Cases Of Postoperative Endophthalmitis Research Articles

Virulence Factors of Bacteria Related to Ocular Infections in Non Immunocompromised Patients: Review Article

The ocular surface is constantly exposed to pathogenic bacteria. Many Gram positive and Gram negative bacteria have been implicated in ocular infections, in non immunocompromised patients, causing severe vision impairment. These microorganisms have in their quiver a variety of arrows to cause infection. The aim of this study is to list the virulence factors of the main ocular pathogens. Data were extracted from PubMed and Google Scholar. <i>S. aureus</i> and <i>Streptococci, Bacillus cereus</i> and <i>Corynebacterium (non-diphtheriae)</i> are the main culprits as far as Gram positive bacteria are concerned. <i>S. aureus</i> causes infections of the lacrimal apparatus, cornea and eyelids, conjunctivitis, keratitis, and endophthalmitis. <i>Streptococcus pneumoniae, Streptococcus pyogenes, Enterococcus</i> and <i>Streptococcus viridians</i> are isolated from post injection endophthalmitis cases. S. pneumoniae</i> is most involved in keratitis, conjunctivitis, and endophthalmitis. <i>Streptococcus pyogenes</i> is most involved in blepharitis and hospital acquired conjunctivitis in neonates in the intensive care unit. <i>Enterococcus faecalis</i> is implicated in postoperative endophthalmitis cases. <i>Corynebacterium (non-diphtheriae) species</i> are involved mainly in infections complicating cataract surgery, keratoplasty, and vitrectomy. <i>Bacillus species</i> provoke conjunctivitis, keratitis and post-traumatic endophthalmitis. <i>Bacillus cereus</i> can cause rapidly destructive endophthalmitis. Among Gram negative bacteria, <i>Neisseria gonorrhoeae, Pseudomonas aeruginosa, Chlamydia trachomatis</i>, and <i>Bartonella species</i> are major ocular pathogens, responsible for severe ocular damage. Gonococcal conjunctivitis (GC) is still a cause of blindness in some developing countries. When it occurs in neonates, it is called gonococcal ophthalmia neonatorum. <i>P. aeruginosa</i> is related to contact lens-associated keratitis. <i>Chlamydia trachomatis</i> is the culprit of trachoma and inclusion conjunctivitis. <i>Bartonella henselae</i> causes bartonellosis or cat scratch disease, or cat scratch fever. Eye infection includes optic neuropathy and neuroretinitis. When the eye is the primary site of inoculation, the patients are diagnosed with Parinaud oculo-glandular syndrome (infection of the conjunctiva, eyelid and adjacent skin with regional lymphadenopathy). Chronic <i>Bartonella</i> infection provokes blurred vision, photophobia and eye irritation. Comprehension of the mechanism of infection, caused by these pathogens, is crucial in diagnosis and treatment.

Cap-puncturing mechanism for ophthalmic postoperative antibiotic eye drops: friend or foe?

A retrospective case series highlights two cases of postoperative endophthalmitis, in which similar improper technique of puncturing the antibiotic bottle with a nonsterile needle was noted.&#x0D; Patient A, a 65-year-old man with three weeks’ history of uneventful combined cataract and pars plana vitrectomy (PPV) presented with acute painful right eye and vision blurring from 6/12 to 1/60 for two days. Examination showed severe anterior chamber activity and hazy fundal view. B-scan showed dense vitritis. Vitreous sampling revealed gram positive cocci, but no culture growth. Patient B, a 69-year-old man presented with three days’ history of right painful red eye and vision dropped to light perception following an uneventful cataract surgery. Examination showed severe anterior chamber activity with hypopyon, raised intraocular pressure, and no fundal view. B-scan detected dense vitritis with loculation. Vitreous sampling cultured Pseudomonas aeruginosa in Patient B. In both cases, the patients reported piercing the generic topical ciprofloxacin 0.3% bottle tip with a nonsterile needle instead of the prescribed method of using the sterile, inner aspect of the bottle cap. However, the cultures of the bottle contents were negative in both cases. Both patients received intravitreal, topical, and systemic antibiotics and subsequently underwent PPV. Patient A recovered vision to baseline, while Patient B recovered to counting finger vision.&#x0D; The cap-puncturing mechanism for eye drop bottles is designed to maintain the sterility of the contents. However, this may backfire when patients do not understand the prescribed technique. We postulate that this improper technique predisposed the two cases to endophthalmitis.

