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Endophthalmitis
Selected Abstracts4367: Intravitreal injection of anti-VEGF and diagnosis of primary intraocular-central nervous system lymphomaACTA OPHTHALMOLOGICA, Issue 2010J GAMBRELLE Purpose We report the case of the diagnosis of primary intraocular- central nervous system (CNS) lymphoma in a patient treated by anti-VEGF. Methods An 88-year old female, with a medical history of bilateral ARMD treated by intravitreal injections of ranibizumab for 1 year, was referred to our department for bilateral vitritis diagnosed 10 days after the last anti-VEGF injection. A complete vitritis work-up including aqueous humour analysis, magnetic resonance imaging of the brain and vitreous biopsy enabled us to confirm the diagnosis of primary intraocular-CNS lymphoma. Results To the best of our knowledge, this is the first report of the diagnosis of primary intraocular-CNS lymphoma in a patient treated by anti-VEGF for ARMD. In our opinion, the occurrence of lymphoma in this case was coincidental and not due to the anti-VEGF injections. The differential diagnosis of vitritis in elderly patients is relatively large. Endophthalmitis or uveitis has been described after anti-VEGF injections. In such a situation, there is actually a risk of overlooking a diagnosis of intraocular lymphoma in the mistaken belief that the observed vitritis may be a reaction to administred anti-VEGFs. If no direct time-relationship with the anti-VEGF injections can be found, a classic vitritis work-up should be performed. Anti-VEGF treatment did not impede cytological diagnosis in our patient. Conclusion Although in some none-CNS non-Hodgkin lymphomas (NHL) systemic anti-VEGF therapy is added to chemotherapy schedules, the use of anti-VEGF did not halt the spread of the lesion within the eye in this case. It can, therefore, be presumed that local anti-VEGF therapy has no adjuvant effect in primary intraocular lymphoma. [source] Fine-needle aspiration biopsy and other biopsies in suspected intraocular malignant disease: a reviewACTA OPHTHALMOLOGICA, Issue 6 2009Nils Eide Abstract. Ocular oncologists require a strong indication for intraocular biopsy before the procedure can be performed because it carries a risk for serious eye complications and the dissemination of malignant cells. The purpose of this review is to evaluate the extent to which this restricted practice is supported by evidence from previous reports and to outline our main indications and contraindications. The different intraocular biopsy techniques in the anterior and posterior segment are discussed with a focus on our preferred method, fine-needle aspiration biopsy (FNAB). In the literature, complications are typically under-reported, which reduces the possibilities of evaluating the risks correctly and of making fair comparisons with other biopsy methods. In FNAB, the exact placement of the needle is critical, as is an accurate assessment of the size of the lesion. Fine-needle aspiration biopsy is usually not a reliable diagnostic tool in lesions < 2 mm in thickness. It is very advantageous to have a cytopathologist present in the operating theatre or close by. This ensures adequate sampling and encourages repeated biopsy attempts if necessary. This approach reduces false negative results to < 3%. Adjunct immunocytochemistry is documented to increase specificity and is essential for diagnosis and management in about 10% of cases. In some rare pathological processes the diagnosis depends ultimately on the identification of specific cell markers. An accurate diagnosis may have a decisive influence on prognosis. The cytogenetic prognostications made possible after FNAB are reliable. Biopsy by FNA has a low complication rate. The calculated risk for retinal detachment is < 4%. Intraocular haemorrhage is frequently observed, but clears spontaneously in nearly all cases. Only a single case of epibulbar seeding of malignant cells at the scleral pars plana puncture site of transvitreal FNAB has been documented. Endophthalmitis has been reported and adequate standard preoperative preparation is obligatory. An open biopsy is still an option in the anterior segment, but has been abandoned in the posterior segment. Although vitrectomy-based procedures are becoming increasingly popular, we recommend using FNAB as part of a stepwise approach. A vitrectomy-assisted biopsy should be considered in cases where FNAB fails. In any adult patient with suspected intraocular malignancy in which enucleation is not the obvious treatment, the clinician should strive for a diagnosis based on biopsy. When the lesion is too small for biopsy or the risks related to the procedure are too great, it is reasonable to be reluctant to biopsy. The standards applied in the treatment of intraocular malignant diseases should be equivalent to those in other fields of oncology. Our view is controversial and contrary to opinion that supports current standards of care for this group of patients. [source] Endophthalmitis after contemporary cataract surgery: defining incidence and risk factorsCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 3 2003Charles NJ McGhee PhD FRCOphth FRANZCO No abstract is available for this article. [source] Endophthalmitis in the western Sydney region: a case-control studyCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 6 2001Somsak Lertsumitkul FRACO ABSTRACT Background: A retrospective case-control study was conducted to investigate risk factors for endophthalmitis following routine intraocular surgery. Methods: A review was performed of consecutive cases of endophthalmitis from three teaching hospitals in the western Sydney region and matched controls from the same institutions between 1996 and 1998. Results: There were 31 cases and 66 controls. Eighty procedures were phacoemulsification, 15 conventional extracapsular cataract extraction, and two were penetrating keratoplasties. Of the 80 patients who had phacoemulsification surgery, 50 had a clear corneal incision, and 26 had a scleral incision (four were unknown). Logistic regression showed an increased risk of endophthalmitis with surgical complications (P = 0.002) and clear cornea temporal incisions (P = 0.007). Risk of endophthalmitis was reduced with use of subconjunctival injections (P = 0.008). The yield for the Gram stain was 47% and for culture was 67%. Anterior chamber tap in addition to vitreous biopsy alone did not increase the yield for microorganism (P = 0.78). Mean visual acuity on presentation was hand movement with 13 patients (50%) showing visual improvement following intravitreal injections of antibiotics (P = 