Intravitreal Ampicillin Sodium for Antibiotic-Resistant Endophthalmitis: Streptococcus uberis First Human Intraocular Infection Report

Purpose. To describe the clinical characteristics, diagnosis, and treatment with intravitreal ampicillin sodium of a postoperative endophthalmitis case due to Streptococcus uberis; an environmental pathogen commonly seen in mastitis cases of lactating cows. Methods. Case Report. A 52-year-old, Hispanic diabetic patient who suddenly developed severe pain and severe loss of vision, following vitrectomy. Results. The patient was diagnosed with postoperative endophthalmitis secondary to a highly resistant strain of Streptococcus uberis that did not respond to intravitreal antibiotics. He was treated with an air-fluid interchange, anterior chamber washout, intravitreal ampicillin sodium (5 mg/0.1 mL), and silicon oil tamponade (5000 ck). The eye was anatomically stabilized, though there was no functional recovery. Conclusion. Streptococcus uberis is an uncommon pathogen to the human eye, which has unique features that help the strain in developing resistance to antibiotics. While treatment with intravitreal ampicillin is feasible, there are still concerns about its possible toxicity

Changes in Retinal and Choroidal Vascular Blood Flow after Oral Sildenafil: An Optical Coherence Tomography Angiography Study

Purpose. To describe changes in the retina and choroidal flow by optical coherence tomography angiography (OCT-A) after a single dose of oral sildenafil. Method. A case-control study. Patients in the study group received 50 mg of oral sildenafil. Patients in the control group received a sham pill. Retinal and choroidal images were obtained at baseline (before pill ingestion) and 1 hour after ingestion. Central macular and choroidal thickness, choroidal and outer retina flow, and the retinal and choroidal vascular density were compared using a Mann-Whitney U test. Results. Twenty eyes were enrolled into the study group and 10 eyes in the control group. There was a significant difference in central choroidal thickness and outer retina blood flow between groups after 1 hour of sildenafil ingestion (p<0.01). There were no differences in central macular thickness, choroidal flow, and retinal vascular density among groups. Conclusions. A single dose of oral sildenafil increases choroidal thickness, probably due to sildenafil-induced vasodilation

Primary Repair of Moderate Severity Rhegmatogenous Retinal Detachment: A Critical Decision-Making Algorithm

We reviewed all the available data regarding the current management of non-complex rhegmatogenous retinal detachment and aimed to propose a new decision-making algorithm aimed to improve the single surgery success rate for mid-severity rhegmatogenous retinal detachment. An online review of the Pubmed database was performed. We searched for all available manuscripts about the anatomical and functional outcomes after the surgical management, by either scleral buckle or primary pars plana vitrectomy, of retinal detachment. The search was limited to articles published from January 1995 to December 2015. All articles obtained from the search were carefully screened and their references were manually reviewed for additional relevant data. Our search specifically focused on preoperative clinical data that were associated with the surgical outcomes. After categorizing the available data according to their level of evidence, with randomized-controlled clinical trials as the highest possible level of evidence, followed by retrospective studies, and retrospective case series as the lowest level of evidence, we proceeded to design a logical decision-making algorithm, enhanced by our experiences as retinal surgeons. A total of 7 randomized-controlled clinical trials, 19 retrospective studies, and 9 case series were considered. Additional articles were also included in order to support the observations further. Rhegmatogenous retinal detachment is a potentially blinding disorder. Its surgical management seems to depend more on a surgeon´s preference than solid scientific data or is based on a good clinical history and examination. The algorithms proposed herein strive to offer a more rational approach to improve both anatomical and functional outcomes after the first surgery

Acute Postoperative Infectious Endophthalmitis: Advances in Diagnosis and Treatment

