Clinical profile and visual outcome following pars plana vitrectomy in acute post-operative endophthalmitis

Introduction: Endophthalmitis following cataract surgery is a rare but devastating ocular complication where delay in treatment not only results in vision loss but also in difficulty to save the eye ball. Objective: To explore the clinical profile and visual outcome following pars plana vitrectomy (PPV) in acute endophthalmitis after cataract surgery. Materials and methods: This is a retrospective interventional case series study conducted at Tilganga Institute of Ophthalmology (TIO), Nepal. All consecutive cases of acute endophthalmitis following cataract surgery treated with PPV from January 2005 to August 2010 were included in the study. Results: There were a total of 34 cases (34 eyes) treated with PPV. The age range was 8 - 93 years with mean age of 56.9 ± 19.5 years. The mean duration of presentation and duration following cataract surgery was 7.7 ± 8.1days and 13 ± 11.6 days respectively. Small incision cataract surgery was done in 75 % of cases followed by phacoemulsification (15.6 %). The mean duration of the last follow -up was 4.3 months. Vision was improved in two-thirds of cases (67.67 %) with a good vision of 6/18 or better in 17.6 %. Among the available vitreous samples of 22 cases, 36.36 % had an abnormality in Gram and Giemsa stains and culture was positive in 13.6 % of cases. Conclusion: Despite the late presentation, the majority of eyes were salvaged with improvement of vision in 67.67 %, with a good vision of 6/18 or better in 17.6 4 % of cases following PPV in acute post operative endophthalmitis. Key words: Endophthalmitis, vitrectomy, cataract surgery, visual outcome DOI: http://dx.doi.org/10.3126/nepjoph.v3i2.5260 Nepal J Ophthalmol 2011; 3(2): 102-108

Download Full-text

Triple Procedure for Dense Cataractous Neovascular Glaucoma Patients

Journal of Ophthalmology ◽

10.1155/2020/1251203 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Hossam M. Moharram ◽

Shaaban Abd-Elhamid Mehany Elwan ◽

Mahmoud M. Nassar ◽

Mohamed F. Abdelkader

Keyword(s):

Case Series ◽

Neovascular Glaucoma ◽

Panretinal Photocoagulation ◽

Case Series Study ◽

Triple Procedure ◽

Distant Visual Acuity ◽

Pars Plana ◽

The Mean ◽

Series Study

Purpose. One of the most difficult refractory glaucomas is the neovascular type (NVG), and its association with dense cataract adds to this difficulty. This study aimed to provide results of the triple surgical procedure for such conditions. Methods. 12 eyes of 12 patients with NVG and dense cataract were included in this case series study. The mean age of patients was 57.25 ± 5.9 years. The mean preoperative intraocular pressure (IOP) was 47.25 ± 4.04 mmHg with maximum antiglaucoma therapy. The mean best corrected distant visual acuity (BCDVA) in LogMAR was 2.13 ± 0.38. All patients received intravitreal injection of 1.25 mg (0.05 ml) bevacizumab followed by phacoemulsification, pars plana vitrectomy (PPV) including panretinal photocoagulation (PRP), and trabeculectomy with mitomycin C (MMC). Mean IOP and BCDVA changes were the main outcome results of this study. Results. The follow-up period was 2 years. The mean BCDVA was improved to 1.22 ± 0.35, 1.13 ± 0.34, 1.12 ± 0.37, 1.06 ± 0.38, and 1.01 ± 0.37 at 1, 3, 6, 12, and 24 months, respectively, after this procedure. This improvement was statistically significant when compared with preoperative BCDVA (P<0.0001). The mean postoperative IOP was dropped to 20.08 ± 4.1, 17.08 ± 2.1, 17.17 ± 5, 15.75 ± 4.7, and 16.17 ± 6.1 mmHg, respectively. At the last follow-up, the mean IOP was statistically significantly lower than preoperative IOP (P<0.0001) at the previously mentioned time points. The success rate was complete in 90.9% of eyes and qualified in 100% of eyes. Iris and angle neovascularization had regressed significantly in all patients, and no serious complications occurred during the follow-up period. Conclusions. This triple surgery can safely improve patients with NVG and dense cataract regarding BCDVA and IOP control. This trial is registered with NCT04143620.

Download Full-text

Mobile App for Pre- and Intraoperative Assessment of Astigmatism Correction with Toric Intraocular Lenses in Cataract Surgery

Journal of Ophthalmology ◽

10.1155/2020/8354140 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Francisco Aecio Fernandes Dias ◽

Vinicius Jose Fernandes Dias ◽

Barbara de Araujo Lima Dutra ◽

Anna Christina Siqueira Marques ◽

Edgar Marçal ◽

...

