ABSTRACT
Purpose@#To investigate the predictive accuracy of refraction and any change in intraocular pressure (IOP) after transscleral fixation of intraocular lenses (IOLs) in trabeculectomized eyes with glaucoma. @*Methods@#We retrospectively reviewed the medical records of glaucoma patients who underwent trabeculectomy, followed by transscleral fixation of dislocated IOLs combined with vitrectomy. The refraction predicted by the SRK/T formula and the postoperative refraction were converted into spherical equivalents. Predictive refraction accuracies were analyzed when the differences between the two values were within ± 0.5 diopters (D) and ± 1.0 D. The IOP was measured before and after surgery. @*Results@#Eleven eyes of 11 men (mean age, 67.27 ± 10.55 years) were included. The mean axial length was 23.64 ± 1.26 mm; the mean predicted and postoperative refractions were -0.02 ± 0.46 D and -0.80 ± 0.98 D, respectively (p = 0.029). The refractive outcome was more myopic (by -0.78 ± 1.11 D) than predicted. The predictive accuracies were 36.4% and 72.7% when the differences were ± 0.5 and ± 1.0 D, respectively. The IOP did not change during follow-up (13.18 ± 4.56, 12.82 ± 5.88, and 12.73 ± 4.58 mmHg at baseline, 1 week, and 3 months, respectively). @*Conclusions@#In trabeculectomized eyes, transscleral IOL fixation did not affect the IOP, but the refractive outcome was more myopic than predicted. This difference should be considered when choosing IOL target power.
ABSTRACT
Purpose@#To evaluate the surgical outcomes of a perfluoro-n-octane (PFO)-assisted superior inverted internal limiting membrane (ILM) flap without the peeling-off technique for the treatment of a large macular hole (MH). @*Methods@#This retrospective interventional case series examined 13 eyes with a MH ≥ 400 μm. All eyes underwent 25-gauge pars plana vitrectomy. An ILM flap stained with 0.025% brilliant blue G was made in the superior area of the hole. The ILM in the temporal, nasal, and inferior areas around the hole was not peeled off. The hole was gently covered using the inverted ILM flap, which was stabilized using a small amount of PFO. Fluidair exchange was performed slowly. The small amount of residual PFO was removed by evaporation. The patients were instructed to maintain a facedown position for 1 day postoperatively. Anatomical closure of the hole and visual acuity were assessed postoperatively. @*Results@#The average hole size was 605.08 ± 102.41 μm. Nine eyes had an idiopathic MH, two exhibited age-related macular degeneration, and one each had high myopia and a traumatic MH. All eyes achieved type I closure. The foveal contour improved gradually during follow-up: 92.3% of eyes had a U-shaped fovea, and 61.5% exhibited complete recovery of the ellipsoid zone. The visual acuity improved from 0.91 to 0.55 logarithm of the minimum angle of resolution (p = 0.003). @*Conclusions@#The PFO-assisted superior inverted ILM flap without peeling-off was effective for stabilizing the flap over the hole and consequently achieving good anatomical and visual outcomes in large MHs.
ABSTRACT
Purpose@#To investigate the incidence and clinical course of acute endophthalmitis after idiopathic epiretinal membrane (iERM) surgery employing microincision vitrectomy (MIVS). @*Methods@#We retrospectively reviewed the medical records of eyes with acute endophthalmitis developing after iERM surgery via 23- or 25-gauge MIVS from 2011 to 2021. The incidence, culture-positive rate (and responsible bacteria), final visual acuity (VA), and factors affecting poor visual outcomes were assessed. @*Results@#Acute endophthalmitis developed in 20 of the 12,921 eyes (0.15%) after MIVS. Of these, 14 of 3,180 eyes treated via iERM (0.44%, one per 227 procedures) developed endophthalmitis; the incidence ratio (iERM versus non-iERM) was 7.1 (p < 0.001, 95% confidence interval [CI] = 2.6-22.7). At least one sclerotomy remained unsutured in all eyes after iERM surgery. Thirteen eyes (92.9%) were given intravitreal antibiotic injections after emergency vitrectomy, and one eye was treated with intravitreal antibiotic injection alone. Staphylococcus epidermidis was cultured from four eyes (28.6%); three strains were methicillin-resistant. All final VAs were not better than the initial VAs; the average VA decreased from 20/42 to 20/259 (p < 0.001). Six eyes (42.9%) attained legal blindness status (final VA < 20/200); Macular invasion was a unique risk factor for such blindness (p = 0.020, odds ratio = 35.0, 95% CI = 1.7-703.0). @*Conclusions@#Acute endophthalmitis developing after iERM surgery with MIVS was more common than such endophthalmitis after other retinal surgery. Approximately 40% of the former patients became legally blind, and the risk was higher in eyes with macular involvement of endophthalmitis.
