Clinical Congenital Anophthalmos and Microphthalmos-Experiences of Patients and Their Parents after More than 10 Years of Treatment.

Congenital clinical anophthalmos and blind microphthalmos describe the absence of an eye or the presence of a small eye in the orbit. Between 1999 and 2013, 97 children with anophthalmos or microphthalmos were treated with self-inflating, hydrophilic gel expanders at the Rostock Eye Clinic. More than a decade later, this study investigated the perspective of patients and parents regarding the treatment, the surgical outcome, and the emotional and social well-being of the patients. A total of 22 families with 16 patients sighted in the other eye and six patients blind in both eyes participated. Questionnaires were developed, including items on physical, emotional, social, and medical aspects. The patients felt emotionally stable and integrated into their social environment, with no major limitations reported by the majority. These statements were confirmed by most of the parents. Parents (67%) indicated that the success of the operation was already apparent after the first intervention and that the current situation did not play a role in the patients' social environment. The study provided new insights into the therapy results, the postoperative care, and the social and emotional stability of the prosthesis-wearing patients, indicating the chosen expander methods as promising in terms of positive postoperative care.

New retinal tack designs: an analysis of retention forces in human scleral tissue.

PURPOSE: The study aimed to construct a new retinal tack design with high retention forces to prevent spontaneous disentanglement in cases of complicated retinal surgery. METHODS: Six new forms for the peak of a retinal tack were developed using computer-aided design (CAD); then a prototype was produced for each model. Finally, standardised design testing was conducted using human (ex vivo) sclera by logging 15 consecutive measurements for each model. RESULTS: Seven different models underwent pull-out testing (six new models and the original tack model), but two tack models (Model 4, Model 5) failed to penetrate the human tissue. The highest pull-out forces (median) were measured for Model 3, followed by Model 6, Model 2 and Model 1. The original Heimann tack (Model H) was found to have the lowest retention forces. CONCLUSION: The different tack designs altered the penetration and holding forces. The retention forces of the proposed peak design led to a significant increase in the retention forces that were more than twice as high as those in the original Heimann Model.

Treatment of cancer in a child with ocular xeroderma pigmentosa (XP) in Malawi.

A 3-year-old girl presented to the Eye Hospital, Blantyre, Malawi, with multiple ulcerating lesions on her face and in her eyes. Her skin was freckled, with hypopigmented and hyperpigmented areas (poikilodermia) typical of xeroderma pigmentosa. The tumors on the conjunctiva of the right eye and the lower eyelid of the left eye appeared to be squamous cell carcinomas. Chemotherapy with intravenous 5-flourouracil (1000 mg/m) for 5 days and cisplatin (50 mg/m) for 2 days for 3 cycles every 3 weeks was well tolerated. Good response occurred after 1 cycle and after 2 more courses the tumors had resolved.

Low-dose transscleral diode laser cyclophotocoagulation (TSCPC) as a potential single treatment for primary open-angle glaucoma (POAG) in Malawi?

PURPOSE: To investigate if low-dose 810 nm transscleral cyclophotocoagulation (TSCPC) can be used as single treatment in Malawian glaucoma patients. METHODS: Forty-seven eyes of 28 patients with primary open-angle and pseudoexfoliation glaucoma were treated with TSCPC using 12 spots with 900 mW, 2,000 ms (1.8 J per spot); six spots in the upper half, six in the lower by sparing the 3 and 9 o'clock positions ±20°. Intraocular pressure (IOP) and uncorrected visual acuity (UVA) were measured by an independent examiner preoperatively, on the first postoperative day, after 2 weeks, and after 3 months. RESULTS: Twenty-four (86%) and 18 (64%) of 28 patients (31 of 47 eyes; 66%) completed follow-up at 2 weeks and at 3 months respectively. After a single treatment session, IOP decreased by at least 25 % in 88% (21 of 24) after 2 weeks, and in 50% (nine of 18) of patients after 3 months. Mean IOP was 38.5 mmHg before TSCPC, 23.5 mmHg (p < 0.001) after 1 day, 24.5 mmHg (p < 0.001) after 2 weeks, and 35.6 mmHg (p = 0.37) after 3 months. In three patients, however, IOP increased after 3 months to levels significantly higher than before TSCPC. CONCLUSION: Low-dose TSCPC caused a significant IOP lowering for up to 2 weeks (15 mmHg less from baseline) in most patients. After 3 months, this effect was stable in 50% of patients; in the other half, IOP nearly returned back to baseline.

