Subacute Methicillin-resistant Coagulase-Negative Staphylococcus hominis Endophthalmitis after Penetrating Keratoplasty Re-operation

Purpose@#To report a case of subacute methicillin-resistant coagulase-negative Staphylococcus hominis endophthalmitis after re-operation for penetrating keratoplasty in a patient who had a penetrating keratoplasty rejection.Case summary: A 74-year-old man with underlying diabetes and hypertension who underwent bilateral penetrating keratoplasty at another hospital underwent penetrating keratoplasty reoperation due to corneal transplant rejection in the right eye. He had a history of end-stage glaucoma in the right eye and the visual acuity was finger counting at 30 cm. About 25 days postoperatively, the corneal epithelial defect was first found. Treatment based on suspicion of herpes simplex virus infection did not result in improvement and endophthalmitis was suspected in the right eye about 35 days after surgery. Anterior chamber irrigation, pars planar vitrectomy, and intravitreal antibiotic injection were performed. Culture revealed methicillin-resistant coagulase negative Staphylococcus hominis. After 2 months of treatment, the anterior chamber and vitreous inflammation decreased and best corrected visual acuity in the right eye recovered to 0.06. @*Conclusions@#Subacute endophthalmitis caused by methicillin-resistant coagulase-negative Staphylococcus may occur after penetrating keratoplasty. Transplant failure due to infection can be avoided with vitrectomy and antibiotic treatment at the right time.

Changes in Tear Volume after 3% Diquafosol Treatment in Patients with Dry Eye Syndrome: An Anterior Segment Spectral-domain Optical Coherence Tomography Study

PURPOSE: To evaluate changes in the tear meniscus area and tear meniscus height over time in patients with dry eye syndrome, using anterior segment spectral-domain optical coherence tomography after the instillation of 3% diquafosol ophthalmic solution. METHODS: Sixty eyes from 30 patients with mild to moderate dry eye syndrome were included. Tear meniscus images acquired by anterior segment spectral-domain optical coherence tomography were analyzed using National Institutes of Health's image-analysis software (ImageJ 1.44p). Tear meniscus area and tear meniscus height were measured at baseline, 5 minutes, 10 minutes, and 30 minutes after instillation of a drop of diquafosol in one eye and normal saline in the other eye. Changes in ocular surface disease index score, tear film break-up time, corneal staining score by Oxford schema, and meibomian expressibility were also evaluated at baseline, and after 1 week and 1 month of a diquafosol daily regimen. RESULTS: Sixty eyes from 30 subjects (mean age, 29.3 years; 8 men and 22 women) were included. In eyes receiving diquafosol, tear volume was increased at 5 and 10 minutes compared with baseline. It was also higher than saline instilled eyes at 5, 10, and 30 minutes. Changes in tear volume with respect to baseline were not statistically different after the use of diquafosol for 1 month. Ocular surface disease index score, tear film break-up time, and Oxford cornea stain score were significantly improved after 1 week and 1 month of daily diquafosol instillation, but meibomian expressibility did not change. CONCLUSIONS: Topical diquafosol ophthalmic solution effectively increased tear volume for up to 30 minutes, compared to normal saline in patients with dry eye syndrome.

Surgical outcomes of 2 3-gauge vitrectomy for the management of lens fragments dropped into the vitreous cavity during cataract surgery

