Propionibacterium endophthalmitis

This is the first report of a Propionibacterium acnes endophthalmitis in Saudi Arabia. The case displayed all characteristic features of this disease entity, including delayed onset following cataract extraction with implantation of an intraoccular lens, delay in diagnosis, intermittent response to corticosteroid therapy alone, typical clinical appearance including a white capsular plaque and vitreitis, delayed growth of the organism on culture, and good recovery of visual function following appropriate treatment. A novel approach to the latter was chosen: higher concentrations of the antibiotics [vancomycin, clindamycin, and gentamicin] were injected into the anterior chamber than into the vitreous cavity, the purpose being to achieve maximal concentrations in the region of the intraoccular lens and capsular plaque. With a follow-up of more than a year without recurrence, a cure may be assumed. Regarding the postoperative inflammatory reaction with cystoid macular edema that was observed in the second eye, an infectious etiology can only be ruled out after further follow-up

Trabeculectomy with a scleral wing flap

The limbus is a critical area in ocular surgery, particularly glaucoma surgery. Surgical invasion of the external limbus in trabeculectomy weakens the insertion of the conjunctiva and disinserts tenon's capsule in limbus flap, and approximates conjunctival and scleral wounds in fornix-based flaps. This may lead to complications like leakage, buttonholing, Dellen formation, corneal dissection of bleb, thin-walled, cystic, and overhanging blebs. These complications are less likely to occur when the shape of the scleral flap is modified, giving it lateral extensions, "wings", resulting in an incision that reaches the scleral surface behind the sclero-corneal junction, yet can be carried forward into clear cornea for the internal wound lip

Closed chamber endocapsular lens implantation with the lens loop injector

Endocapsular cataract surgery has been ignored by ophthalmic surgeons until recently when increased emphasis on in-the-bag implantation has made this technique more attractive. We describe a safe and simple method for performing endocapsular cataract surgery and lens implantation that requires no sophisticated equipment and can be mastered by all microsurgeons. Adherence to a strict closed chamber technique and use of the lens loop injector allows lens implantation into the bag routinely without using visco-elastic substances. While this operation may appear difficult to the beginning surgeon, it soon becomes apparent that almost every step is easier to perform with less tissue trauma than in standard endocapsular extraction [ECCE]. Above all, it gives the surgeon superior control throughout the procedure