0.003). Visual prognosis did not correlate with presenting visual acuity but appeared to be better in those who grew Staphylococcus epidermidis or were culture negative. Conclusions: Although this study is unable to draw definite conclusions regarding risk of endophthalmitis in clear corneal temporal cataract surgery, sufficient data suggest the importance of incision type and location. Surgical complication is an important risk factor for endophthalmitis. Use of subconjunctival antibiotic injections at the conclusion of the procedure is recommended. [source] Blindness following a diabetic foot infection: a variant to the ,eye,foot syndrome'?DIABETIC MEDICINE, Issue 7 2000K. C. J. Yuen SUMMARY Aims The ,eye,foot syndrome' was initially described by Walsh et,al. to highlight the important association of foot lesions in patients with diabetic retinopathy. We present a case of a 58-year-old patient with Type 2 diabetes mellitus who developed blindness following endogenous staphylococcal endophthalmitis from an infected foot ulcer. Results Our case describes the link between the eye and the foot but is somewhat different to the association as described by Walsh et,al. Endogenous endophthalmitis is rare with diabetic patients being especially at risk, and we report the first case of endogenous staphylococcal endophthalmitis related to a diabetic foot lesion. Conclusions Our case illustrates several important issues in the management of diabetic patients admitted to hospital with infection; the need to thoroughly examine the feet to ascertain any foot lesions and any underlying peripheral vascular disease or peripheral neuropathy, to treat aggressively any infected foot lesions to prevent serious complications of septicaemia and to consider rare conditions like endogenous endophthalmitis in any diabetic patient presenting with acute visual impairment and septicaemia. [source] Non-invasive monitoring of commonly used intraocular drugs against endophthalmitis by raman spectroscopyLASERS IN SURGERY AND MEDICINE, Issue 4 2003K. Hosseini MD Abstract Purpose To develop a non-contact and non-invasive method for quantification of the local concentration of certain antibiotic and antifungal drugs in the eye. Study Design/Materials and Methods An integrated CCD-based Raman spectroscopic system designed specifically for ophthalmic applications was used to non-invasively detect the presence of ceftazidime and amphotericin B in ocular media. Specific Raman signatures of the above named drugs were determined for various concentrations that were injected through a needle in the aqueous humor of rabbit eyes in vivo. Raman spectra were subsequently acquired by focusing an argon laser beam within the anterior chamber of the eye. Results Compared to ocular tissue, unique spectral features of ceftazidime appeared near 1,028, 1,506, 1,586, and 1,641 cm,1. Amphotericin B exhibited its characteristic peaks at 1,156.5 and 1,556 cm,1. The amplitude of the spectral peak corresponding to these drugs (acquired by 1 second exposure time and 25 mW of laser power) were determined to be linearly dependent on their local concentration in the anterior chamber of the eye. Conclusions Raman spectroscopy may offer an effective tool to non-invasively assess the local concentration of the delivered drugs within the ocular media. This technique potentially could be used to investigate the pharmacokinetics of intraocular drugs in vivo either from a releasing implant or a direct injection. Lasers Surg. Med. 32:265,270, 2003. © 2003 Wiley-Liss, Inc. [source] Retinal and Optic Nerve DiseasesARTIFICIAL ORGANS, Issue 11 2003Eyal Margalit Abstract:, A variety of disease processes can affect the retina and/or the optic nerve, including vascular or ischemic disease, inflammatory or infectious disease, and degenerative disease. These disease processes may selectively damage certain parts of the retina or optic nerve, and the specific areas that are damaged may have implications for the design of potential therapeutic visual prosthetic devices. Outer retinal diseases include age-related macular degeneration, pathologic myopia, and retinitis pigmentosa. Although the retinal photoreceptors may be lost, the inner retina is relatively well-preserved in these diseases and may be a target for retinal prosthetic devices. Inner retinal diseases include retinal vascular diseases such as diabetic retinopathy, retinal venous occlusive disease, and retinopathy of prematurity. Other retinal diseases such as ocular infections (retinitis, endophthalmitis) may affect all retinal layers. Because the inner retinal cells, including the retinal ganglion cells, may be destroyed in these diseases (inner retinal or whole retinal), prosthetic devices that stimulate the inner retina may not be effective. Common optic nerve diseases include glaucoma, optic neuritis, and ischemic optic neuropathy. Because the ganglion cell nerve fibers themselves are damaged, visual prosthetics for these diseases will need to target more distal portions of the visual pathway, such as the visual cortex. Clearly, a sound understanding of retinal and optic nerve disease pathophysiology is critical for designing and choosing the optimal visual prosthetic device. [source] Effect of caffeic acid phenethyl ester on treatment of experimentally induced methicillin-resi,stant Staphylococcus epidermidis endophthalmitis in a rabbit modelCELL BIOCHEMISTRY AND FUNCTION, Issue 6 2007Özlem Y Abstract This study investigated the anti-inflammatory effects of caffeic acid phenethyl ester (CAPE), a natural bee-produced compound, and compared it with corticosteroids in the treatment of experimentally induced methicillin-resistant Staphylococcus epidermidis (MRSE) endophthalmitis in addition to intravitreal antibiotics. An experimental endophthalmitis model was produced in 24 New Zealand albino rabbits by unilateral intravitreal injection of 0.1,ml of 4.7,×,104 colony-forming units (CFU) methicillin-resistant S. epidermidis. The animals were then divided randomly into three treatment groups and a control group, group 1 (six rabbits), received only intravitreal vancomycin (1.0,mg/0.1,ml); group 2 (six rabbits), received both intravitreal vancomycin (1.0,mg/0.1,ml) and intravitreal dexamethasone (400,µg/0.1,ml) and group 3 (six rabbits), received both intravitreal vancomycin (1.0,mg/0.1,ml) and subtenon CAPE (10,mg/0.3,ml) after 24,h post-infection. No treatment was given to the control group. Treatment efficacy was assessed by clinical examination, vitreous culture and histopathology. There were no statististically significant differences between clinical scores of all groups in