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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: Posterior retinopathy of prematurity (ROP) is unusual in its atypical features and its aggressive, rapidly progressive course. It is more difficult to recognize and to treat, with many of these eyes progressing to retinal detachment despite multiple treatments with laser or cryotherapy. The authors present a case of aggressive posterior ROP refractory to multiple laser treatment. This patient was successfully treated with intravitreal bevacizumab, but required repeat treatment 4 months later. The second injection with bevacizumab was followed by progression to retinal detachment requiring surgery. The patient remains stable after surgery.
Journal of Pediatric Ophthalmology & Strabismus 01/2010; 47 Online:e1-4. · 0.63 Impact Factor
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ABSTRACT: To report the short term anatomic response of intravitreal bevacizumab (Avastin, Genentech) as salvage treatment in progressive retinopathy of prematurity (ROP) in a small series of patients.
The study included five eyes of three patients with progressive ROP despite peripheral laser ablation. Patients received intravitreal injections of bevacizumab (Avastin, Genentech). RetCam (Clarity Medical Systems, Inc., Pleasanton, CA) photography and ultrasonography were used to document effect.
Three patients were transferred to the Bascom Palmer Eye Institute/Jackson Memorial Hospital for management of progressive ROP despite laser therapy at an outside facility. RetCam fundus photography and ultrasonography were used to document all cases. After informed consent was obtained from the parents, the patients received off-label intravitreal bevacizumab as salvage treatment. Repeat intravitreal injections of bevacizumab were utilized in several cases. The ROP stabilized allowing laser supplementation. There was varying development of tractional retinal detachments in several of the eyes but the ROP component quieted in all cases.
Off-label use of bevacizumab appears to be useful as a salvage treatment for ROP when laser treatment is precluded. It improves dilation, quiets the disease when visibility is difficult, and temporizes the disease until laser can be supplemented.
Retina 03/2008; 28(3 Suppl):S13-8. · 2.81 Impact Factor
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ABSTRACT: To report on the clinical characteristics and outcomes of premature infants developing signs of anterior segment ischemia after laser therapy for threshold retinopathy of prematurity treated or referred to a university institution.
A retrospective review of the medical records of premature infants with a primary diagnosis of retinopathy of prematurity undergoing laser therapy for threshold disease from January 1, 2001, to June 1, 2006.
A total of 10 eyes in six patients were identified that developed signs of anterior segment ischemia for which a 1-year follow-up was available. The mean gestational age of patients developing anterior segment ischemia was 26.1 weeks. The mean weight was 855 g. The mean gestational age when laser photoablation was initiated was 36.3 weeks. All infants developing ischemia were treated with intermittent dense laser pattern using the diode laser. No infants treated thus far with confluent laser pattern have developed anterior segment ischemia.
Confluent laser pattern in our experience does not predispose to anterior segment ischemia. Anterior segment ischemia primarily affects premature infants less than 28 weeks gestational age with low birthweights, less than 1,075 g. Intravitreal steroids at the time of pars plana vitrectomy and lensectomy may be beneficial in selected patients.
Retina 03/2008; 28(3 Suppl):S55-7. · 2.81 Impact Factor
