Intraocular Lens Removal Research Articles

Lens epithelial cell growth on the anterior optic of 2 hydrophobic intraocular lens models

To evaluate lens epithelial cell (LEC) proliferation on the anterior optic of 2 types of hydrophobic intraocular lenses (IOLs). Harlan Biotech Israel and Kaplan Medical Center, Rehovot, Israel. Experimental study. Ten New Zealand white rabbits had crystalline lens removal and implantation of an Acrysof IOL in 1 eye (Group 1) and a Tecnis IOL in the fellow eye (Group 2). A weekly biomicroscopy examination was performed during the 2-week study duration, after which the rabbits were humanely killed. The eyes were enucleated, and the complexes containing the IOL and the capsular bag were evaluated for the presence of LECs and large cells (macrophages and giant cells) on the IOL anterior optic and for proteinaceous matrix deposits along the capsulorhexis margin. Lens epithelial cell were detected on all of the IOLs in Group 1 and on none in Group 2 (P < .001). Areas of proteinaceous matrix deposits adjacent to the edge of the capsulorhexis were detected on 8 IOLs in Group 1 and on none in Group 2 (P < .001). Large cells were identified on all IOLs in Group 1 and on 9 IOLs in Group 2 (P = 1.0). No difference in the general inflammation markers was found between the 2 IOL types (P = .234). Lens epithelial cell with corresponding proteinaceous matrix deposits were significantly more abundant on the IOLs in Group 1 than on the IOLs in Group 2. There was no difference in the presence of large cells or in general inflammation markers between the 2 IOL types. No author has a financial or proprietary interest in any material or method mentioned.

Primary versus secondary IOL implantation following removal of infantile unilateral congenital cataract: outcomes after at least 5 years

To report outcomes after at least 5years' follow-up of consecutive patients at a single center undergoing unilateral congenital cataract surgery during infancy with primary intraocular lens (IOL) implantation at the time of surgery or undergoing secondary IOL implantation later in childhood. The medical records of pseudophakic children who received initial cataract surgery before 7months of age were retrospectively reviewed. Children with acquired cataract, persistent fetal vasculature, congenital glaucoma, or follow-up of <5years were excluded. Mean age at time of cataract surgery was 2.7months in the primary group (n=13) and 1.9months in the secondary group (n=13). Mean age at IOL implantation in the latter group was 4.9±2.2years. Mean age at final follow-up was 10.7±4.2years in the primary group and 8.7±3.0years in the secondary group. Glaucoma surgery was performed in 2 primary group eyes and 1 secondary group eye; it was medically controlled in 2 additional eyes of the latter group. One secondary group eye was diagnosed as glaucoma suspect. Visual axis opacification required surgery in 5 primary group eyes and 2 secondary group eyes before IOL implantation. Unplanned IOL exchange or removal for high myopia was required in 3 primary group eyes and 1 secondary group eye. Strabismus surgery was performed in 3 primary group eyes and 7 secondary group eyes. Median visual acuity at final follow-up was 20/150 in both groups. Refraction at last follow-up was -2.9±3.3 D in the primary and -1.8±2.5 D in the secondary group. Reoperations were common in both groups over long-term follow-up. Close monitoring for glaucoma is also needed in both groups.

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 of rigidpolymethylmethacrylate and foldable square edgeacrylic lens replacement for management of cataract after phacoemulsification in 22 eyes of dogs

The clinical study was conducted on 22 eyes of 18 dogs (16 male and 2 female)to evaluate efficacy of Phacoemulsification for cataract removal and feasibility of rigid and foldable intraocular lens(+41 D) implantation in dogs. Animlas were operated under general anaesthesia using diazepam @ 0.5mg/kg b.wt and ketamine @ 5mg/kg b.wt combination and maintained on isoflurane inhalation anaesthesia. Animals were divided in two groups. In group I (n=5) rigid IOL polymethylmethacrylate (PMMA) was used and in group II (n=17) square edge foldable acrylic lens was used. Cataractic lenses were removed by phacoemulsification using coaxial operating microscope. The animals were reviewed for surgical outcome, intraoperative and postoperative complications. Success rate was determined by dividing the number in which successful restoration of vision was observed with the total number of the eyes operated for cataract surgery and lens implantation. The results showed that restoration of functional vision was noted in 1/5 (20%) and 11/17 (64.70%) in group I and Group II respectively at the end of the study. Intraoperative complications observed were hyphema andmiosis in both groups however these complications were significantly lower in group II. Postoperative complications included corneal opacity, uveitis and corneal oedema in both the groups but severity of the complications were lower in group II.To conclude intraocular foldable lens implantation with +41D following phacoemulsification was found comparatively effective technique with success rate of 64.70% for management of mature cataract in dogs.

