ENTEROCOCCUS ENDOPHTHALMITIS: Clinical Settings, Antimicrobial Susceptibility, and Management Outcomes.

PURPOSE: To report the clinical presentation and management outcome of patients with endophthalmitis caused by Enterococcus species and to report the susceptibility profile of the isolates. METHODS: Twenty-nine cases with culture-proven Enterococcus endophthalmitis from January 2005 to May 2018 underwent vitrectomy/vitreous biopsy, intravitreal antibiotic with or without additional procedures. The undiluted vitreous was subjected to microbiologic evaluation. A favorable anatomical outcome was defined as preservation of the globe, absence of hypotony, attached retina, and absence of active inflammation at the last visit. Favorable visual outcome was final visual acuity ≥20/400. RESULTS: There were 24 men (82.8%). Mean age at presentation was 32.89 ± 25.25 years (median 24 years). Inciting event was open globe injury in 18 (62%), endogenous in 5 (17.24%), postcataract surgery in 3 (10.34%), postscleral buckling in 2 (6.89%), and postkeratoplasty in 1 (3.44%). Enterococcus casseliflavus was the commonest species isolated (14/29, 48.27%) followed by E. faecalis (9/29, 31%). Susceptibility to vancomycin was seen in 27/29 isolates (93%). Visual acuity was ≤20/400 in all eyes at presentation and ≥20/400 in 10/29 cases (34.48%) at final visit. Anatomical success was seen in 18/29 eyes (62%). Corneal involvement was high at 24/29 eyes (82.75%). CONCLUSION: Enterococcus is not an uncommon organism in the setting of endophthalmitis after open globe injury. Resistance to vancomycin is rare. Multidrug resistance pattern is restricted to E. faecalis. Visual outcome is poor despite early and appropriate therapy due to inherent organism virulence.

Comparison of different settings for yellow subthreshold laser treatment in diabetic macular edema.

BACKGROUND: To assess the safety and efficacy of two subthreshold parameters (5 and 15% duty cycle (DC)) compared to standard ETDRS (early treatment of diabetic retinopathy study) continuous wave (CW) laser. METHODS: In this prospective randomized study, 30 eyes from 20 patients with non-center involving macular edema were randomized into 3 different groups: 5% DC, 15% DC and CW navigated modified ETDRS laser treatment. Titration in subthreshold groups was performed with 30% of the threshold power, decided with microsecond pulses. CW laser was titrated to a barely visible burn. All patients underwent microperimetry, thickness measurements and visual acuity examinations at baseline, 6 weeks and 12 weeks post treatment. RESULTS: At three months follow up, retinal sensitivity was significantly reduced in the CW group by - 2.2 dB whereas in both subthreshold groups, retinal sensitivity increased by 2.4 dB for 5% and 1.9 dB for 15% DC with no significant difference. Retinal volume (mm3) decreased in both subthreshold groups by 0.08 ± 0.3 and 0.12 ± 0.11 in 5 and 15% DC group respectively. Whereas the CW group showed volume increase of 0.55 ± 0.92 (p = 0.02 and 0.01 for 5 and 15% DC groups). Visual acuity remained stable in all 3 groups (- 0.7 letter in 5% DC; 2.11 letters in 15% DC and 0.88 in CW with no significant difference). CONCLUSION: Subthreshold microsecond laser was shown to be safe and effective with both 5 and 15% DC as compared to conventional photocoagulation with ETDRS parameters. The 15% DC setting trended to achieve better anatomical, visual and functional outcomes. TRIAL REGISTRATION: Retrospectively registered ( NCT03571659 , 06/26/2018).

Clinical presentations, risk factors and outcomes of ceftazidime-resistant Gram-negative endophthalmitis.

