Seidel Test Research Articles

Interpretation of the Seidel test for open eye injury: Experimental study

AIM: The study aimed to examine the phenomenon of fluorescence during the Seidel test on an experimental model of open eye injury (OEI). MATERIAL AND METHODS: The experimental study used cadaver pig eyes and was conducted in the Wetlab educational laboratory of the St. Petersburg branch of the S.N. Fedorov National Medical Research Center Interbranch Scientific and Technical Complex “Eye Microsurgery”. After creating a perforated hole, the cornea was stained with fluorescein and observed under a cobalt-blue slit-lamp light. After the test strips were removed, the experiment was timed. RESULTS: The fluorescence phenomenon was noted immediately after applying the stain to the ocular surface of cadaver eyes with OEI. Fluorescein was dissolved in the flowing intraocular fluid (IOF) and was restrained at the wound edges. Then, the color of the flowing IOF changed. In the experiment, two phases of the flowing IOF color were registered, that is, up to 2.95 s, a bright-green fluid flow was noted. After 2.95 s, the stain washed out, and the main stream of liquid was divided into several streams with varying degrees of staining intensity. At 4.12 s, a transparent stream of escaping liquid was noted in the center and green streams along the edges. CONCLUSION: The Seidel test consists of two successive phases, namely, the initial appearance of a “bright-green stream” of IOF flowing through the corneal wound, lasting no more than 3 s after the administration of fluorescein; and during phase 2, in the flow center, the fluid became transparent, and bright-green staining remained at the edges. The Seidel test should be performed in compliance with all conditions that ensure the manifestations of fluorescence, always using a cobalt slit-lamp filter, and the result should be evaluated considering the sequence of its phases.

Treatment of Corneal Perforation Using Periosteal Graft Technique With the Continuation of Penetrating Keratoplasty

Introduction : Corneal perforation occurs due to various conditions and management are based on the underlying cause. Modalities to treat corneal leaks is dependent on the size of corneal defect and include tissue adhesive, conjunctival flap, grafts and transplants. Penetrating Keratoplasty (PK) is effective to treat large corneal defect and to improve visual acuity (VA), but unfortunately PK is usually delayed due to availability.
 Case Illustration : A 17-years-old teenager was diagnosed with corneal perforation on his left eye, VA at initial visit was 1/300, positive seidel test, and shallow anterior chamber. Patient immediately underwent periosteal graft with subsequent PK surgery one month later. First until eight days postoperatively, VA improved from 3/60 to 6/30. Ten days after PK, a mechanical trauma caused the transplant to be detached, and VA greatly decreased to 1/300. Patient underwent immediate repair surgery. First day after surgery, VA was light perception. Eight days later, VA increased to 1/60 with concurrent iris prolapse. Iris repair was done immediately and eight days later VA increased to 6/60. At day sixteen, the final VA is 6/30.
 Discussion : Periosteal graft was performed to maintain ocular integrity. After waiting for a month, PK was performed to improve vision. This combination therapy was successful proven by VA improvement from 1/300 to 6/30.
 Conclusion : Periosteal graft is necessary to maintain ocular integrity while waiting for availability of donor cornea. Penetrating keratoplasty is an appropriate procedure for patients with large corneal leaks. It replaces all corneal structures, and it also improve visual function.

Treatment of Corneal Perforation Using Periosteal Graft Technique With the Continuation of Penetrating Keratoplasty

