[Clinical features of endophthalmitis after cataract surgery evaluated by the presence of background factors].

PURPOSE: The clinical features and visual prognosis after vitrectomy for endophthalmitis which had developed after cataract surgery were compared in two groups with or without background factors, including malignant tumor, diabetes, oral steroid administration, collagen disease, dacryocystitis, and lid closure disturbance. METHOD: Fifty-two patients (53 eyes) who underwent a vitrectomy for the treatment of endophthalmitis which had developed within 6 weeks after cataract surgery. They were divided into two groups according to the presence (21 eyes, group A) or absence (32 eyes, group B) of background factors, and were retrospectively compared based on their medical records. RESULTS: The culture-positive rate was 62% in group A and 69% in group B. The incidence of a final visual acuity of more than 20/20 was significantly lower in group A (14%) than in group B (47%, p < 0.05). Methicillin-resistant Staphylococcus aureus, alpha-hemolytic Streptococcus and Enterococcus were frequently identified in group A. Leakage from the cataract wound was found in about 80% of the patients with corneal incisions, and a wound that had not been covered by the conjunctiva was significantly more frequent as a factor in group A (group A, 13 eyes; group B, 10 eyes; p < 0.05). CONCLUSION: Postoperative endophthalmitis may have a less favorable visual prognosis in patients with background factors, so precise wound construction during cataract surgery is important in these patients.

[Sweet syndrome presenting as orbital cellulitis].

BACKGROUND: A case of Sweet syndrome mimicking orbital cellulitis is reported. CASE: A 17-year-old girl presented with painful eyelid swelling, limited ocular movement in the right eye, and an increased white cell count. The patient was initially diagnosed as having infectious orbital cellulitis, but her symptoms did not improve with administration of intravenous carbanpenem and cefzon. Systemic examination revealed erythema of the extremities, and blood tests showed elevated C-reactive protein. These findings are consistent with a diagnosis of Sweet syndrome, and the patient was treated with 30 mg of oral prednisone. The eyelid swelling and erythema of the extremities decreased one day after the initiation of corticosteroid therapy. Skin biopsy showed infiltration of neutrophils and histiocytes in the dermis, confirming the diagnosis of Sweet syndrome. CONCLUSION: Sweet syndrome with eyelid and orbital involvement may mimic infectious orbital cellulitis.

[Vitrectomy for endophthalmitis after cataract surgery].

PURPOSE: To identify risk factors of poor visual outcome with vitrectomy for early-onset endophthalmitis after cataract surgery. PATIENTS AND METHODS: Clinical records of 29 consecutive eyes with endophthalmitis developing within 6 weeks after cataract surgery and that underwent therapeutic vitrectomy between June 1996 and April 2001 were retrospectively reviewed. Twenty-two of the eyes received intravitreal injections of vancomycin and ceftazidime at the time of vitrectomy, and all patients received intravenous antibiotics. Eyes were divided into two groups; group A consisted of 22 eyes with a final visual acuity of 0.2 or greater, and group B consisted of 7 eyes with a final visual acuity of less than 0.2. RESULTS: Fifteen eyes (52%) in group A achieved a visual acuity of 0.5 or better and 8(28%) achieved a visual acuity of 1.0, while 4 eyes in group B developed phthisis bulbi. For eyes with a preoperative visual acuity of hand motions or worse, there was no correlation between final visual acuity and preoperative visual acuity. The overall culture-positive rate was 57%. In group A, methicillin-resistant Staphylococcus epidermidis was identified in 6 eyes, methicillin-resistant Staphylococcus aureus (MRSA) in 3 eyes and enterococcus in 2 eyes. In group B, alpha-hemolytic streptococcus (AHS) was identified in 4 eyes, aspergillus in 1 eye, and MRSA in 1 eye. All isolates were sensitive to vancomycin with the exception of the aspergillus. AHS infection appeared to be associated with wound failure from the initial cataract surgery and a poor visual outcome. Among 3 of the eyes that developed phthisis bulbi, intravitreal injection of antibiotics was not performed. CONCLUSION: Early vitrectomy and intravitreal injection of vancomycin may improve visual outcomes, but infection with AHS may be associated with cataract surgery wound failure and poor visual outcomes.

Long-term complications of hydrogel buckles.

PURPOSE: To investigate long-term complications of hydrogel buckles used in scleral buckling surgery for retinal detachment. METHODS: Clinical records of 31 patients who underwent scleral buckle removal between April 1998 and April 2001 were reviewed. Removed buckles were examined by scanning electron microscopy (SEM). RESULTS: Nineteen patients were men and 12 were women, with a mean age of 43 years. Initial scleral buckling surgery using hydrogel buckles had been performed between February 1988 and October 1995. Patients presented at a mean of 8.5 years postoperatively with complaints of symptoms such as foreign body sensation and diplopia, prompting buckle removal. Buckles from 28 eyes, left in place for 5.8 years or more, were discolored, friable, and swollen. Buckles from three eyes, left in place for 5.5 years or less, appeared grossly unaltered. One eye with buckle swelling associated with a large retinal cyst underwent buckle removal and vitrectomy. SEM of deteriorated buckles showed distortion of micropores when compared to grossly unaltered buckles and unused controls. CONCLUSIONS: Severe deterioration of hydrogel buckles may occur when they are left in place for 5 years or longer and may cause adverse symptoms and rarely intraocular complications. This deterioration is associated with changes in the microstructural architecture of the hydrogel material.

[Long-term complications of MIRAgel exoplants in scleral buckling surgery].

BACKGROUND: Long-term complications of extrusion have been reported in patients who received MIRAgel buckles for retinal detachment. All ophthalmologists need to recognize the clinical characteristics of these severe complications, and how the clinical course of complication after the use of MIRAgel buckles differs from that of silicone buckles. METHODS: Case reports and a review of the literature. RESULTS: Severe deterioration of MIRAgel buckles may occur when left in place for 5 years or longer, causing adverse symptoms and occasionally intraocular complications. This deterioration is associated with changes in the microstructural architecture of the hydrogel material in the MIRAgel buckles. CONCLUSION: Long-term follow-up is necessary for patients with MIRAgel buckles, and the buckles should be removed prophylactically when advisable. When severe ocular motility disturbances and/or presence of a tumor-like extraocular mass are observed in patients several years after retinal detachment surgery, the cause may be a swollen MIRAgel buckle.