Incidence of Endophthalmitis after Intravitreal Bevacizumab using Aliquots Prepared On-site in 2 Operating Rooms in Kuwait.

PURPOSE: To report the incidence of endophthalmitis after intravitreal injection of bevacizumab and the outcomes of treatment of endophthalmitis at two centers in Kuwait. SUBJECTS AND METHODS: The aliquots of bevacizumab were prepared under aseptic precautions and administered in the operating theater on the same day at both centers. All patients received antibiotic drops after injection of bevacizumab. Data were collected on the number of cases that received intravitreal bevacizumab (IVB) and those that developed endophthalmitis were identified at the two centers. All cases of endophthalmitis received an intravitreal antibiotic injection and additional treatments as warranted. Data were collected on the outcomes of endophthalmitis treatment. RESULTS: There were 5 cases of endophthalmitis among a total of 5429 injections (0.09%: Confidence interval: 0.084-0.1). The incidence was 3 cases among 4690 (0.06%) and 2 cases among 739 injections (0.027%) at each center, respectively (P = 0.08). Four cases of endophthalmitis were culture-positive and organisms isolated were, coagulase negative Staphylococcus in 2 cases, Staphylococcus lugdunensis and Streptococcus pneumoniae in 1 case each. The final visual acuity was better than pre-IVB in 3 cases, same as pre-IVB in 1 case and worse in 1 case with streptococcal infection. No eyes developed phthisis bulbi or required enucleation. CONCLUSIONS: The incidence of endophthalmitis after intravitreal injection of bevacizumab using aliquots prepared in the operating room is comparable to other studies. There were no clusters of endophthalmitis cases.

A case of submacular cysticercosis treated by pars plana vitrectomy in Kuwait.

We report a case of submacular cysticercosis in the left eye of an Indian patient living in Kuwait. Though he was systemically asymptomatic, his magnetic resonance imaging showed multiple cysts in the brain. The patient underwent pars plana vitrectomy (PPV), and the cyst was removed in total through a retinotomy over the cyst. He had another small cyst in the periphery that was also removed. He was treated with oral albendazole and systemic steroids after the surgery to treat his neurocysticercosis. He developed rhegmatogenous retinal detachment after the surgery, and the retina was successfully reattached with scleral buckling and PPV procedure. His final best corrected visual acuity improved from counting fingers at 1/2 m at presentation to 20/400. This case report shows that the ocular cysticercosis may be seen among expatriates working in the Middle East. It is important to rule out the presence of neurocysticercosis in such patients as well as multiple cysts in the affected eye. However, the functional outcome of surgical treatment of submacular cysticercosis can be disappointing.

Partial-thickness macular hole in vitreomacular traction syndrome: a case report and review of the literature.

INTRODUCTION: Vitreomacular traction syndrome has recently been recognized as a distinct clinical condition. It may lead to many complications, such as cystoid macular edema, macular pucker formation, tractional macular detachment, and full-thickness macular hole formation. CASE PRESENTATION: We report a case of vitreomacular traction syndrome with eccentric traction at the macula and a partial-thickness macular hole in a 63-year-old Pakistani Punjabi man. The patient was evaluated using optical coherence tomography, and he underwent a successful pars plana vitrectomy. After the operation, his foveal contour regained normal configuration, and his visual acuity improved from 20/60 to 20/30. CONCLUSIONS: Pars plana vitrectomy prevents the progression of a partial thickness macular hole in vitreomacular traction syndrome. The relief of traction by vitrectomy restores foveal anatomy and visual acuity in this condition.

Endophthalmitis after vitrectomy and vitrectomy combined with phacoemulsification: incidence and visual outcomes.

PURPOSE: To study the incidence of endophthalmitis after vitrectomy and after combined vitrectomy and phacoemulsification surgery and to report the results of treatment in such cases. METHODS: This is a retrospective, noncomparative, interventional study based at a tertiary ophthalmology center in Kuwait. Cases of vitrectomy only and combined vitrectomy with phacoemulsification surgery performed during the period from January 1, 1997, to December 31, 2007, were included. Patients undergoing vitrectomy for traumatic etiologies and endophthalmitis were excluded. Patients who developed endophthalmitis after vitrectomy were identified and their records were analyzed. RESULTS: Six patients developed endophthalmitis among 2965 cases of all vitrectomy procedures, resulting in an incidence of 0.20%. The incidence of endophthalmitis was 0.12% for cases undergoing vitrectomy (3 out of 2564 cases) and 0.75% for cases undergoing combined vitrectomy and phacoemulsification surgery (3 out of 401 cases), respectively. Three cases were culture positive. Four cases ended up with final visual acuity of perception of hand movements or worse. CONCLUSIONS: Incidence of endophthalmitis in our series was higher than in other studies. The visual results were poor in 4 out of 6 cases. Earlier diagnosis and more aggressive approach may be needed to improve the results of treatment in these cases.

Vitrectomy for posterior segment intraocular foreign bodies: visual results and prognostic factors.

PURPOSE: To evaluate the visual results and determine the prognostic factors after the removal of retained posterior segment intraocular foreign bodies (IOFBs) by pars plana vitrectomy. METHODS: A retrospective study of 40 consecutive cases of pars plana vitrectomy for the removal of IOFBs during the period of January 1991 to June 2000 was conducted. Association between visual outcome and various preoperative, operative, and postoperative variables was statistically analyzed. RESULTS: Of the 40 cases available for the study, the IOFBs could be removed in 36 eyes. Half the patients had removal of the IOFB within 14 days of the injury. Nineteen patients (47.5%) achieved a visual acuity of 20/40 or better. Postoperative retinal detachment occurred in 13 patients (32.5%). Poor visual outcome was found to be significantly associated with poor initial visual acuity and postoperative retinal detachment, whereas good visual outcome was significantly associated with the absence of lens injury and absence of postoperative retinal detachment. CONCLUSIONS: Acceptable visual results could be achieved after the removal of posterior segment IOFBs by vitrectomy, despite a delay in surgery. Postoperative retinal detachment, poor initial visual acuity, and the absence of lens injury were the factors that played a significant role in determining the visual outcome.

Efficacy and reliability of fundus digital camera as a screening tool for diabetic retinopathy in Kuwait.

OBJECTIVE: Many screening and follow-up methods are available for detecting diabetic retinopathy (DR). However, once patients develop retinopathy, it is unclear as to what method should be used for their review. This study is designed to assess the correlation between fundus digital image and clinical examination and to develop a screening program for the early detection of sight-threatening DR using a Canon CF 60 UV fundus camera. METHODS: Patients who were not treated for DR earlier were enrolled in the study. All patients underwent digital fundus photography. The photographs were evaluated and compared with the clinical findings as recorded by retinal specialists. DR and macular edema were analyzed separately, and the correlation was statistically measured. The kappa statistic was used to estimate the extent of the agreement between the two procedures. RESULTS: A total of 92 eyes of 51 patients were eligible to be entered in the study. Comparison of the digital image of the fundus and the examination by an ophthalmologist showed a good correlation. The kappa score for retinopathy was estimated to be 93% with 95.6% concordance. The kappa score for diabetic maculopathy was 88% with concordance of 92.2%. CONCLUSION: We conclude that digital images provide an efficient method for diagnosing and classifying sight-threatening DR, particularly proliferative diabetic retinopathy (PDR). However, agreement between the digital fundus camera and clinical examination by an ophthalmologist for diabetic maculopathy detection, though substantial statistically, was not very satisfactory. It was also felt that the digital photographs can be used as a tool for teleophthalmology and can be integrated as a screening system in Kuwait.