Keyword(s):

Cataract Surgery ◽

Case Series ◽

Mobile App ◽

Mean Difference ◽

Ease Of Use ◽

Intraocular Lenses ◽

Toric Iol ◽

Astigmatism Correction ◽

Case Series Study ◽

The Mean

Purpose. To develop a mobile app that allows capturing and editing of photographs, performs image transposition and projection of a protractor with 360° axis markings, and permits accurate visualization of programmed alignment for the positioning of toric intraocular lenses (IOLs). Methods. In this prospective case series study, a codesign methodology was chosen to develop the Eye Axis Check application. After app development, measurements were obtained and comparisons were made between manual marks and toric IOL alignment without and with the app in 30 eyes that had undergone cataract surgery with toric IOLs. The mobile app was made available to 15 ophthalmic surgeons in different cities to assess its usability. Results. The users approved the developed application for its ease of use and utility. The mean difference between the markings made manually and those made with the app was 1° (±2°; range: 0°–5°), and the mean difference between the IOL position and the assessment made by the app was 3° (±3°; range: 0°–12°). Upon comparison of the agreement between the app measurements and the manual measurements for the IOL angle, no significant differences were found, and an excellent concordance (0.997) and a strong positive linear correlation (0.995) were observed. Conclusion. A mobile app for preoperative planning and intraoperative toric IOL alignment was developed and revealed to be useful and easy to use.

Download Full-text

Selective Laser Trabeculoplasty for Glaucoma Secondary to Emulsified Silicone Oil after Pars Plana Vitrectomy: A Pilot Study

BioMed Research International ◽

10.1155/2014/469163 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Zeynep Alkin ◽

Banu Satana ◽

Abdullah Ozkaya ◽

Berna Basarir ◽

Cigdem Altan ◽

...

Keyword(s):

Pars Plana Vitrectomy ◽

Silicone Oil ◽

Open Angle Glaucoma ◽

Case Series ◽

Open Angle ◽

Selective Laser Trabeculoplasty ◽

Consecutive Case ◽

Laser Trabeculoplasty ◽

Pars Plana ◽

The Mean

Background. To investigate the efficacy of selective laser trabeculoplasty (SLT) for lowering intraocular pressure (IOP) in patients with open angle glaucoma (OAG) secondary to emulsified silicone oil (SO).Methodology/Principal Findings. Prospective, interventional, consecutive case series of 11 eyes with sustained elevation of IOP after SO removal. The mean IOP at baseline, week 1, month 1, month 3, and month 6 was evaluated. The mean baseline IOP was significantly decreased from 25 ± 2.7 mmHg to 18.4 ± 5.5 mmHg at week 1(P=0.01), 17.9 ± 3.1 mmHg at month 1(P=0.008), 15.8 ± 3.9 mmHg at month 3(P=0.003), and 16.2 ± 4.7 mmHg at month 6(P=0.004). IOP < 21 mmHg was achieved in 91% of the eyes without a significant complication at month 6.Conclusion/Significance. SLT may be successful for lowering IOP in patients with OAG secondary to emulsified SO which was not controlled with maximum antiglaucomatous medical treatment.

Download Full-text

PARS PLANA VITRECTOMY IN POST-CATARACT SURGERY ENDOPHTHALMITIS IN CIPTO MANGUNKUSOMO HOSPITAL

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i10.1448 ◽

2020 ◽

Vol 4 (10) ◽

Author(s):

Andi Arus Victor ◽

Fitria Romadiana ◽

Ari Djatikusumo ◽

Elvioza ◽

Gitalisa Andayani Adriono ◽

...

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Effective Treatment ◽

Pars Plana Vitrectomy ◽

Demographic Data ◽

Visual Outcome ◽

Descriptive Study ◽

Common Cause ◽

Causative Microorganism ◽

Pars Plana

Background: Endophthalmitis is one of the emergencies in ophthalmology and can cause blindness. The most common cause of endophthalmitis in intraocular surgery is cataract surgery. Immediate diagnosis and treatment can provide optimal final vision. This research aimed to describe the demographic data, and causative microorganisms, as well as the success rate of visual outcome after pars plana vitrectomy (PPV) in post-cataract surgery endophthalmitis in Cipto Mangunkusumo Hospital. Methods: A retrospective descriptive study of post-cataract surgery endophthalmitis underwent vitrectomy in Cipto Mangunkusumo Hospital, Indonesia, from January 2017 - June 2017. Results: There were twenty one cases of post-cataract surgery endophthalmitis undergoes PPV within the period of January 2017-June 2017. The most frequently identified causative microorganism was Staphylococcus (23%). There was an improvement of visual acuity after PPV procedure in 47,6% post-cataract surgery endophthalmitis. Conclusion: Immediate PPV is an effective treatment and leads to vision improvement in post-cataract surgery endophthalmitis. Keywords: pars plana vitrectomy, endophthalmitis, cataract surgery

