Treatment of Bilateral Endogenous Aspergillus Endophthalmitis with Multiple Intravitreal Voriconazole Injections with Good Visual Outcome

Endogenous endophthalmitis caused by <i>Aspergillus</i> species tends to be very aggressive, often leading to devastating visual outcomes. Historically, intravitreal amphotericin injections have played a central role in management, but with variable visual outcomes and a risk of toxicity. Limited reports suggest that use of intravitreal voriconazole is a safe and efficacious alternative, though these cases were treated with only few intravitreal injections. Here, we report a case of bilateral endogenous <i>Aspergillus</i> endophthalmitis treated with 8 intravitreal voriconazole injections in the right eye and 11 in the left eye with good best-corrected final visual outcome (20/50 right eye and 20/40 left eye).

Clinical profile and outcomes of descemetopexy in descemet membrane detachment (DMD) post-cataract surgery

To identify the preoperative risk factors, type of cataract surgery, cataract grade, and final visual outcome in patients undergoing descemetopexy for DMD. This was a retrospective study in which records of patients who underwent descemetopexy with either air or 20% sulfur hexafluoride (SF6) between 1st July 2014 and 30th June 2017. Grade of cataract, type of surgery, visual outcomes, and site of DMD were recorded.The mean age of the patients was 63.21 ± 5.8 years. Of the total 23 cases undergoing descemetopexy, 20 cases (87%) were after manual small incision cataract surgery (MSICS) and three cases (13%) were post phacoemulsification. The mean duration of presentation with a detachment was 13.03± 10.9 days (1-40 days). The most common types of DMD were total (34.8%) followed by temporal (30.4%) and superior (26.1%). Two patients (8.6%) obtained LOGMAR visual acuity (VA) of 0.0 and 5 of 23 patients (21.7%) achieved LOGMAR VA 0.3 after descemetopexy. Reattachment rates were 87% and three cases had reintervention. : This study identifies mature cataract and pre-existing corneal pathology as major risk factors for DMD during cataract surgery. DMD can be treated effectively and good visual outcome after successful descemetopexy.

Profile of Amblyopia and Outcome of Occlusion Therapy in Amblyopic Patients Attending Tertiary Care Hospital of Kathmandu

Amblyopia is a common cause of visual impairment in children. The aim of this study was to assess the profile of amblyopia and the outcome of occlusion therapy in amblyopic children attending the eye department of a tertiary care hospital. This was a hospital based prospective interventional study. Sixty-five eyes of 47 patients fulfilling the inclusion criteria were included in the study. Occlusion therapy was started for the diagnosed amblyopic cases after refractive adaptation of 4 weeks. The mean age of presentation was 8.8 ±3.2 years. 29(61.7%) cases had unilateral amblyopia, 18(38.3%) cases had bilateral amblyopia. Ametropic amblyopia (52.3%) was the most common type of amblyopia followed by Anisometropia (23.1%). Refractive error was the most common cause of amblyopia with compound myopic astigmatism seen among 30.8% and hypermetropia among 29.2% of patients. There was no significant association between initial visual acuity with age of presentation and types of amblyopia respectively (P=0.1, P=0.5). The final visual outcome after therapy was better among patients with Ametropic amblyopia than other types (P=0.02). There was significant association between final visual outcome with age, initial visual acuity, type and severity of amblyopia respectively (P<0.001, P<0.001, P=0.02, P=0.02). In conclusion, Ametropia was the most common type of amblyopia. The mean age of presentation was 8.8 years, which was beyond the critical period affecting the outcome of treatment. Uncorrected refractive error was the most common amblyogenic factor. Age of presentation, types and severity of amblyopia are the important contributing factors for the outcome of occlusion therapy. Therefore, early detection and management of amblyopia is important to reduce visual impairment among children.

Bacillus endophthalmitis after cataract removal surgery following initial ocular trauma: a case report

Infectious endophthalmitis is an ocular infection caused by bacterial or fungal organisms involving intraocular tissues, aqueous, and vitreous humour. Bacillus sp. is an uncommon microorganism causing endophthalmitis. We describe a teenager who presented with a self-sealed corneal laceration, cataractous lens, and evidence of a breach in the anterior capsule. The eye was initially quiet and stable. The event started 1 day after uncomplicated cataract surgery. The patient developed fulminant postoperative endophthalmitis with a fatal final visual outcome. A high index of suspicion is mandatory, and more aggressive treatment may be able to improve the final outcome.

