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ABSTRACT: The purpose of this study was to report on the incidence and treatment outcomes of endogenous endophthalmitis among newborns in the neonatal intensive care unit (NICU) of a single medical center.
This was a noncomparative, retrospective case series of endogenous endophthalmitis among infants at the Jackson Memorial Hospital NICU treated between March 1, 2002 and March 1, 2007.
Of 4323 infants admitted to the NICU, seven eyes of six (0.139%) infants (two males, four females) were diagnosed with endophthalmitis during the study period. Four patients were born prematurely with a mean gestational age of 27.5 weeks and a mean birth weight of 1153 g. Retinopathy of prematurity was reported in two of the six patients. Mean follow-up was 3.5 years. The diagnosis was confirmed by positive cultures or polymerase chain reaction testing at a median age of 34 postnatal days. Positive cultures included Candida albicans (n = 4), Pseudomonas aeruginosa (n = 1), and Herpes simplex type 2 (n = 1). All patients received systemic treatment and five received adjunctive ophthalmic interventions, including intravitreal antibiotics in five eyes of four patients and vitrectomy with pars plana lensectomy in three eyes. One patient underwent primary enucleation and another had delayed evisceration. In the remaining five eyes, there was a normal appearing posterior segment and normal intraocular pressures at last follow-up.
Endogenous endophthalmitis is a rare complication in infants in the NICU, but may occur in patients with candidemia, bacteremia, retinopathy of prematurity, and low birth weight. Despite early and appropriate treatment, involved eyes may have poor outcomes.
Clinical Ophthalmology 01/2012; 6:733-7.
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ABSTRACT: The authors describe a 3-month-old female infant with infantile rhegmatogenous retinal detachment with no associated congenital or developmental abnormalities. The unique presentation of this patient indicates that the detachment was a result of an early developmental defect.
Ophthalmic Surgery Lasers and Imaging 01/2011; 42 Online:e63-4. · 0.62 Impact Factor
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ABSTRACT: To determine visual and anatomic outcomes for patients with persistent fetal vasculature (PFV) observed or treated with surgery.
Retrospective interventional consecutive case series.
A total of 165 eyes of 150 patients diagnosed with PFV between January 1, 1983, and December 31, 2006, at the Bascom Palmer Eye Institute.
Patients with media opacity, progressive glaucoma, or retinal detachment who were deemed to have visual potential underwent lensectomy, 3-port vitrectomy, or both, through a limbal or pars plicata/plana approach.
Vision, postsurgical retinal attachment, lens status, need for eye removal, and rate of complications.
Of the 81 eyes that underwent surgical repair, 70 had at least 6 months of follow-up (median 47 months) and 49 (70.0%) had form vision, defined as finger counting, fix-and-follow, or better. Twenty (95.2%) of 21 eyes without form vision had a significant posterior component of PFV (P < 0.001). Forty eyes had limbal incisions, and 30 eyes had pars plicata incisions. The choice of surgical approach did not have a statistically significant effect on final visual acuity or rate of complications (P=0.43). Postoperative events occurred in 28 eyes (40.0%). Retinal attachment was achieved in 54 eyes (77.1%), and 61 eyes (87.1%) were left aphakic. Eighty-four eyes were not offered surgery, of which 78 eyes (92.9%) had a posterior component of PFV. The median age at diagnosis was greater compared with the surgical group (197 vs. 67.5 days, P=0.00545). Fifty-eight eyes (69.0%) lacked form vision, and 39 eyes (46.4%) had no light perception. Posterior manifestations of PFV, bilaterality, and microphthalmia were associated with poorer visual outcomes (P < 0.001, 0.041, and 0.002, respectively).
The majority of patients receiving surgical intervention for PFV achieved form vision. Posterior disease, microphthalmia, glaucoma, and amblyopia limited visual acuity outcomes even after aggressive intervention. The choice of limbal versus pars plicata approach produced similar visual and anatomic outcomes without a significant difference in rate of complications.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Ophthalmology 11/2010; 117(11):2178-83.e1-2. · 5.45 Impact Factor
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ABSTRACT: To evaluate the safety and visual outcomes of combined phacoemulsification and sutureless 23-gauge vitrectomy for concomitant cataract and vitreoretinal diseases.
