Clinical characteristics and outcome of Candida keratitis.

PURPOSE: To characterize the clinical features and therapeutic outcome of Candida keratitis. DESIGN: Retrospective, observational case series. METHODS: We reviewed 26 patients treated for Candida keratitis, including two with recurrent keratitis and one with bilateral infection. RESULTS: Of 29 keratitis episodes resulting from Candida albicans (n = 20) or Candida parapsilosis (n = 9), 16 (55%) complicated chronic ocular surface disease, and nine (31%) followed previous keratoplasty. Only two were clinically suspected to have keratomycosis at initial presentation, and 21 (72%) used antibacterial therapy before corneal scrapings. Reconstructive keratoplasty occurred more often in previously grafted eyes (P = .03). Visual outcome was 20/60 or better in six (100%) medically treated eyes with good presenting visual acuity but in only five eyes (24%) with worse initial vision (P = .002). CONCLUSIONS: Candida keratitis is an opportunistic infection of a compromised cornea that often is misdiagnosed initially and, despite antifungal therapy, occasionally requires corneal grafting.

Visual outcomes after 3-port lens-sparing vitrectomy in stage 4 retinopathy of prematurity.

OBJECTIVE: To assess the visual acuity of eyes successfully treated with 3-port lens-sparing vitrectomy for stage 4 retinopathy of prematurity. METHODS: Of 102 consecutive eyes achieving at least posterior pole reattachment, 30 eyes of 26 patients were tested by Teller or Allen acuity measurements and were subsequently converted to logarithm of the minimum angle of resolution (logMAR). Visual outcomes were also examined as either favorable or unfavorable (Snellen equivalent >20/200). RESULTS: Seventy-two eyes were not tested because of either inability to perform testing (age or neurologic sequelae related to prematurity) or loss of follow-up. Of those tested, mean +/- SD logMAR visual acuity for the stage 4A and stage 4B groups was 0.51 +/- 0.09 (Snellen approximate 20/62) and 1.03 +/- 0.19 (Snellen approximate 20/200), respectively (odds ratio, 0.39; 95% confidence interval, 0.24-0.64; P = .001). Of those eyes assessed by Teller measurements, 10 of 10 stage 4A eyes and 3 (37.5%) of 8 stage 4B eyes had favorable outcomes; among eyes assessed with Allen measurements, 4 of 4 stage 4A eyes and 0 of 8 stage 4B eyes had favorable outcomes. CONCLUSIONS: The majority of eyes were not tested. Among eyes tested after successful 3-port lens-sparing vitrectomy, some eyes treated prior to macular detachment may be associated with a more favorable outcome and improved maintenance of functional visual acuity.

Lens clarity after 3-port lens-sparing vitrectomy in stage 4A and 4B retinal detachments secondary to retinopathy of prematurity.

OBJECTIVE: To assess lens clarity after 3-port lens-sparing vitrectomy for stages 4A and 4B tractional retinal detachment secondary to retinopathy of prematurity. METHODS: In a retrospective, interventional, consecutive clinical case series, 108 eyes of 102 patients who underwent lens-sparing vitrectomy for stages 4A and 4B tractional retinal detachment from February 1, 1998, through January 31, 2004, were reviewed. All procedures and follow-up examinations were performed by a single surgeon. Lens clarity was assessed at the final follow-up examination. RESULTS: Of the 108 eyes reviewed, 102 (94.4%) maintained clear lenses at the final follow-up examination, which ranged from 6 to 48 months (mean, 32 months) after the procedure. Thirty-two eyes had stage 4A detachments and 76 eyes had stage 4B. CONCLUSIONS: Three-port lens-sparing vitrectomy may be performed with relatively low risk of cataract formation during the early postoperative period. Maintenance of a clear crystalline lens during the critical period of visual development may lead to better functional outcomes.

Anatomic success rate after 3-port lens-sparing vitrectomy in stage 4A or 4B retinopathy of prematurity.

PURPOSE: To assess the anatomic success rate after 3-port lens-sparing vitrectomy (LSV) in stage 4A and 4B tractional retinal detachments (TRDs) due to retinopathy of prematurity (ROP). DESIGN: A chart review and data evaluation of 108 eyes of 102 consecutive patients presenting with stage 4A (32 eyes) or 4B (76 eyes) TRDs that underwent primary LSV from February 1998 to January 2004 were performed. INTERVENTION: Three-port LSV was performed on all eyes by the same surgeon (ERH). MAIN OUTCOME MEASURES: Retinal reattachment status was reviewed at final follow-up visit, which ranged from 6 to 48 months (mean, 32 months) after LSV. RESULTS: Ninety-two of 108 (85.2%) eyes were reattached after a single LSV and 102 of 108 (94.4%) eyes ultimately achieved at least partial posterior pole reattachment at the final follow-up visit. All 4A eyes achieved complete reattachment and 70 of 76 (92.1%) 4B eyes achieved partial or complete reattachment. Reversal or complete arrest of dragging of the macula was noted in all eyes that maintained partial or complete reattachment (94.4%). Six (5.6%) 4B eyes remained detached despite additional vitreoretinal procedures; 4 (66.7%) of these had intraoperative retinal tears. CONCLUSIONS: Eighty-five percent of eyes with 4A and 4B TRDs secondary to ROP were completely reattached with a single 3-port LSV procedure and nearly 95% were ultimately at least partially reattached at the posterior pole by the final follow-up visit. The development of retinal tears intraoperatively portended a poor prognosis for reattachment.

Anatomical success rate after primary three-port lens-sparing vitrectomy in stage 5 retinopathy of prematurity.

PURPOSE: To assess the anatomical success rate after three-port lens-sparing vitrectomy (LSV) in stage 5 (total) retinal detachments secondary to retinopathy of prematurity. METHODS: In a retrospective, interventional, single-surgeon, consecutive case series, the records of 33 eyes of 21 patients presenting with stage 5 retinal detachment secondary to retinopathy of prematurity who underwent primary three-port LSV from February 1998 to January 2004 were evaluated. Twenty-one eyes (63.6%) had open anteriorly-open posteriorly and 12 (36.4%) had open anteriorly-narrow posteriorly in terms of anatomical configuration. The main outcome measure, retinal reattachment, was reviewed at final follow-up visits, which ranged from 6 months to 48 months (mean, 32 months) after LSV. RESULTS: Fifteen eyes (45.5%) maintained attachment and 18 eyes (54.5%) remained detached at the final visit. Open anteriorly-open posteriorly configuration eyes had a statistically significant higher anatomical success rate than eyes with an open anteriorly-narrow posteriorly configuration (P<0.001). CONCLUSIONS: Three-port LSV may achieve anatomical success in stage 5 retinopathy of prematurity-related detachments. The open anteriorly-open posteriorly configuration portends a better prognosis; thus, surgery should be performed before closure of the posterior retina into a funnel configuration, if possible.