Outcomes and Prognostic Factors of Posttraumatic Endophthalmitis: A Three-Year Retrospective Study

Purpose. To describe the clinical features, management, and outcomes of patients with posttraumatic endophthalmitis (PTE) and to determine risk factors for poor visual prognosis. Methods. We retrospectively reviewed the medical records of 42 consecutive patients presenting with PTE who were treated at our institution between 2017 and 2019. Each patient’s data, including demographic characteristics, ocular injury details, surgical records, patient outcomes, and laboratory results, were collected and analyzed. Multivariate analysis was conducted to determine the factors associated with poor visual outcomes. Results. In our series, male (n = 36, 85.7%) and patients below 60 years of age (20–40 years, 23.8%; 40–60 years, 57.14%) comprised most of the total cohort. On presentation, 39 (92.8%) of the 42 PTE patients presented best-corrected visual acuity (BCVA) worse than counting fingers. Pars plana vitrectomy (PPV) was performed in all the patients. 59.5% (n = 25) of the patients’ BCVA improved after surgery and 33.3% (n = 14) achieved BCVA of 20/200 or better. The rate of evisceration was 7.1% (n = 3). Of the 42 specimens, the culture was positive in 10 (23.8%) eyes. By univariate analysis, factors including sex, occupation, systemic disease, source of trauma, lens injury, silicone oil tamponade, usage of intravitreal antibiotics, BCVA at presentation, and culture positive for any organism did not affect the final visual outcome. The features associated with poor BCVA (grouped as < 20/200 and ≥ 20/200) included older age ( P = 0.035 ), corneal-sclera wound (versus sclera wound) ( P = 0.047 ), retained intraocular foreign bodies (IOFBs) ( P = 0.006 ), treatment > 3 days (versus < 1 day) ( P = 0.033 ), and more times of surgeries ( P = 0.033 ). Conclusions. PTE is a severe complication of penetrating globe injuries associated with irreversible visual loss. Our results highlighted the importance of conducting early therapeutic PPV and IOFB removal to achieve better visual outcomes.

PROFILE OF PATIENTS IN HOOCH TRAGEDY AND ASSESSMENT OF FACTORS AFFECTING FINAL VISUAL OUTCOME

Acute methanol poisoning is a global crisis. It can be very dangerous by causing severe visual dysfunction, metabolic disturbances, permanent neurological dysfunction and even death. In a recent hooch tragedy in suburban area in Punjab, 24 (47 eyes) male patients in age group of 25-65 years presented to us after spurious alcohol intake. The time of presentation after alcohol intake varied between 1-15 days as they were referred after medical treatment for systemic ailments at other centers. The amount of alcohol intake in all these patients ranged between 125ml-500ml. At presentation, 19 (40.4%) eyes were PL-VE while 16 (34%) were PL+VE or HMCF, 5 (10.6%) had vision between 6/60-FCCF and 7(14.9%) between 6/6 -6/36. 11(23.4%) eyes showed improvement in visual acuity at 6 weeks of treatment and 6 (12.7%) eyes deteriorated even after the treatment. The nal visual outcome was correlated with age, day of presentation, amount of alcohol and initial visual acuity. In this study, we describe prole of patients who presented with a history of spurious alcohol consumption and assessment of risk factors affecting their nal visual outcome.

Predictors of Visual outcome in Post Fever Retinitis: A Retrospective Analysis

Purpose: To identify the predictors of final visual outcome in cases with post fever retinitis (PFR).Methods : This is a retrospective study of cases with diagnosis of post fever retinitis. Color fundus photograph and optical coherence tomography (OCT) parameters at presentation and final visit were analysed. Various factors at presentation [age, systemic illness, best corrected visual acuity (BCVA), area of retinitis and hard exudates, OCT parameters], at final visit (optic disc pallor, OCT parameters) and the treatment modalities used were correlated with BCVA at final visit.Results : Twenty four eyes of 16 patients with PFR were included in the study. Median BCVA at presentation was 6/60 and at final visit was 6/9. By multiple linear regression after adjusting for other variables, for every 1 unit increase in height of SRF at fovea at presentation, the value of final BCVA decreased by 0.001 unit. For every 1 unit increase in extent of EZ loss and subfoveal deposit height, the value of final BCVA decreased by 0.0001unit and 0.004 unit respectively.Conclusion: Height of SRF at presentation, extent of EZ loss and subfoveal deposit height at final visit were associated with poor final BCVA in PFR.

