Endophthalmitis caused by Pseudomonas aeruginosa after phakic posterior chamber intraocular lens implantation to correct high myopia

Immediate versus delayed sequential bilateral ICL implantation: A retrospective comparison of vault height and visual outcomes

PURPOSE

To compare the visual outcomes and risks of suboptimal vault-related complications between immediate sequential bilateral ICL surgery (ISBICLS) and delayed sequential bilateral ICL surgery (DSBICLS).

DESIGN

A retrospective cohort study.

METHODS

Patients who underwent bilateral ICL implantation between November 2014 and December 2021 at the Eye and ENT Hospital of Fudan University (Shanghai, China) were included and divided into two groups: (1) ISBICLS: both eye surgeries performed on the same day, and (2) DSBICLS: second eye surgery performed < 7 days following the first one. Propensity score matching (PSM) was performed to compare the visual outcomes. Multivariable logistic regression models were used to estimate the odds ratios (ORs) of the suboptimal vaults.

RESULTS

Finally, 10,985 eyes were included. After PSM, 204 first surgery eyes and 162 s surgery eyes with complete postoperative data were matched. The safety and efficacy indices did not statistically differ between groups (all > 1.00), except that ISBICLS first surgery eyes achieved better efficacy index than DSBICLS group (1.03 ± 0.26 vs. 1.08 ± 0.23, P = 0.034). Excessive vault was observed in eight (4.06 %) ISBICLS first eyes, one (0.50 %) DSBICLS first eye, and none in the second surgery eye in either group. An insufficient vault was observed in one second eye and one DSBICLS second eye. We found no evidence of differences in the rate of excessive vault (OR = 0.831, 95 % CI: 0.426-1.622, P = 0.588) or insufficient vault (OR = 0.609, 95 % CI:0.062-5.850, P = 0.668).

CONCLUSION

ISBICLS provided safety, efficacy, and refraction predictability comparable to DSBICLS without increasing the risk of suboptimal vault-related complications.

Successful antibiotic management of Staphylococcus epidermidis endophthalmitis after implantable collamer lens implantation

PURPOSE

We report a case of successful medical management of endophthalmitis post implantable collamer lens (ICL) culture-positive of Staphylococcus epidermidis.

OBSERVATIONS

A 18-year-old female presented with decreased visual acuity in the left eye 20 days after ICL implantation. A diagnosis of postoperative endophthalmitis was made based on examination and ultrasonography. A vitreous tap was taken, and intravitreal antibiotics (vancomycin 1 mg/0.1ml and ceftazidime 2 mg/0.1ml) were administered twice (every 72 h), and peribulbar injection of triamcinolone acetonide after four days of the second intravitreal injection. The vitreous culture was confirmed for Staphylococcus epidermidis. The endophthalmitis was resolved, and visual acuity improved from 6/20 to 12/20 on day 7 and 22/20 on day 38. This is the first successful medical resolution of Staphylococcus epidermidis endophthalmitis post ICL surgery without ICL explantation and vitrectomy in the V4c model.

CONCLUSIONS AND IMPORTANCE

In antibiotic therapy, the excellent compliance and close follow-up of this endophthalmitis patient enabled careful postoperative surveillance on the effect of antibiotic therapy, avoiding the removal of the ICL or the loss of the integrity of the eye. The risk of potential infectious endophthalmitis post-ICL surgery should be fully emphasized during preoperative counseling.

Analysis of perioperative problems related to intraocular Implantable Collamer Lens (ICL) implantation

PURPOSE

To introduce a modified procedure of ICL implantation, to summarize the perioperative problems and their corresponding treatment after myopia correction with Implantable Collamer Lens (ICL), and to compare the difference of complications between the no-hole ICL and hole ICL.

METHODS

We searched all articles on ICL-related perioperative problems and their corresponding treatment in Scopus, Embase, PubMed and Web of Science databases for the last 22 years.

RESULTS

ICL implantation is safe, effective, stable and predictable in the correction of myopia, hyperopia and astigmatism, but can also cause a series of perioperative problems, including intraoperative and postoperative complications.

