Anatomical Outcomes Research Articles

Clinical Profile and Treatment Outcome of Endogenous Endophthalmitis

Background: Endogenous Endophthalmitis is a sight threatening intraocular infection resulting from hematogenous spread of pathogens from distant foci.Objective: To find out the source, risk factors, microbiological profile, visual and anatomical outcome of management of Endogenous endophthalmitis.Materials and Methods: A retrospective study was done from medical records of diagnosed case of Endogenous Endophthalmitis at Vision Eye Hospital, Dhaka. Data collection was done on demographic factors, medical and surgical history, infectious data, BCVA throughout the clinical course and complications. Visual outcome and anatomical outcome were measured and compared.Results: 20 Eyes of 18 patients were diagnosed as Endogenous Endophthalmitis where 88.9% were unilateral and 11.1% were bilateral. Known foci of infection were found in 27.8% of cases and infective foci were not found on 33.3%. 44.4% were culture positive where the commonest organism was Pseudomonas followed by Klebsiella. 70% patients were treated by PPV and 30% were treated conservatively. Among 18 patients 6 had normal eyeball, 7 had formed eyeball, 3 developed phthisis bulbi and 1 needed enucleation. Finally, VA improved at 44.4% patients, remain unchanged at 22.2% patients and deteriorated at 33.3% patients. Conclusion: The prognosis of endogenous endophthalmitis is often poor despite treatment. A high index of suspicion, early diagnosis and prompt treatment are crucial to salvage vision and eye. KYAMC Journal Volume: 14, No: 04, January 2024: 220-225.

Эффективность современных методов микробиологической диагностики инфекций в офтальмологии. Клинический пример

Purpose. To demonstrate the interaction of ophthalmic and microbiological services based on the use of technologies to minimize the time of microbiological diagnosis of ocular infection on a clinical example. Methods. A clinical example of an 82-year-old patient who underwent planned cataract phacoemulsification surgery with IOL implantation is presented. On the 3rd day after surgery, the patient was diagnosed with postoperative endophthalmitis. A rapid (48 h) microbiological diagnosis of the pathogen (E. faecalis), which made possible an early etiotropic adjustment of antibacterial treatment, provided maximum therapeutic effect, minimized the toxic side effects of pharmacotherapy and gave a good anatomical and functional result. Results The clinical case demonstrated organization of a precise interaction between ophthalmic service and the laboratory, which made it possible to identify the pathogen and determine the spectrum of its sensitivity to antibiotics during the first two days after diagnosis of postoperative endophthalmitis, prescribe etiotropic treatment with a good clinical and functional outcome. Key words: mass spectrometry; infection; microbiology; endophthalmitis.

Первый опыт хирургического лечения макулярных разрывов без удаления внутренней пограничной мембраны

Purpose. To evaluate the possibility of macular holes closing with platelet-rich blood plasma without internal limiting membrane (ILM) peeling and vitreous cavity tamponade. Methods. We studied a group of patients with vitrectomy without ILM peeling, a total of 17 eyes. Results In our study, we noted a significant improvement in best corrected visual acuity from 1 month after surgery, the dynamics of central retinal photosensitivity showed a clear improvement from 3 months after surgery. Overall photosensitivity of the retina improved faster than central photosensitivity of the retina. However, at 3 months after surgery these indicators had the same rate of improvement. Conclusion. Surgical treatment of macular hole with preservation of the ILM allows obtaining good anatomical and functional results with maximum satisfaction of the patient with the result of treatment. Key words: macular hole; internal limiting membrane; ILM peeling; PRP therapy.

Срединная кольпорафия как способ коррекции пролапса гениталий у пациенток пожилого и старческого возраста.

