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1.
Int J Mol Sci ; 25(12)2024 Jun 13.
Article in English | MEDLINE | ID: mdl-38928220

ABSTRACT

We hypothesize that the injection of JP4-039, a mitochondria-targeted nitroxide, prior to irradiation of the mouse retina may decrease apoptosis and reduce neutrophil and macrophage migration into the retina. In our study, we aimed to examine the effects of JP4-039 in the mouse retina using fluorescent microscopy, a terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay, and flow cytometry. Forty-five mice and one eye per mouse were used. In Group 1, fluorescent microscopy was used to determine retinal uptake of 10 µL (0.004 mg/µL) of intravitreally injected BODIPY-labeled JP4-039 at 0, 15, and 60 min after injection. In Group 2, the TUNEL assay was performed to investigate the rate of apoptosis after irradiation in addition to JP4-039 injection, compared to controls. In Group 3, flow cytometry was used to determine the extent of inflammatory cell migration into the retina after irradiation in addition to JP4-039 injection, compared to controls. Maximal retinal uptake of JP4-039 was 15 min after intravitreal injection (p < 0.0001). JP4-039-treated eyes had lower levels of retinal apoptosis (35.8 ± 2.5%) than irradiated controls (49.0 ± 2.7%; p = 0.0066) and demonstrated reduced migration of N1 cells (30.7 ± 11.7% vs. 77.7 ± 5.3% controls; p = 0.004) and M1 cells (76.6 ± 4.2 vs. 88.1 ± 3.7% controls, p = 0.04). Pretreatment with intravitreally injected JP4-039 reduced apoptosis and inflammatory cell migration in the irradiated mouse retina, marking the first confirmed effect of this molecule in retinal tissue. Further studies may allow for safety profiling and potential use for patients with radiation retinopathy.


Subject(s)
Apoptosis , Cell Movement , Mitochondria , Retina , Animals , Apoptosis/drug effects , Apoptosis/radiation effects , Mice , Retina/drug effects , Retina/metabolism , Retina/radiation effects , Retina/pathology , Mitochondria/metabolism , Mitochondria/drug effects , Mitochondria/radiation effects , Cell Movement/drug effects , Cell Movement/radiation effects , Mice, Inbred C57BL , Male , Nitrogen Oxides/pharmacology , Inflammation/pathology
2.
Clin Infect Dis ; 75(6): 1092-1096, 2022 09 29.
Article in English | MEDLINE | ID: mdl-35325089

ABSTRACT

Ocular candidiasis (OC) complicates approximately 10% of candidemia and carries potentially severe morbidity. There are conflicting recommendations about the need for routine funduscopic examinations of candidemic patients. Indirect funduscopy is accurate and safe in diagnosing OC, and positive findings change recommended treatment. However, conclusive evidence that treatment changes improve outcomes is lacking. Bringing perspectives as infectious diseases physicians and ophthalmologists, we review controversies about OC and endorse routine screening during candidemia. We acknowledge difficulties in obtaining inpatient ophthalmologic consults and recommend studies to evaluate digital fundus photography and teleophthalmology as an alternative to funduscopic examinations by ophthalmologists in asymptomatic patients.


Subject(s)
Candidemia , Candidiasis , Endophthalmitis , Eye Infections, Fungal , Ophthalmology , Telemedicine , Candidemia/complications , Candidemia/diagnosis , Candidemia/drug therapy , Candidiasis/diagnosis , Candidiasis/drug therapy , Endophthalmitis/diagnosis , Eye Infections, Fungal/complications , Eye Infections, Fungal/diagnosis , Humans
3.
Medicina (Kaunas) ; 58(3)2022 Mar 21.
Article in English | MEDLINE | ID: mdl-35334633

