Anterior chamber stability during bimanual irrigation and aspiration. Theoretical and experimental analysis.

PURPOSE: To determine the requirements for maintaining a stable anterior chamber during bimanual irrigation and aspiration (I/A) using side-port cannulas. SETTING: Cole Eye Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA. METHODS: A theoretical fluid dynamic model of the closed I/A system was developed. Model predictions were compared with experimental flow measurements made on the Alcon Legacy 20000 system using a number of commercial and custom I/A cannulas. RESULTS: Bore diameter, length, and orifice size determine the pressure-flow relationship of cannulas. Four of 18 tested irrigation cannulas were able to maintain anterior chamber stability when used with a 23-gauge/0.3 mm orifice aspiration cannula and maximum aspiration settings. All 4 had a 21-gauge lumen diameter. A shorter cannula length also contributed to higher flow. CONCLUSIONS: Anterior chamber stability during bimanual I/A required the irrigation system to have lower flow resistance than the aspiration system, which can be provided by using cannulas with larger lumen diameters and shorter lengths. Special cannula designs can provide these characteristics without requiring larger side-port incisions.

Compression sutures in the management of corneal transplant wound infections.

PURPOSE: To report the usefulness of compression sutures in the management of three cases of bacterial wound infections in corneal transplants. METHODS: Interventional case series. RESULTS: All three cases of wound dehiscence and perforation resulting from bacterial wound infections were successfully treated with placement of compression sutures with concurrent topical antibiotic treatment. CONCLUSION: The placement of compression sutures is a successful surgical technique to reestablish corneal transplant wound integrity compromised by infection.

Severe penetrating ocular injury from ninja stars in two children.

The authors describe two cases of penetrating ocular trauma in children resulting from ninja stars. In the first case, despite a scleral laceration, loss of iris tissue, and a vitreous hemorrhage, the child had a good result with a final best corrected visual acuity of 20/20. Unfortunately, the child in the second case did not fare as well. In this case, the child suffered a large corneal laceration and traumatic cataract. He ultimately required a penetrating keratoplasty, and he is currently being treated for amblyopia, strabismus, and elevated intraocular pressures. His best corrected visual acuity is 20/70.

Retinal vasculitis and posterior pole "hypopyons" as early signs of acute bacterial endophthalmitis.

PURPOSE: To report a case of acute postoperative bacterial endophthalmitis presenting with retinal vasculitis and posterior pole "hypopyons." DESIGN: Observational case report. METHODS: Observational case report. RESULTS: In a 73-year-old woman, acute postoperative endophthalmitis presented with retinal vasculitis, diffuse retinal hemorrhages, and several posterior pole "hypopyons" that were collections of yellow-white inflammatory debris. The inflammation was located primarily in the posterior one third of the vitreous, and except for severely impaired visual acuity, the classic signs of acute postoperative endophthalmitis were not present until the next day. An immediate pars plana vitrectomy with intravitreal injection of vancomycin, amikacin, and dexamethasone was performed. Vitreous and aqueous cultures grew coagulase-negative Staphylococcus species. After intravenous and topical therapy for endophthalmitis, the inflammation subsided. Eight weeks after the initial cataract surgery, the best corrected visual acuity of the patient was 20/25. CONCLUSION: Acute postoperative bacterial endophthalmitis may present with atypical clinical signs and inflammation located primarily in the retina and posterior vitreous.