[Primary vitrectomy with intraocular antibiotic application in postoperative endophthalmitis]

PURPOSE

Pars plana vitrectomy with intravitreal antibiotic application is an established procedure for treating postoperative endophthalmitis. The presented study analyzes our own results with this treatment as well as the role of adjuvant systemic steroid treatment.

METHOD

We analyzed the data of 34 consecutive patients with postoperative endophthalmitis from January 2000 to March 2006. Thirty-two patients underwent vitrectomy and intravitreal application of antibiotics, and two patients received intravitreal antibiotics only. All patients received intravitreal dexamethasone and systemic antibiotics, and 12 patients received the systemic treatment with prednisolone. The effect of vitrectomy with respect to final visual acuity and the rate of postoperative complications were analyzed. The vitreous was microbiologically examined. Postoperative follow-up time ranged from 2 weeks to 24 months.

RESULTS

Endophthalmitis followed cataract surgery with intraocular lens implantation in 30 patients (89%) and followed pars plana vitrectomy in four patients (11%). Positive cultures were obtained in 19 (56%) patients. Visual acuity improved in 31 (91%) patients. At their final examinations, 27 (79%) patients had gained visual acuity of 0.05 or better.

CONCLUSIONS

CONCLUSION

Immediate vitrectomy in combination with intraocular antibiotics and steroid administration resulted in preservation of ambulatory vision in most of the patients. Systemic postoperative therapy with steroids seems to be associated with better final visual acuity.

[Primary vitrectomy with intravitreal antibiotic application in postoperative and posttraumatic endophthalmitis]

AIM

The aim of our study was to evaluate the results of the treatment of postoperative and posttraumatic endophthalmitis by means of primary vitrectomy with intravitreal antibiotic application.

METHODS

In 42 patients treated for postoperative and posttraumatic endophthalmitis during the period January 2000-March 2006 at the University Department of Ophthalmology in Leipzig, Germany, EU, the postoperative visual acuity was followed-up. Furthermore, the results of microbial cultivation of the vitreous sample and the correlation between the final visual acuity and the causing etiological agent were evaluated. The treatment of endophthalmitis in 39 patients consisted of the primary vitrectomy with intravitreal antibiotics application; in three patients, solely the intravitreal injection of antibiotics was performed. In all patients, the antibiotics were administered locally and intravenously as well. The postoperative follow-up period lasted between 2 weeks to 24 months (median, 4.5 months).

RESULTS

The cause of endophthalmitis was in 31 (73%) patients the cataract surgery or secondary implantation of the intraocular lens; and in 4 (10%) patients the previous pars plana vitrectomy was performed. In 2 patients (5%) the endophthalmitis developed after trabeculectomy and in 5 (21%) patients, the endophthalmitis followed after perforating eye trauma. By means of microbiological cultivation, the agent was proved in 20 patients. The most common cause of endophthalmitis was Staphylococcus epidermidis. The postoperative improvement of the visual acuity we noticed in 39 patients. The final visual acuity better than 1/50 was reached by 88% of patients, thereof in 52% we proved at the end of the follow-up period the visual acuity better than 0.5.

CONCLUSION

The primary vitrectomy with intravitreal application of antibiotics combining with local as well as intravenous applications of antibiotics is a successful method of endophthalmitis treatment; in our study, in 88% of patients, the partial (orientational) vision was maintained.

[Intravitreal bevacizumab for recurring choroidal neovascularisation]

We administered bevacizumab intravitreally to treat a recurrence of CNV after confocal laser coagulation and photodynamic therapy in a 32-year-old female patient with a single functional eye. Before and after treatment the vision in the affected eye was stable at 1.0. Before administration of the VEGF antibody leakage was distinctly seen on fluorescein angiography, which did not appear on examination after the treatment. Despite the entailed measure of risk we decided in favour of intravitreal application because it seemed promising in view of earlier positive clinical experience with it in exsudative AMD and macular oedema following central retinal vein occlusion. Intravitreal bevacizumab is an alternative that should also be considered for the treatment of idiopathic CNV. Careful clinical studies will follow.

[Diabolic injury with the localization of foreign bodies in the apex of the intraorbital region ]

BACKGROUND

Air-gun injuries with localisation of the pellet at the apex of the orbital cavity can cause difficult decisions in diagnostics and therapy, especially if you decide to retain the foreign body.

