Combined endoscopic vitrectomy with pars plana tube shunt procedure.

PURPOSE: We report a case series of patients with limited fundus view due to advanced and complex anterior segment disease that underwent combined endoscopic vitrectomy and pars plana tube shunt for intraocular pressure (IOP) control. METHODS: The records of 13 eyes of 11 patients operated at Cincinnati Eye Institute from 2006 to 2010 with combined endoscopic pars plana vitrectomy and pars plana tube shunt placement were retrospectively reviewed. Preoperative and postoperative IOP and visual acuity, clinical course and complications were noted. RESULTS: Nine eyes had aniridia, two had chemical burn injury, one had Axenfeld-Rieger syndrome and one had ocular trauma. Median follow-up was 18 months. Preoperative and postoperative mean LogMAR visual acuities were 1.42±0.9 and 1.24±0.7 (p=0.55). Preoperative mean IOP was 23±9 mm Hg and improved to 12±5 mm Hg postoperatively (p<0.0003). No complications were noted. CONCLUSIONS: Endoscopic vitrectomy with pars plana glaucoma tube shunt implantation may be considered in the management of uncontrolled IOP in patients with media opacity. Achieving IOP control prior to attempted anterior segment reconstruction in these severely diseased eyes may increase the success rate and decrease the complexity of subsequent anterior reconstruction procedures.

Intraocular pressure and visual field damage as risk factors for visual field progression in filtering surgery.

BACKGROUND AND OBJECTIVE: To evaluate the relationship between preoperative visual field severity and postoperative intraocular pressure as risk factors for visual field progression. PATIENTS AND METHODS: Patients undergoing trabeculectomy (TRAB, n = 92 eyes of 73 patients) or combined trabeculectomy and cataract extraction by phacoemulsification (COMBO, n = 49 eyes of 41 patients) by one surgeon with at least 6 months of follow-up were reviewed. RESULTS: Both the COMBO and TRAB treatment groups experienced a substantial decrease in mean intraocular pressure (4.7 +/- 6.0 and 10.1 +/- 6.5 mm Hg) and mean number of ocular hypotensive medications (1.8 +/- 1.2 and 2.2 +/- 1.5), respectively. In the subset of 47 eyes with reliable visual fields, the COMBO group experienced a mean improvement in mean deviation of 2.75 dB, and the TRAB group experienced only minimal changes in visual fields. CONCLUSION: In general, visual fields did not worsen following trabeculectomy or combined surgery.

Hypopyon uveitis associated with systemic lupus erythematosus and antiphospholipid antibody syndrome.

PURPOSE: To report a case of hypopyon uveitis associated with systemic lupus erythematosus and antiphospholipid antibody syndrome. METHODS: Interventional case report: a 49-year-old woman with a history of systemic lupus erythematosus and antiphospholipid antibody syndrome presented with sudden onset of pain, redness, photophobia, and decreased vision in the left eye. Examination revealed hypopyon uveitis and vaso-occlusive retinopathy. RESULTS: Following treatment with intravenous steroids and cyclophosphamide, the patient's vision improved from CF to 20/80 with no inflammation 6 months following initial presentation. CONCLUSIONS: In this case, systemic lupus and antiphospholipid syndrome were associated with hypopyon uveitis. Prompt treatment with systemic immunosuppressive therapy resulted in improvement in the hypopyon uveitis and vaso-occlusive retinopathy.

Clostridium sordellii endophthalmitis after suture removal from a corneal transplant.

PURPOSE: To report a case of endophthalmitis caused by Clostridium sordellii. METHODS: A 33-year-old man sustained a penetrating injury of the right eye that resulted in several ocular surgical procedures including pars plana vitrectomy, scleral buckling, scleral-sutured posterior chamber intraocular lens, and penetrating keratoplasty. More than 4 years after the penetrating injury he presented for examination with pain, photophobia, redness, decreased vision, and floaters in the right eye. Vitreous culture grew Clostridium sordellii. RESULTS: Following intravitreal injection of antibiotics, the patient's vision improved from 3/200 to 20/80 (baseline visual acuity) within 2 days. All signs of inflammation resolved without recurrence. CONCLUSIONS: Clostridium sordellii endophthalmitis may have a more benign course than the fulminant endophthalmitis typically seen with other Clostridium species.