Retrospective consecutive interventional case series. 114 eyes of 111 patients underwent combined sutureless 23-gauge vitrectomy and phacoemulsification surgery between 1 January 2006 and 1 March 2009. Main outcome measures were visual acuity and perioperative complications.
All patients had at least 3 months follow-up (mean 263 days). The main vitreoretinal surgical indications were intractable cystoid macular oedema, epiretinal membrane and retinal detachment. Mean logMAR visual acuity improved from baseline 20/192 to 20/129 at 3 months (p=0.005). Mean intraocular pressure (IOP) increased from baseline 15.8 mm Hg to 17.7 mm Hg (p=0.033) on postoperative day 1 and then decreased by postoperative month 3 to 14.8 mm Hg (p=0.019). 110 (96.5%) eyes had significant pre-existing macular disease, and 93 (81.6%) received preoperative treatments. 82 (71.9%) patients required supplemental treatment(s) at a mean of 91.5 days, most commonly intravitreal injections to reduce vascular leakage or YAG capsulotomy. Hypotony, defined as IOP <5, was observed in four (3.5%) patients, and no patient developed endophthalmitis. Capsular tears were more frequent in eyes with a history of previous radiation or vitrectomy.
Combined phacoemulsification and sutureless 23-gauge vitrectomy surgery was safely and effectively used for cataracts and a variety of complex vitreoretinal diseases.
The British journal of ophthalmology 08/2010; 94(8):1028-32. · 2.92 Impact Factor
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ABSTRACT: The purpose of this study was to describe a subset of severely affected patients with neurofibromatosis type 2 (NF2), multiple central nervous system tumors, and characteristic retinal lesions.
This is a retrospective observational case series of 4 patients with NF2. The time domain-optical coherence tomography findings of three patients have previously been described in another series.
Ophthalmic signs were identified at a mean age of 6 years, and NF2 was diagnosed at a mean age of 11 years. Patients presented with diminished visual acuity in one or both eyes and epiretinal membranes in the absence of posterior vitreous detachment. The biomicroscopic and optical coherence tomography features were distinct from secondary epiretinal membranes or combined hamartomas of the retina and retinal pigment epithelium and pathognomonic for NF2. The ophthalmic manifestations were recognized before neurologic signs and led to the diagnosis of NF2 in 3 of the 4 patients. Each patient had > or =2 central nervous system tumors at the time of diagnosis, and 3 of 4 eventually required neurosurgical interventions for symptomatic, compressive lesions at a mean age of 12 years.
Recognition of epiretinal membranes with a characteristic optical coherence tomography appearance may permit early diagnosis in neurologically asymptomatic children with a severe phenotype of NF2.
Retina (Philadelphia, Pa.) 04/2010; 30(4 Suppl):S51-8. · 2.93 Impact Factor
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ABSTRACT: The use of perfluoro-n-octane (PFnO) for extended endotamponade in an infant with X-linked retinoschisis and complex tractional retinal detachments associated with proliferative vitreoretinopathy (PVR) was reported. The patient had undergone multiple vitrectomy surgeries with silicone oil tamponade. After extensive retinectomy, slippage of the retina produced folds that were flattened under extended PFnO tamponade. The retinas of both eyes remained anatomically reattached 11 months after exchange of PFnO for silicone oil.
Ophthalmic Surgery Lasers and Imaging 03/2010; · 0.62 Impact Factor
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ABSTRACT: To describe a previously unreported finding on optical coherence tomography (OCT) in a patient with occult macular dystrophy (OMD) and correlate it with retinal dysfunction. Retrospective observational case report. A 72-year-old woman presented with sequential progressive central scotomata with reduced visual acuities and color vision in both eyes. Fundoscopic appearance, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography were normal. Full-field ERG was normal, but multifocal ERG demonstrated reduced amplitudes, confirming the diagnosis of OMD. OCT demonstrated loss of cone outer segments with preservation of the inner segment-outer segment junction and photoreceptor cell bodies in both eyes. Loss of cone photoreceptor outer segments may be responsible for decreased visual acuity and foveal thinning in OMD.
