eHealth 2015 Special Issue: Impact of Electronic Health Records on the Completeness of Clinical Documentation Generated during Diabetic Retinopathy Consultations.

BACKGROUND: Two years ago, the Diabetic Retinopathy (DRP) and Traumatology clinic of the Department of Ophthalmology and Optometrics at the Medical University of Vienna, Austria switched from paper-based to electronic health records. A customized electronic health record system (EHR-S) was implemented. OBJECTIVES: To assess the completeness of information documented electronically compared with manually during patient visits. METHODS: The Preferred Practice Pattern for Diabetic Retinopathy published by the American Academy of Ophthalmology was distilled into a list of medical features grouped into categories to be assessed and documented during the management of patients with DRP. The last seventy paper-based records and all electronic records generated since the switch were analyzed and graded for the presence of features on the list and the resulting scores compared. RESULTS: In all categories, clinical documentation was more complete in the EHR group. CONCLUSIONS: In our setting, the implementation of an EHR-S showed a statistically significant positive impact on documentation completeness.

Intravitreal bevacizumab (Avastin) versus triamcinolone (Volon A) for treatment of diabetic macular edema: one-year results.

PURPOSE: The objective was to compare retinal morphology and function following intravitreal injections of bevacizumab (Avastin) or triamcinolone (Volon A) in patients with early diabetic macular edema (DME). PATIENTS AND METHODS: The study was planned as a randomized, prospective, interventional clinical trial. A total of 30 diabetic patients with treatment-naïve, clinically significant macular edema were included in this study and randomized to two equal groups. One group initially received three injections of 2.5 mg bevacizumab in monthly intervals. The second group received a single injection of 8 mg triamcinolone, followed by two sham interventions. Functional and anatomic results were evaluated monthly using ETDRS vision charts and spectral-domain optical coherence tomography. According to the study protocol, retreatment after 3 months was dependent on functional and anatomic outcome in a PRN regimen. RESULTS: Baseline best corrected visual acuity (BCVA) was 0.30 logMAR and central retinal subfield thickness (CSRT) was 505 µm in the bevacizumab group and 0.32 logMAR and 490 µm CSRT in the triamcinolone group. After 3 months, BCVA improved to 0.23 logMAR (bevacizumab) and 358 µm CRST and 0.26 logMAR (triamcinolone) and 308 µm CSRT. After 12 months, BCVA further recovered in the bevacizumab group (0.18 logMAR) but slightly decreased in the triamcinolone group (0.36 logMAR). CONCLUSION: Intravitreal bevacizumab and triamcinolone are both equally effective in reducing CSRT in early DME. After 6 months, rehabilitation of vision was comparable in both treatment arms, whereas at the final follow-up at month 12, BCVA was superior in the bevacizumab than in the triamcinolone sample. This may be related to cataract development following steroid treatment, as well as to substance-specific mechanisms within the angiogenic versus the inflammatory cascade.

[Three-dimensional optical coherence tomography for evaluating the retinal architecture before and after surgery for vitreomacular traction.] / Untersuchung von vitreomakulären Traktionen vor und nach Membranpeeling mittels hochauflösendem Raster-OCT.

