bodies (IOFBs). PATIENTS AND METHODS A retrospective, interventional case series of OGIs (n = 718) treated between 2004 and 2015. Patients underwent a management protocol for OGI, including systemic broad-spectrum antibiotics, on presentation. RESULTS Culture-positive cases of endophthalmitis after open globe repair occurred in 2.1% of eyes (n = 15 of 718 eyes); two eyes had evidence of endophthalmitis on presentation. The most common organism was Staphylococcus species (five of 17 eyes). An IOFB was present in 6.8% of eyes (n = 49 of 718 eyes). All of these eyes received prophylactic intravitreal antimicrobials. In eyes with IOFB, the rate of culture-positive endophthalmitis after initial globe repair was 8.1% (n = 4 of 49 eyes) versus 1.6% (n = 11 of 669 eyes) in eyes without IOFB (P < .01). CONCLUSION Culture-positive endophthalmitis was identified after OGIs more often in eyes with a concurrent IOFB. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:632-637.].

Pneumatic retinopexy for retinal detachment occurring after prior scleral buckle or pars plana vitrectomy.

BACKGROUND AND OBJECTIVE To report outcomes of pneumatic retinopexy (PR) for retinal detachment (RD) occurring after prior scleral buckling surgery (SB) or pars plana vitrectomy (PPV). PATIENTS AND METHODS Single-center study evaluating all patients treated between January 2000 and March 2013. RESULTS Ten eyes underwent PR after prior SB. Nine of these 10 eyes had persistent subretinal fluid posterior to the buckle in the setting of an open break on the scleral buckle. The mean time to PR in these cases was 8.5 days after SB. PR achieved anatomic reattachment in eight of 10 eyes, but two of 10 eyes required additional PPV to achieve retinal reattachment. Seven eyes underwent PR after prior PPV. The average time to RD after PPV was 67 days (range: 15-232 days). The location of the break was superior in four eyes, horizontal in two, and inferior in one. Anatomic reattachment with PR alone occurred in four of seven eyes (57%). CONCLUSION In the setting of recurrent RD after initial SB, pneumatic retinopexy was usually successful in the early postoperative course. In the setting of a new-onset RD after PPV, pneumatic retinopexy was a useful option, but recurrent RD was more common.

Management of endophthalmitis while preserving the uninvolved crystalline lens

Background The purpose of this work is to report on the management of endophthalmitis in phakic eyes in which the crystalline lens was preserved. Methods The current study is a noncomparative consecutive case series of patients who developed culture-proven endophthalmitis and were treated between January 1995 and June 2009. The study included only phakic patients whose infection was managed without removal of the crystalline lens. Using a computerized search of Microbiology Department records, patients were identified with phakic lens status and clinically diagnosed endophthalmitis. Results A total of 12 phakic eyes from 11 patients met the study criteria. The etiology of infection was endogenous (n = 6), postoperative (n = 5), and post-traumatic (n = 1). Pars plana vitrectomy and injection of intravitreal antimicrobials was performed in seven eyes (58%), and vitreous tap and injection of antimicrobials was performed in five eyes (42%). All eyes showed progression of lens opacification after treatment. Overall, nine (75%) achieved visual acuity outcomes ≥20/80, including five of seven (71%) eyes treated with vitrectomy and four of five eyes (80%) treated with injection of antibiotics alone. One of seven eyes (14%) treated with vitrectomy had a poor visual outcome (defined as <20/400) compared with one of five (20%) eyes treated with intravitreal antimicrobials alone. During follow-up, all 12 eyes had progression of lens opacification and five of 12 (42%) eyes underwent cataract surgery with posterior chamber intraocular lens placement. Conclusion In phakic patients, successful treatment of endophthalmitis can be achieved while preserving the uninvolved crystalline lens. Future cataract surgery with posterior chamber intraocular lens placement can be accomplished in many of these patients.

MACULAR HOLE AFTER PARS PLANA VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT.

Purpose: To report the clinical features, possible associations and treatment outcomes of patients with macular hole after pars plana vitrectomy (PPV) (single or multiple) for rhegmatogenous retinal detachment (RD). Methods: Retrospective consecutive case series from July 2009 to July 2014. Results: In the 15 study patients, the average time from RD surgery to macular hole diagnosis was 119 days (range: 41–398 months). Possible associations include epiretinal membrane (73%, 11/15 patients), macula-off RD (60%, 9/15 patients), recurrent RD (47%, 7/15 patients), and high myopia (56%, 5/9 patients). Single surgery was successful in hole closure in 8/15 patients (Group A) while 7/15 patients underwent multiple surgeries (Group B). Macular hole closure was achieved in 7/8 (87.5%) patients in Group A compared to 4/7 (57.1%) patients in Group B. Improvement of at least two lines of Snellens visual acuity was achieved in 4/8 (50.0%) and 4/7 (57.1%) patients in Group A and B, respectively. Conclusion: In patients with macular hole formation after pars plana vitrectomy for RD, possible associations were epiretinal membrane, macula-off RD, recurrent RD, and high myopia. Even when macular hole closure was achieved, limited visual improvement occurred.

Retinal Detachment Repair in a Patient With Active Zika Virus Infection

A patient had successful retinal detachment repair during the active phase of serologically confirmed Zika virus infection. To the best of our knowledge, this is the first case documenting a necessary vitreoretinal surgery in a patient with active Zika disease. As more traveling and domestic patients become infected, data on surgical management during active Zika viremia may prove useful.

Advances in Optical Coherence Tomography in Clinical and Surgical Management of Vitreomacular Disease

SD-OCT is a fast, noncontact, and noninvasive method of imaging intraocular tissue. It is currently the most widely used OCT technology, using a 820to 880-nm probing light and a scan rate of 52,000 Hz or greater. Most would argue that it has revolutionized the retina specialist’s treatment of surgical and nonsurgical retinal pathology and, in particular, the understanding, diagnosis, preoperative evaluation, and followup of macular diseases. Presently available SD-OCT units include the Cirrus HD-OCT (Carl Zeiss Meditec), Spectralis SD-OCT (Heidelberg Engineering), iVue SD-OCT (Optovue), EnFocus (Bioptigen), and 3D OCT-2000 (Topcon). Current SD-OCTs achieve exquisite definition of retinal imaging with an axial resolution as high as 5 mm. In the world of vitreoretinal surgery, SD-OCT has rapidly become the gold standard to evaluate many surgical candidates before and after surgery (Fig. 1). SD-OCTwas integral to the reclassification of vitreomacular interface disease in 2013 and continues to guide our decision-making and timing of intervention. Factors such as the presence of an epiretinal membrane (ERM), lamellar or full-thickness macular hole, cystoid maculopathy, or outer retinal changes are easily visualized with SD-OCTand help predict visual outcomes in cases that undergo pars plana vitrectomy, pneumatic vitreolysis, enzymatic vitreolysis, or observation. Analysis software has improved the accuracy and quality of topographical maps as well granting wider scans in great detail (Fig. 2).