Corynebacterium ocular infection after Baerveldt glaucoma implant surgery: treatment involving immediate tube withdrawal and temporary subconjunctival tube placement: a case report.

BACKGROUND: We report a case of Corynebacterium endophthalmitis secondary to tube exposure following Baerveldt glaucoma implant surgery that was successfully treated with prompt tube withdrawal and temporary subconjunctival tube placement without removing the glaucoma drainage device. CASE PRESENTATION: A 65-year-old Japanese man with secondary glaucoma underwent glaucoma drainage device surgery with a donor scleral patch graft in the inferonasal quadrant of his right eye. Ten months after surgery, he presented with tube exposure due to dehiscence of the overlying conjunctiva and erosion of the scleral patch graft. Eleven days later, mild inflammation was found in the anterior chamber and anterior vitreous body, with the root of the tube surrounded by a plaque at the site of insertion in the anterior chamber. He was diagnosed with infectious endophthalmitis secondary to tube exposure. Two days later, since medical therapy was ineffective, the tube was withdrawn from the anterior chamber and irrigated with a polyvinyl alcohol-iodine solution, and the tube was tucked into the subconjunctival space. Complete resolution of the infection was achieved 1.5 months later. The tube was reinserted nasally into the anterior chamber and covered with a scleral patch graft and a free limbal conjunctival autograft. Thereafter, there has been no recurrence of infection or tube exposure. Twenty eight months after tube reinsertion, his right best-corrected visual acuity was 20/50 and intraocular pressure was 12 mmHg. CONCLUSION: Prompt tube withdrawal and temporary subconjunctival tube placement followed by tube reinsertion may be effective for endophthalmitis associated with tube exposure after glaucoma drainage device surgery.

Evaluation of Blood-filling Patterns in Schlemm Canal for Trabectome Surgery.

PRéCIS:: Regardless of the blood-filling patterns in Schlemm canal (SC) before the trabecular meshwork (TM) ablation, the trabectome surgery, combined with phacoemulsification, is effective for mild to moderate primary open-angle glaucoma patients. PURPOSE: The purpose of this study was to evaluate the association between trabectome surgery outcomes and the blood filling patterns in SC before TM ablation. MATERIALS AND METHODS: This retrospective cohort study included 105 eyes of 84 Japanese primary open-angle glaucoma patients who had undergone trabectome surgery in combination with cataract surgery. Provocative gonioscopy was performed before TM ablation to classify the blood filling patterns in SC into 3 groups: no filling (group 1); patchy/irregular filling (group 2); and complete filling (group 3). The subjects were divided into 3 groups according to the blood filling patterns and the trabectome surgery outcomes were compared, including intraocular pressure (IOP), the percentage reduction in IOP, surgical success rate, and the number of glaucoma medications. Success was defined by IOP ≤15 mm Hg and a >20% reduction in IOP with/without glaucoma medication, and without additional glaucoma surgery after trabectome surgery combined with cataract surgery. RESULTS: Twenty-four eyes were assigned to group 1, 48 to group 2, and 33 to group 3. Between-group analyses showed no significant intergroup differences in age (P=0.213), preoperative mean deviation (P=0.505), preoperative and postoperative IOP (P=0.941 and 0.458, respectively), preoperative and postoperative number of glaucoma medications (P=0.805 and 0.077, respectively), percentage IOP reduction (P=0.256), and success rates (P=0.540). CONCLUSION: Trabectome surgery is effective for mild to moderate primary open-angle glaucoma patients, independent of the blood-filling patterns in SC before the TM ablation.

Impact of Cataract Surgery on Filtering Bleb Morphology Identified Via Swept-source 3-dimensional Anterior Segment Optical Coherence Tomography.