examinations at 24 and 48,h post-infection (p,=,0.915 and p,=,0.067 respectively), but in examinations at 72,h post-infection and after 7 days post-infection, although the clinical scores of treatment groups were not significantly different from each other, they were significantly lower than the control group (p,<,0.05). The culture results of all groups were sterile. As a result, CAPE was found to be as effective as dexamethasone in reducing inflammation in the treatment of experimental MRSE endophthalmitis when used with antibiotics. More studies are needed to determine the optimal administration route and effective dosage of this compound. Copyright © 2006 John Wiley & Sons, Ltd. [source] 1253: Technique and role of biopsies in intraocular tumoursACTA OPHTHALMOLOGICA, Issue 2010BE DAMATO Purpose To discuss the roles of various forms of biopsy of intraocular tumours, to describe the techniques and to highlight the main pitfalls and complications. Methods Intraocular tumours can be sampled by exo- or endo-biopsy. Exo-biopsy can consist of excisional biopsy (e.g., iridocyclectomy), trans-scleral incisional biopsy, or trans-scleral fine-needle aspiration biopsy. Endo-biopsy comprises vitreous biopsy and retinal or choroidal biopsy performed with a fine needle or vitreous cutter. In rare cases, enucleation is the most pragmatic method of establishing the diagnosis, especially if the eye is blind and painful. Results For many years, biopsy was performed mostly for diagnostic purposes the main reasons being to distinguish melanoma from metastasis and lymphoma from various forms of uveitis. Recently, prognostic biopsy has become more popular, the objective being to determine whether or not a uveal melanoma is likely to be life-threatening. Biopsy can profoundly influence the management of an individual patient but requires special expertise both in the operating theatre and in the laboratory. There are many possible complications, which include endophthalmitis, extraocular seeding of tumour, rhegmatogenous retinal detachment, cataract, haemorrhage, inconclusive result, and mis-diagnosis. Conclusion Biopsy of intraocular tumours is invaluable in the management of selected patients, but requires special expertise to ensure that good results are obtained without causing complications. [source] 1235: How to prevent postoperative complications?ACTA OPHTHALMOLOGICA, Issue 2010C CREUZOT Purpose Retinal detachment can lead to early and delayed post-operative complications. The purpose of the course is to present the different complications following retinal detachment surgery with their appropriate treatments. Methods The postoperative complications will be divided according to the presentation of the patient (ie inflamed, painful eye or white painless eye) with or without visual loss.Then, IOP measurement and the results from slit lamp and fundus exam will provide us with the main signs useful for diagnosis. Results With a painful red eye, the main severe diagnoses will be the different causes of increased IOP and endophthalmitis. The main cause of increased ocular pressure is related to the internal tamponade used during surgery (gas or silicone). However, the diagnosis of massive passage of silicone in the anterior chamber should be difficult. Hyphema or cataract due to gas should prevent us from a good fundus examination. Conclusion This course will mainly focus on the different early and more delayed complications after retinal detachment surgery and will try to give some rules to decrease this risk. [source] 4235: Vitreoretinal considerations in OOKPACTA OPHTHALMOLOGICA, Issue 2010E HUGHES Purpose To present the difficulties of managing vitreoretinal complications in patients with OOKP and open a discussion about future strategies to prevent and deal with these problems. Methods Retrospective review of cases. Results Vitreo-retinal complications occurred in 14 of 54 patients receiving OOKP surgery. These included vitreous hemorrhage (4 patients), rhegmatogenous retinal detachment (3 patients), endophthalmitis with retinal detachment (5 patients), endophthalmitis without retinal detachment (1 patient) and intraoperative choroidal hemorrhage (1 patient). Most cases of endophthalmitis presented late and may result from lamina resorption, leak and hypotony. The prognosis of retinal detachment in an eye with OOKP was poor with successful repair in 1 of 3 cases not related to endophthalmitis and 0 of 5 cases with endophthalmitis. Overall, pars plana vitrectomy was performed on 10 occasions (8 patients), of which 2 were endoscopic and 2 utilised a temporary keratoprosthesis. Conclusion There is a relatively high rate of posterior segment problems in OOKP patients and their management is challenging both in assessment (limited view and ultrasound amenability) and surgical approach. Surgical outcomes were poor for these complications. Other concepts in management, including endoscopic vitrectomy at stage I surgery should be considered, which will be discussed. [source] 3314: Risk of endophthalmitis in minimally invasive surgeryACTA OPHTHALMOLOGICA, Issue 2010HS TAN [source] 2332: Pathological changes of anatomical structure and markers of limbal stem cell niche due to inflammationACTA OPHTHALMOLOGICA, Issue 2010C CURCIO Purpose It's known that severe inflammatory processes may cause limbal stem cell (SC) deficiency decreasing the number of SC niches and changing the microanatomy of these structures. Methods The aim of this study was to evaluate the expression of different SC markers in normal human limbus and to study how an inflammatory conditions can modulate these antigens. To understand the pathological changes in limbal crypts structure due to severe inflammation, a case of corneal melting and perforation in advanced herpes simplex (HSV) disease, two cases of endophthalmitis and a case of fungal infection were analyzed.Samples were examined by immunohistochemistry or immunofluorescence for p63, vimentin, laminin5, integrin (Int) ,6, int ,1, int ,4, ABCG2, desmoglein 3, connexin43, N-cadherin and cytokeratin (K) 12 positivity. We evaluated the anatomical structure of limbal crypts in each case and the positivity for SC marker used to identify SC. Results In normal limbus, the investigated SC markers were positive. In the HSV we didn't observe presence of crypts, whereas in both cases of endophthalmitis crypts were still present but they had an atypical structure: the basal cells in the crypts were "stretched" and endowed by inflammatory cells. In the pathological cases, we observed positivity for K12 while, among SC markers, p63, ABCG2 and connexin43 were still present; the