Outcomes of 27G(+) transconjunctival sutureless vitrectomy for posterior segment disease

Objective: To report the clinical outcomes and safety profile of 27G(+) transconjunctival sutureless vitrectomy (TSV) in eyes with posterior segment disease. Methods: Prospective, interventional case series. Eyes undergoing 27G(+) TSV for a vitreoretinal surgery indication were included from Dec 2015 to Mar 2016. Change in visual acuity and occurrence of intraoperative and postoperative complications with minimum follow-up of 6 weeks were recorded. Results: Eighty-three eyes met the inclusion criteria. Surgical indications included epiretinal membrane (n=27), proliferative diabetic retinopathy (n=17), full-thickness macular hole (n=11), rhegmatogenous retinal detachment with or without proliferative vitreoretinopathy (PVR) (n=8), vitreous hemorrhage(n=7), vitreous opacities (n=7), diabetic macular edema non-response to anti-VEGF agents(n=4), intraocular lens or cataract nucleus dropped into vitreous cavity (n=2). Mean follow-up was 19 weeks (range 6-34 weeks). Visual acuity improved in all cases. The cutter incarcerated with trocar in a vitreous hemorrhage case. There were no other intraoperative complications and no case required sutured at the conclusion of surgery. Postoperative complications included transient ocular hypertension in 2 eyes (2.4%) and transient hypotony in 1 eye (1.2%). No cases of postoperative endophthalmitis, sclerotomy related retinal tears, or choroidal detachments were encountered in the follow-up period. Conclusion: The 27G(+) TSV was effective and safe for varied surgical indications with low rates of intraoperative and postoperative complications. (Chin J Ophthalmol, 2018, 54:918-922).

Unusual microbiological presentations in polymicrobial post-operative endophthalmitis and their clinical correlations.

To report the clinical course, microbiological spectrum and visual outcomes of three cases of post-operative endophthalmitis caused by unusual combination of micro-organisms. Retrospective review of medical charts at a tertiary eye care centre over a period of 1year, of subjects with post-operative endophthalmitis and more than one microbiological isolate. We report 3 cases with unusual combination of microorganisms. In case 1, two organisms (Burkholderia cepacia and Aeromonas veronii, from the vitreous cavity and capsular bag, respectively) with an identical antibiotic sensitivity pattern were found, while in case 2, the organisms (Streptococcus pneumoniae and Sphingomonas paucimobilis, from cornea and vitreous cavity, respectively) isolated had different sensitivity patterns. In case 3, two different strains of the same organism (Enterococcus faecalis) were found. Cases 1 and 2 achieved good anatomical and visual outcomes, while in case 3, vision remained poor despite a good anatomical outcome. Unusual combinations of organisms in post-operative endophthalmitis can introduce unique clinical characteristics and should specifically be considered in atypical clinical presentations, poor response to standard therapy and unusual recurrence patterns.

A diagnostic dilemma in a patient with delayed onset endophthalmitis

We report a case of nonpainful uveitis nine months after an uncomplicated phacoemulsification cataract surgery. Chronic postoperative endophthalmitis was suspected. Diagnostic vitrectomy and partial capsular bag removal was performed, but the specimens cultured in microbiology laboratory showed no pathogens. Systemic workup came positive for skin Tuberculosis test, and presumed intraocular tuberculosis treatment was started accordingly. Inflammation persisted, so a repeat vitrectomy was performed with removal of the lens implant with the capsule, and this time bedside culture inoculation was performed in operating room, revealing Pseudomonas infection. Delayed-onset postoperative endophthalmitis typically progresses slowly and therefore can be confused with uveitis and treated with steroid and immunosuppressant treatment regimes. Our case confirms both the value of immediate bacterial inoculation and the necessity of aggressive surgical treatment in chronic postoperative endophthalmitis cases.

COMBINED PARS PLANA VITRECTOMY AND SCLERAL FIXATION OF AN INTRAOCULAR LENS USING GORE-TEX SUTURE: One-Year Outcomes.