ABSTRACT
Purpose@#We report bilateral, diffuse, uveal melanocytic proliferation caused by a stomach adenocarcinoma.Case summary: A 78-year-old male complained of visual impairment 3 months in duration. He had diabetes and had undergone cataract surgery on both eyes 4 years prior. His best-corrected visual acuity was counting fingers in the right eye and 20/160 in the left eye. Both intraocular pressures were normal. The anterior segments yielded no specific findings. The maculae exhibited multiple, round, patchy, pigmented or depigmented lesions with exudative retinal detachment. Fluorescein angiography revealed multiple hyperfluorescent lesions. Optical coherence tomography revealed that the hyper-reflective exudates lay between the neurosensory retina and the retinal pigment epithelium. We diagnosed bilateral, diffuse, uveal melanocytic proliferation and performed a systemic evaluation. Computed tomography revealed several mass lesions in the lung, stomach, and lymph nodes; these appeared to be malignant. An esophagogastroduodenoscopic biopsy confirmed that the lesions were adenocarcinomas. @*Conclusions@#A bilateral, diffuse, uveal melanocytic proliferation induced by a primary malignant tumor exhibited multiple, pigmented subretinal exudates associated with exudative macular retinal detachment. In patients with such findings, it is necessary to evaluate the malignant tumor status of remote organs.
ABSTRACT
Purpose@#To investigate the changes in intraocular cytokines after ranibizumab treatment in patients with polypoidal choroidal vasculopathy (PCV). @*Methods@#This multicenter, prospective study enrolled patients with PCV treated with three monthly ranibizumab followed by a pro re nata regimen for 24 weeks. Best corrected visual acuity, slit lamp examination, fundus photography, and optical coherence tomography were performed every 4 weeks. Aqueous humor was collected to measure intraocular cytokines at baseline, week 8, and the time of recurrence or week 20. The association of changes in intraocular cytokines with visual acuity, central macular thickness, central choroidal thickness, area of abnormal vessels, and polyp closure was assessed. @*Results@#This study included 25 eyes. The mean patient age was 70.3 ± 6.1 years. The vascular endothelial growth factor (VEGF) concentration decreased at week 8, but only interferon (IFN)-γ, tissue inhibitors of matrix metalloproteinases (TIMP)-2, and monocyte chemoattractant protein (MCP)-2 decreased at the time of recurrence. The recurrence interval was positively associated with the baseline epithelial-neutrophil activating peptide (ENA)-78, interleukin (IL)-17, leptin, and transforming growth factor-β1, and baseline central macular thickness was positively correlated with the baseline fibroblast growth factor-4 and IL-10. Thick central choroidal thickness was associated with a low basic fibroblast growth factor and high IFN-γ at baseline. The MCP-3 and Tie-2 levels decreased in two eyes with polyp closure. @*Conclusions@#Ranibizumab significantly reduced intraocular VEGF concentrations and consequently improved PCV. However, the cytokines IFN-γ, TIMP-2, and MCP-2, rather than VEGF, were associated with PCV recurrence. Further studies of intraocular cytokines involved in neovascularization in PCV are needed.
ABSTRACT
Purpose@#To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors. @*Methods@#The medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis. @*Results@#Multiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD. @*Conclusions@#Multiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.
