Light Perception Vision Research Articles

CASE–CONTROL STUDY OF RISK FACTORS FOR NO LIGHT PERCEPTION AFTER OPEN-GLOBE INJURY

Investigate possible risk factors of no light perception (NLP) after open-globe injury. Explore whether these risk factors are predictors for an unfavorable visual outcome. This case-control study matched 72 eyes with NLP according to type and zone of injury to 2 controls per case with light perception or better vision. Cases were selected from the Eye Injury Vitrectomy Study database. All injured eyes in the study underwent surgical intervention. Ciliary body damage (odds ratio = 2.94), closed funnel retinal detachment (odds ratio = 2.43), and choroidal damage (odds ratio = 2.80) were independent risk factors for NLP after open-globe injury. There were 67 traumatized eyes with NLP that had ≥1 of these risk factors. In 43 of the cases (64.2%), the eyes recovered light perception or better after vitreoretinal surgery. The five traumatized NLP cases without these risk factors obtained a favorable visual outcome after vitreoretinal surgery. There was no statistical significance in visual outcome between them (P = 0.162). Ciliary body damage, closed funnel retinal detachment, and choroidal damage are independent risk factors for NLP posttrauma but not prognostic indicators for NLP visual outcome. Traumatized eyes with NLP may recover light perception or better vision if appropriate interventional measures are used for treatment of the injured ciliary body, retina, and choroid.

Deep sclerectomy with mitomycin C in eyes with failed glaucoma surgery and pseudophakia

To report outcomes of deep sclerectomy (DS) with intraoperative mitomycin C (MMC) application in eyes with previous failed glaucoma surgery (GS) and/or cataract extraction (CE). Single-surgeon case series of 82 eyes of 82 patients undergoing DS with MMC. The patients had previous CE with IOL and/or conjunctival GS and treated intraocular pressure (IOP) >18 mm Hg. MMC (0.2 mg/ml) was applied for 2-3 min before scleral flap dissection. Complete success was defined as IOP between 6 and 21 mm Hg or a reduction of 20% from baseline without medications. Reoperation for glaucoma or related complications, or loss of light perception vision was considered as failure. Mean follow-up was 57.7 ± 22.4 months with 78% of patients completing the 3-year follow-up. Mean IOP decreased from 24.0 mm Hg (22.3-25.6, 95% confidence intervals) to 13.4 mm Hg (12.0-14.2) at 3 years after surgery (P<0.001). There was a significant decrease in the number of glaucoma medications from 2.0 ± 1 preoperatively, to 0.3 ± 0.7, 3 years after surgery. Kaplan-Meier cumulative success rates were 85.6% at 1 year, 80.0% at 2 years, and 76% at 3 years. At 3 years, IOP was maintained <19 and 15 mm Hg in 83 and 70% of eyes, respectively. Fourteen eyes (17.1%) had complications. Delayed hypotony (IOP <6 mm Hg) was the commonest complication in five eyes (6.1%). DS with MMC appears to be a safe and effective surgical procedure for eyes with previous intraocular surgery.