others antigens were variably expressed. Conclusion Different pathologies involving the limbus may result in marked chenges of expression of SC markers within the crypts. [source] EXTEND-I: safety and efficacy of ranibizumab in Japanese patients with subfoveal choroidal neovascularization secondary to age-related macular degenerationACTA OPHTHALMOLOGICA, Issue 3 2010Yasuo Tano Abstract. Purpose:, To evaluate the efficacy and safety of intravitreal ranibizumab for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) in Japanese patients. Methods:, This open-label, multicentre, Phase I/II study enroled patients into Group A (single injection of ranibizumab nonrandomized doses of 0.3 or 0.5 mg followed by 11 monthly injections of the same dose) and Group B (12 monthly injections of ranibizumab randomized to 0.3 or 0.5 mg). The primary efficacy endpoint was the mean change from baseline in best-corrected visual acuity (BCVA) score at Month 6. Safety was evaluated in all patients who received ranibizumab. Results:, Of 88 patients enroled, 12 entered Group A (six per dose) and 76 entered Group B (0.3 mg: n = 35; 0.5 mg: n = 41). Mean change from baseline in BCVA was significantly increased for both doses (Group B) at Month 6 (0.3 mg: +8.1 letters, p = 0.0006; 0.5 mg: +9.0 letters, p < 0.0001) and Month 12 (0.3 mg: +9.5 letters, p = 0.0001; 0.5 mg: +10.5 letters, p < 0.0001). At Month 12, one patient (0.3 mg) and 0 patients (0.5 mg) lost ,15 letters, while 37.1% (0.3 mg) and 31.7% (0.5 mg) of patients gained ,15 letters. Ocular serious adverse events (SAEs) of the study eye were reported in 1 and 2 patients in the 0.3- and 0.5-mg groups, respectively. Nonocular SAEs were experienced by 2 and 5 patients in the 0.3- and 0.5-mg groups, respectively. No cases of endophthalmitis were reported. Conclusion:, Ranibizumab was effective and well tolerated in Japanese patients with subfoveal CNV secondary to AMD. [source] Trabeculectomy with OloGen versus trabeculectomy for the treatment of glaucoma: a pilot studyACTA OPHTHALMOLOGICA, Issue 1 2010Dimitris Papaconstantinou Abstract. Purpose:, To present the preliminary results of our study comparing the outcomes of trabeculectomy with or without OloGen implant in patients requiring glaucoma surgery for uncontrolled intraocular pressure (IOP). Methods:, Forty eyes of 40 patients were assigned randomly to undergo trabeculectomy either with OloGen implant (study group) or without implant (control group). Preoperative data included age, gender, type of glaucoma, IOP and number of preoperative glaucoma medications. Postoperative IOP, number of postoperative glaucoma medications and postoperative complications were recorded. Each patient was followed up for at least 6 months. Results:, There were no significant differences between the groups in terms of age, gender, type of glaucoma, preoperative IOP and number of antiglaucoma medications. Mean IOPs for both groups were significantly lower than preoperative levels at all intervals (P < 0.05) The number of glaucoma medications used dropped from a preoperative mean of 3.5 ± 0.7 to a 6-month postoperative mean of 0.3 ± 0.7 (P < 0.001) in the study group and from 3.7 ± 0.4 to 0.5 ± 1.1 (P < 0.001) in the control group. No statistically significant differences between the two groups were observed in terms of postoperative complications. Conclusion:, In this pilot study it appears that trabeculectomy with OloGen does not seem to offer any significant advantages compared with trabeculectomy alone. Additionally, even though there were no statistical differences between the two groups as far as complications were concerned, one eye from the study group developed endophthalmitis 10 days after surgery and two eyes presented with positive Seidel test and flat anterior chamber and required additional suturing. Studies with larger numbers of patients and longer follow-ups are required to confirm these findings and to examine the safety and long-term outcomes of trabeculectomy with OloGen. [source] Beneficial effects of preoperative intravitreal bevacizumab on trabeculectomy outcomes in neovascular glaucomaACTA OPHTHALMOLOGICA, Issue 1 2010Yoshiaki Saito Abstract. Purpose:, This study aimed to investigate the effects of preoperative intravitreal bevacizumab (IVB) on outcomes in trabeculectomy for neovascular glaucoma (NVG). Methods:, Charts for 52 NVG eyes of 52 consecutive patients who received primary trabeculectomy with mitomycin C (MMC) were reviewed. Postoperative follow-up periods for all patients were , 4 months. Thirty-two consecutive eyes were treated without IVB (control group) and 20 consecutive eyes received IVB (1.25 mg) 10 ± 11 days before trabeculectomy (IVB group). The main outcome measures were postoperative intraocular pressure (IOP) and incidence of postoperative complications. Surgical success was defined as IOP< 21 mmHg with or without medication (qualified or complete success, respectively). Failure was defined as IOP exceeding these criteria, phthisis bulbi, loss of light perception or additional glaucoma surgeries. Kaplan,Meier survival analysis with the log-rank test was performed to compare surgical success rates between the two groups. Results:, Complete and qualified success rates at 6 months were 95% versus 50% and 95% versus 75% in the IVB and control groups, respectively. The IVB group achieved significantly better surgical success rates than the control group (complete success, p < 0.001; qualified success, p = 0.026). Postoperative hyphaema on day 1 or hyphaema with a duration of > 1 week occurred significantly less frequently in the IVB group than in the control group (p = 0.009, p = 0.014, respectively). The incidence of serious complications such as endophthalmitis, phthisis bulbi and a marked decrease in visual acuity did not increase in the IVB group. Conclusions:, This retrospective study showed that preoperative IVB decreased postoperative hyphaema and increased surgical success rates, and thus may be an effective adjunct to trabeculectomy in NVG. [source] Evaluation of vitreous levels of gatifloxacin after systemic administration in inflamed and non-inflamed eyesACTA OPHTHALMOLOGICA, Issue 6 2009Rajpal Abstract. Purpose:, This study aimed to evaluate the human vitreous penetration of gatifloxacin in inflamed and non-inflamed eyes after oral administration. Methods:, Vitreous penetration of single-dose (400 mg) oral gatifloxacin was evaluated in patients (n = 33) undergoing vitreous tap during the standard procedure for intravitreal antibiotic injection for acute postoperative endophthalmitis at various time-points. Vitreous penetration of 400 mg oral gatifloxacin