PURPOSE: To investigate the morphology of the vitreoretinal interface before and after delamination of epiretinal membranes using three-dimensional volumetric high-resolution optical coherence tomography (HROCT). METHODS: Extension and intensity of vitreomacular traction due to epiretinal membranes (ERM) and the architecture of retinal layers in 14 eyes of 14 patients were evaluated preoperatively using high-resolution raster scanning OCT (Cirrus prototype, resulting in a 6x6-mm field, 2 mm in depth). Additionally, stratus OCT, visual acuity testing, and fundus photography were performed. Standardized prospective follow-up was done continuously at 1, 4, and 7 days and 1 and 3 months postoperatively. RESULTS: The ERM appeared tightly adherent to the retinal surface in 85% of cases, but nevertheless could be differentiated from the retinal surface in 100%. Vertical traction forces from the ERM to the intraretinal layers were found in 93% of cases. Structural alteration of the retina was seen neither immediately following surgery nor during follow-up. After a mean of 4 weeks, the retinal structural integrity had recovered with resolution of the traction-induced deviations seen preoperatively. Mean preoperative visual acuity increased from 0.4+/-0.2 Snellen preoperatively to 0.5+/-0.2 Snellen after 3 months. Mean retinal thickness decreased from 482+/-84 mum to 328+/-80 mum after 3 months (HROCT). CONCLUSIONS: Three-dimensional HROCT imaging enables unprecedented in vivo identification of the extension and dynamics of epiretinal traction. Epiretinal membranes are clearly delineated in the en face view, and the distribution of traction forces throughout the intraretinal layers is identified down to the level of the retinal pigment epithelium. During follow-up, quantification of substantial release in retinal traction was possible and correlated to conventional OCT findings.

[High-resolution optical coherence tomography to evaluate vitreomacular traction before and after membrane peeling]. / Untersuchung vitreomakulärer Traktionen vor und nach Membranpeeling mittels hochauflösendem Raster-OCT.

AIM: Morphological assessment of the vitreomacular interface and intraretinal architecture using three-dimensional high-resolution optical coherence tomography (HROCT) before and after surgical delamination of epiretinal membranes and the internal limiting membrane (ILM). METHOD: The extent and intensity of traction of the epiretinal membrane (ERM) and the morphology of the individual retinal layers were investigated preoperatively in 14 eyes of 14 patients using three-dimensional HROCT (Cirrus prototype, scanned area 6x6 mm, depth 2 mm). In addition, visual acuity and ophthalmological findings (including stratus OCT) were documented. Standardized follow-up examinations were performed prospectively adhering to a protocol on days 1, 4, and 7 as well as 1 and 3 months after surgery. RESULTS: The ERM adhered closely to the retina in 85% of cases, but in 100% it was still clearly distinguishable from the retinal surface as a separate structure when using HROCT. Vertical traction through the ERM to the deepest retinal layers could be shown on HROCT in 93% of the cases. Structural alterations of the retina were not detectable either directly after surgery or subsequently. After an average of 4 weeks, the architecture of the layers was reorganized with complete regression of the preoperative tractional aberrations. The mean preoperative Snellen visual acuity of 0.4+/-0.2 increased to an average of 0.5+/-0.2. The mean preoperative retinal thickness was 482+/-84 microm and after 3 months 328+/-80 microm (HROCT). CONCLUSIONS: Examination with high-resolution optical coherence tomography allows three-dimensional visualization of the dynamics of epiretinal tractions that had not previously been obtainable. Epiretinal membranes can be clearly distinguished and their tractional effects can be traced through all retinal layers up to the pigment epithelium. As a result of the postoperative elimination of the tractions, the morphological alterations of the individual retinal layers recede already after 1 month.

Retinal detachment after silicone oil removal.

PURPOSE: To evaluate the causes of retinal detachment after silicone oil removal, to define possible risk factors and the anatomical and functional prognosis of this complication. METHODS: 112 eyes that underwent silicone oil removal were included. The group of eyes with retinal detachment after oil removal (18/112 eyes, 16.1%) was compared with the group with no postoperative retinal detachment. RESULTS: The most common cause for retinal detachment after oil removal was anterior PVR (77.8%). Initial PVR detachment, advanced PVR stages, anterior PVR, more preceding operations, aphakia/pseudophakia, myopia and shorter duration of the oil tamponade were significantly more represented in the group of eyes with retinal detachment after oil removal. The prognosis of retinal detachment after oil removal is poor. CONCLUSION: Some criteria could be regarded as risk factors for retinal detachment after silicone oil removal. Improvement of the results should be possible by considering these factors and by control of reproliferations.

Helical and conventional CT in the imaging of metallic foreign bodies in the orbit.