Introduction. The problem of genital prolapse (PG) remains relevant due to its high prevalence, reaching its maximum frequency in elderly women. When choosing surgical treatment of PG in the elderly and senile, it is necessary to take into account the presence of extragenital pathology and the somatic status of the patient. One of the methods of PG correction is median colporaphy, which has a high safety profile and a low recurrence rate. The aim of the study was to evaluate the results of median colporaphy in elderly and senile patients with genital prolapse. Materials and methods. The study included 40 women aged 65 years and older with symptomatic PG III-IV degree (POP-Q), who did not have sexual intercourse and did not seek it in the future, who underwent median colporaphy using the Lefor-Neugebauer technique in combination with colpoperineolevatoroplasty. The results of surgical treatment were evaluated according to the following criteria: duration of surgery, intra- and post- operative complications, assessment of the degree of PG before and after surgery, functional and anatomical results of surgery, duration of hospital stay, assessment of symptoms of PG before and after treatment. The follow-up period for patients is from 1 to 5 years after surgery. Results. The average duration of surgery is 41.5±9.6 minutes. The average volume of intraoperative blood loss was 55.5±20.1 ml. One intraoperative complication was registered – damage to the bladder wall. The average length of hospital stay is 5.6±1.0 days. No recurrence of PG was noted. Ac- cording to The Overactive Blade Questionnaire (OAB-q), there was an improvement in the average score from 9.9+6.0 to 7.3+2.7, which indicated a decrease in the severity of PG symptoms. The frequency of dysuric phenomena after surgery decreased by 2.2 times. Urinary disorders after surgery were detected in 15 (37.5%) patients; stress urinary incontinence – in 9 (22.5%) patients, in 6 (15.0%) – de novo, imperative urinary incontinence de novo – in 1 (2.5%) case. According to the Pelvic Floor Distress Inventory questionnaire (PFDI-20), there was a decrease in symptoms and func- tional disorders of the bladder and intestines in patients: a decrease in the number of points on the POPDI-6 scale from 62.1+18.9 to 1.4+3.7; CRAD-8 – from 18.0+14.8 points to 0.7+2.1; UDI-6 – from 29.9+23 to 7.1+10.2. According to an oral survey, all 40 (100%) patients would agree to undergo this operation again and not a single patient regretted the loss of sexual function. Conclusions. Median colporaphy is a safe and effective way to correct genital prolapse in elderly and senile women, including those with a burdened somatic status, who agree to give up vaginal intercourse. It is necessary to carefully inform patients about the irreversibility of vaginal obliteration and about the possible occurrence of dysuric phenomena after surgery.

Anatomic and Functional Outcomes of Vitrectomy for Advanced Retinopathy of Prematurity: A Systematic Review.

The success of vitrectomy in the advanced stages of retinopathy of prematurity (ROP) is defined not only by anatomical results, but also by functional outcomes. Studies have indicated that vitrectomy produces better outcomes when performed at an earlier stage (stage 4 vs. stage 5 ROP). This study reviewed the outcomes of vitrectomy in advanced stages of ROP and the associated factors. PubMed, ScienceDirect, Cochrane, Wiley, and WorldCat databases were systematically searched for articles published in the last 10 years. Studies involving participants with stages 4 and 5 ROP who underwent vitrectomy were included. The final search was performed on March 24, 2023. Risk of bias was assessed using the National Institutes of Health Quality Assessment Tool.The results were presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Ten studies were included in the review. A total of 1179 eyes underwent vitrectomy (72% lens-sparing vitrectomy [LSV] and 28% lensectomy-vitrectomy [LV]). LSV was mainly performed in stage 4 ROP and LV in stage 5 ROP. Anatomical and functional successes were more significant in stages 4A and 4B than in stage 5. Factors that improved prognosis included no plus diseases, stage 4, prior treatments such as laser or intravitreal anti-vascular endothelial growth factor injection, and sparing the lens intraoperatively. Vitrectomy resulted in better outcomes in patients with stage 4 ROP. Early detection and a strict screening protocol are needed to prevent ROP progression into stage 5.

Short-term outcomes of single port robotic hysterectomy with concomitant sacrocolpopexy.

The Da Vinci single port® (SP) robotic platform heralds a new era of minimally invasive surgery (MIS). The primary objective of this study was to assess short-term outcomes in patients undergoing SP robotic hysterectomy with concomitant sacrocolpopexy for pelvic organ prolapse (POP). We performed a retrospective case series at two tertiary care centers between January 2021 and August 2023. Patients with POP electing to undergo SP robotic hysterectomy with concomitant sacrocolpopexy were included. Chart abstraction was used to collect patient demographics and clinical outcomes. Recurrent POP was defined as new bothersome vaginal bulge symptoms and evidence of POP beyond the hymen on postoperative examination. 69 patients were included. Median operative time was 209min (135-312) and estimated blood loss was 100mL (20-2000). 1 (1.4%) patient sustained a major vascular injury resulting in laparotomy. Median pain score and morphine equivalents administered in PACU were low at 3 (0-7) and 3.2 (0-27) respectively. At 3months, 60 (86.9%) patients were seen either in person or via telemedicine for their follow up appointment. 59/60 (98.3%) reported no vaginal bulge symptoms and 50/51 (98.0%) had stage 0 or 1 prolapse on exam. One (1.4%) patient had recurrent prolapse and underwent an additional repair. Postoperative complications included 2 (2.9%) cases of ileus/small bowel obstruction, 1 (1.4%) pelvic hematoma requiring a blood transfusion, and 1 (1.4%) umbilical hernia. The SP robotic platform is a safe and feasible platform for MIS hysterectomy and sacrocolpopexy with good short term anatomic and symptomatic outcomes.

