Case Of Sterile Endophthalmitis Research Articles

Outcomes of Epiretinal Membrane Removal Utilizing Triamcinolone Acetonide Visualization and Internal Limiting Membrane Forceps.

PurposeTo evaluate epiretinal membrane (ERM) removal utilizing internal limiting membrane (ILM) forceps and visualization with triamcinolone acetonide (TA).MethodsRetrospective interventional case series of eyes undergoing ERM removal with TA visualization with follow-up of up to five years. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and incidence of complications were reviewed.ResultsA total of 132 eyes were included with 54 and 16 eyes completing 3- and 5-year follow-up, respectively. Mean BCVA and CMT improved significantly at all postoperative evaluations compared to baseline (p<0.001). Pre-operative presence of PVD did not affect outcome measures. No intraoperative complications were reported. Immediate post-operative complications included one case of sterile endophthalmitis and one case of vitreous and perimacular hemorrhage. At one year, complications included progression of cataract in phakic eyes (65.4%), steroid-induced glaucoma (2.2%), retinal tear (0.8%), recurrent ERM (4.5%), and recurrent macular edema (11.3%). No further complications were reported at three- and five-year follow-up.ConclusionCombination ILM forceps and TA visualization offers an affordable and safe option for ERM removal with comparable or better outcomes than traditional methods of ERM surgery.

Triamcinolone acetonide induces sterile endophthalmitis in patients with intermediate uveitis: A case report series.

Due to their anti-inflammatory, antiangiogenic and antiedematous properties, corticosteroids have been commonly used in the treatment of retinal diseases. Intravitreal administration of steroids offers the maximal drug efficacy and the lowest risk of systemic side effects. The authors report three cases of presumed sterile endophthalmitis induced by triamcinolone acetonide (TA) in three eyes with intermediate non-infectious uveitis. Each patient received a single intravitreal injection of TA of 4 mg. Because of the intense vitreous inflammatory reaction, retina examination and the optical coherence tomography could not be performed, although vitreous opacities were observed on the ocular ultrasound. The dense vitreous opacity is a defining factor, the anterior segment inflammation is mild to moderate and a hypopyon is present, which may be a sterile inflammatory reaction or the triamcinolone material itself. In cases of sterile endophthalmitis, the visual acuity increases progressively as the intraocular inflammation diminishes. Local treatment with topical antibiotics, prednisolone acetate and cycloplegic eyedrops is recommended to control the inflammatory reaction.

Outcomes and complications of iris-fixated intraocular lenses in cases with inadequate capsular support and complex ophthalmic history.

BackgroundTo report the indications, visual outcomes, and intra-operative and post-operative complications of iris-sutured posterior chamber intraocular lens (IOL) in eyes with inadequate capsular support and complex ocular history.MethodsA chart review and data analysis of eyes that underwent iris fixation of posterior chamber (PC) IOL for correction of aphakia, dislocated and subluxed IOLs, ectopia lentis, and IOL exchange. Data included clinical risk factors, associated eye conditions, previous surgeries, and concomitant procedures. The pre-operative and post-operative vision, manifest refraction, endothelial cell density, intraocular pressure (IOP), as well as intra-operative and post-operative complications were also recorded.ResultsOne hundred and seventeen eyes from 114 patients were examined with a mean follow-up of 22.4 months. The most common identifiable predisposing risk factor was high myopia in 23 eyes. A significant improvement in uncorrected and best corrected visual acuity compared with baseline was observed. The most common post-operative complications included recurrent IOL subluxation in 16 (13.7%) eyes, IOP spike in 7 (5.9%) eyes, cystoid macular oedema in 5 (4.3%) eyes, and epiretinal membrane formation in 4 (3.4%) eyes. There was one (0.85%) case of sterile endophthalmitis.ConclusionsIris suture fixation of PC IOLs is a good treatment option for eyes with inadequate capsular support and complex ocular history.

A Case of Acute Sterile Endophthalmitis after Intravitreal Dexamethasone

Introduction: Intravitreal dexamethasone implant (IDI) has been recently introduced into clinical practice for the treatment of various ocular conditions including non-infectious uveitis and macular edema. Endophthalmitis following IDI is an uncommon and a serious complication. Case Presentation: In this report, we present a case of sterile endophthalmitis following IDI in a fourteen-year-old female for whom IDI was indicated to treat uveitic cystoid macular edema, which was refractory to maximum systemic and local therapy. She presented within 24 hours following the implant insertion, complaining of only a decrease in vision. It was managed by emergent pars plana vitrectomy with the removal of the implant. This resulted in clinical improvement and resolution of the inflammation. Intravitreal and implant Gram stain and polymerase chain reaction came out negative. An IDI was implanted one year later without similar complications. Conclusion: Our case showed that sterile endophthalmitis could occur following intravitreal dexamethasone injection. Repeated IDI does not seem to be contraindicated.