PURPOSE: To compare helical CT to conventional CT imaging in the assessment of orbital metallic foreign bodies with regard to image quality, scanning time, and radiation exposure. METHODS: Twenty-four standardized metallic foreign bodies, placed into the orbit (anterior, epibulbar, posterior) of cadaver heads were studied. Helical CT scanning in the axial plane with multiplanar reconstruction of coronal and sagittal images was performed as well as conventional CT imaging with direct scanning in the axial and the coronal planes (Tomoscan SR 7000, Philips, The Netherlands). Two masked observers consensually graded the studies using 5 predetermined criteria. Radiation dose delivered to the lens and scanning time were measured for the helical and the conventional CT imaging workup. RESULTS: Helical CT imaging scored statistically significantly better with regard to overall accuracy of foreign body localization and presence of beam-hardening streak artifacts from dental fillings. Conventional CT scored significantly better with regard to stair-step artifacts. The radiation dose delivered to the lens was 35.4 mGy for helical CT imaging and 73.9 mGy for conventional CT workup (axial and coronal scanning). Total scanning time was 18 seconds for helical CT axial scanning and 104 seconds for conventional CT axial and coronal scanning. CONCLUSION: Helical CT is superior to conventional CT imaging, because it can provide adequate information about orbital metallic foreign bodies with a single acquisition, thus reducing both the number of examinations and the radiation exposure for the patient.

Orbital helical computed tomography in the diagnosis and management of eye trauma.

OBJECTIVE: To prospectively determine the accuracy of helical computed tomography (CT) and multiplanar reconstruction and its value in surgical planning for the management of ocular trauma with suspected intraocular and orbital foreign bodies using surgical and clinical follow-up findings as the gold standard. DESIGN: Prospective, observational case series. PARTICIPANTS: Thirty-six patients with ocular trauma and suspected foreign bodies were studied. INTERVENTION: All patients were examined using a standardized scanning protocol with helical CT direct scanning in the axial plane and multiplanar reconstruction of coronal and sagittal planes. MAIN OUTCOME MEASURES: The images were analyzed for the presence and number of intraocular and orbital foreign bodies, anatomic location, and foreign body size. The surgical and clinical follow-up findings (contact lens examination, gonioscopy, indirect ophthalmoscopy and scleral depression, perimetry, color testing, measurement of size) were used as the gold standard to which the image results were compared. RESULTS: Helical CT showed a single intraocular foreign body in 14 patients, a single orbital foreign body in 9 patients, and multiple orbital foreign bodies in 2 patients. Intraocular or orbital foreign bodies were excluded in 11 patients. Twenty foreign bodies were correlated with surgical results. Surgical and clinical follow-up findings were in agreement with helical CT results regarding the detection and determination of the number of presumed foreign bodies. Localization to intraocular versus orbital compartment and proximity to the optic nerve was accurate in all patients. Determination of size of the foreign bodies on the helical CT images was reliable and repeatable. CONCLUSIONS: Helical CT axial scanning with multiplanar reconstruction is accurate at detecting and localizing intraocular and orbital metallic, glass, and stone foreign bodies. This imaging method aids the surgeon in choosing the surgical approach to retained intraocular and orbital foreign bodies.

Corneal wound healing after superficial foreign body injury: vitamin A and dexpanthenol versus a calf blood extract. A randomized double-blind study.

A prospective randomized double-blind clinical study was performed to investigate corneal wound healing after treatment either with an eye gel containing calf blood extract or an eye ointment containing vitamin A and dexpanthenol. A total of 54 outpatients were included in this study, all treated for corneal foreign body injury. The size of the corneal lesions was measured by planimetry on days 0, 1, and on the following days until complete epithelial healing occurred. Results showed the calf blood extract eye gel to be statistically more effective in promoting corneal wound healing, especially in patients with wound areas larger than 6 mm(2).

Chemical stability of silicone oil in the human eye after prolonged clinical use.