ABSTRACT

Background and Objectives: Secondary ocular localizations of hematological malignancies are blinding conditions with a poor prognosis, and often result in a delay in the diagnosis. Materials and Methods: We describe a series of rare cases of ocular involvement in six patients with hematological malignancies, reportedly in remission, who presented secondary ocular localizations, challenging to diagnose. Two patients had an acute lymphoblastic leukemia (ALL) and developed either a posterior scleritis or a pseudo-panuveitis with ciliary process infiltration. One patient had iris plasmacytoma and developed an anterior uveitis as a secondary presentation. Two patients had a current systemic diffuse large B-cell lymphoma (DLBCL) and were referred either for intermediate uveitis or for papilledema and vitritis with secondary retinitis. Finally, one patient with an acute myeloid leukemia (AML) presented a conjunctival localization of a myeloid sarcoma. We herein summarize the current knowledge of ophthalmologic manifestations of extramedullary hematopathies. Results: Inflammatory signs were associated with symptomatic infiltrative lesions well displayed in either the iris, the retina, the choroid, or the cavernous sinus, from the admission of the patients in the ophthalmological department. These findings suggest that patients with ALL, AML, systemic DLBCL, and myeloma can present with ophthalmic involvement, even after having been reported as in remission following an effective systemic treatment and/or allograft. Conclusions: Early detection of hidden recurrence in the eyes may permit effective treatment. Furthermore, oncologists and ophthalmologists should be aware of those rare ocular malignant locations when monitoring patient's progression after initial treatment, and close ophthalmologic examinations should be recommended when detecting patient's ocular symptoms after treatment.


Subject(s)
Leukemia, Myeloid, Acute , Multiple Myeloma , Papilledema , Acute Disease , Humans , Iris
4.
Retina ; 41(7): 1547-1552, 2021 Jul 01.
Article in English | MEDLINE | ID: mdl-34137387

ABSTRACT

PURPOSE: To investigate differences in outcomes of acute retinal necrosis with confirmed viral polymerase chain reaction between viral types and highlight different treatment options. METHODS: The study evaluated 22 eyes in 18 patients of polymerase chain reaction-positive acute retinal necrosis at the University of Pittsburgh Medical Center from 2007 to 2018. Outcome measures included final visual acuity, treatment paradigms, and retinal detachment rate. RESULTS: Eight eyes were polymerase chain reaction-positive for varicella zoster virus, two eyes for herpes simplex virus Type 1 (HSV-1), and 12 eyes for herpes simplex virus Type 2 (HSV-2). Final Snellen best-corrected visual acuity averaged 20/51 for varicella zoster virus, 20/25 for HSV-1, and 20/814 for HSV-2. Retinal detachment occurred in 2 (25%) of varicella zoster virus eyes and 8 (75%) of HSV-2 eyes. One eye with HSV-1 and three eyes with HSV-2 received cidofovir for treatment of refractory retinitis. CONCLUSION: Acute retinal necrosis secondary to HSV-2 tended to have persistent active retinitis with a higher rate of retinal detachment despite similar treatment protocols, suggesting that in some cases combination intravenous acyclovir and adjuvant intravitreal foscarnet injections are not sufficient. Despite the risk of renal toxicity, intravenous cidofovir may be a consideration in select patients.


Subject(s)
Acyclovir/therapeutic use , Eye Infections, Viral/drug therapy , Foscarnet/therapeutic use , Herpes Zoster Ophthalmicus/drug therapy , Retinal Necrosis Syndrome, Acute/drug therapy , Adult , Aged , Aged, 80 and over , Antiviral Agents/therapeutic use , DNA, Viral/analysis , Eye Infections, Viral/diagnosis , Female , Follow-Up Studies , Herpes Zoster Ophthalmicus/diagnosis , Herpesvirus 3, Human/genetics , Humans , Male , Middle Aged , Retinal Necrosis Syndrome, Acute/diagnosis , Retrospective Studies , Treatment Outcome , Visual Acuity
5.
Retina ; 40(9): 1719-1723, 2020 Sep.
Article in English | MEDLINE | ID: mdl-31800459