Download Full-text

Posterior Segment Retained Intraocular Foreign Body: A Study from Western Nepal

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v13i1.28981 ◽

2021 ◽

Vol 13 (1) ◽

pp. 22-30

Author(s):

Bikram Bahadur Thapa ◽

Sweta Singh ◽

Gyanendra Lamichhane ◽

Shanti Gurung ◽

Saurav Piya

Keyword(s):

Visual Acuity ◽

Foreign Body ◽

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Large Diameter ◽

Visual Outcome ◽

Posterior Segment ◽

Intraocular Foreign Body ◽

Pars Plana ◽

The Mean

Introduction: Posterior segment retained Intraocular foreign body (IOFB) management is challenging. Facility of pars plana vitrectomy (PPV) and availability of well trained vitreo retina surgeons are the basic need to accomplish this work. Encircling band provide permanent 360° support to close the anterior retinal break and prevent traction on the retina. The objective of this study is to analyse the clinical characteristics and predictors of the final visual outcome and survival of the globe in cases of retained IOFB in the posterior eye segment. Materials and methods: A hospital based retrospective observational study was conducted. All the patients of retained IOFB in the posterior segment presented from January 2016 to June 2019 were enrolled. Patients presented with visual acuity of NPL were excluded. Statistical analysis was performed using a variety of tests using SPSS version 21. Results: Forty eyes of 40 patients were included. The mean age was 27.08±10.68 years (range 5-66). 95% of our patients were male. Most of them (52.5%) worked on the farm. 26(65%) of 40 eyes had Zone I injury. The median time spent before presentation was 13.5 day. Retinal detachment, vitreous hemorrhage, and endophthalmitis were present in 15, 23 and 5 eyes, respectively, before IOFB removal. The mean LogMAR visual acuity was improved significantly from 2.50±0.87 to 1.33± 1.01 (p=0.003). Poor presenting visual acuity, retinal detachment and large diameter of IOFB were found as the predictor of poor final visual acuity. Conclusion: Pars plana vitrectomy by a vitreo retinal surgeon can give encouraging results in the cases of retained posterior segment IOFB. Poor presenting visual acuity, large diameter of IOFB and RD before IOFB removal are predictors of poor visual outcome.

Download Full-text

Topical Anesthesia in 27-Gauge Pars Plana Vitrectomy

Journal of VitreoRetinal Diseases ◽

10.1177/2474126418762228 ◽

2018 ◽

Vol 2 (2) ◽

pp. 100-103

Author(s):

Abdallah M. Jeroudi ◽

Wen-Shi Shieh ◽

Yicheng Chen ◽

Daniel B. Connors ◽

Kevin J. Blinder ◽

...

Keyword(s):

Pain Score ◽

Pars Plana Vitrectomy ◽

Case Series ◽

Pain Scale ◽

Topical Anesthesia ◽

Pain Scores ◽

Lidocaine Gel ◽

Pars Plana ◽

Intraoperative Pain ◽

The Mean

Purpose: To explore the safety, comfort, and feasibility of topical anesthesia in 27-gauge pars plana vitrectomy surgery. Methods: A prospective, observational case series of 37 nonconsecutive patients undergoing 3-port, 27-gauge pars plana vitrectomy under topical anesthesia with lid block from July 2016 to March 2017 with a single surgeon was performed. Topical anesthesia was achieved with proparacaine 0.5% drops and 2% lidocaine gel. Surgery was performed for select indications with carefully selected patients amenable to topical anesthesia. Patients were queried and observed to identify the most painful steps of the case and to rate their intraoperative and postoperative pain scores on a 1- to 10-point pain scale. Results: The mean intraoperative pain score was 2.1 with the most painful steps rated as scleral depression (37.8%), trocar/cannula insertion (24.3%), and conjunctival coaptation (24.3%). When correlating the overall intraoperative pain score with the self-identified most painful step, the mean pain scores were highest for endolaser (2.6), scleral depression (2.1), conjunctival coaptation (2.1), and trocar/cannula insertion (1.6). Supplemental intravenous anesthesia was requested once by the surgeon in 54% of the cases. No rescue with local infiltrative anesthesia was required. The mean pain scores were 0.7 and 0 at postoperative day 1 and week 1. No intraoperative or postoperative complications were encountered. Conclusions: Topical anesthesia for 27-gauge pars plana vitrectomy is a safe and feasible anesthesia option for carefully selected patients for certain surgical indications.

