Search

Group B streptococcus (GBS) is a potentially devastating neonatal pathogen that most commonly causes meningitis, sepsis, and pneumonia. It is also a very rare cause of endogenous endophthalmitis. We present the second case of endogenous endophthalmitis caused by GBS in a healthy newborn and the first case of endogenous endophthalmitis by GBS in a newborn mimicking retinoblastoma and resulting in enucleation., (Copyright (c) 2010 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.)

Frontalis suspension with the use of a silicone elastomer is one of the preferred procedures for correcting moderate-to-severe ptosis with poor levator function. This procedure involves the attachment of the upper eyelid to the frontalis muscle by a silicone sling. Although this surgery has been performed for many years, information regarding long-term outcomes and complications is relatively limited. We report a case of orbital inflammation 15 years after a frontalis silicone sling suspension operation for congenital ptosis., (Copyright (c) 2010 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.)

Background: The objective of the study was the determination of the incidence of culture-proven postoperative endophthalmitis and probable sources of infection., Materials and Methods: It was a prospective study on the microbiology, incidence and probable sources of infection in patients with postoperative infectious endophthalmitis carried out in a tertiary care eye hospital. Consecutive patients diagnosed with postoperative infectious endophthalmitis during the years 2000-2007 were investigated for the causative infective agent and possible sources of infection. The surgical data and microbiological data including the investigations performed to trace the source were recorded in a specific formatted form and were gathered and compiled for analysis., Results: Data of analysis showed that 98 (0.042%) out of 2,31,259 patients who underwent intra-ocular surgery developed infectious endophthalmitis. Among these, 70 (0.053%) occurred after cataract, 10 (0.5%) after penetrating keratoplasty (PK) and 18 (0.018%) following other types of intra-ocular surgeries. The predominant infectious agents isolated were bacteria (89.7%), with equal proportions of gram-positive and gram-negative bacteria. Polymicrobial infection was noted in four and fungi in seven patients. Occurrence of postoperative endophthalmitis was sporadic and not related to any specific part of period in a year. Sources of infection were donor corneal rim in six post-PK patients and phaco probe in one who had postphacoemulsification endophthalmitis, Conclusions: Overall incidence of postoperative endophthalmitis over an 8-year period was quite low. The sources of infection could be established in six post-PK endophthalmitis patients and in a postcataract surgery.

A 58-year-old man with Darier's disease developed endophthalmitis 3 days following left-sided cataract extraction with intraocular lens implantation. Vitreous cultures were positive for Pseudomonas aeruginosa, similar to previously cultured hyperkeratotic plaques on the patient. Despite emergent vitrectomy and aggressive treatment with systemic, intravitreal, and topical fortified antibiotics, the patient required evisceration 19 days postoperatively. Bacterial overgrowth within hyperkeratotic plaques may increase the risk of endophthalmitis following intraocular surgery in patients with Darier's disease., (Copyright 2010, SLACK Incorporated.)

Background: To determine the therapeutic and diagnostic value of vitreoretinal surgery in various types of severe viral retinitis and endogenous endophthalmitis., Material/methods: Pars plana vitrectomy with silicon-oil tamponade was performed on 12 eyes (12 patients) with severe viral retinitis and endogenous endophthalmitis. The mean age of the patients was 35.2 years (range, 18-56 years). Investigations consisted of chest radiography, RT 23, serology (for toxoplasmosis, cytomegalovirus, herpes simplex virus, and human immunodeficiency virus), and routine blood tests and urinalysis. Examination of vitreous samples consisted of polymerase chain reaction for cytomegalovirus, herpes simplex virus, and Mycobacterium tuberculosis, and cultures for fungi and bacteria. The results were analyzed 7 days and 6 months after surgery., Results: Analysis of vitreous samples showed cytomegalovirus in 3 patients, herpes simplex virus in 2, tuberculosis in 2, and Candida albicans in 5. All patients had improvement in visual acuity and severity of clinical signs seven days after surgery and in 10 cases after long-term follow-up. Final visual acuity was compromised by chronic macular edema, postinflammatory macular scarring, optic atrophy, subcapsular cataract formation, and capsular opacification after cataract surgery., Conclusions: Modern laboratory tests are useful for quick and accurate diagnosis of atypical cases of severe infectious posterior uveitis. Early pars plana vitrectomy with silicon oil tamponade is valuable in diagnosing and treating severe infectious posterior uveitis and endophthalmitis.

Purpose: We report a case of Candida albicans endophthalmitis with subretinal abscess formation in a patient who underwent liver transplantation., Methods: Case report., Results: A 51-year-old Japanese woman complained of deep pain and ciliary injection in her right eye. Three months prior, the patient had undergone liver transplantation for cirrhosis caused by hepatitis C. A slit-lamp examination revealed intense anterior chamber inflammation with hypopyon and fundoscopy showed a yellowish-white subretinal mass lesion in the inferior peripheral fundus. Systemic and topical antibiotics did not prevent further progression of the infection. The patient underwent pars plana vitrectomy treatment three times and a histopathological study of a vitreous specimen revealed C. albicans to be the causative organism., Conclusion: A subretinal abscess, previously reported in Nocardia, Pseudomonas, Staphylococcus, and Aspergillus infection cases, can also occur in patients infected with Candida. Therefore, Candida infection should be considered as a potential cause of subretinal abscess in organ transplant recipients.