OBJECTIVE: To investigate the assumption that silicone oil is chemically stable in the human eye after prolonged clinical use as a vitreous substitute. DESIGN: Experimental study. MATERIAL: Samples of silicone oil recovered from the vitreous cavities of 25 consecutive patients up to 26 months (mean, 9.2 months) after implantation and 4 different batches of original highly purified silicone oil with a kinematic viscosity of 5000 mPa.s were analyzed. Visible silicone oil emulsification was present in 18 of the 25 eyes. INTERVENTION: Gas chromatography/mass spectroscopy (GC/MS) was used to detect and characterize low-molecular weight components (LMWC). Gel permeation chromatography (GPC) was used to determine the molecular weight distribution of the silicone oils. Functional groups of the silicone oils were quantified and characterized by infrared (IR) spectroscopy and 1H nuclear magnetic resonance (1H NMR) spectroscopy. MAIN OUTCOME MEASURES: The sample oils explanted from the eyes were compared to the original oils with regard to LMWC, molecular weight distribution, and type and amount of functional groups. RESULTS: The GC/MS chromatograms showed no peaks indicative of LMWC in any of the 25 sample oils explanted from the eyes or any of the original oils. In the GPC chromatograms, the peak position occurred at the same retention times with identical signal shape in all original and sample oils, indicating that the molecular weight and the molecular weight distribution did not change after prolonged implantation. The IR spectroscopy and 1H NMR spectroscopy showed characteristic absorption bands at 1260 cm(-1) related to symmetric deformation vibration of the Si-CH3 group and at 800 cm(-1) related to the Si-(CH3)2 group. This was identical for all sample and original oils. CONCLUSIONS: Highly purified 5000-mPa.s silicone oils, used as prolonged retinal tamponades in patients with proliferative vitreoretinopathy, proliferative diabetic retinopathy, and tractional retinal detachment after central retinal vein occlusion, are chemically stable in the human eye and do not undergo chemical modification. The LMWC do not play a substantial role in the variations of oil emulsification.

A new sponge profile for retinal detachment surgery: design and in vitro-effectiveness.

PURPOSE: To develop a new, calculated design for episcleral sponges to achieve sufficient indentation under avoidance of form related side effects. DESIGN AND METHODS: The new sponge profile consists of two convex halves with different radii, with a calculated optimum relation between inner and outer radius. It was tested on pig eyes and compared with round and half cut sponges. The height of the intraocular buckle was determined by ultrasound (A-Scan, Biovision V Plus), the extraocular height using ultrasound biomicroscopy (Humphrey Biomicroscope System Model 840). RESULTS: The buckle height achieved with the new design showed no significant difference to round sponges, whereas the extrascleral height was significantly lower compared to round sponges (p<0.001). Half cut sponges showed significantly less buckle height compared to round sponges (p<0.001) and to the new design (p<0.02). CONCLUSION: The new design produces sufficient indentation combined with minor change of the outer globe contour. It has the potential to be as efficient as conventional round sponges, but more tolerable for the patient by reduction of form related side effects.

Multiplanar imaging in the preoperative assessment of metallic intraocular foreign bodies. Helical computed tomography versus conventional computed tomography.

