RESUMO
AIM: To report the long-term outcome of the management of a series of culture proven post pars plana vitrectomy endophthalmitis in which the infective agent was in the silicone oil used as an endotamponade. The isolates were Burkholderia cepacia and Pseudomonas aeruginosa. METHOD: A retrospective interventional reporting of a series consisting of a cluster of five cases. CASES: Five consecutive patients received the same batch of 5000-centistoke silicone oil as endotamponade at the conclusion of vitreoretinal surgery and presented with features of acute intraocular inflammation, which was due to an infective cause. The infective organism isolated from the mixture of silicone oil and fluid was B. cepacia in three out of the initial cluster of four eyes and P. aeruginosa in the fifth eye. OUTCOME OF MANAGEMENT: The initial 4 eyes evolved into eyes with poor vision (hand motion, perception of light and no perception of light), advanced proliferative vitreoretinopathy, hypotony, phthisis bulbi and cornea opacity. The poor visual outcome was deemed to be consequent to delay in removal of the silicone oil, despite use of intravitreal, systemic and topical antibiotics. The fifth case, because of the heightened index of suspicion gained from the preceding four cases, had a prompt removal of the silicone oil, vitreal lavage with antibiotics, and intravitreal injection of antibiotics and steroid. He regained a 6/9 vision. CONCLUSION: Gram-negative bacilli can colonize silicone oil resulting in post pars plana vitrectomy endophthalmitis. The index of suspicion for this should be high and can be managed successfully with prompt removal of the silicone oil, microbial sensitive antibiotic lavage of the vitreous cavity, followed by a repeat tamponade.
RESUMO
BACKGROUND: The northern Ghana Upper East Region [UER], Upper West Region [UWR], and Northern Region (NR) lie within the African trachoma belt. The 3 regions share common features of poverty, dryness, dusty environments, and poor environmental hygiene. Trachoma has been identified previously in the NR and the UWR as a disease of public health importance and a control program is underway. PURPOSE: To establish baseline prevalence and risk factor parameters in the Upper East for possible control of trachoma in the region. METHODS: Population-based cross-sectional survey using multi-staged cluster sampling techniques was used. In all 26,323 participants from 4,374 households in 160 communities were examined with a 2.5x magnifying binocular loupe for trachoma; 7,763 were children aged 1-9 years and 15,191 were aged 15 years and over. RESULTS: Only 3 children were identified with active trachoma (trachoma with follicles, TF = 1; trachoma with intense inflammation, TI = 2) giving regional prevalence of 0.01% (Confidence Limits, CL: 0.0-0.1) for TF and 0.03% (CL: 0.0-0.1) for TI. Trachomatous trichiasis was measured at 0.05% (CL: 0.0-0.1) while children with clean faces was measured at 95.5%. Only 3.6% of the examined households in the region had access to a toilet facility. CONCLUSION: Trachoma is not a disease of public health importance in the UER of Ghana despite being in a trachoma endemic zone and sharing the necessary risk factors for the disease.