Download Full-text

VISUAL OUTCOMES OF SAME DAY VERSUS DELAYED PARS PLANA VITRECTOMY FOR DROPPED NUCLEUS DURING CATARACT EXTRACTION

10.36106/ijsr/8014747 ◽

2021 ◽

pp. 9-11

Author(s):

Haniyaa Mufti ◽

Syed Tariq Qureshi ◽

Tufela Shaf

Keyword(s):

Cataract Surgery ◽

Pars Plana Vitrectomy ◽

Prospective Observational Study ◽

Visual Outcome ◽

Cataract Extraction ◽

Time Duration ◽

Ocular Coherence Tomography ◽

Iop Measurement ◽

Pars Plana

Purpose: To compare the visual outcome in patients of nucleus drop undergoing same day pars plana vitrectomy (PPV) versus delayed PPV. Methods: A prospective observational study was conducted on 50 eyes with posteriorly dislocated nucleus after cataract surgery who underwent PPV. Study variables included the time duration between nucleus drop and PPV, nal best-corrected visual acuity(BCVA), and complications after PPV. In 7(14%) eyes, PPV was performed on the same day of cataract surgery and in 43(86%) eyes, an elective PPV was performed after 1 week of cataract surgery. All our cases had intraocular lens(IOL) implanted at the end of PPV. Patients were followed up for 6 months with BCVA, intraocular pressure (IOP) measurement, indirect ophthalmoscopy and ocular coherence tomography(OCT).Results: Comparison was made between VA in patients who underwent PPV on same day (n=7) and those who underwent delayed PPV (n=43). In the same day group, 85.71% patients had BCVA ranged between 6/6 to 6/18, while only 14.29% had BCVA between 6/18 to 6/60 at the nal follow up. In the delayed PPV group , 60.47% had BCVA range between 6/6 to 6/18, 27.90% had BCVA ranged between 6/18 to 6/60 and only 11.63% patients had BCVA of <6/60- hand movements (HM) . Pvalue was 0.398 which was not statistically signicant.Conclusion: Majority of the patients obtain good VAafter PPVfor nucleus drop irrespective of the time. The visual outcome in both the groups was comparable, but slightly better results were obtained in the same day PPVgroup.

Download Full-text

Effect of axial length and age on the visual outcome of patients with idiopathic epiretinal membrane after pars plana vitrectomy

Scientific Reports ◽

10.1038/s41598-019-55544-6 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Sakiko Minami ◽

Hajime Shinoda ◽

Yuta Shigeno ◽

Norihiro Nagai ◽

Toshihide Kurihara ◽

...

Keyword(s):

Confidence Interval ◽

Axial Length ◽

Epiretinal Membrane ◽

Pars Plana Vitrectomy ◽

Visual Outcome ◽

Idiopathic Epiretinal Membrane ◽

Corrected Visual Acuity ◽

Pars Plana ◽

The Mean ◽

Clinical Records

AbstractWe evaluated predictive factors for visual outcomes in patients with idiopathic epiretinal membrane (iERM) after pars plana vitrectomy (PPV). Clinical records for 114 eyes (114 patients, mean age: 70.6 years) with iERM treated by PPV between March 2012 and March 2018 were retrospectively reviewed. Overall, the mean postoperative best-corrected visual acuity (BCVA) and central retinal thickness measured by optical coherence tomography improved as early as 1 month after surgery, and further improved until 3 months (P < 0.01). Multiple linear regression analyses adjusted for the preoperative BCVA showed that older age (B, 0.010; 95% confidence interval, 0.003 to 0.016; P = 0.003) and a shorter axial length (AL; B, −0.059; 95% confidence interval, −0.099 to −0.019; P = 0.005) predicted worse postoperative BCVA. The Mann-Whitney U test showed that the postoperative BCVA was worse in eyes with AL < 23.6 mm than in eyes with AL ≥ 23.6 mm (P = 0.037), and in patients aged ≥69 years than in patients aged <69 years (P = 0.024). The findings may help in evaluating surgical indications for each patient to obtain satisfactory outcomes, irrespective of the preoperative BCVA.