ABSTRACT

PURPOSE: To evaluate alterations in treatment burden and course of exudative age-related macular degeneration in patients who contracted endophthalmitis from intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. METHODS: Retrospective study at the University of Pittsburgh Medical Center examining frequency of anti-VEGF injections, activity of choroidal neovascularization, and visual acuity before and after endophthalmitis treatment. RESULTS: Twenty-one patients meeting inclusion criteria were identified, of whom 7 (33%) patients did not restart anti-VEGF treatment 12 months after endophthalmitis because of quiescence of exudative age-related macular degeneration without significant visual acuity loss (P > 0.05). Patients who resumed anti-VEGF treatment exhibited 32% and 38% decreases in injection frequency by 12 and 24 months after endophthalmitis, respectively (P < 0.05). On first optical coherence tomography follow-up, 10 patients exhibited quiescence of choroidal neovascularization activity, although there were no measurable changes in macular thickness (P > 0.05). No differences in post-endophthalmitis exudative age-related macular degeneration progression or treatment burden were observed when factoring adjuvant intravitreal steroid therapy, culture results, nor choroidal neovascularization subtypes. CONCLUSION: Endophthalmitis resolution is associated with a decrease in choroidal neovascularization activity and a reduction of anti-VEGF treatment burden in patients with exudative age-related macular degeneration.


Subject(s)
Angiogenesis Inhibitors/therapeutic use , Choroidal Neovascularization/physiopathology , Endophthalmitis/drug therapy , Eye Infections, Bacterial/drug therapy , Intravitreal Injections/adverse effects , Wet Macular Degeneration/physiopathology , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Bevacizumab/therapeutic use , Choroidal Neovascularization/drug therapy , Endophthalmitis/etiology , Exudates and Transudates , Eye Infections, Bacterial/etiology , Female , Fluorescein Angiography , Humans , Male , Middle Aged , Ranibizumab/therapeutic use , Retrospective Studies , Tomography, Optical Coherence , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity/physiology , Wet Macular Degeneration/drug therapy
6.
Clin Infect Dis ; 75(7): 1271-1272, 2022 Sep 30.
Article in English | MEDLINE | ID: mdl-35818897
7.
Retina ; 36(11): 2066-2071, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27172097

ABSTRACT

PURPOSE: To present and analyze the anatomical and functional outcomes for scleral buckling (SB) in a group of patients with rhegmatogenous retinal detachment without posterior vitreous detachment. METHODS: A total of 244 patients underwent SB from 2005 through 2014 by a single surgeon (A.W.E.). Forty patients (45 eyes) were identified as fulfilling the criteria of presenting with a rhegmatogenous retinal detachment without posterior vitreous detachment. Visual outcomes, preoperative retinal findings, and the SB technique were analyzed. The main outcome measure was the primary reattachment rate at 6 months after single surgery. RESULTS: The mean age was 29 years (range 11-51 years). The mean follow-up period was 20 months. The mean refractive error was -5.16 diopters. Subretinal fluid drainage was performed in 17 eyes (37.8%). The anatomical success rate after single SB surgery at 6 months was 91.1%. The only factor that had statistically significant correlation with primary anatomical failure was development of subretinal hemorrhage during the drainage procedure (P = 0.03). CONCLUSION: Despite an increasing trend toward primary vitrectomy for rhegmatogenous retinal detachment, an indication for SB is in younger patients without a preexisting posterior vitreous detachment. We showed a 91.1% success rate with a primary SB and 100% with a second surgery.


