Harry W Flynn

• Professor of Ophthalmology
• Academic Director at University of Miami

Purpose: To document the presence of herpes simplex virus (HSV) genomic signatures among Acanthamoeba hosts recovered from patients with Acanthamoeba keratitis (AK) and in contaminated lens cases. Methods: We used a combination of PCR sequencing and shotgun metagenomics to detect and confirm the presence of HSV genomic signatures in Acanthamoeba h...

Introduction: Demarcation laser photocoagulation (DLP) is an infrequently utilized modality for limited retinal detachments. The current study, a retrospective consecutive case series, reviewed anatomic and visual outcomes in these patients at a single academic center. Case presentations: A search of the electronic medical record identified ten eye...

Tractional retinoschisis (TRS) secondary to proliferative diabetic retinopathy (PDR) may be differentiated from tractional retinal detachment (TRD) by its characteristically nonprogressive course. The purpose of the current study was to describe the use of swept-source optical coherence tomography angiography (SS-OCTA) in the diagnosis and monitori...

Introduction: Retinal vasculitis in the setting of positive mycobacterium tuberculosis (mTB) exposure represents an important diagnostic dilemma. Tubercular retinal vasculitis (TRV) is a recognized clinical entity that previously lacked diagnostic consensus. It shares clinical features with cases diagnosed as Eales disease. A precise distinction be...

This chapter provides a comprehensive historical overview of cystoid macular edema (CME), tracing its recognition and evolution in ophthalmology. From its initial identification in the mid-20th century to modern diagnostic advancements, the chapter explores key milestones, including pivotal clinical studies, the development of imaging techniques li...

Aim: Rose Bengal photodynamic antimicrobial therapy (RB-PDAT) has poor corneal penetration, limiting its efficacy against acanthamoeba keratitis (AK). Iontophoresis enhances corneal permeation of charged molecules, piquing interest in its effects on RB in ex vivo human corneas. Methods: Five donor whole globes each underwent iontophoresis with RB,...

Purpose To assess ocular pain in patients undergoing multiple intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) who have previous factors that may influence pain sensitivity. Methodology This is a prospective, observational, case series study involving patients who underwent multiple (≥3) pro re nata intravitreal injec...

Purpose: To report a case of a suspected open-globe injury and globe penetration complicated by a rhegmatogenous retinal detachment (RRD) after administration of intraoral anesthetic injections during an endodontic procedure. Methods: A retrospective chart review was performed. Results: A 34-year-old woman presented with acute onset of flashes, flo...

Purpose To report the clinical features and outcomes in eyes that underwent vitreoretinal surgery for complications of concurrent sickle cell retinopathy (SR) and diabetic retinopathy (DR). Methods Retrospective, consecutive case series of all eyes that underwent vitreoretinal surgery for complications secondary to concurrent SR and DR between 1/1...

Background and Objective This study evaluated the efficacy and durability of faricimab in patients with neovascular age-related macular degeneration (nAMD) who were previously treated with anti-vascular endothelial growth factor (anti-VEGF) agents. Patients and Methods This retrospective case series was conducted at a single tertiary center in the...

Purpose The purpose of this study was to report clinical characteristics and outcomes of surgical repair for patients with traumatic dehiscence of penetrating keratoplasty (PKP) grafts. Methods Retrospective, consecutive chart review of patients evaluated at Bascom Palmer Eye Institute between 2015 and 2020 with traumatic dehiscence of penetrating...

Importance Evaluation of the microbiological diagnostic profile of multidrug-resistant Pseudomonas aeruginosa keratitis and potential management with rose bengal–photodynamic antimicrobial therapy (RB-PDAT) is important. Objective To document the disease progression of carbapenemase-resistant P aeruginosa keratitis after an artificial tear contami...

Endophthalmitis is a rare but vision-threatening infection characterized by marked inflammation of intraocular fluids and tissues, uncommonly seen following surgery and intravitreal injection. Antimicrobials are used worldwide in the prophylaxis and treatment of bacterial and fungal infections of the eye and are standard treatment in the preoperati...