BACKGROUND: To describe the clinical features and outcomes of patients diagnosed with ceftazidime-resistant Gram-negative endophthalmitis and the role of intravitreal imipenem in these cases. DESIGN: Retrospective consecutive interventional case series at a tertiary eye care centre in South India. PARTICIPANTS: Consecutive cases of ceftazidime-resistant Gram-negative endophthalmitis from April 2010 to December 2014. Fifty-six cases diagnosed during this time period were included. METHODS: All cases were managed with vitreous biopsy/vitrectomy, microscopy and undiluted vitreous culture, antimicrobial susceptibility of bacterial isolates and received intravitreal antibiotics. MAIN OUTCOME MEASURES: Anatomic and visual outcome of these cases, antimicrobial susceptibility pattern of intravitreal imipenem and outcome of cases injected with it. RESULTS: Commonest presentation was acute endophthalmitis following cataract surgery (27 eyes, 48.21%). Pseudomonas aeruginosa was isolated in 33 eyes (58.93%; 95% CI 46.05-71.81%). Nineteen eyes (34%; 95% CI 21.59-46.41%) developed phthisis; 14 eyes (25%; 95% CI 13.66-36.34%) had vision <20/200; 17 eyes (30.35%; 95% CI 18.31-42.39%) eyes had an ambulatory vision >20/200 (logMAR 1); 6 eyes (10.71%; 95% CI 2.61-18.81%) had a reading vision >20/40 (logMAR 0.3). Trend was towards better anatomic (72.73% vs. 40%) (P = 0.05) and visual improvement in the imipenem group (logMAR 3.94 + 0.21 to 2.43 + 1.4; P = 0.002), as compared with non-imipenem group (logMAR 2.99 + 1.3 to 2.55 + 1.4; P = 0.13). CONCLUSIONS: Outcome of ceftazidime-resistant Gram-negative endophthalmitis is poor. P. aeruginosa is the commonest isolated organism. All cases were sensitive to imipenem. There was a trend towards better anatomic outcome in imipenem-treated eyes.

Microsecond yellow laser for subfoveal leaks in central serous chorioretinopathy.

PURPOSE: To evaluate the role of navigated yellow microsecond laser in treating subfoveal leaks in nonresolving central serous chorioretinopathy (CSC). METHODS: This prospective study included ten eyes of ten consecutive patients with nonresolving CSC with subfoveal leaks. All eyes were treated with 577 nm navigated yellow microsecond laser (5% duty cycle). Key inclusion criteria include a vision loss for a duration of minimum 3 months duration due to focal subfoveal leak on fluorescein angiography. Key exclusion criteria include prior treatment for CSC and any signs of chronic CSC. Comprehensive examination, in addition to low-contrast visual acuity assessment, microperimetry, autofluorescence, spectral domain optical coherence tomography, and fundus fluorescein angiography, was done at baseline, 1, 3, and 6 months after treatment. Rescue laser was performed as per predefined criteria at 3 months. RESULTS: The average best-corrected visual acuity improved from 73.3±16.1 letters to 75.8±14.0 (P=0.69) at 3 months and 76.9±13.0 (P=0.59) at 6 months, but was not statistically significant. Low-contrast visual acuity assessment (logMAR) improved from 0.41±0.32 to 0.35±0.42 (P=0.50) at 3 months and 0.28±0.33 (P=0.18) at 6 months. Average retinal sensitivity significantly improved from baseline 18.93±7.19 dB to 22.49±6.67 dB (P=0.01) at 3 months and 21.46±8.47 dB (P=0.04) at 6 months. Rescue laser was required only in one eye at 3 months; however, laser was required in three eyes at 6 months. CONCLUSION: Microsecond laser is a safe and effective modality for treating cases of nonresolving CSC with subfoveal leaks.

Endophthalmitis After Pars Plana Vitrectomy: Clinical Features, Risk Factors, and Management Outcomes.

