Search

Objective: This study evaluated the clinical features and treatment outcomes in patients with endogenous Aspergillus endophthalmitis., Design: The study design was a multicenter retrospective chart review., Participants: Ten patients (12 eyes) with culture-proven endogenous Aspergillus endophthalmitis treated by 1 of the authors were studied., Intervention: Intravitreous amphotericin B injection, pars plana vitrectomy, systemic amphotericin B therapy, and oral anti-fungal therapy were performed., Main Outcome Measures: Elimination of endogenous Aspergillus endophthalmitis and Snellen visual acuity, best corrected, were measured., Results: All patients had a 1- to 3-day history of pain and marked loss of visual acuity in the involved eyes. Varying degrees of vitritis was present in all 12 eyes. In 8 of 12 eyes, a central macular chorioretinal inflammatory lesion was present. Four patients (six eyes) had associated pulmonary diseases and were receiving concurrent steroid therapy. One of these patients with chronic asthma also was abusing intravenous drugs. Overall, six patients (six eyes) had a history of intravenous drug abuse, whereas a seventh patient (one eye) was suspected of abusing intravenous drugs. Blood cultures and echocardiograms were negative for systemic aspergillosis. Management consisted of a pars plana vitrectomy in 10 of 12 eyes. Intravitreous amphotericin B was administered in 11 of 12 eyes. Systemic amphotericin B therapy was used in eight patients. One patient was treated with oral antifungal agents. In three eyes without central macular involvement, final visual acuities were 20/25 to 20/200. In eight eyes with initial central macular involvement, final visual acuities were 20/400 in three eyes and 5/200 or less in four eyes. Two painful eyes with marked inflammation, hypotony, and retinal detachment were enucleated., Conclusions: Endogenous Aspergillus endophthalmitis usually has an acute onset of intraocular inflammation and often has a characteristic chorioretinal lesion located in the macula. Although treatment with pars plana vitrectomy and intravitreous amphotericin B is capable of eliminating the ocular infection, the visual outcome generally is poor, especially when there is direct macular involvement.

Straight, 30-, and 45-degree endolaser probes were compared to determine the optimal curve for peripheral endolaser photocoagulation during pars plana vitrectomy. The 30-degree probes allowed panretinal laser coverage in phakic eyes, thereby negating the need for peripheral cryopexy which may cause increased inflammation and contribute to the development of proliferative vitreoretinopathy. The 30-degree probe was less likely to strike the lens inadvertently, produced a more consistent burn, was more versatile in posterior treatments, and had a longer fiberoptic core life than the 45-degree probe. It was impossible to treat the peripheral retina using the straight probe without hitting the lens during phakic pars plana vitrectomy.

The Eckardt style temporary keratoprosthesis was used in six cases of five eyes undergoing simultaneous penetrating keratoplasty and pars plana vitrectomy. This device provided excellent visualization of posterior and peripheral intraocular structures and maintained a closed system during surgery. Corneal grafts remained clear in 80% of the cases, and macular attachment was achieved with either silicone oil or perfluoropropane gas in 50% of cases followed for at least 6 months. Visual function remained the same or improved in three eyes. Suggested refinements to the placement of this device include enlarging the trephination to 6.75 mm and the use of 8-0 nylon sutures to prevent cheesewiring of the soft silicone rim. A plano contact lens required during surgery to visualize the retina did not minify the image. Since the optical cylinder of the Eckardt temporary keratoprosthesis is shorter than that of a Landers-Foulks keratoprosthesis of similar diameter, it provides greater peripheral visualization. It is, however, less durable.

Many vitreoretinal procedures are performed in offices and hospitals where cost control is important. We describe three useful devices and techniques that facilitate these procedures at minimal expense and often greater convenience. These include an accurate method for localising the pars plana without the use of callipers, an inexpensive, reliable, pressure regulated air pump for fluid-air exchange, and an easy method for intraocular injection of silicone oil through 20 gauge instrumentation without the need for expensive pumps. These procedures and techniques should prove to be useful in the treatment of vitreoretinal disease.