Purpose To report a case of paracentral acute middle maculopathy (PAMM) due to branch retinal artery occlusion (BRAO) as a complication of COVID-19. Methods A case report evaluated through spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography, and OCT angiography. Results A 55-year-old man complained of blurred vision in...

Introduction Corneal wound infection is an infrequent complication of cataract surgery that can progress to endophthalmitis. Surgical treatment of endophthalmitis associated with microbial keratitis traditionally involves therapeutic penetrating keratoplasty and pars plana vitrectomy (PPV). In this case report, we describe a patient with cataract w...

Purpose To report the clinical characteristics, antibiotic susceptibilities, and review the literature of Burkholderia cepacia complex (BCC) associated endophthalmitis. Study design Retrospective, observational case series. Methods Clinical and microbiology records were reviewed for patients evaluated at the Bascom Palmer Eye Institute and diagno...

Background/Purpose Within the evolving landscape of healthcare in the United States (US), delineating the demographic nuances and financial implications of emergent conditions, such as rhegmatogenous retinal detachment (RRD), is paramount. This study seeks to analyze the demographic and hospital billing amount/cost of service disparities in RRD vis...

Background and Objective To describe the multimodal imaging and histopathological features of patients with dragged optic disc vessels (DODV). Patients and Methods This is a retrospective, observational analysis using multimodal imaging of eyes with DODV in patients with retinal vascular diseases including familial exudative vitreoretinopathy, inf...

Purpose: To investigate the clinical outcome of cystoid macular edema (CME) in eyes undergoing silicone oil (SO) tamponade with subsequent SO removal (SOR). Methods: A retrospective case series of adult patients with CME treated with SO tamponade and SOR was conducted between January 2015 and January 2021. Exclusion criteria included eyes with a pr...

In this chapter, we discuss techniques in the prophylaxis of infection by inhibiting or arresting the growth and multiplication of germs (infectious agents) which is usually achieved by povidone-iodine, hydrogen peroxide, chlorhexidine, or polyhexanide application on the skin. We also discuss the settings in which topical antibiotics and intracamer...

The diagnosis of endophthalmitis can be made based on clinical examination findings. The patient may present with gradual or sudden onset of symptoms including lid swelling, pain, redness, discharge, and a decrease in vision. Slit-lamp examination may show lid swelling, conjunctival congestion, chemosis, glaucoma implant exposure, corneal edema, ep...

This chapter discusses the findings of the Endophthalmitis Vitrectomy Study (EVS) and the role of pars plana vitrectomy in the management of endophthalmitis.KeywordsEndophthalmitis Vitrectomy Study (EVS)Pars plana vitrectomyManagement

This chapter focuses on the incidence, signs and symptoms, diagnosis, and treatment of endogenous fungal and bacterial endophthalmitis.KeywordsEndogenousFungalBacterial

This chapter is an overview of the different classifications of endophthalmitis along with the most common organisms. Categories include Post-operative endophthalmitis, post-traumatic endophthalmitis, endogenous endophthalmitis, post-intravitreal injection endophthalmitis, and others.KeywordsEndophthalmitisCategoriesPost-operativeEndogenousPost-tra...

This chapter reviews the various categories of acute-onset endophthalmitis including post-operative, post-trauma, and post-intravitreal injection.KeywordsAcute endophthalmitisPost-operativePost-traumaticPost-intravitreal injection

In patients with endophthalmitis, the occurrence of rhegmatogenous retinal detachment (RD) is uncommon and is generally associated with poor visual outcomes. Management of such patients can pose a surgical challenge. While managing the endophthalmitis, RD can be identified at the time of presentation, during vitrectomy, or in the post-operative tim...

In order to address emerging antimicrobial resistance, the CDC recommends antibiotic stewardship programs to optimize antibiotic selection and reduce the inappropriate use of broad-spectrum antibiotics. The new medication management standards (MM.09.01.01) for hospitals, critical access hospitals, and nursing care centers became effective January 1...