PURPOSE: To report the clinical presentations, risk factors, and outcomes of endophthalmitis after pars plana vitrectomy at 4 tertiary eye care centers of an institute in South India. DESIGN: A retrospective case series. METHODS: The records of 38,591 patients undergoing vitrectomy were reviewed using the coding assigned by the medical records department. Consecutive cases diagnosed as endophthalmitis after pars plana vitrectomy (PPV) between 1990 and 2014 for various indications were analyzed. RESULTS: The clinical incidence of postvitrectomy endophthalmitis was 0.052%, and culture-positive incidence of postvitrectomy endophthalmitis was 0.031%. Twelve cases (60%) were culture positive. Mean presenting vision was 2.16 ± 1.51 logMAR (Snellen equivalent 20/2890). Seventeen eyes had received sutureless vitreous surgery (15 cases 23G, 2 cases 25G) and 3 eyes had received 20G suture-assisted vitreous surgery (P < 0.0001). The odds of developing endophthalmitis in sutureless versus sutured vitrectomy were 25.14 [95% confidence interval (CI), 7.37-85.84] (P < 0.0001) and those of developing endophthalmitis in sutureless surgery versus sutured with final tamponade of Ringer lactate (RL) were 19.53 (95% CI, 5.37-71.03) (P < 0.0001). In sutureless surgeries, the odds of developing endophthalmitis in RL tamponaded eyes versus non-RL ones was 4.39 (95% CI, 1.67-11.56) (P = 0.002). Mean interval between vitreous surgery and endophthalmitis was 4 ± 6.89 days; median, 1.5 days. Mean postoperative vision was 1.7 ± 1.36 logMAR (Snellen equivalent 20/1002) (P = 0.31). CONCLUSIONS: Endophthalmitis after vitrectomy is an acute presentation. Sutureless surgery, especially with aqueous tamponade, has a higher risk. The visual outcome is relatively poor.

Clinical features, microbiological profile and treatment outcome of patients with Corynebacterium endophthalmitis: review of a decade from a tertiary eye care centre in southern India.

AIMS: To report the clinical and microbiological profile along with treatment outcome of patients with endophthalmitis caused by Corynebacterium sp. METHODS: This is a retrospective, consecutive, non-comparative case series of patients with culture-proven Corynebacterium endophthalmitis seen between August 2004 and July 2014. RESULTS: Of 5439 patients clinically diagnosed as infective endophthalmitis, vitreous samples were culture positive for bacteria in 1488 (27%). Sixteen patients (1%) were identified as Corynebacterium endophthalmitis. The clinical settings included trauma (n=10), post-cataract surgery (n=5) and post-penetrating keratoplasty (n=1). In 7/16 (44%) patients, the organisms were visualised in direct microscopy. Tested by disc-diffusion method, all isolates were vancomycin sensitive. However, 9 of 10 isolates were resistant to ceftazidime and 5 of 14 isolates were resistant to amikacin. Initial treatment strategies included pars plana vitrectomy with intravitreal antibiotics (vancomycin and amikacin/ceftazidime) injection (n=9) and pars plana lensectomy along with pars plana vitrectomy and intravitreal antibiotics (vancomycin and amikacin/ceftazidime) injection (n=7). Final visual acuity was 20/200 or better in 11 (69%) of 16 patients. CONCLUSIONS: The prevalence of corynebacterial endophthalmitis is low. The organisms are susceptible to vancomycin, and early appropriate treatment results in favourable outcome.

SHORT-TERM SAFETY PROFILE OF INTRAVITREAL ZIV-AFLIBERCEPT.

AIM: To evaluate the safety of intravitreal ziv-aflibercept (Zaltrap) in the treatment choroidal neovascularization secondary to age-related macular degeneration. METHODS: Eligible eyes with choroidal neovascularization secondary to age-related macular degeneration each received a single intravitreal injection of ziv-aflibercept. Comprehensive ophthalmic examinations and detailed systemic evaluations were performed at baseline and Days 1, 7, and 30 after injection, and International Society for Clinical Electrophysiology of Vision standard electroretinography was performed at baseline and Day 30. Primary outcome measures were safety parameters that included signs of clinical and electroretinographic toxicity. Secondary outcome measures included changes in best-corrected visual acuity and central subfield thickness. RESULTS: Twelve eyes of 12 patients were treated. None of the patients complained of blurred vision, ocular pain, or bulbar injection at any of the follow-up visits, nor was intraocular inflammation noted. There were no significant differences in implicit times, "a" and "b" wave amplitudes, or b/a ratios at 1 month when compared with baseline (P = 0.4). None of the patients experienced serious ocular or systemic adverse events. Mean best-corrected visual acuity improved only slightly at 30 days (LogMAR 0.45 ± 0.31 [Snellen equivalent: 20/60]) compared with baseline (LogMAR 0.37 ± 0.24 [Snellen equivalent: 20/50]; P = 0.51). CONCLUSION: Single intravitreal injections of ziv-aflibercept into eyes with neovascular age-related macular degeneration appear to be safe through 1 month. Ziv-aflibercept could become a safe, low-cost therapy for macular diseases in developing countries and in those where intravitreal aflibercept (Eylea) is not available.

