Spectral-domain optical coherence tomography findings in acute retinal pigment epitheliitis.

PURPOSE: To report new findings revealed by spectral-domain optical coherence tomography in a patient with bilateral acute retinal pigment epitheliitis. METHODS: A patient presented with bilateral central scotoma and clinical and angiographic findings consistent with acute retinal pigment epitheliitis. Spectral-domain optical coherence tomography was performed at presentation and throughout follow-up. RESULTS: Early spectral-domain optical coherence tomography showed hyperreflectivity throughout the full thickness of the foveola, suggesting a full-thickness foveal inflammatory disorder. Later images provide insight into the natural course of acute retinal pigment epitheliitis and eventually showed a small outer retinal defect similar to that reported in some patients with macular microhole or foveal red spot. CONCLUSION: Acute retinal pigment epitheliitis is a macular inflammatory disorder that can involve the full thickness of the fovea and underlying retinal pigment epithelium and may result in a small defect in the outer retina similar to that reported in some patients with macular microhole or foveal red spot.

Chronic postoperative fungal endophthalmitis caused by trichosporon asahii.

PURPOSE: To describe a patient with chronic postoperative fungal endophthalmitis caused by Trichosporon asahii. METHODS: A retrospective case report. RESULTS: An 82-year-old woman was found to have culture-proven T. asahii chronic fungal endophthalmitis with initial symptoms beginning 18 months after uneventful phacoemulsification with intraocular lens implantation. Successful treatment was achieved with pars plana vitrectomy, capsulectomy, and oral voriconazole without explantation of the intraocular lens. CONCLUSION: This is the first reported case of chronic postoperative T. asahii endophthalmitis. Our patient was successfully treated with pars plana vitrectomy, capsulectomy, and oral voriconazole without explantation of the intraocular lens.

Vitreous penetration of orally administered famciclovir.

PURPOSE: To determine the vitreous penetration of penciclovir (Denavir; GlaxoSmithKline, Philadelphia, Pennsylvania, USA) after oral administration of the prodrug famciclovir (Famvir; Novartis Pharmaceuticals Corp, East Hanover, New Jersey, USA). DESIGN: Prospective interventional case series. METHODS: Ten patients undergoing elective pars plana vitrectomy at a single institution were enrolled to take 3 oral doses of famciclovir 500 mg the day preceding surgery and a fourth dose on the morning of surgery. Blood and undiluted vitreous samples were acquired from each patient during surgery. High-performance liquid chromatography was used to determine the concentration of penciclovir in each sample. Exclusion criteria included prior vitrectomy, compromised blood-retina barrier, renal or hepatic disease, human immunodeficiency virus infection, bone marrow or renal transplantation, pregnancy or breastfeeding, history of adverse reaction or allergy to famciclovir or penciclovir, and antiviral, probenecid, or cimetidine use within 1 month of surgery. RESULTS: Ten eyes of 10 patients ranging in age from 26 to 82 were included. All patients had normal renal and hepatic function as determined by history and laboratory values. Mean serum penciclovir concentration +/- standard deviation was 4.45 +/- 1.31 microg/ml (range, 2.51 to 6.34 microg/ml). Mean vitreous penciclovir concentration was 1.21 +/- 0.38 microg/ml (range, 0.39 to 1.88 microg/ml). Mean vitreous-to-serum concentration ratio of penciclovir was 0.28 +/- 0.09 (range, 0.16 to 0.41). CONCLUSIONS: Oral administration of famciclovir results in vitreous concentrations of penciclovir within the inhibitory ranges for herpes simplex 1, herpes simplex 2, and varicella zoster virus. Oral famciclovir may be a reasonable alternative to intravenous acyclovir (Zovirax; GlaxoSmithKline) in the treatment of acute retinal necrosis, especially in cases of acyclovir resistance or patient inability to tolerate prolonged intravenous treatment.

Adjunctive intravitreal dexamethasone in the treatment of acute endophthalmitis following cataract surgery.

PURPOSE: Controversy exists regarding the use of intravitreal dexamethasone (IVD) as an anti-inflammatory adjunct to intravitreal antibiotics in patients with acute endophthalmitis following cataract surgery. The purpose of this project was to evaluate our experience regarding the effect of adjunctive IVD use on visual outcomes in such patients. DESIGN: Retrospective, comparative case series. STUDY POPULATION: Patients treated for acute endophthalmitis following cataract surgery from 1995-2004. INTERVENTION: In addition to standard intravitreal antibiotic treatment, some patients also received a single adjunctive injection of IVD. PRIMARY OUTCOME MEASURES: Median visual acuity at last follow-up and percentage of patients achieving a >/=3-line improvement in visual acuity. SECONDARY OUTCOME MEASURES: Inflammatory index scoring, including amount of cell and flare, height of hypopyon, and presence of fibrin as a function of time after treatment. RESULTS: Twenty-six eyes were treated with and 38 eyes without adjunctive IVD. Median presenting visual acuity was Hand Motion in both groups. Median visual acuity at last follow-up measured 20/40 in the IVD group and 20/50 in the No-IVD group (p = 0.75). Seventy-three percent of patients in the IVD group and 82% of patients in the No-IVD group achieved a >/=3-line improvement in visual acuity (p = 0.42). No significant difference was detected between the IVD and No-IVD groups for any of the three measures of inflammation. CONCLUSION: The use of IVD did not significantly improve the final median visual acuity, the chance of achieving a >/=3-line improvement in visual acuity, or the amount of intraocular inflammation. Based on these findings, and the possible detrimental effect of IVD on visual outcomes previously reported in the literature, the use of IVD does not appear to be warranted as a routine adjunctive treatment in postoperative endophthalmitis.