Endophthalmitis Secondary to Occult Intraocular Eyelashes Following Perforating Gunshot Injury: A Case Report.

Purpose: This is a retrospective case report in which we describe our findings in two cases of endophthalmitis associated with perforating gunshot injury, in which we documented intraocular intrusion of multiple eyelashes as a plausible source of infection. Patients and Methods: Two male patients, 22 and 29 years old, respectively, presented with endophthalmitis following primary repair of rupture globe secondary to gunshot injury. Both patients had vitrectomy and silicone oil injection. Preoperative imaging and intraoperative findings confirmed the perforating nature of the projectile. Results: In both patients, we detected eyelashes that were concealed either in the pars plana region or within vitreous exudates. Silicone oil was not removed in both patients to prevent phthisis bulbi and because there was no potential for visual improvement. The postoperative course in both cases was uneventful. Conclusion: Gunshot injuries can inoculate eyelashes impregnated with infectious microorganisms into the eye. In cases presenting with endophthalmitis associated with a gunshot injury, we recommend meticulous examination of the posterior segment and the pars plana region during vitrectomy to exclude the presence of occult lashes.

Pars plana vitrectomy with/without encircling scleral band for treatment of retinal detachment associated with buphthalmos.

BACKGROUND: To evaluate the results of pars plana vitrectomy (PPV) and silicone oil (SO) tamponade with or without encircling scleral band for repair of rhegmatogenous retinal detachment (RRD) in children with buphthalmos. PATIENTS AND METHODS: Retrospective comparative nonrandomized interventional case series including consecutive patients who underwent PPV with or without encircling band and SO tamponade for RRD associated with buphthalmos. RESULTS: The study included 19 eyes of 19 children. Mean age was 8 years, range 3-16 years. Mean follow-up period was 28 months, range 19-63 months. Globe survival has been achieved in 15 out of 19 eyes (79%). Phthisis bulbi was reported in four cases (22%). Eight patients (42%) achieved ambulatory vision. Most eyes initially achieved anatomical success. CONCLUSION: Despite the poor visual and anatomical results of RRD repair in eyes with buphthalmos, globe survival might be the rationale for surgery in such cases. Globe preservation could avoid the psychological and social consequences of phthisis bulbi in non-operated children.

Long-Term Outcome of Pars Plana Vitrectomy for Retained Posterior Segment Intraocular Foreign Body Secondary to Gunshot Injury.

PURPOSE: To report the long-term outcome of pars plana vitrectomy (PPV) for management of retained posterior segment intraocular foreign body (IOFB) secondary to gunshot injury. METHODS: This is a retrospective interventional case series including consecutive patients who had PPV for retained posterior segment IOFB secondary to gunshot injury. Main outcome measures were final best-corrected visual acuity (BCVA), long-term globe survival and detection of complications. Spearman correlation analyzed relationships between numerical data. Kruskal-Wallis test compared differences in initial BCVA and final BCVA across variables. Categorical variables were tested using Chi square or Fisher's exact test. P value is significant at 0.05. RESULTS: The study included 103 eyes of 103 patients. Mean baseline BCVA was 0.01 decimal unit (2 logMAR). Mean duration from primary repair to PPV was 3 weeks. Mean duration of post-operative follow-up was 60 months. Mean final BCVA was 0.04 decimal unit (1.3 logMAR), p 0.001. Post-operatively, BCVA improved in 58.2% of patients. Nineteen patients (18%) gained ≥2 lines of vision, and 15 patients (14.5%) achieved final BCVA of 0.4 decimal unit (logMAR 0.4). All complications were related to the original injury. These included macular scar (19%), macular pucker (6%), recurrent retinal detachment (4%), subretinal fibrosis (3%), consecutive optic atrophy (3%), and PVR (3%). Phthisis bulbi or sympathetic ophthalmia did not develop in any case. CONCLUSION: PPV for removal of IOFB caused by gunshot injury yielded long-term favorable functional outcome with excellent globe survival. Poor initial BCVA, location of IOFB in the posterior pole, associated lens injury and retinal detachment are significant adverse prognostic factors for final BCVA but not for globe survival.

