Early Pars Plana Vitrectomy for Treatment of Acute Infective Endophthalmitis

Purpose: To evaluate the efficacy and safety of early pars plana vitrectomy (PPV) for the treatment of acute infective endophthalmitis, and identify prognostic factors for better visual outcome. Design: Retrospective cohort study. Methods: Consecutive patients who underwent early PPV within 72 hours of presentation for the treatment of acute infective bacterial endophthalmitis and presented to a large tertiary referral center in New South Wales, Australia, between January 2009 and December 2013 were included. Changes in best-corrected visual acuity (VA) from baseline to 1 year were examined. Results: A total of 64 patients were included. The inciting events were cataract surgery (53%), intravitreal injection (36%), trabeculectomy (3%), and endogenous (3%). The mean VA improved from 3.1 logMAR (hand motion) at baseline to 1.02 (approximately 20/200) at 1 year, with 42% achieving final VA equal to or better than 0.477 logMAR (20/60) following early PPV. Positive prognostic factors were negative microbial cultures (P < 0.01) and etiology of post-cataract surgery (P < 0.01). In multivariable analyses adjusting for age and prognostic factors, patients with baseline VA of light perception and hand motion achieved greater visual gains than those with counting fingers, with gains of logMAR of -2.68, -2.09, and -0.85, respectively (P < 0.0001). Conclusions: Most patients who undergo early PPV experience substantial VA improvement. Negative microbial cultures and endophthalmitis after cataract surgery were associated with better final visual outcome. Patients with presenting VA of light perception or hand motion achieved higher visual gains than those with counting fingers, suggesting the possibility that early PPV may be beneficial in both groups

Editorial : To bleed or clot?

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Vitrectomy for diabetic macular edema : a systematic review and meta-analysis

Objective: To systematically review, and perform meta-analysis on, the available data regarding the efficacy of vitrectomy for diabetic macular edema. Design: Systematic review and meta-analysis of published randomized controlled trial data. Methods: We searched PubMed and the Cochrane database for randomized, controlled trials investigating vitrectomy for diabetic macular edema. Structural (foveal thickness) and functional (visual acuity) outcomes were used as the primary outcome measures. Results: Eleven studies met the criteria for inclusion in this review: these studies were heterogenous in their experimental and control interventions, follow-up period, and eligibility criteria. Seven studies compared vitrectomy with the natural history of diabetic maculopathy, with laser, or with intravitreal corticosteroid injection. Four studies compared vitrectomy with internal limiting membrane peeling to vitrectomy alone. One of the latter 4 studies was the only to investigate vitrectomy in patients with vitreomacular traction. Meta-analysis suggests a structural, and possibly functional, superiority of vitrectomy over observation at 6 months. Vitrectomy also appears superior to laser in terms of structural, but not functional, outcomes at 6 months. At 12 months, vitrectomy offers no structural benefit and a trend toward inferior functional outcomes when compared with laser. Conclusions: There is little evidence to support vitrectomy as an intervention for diabetic macular edema in the absence of epiretinal membrane or vitreomacular traction. Although vitrectomy appears to be superior to laser in its effects on retinal structure at 6 months, no such benefit has been proved at 12 months. Furthermore, there is no evidence to suggest a superiority of vitrectomy over laser in terms of functional outcomes.8 page(s

Does unintentional macular translocation after retinal detachment repair influence visual outcome? Response

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Does unintentional macular translocation after retinal detachment repair influence visual outcome?

Abstract: Background: To document the occurrence of postoperative macular translocation after retinal detachment repair and discuss its influence on visual outcome. Design: Retrospective case series in a tertiary care setting. Participants: Five eyes of five patients presenting to our clinic with macula-off rhegmatogenous retinal detachment. Methods: All patients underwent surgical repair of the retinal detachment, with regular postoperative follow-up, including macular optical coherence tomography and fundus autofluorescence. Main Outcome Measures: Visual acuity and subjective visual symptoms in patients with anatomically successful retinal detachment repair, in whom inadvertent macular translocation was noted. Results: Our series demonstrates the presence of unintentional macular translocation after retinal detachment repair, detected by fundus autofluorescence imaging. In contrast to previous reports, we document inadvertent macular translocation in one patient after scleral buckling surgery. In each case, the retina was fully reattached postoperatively and no other complications were identified. There was variability in the symptoms and objective visual outcomes after surgery. Conclusions: Inadvertent macular translocation can occur following repair of macula-off retinal detachment, and may be a significant contributor to poorer visual outcome after retinal detachment, despite objective surgical succes s.5 page(s

Complications with fluorescein angiography : a prospective study

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Endophthalmitis following intravitreal injection versus endophthalmitis following cataract surgery : clinical features, causative organisms and post-treatment outcomes