Combined cataract phacoemulsification and aniridia endocapsular rings implantation in a patient with bilateral congenital aniridia and cataract: A case report

The objective of this article was to determine the long-term outcome of surgical treatment in a patient with bilateral congenital aniridia and congenital cataracts. The patient was treated by cataract removal and implantation of a single piece IOL in both eyes. Two aniridia rings were also implanted in the capsular bag. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), stability of the intraocular lens (IOL) and subjective glare reduction were measured for two years after the surgery. After 10months, the IOP in the left eye had increased to 26mmHg despite the fact that anti-glaucoma medication was added. Therefore, the patient was scheduled for an Ahmed valve implantation. These results suggest that good visual outcomes can be achieved in patients with bilateral congenital aniridia and cataracts. Nevertheless, the IOPs must be continuously monitored, and glaucoma screening performed to prevent further complications.

Opacification of intraocular lens

SummarySoft hydrophobic acrylic intraocular lenses (IOLs) are increasingly being used because they can be implanted through small incisions, provide good postoperative vision. However, long‐term postoperative follow‐up has identified various problems, including calcification, glistening and whitening.Calcium deposit on surface of IOLs are sometimes reported about hydrophilic acrylic materials. Calcification reduces the transmission of light and renders the fundus virtually invisible and decrease visual function easily.Glistening has been attributed to water retention in voids of hydrophobic acrylic materials and nonuniformity of polymer network structures. Whitening refers to the clinical appearance from sub surface nano glistenings (SSNG) of reflected white light due to light scattering as light encounters nano sized fluid filled vacuoles that occur at the anterior and posterior IOL surface. With a hydrophobic IOL, the fundus remains visible despite opacification and less effect of visual function. As a result, removal and replacement of IOLs is indicated in only a few cases. However, sever glistening and whitening increased glare and decreased contrast sensitivity.

Clinical research of different surgical modes for the treatment of severe capsule contraction syndrome

Objective To observe the clinical effect of different surgical methods for the treatment of severe capsule contraction syndrome. Methods Twenty-three eyes of 23 cases of severe capsule contraction syndrome were treated with operation. According to the condition of patients, 12 eyes underwent anterior capsulotomy with intraocular lens(IOL) adjustion in the capsule, 6 eyes underwent anterior capsulotomy with IOL ciliary sulcus fixation, and 5 eyes underwent IOL removal with vitrectomy and IOL ciliary sulcus suture fixation. The follow-up time was 3 months, and the visual acuity, anterior chamber reaction, position of intraocular lens, condition of the anterior and posterior capsule were measured respectively. Results The visual acuity improved postoperatively in all eyes. The size of the transparent area of the capsularhexis holes which underwent anterior capsulotomy significantly increased comparing with that before surgery. The complications such as glare and monocular diplopia in 6 cases disappeared after Nd: YAG laser posterior capsulotomy 1 month after the operation. Among the three different kinds of surgery procedures, postoperative best corrected visual acuity were all improved evidently one month after the surgery. The differences were statistically significant when compared with that of preoperation (P 0.05). Anterior chamber reaction of IOL ciliary sulcus suture fixation cases was the most obvious one, and it returned to normal within a week after appropriate treatment. The IOL were all centered in the capsule, and no other complication was observed during the follow-up of 3 months after operation. Conclusion Various surgical methods for severe capsular contraction syndrome are effective, satisfactory and safe.The right operation methods should be chosen according to the patients' condition. Key words: Cataract; Capsule contraction syndrome; Treatment, surgical

Post-cataract endophthalmitis caused by multidrug-resistant Stenotrophomonas maltophilia: clinical features and risk factors.

