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.

Comparison of Simulation-Based versus Cadaveric-Tissue-Based Ocular Trauma Training on Novice Ophthalmologists: Repair of Corneal Laceration Model

Purpose The aim of this study was to evaluate whether the simulated tissue models may be used in place of animal-based model for corneal laceration repair for surgical skills acquisition. Design Prospective randomized controlled trial. Participants Seventy-nine military and civilian 2nd- and 3rd-year ophthalmology residents and 16 staff ophthalmologists participating in the Tri-Service Ocular Trauma Skills Laboratory at the Uniformed Services University (Bethesda, MD). Methods Resident ophthalmologists underwent preliminary evaluation of their ability to close a 5-mm linear, full-thickness corneal laceration involving the visual axis. They then were randomized to undergo 90 to 120 minutes of either simulator-based (SIM) or swine cadaveric-tissue-based (CADAVER) corneal laceration repair. The same evaluation was performed post training. On a more limited basis, the study was repeated for attending ophthalmologists to act as a pilot for future analysis and test efficacy for “refresher” training. Main Outcome Measures Successful wound closure with secondary outcomes of suture length, tension, depth, and orientation, as graded by attending ophthalmologists. Results No significant difference in CADAVER versus SIM groups in the primary outcome of watertight wound closure of the corneal laceration. CADAVER group performed better than SIM group for certain metrics (suture depth, p = 0.009; length, p = 0.003; and tension, p = 0.043) that are associated with poor wound closure and increased amount of induced corneal astigmatism. For attending ophthalmologists, six of the eight in each group (SIM and CADAVER) retained or improved their skills. Conclusions For resident ophthalmologists, SIM training is sufficient for achieving the primary outcome of watertight wound closure. However, CADAVER training is superior for wound metrics for the ideal closure. For attending ophthalmologists, SIM training may be useful for retention of skills.

Individualized Corneal Patching for Treatment of Corneal Trauma Combined with Tissue Defects

Aim. To evaluate the efficacy of individualized corneal patching using a minimal graft for corneal trauma combined with tissue defects. Methods. Fifteen eyes (15 patients) were enrolled in this study, including 8 eyes with corneal perforation induced by removal of metal foreign bodies, 5 eyes with corneal laceration resulting from metal trauma, and 2 eyes with pencil injuries to the cornea. The size, shape, and depth of the tissue defects were assessed. For corneal perforation or irregular tissue defects, if the diameter or length was ≥3.0 mm, traditional penetrating keratoplasty (PK) or lamellar keratoplasty (LK) was adopted; if the diameter or length was ＜3.0 mm, a conical or irregular patch consistent with the defects was used. The visual acuity, corneal status, and postoperative complications were observed during the follow-up. Results. The diameter of corneal perforations was 1.0 mm in 2 eyes, 1.5 mm in 1 eye, 2.0 mm in 4 eyes, and 3.5 mm in 1 eye. During their PK procedures, a conical corneal graft was used in 7 eyes, while a traditional cylindrical graft was used in 1 eye. The other 7 eyes had corneal trauma combined with irregular tissue defects, which were full-thickness corneal defects in 5 eyes and lamellar defects in 2 eyes, all less than 3.0 mm in length. Thus, five eyes received PK, and 2 eyes received LK using an irregular wedge-shaped patch. The visual acuity increased greatly postoperatively, with mild corneal astigmatism. None of the patients developed immune rejection. Conclusion. Individualized corneal patching with a minimal graft can save corneal materials, relieve corneal scars, gain a good visual prognosis, and avoid immune rejection in the treatment of corneal trauma combined with tissue defects.

Tectonic Graft for Persistent Leakage and Visual Outcome After Corneal Perforation Repair: A Case Series

Keratoplasty is a modality of treatment for large and leaking corneal perforation in a tertiary center. We report cases of 20and 30-years old men presented in an emergency with history of road traffic accident 1 and 3 days back. Best corrected visual acuity was hand movement in both injured eye. Slit lamp examination of both cases revealed full thickness corneal laceration with Siedel test positive. Both cases underwent corneal laceration repair with resuturing and corneal glue on consecutive days but couldn't seal the leaking wound. Then ultimately both were undergone for tectonic keratoplasty. The final best corrected visual activity of involved eye was 6/36 in case 1 and 6/24 in case 2. Most cases of traumatic corneal perforation undergone urgent corneal repair but sometimes very difficult to seal the wound. In such cases donor cornea tissue may have to be used to maintain integrity of globe and better visual potential.

Visual Outcome of Pediatric Traumatic Cataract in Lumbini Eye Institute, Bhairahawa, Nepal

Introduction: There are not many studies of pediatric trauma in Nepal. Therefore, this study was conducted to find out the visual outcome of pediatric traumatic cataract and causes of poor visual acuity. Materials and Methods: In this hospital based prospective study, all children visiting the pediatric department of Lumbini Eye Institute and Research Center with traumatic cataract and visual outcome after surgery from July 2018 to August 2019 were evaluated. A total of 136 children ranging from age (0 months to 15 years) with traumatic cataract were included in the study. Data on age of presentation, sex and diagnosis were collected from clinical charts and analyzed. Results: The study enrolled 136 cases with traumatic cataract. 72.1% male and 27.9% female patients were involved with the average age being 9.46 years (SD 2.95). Final visual acuity was better than 20/60 in 73 percent of the children. Visual acuity was poor in 27 percent of children. In children with poor visual acuity 44 percent of the patients had corneal opacity, 23 percent had retinal detachment and 18 percent had vitreous opacification secondary to trauma. Closed globe injury was seen in 72 percent of children and 28 percent had open globe injury. Conclusion: Male children were more prone to traumatic cataract than female children. Open globe injury with corneal laceration and opacity was the major cause of decreased visual acuity.