Acuity Of Hand Motion Research Articles

The Outcome of Vitrectomy in Acute Postoperative Endophthalmitis

Introduction: Twenty years ago, the results of Endophthalmitis Vitrectomy Study (EVS) were adapted worldwide as the standard management of endophthalmitis. The study suggested that there was no benefit of performing vitrectomy for acute postoperative endophthalmitis, unless for patients who presents with visual acuity of light perception. However, vitrectomy with advanced technology and technique has been changed rapidly in the last decades; therefore, we need to reconsider its role. We conducted a study and the purpose of our study was to describe the indications for vitrectomy and the outcomes in acute postoperative endophthalmitis at Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
 Methods: Our study was a descriptive-retrospective case series. We reviewed clinical and microbiological records of all patients with clinical diagnosis of acute postoperative endophthalmitis who underwent vitrectomy in Cipto Mangunkusumo Hospital between 2007 and September 2015. Presenting visual acuity, visual outcome and complications were described.
 Result: Our study was a descriptive-retrospective case series. We reviewed clinical and microbiological records of all patients with clinical diagnosis of acute postoperative endophthalmitis who underwent vitrectomy in Cipto Mangunkusumo Hospital between 2007 and September 2015. Presenting visual acuity, visual outcome and complications were described. 
 Conclusion: An eight-year experience has taught us that vitrectomy offers better treatment outcome in the group with visual acuity of hand movement than those who only had visual acuity of light perception.

Predictive factors in the treatment of streptococcal endophthalmitis.

ObjectiveTo evaluate visual outcomes and possible predictive factors in the treatment of infectious endophthalmitis caused by Streptococcus species during 2012–2016 at a large referral eye center in northeastern Thailand.MethodsA retrospective medical record chart review of patients with culture-positive endophthalmitis caused by Streptococcus species was conducted. Demographic data including age, gender, occupation, duration of symptoms, time to surgery, surgical procedures, initial visual acuity at presentation, and final visual acuity after treatment were collected and analyzed. Possible predictive factors associated with improved visual outcomes were also studied.ResultsForty-five eyes of 45 patients were recruited for the study. The 3 most common types of endophthalmitis were postoperative (35.56%), posttraumatic (20%), and endogenous (15.56%). At presentation, most patients (95.56%) had visual acuity of hand motion (55.56%), light perception (28.89%), or no light perception (11.11%). The 3 most common isolates were Streptococcus pneumoniae (44.44%), Group B β-hemolytic Streptococcus (26.68%), and Streptococcus viridans (20%). Most patients (62.22%) were treated with surgical interventions, either pars plana vitrectomy with intravitreal antibiotics or pars plana vitrectomy with intravitreal antibiotics and silicone oil tamponade. After treatment, improved visual outcome was noted in only 9 patients (20%), and no visual improvement was seen in 36 patients (80%). Evisceration and enucleation were performed in 15 patients (33.33%). The only possible predictive factor associated with improved visual outcomes was early vitrectomy, performed within 3 days.ConclusionStreptococcal endophthalmitis is often associated with poor visual prognosis. Only 9 patients (20%) had improved vision after treatment. The only possible predictive factor associated with improved visual outcomes was vitrectomy within 3 days. Early diagnosis and early vitrectomy are therefore recommended.

Tenon patch graft for corneal fistula: a rare entity treated by a simple technique

A 50-year-old patient presented with dull aching pain with some discomfort in his right eye for the past 2 weeks. History revealed the patient had a past episode of infective...

Two-staged en bloc excision of a retinal haemangioma

A 31-year-old man presented to us with diminution of vision in the right eye which he noticed since 10 days, with a visual acuity of hand motions only. On examination,...

Acute endophthalmitis after cataract surgery: 164 consecutive cases treated at a referral center in South Korea.

