Thomas M. Aaberg

Nosocomial acute-onset postoperative endophthalmitis survey: A 10-year review of incidence and outcomes

OBJECTIVEnThe purpose of the study was to evaluate the incidence of acute-onset (within 6 weeks after surgery) postoperative endophthalmitis and to assess the visual acuity outcomes after treatment over a 10-year period at one institution.nnnPATIENTS AND METHODSnThis retrospective study reviews all surgical cases performed between January 1, 1984 and December 30, 1994 at the Anne Bates Leach Eye Hospital, Bascom Palmer Eye Institute, University of Miami Medical Center, for the occurrence of nosocomial acute-onset postoperative endophthalmitis.nnnRESULTSnThe overall 10-year incidence of acute-onset postoperative endophthalmitis after intraocular surgery was 0.093% (54/58, 123). The incidences of culture-proven acute-onset postoperative endophthalmitis by surgical category were as follows: cataract surgery with or without intraocular lens (IOL) (0.082%, 34/41, 654), pars plana vitrectomy (PPV) (0.046%, 3/6557), penetrating keratoplasty (0.178%, 5/2805), secondary IOL placement (0.366%, 5/1367), glaucoma surgeries (0.124%, 4/3233), combined trabeculectomy and cataract surgery (0.114%, 2/1743), and combined penetrating keratoplasty and cataract surgery (0.194%, 1/515). The median visual acuity after endophthalmitis treatment was 20/200. The median visual acuities after endophthalmitis treatment by procedure were as follows: cataract surgery with or without IOL (20/133), PPV (no light perception), penetrating keratoplasty (2/200), secondary IOL implantation (20/40), glaucoma surgery (20/80), and combined trabeculectomy and cataract surgery with or without IOL (20/150).nnnCONCLUSIONSnThe overall incidence of endophthalmitis after intraocular surgery was 0.093%. The incidence of endophthalmitis was higher after secondary IOL implantation than after cataract extraction (P = 0.008, Fishers exact test). After treatment, the visual acuity outcomes were worse in the patients who developed endophthalmitis after PPV than after cataract extraction, glaucoma procedures, or secondary IOL implantation (P < 0.05, analysis of variance, Duncans multiple range test). Acuity outcomes after treatment of endophthalmitis were better among the patients with secondary IOL implantation than after penetrating keratoplasty or PPV (P < 0.05, analysis of variance, Duncans multiple range test). The results of this 10-year review from a large teaching center may serve as a source of comparison for other centers and future studies.

Giant Retinal Tear as a Complication of Attempted Removal of Intravitreal Lens Fragments During Cataract Surgery

PURPOSEnTo report giant retinal tear and retinal detachment as a complication of attempted removal of intravitreal lens fragments at the time of cataract surgery and to evaluate the anatomic and visual acuity outcomes of pars plana vitrectomy and retinal reattachment surgery.nnnMETHODSnRetrospectively, 10 patients with giant retinal tear, retinal detachment, and intravitreal lens fragments in 10 eyes were reviewed.nnnRESULTSnIn 10 eyes, retrieval of intravitreal lens fragments using the limbal approach by deep vitrectomy, copious vitreous cavity irrigation, or deep vitreous cavity phacoemulsification had been attempted by the anterior segment surgeon at the time of cataract surgery in each patient. The average interval from cataract surgery to the initial vitreoretinal consultation was 8 days. Each of the 10 eyes had a giant retinal tear involving the inferior retina: in four eyes, of between 90 degrees and 180 degrees; in four, equal to 180 degrees; and in two, of greater than 180 degrees. After pars plana vitrectomy and retinal detachment repair, nine (90%) of 10 eyes had retinal reattachment, but seven patients required more than one operation. One eye had persistent retinal detachment, and one eye had corneal graft failure. Seven (70%) of the 10 eyes had best-corrected final visual acuity of 20/200 or better; three eyes had light-perception, hand-motion, and counting-fingers vision.nnnCONCLUSIONSnAggressive attempts at intravitreal lens fragment retrieval from a limbal-based approach should be avoided because these procedures may result in serious retinal complications, such as formation of a giant retinal tear.

Metastatic Tumors to the Pituitary

PURPOSEnTo illustrate how the ophthalmologist can distinguish a metastatic tumor to the pituitary from a pituitary adenoma through clinical, particularly ophthalmic, findings.nnnMETHODSnWe studied three patients with metastatic disease to the pituitary. One patient had a history of breast cancer without known metastatic disease, and two patients had no previous diagnosis of malignancy. We reviewed the literature with respect to signs and symptoms that may differentiate such lesions from histologically benign pituitary adenomas.nnnRESULTSnIncluding our patients and the recent cases in the literature, 42% of patients with metastatic tumors had oculomotor palsies, compared with less than 5% of patients with pituitary adenomas. Of patients with metastatic tumors, 33% had diabetes insipidus, compared with 1% who had pituitary adenomas. Furthermore, with respect to differentiating a pituitary adenoma from a metastatic process, radiographic examinations were not helpful, and histopathologic examination was occasionally incorrect.nnnCONCLUSIONnThe ophthalmologist can potentially differentiate a metastatic tumor to the pituitary from a pituitary adenoma, thereby assisting in the proper treatment of patients.