CLINICAL PRESENTATIONS, DIAGNOSTIC DILEMMA, AND MANAGEMENT OUTCOMES OF CHRONIC POSTOPERATIVE ENDOPHTHALMITIS CAUSED BY STEPHANOASCUS CIFERRII.

PURPOSE: To report the diagnosis and management of a series of chronic postoperative endophthalmitis caused by Stephanoascus ciferrii. METHODS: This is a retrospective consecutive case series at a tertiary eye care institute. Case records of consecutive cases of chronic postoperative endophthalmitis caused by a novel fungus S. ciferrii were analyzed. The clinical presentations, microbiologic workup including microscopy, culture, antifungal susceptibility and polymerase chain reaction for fungal DNA of clinical samples, and the clinical management were noted. The cases underwent anterior chamber tap, vitreous biopsy, core vitrectomy, and intraocular lens explantation, and the management consisted of a combination of topical and systemic therapy and intravitreal injections of antimicrobial agents. RESULTS: The report includes four eyes of four patients. All patients were diagnosed as chronic postcataract surgery endophthalmitis, and they showed variable levels of persistent low-grade intraocular inflammation till the intraocular lens was explanted. S. ciferrii (identified by the Vitek 2 compact system) was grown in culture from one or more of the clinical samples such as vitreous, anterior chamber fluid, capular bag, and intraocular lens. Fungal DNA was detected from vitreous in one case. One isolate tested for antifungal susceptibility was resistant to amphotericin B; however, the patient responded to treatment with the drug. Good clinical outcome was achieved in all patients. CONCLUSION: We describe successful treatment of endophthalmitis caused by S. ciferrii. A good response is obtained after pars plana vitrectomy and intraocular lens explantation.

IATROGENIC CHOROIDAL NEOVASCULAR MEMBRANE IN MACULAR HOLE-INDUCED RETINAL DETACHMENT.

PURPOSE: To report a case of choroidal neovascular membrane after vitreoretinal surgery in a patient with macular hole-induced retinal detachment. METHODS: Retrospective observational case report. CASE DESCRIPTION: A 64-year-old lady presented with sudden drop in vision in the right eye since 20 days. Her best-corrected visual acuity was 6/36 in the right eye and 6/18 in the left eye. She was diagnosed with retinal detachment with a macular hole in the right eye. She underwent vitrectomy with internal limiting membrane peeling and gas tamponade for the retinal detachment. Internal limiting membrane peeling was performed after staining with brilliant blue green dye and over the detached retina. Drainage of the subretinal fluid was performed through the macular hole and drainage retinotomy. Four months of postoperative examination revealed a scarred subfoveal choroidal neovascular membrane and retinal pigment epithelial atrophy surrounding it. This was confirmed by fluorescein angiography and optical coherence tomography. CONCLUSION: Visual loss secondary to choroidal neovascular membrane can occur because of surgical trauma to the retinal pigment epithelium and Bruch membrane. Drainage of the subretinal fluid should be preferably avoided through the macular hole to prevent this complication.

Retinal meteor.

We describe a case of a 65-year old man diagnosed with retinal vasoproliferative tumour secondary to posterior uveitis. The fluorescein angiography shows an interesting meteor-like leak emanating from the tumour and rising towards the superior retina in the later frames of the angiogram. Pictorially, we call it the "Retinal Meteor" and also describe the possible mechanism for this pattern of leakage.

Ocular infection with Gliocladium species-report of a case.

PURPOSE: The purpose of this study is to report a case of ocular infection with Gliocladium species due to an exposed scleral buckle. DESIGN: Interventional case report was used as the study design. METHODS: A 60-year-old diabetic male patient presented with persistent pain, redness, and discharge in his left eye since 2 months. He had been treated previously with both topical and systemic steroids for a diagnosis of autoimmune scleritis. He had undergone scleral buckling surgery with cryotherapy for an inferior rhegmatogenous retinal detachment in the past. His best-corrected visual acuity was 6/6, N6 and 6/6, N6 in the right and left eyes, respectively. Retraction of the left lower lid revealed an exposed scleral buckle with an overlying necrotic conjunctiva. Scleral buckle removal was done. Microbiological examination showed Gliocladium species growing on blood agar and Sabouraud dextrose agar. Treatment was started with topical antifungal medication and oral antibiotics. RESULTS: Following treatment, signs of infection showed resolution. Patient underwent retinal reattachment surgery with favorable anatomic and visual outcome. CONCLUSION: Ocular infection with Gliocladium species has not been previously reported. Poor response to steroids and uncontrolled diabetes should make the clinician aware of a possible fungal infection. Removal of the scleral buckle, identification of the causative organism, and use of appropriate antibiotics are important for the accurate management of the case.

Nocardia choroidal abscess-a Case report with Review of literature.

INTRODUCTION: Nocardia is a common cause of corneal infections but is a rare cause of choroidal abscess. We report a rare case of choroidal abscess, secondary to Nocardia and its management. CASE: We report a case of choroidal abscess secondary to Nocardia asteroides species in an immunocompetent young male diagnosed by culture positivity of vitreous biopsy. He was managed by oral trimethoprimsulfamethoxazole and intravitreal Amikacin injections. CONCLUSION: All the previous reported cases were found to be immunocompromised patients. However, our patient was immunocompetent and the confirmation of diagnosis was done by culture of vitreous biopsy in comparison to a retinochoroidal biopsy, in all other previous cases.

Capillary Dropout: A Novel Fluorescein Angiography Finding in Primary Vitreoretinal Lymphoma.

Tissue diagnosis with vitreous and/or retinal biopsy usually confirms the diagnosis of primary vitreoretinal lymphoma. Multiple imaging modalities like fundus fluorescein angiography, fundus autofluorescence, and optical coherence tomography have been used to support the diagnosis of vitreoretinal lymphoma. We report a case of a 74-year-old lady diagnosed with primary vitreoretinal lymphoma showing a novel fluorescein angiographic finding of capillary dropout. We hypothesize that this clinical finding on the fluorescein angiogram may be due to the occlusion of the retinal vasculature by the malignant tumor cells. This finding also suggests the possible intraocular invasion of the malignant lymphomatous cells into the inner retinal layers.