Fungal keratitis represents one of the most difficult forms of microbial keratitis to diagnose and treat successfully. It is difficult to obtain correct diagnosis and topical antifungal preparations. Fungi can cause severe stromal necrosis and enter the anterior chamber by penetrating an intact Descemet membrane. The most common pathogens are filamentous fungi (Aspergillus and Fusarium spp.) and Candida albicans. The incidence of Trichophyton spp. keratitis is 5%. A 22 years old female contact lenses wearer after keratitis developed corneal melting syndrome, spontaneous perforation of the cornea and complicated cataract of the left eye. Conjunctival swab was sterile as well as first sample of corneal tissue and sample from the anterior chamber. Urgent therapeutic perforating keratoplasty (PK), was performed together with extracapsular cataract extraction and the implantation of the intraocular lens in the posterior chamber. The patient was treated with ciprofloxacin and diflucan (systemic therapy); with dexamethason and atropin (subconjunctivaly) and chlorhexidine, brolene, levofloxacin, polimyxin B, and dexamethason/neomycin (topically). Microbiology evaluation was performed once again following excisional biopsy of the intracameral portion of the lesion. The presence of Trichophyton spp. was finally confirmed. Itraconazole and garamycin were included in the systemic therapy. Corneal graft was clear for 17 days but decompensated 28 days after the PK. After two weeks microorganisms invaded the vitreous and caused endophthalmitis. Despite urgent pars plana vitrectomy patient developed endophthalmitis, lost light sensation and developed phthysis. Evisceration and the implantation of silicon prosthesis was done. Perforating keratoplasty is a method of choice in treating severe infectious keratitis unresponsive to conservative treatment but without the eradication of microorganisms it cannot restore the vision or save the eye. Trichophyton spp. may cause a severe disease of the anterior and posterior part of the eye which may finish with the lost of vision/eye. Prompt diagnosis and treatment of Trichophyton spp. keratitis are essential for a good visual outcome.

Purpose: The aim of this study was to evaluate the effectiveness of polymerase chain reaction (PCR) in accurate and rapid diagnosis of fungal endophthalmitis in comparison with conventional Gram stain and culture in pediatric fungal endophthalmitis., Patients and Methods: This study included 26 cases with endophthalmitis. Age was less than 16 years old, and all were males with history of ocular trauma and with clinical picture suggestive of fungal endophthalmitis. A prospective nonrandomized study was done. For all cases pars plana vitrectomy was done and sample of vitreous wash was collected from the vitrectomy cassette and was sent for laboratory diagnosis. At the end of surgery, intravitreal injection of 1.0 mg/0.1 mL vancomycin was given. PCR, culture sensitivity and ultrasound were done for all cases. Follow-up of cases by visual acuity, full ophthalmological examination, ultrasound, PCR, and other laboratory investigation. The schedule for follow-up was daily for 1 week, weekly for 1 month, and monthly for 1 year than all data collected and analysed., Results: The ages ranged from 7 to 16 years old. All cases were males. Seventeen cases had central corneal ulcer, 5 of them with penetration full thickness, and 9 cases had peripheral corneal ulcer, 2 of them with penetration. Ophthalmological examination revealed a marked drop of vision ranging from HM to PL in the affected eye. Although Gram stain gave negative results in 20 cases (was positive in only 6 cases), KOH wet mount preparation revealed septate hyphae in only 4 cases, and culture on blood agar was negative in all samples, suggestive of Aspergillus niger and showing Candida albicans colonies in 8 samples. PCR assay was positive for the universal as well as for the Aspergillus-specific primers, but it was negative for Candida-specific primer in 4 samples. No recurrence of infection was noticed for the following 1 year The mean follow-up period was 10.3 months (range, 5-24 months), but with trivial improvement in visual acuity. The sensitivity of PCR assay was found to be highly significant, p < .0001, much superior to that of microscopy and culture in detecting fungal endophthalmitis., Conclusion: PCR assay was found to be a highly sensitive and specific test that allows rapid and accurate diagnosis of pediatric fungal endophthalmitis. PCR was found to give a much more sensitive and more rapid result than Gram stain and culture technique with comparable high specificity. Thus, we recommend the use of conventional methods as culture and stained smears as they are useful if positive, inexpensive, and available in all laboratories. This is in addition to PCR assay, which must be added to the protocol of management of cases of pediatric fungal endophthalmitis.

Herein, we describe what we believe to be the first case of traumatic endophthalmitis caused by Staphylococcus gallinarum, following injury with an iron nail. The patient was successfully treated by vitrectomy and intravitreal injection of cefazolin and vancomycin.

Purpose: To identify the etiology, culture results, pars plana vitrectomy results, complications, and visual outcome of exogenous endophthalmitis in children., Methods: Seven eyes of 7 consecutive pediatric patients who were treated and followed up for exogenous endophthalmitis between February 2006 and June 2008 were included in this study. The etiology of endophthalmos was penetrating eye injuries in 4 eyes and intraocular surgery in 3 eyes. Combined pars plana vitrectomy and intravitreal vancomycin plus ceftazidime injection were performed on all 7 eyes. Anterior chamber fluid and vitreous cultures were taken from all eyes. The patient files were inspected retrospectively., Results: Mean follow-up time was 10.3 months (4-16 months). Mean age of the patients was 8.5 years (3-14 years). At baseline, visual acuity values of the patients were light perception (n=2), hand movements (n=4), and counting fingers from 1 meter (n=1). At final examination, visual acuity improved in 5 eyes, stayed the same in 1 eye, and decreased in 1 eye. Positive culture results were obtained in 3 eyes: alpha hemolytic Streptococcus (n=2) and coagulase-negative Staphylococcus (n=1). Complications seen after vitreoretinal surgery were transient ocular hypertension, emulsification of silicone oil, phthisis bulbi, and secondary retinal detachment., Conclusions: Early pars plana vitrectomy and intravitreal vancomycin plus ceftazidime injection improved anatomic and functional success in pediatric eyes with exogenous endophthalmitis.

