Staphylococcus aureus is an important human bacterial pathogen responsible for a wide variety of ... more Staphylococcus aureus is an important human bacterial pathogen responsible for a wide variety of ocular diseases, including sight-threatening infections such as keratitis, corneal flap melt after laser-assisted in situ keratomileusis (LASIK), cellulitis, endophthalmitis, and panophthalmitis [1-4]. Staphylococcus aureus isolates that are resistant to methicillin are known as methicillin-resistant Staphylococcus aureus (MRSA) and are usually also resistant to other β-lactam antimicrobial drugs [5]. In current practice, methicillin sensitivity is usually performed with oxacillin or cefoxitin, as methicillin is no longer commercially available in the United States. Oxacillin is more likely to maintain its activity during storage better than methicillin, while cefoxitin can give more reproducible and accurate results than tests with oxacillin or methicillin. The organisms are still called "MRSA" and not "oxacillin-resistant Staphylococcus aureus" or "cefoxitin-resistant Staphylococcus aureus" because of this historic role. Organisms resistant to antibiotics pose great difficulty in the management of infection as compared to organisms that are susceptible to antibiotics in terms of treatment options, availability, affordability, and increased cost of alternative drugs. Endophthalmitis caused by drug-resistant organisms is an emerging concern, as well as a diagnostic and therapeutic challenge for treating physicians [5]. In cases of endophthalmitis, MRSA should be considered in patients with poor response to first-line treatment for presumed Staphylococcus aureus infections. MRSA infection was first identified in the 1960s and occurs more frequently in patients with systemic diseases and previous infections with MRSA [6]. Reported risk factors for MRSA include increased age, previous or recent hospitalization, previous MRSA colonization, antibiotic use, and residence in an assisted living facility [7-9]. More frequent cases of endophthalmitis caused by MRSA are increasingly reported from around the world [10, 11]. The current chapter helps in
The aim of this study is to investigate potential correlations between age, gender, spherical equ... more The aim of this study is to investigate potential correlations between age, gender, spherical equivalent and optical coherence tomography (OCT) retinal parameters among healthy children. Methods A macular spectral-domain OCT was performed in all patients using a Spectralis Ò OCT device, and the macular thickness and volume of each of the early treatment diabetic retinopathy study (ETDRS) subfields were analysed. Results Ninety-four children were enrolled. Mean central macular thickness was 274.968 ± 18.28 lm, while mean central macular volume was 0.216 mm 3. Statistical analysis showed a significant correlation between the factor age and central macular thickness (F(3,90) = 4.96, p = 0.003, g 2 = 0.14) and central macular volume (F(3,90) = 4.98, p = 0.003, g 2 = 0.14). Statistical analysis showed a significant correlation between the factor gender and macular thickness/volume of several ETDRS subfields. A significant correlation between refractive error and macular thickness/volume was also noted. Conclusions This study shows significant correlations between macular thickness/volume and the factors age, gender and spherical equivalent. Paediatric spectral-domain optical coherence tomography ranges need further investigations since many significant correlations are still to be confirmed.
Investigative Ophthalmology & Visual Science, Jun 23, 2017
BACKGROUND AND OBJECTIVE: The current study describes the treatment outcomes in patients with end... more BACKGROUND AND OBJECTIVE: The current study describes the treatment outcomes in patients with endophthalmitis and concurrent or delayed-onset retinal detachment managed with pars plana vitrectomy, intravitreal antibiotics, and silicone oil. PATIENTS AND METHODS: In this noncomparative, retrospective case series, the medical records of patients diagnosed with endophthalmitis and retinal detachment from January 1991 through December 2014 at a tertiary eye care center in South India were reviewed. All patients received silicone oil for the management of retinal detachment either concurrently or during follow-up treatment. RESULTS: A total of 93 patients were included in the current study. Retinal detachment was diagnosed at presentation in 20 of 93 patients (21.5%) (concurrent group: Group 1) and during follow-up in the remaining 73 of 93 patients (78.5%) (delayed-onset group: Group 2). In Group 1, the initial treatment consisted of vitrectomy, intravitreal antibiotics, and silicone oil injection in 19 of 20 patients. In Group 2, patients did not receive silicone oil during initial treatment but underwent silicone oil injection during subsequent surgery for repair of retinal detachment. Rates of complete retinal reattachment and visual acuity of 20/400 or better were 73.7% and 30.0%, respectively, in Group 1 and 98.5% and 39.7%, respectively, in Group 2. The median visual acuity at last follow-up in 44 eyes undergoing silicone oil removal was 20/100 (logMAR 0.7), whereas in the remaining 49 eyes that did not undergo silicone oil removal, median visual acuity was 20/2000 (logMAR 2.0). CONCLUSION: In these patients with endophthalmitis with concurrent or delayed-onset retinal detachment, the use of silicone oil can be a useful adjunct.