was evaluated in the non-inflamed eyes of patients (n = 33) undergoing pars plana vitrectomy at similar time-points. The study was extended to evaluate the vitreous penetration of single-dose oral (800 mg) gatifloxacin at a single time-point in inflamed (n = 10) and non-inflamed (n = 11) eyes. Results:, After 400 mg oral gatifloxacin, inflamed eyes showed mean vitreous concentrations of 0.58±0.19,g/ml, 1.33±0.33 ,g/ml and 1.30 ± 0.23 ,g/ml at 2, 4 and 6 hours, respectively. The levels reached at 2 and 4 hours were found to be significantly increased compared with those in non-inflamed eyes. At the 800-mg dose, 4-hour vitreous levels in inflamed and non-inflamed eyes were 1.57 ± 0.3 ,g/ml and 1.42 ± 0.24 ,g/ml, respectively. Although the increased dose of gatifloxacin elevated plasma concentration, it failed to raise vitreous levels significantly higher than the 400-mg dose at the 4-hour time-point. Conclusions:, Orally administered gatifloxacin achieves therapeutic levels in both inflamed and non-inflamed human eyes with a spectrum covering the bacterial species most frequently involved in the various causes of endophthalmitis. However, the levels achieved were below the MIC90 for Pseudomonas aureginosa and Enterococcus. [source] Optical coherence tomography for monitoring the process of Candida endophthalmitisACTA OPHTHALMOLOGICA, Issue 6 2009Michiyo Imago No abstract is available for this article. [source] Prophylaxis of posttraumatic endophthalmitisACTA OPHTHALMOLOGICA, Issue 2009A ABU EL ASRAR Infectious endophthalmitis is a devastating complication of open globe injuries. The incidence of culture-positive endophthalmitis after open globe injuries varies between 0.5% and 17%. Several reports have demonstrated that delayed primary repair, dirty wound, breach of lens capsule, retained intraocular foreign body (IOFB), grade 4 injury (presenting visual acuity of worse than 5/200 to light perception), placement of primary intraocular lens, and rural setting are associated with an increased risk of posttraumatic endophthalmitis. Posttraumatic endophthalmitis is associated with its own microbiologic spectrum which is distinct from other subgroups of exogenous endophthalmitis. Posttraumatic endophthalmitis still carries a poor prognosis. Reasons for guarded prognosis include polymicrobial infection and the virulence of the infecting microorganisms. In addition, concomitant injuries may directly result in ocular damage that limits ultimate visual recovery. Because of the substantial incidence of endophthalmitis after open globe injuries, careful consideration should be given to the use of prophylactic antimicrobial therapy. The purpose of prophylaxis is to provide effective antibiotic levels as rapidly as possible against a broad range of organisms. Good coverage for most organisms is obtained with intravenous vancomycin coupled with a third generation cephalosporin, such as ceftazidime, which can penetrate the vitreous cavity in effective levels in inflamed aphakic experimental eyes. Recently, the use of prophylactic intravitreal antibiotic administration in high-risk cases was recommended. [source] Animal studies for the prevention of endophthalmitisACTA OPHTHALMOLOGICA, Issue 2009RP KOWALSKI Topical anti-infectives are commonly used to prevent post-surgical endophthalmitis. Animal models can be used for the development and selection of topical anti-infectives for optimizing ocular surgical prophylaxis. The primary outcome measures for providing prophylactic efficiency are antibacterial efficacy and anti-infective penetration into the anterior chamber. This curreent presentation will focus on a rabbit prevention of endophthalmitis model. Publish data will be presented detailing clinical correlation and limitations of the models. [source] Cataract, loss of visual acuity, infection after trabeculectomyACTA OPHTHALMOLOGICA, Issue 2009AM BRON Purpose Trabeculectomy is the most popular surgery for glaucoma, however some complications may impair the success of the procedure. Moreover without impacting the overall efficacy of trabeculectomy, the quality of life of the patients could be affected in a certain number of cases. Methods In this session we will give some tips to prevent and to treat these complications. Results Cataract is frequent after trabeculectomy and is mainly related to postoperative hypotony. In most recent clinical studies cataract has been shown to occur in half of the eyes 3 years after trabeculectomy. This has led H Jampel to write a provocative editorial; Trabeculectomy: more effective at causing cataract surgery than lowering intraocular pressure (Ophthalmology 2009;116:173-174). In advanced cases, severe sight-threatening complications such as the wipe-out syndrome, even uncommon may definitely lead the patient to blindness. The two more frequent presentations of infection after trabeculectomy are blebitis and endophthalmitis. Both can occur several years after trabeculectomy and Streptococci which are frequently found are devastating strains. Antimetabolites greatly increase the prevalence of endophthalmitis after trabeculectomy. Other less severe complications such as bleb dysesthesia may alter the quality of life of the patients. Conclusion The information of the patients and the quality of the follow-up are of paramount importance when a trabeculectomy is considered. [source] The first keratoprosthesis implantation 1n 1955ACTA OPHTHALMOLOGICA, Issue 2009MF DE LA PAZ Purpose to describe the Barcelona experience with the different types of keratoprosthesis for end-stage cicatricial corneal disease. Methods We present 6 cases showing various types of keratoprosthesis which we have used at the Barraquer Eye Center from the 1950´s up to the present. Results We describe the first keratoprosthesis ever implanted in Spain, on a case of severe chemical burn on a young lady. We implanted a Dorzee acrylic keratoprosthesis in 1955. 