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Purpose: To assess the effect of foreign body volume on visual and anatomic outcomes in patients with a posterior segment intraocular foreign body (IOFB)., Methods: Patients were divided into three groups according to the volume of the IOFB; group 1 (n=18 eyes) with IOFBs<2mm 3 , group 2 (n=15 eyes) with 2mm 3 ≤IOFBs<6mm 3 , group 3 (n=18 eyes) with IOFBs≥6mm 3 . All eyes underwent pars plana vitrectomy (PPV) for removal of the IOFB. Demographic characteristics, features of the injury and IOFB, findings of the initial and final ophthalmological examinations, and timing of IOFB removal were studied., Results: The mean age was 38.8±12.0years, and the median follow-up period was 12.0 (range: 6-98) months. Initial visual acuity (VA) was significantly lower in group 3 (P=0.005), while final VA was similar between the three subgroups. Frequencies of primary globe repair, initial vitreous hemorrhage (VH), corneoscleral entry, and IOFB removal through the cornea were significantly higher in eyes with large volume IOFBs (P<0.05). Siderosis was only seen in 4 patients in group 1 (22.2%). No patients developed postoperative endophthalmitis., Conclusion: Large volume posterior segment IOFBs are associated with poor initial VA, initial VH and corneoscleral injury. Nevertheless, PPV and IOFB extraction under favorable conditions may provide significant visual improvement in eyes with large volume IOFBs., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate the outcomes of bimanual intraocular foreign body (IOFB) removal with vitrectomy and describe the techniques of "active aspiration to forceps" and "forceps to forceps handshake" for IOFB removal., Methods: Retrospective, interventional, single surgeon case series. The patients who had an IOFB and underwent vitrectomy with bimanual IOFB removal techniques and had a minimum follow-up period of 12 months were included. The main outcome measure was the functional and anatomical results of the bimanual surgical techniques., Results: Twenty eyes were included. The mean follow-up time after surgery was 16.5±3.6 months (range 12-24 months). The baseline best corrected visual acuity (BCVA) was light perception in 8 eyes (40%), hand motions in one eye (5%), and≥1.0LogMAR in 11 eyes (55%). BCVA improved in 14 eyes (70%); was stable in 3 eyes (15%), and decreased in 3 eyes (15%)., Conclusions: Both bimanual handshake techniques were safe and effective methods in the surgical treatment of IOFBs<5mm in size. The "active aspiration to forceps handshake" technique might be a gentle technique for the removal of IOFBs that are located on the surface of or trapped within the retina., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Objective: To report the anatomical and functional outcomes after endoscopy-guided vitrectomy in a series of cases of severe endophthalmitis. Also to identify and compare the outcomes of two different modes of clinical presentation., Patients and Methods: Retrospective case study, single center; all patients who underwent endoscopic 20Ga vitrectomy (Endo optiks E4 system) for severe endophthalmitis were included. For each case, data were recorded for: etiology, surgical indication, preoperative and postoperative visual acuity, comorbidity factors and postoperative complications, and whether any additional surgery was performed. Two groups were distinguished according to their initial mode of presentation; results were then compared in terms of complications and visual prognosis to those found in the literature., Results: Eighteen patients were included, with mean age 62±19years. Severe endophthalmitis was initially obvious for 8 cases (group 1). For 10 cases, disease progression had been considered unfavorable despite adequate medical treatment (group 2). There was no statistically significant difference between the two groups (P=0.55). Endophthalmitis occurred: after intravitreal injections (4 cases), after intraocular foreign body (n=2), after cataract surgery (n=5), following a trabeculectomy (n=2), after epiretinal membrane peeling (n=3), 1 case caused by a corneal infection and 1 case of endogenous leptospirosis. Mean follow-up was 13.7months. The surgical technique was a complete 20Ga vitrectomy under endoscopic visual control. The mean operative time was 70±27minutes. The causative organism was identified in 72% of cases in vitreous humor samples, among which 77% were gram-positive organisms. The infection was controlled in 89% of cases, and these patients have recovered useful visual acuity., Conclusion: The value of endoscopic visualization in ophthalmology has been proven for 30 S. aureus years, but its miniaturization enhances the current enthusiasm for the use of this instrumentation. When visualization is compromised, endoscopic guided vitrectomy is very useful and may assist the surgeon in the management of these difficult cases. Our anatomical and functional outcomes are encouraging, but we must keep in mind the poor long-term prognosis of severe endophthalmitis., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Due to the need for treatment guidelines for endophthalmitis in impoverished