To evaluate the outcomes and complications in patients with retained lens fragments (RLF) after c... more 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 Bascom Palmer Eye Institute between January 1, 2012 and September 30, 2020. Individuals with less than 3 months of follow-up, chronic uveitis, congenital cataract, previtrectomy retinal detachment (RD), and severe trauma were excluded. All analyses for categorical and binary variables used chi-squared tests. Analyses for continuous variables were performed using multivariate analyses of covariance, adjusting for differences in baseline visual acuity before cataract surgery. Results: The study included 246 eyes of 246 patients. The timing distribution included the following: 140 (57%) eyes underwent same-day PPV, 33 (13%) eyes underwent same-week PPV, and 73 (30%) eyes underwent PPV after 1 week (up to 90 days). When all eyes were included in analysis, there were no statistically significant differences in mean best-corrected visual acuity (BCVA) between groups at last follow-up examination (P = 0.07). When only eyes without known pre-existing ocular disease (N = 157) were included in analysis, there were no differences in mean BCVA between groups at all postoperative timepoints (P > 0.05). The rate of RD did not differ between groups when eyes with and without pre-existing ocular disease were analyzed (P > 0.05). Conclusion: In the current study, there were no statistically significant differences in postoperative BCVA or rates of RD at last follow-up examination in eyes undergoing PPV for RLF on the same day, within 1 week, or later than 1 week after cataract surgery.
• Single-institution (Bascom Palmer Eye Institute), retrospective, observational study of 488 con... more • Single-institution (Bascom Palmer Eye Institute), retrospective, observational study of 488 consecutive cases with primary RRD repaired via PPV-alone or SB-PPV and gas tamponade. • Primary outcome measure: single operation anatomic success (SOAS) • Secondary outcome measure: best corrected visual acuity (BCVA) • SOAS and final anatomic success were achieved in 425 (87.1%) and 487 (99.8%) cases, respectively. • SOAS was achieved in 90/111 (81.1%) cases with PPV-alone compared to 345/374 (92.2%) cases with SB-PPV (p=0.0010). • SB-PPV had greater SOAS than PPV-alone in phakic eyes (p<0.0001), but not in eyes with a posterior chamber intraocular lens (PCIOL). • Retinal re-detachments occurred on average at 1.5 and 9 months postoperatively. • Significant BCVA improvement was associated with SOAS (p<0.0001).
