ABSTRACT
Purpose: To assess the fluoroquinolone resistance pattern and trends among bacterial isolates from ocular infections over a 16?year period and explore alternative antibiotics in fluoroquinolone?resistant strains. Methods: In this retrospective, longitudinal study, the microbiology laboratory records of patients with different ocular infections diagnosed at an eye institute in central India from 2005–2020 were reviewed to determine the pattern of fluoroquinolone (ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin) resistance. Antibiotic susceptibility testing was done using the Kirby–Bauer disc diffusion method. Results: In 725 Gram?positive bacteria, the resistance of ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin was 55.9% (95% confidence interval [CI]: 52.2 – 59.6), 42.7% (95% CI: 39.0 – 46.4), 47.6% (95% CI: 43.9 – 51.3), and 45.6% (95% CI: 41.7–49.5), respectively. In 266 Gram?negative bacteria, the resistance of ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin was 57.9% (95% CI: 51.9 – 63.9), 56.0% (95% CI: 49.7 – 62.1), 59.9% (95% CI: 53.8 – 66.0), and 74.3% (95% CI: 68.3 – 80.2), respectively. A declining trend in resistance to ciprofloxacin (P < 0.001), ofloxacin (P < 0.001), and moxifloxacin (P < 0.001) was seen in Gram?positive bacteria, whereas a reduction in resistance to only moxifloxacin (P = 0.04) was seen in Gram?negative bacteria. In fluoroquinolone?resistant Gram?positive bacteria, cefuroxime exhibited the highest susceptibility, whereas in fluoroquinolone?resistant Gram?negative bacteria, colistin exhibited the highest susceptibility. Conclusion: Fluoroquinolone resistance was high among bacteria from ocular infections in central India, but a declining trend in resistance to some of the fluoroquinolones was observed in recent times. Cefuroxime and colistin emerged as alternatives in fluoroquinolone?resistant Gram?positive and Gram?negative bacterial infections, respectively.
ABSTRACT
Purpose: To evaluate the impact of comprehensive eye examination in identifying the ocular co?morbidities in patients presenting for cataract surgery through the community screening program. Methods: This was a hospital?based retrospective cross?sectional descriptive study in a tertiary eye care institute. Comprehensive eye examination was performed for all patients screened for cataract surgery through the out?reach activities. Patients suspected to have any ocular co?morbidity were revaluated by sub?specialty trained ophthalmologists, and further management was planned. The demographic details of patients, sub?specialty consultation, final diagnosis, and type of the treatment received by these patients were recorded. Results: During the study period, 4022 patients were referred to the base hospital for cataract surgery, of whom 922 (22.9%) needed a specialist opinion. Glaucoma (238) and retinal disorders (232) constituted half (51%) of these referrals. There were 313 (33.9%) patients having co?morbidities because of corneal, oculoplastic, and neuro?ophthalmic conditions. After specialist review, 397 (43.1%) patients underwent only cataract surgery, 55 patients (5.9%) underwent combined surgeries, and 168 (18.2%) patients underwent other procedures. Cataract surgery was not performed in 470 (50.9%) patients, of which 302 were prescribed glasses or managed medically. Conclusion: All patients screened for cataract surgery through out?reach programs require a comprehensive eye examination to identify ocular diseases other than cataract. Provisions must be made for providing alternative or additional treatment in those with various ocular co?morbidities.
ABSTRACT
Background: Intraocular foreign body (IOFB) removal becomes tricky if its large and impacted in the ocular coats. When confronted with such a combination, the vitreoretinal surgeon will need to modify the surgical plan. This surgical video describes one of such situation encountered during removal of a long wooden IOFB impacted in the ocular coats. Purpose: The video describes a scenario when the surgeon becomes aware that injury to ocular structure is inevitable due to inherent length of the IOFB. However, a careful assessment of the situation helps the surgeon to identify how he could minimize the damage to the eye and not put vision at risk. Synopsis: A young boy presented with painful loss of vision in left eye since 15 days. Examination showed BCVA of 20/32 and limitation movement in up gaze. Fundus showed hazy media and an IOFB in superior quadrant. It was noted that IOFB was moving with eye movement. The impaction in sclera and extraocular extension was suspected. After pars plana vitrectomy, it was observed that IOFB was longer than what was measured by the scan and it was impacted in the coats. Removal using IOFB forceps further pulled the IOFB into vitreous cavity. A rectangular scleral window was created, IOFB was pushed towards opposite pars plana region to avoid injury to macula, optic nerve, lens and peripheral retina. The IOFB was then removed.The retinal tears were lasered. Three months following the surgery, he developed cataract, which needed surgery. His BCVA at the last follow up visit was 20/25 with attached retina. Highlights: 1. Limitation of movement in presence of linear IOFB shall raise a suspicion of IOFB being impacted in coats and possibility of its extraocular extension; 2.An oblique IOFB posterior to limbus, can have length more in transverse diameter of the eyeball. Though rarely used, an ab?externo approach can be a viable option in such a case to minimise injury to vital structure of the eye, particularly if the IOFB is severely impacted in sclera.
ABSTRACT
A 34‑year‑old female presented with firecracker injury with curved metallic foreign body embedded in the left orbit and protruding out through the upper eyelid. The report highlights notable aspects in diagnosis, decision‑making, and successful removal of this unusual case of retro‑orbital foreign body.