Early vitrectomy and diagnostic testing in severe infectious posterior uveitis and endophthalmitis

BACKGROUND

To determine the therapeutic and diagnostic value of vitreoretinal surgery in various types of severe viral retinitis and endogenous endophthalmitis.

MATERIAL/METHODS

Pars plana vitrectomy with silicon-oil tamponade was performed on 12 eyes (12 patients) with severe viral retinitis and endogenous endophthalmitis. The mean age of the patients was 35.2 years (range, 18-56 years). Investigations consisted of chest radiography, RT 23, serology (for toxoplasmosis, cytomegalovirus, herpes simplex virus, and human immunodeficiency virus), and routine blood tests and urinalysis. Examination of vitreous samples consisted of polymerase chain reaction for cytomegalovirus, herpes simplex virus, and Mycobacterium tuberculosis, and cultures for fungi and bacteria. The results were analyzed 7 days and 6 months after surgery.

RESULTS

Analysis of vitreous samples showed cytomegalovirus in 3 patients, herpes simplex virus in 2, tuberculosis in 2, and Candida albicans in 5. All patients had improvement in visual acuity and severity of clinical signs seven days after surgery and in 10 cases after long-term follow-up. Final visual acuity was compromised by chronic macular edema, postinflammatory macular scarring, optic atrophy, subcapsular cataract formation, and capsular opacification after cataract surgery.

CONCLUSIONS

Modern laboratory tests are useful for quick and accurate diagnosis of atypical cases of severe infectious posterior uveitis. Early pars plana vitrectomy with silicon oil tamponade is valuable in diagnosing and treating severe infectious posterior uveitis and endophthalmitis.

[Use of bevacizumab as an additional strategy in angle closure glaucoma--case report]

We report the use of bevacizumab (Avastin) as an additional strategy in angle closure glaucoma based on the case of 47 years old male qualified to cataract removal as anti-glaucoma procedure, in whom we observed iris and lens neovascularization. As a first step we administered 1.25 mg of bevacizumab into the anterior chamber. Iris as well as lens neovasularization completely disappeared after 48 hours later. Finally after lens removal we achieved deeper anterior chamber, reduction and stabilization of intraocular pressure without necessity of administration hipotensive agents, and improvement of visual acuity.

[Evaluation on the cellular level the filtering bleb following trabeculectomy, using the HRT II Cornea Module]

PURPOSE

Evaluation on the cellular level the filtering bleb following trabeculectomy, using the HRT II Cornea Module.

MATERIAL AND METHODS

Confocal microscopy was performed in 47 eyes following trabeculectomy to state typical images for functioning blebs with no MMC application, with MMC application and non-functioning blebs. In gathered images we assessed appearance, size and number of intraepithelial microcysts, encapsulation, density of subepithelial tissue and blood vessels.

RESULTS

A large number of microcysts filled with fluid and loosely arranged subepithelial tissue were observed in functioning blebs with no MMC application (20 eyes). Smaller amount of microcysts but their larger size and inflammatory cells were typical for functioning blebs with MMC application (18 eyes). We found encapsulated microcysts and dense connective tissue in non-functioning blebs (9 eyes).

CONCLUSIONS

Visualization of filtering bleb structure in vivo is an objective and helpful method of evaluation of functioning status following trabeculectomy.

[Quality of life in glaucoma patients]

Glaucoma as a chronic and often asymptomatic disease in its early stages has a great influence on Quality of Life (QOL). Mostly because of disturbances in visual functions like damage to the visual field, lower visual acuity, the psychological impact of the diagnosis, side effects and the cost of treatment. Evaluation of QOL is very useful instrument which helps to decide about the ways of treatment. Especially if they are equally beneficial but have totally different psychological impact. Considering patients' needs, satisfying their expectations and education, there is a guarantee of keeping the therapeutic indications and high efficiency of treatment.

[Mycoplasmal infections--still actual problem]

In the research there was presented a wide variety of infections caused by different Mycoplasma subtypes, the most frequently systemic location, diagnostic and treatment procedures and problems connected with.