To report the 1-year clinical outcomes of combined pars plana vitrectomy and ab externo scleral fixation of an intraocular lens using Gore-Tex suture. Retrospective, interventional case series. Outcome measures were change in visual acuity and occurrence of intraoperative and postoperative complications with minimum follow-up of 1 year. Eighty-four eyes of 83 patients were identified. The mean best available visual acuity improved from 20/782 preoperatively to 20/65 postoperatively (P < 0.001). The mean follow-up was 598 ± 183 days (median 533 days, range 365-1,323 days). There were no intraoperative complications noted. A Bausch & Lomb Akreos AO60 intraocular lens was implanted in 77 eyes and an Alcon CZ70BD in 7 eyes. Postoperative complications included transient vitreous hemorrhage in six eyes (7.1%), cystoid macular edema in four eyes (4.8%), ocular hypertension in three eyes (3.6%), hyphema in two eyes (2.4%), and transient corneal edema in two eyes (2.4%). There were no cases of postoperative endophthalmitis, suture erosion/breakage, hypotony, retinal detachment, suprachoroidal hemorrhage, choroidal detachment, uveitis-glaucoma-hyphema syndrome, or persistent postoperative inflammation during the follow-up period. Combined pars plana vitrectomy and ab externo scleral fixation of an intraocular lens with Gore-Tex suture was well tolerated at a minimum of 1-year follow-up. No suture-related complications were encountered.

Change in Nationwide Incidence of Post-Cataract Surgery Endophthalmitis: Korean Cohort Study from 2002 to 2013

ABSTRACTPurpose: To investigate the change in nationwide incidence of endophthalmitis following cataract surgery in Korea from 2002 to 2013.Methods: From a national sample cohort (n = 1 025 340), cases of postoperative endophthalmitis between 2002 and 2013 were identified.Results: From 70,719 cases of cataract surgery, 49 incidents of endophthalmitis were reported, yielding an incidence of 0.069% (95% confidence interval [CI], 0.051–0.092%). Overall, the endophthalmitis incidence decreased from 0.103% in 2002–2005 to 0.045% in 2010–2013, corresponding to an annually decreasing time-trend (0.902, 95% CI, 0.827–0.984). In diabetic patients, however, the incidence was 0.128% and did not change (time trend, 1.015; 95% CI, 0.828–1.245).Conclusions: This study revealed the incidence of endophthalmitis decreased during a 12-year period, but remained constant in diabetic patients.

A Novel Biomimetic Nanosponge Protects the Retina from the Enterococcus faecalis Cytolysin.

Intraocular infections are a potentially blinding complication of common ocular surgeries and traumatic eye injuries. Bacterial toxins synthesized in the eye can damage intraocular tissue, often resulting in poor visual outcomes. Enteroccocus faecalis causes blinding infections and is responsible for 8 to 17% of postoperative endophthalmitis cases. These infections are increasingly difficult to treat due to the emergence of multidrug-resistant strains. Virulent E.faecalis isolates secrete a pore-forming bicomponent cytolysin that contributes to retinal tissue damage during endophthalmitis. We hypothesized that a biomimetic nanosponge, which mimics erythrocytes, might adsorb subunits of the cytolysin and reduce retinal damage, protecting vision. To test the efficacy of nanosponges in neutralizing the cytolysin in vitro, hemoglobin release assays were performed on culture supernatants from cytolysin-producing E.faecalis with and without preincubation with nanosponges. Treatment with nanosponges for 30min reduced hemolytic activity by ~70%. To determine whether nanosponges could neutralize the cytolysin in vivo, electroretinography was performed on mice 24h after intravitreal injection with cytolysin-containing supernatants treated with nanosponges. Pretreatment of cytolysin-containing supernatants with nanosponges increased the A-wave retention from 12.2% to 65.5% and increased the B-wave retention from 21.0% to 77.0%. Histology revealed that in nanosponge-treated eyes, retinas remained intact and attached, with little to no damage. Rabbit nanosponges were also nontoxic and noninflammatory when injected into mouse eyes. In an experimental murine model of E.faecalis endophthalmitis, injection of nanosponges into the vitreous 6h after infection with a wild-type cytolysin-producing strain increased A-wave retention from 5.9% to 31% and increased B-wave retention from 12.6% to 27.8%. Together, these results demonstrated that biomimetic nanosponges neutralized cytolysin activity and protected the retinas from damage. These results suggest that this novel strategy might also protect eyes from the activities of pore-forming toxins of other virulent ocular bacterial pathogens. IMPORTANCE Endophthalmitis is a serious, potentially blinding infection that can result in vision loss, leaving a patient with only the ability to count fingers, or it may require enucleation of the globe. The incidence of postoperative endophthalmitis has markedly increased over the past 2 decades, paralleling the rise in ocular surgeries and intravitreal therapies. E.faecalis is a leading cause of infection following ocular procedures, and such infections are increasingly difficult to treat due to multidrug resistance. Cytolysin is the primary virulence factor responsible for retinal tissue damage in E.faecalis eye infections. Treatment of these infections with antibiotics alone does not impede ocular damage and loss of visual function. Pore-forming toxins (PFTs) have been established as major virulence factors in endophthalmitis caused by several bacterial species. These facts establish a critical need for a novel therapy to neutralize bacterial PFTs such as cytolysin. Here, we demonstrate that biomimetic nanosponges neutralize cytolysin, protect the retina, preserve vision, and may provide an adjunct detoxification therapy for bacterial infections.

