Immediate Sequential Bilateral Vitreoretinal Surgery: Descriptive Case Series and Literature Review.

BACKGROUND AND OBJECTIVE: Bilateral vision-threatening disease necessitating urgent surgery in both eyes is challenging in vitreoretinal disorders, where surgeries are often longer and higher risk than in other ocular disorders. The authors present a case series of patients undergoing immediate sequential bilateral vitreoretinal surgery (ISBVS) on the same day. PATIENTS AND METHODS: Retrospective case series and literature review. Main outcome measures were surgical indications, systemic diseases, presenting and final visual acuity, and adverse events or complications during or after surgery. RESULTS: During the time period searched, 14 patients underwent ISBVS, without significant adverse events, infections, or complications. Illustrative cases are presented. CONCLUSION: The authors recommend considering ISBVS under certain conditions, such as in patients who are unable to undergo local anesthesia surgery, and in those who definitely require urgent or semi-urgent bilateral vitreoretinal surgery requiring a second general anesthesia in the near future if performed separately, especially in cases where the anesthesia is considered high risk. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:494-498.].

Acute otitis media in infants younger than two months of age: Epidemiologic and microbiologic characteristics in the era of pneumococcal conjugate vaccines.

OBJECTIVES: To evaluate the epidemiology, microbiology, Streptococcus pneumoniae serotypes distribution and serious bacterial infections (SBIs) occurrence in infants <2 months of age with tympanocentesis-documented acute otitis media (AOM), before and after the introduction of pneumococcal conjugate vaccines (PCVs). METHODS: The medical records of all hospitalized infants with AOM who underwent tympanocentesis during 2005-2014 were reviewed. RESULTS: Of the 303 infants with AOM who were diagnosed by an ENT specialist, 182 underwent tympanocentesis, 92 during 2005-2009 (prevaccine period) and 90 during 2010-2014 (postvaccine period). Streptococcus pneumoniae and nontypeable Hemophilus influenzae were isolated in 46/92 (50%) and 37/92 (40.2%) patients during 2005-2009 and decreased to 27/90 (30%) and 21/90 (23.3%). Respectively, during 2010-2014 (P = 0.006 and P = 0.001). The proportion of culture-negative patients increased from 18/92 (19.6%) during 2005-2009 to 32/90 (35.6%) during 2010-2014 (P = 0.02). There were only 6 (3.3%) patients <2 weeks of age. The most common S. pneumoniae vaccine serotypes isolated during 2005-2009 were 5, 3, 1, 19F and 14 (15.2%, 13.0%, 10.9%, 6.5%, and 4.3%, respectively) and 3, 5, 1, 14 and 19A (22.2%, 11.1%, 7.4%, 7.4%, and 7.4%, respectively) during 2010-2014. The proportion of culture-positive patients decreased during 2013-2014 compared with 2011-2012 (7/18, 38.9% vs. 40/54, 74.1%, P = 0.007). Serotypes 1 and 5 were not isolated during 2013-2014 and serotype 19A was not isolated during 2011-2014. . SBIs were recorded in 23/182 (12.64%) patients and urinary tract infections represented 19/23 (82.61%) of them (Escherichia coli isolated in 12, 63.2%). CONCLUSIONS: The overall number of AOM cases needing tympanocentesis seen at the PER and the proportion of S. pneumoniae and nontypeable H. influenzae-AOM decreased while the proportion of culture-negative AOM increased following the introduction of PCVs. SBIs associated with AOM were frequent and were represented mostly by urinary tract infections caused by pathogens unrelated to the etiologic agents of AOM.