Search

Purpose: To report intrusion of encircling suture used for scleral buckling 20 years ago., Methods: Observational case report of a patient who admitted with the complaint of floaters. The patient had surgery for retinal detachment 20 years ago. Fundus examination revealed an encircling suture material. In some locations, the encircling suture had eroded all the way through the sclera to the vitreous cavity. In these locations, it was passing through the vitreous cavity. There was no retinal detachment, inflammation, or hemorrhage., Results: Prophylactic argon laser photocoagulation was performed. No complication occurred during 1-year follow-up., Conclusion: A conservative approach with close follow-up may be suitable in case of an intrusion of suture material if there are no accompanying complications.

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.

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: To evaluate the rate, duration, and associated complications of postoperative hypotony after 25-gauge sutureless vitrectomy., Methods: In a retrospective, interventional, institutional case series, 25-gauge sutureless vitrectomy with straight incisions was performed on 111 eyes. Postoperative intraocular pressure (IOP) was measured routinely at 2 hours, 1 day, 1 week, and 1 month. Postoperative IOP, hypotony (IOP, <8 mmHg) rates, and complications associated with low IOP were assessed to determine outcome., Results: Mean follow-up +/- SD was 5.45 +/- 3.44 months. Mean IOP decreased significantly by 2 hours and on postoperative day 1 (P < 0.001) and increased to preoperative levels at week 1 (P = 0.48). Postoperative hypotony rates were 26.12%, 17.11%, and 8.10% at 2 hours, 1 day, and 1 week, respectively. The ratio of postoperative vitreous hemorrhage in eyes with and without hypotony on day 1 was 2:6 (P = 0.412). Two eyes with macular holes (MHs) filled inadequately with gas endotamponade that remained hypotonic for the first postoperative week underwent reoperation due to unsealed MHs., Conclusions: Twenty-five-gauge sutureless vitrectomy with straight incisions resulted in a hypotony rate of 26.12% at 2 hours that decreased to 17.11% on day 1 and to 8.10% at week 1 but did not increase the incidence of postoperative complications.

Purpose: To report a case with acute endophthalmitis as a postoperative complication of 25-gauge transconjunctival sutureless vitrectomy., Methods: A 65-year-old gentleman, who underwent 25-gauge sutureless vitrectomy for an idiopathic epiretinal membrane at Beyoğlu Eye Research and Training Hospital, presented with painful loss of vision three days later. For the treatment of acute postoperative endophthalmitis, revitrectomy, phacoemulsification with total capsulectomy and silicone oil injection were performed with intravitreal vancomycin and ceftazidim injections. No predisposing risk factors for endophthalmitis or postoperative hypotony were present., Results: Cultures were positive for coagulase negative staphylococcus. He was treated with systemic moxifloxacin and topical ofloxacin, prednisolone acetate postoperatively. Intraocular inflammation resided in 10 days. Silicone oil was removed three months later. At the last visit after 10 months of follow-up, visual acuity increased to 20/63., Conclusions: Postoperative endophthalmitis following 25-gauge sutureless vitrectomy occurred after 3 days in the absence of known predisposing factors. Endophthalmitis responded well to antibiotics and vitrectomy with a favorable visual outcome. Unsutured sclerotomies may provide a conduit for bacterial ingress. Preoperative prophylactic antibiotic usage may be considered as a preventive measure in sutureless vitrectomy.

Purpose: To study the use of blood culture bottles for culturing vitreous specimens in acute-onset postoperative infectious endophthalmitis cases., Methods: Forty-eight eyes of 48 patients with mean age of 66.4 +/- 14.7 years with postoperative endophthalmitis that occurred within 6 weeks after ocular surgery, presenting from June 2001 to January 2005, were retrospectively studied. Vitreous fluid specimens of these patients were cultured in blood culture bottles. The measured outcome is the yield of positive culture., Results: Vitreous specimens yielded positive in 34 of 48 (70.8%) eyes with blood culture bottles. The most common organism isolated was Staphylococcus epidermidis in 17.6% (6/34) of cases., Conclusion: The direct inoculation of vitreous specimens into the blood culture bottles is easy to perform, with a high yield positive rate (70.8%). It may be an alternative to conventional culture media for culturing vitreous specimen in infectious endophthalmitis especially in clinics or hospitals that are unable to have adequate microbiology laboratory facilities.

Purpose: To investigate the influence of uneventful phacoemulsification on anterior chamber depth (ACD), iridocorneal angle (ICA) width, and intraocular pressure (IOP) in nonglaucomatous eyes with open ICA preoperatively., Setting: Beyoglu Eye Education and Research Hospital, Istanbul, Turkey., Methods: Fifty-three eyes of 49 patients were evaluated for 6 months postoperatively. The nonparametric Wilcoxon signed rank test was used to compare preoperative and postoperative IOP, ACD, and ICA width. Univariate and multivariate regression analyses were used to evaluate the relationships between IOP, ACD, and ICA width and between preoperative patient characteristics., Results: The mean preoperative IOP of 15.1 mm Hg +/- 2.8 (SD) dropped postoperatively to 13.4 +/- 3.4 mm Hg at 1 day, 13.3 +/- 2.6 mm Hg at 1 week, 13.2 +/- 3.1 mm Hg at 1 month, 13.3 +/- 2.7 mm Hg at 3 months, and 14.1 +/- 2.5 mm Hg at 6 months (P<.05). The mean preoperative ICA grade of 2.97 +/- 0.72 increased to 3.55 +/- 0.48 at 1 week and 3.68 +/- 0.45 at 1 month (P<.05). The mean preoperative ACD of 3.06 +/- 0.49 mm increased to 3.57 +/- 0.47 mm at 4 weeks, 3.69 +/- 0.32 mm at 1 month, and 3.70 +/- 0.36 mm at 3 months (P<.05). The IOP decrease was not correlated with the changes in ICA width or ACD. Multiple regression analysis showed preoperative IOP was the single predictor of the postoperative IOP drop (P<.001)., Conclusions: In nonglaucomatous eyes with an open ICA preoperatively, uneventful phacoemulsification reduced IOP, increased ACD, and widened the ICA. The changes were statistically significant over 6 months.