A Case of Acute Endophthalmitis After 23-gauge Transconjunctival Sutureless Vitrectomy

PURPOSE: To report a case of acute endophthalmitis associated with 23-gauge transconjunctival sutureless vitrectomy and gas tamponade for macular hole surgery. CASE SUMMARY: A 66-year-old female patient who presented with a macular hole in the left eye was treated with 23-gauge transconjunctival sutureless vitrectomy. On postoperative day 2, the patient developed acute endophthalmitis and was treated with gas-fluid exchange, lensectomy and intravitreal antibiotic injection. Staphylococcus epidermidis was detected in the vitreous fluid of the operated eye. Intraoperative fundus findings showed severe retinal hemorrhage, vascular occlusion and fibrous membranes due to inflammatory response. After treatment, the patient's fundus findings markedly improved and the inflammatory response was controlled. CONCLUSIONS: Acute endophthalmitis after sutureless vitrectomy performed via intraocular gas injection may quickly result in inflammation and disease due to infection. Immediate reoperation and intravitreal antibiotic injections are recommended in such cases.

Electrooculographic Study of Latent Nystagmus

The authors analysed eleven patients with latent nystagmus who were diagnosed by clinical manifestation and electrooculography during six months. Among them, six patients had monocular amblyopia, four had binocular amblyopia and only one had normal visual acuity. All of them had manifest latent nystagmus which had a small amplitude of nystagmus in binocular fixation. Two of them showed typical latent nystagmus, jerky wave form characterized by decreasing velocity in slow phase and directing to fixing eye. Seven patients showed typical latent nystagmus wave form associated with pendular wave form and two patients showed jerky wave form with increasing velocity in slow phase. Therefore nine patients had componant of infantile nystagmus wave form. Ten of them had strabismus. Among them, five patients had hyper tropia. Three of the hypertropic patients showed dissociated vertical deviation. The authors suggest that the latent nystagmus is a kind of infantile nystagmus, and abnormal ocular conditions such as strabismus and amblyopia affects the infantile motor nystagmus.

Polaroid Photoscreening for Amblyogenic Factors

We investigate the effect of a new photoscreening camera designed to detect amblyogenic factors including strabismus, asymmetric and abnormal refractive errors and media opacities. The photoscreener uses eccentric photorefraction principles and provides two meridian photographs of the retinal reflex. Pass/fail screening data from photograph of 58 nondilated children, determined by two masked observers, were compared with data from complete ophthalmologic examinations. Photoscreener had a sensitivity rate of 92.0%, a specificity rate of 72.2%, a positive predictive value of 94.8%, a negative predictive value of 61.9% and overall agreement rate of 90.5%. The new two-flash photoscreenig camera, which uses high-speed polaroid film, is an accurate and reliable method of detecting amblyogenic factors in undilated children, and the camera promise as a useful mass screening tool.

The Refractive Change after Secondary Intraocular Lens Implantation

The authors analyzed one hundred and forty-six consecutive patients(146 eyes) receiving secondary intraocular lens implantation from May 1983 to September 1990 in respect to refractive change. The results were as follows: 1. The secondary implantation is gradually increased year by year and age range of that becomes younger than before. 2. ACL is replaced with PCL according to the introduction of transs-cleral fixation techmque. 3. The postoperative corrected visual acuity shows no difference between ACL group and PCL group. 4. The change of keratometric reading between before and after secondary IOL implantation shows 66.1% within 1 diopter. 5. The final refractive error shows no difference between ACL group and PCL group. 6. The final change of refractive error in relationsphip between with IOL power calculation and without that shows no different change. 7. The postoperative complication shows that after-cataract is the most common in PCL group and glaucoma in ACL group. The incidence of complication is not different between the two groups.

A Clinical Study of the Biconvex Posterior Chamber Lens Implantation in Cataract Surgery

One hundred and twenty-three cases of planned ECCE with biconvex posterior chamber lens implantation were performed in St. Mary's Hospital from April 1988 to February 1990, were followed up for more than 6 months. We also analyzed 123 cases of planned ECCE with convex-plano posterior chamber lens implantation during the same period. The results were as follows: 1. The difference of visual acuity between the two groups was not statistically significant. 2. Of the 123 eyes with biconvex lens, 106 eyes (86%) were within +/- 0.50 spherical equivalent diopter compared to 55 of 123 eyes (44.7%) with convex-plano lens. This difference is statistically signficant (p<.001). 3. Eight out of the 123 eyes with biconvex lens (6.5%) developed after-cataract and two of these eight eyes were of the central type: 36 out of the 123 eyes (29.3%) with convex-plano lens developed after-cataract and 31 of the these 36 eyes were of the central type. This difference is statistically significant(p<.001).