Posterior Segment Intraocular Foreign Bodies: A 10-Year Review

To describe the characteristics of open-globe injuries with posterior segment intraocular foreign bodies (IOFBs). Retrospective chart review study. Patients treated for posterior segment IOFB injuries. Retrospective analysis of all patients with posterior segment IOFBs from 2003 to 2014 was conducted. Data including demographics, mechanism of injury, type of IOFB, method of diagnosis, presenting examination, medical and surgical treatment, visual outcomes, and complications were recorded. Visual acuity (VA); anatomically successful retinal reattachment; need for additional surgery; frequency of post-traumatic complications, such as sympathetic ophthalmia (SO), endophthalmitis, and enucleations; and accuracy of Ocular Trauma Score (OTS). Thirty-one patients (28 male; mean age, 36.6 years; 42% Hispanic) had posterior segment IOFB injuries, 23 (74%) of which were construction work related. Twenty-five IOFBs (81%) were metallic. Twenty-four IOFBs (77%) had Zone I entry. Computed tomography (CT) scan detected an IOFB in 21 of 22 eyes in which it was performed, with 1 scan highly suspicious for an IOFB. Average size of the IOFB was 10 mm3; size or initial VA did not have any correlation with final VA. The OTS had 60% accuracy in predicting final VA (n= 20). The majority of patients had traumatic cataract and vitreous hemorrhage (VH) on presentation (77% and 61%, respectively); 65% had a retinal tear or retinal detachment (RD), and these patients had worse final VA than those with no retinal pathology. Average time from injury to IOFB removal was 3 days because of the delay in presentation to our facility; 27 of 31 patients (87%) had IOFBs removed within 24 hours of presentation with pars plana vitrectomy (PPV) and either gas or silicone oil tamponade. Patients were admitted for an average of 4 days of intravenous antibiotics. The most common complication was recurrent RD in 11 patients (35%), which portended worse final VA. One patient (3%) developed SO. There were no cases of postoperative endophthalmitis or enucleation. Open-globe injuries with posterior segment IOFBs have a guarded visual prognosis, particularly when associated with RD. Increased awareness of the importance of eye protection can help minimize the occurrence of these injuries.

The occurrence rate of acute-onset postoperative endophthalmitis after cataract surgery in Chinese small- and medium-scale departments of ophthalmology

Endophthalmitis can be a devastating complication after cataract surgery. Therefore, this study sought to better understand the occurrence rate of acute-onset postoperative endophthalmitis after cataract surgery in Chinese small and medium-scale departments of ophthalmology, as well as identify its risk factors and assess the treatment options. This investigation revealed 52 postoperative endophthalmitis cases in 46,185 operations at 30 hospitals from 2011 to 2013, at an occurrence rate of 0.11%. A small cataract surgery volume of less than 500 cases per year (OR 2.21; p = 0.006), the absence of 0.5% povidone iodine (PVP-I) irrigation (OR 1.73; p = 0.046), and intraoperative posterior capsular rupture (PCR) with vitreous loss (OR 4.40; p = 0.034) showed statistically significant associations with endophthalmitis in the multivariate analysis. The rate of culture positivity was 44.2%, with Staphylococcus epidermidis being the most common organism isolated in China. More than 40% of the endophthalmitis cases were treated with a nonstandard antibiotics regimen, and only 32.7% of these had a visual acuity of better than 20/40. We concluded that the occurrence rate of acute-onset endophthalmitis following cataract surgery in Chinese small and medium-scale departments of ophthalmology lags behind the level of developed countries, as well as Chinese top eye centers. Overall, the use of 0.5% PVP-I irrigation seemed to be an effective measure to reduce the risk of the development of postoperative endophthalmitis.