Introduction : Corneal perforation occurs due to various conditions and management are based on the underlying cause. Modalities to treat corneal leaks is dependent on the size of corneal defect and include tissue adhesive, conjunctival flap, grafts and transplants. Penetrating Keratoplasty (PK) is effective to treat large corneal defect and to improve visual acuity (VA), but unfortunately PK is usually delayed due to availability.
 Case Illustration : A 17-years-old teenager was diagnosed with corneal perforation on his left eye, VA at initial visit was 1/300, positive seidel test, and shallow anterior chamber. Patient immediately underwent periosteal graft with subsequent PK surgery one month later. First until eight days postoperatively, VA improved from 3/60 to 6/30. Ten days after PK, a mechanical trauma caused the transplant to be detached, and VA greatly decreased to 1/300. Patient underwent immediate repair surgery. First day after surgery, VA was light perception. Eight days later, VA increased to 1/60 with concurrent iris prolapse. Iris repair was done immediately and eight days later VA increased to 6/60. At day sixteen, the final VA is 6/30.
 Discussion : Periosteal graft was performed to maintain ocular integrity. After waiting for a month, PK was performed to improve vision. This combination therapy was successful proven by VA improvement from 1/300 to 6/30.
 Conclusion : Periosteal graft is necessary to maintain ocular integrity while waiting for availability of donor cornea. Penetrating keratoplasty is an appropriate procedure for patients with large corneal leaks. It replaces all corneal structures, and it also improve visual function.

CORNEAL INJURY AFTER BEING STRUCK BY A PIECE OF STONE - A CASE REPORT

Introduction : Corneal lacerations in oculi trauma are common, any disruption or trauma to the cornea will affect the person's visual acuity.
 Case Illustration : 50 years old man came to the eye clinic of Sanjiwani General Hospital Gianyar with pain, blurred vision, and redness in his left eye, The symptom appeared abruptly after a piece of stone struck his left eye where the stone penetration looks deep enough and touched the surface of the iris. Visual acuity of his left eye (VOS) was 6/60, and open globe injury suspicion was removed by seidel test negative. He underwent surgery for corpus alienum removal with local anesthesia. During the procedure, the stone appeared to be even with the corneal surface, making it difficult to pick it up directly, so the removal technique is to pry it from the edge. The wound is closed using the suture. One week after the procedure, the patient came for a re-evaluation examination; visual acuity was improved; VOS: 6/7.5, no sign of infection or complication.
 Discussion : The form of the corneal lacerations can vary, with or without globe rupture. To reduce the risk of infection, tissue necrosis, and anterior peripheral synechiae formation, it is suggested that repair should occur within 24 hours after injury. In addition, repairs within this time limit may also aim to provide comfort and reduce the pain that patients may experience.
 Conclusion : Immediate recognition and repair procedure of corneal injury in this patient brings good vision results with no complaints of complications.

Epiphora: A case of a weeping bleb

An 82-year-old female with both eyes glaucoma underwent trabeculectomy 10 years back, presented with continuous watering in the left eye for 1 week. Her visual acuity in the left eye was counting fingers at 2 m. On examination, cystic bleb in the superior quadrant with positive Seidel test was seen. Intraocular pressure was 2 mmHg. Fundus evaluation showed kissing choroids. The cause for this epiphora was found due to a late leaking bleb, and this was revised surgically. It is imperative to educate patients with cystic bleb about this kind of symptom and seek medical help immediately to avoid dreaded complications.

Acute Corneal Melting Induced by the Concomitant Use of a Non-steroidal Anti-inflammatory Agent with an Antiseptic Eye Drop.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly employed perioperatively to reduce intraoperative prostaglandin release, diminishing pain, preventing miosis, modulating postoperative inflammation, and reducing the incidence of cystoid macular edema (CME). A 70-year-old female patient without previous history of ocular or systemic disease was urgently referred to our hospital because of a sudden corneal perforation concerning her left eye (OS). The patient had instilled bromfenac eye drops and antiseptic eye drops twice and four times daily, respectively, for 2days only, in preparation of scheduled cataract surgery. Slit-lamp examination revealed diffuse inferior corneal melting with a 1 × 2 mm area of full-thickness perforation and a very shallow anterior chamber. Both topical agents were immediately discontinued. Cyanoacrylate glue was applied to seal the perforation and a bandage contact lens was applied together with a topical antibiotic given hourly. Two hours later, the anterior chamber started to reform. The following day, the anterior chamber was fully reformed with a negative Seidel test. At her next follow-up appointment, 1month later, the glue was detached and the cornea was seen to have successfully healed with only some corneal thinning remaining inferiorly. Perioperative use of topical NSAIDs in combination with antiseptic eye drops may rarely elicit corneal perforation in certain susceptible elderly individuals. Their use should therefore be carefully monitored.