BackgroundTo report clinical features and risk factors of post-cataract surgery endophthalmitis (PE) due to Stenotrophomonas maltophilia.MethodsA retrospective case review from December 10, 2010 to April 7, 2011 was performed at the Eye & ENT Hospital, Fudan University. Data were collected for surgical details, disease characteristics, antibiotic sensitivity of the pathogen, and treatment response. Visual outcomes were examined with a minimum follow-up of 12 months.ResultsFourteen cases of S. maltophilia endophthalmitis were identified. The onset of infection occurred from 1–56 days postoperatively (median, 13.5 days). Obvious cellular reactions were found in all patients in the anterior chamber, along with the absence of pupil synechia. Retinal periphlebitis was an early sign of PE. S. maltophilia was positive in eight patients (57.1%). The fluids from aspiration tubes revealed the same bacteria, which were resistant to multiple drugs (e.g., amino glycosides, most of the β-lactams, aztreonam, imipenem, and ciprofloxacin), except levofloxacin. Compared with the culture-negative group, the infection was more rapid, more severe, and more difficult to control in the culture-positive group. Among 14 patients, 11 patients (78.6%) underwent pars plana vitrectomy (PPV) with intravitreal injection. Three patients had PPV twice, and three patients had intraocular lens and capsular bag removal. A final visual acuity of ≥20/100 was achieved by 13/14 patients (92.9%). Complications included retinal detachment in three cases (21.4%) and recurrence of infection in two cases (14.8%). Statistical analysis showed that age over 90 years and posterior capsule rupture were risk factors of infection (P = 0.034 and P = 0.034, respectively). The phacoemulsifier allowed potential contamination between the aspiration and irrigation tubes.ConclusionsS. maltophilia should be considered a pathogenic organism of PE. The infection often occurs in older patients with posterior capsule rupture. Intravitreal or systemic administration of effective antibiotics and earlier initial PPV may contribute to better clinical outcomes. Tubes with connections between aspiration and irrigation should be avoided during surgery.

Clinical analysis of 23-gauge vitrectomy for the treatment of acute endophthalmitis after cataract surgery.

We performed a retrospective study to evaluate the surgical efficacy and timing of 23-G vitrectomy for acute endophthalmitis following cataract surgery, and to determine when silicone oil tamponade and intraocular lens (IOL) removal are indicated during vitrectomy for endophthalmitis. We enrolled 21 patients (21 eyes) diagnosed with acute endophthalmitis following cataract surgery who underwent endoscope-assisted 23-G vitrectomy using a wide-angle noncontact lens. Silicone oil tamponade was performed when retinal tear or detachment occurred. The IOL was not removed during primary vitrectomy. Postoperative systemic broad-spectrum antibiotics were used. All infections were controlled by treatment. Best-corrected visual acuity was &gt;0.05 in 14 patients (66.7%) after treatment, which was significantly higher than that before treatment (2/21, 9.5%). Two patients experienced retinal detachment at 10 and 14 days after primary vitrectomy; the IOL was removed during secondary surgery, and silicone oil tamponade was performed. One patient experienced endophthalmitis recurrence 2 months after vitrectomy; secondary surgery was performed to remove the peripheral vitreous body, the pars plana of the ciliary body, and the IOL and capsule. Vitrectomy should be performed when acute endophthalmitis is diagnosed following cataract surgery. Silicone oil tamponade should be performed only when retinal break or detachment occurs. The IOL does not necessarily require removal.

Late surgical complications to endophthalmitis after cataract surgery in the post-EVS era.

To compare the risk of surgical complications after primary surgical intervention for postoperative endophthalmitis after cataract surgery (PE) in cases that underwent a pars plana vitrectomy (PPV) or a vitreous tap (VT) in Denmark in the calendar period 1 January 2000 to 30 June 2011. Retrospective, register- and chart-based study. A total of 121 PE cases were identified and followed up to 12.8 years. The overall risk of surgical complications in PE cases that underwent a PPV and a VT was 24.2 and 36.7 %, respectively. This difference was non-statistically significant (p = 0.18). In all, 9.9 % of the PE cases had more than one surgical complication, and 97 % of the primary surgical complications occurred within the first 5 months. There was no statistically significant difference in the risk of retinal detachment (p = 0.45), surgery for PE (p = 0.22), intraocular lens removal (p = 0.19), or removal of the eye (p = 0.69) between the two groups. PE cases that underwent a VT had a statistically significantly higher risk of surgery for vitreous opacities (p = 0.047) compared to a PPV. In all, 27.3 % of all cases developed a surgical complication after primary surgical intervention for PE. If a PE case did not have a surgical complication within the first 5 months, it was highly unlikely that a new surgical complication would occur. A VT was not associated with a statistically significantly higher overall risk of surgical complications compared to a PPV.

Intraocular lens explantation in Chinese patients: different patterns and different responses.