PRéCIS:: Analysis of filtering bleb morphology using swept-source 3-dimensional anterior segment optical coherence tomography (3D AS-OCT) indicates that phacoemulsification can negatively impact the morphology of preexisting filtering blebs. PURPOSE: To identify the cross-sectional morphologic changes in successful filtering blebs after phacoemulsification using swept-source 3D AS-OCT. MATERIALS AND METHODS: In total, 30 phakic eyes of 29 patients with successful filtering blebs after primary trabeculectomy were included in this retrospective cohort study. Success was defined as intraocular pressure (IOP)≤15 mm Hg and a>20% reduction in IOP without glaucoma medication or additional glaucoma surgery after trabeculectomy. The subjects were classified into 2 groups according to whether they had undergone phacoemulsification or not after trabeculectomy: a phaco group and a control group. Filtering blebs were examined using swept-source 3D AS-OCT and evaluated for quantitative parameters, including maximum bleb height, maximum bleb wall thickness, and the ratio of the hyporeflective space of the bleb wall. RESULTS: Sixteen eyes were assigned to the phaco group and 14 eyes to the control group. The eyes in the control group showed no significant differences in IOP or in any of the 3D AS-OCT parameters at any of the follow-up timepoints. In the phaco group, the mean IOP increased significantly after phacoemulsification (P=0.003). Furthermore, the eyes in the phaco group showed a significant decrease in maximum bleb height (P=0.030), maximum bleb wall thickness (P=0.006), and the ratio of the hyporeflective space of the bleb wall (P=0.011) between prephacoemulsification and 1-year postphacoemulsification. CONCLUSION: Phacoemulsification can have a negative impact on filtering bleb morphology, which may lead to an IOP increase.

Characteristics of early filtering blebs that predict successful trabeculectomy identified via three-dimensional anterior segment optical coherence tomography.

BACKGROUND/AIMS: To identify the cross-sectional characteristics of filtering blebs at 2 weeks post-trabeculectomy associated with intraocular pressure (IOP) control at 1 year post-trabeculectomy. METHODS: Ninety-nine eyes of 94 patients who had undergone primary trabeculectomy were included in this retrospective consecutive case series study. Surgical success was defined as an IOP ≤15 mm Hg and a >20% reduction in IOP without glaucoma medication or additional glaucoma surgeries at 1 year post-trabeculectomy. Subjects were classified into two groups according to whether surgery was successful or unsuccessful. Blebs were examined using swept-source three-dimensional anterior segment optical coherence tomography and evaluated for quantitative parameters, including maximum height, maximum wall thickness and ratio of hyporeflective space of the wall, as well as qualitative parameters, including multiple parallel hyporeflective layers within the wall (striping phenomenon), decreased visibility of the sclera underlying the bleb (shading phenomenon) and cyst-like structures of the wall. RESULTS: Seventy-seven eyes (77.8%) were assigned to the successful group and 22 (22.2%) to the unsuccessful group. Univariate analysis showed significant differences between the groups regarding maximum bleb height (p=0.044), maximum bleb wall thickness (p=0.017) and the striping phenomenon of the bleb wall (p=0.007). Multivariate logistic regression analysis confirmed that the striping phenomenon at 2 weeks post-trabeculectomy was significantly associated with success at 1 year post-trabeculectomy (OR 3.405; 95% CI 1.059 to 10.947; p=0.040). CONCLUSION: Taller blebs with thicker walls that showed the striping phenomenon at 2 weeks post-trabeculectomy appeared to predict good IOP control at 1 year post-trabeculectomy.

Characteristics of successful filtering blebs at 1 year after trabeculectomy using swept-source three-dimensional anterior segment optical coherence tomography.

PURPOSE: To identify the cross-sectional characteristics of filtering blebs associated with intraocular pressure (IOP) control at 1 year after trabeculectomy with a square scleral flap and a fornix-based conjunctival flap. METHODS: A retrospective consecutive case series study was conducted. Eighty-four eyes of 79 patients who had undergone primary trabeculectomy were included. Surgical success was defined as IOP ≤15 mmHg and a >20% reduction in IOP without glaucoma medication and without additional glaucoma surgery at 1 year after trabeculectomy. The subjects were classified into two groups according to whether surgery was successful or unsuccessful. Filtering blebs were examined using swept-source three-dimensional anterior segment optical coherence tomography and evaluated for the following quantitative parameters: maximum bleb height, maximum bleb wall thickness, and ratio of hypo-reflective space of the bleb wall. RESULTS: Sixty-six eyes were determined to be successful and 18 eyes unsuccessful. Univariate analysis showed significant differences between the two groups regarding bleb height (P < 0.001), bleb wall thickness (P = 0.011), and ratio of hypo-reflective space of the bleb wall (P = 0.002). Multivariate logistic regression analysis confirmed that the bleb height was significantly associated with success in trabeculectomy [odds ratio 13.996 (95% confidence interval 1.184-165.420); P = 0.036]. CONCLUSION: A tall bleb with a thick hypo-reflective wall may be a feature of the well-functioning bleb.