Endophthalmitis is a clinical diagnosis, confirmed with subsequent laboratory testing. Endophthalmitis must be distinguished from noninfectious inflammation as well as noninflammatory cellular infiltration, including hemorrhage and tumor cells. Endophthalmitis with negative intraocular cultures is relatively common, reported in the range of about 2...

This chapter reviews the various categories of delayed-onset endophthalmitis from various etiologies including post-cataract surgery, conjunctival filtering bleb, glaucoma drainage devices, keratitis, and other anterior segment procedures.KeywordsChronic endophthalmitisFiltering blebGlaucoma drainageKeratitis

Treatment outcomes are highly variable and are related to the infecting organism as well as the time to diagnosis and treatment. Prompt treatment is more important than any other consideration, including the decision between TAP and PPV. Treatment outcomes may be substantially worse in certain categories of endophthalmitis, such as post-traumatic a...

This chapter reviews the antimicrobial treatment options for different categories of endophthalmitis.KeywordsAntimicrobial treatmentDosagesPreparationResistanceAdverse effects

Purpose To report the clinical characteristics, antibiotic susceptibilities, and review the literature of Burkholderia cepacia complex (BCC) associated endophthalmitis. Study design: Retrospective, observational case series Methods Clinical and microbiology records were reviewed for patients evaluated at the Bascom Palmer Eye Institute and diagnose...

Introduction: Diabetic retinopathy is a major cause of visual loss worldwide. The most important clinical findings include diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). Areas covered: PubMed was used for our literature review. Articles from 1995 to 2023 were included. Pharmacologic treatment of diabetic retinopathy g...

We present 2 cases of sutureless 25-gauge pars plana vitrectomy and fluid-gas exchange, in which incorrect gas concentrations likely led to elevated intraocular pressures and retrobulbar gas. Combined removal of orbital gas with anterior orbitotomy and pars plana vitrectomy was performed in the first case to address expanding intraocular and retrob...

Retinal displacement following the repair of rhegmatogenous retinal detachment (RRD) has been reported in recent studies. It was described as vertical movement of the retinal relative to its original location, as evidenced by retinal vessel printing on fundus autofluorescence imaging. This review reports the current literature on retinal displaceme...

Purpose: We evaluated the clinical outcomes of Intraocular inflammation (IOI) of eyes with neovascular age-related macular degeneration (AMD) injected with brolucizumab in our tertiary referral center. Methods: A retrospective case series for which clinical records of all eyes that received intravitreal brolucizumab at Bascom Palmer Eye Institut...

Purpose: To report the surgical approaches and outcomes in patients undergoing surgery for retinal detachment associated with retinal dialysis. Design: Retrospective, consecutive case series SUBJECTS: All patients who underwent surgery for retinal detachment secondary to retinal dialysis between January 1, 2012 and January 1, 2022. Methods: Re...

Purpose To report the use of intravitreal triamcinolone to treat macular edema associated with isolated perifoveal exudative vascular anomalous complex (PVAC) and resembling lesion (PVAC-RL). Methods In this case series, three diabetic patients (3 eyes) with PVAC-RLs and one healthy patient (1 eye) with PVAC lesion associated with cystic spaces un...

Immediate sequential bilateral cataract surgery (ISBCS) is a reasonable approach for cataract surgery in patients needing general anesthesia, such as those with cognitive impairment. To our knowledge, this is the first reported case of unilateral acute-onset postoperative endophthalmitis in a patient with cognitive impairment after ISBCS, with emph...

Purpose: Swept-source optical coherence tomography angiography (SS-OCTA) was used to detect the presence of macular neovascularization (MNV) in eyes with exudative central serous chorioretinopathy (CSCR). Observations: Case 1 is a 73-year-old man using prednisolone drops with 20/40 vision and a retinal pigment epithelial detachment (PED) associa...

Purpose: The aim of this study is to report the clinical characteristics, causative organisms, and treatment outcomes in patients presenting with endophthalmitis related to XEN stent implants DESIGN: This is a retrospective, noncomparative consecutive case series. Methods: Clinical and microbiological review was performed for eight patients pres...