Purpose: To report the clinical features, antibiotic susceptibilities, and visual acuity outcomes... more Purpose: To report the clinical features, antibiotic susceptibilities, and visual acuity outcomes with endophthalmitis caused by methicillin-sensitive Staphylococcus epidermidis and methicillin-resistant S. epidermidis. Design: Retrospective case series. Participants: All patients seeking treatment at a tertiary referral center between 2006 and 2016 with endophthalmitis caused by S. epidermidis. Methods: All records were reviewed for patients with a clinical diagnosis of endophthalmitis and positive vitreous culture results for S. epidermidis. Data were compared with the prior series at the same institution. Main Outcome Measures: Clinical settings, antibiotic susceptibilities, and visual acuity. Results: Among 96 eyes of 96 patients, the most common postprocedural clinical settings were cataract surgery (47/96 [49%]), intravitreal injection (21/96 [22%]), trauma (8/96 [8%]), glaucoma surgery (7/96 [7%]), and penetrating keratoplasty (5/96 [5%]). The initial treatment included intravitreal vancomycin and ceftazidime in 89 of 96 eyes (93%) and intravitreal vancomycin and amikacin in 7 of 96 eyes (7%). A vitreous tap and injection with antibiotics was performed as the initial treatment in 83 of 96 eyes (86%) and pars plana vitrectomy was performed in 13 of 96 eyes (14%). All isolates were sensitive to vancomycin in both decades. In the most recent series, visual acuity at last follow-up was 5/200 or better in 68 of 96 eyes (71%) compared with 71 of 86 eyes (83%) in the prior study. In the current study, susceptibility to methicillin and moxifloxacin was present in 45 of 96 eyes (47%) and 29 of 85 eyes (34%), respectively, compared with 34 of 86 eyes (40%) and 27 of 39 eyes (69%) in the prior study. Final visual acuity was not significantly different between those eyes that were methicillin or fluoroquinolone sensitive and those that were resistant. Conclusions: In the current and prior series, all S. epidermidis isolates were sensitive to vancomycin. Visual acuity outcomes were not dependent on methicillin or fluoroquinolone sensitivity. Ophthalmology Retina 2017;-:1e5 ª 2017 by the American Academy of Ophthalmology Staphylococcus epidermidis, a coagulase-negative grampositive coccus, is the most common cause of cultureproven endophthalmitis. 1,2 In a previous study conducted from 1996 through 2004, clinical outcomes and in vitro antibiotic susceptibilities were reported, comparing methicillin-sensitive and methicillin-resistant isolates. 3 The purpose of the present study was to describe the current features and resistance profiles from 2006 through 2016 and to compare them with those of the prior study. Methods This was a retrospective consecutive case series of all patients treated at our institution, a tertiary referral center, with endophthalmitis caused by S. epidermidis. All records were reviewed for patients with a clinical diagnosis of endophthalmitis between
Purpose: This article reports the influence of timing on the clinical outcomes in primary extrama... more Purpose: This article reports the influence of timing on the clinical outcomes in primary extramacular rhegmatogenous retinal detachment (RRD) at a tertiary referral center. Methods: A retrospective case series was conducted of all patients presenting between January 1, 2014 and December 31, 2016, with primary extramacular RRD. Retinal detachments with grade C proliferative vitreoretinopathy, combined tractional and RRD, eyes with inflammatory disease, and prior retinal surgery were excluded. The main outcome measures were single-operation anatomic success (SOAS), final anatomic success, and best-corrected visual acuity (BCVA). Results: There were 202 eyes of 198 patients with an average of 22 months’ follow-up (range, 6-47 months). Eyes were operated on an average of 1.1 days after initial presentation. At last clinical examination, SOAS had been achieved in 174 (86%) eyes, final anatomic success in 200 (99%) eyes, and average postoperative logarithm of the minimum angle of resolut...
Background/aims: To report the clinical course of patients with idiopathic epiretinal membranes (... more Background/aims: To report the clinical course of patients with idiopathic epiretinal membranes (iERMs) and good baseline best-corrected visual acuity (BCVA) managed without surgical treatment. Methods: Retrospective, observational case series of patients with iERMs and 20/50 or better BCVA who did not undergo surgery between January 2014 and December 2017 with a 1-year follow-up. Secondary epiretinal membranes were excluded. iERMs were stratified into two groups: Group I (BCVA 20/30 or better) and Group II (BCVA 20/40 to 20/50). The main outcome measures included baseline and final follow-up BCVA, central macular thickness (CMT) on OCT. Results: The study included 174 eyes (145 patients): 139 eyes (79.8%) had typical iERMs and 35 eyes (18%) had LMH. For Group I typical iERMs, the logMAR baseline and final mean BCVA were 0.09 ± 0.1 (Snellen equivalent 20/25) and 0.10 ± 0.1 (20/25 +) respectively (p = 0.22). In this group, the baseline and final mean CMT were 335 ± 73µm and 342 ± 78µm, respectively (p = 0.47). For Group II typical iERMs, the logMAR baseline and final mean BCVA were 0.3 ± 0.1 (20/44) and 0.4 ± 0.2 (20/45) respectively (p = 0.31). In this group, the baseline and final mean CMT were 386 ± 95µm and 391 ± 93µm, respectively (p = 0.84). Conclusion: The clinical course of patients with iERM and good baseline BCVA is generally favorable without surgery and includes stable BCVA and OCT measurements after at least one year.