5 years later she had extrusion of the prosthesis and superior retinal detachment. The second case describes the Dorzee-Barraquer-Cardona acrylic implant implanted in 1958 on a patient with end-stage glaucoma. Patient had good anatomical retention until his death in 1970. The third case describes the use of the Cardona keratoprosthesis in 1960. Patient had good anatomical and functional results for 8 years until suffering from an acute endophthalmitis. The fourth case demonstrates the expulsion of a Teflon-supported keratoprosthesis designed by Girard. The fifth case describes the first implantation of an osteo-odontokeratoprosthesis designed by Strampelli on a blast injury showing good results for 10 years. The last case shows our experience on the Boston keratoprosthesis which we started using in 2006. Finally, we present our technique of the osteo-odontokeratoprosthesis and a summary of our clinical results from 1970´s to the present. Conclusion Our clinical experience for more than 50 years on the use of keratoprosthesis shows that while the surgical technique, design and post-operative treatment of both biological and non-biological keratoprosthesis have improved thru the years, the anatomical and functional success remains a challenge for the KPro surgeon. [source] Does imaging help with preventing extrusion?ACTA OPHTHALMOLOGICA, Issue 2009A GOMAA Both clinical and radiological methods can be used for early detection of resorption in OOKP patients; this is influential in preventing serious complications such as extrusion and endophthalmitis. Radiologically, use of either multidetector computed tomography (MDCT) or electron beam tomography (EBT) is valuable in identifying laminar resorption. A novel approach was recently adopted in Sussex Eye Hospital, using volume rendering software in processing previously obtained MDCT images, to calculate volume of the OOKP lamina rather than 2D measurements. We present the results of an observational retrospective case series study to illustrate the use of this approach. We describe how it can be used to calculate percentage change in volume of the lamina over time and how this can be correlated with clinical laminar resorption. We will also discuss further recommendations to build upon this advance. [source] Predictive factors of visual outcome in acute post-cataract endophthalmitisACTA OPHTHALMOLOGICA, Issue 2009A COMBEY-DE LAMBERT Purpose To study potential clinical and microbiological predictive factors of visual outcome in patients with acute endophthalmitis following cataract surgery. Methods A prospective study included 100 patients in 4 University hospital.Factors related to the cataract surgery, the initial clinical presentation and the microbiological identification were analyzed according to the final visual outcome using univariate and multivariate (logistic regression) analysis. Results 46% out of the patients had a final visual acuity less than or equal to 0.3 logMar (good visual outcome) at 6 months while 10% had only light perceptions. Patients with good visual outcome differed for the duration of cataract surgery, initial visual acuity, the visibility of fundus and the identification of a coagulase negative staphylococcus. In contrast, patients with a poor visual outcome were older, had more cornea oedema and a more important hypopion at the admission, more complications at the time of cataract surgery. Furthermore a bacterium was more frequently identified in this latter group. Multivariate analysis showed that age, complications at the time of cataract surgery, microbiological identification, pars plana vitrectomy were independent predictive factors. Conclusion Factors of visual outcome in acute postcataract endophthalmitis identified in this prospective study were similar to that reported during the Endophthalmitis Vitrectomy Study 10 years ago. As part of the treatment, pars plana vitrectomy is associated with predictive factors of poor visual outcome. Identification of these predictive factors at presentation should allow a better management of patients needed an aggressive treatment. [source] Peribulbar fungal abscess and endophthalmitis following posterior subtenon injection of triamcinolone acetonideACTA OPHTHALMOLOGICA, Issue 1 2009Junko Ikewaki No abstract is available for this article. [source] Boston KPro experience in BarcelonaACTA OPHTHALMOLOGICA, Issue 2008M DE LA PAZ Purpose To describe the indications, intraoperative complications, post-operative complications and anatomical and functional results of Type I Boston keratoprosthesis at our eye center in Barcelona. Methods Retrospective interventional case series on 24 eyes of 22 patients who underwent Boston keratoprosthesis implant from May 2006 to May 2008. Results The main indication for Boston keratoprosthesis implantation was a repeated failed graft (mean = 2.33 previous grafts). The most common principal pathologies were: bullous keratopathy, herpetic keratitis, aniridic keratopathy, corneal ectasia, calcific band keratopathy. No major intraoperative complications were noted and average time of surgery was 47 minutes. The mean follow-up time was 7.42 months. The major post-operative complications encountered were retroprosthetic membrane in 2 eyes, endophthalmitis in 2 eyes and corneal graft melting in 1 eye. The mean best corrected visual acuity improved from 0.015 pre-operatively to 0.1 post-operatively. Only one case of extrusion due to melting was encountered which was resolved by a reimplantation of the keratoprosthesis. Conclusion Our short-term experience with the type I Boston Keratoprosthesis is a good alternative for patients with repeated graft failures. Improvement in visual acuity is immediate and only minor complications were encountered. [source] Incidence of endophthalmitis after cataract surgery in JapanACTA OPHTHALMOLOGICA, Issue 8 2007Tetsuro Oshika Abstract. Purpose:, To estimate the incidence rate of endophthalmitis after cataract surgery performed by Japanese surgeons. Methods:, A sample of 20% of members of the Japanese Society of Ophthalmic Surgeons was randomly selected. Each member was sent a postal survey asking for information on the number of cataract surgeries performed in 2003 and the number of postsurgery cases of endophthalmitis. Results:, Replies were received from 78.7% (513/652) of survey recipients. The total number of cataract surgeries was 100 539, among which 52 cases of endophthalmitis occurred, resulting in an overall incidence rate of 0.052%. Incidence rates were 0.049% (38/78 170) for scleral incision phacoemulsification and 0.043% (9/20 894) for clear corneal incision phacoemulsification, with no significant difference between groups. The average annual volumes of surgery were 210 and 280 cases for surgeons who preferred scleral incision and clear corneal incision, respectively. There was a significant difference between volumes (Student's t -test, p < 0.01). The incidence of endophthalmitis was significantly lower with high-volume (> 300 cases/year) surgeons than with low-volume (, 300 cases/year) surgeons (0.040% versus 0.066%, chi-square test, p < 0.05). Conclusions:, The incidence of endophthalmitis after cataract surgery in Japan as estimated by a postal survey was low (0.052%) and consistent with rates reported previously. Surgeons who preferred clear corneal incision performed significantly more