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Purpose: To report a case of endophthalmitis associated with Legionella Pneumophila . Case Report: A 46-year-old, highly myopic male with a complex history of recurrent retinal detachments, macular hole, cataract surgery and an infected scleral buckle in the left eye, presented with pain, redness, hypopyon and vision loss in the left eye, 14 days following blunt head trauma. Empirical treatment for endophthalmitis with intravitreal injections of Vancomycin and Ceftazidime afforded minimal improvement. He developed recurrent hypopyon and underwent vitrectomy surgery with intravitreal antibiotic injections at the time of surgery and had improvement. Intraoperative culture was positive for Legionella Pneumophila. He had continued episodes of recurrent inflammation which were quelled by intravitreal moxifloxacin injections performed every 3-10 days. He developed a recurrent RD with proliferative vitreoretinopathy (PVR) and underwent vitrectomy with silicone oil. The retina was reattached but had no light perception vision in the affected eye. Conclusion: When endophthalmitis is contracted in a work-place setting, a culture for L. pneumophila should be considered. A combination of intravitreal moxifloxacin and oral azithromycin may be effective.

Age-related macular degeneration (AMD) is the leading cause of blindness in individuals over age 50 in developed countries. Current therapy for nonexudative AMD (neAMD) is aimed at modifying risk factors and vitamin supplementation to slow progression, while intravitreal anti-vascular endothelial factor (VEGF) injections are the mainstay for treatment of choroidal neovascularization in exudative AMD (eAMD).Over the past decade, promising therapies have emerged that aim to improve the current standard of care for both diseases. Clinical trials for neAMD are investigating targets in the complement cascade, vitamin A metabolism, metformin, and tetracycline, whereas clinical trials for eAMD are aiming to decrease treatment burden through novel port delivery systems, increasing drug half-life, and targeting new sites of the VEGF cascade. Stem cell and gene therapy are also being evaluated for treatment of neAMD and eAMD.With an aging population, the need for effective, long term, low burden treatment options for AMD will be in increasingly high demand. Current investigations aim to address the shortcomings of current treatment options with breakthrough treatment approaches. Therapeutics in the pipeline hold promise for improving the treatment of AMD, and are on track for widespread use within the next decade.

Author(s): Mukkamala, Lekha K; Avaylon, Jaycob; Welch, R Joel; Yazdanyar, Amirfarbod; Emami-Naeini, Parisa; Wong, Sophia; Storkersen, Jordan; Loo, Jessica; Cunefare, David; Farsiu, Sina; Moshiri, Ala; Park, Susanna S; Yiu, Glenn | Abstract: PurposeTo investigate whether intraoperative retinal changes during epiretinal membrane (ERM) peeling affect anatomic or functional outcomes after surgery.MethodsWe measured retinal thickness using an intraoperative optical coherence tomography (iOCT) device in patients undergoing pars plana vitrectomy with membrane peeling for idiopathic ERM. Changes in intraoperative central macular thickness (iCMT) were compared with postoperative improvements in CMT and best-corrected visual acuity (VA).ResultsTwenty-seven eyes from 27 patients (mean age 68 years) underwent iOCT-assisted ERM peeling surgery. Before surgery, mean VA was logMAR 0.50 ± 0.36 (Snellen 20/63), and mean baseline CMT was 489 ± 82 µm. Mean iCMT before peeling was 477 ± 87 µm, which correlated well with preoperative CMT (P l 0.001). Mean change in iCMT was -39.6 ± 37 µm (range -116 to +77 µm). After surgery, VA improved to logMAR 0.40 ± 0.38 (Snellen 20/50) at month 1 and logMAR 0.27 ± 0.23 (Snellen 20/37) at month 3, whereas CMT decreased to 397 ± 44 µm and 396 ± 51 µm at months 1 and 3. Eyes that underwent greater amount of iCMT change (absolute value of iCMT change) were associated with greater CMT reduction at month 1 (P l 0.001) and month 3 (P = 0.010), whereas those with greater intraoperative thinning (actual iCMT change) showed a trend toward better VA outcomes at months 1 (P = 0.054) and 3 (P = 0.036).ConclusionsIntraoperative changes in retinal thickness may predict anatomic and visual outcomes after idiopathic ERM peeling surgery.Translational relevanceOur study suggests that intraoperative retinal tissue response to ERM peeling surgery measured by iOCT may be a prognostic indicator for restoration of retinal architecture and for visual acuity outcomes.