VITRECTOMY FOR PHACOANAPHYLACTIC GLAUCOMA SECONDARY TO POSTERIOR CAPSULAR RUPTURE IN AN ADULT WITH PERSISTENT HYPERPLASTIC PRIMARY VITREOUS.

PURPOSE: Persistent hyperplastic primary vitreous (PHPV) is a developmental anomaly in which the normal regression of the primary vitreous and hyaloid vasculature does not occur. In the literature, there are a few cases of PHPV in adulthood. We report the novel presentation of phacoanaphylactic glaucoma secondary to posterior capsular rupture in an adult with PHPV. We discuss the best management of this condition with a review of the literature on this topic. METHODS: Case report and literature review. RESULTS: Medical management was unsuccessful in this case and vitrectomy and fragmatome lensectomy improved vision from PL to counting fingers. CONCLUSION: This case is unusual in the age of the patient in question as PHPV usually presents in childhood, as such there are few accounts in the literature to guide optimum management of adult PHPV. We suggest that surgical management of late-presenting PHPV should be considered to improve functional outcome.

Facoemulsificación en la cirugía de catarata / Phacoemulsification in cataract surgery

Introducción: la cirugía de catarata es una de las más frecuentes de toda la medicina. Es un procedimiento seguro que se efectúa anualmente a millones de pacientes en el mundo. A través de la historia se han ideado diferentes procedimientos para remover la catarata haciendo que esta cirugía sea relativamente fácil, segura y la rehabilitación visual usualmente exitosa. La facoemulsificación del cristalino es la técnica quirúrgica más segura y con mejores resultados para la cirugía de catarata en cirujanos oftalmólogos entrenados con las condiciones técnicas adecuadas. Objetivo: determinar los resultados de la técnica de facoemulsificación en la cirugía de catarata en el Hospital Militar Dr. Carlos J. Finlay. Métodos: se realizó un estudio descriptivo, en el período comprendido desde enero del 2013 hasta diciembre de 2016. Fueron estudiados los pacientes operados de catarata mediante la técnica de facoemulsificación (315 ojos). Resultados: no hubo diferencias significativas entre ambos sexos, con mayor incidencia en pacientes de 70 y más años, la agudeza visual mejor corregida (AVMC) que predominó durante el preoperatorio fue de 0,4 a 0,6, y en el posoperatorio fue de 0,7 a 1, la rotura de cápsula posterior fue la complicación más frecuente en el transoperatorio, el edema corneal en el posoperatorio inmediato y la opacidad de cápsula posterior en el posoperatorio tardío; el promedio de pérdida de células endoteliales fue de 257 células. Conclusiones: la facoemulsificación muestra resultados beneficiosos, con mejoría visual evidente y mínima incidencia de complicaciones(AU)

Introduction: Cataract surgery is one of the most often carried out in medicine. It is a safe procedure that is performed annually to millions of patients in the world. Throughout history, different procedures have been devised to remove the cataract, making this surgery relatively easy, safe and the visual rehabilitation usually successful. Phacoemulsification of the lens is the safest surgical technique with the best results for cataract surgery in trained ophthalmological surgeons with the appropriate technical conditions. Objective: To determine the results of the phacoemulsification technique in cataract surgery at the Dr. Carlos J. Finlay Military Hospital. Methods: A descriptive study was conducted in the period from January 2013 to December 2016. Patients undergoing cataract surgery using the phacoemulsification technique (315 eyes) were studied. Results: There were no significant differences between both sexes, with higher incidence in patients aged 70 and older, the best corrected visual acuity that predominated during the preoperative period was 0.4 to 0.6, and in the postoperative period it was 0.7 to 1, posterior capsule rupture was the most frequent complication in the transoperative period, corneal edema in the immediate postoperative period and posterior capsule opacity in the late postoperative period; the average endothelial cell loss was 257 cells. Conclusions: Phacoemulsification shows beneficial results, with evident visual improvement and minimal incidence of complications(AU)

Endophthalmitis Reduction with Intracameral Moxifloxacin Prophylaxis: Analysis of 600 000 Surgeries.

PURPOSE: To compare the postoperative endophthalmitis rate before and after initiation of intracameral (IC) moxifloxacin prophylaxis for both phacoemulsification and sutureless, manual small-incision cataract surgery (M-SICS), as well as in patients with posterior capsular rupture (PCR). DESIGN: Retrospective, clinical registry. PARTICIPANTS: All cataract surgeries (617 453) performed during the 29-month period from January 2014 to May 2016 at the 10 regional Aravind eye hospitals were included. METHODS: The electronic health record data for all study eyes were analyzed. Endophthalmitis rates before and after moxifloxaxin were statistically compared for all eyes and separately for both phacoemulsification and M-SICS, and for the eyes complicated by PCR. MAIN OUTCOME MEASURES: The postoperative endophthalmitis rates before and after initiation of IC moxifloxacin prophylaxis. RESULTS: Overall, 302 815 eyes did not receive IC moxifloxacin and 314 638 eyes did, and there was a significant decline in the endophthalmitis rate, from 0.07% (214/302 815) to 0.02% (64/314 638) (P < 0.001), with moxifloxacin. For the 194 252 phacoemulsification eyes, the endophthalmitis rate was 0.07% (75/104 894) without IC moxifloxacin prophylaxis, compared with 0.01% (11/89 358) with moxifloxacin (P < 0.001). For the 414 657 M-SICS eyes, the endophthalmitis rate was 0.07% (135/192 149) without IC moxifloxacin prophylaxis, compared with 0.02% (52/222 508) with moxifloxacin (P < 0.001). Approximately half of the 8479 eyes that had PCR received IC moxifloxacin, and half did not. Without IC moxifloxacin, PCR increased the endophthalmitis rate nearly 7-fold to 0.48% (20/4186); IC moxifloxacin reduced the endophthalmitis rate with PCR to 0.21% (9/4293) (P = 0.034). No adverse events were due to IC moxifloxacin. CONCLUSIONS: Routine IC moxifloxacin prophylaxis reduced the overall endophthalmitis rate by 3.5-fold (3-fold for M-SICS and nearly 6-fold for phacoemulsification). There was also a statistical benefit for eyes complicated by PCR, and IC antibiotic prophylaxis should be strongly considered for this high-risk population. These conclusions are strengthened by the high volume of cases analyzed at a single hospital network over a comparatively short time frame. Considering the association of hemorrhagic occlusive retinal vasculitis with vancomycin and the commercial unavailability of IC cefuroxime in many countries, moxifloxacin appears to be an effective option for surgeons electing IC antibiotic prophylaxis.

Glued intraocular lens scaffolding to create an artificial posterior capsule for nucleus removal in eyes with posterior capsule tear and insufficient iris and sulcus support.

Glued IOL scaffolding decreases the chance of nucleus drop in eyes with insufficient iris and capsule support. The advantages include no temporary device or substance that must be removed after nucleus emulsification, ability to perform complete surgery without enlarging incisions, stable fixation of the IOL, compartmentalization of the eye, and decreased vitreous hydration and aspiration. The IOL is preplaced via glued transscleral haptic fixation of the IOL. The glued IOL placed under the nucleus then acts as a scaffold nuclear fragments are emulsified and thus acts as an artificial posterior capsule.