surgeries annually, but the incidence of endophthalmitis was similar between scleral and clear corneal incision phacoemulsification surgery. [source] PCR identification of Rhizobium radiobacter in post-operative endophthalmitisACTA OPHTHALMOLOGICA, Issue 2007V VINH Purpose: To present 2 cases of PCR identification of Rhizobium radiobacter in post-operative endophthalmitis. Methods: Microbiological identification was carried out using samples from aqueous humor and/or vitreous. Conventional cultures were performed using a Brain Heart Infusion broth. We used broad-range eubacterial PCR amplification followed by direct sequencing. Results: In both cases, Rhizobium radiobacter was identified using eubacterial PCR and cultures of vitreous from vitreous tap. An 81-year-old female presented an endophthalmitis 4 weeks after an cataract surgery. Inflammation and infection were controlled after 2 intravitreal antibiotic injections and the final visual acuity was of 20/24 at the one-year follow-up exam. A 75-year-old male who underwent a cataract surgery presented an endophthalmitis 9 days after. This patient was treated by 3 intravitreal antibiotic injections and a vitrectomy. The 6-month follow-up exam showed an optic nerve atrophy with a poor visual outcome (20/120). Both patients had an initial marked anterior chamber inflammation with a hypopyon and a severe retinal vasculitis was observed in the second case. Conclusions: Rhizobium radiobacter is a rare pathogen involved in postoperative endophthalmitis. As it is an environmental soil organism, we may assume that the patient's exposure to outdoor environnement and moist soil remains the source of this organism. This gram negative rod is resistant to vancomycin and have an intermediate resistance to most antibiotics used to treat post-operative endophthalmitis. PCR allows a swifter bacterial identification than do cultures and may help choose the most efficient antibiotics. [source] Results from the International Cataract Surgery Outcomes StudyACTA OPHTHALMOLOGICA, Issue thesis2 2007Jens Christian Norregaard MD Abstract It is widely accepted that cataract extraction with intraocular lens implantation is a highly effective and successful procedure. However, quality assessments and studies of effectiveness should still be undertaken. As with any surgical treatment modality, complications may occur, leading to suboptimal outcomes, additional health costs and deterioration in patients' functional capacity. International variation in clinical practice patterns and outcomes can serve as important pointers in the attempt to identify areas amenable to improvements in quality and cost-effectiveness. Once demonstrated, similar clinical results obtained in different health care systems can improve the level of confidence in a clinical standard against which the quality of care can be evaluated. The International Cataract Surgery Outcomes Study was established in 1992. The objective of this international comparative research project was to compare cataract management, outcomes of surgery and quality of care in four international sites. The study was conducted in the 1990s, since when many developments and refinements have emerged within cataract surgery. The actual figures reported in this thesis may no longer be of specific relevance as a decade has passed since their collection. However, the research questions and methods used in the study are still highly important and justify the publication of this report. The report deals with problems related to quality assessment, benchmarking, and the establishment and design of nationwide clinical databases , issues that are currently the focus of much attention. Moreover, the problems related to cross-national comparisons are increasingly relevant as more international databases are established. The study makes suggestions on how to report and compare objective as well as subjective criteria for surgery. The issue of how to report subjective criteria is a particular subject of current discussion. Four sites with high-quality health care systems were examined in this study: the USA, Denmark, the Province of Manitoba (Canada), and Barcelona (Spain). The design of the international research programme was based on methods developed by the US National Cataract Surgery Outcomes Study conducted by the US Cataract Patients Outcomes Research Team. The International Cataract Surgery Outcomes Study comprised three separate studies: a survey of ophthalmologists; a prospective cohort study, and a retrospective register-based cohort study. The survey study was based on data generated by a self-administered questionnaire completed by ophthalmologists in the four study areas. The questionnaire examined routine clinical practice involving patients considered for cataract surgery, and included questions on anaesthesia, monitoring and surgical techniques. The prospective cohort study was a large-scale, longitudinal observational study of patients undergoing first-eye cataract surgery in each study site. Patients were sampled consecutively from multiple clinics and followed for 4 months postoperatively. The retrospective cohort study was based on the Danish National Patient Register and claims data from the USA. This study could not be carried out in Barcelona or Manitoba as no suitable administrative databases were available. The papers based on register databases deal with retinal detachment and endophthalmitis but are not included in this thesis as the material was previously reported in my PhD thesis. The application of the studies was highly co-ordinated among the four sites and similar methods and instruments were used for data collection. The development of the data collection strategy, questionnaires, clinical data forms and data analyses were co-ordinated through weekly telephone conferences, annual in-person conferences, correspondence by mail or fax, and the exchange of sas programs and data files via the Internet. The survey study was based on responses from 1121 ophthalmologists in the four sites and results were presented in two papers. Within the previous year the participating ophthalmologists had performed a total of 212 428 cataract surgeries. With regard to preoperative ophthalmic testing, the present study reveals that refraction, fundus examination and A-scanning were performed routinely by most surgeons in all four sites. Other tests were reported to be performed routinely by some surgeons. It is unclear why any surgeon would use these other tests routinely in cataract patients with no ocular comorbidity. It appears that if this recommendation from the US Clinical Practice Guidelines