Conservative management of streptococcal necrotizing periorbital fasciitis following primary VZV infection.

A 45-year old male patient, with a past history of illicit drug abuse and hepatitis C, presented with a 2 day history of worsening eyelid edema. Examination of the globe was impossible due to eyelid fusion caused by extensive soft tissue damage. Based on the examination, a diagnosis of necrotic fasciitis secondary to VZV infection was Romamade. The patient received empirical treatment with intravenous acyclovir, meropenem and vancomycin. CT imaging demonstrated no ocular involvement. Lesions were cultivated, revealing presence of Streptococcus pyogenes. Intravenous clindamycin was added to his course. Improvement was gradually observed. The patient received treatment for a total of 21 days, resulting in excellent final outcome. His final visual acuity was 0.9 on a Snellen chart, without signs of ocular inflammation. No surgical intervention was required and lesions fully healed with conservative management. Clinical outcomes depend on prompt treatment initiation, whilst delay in the diagnosis can prove fatal.

Vitreoretinal interface changes in acute-onset postoperative endophthalmitis.

BACKGROUND: The aim of this study was to assess the significance of different clinical appearances of the vitreoretinal interface in the surgical management of acute postoperative endophthalmitis. PATIENTS AND METHODS: 22 patients underwent vitrectomy and were divided intraoperatively in 3 groups according to the degree of vitreoretinal interface changes: 10 patients had white infiltrates in the vitreous cortex but no retinal hemorrhages (group A), eight patients had white infiltrates in the vitreous cortex and retinal hemorrhages (group B) and four patients had advanced vitreous opacification, strong vitreoretinal adhesions and retinal hemorrhages (group C). In group A vitrectomy was performed and the vitreous cortex was removed cautiously, while in groups B and C the vitreous cortex was not removed in the first procedure. RESULTS: Visual acuity improved in 14 patients, remained stable in 2 patients and deteriorated in 6 patients. The visual prognosis was better in group A. None of the cases was complicated with retinal detachment following vitrectomy, but in groups B and C 37.5 % and 50 % of the patients, respectively, went into phthisis. CONCLUSIONS: Intraoperative assessment of the vitreoretinal interface insult in acute postoperative endophthalmitis contributes to an optimal surgical management, and it also has a prognostic value.

Secondary management and outcome of massive suprachoroidal hemorrhage.

PURPOSE: To present the results of secondary surgical treatment of five patients with massive suprachoroidal hemorrhage (MSCH), which occurred intraoperatively, postoperatively, or following ocular trauma. METHODS: Five patients presenting with MSCH were included in this study during or after phacoemulsification surgery (1 patient), glaucoma surgery (1 patient), combined glaucoma and phacoemulsification surgery (2 patients), and after traumatic sclera rupture (1 patient). Diagnosis was confirmed by ophthalmoscopy and B-scan ultrasonography. Pre-existing risk factors and distance visual acuity were documented. All cases received medical therapy and underwent secondary surgical intervention with radial sclerotomies combined with vitrectomy, use of perfluorocarbon, and silicone oil. Postoperative assessment included visual acuity measurement, ocular examination, and ultrasonography. RESULTS: In all cases, anatomic restoration of ocular structures was achieved. Distance visual acuity improved in all cases (preoperative Snellen visual acuity ranged from light perception to hand motions; postoperative Snellen visual acuity ranged from 0.05 to 0.3). The mean follow-up period was 17 months. CONCLUSIONS: In general, despite the advanced surgical techniques, the prognosis of MSCH remains guarded and the visual outcome poor. However, secondary surgical treatment with combined radial sclerotomies and vitrectomy should be considered in order to minimize the damaging effect and maximize the anatomic and functional restoration.