Managing bevacizumab-induced intraocular inflammation

The outcome of four cases of sterile endophthalmitis that developed after intravitreal injections of bevacizumab has been reported here. All four eyes received 1.25 mg/0.05 ml intravitreal bevacizumab from 0.2-ml aliquots for different etiologies. The inflammation predominantly involved the anterior chamber with mild vitreous reaction. All patients were culture negative and regained preinjection visual acuity and were culture negative following intravitreal antibiotic administration. This report highlights that intravitreal bevacizumab can cause sterile endophthalmitis and this has to be kept in mind, and clinical judgment should be used to differentiate it from infective endophthalmitis.

Long‐term result of intravitreal steroid for macular oedema: 2 to 5 year follow‐up of 92 eyes

Abstract Purpose A topical area is how best to manage diabetic macular oedema (intravitreal steroid, laser, anti‐VEGF). However little or no long‐term data exists for steroids. We hence studied the 2 to 5‐year results of intravitreal triamcinolone (IVTA) in diabetic macular oedema. Methods A retrospective cohort of 92 eyes was recruited, inclusion criteria subjects with diabetic macular oedema injected with 4mg / ml IVTA with regular follow‐up of 2 to 5 years. Exclusion criteria were subjects with non‐diabetic oedema (uveitis, vascular, post‐operative) and baseline foveal ischaemia at time of first injection. The following were recorded: visual acuity, central retinal thickness (OCT) prior, 1 month after (+/‐ 1 week) and 3 months post‐IVTA (+/‐ 2 weeks), complications, and angiograms pre‐ and post‐treatments. 88% had Type 2 diabetes. Mean duration of diagnosis of diabetes was 14 years, mean age 64 (29‐84). Results At 2 to 5 years IVTA continued to be effective both in improving visual acuity and reducing macular thickness in 76% of subjects, including after multiple injections. In 24% of subjects foveal ischaemia limited outcome, usually 36 to 54 months post initial treatment. In 8% of subjects a repeat injection was associated with cessation of leakage for 2 to 3 years, or a persistent marked dimunition in leakage of in excess of 100 microns, thereafter vision dropping to 6/12 to 6/18 despite further injections. Intra‐ocular pressure rises were controlled topically, there was one case of sterile endophthalmitis. Conclusion IVTA continues to offer significant visual benefit and reduction in macular thickness 2 to 5 years after initiation of therapy, including after multiple injections. Therapeutic potential is limited by ischaemia in 24% of subjects.

25-GAUGE SUTURELESS VITRECTOMY VERSUS 20-GAUGE VITRECTOMY FOR THE REPAIR OF PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT

To compare the anatomic and visual results and complications of 25-gauge transconjunctival sutureless vitrectomy versus conventional 20-gauge vitrectomy for the management of primary rhegmatogenous retinal detachment. A retrospective comparative analysis of 125 consecutive eyes from 125 patients with a minimum of 3 months follow-up was performed. All patients underwent primary vitrectomy with complete fluid air exchange, gas tamponade, and laser retinopexy. Excluded were eyes with prior retinal or vitreous surgery, and patients with inadequate follow-up. Sixty-four patients underwent 25-gauge transconjunctival sutureless vitrectomy and 61 patients underwent 20-gauge pars plana vitrectomy from September 2004 to April 2007. Primary endpoints included one surgery retinal reattachment success rate, visual outcomes, postoperative intraocular pressures and complications as determined by standard clinical evaluation. Baseline demographic and preoperative ocular characteristics showed no statistically significant difference between the two cohorts. The mean follow-up interval was 305.4 days for the 25-gauge group and 452.4 days for the 20-gauge group. The single operation success rate with one procedure was 58/64 (90.6%) for 25-gauge cases and 56/61 (91.8%) for 20-gauge cases, Fisher Exact Test (P = 0.801). All cases were attached at final follow-up and the anatomic success rate was 100% for each of the two cohorts. Preoperative best-corrected visual acuity (BCVA) was 20/125 and 20/169 for 25-gauge and 20-gauge cases, respectively (P > 0.5). The final follow-up mean BCVA was 20/34 and 20/36 for the 25-gauge and 20-gauge groups, respectively (P > 0.6). In the 25-gauge group two cases were complicated by hypotony that resolved uneventfully and one case developed postoperative choroidal and vitreous hemorrhage. In the 20-gauge group there was one case of sterile endophthalmitis and one case of vitreous hemorrhage. There was no significant difference between 25-gauge transconjunctival sutureless vitrectomy and 20-gauge vitrectomy for the repair of primary rhegmatogenous retinal detachments.