areas, we have formulated an approach which takes into account pharmacokinetic data, keeping in mind that, whether oral or intramuscular, antibiotics must achieve therapeutic intraocular levels, antibiotic susceptibility of the most common pathogens in endophthalmitis, and routine availability of bioequivalent generics in the areas in question. In this work, we present the basic guidelines for the management of postoperative endophthalmitis by ophthalmology services in impoverished areas., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Introduction: Transconjunctival sutureless vitrectomy is a recent advance in vitreoretinal surgery. Some authors have reported an increased risk of postoperative hypotony and endophthalmitis and recommend the creation of oblique incisions, intended to be self-sealing, so as to reduce these risks. However, there is still a debate about the best architecture for transconjunctival sutureless incisions., Materials and Methods: We report two cases of acute endophthalmitis occurring after 23 and 25 gauge transconjunctival sutureless vitrectomy. We analyzed the scleral incisions using the anterior segment module of the Spectralis(®) OCT. To our knowledge, this is the first direct description of the appearance of sclerotomies associated with endophthalmitis., Results: The anterior segment module of Spectralis(®) OCT permitted a high-resolution evaluation of the architecture of the scleral incisions. We found straight, gaping incisions with misaligned edges and vitreous incarceration., Discussion: By way of these two case reports and a review of the literature, we discuss the contribution of anterior segment OCT in the analysis of scleral incision architecture in sutureless vitrectomy. Our findings are consistent with those reported in the literature. The presence of a direct incision, wound gap or edge misalignment are associated with an increased risk of early leakage and postoperative hypotony., Conclusions: The anterior segment module of the Spectralis(®) OCT is a valuable tool for non-invasive, painless and high-resolution documentation of sutureless vitrectomy incisions. It allows for causal analysis and better understanding of the conditions associated with endophthalmitis after sutureless vitrectomy., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Introduction: Endogenous bacterial endophthalmitis (EBE) is an intraocular bacterial infection transmitted via a hemotogenous route, usually occuring in immunocompromised patients with bacteremia spreading from extraocular foci of infection. We report a case of EBE secondary to a dental infection occurring in an immunocompetent patient., Case Report: A 61-year-old-man with no past medical history other than a dental bridge on the 13th tooth was referred for rapid onset hypertensive fibrinous panuveitis of the right eye. He presented with profound visual loss in this eye, an absent pupillary reflex and an obscured fundus. The left eye was normal. Neither fever nor constitutional symptoms were noted at presentation. Work-up revealed a mild inflammatory syndrome with increased C-reactive protein, a high antistreptolysin O titer, and an abscess of the dental bridge. The clinical picture worsened rapidly, suggesting the possibility of EBE secondary to an organism of dental origin. Aqueous humor polymerase chain reaction (PCR) was positive for streptococci, which could not be identified more specifically. Removal of the dental bridge in combination with systemic and intravitreal multiple antiobiotic therapy achieved a rapid cure of the EBE. Vitrectomy combined with phacoemulsification was performed later in order to clear media opacities. At 6 months follow-up, best-corrected visual acuity was 8/10 with no recurrent inflammation., Conclusion: This case shows that EBE can occur in the absence of predisposing factors but with an extraocular infectious focus as simple as a dental abscess. In the absence of associated septicemia, with the involved tooth superior and ipsilateral to the affected eye, a spread of the infection by retrograde venous flow should be suspected. The prognosis for visual function may be good if early diagnosis and immediate treatment can be provided., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Early diagnosis and appropriate treatment with intravitreous antibiotics are the most important factors for the successful management of endophthalmitis. The intraocular concentration of antibiotics after intravitreous injection is far greater than that achieved by any other modality. The organisms in postoperative endophthalmitis are usually Gram-positive cocci and less commonly Gram-negative bacteria. Drug combinations are necessary to cover the full range of bacteria causing endophthalmitis. Vancomycin (1 mg/0.1 ml) is considered the drug of choice for Gram-positive organisms. Controversy remains concerning the best choice against Gram-negative bacteria. Aminoglycosides (amikacin, 0.4 mg/0.1 ml) have traditionally been recommended for Gram-negative coverage. However, because of their possible role in macular toxicity, recent trends have shifted to using ceftazidime (2.25 mg/0.1 ml) in combination with vancomycin.