Risk factors for endophthalmitis following cataract surgery-our experience at a tertiary eye care centre in India.

AIM: To determine the risk factors for acute endophthalmitis after cataract extraction in a tertiary care centre in India. METHODS: We performed a nested case control study within a retrospective cohort. The surgical records of all patients with clinically diagnosed endophthalmitis within one month after cataract surgery, performed between January 2006 and December 2009, were reviewed. These were compared with randomly selected age and gender-matched controls, from patients having routine cataract surgery within ±1wk of the endophthalmitis case. Univariable and multivariable analysis were performed to identify risk factors for endophthalmitis. RESULTS: Of the total 33 856 cataract surgeries performed during this period, there were 57 cases of postoperative acute endophthalmitis that met our study criteria. Thus, the overall incidence of endophthalmitis in our cohort was 1.6 per 1000 cataract extractions performed. Mean age of cases was 55.9y (SD: 10.9y) and for controls was 55.6y (SD: 9.8y). Thirty-five cases (61.4%) and 133 controls (59.6%) were males. Median time of onset of endophthalmitis was 4d (IQR 2-9d; range: 1-30d). Thirty-nine cases (68.4%) presented within 7d and 27 cases (47.4%) were culture positive. Two hundred and twenty-three age and gender matched controls were selected. In multivariate analysis, endophthalmitis was associated with posterior capsular rupture (PCR) during surgery (OR 6.98, 95%CI: 2.22-21.98), phacoemulsification via scleral incision with a foldable intraocular lens (IOL) implantation (OR 3.02, 95%CI: 1.13-8.04) and ocular co-morbidity (OR 2.32, 95%CI: 1.11-4.87). CONCLUSION: PCR, presence of ocular co-morbidity, and phacoemulsification via scleral incision with foldable-IOL were found to be independent risk factors for acute endophthalmitis.

Atypical cytomegalovirus retinitis in non-Hodgkin's lymphoma.

A 54-year-old woman, a known case of non-Hodgkin's lymphoma (NHL) in complete remission, presented with floaters and diminution of vision in her left eye. The eye had vitritis with non-haemorrhagic retinitis mimicking intraocular lymphoma and acute retinal necrosis. A vitreous sample was positive for cytomegalovirus (CMV) and herpes simplex virus 1 (HSV-1) DNA by PCR. The possibility of intraocular lymphoma was not confirmed by the immunohistochemistry of the vitreous sample. The patient had a relapse of NHL along with rapid deterioration of vision in her left eye to no perception of light, due to optic nerve involvement. The right eye developed a new patch of focal haemorrhagic retinitis threatening the fovea. Based on the laboratory results and the clinical findings, she was successfully managed as a case of bilateral CMV retinitis and the vision in her right eye was salvaged.

Microbiologic spectrum and susceptibility of isolates in delayed post-cataract surgery endophthalmitis.

The objective of this study was to evaluate the microbiological spectrum and antimicrobial susceptibility of isolates in delayed post-cataract surgery endophthalmitis. A retrospective review of 33 consecutive patients with culture proven delayed post-cataract surgery endophthalmitis was done from January 2006 to March 2013. There were 22 bacterial and eleven fungal cases. Common isolates were Streptococci (seven cases), coagulase-negative staphylococci (five), Gram-negative bacilli (seven), Nocardia (two), Aspergillus (five), Candida (five). Gram-positive cocci were most susceptible to vancomycin and gatifloxacin (91.7%). Gram-negative isolates were most susceptible to ofloxacin (85.7%). Fungi being slow growing organisms are an important cause of delayed post-cataract surgery endophthalmitis.