Long-Term Outcome After Silicone Oil Removal in Eyes with Myopic Retinal Detachment Associated with Macular Hole.

PURPOSE: To assess the efficacy of pars plana vitrectomy (PPV) and silicone oil tamponade for management of myopic retinal detachment associated with macular hole (MRDMH) and to assess the anatomical and functional outcomes of this technique and its long-term validity after silicone oil removal. METHODS: Retrospective interventional non-comparative case series including consecutive patients who had PPV and silicone oil tamponade for MRDMH. All patients had an axial length ≥26 mm. Main outcome measures were retinal re-attachment and macular hole closure after silicone oil removal, improvement of best-corrected visual acuity (BCVA), and complications secondary to surgery. Chi square/Fisher's exact test was used to analyze categorical variables, while One-way ANOVA/Kruskal-Wallis test was used to compare variables across the closure type and complications. Correlations between numerical variables were tested using Spearman correlation. Kaplan-Meier method was used to estimate the event-free survival. P value is significant at 0.05. RESULTS: The study included 26 eyes of 26 patients. Retinal re-attachment rate after primary and secondary surgeries was 88.4% and 100%, respectively. W-type macular hole closure occurred in 58% of eyes. Vision improved in 58% of eyes. Mean final BCVA was 0.05 decimal units, p = 0.004. Cataract and glaucoma developed in 42% and 15% of eyes, respectively. Initial BCVA, axial length and duration of silicone oil tamponade did not correlate significantly with either the type of macular hole closure or the final BCVA. CONCLUSION: PPV and silicone oil tamponade technique promotes successful anatomical and functional outcome in MRDMH. Long-term success is maintained after silicone oil removal. High incidence of silicone oil-induced complications mandate its removal from eyes with successful retinal re-attachment.

Results of Pars Plana Vitrectomy for Different Types of Macular Holes.

PURPOSE: To compare different types of macular holes regarding the anatomic and functional success following pars plana vitrectomy (PPV) and internal limiting membrane (ILM) removal. METHODS: A retrospective review of all patients with macular holes treated by PPV, ILM removal with gas tamponade from January 2014 to July 2017 in Magrabi Eye Hospital. RESULTS: One hundred fifty-seven eyes of 153 patients were analyzed. The eyes were classified according to the etiology of macular hole into four groups: 79 eyes with idiopathic macular hole (IMH), 51 eyes with traumatic macular hole (TMH), 16 eyes with macular hole in diabetic patients (DMH) and 11 eyes with myopic macular hole (MMH). We classified the IMH group based on the International Vitreomacular Traction Study Classification according to size into 3 subgroups; subgroup 1: ≤250µ, subgroup 2: >250 to 400µ and subgroup 3: ≥400 µ. All types of macular hole showed statistically significant postoperative improvement in BCVA compared to the baseline except cases with MMH. Anatomic postoperative hole closure was achieved in 86.1%, 60.7%, 43.65%, an 45.46% of eyes with IMH, TMH, DMH and MMH, respectively. In eyes with IMH, closure rate in subgroup 1 was significantly higher than in subgroups 2, and 3. CONCLUSION: PPV, ILM peel and C2F6 technique yielded variable anatomic and functional outcomes in different types of macular holes. Anatomic results were most favorable in IMH and least favorable in MMH. The smaller the diameter of the hole the better the results. The underlying pathogenetic mechanisms that lead to different types of macular holes are pivotal in determining the final outcome.

Comparison Between Pars Plana Vitrectomy with and without Encircling Band in the Treatment of Pediatric Traumatic Rhegmatogenous Retinal Detachment.

