Acrylic intraocular lens placement in conjunction with pars plana vitrectomy

PURPOSE: To report the results of placing a foldable acrylic intraocular lens through a clear cornea incision in eyes undergoing pars plana vitrectomy. METHODS: This interventional case series is a retrospective report of 15 eyes of 15 consecutive patients undergoing foldable (acrylic) intraocular lens insertion in conjunction with pars plana vitrectomy in a single academic institution. Outcome measures included visual acuity and complications. RESULTS: The intraocular lens was successfully implanted and retained in position in all 15 cases. The intraocular lens did not pose difficulty in examining the fundus or cause any vitreoretinal complications. With mean follow-up of 4.5 months (range, 1--10 months), final median postoperative visual acuity range was 20/200 (range, 20/40--2/200) and consistent with the level of vitreoretinal disease. CONCLUSION: Acrylic intraocular lenses may be safely implanted in conjunction with pars plana vitrectomy in selected cases.     

玻璃体切割联合玻璃体注药治疗眼内炎

目的 回顾性分析玻璃体切割联合玻璃体注药治疗化脓性眼内炎的临床应用价值。方法 对２８例２８眼化脓性眼内炎经平坦部行玻璃体切割联合玻璃体注药、眼内异物摘出,配合全身及局部应用抗生素、玻质类固醇药物或抗真菌药物治疗。结果 随访６～１２ｍｏ,２８例２８眼内感染全部控制,２６眼视力有没程度的提高,２眼眼球萎缩,无１眼眼球摘出。结论 玻璃体切割联合玻璃体注药是治疗化脓性眼内炎最有效方法。     

Management of endophthalmitis with retained intraocular foreign body

AIMS: To assess the impact of primary injection of intravitreal antibiotics and delayed pars plana vitrectomy with removal of intraocular foreign body (IOFB) in patients with clinical features of bacterial endophthalmitis and retained IOFB. METHODS: Retrospective review of all patients with clinical features of infective endophthalmitis and a retained IOFB who had immediate injection of intravitreal antibiotics and delayed pars plana vitrectomy with removal of IOFB in two vitreo-retinal centres during 1995-2001. Nine patients were identified and minimum follow-up was 3 months. RESULTS: Four of the nine patients had a final visual outcome of 6/18 or better. One patient developed total retinal detachment. CONCLUSIONS: The current series suggests that immediate injection of intravitreal antibiotics with delayed removal of IOFB in eyes with clinical features of infective endophthalmitis and a retained IOFB is a possible alternative to immediate removal of IOFB. This management may be associated with preservation of the eye and restoration of useful visual acuity.     

Primäre Vitrektomie mit intraokularer Antibiotikaapplikation bei akuter postoperativer 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.     

Treatment strategies and visual acuity outcomes in chronic postoperative Propionibacterium acnes endophthalmitis.

PURPOSE: To report the treatment strategies and visual acuity outcomes of chronic postoperative endophthalmitis caused by Propionibacterium acnes. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: All patients presenting 8 or more weeks after cataract surgery with intraocular inflammation caused by culture-proven P. acnes infection and treated at two institutions from 1974 through 1996 were included. METHODS: Patients underwent three different initial treatment strategies. The study did not have a defined treatment protocol, but all patients received intraocular antibiotics. Patients were not randomly assigned to the various treatment strategies. MAIN OUTCOME MEASURES: Final visual acuity and effectiveness of various treatment procedures either as initial or follow-up therapy were assessed. RESULTS: Using the 3 initial strategies, 36 patients were treated: (1) intraocular antibiotic injection alone (IOAB; n = 12); (2) pars plana vitrectomy and IOAB injection (PPV; n = 10); and (3) PPV with subtotal capsulectomy and IOAB injection (PPV-PC; n = 14). The number of patients with recurrent or persistent inflammation after one of the three initial treatment strategies were as follows: (1) IOAB alone, 12 (100%); (2) PPV, 5 (50%); and (3) PPV-PC, 2 (14%). None of the patients that underwent subsequent PPV, total capsular bag removal, IOAB injection, and either intraocular lens (IOL) exchange or removal had persistent or recurrent intraocular inflammation. Overall, final visual acuity was 20/40 or better in 18 patients (50%), and a total of 28 patients (78%) retained 20/400 or better vision. The mean follow-up after the last treatment was 2.9 years. CONCLUSIONS: In this series of chronic P. acnes endophthalmitis, initial treatment with IOAB injection alone or vitrectomy without capsulectomy was associated with high rates of recurrent or persistent intraocular inflammation. Pars plana vitrectomy, partial capsulectomy, and IOAB injection without IOL exchange was usually successful on long-term follow-up. In patients with recurrent intraocular inflammation, pars plana vitrectomy, total capsular bag removal, IOAB injection, and IOL exchange or removal was a uniformly successful strategy. In contrast to other types of postoperative endophthalmitis, IOL exchange can be considered in these patients after total capsular bag removal.     