METHODS

We report on a 14-year-old boy who was hit by an air-gun pellet. The foreign body went into the left orbit without damaging the globe or the optic nerve.

RESULTS

The visual acuity was 1.0, the mobility was only slightly disturbed. A systemic therapy with antibiotics and corticosteroids could stop a series of relapses very well.

CONCLUSIONS

Foreign bodies of the orbit can be retained if it is possible to deal with the surrounding reactions properly by conservative therapy.

Refractive lens exchange combined with pars plana vitrectomy to correct high myopia

PURPOSE

To describe the results of refractive lens exchange (RLE) combined with simultaneous pars plana vitrectomy (PPV) in the management of severe myopia.

METHODS

This retrospective study comprised 14 eyes of eight patients who had RLE to treat myopia of -19.0+/-5.4 diopters (D). Phacoemulsification, posterior chamber intraocular lens (IOL) implantation, and standard three-port vitrectomy were performed. Mean postoperative follow-up time was 30 months (range 12-49).

RESULTS

The postoperative best-corrected visual acuity (BCVA) was 0.68+/-0.23 compared to 0.37+/-0.24 preoperatively. There was no postoperative decrease in visual acuity in any eye. Mean postoperative spherical equivalent was -0.7 D (+/-1.6). At 30 months mean follow-up time, the spherical equivalents of nine eyes (64.3%) were within +/-1 D of emmetropia. There was no significant change in astigmatism due to operative procedures. During the 30 months follow-up period three eyes (21.4%) required neodymium : yttrium-aluminium-garnet (Nd : YAG) capsulotomy for posterior capsule opacification. No retinal detachments or cases of cystoid macular oedema (CME) were observed during the follow-up.

CONCLUSION

RLE was effective in correcting severe myopia. The simultaneously performed PPV may reduce the risk of postoperative retinal detachment. This was a pilot study, to draw definitive conclusions a prospective study has to be initiated.

[Carboxyamido-triazole inhibits substeps of choroidal neovascularization on retinal pigment epithelial cells and choroidal endothelial cells in vitro]

BACKGROUND

Retinal pigment epithelial cells (RPE cells) and choroidal endothelial cells (CECs) are important cell types in the process of choroidal neovascularization in exudative age-related macular degeneration (AMD). In this study, we evaluated the antiproliferative and antimigratory abilities of carboxyamido-triazole (CAI), a drug modulating calcium-dependent signal transduction on RPE cells and CECs.

METHODS

Human fetal RPE cells and bovine CECs were exposed to CAI in a concentration range of 0.1 to 10 microM. Cell proliferation was stimulated with 10% serum or 10 ng/ml bFGF. The effect of CAIs on cell proliferation was estimated. Furthermore, we evaluated CAI's effects on CEC and RPE cell migration induced by fibronectin.

RESULTS

CAI had a stronger inhibitory effect on serum-induced CEC proliferation than on RPE cell proliferation. A much stronger effect was seen on the proliferation of bFGF-stimulated RPE cells and CECs. Furthermore, the fibronectin-stimulated migration of RPE cells and CECs was inhibited by CAI. In this assay, a stronger inhibitory effect was seen on RPE cells than on CECs. CONCLUSION; CAI inhibits important substeps of choroidal neovascularization on RPR cells and CECs. Therefore, CAI may be of value for the treatment of choroidal neovascularization in exudative AMD.

[Factor VIII activity in patients with central retinal vein occlusion in comparison to patients with a history of pelvic and lower limb venous thrombosis and a healthy control group]

BACKGROUND

High factor VIII activity levels increase the risk of venous thromboembolism. This study was carried out to investigate the association between factor VIII activity and central retinal vein occlusion (CRVO) in comparison to patients with a history of venous thrombosis and a healthy control group.

PATIENTS AND METHODS

We examined the factor VIII activity in 62 patients with CRVO, 67 patients with venous thrombosis and 107 healthy individuals. The study measure employed for factor VIII activity was a one-stage clotting assay.

RESULTS

53.2 % of the patients with CRVO had an elevated factor VIII activity of more than 150 % (> 150 IU/dl). 78.5 % of the patients with venous thrombosis and 19.7 % of the healthy control group had an elevated factor VIII activity (> 150 IU/dl).

CONCLUSIONS

Elevated factor VIII activity is likely to have an influence on the pathogenesis of the central retinal vein occlusion.