BACKGROUND AND OBJECTIVES: To compare anatomical and visual results of pars plana vitrectomy (PPV) with or without additional encircling band in the management of pediatric traumatic rhegmatogenous retinal detachment (RD) in a tertiary referral center. METHODS: A retrospective review of children diagnosed with traumatic rhegmatogenous retinal detachment treated by pars plana vitrectomy with or without encircling band. RESULTS: One hundred thirty-nine eyes of 139 children diagnosed with traumatic rhegmatogenous retinal detachment. Surgeries were performed between May 2011 and November 2016. Patients were followed up for at least 18 months after last intervention. The included eyes were categorized into two groups. Group A (vitrectomy with additional encircling band) included 72 eyes of 72 children; 58 boys and 14 girls. Group B (vitrectomy without encircling band) included 67 eyes of 67 children; 58 boys and 9 girls. In group A, the mean age was 9.21±3.24. Attached retina was achieved in 61% (44 out of 72 eyes), of which 34 eyes remained attached after silicon oil removal, and 10 eyes remained attached under silicon oil tamponade. Recurrent RD under oil was present in 28 eyes (38.9%). In group B, the mean age was 11.06±3.64. Attached retina was present in 61.2% (41 out of 67 eyes), of which 30 eyes remained attached after oil removal, and 11 eyes remained attached under silicon oil tamponade. Recurrent RD was present in 26 eyes (38.8%). In group A, the final visual acuity (VA) ranged from NLP to 0.5; 58.7% of patients achieved VA more than counting fingers at 1 meter, and 34.6% of patients achieved VA of 0.05 or more. In group B, the final postoperative VA ranged from NLP to 0.9; 16% of patients achieved VA from counting fingers at 1 meter to 0.05, and 29.2% achieved VA of 0.05 or more. CONCLUSION: Although no statistically significant difference between the two groups (combined vitrectomy and encircling band versus vitrectomy alone in pediatric traumatic retinal detachment), it is wise to consider adding encircling band in severe trauma cases.

Optical Coherence Tomography Morphological Features Following Modified Internal Limiting Membrane Surgical Technique In Traumatic Macular Holes.

OBJECTIVE: To describe the optical coherence tomography (OCT) findings in terms of macular hole closure and ellipsoid zone (EZ) recovery following modified internal limiting membrane (ILM) surgical technique in traumatic macular holes (TMH). METHODS: The study was a retrospective case series that recruited 16 consecutive patients with TMH. Following vitrectomy (PPV), we performed modified ILM surgical technique (IFT) in which ILM peel was stopped at the edges of the hole forming a floating ILM flap. Primary outcome measures were pattern of TMH closure and recovery of EZ. Student's T-test and Pearson's correlation coefficient were used for statistical analysis. RESULTS: The study had 16 eyes of 16 patients. Mean baseline minimum linear diameter (MLD) was 562µ. Mean baseline best-corrected visual acuity (BCVA) was 1.4 logMAR. U-pattern closure occurred in 50% of eyes, V-pattern closure occurred in 31.2% of eyes, whereas W-pattern closure occurred in 18.7% of eyes. Mean BCVA improvement was 5 lines (p 0.02). Failure of recovery of EZ was detected in 75% of eyes. In the present series, neither pre-operative MLD nor time lapse prior to surgery were significant factors in determining the closure pattern of TMH, the grade of EZ recovery or final BCVA. CONCLUSION: Modified IFT is effective in promoting macular hole closure and improving visual acuity in patients with TMH. The technique does not promote recovery of EZ.

Comparative Study between Pars Plana Vitrectomy with Internal Limiting Membrane Peel and Pars Plana Vitrectomy with Internal Limiting Membrane Flap Technique for Management of Traumatic Full Thickness Macular Holes.

PURPOSE: To compare the efficacy of PPV and ILM peel versus PPV and IFT in patients with traumatic FTMH. METHODS: Retrospective interventional comparative case series including two groups of patients with traumatic FTMH. Patients were divided into group I (ILM peel) and group II (IFT). The main outcome measure was closure of the macular hole and restoration of the foveal microstructure. The independent-samples T-test and ANOVA test were used to study the mean between 2 groups and calculate the P value, whereas the bivariate correlation procedure studied the interaction between the variables tested. RESULTS: Group I included 28 patients. Mean preoperative MLD was 757 µm. Mean preoperative BCVA was approximately 20/320. Group II included 12 patients. Mean preoperative MLD was 529.5 µm. Mean preoperative BCVA was 20/320. Group I had a macular hole closure rate of 75% versus 92% in group II P=0.05. Mean BCVA improvement was 2.5 lines in group I versus 5 lines in group II P=0.02. Disrupted ELM and IS/OS was the most salient finding in both groups. CONCLUSION: IFT has a significantly superior anatomic and functional outcome compared to ILM peel in traumatic FTMH.