Simultaneous Bilateral Cataract Surgery in Outreach Surgical Camps.

OBJECTIVESThe aim of this study was to evaluate the safety and visual outcomes of simultaneous bilateral cataract surgery (SBCS) with intraocular lens implantation performed in outreach surgical eye camps.METHODSThe medical records of 47 consecutive patients who underwent simultaneous bilateral small-incision cataract surgery between January 2010 and December 2015 in outreach surgical camps in rural Cameroon were reviewed. The measures included postoperative visual outcomes and intraoperative and postoperative complications.RESULTSData from 94 eyes of 47 participants (30 men, 17 women; mean age: 60.93 ± 13.58 years, range: 45–80 years) were included in this study. The presented best visual acuity (VA) was less than 3/60 in 100% of the eyes. At the 4-week follow-up, 84.04% of the eyes showed increased VA of 1 line or more (P = .001). Of these, 71 (75.53%) achieved good VA (greater than 6/18). Intraoperative or postoperative complications occurred in 19 (20.21%) eyes. The most serious intraoperative complication was a posterior capsule rupture and vitreous loss (2 patients, 2 eyes). The postoperative complications included a transient elevation in the intraocular pressure (6 eyes), chronic corneal oedema (5 eyes), iris capture (3 eyes), lens decentration (2 eyes), and hyphema (1 eye). No cases of postoperative endophthalmitis were recorded.CONCLUSIONSUnder the strict observation of endophthalmitis prophylaxis, SBCS is an option to reduce the cataract blindness backlog in rural areas of developing countries.

Clinical outcomes after injection of a compounded pharmaceutical for prophylaxis after cataract surgery: a large-scale review.

Purpose of reviewTo evaluate relevant clinical outcomes following a transzonular intravitreal injection of a compounded triamcinolone–moxifloxacin–vancomycin (TMV) formulation for postoperative prophylaxis after cataract surgery in a retrospective review of medical records from a private practice, single-specialty ambulatory center in New Jersey, USA.Recent findingsThe analysis included 1541 cases from 922 patients who underwent cataract surgery with an intravitreal injection of TMV from November 2013 to December 2014. Cataract surgery was performed by a standard clear corneal phacoemulsification technique. Transzonular injection was used to deliver TMV directly into the anterior vitreous after implantation of an intraocular lens.SummaryThere were no major intraoperative complications associated with the transzonular injection technique. There were no cases of postoperative endophthalmitis. Nearly 92% of cases (n = 1413/1541) did not require supplemental medication after surgery. The rate of breakthrough inflammation at Days 14–21 was 9.2% (n = 132/1429). The rate of visually significant postoperative cystoid macular edema was 2.0% (n = 28/1429). The rate of clinically significant postoperative intraocular pressure increase was low: 0.9% (n = 13/1425) of cases had an at least 10 mmHg increase at Days 14–21 or 90. Four of these cases had intraocular pressure at least 30 mmHg. The rates of infection and inflammation reported in this retrospective review of a transzonular injection of TMV for prophylaxis after cataract surgery appear similar to reported rates with alternative prophylactic therapies such as topical drops. The transzonular injection of TMV may have advantages in terms of patient compliance.

Incidence, management, and visual outcomes in pediatric endophthalmitis following cataract surgery by a single surgeon

To report the incidence of endophthalmitis following cataract surgery by a single surgeon in children and to describe its microbiological profile, management, and visual outcomes. The medical records of patients who underwent cataract surgery performed by a single surgeon between January 2000 and December 2012 were retrospectively reviewed to identify those with postoperative endophthalmitis. The primary goals of the study were to describe the incidence of endophthalmitis, microbiological profile, and measure visual acuity after management. A total of 2,390 cataract surgeries were performed during the study period. The overall endophthalmitis rate during the study period was 0.376% (95% CI, 0.357-0.395). Of the 9 cases of postoperative endophthalmitis identified, 8 had a median duration of 2.5days between time of surgery and diagnosis. The common presenting symptoms were pain and redness. Of the 5 cases in which early vitrectomy was performed, 4 showed good visual recovery at final follow-up visit. Both Gram-positive and Gram-negative organisms were seen equally. Culture-positive results were seen in 4 patients, the majority of which showed Acinetobacter calcoaceticus. Most of the organisms were resistant to ceftazidime. Endophthalmitis following pediatric cataract surgery is rare but occurs rapidly and can cause severe loss of vision. Early recognition and treatment can help in salvaging the vision.