Posterior scleral application of a mitomycin C-soaked sponge during trabeculectomy.

To evaluate the safety and efficacy of posterior scleral application (a modified technique) of an antimetabolite mitomycin C-soaked sponge in trabeculectomy for patients with glaucoma. This retrospective study included 101 patients (115 eyes) with glaucoma (aged 12-83y) who underwent trabeculectomy using a modified mitomycin C-soaked sponge placement method. A piece of 3.5×10 mm2 sponge was placed vertically and posteriorly with the long side perpendicular to the limbus. The mitomycin C concentration and exposure time were 0.2-0.5 mg/mL and 1-5min, respectively. Intraocular pressure, best-corrected visual acuity, and hypotensive medications were recorded at baseline and at the final visit. Complications, interventions required, and bleb morphology were recorded postoperatively. The primary outcome was trabeculectomy safety, including complications and bleb morphology; the secondary outcome was the trabeculectomy success rate. At the final follow-up [median 28mo, range 7-67mo and interquartile range (IQR) 13mo], the qualified (cumulative) success rate was 93.0% and the complete success rate was 60.0%. No bleb-related complications were observed. The mean height, extent, and vascularity grades were 0.6±0.9, 1.1±0.4, and 2.4±0.9, respectively. All Seidel tests were negative. The mean posteriority grade was 0.8±0.4. Trabeculectomy with the long side of a mitomycin C-soaked sponge placed perpendicular to the corneal limbus is safe and effective.

Outcomes of Open Bleb Revision After PreserFlo MicroShunt Failure in Patients With Glaucoma.

After the open bleb revision following PreserFlo, the mean postoperative intraocular pressure (IOP) was lowered from 26.4 ± 9.9 mm Hg to 12.9 ± 5.6 mm Hg at 1 month and 15.9 ± 4.1 mm Hg at 12 months. The purpose of this study was to evaluate the effectiveness and safety of an open bleb revision with mitomycin- C (MMC) for bleb fibrosis after PreserFlo MicroShunt implantation. We performed a retrospective analysis of 27 consecutive patients with bleb fibrosis after PreserFlo MicroShunt Implantation that underwent an open revision with MMC 0.2 mg/mL applied for 3 minutes at the Department of Ophthalmology of the Mainz, University Medical Center, Mainz, Germany. Demographic data, such as age, sex, glaucoma type, number of glaucoma medications, IOP before and after PreserFlo implantation and revision, complications, and reoperations within 12 months, were analyzed. Twenty-seven patients (27 eyes) received an open revision after previous PreserFlo Microshunt implantation and consecutive bleb fibrosis. The mean preoperative IOP was 26.4 ± 9.9 mm Hg before revision, 7.0 ± 2.7 mm Hg ( P < 0.001) in the first week after the revision, and 15.9 ± 4.1 mm Hg at 12 months ( P = 0.02). Four patients needed IOP-lowering medication after 12 months. One patient had a positive Seidel test and needed a conjunctival suture. Four patients required a second procedure due to recurring bleb fibrosis. At 12 months, open revision with MMC for bleb fibrosis after failed PreserFlo implantation effectively and safely reduced IOP with a similar medication burden.

Management of perforated corneal ulcer with iris prolapse by cyanoacrylate glue: A case report

We report a rare case of perforated corneal ulcer due to recurrent viral keratitis with stromal necrosis and iris prolapse. The patient was 75 years old farmer, normotensive, diabetic, and presented with complaints of pain, watering, photophobia, redness and dimness of vision in the left eye. The left eye's visual acuity was perception of light and projection of rays in all four quadrants. Slit lamp examination found swollen eyelids, matted eyelashes, congested conjunctiva, seidel test positive, an inferonasal corneal perforation, shallow anterior chamber, irregular pupil, and prolapse of the iris through the perforated cornea. The patient was diagnosed with a left-sided perforated corneal ulcer (recurrent viral keratitis with stromal necrotizing variety) having iris prolapse. The perforation was sealed by cyanoacrylate glue and a soft bandage contact lens. This improved the patient’s condition. Early medical and surgical interventions thus can save vision as well as the eyeball.