Subject(s)
Retinal Detachment/surgery , Scleral Buckling/methods , Vitreous Detachment/surgery , Adolescent , Adult , Child , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications , Retinal Detachment/physiopathology , Retrospective Studies , Treatment Outcome , Visual Acuity/physiology
8.
Retina ; 34(4): 700-4, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24263467

ABSTRACT

BACKGROUND: We review a three-year series of cases with pneumatic retinopexy (PR), specifically evaluating failures and suggesting a new mechanism of failure. METHODS: One hundred and thirty-five consecutive patients who underwent PR for rhegmatogenous retinal detachments were included. The primary outcome measure was the characteristics of PR failures. Secondary outcome measures included preoperative clinical characteristics. RESULTS: Seventy-five percent of the patients had successful results with PR; 100% were ultimately reattached with additional surgery. All but 1 failure (97%) occurred within the first postoperative month and 85% occurred by postoperative Day 10. The most common cause of failure was a new detachment from a new break (23 of 35 failures). Risk factors for failure included presenting visual acuity worse than 20/60 (odds ratio [OR] = 1.89), male gender (OR = 1.52), age >60 years (OR = 1.32), >2 breaks (OR = 1.28), pseudophakia/aphakia (OR = 1.20), and detachments after trabeculectomy (OR = 2.43). Lattice degeneration, high myopia (>-6.00 diopters), left eye, detachment after cataract surgery or yttrium aluminum garnet capsulotomy had minimal influence on outcome (all OR < 1.10). CONCLUSION: Characterization of PR failures will improve patient selection. We have named a new complication secondary to a patient performing the steamroller maneuver five times the "pneumatic pump."


Subject(s)
Cryosurgery/adverse effects , Endotamponade/adverse effects , Laser Therapy/adverse effects , Retinal Detachment/etiology , Retinal Detachment/surgery , Aged , Female , Fluorocarbons , Follow-Up Studies , Humans , Male , Middle Aged , Recurrence , Retinal Detachment/physiopathology , Retinal Perforations/etiology , Risk Factors , Sulfur Hexafluoride , Treatment Failure , Treatment Outcome , Visual Acuity/physiology
9.
Can J Ophthalmol ; 2023 Jun 13.
Article in English | MEDLINE | ID: mdl-37321555

ABSTRACT

OBJECTIVE: To identify characteristics and visual outcomes of coagulase-negative staphylococcal (CoNS) endophthalmitis in the era after the Endophthalmitis Vitrectomy Study. DESIGN: Single-centre retrospective analysis. PARTICIPANTS: Forty-two samples from 40 patients with documented CoNS endophthalmitis. METHODS: Visual acuity outcomes of CoNS endophthalmitis were assessed in relation to species and type of treatment instituted (i.e., pars plana vitrectomy [PPV] versus vitreous tap and injection of intravitreal antibiotics [T&I]) on 42 samples from 40 patients. RESULTS: Staphylococcus epidermidis was the most prevalent CoNS in our study. Cataract surgery and intravitreal injections were the most common sources for acute CoNS endophthalmitis. Eyes presenting with hand motion or better vision had similar mean final vision after either intravitreal antibiotics or PPV, whereas those with light perception or worse vision at onset had better outcomes after PPV only. Subanalysis showed that patients with S. epidermidis endophthalmitis (n = 39 eyes) had similar visual outcomes with either intravitreal injections or PPV regardless of visual acuity. Hypopyon and vitritis are not always present. CONCLUSIONS: Patients with S. epidermidis endophthalmitis may benefit similarly from either early vitrectomy or intravitreal antibiotic injections regardless of visual acuity. This finding may be a supplement to the complements the management standards set forth by the Endophthalmitis Vitrectomy Study.