PurposeTo identify prognostic factors in patients referred with endophthalmitis after cataract surgery, and to evaluate the efficacy of primary vitrectomy as an initial management.MethodsOver an eight-year study period, we retrospectively reviewed the medical records of 164 patients who were referred with endophthalmitis following cataract surgery. Treatment generally conformed to standard guidelines, although primary vitrectomy was performed in several eyes with a visual acuity of hand motion or better, depending on the patient's status. Using multivariate analysis, we analyzed outcomes to determine the effect on final visual outcome.ResultsA final visual acuity of ≥20/40 was achieved in 92/164 (56.1%) cases after treatment. Bacterial cultures showed bacterial growth in 89/164 cases (54.3%). Among the various baseline characteristics, old age (P=0.028), poor visual acuity at presentation (P=0.004), gram-negative bacterial infection (P=0.030), and short time between cataract surgery and signs of endophthalmitis (P=0.021) were associated with poor visual outcome. The visual outcome showed no significant difference, in terms of initial treatment feature, between the primary vitrectomy with intraocular antibiotics injection (IOAI) and IOAI-only groups. However, reintervention was significantly less frequent in the primary vitrectomy group than in the IOAI group (12.5 and 32.7%, respectively; P=0.002).ConclusionOld age, poor visual acuity at presentation, type of cultured organism (gram-negative bacteria), and early onset of endophthalmitis after cataract surgery were significantly related to poor visual outcome after endophthalmitis treatment. Primary vitrectomy may decrease the need for reintervention to control infection, although the treatment showed no benefits with regard to visual outcome.

Clinical Profile and Outcomes of Optic Neuritis in an HIV Prevalent Urban Community in South Africa.

PURPOSE:To determine the clinical profile, causes and response to corticosteroid therapy in patients admitted and treated for optic neuritis at a tertiary hospital in Cape Town, South Africa.METHODS:A retrospective case review of 117 patients with optic neuritis between January 2002 and December 2012. Demographic information, clinical presentation, course of illness, investigations performed and visual outcomes at discharge and at three month follow up were collected for analysis.RESULTS:60 of 117 patients (51%) had an identifiable secondary cause for optic neuritis. Of the 57 patients with idiopathic optic neuritis, 14 had features associated with demyelinating disease. HIV and syphilis accounted for 62% of secondary causes of optic neuritis. Presenting visual acuity of hand movements (HM) or worse and absence of pain with extra ocular movement were associated with poorer final visual outcomes in the idiopathic optic neuritis group.CONCLUSION:Optic neuritis in our patients, as elsewhere in Africa, tends to be atypical in presentation. A high proportion of patients have an identifiable secondary cause. These patients thus require more extensive investigation in order to identify causes which may influence management. Secondary optic neuritis and idiopathic atypical optic neuritis carry a poorer prognosis than typical demyelinating optic neuritis.

A rare case of Phialemonium obovatum keratitis

PurposeWe report a rare case of Phialemonium obovatum fungal keratitis in a patient sustaining a corneal laceration from impact with a piece of moldy plaster. ObservationsThe patient was treated with topical voriconazole with resolution of active keratitis and formation of a stromal scar. The patient's final visual acuity was 20/20 in the affected eye. Conclusions and importanceThere is only one other case of Phialemonium obovatum keratitis reported in the literature. The patient in the previous case required amniotic membrane transplantation for persistent stromal melting with resultant visual acuity of hand motions only. The present case demonstrates that the early use of topical antifungal medication with close follow-up can prevent corneal perforation and result in excellent visual acuity.

Two cases of Vogt-Koyanagi-Harada's disease in sub-Saharan Africa.

Vogt–Koyanagi–Harada’s (VKH) disease has been reported to be rare in sub-Saharan Africa. Two Nigerians with the disease are presented in this report. The first patient, a 32-year-old pregnant Nigerian woman presented with a 1-month history of bilateral blurring of vision, persistent headache, and alopecia. Presenting visual acuity was 1 m counting fingers in both eyes. Examination revealed vitiligo and poliosis with bilateral panuveitis as well as bilateral exudative retinal detachment. A clinical assessment of complete VKH disease was made. The patient commenced systemic and topical steroids that resulted in remarkable recovery of vision and control of inflammation. The second patient, a 56-year-old Nigerian woman presented with severe headache, tinnitus, and visual loss in both eyes of 2 weeks duration. There was associated redness of both eyes and photophobia. Examination showed visual acuity of Hand motion (HM) and counting fingers at 1 meter (CF). in the right and left eye, respectively, with bilateral panuveitis and bilateral exudative retinal detachment. Subsequent follow-up showed poliosis, vitiligo, and sunsetting fundus appearance. The patient improved with systemic and topical corticosteroids. Developing a high index of suspicion is necessary in diagnosing VKH disease, even in sub-Saharan Africa. Prompt institution of appropriate treatment prevents blindness.

Long-term Outcomes of Amniotic Membrane Transplantation in Contact Lens-Induced Pseudomonas Keratitis with Impending Corneal Perforation.

