Eicosanoid Profiles in the Vitreous Humor of Patients with Proliferative Diabetic Retinopathy.

Proliferative diabetic retinopathy is a potentially blinding sequela of uncontrolled diabetes that involves a complex interaction of pro-angiogenic and inflammatory pathways. In this study, we compared the levels of pro-angiogenic arachidonic acid-derived mediators in human vitreous humor obtained from eyes with high-risk proliferative diabetic retinopathy versus controls. The results indicated that lipoxygenase and cytochrome P450-derived eicosanoids were elevated (5-HETE, 12-HETE, 20-HETE, and 20-COOH-AA), and there appeared to be no differences in levels measured in eyes with tractional retinal detachments versus those without. These results provide further insight into the pathogenesis of this disease and for the development of future potential therapeutic agents that target arachidonic acid metabolites to treat diabetic retinopathy.

Characteristics and Risk Factors for Rhegmatogenous Retinal Detachment Related to Endophthalmitis.

Purpose: To evaluate the risk factors for the development of concurrent or delayed-onset rhegmatogenous retinal detachment (RRD) related to endophthalmitis as well as the anatomic and visual outcomes with subsequent RRD repair. Methods: In this retrospective case study, a 2-tailed t test (continuous) and Fisher exact test were used to determine statistical significance of the observed findings. The relative risk (RR) and 95% CIs were calculated to assess statistical significance. Results: Of the 170 patients included, 22 were found to have a concurrent or subsequent RRD. Initial treatment with pars plana vitrectomy (PPV) (RR, 3.544; 95% CI, 1.650-7.614), aphakia (RR, 4.150; 95% CI, 1.434-12.011), endogenous endophthalmitis (RR, 2.684; 95% CI, 1.065-6.764), and posterior synechiae (RR, 3.026; 95% CI, 1.408-6.505) were statistically significant risk factors for RRD. Anatomically successful repair was achieved in 77.7% of patients. Conclusions: In addition to preexisting risk factors, the initial treatment of endophthalmitis may be a significant risk factor for RRD development, with a higher incidence of subsequent RRD in patients who have PPV as the initial treatment for endophthalmitis.

Factors affecting wound leakage in 23-gauge sutureless pars plana vitrectomy.

PURPOSE: To evaluate risk factors for sclerotomy leakage in 23-gauge sutureless pars plana vitrectomy in 219 patients. METHODS: Nested case-control study involving 48 patients with wound leaks (visible on-table sclerotomy leakage requiring sutures) and 171 control subjects without wound leaks. Patients received either a conventional sclerotomy incision at 45°, which was then changed to 90° midincision, or an extremely oblique sclerotomy incision (OSI) at 10°, which was then changed to 30° midincision. Risk factors studied included age, gender, laterality, surgical duration, sclerotomy incision (OSI vs. conventional sclerotomy incision), preoperative diagnosis (macular vs. nonmacular), history of vitrectomy, and primary surgeon (attending vs. supervised resident). RESULTS: Multivariate logistic regression analysis found significant (P ≤ 0.05) protective factors for wound leakage including OSI, macular preoperative diagnosis, no previous vitrectomy, and female gender. Surgical duration at least 45 minutes was considered a borderline risk factor. CONCLUSION: Using an extremely OSI versus a conventional sclerotomy incision reduces the incidence of wound leakage postoperatively because of its self-sealing effect. Other factors that contribute to wound leakage, such as increased surgical duration and nonmacular diagnosis, may be indirect measurements of extensive trocar rotation, causing wound leakage despite the use of an OSI.

Combined phacovitrectomy with capsular tension ring and gas tamponade for chronic cyclodialysis cleft unresponsive to conventional closure.

Traumatic cyclodialysis clefts, a rare diagnosis after blunt injury to the eye, are typically amenable to closure with either medical therapy or direct surgical cyclopexy. However, when cyclodialysis clefts cannot be closed through these methods, unorthodox techniques may be required. We describe a method to close a traumatic cyclodialysis cleft involving simultaneous vitrectomy, capsular tension ring placement, and insertion of an intraocular lens.