Ab Interno Trabeculectomy Versus Trabeculectomy for Open-Angle Glaucoma

To compare the effect of ab interno trabeculectomy with trabeculectomy. Retrospective, cohort study. A total of 115 patients who underwent ab interno trabeculectomy (study group) compared with 102 patients who underwent trabeculectomy with intraoperative mitomycin as an initial surgical procedure (trabeculectomy group). Inclusion criteria were open-angle glaucoma, age ≥ 40 years, and uncontrolled on maximally tolerated medical therapy. Exclusion criterion was concurrent surgery. Clinical variables were collected from patient medical records. Intraocular pressure (IOP) and Cox proportional hazard ratio (HR) and Kaplan-Meier survival analyses with failure defined as IOP >21 mmHg or less than 20% reduction below baseline on 2 consecutive follow-up visits after 1 month; IOP ≤ 5 mmHg on 2 consecutive follow-up visits after 1 month; additional glaucoma surgery; or loss of light perception vision. Secondary outcome measures include number of glaucoma medications and occurrence of complications. Mean follow-up was 27.3 and 25.5 months for the study and trabeculectomy groups, respectively. Intraocular pressure decreased from 28.1 ± 8.6 mmHg at baseline to 15.9 ± 4.5 mmHg (43.5% reduction) at month 24 in the study group, and from 26.3 ± 10.9 mmHg at baseline to 10.2 ± 4.1 mmHg (61.3% reduction) at month 24 in the trabeculectomy group. The success rates at 2 years were 22.4% and 76.1% in the study and trabeculectomy groups, respectively (P<0.001). Younger age (P = 0.037; adjusted HR, 0.98 per year; 95% confidence interval [CI], 0.97-0.99) and lower baseline IOP (P = 0.016; adjusted HR, 0.96 per 1 mmHg; 95% CI, 0.92-0.99) were significant risk factors for failure in the multivariate analysis of the study group. With the exception of hyphema, the occurrence of postoperative complications was more frequent in the trabeculectomy group (P<0.001). More additional glaucoma procedures were performed after ab interno trabeculectomy (43.5%) than after trabeculectomy (10.8%, P<0.001). Ab interno trabeculectomy has a lower success rate than trabeculectomy. Proprietary or commercial disclosure may be found after the references.

Comparison of standard trabeculectomyversusmicrotrabeculectomy as a surgical treatment for glaucoma: a randomized clinical trial

To determine the effect of scleral flap size on the medium-term intraocular pressure control and complication rates after augmented trabeculectomy. Prospective randomized clinical trial. Glaucoma patients undergoing primary trabeculectomy. Exclusion criteria included previous ocular surgery apart from cataract surgery, secondary glaucoma and age under 18. Patients were randomized to either standard trabeculectomy (4 × 4 mm scleral flap) or microtrabeculectomy (2 × 2 mm scleral flap), both with adjustable sutures and antimetabolites. Bleb needling was performed as required. Patients were evaluated at day 1, weeks 1, 3, 6 and months 3, 6, 12, 18 and 24 postoperatively. Vision, intraocular pressure, complications and failure (intraocular pressure ≥ 21 mmHg or not reduced by ≥20% from baseline, intraocular pressure ≤ 5 mmHg, repeat glaucoma surgery and no light perception vision). Forty-one patients were recruited; 20 had standard trabeculectomy, and 21 had microtrabeculectomy. At 2 years, the mean intraocular pressure and cumulative probability of failure was 12.4 ± 4.6 mmHg and 0.28 for standard trabeculectomy, and 11.5 ± 3.6 mmHg and 0.27 for microtrabeculectomy (P = 0.50 and 0.89, respectively). One patient in each group required Baerveldt device implantation. Vision reduced ≥2 Snellen lines in 15% in the standard trabeculectomy group and 25% in the microtrabeculectomy group, mainly from cataract (P = 0.48). Both trabeculectomy techniques achieved good intraocular pressure reduction and had similar complication rates. Scleral flap size had no significant effect on medium-term intraocular pressure control and complication profile.

Efficacy of combined vitreous surgery and choroidal suture fixation on choroidal avulsion.

To evaluate the feasibility and efficacy of combined vitreous surgery and choroidal suture fixation on choroidal avulsion. A total of 21 patients (21 eyes) with choroidal avulsion, secondary to open eye trauma and a history of one-stage eyeball wall closure were retrospectively evaluated in the present study. Preoperative findings included 3 to 7.5 mmHg (averagely 5.1±1.1mmHg) of intraocular pressure and presence/suspicion of visual light perception. Vitreo-retinal surgery in combination with choroidal suture fixation was conducted for these patients at 4 to 21 days averagely 9.41±2.7 days) after the trauma. The postoperative follow-up lasted for 3 to 9 months (averagely 5.5±1.5 months). The intraoperative findings indicated several choroid residuals with different densities attached on the sclera at the choroidal detachment area. Retinal proliferation/detachment, incarceration and/or partial retinal loss were also observed. Intraoperatively, the retina was separated and released, and the suture fixation outside the sclera in combination with intraocular photocoagulation and silicone oil filling were performed at the avulsed choroidal area. The suture fixation on the ciliary body was also introduced in some of the patients. At one month posteoperatively, a complete choroidal reattachment was achieved in 16 eyes (16/21, 76.19%) and partial reattachment in the remaining 5 eyes. At the end of follow-up, partial choroidal redetachment was observed in 4 of 16 eyes (25%), resulting in complete reattachment in 12 eyes (12/21, 57.1％) and partial reattachment in 9 eyes (9/21, 33.34％). The complete choroidal reattachment rate at the end of follow-up was not significantly different from that observed at one month after the surgery (Chi-square test, P<0.05), while the complete retinal reattachment rate at this time point was significantly lower than that at one month postoperatively (Chi-square test, P>0.05). Transscleral suture fixation serves as a reliable technique, particularly improving the choroidal reattachment rate in the choroidal avulsion.