A rare case of corneal perforation with glass perchlet fish

Penetrating ocular injuries following direct impact of fish are rare. A 26-year-old man presented to the emergency department with history of pain and blurring of vision following injury to the left eye due to the impact of glass perchlet fish. Ocular examination revealed best corrected visual acuity of log of minimum angle of resolution (logMAR) 0.18, eyelid edema, blepharospasm, and circumcorneal congestion. A full-thickness corneal laceration measuring 3 mm, confirmed by positive Seidel's test, and a partial-thickness corneal laceration measuring 1.5 mm were noted. Patient was managed by application of cyanoacrylate glue and bandage contact lens. We report the first case of corneal perforation by glass perchlet fish.

LATE-ONSET, BLEB-ASSOCIATED ENDOPHTHALMITIS CAUSED BY STAPHYLOCOCCUS AUREUS

Introduction: Bleb-associated endophthalmitis (BAE) is a potentially sight-threatening complications of trabeculectomy and is associated with poor visual outcome. BAE denotes an ocular infection with involvement of the vitreous, which usually develops months or years after glaucoma filtering surgery. The purpose of this case report was to present a case about late onset BAE caused by Staphylococcus aureus. Methods: A 55-year-old male presented with a 3-days history of left eye pain, redness, hypopion decreased visual acuity and hypotony with Seidel test positive. He had a history of primary open angle glaucoma that was treated with a combined procedure of cataract surgery and trabeculectomy in the left eye ten years earlier. His visual acuity had decreased from 6/20 to light perception. This patient showed signs of hypotony, endophthalmitis, leak, and pain but no previous history of using anti-fibrotic agents. BAE causative organisms cultures grew the S.aureus, that frequent cause of acute-onset endophthalmitis. The patient underwent treatment with pars plana vitrectomy, vitreous taps, administered intravitreal antibiotic, and prescribed hourly topical antibiotic. Six months after his last treatment, his left eye shows no residual infection, and visual acuity increase to 1/60. Results: One case of late onset BAE with visual improvement after early vitrectomy, intravitreal, oral and topical antibiotic treatment. Conclusion: Despite the poor prognosis of BAE caused by S.aureus infection, after proper treatment can yield an adequate result, as demonstrated in this case.

Corneal stromal lenticule transplantation for the treatment of corneal ulcers.

To evaluate the safety and efficacy of using corneal stromal lenticules (CSLs) obtained during refractive surgery Refractive Lenticule Extraction (ReLEx) with the Small Incision Lenticule Extraction (SMILE) procedure for the treatment of corneal ulcers. This retrospective study included 12 eyes of 12 patients, 7 men and 5 women with varying degrees of corneal ulcer. The mean age was 64 ± 18 (range 34 to 95 years). The monitoring included corrected distance visual acuity (CDVA), slit-lamp biomicroscopy examination, a Seidel test, stability of the graft and anterior segment optical coherence tomography (AS-OCT) inspection. Patients were closely monitored for possible postoperative complications for at least 6 months. In 7/12 (58%) eyes, the corneal ulcer was successfully sealed with CSL and amniotic membrane (AM) without the need for any additional surgical intervention. In 3 eyes, penetrating keratoplasty (PK) was needed in addition to CSL transplantation and in 2 eyes the scleral patch was used to fully seal after CSL transplantation. During the follow-up period no signs of rejection or infection were detected in any patient. The use of CSLs from ReLEx SMILE may be considered as an alternative method for the treatment of corneal ulcers before a more extensive and definitive solution - PK - is used. Our preliminary findings suggest that properly performed CSL transplantation using cryopreserved lenticules is a safe and effective method to temporarily cover the corneal partial-thickness defect or even perforation.