CONCLUSION

There are many kinds of complications related to ICL, but the common intraoperative and postoperative complications mainly include abnormality of arch height, abnormal position of ICL, loss of corneal endothelial cells and corneal decompensation, high intraocular pressure and secondary glaucoma, cataract and night vision symptoms. Compared with ICL without central pore, the incidence of complications such as loss of corneal endothelial cells and corneal decompensation, high intraocular pressure and secondary glaucoma and cataract was relatively lower in central hole ICL, while postoperative complications such as night vision symptoms were obvious.

Atypical endophthalmitis after intraocular collamer lens implantation

Unilateral endophthalmitis occurred after bilateral immediately sequential intraocular collamer lens (Visian Implantable Collamer Lens) implantation for the correction of myopic astigmatism in a 49-year-old woman. The surgeries and initial recovery were unremarkable. However, after 3 days, the patient noticed increasing blurring of vision in the left eye and presented to our clinic. The anterior segment of this eye was quiet, while the vitreous cavity was densely infiltrated. Immediate explantation of the corrective lens and vitrectomy combined with intravitreal antibiotic injection were performed. Staphylococcus epidermidis was detected in the vitreous tap and treated with intravenous antibiotics, antibiotic eyedrops, and parabulbar injections of dexamethasone. The corrected distance visual acuity recovered to 20/20 over a 6-month period. However, a cataract developed thereafter.

Successful re-implantation of implantable collamer lens after management of post-ICL methicillin-resistant Staphylococcus epidermidis endophthalmitis

A 29-year-old man presented with acute onset pain, redness and diminution of vision in the right eye 5 days after implantation of an implantable collamer lens (ICL). A diagnosis of postoperative endophthalmitis was made based on examination and ultrasonography. A vitreous tap was taken and intravitreal antibiotics (vancomycin 1 mg/0.1 ml+piperacillin-tazobactam 225 µg/0.1 mL) were administered. The vitreous culture revealed presence of methicillin-resistant Staphylococcus epidermidis. There was minimal improvement after 48 h; hence the ICL was explanted and repeat injection of intravitreal antibiotics administered. Following this, the endophthalmitis resolved and the patient achieved a corrected distance visual acuity of 20/25 4 weeks later. A repeat implantation of ICL was performed 9 months after the first surgery, following which the patient regained uncorrected distance visual acuity of 20/20. To our knowledge, this is the first case in which an ICL was re-implanted after successful resolution of endophthalmitis.

Endophthalmitis Caused by Rhizobium radiobacter After Posterior Chamber Phakic Intraocular Lens Implantation to Correct Myopia

PURPOSE

To describe a 29-year-old man presenting with acute-onset endophthalmitis caused by Rhizobium (formerly Agrobacterium) radiobacter after uneventful implantable collamer lens implantation for myopia.

METHODS

Case report.

RESULTS

The patient was treated with intravitreal injections of vancomycin and ceftazidime, as well as topical and systemic antibiotics. The patient had a good response with a final visual acuity of 20/50 at the last follow-up visit 25 months postoperatively.

CONCLUSIONS

This case represents the first case report of endophthalmitis caused by Rhizobium radiobacter following implantable collamer lens implantation.

Streptococcus mitis/oralis endophthalmitis management without phakic intraocular lens removal in patient with iris-fixated phakic intraocular lens implantation

Background

To report a case of Streptococcus mitis/oralis endophthalmitis management which had developed after complicated iris-fixated phakic intraocular (pIOL) lens implantation.

Case presentation

A 23-year-old-woman received pIOL implantation followed secondary intraocular intervention to lower intraocular pressure. The patient presented with severe pain and decreased visual acuity and was managed with intravitreal and intracameral antibiotic injection with topical applications of fortified antibiotics. Culture of aqueous humor was positive for S. mitis/oralis, which was sensitive to the empiric antibiotic regimen. Clinical features started to improve 5 days after treatment and the pIOL was left in place. The uncorrected distant visual acuity and endothelial cell count were 20/32 and 3143cells/mm² four weeks after treatment, respectively.

Conclusion

S. mitis/oralis endophthalmitis after pIOL implantation could be managed with appropriate antibiotic administration without pIOL removal if accompanied by rapid clinical improvement after the initial intensive management in the absence of vitreous involvement.