An analysis on therapeutic effect of transcranial microsurgical decompression of optic canal treating optic nerve injury

Objective To analyse the therapeutic effect of transcranial microsurgical decompression of optic canal in treatment of traumatic optic nerve injuries. Methods Retrospective analysis of the operation timing, therapeutic effect and related factors affect of it in 27 cases.. Results Thirteen eases with the vision of no light perception, surgical effective rate is 23.1％, 11 cases with light perception, effective rate is 63.6％ ; hand movement effective rate is 100％. The total effective rate is 48.1％. without surgical complication. All of the effective patients undergoing operative within 2 weeks. Conclusion Simple optic nerve compression, the patients with beyond light perception vision, the therapeutic effect with early and fully decompression of optic canal is curative effect. Key words: Optic nerve injury ; Optic nerve decompression; Surgical approach

Visual recovery in a patient with total hyphema, neovascular glaucoma, long-standing retinal detachment and no light perception vision: a case report

IntroductionWe report the case of a patient with total hyphema, neovascular glaucoma, long-standing retinal detachment and no light perception vision, who regained counting fingers vision with complete regression of neovascularization following anterior chamber washout, intravitreal bevacizumab, pars plana vitrectomy, and silicone oil placement. This represents a rare case in which a patient with no light perception vision was able to regain functional vision.Case presentationA 63-year-old Caucasian man with a 55-year history of long-standing retinal detachment after trauma presented to our facility with pain and redness, a total hyphema, no light perception vision and an intraocular pressure of 60 mmHg (right eye). He had a history of diabetes mellitus and coronary artery disease. Following anterior chamber washout, he was found to have neovascular glaucoma, for which intravitreal bevacizumab was administered. After washout and intraocular pressure control, his visual acuity improved to light perception. He subsequently underwent vitrectomy, membrane peeling, endolaser and silicone oil placement to reattach his retina, and then a second retinal reattachment procedure. Following these procedures, he had visual recovery to counting fingers vision in his right eye at five metres, complete regression of neovascularization, and intraocular pressure of 10 to 12 mmHg on one antiglaucoma medication.ConclusionFunctional vision can be regained despite long-standing retinal detachment.

Pathological findings in poststrabismus surgery endophthalmitis

Bacterial entry into the vitreous cavity via inadvertent scleral perforation is one postulated mechanism for poststrabismus surgery endophthalmitis. In a review of 746 cases, we identified 2 pediatric enucleation specimens related to complications of strabismus surgery. In both cases, the patients developed postoperative endophthalmitis and no light perception vision, and the eyes were enucleated when they became phthisical or painful. In both submitted cases, pathology showed a thick band of scar tissue emanating focally from the sclera into the vitreous. Although no needle tracts were visualized, pathological findings were consistent with scleral perforation.

Neovascular glaucoma as the presenting sign of metastatic small cell lung carcinoma.

The purpose of this study is to describe a case of metastatic lung cancer presenting with neovascular glaucoma. This was a retrospective chart review describing one case. A previously healthy 36-year-old man presented with light perception vision and painful neovascular glaucoma. Examination and ultrasound showed a complete retinal detachment overlying a dome-shaped choroidal mass. After enucleation, histopathology showed findings consistent with small cell lung carcinoma metastasis. Oncologic evaluation showed a necrotic lung carcinoma with extensive bony metastases. Metastatic carcinoma to the eye can manifest with features of neovascular glaucoma.