Retrospective multifactorial analysis of ocular firecracker injuries and review of literature

Purpose To analyse demographics, risk factors, clinical features, functional, anatomical outcomes, and prevalence of blindness in firecracker injury patients presenting to a tertiary eye care centre. Methodology A retrospective analysis of ocular firecracker injuries patients who presented to our hospital from April 2018 to March 2019 was performed. A total of 114 patients with a minimum follow-up of 3 months were included. The parameters recorded were demographics, mode of injury, type of cracker, baseline and last follow up best-corrected visual acuity (BCVA), anterior and posterior segment findings, seidel's test, intraocular pressure, gonioscopy, treatment, functional and anatomical outcomes. Investigations in form of B Scan, X-ray, or CT scan were undertaken whenever indicated. Results A total of 132 eyes of 114 patients were analysed. The mean (SD) age was 18.96 +/−15.4 years (range 3–71 years). Seventy-four (64.91%) patients were ≤ 18 years of age. The male-to-female ratio was 4:1. The ratio of right: left eye involvement was 1:1. Eighteen patients (15.79%) had bilateral involvement. A total of 125 eyes had closed globe injury, 7 eyes had open globe injury and 17 patients needed hospital admission for management. The mean (SD) baseline BCVA was 0.54(+/−0.75). The mean (SD) final BCVA improved to 0.23(+/−0.62) till the last follow-up. The final outcome was good in most patients, except 5 eyes (3.78%) which resulted in near/total blindness. Conclusion Firecracker injuries are a major cause of irreversible blindness, especially among the younger age group. Prompt diagnosis with meticulous management can prevent devastating sequelae.

Corneal epithelial ingrowth after perforating corneal injury: a case report

BackgroundEpithelial ingrowth is a rare complication after ocular perforation and can become manifest many years after the primary trauma.Case presentationA 49-year-old patient presented with a positive Seidel test of unclear origin at her left eye, as well as a sharply defined anterior-stromal corneal scar at both eyes. Prior operations included a bilateral laser-assisted blepharoplasty 3 months earlier. The patient indicated to have been on holiday to France 5 months earlier, during an ongoing oak processionary moth caterpillars infestation.The examination using confocal microscopy confirmed a corneal perforation at the left eye and revealed corneal epithelial ingrowth capped with scarred stroma in both eyes. We performed a penetrating keratoplasty at the left eye. The scarred and perforated host cornea was divided into 4 pieces for further investigation: microbiology (negative), virology (negative), histology and transmission electron microscopy (TEM). Histology revealed differently structured epithelium, centrally inverted into the stroma through defects in Bowman’s layer. TEM revealed full thickness corneal perforation with an epithelial plug extending to the lower third of the cornea, but without evidence of epithelial cell migration into the anterior chamber.Our differential diagnosis of the unclear positive Seidel test with epithelial ingrowth was as follows: (1) corneal perforation by hairs of the oak processionary moth caterpillar, although no hairs could be found histologically; (2) corneal perforation during laser-assisted blepharoplasty, which may be supported by the presence of pigmented cells on the posterior surface of Descemet´s membrane, pointing to a possible iris injury.ConclusionConsequently, we highlighted that contact lenses can be useful, safe and inexpensive protective devices in upper eyelid procedures to protect the cornea against mechanical iatrogenic trauma.

A Porcine-Based Task Trainer for the Instruction of Seidel's Test and Ocular Foreign Body Removal.

Ophthalmologic emergencies account for tens of thousands of patients presenting to the emergency department (ED) each year. Studies continue to show that ophthalmology education in medical school is limited, and this leads to many resident physicians who lack confidence in their ophthalmological examination and procedural skills if opportunities to practice these skills are not deliberately sought out during their training. Medical simulation continues to be an excellent way for physicians to learn and master these anxiety-inducing procedures. We present a newly modified, innovative, and realistic porcine-based emergency ophthalmologic procedural task trainer with live television screen projection to further improve Emergency Medicine (EM) resident education on the performance of Seidel's test and ocular foreign body removal.

