Postoperative Endophthalmitis Before and After Preferred Utilization of Prophylactic Intracameral Antibiotics for Phacoemulsification Cataract Surgeries at Cole Eye Institute.

PURPOSE: To compare the rate of endophthalmitis of intracameral versus topical antibiotic prophylaxis for patients undergoing phacoemulsification at a single-centered, multispecialty ophthalmological institute. METHODS: A retrospective analysis of the rate of endophthalmitis by coding search within 90 days of cataract surgery in periods before (May 15, 2012-May 15, 2014) and after (April 30, 2015-April 30, 2017) intracameral antibiotics became the institution's preferred practice pattern for phacoemulsification. Clinical data were collected for each endophthalmitis case, including timing of onset, presenting symptoms and signs, culture results, treatment performed, and visual acuity outcome. RESULTS: The rate of postphacoemulsification endophthalmitis decreased from 0.18% (29 eyes among 16,201 cataract surgeries) to 0.07% (11 eyes among 16,325 surgeries) when the preferred method was changed from topical to intracameral antibiotics (P=0.004) with an odds ratio of 0.32. Endophthalmitis cases in the 2 groups had comparable visual acuity at initial presentation and at 3 months (P=0.86). The most commonly isolated organism in culture-proven cases of endophthalmitis in both groups was coagulase-negative staphylococcus. The rate of gram-positive endophthalmitis decreased from 0.08% to 0.02% with an odds ratio of 0.23 (P=0.012) while the rate of gram-negative cases remained similar. CONCLUSIONS: The use of intracameral antibiotics during cataract surgery was associated with a statistically significant reduction of postoperative endophthalmitis.

Neovascular Age-Related Macular Degeneration.

Age-related macular degeneration (AMD) is the leading cause of severe vision loss in individuals over the age of 50 years. Choroidal neovascularization (CNV) is the hallmark of 'wet' or 'exudative' AMD, and is responsible for approximately 90% of cases of severe vision loss due to AMD. Vascular endothelial growth factor (VEGF) is a key component in the development and progression of wet AMD. Since the approval of ranibizumab in 2006, VEGF inhibitors have rapidly altered the treatment and standard of care for wet AMD. Ranibizumab, bevacizumab, and aflibercept are now the most widely used anti-VEGF agents for the treatment of wet AMD. This chapter discusses the pharmacologic properties, pharmacokinetics, safety, and efficacy of these medications, as well as revisits landmark clinical trials that establish these drugs as gold standards in care. While these medications have greatly and positively altered the way we treat AMD, there are still many economic and therapeutic limitations with our current therapy regimens. There continue to be advancements and innovations in exploring alternative and new treatment modalities, as well as combining existing treatment options to improve efficacy, and reduce cost and patient burden.

Frequency of vitreomacular interface disease in patients presenting to a tertiary care institution.

BACKGROUND AND OBJECTIVE: To evaluate the frequency of vitreomacular interface disease using a recently published optical coherence tomography (OCT) classification and assess which of these patients would qualify for ocriplasmin. PATIENTS AND METHODS: A retrospective, consecutive case series of patients with macular cyst, hole, or pseudohole (ICD-9 code 362.54) and concurrent OCT imaging was performed. Eyes were classified using OCT as pseudohole, lamellar hole, vitreomacular adhesion (VMA), vitreomacular traction (VMT), and full-thickness macular hole (FTMH). Minimum diameter (MD) of FTMH was measured. RESULTS: The study included 399 eyes of 331 patients. Of these, 61 eyes (15.3%) had VMA or VMT, 120 (30.0%) had a lamellar hole or pseudohole, and 218 (54.6%) had FTMH. Of eyes with FTMH, 73 were small (< 250 µm MD), 48 were medium (250 to 400 µm MD), and 97 were large (> 400 µm MD). Overall, 68 eyes (17.0%) would be candidates for ocriplasmin therapy. CONCLUSION: Most patients had FTMH, and 17% would qualify as candidates for ocriplasmin therapy.