A case of Coats’ disease with visual recovery from no light perception vision after vitrectomy

A case of Coats’ disease with visual recovery from no light perception vision after vitrectomy

Trabeculectomy versus Ahmed Glaucoma Valve implantation in neovascular glaucoma

Purpose:To compare surgical outcomes in neovascular glaucoma patients who underwent trabeculectomy with mitomycin C versus Ahmed Glaucoma Valve implantation.Patients and methods:This was a retrospective comparative case series. We reviewed 40 eyes of 39 patients with underlying diagnosis of neovascular glaucoma, divided into two groups: Ahmed Glaucoma Valve (N = 20) and trabeculectomy with mitomycin C (N = 20). Surgical success was defined as 6 mm Hg ≤ intraocular pressure ≤21 mm Hg, with or without the use of glaucoma medications, with no further glaucoma surgery, and light perception or better vision. Early postoperative hypotony was defined as intraocular pressure <5 mm Hg during the first postoperative week.Results:The average follow-up was 31 months (range 6–87 months) for the Ahmed Glaucoma Valve group and 25 months (6–77 months) for the trabeculectomy group. Although the mean number of postoperative intraocular pressure-lowering medications was significantly higher in the trabeculectomy group compared with the Ahmed Glaucoma Valve group at 3 and 6 month time points, there was no statistically significant difference at any other time point. There was no statistically significant difference between both groups in postoperative visual acuity and intraocular pressure. Success was 70% and 65% at 1 year and 60% and 55% at 2 years after Ahmed Glaucoma Valve and trabeculectomy, respectively. Kaplan–Meier survival curve analysis showed no significant difference in success between the two groups (P = 0.815). Hyphema was the most common complication in both groups.Conclusion:We found similar results after trabeculectomy with mitomycin C and Ahmed Glaucoma Valve implantation in eyes with neovascular glaucoma.

The Ahmed Glaucoma Valve in Patients With and Without Neovascular Glaucoma

To evaluate the results of Ahmed Glaucoma Valve surgery in neovascular glaucoma and control patients. In this retrospective comparative study, we reviewed 76 eyes of 76 patients, comparing the surgical outcomes in control patients (N=38) to matched neovascular glaucoma patients (N=38). Success was defined as intraocular pressure (IOP) ≥6 mm Hg and ≤21 mm Hg, without further glaucoma surgery, and without loss of light perception. Average follow-up for control and neovascular glaucoma patients was 18.4 and 17.4 months, respectively (P=0.550). The mean IOPs were 17.9±8.4 mm Hg and 16.5±15.8 mm Hg at 1-year (P=0.150), and 18.4±11.2 mm Hg and 9.9±6.3 mm Hg at 2 years (P=0.057) in controls and eyes with neovascular glaucoma, respectively. Life-table analysis showed a significantly lower success for neovascular glaucoma patients compared with controls (P=0.0096), with success at 1 year=89.2% and 73.1%, 2 years=81.8% and 61.9%, and 5 years=81.8% and 20.6% for control and neovascular glaucoma eyes, respectively. Cox proportional hazard regression analysis showed neovascular glaucoma as a risk factor for surgical failure (odds ratio=5.384, 95% CI=1.22-23.84, P=0.027). Although IOP control and complications were comparable between the 2 groups, visual outcomes were worse in neovascular glaucoma patients, with 9 (23.7%) eyes with neovascular glaucoma compared with no controls losing light perception vision (P=0.002). The majority with loss of vision (5 of 9) had successful control of IOP during the postoperative period. Neovascular glaucoma patients have greater risk of surgical failure after Ahmed Glaucoma Valve surgery compared with controls. Despite improved IOP with drainage implants, visual outcomes may be poor, probably owing to progression of underlying disease.