Background: Although endophthalmitis is known to occur frequently in patients with KPros, the management remains a challenge both due to the lack of evidence and the exceptionality of the examination and the therapeutic approach., Materials and Methods: Three patients implanted with Boston keratoprosthesis for management of ocular cicatricial pemphigoid and severe alkali injury presented with severe late-onset (10-24 months post-operatively), presumed bacterial endophthalmitis. Three-port 25-gauge (g) pars plana vitrectomy was performed in all patients; vitreous samples were acquired and intravitreal vancomycin and cefuroxime were administered., Results: Post-operative outcome was significantly improved in all three cases. Visual acuity improved from perception of light (PL) to 20/400 in the first, PL to counting fingers in the second and PL to 20/400 in the third patient., Conclusion: We present our experience from managing presumed bacterial endophthalmitis with 25 g PPV in patients previously implanted with Boston Kpro, which to the best of our knowledge has not been reported before. Although the number of cases is small to draw accurate conclusions, we have to report that 25 g vitrectomy was performed without significant difficulties and seems to be a useful tool for the management of patients with Kpros requiring vitreoretinal surgery.

Capsular block syndrome (CBS) is a complication of uncomplicated cataract surgery. Depending on etiology and the time of onset CBS can be subdivide into three types. The cases of 4 patients with CBS type III who presented with a milky fluid in the space between the posterior surface of the implanted intraocular lens (IOL) and the anterior surface of the distended posterior capsular bag are described. All patients complained of reduced vision. The therapy of choice is Nd:YAG laser posterior capsulotomy but with suspected low-grade endophthalmitis surgical intervention can also be carried out and submitting the plug for bacterial culture.

This is a case report concerning a patient that was subject to non-penetrating deep sclerectomy (with intraoperative Mytomicin C) for the management of advanced open angle glaucoma in the only functional eye. The surgery was uneventful, the visual acuity was preserved and the intraocular pressure was reduced. After 2 months the patient presented with symptoms of postoperative bleb-related endophthalmitis. The treatment of this condition (including pars plana vitrectomy) did not succeed in preventing a severe retinal necrosis that resulted in the loss of visual acuity This is, to our knowledge, the first published case of endophthalmitis after non-penetrating deep sclerectomy.

Purpose: The purpose of our study is to analyze the outcome of traumatic endophthalmitis, as revealed by our own experience., Material Method: We conducted a clinical retrospective study including all the consecutive cases with traumatic endophthalmitis that have been hospitalized in the University Ophthalmology Department from Cluj-Napoca (Romania), for a 28 months period of time (September the 1st 2007 - December the 31st 2009)., Results/discussion: The overall incidence of traumatic endophthalmitis has been 4.76% (5 out of 105 open globe injuries). The presence of an Intra Ocular Foreign Body has been associated with the highest risk of endophthalmitis (8%), followed by the penetrating ocular injuries (6.52%). We performed posterior vitrectomy combined with intravitreal antibiotic and steroid injections in 4 of the 5 traumatic endophthalmities (80%). Injection alone of the above mentioned drugs has been indicated in one early traumatic endophthalmitis (20%), with immediate positive response and the complete recovery of the visual acuity. The technical features of the posterior vitrectomy in the infected eyes are discussed, in comparison with the other clinical conditions in which it is indicated. Our results prove the achievement of visual acuities better than 20/40 in 80% of the post-traumatic endophthalmitis eyes. The failure in one case is explained mainly by the delayed vitrectomy (48 hours from the debut), but also by the circumstances of trauma (soil contamination, in a rural setting)., Conclusion: Immediate action in traumatic endophthalmitis is crucial for the final visual prognosis.

Purpose: This study was designed to compare the diagnostic yield of microbiological analysis performed on diluted and undiluted vitreous samples from pars plana vitrectomy (PPV) in patients with acute postcataract endophthalmitis., Design: Cohort study, evaluation of diagnostic test or technology., Participants: Patients with acute postcataract endophthalmitis (<6 weeks)., Methods: Undiluted and diluted vitreous samples were taken from 34 consecutive patients at the beginning of PPV as part of the multicenter prospective study of the French Institutional Endophthalmitis Study (FRIENDS) group. Vitrectomy was performed after 1 (n = 12) or 2 (n = 22) intravitreous antibiotic injections. McNemar's nonparametric test was used to compare culture and polymerase chain reaction (PCR) results between diluted and undiluted samples., Main Outcome Measures: Rate of positivity of conventional culture (brain heart infusion broth) and eubacterial PCR tests from undiluted and diluted vitreous samples., Results: The microbiological analysis of both undiluted and diluted vitreous samples detected and identified a bacterial pathogen in 26 out of 34 cases (76.4%). The analysis of undiluted and diluted vitreous at the time of PPV, using eubacterial PCR and conventional culture, gave similar results (P = 0.99; McNemar test). However, eubacterial PCR was more sensitive than culture in detecting bacteria in vitreous at the time of PPV (76% vs 6%; P = 0.001; McNemar test). The difference in sensitivity between the 2 techniques was primarily associated with false-negative culture results for undiluted samples (2/3 of cases), mainly for coagulase-negative staphylococci., Conclusions: The microbiological results obtained combining PCR and culture techniques were similar for diluted vitreous and undiluted vitreous analysis. When eubacterial PCR is available, sampling diluted vitreous, an easier procedure, may replace sampling undiluted vitreous.

