[Perioperative antibiotics effectiveness on conjunctival flora and microbial sensitivity].

PURPOSE: To compare the affect upon bacterial flora found in the conjunctival sacs and the microbial sensitivity of a gatifloxacin (GFLX) ophthalmic solution prospectively with two instillation method groups. METHODS: In one group (group A) GFLX solution was instilled postoperatively eight times/day for 2 days and subsequently four times/day for 12 days. In the other group (group B) the solution was instilled four times/day for 28 days. We investigated bacterial flora in the conjunctival sacs of patients who were to undergo cataract surgery, and tested for microbial sensitivity. RESULTS: There was no significant difference in the detection rate of bacterial flora in the conjunctival sacs. One bacterial isolate resistant to LVFX was identified in group A, and one resistant to GFLX and LVFX in group B. CONCLUSION: There is a possibility that the application of topical antibiotics may have little influence on positive culture. However, the occurrence of a resistance to GFLX indicates that the aimless use of antibiotics should be avoided during ophthalmic perioperative periods.

Persistence of retinal indocyanine green dye following vitreous surgery.

BACKGROUND AND OBJECTIVE: To investigate the duration of postoperative persistence of indocyanine green (ICG) dye used during vitreous surgery. PATIENTS AND METHODS: Thirty-three patients (34 eyes) underwent macular surgery with removal of the internal limiting membrane (ILM) or epiretinal membrane using ICG dye to stain the membrane for better visualization. Infrared fundus photographs were taken postoperatively until infrared fluorescence had completely disappeared. The time for residual ICG dye to fade from the retina was studied for eyes with full-thickness macular hole, epiretinal membrane, and macular edema for comparison. served at sites where macular hole was present, sites of normal ILM that had not been removed, and the optic disc. ICG dye faded at an average of 7.3 months for patients with macular hole and 3.4 months for patients with other macular diseases (P< .01). CONCLUSIONS: ICG dye used during macular surgery can persist in the macular region for up to 7 months following surgery, and seems to remain for a longer period of time in cases with macular hole than in cases with other diseases. Caution is required regarding light exposure by postoperative fundus examinations, daylight, and other natural light.

Ocular findings of Beals syndrome.

BACKGROUND: In this report of two Okinawan patients with Beals syndrome and accompanying ocular complications, the symptoms of Beals syndrome and Marfan syndrome are compared. The etiology of these two syndromes is considered in relation to fibrillin. CASES: Case 1 was a 5-year-old boy who showed blue sclera and bilateral enlargement of optic disc cupping. Case 2 was a 24-year-old man who had partial coloboma of the lens, mild cataract, and bilateral glaucomatous disc cupping. OBSERVATIONS: Beals syndrome was diagnosed in these two patients based on the initial examination. In further investigations, while the patients were being observed without treatment, the intra ocular pressure of both patients remained within normal range. Funduscopy showed that the cup-to-disc ratio was 0.8 bilaterally in both patients. Case 1 was followed up for 6 years with no changes. Ultrasound biomicroscopy examination in case 2 revealed hypoplasia of the ciliary body, leading to a diagnosis of glaucoma. This patient remains under observation. CONCLUSIONS: Two cases of Beals syndrome with ocular complications including glaucomatous optic disc cupping are reported. Ophthalmic examinations are recommended to identify the ocular complications of Beals syndrome. Further studies are needed to elucidate the relation between fibrillin abnormality and ocular complications in Beals syndrome.

Ciliochoroidal effusion induced by topical latanoprost in a patient with sturge-weber syndrome.

BACKGROUND: To report drug-induced ciliochoroidal effusion in a patient with Sturge-Weber syndrome. CASE: A 17-year-old man presented with unilateral glaucoma associated with Sturge-Weber syndrome. OBSERVATIONS: His corrected visual acuity was RE 20/20 and LE 40/60. Intraocular pressure readings by Goldmann applanation tonometry were RE 32 mm Hg and LE 12 mm Hg. Fundus examination showed marked glaucomatous disc cupping in his right eye and normal finding in his left. The patient had a port-wine stain on his right upper eyelid ipsilateral to the glaucomatous eye. Antiglaucomatous medications were begun, including topical latanoprost, with a diagnosis of juvenile onset glaucoma associated with Sturge-Weber syndrome. Ultrasound biomicroscopy showed a 360 degrees circumference ciliochoroidal effusion. Forty days after starting medication, latanoprost treatment was discontinued. Ten days later, ultrasound biomicroscopy showed a total disappearance of the ciliochoroidal effusion. CONCLUSION: Interaction of the enhanced uveoscleral outflow with latanoprost in conjunction with elevated episcleral venous pressure may have caused the congestion of the aqueous humor in the supraciliary-choroidal space, resulting in the ciliochoroidal effusion.

[Ciliochoroidal effusion after remission of lens-induced glaucoma detected by ultrasound biomicroscopy].