The Ahmed Baerveldt Comparison Study: Methodology, Baseline Patient Characteristics, and Intraoperative Complications

The Ahmed Baerveldt Comparison (ABC) Study compares the long-term outcomes and complications of the Ahmed glaucoma valve (AGV; model FP7; New World Medical, Los Ranchos, CA) and the Baerveldt glaucoma implant (BGI; model 101-350; Abbott Medical Optics, Abbott Park, IL). Multicenter, randomized, controlled clinical trial. Two hundred seventy-six glaucoma patients at 16 clinical centers worldwide who were 18 to 85 years of age with inadequately controlled intraocular pressure (IOP; ≥18 mmHg) in whom placement of an aqueous shunt was planned. Study patients were randomized to undergo implantation of an AGV or a BGI. Failure, defined as IOP >21 mmHg or not reduced by 20% less than baseline or IOP ≤5 mmHg (2 consecutive visits after 3 months), additional glaucoma surgery, removal of the implant, or loss of light perception vision. A total of 276 patients were enrolled between October 2006 and April 2008, including 143 in the AGV group and 133 in the BGI group. The mean age±standard deviation (SD) of patients enrolled was 63±14 years, and 52% were male. The mean baseline IOP±SD was 31.5±11.8 mmHg. Except for a 13% higher prevalence of hypertension in the AGV group, no significant differences in baseline demographic or ocular characteristics were observed between the study groups. Intraoperative complications occurred in 11 (8%) patients in the AGV group and in 16 (12%) patients in the BGI group (P = 0.31). The ABC Study should yield valuable prospective data comparing 2 commonly used aqueous shunts in clinical practice.

Treatment Outcomes in the Ahmed Baerveldt Comparison Study after 1 Year of Follow-up

To determine the relative efficacy and complications of the Ahmed glaucoma valve (AGV) model FP7 (New World Medical, Ranchos Cucamonga, CA) and the Baerveldt glaucoma implant (BGI) model 101-350 (Abbott Medical Optics, Abbott Park, IL) in refractory glaucoma. Multicenter, randomized, controlled clinical trial. Two hundred seventy-six patients, including 143 in the AGV group and 133 in the BGI group. Patients 18 to 85 years of age with refractory glaucoma having intraocular pressure (IOP) of 18 mmHg or more in whom an aqueous shunt was planned were randomized to undergo implantation of either an AGV or a BGI. The primary outcome was failure, defined as IOP >21 mmHg or not reduced by 20% from baseline, IOP ≤5 mmHg, reoperation for glaucoma or removal of implant, or loss of light perception vision. Secondary outcomes included mean IOP, visual acuity, use of supplemental medical therapy, and complications. Preoperative IOP (mean±standard deviation [SD]) was 31.2±11.2 mmHg in the AGV group and 31.8±12.5 mmHg in the BGI group (P = 0.71). At 1 year, mean±SD IOP was 15.4±5.5 mmHg in the AGV group and 13.2±6.8 mmHg in the BGI group (P = 0.007). The mean±SD number of glaucoma medications was 1.8±1.3 in the AGV group and 1.5±1.4 in the BGI group (P = 0.071). The cumulative probability of failure was 16.4% (standard error [SE], 3.1%) in the AGV group and 14.0% (SE, 3.1%) in the BGI group at 1 year (P = 0.52). More patients experienced early postoperative complications in the BGI group (n = 77; 58%) compared with the AGV group (n = 61; 43%; P = 0.016). Serious postoperative complications associated with reoperation, vision loss of ≥2 Snellen lines, or both occurred in 29 patients (20%) in the AGV group and in 45 patients (34%) in the BGI group (P = 0.014). Although the average IOP after 1 year was slightly higher in patients who received an AGV, there were fewer early and serious postoperative complications associated with the use of the AGV than the BGI.

Anterior segment complications after phacoemu-lsification combined vitrectomy and foldable intraocular lens implantation.

To evaluate the anterior segment complications of phacovitrectomy and foldable intraocular lens (IOL) implantation in eyes with significant cataract and co-existing vitreoretinal diseases. This retrospective study was consisted of 285 eyes of 238 patients with various vitreoretinal abnormalities and visually significant cataracts. Vitreoretinal surgery was combined with phacoemulsification and foldable IOL implantation. Main outcome measures were visual acuity, the preoperative data, and the anterior segment complications at postoperative 6 to 72 months. The most common indications for surgery were non-diabetic vitreous hemorrhage, proliferative diabetic retinopathy. Preoperative vision ranged from 20/30 to light perception and postoperative vision ranged from 20/20 to no light perception. Postoperatively, in 245 eyes (85.9%), visual acuity improved by 3 lines or more on the Snellen chart. In 24 eyes (8.4%), vision remained within 3 lines of preoperative levels and in 16 eyes (5.6%), vision had decreased at the last follow-up. The most common anterior segment pathological change was PCO in 50 eyes (17.5%), the second was corneal edema in 32 eyes (11.2%) and the third was elevated IOP in 31 eyes (10.8%). The combined vitreoretinal surgery and phacoemulsification with foldable IOL implantation is safe and effective.