Nucleus drop following phacoemulsification surgery: Incidence, risk factors and clinical outcomes.

To determine the incidence, risk factors and clinical outcomes in patients with nucleus drop (ND) following phacoemulsification surgery at a tertiary care ophthalmic institute. Medical records of patients with ND during phacoemulsification between January'2019 and December'2022 were reviewed retrospectively. Incidence of ND was calculated overall, and according to surgical expertise levels and surgical steps. Associated pre- and intra-operative risk factors were assessed. Clinical outcome parameters [best-corrected visual acuity (BCVA) and intraocular pressure (IOP)] were compared with respect to timing of PPV (immediate vs early vs delayed), location (sulcus vs scleral fixated-IOL) and timing of IOL placement (primary vs secondary). Among 93,760 phacoemulsifications, ND was noted in 130 patients (0.1%). Significant direct and associated pre-operative risk factors were advanced cataract, glaucoma, posterior polar cataract, and diabetes mellitus. Junior medical consultants had 40 ND (mostly in non-complex cases), whereas senior medical consultants had 90 ND (mostly in complex cases). ND most frequently occurred during emulsification of nuclear fragments. Sulcus placement of IOL during primary surgery yielded significantly better visual outcome compared to secondary procedures, although timing of PPV had insignificant effect. 77.1% had BCVA of 6/12 or better at final follow-up. Timing of IOL implantation, PPV, and type of IOL did not have any significant effect on IOP. Though the incidence of ND is low, it is a dreaded complication. Accurate pre-operative evaluation, risk stratification, distribution of cases among surgeons based on their surgical expertise, and immediate or early management of ND yields better anatomical and functional outcomes.

Polypoidal choroidal vasculopathy versus neovascular age related macular degeneration: a comparison of demographics, clinical presentation, and treatment outcomes in Nigerians

PurposeTo compare the demographics, clinical presentation, and outcomes of intravitreal (IV) anti-VEGF monotherapy in the management of treatment-naïve polypoidal choroidal vasculopathy (PCV) and neovascular age-related macular degeneration (nAMD) in Nigerians. MethodsThis is a retrospective, interventional, comparative study. Data obtained from consecutively treated PCV and nAMD patients include age, sex, laterality, symptom duration, LogMAR visual acuity (pre- & post-treatment), occurrence of vitreous hemorrhage, optical coherence tomography central macular thickness (CMT), and duration of clinic visits. Data was analyzed using IBM SPSS version 22.0, P < 0.05. ResultsThe sample population was 162 patients/191 eyes (nAMD 85 patients/106 eyes, and PCV 77 patients/85 eyes). The nAMD patients were older than the PCV patients (72.48 +/− 8.81 years versus 62.04 +/− 10.50 years) p = 0.000. Females constituted 45.9% of the nAMD and 57.1% of the PCV patients, p = 0.1. Symptom duration: nAMD 11 months and PCV 12 months. Bilaterality: nAMD > PCV (38% versus 19%) p = 0.036. Vitreous hemorrhage: more common in PCV (42% versus 19%) p = 0.001. nAMD patients had poorer baseline vision (LogMAR 1.4 versus LogMAR 1.2) p = 0.2, thicker maculae (361 microns versus 331 microns), and received more mean intravitreal anti-VEGF injections (4 versus 3). Visual and anatomical outcomes were better for PCV; final vision (LogMAR 0.89 versus LogMAR 1.04), p = 0.064, final CMT (247 microns versus 331 microns), p = 0.05. nAMD patients had higher rate of >12 months follow-up (57.6% versus 35.0%) p = 0.002. ConclusionDemographic and clinical differences exist between PCV and nAMD. Though chronic presentation for both diseases is common, treatment improves vision and anatomy in most patients, moreso in PCV. Earlier treatment will likely yield better outcomes.