Panel was broadly accepted, the use of these procedures and costs of care could be reduced, especially in Barcelona, the USA and Canada. Restricted use of medical screening tests was reported in Denmark. If this restricted screening were to be implemented in the USA, Canada and Barcelona, it would have significant resource implications. The most striking finding concerned the difference in monitoring practice between Denmark and each of the other three sites. In Denmark, monitoring equipment is seldom used and only occasionally is an anaesthesiologist present during cataract surgery. By contrast, in the other study sites, the presence of an anaesthesiologist using monitoring equipment is the norm. Adopting the Danish model in other sites would potentially yield significant cost savings. The results represent part of the background data used to inform the decision to conduct the two large-scale, multicentre Studies of Medical Testing for Cataract Surgery. The current study is an example of how surveys of clinical practice can pinpoint topics that need to be examined in randomized clinical trials. For the second study, 1422 patients were followed from prior to surgery until 4 months postoperatively. Preoperatively, a medical history was obtained and an ophthalmic examination of each patient performed. After consent had been obtained, patients were contacted for an in-depth telephone interview. The interview was repeated 4 months postoperatively. The interview included the VF-14, an index of functional impairment in patients with cataract. Perioperative data were available for 1344 patients (95%). The 4-month postoperative interview and clinical examination were completed by 1284 patients (91%). Main reasons for not re-evaluating patients were: surgery was cancelled (3%); refusal to participate (2%); lost to follow-up (1%), and death or being too sick (1%). The results have been presented in several papers, of which four are included in this thesis. One paper compared the preoperative clinical status of patients across the four sites and showed differences in both visual acuity (VA) and VF-14 measures. The VF-14 is a questionnaire scoring disability related to vision. The findings suggest that indications for surgery in comparable patients were similar in the USA and Denmark and were more liberal than in Manitoba and Barcelona. The results highlight the need to control for patient case mix when making comparisons among providers in a clinical database. This information is important when planning national databases that aim to compare quality of care. A feasible method may be to use one of the recently developed systems for case severity grading before cataract surgery. In another paper, perioperative clinical practice and rates of early complications following cataract surgery were compared across the four health care systems. Once again, the importance of controlling for case mix was demonstrated. Significant differences in clinical practice patterns were revealed, suggesting a general trend towards slower diffusion of new medical technology in Europe compared with North America. There were significant differences across sites in rates of intra- and early postoperative events. The most important differences were seen for rates of capsular rupture, hyphaema, corneal oedema and elevated pressure. Rates of these adverse events might potentially be minimized if factors responsible for the observed differences could be identified. Our results point towards the need for further research in this area. In a third paper, 4-month VA outcomes were compared across the four sites. When mean postoperative VA or crude proportions of patients with a visual outcome of <,0.67 were compared across sites, a much poorer outcome was seen in Barcelona. However, higher age, poorer general health status, lower preoperative VA and presence of ocular comorbidity were found to be significant risk factors associated with increased likelihood of poorer postoperative VA. The proportions of patients with these risk factors varied across sites. After controlling for the different distributions of these factors, no significant difference remained across the four sites regarding risk of a poor visual outcome. Once again the importance of controlling for case mix was demonstrated. In the fourth paper, we examined the postoperative VF-14 score as a measure of visual outcomes for cataract surgery in health care settings in four countries. Controlling for case mix was also necessary for this variable. After controlling for patient case mix, the odds for achieving an optimal visual function outcome were similar across the four sites. Age, gender and coexisting ocular pathology were important predictors of visual functional outcome. Despite what seemed to be an optimal surgical outcome, a third of patients still experienced visual disabilities in everyday life. A measure of the VF-14 might help to elucidate this issue, especially in any study evaluating the benefits of cataract surgery in a public health care context. [source] Surface modification of silicone intraocular lens by 2-methacryloyloxyethyl phosphoryl-choline binding to reduce Staphylococcus epidermidis adherenceCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 5 2007Xiao-Dan Huang MD Abstract Purpose:, To analyse the in vitro adherence of Staphylococcus epidermidis to the 2-methacryloyl oxyethyl phosphorylcholine (MPC)-modified silicone intraocular lens (IOL). Methods:, The test IOLs were modified by using an air plasma treatment to bind MPC to the surface. The control IOLs were not modified. Chemical changes on the IOL surface were analysed by X-ray photoelectron spectroscopy (XPS) to confirm the covalent binding of MPC. IOL hydrophilicity was determined by measuring the water contact angle. Two different techniques, direct counting of viable adherent bacteria released by sonication, and scanning electron microscopy (SEM), were used to observe and compare the adherence of S. epidermidis to the IOLs after 1- and 18-h incubation. Results:, XPS analysis confirmed that the test IOLs were surface-modified with MPC. The hydrophilicity of the IOLs was improved by surface modification, and the MPC-modified IOLs exhibited significantly reduced adhesion of S. epidermidis (P = 0.002) after an incubation period of 1 h. The SEM results showed that the MPC modification also suppressed the accumulation of bacteria and biofilm production after 18 h incubation. Conclusions:, MPC-modified hydrophilic silicone IOLs reduce bacterial adherence and colonization, and thus may help reduce the incidence of postoperative endophthalmitis. [source] | ||||||||||