Successful resolution of stromal keratitis and uveitis using canakinumab in a patient with chronic infantile neurologic, cutaneous, and articular syndrome: a case study.

BACKGROUND: Cryopyrin-associated periodic syndrome (CAPS) is a group of rare autoinflammatory diseases, and of these, chronic infantile neurologic, cutaneous, and articular/neonatal-onset multisystem inflammatory disease (CINCA/NOMID) syndrome has the most severe phenotype. Canakinumab, a monoclonal antibody that targets interleukin-1ß, has been shown to be an effective treatment for resolving systemic inflammation. However, its efficacy for treating ophthalmic symptoms of this disorder remains unclear. FINDINGS: A 64-year-old female reported episodes of nonpruritic urticaria, fever, aseptic meningitis, and bilateral sensorineural deafness. Her son had experienced similar symptoms. She was initially referred for ophthalmologic treatment for an infectious corneal ulcer. Examination of her right eye by slit lamp biomicroscopy showed diffuse conjunctival injection, corneal infiltrates, a corneal ulcer, and hypopyon. She was therefore treated aggressively with topical and systemic antibiotics in addition to antifungal medications. However, this was ineffective. Genetic analysis detected the heterozygous germline p.Asp303Asn mutation in the NLRP3 gene in both our patient and her son. She was therefore diagnosed with CINCA/NOMID syndrome based on her clinical manifestations. All of the patient's physical and ophthalmic symptoms were resolved within a few days after the initiation of canakinumab treatment. During an 18-month follow-up period, no adverse events or severe infections were observed. CONCLUSIONS: Our case report indicates that canakinumab is effective not only for the treatment of systemic inflammation but also for treating ophthalmic involvement, such as recurrent stromal keratitis and anterior uveitis.

Paecilomyces lilacinus-induced Scleritis Following Bleb-associated Endophthalmitis after Trabeculectomy.

Paecilomyces lilacinus (P. lilacinus) is a rare cause of fungal scleritis. We herein report a case of P. lilacinus-induced scleritis following bleb-associated endophthalmitis after trabeculectomy that was successfully treated with surgical excision of the affected sclera in combination with antifungal medication. An 85-year-old female underwent trabeculectomy of the left eye. A dellen formed in the corneal periphery due to limbal elevation of the filtering bleb and progressed to an infectious corneal ulcer, leading to blebitis. Eight days after the onset of blebitis, the patient was diagnosed with endophthalmitis, which resolved after vitrectomy. The growth of P. lilacinus was identified on swabs of the conjunctiva and the corneal specimen. Scleritis developed after the resolution of the endophthalmitis, and an early excision of the affected sclera, in addition to antifungal medication, resolved it completely. However, the scleritis recurred in a different region of the left eye. After 7 months of antifungal medication, the left eye showed no residual infection. When treating P. lilacinus-induced scleritis, surgical excision of the affected sclera has been shown to be an effective treatment strategy. Nevertheless, it is possible that the infection may recur in another part of the eyeball after the complete resolution of the primary lesion.

Choroidal neovascularization occurring concurrently in myopic eyes of monozygotic twins.

PURPOSE: To present young monozygotic twins both of whom developed choroidal neovascularization at the same time. CASE/OBSERVATIONS: Monozygotic twins, 22-year-old women, who lived in the same house, developed choroidal neovascularization in the left eye at the same time. The degree of myopia was higher in the left eye (-7.75 and -8.5 dpt in spherical equivalent) than in the right eye (-6.75 and -4.5 dpt) of both patients. The choroidal neovascularization regressed in a different time course and the visual acuity returned to normal in both patients. CONCLUSION: This pair of monozygotic twins suggests that both genetic and environmental factors underlie the development of choroidal neovascularization in myopic eyes.