To assess the clinical features and surgical outcomes of 23-Gauge [G] vitrectomy for lens fragments dropped into the vitreous during cataract surgery. A retrospective, non-comparative, interventional case series at a single medical center. The medical records of 45 eyes from 45 consecutive patients who were referred to our hospital for surgical retrieval of phacoemulsification dropped lens fragments and who underwent 23-G vitrectomy were retrospectively reviewed. Data pertaining to patient demographics, pre- and post-operative Snellen visual acuity, and postoperative complications were recorded. Factors associated with dropped lens fragments were also examined. Mean patient age was 68.18 +/- 11.47 years. The preoperative and postoperative mean logarithm of minimum angle of resolution [logMAR] visual acuity was 1.91 +/- 0.59 [Snellen equivalent 0.06 +/- 0.15] and 0.42 +/- 0.51 [Snellen equivalent 0.54 +/- 0.31], respectively. Forty-two eyes [93.3%] had dislocated lens fragments <50% of the total lens size. Two eyes [4.4%] had a large and hard lens nucleus, which necessitated the use of a 20-G fragmatome to efficiently and completely remove the lens material. At the final examination, 30 eyes [66.6%] had a visual acuity better than 20/40. Post-vitrectomy complications included elevated IOP for at least 3 months [n = 5 eyes, 11.1%], intraocular lens dislocation [n = 2 eyes, 4.4%], and cystoid macular edema [n = 1 eye, 2.2%]. No cases of postoperative endophthalmitis or retinal detachment were observed. A 23-G vitrectomy is safe and efficient for the surgical management of dropped lens fragments following cataract surgery

Comparison of the Outcome of Silicone Ahmed Glaucoma Valve Implantation with a Surface Area between 96 and 184 mm2 in Adult Eyes

PURPOSE: To compare the success rates, complications, and visual outcomes between silicone Ahmed glaucoma valve (AGV) implantation with 96 mm2 (FP8) or 184 mm2 (FP7) surface areas. METHODS: This study is a retrospective review of the records from 132 adult patients (134 eyes) that underwent silicone AGV implant surgery. Among them, the outcomes of 24 eyes from 24 patients with refractory glaucoma who underwent FP8 AGV implantation were compared with 76 eyes from 76 patients who underwent FP7 AGV implantation. Preoperative and postoperative data, including intraocular pressure (IOP), visual acuity, number of medications, and complications were compared between the 2 groups. RESULTS: There were no significant differences in baseline characteristics between the 2 groups (p > 0.05). The postoperative visual acuity of the patients in the FP8 group was better than that of the patients in the FP7 group in some early postoperative periods (p 0.05). Postoperative IOP was not significantly different between the 2 groups (p > 0.05) except for IOP on postoperative day 1 (11.42 mmHg for the FP7 group and 7.42 mmHg for the FP8 group; p = 0.031). There was no statistical difference in success rates, final IOP, number of medications, or complication rates between the 2 groups (p > 0.05). CONCLUSIONS: The FP7 and FP8 AGV implants showed no difference in terms of vision preservation, IOP reduction, and number of glaucoma medications required.

The Efficacy of Intravitreal Bevacizumab Injection in Patients with Acute Central Serous Chorioretinopathy

PURPOSE: To evaluate the efficacy of intravitreal bevacizumab injection (IVB) in acute central serous chorioretinopathy. METHODS: Retrospective chart review of 87 eyes of 80 patients. They received intravitreal bevacizumab injection (n = 40) and observed without any treatment or any medication (n = 47) for initial treatment of acute CSC. Patient demographics and best-corrected visual acuity (BCVA), central macular thickness (CMT) at baseline were analyzed. Then we had regular follow-ups of BCVA and CMT. RESULTS: All patients showed improvement in visual acuity and resolution of subretinal fluid following treatment. In the bevacizumab-treated group, the mean BCVA improved from 0.22 +/- to 0.11, mean CMT fell from 361.33 to 185.33 (microm) and recurrence rate was 47%. The conservative-treated group showed an improvement in BCVA from 0.23 at baseline to 0.14, mean CMT fell from 349.65 to 193.41 (microm) and recurrence rate was 70% (p = 0.130, p = 0.908 and p = 0.030, respectively). However, the change of BCVA and CMT of 2 groups showed no differences at any follow-up visit. Recurrence rate was significantly low in bevacizumab-treated group. CONCLUSIONS: The bevacizumab-treated group had relatively low rates of recurrence in acute CSC patients compared to the observation group. However, intravitreal bevacizumab showed no positive effect in BCVA and CMT of acute CSC patients compared to the observation group. Further investigation will be helpful to understand this therapy in patients with CSC.