Clinical efficacy of navigated panretinal photocoagulation in proliferative diabetic retinopathy.

PURPOSE: To compare the clinical efficacy of navigated pattern and conventional slit-lamp pattern panretinal photocoagulation (PRP). DESIGN: Randomized clinical trial. METHODS: Seventy-four eyes with proliferative diabetic retinopathy (PDR) in need of PRP were randomly assigned to 1 of 4 groups: PRP conventional pattern 30 ms, 100 ms, navigated pattern 30 ms, 100 ms pulse. Navigated laser is a fundus camera-based photocoagulator with retinal eye tracking. Outcome variables included stability of visual acuity, regression or development of neovascularization and need for retreatment sessions and surgical intervention, pain perception, and procedure time. RESULTS: There was no change in visual acuity between pre- and post-treatment measurements among the study groups. Short pulse groups in total required 22 procedures compared to 12 procedures in long pulse groups (P < .05). A trend toward worse outcome using 30 ms pulse duration treatments is expressed by slightly increased relative risk of 1.3 compared to 100 ms groups. Only 2 eyes required vitreoretinal surgery for nonclearing vitreous hemorrhage, 1 in each 30 ms group; insignificantly different between study groups (P = .98). The pain score was lower with navigated laser as compared to conventional laser in both 30 ms groups (P = .1) and 100 ms groups, where it reached statistical significance (P = .02). Pain experience was significant (P < .001) between navigated 100 ms pattern and conventional single-spot 100 ms treatments. CONCLUSIONS: This study demonstrates better clinical efficacy of 100 ms compared to 30 ms treatments using both conventional and navigated pattern lasers. The ability to use long-pulse-duration navigated pattern treatments broadens therapeutic options for PRP in proliferative diabetic retinopathy.

Serpiginous choroiditis with atypical presentation treated with intravenous methyl prednisolone.

PURPOSE: The purpose of this study is to report a case of atypical serpiginous choroiditis presenting with disc edema and exudative retinal detachment, treated successfully with intravenous methyl prednisolone. METHODS: A 45-year-old male patient presented with sudden decrease of vision in his left eye. On examination, left eye showed disc edema, exudative retinal detachment, and active serpiginous choroiditis. He was treated with intravenous methyl prednisolone followed by oral steroids and Azathioprine. RESULTS: At six weeks of follow-up, the choroiditis resolved completely with improvement of visual acuity. CONCLUSION: Atypical presentations of serpiginous choroiditis can cause diagnostic dilemma, but prompt diagnosis and immediate treatment can result in good visual recovery.

Vitreous haemorrhage in massive hemorrhagic polypoidal choroidal vasculopathy: clinical characteristics and surgical outcomes: Vitreous hemorrhage in PCV.

BACKGROUND: To report the outcomes of vitreous hemorrhage (VH) associated with hemorrhagic polypoidal choroidal vasculopathy (PCV). METHODS: A retrospective study of 28 eyes of 27 consecutive patients of hemorrhagic PCV with VH, which were managed surgically between January 2003 and December 2011, was performed. All patients underwent pars plana vitrectomy for VH associated with PCV. The main outcome measure was best-corrected visual acuity (BCVA) at baseline, at 1, 3 and 6 months post operatively and at last follow up. RESULTS: The visual acuity measured on early treatment diabetic retinopathy study (ETDRS) chart improved in 16 eyes (57.1 %) by two or more lines, remained unchanged in nine eyes (32.1 %) and decreased in three (10.7 %) after surgery when compared to baseline VA. The mean baseline VA was 2.69 ± 0.57 logMAR units (<20/2000) which improved to 1.65 ± 0.93 logMAR units (20/800) at 1 month post operative visit and was sustained at 1.72 ± 1.12 (20/800) with an improvement of 0.96 logMAR units (p < 0.001, 95 % CI 0.54-1.37). The average postoperative follow up was for 14.2 months (range 1-84). The complications noted in postoperative follow up were cataract (n = 10), macular scaring (n = 9), organised dehemoglobinised blood (n = 7), retinal tear or detachment (n = 5), recurrent VH (n = 3) and choroidal detachment (n = 1). CONCLUSION: Majority of patients with loss of vision due to VH secondary to hemorrhagic PCV have sustained improvement in visual acuity following surgery.