Two cases of endophthalmitis with choroidal detachment submitted to enucleation are presented. The histopathologic study allowed the identification of vascular and nervous tissue between the choroid and sclera, as it was seen on ultrasound examination.

Endogenous Aspergillus endophthalmitis (AE) is a rare complication of invasive aspergillosis in transplant patients. In this report, we have described a patient who underwent liver transplantation because of drug-induced cholestatic cirrhosis and developed AE at 2 weeks after the surgery. The patient was a 22-year-old man who received a right liver lobe from his father. The operation was uneventful but the patient developed signs and symptoms of small-for-size syndrome after the second day of surgery. The patient received intense immunosuppression with methylprednisolone for 3 days, tacrolimus and mycophenolate mofetil from the first day after the operation, with ceftriaxone and metronidazole as prophylactic antibiotics. Because of signs of respiratory distress with pneumonia, vancomycin and amphotericin B were added empirically to his regimen. Polymerase chain reaction for aspergillus DNA in the blood was positive. The patient received one course of methylprednisolone pulse therapy for signs of acute rejection at day 10, and tacrolimus was changed to sirolimus because of a rising serum creatinine and convulsions. After 2 weeks, the patient's symptoms improved and liver function tests were normal, but the complained of sudden intense pain in the left eye with unilateral blurred vision, redness, and other signs of endophthalmitis upon examination by an ophthalmologists. After 24 hours, visual acuity decreased to light perception. AE was confirmed by microscopy and culture of the vitreous fluid and retinal biopsy. Despite changing amphotericin to intravitreal injection of voriconazole followed by intravenous voriconazole and transient resolution of the symptoms, no improvement was seen in visual acuity. Pain and signs of inflammation in the eye recurred after 2 weeks. At last the patient underwent enucleation for resistant infection and fear of involvement of the other eye by aspergillosis or sympathetic ophthalmia.

Purpose: Postoperative endophthalmitis is a dreaded outcome of any intraocular surgery. Fungal endophthalmitis is a particularly severe complication that poses a significant threat of blindness. We experienced seven consecutive cases of postoperative fungal endophthalmitis stemming from a single local clinic in which extensive early intervention resulted in favorable final visual acuity., Methods: The present study is retrospective observational case series of fungal endophthalmitis. The initial case, as diagnosed by fungal culture, resulted in blindness. In the ensuing eight months, seven consecutive cases were referred to our institution. All were presumed to be fungal endophthalmitis as the cases possessed similar inflammatory findings to the preceding case and occurred in the same environment. Extensive surgical and antifungal treatment was immediately administered, including complete vitrectomy with removal of the intraocular lens and lens capsule and Amphotericin B injections., Results: Retinal infiltration was identified in three cases and the lesion site was photocoagulated with an endolaser. All cases were confirmed fungal endophthalmitis by culture (4 cases: Candida parapsilosis, one case each: Fusarium, Acremonium, Candida tropicalis) and five cases required secondary intraocular lens implantation. Final corrected visual acuity ranged from 20/20 to 40/200 by the Snellen chart., Conclusions: Early extensive surgical intervention and antifungal agent administration may result in favorable visual outcomes in patients with fungal endophthalmitis following cataract surgery.

Purpose: To evaluate the safety and outcomes of 25-gauge pars plana vitrectomy (PPV) in the treatment of postoperative endophthalmitis and compare it with 20-gauge PPV., Methods: The medical records of all patients diagnosed with acute endophthalmitis following cataract surgery who underwent PPV between December 2000 and December 2007 were reviewed. Main outcome measures included final visual acuity (VA), additional interventions, and both intraoperative and postoperative complications., Results: Records of 70 eyes of 70 patients with a condition diagnosed as postoperative endophthalmitis were evaluated. Fifty-eight eyes underwent 20-gauge PPV (group 1), and 12 eyes underwent 25-gauge PPV (group 2). Mean follow-up time for group 1 was 9.6 +/- 8.8 months, and for group 2, 7.9 +/- 12.7 months (P = 0.57). Median VA at presentation was hand motion in both groups. The differences between the two groups in frequencies of visual outcome levels of 20/800 and 20/100 were significant in favor of group 2 (20/800, P = 0.006; 20/100, P = 0.01). In group 2, fewer additional interventions were required, and postoperative complications tended to be less frequent., Conclusions: Twenty-five-gauge PPV seems to be safe and effective in the management of postoperative endophthalmitis. This sutureless technique may have some advantages over 20-gauge surgery, but controlled studies are needed to confirm the results.

Acute and invasive fungal infections are usually seen in immunocompromised and debilitated patients. We report a young immunocompetent 28-year-old Indian male who presented with unilateral endogenous endophthalmitis in the left eye and was managed with pars plana vitreous surgery. The polymerase chain reaction from the vitrectomy specimen tested positive for the fungal genome while the cytology examination identified aseptate hyphae with wide-angle branching, most likely suggesting Zygomycosis. A detailed systemic evaluation failed to reveal any systemic focus or predisposing factor for fungal infection. The patient had received intravenous dextrose infusions while undergoing a surgical procedure for post-traumatic hydrocele elsewhere a week prior to this episode. The patient was successfully managed with pars plana vitreous surgery along with intravitreal Amphotericin-B and oral Voriconazole.