American Journal of Ophthalmology Case Reports, 2018
To report the clinical settings, causative organisms, antimicrobial susceptibilities, and treatme... more To report the clinical settings, causative organisms, antimicrobial susceptibilities, and treatment outcomes of patients with endophthalmitis caused by gram-positive bacteria resistant to vancomycin. Methods: Retrospective case series of all patients with culture-proven endophthalmitis caused by gram-positive bacteria resistant to vancomycin between January 2010 and December 2016 in LV Prasad Eye Institute, Visakhapatnam, India. Results: The current study included 14 patients. The clinical settings were post-cataract surgery in 8/14 (57.1%) and open globe injury in 6/14 (42.8%). Primary intervention for all patients included tap and intravitreal antibiotic injection. During subsequent follow-up, pars plana vitrectomy was performed in 6 patients and one patient underwent penetrating keratoplasty. Mean number of intravitreal antibiotic injections performed were 3.4 per patient. The most common organisms isolated were coagulase-negative Staphylococci in 6/14 (42.8%), Staphylococcus aureus in 5/14 (35.7%), Streptococcus sp in 2/14 (14.2%) and Bacillus sp in 1/14 (7.14%). In addition to vancomycin, resistance to multiple drugs (three or more groups of antibiotics) was found in all 14 cases. Antimicrobial susceptibility results showed susceptibility to amikacin in 7/14 (50.0%), gatifloxacin in 6/ 14 (42.8%), moxifloxacin in 3/13 (23.0%), cefazoline in 5/14 (35.7%), cefuroxime in 3/14 (21.4%), ciprofloxacin in 2/14 (14.2%) and linezolid in 5/5 (100%). The mean duration of follow-up was 30.7 weeks (6 weeks-90 weeks). At last follow-up, visual acuity (VA) of 20/200 or better was recorded in 7/14 (50%) and VA < 5/200 occurred in 7/14 (50%). Conclusion and importance: Antimicrobial susceptibility testing may help in selection of suitable antimicrobial agents for repeat intravitreal injection. Inspite of retreatment with intravitreal antibiotics, these patients generally had poor VA outcomes.
Staphylococcus aureus is an important human bacterial pathogen responsible for a wide variety of ... more Staphylococcus aureus is an important human bacterial pathogen responsible for a wide variety of ocular diseases, including sight-threatening infections such as keratitis, corneal flap melt after laser-assisted in situ keratomileusis (LASIK), cellulitis, endophthalmitis, and panophthalmitis [1-4]. Staphylococcus aureus isolates that are resistant to methicillin are known as methicillin-resistant Staphylococcus aureus (MRSA) and are usually also resistant to other β-lactam antimicrobial drugs [5]. In current practice, methicillin sensitivity is usually performed with oxacillin or cefoxitin, as methicillin is no longer commercially available in the United States. Oxacillin is more likely to maintain its activity during storage better than methicillin, while cefoxitin can give more reproducible and accurate results than tests with oxacillin or methicillin. The organisms are still called "MRSA" and not "oxacillin-resistant Staphylococcus aureus" or "cefoxitin-resistant Staphylococcus aureus" because of this historic role. Organisms resistant to antibiotics pose great difficulty in the management of infection as compared to organisms that are susceptible to antibiotics in terms of treatment options, availability, affordability, and increased cost of alternative drugs. Endophthalmitis caused by drug-resistant organisms is an emerging concern, as well as a diagnostic and therapeutic challenge for treating physicians [5]. In cases of endophthalmitis, MRSA should be considered in patients with poor response to first-line treatment for presumed Staphylococcus aureus infections. MRSA infection was first identified in the 1960s and occurs more frequently in patients with systemic diseases and previous infections with MRSA [6]. Reported risk factors for MRSA include increased age, previous or recent hospitalization, previous MRSA colonization, antibiotic use, and residence in an assisted living facility [7-9]. More frequent cases of endophthalmitis caused by MRSA are increasingly reported from around the world [10, 11]. The current chapter helps in
The aim of this study is to investigate potential correlations between age, gender, spherical equ... more The aim of this study is to investigate potential correlations between age, gender, spherical equivalent and optical coherence tomography (OCT) retinal parameters among healthy children. Methods A macular spectral-domain OCT was performed in all patients using a Spectralis Ò OCT device, and the macular thickness and volume of each of the early treatment diabetic retinopathy study (ETDRS) subfields were analysed. Results Ninety-four children were enrolled. Mean central macular thickness was 274.968 ± 18.28 lm, while mean central macular volume was 0.216 mm 3. Statistical analysis showed a significant correlation between the factor age and central macular thickness (F(3,90) = 4.96, p = 0.003, g 2 = 0.14) and central macular volume (F(3,90) = 4.98, p = 0.003, g 2 = 0.14). Statistical analysis showed a significant correlation between the factor gender and macular thickness/volume of several ETDRS subfields. A significant correlation between refractive error and macular thickness/volume was also noted. Conclusions This study shows significant correlations between macular thickness/volume and the factors age, gender and spherical equivalent. Paediatric spectral-domain optical coherence tomography ranges need further investigations since many significant correlations are still to be confirmed.