Most studies show a trend toward a beneficial or at least neutral effect of associating corticosteroids and antibiotics. However, caution must be taken, with various factors considered: the type, virulence, and size of the inoculum, and the treatment chosen. Early intravitreal administration of 400 microg of dexamethasone seems to be beneficial in treating postoperative Staphylococcus epidermidis-related endophthalmitis. However, a large-scale prospective, randomized, controlled study is mandatory to gain evidence supporting steroid therapy in postoperative endophthalmitis.

The decision to perform a vitrectomy in a case of endophthalmitis is mainly based on the Endophthalmitis Vitrectomy Study (EVS) conclusions. An emergency vitrectomy is helpful when the baseline visual acuity is lower than hand motion perceptions. However, various coexisting conditions should be considered: clear media and the availability of an operating room dedicated to emergency surgery. These limitations lead to a frequent delay in vitrectomy to assess the progression of the initial presentation after treatment with antibiotics and anti-inflammatory agents. However, in these cases, the vitrectomy will remain restricted to the center of the vitreous cavity to limit peripheral retinovitreal traction favoring retinal detachment. Vitrectomy performed to treat the residual vitreous opacity or macular complications such as epiretinal membranes, subject to even greater delay, is another indication.

Purpose: To identify the incidence, infecting organisms, and clinical results of late endophthalmitis after trabeculectomy without antifibrotic agents., Material and Methods: The current retrospective study investigated 613 trabeculectomies without adjunctive antifibrotic agents performed between January 1994 and December 2003 in the Clinic of Ophthalmology of Beni-Messous University Hospital (Algiers, Algeria)., Results: Eight eyes presented with late endophthalmitis after an uneventful postoperative period, for an incidence of 1.3%. The endophthalmitis occurred between 1 year and 7 years after the filtering surgery. Conjunctival swabs were taken in all cases. Vitreous swabs were taken in only six cases. There were five positive cases. The organisms identified were Staphylococcus aureus (one case), alpha hemolytic streptococci (two cases), Haemophilus sp. (one case), and Pseudomonas aeruginosa (pyocyanic) (one case). The anatomic and visual results were poor after treatment of endophthalmitis. One case deteriorated, ending in enucleation., Conclusion: Late endophthalmitis may complicate glaucoma filtering surgery, several months or years later, after a postoperative period without incident. The surgical indications of glaucoma must take into account the complications related to this surgery.

Purpose: Primary evisceration followed by secondary enucleation and implant placement makes it possible to use the sclera of a patient with endophthalmitis. This sclera will be used for secondary implantation., Patients and Methods: Four patients with endophthalmitis and corneal perforation (bacterial infection in three cases and fungal infection in one case) underwent evisceration and, 4-6 weeks later, enucleation. During the secondary enucleation, the sclera was recovered and used as wrapping material for the alumina implant (Al2O3) (20 and 22 mm in diameter). Between the two operations, the patients were treated with systemic and topical antibiotics or antifungal agents., Results: No complications were observed for both the first and the second operation. Enucleated sclera was crumpled and bent in all four cases. The sclera was spread out and used as wrapping material. Prosthetic fitting was performed 4-5 weeks after the second operation. No complications have been observed to date (10 to 32 months follow-up)., Conclusion: Primary implantation following endophthalmitis is debatable because an infectious complication cannot be excluded. The use of sclera for implant wrapping decreases the risk of implant extrusion, especially when the conjunctiva and Tenon's facia have been weakened by previous surgery or infection. Primary evisceration with a conformer placement followed by enucleation and implantation is an ideal solution in endophthalmitis because this technique allows the use of patient's own sclera.