Experience in early minimally invasive fixation of pubic symphysis disruption with a system of transpedicular screws in patients with combined pelvic trauma (pilot study)

Introduction Challenges of treating the injuries of pubic symphysis in patients with combined pelvic injury require developing new techniques for stable minimally invasive osteosynthesis in the acute period of trauma.Purpose of the work was to assess the application of low invasive fixation of the pubic symphysis with a system of transpedicular screws in the patients with combined unstable pelvic injuries in the acute period of the traumatic disease.Materials and methods The results of treatment of 12 patients with polytrauma with unstable pelvic injury with rupture of the pubic symphysis who were treated at Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, in the period from 2017 to 2023, were analyzed. All the patients underwent final minimally invasive fixation of the pubic symphysis with a system of transpedicular screws in the early period of the traumatic disease.Results The overall assessment of the results in 12 patients found no complications or technical errors during the installation of transpedicular screws. Control CT scans of the pelvis showed that osteosynthesis was stable in all patients, and the position of metal was correct in all. One patient from the study group died in the clinic from massive pulmonary embolism. The long-term results in 11 patients in the period from 6 months to 3 years after trauma were evaluated as excellent and good anatomical and functional results in 10 patients, one case had fair outcome.Discussion The use of bone plates to fix ruptures of the symphysis pubis leads to disruption of its physiological mobility, and the patient’s activity in the postoperative period can cause an implant fracture. Original dynamic plates and wire cerclage help avoid this complication; however, all these techniques involve significant surgical trauma and blood loss, as well as the risk of postoperative wound suppuration. Minimally invasive methods of fixation using cannulated screws, systems such as Endobutton, Tight Rope can reduce intraoperative trauma and the risk of complications (blood loss, suppuration); however, the procedure for their installation is quite complex and lengthy, and for greater stability, external fixation of the pelvic ring is often required. The proposed minimally invasive fixation of the pubic symphysis with a system of transpedicular screws avoids a lot of shortcomings and is sufficiently stable.Conclusion The method of minimally invasive fixation of the pubic symphysis with a system of transpedicular screws meets current requirements in the treatment of patients with polytrauma and unstable pelvic injury, and it may be successfully used in the acute period of trauma.

Endoscopic lipofilling for velopharyngeal insufficiency after transoral surgery: a technical note.

Velopharyngeal insufficiency (VPI) is a known complication of transoral surgery, with a reported incidence of 8.1%. The main factor related to VPI is the split of the soft palate. However, dead space resulting from transoral decompression may play a pivotal role in the pathogenesis of the dysfunction. In our experience, functionally significant dead space is almost constantly present after transoral decompression. This is probably due to malformation in children and postoperative scarring, thus configuring a nosological entity that we could define as "syndrome of the nasopharyngeal dead space." Palatal prosthesis and pharyngoplasty have been proposed, though these surgical procedures are technically tricky and with possible complications, such as OSA symptoms, snoring, and nasopharyngeal stenosis. We proposed an effortless and minimally invasive procedure to treat this condition based on lipofilling the nasopharynx posterior wall endoscopically. To test the procedure's functional result, the submucosa of the nasopharynx posterior wall was initially filled with resorbable material, namely fibrin glue and autologous blood. The result was optimal but regressed after one month. Then, we repeated the procedure by lipofilling with autologous abdominal fat, resulting in a more stable anatomical and functional outcome at six months follow-up. The patient had a prompt significant improvement of his complaints (rhinolalia and oronasal regurgitation) and a correct projection of the nasopharynx posterior wall, with correct closure during phonation and absence of oronasal reflux. The "syndrome of the nasopharyngeal dead space" should be correctly identified after transoral surgery. It can be effectively treated with lipofilling of the posterior nasopharyngeal wall, a simple and minimally invasive procedure.

Balloon dilation of congenital perforated duodenal web in newborns: Evaluation of short and long-term results.