Intravitreal triamcinolone versus laser photocoagulation for persistent diabetic macular oedema

Aim:To determine if repeated intravitreal triamcinolone improves best corrected visual acuity at 1 year compared with conventional laser therapy for persistent diabetic macular oedema.Methods:88 eyes with persistent clinically significant macular...

Sterile endophthalmitis following intravitreal injection of preservative-free triamcinolone acetonide.

To describe two cases of sterile endophthalmitis following intravitreal injection of preservative-free triamcinolone acetonide. Chart review. Two patients with histories of sterile inflammatory reaction to intravitreal Kenalog (triamcinolone acetonide) subsequently were treated with intravitreal injections of preservative-free triamcinolone. Both patients presented 2 to 3 days after injection with significant anterior chamber cell reaction without pain or inflammation-related conjunctival injection. The intraocular inflammation of both patients resolved completely using only topical steroids and antibiotics. An inflammatory reaction to the vehicle has been the leading hypothesis for the etiology of the sterile inflammatory response following intravitreal Kenalog injections. The use of preservative-free triamcinolone is intended to eliminate this potential source of toxicity. These cases demonstrate that noninfectious endophthalmitis can develop even with preservative-free triamcinolone.

Sterile Endophthalmitis after Suturelesss Cataract Surgery

Sutureless cataract surgery has recently increased in popularity because of the rapid visual rehabilitation and the inherent reduction of surgically induced astigmatism. This procedure is dependent on a lamellar, multiplaned incision. As with new surgical techniques, associated complications become evident with time. Recently, there have been several cases of infectious endophthalmitis after this procedure. The authors report on nine cases of sterile endophthalmitis. In all nine cases, surgery was performed with refrigerated balanced salt solution (BSS) and 100 mg of cefazolin and/or 20 mg of methylprednisolone sodium succinate, given subconjunctivally, at its completion. All nine cases occurred in a period of time during which 68 cases were performed using refrigerated BSS for irrigation. These nine cases came from two different surgeons using basically the same surgical technique. After the investigation of these complications, the refrigerated BSS was discontinued, and there have been no episodes of sterile endophthalmitis in the last 650 cases. It appears that refrigerated BSS should be avoided if periocular injections are going to be used. It may be that the cold BSS fails to allow sufficient tissue swelling to seal the surgical incision, allowing for subconjunctival injections to seep into the wound, and leading to a sterile endophthalmitis.

Vitroctomy for Macular Pucker

Vitreous surgery was used to treat 130 consecutive cases with epiretinal membranes causing macular pucker. The membrane: (1) occurred after otherwise successful retinal reattachment surgery in 78 eyes (60%), (2) was idiopathic in 28 eyes (22%), (3) was associated with other ocular disorders in 20 eyes (15%), and (4) in four eyes may have been developmental. The abnormal tissue was successfully removed in 128 of 130 eyes, and vision improved at least two lines on the Snellen chart in 108 eyes (83%). Postoperative visual acuity was 20/20 in five eyes (4%), 20/25 to 20/40 in 41 eyes (31.5%), 20/50 to 20/100 in 64 eyes (49%), 20/200 in 15 eyes (11.5%), and 20/400 in five eyes (4%).Complications included one case of sterile endophthalmitis and one case of infective endophthalmitis (Staphylococcus epidermidis). Peripheral retinal tears occurred in six eyes (5%). No posterior retinal breaks occurred in this series. Later retinal detachment occurred in eight eyes (6%) requiring further retinal surgery. Progressive postoperative nuclear sclerotic lens changes occurred in 31 (34%) of 90 phakic eyes. Sizable amounts of epiretinal tissue recurred postoperatively in four eyes (3%).