Investigative Ophthalmology & Visual Science, Jun 23, 2017
BACKGROUND AND OBJECTIVE: The current study describes the treatment outcomes in patients with end... more BACKGROUND AND OBJECTIVE: The current study describes the treatment outcomes in patients with endophthalmitis and concurrent or delayed-onset retinal detachment managed with pars plana vitrectomy, intravitreal antibiotics, and silicone oil. PATIENTS AND METHODS: In this noncomparative, retrospective case series, the medical records of patients diagnosed with endophthalmitis and retinal detachment from January 1991 through December 2014 at a tertiary eye care center in South India were reviewed. All patients received silicone oil for the management of retinal detachment either concurrently or during follow-up treatment. RESULTS: A total of 93 patients were included in the current study. Retinal detachment was diagnosed at presentation in 20 of 93 patients (21.5%) (concurrent group: Group 1) and during follow-up in the remaining 73 of 93 patients (78.5%) (delayed-onset group: Group 2). In Group 1, the initial treatment consisted of vitrectomy, intravitreal antibiotics, and silicone oil injection in 19 of 20 patients. In Group 2, patients did not receive silicone oil during initial treatment but underwent silicone oil injection during subsequent surgery for repair of retinal detachment. Rates of complete retinal reattachment and visual acuity of 20/400 or better were 73.7% and 30.0%, respectively, in Group 1 and 98.5% and 39.7%, respectively, in Group 2. The median visual acuity at last follow-up in 44 eyes undergoing silicone oil removal was 20/100 (logMAR 0.7), whereas in the remaining 49 eyes that did not undergo silicone oil removal, median visual acuity was 20/2000 (logMAR 2.0). CONCLUSION: In these patients with endophthalmitis with concurrent or delayed-onset retinal detachment, the use of silicone oil can be a useful adjunct.
To evaluate the outcomes and complications in patients with retained lens fragments (RLF) after c... more 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 Bascom Palmer Eye Institute between January 1, 2012 and September 30, 2020. Individuals with less than 3 months of follow-up, chronic uveitis, congenital cataract, previtrectomy retinal detachment (RD), and severe trauma were excluded. All analyses for categorical and binary variables used chi-squared tests. Analyses for continuous variables were performed using multivariate analyses of covariance, adjusting for differences in baseline visual acuity before cataract surgery. Results: The study included 246 eyes of 246 patients. The timing distribution included the following: 140 (57%) eyes underwent same-day PPV, 33 (13%) eyes underwent same-week PPV, and 73 (30%) eyes underwent PPV after 1 week (up to 90 days). When all eyes were included in analysis, there were no statistically significant differences in mean best-corrected visual acuity (BCVA) between groups at last follow-up examination (P = 0.07). When only eyes without known pre-existing ocular disease (N = 157) were included in analysis, there were no differences in mean BCVA between groups at all postoperative timepoints (P > 0.05). The rate of RD did not differ between groups when eyes with and without pre-existing ocular disease were analyzed (P > 0.05). Conclusion: In the current study, there were no statistically significant differences in postoperative BCVA or rates of RD at last follow-up examination in eyes undergoing PPV for RLF on the same day, within 1 week, or later than 1 week after cataract surgery.
