Management of endophthalmitis related to glaucoma drainage devices: review of the literature and our experience.

Glaucoma drainage device (GDD)-related endophthalmitis is a devastating complication of device implantation. There are no guidelines in the literature to assist clinicians in deciding if the GDD should be explanted or if patients require pars plana vitrectomy (PPV). This study compares the outcomes of GDD explantation with device retention and also independently compares the outcomes of PPV versus intravitreal antibiotics alone in patients with GDD-related endophthalmitis. A literature search for studies discussing GDD-related endophthalmitis from 2005 to 2019 was performed; 30 articles were included. The visual acuity/anatomical outcomes were compared between GDD explantation and retention, and between patients that received a PPV and those that did not. These outcomes were combined with a medical records review of 13 patients with GDD-related endophthalmitis from an academic institution. A total of 88 eyes were included. 70.5% underwent GDD explantation, while 37.8% received a PPV. GDD explantation was associated with a lower rate of evisceration/enucleation when compared to GDD retention (4.8% versus 19.2%, OR 0.22, 95% CI 0.05-1.01, p = 0.05), but visual acuity outcomes were similar. No eyes that received an immediate vitrectomy became phthisic or required evisceration/enucleation, compared an evisceration/enucleation rate of 15.2% in eyes treated solely with intravitreal antibiotics (OR 1.18, 95% CI 1.04-1.33, p = 0.04). Explantation of the GDD and immediate vitrectomy are both associated with better anatomical outcomes in GDD-related endophthalmitis. Further research is needed to provide more definitive guidelines in the ideal management of these patients.

Can an intraoperative bevacizumab injection prevent recurrent postvitrectomy diabetic vitreous hemorrhage?

PURPOSE: To evaluate the recurrence of vitreous hemorrhage (VH) in patients treated with intravitreal bevacizumab (IVB) injection (2.5 mg/0.1 mL) intraoperatively at the end of vitrectomy for treatment of diabetic nonclearing VH. METHODS: A prospective pilot study of 30 eyes of 28 consecutive diabetic patients who underwent pars plana vitrectomy and IVB injection intraoperatively at the end of vitrectomy was performed. The amount of VH was graded with slit lamp biomicroscopy by three masked retinal specialists from grade 0 to grade 3. Main outcome measures were rate of recurrence of the VH, improvement in visual acuity, incidence of cataract formation, and postoperative complications through a follow-up of 6 months. RESULTS: The percentage of severe recurrent VH with no fundus details (grade 3) was 7%, 13%, 27%, and 30%, respectively, at 7 days and 1-, 3-, and 6-month follow-up. At 6-month followup, the best-corrected visual acuity improved from 1.00 to 0.4 logMAR (p=0.01) in 21 out of 30 eyes (70%). Nine out 20 (40%) phakic patients developed cataract during the follow-up period, and 7 (31%) of them underwent cataract surgery. CONCLUSIONS: The study suggests that intravitreal bevacizumab injection cannot prevent rebleeding in eyes undergoing pars plana vitrectomy for treatment of diabetic vitreous hemorrhage.

Heavy silicone oil tamponade after failed macular hole surgery with perfluoropropane (C3F8): a report of five cases.

UNLABELLED: We report five cases of persistent macular holes following conventional surgery. Subsequent management included pars plana vitrectomy, extended Trypan Blue-assisted ILM peel and heavy silicone oil (HSO) tamponade with supine posture. PURPOSE: To report results of redo macular hole surgery using heavy silicone oil (HSO) tamponade. METHODS: Retrospective study of patients with primary failure of macular hole surgery, who failed to posture prone due to medical reasons. Further surgery consisted of vitrectomy, extended-dye-assisted ILM peel, and HSO tamponade with supine posture. RESULTS: Anatomical closure of macular holes was achieved in three out of five cases with parallel improvement in visual acuity after 3 months of removal of heavy silicone oil. These were confirmed clinically and by ocular coherence tomography (OCT). CONCLUSIONS: HSO may be used as tamponade in patients with unsuccessful primary macular-hole surgery, negating the need of prone posturing post-operatively.