Acute postoperative infectious endophthalmitis remains one of the most dreaded complications of ophthalmic surgery. One of the keys to success in treating this complication is to make an early clinical diagnosis and, if possible, an etiologic diagnosis that can guide treatment with antibiotic therapy. Different antibiotic therapy modalities have emerged over the years that have made it possible to treat even resistant strains of various microorganisms that cause endophthalmitis. Another relevant advance made in the etiological diagnosis of endophthalmitis is the advent of molecular biology techniques, such as the real-time polymerase chain reaction, which can detect minimal amounts of the genetic material of the causative microorganism present in the vitreous in a short period of time, thus improving treatment outcomes with better-guided therapy with intravitreal antibiotics. Aside from advances in postoperative diagnosis methods, the surgical treatment of endophthalmitis has had significant improvements in vitrectomy techniques, and in many cases, it has been proposed as the first-line treatment concomitantly with intravitreal antibiotic therapy. Moreover, there is increasing evidence that prophylaxis with intracameral antibiotic therapy further decreases postoperative endophthalmitis incidence

Age-Related Macular Degeneration: New Paradigms for Treatment and Management of AMD

Age-related macular degeneration (AMD) is a well-characterized and extensively studied disease. It is currently considered the leading cause of visual disability among patients over 60 years. The hallmark of early AMD is the formation of drusen, pigmentary changes at the macula, and mild to moderate vision loss. There are two forms of AMD: the “dry” and the “wet” form that is less frequent but is responsible for 90% of acute blindness due to AMD. Risk factors have been associated with AMD progression, and they are taking relevance to understand how AMD develops: (1) advanced age and the exposition to environmental factors inducing high levels of oxidative stress damaging the macula and (2) this damage, which causes inflammation inducing a vicious cycle, altogether causing central vision loss. There is neither a cure nor treatment to prevent AMD. However, there are some treatments available for the wet form of AMD. This article will review some molecular and cellular mechanisms associated with the onset of AMD focusing on feasible treatments for each related factor in the development of this pathology such as vascular endothelial growth factor, oxidative stress, failure of the clearance of proteins and organelles, and glial cell dysfunction in AMD

Ocular Biocompatibility of Nitinol Intraocular Clips

Animal model of biocompatibility and tolerability of a nitinol clip prototype for intraocular surgery

Intraocular and systemic levels of vascular endothelial growth factor in advanced cases of retinopathy of prematurity

Raul Velez-Montoya1, Carmen Clapp2, Jose Carlos Rivera2, Gerardo Garcia-Aguirre1, Virgilio Morales-Cant&amp;oacute;n1, Jans Fromow-Guerra1, Jose Luis Guerrero-Naranjo1, Hugo Quiroz-Mercado31Retina Department Asociaci&amp;oacute;n para Evitar la Ceguera en M&amp;eacute;xico IAP, M&amp;eacute;xico City, M&amp;eacute;xico; 2Department of Cellular and Molecular Neurobiology, Universidad Nacional Aut&amp;oacute;noma de M&amp;eacute;xico, Quer&amp;eacute;taro, M&amp;eacute;xico; 3Department of Ophthalmology, Denver Health Medical Center, University of Colorado School of Medicine, Colorado, USAPurpose: To measure vitreous, aqueous, subretinal fluid and plasma levels of vascular &amp;shy;endothelial growth factor in late stages of retinopathy of prematurity.Methods: Interventional study. We enrolled patients with clinical diagnoses of bilateral stage V retinopathy of prematurity, confirmed by b-scan ultrasound and programmed for vitrectomy. During surgery we took samples from blood, aqueous, vitreous, and subretinal fluids. The vascular endothelial growth factor concentration in each sample was measured by ELISA reaction. A control sample of aqueous, vitreous and blood was taken from patients with congenital cataract programmed for phacoemulsification. For statistical analysis, a Mann&amp;ndash;Whitney and a Wilcoxon W test was done with a significant P value of 0.05.Results: We took samples of 16 consecutive patients who met the inclusion criteria. The vascular endothelial growth factor levels in the study group were: aqueous, 76.81 &amp;plusmn; 61.89 pg/mL; vitreous, 118.53 &amp;plusmn; 65.87 pg/mL; subretinal fluid, 1636.58 &amp;plusmn; 356.47 pg/mL; and plasma, 74.64 &amp;plusmn; 43.94 pg/mL. There was a statistical difference between the study and the control group (P &amp;lt; 0.001) in the aqueous and vitreous samples.Conclusion: Stage 5 retinopathy of prematurity has elevated intraocular levels of vascular endothelial growth factor, which remains high despite severe retinal lesion. There was no &amp;shy;statistical difference in plasma levels of the molecule between the control and study group.Keywords: VEGF, late stages, RO