Safety of high-dose intravitreal triamcinolone acetonide as low-cost alternative to anti-vascular endothelial growth factor agents in lower-middle-income countries.

PURPOSE: The purpose of this study was to evaluate the safety of high-dose intravitreal triamcinolone acetonide (IVTA) as affordable low-cost alternative to anti-vascular endothelial growth factor (anti-vascular endothelial growth factor [anti-VEGF] agents) in lower-middle-income countries. PATIENTS AND METHODS: This was a retrospective interventional non-comparative case series. The study recruited patients who received 20 mg IVTA for treating various retinal and optic nerve diseases over the past 5 years. Main outcome measure was assessment of complications secondary to high-dose IVTA. The crosstabs procedure was used to display the interaction between the variables tested. The ANOVA test was used to analyze the differences among group means. RESULTS: The study included 207 eyes of 168 patients. The main indication for high-dose IVTA were diabetic macular edema 64%, and macular edema secondary to retinal vein occlusion 19%. The mean follow-up period post-injection was 22 months. Mean number of injections was 1.3. Cataract developed in 54% of eyes. Glaucoma developed in 18.5% of eyes. Glaucoma surgery for intractable glaucoma attributed to high-dose IVTA was needed in 1% of eyes. Endophthalmitis and retinal detachment developed in one patient each. CONCLUSION: High-dose IVTA is a safe and cost-effective alternative to anti-VEGF agents. Cataract formation and intraocular pressure rise do not pose major adverse effects when weighed against the risk of vision loss due to inability to afford anti-VEGF treatment.

Safety of Silicone Oil Removal in Cases of Gunshot Perforating Eye Injuries.

BACKGROUND AND OBJECTIVE: To evaluate the feasibility and safety of silicone oil (SO) removal in cases of gunshot perforating eye injuries (PEI). PATIENTS AND METHODS: A retrospective, consecutive, interventional study from medical records regarding cases of gunshot PEI during the periods of Egyptian political instability (January 2011 until December 2013). The main outcomes were to evaluate the feasibility of SO removal in cases of gunshot PEI and management of retinal detachment (RD) after SO removal in such cases. RESULTS: One hundred ninety-six eyes of 193 patients were reviewed. SO was removed in 72 eyes of 70 patients (36.7%). After SO removal, five eyes (6.9%) developed RD. One case refused any other intervention. RD in the remaining four cases was treated with revision surgery and SO reinjection. The retina remained stable throughout follow-up. None of the eyes developed phthisis bulbi after SO removal. Mean follow-up after SO removal was 10.86 months (range: 3 months to 30 months). Mean follow-up after management of RD after SO removal was 17.7 months (range: 13 months to 21 months). CONCLUSIONS: Patients aged younger than 20 years were associated with extensive fibrous proliferation, which might affect the safety profile of SO removal in cases of gunshot PEI. Rate of RD after SO removal in cases of apparent retinal stability and localized fibrous proliferation was 6.9%. Retinal detachment after SO removal in such cases can be treated with revision surgery and SO reinjection. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:242-250.].

Timing of Pars Plana Vitrectomy in Management of Gunshot Perforating Eye Injury: Observational Study.