Multiple methods of surgical treatment combined with primary IOL implantation on traumatic lens subluxation/dislocation in patients with secondary glaucoma

METHODS:Non-comparative retrospective observational case series. Participants:30 cases (30 eyes) of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Ophthalmology of Xi'an No.4 Hospital from 2007 to 2011. According to the different situations of lens subluxation/dislocation, various surgical procedures were performed such as crystalline lens phacoemulsification, crystalline lens phacoemulsification combined anterior vitrectomy, intracapsular cataract extraction combined anterior vitrectomy, lensectomy combined anterior vitrectomy though peripheral transparent cornea incision, pars plana lensectomy combined pars plana vitrectomy, and intravitreal cavity crystalline lens phacofragmentation combined pars plana vitrectomy. And whether to implement trabeculectomy depended on the different situations of secondary glaucoma. The posterior chamber intraocular lenses (PC-IOLs) were implanted in the capsular-bag or trassclerally sutured in the sulus decided by whether the capsular were present. Main outcome measures:visual acuity, intraocular pressure, the situation of intraocular lens and complications after the operations.RESULTS: The follow-up time was 11-36mo (21.4±7.13). Postoperative visual acuity of all eyes were improved; 28 cases maintained IOP below 21 mm Hg; 2 cases had slightly IOL subluxation, 4 cases had slightly tilted lens optical area; 1 case had postoperative choroidal detachment; 4 cases had postoperative corneal edema more than 1wk, but eventually recovered transparent; 2 cases had mild postoperative vitreous hemorrhage, and absorbed 4wk later. There was no postoperative retinal detachment, IOL dislocation, and endophthalmitis.CONCLUSION:To take early treatment of traumatic lens subluxation/dislocation in patients with secondary glaucoma by individual surgical plan based on the different eye conditions would be safe and effective, which can effectively control the intraocular pressure and restore some vision.     

Presumed sterile endophthalmitis following intravitreal triamcinolone acetonide injection.

BACKGROUND AND OBJECTIVE: To report acute postoperative, presumed sterile endophthalmitis following intravitreal injection of triamcinolone acetonide (IVTA). PATIENTS AND METHODS: Retrospective, interventional, multicenter study of patients with acute sterile endophthalmitis following IVTA injection. RESULTS: A total of 922 IVTA injections were performed. Eight eyes of 8 patients with presumed sterile endophthalmitis were identified. The incidence of endophthalmitis was 0.87% (95% confidence interval, 0.38% to 1.70%). Median time to presentation was 1.5 days (range, 1 to 7 days). Median presenting visual acuity was 20/563 (range, 20/80 to light perception). Initial treatment included vitreous tap and injection of antibiotics (n = 4), pars plana vitrectomy and injection of intravitreal antibiotics (n = 2), or systemic treatment alone with oral levofloxacin (n = 2). Six of 6 intraocular cultures were sterile. Median follow-up was 5.9 months (range, 4 to 9 months) with a median visual acuity at last follow-up of 20/75 (range, 20/40 to counting fingers). CONCLUSIONS: Acute presumed sterile endophthalmitis following IVTA injection presents early in the postoperative period. Visual outcomes are generally good.     

