Retrieving A retained Heavy Silicone Oil Bubble: Two Novel Surgical Techniques.

PURPOSE: To describe two surgical techniques for rescuing a retained heavy silicone oil bubble in the posterior pole: 1) light pipe method and 2) perfluorocarbon liquid method. METHODS: The surgical techniques are described in detail, along with an illustrative video for each. RESULTS: A short 25-gauge metallic cannula and active suction pump are used for standard heavy silicone oil removal. Both surgical approaches are practical and effective options to complete the removal of heavy silicone oil when a bubble sinks to the posterior pole. CONCLUSION: Both the light pipe and perfluorocarbon methods are suitable to remove retained heavy silicone oil and thus avoid the need for further incisions and the risks associated with the use of larger gauge instrumentation.

Risk factors, microbial profiles and prognosis of microbial keratitis-associated endophthalmitis in high-risk eyes.

BACKGROUND: Microbial keratitis (MK) is a sight-threatening emergency. Delayed diagnosis and treatment may exacerbate the condition and infection may spread to the posterior segment with resultant endophthalmitis. We describe the presentation, management, visual outcomes and microbial profiles of MK-associated endophthalmitis presenting to a tertiary referral centre. METHODS: Prospective collection of data on all patients presenting with presumed MK-associated endophthalmitis from 1997 to 2007, to the Royal Victorian Eye and Ear Hospital. Outcome measures included: visual acuity, microbial profiles, and management strategy. RESULTS: Thirty-seven cases of MK-associated endophthalmitis were identified over the study period, with a mean age of 73 years and 19 were male. Presenting acuities ranged from Snellen 2/60 to no perception of light (NPL). Thrity-four (91.9%) patients had a prior history of ocular disease. Identifiable non-ocular risk factors were present in 31 (83.8%), including steroid use, dementia, nursing home care or relative systemic immunosuppression. A culture positivity rate of 83.8% was recorded. The most common organisms identified included: Streptococcal species in 12 (32.4%), Pseudomonas aeruginosa in 11 (29.7%), and Staphylococcus aureus in eight (21.6%). Final acuities ranged from 6/36 to NPL. Sixteen (43.2%) eyes were eviscerated/enucleated as primary treatment. Overall, 23 (62.2%) patients required evisceration/enucleation, of which nine (39.1%) were due to Pseudomonas aeruginosa and seven (30.4%) to Streptococcal species (Streptococcal pneumonia). CONCLUSIONS: MK-associated endophthalmitis is a serious ocular condition occurring more frequently in elderly populations, and those with long standing severe pre-existing ocular disease. Visual outcomes are poor, often requiring evisceration/enucleation.

Vitreous cavity haemorrhage post-vitrectomy for diabetic eye disease: the effect of perioperative anticoagulation and antiplatelet agents.

BACKGROUND: To evaluate the effect of perioperative anticoagulation and antiplatelet therapy on postoperative vitreous cavity haemorrhage following pars plana vitrectomy for diabetic eye disease. DESIGN: Retrospective chart review. PARTICIPANTS: 139 patients. METHODS: Retrospective collection of demographic, medical, surgical and postoperative data of all patients undergoing vitrectomy for diabetic eye disease at The Royal Victorian Eye and Ear Hospital. MAIN OUTCOME MEASURE: Correlation of the rates of persistent vitreous cavity haemorrhage and anticoagulation or antiplatelet treatment. RESULTS: Sixty-eight of 155 (43.9%) eyes of 139 patients were on anticoagulation or antiplatelet therapy prior to surgery. At the time of surgery, 29 (42.6%) were on therapy. Eight of 29 (27.6%) patients had significant persistent vitreous cavity haemorrhage in the postoperative period, with four (13.8%) requiring secondary surgery. Thirty-nine (57.4%) patients had discontinued therapy prior to surgery. Among these, four (10.3%) had persistent bleeding, of which three (7.7%) required additional surgery. Six of 87 (6.9%) patients not on any anticoagulation/antiplatelet therapy had persistent postoperative vitreous cavity haemorrhage, with none requiring further surgery. Patients on anticoagulation/antiplatelet therapy at the time of surgery were more likely to experience persistent haemorrhage and subsequent reoperation (OR = 4.8, P = 0.0045 and OR = 6.6, P = 0.024, respectively). CONCLUSION: Perioperative continuation of anticoagulation or antiplatelet treatment appears to increase the risk of persistent postoperative vitreous cavity haemorrhage and the necessity for vitreous cavity washout in this diabetic cohort. Appropriate preoperative cessation of treatment appeared to reduce this risk; however, caution must be taken with regard to the systemic risk associated with cessation of therapy.

Prevalence of Orbscan II corneal abnormalities in relatives of patients with keratoconus.

BACKGROUND: To determine the prevalence of Orbscan II-derived keratoconus traits in relations of individuals with keratoconus and a control group and to apply these to a pedigree analysis. METHODS: In a controlled, prospective, observational case series, four Orbscan II-derived corneal parameters were examined in relations of individuals with keratoconus and a control group of low myopes (<2.5 D). The four parameters and thresholds for abnormality (derived from a literature review) were as follows: average keratometry (> or =47.2 D), I-S value (> or =1.2 D), posterior float apex (> or =42 microm) and thinnest pachymetry (< or =463 microm). RESULTS: Forty-four unrelated controls (88 eyes) and eight families with 90 members without known (178 eyes) and 11 members with keratoconus (19 eyes) were analysed. One of 88 (1.14%) control eyes had a single keratoconus trait, and none had more than one trait. Of 178 eyes from relatives of patients with keratoconus, 45 (25.3%) had one or more keratoconus traits. Relatives of patients with keratoconus had an elevated risk of possessing a keratoconus trait (relative risk 14.67, CI 2.07-104.07, P < 0.001) compared with controls. Approximately 53.3% of relatives with a keratoconus trait were evident on either pachymetric or posterior elevation indices alone. Six of eight families suggested dominant inheritance. CONCLUSIONS: Keratoconus traits are common in relatives of patients with keratoconus. There prevalence may have been previously underestimated by using placido image-based topography alone where corneal pachymetry and posterior elevation are not assessed. This study suggests an autosomal dominant pattern of inheritance with variable expressivity in some families.