Outcomes of combined keratoplasty and pars plana vitrectomy for endophthalmitis with compromised corneal clarity.

IMPORTANCE: Studies evaluating combined penetrating keratoplasty and pars plana vitrectomy for infectious aetiologies are limited. BACKGROUND: To evaluate the outcomes of combined penetrating keratoplasty and pars plana vitrectomy in patients with endophthalmitis and poor corneal clarity. DESIGN: Retrospective interventional case series conducted at a tertiary care eye hospital in North India. PARTICIPANTS: Review of records of 43 eyes of 43 patients. Mean age of patients was 53.39 ± 12.94 years (26 males). Patients with age > 14 years with minimum follow-up of 6 months were included. METHODS: Combined penetrating keratoplasty and pars plana vitrectomy was performed in all eyes. MAIN OUTCOME MEASURES: We analysed the preoperative, intraoperative and microbiological characteristics of patients undergoing combined surgeries. Anatomic and functional success and failure were pre-defined. RESULTS: Aetiology for corneal opacification was corneal ulcer in 30(69.7%) eyes, corneal graft infection in eight(18.6%) eyes, bullous keratopathy in four (9.3%) eyes and corneal scar in one eye. Postoperative visual acuity improved in 20(46.5%) eyes, did not change in 14 (32.5%) eyes and deteriorated in nine eyes (20.9%). Anatomical failure (uncontrolled infection leading to phthisis bulbi or evisceration) was seen in 15 (34.8%) eyes. Microbiological analysis revealed bacterial growth in 26, fungal in 14 and no growth in three eyes. Fungal infection had a poorer outcome (P = 0.03). Six out of 11 monoocular patients regained ambulatory vision. CONCLUSIONS AND RELEVANCE: Combined penetrating keratoplasty and pars plana vitrectomy is a complex but globe salvaging procedure for poor prognosis eyes which otherwise may need evisceration. Fungal infection carries a poorer prognosis.

Comparative Evaluation of Foveal Avascular Zone on Two Optical Coherence Tomography Angiography Devices.

SIGNIFICANCE: This study compares foveal avascular zone (FAZ) geometry in healthy eyes as imaged by two commercially available optical coherence tomography angiography (OCTA) devices. Foveal avascular zone measurements are repeatable and reproducible with each OCTA device, but interdevice agreement was poor. We provide conversion factors between devices. PURPOSE: The purpose of this study was to perform comparative evaluation of FAZ geometry in healthy eyes as imaged by two commercially available OCTA devices. METHODS: Ninety-six eyes of 48 healthy subjects were imaged prospectively on each of two OCTA devices (DRI-OCT [Topcon Corporation, Tokyo, Japan]; Cirrus 5000 [Carl Zeiss Meditec Inc., Dublin, CA]). The FAZ was evaluated in the superficial capillary plexus layer of 6 × 6-mm foveal scans by two masked observers. Intraobserver and interobserver agreement was determined using intraclass correlation by using linear mixed models and Bland-Altman plots. K-means clustering was used to provide conversion values between two devices. Foveal avascular zone acircularity was calculated using scans from each device and compared. RESULTS: The intraobserver repeatability for DRI-OCT was 0.95 (95% confidence interval [CI], 0.90 to 0.98) for observer A and 0.92 (95% CI, 0.83 to 0.96) for observer B. Intraobserver repeatability for Cirrus 5000 was 0.988 (95% CI, 0.972 to 0.995) for observer A and 0.993 (95% CI, 0.983 to 0.997) for observer B. The interobserver variability between observers A and B for DRI-OCT was 0.87 (0.73 to 0.94) and for Cirrus 5000 was 0.984 (95% CI, 0.964 to 0.993). Poor interdevice agreement (0.205 [95% CI, -0.202 to 0.554]) was noted, and conversion formulas were devised to convert FAZ area measurements from one device to another. No significant correlation was found when comparing FAZ acircularity indices between devices (P = .39). CONCLUSIONS: Repeatable and reproducible FAZ area measurements were obtained with each respective OCTA device, but interdevice agreement was poor, yet quantifiable and systematic with calculable conversion factors between devices.

IATROGENIC CHOROIDAL NEOVASCULAR MEMBRANE IN MACULAR HOLE-INDUCED RETINAL DETACHMENT.

PURPOSE: To report a case of choroidal neovascular membrane after vitreoretinal surgery in a patient with macular hole-induced retinal detachment. METHODS: Retrospective observational case report. CASE DESCRIPTION: A 64-year-old lady presented with sudden drop in vision in the right eye since 20 days. Her best-corrected visual acuity was 6/36 in the right eye and 6/18 in the left eye. She was diagnosed with retinal detachment with a macular hole in the right eye. She underwent vitrectomy with internal limiting membrane peeling and gas tamponade for the retinal detachment. Internal limiting membrane peeling was performed after staining with brilliant blue green dye and over the detached retina. Drainage of the subretinal fluid was performed through the macular hole and drainage retinotomy. Four months of postoperative examination revealed a scarred subfoveal choroidal neovascular membrane and retinal pigment epithelial atrophy surrounding it. This was confirmed by fluorescein angiography and optical coherence tomography. CONCLUSION: Visual loss secondary to choroidal neovascular membrane can occur because of surgical trauma to the retinal pigment epithelium and Bruch membrane. Drainage of the subretinal fluid should be preferably avoided through the macular hole to prevent this complication.