• Single-institution (Bascom Palmer Eye Institute), retrospective, observational study of 488 con... more • Single-institution (Bascom Palmer Eye Institute), retrospective, observational study of 488 consecutive cases with primary RRD repaired via PPV-alone or SB-PPV and gas tamponade. • Primary outcome measure: single operation anatomic success (SOAS) • Secondary outcome measure: best corrected visual acuity (BCVA) • SOAS and final anatomic success were achieved in 425 (87.1%) and 487 (99.8%) cases, respectively. • SOAS was achieved in 90/111 (81.1%) cases with PPV-alone compared to 345/374 (92.2%) cases with SB-PPV (p=0.0010). • SB-PPV had greater SOAS than PPV-alone in phakic eyes (p<0.0001), but not in eyes with a posterior chamber intraocular lens (PCIOL). • Retinal re-detachments occurred on average at 1.5 and 9 months postoperatively. • Significant BCVA improvement was associated with SOAS (p<0.0001).
Purpose: To report the clinical features, antibiotic susceptibilities, and visual acuity outcomes... more Purpose: To report the clinical features, antibiotic susceptibilities, and visual acuity outcomes with endophthalmitis caused by methicillin-sensitive Staphylococcus epidermidis and methicillin-resistant S. epidermidis. Design: Retrospective case series. Participants: All patients seeking treatment at a tertiary referral center between 2006 and 2016 with endophthalmitis caused by S. epidermidis. Methods: All records were reviewed for patients with a clinical diagnosis of endophthalmitis and positive vitreous culture results for S. epidermidis. Data were compared with the prior series at the same institution. Main Outcome Measures: Clinical settings, antibiotic susceptibilities, and visual acuity. Results: Among 96 eyes of 96 patients, the most common postprocedural clinical settings were cataract surgery (47/96 [49%]), intravitreal injection (21/96 [22%]), trauma (8/96 [8%]), glaucoma surgery (7/96 [7%]), and penetrating keratoplasty (5/96 [5%]). The initial treatment included intravitreal vancomycin and ceftazidime in 89 of 96 eyes (93%) and intravitreal vancomycin and amikacin in 7 of 96 eyes (7%). A vitreous tap and injection with antibiotics was performed as the initial treatment in 83 of 96 eyes (86%) and pars plana vitrectomy was performed in 13 of 96 eyes (14%). All isolates were sensitive to vancomycin in both decades. In the most recent series, visual acuity at last follow-up was 5/200 or better in 68 of 96 eyes (71%) compared with 71 of 86 eyes (83%) in the prior study. In the current study, susceptibility to methicillin and moxifloxacin was present in 45 of 96 eyes (47%) and 29 of 85 eyes (34%), respectively, compared with 34 of 86 eyes (40%) and 27 of 39 eyes (69%) in the prior study. Final visual acuity was not significantly different between those eyes that were methicillin or fluoroquinolone sensitive and those that were resistant. Conclusions: In the current and prior series, all S. epidermidis isolates were sensitive to vancomycin. Visual acuity outcomes were not dependent on methicillin or fluoroquinolone sensitivity. Ophthalmology Retina 2017;-:1e5 ª 2017 by the American Academy of Ophthalmology Staphylococcus epidermidis, a coagulase-negative grampositive coccus, is the most common cause of cultureproven endophthalmitis. 1,2 In a previous study conducted from 1996 through 2004, clinical outcomes and in vitro antibiotic susceptibilities were reported, comparing methicillin-sensitive and methicillin-resistant isolates. 3 The purpose of the present study was to describe the current features and resistance profiles from 2006 through 2016 and to compare them with those of the prior study. Methods This was a retrospective consecutive case series of all patients treated at our institution, a tertiary referral center, with endophthalmitis caused by S. epidermidis. All records were reviewed for patients with a clinical diagnosis of endophthalmitis between
Purpose: This article reports the influence of timing on the clinical outcomes in primary extrama... more Purpose: This article reports the influence of timing on the clinical outcomes in primary extramacular rhegmatogenous retinal detachment (RRD) at a tertiary referral center. Methods: A retrospective case series was conducted of all patients presenting between January 1, 2014 and December 31, 2016, with primary extramacular RRD. Retinal detachments with grade C proliferative vitreoretinopathy, combined tractional and RRD, eyes with inflammatory disease, and prior retinal surgery were excluded. The main outcome measures were single-operation anatomic success (SOAS), final anatomic success, and best-corrected visual acuity (BCVA). Results: There were 202 eyes of 198 patients with an average of 22 months’ follow-up (range, 6-47 months). Eyes were operated on an average of 1.1 days after initial presentation. At last clinical examination, SOAS had been achieved in 174 (86%) eyes, final anatomic success in 200 (99%) eyes, and average postoperative logarithm of the minimum angle of resolut...
