Pediatric endophthalmitis. A 10-year consecutive series.

PURPOSE: To report the etiology, culture results, management techniques, and visual outcomes for pediatric endophthalmitis at Emory University for the past 10 years. METHODS: Retrospective chart review based on a computer generated database of all cases of endophthalmitis occurring in patients younger than 18 years from 1995 to 2005. RESULTS: Sixteen cases of pediatric endophthalmitis were identified. Ocular trauma and previous ocular surgery were the most common etiologies, accounting for 44% and 38% of cases respectively. Nine cases (56%) had positive vitreous cultures. Sixty-six percent of cases with positive vitreous cultures involved Gram-positive species. All patients were treated with intravitreal antibiotics. Primary vitrectomy was performed in nine cases. Subsequent to the intraocular infection, 6 eyes (38%) developed retinal detachments. At last follow-up, visual acuity of 20/400 or better was obtained in only 6 eyes (38%). CONCLUSIONS: Pediatric endophthalmitis in this series most commonly resulted from penetrating ocular trauma or from ocular surgery. Retinal detachment commonly occurred as a complication. Despite aggressive management with antibiotics and in many cases vitrectomy, visual outcomes were poor in this series.

Intraocular foreign body injuries during Operation Iraqi Freedom.

OBJECTIVE: To evaluate the number of intraocular foreign body (IOFB) injuries that occurred in Operation Iraqi Freedom, and to determine the cause of injury, the type of foreign body, and the associated injuries to other body systems. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Fifty-five United States military personnel with an IOFB injury during Operation Iraqi Freedom. INTERVENTION: Pars plana vitrectomy, foreign body removal, and additional surgical procedures as the clinical situation dictated. MAIN OUTCOME MEASURES: Cause of injury, size of corneal/scleral laceration, number of foreign bodies, type of foreign body, time to foreign body removal, visual acuity, number of enucleations, and injuries to other body systems. RESULTS: The foreign body was caused by a propelled explosive in 20 patients (36%) and a nonpropelled explosive in 31 patients (56%), and the cause of the foreign body was not known in 4 patients (7%). The size of the laceration of the cornea and/or sclera averaged 5.4 mm (range, 0.2-18). There were an average of 1.7 foreign bodies in the injured eye (range, 1-6). The size of those foreign bodies measured ranged from <1 mm to 12 x 14 mm. The most common type of foreign body was metal (68%), followed by glass (14%), stone/cement (14%), bone (5%), and cilia (3%). The time from injury to foreign body removal averaged 20.6 days (range, 0-90). No cases of endophthalmitis were seen. The most common associated injury was to the upper extremity, face, lower extremity, and neck. CONCLUSIONS: Unlike trauma in the civilian sector, IOFB injuries in a military setting tend to be caused by explosive devices, which often result in multiple foreign bodies and simultaneous injuries to other body systems. Because of the lack of availability of specialty care in the combat theater, there is often a delay in removal of the foreign body.

Miotic effect of brimonidine tartrate 0.15% ophthalmic solution in normal eyes.

PURPOSE: To evaluate the effect of brimonidine tartrate 0.15% ophthalmic solution (Alphagan P) on pupil diameter in eyes of healthy adults under different luminance conditions. SETTING: Center for Refractive Surgery, Ophthalmology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, DC, USA. METHODS: Using a Colvard pupillometer, the pupil diameter was measured in 15 eyes of 15 healthy adults under 3 luminance conditions (scotopic, mesopic, photopic). The luminance of the room was measured using the Minolta LS-110 Luminance Meter. Pupil diameter was remeasured using the same technique 30 minutes, 4 hours, and 6 hours after administration of 1 drop of brimonidine tartrate 0.15% ophthalmic solution. RESULTS: Under scotopic conditions (luminance 0.0 candelas [cd]/m(2)), the pupil diameter decreased by 1.0 mm or more in 100%, 87%, and 60% of eyes at 30 minutes, 4 hours, and 6 hours, respectively (P<.005); under mesopic conditions (luminance 0.2 cd/m(2)), in 93%, 73%, and 40% of eyes, respectively (P<.005); and under photopic conditions (luminance 150.2 cd/m(2)), in 73%, 87%, and 67% of eyes, respectively (P<.005). CONCLUSIONS: Brimonidine tartrate 0.15% ophthalmic solution produced a significant miotic effect under all 3 luminance conditions. The reproducible miotic effect under scotopic and mesopic conditions may help postoperative refractive patients who report night-vision difficulties related to a large pupil.