OBJECTIVE: This study aimed to compare the effectiveness of helical computed tomography (CT) versus conventional CT in the preoperative assessment of metallic intraocular foreign bodies on axial, coronal, and multiplanar reconstruction images in clinical routine. DESIGN: Prospective comparative trial, alternate assignment of consecutive patients. PARTICIPANTS: Eighteen patients with penetrating eye injuries and suspected metallic intraocular foreign bodies were studied. INTERVENTION: Alternate patients were assigned to undergo either helical CT or conventional CT in the axial plane. Both the helical and the conventional data were transferred to a workstation, and reconstructions in the coronal and sagittal planes were performed. Additional direct coronal scanning was performed only when necessary for preoperative assessment. MAIN OUTCOME MEASURES: The quality of the directly obtained axial and coronal, as well as the reconstructed coronal and sagittal images, was assessed for each, imaging method based on the ability to detect and accurately localize foreign bodies. The size of the foreign bodies was measured and compared to the actual diameter. Total examination time and radiation dose delivered to the lens were measured for each imaging method. RESULTS: All foreign bodies were detected by each scanning method on the axial, the coronal, and on the reconstructed planes. The quality of the axial images was similar for helical and conventional CT. The helical technique provided high-quality reconstructed images comparable in quality to the directly obtained coronal planes in conventional CT. Reconstructions by conventional technique were not useful for preoperative assessment. The examination time for the total orbital volume was 18 seconds for helical CT examinations and 52 seconds for conventional CT examinations. Radiation dose delivered to the lens for the complete examination was 35 mGy for helical CT axial scanning, 56 mGy for conventional CT axial scanning, and 63 mGy for conventional CT coronal scanning. CONCLUSIONS: Helical CT multiplanar imaging offers several significant advantages for the preoperative assessment of metallic intraocular foreign bodies compared to the conventional CT technique in clinical practice, including short examination time, reduced motion artifacts, reduced radiation exposure, and the ability to obtain diagnostically useful coronal and sagittal reconstruction images without the need for additional scanning.

[Spiral CT and conventional CT in the preoperative imaging of intraocular metal foreign bodies]. / Spiral-CT vs. konventionelle CT zur präoperativen Abklärung intraokularer metallischer Fremdkörper.

PURPOSE: To compare the effectiveness of spiral CT versus conventional CT in the preoperative assessment of metallic intraocular foreign bodies. METHODS: Eighteen patients with penetrating eye injuries and suspected metallic intraocular foreign bodies were assigned to undergo either spiral CT or conventional CT in the axial plane. The spiral and the conventional CT data were transferred to a workstation, and reconstructions in the coronal and sagittal planes were performed. Additional direct coronal scanning was performed only when necessary for preoperative assessment. The quality of the axial as well as the reconstructed coronal and sagittal images was assessed for each imaging modality. The size of the foreign bodies was measured and compared to the actual diameter. Total examination time and radiation dose delivered to the lens were measured for each imaging modality. RESULTS: All foreign bodies were detected by each scanning modality on the axial and on the reconstructed planes. The quality of the axial images was similar for spiral and conventional CT. The spiral technique provided high-quality reconstructed images which allowed accurate localization of the foreign bodies in all cases. Reconstructions by conventional technique were inadequate for preoperative assessment. The examination time for the total orbital volume was 18 s for spiral CT and 52 s for conventional CT. Radiation dose delivered to the lens was 35 mGy for spiral CT and 56 mGy for conventional CT axial scanning. CONCLUSION: Spiral CT multiplanar imaging offers several significant advantages for the preoperative assessment of metallic intraocular foreign bodies compared to the conventional CT technique in clinical practice, including short examination time, minimized motion artifacts, reduced radiation exposure, and accurate localization.

In vitro effectiveness of silicone oil removal.

PURPOSE: To evaluate the effectiveness of silicone oil removal from the human eye under in vitro conditions. METHODS: Six keratoplasty donor eyes were vitrectomized and filled with silicone oil (5000 centistokes). After oil removal, the amount of residual oil was determined by quantifying the silicon content of the eyes. Six control eyes were prepared without oil filling. RESULTS: The six control specimens showed a silicon content of 2.83-10.2 microg (mean 5.06 microg, SD 3.19), the six test specimens a silicon content of 70.54-297.10 microg (mean 163.91 microg, SD 86.89). The difference is significant (p<0.05). The amount of residual oil in the test eyes was 192.0-856.2 microg (0.0037-0.0179% of the applicated oil quantity). CONCLUSION: The low magnitude of residual intraocular oil after oil removal shows that silicone oil could be removed to almost 100% when emulsification and biological mechanisms of oil retention are excluded. This could favour early silicone oil removal.

Evaluation of intraocular foreign bodies by spiral computed tomography and multiplanar reconstruction.