10.
J Ophthalmic Inflamm Infect ; 13(1): 35, 2023 Aug 17.
Article in English | MEDLINE | ID: mdl-37589912

ABSTRACT

PURPOSE: Posterior uveitis is a common chorioretinal pathology affecting all ages worldwide and is a frequent reason for referral to the retina clinic. The spectrum of etiologies for uveitis is very broad and includes infectious and auto-immune diseases. Inflammation can be confined to the eye or may be a part of systemic disease. A useful outline is therefore proposed to aid in the correct diagnosis of these challenging entities. The situation is further complicated by the fact that many neoplastic conditions resemble features of posterior uveitis; they are known as "masqueraders of uveitis". Here, we summarize different posterior uveitides that present with rare findings, along with masqueraders that can be difficult to distinguish. These conditions pose a diagnostic dilemma resulting in delay in treatment because of diagnostic uncertainty. METHODS: An extensive literature search was performed on the MEDLINE/PUBMED, EBSCO and Cochrane CENTRAL databases from January 1985 to January 2022 for original studies and reviews of predetermined diagnoses that include posterior uveitic entities, panuveitis and masquerade syndromes. RESULTS: We described conditions that can present as mimickers of posterior uveitis (i.e., immune check-points inhibitors and Vogt-Koyanagi-Harada-like uveitis; leukemia and lymphoma associated posterior uveitis), inflammatory conditions that present as mimickers of retinal diseases (i.e., Purtscher-like retinopathy as a presentation of systemic lupus erythematosus; central serous chorioretinopathy masquerading inflammatory exudative retinal detachment), and uveitic conditions with rare and diagnostically challenging etiologies (i.e., paradoxical inflammatory effects of anti-TNF-α; post vaccination uveitis; ocular inflammation after intravitreal injection of antiangiogenic drugs). CONCLUSION: This review of unique posterior uveitis cases highlights the overlapping features of posterior uveitis (paradoxical inflammatory effects of anti -TNF α and uveitis; Purtscher-like retinopathy as a presentation of systemic lupus erythematosus, …) and the nature of retinal conditions (ischemic ocular syndrome, or central retinal vein occlusion, amyloidosis, inherited conditions like retinitis pigmentosa, autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV), etc.…) that may mimic them is represented. Careful review of past uveitis history, current medications and recent vaccinations, detailed examination of signs of past or present inflammation, eventually genetic testing and/ or multimodal retinal imaging (like fluorescein angiography, EDI-OCT, OCT-angiography for lupus Purtscher-like retinopathy evaluation, or ICG for central serous retinopathy, or retinal amyloid angiopathy) may aid in correct diagnosis.

12.
Ophthalmology ; 119(5): 1011-6, 2012 May.
Article in English | MEDLINE | ID: mdl-22330962

ABSTRACT

PURPOSE: To report the first described cases of peripheral yellow corneal rings secondary to vitamin supplementation for age-related macular degeneration (ARMD). DESIGN: Retrospective single-center case series. PARTICIPANTS: The eyes of 4 patients taking vitamin supplementation for ARMD were examined at the University of Pittsburgh Medical Center Department of Ophthalmology between January 2010 and April 2011. METHODS: We reviewed the medical records of 4 patients with peripheral corneal rings receiving vitamin supplementation for ARMD. MAIN OUTCOME MEASURES: The presence of peripheral yellow corneal rings, skin findings, and serum carotene levels. RESULTS: Each patient had circumferential, yellow, peripheral corneal rings and exhibited subtle yellowing of the skin most notable on the palms. Serum carotene levels were normal in 2 of the 3 patients and markedly elevated in the last patient in whom it was measured. CONCLUSIONS: It is unclear at this time how to counsel patients with this ocular finding. We suspect that these rings are more common than generally appreciated because they may have a subtle appearance or be misdiagnosed as arcus senilis. We suggest that a formal study be performed on a cohort of patients taking vitamin supplementation for macular degeneration that specifically screens for yellow rings and measures serum carotene levels when they are identified.