Ophthalmic Surgery Lasers and Imaging 03/2010; · 0.62 Impact Factor
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ABSTRACT: Aicardi syndrome, first described by French neurologist Jean François Marie Aicardi in 1965, is a constellation of features characterized mainly by the triad of early infantile spasms, chorioretinal lacunae, and agenesis of the corpus callosum. The authors describe a 1-year-old child with Aicardi syndrome with previously unreported ophthalmic features of aplasia of the right optic nerve and bilateral iris colobomas.
Journal of Pediatric Ophthalmology & Strabismus 01/2010; 47 Online:e1-4. · 0.63 Impact Factor
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Retina (Philadelphia, Pa.) 10/2009; 29(10):1538-41. · 2.93 Impact Factor
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Retina (Philadelphia, Pa.) 10/2009; 29(9):1377-8; author reply 1378-9. · 2.93 Impact Factor
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ABSTRACT: Purpose: To describe a case of chronic endophthalmitis after cataract extraction caused by an unusual pathogen.
Methods: Chart review.
Results: A 79-year-old male presented with chronic endophthalmitis from Cuvularia lunata and received vitrectomy with serial injections of intravitreal voriconazole.
Conclusion: Curvularia endophthalmitis presents late and is difficult to eradicate but responds to intravitreal voriconazole.
Retinal Cases & Brief Reports 12/2008; 3(4):438-439.
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ABSTRACT: To describe a case of sympathetic ophthalmia following vitrectomy for endophthalmitis after an intravitreal injection of bevacizumab.
Retrospective case report.
An 84-year-old male developed sympathetic ophthalmia 4 months after vitrectomy for endophthalmitis following an intravitreal injection. The inciting blind eye was enucleated.
Histopathology demonstrated sympathetic ophthalmia and phacoanaphylactic endophthalmitis. Visual acuity improved from 20/200 to 20/30 in the sympathizing eye with a combination of oral prednisone and azathioprine.
Sympathetic ophthalmia can develop following exogenous endophthalmitis but has a good visual prognosis with appropriate treatment.
Ocular immunology and inflammation 16(5):236-8. · 0.72 Impact Factor
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ABSTRACT: To determine the efficacy of off-label intravitreal bevacizumab (IVB) for the treatment of pediatric retinal and choroidal vascular diseases.
Retrospective, non-comparative, open-label, interventional, consecutive case series of all patients younger than 18 years treated with off-label IVB at a single center from January 1, 2005, to January 1, 2008. Primary outcome measures with best-corrected visual acuity by age-appropriate testing and central macular thickness by time-domain optical coherence tomography.
Thirty-five eyes of 33 patients were treated with IVB alone or in combination with other treatments for choroidal neovascularization, Coats' disease, familial exudative vitreoretinopathy, and various other indications. IVB was used in 24 eyes to reduce excess retinal fluid and exudation. Mean Snellen visual acuity improved from 20/170 at baseline to 20/100 at 1 month (P = .006), 20/80 at 3 months (P = .006), and 20/50 at 6 months (P = .023). Central macular thickness improved from 356 μm at baseline to 287 μm at 6 months (P = .028). IVB was used in 11 eyes to control peripheral retinal neovascularization and iris rubeosis. Although IVB reduced vascular engorgement, it did not prevent the progression of preretinal tractional forces. Mean visual acuity was maintained at each time point. No systemic or ocular adverse events were directly attributable to IVB in any patient.
IVB reduced vascular leakage and temporarily regressed pathologic neovascularization of the choroid, retina, and iris in this series of pediatric patients. Further prospective studies are warranted.
Ophthalmic Surgery Lasers and Imaging 41(6):582-92. · 0.62 Impact Factor