OBJECTIVE: This study aimed to evaluate the ability of spiral computed tomography (CT) and multiplanar reconstruction in the assessment of intraocular foreign bodies. DESIGN: The study design was experimental. MATERIAL: Three foreign bodies (metal, glass, and plastic) implanted into the globe of a cadaveric head were studied. INTERVENTION: Spiral CT in the axial plane was used. Beam collimation and table increment were both 3 mm, whereby overlapping axial slices were reconstructed at 1-mm intervals. The data were transferred to a workstation, and reconstructions in the coronal and sagittal plane were performed. MAIN OUTCOME MEASURES: The ability to detect and evaluate localization, shape, and size of the foreign bodies in all three imaging planes was assessed. RESULTS: All foreign bodies were detected in the axial and in both reconstructed planes. The metal foreign body caused imaging artifacts in the axial plane. In the reconstructed planes. imaging artifacts were less severe, and evaluation of localization and shape was improved. Glass and plastic foreign bodies were well seen in all planes, and shape and localization were well demonstrated. Appropriate window settings improved determination of size of the different foreign bodies. CONCLUSIONS: Spiral CT of the orbit and multiplanar reconstruction offers a promising tool for evaluation of intraocular foreign bodies. Advantages of spiral CT compared to conventional CT are data acquisition in only one axial plane; shortened examination time; reduced radiation exposure; reduced imaging artifacts from metallic foreign bodies in the reconstructed planes; and demonstration of localization, shape, and size of the foreign body in three imaging planes.

Silicone oil tamponade in eyes with posterior staphyloma and retinal detachment caused by macular hole.

PURPOSE: A retinal detachment caused by a macular hole in an eye with a posterior staphyloma presents a therapeutical challenge. Vitrectomy and silicone oil tamponade might be a therapeutic strategy in such eyes. METHODS: We report on three eyes of three patients with retinal detachment caused by a macular hole in the presence of a posterior staphyloma, where a vitrectomy and a silicone oil filling was performed. RESULTS: In all three eyes the retina could be reattached. After oil removal, the retina remained attached in all three eyes until the end of the follow-up period (mean 18.7 months). In all three eyes, visual acuity improved, no major complications were noted. CONCLUSION: The use of silicone oil in eyes with retinal detachment caused by a macular hole in the presence of a posterior staphyloma presents a therapeutic option and we discuss this strategy as a primary treatment for these eyes.

Bacterial growth in human vitreous humor.

The aim of this study was to investigate the capacity of human vitreous to support bacterial growth and to show differences in the growth kinetics of gram-positive and gram-negative bacteria. Vitreous gel of 70 keratoplasty donor eyes was sampled under sterile conditions, screened microscopically for cellular components and tested for sterility and levels of antibiotic drugs by bio-assay. The samples were inoculated with clinical isolates of Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus viridans and Streptococcus pyogenes. As control each strain was added both to 0.9% sodium chloride solution and to Mueller-Hinton broth. In order to determine bacterial growth the number of colony forming units was determined 4, 6, 24, 48 and 72 hr after inoculation by viable count. Vitreous gel did not support bacterial growth; the tested strains could not be recovered after 48 hr. Similar results could be obtained with sodium chloride; whereas in Mueller Hinton broth the strains showed normal pattern of growth. It seems that vitreous humor has inherent antibacterial capacity in vitro, although the responsible factors remain unknown.

Silicone oil removal: results, risks and complications.