A novel approach to sclerotomy closure in pars plana vitrectomy: a pilot study

BackgroundMethods of sclerotomy closure following a vitrectomy, including the use of sutures, have been associated with complications such as inflammation, foreign body sensation, and infection. Here, we test an innovative approach to scleral wound closure following pars plana vitrectomy that involves plugging the wound. We investigated several materials with the intent of using products that were either already approved by the FDA for other types of procedures or were biocompatible patient-derived materials.MethodsWe examined whether scleral wounds could be sealed by a clot or internal “plug” rather than a suture or an external adhesive. We tested patient-derived materials (platelet-rich plasma (PRP) and whole blood) as well as polyethylene glycol (PEG) sealant. Whole blood and PRP were prevented from clotting prematurely using sodium citrate, and were clotted for the study with thrombin. Polyethylene glycol (PEG) sealant was prepared according to manufacturer’s recommendations. We used fresh-frozen cadaveric porcine eyes. We tested several methods to form plugs using the above materials, as well as various methods to deliver the plugs into the sclerotomy incisions. We used a novel technique of manual vitrectomy. Successfully generated and implanted clots were tested for efficacy with the Seidel test.ResultsPolyethylene glycol (PEG) sealant fractured during our attempts at molding and inserting the plug. In contrast, both whole blood and PRP yielded successful plugs for insertion. We molded a whole blood clot plug by allowing it to clot inside a 20-gauge angiocath catheter and we successfully delivered it through a 23G trocar. At baseline, no wound leakage was apparent. However, the whole blood clot dislodged during the Seidel test. We successfully molded and delivered a PRP clot plug using a tapered 2-20 μl pipette tip, using MAXGrip Forceps to push it through into the wound. No scleral wound leakage was noted at our baseline physiologic infusion pressure. Furthermore, the PRP clot plug prevented scleral wound leakage up to a pressure of 60 mmHg and was confirmed with the Seidel test.ConclusionOur findings suggest that insertion of a clot plug made from either whole blood or PRP may be an effective strategy for scleral wound closure following pars plana vitrectomy. Further testing in preclinical models is warranted to further refine the materials and methods, since this appears to have the potential to improve the closure of the scleral wounds after pars plana vitrectomy.

Management of a central corneal perforation in the emergency room: Tenon patch technique.

PurposeCorneal perforations are defined as a solution of continuity in the cornea. Usually, these cases evolve to the formation of a corneal-iridial scar or require surgical intervention. The tenon patch graft represents a good alternative to other methods and has many advantages.ObservationA 63-year-old patient who had been followed for severe dry eyes due to rheumatoid arthritis for 10 years presented to the emergency room with a central corneal perforation, partially sealed by the iris, accompanied by significant corneal edema in the right eye. Given the clinical picture that had been developing for 5 days, we decided to perform a tenon patch graft on the perforation. At 4 weeks of follow-up, globe integrity was maintained with a well-placed tenon patch. No evidence of leakage in the Seidel test was noted.ConclusionThe tenon patch graft represents a good alternative in the management of corneal perforations and has many advantages, among which the feasibility in an emergency, allowing a corneal graft afterwards.

Postoperative Complications of Trabeculectomy in Primary Open Angle Glaucoma Versus Primary Angle Closure Glaucoma

