Chronic postoperative Cutibacterium acnes endophthalmitis with implantable collamer lens.

Purpose: We report a case of chronic post-operative endophthalmitis secondary to Cutibacterium acnes (C. acnes) in a patient with an implantable collamer lens (ICL). Observations: A 45-year-old male presented three months after ICL implantation of the right eye with blurry vision, redness, and ocular pain in the setting of prolonged post-operative anterior chamber (AC) cell. Reduced visual acuity (VA) at 20/30-1, keratic precipitates, 1+ AC cell, and white ICL precipitates were concerning for chronic post-operative endophthalmitis. Anaerobic cultures from a vitreous tap grew C. acnes. Multiple intravitreal and intracameral injections with topical steroids were required to maintain a stable VA at 20/30; however, inflammation persisted and removal of the ICL and his native lens was ultimately required. Conclusions and importance: Chronic post-operative inflammation and white plaque after ICL implantation should raise high suspicion for endophthalmitis secondary to C. acnes. Anaerobic vitreous cultures can confirm the diagnosis. Removal of the ICL implant is often necessary for treatment. More research is needed to best manage this vision threatening condition.

Monson small-incision lenticule extraction fixation device.

Small-incision lenticule extraction (SMILE) is a stromal based, flapless, minimally invasive form of laser vision correction for the treatment of myopia and myopic astigmatism. SMILE surgery is a more technical procedure compared with other refractive surgeries and generally has a longer skill mastery acquisition period. Thus far, no new stabilization devices or techniques have been proposed. To rectify this, a new distal corneal countertraction device for SMILE surgery, the Monson SMILE Fixation Device, is introduced. This device provides reliable corneal and globe stabilization during delamination and lenticular dissection. It may minimize tissue distortion and manipulation, simplify lenticule dissection, and may decrease operation times and improve cosmesis. Countertraction can also easily be adjusted throughout the procedure.

Transscleral fixation of a foldable posterior chamber intraocular lens.

UNLABELLED: We describe an approach to transscleral fixation of a foldable posterior chamber intraocular lens (PC IOL) using a 25-gauge pars plana vitrectomy. The technique was used in 80 consecutive eyes, and the results were analyzed for corrected distance visual acuity and safety indicators. Postoperative complications included retinal detachment in 2 eyes (2.5%), Irvine-Gass cystoid macular edema in 3 eyes (3.75%), persistent postoperative corneal edema in 1 eye (1.25%), hyphema in 2 eyes (2.5%), and postoperative vitreous hemorrhage with spontaneous clearing in 1 eye (1.25%). The modified external approach with a 25-gauge pars plana vitrectomy had relatively few complications, improved visual acuity in patients requiring a transsclerally sutured PC IOL, and offered several advantages over traditional anterior chamber and conventional techniques of scleral suturing. FINANCIAL DISCLOSURE: Dr. Adelberg is a consultant to Bausch & Lomb. No author has a financial or proprietary interest in any material or method mentioned.

Metastatic mucinous adenocarcinoma of the orbit.

Metastatic mucinous adenocarcinoma in the orbit is extremely rare. We review the literature and report a case of metastatic mucinous adenocarcinoma of the orbit in a 37-year-old male with primary pancreatic adenocarcinoma.

Scanning electron microscopy visualization of methicillin-resistant Staphylococcus aureus after contact with gatifloxacin with and without preservative.

PURPOSE: To test a visual model by looking at the differences in effect of Zymar((R)) (gatifloxacin plus benzalkonium chloride [BAK]) when compared to gatifloxacin and a normal saline (NS) control upon a methicillin and gatifloxacin-resistant Staphylococcus aureus (MRSA) species. METHODS: An ocular isolate of gatifloxacin-resistant (minimal inhibitory concentration >2 to 4 microg/mL) MRSA was grown to confluency. Chambered slides were prepared with bacterial culture smears, and then incubated with either gatifloxacin at the concentrations of 1 and 10 microg/mL, Zymar containing equivalent concentrations of gatifloxacin, or NS. Bacterial cultures were fixed after 10, 30, and 60 min. Fixed slides were coated in gold sputter for examination. Bacteria were visually evaluated with scanning electron microscopy (SEM) at 50,000x. Blinded review of SEM images compared structural changes and mitotic activity across samples. RESULTS: MRSA exposed to 10 microg Zymar for 60 min showed significantly greater pleomorphism and cell wall surface changes when compared to gatifloxacin (P < 0.0001) and NS (P = 0.001), and significantly less mitotic activity than NS (P = 0.002). CONCLUSION: Using SEM, the topical formulation of gatifloxacin 0.3% (Zymar), which contains BAK, had greater antibacterial activity than did gatifloxacin alone in gatifloxacin and methicillin-resistant S. aureus, thereby illustrating potential advantages of the preservative in the commercial formulation. We further show that these effects can be visualized and quantified.

Characterization of outer retinal morphology with high-speed, ultrahigh-resolution optical coherence tomography.

PURPOSE: To visualize, quantitatively assess, and interpret outer retinal morphology by using high-speed, ultrahigh-resolution (UHR) OCT. METHODS: Retinal imaging was performed in the ophthalmic clinic in a cross-section of 43 normal subjects with a 3.5-microm, axial-resolution, high-speed, UHR OCT prototype instrument, using a radial scan pattern (24 images, 1500 axial scans). Outer retinal layers were automatically segmented and measured. High-definition imaging was performed with a 2.8-microm axial-resolution, high-speed, UHR OCT research prototype instrument, to visualize the finer features in the outer retina. RESULTS: Quantitative maps of outer retinal layers showed clear differences between the cone-dominated fovea and the rod-dominated parafovea and perifovea, indicating that photoreceptor morphology can explain the appearance of the outer retina in high-speed, UHR OCT images. Finer, scattering bands were visualized in the outer retina using high-definition imaging and were interpreted by comparison to known anatomy. CONCLUSIONS: High-speed UHR OCT enables quantification of scattering layers in the outer retina. An interpretation of these features is presented and supported by quantitative measurements in normal subjects and comparison with known anatomy. The thick scattering region of the outer retina previously attributed to the retinal pigment epithelium (RPE) is shown to consist of distinct scattering bands corresponding to the photoreceptor outer segment tips, RPE, and Bruch's membrane. These results may advance understanding of the outer retinal appearance in OCT images. The normative measurements may also aid in future investigations of outer retinal changes in age-related macular degeneration and other diseases.