Introduction: To describe a patient who presented with visual loss and an apparent hypopyon but none of the other symptoms or signs most common with infectious endophthalmitis. Methods: A case and its findings were analyzed. Results: A 73-year-old woman was treated with intravitreal triamcinolone acetonide (IVTA) for cystoid macular edema. The eye...

Purpose To evaluate the outcomes and complications in patients with retained lens fragments (RLF) after cataract surgery, comparing those who received pars plana vitrectomy (PPV) on the same day, within 1 week, or later than 1 week after cataract surgery. Patients and Methods Retrospective case series of all patients who underwent PPV for RLF at B...

Purpose: The purpose of the current study is to report outcomes with the evolving use of regional anesthesia with monitored anesthesia care (RA-MAC) versus general anesthesia (GA) in the repair of open globe injuries. Design: Retrospective, consecutive, comparative, non-randomized clinical study. Methods: The study includes 507 eyes of 507 pat...

Purpose Identify the long-term rate of fellow eye full-thickness macular hole (FTMH) development. Patients and Methods In this single site, single provider retrospective consecutive case series, idiopathic FTMH patients who underwent surgery from 2003 to 2014 who also had at least 5 years of follow-up information within our electronic medical reco...

Purpose: To report the clinical features and best corrected visual acuity (BCVA) outcomes in patients with acute and delayed-onset endophthalmitis after open globe injuries. Methods: A retrospective, comparative, consecutive case series of patients with endophthalmitis after open globe injury between January 2016 and October 2020 at the Bascom P...

Objective: The purpose of the current study is to report outcomes of suprachoroidal hemorrhage (SCH) after anterior segment surgery at a single institution, and to identify clinical features associated with visual prognosis. Methods and analysis: Retrospective consecutive case series of patients with SCH occurring after anterior segment surgery....

Background and objective: Determine clinical characteristics and long-term outcomes of fellow eyes for patients with prior repair of rhegmatogenous retinal detachments due to a giant retinal tear (GRT). Study design: Retrospective case series of patients who underwent vitreoretinal surgery between January 2005 and August 2017 for GRT at the Basc...

In this case study, the authors describe peculiar bilateral cotton wool-like retinal lesions associated with macular edema in a patient with COVID-19 who was vaccinated with a single dose of AstraZeneca one month earlier. This patient had no pulmonary or systemic cardiovascular complications from COVID-19, as reported in other papers that found ret...

Although infectious endophthalmitis after intravitreal antivascular endothelial growth factor injections is rare, it is the most feared and potentially devastating complication of this procedure. There is no high-level evidence to provide definitive guidance on the management of endophthalmitis occurring after intravitreal injection (IVI). This cli...

Objective To report long-term outcomes of patients with asymptomatic retinal detachments (RDs) that did not undergo initial surgical intervention. Design Retrospective case series. Methods A retrospective chart review of patients diagnosed with asymptomatic RD at Bascom Palmer Eye Institute between 2011 and 2021. Patients with symptoms of photops...

Herein are reported four eyes among three patients with favorable anti-vascular endothelial growth factor crunch syndrome by which contraction of fibrovascular tissue led to relief of vitreoretinal traction without surgical intervention. This phenomenon led to complete or partial retinal reattachment in two patients with diabetic tractional retinal...

Purpose Bilateral endogenous Candida endophthalmitis (ECE) treatment usually involves administering systemic and intravitreal antifungal medications. In advanced cases with vitreous seeding, pars plana vitrectomy (PPV) is considered. The use of focal endolaser treatment to chorioretinal lesions has not been reported. We present a case of bilateral...

Purpose: To evaluate acute-onset postoperative endophthalmitis following cataract surgery and to compare rates between resident and attending physician-performed cohorts. Methods: Records of patients diagnosed with endophthalmitis within 6 weeks of surgery performed by attending and resident physicians between January 1, 2015, and December 31, 2...