Incomplete congenital duodenal obstruction (ICDO) is caused by a congenitally perforated duodenal web (CPDW). Currently, only six cases of balloon dilatation of the PDW in newborns have been described. To present our experience of balloon dilatation of a perforated duodenal membrane in newborns with ICDO. Five newborns who underwent balloon dilatation of the CPDW along a preinstalled guidewire between 2021 and 2023 were included. Nineteen newborns diagnosed with ICDO who underwent laparotomy were included in the control group. In all cases, good anatomical and clinical results were obtained. In three cases, a follow-up study was conducted after 1 year. The average time to start enteral feeding per os was significantly earlier in the study group (4.4 d) than in the laparotomic group (21.2 days; P < 0.0001). The time spent by patients in the intensive care unit and hospital after balloon dilatation was also significantly shorter. We determined the selection criteria for possible and effective CPDW balloon dilatation in newborns as follows: (1) Presence of dynamic radiographic signs of the passage of a radiopaque substance beyond the zone of narrowing or radiographic signs of pneumatisation of the duodenum and small bowel distal to the web; (2) presence of endoscopic signs of CPDW; (3) successful cannulation with a guidewire performed parallel to the endoscope, with holes in the congenital duodenal web; and (4) successful positioning of the balloon performed along a freestanding guidewire on the web. Strictly following selection criteria for newborns with ICDO caused by CPDW ensures that endoscopic balloon dilatation using a pre-installed guidewire is safe and effective and shows good 1-year follow-up results.

Short-Term Real-World Outcomes of Intensive Aflibercept Injection for Refractory Neovascular Age-Related Macular Degeneration.

Background: The aim of this study is to report short-term outcomes after the shortening of the treatment interval to 4 weeks with a treat-and-extend (TAE) regimen (Si4w) of aflibercept in patients with refractory neovascular age-related macular degeneration (nAMD). Methods: This retrospective study included 34 patients given aflibercept with a TAE regimen of a minimum of a 4-week interval when they had a limited response to bimonthly aflibercept. The best-corrected visual acuity (BCVA) and central macular thickness (CMT) were compared before and after Si4w. The resolution of subretinal and intraretinal fluid before and after Si4w was also examined. The risk factors associated with persistent fluid were analyzed. Results: The average treatment duration until initiation of Si4w was 57.82 ± 28.59 months, with an average of 23.64 ± 12.40 injections administered. The BCVA was not significantly improved after Si4w. The CMT decreased significantly from 427.91 ± 125.74 μm to 336.38 ± 121.67 μm at the third visit (p < 0.001). Eighteen eyes (52.9%) showed complete resolution, and twenty-three eyes (67.6%) experienced complete resolution at least once during the three visits. The duration of fluid before Si4w was significantly associated with complete resolution (p = 0.011). Conclusions: Si4w of aflibercept showed satisfactory anatomical outcomes with complete resolution of fluid in patients with a limited response to bimonthly aflibercept injections, and should be considered as a useful treatment option.

Анализ ОКТ-предикторов анатомических и функциональных результатов aнтиангиогенной терапии отслойки пигментного эпителия при неоваскулярной возрастной макулярной дегенерации

Abstract Analysis of OCT predictors of anatomical and functional results of anti-VEGF therapy of pigment epithelium detachment in neovascular age-related macular degeneration E.V. Kozina, S.N. Sakhnov, V.V. Myasnikova, E.V. Bykova S. Fyodorov Eye Microsurgery Federal State Institution, Krasnodar branch, Krasnodar, Russian Federation Kuban State Medical University Ministry of Health of Russia, Krasnodar, Russian Federation Purpose. Analysis of optical coherence tomography (OCT) biomarkers for anatomical results prediction of anti-angiogenic therapy (antiVEGF) of pigment epithelial detachments (PED) in neovascular macular degeneration (n-AMD). Material and methods. Primary tomograms of 260 patients with PED higher than 200 µm were analyzed. The shape, height, length of the detachment and subpigmentary space reflectivity were assessed. After anti-VEGF injections, reattachment of PED according to OCT was observed in 114cases (44%) – 1st group; in 111 cases (43%) OCT showed PED resistance – 2nd group; in 35 cases (13%), the pigment epithelium tear (RPET) of 3–4 degrees was happened – 3rd group. In each OCT were studied of the following biomarkers: the ellipsoidal zone and RPE integrity, intra – and subretinal fluid, the drusen under RPE around PED, hyperreflective foci in retina. Results. A statistically significant difference was revealed between 1st and 2nd groups in the height and length of pigment epithelium detachment: PED height (506.2±204.3 µm) and length (3206.2±722.1 µm) have a tendency to reattachment during anti-VEGF therapy (р&lt;0.05). High PED with neuroepithelial detachment has a higher risk of RPET (р&lt;0.05). Presence of RPE defects and large hyperreflective foci in the retina can be considered as a predictor of the PED reattachment (р&lt;0.05). Low PED with reflectivity subpigmentary space is a predictor of PED resistance (р&lt;0.05). Conclusion. Patients with high PED, with neuroepithelial detachment, should be given antiVEGF therapy with great caution. Lower PED with hyperreflectity under PED tend to be anatomically resistant to therapy. Biomarkers of the adherence of the PE can be RPE defects and large hyperreflective inclusions in the internal layers. Key words: retinal pigment epithelium detachment, pigment epithelium tear, OCT biomarkers, hyperreflective foci, antiangiogenic therapy

