Conservative management of streptococcal necrotizing periorbital fasciitis following primary VZV infection.

A 45-year old male patient, with a past history of illicit drug abuse and hepatitis C, presented with a 2 day history of worsening eyelid edema. Examination of the globe was impossible due to eyelid fusion caused by extensive soft tissue damage. Based on the examination, a diagnosis of necrotic fasciitis secondary to VZV infection was Romamade. The patient received empirical treatment with intravenous acyclovir, meropenem and vancomycin. CT imaging demonstrated no ocular involvement. Lesions were cultivated, revealing presence of Streptococcus pyogenes. Intravenous clindamycin was added to his course. Improvement was gradually observed. The patient received treatment for a total of 21 days, resulting in excellent final outcome. His final visual acuity was 0.9 on a Snellen chart, without signs of ocular inflammation. No surgical intervention was required and lesions fully healed with conservative management. Clinical outcomes depend on prompt treatment initiation, whilst delay in the diagnosis can prove fatal.

Vitrectomy with fibrovascular membrane delamination for proliferative diabetic retinopathy with or without preoperative Avastin.

OBJECTIVE: To describe and compare 1. The changes in intraretinal microstructure using serial spectral domain optical coherence tomography (SD-OCT) preceding and following pars plana vitrectomy and delamination of fibrovascular membranes and 2. Intraoperative and postoperative complications in patients with proliferative diabetic retinopathy (PDR) who had preoperative Avastin (group A) or not (group B). SUBJECTS AND METHOD: This retrospective, interventional case series includes 113 eyes. Outcome measures included LogMAR distance best-corrected visual acuity (BCVA), SD-OCT integrity of photoreceptor inner and outer segments junction (IS/OS), and integrity of external limiting membrane (ELM), intraoperative and postoperative complications. RESULTS: Pre-operative central macular thickness (CMT) was significantly correlated with the final post-operative LogMAR BCVA in group A. Both groups were also categorised into three sub-groups based on post-operative IS/OS integrity (group 0: IS/OS intact; group 1: IS/OS irregular but not completely disrupted; group 2: IS/OS completely disrupted). Mean BCVA improved significantly and IS/OS integrity and ELM integrity postoperatively, were significantly and positively correlated with final BCVA in group A. Intraoperative complications such as iatrogenic tears and haemorrhage and postoperative such as vitreous haemorrhage and neovascular glaucoma were significantly less in group A compared to group B. CONCLUSION: Pre-operative Avastin reduces the risk of intraoperative and postoperative complications and results in better postoperative anatomic and functional outcomes in fibrovascular delamination surgery for patients with PDR.

Characteristics, socioeconomic status and ethnic variations of primary idiopathic macular hole repair in vitreoretinal centers in the United Kingdom.

OBJECTIVE: The purpose of this multicentre retrospective study was to investigate the characteristics and role of ethnicity and socioeconomic status amongst patients with idiopathic macular holes (IMH) and the surgical outcome. SUBJECTS AND METHOD: Consecutive patients undergoing primary IMH surgery at three vitreoretinal units in the UK (King's College Hospital, London, UK, Western Eye Hospital, London, UK, Sunderland Eye Infirmary, Sunderland, UK) between January 2007 and May 2017 were included. The main outcome measure was anatomical closure of IMH. RESULTS: Two hundred and thirty three primary IMH surgeries were included. All patients underwent pars plana vitrectomy, internal limiting membrane peeling, and gas tamponade. 69.10% of patients were European Caucasian, 6.44% were Asian, and 24.46% were Afro-Caribbean. The mean base macular hole diameter (BD) was 475.5mcm. Mean BD was 432.2mcm in European Caucasian patients, 481.3mcm in Asians (P=0.005), and 505.61mcm in Afro-Caribbeans (P=0.006). Regression analysis demonstrated that BD and Afro-Caribbean ethnicity were independent significant risk factors for surgical failure. Those who have longer duration of symptoms (Afro-Caribbeans) and leave in more deprived places (Afro-Caribbeans) in England where found to have lower success rate on macular hole closure. CONCLUSION: Asian and Afro-Caribbean patients present with larger IMH than European Caucasians. In addition to IMH base diameter, black origin and lower socioeconomic status are independent risk factors for surgical failure. This study presents a large population-based data analysis on ethnic variation in macular holes and may assist in the management and predicting the surgical outcome.