Combined surgery, phacoemulsification, implantation of intraocular lens and pars plana vitrectomy

PURPOSE: To evaluate the effectiveness, technical feasibility and incidence of complications after combining pars plana vitrectomy, phacoemulsification and intraocular lens implantation. MATERIAL AND METHODS: The results of combined vitreoretinal and cataract surgery in 100 eyes of 96 patients were retrospectively and prospectively analyzed. The mean follow-up period was 8.4 months. All patients had clinically significant lens opacities and vitreoretinal pathology requiring pars plana vitrectomy. Indications for vitreoretinal surgery included: persistent vitreous haemorrhage (28 eyes), vitreous hemorrhage combined with tractional retinal detachment (50 eyes), tractional retinal detachment without vitreous haemorrhage caused by proliferative diabetic retinopathy (7 eyes), rheumatogenous retinal detachment with proliferative vitreoretinopathy (10 eyes) and dislocated crystalline lens in the vitreous (5 eyes). RESULTS: Postoperatively, best corrected visual acuity improved in 81 eyes (81%)- by two lines or more in 31 eyes (31%) - by less than two lines in 50 eyes (50%). In 14 eyes (14%) visual acuity was unchanged and was worse in 5 cases (5%). Postoperative complications included fibrin reaction, posterior synechias of the iris, vitreous hemorrhage, neovascular glaucoma, posterior capsule opacification, redetachment of retina. CONCLUSIONS: Our cases confirm previous study, that performing phacoemulsification, IOL implantation and vitrectomy in one operation is safe and allows visual recovery with good technical results.     

Alcaligenes xylosoxidans and Propionibacterium acnes postoperative endophthalmitis in a pseudophakic eye

PURPOSE: To report a case of persistent polymicrobial postoperative endophthalmitis caused by Alcaligenes xylosoxidans and Propionibacterium acnes in a pseudophakic eye. A. xylosoxidans is a gram-negative bacteria resistant to most antibiotics. METHODS: Case report. RESULTS: A 72-year-old man presented with clinical signs of endophthalmitis on the first postoperative day after a phacoemulsification procedure with posterior chamber intraocular lens, left eye. Initial treatment included topical, subconjunctival, and oral antibiotics. After initial clearing, there was recrudescence of infection on postoperative day 37 that prompted referral of the patient to the Cullen Eye Institute. Treatment at that time included anterior chamber and vitreous taps with intravitreal antibiotic injections. Complete pars plana vitrectomy and intraocular lens explantation were eventually required because of persistent infection with a resistant organism. Cultures from the first procedure grew A. xylosoxidans and P. acnes. Cultures from the vitrectomy grew only A. xylosoxidans. At the final follow-up visit 6 months after the initial procedure. The eye was without inflammation with best-corrected visual acuity of 20/40. CONCLUSION: Both A. xylosoxidans and P. acnes can cause chronic progressive endophthalmitis after cataract extraction often resistant to corrective antibiotic therapy. Successful intervention may require complete vitrectomy with intraocular lens and capsule removal.     

Combined phacoemulsification and pars plana vitrectomy for macular hole treatment

PURPOSE: To assess the outcome of simultaneous phacoemulsification, pars plana vitrectomy and intraocular lens (IOL) implantation in eyes with macular hole. METHODS: A retrospective study was conducted in 38 eyes (36 patients) after combined phacoemulsification, insertion of a posterior capsule IOL and pars plana vitrectomy. RESULTS: The macular hole was successfully closed in 32 of the 38 eyes (84%). In six eyes (16%) the hole failed to close and one eye underwent a second operation. Vision improved by two or more Snellen lines in 29 eyes (73%), there was no change in seven eyes (18%), and visual acuity decreased in two eyes (5%). Intraoperative and postoperative complications included retinal tears in nine eyes (24%), posterior capsule rupture in two eyes (5%), transient postoperative increase of intraocular pressure in eight eyes (21%), and posterior capsule opacification in five eyes (13%). CONCLUSION: Combining phacoemulsification, IOL insertion and pars plana vitrectomy for macular hole repair can reduce the need for cataract surgery in the future, decrease costs, shorten postoperative recovery time and allow for clearer intraoperative visualization, making the procedure safer and more effective.     

