Epidemic Bacillus endophthalmitis after cataract surgery I: acute presentation and outcome.

OBJECTIVE: The purpose of the study is to report the clinical outcome of acute Bacillus endophthalmitis after cataract surgery. DESIGN: The study design is a cohort study. PARTICIPANTS: Fourteen eyes of 14 patients with epidemic acute postoperative inflammation after exposure to bacteria-contaminated viscoelastic material were studied. INTERVENTION: Three patients with milder clinical presentations were treated without vitrectomy or antibiotics. Eleven patients with more severe infection were treated with vitrectomy as well as intravitreous and topical fortified antibiotics. MAIN OUTCOME MEASURES: Final visual acuities were obtained in all 14 study patients. Results of microbiologic studies of aqueous and vitreous specimens from 11 vitrectomized eyes also were analyzed. RESULTS: One patient with late presentation had severe inflammation and had phthisis bulbi develop with no light perception. The remaining 13 patients had successful resolution of inflammation after treatment by 1 month of follow-up. Twelve of these 13 patients, including 1 nonvitrectomized patient, had final visual acuities of 20/100 or better at 6 months' follow-up. Six patients, including two patients with nonvitrectomized eyes, had outcomes of 20/40 or better visual acuity. Bacillus species were grown from all 11 (100%) vitreous and 7 (88%) of 8 aqueous specimens obtained from vitrectomized patients, as well as from the contaminated viscoelastic material remaining in the operating room. CONCLUSIONS: Postoperative Bacillus endophthalmitis need not result in poor outcome. Results depend on factors including bacterial load, specific bacterial species, timing of treatment, and immune status of the patient.

Treatment of encapsulated blebs with 30-gauge needling and injection of low-dose 5-fluorouracil.

We describe a simplified needling procedure, performed at the slit-lamp, with injection of low-dose 5-fluorouracil to treat encapsulated filtering blebs. Between August 1989 and December 1990 we treated 17 eyes of 14 patients with this procedure. At 2 months 13 of the eyes had needed only one needling procedure. Risk factors for reencapsulation of the bleb were a history of three or more previous surgical procedures (p less than 0.05) and prolonged preoperative use of topical adrenergic drugs (p less than 0.05). At 1 year all but one eye had an intraocular pressure below 21 mm Hg (median 15 mm Hg). Twelve of the eyes had needed more than one needling procedure. There were no serious complications of the 32 procedures performed. The incidence rate of minor complications (wound leaks, corneal erosion and small hyphemas) was 38%.

Glaucomatous optic nerve atrophy: the circumlinear vessel revisited.

Baring of a circumlinear vessel, or gap sign, is a sign of glaucomatous optic neuropathy that can be rapidly assessed during direct ophthalmoscopy. We previously found a significant association between the presence of this sign and the diagnosis and status of visual field defects. In the current study we followed this same group of patients for a mean of 78 months. The rate of agreement between two independent observers for the presence or absence of a circumlinear vessel was 79%, and the intraobserver rate was 71%. The corresponding rates for the presence of a gap sign were 84% and 90%. The presence of baring was significantly associated with development of a visual field defect in the glaucoma suspect group (p = 0.0105). The development of a gap sign in photographs taken approximately 6 years later was significantly associated with clinical progression of the appearance of the disc or the visual field defect (p = 0.0142). We conclude that patients with baring of a circumlinear vessel should be closely monitored for the development or progression of the glaucomatous process.

Possibly reduced prevalence of peripapillary crescents in ocular hypertension.

We studied optic disc photographs from 137 healthy subjects and 195 subjects with ocular hypertension. The prevalence of peripapillary crescents was lower among hyperopes than among myopes (p less than 0.05). Moreover, the ocular hypertensive subjects had a statistically significant tendency toward a hyperopic median refraction (p less than 0.01). In keeping with this, we observed a lower prevalence rate of crescents in the ocular hypertensive group (35%) than among the healthy subjects (41%). This difference is in the expected direction and magnitude if the absence of a crescent decreases the risk of glaucomatous damage from elevated intraocular pressure, but the number of subjects was too small to obtain statistical significance; however, the evidence is suggestive. Further study, such as in a large population survey or by comparison of two groups with matched genetic heritage, is needed to substantiate the relation between the presence of a crescent and increased risk of glaucomatous damage.