Purpose:To report the anatomical and visual outcomes of double layered amniotic membrane transplantation (AMT) in eyes with advanced Pseudomonas keratitis leading to Descemetocele formation.Methods:This prospective interventional case series included 6 eyes of 6 female patients with pseudomonas keratitis caused by contact lens-induced infection who underwent double layered AMT. Surgery was performed after the ulcers were found to be poorly responsive to antibiotics, and severe thinning or Descemetocele had developed. All patients underwent a complete examination pre- and postoperatively, as well as anterior segment optical coherence tomography (OCT) and pachymetry or Orbscan after the procedure.Results:Mean follow-up period was 24 months. There was neither frank corneal perforation nor a need for emergent corneal transplantation in any of the eyes. All patients had visual acuity of hand motions before the procedure which improved to 20/50 to 20/30 three months after surgery. No surgical or postoperative complication occurred in this series.Conclusion:Double layered AMT may result in acceptable anatomical outcomes in patients with advanced Pseudomonas keratitis with Descemetocele formation and can eliminate the need for emergent corneal transplantation.

Visual outcome in early vitrectomy for posterior persistent fetal vasculature associated with traction retinal detachment.

This study investigates the anatomical and visual outcome of vitrectomy for the treatment of unilateral posterior persistent fetal vasculature with associated traction retinal detachment in very young patients. A retrospective case series study from 1998 through 2010 of 11 eyes in 11 patients who underwent pars plana vitrectomy with or without lensectomy for unilateral posterior persistent fetal vasculature with traction retinal detachment affecting the macula. Ten of the 11 patients (91%) received surgical intervention when 13 months old or younger (average age, 4 months). Postoperatively, 6 of 10 eyes (60%) had 20/800 or better vision, 2 of which had 20/60 vision. All 10 patients in this group had their retinas reattached postoperatively with significant reversal of retinal dragging. One of the 11 patients (9%) received surgical intervention for posterior persistent fetal vasculature at 33 months of age. This patient had persistent traction retinal detachment and a postoperative visual acuity of hand motion. Postoperative glaucoma was detected in 4 patients (36%). This study suggests that early intervention in patients with unilateral posterior persistent fetal vasculature with associated macula affecting traction retinal detachment may provide a better visual and anatomical outcome when vitrectomy and retinal reattachment are performed at a very early age.

360° laser retinopexy in preventing retinal re-detachment after 23-gauge vitrectomy for primary repair of retinal detachment

Aims: To evaluate the role of intraoperative 360° laser retinopexy in the prevention of retinal re-detachment in cases of primary rhegmatogenous retinal detachment (RRD). Settings and Design: Prospective randomized controlled trial, 80 eyes of 80 patients with primary RRD. Subjects and Methods: Totally, 80 eyes of 80 patients with primary RRD will be divided into two groups. In Group (A), laser will be applied to all existing breaks as well as 360° laser retinopexy anterior to the equator will be performed while Group (B) laser will be applied only to the retinal breaks and will not receive the 360° laser treatment. Follow-up was for 3 months after clearance of the tamponading agent. Statistical Analysis Used: Backward logistic multi-regression analysis identified significant independent predictors of re-detachment (P < 0.01, Hosmer-Lemeshow, χ2: 7.593, P = 0.474). Results: Backward logistic multi-regression analysis identified significant independent predictors of re-detachment (P < 0.01, Hosmer-Lemeshow, χ2: 7.593, P = 0.474): Duration of detachment and preoperative visual acuity. Specifically, for every day more of duration of detachment, the odds of re-detachment increased by a factor of 1.007 (P < 0.01). Likewise, for every day more of duration of detachment, the odds of re-detachment was increased by a factor of 8.840 if a preoperative visual acuity of hand motion with bad projection (HMBP) or worse was present (P = 0.05). Conclusions: We concluded that prophylactic intraoperative 360° laser retinopexy did not have a statistically significant role in the prevention of retinal re-detachment after primary retinal repair. The statistically significant preoperative risk factors that have a poor prognostic effect on surgical outcomes are preoperative visual acuity of ≤ HMBP or worse and a longer duration of the retinal detachment.

Is There a Role for Intravitreal Triamcinolone Acetonide Injection in the Treatment of Purtscher-Like Retinopathy? Report of Two Cases

We hereby described two cases with unilateral Purtscher-like retinopathy. The first case occurred following an uneventful spontaneous vaginal delivery. The second case had no discernable cause despite having meticulous systemic work-up. Both eyes had low presenting visual acuity of hand movements and 20/200 consecutively. We elected to inject 1 mg triamcinolone acetolamide in-travitreally for the treatment. Though, there was some subjective visual and clinical improvement within time in both patients, we were not convinced that intravitreal injection was superior to no treatment approach.