人工晶状体眼并发大泡性角膜病变及视网膜脱离时应用临时人工角膜进行眼前后节联合手术

目的探讨在人工晶状体眼合并大泡性角膜病变及视网膜脱离病例中应用临时人工角膜行玻璃体切割联合穿透性角膜移植的临床价值。方法对6例(6眼)人工晶状体眼合并大泡性角膜病变及视网膜脱离患者行临时人工角膜下玻璃体切割联合穿透性角膜移植术。结果6例患者术后视网膜均复位良好，5例角膜植片透明，1例患者视力达0．1．2例患者手术中取出人工晶状体。结论该手术是一种安全、有效的治疗手段，对保留人工晶状体眼合并大泡性角膜病变及视网膜脱离患者的眼球及部分视力起到了积极的作用。     

玻璃体切除联合两性霉素B脂质体球内注射治疗真菌性眼内炎

目的:探讨玻璃体切除联合两性霉素B脂质体眼内注药治疗真菌性眼内炎的疗效。方法:对34例(34眼)真菌性眼内炎采取玻璃体切除联合眼内注药治疗进行回顾性研究,观察其疗效。结果:34眼中有30眼视力均较术前提高,3例给予两性霉素B脂质体5μg两次前房注射,4眼感染复发行眼内容物摘出。结论:真菌性眼内炎的预后不佳。早期行玻璃体切除联合两性霉素B脂质体眼内注药,可挽救部分视力,是目前治疗真菌性眼内炎有效方法。     

玻璃体切割联合玻璃体注药治疗眼内炎

对２８例２８眼化脓性眼内炎经平坦部行玻璃体切割联合玻璃体注药、眼内异物摘出,配合全身及局部应用抗生素、皮质类固醇药物或抗真菌药物治疗患者,回顾性分析了玻璃体切割联合玻璃体注药治疗化脓性眼内炎的临床应用价值。结果：随访６～１２月２８例２８眼眼内感染全部控制,２６眼视力有不同程度的提高,２眼眼球萎缩,无１眼眼球摘除。结论：玻璃体切割联合玻璃体注药是治疗化脓性眼内炎最有效方法。     

Combined cataract surgery and vitrectomy for recurrent retinal detachment

PURPOSE: To report our experience with combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in the management of recurrent retinal detachment (RD) and visually significant cataract. METHODS: Retrospective chart review of patients with cataract and recurrent RD who underwent combined cataract extraction, posterior chamber intraocular lens implantation, and pars plana vitrectomy between January 1991 and September 1998 at the Bascom Palmer Eye Institute. Sixteen eyes were included. All eyes had visually significant cataract and had undergone primary repair of the RD with encircling scleral buckle; eight eyes also had undergone pars plana vitrectomy during the primary repair. The technique of cataract extraction included phacoemulsification (10 eyes), extracapsular cataract extraction (5 eyes), and pars plana lensectomy (1 eye). All eyes underwent pars plana vitrectomy, membrane peeling, fluid-air exchange, endolaser treatment, and placement of a retinal tamponade. Perfluoropropane (C3F8) gas was used in 14 eyes, and silicone oil was placed in two eyes. RESULTS: The postoperative follow-up interval ranged from 4 to 64 months (mean, 16 months). Preoperative visual acuity ranged from 20/60 to hand motions and was better than 20/200 in 3 (19%) eyes. Postoperatively, 9 (56%) eyes improved to better than 20/200. Anatomic success was achieved after the initial reoperation in 13 (81 %) eyes. With further surgery, the overall success rate was 94%. CONCLUSIONS: Combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in selected patients with cataract and recurrent RD was successful in improving visual acuity and achieving retinal reattachment in most of these reoperated patients.     