We report the first case of orbital cellulitis and endogenous endophthalmitis secondary to Proteus mirabilis bacteremia that resulted from a calculus cholecystitis. Despite resolution of the gallbladder infection with antimicrobial therapy, the patient required evisceration of the affected eye. The pathogenesis of hematogenous endophthalmitis due to Gram-negative bacilli is discussed.

Objective: To explore the effects of vitrectomy combined with silicone oil injection on the treatment of postoperative endophthalmitis following cataract surgery without intraocular lens removal, and to analyze the relative factors., Methods: This was a retrospective case series study. Clinical data of 7 eyes of 7 patients with postoperative endophthalmitis following cataract surgery underwent the treatment of vitrectomy combined with silicone oil injection without intraocular lens removal from 2003 to 2008 were collected. The outcomes of vision, slit lamp examination, direct and indirect ophthalmoscopy, IOP, and B-scan were observed, and the surgical effects were analyzed., Results: Five patients were male, and 2 patients were female. The age ranged from 67.0 to 84.0 years with a mean of 70.0 + or - 4.5. The onset of endophthalmitis ranged from 1 to 3 days with a mean of 2 days. Silicone oil was removed in 5 eyes 3 to 6 months postoperatively. Preoperative visual acuity ranged from non light perception to hand moving. The mean preoperative intraocular pressure (IOP) was (35.0 + or - 0.5) mmHg with a range from 35.0 to 56.0 mmHg. Follow-up periods ranged from 6 to 43 months with a mean of (10 + or - 6) months. Postoperative visual acuity ranged from non light perception to 0.8. Postoperative vision increased in 6 eyes (86%), and was stable in 1 eye (14%). The mean postoperative IOP was (18.0 + or - 1.5) mmHg with a range from 10.0 to 20.0 mmHg, this was significantly lower than that preoperatively (t = 1.94, P < 0.05). Postoperative complications mainly included fibrous exudates in the anterior chamber at early stage after the surgery (7 eyes) and temporary intraocular pressure elevation (1 eye). There was no retinal detachment and atrophia bulbi., Conclusion: Vitrectomy combined with silicone oil injection may be a safe and effective method in treating postoperative endophthalmitis following cataract surgery without intraocular lens removal.

Purpose: The purpose of this study was to report the clinical presentation, causative organisms, antibiotic sensitivities, management, and visual acuity outcomes in patients with endophthalmitis caused by Proteus species at a university teaching hospital over a 24-year period., Methods: This was a retrospective consecutive case series. The Bascom Palmer Eye Institute Microbiology Laboratory database was reviewed to identify all patients with intraocular cultures positive for Proteus species between 1983 and 2007. Clinical records were reviewed to ascertain the clinical presentation, management, and visual acuity outcomes., Results: In the 13 patients identified, all cases followed intraocular surgery, and 1 was associated with a recurrent corneal ulcer. Of the 1,751 organisms isolated from intraocular culture during the study period, 244 were Gram negative. Proteus species represented 5.3% of gram-negative organisms and <1% of the total isolates identified. Endophthalmitis developed 2 days to 14 days postoperatively (median, 3.5 days), and patients were observed 1 month to 61 months after presentation (median, 17 months). Presenting vision ranged from light perception to 20/200. Ten patients had positive cultures for Proteus mirabilis, and three patients had a growth of Proteus morganii. Four patients (31%) were infected with >1 organism. All Proteus isolates were sensitive to the antibiotics clinically administered, including cefazolin, ceftazidime, gentamicin, and the fluoroquinolones. Five patients (38%) initially received intravitreal injections of antibiotics alone, 1 received an anterior chamber washout in combination with intravitreal injections, and 7 patients (54%) received pars plana vitrectomy in combination with intravitreal injections. Two of the patients (15%) who received vitrectomies had either an intraocular lens or retained nuclear fragments removed. Six patients (46%) received additional antibiotic injections during the clinical course, and 6 patients (46%) underwent additional surgical procedures. Final visual acuity was better than light perception in 5 patients (38%) and was light perception or no light perception in 8 patients (62%). Only 4 patients (31%) had a final vision acuity > or =5/200., Conclusion: Despite prompt treatment with appropriate antibiotics, the clinical outcome for Proteus species endophthalmitis is often poor.

In this report, we describe a patient with drug-induced liver failure who developed endogenous endophthalmitis after liver transplantation. Our patient's clinical course was so fulminant that the eye was lost in less than 1 month, without any response to therapy. Recognition of this infection is important because many patients die of disseminated Aspergillus infection, which may be detected early with bedside funduscopic examination by an ophthalmologist. Probably if the patient had referred to us earlier, it may have been possible to save the eye.

Purpose: To evaluate the success of initial treatment and the factors influencing the outcome in acute-onset endophthalmitis after cataract surgery., Methods: We retrospectively reviewed the medical records of all patients with acute postoperative endophthalmitis between 2000 and 2007. We performed pars plana vitrectomy (PPV) to all eyes with initial visual acuity of light perception. Eyes with visual acuity of hand motions or better underwent either intraocular antibiotic injection (IOAI) or PPV. Eyes that did not give a good clinical response to initial therapy within 60 hours underwent a second procedure. The main outcome measure was the rate of early reintervention after PPV and IOAI., Results: We evaluated 88 eyes of 88 patients. Thirty-seven patients underwent PPV and 51 patients underwent IOAI alone. Six of 37 (16.2%) patients required 1 or more procedures within 60 hours of the initial procedure in the PPV group. Twenty-eight of 51 eyes (54.9%) in the IOAI group underwent PPV within 60 hours. The rate of response to primary PPV was significantly higher than to primary IOAI (P < 0.001). Gram-negative organisms composed 35.1% of the isolates., Conclusion: Pars plana vitrectomy may be preferable to IOAI in postoperative endophthalmitis since the rate of early reintervention is lower with initial PPV.

