ENDOGENOUS ENDOPHTHALMITIS IN WESTERN AUSTRALIA: A Sixteen-Year Retrospective Study.

PURPOSE: To review the clinical features, microbiology spectrum, management, and outcomes of patients with endogenous endophthalmitis in Western Australia over a 16-year period. METHODS: This is a retrospective chart review of all patients with endogenous endophthalmitis who presented to all tertiary ophthalmology departments between 2000 and 2015 in Western Australia. RESULTS: Sixty-six eyes of 57 patients with endogenous endophthalmitis were identified, and follow-up data were available for a mean of 554 days. The average frequency was 1.6 per 1,000,000 population per year. Diabetes mellitus (33%) and intravenous drug use (30%) were the most common risk factors. Concurrent systemic infections included urinary tract infection (28%), pneumonia (23%), and endocarditis (21%). Among culture-positive cases (93%), 57% were bacterial and 43% were fungal. Visual acuity improved in 33 (50%) and declined in 15 eyes (22.7%). Baseline visual acuity and the presence of Gram-negative or filamentous fungi were the only predictors of final visual acuity (P = 0.023 and P = 0.001). CONCLUSION: The population frequency of endogenous endophthalmitis has not changed over 16 years despite the changing profile of pathogen and risk factors. Similar to previous studies in Asian and Western countries, visual and anatomical prognosis depends on initial visual acuity and isolated pathogen. Gram-negative and filamentous fungi culture predicted a worse visual outcome.

Intravitreal dexamethasone implant use as first-line therapy for cancer-associated retinopathy.

We present a 65-year-old female smoker who presented with acute bilateral blurred vision. Investigations led to an endobronchial ultrasound-guided fine-needle aspiration resulting in an early diagnosis of limited stage small cell lung cancer. Positive recoverin antibodies supported the diagnosis of cancer-associated retinopathy (CAR). CAR was the first manifestation of systemic malignancy in our patient and early diagnosis enabled curative intent systemic treatment with chemotherapy and radiotherapy. Ocular-specific treatment is required in CAR, although no standardised treatment exists. Current treatment options include steroids and immunosuppressive agents. Our patient was administered bilateral intravitreal dexamethasone implants, resulting in significant visual field and electroretinogram improvement at 8 weeks post-intervention. To our knowledge, this represents the first reported successful use of intravitreal dexamethasone implants as first-line therapy, in conjunction with chemoradiotherapy. Intravitreal dexamethasone implants therefore may provide an effective and safe treatment for CAR by reducing intraocular inflammation without systemic effects.

Delayed bilateral hypertensive crisis with CyPass Micro-stent - The highs and lows.

PURPOSE: Microinvasive glaucoma surgery and its associated devices remain a field of continued interest and innovation in the management of patients with glaucoma. While a range of outflow optimisation devices have been designed, the efficacy and safety and these devices remains to be proven, particularly in the long term. OBSERVATIONS: The authors present the first reported case to our knowledge of bilateral hypertensive crisis associated with CyPass® Micro-stent insertion two months post-operation and its resultant management. CONCLUSIONS AND IMPORTANCE: Despite the recall of the CyPass Micro-stent (Alcon, Fort Worth, Texas, USA), further clinical experience in the use of these and similar stents is required. Possible hypotheses explaining this phenomenon are also presented, the most likely being sudden closure of the suprachoroidal space.

Successful Treatment of Mycobacterium chelonae Keratitis Within a Corneal Transplant Using Intrastromal Amikacin Injections-A Case Report Demonstrating the Fundamental Principles and Challenges of Infective Keratitis Management and Novel Therapeutic Approaches.

Mycobacterium chelonae keratitis is rare and difficult to treat. This is the first known case worldwide of effective treatment using intrastromal amikacin injections in a corneal transplant recipient who had metastatic breast cancer. The challenges and principles of management, applicable to other causes of infective keratitis, are reviewed.