Résultats anatomiques et fonctionnels du protocole thérapeutique « 3 + PRN » dans le traitement de l’œdème maculaire diabétique

Purpose: To evaluate the anatomical and functional results of the “3 + PRN” protocol in the treatment of diabetic macular edema (DME), determine the predictive factors for good final visual acuity, and compare it to other protocols.Materials and methods: We conducted a retrospective, descriptive, comparative, cross-sectional study of patients with DME, which we dubbed HTSM. All patients were treated with three monthly initial intravitreal injections (IVT) of 1.25 mg bevacizumab and followed according to the pro re nata (PRN) protocol for a period of 3 years. The protocol was based on a monthly monitoring schedule for the first 3 months, then increasingly spaced out over time. “On-demand” treatment was indicated with resumption of bevacizumab IVT in the event of worsening of DME.Results: A total of 52 patients were included. The mean age was 65 years. Type 2 was the most frequently observed type of diabetes. The mean duration of the PRN protocol was 6 months, and the mean number of injections was 6. The mean visual acuity (VA), initially 1/10, improved to 3/10 by the conclusion of the 3+PRN protocol, with an improvement of more than 5 letters in 77.6% of cases. The mean initial central macular thickness (CMT) was 451.5 µm. The final mean EMC decreased to 298.5 µm, which corresponds to a reduction of 153 µm compared to the initial value. The mean subfoveal choroidal thickness, initially 304.2 µm, decreased to a mean of 284.5 µm at completion. Comparative analysis of the results before and after the PRN protocol confirmed the existence of a statistically significant correlation between VA and CMT (p<0.05). No correlation was observed between age and visual acuity or between initial and final VA. The analysis of the various tomographic parameters and VA revealed a significantly better visual improvement in the group in whom the external limiting membrane (MLE) and ellipsoid zone (ZE) were intact (p = 0.04), as well as in the group in whom serous retinal detachment (SRD) was absent (p<0.001). Posterior vitreous detachment (PVD) was the most frequently observed vitreomacular anomaly. The final VA was similar in the groups with and without PVD (p = 0.04).Conclusion: The 3+PRN protocol is effective both functionally and tomographically in the treatment of DME. Various tomographic parameters might influence therapeutic efficacy. However, further in-depth studies are needed to better investigate these parameters.

Pediatric Endophthalmitis Over the Last Five Decades: A Case Report and Systematic Review.

Pediatric infectious endophthalmitis is a rare, severe ocular infection that can have devastating consequences. It may be exogenous or endogenous, with exogenous endophthalmitis being more common. Current data on the etiology, microbiology, antibiotic treatments and outcomes in pediatric cases is limited. To summarize the etiology, microbiology, visual outcomes and management of pediatric endophthalmitis. A literature review was conducted on cases of pediatric endophthalmitis published from 1980 to 2022, identified through searches of PubMed, Medline, Web of Science and Google Scholar databases. A total of 796 patients were included. Ocular trauma was the most common cause with 623 patients (78.3%), followed by posteye surgery with 100 patients (12.6%) and endogenous endophthalmitis with 67 patients (70 eyes) (8.4%). Among culture-positive cases, gram-positive microorganisms predominated. Treatment involved pars plana vitrectomy in 608 patients (76%) and intraocular antibiotics in 590 patients (74%). Favorable visual acuity (≥20/200) was achieved in 30.5% of patients, 20% had no light perception and 12.5% developed poor anatomical outcomes with phthisis bulbi. Our review provides insights into the etiology, epidemiology, microbiology, treatment and visual outcomes of pediatric endophthalmitis based on available literature worldwide.

An Observational Study to Assess the Outcome of Canal Wall Window Tympanomastoidectomy in Chronic Suppurative Otitis Media.