ABSTRACT
Purpose@#To report complications requiring surgical management related to intravitreal dexamethasone implant. @*Methods@#The medical records of patients who received intravitreal dexamethasone implant injection from June 2013 to March 2020 were reviewed retrospectively. Patients who had undergone intraocular surgical management within 6 months after implant injection, with the exception of cataract surgery, were included. Of them, only the cases in which the surgery was definitely related to complications with the Ozurdex implant were included. In these patients, underlying disease, intraocular pressure change, and the number of injections were analyzed. @*Results@#A total of 1,168 injections of 473 eyes (439 patients) were enrolled in the study. The mean number of injections was 2.5 per eye. The mean age was 61.4 ± 11.3 years. The complications requiring an additional surgical procedure occurred in six (0.5%) injections. Of them, four, one, and one eyes showed uveitis, diabetic macular edema, and branch retinal vein occlusion, respectively. Surgical management was performed to control the increased intraocular pressure in two eyes, inappropriate implant location in two eyes, scleral wound leakage in one eye, and retinal detachment in one eye. The incidence of severe complications requiring surgical management was high in cases with a history of previous vitrectomy (p = 0.007, Fisher’s exact test) and uveitis (p = 0.007, Fisher’s exact test). @*Conclusions@#Severe complications requiring surgical management occurred in 0.5% of cases (six cases) after intravitreal dexamethasone implant injections. These complications were related to a history of previous vitrectomy and uveitis. Five eyes recovered to favorable visual function after surgery, with the exception of one eye with retinal detachment.
ABSTRACT
Purpose@#To report the effect of an intravitreal dexamethasone implant on refractory posterior scleritis. @*Methods@#The medical records of patients treated with an intravitreal dexamethasone implant for non-infectious refractory posterior scleritis were retrospectively reviewed, including age, sex, duration of follow-up, and presence of associated systemic diseases. The duration until relapse, changes in visual acuity, number of implants, and side effects associated with the implant were also analyzed. @*Results@#Seven eyes from five patients were included. The mean age was 73.2 ± 12.5 years (59-92 years). Although all patients had been treated with high-dose systemic steroid, and immunosuppressants were added, the posterior scleritis was poorly controlled. The duration from the diagnosis to the first dexamethasone implant was a mean of 8.2 months (3-27 months). The scleritis was well controlled in all eyes until at least 2 months (2-5 months) after inserting the implant. An average of 2.1 (total of 15 times in the seven eyes) implants were inserted. No complications related to the implant were observed other than a temporary increase in intraocular pressure in one eye. @*Conclusions@#Intravitreal dexamethasone implants were an effective treatment option for refractory posterior scleritis.
ABSTRACT
Purpose@#We report a case of infectious scleritis featuring kissing choroidal detachment and serous retinal detachment.Case summary: A 65-year-old female presented with ocular pain and hyperemia of the right eye 1 week in duration. Anterior chamber inflammation was evident. After pterygium excision, a thinned sclera and loss of conjunctiva around a necrotic lesion were observed. Necrotizing scleritis with anterior uveitis was diagnosed and topical and systemic steroids commenced. After 1 week, the scleral thickness increased, but conjunctival injection and choroidal detachment were newly noticed. Infectious scleritis was suspected and the pterygium excision site cultured. Although empirical antibiotics (fortified ceftazidime and tobramycin) were prescribed, the choroidal and serous retinal detachments became aggravated. Pseudomonas aeruginosa was identified on scleral culture, and topical piperacillin/tazobactam and systemic cefepime (2 g) commenced. Although the antibiotics were appropriate, the choroidal and serous retinal detachments became further aggravated. Necrotic tissue was subjected to surgical debridement. Two days later, the infectious signs had diminished and a systemic steroid was added. Over the next few weeks, all of the choroidal and serous retinal detachments, and the infectious signs, improved. @*Conclusions@#Patients with infectious scleritis featuring severe choroidal detachment and serous retinal detachment resistant to appropriate antibiotics may require surgical debridement of necrotic tissue. After controlling the infectious signs, systemic steroids should be considered to ensure a good prognosis.
