ABSTRACT
The first case of Bacillus cereus endophthalmitis following an intravitreous injection of bevacizumab is described. A 77-year-old man presented to a retina specialist with an active choroidal neovascularization related to age-related macular degeneration for which he received intravitreous bevacizumab (1.25 mg) and post-injection topical gatifloxacin. Eight hours later, the patient woke up with excruciating pain and a decline in vision associated with nausea and vomiting. A vitreous biopsy was performed that revealed B. cereus. Despite intravitreous injections of vancomycin and ceftazidime on day 1 and pars plana vitrectomy with repeat intravitreous injections on day 3, the eye did not recover light perception.
Subject(s)
Angiogenesis Inhibitors/administration & dosage , Antibodies, Monoclonal/administration & dosage , Bacillus cereus/isolation & purification , Endophthalmitis/microbiology , Eye Infections, Bacterial/microbiology , Gram-Positive Bacterial Infections/microbiology , Injections/adverse effects , Aged , Anti-Bacterial Agents/therapeutic use , Antibodies, Monoclonal, Humanized , Bevacizumab , Blindness/etiology , Ceftazidime/therapeutic use , Choroidal Neovascularization/drug therapy , Combined Modality Therapy , Drug Therapy, Combination , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/drug therapy , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/drug therapy , Humans , Macular Degeneration , Male , Vancomycin/therapeutic use , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity , Vitrectomy , Vitreous Body/microbiologyABSTRACT
PURPOSE: To compare outcomes and complications of pars plana lensectomy-vitrectomy (PPL-PPV) for the management of ectopia lentis in children with and without a foldable iris-sutured intraocular lens (IOL). SETTING: Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA. METHODS: This study comprised 22 eyes of 12 consecutive pediatric patients with ectopia lentis who had PPL-PPV by the same vitreoretinal surgeon with (12 eyes; Group L) or without (10 eyes; Group A) insertion of a foldable iris-sutured IOL between June 1998 and October 2006. Outcome measures included the proportion of eyes achieving visual acuity of 20/40 or better, mean logMAR visual acuity, and complications. RESULTS: There was no statistically significant difference between the 2 groups in the proportion of eyes achieving a visual acuity of 20/40 or better (Group A: 5/10; Group L: 10/12) (P = .17) or the mean postoperative best corrected logMAR visual acuity (Group A: 0.41 [20/52]; Group L: 0.24 [20/35]) (P = .18). Complications included IOL dislocation in 4 (33%) of 12 eyes in Group L (95% confidence interval, 11%-65%). Eyes with dislocated IOLs had retrieval with resuturing of the IOL to the iris and had a mean visual acuity of 20/27 at the last follow-up. No retinal detachment was observed. CONCLUSION: Pars plana lensectomy-vitrectomy with iris-fixation of a foldable IOL for the management of ectopia lentis yielded visual outcomes as least as good as those of optically corrected aphakia with a significant risk for dislocation.
Subject(s)
Ectopia Lentis/surgery , Iris/surgery , Lens Implantation, Intraocular/methods , Lenses, Intraocular , Suture Techniques , Child , Child, Preschool , Follow-Up Studies , Humans , Lens, Crystalline/surgery , Postoperative Complications , Retrospective Studies , Treatment Outcome , Visual Acuity/physiology , VitrectomyABSTRACT
PURPOSE: To report on the outcomes of 25-gauge pars plana vitrectomy using sulfur hexafluoride and no prone positioning for repair of macular holes. METHODS: Retrospective case series of 44 consecutive patients who underwent pars plana vitrectomy with internal limiting membrane peeling for repair of stages 2 to 4 idiopathic macular holes using 20% to 30% sulfur hexafluoride. No postoperative prone positioning or gas augmentation was used. RESULTS: The macular hole closure rate was 88.6%. There were no differences in the macular hole closure rates between phakic and pseudophakic patients (21 of 23 vs. 17 of 21, respectively) or among stages 2, 3, and 4 macular holes (12 of 13, 20 of 23, and 7 of 8, respectively). In eyes successfully operated on, visual acuity improved from 0.61 logarithm of the minimal angle of resolution (logMAR) (20 of 82) preoperatively to 0.483 logMAR (20 of 61) at 1 month and 0.396 logMAR (20 of 50) at a mean final follow-up of 10.8 months. Adverse effects were elevation of intraocular pressure to >30 mmHg in 7 (13.6%) of 44 patients on the first postoperative day, postoperative retinal detachments in 2 (4.5%) of 44 patients, and progression of cataract requiring cataract surgery in 7 (30.4%) of 23 phakic patients during follow-up. CONCLUSIONS: Macular hole closure rates similar to those achieved using pars plana vitrectomy with perfluoropropane and prone positioning can be achieved using sutureless 25-gauge vitrectomy with sulfur hexafluoride tamponade and no prone positioning for both phakic and pseudophakic patients.
Subject(s)
Retinal Perforations/surgery , Vitrectomy/instrumentation , Vitrectomy/methods , Aged , Cataract/physiopathology , Disease Progression , Epiretinal Membrane/surgery , Female , Follow-Up Studies , Humans , Intraocular Pressure , Intraoperative Care , Male , Postoperative Period , Posture , Retinal Detachment/etiology , Retinal Perforations/physiopathology , Retrospective Studies , Sulfur Hexafluoride/administration & dosage , Suture Techniques , Treatment Outcome , Visual Acuity , Vitrectomy/adverse effectsABSTRACT
PURPOSE: To report two cases of retinal pigment epithelium (RPE) tears following intravitreous ranibizumab injection for age-related macular degeneration (AMD)-associated serous pigment epithelium detachment (PED). DESIGN: Noncomparative case series. METHODS: The charts of two patients who received intravitreous ranibizumab for AMD-associated PED and developed RPE tears were reviewed. Fundus photography, fluorescein angiography and optical coherence tomography performed prior to injection and upon follow-up confirmed the diagnosis. RESULTS: Two patients with serous PED and occult choroidal neovascularization associated with AMD developed RPE tears within four weeks of injection with ranibizumab. CONCLUSIONS: RPE tears may complicate ranibizumab intravitreous injection for the treatment of AMD-associated PEDs. Further studies need be undertaken to determine whether this complication may also occur when treating choroidal neovascular membranes not associated with PED and whether certain angiographic subtypes are more susceptible to this complication.