Cilioretinal artery branch avulsion secondary to surgical embolectomy: management and outcome. Case report

ABSTRACT We report the trans-operative approach and short-term outcome for a patient who suffered a traumatic avulsion of the cilioretinal artery branch during the surgical management of a cilioretinal arterial branch occlusion with intraocular embolectomy. The patient underwent a pars plana vitrectomy with in situ embolectomy. The blocked artery was incised using 25 Ga vertical scissors, and embolus manipulation was performed using microsurgical forceps. During embolus extraction, the occluded cilioretinal artery and its branch were inadvertently avulsed and torn with subsequent intense bleeding. Laser and endodiathermy were used for acute hemostasis. The maneuvers created an unintended retinochoroidal anastomosis. Visual-field improvement was noted three months after the surgery. In the event of a complicated surgical embolectomy with the avulsion of the artery, the formation of a retinochoroidal anastomosis and reperfusion of the occluded artery may occur along with the improvement of the visual field in some cases

Management of orbital emphysema secondary to rhegmatogenous retinal detachment repair with hyperbaric oxygen therapy

Purpose: To describe the case of orbital subcutaneous emphysema who was successfully treated with hyperbaric oxygen therapy. Observations: Case report. Retrospective analysis of medical records and computer tomography images. A 40 years-old female, with retinal detachment who was seen at the emergency department, two weeks after undergoing a combined procedure of pars plana vitrectomy, scleral buckle and Sulfur hexafluoride tamponade. The patient complained of pain, decrease eye movement and edema of the upper eyelid. Clinical examination revealed periorbital crepitus. She was treated immediately with soft tissue decompression with small-gauge needle. Orbital emphysema recurred quickly, indicating possible gas trapped in the soft tissue. Using the US NAVY decompression protocol we were able to achieve fast clinical improvement. The protocol was repeated in several occasions until complete resolution. Conclusion and importance: Hyperbaric oxygen therapy is an effective treatment for orbital and periorbital emphysema, due to its property of helping accelerate N2 elimination from adipose tissue

Posterior capsule opacification and neovascularization treated with intravitreal bevacizumab and Nd:YAG capsulotomy

Grimelda Yuriana S&amp;aacute;nchez-Castro1, Alejandra Hitos-F&amp;aacute;jer1, Erick Mendoza-Schuster1, Raul Velez-Montoya2, Cecilio Francisco Velasco-Barona11Asociaci&amp;oacute;n para Evitar la Ceguera en M&amp;eacute;xico. Hospital &amp;ldquo;Dr. Luis S&amp;aacute;nchez Bulnes&amp;rdquo;, M&amp;eacute;xico, D.F. Ophthalmology Department &amp;ndash; Anterior Segment; 2Asociaci&amp;oacute;n para Evitar la Ceguera en M&amp;eacute;xico. Hospital &amp;ldquo;Dr. Luis S&amp;aacute;nchez Bulnes&amp;rdquo;, M&amp;eacute;xico, D.F. Ophthalmology Department &amp;ndash; Retina departmentAbstract: We reported a 75-year-old diabetic man, who developed opacification and neovascularization of the posterior capsule after extracapsular cataract extraction and posterior chamber intraocular lens implantation. The patient was treated with two injections of 2.5 mg of intravitreal bevacizumab. The treatment produced an important regression of the posterior capsular new vessels, allowing us to perform a successful Nd:YAG capsulotomy, clearing the visual axis and improving the visualization of the posterior pole. Even though, best corrected visual acuity was 20/200 due to diabetic macular edema.Keywords: posterior capsule opacification, posterior capsule neovascularization, cataract surgery, postoperative complications, intravitreal bevacizuma