Since 1980, the authors have observed 56 cases of endophthalmitis after cataract surgery which they classify into three groups: A. 18 cases of forms confined to the anterior segment, which just received medical treatment; B. 37 cases of more serious forms with vitreous abscess, treated by vitrectomy; C. 1 case of fulminant form which was eviscerated. The results of group B are better than those of group A: organic: 2.7% versus 11.1% of phtisis; functional: 73% of calculable visual acuity versus 66.6%, although the initial forms had been more severe. Vitrectomy, however causes some complications such as initial detachment (16.2%) cystoïd macular oedema (11%) and vascular complications (11%). However that may be, vitrectomy has several advantages: to collect a larger amount of vitreous liquid; to mechanically eliminate the pus; a faster functional rehabilitation by lightening of the vitreous.

A protocol combining chemoprophylaxis and antibioprophylaxis has been used since January 1st, 1990 for all patients (2,337 cases) undergoing planned open eyeball surgery (except emergencies). The chemoprophylaxis is local, by eyedrops (picloxidin) during the days before surgery, and by eyewash of the conjunctival cul-de-sac with iodized polyvidone immediately before surgery. The systemic antibioprophylaxis associates two bactericidal antibiotics with a wide spectrum and good intraocular penetration, active on 89 to 90% of the bacteria incriminated in postoperative endophthalmitis: a ureidopenicillin, piperacillin, and a fluoroquinolone, ciprofloxacin; the adverse effects are minimal. Although the sample size does not allow statistical, analysis the results of this study (the absence of any endophthalmitis) are very encouraging in comparison with those of the literature, those of the same department during the years before the protocol, and those of the other departments in the same hospital which carry out the same surgery under the same conditions.

Retinopexy was performed by endodiathermy coagulation around a retinal tear provoked during dissection of epiretinal membranes. The dissection was a complement to vitrectomy for Candida albicans endophthalmia. The choice of this technique was dependent on the absence of need for the laser, and allowed an internal buffering to be carried out by the use of silicone oil. Angiography showed depigmented areas confirming the presence of scar tissue as seen in experimental rabbit studies. The scar involved the whole thickness of the retina and choroid adjacent to the cauterized pigmented epithelium. This method is simple and possesses the advantage of being able to be used when the perioperative laser beam is unable to cross the transparent media of the eye.

A chronic bilateral endogenous Candida albicans endophthalmitis in a heroin addict was treated by vitrectomy, argon laser photocoagulation and endodiathermy. In the left eye with a visual acuity of 6/6 there was a totally asymptomatic retinal tear due to vitreous traction. The eye was treated by argon laser photocoagulation immediately, and then underwent a vitrectomy several weeks later. Analysis of the vitrectomy specimen was negative for any organism. In the vitreous of the right eye a "fungus ball" was noted nasally. Visual acuity was also 6/6. Fluorescein angiography demonstrated the presence of a small area of retinal involvement above the optic disc. During vitrectomy and membrane peeling the area of retinal involvement was torn away. The tear was then treated by endodiathermy. Vitreous analysis showed the presence of Candida albicans, sensitive to 5-fluorocytosine which was then used in treatment. All other cultures and stains were negative for Candida. The patient had negative serology for Candida, but normal immune responses based on cutaneous testing to several antigens and dosage of serum immunoglobulins and complement. A negative serology to Candida is most likely explained by the supposition that an episode of blood stream infection occurred only briefly and long before the eye involvement became clinically significant. At 4 months after bilateral vitrectomy, the patient has maintained 6/6 vision in each eye.

We describe an infrequent case of endophthalmitis due to intraocular caterpillar hairs. We report a notable decrease of inflammation after Argon laser photocoagulation of the caterpillar hairs. We also present optical and electronic microscope photographs of one of the hairs extracted from the patient's conjunctiva.