Anterior vitrectomy and partial capsulectomy via anterior approach to treat chronic postoperative endophthalmitis

AIM:To describe the results of vitrectomy and partial capsulectomy via anterior approach surgical technique in treatment of chronic postoperative endophthalmitis (CPE). METHODS:Clinical records of 9 patients treated for CPE between 2006 and 2010 were reviewed retrospectively. All of these patients were treated with vitrectomy and partial capsulectomy via anterior approach. RESULTS:Six of 9 patients were male. The average patients’ age was (60 ±8.1) years. The average period between cataract extraction and onset of signs and symptoms was (3.6±1.3) weeks. The average presenting visual acuity was 0.3 ±0.1 and the average final post operative visual acuity was 0.7±0.2. The mean follow-up period was (28.1±8.9) weeks. In all patients, the inflammation subsided after surgery. · CONCLUSION:Our results suggest that anterior vitrectomy and partial capsulectomy via anterior approach may be considered as potentially useful and relatively less invasive technique to treat CPE.

Delayed-onset micrococcus luteus-induced postoperative endophthalmitis several months after cataract surgery:A case report

BACKGROUND Micrococcus luteus(M.luteus)-induced endophthalmitis is very rare and and may present as either acute or chronic postoperative endophthalmitis.The aim of this study was to report a case of delayed-onset M.luteus-induced endophthalmitis that occurred several months after cataract surgery.CASE SUMMARY A 78-year-old man presented with decreased vision,pain and redness in the right eye that had begun 3 days prior.He had undergone cataract surgery 4 mo prior.Visual acuity was counting fingers;slit-lamp examination revealed conjunctival injection,posterior corneal precipitates,anterior chamber inflammation(cell 4+),and hypopyon.Fundus examination revealed moderate vitreous haze.Urgent vitrectomy was performed for suspected infectious endophthalmitis,followed by vitreous irrigation with injections of antibiotics.On the postoperative day 1,anterior chamber cell decreased to 2+and hypopyon was not observed on slit lamp examination.Six days postoperatively,the patient had recurrent eye pain,and the anterior chamber cell grade increased to 4+;hypopyon recurred in the anterior chamber,and whitish plaque was observed in the lens capsule.Therefore,the patient underwent intraocular lens(IOL)and lens capsule removal,followed by vitreous irrigation,antibiotics injection,and vitrectomy.M.luteus was identified from a lens capsule culture.CONCLUSION In cases of delayed-onset M.luteus-induced endophthalmitis,early vitrectomy and removal of the IOL and lens capsule may be necessary.

A novel gatifloxacin-loaded intraocular lens for prophylaxis of postoperative endophthalmitis

Postoperative endophthalmitis(POE)has been the most threatening complication after cataract surgery,which perhaps can be solved by the antibiotic-loaded intraocular lens(IOL).However,most drug-loaded IOLs demonstrate insufficient drug quantity,short release time,increased implantation-related difficulties or other noticeable drawbacks.To prevent POE and to address these deficiencies,a drug-loaded copolymer IOL,prepared from poly(urethane acrylate)prepolymer,isobornyl methacrylate(IBOMA),N-vinyl-2-pyrrolidone(NVP),Irgacure 819,RUVA-93,and gatifloxacin(GAT),was rapidly fabricated via photocuring and by using a 3D-printed mold.This composite displayed an outstanding and controllable GAT release behavior in vitro,a high light transmittance,and a moderate refractive index.Also,it demonstrated improved strain stress and elongation compared with the reference commercial acrylic IOL material.In vivo tests demonstrated satisfying released drug concentration at the early treatment stage.In vitro and in vivo studies further confirmed the remarkable bacterial inhibition and prevention of POE by the proposed IOL,which also displayed good biocompatibility.These findings suggested that the GAT-loaded IOL could be a promising implant to prevent and cure POE,also the proposed methods could inspire more designs for various medical applications.

Nanopore techniques as a potent tool in the diagnosis and treatment of endophthalmitis:a literature review

Endophthalmitis is a serious ophthalmic disease characterized by changes in the eye's posterior segment,such as hypopyon and intraocular inflammation,vitritis being a hallmark.Infection-caused endophthalmitis can lead to irreversible vision loss,accompanied by eye pain or eye distention,and in the most severe cases the removal of the eyeball.Microorganisms such as bacteria,fungi,viruses,and parasites typically account for the disease and the entry pathways of the microbial can be divided into either endogenous or exogenous approaches,according to the origin of the etiological agents.Exogenous endophthalmitis can be derived from various occasions(such as postoperative complications or trauma)while endogenous endophthalmitis results from the bloodstream which carries pathogens to the eye.This review aims to summarize the application of new technology in pathogen identification of endophthalmitis so as to prevent the disease and better guide clinical diagnosis and treatment.

Delayed-onset endophthalmitis associated with Achromobacter species developed in acute form several months after cataract surgery:Three case reports

BACKGROUND Achromobacter species-associated endophthalmitis is rare and may present as either acute or chronic postoperative endophthalmitis.Delayed-onset Achromobacter species endophthalmitis appearing in acute presentation that develops more than several months after cataract surgery is very rare.Intraocular lens(IOL)removal is commonly recommended to treat Achromobacter species endophthalmitis,which is based on previous studies.Here,we report the results of surgery without IOL removal when treating patients with delayed-onset postoperative Achromobacter species endophthalmitis that developed in an acute form.CASE SUMMARY Three patients visited our ophthalmology clinic due to visual impairment that began 2-3 d earlier.They had undergone cataract surgery 5-18 mo prior.Bestcorrected visual acuity of the diseased eye was between counting fingers at 30 cm to non-light perception.They showed conjunctival injection,inflammation in the anterior chamber(cell reaction 4+)and hypopyon formation.The patients were diagnosed with infectious endophthalmitis and immediately underwent pars plana vitrectomy,anterior chamber irrigation and intravitreal injection of ceftazidime and vancomycin.Before fluid infusion,a vitreous specimen was obtained. In all cases, the IOLs were not removed. Achromobacter species was detected on vitreousspecimen culture. After surgery, the vitreous opacity decreased gradually and there was littleretinal damage. At 1 mo after treatment, the best-corrected visual acuity had improved to 20/50and 20/40.CONCLUSIONDelayed onset postoperative endophthalmitis caused by Achromobacter species can appear in anacute form. All patients responded well to early vitrectomy and administration of empiricalantibiotics including ceftazidime. There was no need for IOL removal during surgery.

Uveitis-glaucoma-hyphema syndrome associated with an in-the-bag square-edge intraocular lens

A 54-year-old woman presented with recurrent redness and blurred vision of the left eye with elevated intraocular pressure(IOP)for one year.She was treated as“iridocyclitis”and“Posner-Schlossman syndrome”at the local hospitals.However,the patient developed intermittent ocular inflammation and hyphema.Patient had a cataract surgery and intraocular lens(IOL)implantation in the left eye one year before at the local hospital.A diagnostic procedure was performed and the possible pathogenesis was discussed.