Postoperative endophthalmitis caused by Candida parapsilosis: clinical features and treatment outcomes.

Three consecutive patients with postoperative Candida parapsilosis endophthalmitis presented from a single surgeon and surgery center after uncomplicated cataract surgery. All patients were treated with pars plana vitrectomy (PPV), intraocular lens removal, total capsulectomy, and intraoperative injection of intravitreal antifungal agent. Intraoperative cultures of undiluted vitreous and lens capsule were all positive for the fungus. All patients also received oral antifungal agents postoperatively. Two of these patients received several serial intravitreal antifungal injections after PPV. Following these treatments, all infections were resolved and vision outcomes were favorable at last follow-up.

Rhegmatogenous retinal detachment after a lower extremity dog bite: a case report.

INTRODUCTION: The occurrence of endogenous endophthalmitis is well known in the settings of bacteremia or candidemia, although its association with rhegmatogenous retinal detachment remains unclear. CASE PRESENTATION: We present a case of rhegmatogenous retinal detachment in a 39 year old man who presented with acute vision loss six weeks after a lower extremity dog bite. Further workup revealed oxacillin resistant staphylococcus aureus bacteremia with multiple septic emboli to various organs including bilateral loculated pleural effusion, left renal abscess, left obturator abscess, and right eye endogenous endophthalmitis. CONCLUSION: Our case illustrates an interesting presentation of oxacillin resistant staphylococcus aureus bacteremia after a dog bite, where endogenous endophthalmitis and rhegmatogenous retinal detachment were part of the manifestations. Early diagnosis and intervention are crucial to preserve the visual acuity.

Intraoperative sclerotomy-related retinal breaks for macular surgery, 20- vs 25-gauge vitrectomy systems.

PURPOSE: To compare the rate of intraoperative sclerotomy-related retinal breaks (SRRB) between 20- and 25-gauge vitrectomy systems for the correction of macular pucker (MP) and macular hole (MH). DESIGN: Retrospective interventional case series. METHODS: Single institution review of 347 consecutive eyes of 333 patients between August 2003 and May 2005 receiving pars plana vitrectomy (PPV) for MP or MH repair. Eyes were excluded if they had any form of proliferative retinopathy, or if there was an intraoperative conversion of any sclerotomy from 25- to 20- gauge. RESULTS: Fourteen (6.4%) of 219 eyes in the 20-gauge group had SRRB vs 4 (3.1%) of 128 eyes in the 25-gauge group (Fisher exact test, P value = .22). CONCLUSIONS: There was a trend for slightly lower rates of intraoperative sclerotomy-related retinal breaks, single or multiple, with 25-gauge PPV compared with 20-gauge PPV, but the differences were not statistically significant.

Survey of 1264 patients with orbital tumors and simulating lesions: The 2002 Montgomery Lecture, part 1.

OBJECTIVE: To determine the incidence of specific orbital tumors based on patients referred to an ocular oncology center. DESIGN: Retrospective, observational case series. PARTICIPANTS: A total of 1264 consecutive patients referred to an ocular oncology service because of space-occupying orbital lesions. METHODS: A retrospective chart review was carried out for 1264 consecutive patients referred for a suspected orbital mass over a 30-year period. The lesions were grouped into general categories, as shown in "Results." The specific diagnosis in each case was based on clinical findings, computed tomography scan results, magnetic resonance imaging results, and histopathologic analysis results, when available. The number and percentage of benign and malignant tumors per age group also was determined. MAIN OUTCOME MEASURES: The incidence of orbital tumors and pseudotumors. RESULTS: Among 1264 consecutive patients, the number and percentage of lesions in each general category were as follows: cystic, 70 cases (6%); vasculogenic, 213 cases (17%); peripheral nerve lesions, 23 (2%); optic nerve and meningeal tumors, 105 (8%); fibrocytic lesions, 13 (1%); osseous and fibro-osseous tumors, 21 (2%); cartilaginous lesions, 1 (<1%); lipocytic and myxoid lesions, 64 (5%); myogenic tumors, 36 (3%); lacrimal gland lesions, 114 (9%); primary melanocytic lesions, 11 (<1%); metastatic tumors, 91 (7%); lymphoma and leukemia lesions, 130 (10%); secondary orbital tumors, 142 (11%); histiocytic lesions, 17 (1%); thyroid-related orbitopathy, 67 cases (5%); other inflammatory lesions, 133 cases (11%); and miscellaneous other lesions, 13 (1%). The most common diagnoses were: lymphoid tumor (139 cases;11%), idiopathic orbital inflammation (135 cases; 11%), cavernous hemangioma (77 cases; 6%), lymphangioma (54 cases; 4%), meningioma (53 cases; 4%), optic nerve glioma (48 cases; 4%), metastatic breast cancer (44 cases;4%), orbital extension of uveal melanoma (41 cases; 3%), capillary hemangioma (36 cases;3%), rhabdomyosarcoma (35 cases; 3%), dermolipoma (31 cases; 3%), herniated orbital fat (30 cases; 2%), dermoid cyst (26 cases; 2%), varix (26 cases; 2%), dacryops (19 cases; 2%), and other less common lesions. Of the 1264 lesions, 810 (64%) were benign and 454 (36%) were malignant. The percentage of malignant lesions was 20% in children (age range, 0-18 years), 27% in young adults and middle-aged patients (age range, 19-59 years), and 58% in older patents (age range, 60-92 years). Rhabdomyosarcoma was the most common malignancy in children, representing 3% of all orbital masses, and lymphoma was the most common malignancy in older patients, representing 10% of cases. CONCLUSIONS: A variety of tumors and pseudotumors can involve the orbit. In this series of 1264 lesions, 64% were benign and 36% were malignant. The percentage of malignant tumors increased with age, with malignancies being common in older patients because of the higher incidence of lymphoma and metastasis in the elderly.

Chondroid chordoma of the nasal septum.

Chondroid chordoma is an uncommon malignant tumor of bone that occurs mostly in patients of early middle age. To our knowledge, this tumor has not been previously described in the nasal septum as a primary lesion. We describe a 39-year-old woman who presented with a 1-year history of nasal obstruction. Results of her physical examination and imaging studies demonstrated a nasoseptal mass. We also discuss the histologic and radiographic characteristics of the chondroid chordoma and compare it with other tumors that arise in the nasoseptal area to highlight the different prognoses and approaches to management.