Download Full-text

Outcomes of Late-Onset Bleb-Related Endophthalmitis Treated with Pars Plana Vitrectomy

Journal of Ophthalmology ◽

10.1155/2015/923857 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

Kazuyoshi Ohtomo ◽

Chihiro Mayama ◽

Takashi Ueta ◽

Miyuki Nagahara

Keyword(s):

Pars Plana Vitrectomy ◽

Pathogenic Bacteria ◽

Late Onset ◽

Influence Factors ◽

Visual Outcome ◽

Careful Consideration ◽

Visual Prognosis ◽

Poor Visual Outcome ◽

Pars Plana ◽

The Mean

Purpose. To investigate clinical results on bleb-related endophthalmitis (BRE) after trabeculectomy treated with pars plana vitrectomy (PPV) and to evaluate influence factors for visual prognosis. Methods. Investigating medical records retrospectively, BRE was defined as an endophthalmitis induced by bleb infection. A total of 2018 eyes of 1225 patients who had trabeculectomy between December 2000 and July 2013 were included in this study. Eleven eyes of 11 patients with BRE were performed with PPV. Results. The mean age was 56.6 years. The mean period between trabeculectomy and BRE onset was 7.4 years. The mean period from starting symptom to initiation of treatment for endophthalmitis (PSITE) was 2.3 days. Bleb leakages were observed in 7 eyes (64%). On culture examinations, highly pathogenic bacteria (HPB) were identified in 6 cases (55%). HPB infection was influence factors on visual disturbance (P=.0337). Number of HPB infections is significantly higher in poor visual outcome than without poor visual outcome (P=.0310). Conclusion. Visual prognosis of BRE treated by PPV is significantly better when the pathogenic bacteria are not HPB. Severe visual loss occurred with HPB infection even though patients had appropriate treatments. Physicians need to have careful consideration to prevent bleb infection after trabeculectomy with MMC.

Download Full-text

Postoperative Endophthalmitis Caused by Cutibacterium (Formerly Propionibacterium) Acnes: Case Series and Review

Case Reports in Ophthalmology ◽

10.1159/000510208 ◽

2021 ◽

pp. 1-10

Author(s):

Benjamin J. Fowler ◽

Darlene Miller ◽

Xiaohe Yan ◽

Nicolas A. Yannuzzi ◽

Harry W. Flynn Jr.

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Clinical Features ◽

Pars Plana Vitrectomy ◽

Case Series ◽

Postoperative Endophthalmitis ◽

Cutibacterium Acnes ◽

Pars Plana ◽

Microbiologic Diagnosis

We report the clinical features, treatment strategies and outcomes in a series of patients with infectious endophthalmitis after cataract surgery caused by Cutibacterium acnes (C. acnes), formerly known as Propionibacterium acnes (P. acnes). This retrospective case series includes six eyes of six patients with chronic postoperative endophthalmitis caused by culture-proven C. acnesfrom December 2010 to July 2019 at a University referral center. All patients underwent prior cataract extraction with intraocular lens (CE/IOL) implantation. The mean time between cataract surgery and the microbiologic diagnosis of endophthalmitis was 7.4 ± 5.2 months (range 1.5–17 months). The average time from obtaining the specimen to culture positivity was 7.7 ± 4.4 days (range 3–15 days). Three eyes (50%) presented with hypopyon and three eyes (50%) presented with prominent keratic precipitates without hypopyon. Presenting visual acuity ranged from 20/25 to 2/200. Initial treatments included intravitreal antibiotics alone (n = 2), pars plana vitrectomy (PPV) with partial capsulectomy and intravitreal antibiotics (n = 3), and pars plana vitrectomy with IOL removal and intravitreal antibiotics (n = 1). Follow-up treatments included IOL removal (n = 2), intravitreal antibiotics (n = 1), and topical antibiotics (n = 1). The best-corrected visual acuity at last follow-up was 20/70 or better in all patients. In a literature review, the clinical features and treatment outcomes for all case series of delayed-onset postoperative endophthalmitis caused by C. acnes(n = 120) are listed. A definitive cure (the absence of recurrent inflammation) was achieved in 100% of patients that underwent IOL removal, in 77% of those that underwent PPV/partial capsulectomy and intravitreal antibiotics, and in 18% of cases treated with intravitreal antibiotics alone. Endophthalmitis after CE/IOL caused by C. acnesis characterized by slowly progressive intraocular inflammation and has a protracted course from surgery to microbiologic diagnosis. Visual outcomes are generally favorable, but IOL explantation may be necessary for definitive cure.

Download Full-text