Background/aims: To report the clinical course of patients with idiopathic epiretinal membranes (... more Background/aims: To report the clinical course of patients with idiopathic epiretinal membranes (iERMs) and good baseline best-corrected visual acuity (BCVA) managed without surgical treatment. Methods: Retrospective, observational case series of patients with iERMs and 20/50 or better BCVA who did not undergo surgery between January 2014 and December 2017 with a 1-year follow-up. Secondary epiretinal membranes were excluded. iERMs were stratified into two groups: Group I (BCVA 20/30 or better) and Group II (BCVA 20/40 to 20/50). The main outcome measures included baseline and final follow-up BCVA, central macular thickness (CMT) on OCT. Results: The study included 174 eyes (145 patients): 139 eyes (79.8%) had typical iERMs and 35 eyes (18%) had LMH. For Group I typical iERMs, the logMAR baseline and final mean BCVA were 0.09 ± 0.1 (Snellen equivalent 20/25) and 0.10 ± 0.1 (20/25 +) respectively (p = 0.22). In this group, the baseline and final mean CMT were 335 ± 73µm and 342 ± 78µm, respectively (p = 0.47). For Group II typical iERMs, the logMAR baseline and final mean BCVA were 0.3 ± 0.1 (20/44) and 0.4 ± 0.2 (20/45) respectively (p = 0.31). In this group, the baseline and final mean CMT were 386 ± 95µm and 391 ± 93µm, respectively (p = 0.84). Conclusion: The clinical course of patients with iERM and good baseline BCVA is generally favorable without surgery and includes stable BCVA and OCT measurements after at least one year.
American Journal of Ophthalmology Case Reports, 2018
To report the clinical settings, causative organisms, antimicrobial susceptibilities, and treatme... more To report the clinical settings, causative organisms, antimicrobial susceptibilities, and treatment outcomes of patients with endophthalmitis caused by gram-positive bacteria resistant to vancomycin. Methods: Retrospective case series of all patients with culture-proven endophthalmitis caused by gram-positive bacteria resistant to vancomycin between January 2010 and December 2016 in LV Prasad Eye Institute, Visakhapatnam, India. Results: The current study included 14 patients. The clinical settings were post-cataract surgery in 8/14 (57.1%) and open globe injury in 6/14 (42.8%). Primary intervention for all patients included tap and intravitreal antibiotic injection. During subsequent follow-up, pars plana vitrectomy was performed in 6 patients and one patient underwent penetrating keratoplasty. Mean number of intravitreal antibiotic injections performed were 3.4 per patient. The most common organisms isolated were coagulase-negative Staphylococci in 6/14 (42.8%), Staphylococcus aureus in 5/14 (35.7%), Streptococcus sp in 2/14 (14.2%) and Bacillus sp in 1/14 (7.14%). In addition to vancomycin, resistance to multiple drugs (three or more groups of antibiotics) was found in all 14 cases. Antimicrobial susceptibility results showed susceptibility to amikacin in 7/14 (50.0%), gatifloxacin in 6/ 14 (42.8%), moxifloxacin in 3/13 (23.0%), cefazoline in 5/14 (35.7%), cefuroxime in 3/14 (21.4%), ciprofloxacin in 2/14 (14.2%) and linezolid in 5/5 (100%). The mean duration of follow-up was 30.7 weeks (6 weeks-90 weeks). At last follow-up, visual acuity (VA) of 20/200 or better was recorded in 7/14 (50%) and VA < 5/200 occurred in 7/14 (50%). Conclusion and importance: Antimicrobial susceptibility testing may help in selection of suitable antimicrobial agents for repeat intravitreal injection. Inspite of retreatment with intravitreal antibiotics, these patients generally had poor VA outcomes.
Uploads
Papers by Harry Flynn