Late-Onset Endophthalmitis Associated with Glaucoma Surgery

Purpose: To report cases of late-onset endophthalmitis associated with glaucoma surgery. Methods: We retrospectively reviewed the medical records of 4905 consecutive patients who underwent glaucoma surgery (trabeculectomy or valve implant surgery) from January 1, 1988 to March 31, 2013. Results: There were a total of 14 late-onset endophthalmitis (0.29%) cases associated with glaucoma surgery occurring at 1 year to 21 years postoperatively. Six cases (6/993, 0.60%) occurred after valve implantation and the other 8 cases (8/3912, 0.20%) occurred after trabeculectomy (p = 0.046). All but one patient were injected with fortified vancomycin and ceftazidim. Four patients also received a vitrectomy with the injection. The implanted valve was removed in 2 cases. In four cases, organisms were found in the culture (staphylococcus.aureus, streptococcus viridians, propionibacterium acnes and candida parapsilosis). After 1 year, only 4 patients achieved a visual acuity above 4/200 compared with other patients who had a final visual acuity of hand motion or worse. Three patients (33%) who developed endophthalmitis underwent other intraocular procedures. Conclusions: Late-onset endophthalmitis associated with glaucoma surgery can often occur with fulminant sight-threatening complications. Due to devastating sequelae, the surgeon should carefully check the surgery site in the patients who underwent glaucoma surgery at every follow-up visit. Delayed endophthalmitis after glaucoma surgery still carries a poor visual prognosis and its onset is difficult to predict. Therefore, patients who undergo glaucoma surgery should be educated and carefully evaluated during regular follow-ups. J Korean Ophthalmol Soc 2014;55(11):1651-1658

Listeria monocytogenes endophthalmitis following keratoconjunctivitis

Endophthalmitis due to endogenous or exogenous bacteria is a rare infection of the eye. We report a case of endophthalmitis following Listeria monocytogenes keratoconjunctivitis in a 27-year-old healthy white male presenting with hand motion visual acuity, right eye mucopurulent conjunctivitis, elevated intraocular pressure, and pigmented hypopyon 6 months post-keratectomy. The conjunctivitis was unresponsive to a 5-day course of topical tobramycin eye drops, and the patient developed keratitis with pain that progressed to endophthalmitis after 21 days. Diagnostic B-scan revealed vitreous exudates. Intraocular fluid specimen showed Gram-positive organisms and the aqueous culture grew penicillin-/aminoglycoside-sensitive L. monocytogenes. The patient was given intravitreal and systemic vancomycin and ceftazidime. The eye was unresponsive to intravenous penicillin and gentamicin; the anterior chamber progressively flattened and developed phthisis bulbi. L. monocytogenes keratoconjunctivitis may lead to bacterial endophthalmitis. Prompt culture and early antibiotic therapy are recommended.

Efficacy of Intravitreal Ranibizumab Injection in Acute Nonarteritic Ischemic Optic Neuropathy: A Long-Term Follow Up§

Background: To evaluate the effect of a single intravitreal ranibizumab injection in eyes with acute nonarteritic ischemic optic neuropathy (NAION).Subjects and Methods: In this retrospective clinical data analysis, 17 eyes of sixteen patients who experienced a visual loss with duration of 15 days or less comprised the study group. In addition to standard ophthalmic examination, retinal nerve fiber layer thickness (RNFLT) analysis with spectral domain OCT was also performed prior to 0.5 mg Ranibizumab injection, one week, one, three, six months and one year after the injection.Results: The mean time between visual loss and intravitreal injection was 7.5 days (Range, 2-15 days). Mean age of patients was 59 years (Range, 41-90 years). Male to female ratio was 6:10. After a single dose of ranibizumab injection, visual gain was noted in 14 of 17 study eyes. In two eyes, visual acuity was minimally reduced and no change was noted in the remaining eye with an initial visual acuity of hand motions. While pre-injection mean best-corrected visual acuity (BCVA) was 1.45 ±0.88 log Mar unit, post-injection mean BCVA was 1.00±0.68, 0.86 ±0.70, 0.80 ±0.71, 0.77 ±0.70, 0.77 ±0.70 log Mar unit respectively at the first week, first month, third month, sixth month and first year. In all patients, the mean RNFLT dramatically decreased after the injection during the follow- up. While pre-injection mean RNFLT was 210 ±38 µm, post-injection mean RNFLT was 162.11±40.2, 94±27, 71.23±22.5, 63 ±19 and 57 ±18 µm respectively at the first week, first month, third month, sixth month and first year. No injection related complication was noted during the follow-up period.Conclusion: Intravitreal ranibizumab injection can be a treatment modality in eyes with acute NAION.