The aim of the study was to evaluate the indications and outcomes of intraocular lens (IOL) explantation in Chinese patients. The medical records of all Chinese patients who underwent IOL explantation in Hong Kong Eye Hospital, from January 2008 to March 2013, were reviewed. A total of 98 IOLs were explanted over the study period. The main reasons for lens removal included lens malposition (71.4%), isolated uveitis-glaucoma-hyphema (UGH) syndrome (9.1%), refractive surprise (6.1%), and pseudophakic bullous keratopathy (4.1%). "In-the-bag" IOL malposition was associated with intraocular complications during cataract extraction (28.9%) and high myopia (22.2%). Sulcus implantation of a single-piece acrylic (SPA) IOL resulted in UGH syndrome in all cases, while sulcus-fixated 3-piece lenses had such complication in only 7.1% of cases. Importantly, the problem persisted despite the removal of the SPA IOL from the ciliary sulcus. Majority of the patients had resolution of the original problems after lens removal or exchange and had the same or improved visual acuity after surgery. Lens malposition was the major indication of intraocular lens explantation in our case series. Resolution of symptoms and visual acuity can be achieved with IOL explantation. Implantation of SPA in ciliary sulcus is not recommended.

Piggyback Intraocular Lens Implantation to Correct Pseudophakic Refractive Error After Segmental Multifocal Intraocular Lens Implantation

To evaluate refractive and visual outcomes of secondary piggyback intraocular lens implantation in patients diagnosed as having residual ametropia following segmental multifocal lens implantation. Data of 80 pseudophakic eyes with ametropia that underwent Sulcoflex aspheric 653L intraocular lens implantation (Rayner Intraocular Lenses Ltd., East Sussex, United Kingdom) to correct residual refractive error were analyzed. All eyes previously had in-the-bag zonal refractive multifocal intraocular lens implantation (Lentis Mplus MF30, models LS-312 and LS-313; Oculentis GmbH, Berlin, Germany) and required residual refractive error correction. Outcome measurements included uncorrected distance visual acuity, corrected distance visual acuity, uncorrected near visual acuity, distance-corrected near visual acuity, manifest refraction, and complications. One-year data are presented in this study. The mean spherical equivalent ranged from -1.75 to +3.25 diopters (D) preoperatively (mean: +0.58 ± 1.15 D) and reduced to -1.25 to +0.50 D (mean: -0.14 ± 0.28 D; P < .01). Postoperatively, 93.8% of eyes were within ±0.50 D and 98.8% were within ±1.00 D of emmetropia. The mean uncorrected distance visual acuity improved significantly from 0.28 ± 0.16 to 0.01 ± 0.10 logMAR and 78.8% of eyes achieved 6/6 (Snellen 20/20) or better postoperatively. The mean uncorrected near visual acuity changed from 0.43 ± 0.28 to 0.19 ± 0.15 logMAR. There was no significant change in corrected distance visual acuity or distance-corrected near visual acuity. No serious intraoperative or postoperative complications requiring secondary intraocular lens removal occurred. Sulcoflex lenses proved to be a predictable and safe option for correcting residual refractive error in patients diagnosed as having pseudophakia.

ENDOPHTHALMITIS CAUSED BY ACHROMOBACTER XYLOSOXIDANS AFTER CATARACT SURGERY

To report Achromobacter xylosoxidans as a cause of both acute-onset and delayed-onset postoperative endophthalmitis after cataract surgery. A noncomparative consecutive case series of patients with culture-proven A. xylosoxidans endophthalmitis between 1970 and 2012. Cataract surgery and intraocular lens placement were performed in all patients before endophthalmitis. Positive cultures were obtained from the vitreous, capsular bag, and/or the removed intraocular lens. The clinical diagnosis was confirmed in four patients with positive cultures. Two patients with endophthalmitis had a preliminary culture report of Pseudomonas species. In addition to receiving intravitreal antibiotics, all patients underwent capsulectomy and intraocular lens removal at the time of pars plana vitrectomy. Visual acuity at last follow-up was 20/40 or better in 2 (50%) of the 4 patients, but the remaining 2 patients were 20/200 or worse. A. xylosoxidans may be a cause of acute, recurrent, and delayed-onset postoperative endophthalmitis after cataract surgery. Complete capsulectomy and intraocular lens removal can be considered in recurrent and recalcitrant patients.

