Peter E. Liggett

Human Autologous Serum for the Treatment of Full-thickness Macular Holes: A Preliminary Study

BACKGROUND Recent studies have shown the usefulness of pars plana vitrectomy with/or without the use of transforming growth factor-beta in treating macular holes. The purpose of the present study is to test the efficacy of autologous serum in conjunction with current surgical techniques in the repair of stage 3 or 4 macular holes. METHODS A total of 11 eyes in nine patients with stage 3 or 4 full-thickness macular holes were treated. The patients ranged in age from 53 to 80 years (mean, 68 years). These patients were followed for 4 to 11 months (mean, 8.4 months). Preoperative best-corrected visual acuity ranged from 2/200 to 20/80 (mean, 20/200). A standardized pars plana vitrectomy was performed with removal of the posterior hyaloid and/or removal of epiretinal membranes, fluid-gas exchange. Autologous serum (0.1 ml) was instilled over the macular hole followed by perfluorocarbon gas tamponade and head positioning for 2 weeks. RESULTS All 11 (100%) of the eyes in 9 patients had resolution of the surrounding subretinal fluid and flattening of the macular hole. All of the eyes showed an improvement of at least two lines or more (mean, 4.7 lines) in visual acuity. Three eyes (27%) had visual acuities of 20/40 or better, and seven (64%) had visual acuities of 20/60 or better. No exuberant fibrosis proliferation was noted in any eye. CONCLUSION The results of this preliminary study indicate the possible benefit of autologous serum when used in conjunction with current surgical techniques in treating stage 3 or 4 macular holes.

Intravenous cefazolin in penetrating eye injuries

The poor intraocular penetration of systemically administered antibiotics has raised questions regarding their usefulness as prophylactic agents in the management of penetrating eye injuries. Cefazolin was administered intravenously to rabbits with penetrating eye injuries to determine the influence of trauma on ocular pharmacokinetics. Following a standardized penetrating eye injury in 27 New Zealand white rabbits, animals were divided into three groups that received either three, six, or nine doses of intravenous cefazolin every 8 h. Cefazolin levels were then measured in the traumatized eye, the non-traumatized (control) fellow eye, and in the serum of each animal. In the three treatment groups vitreous concentrations of cefazolin were significantly higher in traumatized eyes than in the non-injured eyes. After three doses, vitreous concentrations of cefazolin in traumatized eyes averaged 9.1 mg/l; mean concentrations of cefazolin in non-injured eyes were 0.6 mg/l (P < 0.0002). After six doses of intravenous cefazolin, vitreous concentrations in traumatized eyes averaged 7.3 mg/l; cefazolin levels in non-injured eyes were 0.6 mg/l in the non-traumatized eyes (P < 0.0005). After nine doses, vitreous cefazolin concentrations in traumatized eyes averaged 9.7 mg/l, while mean levels in the non-traumatized eyes were all 0.05 mg/l (P < 0.0002).The poor intraocular penetration of systemically administered antibiotics has raised questions regarding their usefulness as prophylactic agents in the management of penetrating eye injuries. Cefazolin was administered intravenously to rabbits with penetrating eye injuries to determine the influence of trauma on ocular pharmacokinetics. Following a standardized penetrating eye injury in 27 New Zealand white rabbits, animals were divided into three groups that received either three, six, or nine doses of intravenous cefazolin every 8 h. Cefazolin levels were then measured in the traumatized eye, the non-traumatized (control) fellow eye, and in the serum of each animal. In the three treatment groups vitreous concentrations of cefazolin were significantly higher in traumatized eyes than in the non-injured eyes. After three doses, vitreous concentrations of cefazolin in traumatized eyes averaged 9.1 mg/l; mean concentrations of cefazolin in non-injured eyes were 0.6 mg/l (P < 0.0002). After six doses of intravenous cefazolin, vitreous concentrations in traumatized eyes averaged 7.3 mg/l; cefazolin levels in non-injured eyes were 0.6 mg/l in the non-traumatized eyes (P < 0.0005). After nine doses, vitreous cefazolin concentrations in traumatized eyes averaged 9.7 mg/l, while mean levels in the non-traumatized eyes were all 0.05 mg/l (P < 0.0002).This work suggests that penetrating injuries of the eye alter ocular pharmacokinetics, resulting in high intraocular concentrations of systemically administered cefazolin.

A Cluster of Patients With Acute-Onset Endophthalmitis Following Cataract Surgery

BACKGROUND AND OBJECTIVE To describe a cluster of patients who had acute-onset endophthalmitis following cataract surgery. PATIENTS AND METHODS Ten patients with endophthalmitis following cataract surgery who were referred from three different anterior segment surgeons were evaluated. RESULTS Presenting visual acuities ranged from 20/30 to light perception (median, 20/80). All 10 eyes demonstrated vitritis, 8 of 10 eyes had hypopyon, and the remaining 2 eyes had significant anterior segment fibrin. All patients were treated with intravitreal injections of vancomycin and ceftazidime, as well as subconjunctival steroids. Vitreous cultures were positive in 2 of 10 eyes, and both grew Staphylococcus epidermidis, aqueous cultures were negative in 8 of 8 eyes (not performed in 2 patients). Follow-up ranged from 13 to 85 days (median, 37 days). All eyes showed complete resolution of inflammation and visual acuity improved to 20/40 or better in 9 eyes (90%). CONCLUSIONS Acute-onset endophthalmitis may occur in a cluster of patients within a short time frame. Early diagnosis and treatment may result in favorable visual outcomes.

Branch Retinal Artery Occlusion Associated With Directional Coronary Atherectomy After Percutaneous Transluminal Coronary Angioplasty

PURPOSE To report a case of branch retinal artery occlusion after atherectomy. METHODS A 51-year-old man complained of visual loss in the right eye after directional coronary atherectomy, performed secondary to a complicated percutaneous transluminal coronary angioplasty. He underwent a full ophthalmologic examination, including fluorescein angiography and Doppler ultrasound. RESULTS Visual Acuity was 20/30 with an inferior scotoma present in the right eye. There were three Hollenhorst plaques present inside the superotemporal vascular arcade. CONCLUSIONS There is a small but definite risk of retinal microinfarctions after atherectomy.