ABSTRACT
Purpose@#To determine the incidence and characteristics of iatrogenic retinal breaks in patients who underwent 25-gauge vitreous surgery for macular hole and idiopathic epiretinal membrane, with a comparison and analyses of surgical records and preoperative data, including wide-angle fundus imaging and indirect ophthalmoscopic examination findings. @*Methods@#The medical records were analyzed retrospectively for 82 macular hole eyes and 285 epiretinal membranes that underwent vitrectomy at our hospital from January 2016 to December 2019. The number and location of retinal breaks observed in preoperative fundus examination and wide-angle fundus imaging were compared with those indicated in the surgical records. The presence of retinal breaks and retinal lattice degeneration was investigated, and the relationship of each factor with respect to posterior vitreous detachment (PVD) was examined. @*Results@#Of the 367 eyes that underwent vitrectomy, six eyes (1.6%) developed iatrogenic retinal breaks. Thirty-four eyes (9.3%) had retinal breaks before surgery. Retinal break was found in 15 (4.1%) eyes, retinal lattice degeneration was indicated in 32 eyes (8.7%), and PVD occurred in 261 eyes (71.1%). The association of iatrogenic retinal break and PVD was not confirmed. An additional 14 preoperative breaks, not seen in indirect ophthalmoscopic examination, were identified in wide-angle fundus images. @*Conclusions@#It was found that 25-gauge vitrectomy-related iatrogenic retinal breaks occurred at a lower frequency than previously reported for 20-gauge vitrectomy procedures. Wide-angle fundus imaging was able to identify retinal breaks more accurately than conventional research methods.
ABSTRACT
Purpose@#To report a case of unilateral progressive atypical acute zonal outer retinitis in a healthy young female.Case summary: A 32-year-old healthy woman presented with visual disturbance in the left eye for 1 week. Best corrected visual acuity was 0.4 in the left eye. No abnormal findings were detected on brain magnetic resonance imaging and a laboratory work-up. Zonal retinal opacity around the optic nerve disc was noticed in a fundus photo which was consistent with the outer retinal signal defect on optical coherence tomography and a defect in the central visual field from perimetry. Multiple evanescent white dot syndrome was suspected based on fluorescein angiography and indocyanine green angiography. Prednisolone was prescribed. Visual acuity was reduced to hand-motion after 10 days with extended zonal retinal opacity. No virus was detected by multiplex polymerase chain reaction of the aqueous humor. The lesion did not improve despite high-dose intravenous steroid and antiviral treatment. @*Conclusions@#Visual function was lost with the progression of outer retinitis. This case differed from previous cases as the outer retinitis progressed rapidly from the posterior pole to the peripheral retina. It was named fulminant progressive atypical acute zonal outer retinitis.
ABSTRACT
Purpose@#To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors. @*Methods@#The medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis. @*Results@#Multiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD. @*Conclusions@#Multiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.
ABSTRACT
Purpose@#To report complications requiring surgical management related to intravitreal dexamethasone implant. @*Methods@#The medical records of patients who received intravitreal dexamethasone implant injection from June 2013 to March 2020 were reviewed retrospectively. Patients who had undergone intraocular surgical management within 6 months after implant injection, with the exception of cataract surgery, were included. Of them, only the cases in which the surgery was definitely related to complications with the Ozurdex implant were included. In these patients, underlying disease, intraocular pressure change, and the number of injections were analyzed. @*Results@#A total of 1,168 injections of 473 eyes (439 patients) were enrolled in the study. The mean number of injections was 2.5 per eye. The mean age was 61.4 ± 11.3 years. The complications requiring an additional surgical procedure occurred in six (0.5%) injections. Of them, four, one, and one eyes showed uveitis, diabetic macular edema, and branch retinal vein occlusion, respectively. Surgical management was performed to control the increased intraocular pressure in two eyes, inappropriate implant location in two eyes, scleral wound leakage in one eye, and retinal detachment in one eye. The incidence of severe complications requiring surgical management was high in cases with a history of previous vitrectomy (p = 0.007, Fisher’s exact test) and uveitis (p = 0.007, Fisher’s exact test). @*Conclusions@#Severe complications requiring surgical management occurred in 0.5% of cases (six cases) after intravitreal dexamethasone implant injections. These complications were related to a history of previous vitrectomy and uveitis. Five eyes recovered to favorable visual function after surgery, with the exception of one eye with retinal detachment.