EARLY VITRECTOMY EFFECTIVE FOR BILATERAL COMBINED ANTERIOR AND POSTERIOR PERSISTENT FETAL VASCULATURE SYNDROME

The purpose of this study was to review our surgical experience with patients with bilateral combined anterior and posterior persistent fetal vasculature syndrome (PFVS). We retrospectively reviewed the charts of all patients seen in our tertiary care pediatric retinal practice from 1988 to 2008 with a potential diagnosis of bilateral PFVS with posterior involvement. Clinical diagnosis required the presence of either bilateral persistent hyaloidal stalk tissue with retinal involvement or bilateral dense retrolental fibrovascular plaques (usually with no posterior view preoperatively) without a family history or genetic testing consistent with Norrie disease or familial exudative vitreoretinopathy. Chart review showed 22 vitrectomized patients with clinical findings consistent with bilateral PFVS with posterior involvement who did not have a family history or genetic testing consistent with Norrie disease or familial exudative vitreoretinopathy. All 22 of these patients with posterior retinal involvement also had anterior findings and thus can be classified as combined anterior and posterior PFVS. Of the 13 patients with visual acuity follow-up data, 9 patients (69%) maintained at least light perception vision in at least 1 eye at last follow-up. Of the 28 operated eyes in 16 patients with follow-up data, 3 eyes (11%) were phthisical at last follow-up. Children with bilateral PFVS with posterior retinal involvement have a dismal visual prognosis if left unoperated. In this relatively large series of a rare condition, we find that vitrectomy with or without lensectomy is beneficial in bilateral combined anterior and posterior PFVS in two regards: maintenance or restoration of vision and avoidance of phthisis bulbi.

SURGICAL TREATMENT OF SEVERELY TRAUMATIZED EYES WITH NO LIGHT PERCEPTION

The purpose of this study was to evaluate the anatomical and functional outcomes of surgical intervention in severely traumatized eyes with no light perception (NLP). In this prospective interventional case series, 18 eyes of 18 patients with severe ocular trauma whose vision was documented as NLP and with relative afferent pupillary defect of 3 to 4+ underwent deep vitrectomy and other appropriate procedures 1 to 3 times. Vision was NLP in all eyes at the time of surgery, which was performed 3 days to 14 days after the initial trauma. During a mean follow-up period of 20.5 +/- 5.2 months (range, 11-36 months), except for 1 case of phthisis, other eyes achieved acceptable anatomical and functional outcomes. Postoperative vision was NLP in 2 eyes (11.1%), light perception in 3 eyes (16.7%), hand motions in 4 eyes (22.2%), counting fingers in 3 eyes (16.7%), and 20/200 or better in 6 eyes (33.4%). After eye trauma, NLP vision and relative afferent pupillary defect of 3 to 4+ alone may not be an indication for enucleation. Performing exploratory surgery within 14 days after the injury may salvage the globe and improve vision; this approach also entails positive psychologic effects for patients and relatives.

Artificial vision by direct optic nerve electrode (AV-DONE) implantation in a blind patient with retinitis pigmentosa

The purpose of this study was to evaluate the efficacy and safety of artificial vision by using a direct optic nerve electrode (AV-DONE) in a blind patient with retinitis pigmentosa (RP). This device, comprising three wire electrodes (0.05 mm in diameter), was implanted into the optic disc of a patient with RP with no light perception vision and the device was left implanted. Six months later, visual sensations were elicited by electrical stimulation through each electrode and the thresholds for the phosphene perception elicited by pulses of 0.25-ms duration/phase and a pulse frequency of 320 Hz were 30, 5, and 70 microA for each electrode. The phosphenes, which ranged in size from that of a match head to an apple, were round, oval, or linear, primarily yellow, and focally distributed. The area of the phosphenes changed when the electrical stimulation was supplied from different electrodes. No complications arose during the follow-up period. Localized visual sensations were produced in a blind patient with advanced RP, suggesting that our system could lead to the development of a useful visual prosthesis system.

