Peri-Operative Cataract Surgery Complications associated with Hepatitis C: an observational study

 Introduction: Small Incision Cataract surgery (SICS) is one of the most commonly performed surgery and the Hepatitis C virus infection in the country like ours is an upcoming health hazard. Undiagnosed asymptomatic HCV sero-positive cases outnumber the diagnosed cases. Hypocoagulability because of hepatitis, can cause detrimental effect on cataract surgery.  Objective: To analyze the cataract surgery complications in HCV infected cases. Methods: This was a prospective, observational study conducted in the department of Ophthalmology of Muzaffarnagar Medical College, Uttar Pradesh from January 2019 to January 2020. After taking permission from the ethical committee and informed-written consent from the patients, total 200 eyes of 158 patients having (116 unilateral and 42 bilateral) cataract and incidentally diagnosed positive for HCV infection were enrolled in the study.Results: Out of 200 eyes, 48 eyes had no complications and 152 (76%) eyes had one or more complications like intra-operative bleed (68%), difficulty in wound closure (19.5%), post-operative AC reaction (61.5%), delayed healing (49%), hyphema (48%), leaky wound (37%) and keratitis (34%).Conclusion: Significant number of asymptomatic HCV sero-positive patients undergoing cataract surgery had peri-operative complications. It is recommended that pre-operative viral marker screening of all cataract patients should be done and measures to combat the difficulties during and after the surgery should be taken care of.&nbsp

Macular toxicity following brilliant blue G-assisted macular hole surgery – a report of three cases

Introduction: Brilliant blue G is a new dye used for staining the internal limiting membrane to ease its peeling in cases like a macular hole. Cases: Three patients presented with full-thickness idiopathic macular hole. They underwent pars planavitrectomy, Brilliant Blue G (BBG) stained internal limiting membrane peeling and fluid gas exchange. Observations: Postoperatively,the macular hole closed but foveal thinning and perifoveal hyperpigmentation presumably due to BBG toxicity were observed in all three patients. All of them had a subnormal final best corrected visual acuity. Conclusion:This case series highlights the unusual occurrence of macular toxicity following brillantblue G-assisted macular hole surgery. DOI: http://dx.doi.org/10.3126/nepjoph.v6i1.10779   Nepal J Ophthalmol 2014; 6 (2): 98-10

Filamentous fungal endophthalmitis: results of combination therapy with intravitreal amphotericin B and voriconazole

PURPOSE: To report outcomes of exogenous fungal endophthalmitis treated with combination of intravitreal antifungal agents. DESIGN: Retrospective, non-randomized, interventional, consecutive case series. METHODS: Twelve eyes of twelve consecutive cases of filamentous fungal endophthalmitis were treated with a combination of intravitreal amphotericin-B and intravitreal voriconazole (AmB-Vo Regime) along with pars plana vitrectomy at a single center. Clinical characteristics, microbiology results, treatment strategy, visual, and anatomical outcomes were analyzed. RESULTS: Ten cases out of the twelve were postoperative endophthalmitis of which nine were part of a post cataract surgery cluster. The remaining included endophthalmitis following keratitis post pterygium excision (1) and following open globe injury (2). The most common fungus was Aspergillus terreus, which was isolated in 8/12, followed by A. flavus in 2/12 and Fusarium solani in 1/12. The presenting visual acuity ranged from light perception (LP) to counting fingers. The visual acuity at final follow-up was 20/400 or better in 7/12 eyes (58.33%) and 20/60 in 2/12 eyes (range 20/60 to LP). All eyes with corneal involvement had final visual acuity 20/400 or worse. Globe salvage was achieved in all cases. CONCLUSION: Combining intravitreal amphotericin-B and voriconazole could be a novel treatment strategy in the management of endophthalmitis caused by filamentous fungus. Eyes with corneal involvement had poor visual outcome either with or without therapeutic penetrating keratoplasty

Filamentous fungal endophthalmitis: results of combination therapy with intravitreal amphotericin B and voriconazole

To report outcomes of exogenous fungal endophthalmitis treated with combination of intravitreal antifungal agents. Retrospective, non-randomized, interventional, consecutive case series. Twelve eyes of twelve consecutive cases of filamentous fungal endophthalmitis were treated with a combination of intravitreal amphotericin-B and intravitreal voriconazole (AmB-Vo Regime) along with pars plana vitrectomy at a single center. Clinical characteristics, microbiology results, treatment strategy, visual, and anatomical outcomes were analyzed. Ten cases out of the twelve were postoperative endophthalmitis of which nine were part of a post cataract surgery cluster. The remaining included endophthalmitis following keratitis post pterygium excision (1) and following open globe injury (2). The most common fungus was Aspergillus terreus, which was isolated in 8/12, followed by A. flavus in 2/12 and Fusarium solani in 1/12. The presenting visual acuity ranged from light perception (LP) to counting fingers. The visual acuity at final follow-up was 20/400 or better in 7/12 eyes (58.33%) and 20/60 in 2/12 eyes (range 20/60 to LP). All eyes with corneal involvement had final visual acuity 20/400 or worse. Globe salvage was achieved in all cases. Combining intravitreal amphotericin-B and voriconazole could be a novel treatment strategy in the management of endophthalmitis caused by filamentous fungus. Eyes with corneal involvement had poor visual outcome either with or without therapeutic penetrating keratoplasty

Endophthalmitis after open globe injuries: changes in microbiological spectrum and isolate susceptibility patterns over 14 years

BACKGROUND: The objective of this study was to evaluate the microbiologic spectrum and antimicrobial susceptibility of isolates in post-traumatic endophthalmitis and compare with our earlier published report. A retrospective review was conducted on 581 consecutive patients with culture-proven post-traumatic endophthalmitis at L. V. Prasad Eye Institute, India, from January 2006 to March 2013. FINDINGS: A total of 620 isolates from 581 patients were identified (565 bacteria and 55 fungi). The most common isolate was Bacillus spp. (106/620, 17.1%) closely followed by Streptococcus pneumoniae (105/620, 16.9%), and coagulase-negative Staphylococci (97/620, 15.6%). In our earlier report, the commonest bacteria included Streptococcus spp. (30/139, 21.6%) and gram-positive coagulase-negative micrococci (26/139, 18.7%). Gram-positive isolates were usually susceptible to vancomycin (98.2%). Gram-negative isolates were generally susceptible to gatifloxacin (92.9%), ofloxacin (89.4%), chloramphenicol (88.6%, Pseudomonas isolates were often resistant), amikacin (83.5%), and ceftazidime (77.2%). Fourteen years ago, the most sensitive antibiotic was ciprofloxacin for both gram-positive bacteria (95.12%) and gram-negative bacteria (100%). CONCLUSIONS: The microbiological spectrum of post-traumatic endophthalmitis has remained unchanged over the last 14 years, and Bacillus spp. continues as the most common infecting organism. Vancomycin is the drug of choice for empiric coverage of gram-positive bacteria. Susceptibility of gram-negative bacteria to commonly used antimicrobials (amikacin and ciprofloxacin) has decreased by 10% - 15% and to ceftazidime has increased by 10.5%