Endogenous Endophthalmitis: A 10-Year Retrospective Study at a Tertiary Hospital in South India.

PURPOSE: The aim of this study was to review the clinical profile including predisposing systemic conditions, microorganisms responsible, clinical presentation, and outcomes of endogenous endophthalmitis (EE) in South India. DESIGN: This study is a retrospective, noncomparative case series. METHODS: This study presents a retrospective analysis of records of patients with EE in a 10-year period. RESULTS: A total of 61 eyes of 58 patients were included in the study. Preceding systemic illness or surgery was noted in 31 patients (53.4%). No predisposing condition was found in 27 patients (46.5%). All eyes had severe diffuse EE. Culture positivity was seen in 34 of 58 patients (58.6%). Gram-positive organisms were isolated in 9 cases (15.5%), and Gram-negative organisms were isolated in 20 cases (34.5%). Pseudomonas aeruginosa (13.8%) was the most common isolate. Eleven eyes (18%) were managed medically with intravenous and intravitreal antibiotics, and 38 eyes (62.3%) also underwent vitrectomy. Eight eyes (13.1%) required repeat vitrectomy, and 12 eyes (19.7%) were eviscerated. The mean follow-up was 16.2 ± 13.9 months. Final visual acuity of 20/200 or better was seen in 29.5% eyes. A favorable outcome was noted in culture-positive patients (P = 0.03) and in patients with no predisposing causes. CONCLUSIONS: This study provides information about the clinical and microbiologic profile of EE. Aggressive medical and surgical treatment can result in favorable outcomes.

Transpupillary thermotherapy for circumscribed choroidal hemangioma: clinical profile and treatment outcome.

BACKGROUND AND OBJECTIVE: To report the outcome of treating circumscribed choroidal hemangioma (CCH) using transpupillary thermotherapy (TTT). PATIENTS AND METHODS: An infrared diode laser was used at 810 nm with a median spot size of 2.5 mm, power of 550 mW, and duration of 6.5 minutes; the median number of sittings was two. TTT spared the center of the macula when CCH involved the fovea. RESULTS: The mean age was 36 years (range: 13 to 63 years). CCH was subfoveal in 37.5% of the eyes and exudative retinal detachment was evident in all eyes. The tumor dimensions included thickness (median: 4.05 mm; range: 2.2 to 9.1 mm), horizontal diameter (median: 11 mm; range: 6 to 17.7 mm), and vertical diameter (median: 9.4 mm; range: 5.9 to 15.8 mm). After TTT, visual acuity improved in 44%, was maintained in 37%, and worsened in 19% of eyes. Likewise, tumor regression was achieved in thickness, vertical, and horizontal diameter in proportion of 20%, 15%, and 11%, respectively. The exudative retinal detachment resolved in 94% of eyes at the last follow-up. The median follow-up was 9.5 months. CONCLUSION: Macula-sparing TTT was effective in causing regression of CCH and resorption of associated exudative retinal detachment, and helped in preserving or improving vision in 81% of treated eyes.

Rhegmatogenous retinal detachment following treatment for retinoblastoma.

PURPOSE: To elucidate characteristics of rhegmatogenous retinal detachment that developed in children who underwent treatment for retinoblastoma and to analyze the outcome following vitreoretinal surgery in such clinical settings. METHODS: This was a retrospective case series of 9 eyes of 9 patients who underwent vitreoretinal surgery for tumor control and retinal reattachment. RESULTS: At the time of diagnosis of rhegmatogenous retinal detachment, retinoblastoma was regressed in 6 eyes (67%). The retinal detachment involved less than two quadrants in 7 eyes (78%) and was caused by an atrophic break in 7 eyes. Seven eyes underwent a non-drainage scleral buckling procedure. Three eyes underwent vitreous surgery; in 2 of these eyes, tumor excision along with retinectomy using melphalan infusion was performed and eventually silicone oil tamponade was used. Retinal reattachment was achieved in all eyes with eventual tumor control in 7 eyes. The median follow-up after retinal reattachment surgery was 24 months. CONCLUSION: Rhegmatogenous retinal detachment in treated eyes with retinoblastoma is usually caused by an atrophic retinal break. Retinal detachment can be repaired successfully in most eyes.

KIF14 and E2F3 mRNA expression in human retinoblastoma and its phenotype association.