Efectividad y costos de la cefuroxima intracameral en la profilaxis de la endoftalmitis poscirugía de catarata

AimTo evaluate the effectiveness and cost of intracameral cefuroxime for postoperative endophthalmitis (PE) prophylaxis in Holguín's Ophthalmological Center. MethodsRetrospective consecutive cohort study including all patients undergoing cataract surgery in Holguín's Ophthalmological Center between January 2008 and June 2015. Patients were classified in 2 groups: Group 1 operated on between January 2008 and June 2010, with the use of subconjunctival gentamycin at the end of surgery and group 2 operated on between July 2010 and June 2015, in whom a 1mg/0.1 bolus of intracameral cefuroxime was instilled. The rates of PE were determined per year and groups of study as the effectiveness and cost of the 2 prophylactic methods. ResultsAt Holguín's Ophthalmological Center there were 27 reported cases of PE from 2008 to June 2015 from a total of 11,117 cataract procedures. The highest incidence was reached in 2009 with a rate of 0.83%. The mean incidence rate in group 1 was 0.85%, while in group 2 de mean incidence was 0.07%. Introduction of intracameral cefuroxime represented a significant reduction in the incidence of PE (P<.005). The relative risk for endophthalmitis in group 1 against group 2 was 13.3 times bigger. The use of cefuroxime resulted less expensive. Cost- effectiveness relationship for this drug (0.0027) was 3 times better than gentamicin's (0.0075). ConclusionsAdministration of intracameral cefuroxime resulted more effective and less expensive in preventing endophthalmitis after cataract surgery.

Post-Operative Endophthalmitis Caused by the Nutritionally Variant Streptococcus Granulicatella adiacens

Objective: Bacterial endophthalmitis is among the most serious ocular infections. Nutritionally variant streptococci (NVS) are bacteria that are difficult to culture with standard media because of fastidious growth requirements. The cases of post-operative endophthalmitis caused by Granulicatella adiacens, one of the NVS were reported. Method: Case report and review of literature Results: In Case 1, a 77-year-old female, who had undergone repeated ocular surgeries including trabeculectomy in the left eye, had developed late-onset bleb-related endophthalmitis without bleb leakage. The best corrected visual acuity (BCVA) showed light perception. A vitrectomy was performed, following this procedure and topical, intravitreal and systemic antibiotics, the BCVA recovered to 18/20. In Case 2, an 85-year-old male had developed acute postoperative endophthalmitis after cataract surgery in his left eye. The BCVA was light perception in the left eye. A vitrectomy and the removal of intraocular lens were performed. Inflammation was improved after the vitrectomy and administration of topical, intravitreal and systemic antibiotics. Bacteria isolated from the vitreous samples of these patients were identified as Granulicatella adiacens by the 16S ribosomal RNA gene sequencing. Conclusion: We report the first cases of post-operative endophthalmitis caused by G. adiacens identified by molecular genetic analysis. NVS should be considered in cases of post-operative endophthalmitis.

Comparison between 20-, 23-, and 25-G transconjunctival sutureless vitrectomy in the surgical treatment of idiopathic macular hole and idiopathic epiretinal membrane

