Outbreak of Multidrug-resistant Pseudomonas Aeruginosa Endophthalmitis Due to Contaminated Trypan Blue Solution.

PURPOSE: To report the investigation of an outbreak of multidrug-resistant (MDR) Pseudomonas aeruginosa endophthalmitis in 13 patients after cataract surgery and to emphasize on the importance of clinical profile, risk factors, and treatment outcomes. METHODS: This was a hospital-based, retrospective case study with 13 consecutive patients who had man- ual small-incision cataract surgery with intraocular lens (IOL) implantation and developed acute postoperative Pseudomonas aeruginosa endophthalmitis. The anterior chamber taps, vitreous aspirates, and environ- mental surveillance specimens were inoculated for culturing. Antibiotic susceptibility testing was performed using the agar diffusion method. Pulsed-field gel electrophoresis (PFGE) was used to determine the relation- ship between bacterial isolates recovered from study patients and contaminated surveillance samples. RESULTS: Pseudomonas aeruginosa was isolated from all 13 eyes with acute postoperative endophthalmitis and the trypan blue solutions used during surgery. Sensitivity tests revealed that all isolates had an identical resistance to multiple drugs and were only susceptible to imipenem. Genomic DNA typing of Pseudomonas aeruginosa isolates recovered from patients and trypan blue solutions showed an identical banding pattern on the PFGE. Despite the prompt use of intravitreal antibiotics and early vitrectomy with IOL explantation in some patients, the outcome was poor in about 50% of patients. CONCLUSION: Positive microbiology and genomic DNA typing results proved that the contaminated trypan blue solutions were the source of infection in this outbreak. Postoperative endophthalmitis caused by Pseudomonas aeruginosa is often associated with a poor visual prognosis despite prompt treatment with intravitreal antibiotics.

Surgical outcome in optic disc pit maculopathy.

The purpose of this study was to present the surgical outcome in optic disc pit associated maculopathy in a patient who was treated with vitrectomy, internal limiting membrane (ILM) peeling, barrage laser photocoagulation, and silicone oil tamponade. A 21-year-old Indian male was diagnosed with optic disc pit maculopathy in his left eye with a best-corrected visual acuity (BCVA) of 20/200. A 23-gauge pars plana vitrectomy with peeling of ILM was done using brilliant blue dye. After completion of vitrectomy, fluid-air exchange was performed and silicone oil was instilled into eye. Peripapillary endolaser barrage photocoagulation using two rows of low-intensity laser was performed temporally. Silicone oil was removed 4 months after surgery. During the next 24 months, the retina gradually flattened with gradual improvement of BCVA in the left eye. At 24 months, fundus examination showed retinal pigment epithelium atrophy temporal to optic disc not involving the fovea, and optical coherence tomography showed complete resolution of subretinal fluid, with a BCVA of 20/60. The patient maintained the same vision 4 years following the surgery. vitrectomy combined with posterior hyaloid and ILM peeling followed by silicone oil tamponade, with additional laser photocoagulation, was successful for the treatment of optic disc pit maculopathy in our patient. Further studies are warranted to explore the various treatment options and try to set a standard treatment protocol for this rare challenging condition.

Cyclophotocoagulation-induced sympathetic ophthalmia in a Coats' disease patient supported by histopathology and immunohistochemistry.

We describe a case of a 13-year-old male patient of Coats' disease who developed sympathetic ophthalmia (SO) following contact diode laser cyclophotocoagulation. There was no history of invasive surgery or any perforating injuries preceding cyclodestructive therapy. The eye had neovascular glaucoma secondary to Coats' disease, which was treated once with contact cyclophotocoagulation. Subsequently, the intraocular pressure slowly decreased, and the eye became phthisical. Intraocular inflammation developed in the fellow eye and SO was suspected, which was confirmed by characteristic findings seen on fluorescein angiography. The case was successfully managed with the help of topical and systemic immunosuppression. Enucleation with silicone ball implantation was performed in the right phthisical eye and specimen was sent for histopathological examination. Histopathology and immunostaining supported the diagnosis of SO.

Mucous membrane grafting for the post-Steven-Johnson syndrome symblepharon: a case report.

An 18-year-old woman was referred with late sequelae of chloroquine-induced Steven-Johnson syndrome. At the time of presentation, the symblepharon was involving the upper lids to almost the whole of the cornea, and part of the lower bulbar conjunctiva with the lower lid bilaterally. Other ocular examinations were not possible due to the symblepharon. B-scan ultrasonography revealed acoustically clear vitreous, normal chorioretinal thickness, and normal optic nerve head, with an attached retina. Conjunctivo-corneal adhesion released by superficial lamellar dissection of the cornea. Ocular surface reconstruction was carried out with a buccal mucous membrane. A bandage contact lens was placed over the cornea followed by the symblepharon ring to prevent further adhesion. The mucosal graft was well taken up along with corneal re-epithelization. Best corrected visual acuity of 20/120 in both sides after 1 month and 20/80 after 3 months was achieved and maintained till the 2.5-year follow-up.

Sphenoethmoidal mucocele presenting with unilateral visual loss.

BACKGROUND: Sphenoethmoidal sinus mucocele causing uniocular progressive vision loss is a rare entity and was first described by Bery in 1985. It is generally diagnosed in its advanced stage when the patients develop subjective ophthalmic symptoms. CASE: A 43-year-old male presented to our institute for further evaluation and treatment of progressive visual deterioration in his left eye. The patient complained of visual impairment in his left eye for the past three months, in the form of a dark area in his left side of the visual field. OBSERVATIONS: Magnetic resonance imaging (MRI) revealed a large expansile lesion in the left sided posterior ethmoidal air cells, abutting on the left optic nerve and displacing it in the region of the orbital apex. The patient underwent an urgent endoscopic sinus surgery by an Ear-Nose-Throat surgeon which resulted in stable visual acuity in the sixth postoperative month. CONCLUSIONS: Sphenoethmoidal mucocele can cause irreversible blindness. Progressive vision loss with a neurological visual field defect should raise a high index of suspicion and computed tomography and MRI are to be performed to confirm the diagnosis. Collaboration between radiologists, ENT specialists, and ophthalmologists is essential for treating such cases.

Orbital manifestations of Langerhans Cell Histiocytosis: A report of three cases.

Langerhans Cell Histiocytosis (LCH) is a spectrum of disorders characterized by accumulation of histiocytes in various tissues. It is rarely encountered in ophthalmic practice and has an affinity for the orbit. We report three patients with LCH involving the lateral orbital wall, each with a different form of the condition.