Purpose: The purpose of this study was to evaluate the predisposing risk factors and treatment outcomes of endogenous fungal endophthalmitis (EFE)., Methods: Records of 25 patients (29 eyes), diagnosed with EFE and treated at Shanghai Eye, Ear, Nose & Throat Hospital from January 2002 to December 2006, were retrospectively reviewed. Four patients had bilateral disease. Final visual acuity and recurrence of EFE were evaluated., Results: Of these 25 patients diagnosed with EFE, 20 patients (22 eyes) were treated by pars plana vitrectomy. Of the remaining 5 patients (7 eyes), 3 cases (4 eyes) were cured by antifungal drugs through systemic treatment and intravitreal injection, but another 2 cases (3 eyes) were only given intravitreal injection because of severe general conditions. Of the 22 eyes that underwent pars plana vitrectomy, 16 (73%) eyes gained visual acuity of counting fingers or better. Recurrent EFE was happened in 2 eyes. Vitrectomy was repeated in 1 eye, another was subsequently enucleated due to phthisis. Vitreous culture-proven or smear-proven EFE occurred in 27 or 2 eyes, respectively. Candida albicans occurred in 17 of 29 eyes (59%), and other causative organisms were yeast fungus (3 eyes), Aspergillus niger (3 eyes), Actinomyces (2 eyes),Aspergillus flavus (1 eye), and Fusarium (1 eye)., Conclusion: Candida albicans were the most common causative organisms in EFE. The most common predisposing risk factors include recent major operation and intravenous administration in rural settings. Most patients with EFE will gain useful vision (counting fingers) after pars plana vitrectomy.

Background: To determine the prognostic indicators of functional outcome in eyes with severe posterior segment trauma managed with pars plana vitrectomy., Methods: One hundred and six eyes of 101 patients were retrospectively reviewed to determine the accuracy of a number of factors in predicting functional outcome after surgery. These potential prognostic indicators included initial visual acuity (VA), retinal detachment (RD), type of trauma, presence of intraocular foreign body (IOFB), type of IOFB, posttraumatic endophthalmitis, hyphema, choroidal detachment, initial hypotonia, accompanying lens subluxation/dislocation, and severe vitreous hemorrhage. In our study, functional success was defined as VA > or =5/200. Fisher's exact and chi-square tests were used for statistical analysis., Results: The mean follow-up time was 12.8+/-0.52 (8-18) months. Thirty-three eyes (31.13%) had functional success. Forty-four (68.7%) of 64 eyes with preoperative RD had anatomical success (total retinal reattachment). Predictors of poor visual outcome (VA < or =5/200) were found to be poor initial VA (p<0.0001), presence of RD (p<0.001), and presence of endophthalmitis (p<0.05). No statistically significant correlation was found between the other predictors surveyed and visual outcome (p>0.05)., Conclusion: Vitreoretinal surgery can improve anatomical and functional success in eyes with severe posterior segment trauma. Poor initial VA, RD, and posttraumatic endophthalmitis are poor predictors of visual outcome.

Congenital erythropoietic porphyria is a rare error of heme metabolism. Derangement of heme metabolism leads to disfiguration, phototoxicity, and the precipitation of porphyric crises. This case report discusses the myriad perioperative considerations in a patient with congenital erythropoietic porphyria.

Purpose: To evaluate the outcomes of pars plana vitrectomy and silicone oil injection for the treatment of infectious endophthalmitis., Methods: 35 cases of endophthalmitis secondary to phacoemulsification (20 patients), trabeculectomy (8 patients), perforating trauma (2 patients), trauma (2 patients), corneal transplantation (1 patient), vitrectomy (1 patient) and corneal ulceration (1 patient) were retrospectively studied. Patients were separated into two groups: Group 1 (n=24): intravitreal antibiotic injection, associated with topical and oral antibiotics; Group 2 (n=11): vitrectomy with intravitreal antibiotic injection and silicone oil injection. The follow-up ranged from 1 to 48 months (mean of 16 months)., Results: From 24 patients in group 1, 11 patients (45.83%), had infection controlled with intravitreal antibiotic injection only; 13 patients (54.15%) regressed to uncontrolled endophthalmitis, in which two patients (8.33%) were submitted to evisceration and one patient (4.16%) had corneal melting. The remaining 10 patients (41.66%) with uncontrolled endophthalmitis were submitted to pars plana vitrectomy and silicone oil injection. Six patients (25%) from Group I had retinal detachment during the first month of follow-up and also required pars plana vitrectomy and silicone oil injection. In Group 2 patients (n=11), all of them had controlled infection at the first procedure. In one case (9.09%), a severe proliferative vitreoretinopathy induced loss of vision., Conclusion: These results suggest that silicone oil tamponade might be beneficial in the treatment strategy of infectious endophthalmitis.

Purpose: We report on 15 cases of suspected toxic anterior segment syndrome after uneventful phaco surgery., Methods: We retrospectively reviewed the charts of patients who had developed toxic anterior segment syndrome (TASS) after uneventful phacoemulsification for senile cataracts between April and December of 2005. Clinical features and all possible causes were investigated including irrigating solutions or drugs, surgical instruments or intraocular lenses, sterilization techniques for instruments, or any other accompanying disease., Results: The patients consisted of 2 males and 13 females with an average age of 64.7+/-10.9 years. Five different surgeons had performed their phaco surgeries. No abnormal preoperative or operative findings were reported. Nevertheless, all 15 patients developed a moderate degree of corneal edema. Ordinary treatments were not helpful. We suspect that lack of sterilization resulted in the development of the syndrome, because after ethylene oxide gas sterilization was replaced with autoclaving, no such incidents have occurred., Conclusions: Toxic anterior segment syndrome requires special attention and thorough management, including sterilization of reused surgical instruments.