PURPOSE: We studied the results and complications of silicone oil removal applying basic criteria for the selection of eyes. METHODS: The criteria for oil removal: 1. Completely attached retina for at least 4 weeks, 2. Absence of tractions and active proliferations, 3. Preoperative vision > 0.01. The oil was removed from 90 of 261 oil filled eyes (removal rate: 34.5%). 83 eyes were included in the further study. FOLLOW-UP: 1.3-62.5 months (mean 15.7). RESULTS: Visual acuity improved (> or = 1 line) in 40 of the 83 eyes (48.2%), remained unchanged in 22 eyes (26.5%) and deteriorated (> or = 1 line) in 21 eyes (25.3%). COMPLICATIONS: reproliferations (42.2%), retinal detachment (20.5%), pressure rises (27.7%), lens opacification (36.7%), severe keratopathy (8.4%). CONCLUSION: Silicone oil removal has a distinct rate of complications, despite preoperative selection of eyes with a better prognosis. Reduction of reproliferations and weighing of risk and benefit could improve the results.

A system for obtaining undiluted intraoperative vitreous biopsy samples.

For many analyses of the vitreous, it is essential to obtain undiluted vitreous specimens under sterile conditions intraoperatively. In this new technique, a metal device is integrated into the aspiration system. The device fits on standard laboratory plastic containers with integrated caps. Undiluted vitreous accumulates in the container, which is then removed and sent to the laboratory. With a new container in place, vitrectomy can be continued as usual. This technique is simple, safe, effective, and inexpensive.

[Contamination of intraocular fluid in pars plana vitrectomy]. / Kontamination intraokularer Flüssigkeiten bei Pars-plana-Vitrektomien.

UNLABELLED: Endophthalmitis after pars plana vitrectomy is rare, with an incidence of 0.05-0.14%. The aim of this study was to evaluate the microbiological situation during pars plana vitrectomy and to ascertain what organisms and how many enter the eye during the operation. PATIENTS AND METHODS: Twenty-five consecutive subjects undergoing primary pars plana vitrectomy were included in the study. Patients were excluded if they had evidence of local or systemic infections or had undergone antibiotic therapy within 3 weeks before surgery. A standard three-port pars plana vitrectomy was performed on each patient. Preoperative smears of the conjunctiva and intraoperative aspirates of the vitreous were taken immediately after sclerotomy, and aspirates of the intraocular fluid at the conclusion of operation. RESULTS: We obtained preoperative smears from the conjunctival sac of all patients, and found that 19 patients (76%) had positive cultures, with coagulase-negative staphylococci as the most commonly isolated organisms, (n = 14; 56%). Vitreous--aspirated immediately after sclerotomy--was sterile in 68% (n = 17). In 32% (n = 8) contamination occurred, the microorganisms isolated being coagulase-negative staphylococci (20%) and Staphylococcus aureus (12%). Five of the samples (20%) of intraocular fluid from the vitreous cavity--aspirated before wound closure--were contaminated, coagulase-negative staphylococci (8%) and Staphylococcus aureus (12%) again being found in culture. In no case did postoperative endophthalmitis develop. CONCLUSIONS: This study demonstrates that bacteria enter the eye during pars plana vitrectomy and that there is a change in the contaminating bacterial species during operation. Even if bacteria remain in the eye after pars plana vitrectomy, postoperative endopthalamitis does not necessarily develop.

Ocular side effects associated with 13-cis-retinoic acid therapy for acne vulgaris: clinical features, alterations of tearfilm and conjunctival flora.

Isotretinoin (13-cis-retinoic acid) is commonly used for the treatment of acne vulgaris. We included 55 patients in this prospective study, and inspected them before, while and after therapy with isotretinoin regarding ocular side effects. Careful slit-lamp inspection, measurement of break-up-time and Schirmer-test and microbiological investigations of the conjunctival flora were performed. While staphylococcus aureus was cultured from the conjunctival sac before application of isotretinoin in 7.3%, this percentage increased to 61.8% during therapy. A pathological decrease of break-up-time was realized in 69.1% of the cases, the development of blepharitis in 40%. But in spite of the alteration of conjunctival flora, bacterial conjunctivitis developed in just 7.3% of the cases. However, only 34.5% of the patients showed symptoms of a conjunctivitis sicca, in spite of the impressive diminution of break-up-time in so many cases. All ocular side effects of isotretinoin were treatable and disappeared completely within 1 month after stopping therapy.