CORNEAL ENDOTHELIAL CELL DENSITY AFTER VITRECTOMY WITH SILICONE OIL FOR COMPLEX RETINAL DETACHMENTS

To evaluate the endothelial cell density changes in eyes with silicone oil tamponade after vitrectomy for complex rhegmatogenous retinal detachment. A prospective controlled study with 81 eyes with complex rhegmatogenous retinal detachment undergoing vitrectomy and silicone oil tamponade. Fellow eyes that fulfilled specific inclusion criteria served as controls. Endothelial cell density (in cells per square millimeter), coefficient of variance (standard deviation per mean cell area × 100), percentage of hexagonal cells, and corneal thickness were documented preoperatively and compared with values obtained at 3, 6, and 12 months postoperatively. For the purpose of the study analysis, all study eyes were divided into 5 groups, according to their lens status during the follow-up. High endothelial cell density loss was found in Group 3, (eyes that underwent an additional phacoemulsification procedure) and Group 4 (eyes that underwent lens and/or intraocular lens removal during the follow-up) at 12 months with a mean cell loss of 19% and 39%, respectively (P < 0.001). An intact natural or artificial lens-iris diaphragm may provide a protective barrier against corneal endothelial cell damage from long-term silicone oil tamponade.

Endothelial keratoplasty for bullous keratopathy in eyes with an anterior chamber intraocular lens

To describe how to approach eyes with phakic or pseudophakic bullous keratopathy that have an anterior chamber intraocular lens (AC IOL) using thin Descemet-stripping endothelial keratoplasty (thin-DSEK) or Descemet membrane endothelial keratoplasty (DMEK) with or without AC IOL removal. Tertiary referral center. Comparative case series. Descemet membrane endothelial keratoplasty or thin-DSEK was performed in pseudophakic eyes with iris-claw AC IOLs (Group 1) or in phakic eyes with angle-supported AC IOLs (Group 2). In both groups, DMEK was routinely performed except in eyes with insufficient corneal transparency or a high risk for graft detachment. Preoperative surgical considerations, postoperative corrected distance visual acuity (CDVA), endothelial cell density, and complications were documented. In Group 1, all AC IOLs were left in situ. In Group 2, AC IOLs were removed in 90% of cases. At 6 months, the CDVA was 20/40 (≥0.5 decimal) or better in 36% of eyes in Group 1 and 90% in Group 2. Graft detachment occurred in 20% of eyes and de novo or glaucoma exacerbation in 29%. Bullous keratopathy treatment in eyes with an AC IOL was feasible with DMEK. Intraocular lens removal may be required if postoperative complications are anticipated, but not to facilitate surgery. Overall, the surgical approach may aim to minimize postoperative complications; that is, thin-DSEK in eyes with low visual potential and/or concomitant pathology and DMEK in eyes with a phakic AC IOL and normal visual potential.

Glued Trans-scleral Intraocular Lens Exchange for Anterior Chamber Lenses in Complicated Eyes: Analysis of Indications and Results

To determine the clinical outcomes after glued trans-scleral posterior chamber intraocular lens (IOL) exchange for anterior chamber (AC) IOL. Retrospective case series. Eyes with AC IOL explantation with glued IOL implantation in a single setting at the Dr Agarwal Eye Hospital and Eye Research Centre, Chennai, India, from 2008 through 2012 were included. Data were collected from the patient records. Corrected distance visual acuity (CDVA) in logarithm of the minimal angle of resolution units, intraocular pressure, AC reaction, AC depth, central corneal thickness, central macular thickness, endothelial cell density, and endothelial cell loss (percentage) were determined before and after IOL exchange. Thirty-eight eyes with mean follow-up of 24.1 ± 15.4months (range, 8 to 60months) were analyzed. The indications were corneal decompensation (39.4%), malpositioned AC IOL (28.9%), uveitis (15.7%), glaucoma (13.1%), and broken haptic (2.6%). There was significant improvement in the postoperative CDVA (P= .000) and central corneal thickness (P= .000) after AC IOL removal. CDVA better than 20/60 was obtained in 65.7% eyes. Thirty-four (86.8%) eyes showed an increase in the CDVA after IOL exchange. The mean endothelial cell loss was 3.4 ± 2.4% (range, 0.13% to 10.5%). There was significant correlation between the CDVA and the central corneal thickness (P= .000). There was significant change in the AC depth (P= .000), the intraocular pressure (P= .005), and the AC inflammation (P= .000) after IOL exchange. The preoperative macular edema in 3 eyes resolved after surgery (mean central macular thickness, 205.6 ± 7.2μm). Glued trans-scleral fixated posterior chamber IOL exchange for AC IOL can be an excellent alternative in eyes with ocular complications related to AC IOL.