Navigated focal laser photocoagulation for central serous chorioretinopathy.

BACKGROUND AND OBJECTIVE: To assess the efficacy of navigated laser (Navilas(®)) treatment for central serous chorioretinopathy. MATERIALS AND METHODS: Prospective study included 16 eyes of 15 subjects with nonresolving central serous chorioretinopathy. Fluorescein-angiography guided Navilas(®) treatment was performed. Pre- and posttreatment best-corrected visual acuity, pre- and posttreatment central macular thickness, number of leaks on fluorescein angiography, and various treatment parameters were analyzed. Pain experience was evaluated using the visual analog pain scale. RESULTS: Sixteen eyes from 15 subjects (mean age 42.2±9.9 years) were analyzed. Mean duration of symptoms was 11.45±6.6 months. Average number of leaks per eye was 2.8 and one laser spot per leak was performed. There was complete resolution of subretinal fluid in 15 out of 16 eyes at 2 months. Average visual analog pain scale score was 0.63±1.41. CONCLUSION: Navilas(®) without a contact lens achieved resolution of subretinal fluid with a single laser spot for each single leak and minimum iatrogenic damage.

Comparison of conventional pattern and novel navigated panretinal photocoagulation in proliferative diabetic retinopathy.

PURPOSE: To compare the laser spot quality between the conventional slit lamp pattern laser (PASCAL) and the navigated pattern laser (NAVILAS) for panretinal photocoagulation (PRP). METHODS: Prospective randomized interventional trial of 73 eyes (51 patients) with high-risk proliferative diabetic retinopathy. Eyes underwent PRP using 30-ms pulse duration with either PASCAL (16 eyes) or NAVILAS laser (21 eyes), or 100-ms pulse duration with either PASCAL (16 eyes) or NAVILAS laser (20 eyes). Fundus color images of all quadrants were taken 5 minutes after treatment. Laser burn size (major and minor diameter and area) and ellipticity (ratio of minor to major axis) were analyzed across the retina. Treatment time and pain were compared between both groups. RESULTS: The burn size variation in navigated laser 30 ms, 100 ms, and conventional pattern 30 ms and single-spot 100 ms laser was 22%, 24%, 21%, and 35%, respectively. The variation of the laser burn area near the arcade for NAVILAS and for PASCAL was 29% and 22%, respectively (P < 0.01). Closer to the equator, burns from the NAVILAS showed even smaller variation of 15% compared with 25% with PASCAL (P < 0.005). Laser spots from PASCAL exhibited an increasing elliptical shape toward the periphery, whereas NAVILAS laser spots tended to be more uniform all over the retina. Average treatment duration and pain experience was less with navigated laser compared with pattern laser (P ≤ 0.05). CONCLUSIONS: Navigated laser treatment achieves more uniform laser burns with less pain during shorter treatment duration in comparison with conventional pattern laser.

Endophthalmitis after open globe injuries: changes in microbiological spectrum and isolate susceptibility patterns over 14 years.