玻璃体切除联合眼内注药治疗真菌性眼内炎

目的探讨玻璃体切除联合眼内注药治疗外源性真菌性眼内炎的远期疗效。方法对13例（13眼）外源性真菌性眼内炎采取玻璃体切除联合眼内注药治疗，随访1～2年，观察疗效。结果13眼中有6眼保存有用视力，眼前数指～手动者2眼，光感者1眼，眼球萎缩者2眼，2眼因术后疼痛行眼内容物摘出。结论真菌性眼内炎的预后不佳。早期行玻璃体切除联合眼内注药，可拯救部分视力，是目前治疗真菌性眼内炎有效方法。     

人工晶状体植入术后急性眼内炎

目的 探讨白内障摘出联合人工晶状体植入术后急性眼内炎的临床特点、治疗方法及效果.方法 回顾性分析5848例白内障摘出人工晶状体植入术后发生急性眼内炎4例(4眼),眼内炎发生于术后2～6d,视力为光感～数指/10 cm.治疗方法:2例行玻璃体腔内注药术,其中1例效果欠佳,于次日行玻璃体切除联合玻璃体内注药;另2例行玻璃体切除术联合玻璃体腔内注药,均配合全身及局部应用抗生素及皮质类固醇类药物.结果 随访8～26个月,4例眼内炎均得到控制,最后视力分别为0.15、0.25、0.6、0.8.结论 白内障摘出人工晶状体植入术后急性眼内炎是白内障手术的严重并发症,玻璃体切除联合玻璃体腔注药是一种安全、有效的治疗方法.     

Long-term results of pars plana lensectomy with double-capsule-supported intraocular lens implantation in children

Background: To report the long-term results of the pars plana lensectomy with double-capsule-supported intraocular lens implantation technique for the treatment of pediatric cataracts.Methods: A lensectomy and an anterior vitrectomy were performed through the pars plana approach, followed by implantation of a posterior chamber intraocular lens (IOL) to the sulcus over the capsules. Patients with a minimum follow-up of 5 years were included in the study and patient data were collected retrospectively from the patient reports.Results: Sixteen eyes of 10 patients with a mean age of 4.3 (SD 1.1) years were included in the study. Only one case was traumatic, and the others were congenital cataract cases. A 6.5 mm polymethyl methacrylate posterior chamber IOL was used in all cases. The visual axis was clear in all the cases through the mean follow-up period of 79.2 (SD 14.1) months. IOL decentration was observed in 1 eye at postoperative month 24, and it needed to be repositioned. There was no posterior capsular opacification in any of the cases. Best-corrected visual acuity was 20/40 or better in 81.3% of the eyes.Interpretation: The pars plana lensectomy with double-capsule-supported intraocular lens implantation technique seems to be a safe and easy method in children, limiting postoperative IOL-related complications and posterior capsule opacification in the long term.     

