Full preoperative panretinal photocoagulation improves the outcome of trabeculectomy with mitomycin C for neovascular glaucoma.

PURPOSE: To investigate the efficacy of full panretinal photocoagulation (PRP) followed by trabeculectomy with mitomycin C (MMC) in the management of eyes with neovascular glaucoma (NVG). METHODS: This study is based on 30 consecutive eyes of 27 patients with NVG who underwent full PRP followed by trabeculectomy with MMC. NVG was secondary to proliferative diabetic retinopathy (23 eyes) and central retinal vein occlusion (7 eyes). Kaplan-Meier survival analysis of the surgical outcome was performed. Operative success was defined as an intraocular pressure (IOP) of < or = 21 mmHg without medical therapy. RESULTS: Kaplan-Meier cumulative success rates at the 6-, 12-, and 24-month intervals were 86.5%, 74.7%, and 57.6%, respectively. Pseudophakia was the only identified significant risk factor for failure (p=0.0138; Fisher exact test). Additional surgical procedures were performed in 8 (26.6%) eyes. The mean IOP decreased from 41.0+/-10.2 mmHg to 18.2+/-9.2 mmHg (p<0.001; Wilcoxon signed rank test). The number of anti-glaucoma medications was reduced from 3.1+/-0.5 preoperatively to 0.3+/-0.7 postoperatively (p<0.001; Wilcoxon signedrank test). Twenty-four (80%) eyes were classified as surgical success after a mean followup period of 17.3+/-22.1 months. Twenty-two (73.3%) eyes had improved vision or retained preoperative vision. CONCLUSIONS: Full PRP followed by trabeculectomy with MMC can effectively reduce the elevatedIOP associated with NVG. Presence of pseudophakia is a significant negative predictor of surgical outcome.

Sympathetic ophthalmia after complicated cataract surgery and intraocular lens implantation.

PURPOSE: To report a case of sympathetic ophthalmia (SO) associated with cataract surgery and intraocular lens (IOL) implantation. METHODS: Case report. RESULTS: A 50-year-old man developed SO two months after complicated cataract surgery and IOL implantation. Adequate and prompt use of immunosuppressive medications and removal of the IOL by pars plana vitrectomy techniques resulted in control of the uveitis with significant visual improvement. CONCLUSIONS: Sympathetic ophthalmia should be included as one of the devastating complications of IOL insertion. A high index of suspicion must be maintained whenever inflammation occurs in the fellow eye of an eye that has undergone intraocular surgery.

Retinal periphlebitis resembling frosted branch angiitis with nonperfused central retinal vein occlusion.

PURPOSE: To report the unusual association between severe retinal periphlebitis resembling frosted branch angiitis and nonperfused central retinal vein occlusion (CRVO). METHODS: Observational case reports. RESULTS: Patient 1 was a 28-year-old man who presented with extensive sheathing involving all retinal veins in one eye followed by nonperfused CRVO. Twenty-seven months after initial presentation, he developed perfused CRVO in the other eye followed by periphlebitis that progressed into nonperfused CRVO. Patient 2 was a 47-year-old man who presented with unilateral severe retinal periphlebitis associated with nonperfused CRVO. Despite systemic administration of corticosteroid therapy, rubeosis iridis developed in both patients and neovascular glaucoma developed in Patient 1 despite full panretinal photocoagulation. Extensive systemic workup and coagulation studies were unremarkable except for the presence of antiphospholipid antibodies in both patients and elevated plasma homocysteine level in Patient 2. CONCLUSIONS: Severe retinal periphlebitis complicated by nonperfused CRVO is associated with poor visual outcome despite appropriate medical and surgical treatment.

Late onset posttraumatic Propionibacterium acnes endophthalmitis.

PURPOSE: To report a case of late onset posttraumatic endophthalmitis secondary to Propionibacterium acnes infection. METHODS: Interventional case report. RESULTS: A 28-year-old man developed endophthalmitis 6 months after a penetrating trauma. The patient underwent pars plana lensectomy and vitrectomy along with injection of intravitreal antibiotics. Anaerobic cultures of the vitreous yielded P. acnes. Seven months after surgery, the eye was quiet with a best-corrected visual acuity of 20/60. CONCLUSIONS: This case emphasizes the importance of considering P acnes when treating patients with late onset posttraumatic endophthalmitis.

Pars plana vitrectomy in the management of ghost cell glaucoma.

In this report we describe, herewith, 5 cases of ghost cell glaucoma that followed spontaneous vitreous hemorrhage complicating branch retinal vein occlusion in a phakic eye (one case), and traumatic vitreous hemorrhage (4 cases). Because intraocular pressure was uncontrolled, pars plana vitrectomy was performed to remove the reservoir of ghost cells. Vitrectomy resulted in successful control of intraocular pressure without medications and visual improvement.

Late onset posttraumatic Propionibacterium acnes endophthalmitis.

PURPOSE: To report a case of late onset posttraumatic endophthalmitis secondary to Propionibacterium acnes infection. METHODS: Interventional case report. RESULTS: A 28-year-old man developed endophthalmitis 6 months after a penetrating trauma. The patient underwent pars plana lensectomy and vitrectomy along with injection of intravitreal antibiotics. Anaerobic cultures of the vitreous yielded P. acnes. Seven months after surgery, the eye was quiet with a best-corrected visual acuity of 20/60. CONCLUSIONS: This case emphasizes the importance of considering P. acnes when treating patients with late onset posttraumatic endophthalmitis. (Eur J Ophthalmol 2004; 14: 442-4).