Aims: To describe and compare the causative organisms, clinical features and visual outcomes of endophthalmitis following intravitreal injection (IVI) to endophthalmitis following cataract surgery. Methods: Patient population and setting: A retrospective case series of patients with acute endophthalmitis following either cataract surgery or IVI presenting to a tertiary referral centre - Sydney Eye Hospital - between 2007 and 2010. Main outcome measures: (1) identification of the causative organism; (2) time to presentation; (3) odds of improvement in visual acuity (VA) following treatment; (4) odds of final VA of counting fingers (CF) or less and (5) odds of enucleation. Results: Of the 101 patients in our study, 48 had preceding cataract surgery and 53 had preceding IVI. There was an increased incidence of Streptococcus spp. endophthalmitis in post-IVI cases (24.53% vs 6.25%; OR 5.85; p=0.022). Endophthalmitis following IVI had increased likelihood of a final VA of CF or less (OR=6.0; p<0.01), decreased likelihood of any improvement in acuity following treatment (OR=0.13; p<0.01) and an increased likelihood of presenting within a week of the procedure (OR=3.93; p<0.01). Endophthalmitis caused by Streptococcus spp. was associated with increased likelihood of a final VA of CF or less (OR=10.2; p<0.01), decreased likelihood of any improvement in acuity following treatment (OR=0.06; p<0.01) and increased likelihood of enucleation (OR=17.11; p<0.01). Conclusions: Endophthalmitis following IVI is associated with an increased incidence of Streptococcus spp. infection, earlier presentation and poorer visual outcomes when compared with endophthalmitis following cataract surgery.5 page(s

Pars plana vitrectomy for the management of retained lens material after cataract surgery

Purpose: To evaluate the management and outcomes of patients undergoing pars plana vitrectomy (PPV) for retained lens material after cataract surgery; and to evaluate risk factors for poor visual outcome, retinal detachment, raised intraocular pressure (IOP), and cystoid macular edema (CME). Design: Retrospective interventional consecutive case series. Methods: Setting: Institutional and Clinical practice. study population: Patients with retained lens material after cataract surgery who underwent vitrectomy at Sydney Eye Hospital between July 1, 1998 and October 31, 2003. intervention: Standard three-port PPV/lensectomy. main outcome measures: Final best-corrected visual acuity (BCVA), retinal detachment, raised IOP, and CME. Results: A total of 223 eyes of 223 patients were included, with a mean follow-up of 20.5 months after vitrectomy. Final BCVA was 6/12 or better in 159 patients (71.3%). Retinal detachment occurred in 20 patients (9%), with 11 diagnosed before or during vitrectomy, and nine occurring after vitrectomy. Ten patients (5.0%) developed raised IOP and 42 (23.2%) developed CME. Poor final visual acuity was associated with retinal detachment (P = .0026), and with poor visual acuity at presentation (P = .030). There was a significant association between retinal detachment and a long interval (>30 days) between cataract surgery and vitrectomy (P = .00047) and between retinal detachment and younger age (P = .0070). Conclusions: Visual acuity results in this study compared favorably with previously published reports. Although the overall rate of retinal detachment was low, it was significantly higher in those with a delayed interval between cataract surgery and vitrectomy, and was significantly associated with a poorer visual outcome. Dislocation of lens fragments into the vitreous during cataract surgery is a potentially sight-threatening complication that has been reported to occur in 0.1% to 1.5% of cases. The sequelae commonly include corneal edema, elevated intraocular pressure (IOP), intraocular inflammation, cystoid macular edema (CME), retinal detachment, and reduced visual acuity. Removal by pars plana vitrectomy (PPV) is often required, unless fragments are small and elicit minimal inflammation. The aims of this study were to report the management and outcomes of 223 patients who underwent PPV for the removal of retained lens material after cataract surgery at a tertiary referral center in Sydney, Australia.7 page(s

Acute idiopathic maculopathy with coxsackievirus infection

Purpose: To report a case of visual loss immediately after hand, foot, and mouth disease and demonstrate the high-resolution optical coherence tomography findings. Methods: A retrospective case report of a 19-year-old nursery worker with resolving hand, foot, and mouth disease and acute unilateral visual loss. Results: The clinical features were characteristic of unilateral acute idiopathic maculopathy. High-resolution optical coherence tomography demonstrated highly reflective subretinal material at the macula of one eye with disruption of the photoreceptor inner segment/outer segment junction. Vision remained poor for 4 weeks when there was rapid recovery coinciding with reconstitution of the inner segment/outer segment junction on optical coherence tomography. Conclusion: Unilateral acute idiopathic maculopathy may be caused by Coxsackievirus infection. Optical coherence tomography and clinical findings suggest an acute viral retinal pigment epitheliitis to be the main pathologic feature.3 page(s