The aim of this study is to report the difference in either anatomical or functional outcome of vitreoretinal intervention in cases of gunshot perforating eye injury if done 2-4 weeks or after the 4th week after the original trauma. Patients were treated with pars plana vitrectomy and silicon oil. Surgeries were performed in the period from February 2011 until the end of December 2014. 253 eyes of 237 patients were reviewed. 46 eyes were excluded. 207 eyes of 197 patients were analyzed. The included eyes were classified based on the timing of vitrectomy in relation to the initial trauma into two groups: 149 eyes (the first group) operated on between the 3rd and the 4th week and 58 eyes (the second group) operated on after the 4th week after the trauma. Following one surgical intervention, in the first group, attached retina was achieved in 93.28% of patients. In the second group, attached retina was achieved in 96.55% of patients. All RD cases could be attached by a second surgery. Visual acuity improved in 81.21% of patients, did not change in 15.43% of patients, and declined in 3.35% of patients. In the second group, visual acuity improved in 81.03% of patients, did not change in 12.06% of patients, and worsened in 6.89% of patients. There was no statistically significant difference between the two groups in either anatomical or functional results. We recommend interfering before the 5th week after the trauma as retinal detachment is encountered more in cases operated on after the 4th week. The visual outcome depends on the site of entry and exit (the route of gunshot).

COMPARISON BETWEEN PARS PLANA VITRECTOMY WITH VERSUS WITHOUT A 360° EPISCLERAL BAND IN THE MANAGEMENT OF GUNSHOT PERFORATING EYE INJURY.

PURPOSE: To evaluate whether omitting the use of the 360° episcleral band in combination with pars plana vitrectomy and silicone oil tamponade had an effect on either anatomical or functional success in cases of perforating eye injury due to gunshot. METHODS: A retrospective consecutive interventional study from medical records. Surgeries were performed in the period from January 2011 until the end of December 2013. Patients with perforating eye injury due to gunshots were treated with pars plana vitrectomy and silicone oil tamponade with or without the addition of a 360° scleral band. RESULTS: Two hundred and thirteen eyes of 210 patients were reviewed of which 17 patients were excluded, 5 patients because the vision had no light perception and 12 patients because of the short follow-up period (less than 6 months). The remaining 196 eyes of 193 patients were analyzed. All surgeries were performed by 1 surgeon. The included eyes have been classified into 2 groups; 101 eyes in the first group (360° band was used), and 95 eyes in the second group (without 360° band). The included patients were followed up at least 6 months after the last surgery. By first surgery, anatomical success was achieved in 93 eyes (92.08%) in Group 1, and retinal detachment developed in 8 eyes (7.92%). In Group 2 anatomical success was achieved in 91 eyes (95.78%), and retinal detachment developed in 4 eyes (4.21%). All cases with retinal detachment were reattached by second surgery. In the first group, visual acuity improved in 80 eyes (79.2%), unchanged in 14 eyes (13.86%), and was less than that of preoperative value in 7 eyes (6.93%). In the second group visual acuity improved in 78 eyes (82.1%), unchanged in 13 eyes (13.68%) and less than that of preoperative value in 4 eyes (4.21%). No statistically significant difference was found between the two groups (P = 0.943) in anatomical or functional results. None of the operated eyes developed phthisis bulbi. CONCLUSION: The abundant use of the 360° scleral band in combination with pars plana vitrectomy and silicone oil tamponade did not change the anatomical or the functional outcomes in the management of perforating eye injury due to gunshots.

Silicone Oil Reinjection without Macular Buckling for Treatment of Recurrent Myopic Macular Hole Retinal Detachment after Silicone Oil Removal.

Purpose. To evaluate the efficacy of silicone oil (S.O) reinjection without macular buckling for treatment of recurrent myopic macular hole retinal detachment (MHRD) after silicone oil removal. Methods. A retrospective consecutive interventional study from medical reports on cases of myopic MHRD. Fifty-three eyes of 51 patients underwent silicone oil removal after successful repair of MHRD were reviewed. The main outcomes were the retinal status after silicone oil removal and management of recurrent cases. Results. The rate of recurrent RD (Re RD) after silicone oil removal was 11.3% (6 out of 53 eyes). One case refused any other interference. In the remaining 5 eyes, 4 eyes (80%) could be reattached by S.O re-injection and one eye (20%) developed Re RD after S.O re-injection. Range of followup after management of recurrence was 5-53 months (mean 18.7 months). Conclusions. This case series concluded that the risk factors for recurrent RD after silicone oil removal from cases of myopic MHRD were high myopia, open flat MH, and large posterior staphyloma. Revision of vitrectomy and S.O re-injection can reattach most of recurrent cases.