A retrospective study of patients with retained nuclear fragments after cataract extraction.

PURPOSE: A registration and follow-up of patients who underwent pars plana vitrectomy after dislocated nuclear fragments to the vitreous following cataract extraction. MATERIAL AND METHODS: A retrospective study of 125 patients referred to The National Hospital during the years 1991 to 1998. Phacoemulsification and extracapsular technique were used in 115 eyes and 10 eyes, respectively. A pars plana vitrectomy was performed within an average of 13 days (1-99 days) after cataract extraction. Average follow-up period was 9 months (0.5-35 months). RESULTS: The visual acuity at follow-up was > or = 0.5 in 67 eyes (55.4%), <0.5->0.1 in 32 eyes (26.4%), and < or = 0.1 in 22 eyes (18.2%). The total number of retinal detachments was 26 (21.5%). CONCLUSION: Retained nuclear fragments in the vitreous is a serious complication and most eyes achieve acceptable visual results.

Acute bacterial meningitis in adults. A 20-year overview.

BACKGROUND: Most clinical overviews of acute bacterial meningitis have either focused on children or all age groups combined, although the disease poses serious problems in the adult population. OBJECTIVE: To study the clinical and microbiological features of adult bacterial meningitis in Iceland, as a representative of the average European or North American community. PATIENTS AND METHODS: Data on a total of 132 cases in 127 patients (age, > or = 16 years) who were diagnosed as having acute bacterial meningitis in Iceland during the years 1975 to 1994 were collected from patient and laboratory records. Complete hospital records were found for 119 of the 132 cases identified. RESULTS: The annual incidence was 1.7/100,000 to 7.2/ 100,000 inhabitants (mean, 3.8/100,000). The most common causative organisms were Neisseria meningitidis (56%), Streptococcus pneumoniae (20%), Listeria monocytogenes (6%), and Haemophilus influenzae (5%). Neisseria meningitidis caused 93% of the infections in the 16- to 20-year-old age group, but it caused only 25% of the infections in patients aged 45 years or older. Listeria monocytogenes caused 14% of these cases. Cases of nosocomial and recurrent meningitis were rare. A significant underlying illness or condition was present in 39% of the patients. The mean mortality was 19.7%, and it did not change during the study period. CONCLUSIONS: In a study that involved all adult patients with bacterial meningitis in a single country for 2 decades, meningococci and pneumococci were the most frequent causative agents. However, meningococci were responsible for only one fourth of the cases among adult patients aged 45 years or older, most of these cases were caused by pneumococci and Listeria. Despite modern medical developments, approximately 20% of adult patients with bacterial meningitis died.

[Acute bacterial meningitis in adults, a 20 year overview.].

INTRODUCTION: Although acute bacterial meningitis is most common among children, the disease nevertheless poses serious problems in the adult population. However, most clinical overviews of the disease have either focused on children or all age groups combined. SUBJECTS AND METHODS: Information on all patients 5=16 years of age diagnosed in Iceland during the years 1975-1994 was collected from patient records from 10 hospitals and the records of the Dept. of Microbiology at the University Hospital which processes all bacterial isolates from the CSF identified in the country. RESULTS: One hundred thirty six patients were identified, but complete records were found for 123 patients. Yearly incidence ranged from 1.7-7.2/100,000 inhabitants with a mean of 3.8/100,000. The most common causative organisms were Neisseria meningitidis (54%), Streptococcus pneumoniae (20%), Listeria monocytogenes (6%) and Haemophilus influenzae (5%). The relative incidence of N. meningitidis was dependent on age, the organism caused 93% of infections in the 16-20 year age group, whereas only 25% of infections in subjects 3=45 years of age were due to meningococci. On the other hand, the relative incidence of S. pneumoniae did increase from 2% in the younger age group to 37% in the older subjects. L. monocytogenes caused 14% of cases among patients 3=45 years of age. The mean mortality was 19.1% and did not change significantly during the study period. A significant underlying illness or condition was present in 39% of the patients. During the first third of the study period penicillin or ampicillin alone or in combination with chloramphenicol were used as initial empiric therapy in 76% of cases, wheras during the last third of the period these agents were used initially in 24% of patients. The third generation cephalosporins either alone or in combination were instead employed for empiric treatment in almost two-thirds of the patients. CONCLUSIONS: Meningococci were the most common cause of bacterial meningitis in adults in Iceland during the study period, albeit age dependent, and causing only a fourth of infections in patients 3=45 years of age. Mortality did not change during the period. The third generation cephalosporins are now the most commonly used agents for empiric therapy.