PURPOSE: We quantified mRNA expression of candidate genes for proliferation (KIF14 and E2F3) in a large retinoblastoma tumor cohort and associated with disease phenotype. METHODS: KIF14 and E2F3 mRNA expression was quantified by real time PCR in 57 retinoblastoma (RB) tumors, 3 RB cell lines, and control samples that included 4 each fetal, age-matched, adult retinas. Immunohistochemistry was done to confirm KIF14 and E2F3 protein expression in tumor cells. The mRNA expression levels were correlated with disease phenotypes including the significance of chemotherapy on tumors. RESULTS: There was statistically significant overexpression of KIF14 and E2F3 mRNA in tumors compared with control retinas (p<0.0001). Further, E2F3 also showed a significant overexpression compared to RB cell lines (p=0.01). Immunohistochemistry confirmed KIF14 and E2F3 protein overexpression in tumor cells. KIF14 had significant mRNA overexpression with older age (p=0.01) in presenting patients and in unilateral RB patients (p=0.04). Chemotherapy-treated tumors showed a significant decrease in KIF14 and E2F3 expression compared to untreated tumors (p<0.01 and 0.001, respectively). CONCLUSIONS: This report confirms significant mRNA overexpression of KIF14 and E2F3 together in a large cohort of RB tumors. The decreased expression in chemotherapy treated cases needs further validation in a large chemotherapy-treated cohort.

Direct aspiration of capsular bag material in a case of sequestered endophthalmitis.

Chronic recurrent endophthalmitis can occur following uncomplicated cataract surgery with intraocular lens implantation secondary to organisms sequestered in the capsular bag. There is a need to identify these sequestered organisms to facilitate appropriate management. Frequently, specimens from the anterior chamber and vitreous cavity could be unyielding, especially in the early cases in which the vitreous is still uninvolved. This article highlights the technique of directly sampling the capsular bag material in the effective diagnosis of the organism, which facilitates the total cure by irrigation with appropriate antibiotics into the capsular bag.

Anterior chamber collapse following vitreoretinal surgery with gas tamponade in aphakic eyes: incidence and risk factors.

PURPOSE: To report the risk factors associated with occurrence of anterior chamber collapse in aphakic eyes that underwent vitrectomy with gas tamponade. METHODS: A total of 314 eyes of 314 patients who underwent vitrectomy with gas tamponade and who were aphakic or were made aphakic intraoperatively were studied prospectively. Factors such as iris and pupillary integrity, depth of anterior chamber, gonioscopic grading, behavior of the anterior chamber on the operation table during fluid-air exchange, removal of crystalline lens or intraocular lens during surgery, and type of internal tamponade were noted. The anterior chamber was assessed postoperatively in supine and sitting position and with head bent forward. Statistical methods were used to identify risk factors for development of postoperative anterior chamber collapse using SPSS soft ware. RESULTS: Anterior chamber collapse occurred in 13 eyes (3.14%). Presence of preoperative shallow anterior chamber, removal of intraocular lens as a part of the procedure, occurrence of intraoperative anterior chamber collapse, and use of sulfur hexafluoride (SF6) were associated with higher risk of anterior chamber collapse postoperatively. CONCLUSIONS: The identification of potential risk factors in a given eye can alert the surgeon to the possibility of development of anterior chamber collapse postoperatively.

Pseudouveitis--analysis of cases misdiagnosed as posterior uveitis.

PURPOSE: Analysis of non-uveitic entities that were referred as posterior uveitis to a uveitis referral center. METHODS: We came across and analyzed 32 cases of non-uveitic entities (1.12%) that had been misdiagnosed and referred as posterior uveitis out of 2846 outpatient cases of posterior uveitis registered from 1990 to June 2002. The final diagnosis was achieved by history, slit-lamp biomicroscopy, meticulous fundus evaluation, imaging, and ancillary studies. RESULTS: The finally diagnosed 32 non-uveitic entities that mimicked posterior uveitis were multiple leak central serous retinopathy (n = 8; 25%), choroidal neovascular membrane (n = 6; 18.75%), typical central serous retinopathy (n = 4; 12.5%), dry form of age-related macular degeneration (n = 3; 9.3%), retinitis pigmentosa (n = 3; 9.3%), heredomacular degeneration (n = 3; 9.3%), myelinated nerve fibers (n = 2; 6.2%), malignant melanoma of the choroid (n = 1; 3.1%), old spontaneously reattached retinal detachment (n = 1; 3.1%), and subhyaloid hemorrhage (n = 1; 3.1%). CONCLUSION: The purpose of the study was to underline the fact that there are some non-uveitic entities that mimic posterior uveitis and that an ophthalmologist can be deceived. The study highlights the problems diagnosing posterior uveitis and presents an algorithm of diagnostic approach to avoid misdiagnosis.

Resolution of chicken pox neuroretinitis with oral acyclovir: a case report.

It is usual to consider chicken pox as a benign infectious disease with a few anterior segment ocular complications like conjunctivitis, keratitis, episcleritis, scleritis, iridocyclitis, and glaucoma. The retinal manifestations are necrotising retinitis, vitritis, neuroretinitis, and retinal detachments. We report a case of neuroretinitis following chicken pox in a 23-year-old male. The complication was resolved by treatment with oral acyclovir in combination with systemic steroids. This report highlights the necessity for fundus examination in cases of chickenpox exhibiting visual symptoms.