This study was undertaken to assess the outcome of canal wall window tympanomastoidectomy in chronic suppurative otitis media in a tertiary care centre of central India. A total of 50 patients were taken for this study in which the youngest patient was 13-year-old male and oldest 55-year female. Maximum patients were in between age group 10 to 20 years, 20 (40%) patients and minimum 03 (6%) between age group 51 to 60 year. The study mainly emphasized on: To study the clinical profile of the cases of chronic suppurative otitis media, to study the hearing outcome after 3 months of Canal wall window tympanomastoidectomy technique, to study the post-operative condition of ear after 3 months whether dry or wet and to study the post-operative follow up of cases to assess the graft uptake. Average PTA & ABG improvement of different tympanoplasty was also calculated in our study in which Type I tympanoplasty had 12.20dB gain, Type II of 10.50 and Type III of 10.31dB.An overall average improvement in all patients with tympanoplasty was 11.00dB.At the end of the study 100% dry ears were achieved. The technique of canal wall window tympanomastoidectomy involves formation of a window in the outer attic wall to look at the disease extent which was then closed by a snuggly fitting cartilage.It is a novel technique & without compromising the structural integrity in case of a limited disease which is only extending till attic and aditus good anatomical and hearing results could be gained.

Shortfalls of free autologous internal limiting membrane transplantation for highly myopic refractory macular holes in a long term follow-up.

The aim of this study is to evaluate long-term anatomical and functional outcomes of autologous internal limiting membrane (ILM) transplantation in refractory highly myopic macular holes (HMMHs). Retrospective interventional analysis of 13 eyes with refractory HMMH undergoing autologous ILM transplantation with gas tamponade. Best-corrected visual acuity (BCVA, Snellen), optical coherence tomography and fundus photography were scheduled at baseline and every follow-up visit (1, 3, 6, 12, 18, 24 months and the most recent). Preoperatively, we collected minimum linear diameter (MLD) and basal diameter (BD). Post-operatively, rates of external limiting membrane (ELM)/ellipsoid zone (EZ) restoration, excessive gliosis and subfoveal retinal pigmented epithelium (RPE) atrophy were evaluated. Average AXL was 31.45 ± 2.07mm and mean follow-up was 47.2 ± 31.4 months. Anatomical success was reached in 7/13 eyes (54%), while 2 cases showed persisting HMMH, 2 cases had early recurrence and 2 cases late recurrence. BCVA went from 0.19 ± 0.18 to 0.22 ± 0.20 at final follow-up (p = 0.64), improving in 5/13 eyes (38%). One eye showed continuous ELM and EZ lines, while another eye showed an irregular ELM but no EZ. Post-operatively, 5 eyes (71%) developed progressive atrophy of the subfoveal RPE, while excessive gliosis was reported in 3 eyes (43%). Furthermore, one patient developed post-operative chronic macular edema-like changes in the perifoveal area. Autologous ILM transplantation showed controversial anatomical outcomes and and poor visual results in refractory HMMH. Moreover, progressive subfoveal patchy atrophy and excessive gliosis are possible post-operative complications.

The effectiveness of the 0.19 mg fluocinolone acetonide implant in treating non-infectious posterior uveitis: a real-world experience

BackgroundThe 0.19 mg fluocinolone acetonide (FAc) implant (ILUVIEN) has been approved for prevention of relapse in recurrent non-infectious uveitis affecting the posterior segment of the eye (NIU-PS). There is little data assessing the long-term efficacy and safety of the FAc implant in this indication. Therefore, we conducted a retrospective interventional case review of 18 eyes from 13 patients with NIU-PS treated with the FAc implant at three ophthalmology departments in the Middle East between 2018 and 2021.Main textBaseline patient characteristics, including best-corrected visual acuity (BCVA), central retinal thickness (CRT) and intraocular pressure (IOP), were collected at the time of FAc implant administration and at 1–3 months, 6 months and every six months thereafter. The mean time of follow-up was 29.7 ± 14.6 (mean ± SD) months. Over the follow-up, the BCVA significantly increased from month 1 (P = 0.002) until month 36 (P = 0.024) and remained improving throughout the follow-up period (P = 0.004). The CRT significantly decreased from month 1 (P = 0.008) until month 12 (P = 0.003) and was persistently lower during the follow-up period (P = 0.022). Significant improvements in anterior chamber cells (P = 0.004) and vitritis scores (P = 0.001) were observed by Month 6. Similarly, at Month 12, significant improvements were noted in both parameters as well (anterior chamber cells: P = 0.012; vitritis scores: P = 0.004). Mean IOP remained relatively stable throughout (P = 0.205) the follow-up.ConclusionsOur results suggest improvements and long-term maintenance in functional and anatomical outcomes with FAc implant with a manageable safety profile in a real-world clinical setting in patients with NIU-PS.

