Prosthetic rehabilitation of a patient with enucleated eye - a case report

BACKGROUND

The loss of an eye has a crippling effect on the psychology of the patient, making rehabilitation process challenging for both doctor and patient.

OBJECTIVE

To report a case of anophthalmic socket with prosthetic rehabilitation in a cost effective manner.

CASE

A 32-year-old female presented with anophthalmic socket for prosthetic rehabilitation. A custom made ocular prosthesis was implanted successfully.

CONCLUSION

The custom made ocular prosthesis is simple, affordable and can be carried out in a small clinical set-up and provides a superior natural appearance.

Analysis of resident-performed manual small incision cataract surgery (MSICS): an efficacious approach to mature cataracts

To examine and improve outcomes of resident-performed manual small incision cataract surgery (MSICS) cases via analysis of visual recovery, intraoperative adverse events, and early postoperative course. Particular focus was directed toward mature cataracts extracted by MSICS. A retrospective review was performed to identify MSICS cases performed by resident surgeons unfamiliar with the technique (initial ten cases) in an academic setting. Preoperative history, intraoperative adverse events, and postoperative course were reviewed. Of 30 cases identified, mean preoperative acuity was 1.8 ± 0.9 logMAR units (Snellen equivalent = 20/1262) improving to 0.20 ± 0.35 logMAR units (20/31) at final follow-up (p < 0.0001). Mean follow-up was 22.1 ± 19.0 days. The most frequent intraoperative adverse events were wound leak requiring intraoperative suturing (33 %), vitreous loss (6.7 %), and capsulorhexis radialization (6.7 %). Transient cornea edema was the most frequent (56.7 %) early postoperative minor complication. Two major complications occurred that required wound revision in one eye and iridoplasty in one eye. Of the 30 eyes undergoing surgery, 19 were noted to have mature cataracts. In this subset, mean acuity was 2.25 ± 0.64 logMAR units (20/3557) improving to 0.28 ± 0.42 logMAR (20/38) at final follow-up (p < 0.0001). Complications were similar in nature and frequency to the entire population in this subgroup. Supervised resident MSICS cataract surgery can result in excellent anatomic and visual outcomes. Appropriate wound construction is a frequently encountered difficulty, so particular attention should be directed to this step by both trainers and trainees.

Post-traumatic endophthalmitis with retained intraocular foreign body - a case report with review of literature

INTRODUCTION

Endophthalmitis following penetrating eye injuries has a poor prognosis and presents a diagnostic and therapeutic challenge. The aim of reporting this case was to identify the causative organism of post-traumatic endophthalmitis due to retained iron foreign body and to highlight the importance of carrying out diagnostic investigations.

CASE

A 20-year-old male presented with tenderness and blurring in the right eye 3 days after injury with an iron particle. Visual acuity was perception of light with accurate projection of rays in all quadrants. The slit-lamp examination revealed ciliary and conjuctival congestion. There was a vertically-oriented self-sealed, full-thickness laceration in the cornea adjacent to the limbus. The anterior chamber evaluation revealed + 4 cells, +3 flare and a 2 - mm hypopyon. There was cataract with a ruptured anterior lens capsule. Posterior synechae was present at 5�0 clock position. B-scan showed echogenic metallic foreign body in the posterior chamber, with vitreous opacities. The vitreous tap was done and intra-vitreal antibiotics injections of 1 mg in 0.1 ml vancomycin and 2.25 mg in 0.1 ml ceftazidime were given. Culture and sensitivity of the tap revealed staphylococcus as the causative agent. The patient was put on moxifloxacin eye drops, fortified tobramycin and cephazolin eye drops 1 hourly along with atropine eye drops. The patient was referred to the vitreoretinal surgeon urgently for pars plana vitrectomy and foreign body removal. At follow up, the patient's BCVA was improved.

CONCLUSION

The causative organism isolated was similar to that documented in other reports. Endophthalmitis must be treated with vitrectomy and intra-vitreal injections of antibiotics after a proper vitreous tap.

