Endophthalmitis following intravitreal injections.

BACKGROUND: To report the clinical features, culture results, management and visual outcome of patients with endophthalmitis following intravitreal injections. METHODS: Retrospective review of all patients with suspected endophthalmitis after intravitreal injections treated with intravitreal antibiotics (teicoplanin and ciprofloxacin) at a referral centre between January 2003 and December 2010. RESULTS: Nineteen cases that had aqueous or vitreous biopsy were identified. Nine had negative culture. Ten had positive culture; Staphylococcus species in 4/10, Streptococcus species in 4/10, E. coli in 1/10 and gram-negative bacilli in 1/10. Symptoms developed within the first 48 hours in all. One of ten culture-positive cases had no pain on presentation, while 5/9 patients with negative culture reported pain. Initial treatment consisted of intravitreal antibiotics in all cases, 6/19 cases required a second intravitreal antibiotic injection, 4/19 underwent vitrectomy as secondary therapy. At the last follow up, 7/19 patients had visual acuity of 6/18 or better, 9/19 had visual acuity of 6/60 or worse. CONCLUSION: The overall numbers of patients with endophthalmitis following intravitreal injections has risen dramatically over the past years. In contrast to earlier reports of multicentre studies, outcome of patients is relatively poor in the current treatment settings. We did not find clinical features useful in identifying cases with negative culture.

Retrospective review of 50 eyes with long-term silicone oil tamponade for more than 12 months.

BACKGROUND: Silicone oil (SO) is an established tamponade in treating complex vitreoretinal diseases. Although SO is intended to be removed after several weeks to months, permanent SO might be unavoidable in a small subgroup of patients with an extremely complicated clinical course. The aim of this study is to describe the long-term effects of intraocular SO tamponade. METHODS: This retrospective study included 50 patients with intraocular SO (Oxane 5700 Bausch & Lomb, Kingston-upon-Thames, UK) for at least 12 months. The most common reasons for long-term SO tamponade were: retinal re-detachment (re-RD), proliferative diabetic retinopathy (PDR), ocular trauma, and persistent hypotony. RESULTS: Mean age was 59.2 ± 18.4 years, and mean duration of silicone oil in the eye was 54.5 ± 58.6 months (median, 30 months). The average number of previous surgeries were 2.2 ± 1.5. Anatomic success was achieved in 37/50 (74%) of patients. Visual acuities (logMAR) were 1.8 ± 0.6, 1.6 ± 0.6, 2 ± 0.7 and intraocular pressures (mmHg) were 15.6 ± 7, 15.7 ± 5.5, 16.5 ± 7.1 at 3 months, 1 year and at last follow-up respectively. The main long-term silicone-oil-related complications observed were: band keratopathy (8%), corneal decompensation (12%), iris rubeosis (14%), and optic neuropathy (28%). Forty percent of patients achieved ambulatory vision in the SO-filled eye at final follow-up. CONCLUSION: Long-term silicone oil can be a last-resort option in selected patients with severe vitreoretinal disease. Anterior and posterior segment complications did occur at significant rates. Forty percent of our patients maintained ambulatory vision. The actual number of patients that achieved satisfactory stereopsis and benefited functionally from long-term SO was much less [7/50 (14%)].

Is there a role for long-term silicone oil tamponade for more than twelve months in vitreoretinal surgery?

Despite modern and sophisticated vitreoretinal techniques, the authors are convinced that an underreported patient group exists, for whom long-term silicone oil tamponade is unavoidable. We conducted a literature review of the current evidence base in order to provide guidance on the ocular tolerance and side effects of long-term silicone oil, weighing up benefits against complications as well as providing an outlook on future silicone oils with improved physical properties. We advocate the removal of silicone oil in all cases; however, one has to recognise that long-term silicone oil tamponade may have to be considered as a measure of last resort for selected patients. There is a clinical need to develop novel, emulsification-resistant tamponades.

Binasal hemianopia in two sisters.

Binasal hemianopia is a rare visual field defect. A teenage girl presented with blurred vision and persistent headaches following a minor head injury. The ocular examination was normal except for a binasal hemianopia, and subsequent neuroimaging was also unremarkable. Her older sister was found to have the same visual field defect, also with normal neuroimaging. This represents the first reported case of binasal hemianopia found in siblings. Given that no neurological or ocular cause was identified in either sister, this supports the theory of an unknown congenital aetiology.

Association between corneal hysteresis and central corneal thickness in glaucomatous and non-glaucomatous eyes.

PURPOSE: We aimed to determine corneal hysteresis values (CH) using the ocular response analyser (ORA) in non-glaucomatous and glaucomatous eyes and their relationship with central corneal thickness (CCT). METHODS: Corneal hysteresis, intraocular pressure (IOP) as measured by Goldmann applanation tonometry (GAT) and CCT were prospectively evaluated in 74 non-glaucoma subjects with IOP < 21 mmHg and in 108 patients with treated primary open-angle glaucoma (POAG). One eye in each subject was randomly selected for inclusion in the analysis. RESULTS: Mean (+/- standard deviation [SD]) age was 59.2 +/- 14.2 years in the non-glaucoma group and 62.4 +/- 9.8 years in the glaucoma group. Mean (+/- SD) GAT IOP was 15.7 +/- 2.65 mmHg and 16.38 +/- 2.73 mmHg in the non-glaucoma and glaucoma groups, respectively. There was no statistically significant difference between the two groups in mean age (p = 0.396) or mean GAT IOP (p = 0.098). Mean (+/- SD) CH was 10.97 +/- 1.59 mmHg in the non-glaucoma and 8.95 +/- 1.27 mmHg in the glaucoma groups, respectively. The difference in mean CH between the two groups was statistically significant (p < 0.0001). There was a strong positive correlation between CH and CCT in the non-glaucoma group (r = 0.743) and a significantly (p = 0.001) weaker correlation (r = 0.426) in the glaucoma group. CONCLUSIONS: Corneal hysteresis was significantly lower in eyes with treated POAG than in non-glaucomatous eyes. The corneal biomechanical response was strongly associated with CCT in non-glaucoma subjects, but only moderately so in glaucoma patients. It can be assumed that diverse structural factors, in addition to thickness, determine the differences in the corneal biomechanical profile between non-glaucomatous and glaucomatous eyes. Corneal hysteresis could be a useful tool in the diagnosis of glaucoma.