Purpose: To compare the frequency of postoperative complications of trabeculectomy in primary open angle glaucoma (POAG) with primary angle closure glaucoma (PACG). Study Design: Comparative experimental study. Place and Duration of Study: Department of Ophthalmology, Abbasi Shaheed Hospital, Karachi, from January 2017 to November 2019. Methods: Seventy-one patients who underwent primary trabeculectomy without antimetabolites for primary open-angle glaucoma and primary angle-closure glaucoma during the given period were included in the study. Patients who had significant cataract, repeated trabeculectomy, failed argon laser trabeculoplasty and trabeculectomy done for congenital glaucoma, traumatic glaucoma, secondary glaucoma were excluded from the study. Patients were followed up for 12 months and complications were compared. Secondary outcome was reduction in IOP. Results: Out of 71 patients, 52 had POAG and 19 had PACG. The mean age was 56.7 ± 10.9 for POAG and 52.2 ± 9.5 for PACG. The frequency of complications in POAG group was 28.2% and in PACG group was 21.1% (p &gt;0.005).Complications were: cataract, uveitis, hyphema, choroidal folds, shallow anterior chamber, high IOP and positive Seidel test. Mean IOP reduction was from 31 ± 6.7mm of Hg and 40 ± 14.8 to 15.6 ± 4.2 and 13.8 ± 4.7 in POAG and PACG respectively (p-value &gt; 0.005).Trabeculectomy was successful in 80.7% POAG and 73.6% PACG patients (p value &gt; 0.005). Conclusion: No significant difference was observed in the frequency of complications in POAG and PACG patientsfollowing Trabeculectomy, over a period of 12 months. Trabeculectomy was equally effective in lowering IOP in both the groups. Key Words: Glaucoma, Primary Open Angle Glaucoma, Primary Angle Closure Glaucoma, Trabeculectomy,

Endophthalmitis after corneal suture removal

Introduction: To report 2 patients with acute-onset endophthalmitis after intraocular lens exchange and delayed corneal suture removal. Patient and Clinical Findings: An 83-year-old woman and a 64-year-old man developed pain, decreased vision, corneal infiltrate, marked intraocular inflammation, and vitreous membranes after corneal suture removal. Topical povidone–iodine was not used before suture removal, and the wounds showed negative results for Seidel test at presentation. Diagnosis, Intervention, Outcomes: Both patients were diagnosed with acute-onset endophthalmitis. One received vitreous tap and injection (T&amp;I) and the other received both T&amp;I and pars plana vitrectomy. Intravitreal vancomycin and ceftazidime were administered in both patients. Cultures demonstrated streptococcal species. Outcomes were poor: 1 eye was enucleated and the other showed light perception. Conclusions: Endophthalmitis in the setting of corneal suture removal can be associated with severe vision loss. Topical povidone–iodine antisepsis and topical antibiotics should be considered for endophthalmitis prophylaxis in this procedure.

CLINICAL CHARACTERISTICS AND VISUAL OUTCOMES IN ENDOPHTHALMITIS AFTER KERATOPROSTHESIS IMPLANTATION.

To describe the presentation, microbiology, management, and prognosis of eyes with endophthalmitis after Boston keratoprosthesis implantation. Retrospective case series with history, diagnostics, management, and outcomes data in endophthalmitis after keratoprosthesis implantation presenting to a tertiary center between 2009 and 2020. Of 137 keratoprosthesis-implanted eyes, 7 eyes of 7 patients (5%) developed endophthalmitis. On presentation, 6 (86%) reported decreased visual acuity, and only 1 (14%) reported pain. Peripheral corneal ulcers were present in 2 eyes (29%). Seidel testing was negative in all cases. Six eyes (86%) had retroprosthetic membranes. One (14%) underwent initial pars plana vitrectomy with mechanical vitreous biopsy, whereas 6 (86%) received a needle vitreous tap-half of which were dry. Organisms were isolated after vitreous tap in two eyes: Streptococcus intermedius and Mycobacterium abscessus. The mean visual acuity preendophthalmitis, at presentation, and at 6 months were 20/267, 20/5,944, and 20/734, respectively. The visual acuity improved 9.08 ± 11.78 Early Treatment Diabetic Retinopathy Study lines from presentation to 6 months. Six-month visual acuity was correlated with preendophthalmitis visual acuity (r = 0.92, P = 0.003) but not presenting visual acuity (P = 0.838). Visual acuity at 6 months is correlated with preendophthalmitis visual acuity, not presenting visual acuity. Endophthalmitis should be considered in the differential diagnosis of painless intraocular inflammation any time after keratoprosthesis implantation, even if Seidel negative.