Subject(s)
Corneal Diseases/chemically induced , Corneal Stroma/drug effects , Dietary Supplements/adverse effects , Limbus Corneae/drug effects , Vitamins/adverse effects , beta Carotene/adverse effects , Aged , Aged, 80 and over , Clinical Trials as Topic , Corneal Stroma/chemistry , Corneal Stroma/pathology , Female , Humans , Intraocular Pressure/physiology , Limbus Corneae/chemistry , Limbus Corneae/pathology , Macular Degeneration/drug therapy , Macular Degeneration/physiopathology , Retrospective Studies , Visual Acuity/physiology , Vitamins/blood , Vitamins/chemistry , beta Carotene/blood , beta Carotene/chemistry
13.
Ocul Immunol Inflamm ; 30(2): 364-378, 2022 Feb 17.
Article in English | MEDLINE | ID: mdl-33617412

ABSTRACT

PURPOSE: To describe the application of OCT-A in various posterior uveitis disorders in our experience and to compare it with the available literature. METHODS: Eighteen eyes with the diagnoses of multifocal choroiditis (MFC), multifocal placoid pigment epitheliopathy (APMPPE), multiple evanescent white dot syndrome (MEWDS), tuberculous serpiginous-like choroiditis (SLC), serpiginous choroiditis (SC), and birdshot chorioretinopathy (BSCR) were studied. RESULTS: We found flow void of the choriocapillaris in patients with APMPPE, SC, MFC, BSCR, and in SLC. In contrast, perfusion of the choriocapillaris seemed normal in patients with MEWDS. CONCLUSIONS: We confirmed that OCT-A contributes new information on the physiopathology of white dot syndromes and inflammatory chorioretinopathies, notably on whether or not the choriocapillaris is involved. Comparing the OCT-A features allowed us to suggest that both APMPPE and SLC might be part of the same spectrum of inflammatory disease with primary involvement at the level of the choriocapillaris and secondary RPE damage.


Subject(s)
Choroiditis , White Dot Syndromes , Birdshot Chorioretinopathy , Choroid , Choroiditis/diagnosis , Fluorescein Angiography , Humans , Multifocal Choroiditis , Tomography, Optical Coherence
15.
J Vitreoretin Dis ; 5(3): 208-215, 2021.
Article in English | MEDLINE | ID: mdl-37006521

ABSTRACT

Purpose: This work compares clinical presentation and course of bacterial and fungal causes of endogenous endophthalmitis (EE). Methods: A single-institutional study of consecutive patients diagnosed with EE was conducted at the University of Pittsburgh Medical Center between September 2015 and September 2018. Exclusion criteria included history of ocular trauma, intraocular surgery or injection 6 months before presentation, or primary external ocular infection. Data included demographics, medical and ocular history, clinical examination, culture data, therapeutic interventions, final corrected visual acuity (VA), and mortality. Results: Thirty-six eyes of 26 patients were diagnosed with EE during a 3-year period. Median age at diagnosis was 55.5 years (range, 19-86 years). Based on ocular and systemic cultures, 19 patients had bacterial EE and 6 patients had fungal EE; findings from all cultures remained negative in 1 patient. All patients had risk factors for EE. Presenting VA, subjective symptom report, and objective measures of intraocular inflammation were similar between bacterial and fungal causes. Overall, EE presented indolently and was initially misdiagnosed in 19% of cases. Complications including final VA less than 20/200, retinal detachment, enucleation, or death within 6 months of diagnosis were equivalent between bacterial and fungal cases. Conclusions: The presentation of EE is remarkably different from that of exogenous endophthalmitis. Without a high index of suspicion, the indolent presentation of EE may lead to misdiagnosis. No clinical features reliably differentiated bacterial and fungal sources. This highlights the importance of considering empiric therapy for antibacterial and antifungal coverage on initial presentation.