Background: To assess prognostic value of the Ocular Trauma Score (OTS) in childhood open-globe injuries., Methods: This retrospective, interventional case series included 61 children with open-globe injuries. Certain numerical values rendered to the OTS variables (visual acuity, rupture, endophthalmitis, perforating injury, retinal detachment, afferent pupillary defect) at presentation were summated and converted into OTS categories; the likelihood of the final visual acuities in the OTS categories were calculated, and compared with those in the OTS Study., Results: Age ranged from 3 years to 14 years (mean, 8.0 years). Forty-two boys and 19 girls were included. Follow-up ranged from 6 months to 56 months (mean, 18 months). The likelihood of the final visual acuities (no light perception, light perception/hand motion, 1/200-19/200, 20/200-20/50, and > or = 20/40) in the OTS categories (1 through 5) in this group were similar to those in the OTS Study group., Conclusions: OTS calculated at initial examination may provide prognostic information in children with open-globe injuries.

Purpose: To evaluate the echographic vitreoretinal patterns before and after intravitreal injection of triamcinolone (IVTA) in eyes with opaque media and several pathologies., Methods: One eye with pseudophakic cystoid macular edema and two eyes with postoperative endophthalmitis and opaque media were examined using B-scan ultrasonography, before and after 0.1 mL ITVA (4 mg Kenacort). The obtained images were compared and the two eyes with endophthalmitis underwent pars plana vitrectomy (PPV) the same day. The relationship between intraoperative and echographic findings was evaluated., Results: Vitreous was relatively anechoic in all three cases before ITVA. Postinjection examination improved visualization of vitreous and posterior hyaloid face (PHF) and revealed vitreoretinal adhesions. The echographic findings confirmed intraoperatively in the two vitrectomized eyes., Conclusions: Triamcinolone-assisted ultrasonography enhances imaging of the PHF. This method might be useful in cases with opaque media regarding PPV planning and prognosis. It is suggested to be applied in selected cases taking into account the beneficial diagnosis information versus the risks to IVTA application.

Myiasis is defined as an occupational disease and it is mainly seen in people who are in contact with animals, in particular sheep. We detected nasal and external ophthalmomyiasis caused by Oestrus ovis in a 33-year-old male who worked as a research assistant in the faculty of agriculture. The presenting complaints were severe foreign body sensation and discharge in the nose, cough, and foreign body sensation in the right eye. Ophthalmologic examination revealed many moving larvae in the right eye of the patient. Larvae were removed and nasolacrimal duct irrigation was performed through the inferior canaliculus. Endoscopic nasal examination also showed larvae colonies. The larvae were removed under local anesthesia and were taken to the parasitology laboratory, wherein Oestrus ovis was identified. Minimal endoscopic sinus surgery showed nonspecific chronic inflammation.

To avoid a postoperative endophthalmitis several measures have been proposed. These are predominantly drug-related, e. g. PVP-iodine, topical antibiotics pre-, intra- and postoperatively. Due to the actual ESCRS study for intracameral antibiotics, the current discussion focusses almost exclusively on drug-related causes. Therefore, in this paper the surgical priority is pointed out without neglecting the drug-related causes. The construction of the tunnel must be water-tight even under pressure from outside to avoid a postoperative hypotony. In cases of doubt the tunnel should be sutured.

Purpose: We aimed to report our observation regarding the long-term follow-up results of 2 cases with similar ophthalmic manifestations of 2 different porphyrias, congenital erythropoietic porphyria (CEP), and porphyria cutanea tarda (PCT)., Methods: Both patients presented with ocular pain and photophobia in both eyes. The patient with CEP had a scleral necrosis of 3 mm in diameter at the lateral limbus of the right eye and medial limbus of the left eye, accompanied with cicatricial ectropion and lid swelling OU. The patient with PCT had scleral necrosis in the interpalpebral area nasally, OU., Results: Both patients were followed-up for 4 years. The patients received intensive topical lubrication and topical and oral immune-suppressive medication. They underwent amniotic membrane grafting, when required, and were advised to wear UV glasses. The case with PCT followed a more salient course and remained symptom free until the end of the follow-up period. In contrast, the patient with CEP developed further scleral necrosis, despite the treatment and evisceration surgery were inevitable owing to endophthalmitis unresponsive to the treatment., Conclusions: Ocular complications are rarely reported in porphyrias, and the studies on the long-term follow-up results are fewer. Despite careful follow-up and intensive treatment, scleral necrosis can be progressive and results in the loss of vision or even the loss of eye. Further studies regarding the care of patients with porphyrias are required to more effectively treat these rare ophthalmic conditions.