Purtscher-like retinopathy in adult-onset Still's disease, complicated by treatment-related central serous chorioretinopathy.

PURPOSE: We describe a case of Purtscher-like retinopathy associated with adult-onset Still's disease, complicated by the development of central serous chorioretinopathy secondary to high dose corticosteroids. OBSERVATIONS: A 53 year old female diagnosed with adult-onset Still's disease (AOSD) presented to us with findings consistent with Purtscher-like retinopathy in both eyes, with 20/70 visual acuity in the right eye and 20/20 visual acuity in the left eye. She was initiated on high dose corticosteroids by her rheumatologists for her AOSD. A month later, her vision worsened significantly to counting fingers at 3 feet in the right eye and 20/60 visual acuity in the left. Her examination revealed serous macular detachments involving her fovea consistent with central serous chorioretinopathy secondary to exogenous steroids. After discussion with her rheumatologists, she was tapered off her steroids quickly and bridged to steroid sparing agents, with subsequent resolution of her serous macular detachments and improvement of vision back to baseline. CONCLUSION AND IMPORTANCE: The association of Purtscher-like retinopathy and AOSD is important from a multidisciplinary standpoint due to the possibility of life-threatening systemic thrombotic microangiopathy. In addition, patients undergoing treatment for AOSD with exogenous corticosteroids may develop central serous retinopathy with vision loss, and may require quick transitioning to steroid-sparing agents if focal laser is not feasible.

Utility of wound cultures in the management of open globe injuries: a 5-year retrospective review.

BACKGROUND: Endophthalmitis after open globe injury can be devastating to vision recovery. As treatment of endophthalmitis is often empiric, some surgeons may obtain cultures at presentation of trauma in anticipation of later infection. This study examines the usefulness of wound cultures obtained during globe repair. RESULTS: Institutional Review Board approval was obtained. Medical records were retrospectively reviewed, with 168 open globes included. Cultures of the wound site had been taken in all cases included in this study. Wound cultures were positive in 63% of cases but were not used for clinical decision-making for any patient in this study. Two patients had evidence of endophthalmitis at presentation, with results of vitreous culture matching those from the wound. No patient later developed endophthalmitis after open globe repair. CONCLUSIONS: Despite a high rate of wound contamination, few cases of endophthalmitis (1.2%) were seen in this series. In no case did the results of wound culture impact choice of antibiotic prophylaxis or treatment. Cultures obtained at the time of open globe repair were not cost effective in the subsequent management of the injury.

OCULAR MANIFESTATIONS OF PRIMARY MYELOFIBROSIS.

PURPOSE: To report ocular manifestations of idiopathic primary myelofibrosis in a patient with relapsed primary myelofibrosis. METHODS: Observational case report. RESULTS: A 57-year-old African American male with history of primary myelofibrosis, diagnosed by bone marrow aspirate and biopsy, believed to be in remission was referred to us for bilateral angle-closure glaucoma refractory to medical treatment and laser peripheral iridotomy. His fundus examination revealed serous retinal detachments, choroidal effusions, and Roth spots, and B-scan revealed his angle closure was due to annular anterior ciliochoroidal effusions. The patient was taken to surgery for a pars plana vitrectomy with radial sclerotomies performed to relieve the patient's eye pressure in the left eye. Cytologic analysis of the choroidal effusions revealed neutrophilic infiltrates with immature forms and erythroid precursors, suggesting a neoplastic infiltration from the patient's primary myelofibrosis. The patient's vision and ocular symptoms significantly improved after chemotherapy. Repeat bone marrow aspiration and biopsy confirmed the patient's primary myelofibrosis with no progression to acute leukemia despite his high leukocyte count. CONCLUSION: Neoplastic infiltration of primary idiopathic myelofibrosis into the eye and surrounding structures, which is scantly described in the current literature, may be an early sign of new onset or relapsing primary myelofibrosis. Chemotherapy can be very effective in the ultimate treatment and remission of these ocular symptoms.