16.
Front Med (Lausanne) ; 8: 769308, 2021.
Article in English | MEDLINE | ID: mdl-34957148

ABSTRACT

Torpedo maculopathy (TM) is a rare congenital defect of the retinal pigment epithelium (RPE). The RPE is often evaluated clinically using fundus autofluorescence (AF), a technique that visualizes RPE structure at the tissue level from the intrinsic AF of RPE fluorophores. TM lesions typically emit little or no AF, but this macroscopic assessment is unable to resolve the RPE cells, leaving the organization of the RPE cell mosaic in TM unknown. We used fluorescence adaptive optics scanning laser ophthalmoscopy (AOSLO) to show here for the first time the microscopic cellular-level structural alterations to the RPE cell mosaic in TM that underlie the tissue-level changes seen in conventional clinical imaging. We evaluated two patients with TM using conventional clinical imaging techniques and adaptive optics (AO) infrared autofluorescence (IRAF) in AOSLO. Confocal AOSLO revealed relatively normal cones outside the TM lesion but altered cone appearance within it and along its margins in both patients. We quantified cone topography and RPE cell morphometry from the fovea to the margin of the lesion in case 1 and found cone density to be within the normal range across the locations imaged. However, RPE morphometric analysis revealed disrupted RPE cells outside the margin of the lesion; the mean RPE cell area was greater than two standard deviations above the normative range up to approximately 1.5 mm from the lesion margin. Similar morphometric changes were seen to individual RPE cells in case 2. Multi-modal imaging with AOSLO reveals that RPE cells are abnormal in TM well beyond the margins of the characteristic TM lesion boundary defined with conventional clinical imaging. Since the TM fovea appears to be fully formed, with normal cone packing, it is possible that the congenital RPE defect in TM occurs relatively late in retinal development. This work demonstrates how cellular level imaging of the RPE can provide new insight into RPE pathologies, particularly for rare conditions such as TM.

17.
Clin Ophthalmol ; 15: 3697-3704, 2021.
Article in English | MEDLINE | ID: mdl-34511873

ABSTRACT

PURPOSE: Prophylactic topical antiseptics used to eliminate bacteria on the ocular surface prior to ocular surgery should be both effective and non-irritating. Five percent povidone iodine (PI) is an accepted antiseptic used for prophylaxis. Dilute 2.5% PI and 0.01% hypochlorous acid (HOCl) may be more patient comfortable and equally effective. PI at 5% and 2.5% were compared to HOCl against a battery of bacterial endophthalmitis isolates using corneoscleral tissue as a solid-phase medium to determine antiseptic efficacy. METHODS: Bacteria from 20 cases of endophthalmitis were tested for the elimination of growth against topical 5% PI, 2.5% PI, HOCl, and no antiseptic using donor corneoscleral tissue. The tissue was inoculated with 103 colony forming units of bacteria prior to a 3-minute contact time with the antiseptics, placed in liquid growth medium, and monitored for growth at three days. No growth indicated antiseptic treatment success. Differences were analyzed using Chi square (χ2). RESULTS: For 20 isolates, 5% PI was comparable to 2.5% PI for preventing bacteria growth (p=0.71), and both were more effective than HOCl (p=0.004). Estimated weighted comparison over a 27-year period indicated that for all bacterial groups, except Streptococcus viridans, 5% PI was equally effective to 2.5% PI for preventing bacterial growth (p=1.0). For Streptococcus viridans, 5% PI was more effective than 2.5% PI (p=0.0001). Both concentrations of PI were more effective than HOCl (p=0.00001). CONCLUSION: Five percent PI appears to be optimal as a prophylaxis prior to ocular surgery.

18.
Am J Ophthalmol Case Rep ; 18: 100636, 2020 Jun.
Article in English | MEDLINE | ID: mdl-32154437

ABSTRACT

PURPOSE: To describe an unusual case of bilateral acute retinal necrosis (ARN) that was caused by varicella zoster virus in one eye and Epstein-Barr virus in the fellow eye. OBSERVATIONS: A 67-year-old immunocompromised man presented with ARN in the left eye following a dermatomal vesicular rash, with an aqueous sample positive for varicella zoster virus. Four months later, the patient presented with panuveitis and serous retinal detachment in the right eye, with vitreous sample positive for Epstein-Barr virus and negative for varicella zoster, herpes simplex, and cytomegalovirus. CONCLUSIONS AND IMPORTANCE: We report a rare case of bilateral ARN with independent infection of each eye by different viruses; varicella zoster in the left eye and, four months later, Epstein-Barr virus in the right eye. Immunocompromised patients are vulnerable to ARN from any of its inciting viral causes, and intraocular fluid should be obtained for diagnostic confirmation from the second eye in cases of bilateral ARN.