ABSTRACT
Purpose@#To report the effect of an intravitreal dexamethasone implant on refractory posterior scleritis. @*Methods@#The medical records of patients treated with an intravitreal dexamethasone implant for non-infectious refractory posterior scleritis were retrospectively reviewed, including age, sex, duration of follow-up, and presence of associated systemic diseases. The duration until relapse, changes in visual acuity, number of implants, and side effects associated with the implant were also analyzed. @*Results@#Seven eyes from five patients were included. The mean age was 73.2 ± 12.5 years (59-92 years). Although all patients had been treated with high-dose systemic steroid, and immunosuppressants were added, the posterior scleritis was poorly controlled. The duration from the diagnosis to the first dexamethasone implant was a mean of 8.2 months (3-27 months). The scleritis was well controlled in all eyes until at least 2 months (2-5 months) after inserting the implant. An average of 2.1 (total of 15 times in the seven eyes) implants were inserted. No complications related to the implant were observed other than a temporary increase in intraocular pressure in one eye. @*Conclusions@#Intravitreal dexamethasone implants were an effective treatment option for refractory posterior scleritis.
ABSTRACT
Purpose@#We report a case of infectious scleritis featuring kissing choroidal detachment and serous retinal detachment.Case summary: A 65-year-old female presented with ocular pain and hyperemia of the right eye 1 week in duration. Anterior chamber inflammation was evident. After pterygium excision, a thinned sclera and loss of conjunctiva around a necrotic lesion were observed. Necrotizing scleritis with anterior uveitis was diagnosed and topical and systemic steroids commenced. After 1 week, the scleral thickness increased, but conjunctival injection and choroidal detachment were newly noticed. Infectious scleritis was suspected and the pterygium excision site cultured. Although empirical antibiotics (fortified ceftazidime and tobramycin) were prescribed, the choroidal and serous retinal detachments became aggravated. Pseudomonas aeruginosa was identified on scleral culture, and topical piperacillin/tazobactam and systemic cefepime (2 g) commenced. Although the antibiotics were appropriate, the choroidal and serous retinal detachments became further aggravated. Necrotic tissue was subjected to surgical debridement. Two days later, the infectious signs had diminished and a systemic steroid was added. Over the next few weeks, all of the choroidal and serous retinal detachments, and the infectious signs, improved. @*Conclusions@#Patients with infectious scleritis featuring severe choroidal detachment and serous retinal detachment resistant to appropriate antibiotics may require surgical debridement of necrotic tissue. After controlling the infectious signs, systemic steroids should be considered to ensure a good prognosis.
ABSTRACT
Purpose@#To determine the incidence and characteristics of iatrogenic retinal breaks in patients who underwent 25-gauge vitreous surgery for macular hole and idiopathic epiretinal membrane, with a comparison and analyses of surgical records and preoperative data, including wide-angle fundus imaging and indirect ophthalmoscopic examination findings. @*Methods@#The medical records were analyzed retrospectively for 82 macular hole eyes and 285 epiretinal membranes that underwent vitrectomy at our hospital from January 2016 to December 2019. The number and location of retinal breaks observed in preoperative fundus examination and wide-angle fundus imaging were compared with those indicated in the surgical records. The presence of retinal breaks and retinal lattice degeneration was investigated, and the relationship of each factor with respect to posterior vitreous detachment (PVD) was examined. @*Results@#Of the 367 eyes that underwent vitrectomy, six eyes (1.6%) developed iatrogenic retinal breaks. Thirty-four eyes (9.3%) had retinal breaks before surgery. Retinal break was found in 15 (4.1%) eyes, retinal lattice degeneration was indicated in 32 eyes (8.7%), and PVD occurred in 261 eyes (71.1%). The association of iatrogenic retinal break and PVD was not confirmed. An additional 14 preoperative breaks, not seen in indirect ophthalmoscopic examination, were identified in wide-angle fundus images. @*Conclusions@#It was found that 25-gauge vitrectomy-related iatrogenic retinal breaks occurred at a lower frequency than previously reported for 20-gauge vitrectomy procedures. Wide-angle fundus imaging was able to identify retinal breaks more accurately than conventional research methods.
