Bacillus Panophthalmitis with Posterior Extension to the Prechiasmatic Optic Nerve.

A rare case of Bacillus panophthlamitis with extension to the prechiasmatic optic nerve secondary to hematogenous spreading after intravenous drug use is presented. A 27-year-old man with a recent history of trauma to the left eye presented with severe left eye pain following a binge of intravenous drug use. Visual acuity (VA) was LP. On examination he had chemosis, proptosis, elevated intraocular pressure, and a complete hyphema. CT-scan identified preseptal swelling, but no evidence of any posterior extension of the anterior process or orbital fractures. Topical and systemic therapy were initiated. On follow-up clinical examination less than 12 hours after presentation he had signs of a keratitis with worsening ophthalmoplegia and repeat imaging demonstrated posterior extension to the prechiasmatic optic nerve. Shortly after the cornea ruptured with cultures growing Bacillus. The patient underwent enucleation and has had no further progression of infection. To the best of our knowledge, this is the first report of Bacillus panophthalmitis presenting with signs of trauma with posterior extension to the prechiasmatic optic nerve.

Flat Electroretinography and Acute Visual Loss After Ocriplasmin Injection for Vitreomacular Adhesion Complicating Macular Schisis.

A 53-year-old woman with macular and diffuse retinoschisis complicated by presumed vitreomacular traction underwent unilateral intravitreal ocriplasmin injection. Within hours after injection, she noted a loss of vision and the perception of "negative" images in the treated eye. Electrophysiologic testing revealed flat waveforms, and optical coherence tomography (OCT) showed initial decreased central macular thickness at day 1, followed by massive increased macular thickness with subfoveal neurosensory retinal detachment at 1 week. Her central macular thickness on OCT slowly returned to baseline during a period of 1 month until development of a macula-off rhegmatogenous retinal detachment at 6 months after injection. The authors believe this unique case of vitreomacular adhesion and macular schisis complicated by post-injection visual loss and electroretinography changes may offer further insight into this unusual complication.

Endogenous endophthalmitis due to clinically vancomycin-resistant Staphylococcus aureus.

PURPOSE: To report a case of clinically vancomycin-resistant Staphylococcus aureus endophthalmitis. METHODS: This is an observational case report of a patient referred for decreased vision during an admission for methicillin-resistant S. aureus bacteremia. RESULTS: A 48-year-old woman with methicillin-resistant S. aureus bacteremia presented with decreased vision in one eye. Best-corrected visual acuity at presentation was 20/25 in the right eye and hand motion in the left eye. Biomicroscopic examination revealed evidence of endophthalmitis in both eyes. After a period of deterioration despite treatment with intravenous and intravitreal vancomycin and intravitreal ceftazidime-20/200 in the right eye and light perception in the left eye, an alternative treatment regimen with intravenous daptomycin and intravitreal clindamycin and amikacin led to clinical improvement in both eyes, with quiescence of anterior chamber cell and vitritis. Best-corrected visual acuity at 3 weeks of follow-up had improved to 20/40 in the right eye and remained light perception in the left eye. CONCLUSION: In cases of endogenous endophthalmitis secondary to methicillin-resistant S. aureus not responsive to intravenous and intravitreal vancomycin, particularly with borderline sensitivities, consideration to clinical resistance should be entertained.