Prcis: Bleb-related endophthalmitis is a serious complication of glaucoma filtration surgery. The current study reports similar visual and intraocular pressure outcomes in eyes treated with pars plana vitrectomy compared to vitreous biopsy and intravitreal antibiotics. Purpose: To investigate the isolated organisms, visual acuity (VA) and intrao...

i>Kocuria is an anaerobic, Gram-positive bacterium, which has been rarely reported to cause endophthalmitis following cataract surgery, intravitreal injections, penetrating ocular trauma, and also secondary to endogenous sources. Visual prognosis is often guarded, with no previous cases reporting a final visual acuity better than 20/60. We describe...

Objective To review the clinical course and outcomes of patients with idiopathic vitreomacular traction (VMT) managed initially by observation. Design Retrospective chart review including patients with idiopathic VMT based on clinical symptoms and findings on optical coherence tomography (OCT) between January 1, 2015 and February 15, 2021. Subjec...

Asbtract Purpose : To present a case series of retinal detachments associated with the use of pilocarpine for presbyopia. Design : Multicenter case series of 3 eyes from 2 patients. Results : Patient 1, a 47-year-old male, presented with flashes and floaters in both eyes. The patient had started pilocarpine 1.25% drops one month prior for presby...

We report a case of endophthalmitis occurring secondary to a retained cilium in a clear corneal wound after cataract surgery. A 67-year-old female presented to an ophthalmology emergency room with light perception vision in the right eye 5 days after routine cataract surgery. Examination of the right eye demonstrated decreased vision, conjunctival...

A 59-year-old woman presented with iritis and uveitis in the OD approximately 3 weeks after she underwent a bilateral upper and lower blepharoplasty by an outside oculoplastic specialist. Examination revealed a visual acuity of hand motion in the OD, scleral ulceration suspicious for prior globe perforation, dense vitritis, and loculations and memb...

Purpose: To evaluate the incidence and degree of retinal displacement following scleral buckling (SB) surgery for macula-involving rhegmatogenous retinal detachment (RRD). Methods: Retrospective interventional case series comprised of patients treated with primary SB procedure without gas tamponade for macula-involving RRD and imaged postoperati...

Introduction To report 2 patients with acute-onset endophthalmitis after intraocular lens exchange and delayed corneal suture removal. Patient and Clinical Findings An 83-year-old woman and a 64-year-old man developed pain, decreased vision, corneal infiltrate, marked intraocular inflammation, and vitreous membranes after corneal suture removal. T...

Purpose: To describe two cases of multiple epithelial detachments (PEDs) occurring in otherwise young, healthy patients. Methods: The medical and imaging records of two cases were reviewed retrospectively. Results: Multiple serous non-vascularized pigment epithelial detachments (PEDs) were present in two young, healthy patients who underwent m...

Purpose To report the increasing trends in Nocardia keratitis species diversity and in vitro antibiotic susceptibility, to demonstrate contact lens wear as a risk factor, and to report visual acuity outcomes after treatment. Methods A retrospective clinical case series was performed at a single academic referral center which identified 26 patients...

Objectivec This study assessed the prevalence of progression to surgery of idiopathic epiretinal membranes (iERM) and the results compared to immediate surgery. Design Retrospective study with nested case control comparison. Subjects Patients with mild iERMs upon initial presentation. Methods A retrospective study with a nested case control stud...

Purpose To report two cases of laser-induced choroidal neovascularization (CNV) using swept source optical coherence tomography (SS-OCTA) imaging in patients with proliferative diabetic retinopathy. Observations Two patients developed CNV adjacent to laser scars, and these neovascular lesions were detected on SS-OCTA imaging. Historically, both pa...

Ella H Leung,1 Jason Fan,2 Harry W Flynn Jr,2 Thomas A Albini2 1Georgia Retina, Atlanta, GA, USA; 2Bascom Palmer Eye Institute/University of Miami, Miami, FL, USACorrespondence: Ella H LeungGeorgia Retina, 833 Campbell Hill St NW, Suite 300, Marietta, GA, 30328, USATel +1 770-218-1888Email eleung@garetina.comAbstract: There is increasing informatio...