Severe eye complications from Stevens-Johnson syndrome in a human immunodeficiency virus-infected patient in Malawi.

Stevens-Johnson syndrome (SJS) is a severe form of erythema multiforme that primarily affects skin and mucous membranes. In Malawi, manifestations of SJS may become more common in human immunodeficiency virus-infected patients receiving nevirapine-based antiretroviral therapy (ART) because the CD4 cell threshold for starting ART has increased from 250 to 350 cells/µL. We describe a patient with severe ocular complications from SJS that developed soon after initiation of nevirapine-based ART and cotrimoxazole preventive treatment, which led to blindness. We draw attention to preventive measures that can potentially reduce permanent ocular damage from SJS.

Intravitreal vancomycin and amikacin versus intravenous imipenem in the treatment of experimental Staphylococcus aureus endophthalmitis.

BACKGROUND: Controversy still surrounds the intravenous (IV) treatment of endophthalmitis. The purpose of this study was to compare IV and intraocular (IO) treatment in experimental Staphylococcus aureus endophthalmitis: intravitreal injection of vancomycin and amikacin (VA/AN) in comparison with IV imipenem (IPM) and a combination of IV and IO (IV+IO) therapy. METHODS: The right eyes of 27 rabbits were injected with 25000 S. aureus. After 24 h, animals were either treated with IO VA/AN ( n=5; 1.0 mg/0.4 mg in 0.1 ml saline), or IV IPM ( n=9; 37 mg/kg body weight 3x daily), or IV+IO therapy ( n=7), or served as untreated controls ( n=6). Clinical appearance was evaluated daily and vitreous aspirates were obtained for bacterial culture 24 h and 6 days after therapy, when the eyes were enucleated for histopathologic examination. RESULTS: Eyes in the IO or IO+IV treatment group had a significantly better appearance clinically and histologically than did eyes in the IV or untreated control group. Eyes in the IO+IV group had a similar appearance to the IO-treated eyes. All aspirates from the IO and IO+IV groups were culture-negative 24 hours after therapy, whereas only five of nine in the IV-treated group were culture-negative. Aspirates from all treatment groups were culture-negative by day 6 after the initiation of therapy. Untreated control eyes were culture-positive at all times. CONCLUSION: IO therapy with VA/AN proved more effective in treating experimental S. aureus endophthalmitis than did IV therapy with IPM alone. IV+IO treatment was not superior to IO treatment alone.

Intravenous treatment of experimental Staphylococcus aureus endophthalmitis: imipenem versus the combination of ceftazidime and amikacin.

BACKGROUND: To compare the efficacy of intravenous (IV) imipenem (IPM) and a combination of IV ceftazidime (CAZ) and amikacin (AN) in the treatment of Staphylococcus aureus endophthalmitis in a rabbit model. METHODS: Right eyes of 60 albino rabbits were injected with 1000 colony-forming units of S. aureus intravitreally. After 24 h, treatment with either IV IPM (37.5 mg/kg) every 8 h ( n=18) or IV CAZ (50 mg/kg) and AN (10 mg/kg) every 8 hours ( n=18) was begun and continued until the animals were killed at the indicated timepoints; 24 control animals received no treatment. The concentration of bacteria in the vitreous from six animals per group was determined microbiologically on days 2, 3, and 5 after infection, and histologic examination was performed on all eyes. RESULTS: The number of eyes with positive cultures on day 5 was lower in the group that received IV IPM (2/6) compared with the IV CAZ/AN group (4/6) and the control group (6/6). For the culture-positive eyes, the bacterial concentrations were significantly lower for the IV IPM group compared with the IV CAZ/AN group on days 2 and 5 ( P<0.05 and P<0.0065, respectively), but not on day 3 ( P <0.8. Bacterial counts in both treatment groups were significantly lower than in the control group ( P<0.005). Eyes in all groups, however, showed severe intraocular inflammation. CONCLUSIONS: IV IPM is more effective than is IV CAZ/AN in reducing the number of bacteria in an animal model of S.aureus endophthalmitis.