Post-traumatic endophthalmitis: causative organisms and visual outcome

PURPOSE: Post-traumatic endophthalmitis makes up a distinct subset of intraocular infections. The purpose of the present study was to identify the causative organisms and record the visual outcome after infectious endophthalmitis in eyes with penetrating trauma. METHODS: We reviewed 18 consecutive cases of culture-positive endophthalmitis that developed after penetrating ocular trauma. All cases were treated with pars plana vitrectomy and intravenous and intraocular antibiotics. RESULTS: The 15 males and 3 females ranged in age from 4 to 43 years (mean 25.1 +/- 11 years). Nine (50%) had intraocular foreign bodies. A single species was isolated in 16 cases, and multiple organisms in two. Staphylococcus epidermidis and gram-negative organisms were the most frequent and were cultured either alone or in association with other organisms in respectively five (27.7%) and four cases (22.2%). Clostridium perfringens was isolated in three cases (16.6%). Bacillus was not found as a cause of endophthalmitis. Final visual acuity was better than 20/400 in eight cases (44%). In five cases (27.7%), the eye was saved but visual acuity was counting fingers. Two eyes (11%) had no light perception. The remaining three eyes (16.6%) were enucleated or eviscerated. Clostridium perfringens was isolated from two eyes and Aspergillus niger from one. Postoperative retinal detachment developed in four eyes, which were successfully operated. CONCLUSIONS: Organisms isolated in this series were similar to those in previous reports of post-traumatic endophthalmitis from other parts of the world, except that the frequency of Clostridium perfringens isolation was high and no Bacillus species were cultured. In view of its devastating outcome, post-traumatic endophthalmitis must be treated promptly with vitrectomy and intravitreal antibiotics.     

Pars plana lentectomy for treatment of congenital cataract

BACKGROUND: Congenital cataract surgery can be performed using a pars plicata/plana or a limbal approach, if placement of an intraocular lens at the time of cataract removal is not a consideration. Because of the high incidence of secondary cataract formation in children the operation should be combined with capsulotomy and anterior vitrectomy. METHODS: The series consisted of 30 eyes from 20 consecutive children who suffered from congenital cataract and underwent cataract surgery between May 1995 and June 2000. The inclusion criterion was congenital cataract affecting the visual axis. We performed the operations as lens aspiration with anterior and posterior capsulotomy and anterior vitrectomy via the pars plana or plicata. We used contact lenses to rehabilitate vision. All patients received intensive orthoptic and pleoptic treatment. RESULTS: This surgical technique provided in all eyes a clear visual axis. During follow-up of 3 months to 4.5 years, secondary cataract developed in five eyes. Retinal detachment, glaucoma and endophthalmitis did not occur. One patient developed contact lens intolerance and a secondary intraocular lens was placed in the ciliary sulcus. DISCUSSION: Lentectomy via a pars plana or pars plicata approach is a suitable and safe method for treating cataract in children. Our chosen method of lentectomy is an alternative to early implantation of an intraocular lens. It is possible to perform uncomplicated secondary implantation of an intraocular lens in the ciliary sulcus.     

Pars plana vitrectomy and transscleral fixation of black diaphragm intraocular lens for the management of traumatic aniridia

BACKGROUND AND OBJECTIVES: Partial or complete aniridia occurring after severe ocular trauma is a difficult therapeutic problem. Diaphragm intraocular lenses were developed for the correction of aniridia, but the safety and efficacy of implanting such lenses are not well established in traumatic cases because of very few reports, and the small number of cases studied. PATIENTS AND METHODS: Six patients, 4 men and 2 women with a mean age of 44 years, were treated for traumatic aniridia using pars plana vitrectomy and transscleral fixation of a black diaphragm intraocular lens. Total aniridia was observed in 3 eyes and partial aniridia in 3 eyes. Four eyes were aphakic and severe lens subluxation was seen in 2 eyes. Vitreous hemorrhage coexisted in 2 patients and bacterial endophthalmitis was present in 1 patient. Follow-up time ranged between 4 and 39 months (mean, 23 months). RESULTS: Best-corrected visual acuity improved in 5 patients and 1 remained unchanged. Good visual acuity (20/20 - 20/40) was achieved in all cases and all lenses were well-centered. No severe complications were noted. Three of 6 patients required glaucoma topical medications pre- and postoperatively achieving good intraocular pressure control. CONCLUSION: The management of traumatic aniridia using pars plana vitrectomy and implantation of scleral fixation black diaphragm intraocular lenses seem to be safe. Very good functional results and lack of severe complications are encouraging. Additional cases with a longer follow-up study are necessary to support our opinion.