19.
Am J Ophthalmol Case Rep ; 13: 59-61, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30582073

ABSTRACT

PURPOSE: To describe an unusual case of spontaneous closure of a chronic, large, idiopathic, stage 4 macular hole after failed surgery. OBSERVATIONS: A 75-year-old female presented with a history of a chronic, full thickness macular hole after failed surgery in the right eye. Two years after onset, she developed a fibrotic scar, which closed the macular hole and unexpectedly improved her vision. At her 4 year follow up exam, optical coherence tomography demonstrated a stable, closed macular hole with continued improvement in her visual acuity despite lack of surgical and medical intervention. CONCLUSIONS AND IMPORTANCE: The spontaneous closure of an idiopathic full thickness macular hole is an unusual event. When it occurs, it is typically in an acute setting and is attributed to bridging retinal tissue, vitreofoveal separation, and a small diameter size. In this report, we show that a chronic, large break, that failed prior surgical intervention, can spontaneously close. The formation of an underlying fibrotic scar from type 1 neovascularization bridged the macular hole and improved her visual acuity.

20.
Ophthalmol Retina ; 3(6): 468-472, 2019 06.
Article in English | MEDLINE | ID: mdl-31174667

ABSTRACT

PURPOSE: To report refractive outcomes of scleral-fixated intraocular lens (IOL) implantation with Gore-Tex (W.L. Gore & Associates, Newark, DE) suture and combined pars plana vitrectomy and compare predicted refractive outcomes among 5 IOL power calculation formulas. DESIGN: Retrospective case series. PARTICIPANTS: Patients undergoing scleral-fixated IOL implantation with Gore-Tex suture at our institution between January 2015 and June 2018. METHODS: Comparison of preoperative biometrics with postoperative refraction and calculation of predicted refractive outcome with 5 different IOL formulas. MAIN OUTCOME MEASURES: Prediction error and absolute error to compare postoperative refraction with refraction predicted by lens power calculation formulas. RESULTS: Thirty-one eyes of 31 patients were included. All power calculations assumed in-the-bag position of the IOL. The Akreos A060 (Bausch & Lomb, Rochester, NY) was implanted in 23 eyes and the CZ70BD (Alcon, Fort Worth, TX) in 8 eyes, and all lenses were sutured 3 mm behind the limbus. Average postoperative spherical equivalent (SE) was -0.79±0.95 diopters (D). Average prediction error (postoperative SE refraction minus target refraction) was -0.19±0.72 D. Postoperative SE was within 1.0 D of target in 25 of 31 patients (81%) and 2.0 D of target in 31 of 31 patients (100%). The repeated-measures analysis of variance of absolute error by lens power formula was significant (P = 0.012), with Haigis demonstrating greater error. There was no significant difference among Barrett II, Sanders-Retzlaff-Kraff theoretical (SRK/T), Holladay 2, or Hoffer Q. CONCLUSIONS: For eyes undergoing pars plana vitrectomy with scleral-sutured IOL implantation, assumption of in-the-bag IOL position when calculating lens power leads to acceptable refractive outcomes. Barrett II, SRK/T, Holladay 2, and Hoffer Q formulas were noninferior to each other.


Subject(s)
Eye Diseases/surgery , Lens Implantation, Intraocular/methods , Lenses, Intraocular , Optics and Photonics , Refraction, Ocular/physiology , Sclera/surgery , Suture Techniques/instrumentation , Adult , Aged , Aged, 80 and over , Anterior Chamber/surgery , Biometry , Eye Diseases/physiopathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Polytetrafluoroethylene , Prosthesis Design , Retrospective Studies , Sutures , Treatment Outcome , Visual Acuity , Vitrectomy/methods
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