ABSTRACT
Purpose@#To report a case of unilateral progressive atypical acute zonal outer retinitis in a healthy young female.Case summary: A 32-year-old healthy woman presented with visual disturbance in the left eye for 1 week. Best corrected visual acuity was 0.4 in the left eye. No abnormal findings were detected on brain magnetic resonance imaging and a laboratory work-up. Zonal retinal opacity around the optic nerve disc was noticed in a fundus photo which was consistent with the outer retinal signal defect on optical coherence tomography and a defect in the central visual field from perimetry. Multiple evanescent white dot syndrome was suspected based on fluorescein angiography and indocyanine green angiography. Prednisolone was prescribed. Visual acuity was reduced to hand-motion after 10 days with extended zonal retinal opacity. No virus was detected by multiplex polymerase chain reaction of the aqueous humor. The lesion did not improve despite high-dose intravenous steroid and antiviral treatment. @*Conclusions@#Visual function was lost with the progression of outer retinitis. This case differed from previous cases as the outer retinitis progressed rapidly from the posterior pole to the peripheral retina. It was named fulminant progressive atypical acute zonal outer retinitis.
ABSTRACT
Purpose@#To report a case of Streptococcus infantarius endophthalmitis related to the use of a XEN® Gel Stent.Case summary: A 75-year-old male was referred to our practice with a diagnosis of endophthalmitis 55 days after XEN® Gel Stent implantation. He had primary open-angle glaucoma. Visual acuity was 20/50. Slit-lamp examination revealed conjunctival injection and anterior chamber inflammation with hypopyon. Fundus examination showed inflammatory cells with exudative materials in the vitreous. The aqueous sampling for culture of causative micro-organisms was followed by removal of the XEN® Gel Stent, along with anterior chamber irrigation and intracameral and intravitreal injection of antibiotics. Streptococcus infantarius was isolated after 5 days. Vitrectomy, anterior chamber lavage, and intravitreal injection of antibiotics were additionally performed to control the intraocular inflammation. Sixteen days after vitrectomy, the intraocular inflammation disappeared. The choroidal detachment was resolved 34 days after vitrectomy. Visual improvement was limited to 20/100 at 6 months. @*Conclusions@#XEN® Gel Stent-related bacterial endophthalmitis was successfully treated by implant removal, vitrectomy, and proper intraocular antibiotic treatment.
ABSTRACT
Purpose@#Here, we report a case of acute noninfectious endophthalmitis after removal of silicone oil (SO) and posterior capsulectomy in a patient with proliferative diabetic retinopathy.Case summary: SO removal and posterior capsulectomy were performed in a 61-year-old man who had undergone vitrectomy with combined cataract surgery, membrane peeling, laser photocoagulation, and SO injection to treat vitreous hemorrhage and tractional retinal detachment three months previously. The patient’s best-corrected visual acuity on the day after surgery was 20/50; it decreased to hand motion at five days after SO removal. Exudative membrane with hypopyon, anterior chamber cell (trace), and mild conjunctival injection were observed. The patient did not complain of ocular pain. Topical steroid was applied following a diagnosis of postoperative noninfectious endophthalmitis. The exudative membrane and hypopyon decreased after three days of treatment and had resolved completely after one month of treatment. The patient’s visual acuity improved to 20/50. @*Conclusions@#Noninfectious endophthalmitis can develop after removal of SO and posterior capsulectomy. Topical steroid treatment is effective in such cases.
ABSTRACT
Purpose@#To report a case of poor visual prognosis complicated by residual subretinal fluid after use of the internal limiting membrane flap technique to treat macular hole retinal detachment in a patient with high myopia.Case summary: A 55-year-old male stated that he had experienced a transparent circle in the central visual field of the right eye for 1 month. His best-corrected visual acuity (BCVA) was 0.32 and the axial length of the right eye was 32.57 mm. Fundus examination revealed a macular hole with retinal detachment localized to the posterior pole. We performed vitrectomy, membrane peeling, internal limiting membrane peeling with inverted internal limiting membrane flap, and silicone oil injection. On day 1 after surgery, the macular hole was closed, but subretinal fluid was noticed in the macula. At 3 months after surgery, the BCVA was 0.16 and the silicone oil was removed. At 14 months after the first surgery, the subretinal fluid was completely absorbed, but leopard-pattern pigment degeneration became prominent and the macula exhibited ellipsoid zone disruption. The BCVA decreased to 0.1. @*Conclusions@#In patients exhibiting macular hole retinal detachment in the context of high myopia, an inverted internal limiting membrane flap may increase the macular hole closure rate but disturb subretinal fluid drainage. As persistent subretinal fluid may cause permanent retinal damage with a poor visual prognosis, the surgical method must be carefully chosen.