BACKGROUND: The objective of this study was to evaluate the microbiologic spectrum and antimicrobial susceptibility of isolates in post-traumatic endophthalmitis and compare with our earlier published report. A retrospective review was conducted on 581 consecutive patients with culture-proven post-traumatic endophthalmitis at L. V. Prasad Eye Institute, India, from January 2006 to March 2013. FINDINGS: A total of 620 isolates from 581 patients were identified (565 bacteria and 55 fungi). The most common isolate was Bacillus spp. (106/620, 17.1%) closely followed by Streptococcus pneumoniae (105/620, 16.9%), and coagulase-negative Staphylococci (97/620, 15.6%). In our earlier report, the commonest bacteria included Streptococcus spp. (30/139, 21.6%) and gram-positive coagulase-negative micrococci (26/139, 18.7%). Gram-positive isolates were usually susceptible to vancomycin (98.2%). Gram-negative isolates were generally susceptible to gatifloxacin (92.9%), ofloxacin (89.4%), chloramphenicol (88.6%, Pseudomonas isolates were often resistant), amikacin (83.5%), and ceftazidime (77.2%). Fourteen years ago, the most sensitive antibiotic was ciprofloxacin for both gram-positive bacteria (95.12%) and gram-negative bacteria (100%). CONCLUSIONS: The microbiological spectrum of post-traumatic endophthalmitis has remained unchanged over the last 14 years, and Bacillus spp. continues as the most common infecting organism. Vancomycin is the drug of choice for empiric coverage of gram-positive bacteria. Susceptibility of gram-negative bacteria to commonly used antimicrobials (amikacin and ciprofloxacin) has decreased by 10% - 15% and to ceftazidime has increased by 10.5%.

Sympathetic ophthalmia in pediatric age group: clinical features and challenges in management in a tertiary center in southern India.

PURPOSE: To study the clinical features and visual outcome of sympathetic ophthalmia in pediatric patients attending a tertiary care center. METHODS: Retrospective review of patients ≤16 years with sympathetic ophthalmia seen during the period 2001-2011. RESULTS: During this period, 2511 pediatric patients with open globe injuries and 14 patients with sympathetic ophthalmia were seen. Six patients developed sympathetic ophthalmia during follow-up here. The incidence rate of sympathetic ophthalmia is 0.24% (6/2511, 95% CI:0.05-0.43%). The commonest presenting signs were anterior uveitis and exudative detachment. All patients were treated with systemic steroids, while 7 patients received additional immunosuppressive therapy. Eight patients had a follow-up of more than 6 months. Mean presenting best-corrected visual acuity (1.25 ± 1.03 logMAR) in the sympathizing eye improved significant following treatment (0.42 ± 0.80 logMAR, p = 0.003). CONCLUSIONS: The incidence of sympathetic ophthalmia was 0.24%. Appropriate immunosuppression can lead to favorable visual outcomes in the sympathizing eye.

Scleral buckle infections: microbiological spectrum and antimicrobial susceptibility.

BACKGROUND: The purpose of the present study was to evaluate the microbiological spectrum and antimicrobial susceptibility in patients with scleral buckle infection. Medical records of all the patients diagnosed as buckle infection at L. V. Prasad Eye Institute between July 1992 and June 2012 were reviewed in this non-comparative, consecutive, retrospective case series. FINDINGS: A total of 132 eyes of 132 patients underwent buckle explantation for buckle infection during the study period. The incidence of buckle infection at our institute during the study period was 0.2% (31 out of 15,022). A total of 124 isolates were identified from 102 positive cultures. The most common etiological agent isolated was Staphylococcus epidermidis (27/124, 21.77%) followed by Mycobacterium sp. (20/124, 16.13%) and Corynebacterium sp. (13/124, 10.48%). The most common gram negative bacilli identified was Pseudomonas aeruginosa (9/124, 7.26%). The median interval between scleral buckling surgery and onset of symptoms of local infection was 30 days. All eyes underwent buckle explantation and median time interval between primary SB surgery and explantation was 13 months. Recurrent retinal detachment was observed in two cases at 7 and 48 months, respectively, after buckle explantation. Gram positive, gram negative, and acid-fast organisms isolated from 2003 to 2012 were most commonly susceptible to vancomycin (100%), ciprofloxacin (100%), and amikacin (89%). Susceptibility to ciprofloxacin during the same time period was observed in 75% (15/20), 100% (13/13), and 87% (7/8) of gram positive, gram negative, and acid-fast isolates, respectively. CONCLUSION: Scleral buckle infection is relatively rare and has a delayed clinical presentation. It is most commonly caused by gram positive cocci. Based on the current antimicrobial susceptibility, ciprofloxacin can be used as empirical therapy in the management of scleral buckle infections.