Real-World Outcomes of a Loading Phase with Intravitreal Faricimab in Neovascular Age-Related Macular Degeneration (n-AMD) and Diabetic Macular Edema (DME).

The aims of this work were to evaluate the real-world efficacy and safety of a loading dose of intravitreal faricimab in eyes with active neovascular age-related macular degeneration (n-AMD) or diabetic macular edema (DME) and to analyze the treatment outcome in relation to specific biomarkers. Patients with active n-AMD or DME, treated with four monthly intravitreal injections of faricimab, were enrolled in this retrospective, uncontrolled study. Best-corrected visual acuity (BCVA), central subfield thickness (CST), presence of retinal fluid (RF) on optical coherence tomography (OCT), and adverse events were assessed at baseline and at weeks 4, 8, 12, and 16. Predefined biomarkers were evaluated at baseline (BL) and at last visit. Sixteen eyes of 15 patients with n-AMD (n-AMD group) and 15 eyes of 12 patients with DME (DME group) were included. Mean (± standard deviation) logarithm of minimum angle of resolution (logMAR) BL BCVA changed from 0.68 (± 0.43) to 0.53 (± 0.36; P = 0.13) and from 0.51 (± 0.34) to 0.32 (± 0.24; P: 0.048) at week 16 in n-AMD and DME group, respectively. A statistically significant mean CST reduction was reported in both groups at last visit (n-AMD: - 166.5μm; P = 0.0009/DME: - 110.8μm; P = 0.0086). Seventy-five and 33% of eyes with n-AMD and DME respectively achieved complete RF resolution at last visit. Subfoveal inner and outer retinal damage correlated with a lower final BCVA in n-AMD group. The presence of large (> 100μm) juxtafoveal microaneurysms (MAs) was significantly correlated with a higher chance of residual fluid in eyes with DME. Both n-AMD and DME groups achieved satisfactory anatomical results after a loading-dose of intravitreal faricimab. BCVA improvement might be hampered by pre-existing retinal damage in eyes with n-AMD. Large, juxtafoveal MAs might represent a hallmark of a slower anatomical response to the treatment in eyes with DME.

Comparison of facedown and non-facedown positions after vitrectomy with fovea-sparing internal limiting membrane peeling and air tamponade for treating myopic foveoschisis with foveal detachment: A prospective, randomized interventional study

PurposeTo compare the anatomical and visual outcomes after vitrectomy with facedown (FD) or non-FD positions for treating myopic foveoschisis (MF) with foveal detachment. DesignProspective, randomized interventional study. Methods55 eyes with MF and foveal detachment that underwent vitrectomy with fovea-sparing internal limiting membrane (ILM) peeling and air tamponade were randomized to either the postoperative FD (26 eyes) or non-FD (29 eyes) positions. Best-corrected visual acuity (BCVA) and optical coherence tomography were assessed at baseline, 2 weeks, 3 months, and 6 months after vitrectomy with fovea-sparing ILM peeling and air tamponade with the FD or non-FD positions. Logistic and linear regression analyses were performed to study correlations between clinical factors and foveoschisis resolution and postoperative BCVA. ResultsAll patients completed ≥6 months of follow-up. MF and foveal detachment were completely resolved in 22 eyes (92 %) in the FD group and 22 eyes (76 %) in the non-FD group (P = 0.160). Macular hole-associated retinal detachment occurred in one eye in the FD (4 %) and non-FD (3 %) groups. The postoperative best-corrected visual acuity (BCVA) at 6 months did not differ significantly between the two groups (P = 0.495). The BCVA improved by ≥0.3 logMAR in 14 eyes (58 %) in the FD group versus 17 eyes (59 %) in the non-FD group (P = 0.983). Central foveal thickness (CFT) and height of foveal detachment were significantly associated with foveoschisis resolution (P = 0.045 and 0.039, respectively). Better preoperative BCVA and foveoschisis resolution were significantly associated with better postoperative BCVA (P = 0.031 and 0.003, respectively). ConclusionsThe non-FD position appeared to be as effective as the FD position after vitrectomy with fovea-sparing ILM peeling and air tamponade for treating MF with foveal detachment.