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 explore the effects of vitrectomy combined with silicone oil injection in the treatment of traumatic endophthalmitis without retinal detachment, and analyze the relative factors., Methods: Eighteen eyes of 18 patients with traumatic endophthalmitis and without retinal detachment received the treatment of vitrectomy combined with silicone oil filling. Silicone oil removal combined with intraocular lens implantations were performed in all eyes 6 months postoperatively. The visual acuity was measured by logMAR values. Preoperative visual acuity ranged from light perception to 0.1. The mean preoperative intraocular pressure was 9 mmHg with a range from 5 to 25 mmHg. Follow-up ranged from 6 to 43 months with a mean of 18 months., Results: The postoperative visual acuity ranged from light perception to 0.8 at the last follow-up examination. The visual acuity increased in 15 eyes (83%), and was stable in 3 eyes (17%). The mean postoperative intraocular pressure was 17 mmHg with a range from 10 to 20 mmHg, and was significantly higher than preoperatively (p<0.05). There was no retinal detachment or ocular atrophy. Postoperative complications mainly included fibrosis exudates in the anterior chamber (18 eyes) and temporary intraocular pressure elevation (3eyes)., Conclusions: Under treatment with systemic antibiotics, vitrectomy combined with silicone oil filling may be a reasonable alternative to standard endophthalmitis treatment using intravitreal antibiotics.

Purpose: To describe a case of sympathetic ophthalmia following vitrectomy for endophthalmitis after an intravitreal injection of bevacizumab., Design: Retrospective case report., Methods: An 84-year-old male developed sympathetic ophthalmia 4 months after vitrectomy for endophthalmitis following an intravitreal injection. The inciting blind eye was enucleated., Results: Histopathology demonstrated sympathetic ophthalmia and phacoanaphylactic endophthalmitis. Visual acuity improved from 20/200 to 20/30 in the sympathizing eye with a combination of oral prednisone and azathioprine., Conclusions: Sympathetic ophthalmia can develop following exogenous endophthalmitis but has a good visual prognosis with appropriate treatment.

Aims: To estimate the incidence of penetrating injuries with retained intraocular foreign bodies (IOFBs) in the United Kingdom, and to provide epidemiological data on the aetiology, management, and visual outcome of such injuries., Methods: Cases were identified prospectively by active surveillance through the British Ophthalmological Surveillance Unit reporting card system, for the 12-month period June 2004 to May 2005 inclusive. Questionnaire data were obtained from UK ophthalmologists at presentation and 6 months following presentation., Results: Data were available on 97 patients at presentation and 95 patients at follow-up. The minimum estimated incidence of IOFBs in the United Kingdom identified in this study was 0.16 per 100 000. All patients were male. Hammering was the most common mechanism of injury, occurring in 62% of patients. The IOFB was found in the anterior segment in 24%, the posterior segment in 73%, and involved both segments in 3%. Endophthalmitis was diagnosed in 9% of patients. Best-corrected visual acuity of the injured eye at final follow-up was 6/12 or better in 67%, 6/18 to 6/60 in 11%, and worse than 6/60 in 22%. Prognostic factors for a poor visual outcome included poor visual acuity at presentation, prolapse of intraocular tissue, development of endophthalmitis, development of retinal detachment, and large size of IOFB., Conclusions: The incidence of IOFB in the United Kingdom appears to have reduced compared to previous studies. The majority of patients (67%) retain good visual acuity in the injured eye; however, a significant minority (22%) sustain long-term severe visual loss.

Background: To report on the diagnosis and management of a"firecracker" injury presenting with a post-traumatic intraocular inflammation., Case Report: A 10-year-old boy sustained a penetrating 16-mm cornea-sclera blast injury to his left eye with uveal prolapse and hemophthalmus and doubtful light perception. The cranial computed tomography revealed a metallic intraocular foreign body (IOFB), retinal detachment, and subretinal and subchoroidal hemorrhage. After primary wound closure and antibiotic treatment for 1 week, increasing cell infiltration and amaurosis developed, and a lensectomy, pars plana vitrectomy, and extraction of the 17x7x7-mm encapsulated IOFB via a scleral tunnel was indicated., Results: A vitreous specimen did not reveal microbial growth; however, plenty of polymorphonuclear cells, macrophages, and lymphocytes were observed. Spectroscopy of the IOFB showed copper, zinc, silicon, lead, and other metals. A diagnosis of noninfectious inflammation due to heavy metals, primarily copper (=chalcosis), was made. The postoperative course was unremarkable, the intraocular lens in place, fundus CDR 0.2, retina and macula attached, intraocular pressure 9 mmHg. Three weeks after surgery, the flash VEP showed absent potentials., Conclusions: Large projectiles or parts should be removed from the eye immediately in order to prevent complications from toxic metallosis and early fibrotic reactions.

Purpose: The clinical features and visual prognosis after vitrectomy for endophthalmitis which had developed after cataract surgery were compared in two groups with or without background factors, including malignant tumor, diabetes, oral steroid administration, collagen disease, dacryocystitis, and lid closure disturbance., Method: Fifty-two patients (53 eyes) who underwent a vitrectomy for the treatment of endophthalmitis which had developed within 6 weeks after cataract surgery. They were divided into two groups according to the presence (21 eyes, group A) or absence (32 eyes, group B) of background factors, and were retrospectively compared based on their medical records., Results: The culture-positive rate was 62% in group A and 69% in group B. The incidence of a final visual acuity of more than 20/20 was significantly lower in group A (14%) than in group B (47%, p < 0.05). Methicillin-resistant Staphylococcus aureus, alpha-hemolytic Streptococcus and Enterococcus were frequently identified in group A. Leakage from the cataract wound was found in about 80% of the patients with corneal incisions, and a wound that had not been covered by the conjunctiva was significantly more frequent as a factor in group A (group A, 13 eyes; group B, 10 eyes; p < 0.05)., Conclusion: Postoperative endophthalmitis may have a less favorable visual prognosis in patients with background factors, so precise wound construction during cataract surgery is important in these patients.