Non-surgical Pneumoperitoneum in the Setting of Gram-negative Sepsis.

Pneumoperitoneum is described as the presence of free air in the peritoneal cavity. In the majority of cases, it is the manifestation of abdominal viscus perforation, requiring an emergent surgical exploration. In rare cases, however, no evidence of perforation of the gastrointestinal or genitourinary tracts can be found at exploration, and in such cases, the pneumoperitoneum is referred to as non-surgical pneumoperitoneum. We present a case of an 87-year-old man who developed a non-surgical pneumoperitoneum in the setting of gram-negative sepsis. The patient was admitted for treatment of obstructive uropathy and sepsis secondary to a gram-negative urinary tract infection. Despite the initial resuscitation and antibiotic therapy, his hospital course was complicated by worsening abdominal discomfort, and a chest radiograph revealed free air under the diaphragm. He was taken to the operating room for an emergent surgical exploration that revealed no visceral perforation or other possible surgical causes. He tolerated and recovered from surgery well, and had a complete resolution of pneumoperitoneum in the early post-surgery period, per radiographic imaging. This interesting case highlights a rare case of idiopathic nonsurgical pneumoperitoneum in the setting of gram-negative sepsis. Additionally, we discuss considering non-surgical etiologies for patients without clinical signs or surgical evidence of perforation.

MIRAgel Buckle Extrusion With Preseptal Cellulitis and Erosion Through the Eyelid Skin.

MIRAgel (MIRA, Waltham, MA) scleral buckle material was initially developed in the 1980s as an alternative to more traditional silicone buckles. Long-term follow-up has demonstrated complications necessitating removal due to unanticipated hydrolytic degeneration of the exoplant. Material expansion and fragmentation have led to pain, limited extraocular motility, ocular masses, infection, and eventual extrusion. Complications occur later than in other materials; most patients need removal an average of 7 years to 13 years after implantation. This case describes a previously not reported case of MIRAgel scleral buckle extrusion complicated by preseptal cellulitis and complete erosion of the material through the inferior eyelid and extrusion through the skin. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1147-1150.].

Timing and Outcomes of Vitreoretinal Surgery after Traumatic Retinal Detachment.

Traumatic retinal detachments are a significant cause of morbidity. There are currently no evidence-based guidelines on the appropriate time to perform vitreoretinal surgery to repair a traumatic retinal detachment. Early intervention, within seven days of the inciting trauma, may decrease proliferative vitreoretinopathy and postoperative endophthalmitis. Later intervention may yield a reduced risk of inflammation and hemorrhage, particularly in cases of concomitant open globe injuries. This article reviews the literature on the management of retinal detachments associated with ocular trauma from the years 2006 to 2016. Particular focus was placed on the timing of surgery, concomitant open globe injury, anatomical success rates, visual acuity, and complication rates. In this review, anatomical success was not significantly related to timing of intervention when compared between early and delayed intervention in eyes with and without concomitant open globe injuries. Visual acuities postoperatively varied widely despite timing of intervention due to the large variation in mechanism and extent of ocular injuries. Proliferative vitreoretinopathy was a common complication. Preliminary data indicate that endophthalmitis rates may be lower when early vitreoretinal surgery is performed. There is insufficient data to conclude whether early or delayed surgery leads to improved outcomes, highlighting the need for further research in this domain.