Early spontaneous closure after reopening of a previously repaired macular hole.

PURPOSE: To describe a case of early spontaneous closure of macular hole after reopening after previous successful surgical repair. METHODS: A 72-year-old female patient was treated for stage 2 idiopathic macular hole in the right eye. The hole remained anatomically closed for 2 months postoperatively, before reopening 1 month later. RESULTS: The patient was listed for revision surgery; however, on the day of the operation, which was 2 months after the reopening, the hole seemed to have closed spontaneously. Two years later, the macular hole remains closed with best-corrected visual acuity of 6/9. CONCLUSION: Spontaneous closure of macular holes after reopening is a rare phenomenon. The case presented here demonstrates that for early reopening of macular holes, a period of observation with serial optical coherence tomography may allow the hole to close spontaneously before proceeding with further surgical intervention.

Keratectasia as a presentation of surgically induced necrotizing sclerokeratitis (SINS).

PURPOSE: A case of keratectasia is reported as a severe presentation of surgically induced necrotizing sclerokeratitis (SINS). METHODS: A 72-year-old white woman had a painful, raised lesion on the superior cornea of her right eye 3 years after uncomplicated extracapsular cataract extraction with intraocular lens implantation. Examination showed a large ectatic area of the superior cornea with inflamed sclera adjacent to the surgical wound, which was diagnosed as SINS. RESULTS: No underlying systemic autoimmune condition or vasculitis was identified on investigation. Progressive painful keratectasia necessitated enucleation, which confirmed on histopathologic examination features of chronic nodular episcleritis and nongranulomatous scleritis with evidence of keratitis and fibrovascular scarring. CONCLUSION: The predominant inflammatory response in the cornea represents surgically induced necrotizing keratoscleritis (SINK) as a new variant presentation of SINS. Oral corticosteroids and immunosuppressive agents should not be delayed to prevent progressive tissue destruction and poor outcome.

Chronic postoperative endophthalmitis caused by Actinomyces neuii.

Uneventful phacoemulsification with implantation of a foldable, acrylic posterior chamber intraocular lens was performed in the right eye of a 73-year-old white man. Postoperatively, the patient developed a chronic, low-grade intraocular inflammation. Cultures from the aqueous specimen grew Actinomyces neuii, an unusual gram-positive bacillus. The low-grade intraocular inflammation persisted with intensive topical steroid-antibiotic medication and systemic antibiotics. A diagnostic, 3-port, pars plana vitrectomy was performed, and aqueous aspirate specimens were sent for culture and sensitivity and to look for abnormal cells. Intracameral antibiotics were not injected. The specimens were sterile to culture, and chronic inflammatory cells were reported on the vitreous specimen. On examination 6 months later, inflammation had not recurred and the best corrected visual acuity was 6/18.