Aim The aim of the present study was to compare 20, 23, and 25-G transconjunctival sutureless vitrectomy (TSV) systems in the management of idiopathic macular hole and idiopathic epiretinal membrane (EMM) as regards the operative time and postoperative complications such as hypotony (as shown by intraocular pressure Patients and methods This prospective, comparative, randomized clinical study was carried out on 60 consecutive patients undergoing TSV at a single center and by the same surgeon. Included patients were with preoperative diagnoses of idiopathic macular hole (group A) and idiopathic EMM (group B). Ten patients of each group were randomly allocated to 25-, 23-, or 20-G TSV subgroups using a table of random numbers. Three-port pars plana vitrectomy with internal limiting membrane peeling in group A with gas tamponade and EMM peeling in group B was carried out. Results In group A, the mean duration of surgery in the 20-G TSV subgroup was 43.7 ± 1.89 min compared with 42.5 ± 2.01 min in the 23-G subgroup and 43.5 ± 1.84 min in the 25-G subgroup. There was no statistically significant difference between the three subgroups. In group B, there was no statistically significant difference between the three subgroups, with a mean time of surgery of 35.8 ± 1.81 min in the 20-G subgroup versus a mean time of 37.9 ± 2.33 and 37.3 ± 1.98 min in the 23-G and the 25-G subgroups, respectively. In group A, the intraocular pressure was within the normal range in all follow-up periods in the three subgroups and no reported cases of hypotony either in the early or late follow-up periods. In group B, there was a statistically significant difference only in the first follow-up period between the three subgroups, as two cases of hypotony in the 20-G subgroup and two cases in the 25-G subgroup were reported, all of which resolved without sequelae. There were no cases of postoperative endophthalmitis in any case of either group A or group B. There were no cases of postoperative retinal detachment in any case of either group A or group B in all follow-up periods. Conclusion The current study indicated no increased risk of postoperative complications such as hypotony, endophthalmitis, or retinal detachment during sutureless vitrectomy.

Outcomes of 27 Gauge Microincision Vitrectomy Surgery for Posterior Segment Disease

To report the initial experience, clinical outcomes, and safety profile of 27 gauge pars plana vitrectomy (PPV) in eyes with posterior segment disease. Multicenter, retrospective, interventional case series. setting: Private practice and tertiary care settings. Eyes undergoing 27 gauge PPV for a vitreoretinal surgery indication. Three-port, transconjunctival 27 gauge PPV. Change in visual acuity and occurrence of intraoperative and postoperative complications with minimum follow-up of 90 days. Ninety-five eyes met the inclusion criteria. Surgical indications included epiretinal membrane (n = 26), diabetic tractional retinal detachment (n = 14), full-thickness macular hole (n = 11), rhegmatogenous retinal detachment with (n = 7) or without (n = 9) proliferative vitreoretinopathy (PVR), vitreous hemorrhage (n = 10), vitreous opacities (n = 8), endophthalmitis (n = 4), sub-silicone oil retinal detachment (n = 3), retained lens material (n = 1), submacular hemorrhage (n = 1), and aqueous misdirection (n = 1). Mean logMAR visual acuity improved from 1.08 ± 0.71 (20/240 Snellen equivalent) preoperatively to 0.53 ± 0.65 (20/67 Snellen equivalent) postoperatively (P < .001). Mean follow-up was 144 days (median 127 days, range 90-254 days). There were no intraoperative complications and no case required conversion to 20, 23, or 25 gauge instrumentation. A total of 3 sclerotomy sites (1.1%) were sutured at the conclusion of surgery. Postoperative complications included transient ocular hypertension in 8 eyes (8.4%), transient hypotony in 5 eyes (5.3%), and vitreous hemorrhage in 5 eyes (5.3%). No cases of postoperative endophthalmitis, sclerotomy-related retinal tears, or choroidal detachments were encountered in the follow-up period. The 27 gauge PPV was well tolerated with low rates of intraoperative and postoperative complications across varied surgical indications.

Profil microbiologique des endophtalmies aiguës dans un centre de référence en Tunisie

To investigate the microbiological profile of acute postoperative endophthalmitis in a referral center in Tunisia and to assess the antibiotic sensitivity of the organisms. This is a retrospective study over a period of eleven years, conducted on patients hospitalized with acute infectious postoperative endophthalmitis. Cultures were performed on aqueous (93%) and vitreous specimens (68%) obtained at presentation. Each sample underwent direct examination, culture and antibiotic susceptibilities. The number of acute postoperative endophthalmitis cases identified during the study period was 308. Organisms were found in 43% of samples (endophthalmitis was bacterial in 39.5%, fungal in 0.9% and polymicrobial in 2.6%). Cultures grew primarily Staphylococcus epidermidis in 31.4% of cases, Streptococcus pneumoniae in 22.7% of cases and Staphylococcus aureus in 12.7% of cases. Gram-positive cocci are more sensitive to vancomycin and Gram-negative bacilli are more susceptible to ofloxacin and ciprofloxacin. In our study, microbiological samples were positive in 43% and coagulase-negative Gram-positive cocci are the most common organisms. However, antibiotic resistance has been increasing over the years.

