An outbreak of acute postoperative endophthalmitis after cataract surgery.

BACKGROUND: Endophthalmitis is one of the most serious complications of ophthalmic surgery, which includes postoperative cataract extraction. Outbreak of acute postoperative endophthalmitis after cataract surgery has been reported in Thailand and other countries. OBJECTIVE: To describe an outbreak of acute postoperative endophthalmitis after cataract surgery that was referred to Chiang Mai University Hospital during March 2006. MATERIAL AND METHOD: Observational case series were made from the records of inpatients and outpatients, who had been referred for treatment of acute postoperative endophthalmitis after cataract surgery at a district hospital in northern Thailand. The surgery was conducted on two consecutive days by volunteer ophthalmologists of a non-profit foundation from Bangkok. RESULTS: In this outbreak, the authors recorded 31 endophthalmitis cases, with 33 eyes (bilateral 2 cases). Of the 33 endophthalmitis eyes, 32 occurred following extracapsular cataract extraction with intraocular lens and one after the secondary intraocular lens implant. Microbiological investigations in the hospital were done with aqueous tapping, vitreous tapping, and vitreous from pars plana vitrectomy. Gram-positive cocci were detected from vitreous tapping in four eyes. Thirty-two cases were managed with intravitreous antibiotics, one with subconjunctival antibiotic only, and all eyes were treated with fortified topical antibiotics. Fifteen eyes underwent pars plana vitrectomy Assessment of visual acuity (VA) before and after treatment showed improvement in 75.8% (25/33), decrease of VA in 9.1% (3/33), while visual acuity remained stable in 15.2% (5/33). CONCLUSION: In high-volume cataract surgery, an outbreak of endophthalmitis is always possible. Prompt and appropriate treatment can improve the visual outcome.

Photodynamic therapy for AMD and non-AMD patients: one-year results in Thais.

OBJECTIVE: To evaluate the effect of photodynamic therapy (PDT) with verteporfin for age-related macular degeneration (AMD) and non-AMD in Thais, and compare with the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) and Verteporfin in Photodynamic Therapy (VIP) study. MATERIAL AND METHOD: The authors prospectively evaluated all data of 51 eyes of 51 patients who had undergone PDT and accomplished a 1-year follow up. The assessments were divided into two categories: group 1 included three subsets of AMD, and group 2 was non-AMD. The first group classified into three subgroups: group 1A: AMD with subfoveal choroidal neovascularization (CNV) and TAP/VIP compatible with recommendation guidelines characteristics, group 1B: AMD with subfoveal CNV and TAP/VIP incompatible, and group 1C: AMD with non-subfoveal CNV. The measurement outcomes comprised of the baseline characteristics, change in visual acuity, and number of treatments. RESULTS: Thirty-eight eyes had CNV-related AMD and 13 eyes were non-AMD. At the 12-month examination, the mean visual acuity change in group 1A, 1B, 1C had increased 0.19 (p = 0.077), 0.14 (p = 0.076), and 0.24 (p = 0.003), respectively. The number of treatments was 1.8 in group 1A, 2.3 in group 1B, and 1.5 in group 1C. CONCLUSION: PDT is beneficial to Thai patients with AMD at first year even if they were not compatible with TAP/VIP criteria.

Intravitreal angiostrongyliasis: report of 2 cases.

Two male patients presented with unilateral blurred vision. A small motile worm was found in the vitreous cavity in both cases. In one case, another dead, disintegrated worm was noted in the inferior portion of the vitreous cavity. On each eye, vitreous surgery was performed and the worm was removed by an aspirator. Both worms were identified as Angiostrongylus cantonensis. Since both patients had no signs of meningitis, lumbar puncture was not done. Long-term follow-up confirmed the benefit and safety of the vitreous surgery. Fluorescein angiography revealed severe pigmentary alteration, probably from inflammation of the choroid and retina due to subretinal migration of the worm prior to access into the vitreous cavity.

Comparison of intraocular pressure measured by non-contact air puff versus Goldmann applanation tonometers in gas-filled vitrectomized eyes.

OBJECTIVE: To compare intraocular pressure (IOP) measured by two different instruments, air puff tonometer (APT) versus Goldmann applanation tonometer (GAT), in gas-filled vitrectomized eyes. DESIGN: Three-month, prospective, comparative trial. PARTICIPANTS: Thirty-eight patients (38 eyes), who underwent a pars plana vitrectomy (PPV) with gas injection, were enrolled in the study. INTERVENTION: The IOP was measured by an APT, followed by GAT within 10 minutes by two different, masked investigators. MAIN OUTCOME MEASURES: IOPs were measured by two methods and then were compared. RESULTS: Overall, there was a high correlation between both measurements (r = 0.908, p < 0.05). Using the paired t-test, IOPs measured by the APT (21.69 +/- 9.28 mmHg) and GAT (22.84 +/- 9.84) were not significantly different (p > 0.05). By a subgroup analysis of 17 eyes with IOP measured by a GAT of 21 mmHg or less, the APT readings (15.28 +/- 4.81) and GAT readings (14.47 +/- 3.89) were not significantly different (p > 0.05). Of 21 eyes, with IOP measured by a GAT of 22 mmHg or more, the APT readings (26.88 +/- 8.81) were significantly lower than those obtained by the GAT (29.62 +/- 7.69) (p < 0.05). CONCLUSION: In gas-filled vitrectomized eyes, IOP measurements obtained by an APT correlated well with those obtained by GAT, especially when the IOP was within normal range. However, in eyes with elevated IOP, the APT significantly underestimated the IOP measurement when compared to the gold standard, GAT.

Epidemiology of the ocular complications of HIV infection in Chiang Mai.

OBJECTIVE: To identify the magnitude of ocular complications in HIV infection in Chiang Mai, and determine the signs or symptoms that indicate the risk factors for developing ocular complications in HIV-positive patients METHOD: A prospective study was carried out in newly diagnosed HIV-positive patients seen in the Ocular Infectious Disease Clinic of Maharaj Nakorn Chiang Mai Hospital from March 1, 2000 through February 28, 2001. A complete ophthalmic examination was performed on each patient together with a systemic evaluation of present illness and current medications. RESULTS: Three-hundred and ninety-five HIV-positive patients were seen for ophthalmic evaluation. Of these, 90 were in stage A (asymptomatic), 84 were in stage B (symptomatic), and 221 were in stage C (AIDS). Ocular complications were found in 44.6 per cent of the patients. Cytomegalovirus (CMV) retinitis was the most common ophthalmic complication (33%). Other ocular complications included cotton wool spot (8%), uveitis (4%), optic neuropathy (3%), and keratoconjunctivitis sicca (2%). The clinical presenting symptoms, which were the indicators for ocular complications and CMV retinitis, included chronic cough, oral thrush, chronic diarrhea, weight loss, wasting, and skin disorders. Ocular symptoms, which indicated a high risk of developing CMV retinitis, included flashing, floaters, and scotoma. CONCLUSIONS: Ocular complications are common in HIV-positive patients. CMV retinitis, which is a major vision-threatening problem, represented the most common finding. It is recommended that HIV-positive patients should have their eyes examined regularly, particularly when they have the clinical presenting symptoms previously mentioned. The patients should also notice early symptoms of CMV retinitis, which includes flashing, floaters, and scotoma.