A 14-Year Retrospective Analysis of Endogenous Endophthalmitis in a Tertiary Referral Center of Southern Thailand

Purpose. To investigate patient characteristics, clinical features, common causative organisms, and visual acuity outcomes in endogenous endophthalmitis. Methods. This was a retrospective chart analysis of patients with endogenous endophthalmitis between January 2006 and December 2019. Collected data included basic patient characteristics, presenting symptoms, causative organisms, treatments, and 3-month and 1-year visual outcomes. Results. Twenty-nine eyes of 27 patients were included in the study. The mean age of the patients was 45.4 ± 19.9 years, and 63% were female. Visual acuity at presentation ranged from counting fingers to no light perception. Systemic comorbidities presented in 66.7% of the patients, the majority of which were related to diabetes mellitus (48.1%). The most common primary infection was a urinary tract infection. Positive blood cultures were identified in 48.1% of patients, and positive cultures from vitreous and aqueous samples were identified in 59.3% and 31.6% of eyes, respectively. Among all the specimens, Gram-positive bacteria were identified in 55.5%, Gram-negative bacteria in 22.2%, fungi in 14.8%, and mixed organisms in 7.4%. Among ocular specimens, 61.1% contained Gram-positive organisms, 16.7% contained Gram-negative organisms, and 22.2% contained fungi. Streptococcus spp. was the most common causative organism. From 29 eyes, 18 (62.1%) underwent vitrectomy, and 12 (42.9%) underwent either evisceration or enucleation. Positive vitreous culture was significantly associated with unfavorable final visual outcome. Final visual acuity ranged from 20/125 to no light perception. Although visual improvement at 3 months was significantly better in younger patients, this had no impact on final visual outcome at 1 year. Conclusion. Eyes with positive vitreous cultures had significantly poorer visual outcomes. Despite full treatment coverage, visual prognosis was extremely poor and the rates of blindness and evisceration/enucleation were still high.

Evaluation of the factors affecting visual prognosis in patients with traumatic cataract

Background: Ocular trauma is a major cause of visual impairment throughout the world, although little is known about the factors that affect the visual outcome in traumatic cataract in developing countries. The objective of the study was to find out the associated ocular injuries and the factors affecting final visual outcome of patients with traumatic cataract.Methods: This prospective-hospital based study was conducted on 50 patients of traumatic cataract in the department of ophthalmology government medical college, Ernakulam, from January 2009 to December 2011. Patients were managed with lens extraction and intraocular lens implantation. Regular follow up of patients was done and best corrected visual acuity (BCVA) and post-operative complications were assessed at the end of six months.Results: Our study showed that majority (64%) of patients were in the age group of <40 years with male preponderance. visual outcome was significantly better in younger age group (<20 years) than the older group (>20 years) (p=0.03). There was no significant difference in final visual outcome of traumatic cataracts caused by penetrating or blunt trauma (p=0.73). Corneal tear was most common associated ocular damage followed by uveitis, lens matter in anterior chamber.Conclusions: Age of the patient affects final visual outcome after surgical treatment of traumatic cataract but type of trauma (blunt/penetrating) had no significant effect on final visual outcome. Corneal tear was most common associated ocular damage.

Intravitreal Bevacizumab for Macular Edema Secondary to Retinal Vein Occlusion

Introduction: The most common cause of vision loss in cases of Retinal vein occlusion (RVO) is due to macular edema. This study was conducted to examine the effect of intravitreal bevacizumab (IVB) in the treatment of macular edema secondary to RVO. Materials and methods: The authors conducted a retrospective study of 94 eyes (N) of 92 patients with macular edema associated with decreased visual acuity secondary to RVO who were treated with IVB. Patients received IVB at baseline, 1 month and 2 months. At each follow up patients were evaluated and re-injected if necessary. Results: The mean age of the patients was 56.6 ±11.51 years. The average number of injections per eye was 2.1 ± 0.87. The baseline median central macular thickness (CMT) and best-corrected visual acuity (BCVA) in LogMAR was 465.00μm (Min 254μm, Max 1218μm) and 1.00 (Min 0.30, Max 2.28), respectively. The median CMT at one month following first, second and third dose of IVB was 258μm (N=94, Z= -7.64, p <0.001), 261μm (N=63, Z= -0.17, p=0.86), and 292μm (N=41, Z= -0.21, p= 0.83), respectively. The median LogMAR BCVA at one month following first, second and third dose of IVB was 0.60 (N=94, Z= -5.70, p < 0.001), 0.60 (N=63, Z= -1.69, p=0.09), and 0.60 (N=41, Z= -0.03, p=0.97), respectively. Pre-operative BCVA was the best predictor of the final visual outcome after IVB in cases of RVO. None of the patients developed any serious ocular or systemic complications due to IVB. Conclusion: IVB is an effective and safe treatment for macular edema associated with decreased visual acuity secondary to RVO. The most beneficial effect of IVB is seen at one month after the first dose. The efficacy of subsequent doses could not be established in this study