Purpose To evaluate the occurrence of transient central retinal artery occlusion following intravitreal anti-vascular endothelial growth factor injection. Methods Prospective, observational study of 807 patients (807 eyes) who were given intravitreal injections of ranibizumab or aflibercept to treat any cause of retinal vascular diseases between 1...

i>Agrobacterium radiobacter is a Gram-negative bacillus and a rare cause of endophthalmitis. An 85-year-male presented with late-onset endophthalmitis associated with exposure of an inferonasal Baerveldt tube. The patient was initially treated with anterior chamber paracentesis and intravitreal antibiotics. Aqueous humor culture revealed A. radioba...

Purpose: The purpose of this study was to evaluate the risk of symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection after corneal transplantation surgery, with cataract surgeries as controls, and the impact of the novel coronavirus disease pandemic in the clinical and surgical complications of corneal transplantation...

Purpose of Review In this article, we review the pathogenesis, clinical features, imaging modalities, and latest management options for optic pit maculopathy (OPM). Recent Findings The pathogenesis of OPM remains to be unclear, but imaging tools such as optical coherence tomography (OCT) and OCT angiography are enhancing our knowledge. Observation...

This chapter evaluates endophthalmitis, which is a vision-threatening inflammation of the inner eye fluids and tissues. Infectious endophthalmitis results from either exogenous or endogenous entry of microbes into the eye. In reported clinical series, exogenous endophthalmitis is much more common than endogenous (or metastatic) endophthalmitis. By...

Purpose To report two patients with transient decreased vision and associated paracentral acute middle maculopathy (PAMM) lesions identified with multi-modal imaging, including what we believe to be the first documented patient of PAMM associated with iron deficiency anemia. Observations Case 1 is a 56-year-old man who experienced transient blurre...

Purpose: The purpose of this study was to report the closure of macular hole without surgery in 7 cases using medical therapies. Methods: The retrospective review of 7 cases of full-thickness macular holes, which closed after medical therapy without surgery. Results: Seven eyes of 7 patients developed full-thickness macular holes, which initia...

Importance Pneumatic retinopexy (PR) is the only clinic-based method of rhegmatogenous retinal detachment (RRD) repair. Registry-acquired clinical practice setting outcomes data with this procedure have not yet been reported. Objective To describe the clinical outcomes associated with RRD treated primarily with PR. Design, Setting, and Participan...

Background and objective: To report the incidence and clinical features of infectious endophthalmitis after intravitreal (IV) injection of anti-vascular endothelial growth factor inhibitors (VEGF) between 2018 and 2020 and to compare to prior rates. Patients and methods: Retrospective analysis of patients with endophthalmitis after anti-VEGF IV...

Purpose: The purpose of this study was to determine if it is possible for the macula to remain attached if a bullous retinal detachment blocks the examiner's view to the macula. Methods: A mathematical analysis compared the arc length of the attached retina versus the length of a detached retina necessary to obscure the macula (hang over the vis...

Background and objective: To report the clinical settings, antibiotic susceptibilities, and outcomes of streptococcal endophthalmitis. Patients and methods: Retrospective case series evaluating culture-positive streptococcal endophthalmitis from January 1, 2014, to December 31, 2019. Results: Thirty-eight eyes met study criteria. The most comm...

Submacular hemorrhage (SMH) has been reported to be toxic to the retina based on animal studies. However, observational studies of patients with neovascular-related SMH and those treated with intravitreal anti-vascular growth factor (anti-VEGF) therapy have shown many favorable visual acuity outcomes. We report two cases of neovascular-related SMH...

Purpose: Wide-field (WF) swept-source (SS) optical coherence tomography angiography (SS-OCTA) was used to image diabetic tractional retinal detachments (TRDs) before and after pars plana vitrectomy. The clinical utility of SS-OCTA was assessed. Methods: Patients with diabetic TRDs were imaged prospectively with SS-OCTA. Ultrawide-field imaging w...