Neodymium: yttrium-aluminum-garnet laser anterior hyaloidotomy to treat trapped triamcinolone acetonide behind the crystalline lens after intravitreal injection.

A 65-year-old male underwent intravitreal triamcinolone acetonide (IVTA) injection for treating a clinically significant macular edema (CSME) due to background diabetic retinopathy in his left eye. On the first postoperative day, visual acuity dropped from 20/80 to hand movements. Slit-lamp examination showed the drug between the posterior capsule of the lens and the anterior hyaloid face. Two weeks later, visual acuity and the milky fluid seemed unchanged. Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser anterior hyaloidotomy was performed. One week later, slit-lamp examination of the retrolental space revealed the complete disappearance of triamcinolone and intraocular pressure remained stable. After a follow-up period of 2 months, visual acuity increased to 20/50 with the lens remaining clear. Nd:YAG laser anterior hyaloidotomy is an effective, simple, useful and minimally invasive outpatient procedure in patients with persistent entrapment of triamcinolone behind the crystalline lens, allowing the drug to clear without trauma to the lens.

Acute postoperative endophthalmitis caused by Gemella morbillorum.

PURPOSE: We present a case of Gemella morbillorum endophthalmitis after uneventful cataract surgery. METHODS: A 78-year-old woman developed progressive blurring of vision, hypopyon, and vitritis in the precocious postoperatory following cataract surgery. Pars plana vitrectomy and intraocular lens explantation were performed followed by intravitreal injection of vancomycin and ceftazidime. Postoperatively, the patient was given hourly topical fortified vancomycin according to antimicrobial susceptibility testing. At the final follow-up visit 6 months after the initial procedure, visual acuity was 20/50 and no signs or symptoms of endophthalmitis were observed. RESULTS: The undiluted vitreous samples and explanted lens were analyzed. Cultures revealed the growth of G morbillorum, an infrequent opportunistic pathogen. CONCLUSIONS: To date, this is the second reported case of postoperative endophthalmitis by this species. Although endophthalmitis is rare, ophthalmologists should be alert to the possibility of patients having endophthalmitis caused by G morbillorum. Especially, it is necessary to be cautious with surgery in patients with recent infections. A review of the medical literature of this rare ocular infection is presented.