PURPOSE: To report the results of ultrasound biomicroscopy(UBM) cases of ciliochoroidal effusion after a lens-induced glaucoma attack. CASES: Case 1 was an 83-year-old female. She had shallow anterior chamber with expanded cataract with exfoliation in her right eye. Intraocular pressure(IOP) of the right eye was 64 mmHg. On the next day, IOP was reduced to 16 mmHg by conservative therapy. UBM showed circumference ciliochoroidal effusion in the right eye. On the 5th day, IOP increased to 38 mmHg. UBM was repeated and showed the disappearance of ciliochoroidal effusion. On the 9th day, phacoemulsification was done to treat the lens induced glaucoma attack. Two weeks after operation, IOP of the right eye was 6 mmHg and UBM showed ciliochoroidal effusion. Case 2 was an 85-year-old female. She had been diagnosed by an ophthalmologist as having an attack of lens-induced glaucoma in her left eye. IOP was 46 mmHg. When she was referred to us, IOP was decreased to 24 mmHg and ciliochoroidal effusion was observed in her left eye by UBM. CONCLUSION: We report two cases of ciliochoroidal effusion associated with lens-induced glaucoma attack. UBM is useful to observe changes in the ciliary body after lens-induced glaucoma attack.

A case of endogenous bacterial endophthalmitis caused by Streptococcus bovis.

BACKGROUND: Streptococcus bovis is a gram-positive streptococcus present as normal flora in the digestive tracts of herbivores. It is occasionally isolated from the human intestine and may act as a causative organism of infectious endocarditis, urinary infections and meningitis. This report describes a rare case of a patient that underwent surgical treatment for endogenous endophthalmitis caused by S. bovis complicated by bacteremia and suppurative spondylitis. METHODS: Endophthalmitis of the right eye occurred in a 76-year-old man accompanied by hypopyon and prominent vitreous opacity complicated by suppurative spondylitis. The visual acuity of the right eye consisted of light perception. Lensectomy and vitrectomy were performed immediately using a perfusate containing antibiotics. Antibiotics were administered by intravenous infusion following surgery. RESULTS: S. bovis was detected in the cultures of blood and vitreous fluid collected during surgery. The visual acuity was 20/160 at 11 months after surgery. CONCLUSIONS: Reports of endogenous endophthalmitis in human caused by S. bovis have not been found to date in a search of the MEDLINE database. This is the first report of acute endogenous endophthalmitis caused by S. bovis.

Visual outcome after vitreous, sub-internal limiting membrane, and/or submacular hemorrhage removal associated with ruptured retinal arterial macroaneurysms.

BACKGROUND: Ruptured retinal arterial macroaneurysms (RAM) can bleed into the various spaces of the eye. The hemorrhage of the inner layer conceals hemorrhage of the outer layer, making it difficult to diagnose the distribution of hemorrhage accurately and to predict the prognosis in clinical examinations. The objective of this study was to examine the clinical features and prognosis of ruptured RAM on the basis of surgical observations. METHODS: Retrospective review of 33 eyes of 31 patients with impairment of visual acuity due to hemorrhage from a ruptured RAM, who had undergone pars plana vitrectomy. A study of the location of hemorrhage was made from the preoperative fundus photographs and video of the surgical procedure. RESULTS: Hemorrhage from the RAM was present in two or more locations, consisting of the vitreous cavity, beneath the internal limiting membrane (sub-ILM), or the subretinal space in all but one eye. Sub-ILM hemorrhage was presented in the macular region in 22 of the 27 eyes presenting with sub-ILM hemorrhage (81%). Submacular hemorrhage was only detected when sub-ILM hemorrhage removed during surgery in 12 of the 22 eyes (55%) with sub-ILM hemorrhage. The preoperative VA ranged from hand motion to 0.1, while postoperative VA improved 0.01 to 1.0 (average: 0.2, paired t-test, P<0.01). The VA was poor in eyes with dense submacular hemorrhage, while it was good in eyes with other hemorrhage. CONCLUSIONS: The effects of vitrectomy were influenced by the location of hemorrhage from the RAM. The VA was poor in eyes exhibiting dense submacular hemorrhage. However, since hemorrhage from a RAM was present at various levels within the eye, it was difficult to evaluate the amount of submacular hemorrhage prior to surgery.

Removal of retinal indocyanine green dye by autologous serum irrigation in macular hole surgery.

PURPOSE: To investigate the efficacy of autologous serum irrigation for removal of retinal indocyanine green (ICG) dye used to visualize the internal limiting membrane (ILM) in macular hole surgery. METHODS: Eighteen consecutive eyes of 16 patients with macular holes underwent vitrectomy and ILM peeling using ICG solution. Nine of 18 eyes underwent intravitreal autologous serum irrigation before completion of the surgery to remove residual ICG dye in the retina. The main outcome measures were postoperative visual acuity, macular hole status, retinal pigment epithelial changes, and time course of ICG dye fading from the retina with or without intravitreal autologous serum irrigation. RESULTS: No significant difference was noted in the improvement of visual acuity between the two groups. An abnormal pigment epithelial change was seen in one eye without serum application. ICG dye disappeared from the retina within an average of 6.1 months after surgery without serum and 2.4 months after surgery with serum (P < 0.01). CONCLUSIONS: Autologous serum irrigated in the vitreous cavity just before completion of macular hole surgery can help remove ICG dye used in surgery. The application was simple and safe and significantly shortened the period of residual retinal ICG staining.