Cryptococcus laurentii endogenous endophthalmitis post COVID-19 infection.

A man in mid-50s presented with progressive blurred vision in his left eye for over 6 weeks. He was a known diabetic with history of COVID-19 pneumonia treated with steroids and remdesivir. He had pyelonephritis and urinary culture grown Klebsiella He was referred as a case of non-resolving vitreous haemorrhage. Visual acuity (VA) was hand movements with fundus showing dense vitritis. He underwent pars plana vitrectomy, vitreous biopsy with intraocular antibiotics (imipenem) suspecting as a case of endogenous bacterial endophthalmitis. Vitreous biopsy did not yield organisms on the smear/culture. The patient's condition worsened with perception of light and fundus showing dense vitritis with discrete yellowish white deposits on the surface of the retina. A repeat vitreous biopsy done along with intravitreal injection of voriconazole (suspecting fungal aetiology) grown fungal colonies and the organism was identified as Cryptococcus laurentii At 4-month follow-up, the VA improved to 6/24.

Aerosol generation through pars plana vitrectomy.

PURPOSE: To assess whether pars plana vitrectomy (PPV) is an aerosol-generating procedure (AGP) in an ex vivo experimental model. METHODS: In this ex vivo study on 10 porcine eyes, optical particle counter was used to measure particles ≤10 µm using cumulative mode in the six in-built channels: 0.3 µm, 0.5 µm, 1 µm, 2.5 µm, 5 µm and 10 µm aerosols during PPV. Two parts of the study were as follows: (1) to assess the pre-experimental baseline aerosol count in the theatre environment where there are dynamic changes in temperature and humidity and (2) to measure aerosol generation with 23-gauge and 25-gauge set-up. For each porcine eye, five measurements were taken for each consecutive step in the experiment including pre-PPV, during PPV, fluid-air exchange (FAX) and venting using a flute with 23-gauge set-up and a chimney with 25-gauge set-up. Therefore, a total of 200 measurements were recorded. RESULTS: With 23-gauge and 25-gauge PPV, there was no significant difference in aerosol generation in all six channels comparing pre-PPV versus PPV or pre-PPV versus FAX. Venting using flute with 23-gauge PPV showed significant reduction of aerosol ≤1 µm. Air venting using chimney with 25-gauge set-up showed no significant difference in aerosol of ≤1 µm. For cumulative aerosol counts of all particles measuring ≤5 µm, compared with pre-PPV, PPV or FAX, flute venting in 23-gauge set-up showed significant reduction unlike the same comparison for chimney venting in 25-gauge set-up. CONCLUSION: PPV and its associate steps do not generate aerosols ≤10 µm with 23-gauge and 25-gauge set-ups.