Scleral fixation of intraocular lenses using Gore-Tex suture: clinical outcomes and safety profile

Background/aimsTo report the short-term safety profile and clinical outcomes of scleral fixation of intraocular lenses (IOLs) using Gore-Tex suture.MethodsRetrospective, interventional case series. 85 eyes of 84 patients undergoing ab externo...

Quality assessment of cataract surgery in Denmark - risk of retinal detachment and postoperative endophthalmitis.

The main purpose of this thesis was to examine whether the Danish National Patient Registry (NPR) could be used to monitor and assess the quality of cataract surgery in Denmark by studying the risks of two serious postoperative complications following cataract surgery – retinal detachment (RD) and postoperative endophthalmitis (PE). The thesis consists of four retrospective studies. In the first study (paper I), we used data from the NPR in the calendar period 2000–2010 to investigate the risk of pseudophakic retinal detachment (PRD) using the fellow non-operated eyes of the patients as reference. The study showed that over a 10-year study period, the risk of PRD was increased by a factor of 4.2 irrespective of sex and age. The risk of PRD was highest in the first part of the postoperative period and then gradually decreased but remained statistically significantly higher than the risk of RD in non-operated fellow eyes up to 10 years after cataract surgery. The epidemiology of RD in the non-operated fellow eyes was different from the epidemiology of RD in the background population as young men had the highest risk of RD in the non-operated fellow eyes. This means that the absolute risk of PRD was highest for young men because they had a higher risk of RD before they underwent cataract surgery. In the second study (paper II), we used data from the NPR and reviewed patient charts to assess the risk of PE after cataract surgery performed in public eye departments and private hospitals/clinics in the study period 2002–2010. The overall risk of PE among the seven public eye departments was 0.36 per 1000 registered cataract operations, and the PE risk among the departments was homogeneous. The overall risk of PE among the 28 private hospitals/clinics was 0.73 per 1000 registered cataract operations, and the risk among the private hospitals/clinics was heterogeneous. Most private hospitals/clinics had a risk of PE that was lower than or similar to the risk of PE after registered cataract surgery in public eye departments, but six private hospitals/clinics had a statistically significantly higher risk of PE compared to the public eye departments. We used PE as a proxy measure of the registration of cataract surgery and found that 98% of the cataract operations performed in public eye departments were registered in the NPR while only 38% of the cataract operations performed in private hospitals/clinics were registered in the NPR. In general, the coding of the PE cases was not uniform and the lack of registration by the private hospitals/clinics meant that the NPR could not be used to monitor the true risk of PE. NPR data were also used in the third study (paper III) to examine whether patients who had surgical intervention for PE following cataract surgery with either a pars plana vitrectomy (PPV) or a vitreous tap (VT) had a higher risk of subsequent surgical complications. There was no statistically significant difference in the overall risk of complications among the two groups, but the risk of surgery for vitreous opacities was statistically significantly higher for patients who underwent a VT. A surgical complication occurred in 27.3% of the patients and 9.9% of the patients developed more than one surgical complication. Ninety-seven per cent of the primary surgical complications occurred within the first 5 months. The risk of surgical complications in this study was similar to or higher than the risk of complications in the landmark Endophthalmitis Vitrectomy Study from the early 1990s. In the fourth study (paper IV), we used data from all three Danish cataract registries to describe the epidemiology of cataract operations performed in public hospitals and private hospitals/clinics in the study period 2004–2012. Again, PE was used as a proxy measure of the registration of cataract surgery. There were several noticeable differences in the epidemiology of the cataract operations performed in public hospitals and private hospitals/clinics. Patients who had cataract surgery in public hospitals had a statistically significantly higher mortality compared to patients who had cataract surgery in private hospitals/clinics during the entire period. The decrease in the mean age at first eye cataract surgery in private hospitals/clinics was statistically significantly greater compared to public hospitals during the study period. There was a statistically significantly shorter median time interval between first and second eye cataract surgery at private hospitals/clinics compared to public hospitals during the entire study period. The study showed that only 54% of the cataract operations performed in private hospitals/clinics that led to PE were registered. The lack of registration of cataract surgery is the main reason why the NPR has limitations when used as a tool to monitor and assess the quality of cataract surgery in Denmark.