Natamycin in the treatment of keratomycosis: correlation of treatment outcome and in vitro susceptibility of fungal isolates

In this study, 60 fungal isolates from 60 patients with fungal keratitis were tested in vitro for their susceptibility to natamycin and the mean minimum inhibitory concentrations of natamycin (MICn) were correlated with clinical outcome. The mean MICn for various groups of fungi from patients with either early (<10 days) or late (≥ 10 days) presentation was correlated with the outcome. Aspergillus flavus showed resistance to natamycin with a high mean MICn (>16 μg/ml). While the clinical response in all patients with early A. flavus keratitis was good it was poor in late cases (5/8 patients, 62.5%). Fusarium species, Acremonium species and dematiaceous fungi were sensitive with low mean MICn (Fusarium: 5.7-7.2 μg/ml, Acremonium: 5.7-6.8 μg/ml, dematiaceous: (1.6-4 μg/ml). However, 46.6% (7/15) patients in Fusarium and 57.1% (4/7) in Acremonium group needed keratoplasty. We conclude that despite susceptibility of most fungal species causing keratitis to natamycin, the treatment outcome is poor in advanced fungal keratitis.

An outbreak of acute post-cataract surgery Pseudomonas sp. endophthalmitis caused by contaminated hydrophilic intraocular lens solution

OBJECTIVE

To report the investigation for the source of infection and the clinical course and treatment response of 11 cases of acute post-cataract surgery endophthalmitis that developed during an outbreak.

DESIGN

Retrospective, consecutive, interventional case series.

PARTICIPANTS

Eleven patients who developed acute postoperative endophthalmitis after an uneventful cataract surgery with intraocular lens implantation from September 6 to 29, 2010, at a tertiary eye care center in South India.

METHODS

Aqueous aspirates, vitreous aspirates, and environmental surveillance specimens were sampled. All specimens were subjected to smear and culture. Positive cultures were subjected to antibiotic susceptibility. Genotypic diversity was determined by polymerase chain reaction (PCR) with enterobacterial repetitive intergenic consensus (ERIC) primers of each strain and was used to establish the clonal relationship between clinical and environmental isolates. The clinical patterns were analyzed.

MAIN OUTCOME MEASURES

Positive microbiology, molecular diagnostic similarity among the culture positive endophthalmitis cases, and surveillance specimens.

RESULTS

Aqueous and vitreous samples showed gram-negative bacilli in the smears of 8 of 11 eyes, and cultures grew Pseudomonas aeruginosa in 5 of 11 eyes. Among the samples from various surveillance specimens cultured, only the hydrophilic acrylic intraocular lenses and their solution grew P. aeruginosa, with antibiotic susceptibility pattern identical to the clinical isolates. The isolates from the patients and the intraocular lens solution revealed matching patterns similar to an American Type Culture Collection (ATCC) strain of P. aeruginosa on ERIC-PCR. The intraocular lenses of the same make were discontinued at our hospital, and the endophthalmitis did not recur. The final visual acuity improved to ≥ 20/50 in 8 of 11 patients (72.7%). One patient developed retinal detachment, but was treated successfully, and 2 other patients progressed to phthisis bulbi.

CONCLUSIONS

Positive microbiology and the ERIC-PCR results proved that contamination of hydrophilic intraocular lenses and the preservative solution was the source of infection in this outbreak. Early detection and a planned approach during the outbreak helped us to achieve good visual and anatomic outcomes, even though the offending organism was identified as P. aeruginosa.

Phenotypic and genotypic characterization of coagulase negative staphylococci (CoNS) other than Staphylococcus epidermidis isolated from ocular infections

PURPOSE

The clinical significance of many species belonging to coagulase-negative staphylococci (CoNS) other than Staphylococcus epidermidis has been increasingly recognized. The present study attempted the characterization of non-S. epidermidis CoNS isolates of ocular origin.

METHODS

The isolates were characterized phenotypically by analytical profile index (API) and genotypically by fluorescent amplified fragment length polymorphism (FAFLP). In addition, the presence of genes that are likely to enhance virulence such as biofilm related genes (icaA and icaB) and methicillin resistance (mecA) were detected.

RESULTS

API identified seven different species with an identification score varying from 44% to 99%. S. haemolyticus and S. xylosus species identified by API showed good API scores when compared with all other species identified. FAFLP generated 12 clusters from all the isolates and appeared to be more discriminatory. API identification results corresponded well with the FAFLP results only in six clusters. Nearly 40% of isolates showed the presence of mecA and icaAB genes.

CONCLUSIONS

Identification results of these two methods corresponded only in 48.4% of the isolates suggesting that the battery of tests using API were not sufficient enough to identify all the species of CoNS. Therefore, it is sensible to rely on two or more identification methods particularly when API species identification has a lower score. FAFLP genotyping appears to be a reliable and rapid alternative identification method for CoNS that can be used in conjunction with any other phenotypic method.