Management of Lens Dislocation and Iris Cyst After Iris Sutured Intraocular Lens Implantation in Children With Marfan Syndrome

The authors describe two brothers with Marfan syndrome who developed severe complications after iris-suture fixation of an intraocular lens (IOL). A secondary iris cyst developed in one and the IOL dislocated into the vitreous in the other, requiring pars plana vitrectomy and IOL removal. Although the visual outcome was good in both cases, severe complications of iris-suture fixated IOLs must be considered when surgical correction of aphakia is attempted in children with Marfan syndrome.

Refractive Changes after Removal of Anterior IOLs in Temporary Piggyback IOL Implantation for Congenital Cataracts

PurposeTo assess the refractive change and prediction error after temporary intraocular lens (IOL) removal in temporary polypseudophakic eyes using IOL power calculation formulas and Gills' formula.MethodsFour consecutive patients (7 eyes) who underwent temporary IOL explantation were enrolled. Postoperative refractions calculated using IOL power calculation formulas (SRK-II, SRK-T, Hoffer-Q, Holladay, and the modified Gills' formula for residual myopia and residual hyperopia) were compared to the manifest spherical equivalents checked at 1 month postoperatively.ResultsThe mean ages of temporary piggyback IOL implantation and IOL removal were 6.71 ± 3.68 months (range, 3 to 12 months) and 51.14 ± 18.38 months (range, 29 to 74 months), respectively. The average refractive error was -13.11 ± 3.10 diopters (D) just before IOL removal, and improved to -1.99 ± 1.04 D after surgery. SRK-T showed the best prediction error of 1.17 ± 1.00 D. The modified Gills' formula for myopia yielded a relatively good result of 1.47 ± 1.27 D, with only the variable being axial length.ConclusionsFormulas to predict refractive change after temporary IOL removal in pediatric polypseudophakia were not as accurate as those used for single IOL implantation in adult eyes. Nonetheless, this study will be helpful in predicting postoperative refraction after temporary IOL removal.

Vancomycin-resistant Staphylococcus hominis endophthalmitis following cataract surgery

We report a case of acute postoperative endophthalmitis caused by vancomycin-resistant Staphylococcus hominis, treated at our hospital. An 80-year-old male presented 2 days after uncomplicated phacoemulsification and posterior chamber intraocular lens implantation, with a 24-hour history of progressive visual loss and redness in the operated (right) eye. On examination, best corrected visual acuity was counting fingers. Anterior segment examination revealed conjunctival injection, chemosis, corneal edema, and hypopyon. B-scan ultrasonography showed vitreous opacification, but no retinal detachment. Acute postoperative endophthalmitis was diagnosed. We performed vitrectomy with vancomycin in the irrigating solution, intraocular lens removal, and silicone oil tamponade. Culture of the vitreous grew Staphylococcus hominis. Antibiotic susceptibility testing showed the isolate was sensitive to trimethoprim/sulfamethoxazole and teicoplanin but resistant to ciprofloxacin, moxifloxacin, levofloxacin, cefazolin, and vancomycin. At 3 months, the visual acuity of the silicone oil-treated eye was 20/400.

The causes of removing the intraocular lenses in 13 cases

Objective To analyze the causes of removing the intraocular lenses ( IOLs) in 13 cases,and to investigate the prevention and the management to reduce the complication.Methods A retrospective study was done in 13 cases ( 13 eyes) of removing IOLs in any conditions from March 2005 to January 2011 in Xijing Hospital.We analyzed the causes and the management of removing IOLs,and the type of removed IOLs.Results In 13 cases,the range of age was 8 to 64 years old,mean age was (30 ± 17.3)years old.The primary ocular diseases were traumatic cataract in nine cases,age-related cataract in two cases,congenital cataract in one case,and secondary cataract in one case.The causes of removing IOLs were dislocation to vitreous cavity,severe disconcentration,corneal endothelial dysfunction and uncontrolled secondary glaucoma with IOLs dislocation.Among the 13 removed IOLs,six pieces were 3-piece unfold PMMA IOLs,two pieces were 1-piece unfold PMMA IOLs,three pieces were 2-piece fold IOLs,one piece was 1-piece fold IOLs and one was anterior chamber 1-piece IOLs.IOLs were replaced in 8 cases,and in the other 5 cases,IOLs were removed.Conclusion The positive methods avoiding removing IOLs include appropriate treatment of complicated cataract,correct treatment for ruptured posterior lens capsule,suitable IOL type and IOL implantation procedure. Key words: Intraocular lens; Removal or exchange of IOL; Complications