Incidence, Clinical Features, Causative Organisms, and Visual Outcomes of Delayed-Onset Pseudophakic Endophthalmitis

To report the incidence, clinical features, causative organisms, and visual outcomes associated with delayed-onset pseudophakic endophthalmitis. We retrospectively reviewed the clinical records and microbiology files of all patients with culture-proven endophthalmitis that was present 6 weeks or more after cataract extraction and posterior chamber intraocular lens (IOL) implantation who were treated at King Khaled Eye Specialist Hospital (KKESH) during a 10-year period. From January 1997 through December 2006, 17 patients with culture-proven, delayed-onset pseudophakic endophthalmitis were treated at KKESH. Of the 17 cases, only 5 cases developed delayed-onset endophthalmitis, among 29,509 cataract surgeries performed at KKESH, indicating an incidence rate of 0.017% (5/29,509). The mean time between cataract surgery and diagnosis of endophthalmitis was 5+/-2.48 months. The culture isolates revealed Propionibacterium acnes in 7 (41.2%) eyes, polymicrobial (mixed) infections in 3 (17.6%) eyes, Staphylococcus species in 3 (17.6 %) eyes, fungal infections in 3 (17.6%) eyes, and Alcaligenes xylosoxidans in 1 (5.9%) eye. The mean follow-up period was 29.8 months. The final visual outcomes were as follows: 7 eyes (41.2%) achieved a final best-corrected visual acuity of >or=20/60; 6 eyes (35.3%) achieved a best-corrected visual acuity of <20/60 to >or= count fingers; 2 eyes (11.8%) had hand motion to light perception vision; and 2 eyes (11.8%) were enucleated. In this study, infection by P acnes was the most common cause of delayed-onset pseudophakic endophthalmitis and had the most favorable visual outcome, whereas fungal endophthalmitis had the worst visual prognosis.

Three-Year Follow-up of the Tube Versus Trabeculectomy Study

To report 3-year results of the Tube Versus Trabeculectomy (TVT) Study. Multicenter randomized clinical trial. Seventeen clinical centers. Patients 18 to 85 years of age who had previous trabeculectomy, cataract extraction with intraocular lens implantation, or both and uncontrolled glaucoma with intraocular pressure (IOP) > or =18 mm Hg and < or =40 mm Hg on maximum tolerated medical therapy. A 350-mm(2) Baerveldt glaucoma implant or trabeculectomy with mitomycin C (MMC 0.4 mg/ml for 4 minutes). IOP, visual acuity, use of supplemental medical therapy, surgical complications, and failure (IOP >21 mm Hg or not reduced by 20%, IOP < or =5 mm Hg, reoperation for glaucoma, or loss of light perception vision). A total of 212 eyes of 212 patients were enrolled, including 107 in the tube group and 105 in the trabeculectomy group. At 3 years, IOP (mean +/- standard deviation [SD]) was 13.0 +/- 4.9 mm Hg in the tube group and 13.3 +/- 6.8 mm Hg in the trabeculectomy group (P = .78). The number of glaucoma medications (mean +/- SD) was 1.3 +/- 1.3 in the tube group and 1.0 +/- 1.5 in the trabeculectomy group (P = .30). The cumulative probability of failure during the first 3 years of follow-up was 15.1% in the tube group and 30.7% in the trabeculectomy group (P = .010; hazards ratio, 2.2; 95% confidence interval, 1.2 to 4.1). Postoperative complications developed in 42 patients (39%) in the tube group and 63 patients (60%) in the trabeculectomy group (P = .004). Surgical complications were associated with reoperation and/or loss of > or =2 Snellen lines in 24 patients (22%) in the tube group and 28 patients (27%) in the trabeculectomy group (P = .58). Tube shunt surgery had a higher success rate compared to trabeculectomy with MMC during the first 3 years of follow-up in the TVT Study. Both procedures were associated with similar IOP reduction and use of supplemental medical therapy at 3 years. While the incidence of postoperative complications was higher following trabeculectomy with MMC relative to tube shunt surgery, most complications were transient and self-limited.