English

AIM: To report a case of Central Retinal Artery Occlusion (CRAO) in young males in its initial manifestation as Primary Antiphospholipid Syndrome. METHODS: 32 year healthy male, with abrupt sudden painless loss of vision in right eye since 48 hours, with Grade 2 Relative afferent pupillary defect, visual acuity of hand movements in OD and 6/18 in OS. Fundoscopy disclosed signs compatible of central retinal artery occlusion confirmed with FFA. Carotid Doppler imaging and echocardiography was done to determine the source. RESULTS: Antiphospholipid antibody cofactor, beta2-glycoprotein 1 antibodies, IgM, was positive with titre of more than 94 un its/ml on two occasions, 12 weeks apart, with normal range being less than 20 units/ml for each isotope (IgG, IgM, or IgA).According to the 2006 revised Sapporo criteria Antiphospholipid syndrome was diagnosed. Thorough examination excluded other system involvement. Immunological studies excluded other systemic disorders. CONCLUSIONS: In literature, prevalence of CRAO is 0.85% for every 100000 and prevalence of Antiphospholipid Syndrome in patients showing a major retinal vascular obstruction is 5% - 33%. Antiphospholipid syndrome should be ruled out in every young patient who presents with Central retinal artery occlusion. Association must be considered, as Central retinal artery occlusion could be the initial manifestation of antiphospholipid syndrome with high risk of recurrence.

Frosted Branch Angiitis as Ocular Manifestation of Behçet's Disease: Unusual Case Report and Literature Review

We report an unusual case of unilateral frosted branch angiitis associated with Behçet's disease, including a review of previously reported cases. A 39-year-old male with history of recurrent oral and genital ulcers presented with visual loss in his left eye. Fundus findings demonstrated occlusive retinal vasculitis resembling acute frosted branch angiitis. Laboratory examinations including viral markers revealed no abnormal findings except positive HLA-B51. The patient was treated with systemic steroid and cyclosporine. Six months after presentation, new oral ulcers and pseudofolliculitis appeared, and he was diagnosed with Behçet's disease following rheumatology consultation. During follow-up, there was no change in visual acuity of hand movement, and disc neovascularization developed even after complete panretinal photocoagulation. Ocular manifestations of Behçet's disease can present as unilateral frosted branch angiitis, and may consecutively involve in both eyes. Early immunosuppressive treatment is recommended.

Candida dubliniensis endophthalmitis: five cases over 15 years

BackgroundRecent studies have shown that the recently identified organism Candida dubliniensis is less pathogenic than the more common Candida albicans. Due to its rare nature, C. dubliniensis has been previously reported as the causative organism in endophthalmitis in only three cases. We undertook a multicenter, retrospective, consecutive case series to describe the clinical features and outcomes of patients with culture-proven C. dubliniensis endophthalmitis. Medical records were reviewed for all patients with C. dubliniensis endophthalmitis on vitreous/aqueous cultures from June 1998 to June 2013 from all public hospitals throughout Queensland, Australia.ResultsSix eyes from five patients were identified - four males and one female aged from 21 to 55 years (mean 37 years). Four patients were intravenous drug users and four patients had hepatitis C. All five patients were treated with systemic antifungal therapy and intravitreal antifungal injections, and all required vitrectomy. Two eyes developed retinal detachment over the course of the endophthalmitis. Five eyes had visual outcomes of 20/60 or better, and one eye had a poor outcome with final visual acuity of hand movements only. There was no associated mortality, and no infected eyes required enucleation or evisceration.ConclusionsC. dubliniensis endophthalmitis is a rare condition which occurs mainly in intravenous drug users and can occur in both HIV-positive and HIV-negative patients. Unlike C. albicans endophthalmitis, C. dubliniensis endophthalmitis has reasonable visual outcomes and does not appear to be associated with high mortality.

Tacrolimus-Associated Ischemic Optic Neuropathy and Posterior Reversible Encephalopathy Syndrome After Small Bowel Transplantation

Tacrolimus-Associated Ischemic Optic Neuropathy and Posterior Reversible Encephalopathy Syndrome After Small Bowel Transplantation

Treatment of Acute Visual Loss in Giant Cell Arteritis

Treatment of Acute Visual Loss in Giant Cell Arteritis