Post-traumatic endophthalmitis ☆

Post-traumatic Infectious Endophthalmitis

The incidence of traumatic endophthalmitis may be decreasing due to earlier wound closure and prompt initiation of antibiotics. Risk factors for endophthalmitis include retained intraocular foreign body, rural setting of injury, disruption of the crystalline lens, and a delay in primary wound closure. The microbiology in the post-traumatic setting includes a higher frequency of virulent organisms such as Bacillus species. Recognizing early clinical signs of endophthalmitis, including pain, hypopyon, vitritis, or retinal periphlebitis may prompt early treatment with intravitreal antibiotics. Prophylaxis of endophthalmitis in high-risk open-globe injuries may include systemic broad-spectrum antibiotics, topical antibiotics, and intravitreal antibiotics to cover both Gram-positive and Gram-negative bacteria. For clinically diagnosed post-traumatic endophthalmitis, intravitreal vancomycin, and ceftazidime are routinely used. Concurrent retinal detachment with endophthalmitis can be successfully managed with vitrectomy and use of intravitreal antibiotics along with a long acting gas or silicone oil tamponade. Endophthalmitis is a visually significant complication of open-globe injuries but early wound closure as well as comprehensive prophylactic antibiotic treatment at the time of injury repair may improve visual acuity outcomes.

/pdf/endophthalmitis-following-open-globe-injuries-rn592gqwf9.pdf

Endophthalmitis following open-globe injuries

Bacterial endophthalmitis: therapeutic challenges and host-pathogen interactions.

Purpose of reviewThe aim of this article is to present the recent literature on the preoperative assessment, intraoperative management and postoperative care of patients with intraocular foreign bodies and present a management algorithm.Recent findingsThe preoperative assessment includes an evaluati

Current trends in the management of intraocular foreign bodies.

Background
Results of core vitrectomy in post-traumatic endophthalmitis are poor. Our initial results of complete vitrectomy with primary silicone oil endotamponade were promising. A comparative study of this procedure with conventional core vitrectomy was therefore carried out.

Pars plana vitrectomy with or without silicone oil endotamponade in post-traumatic endophthalmitis

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Purpose: Post-traumatic cysts of the iris pose a diagnostic and therapeutic challenge for ophthalmic surgeons. This prospective case series highlights the clinical spectrum and longterm outcomes of different modes of treatment in these cases.



Methods:  Eleven cases of post-traumatic iris inclusion cysts, treated with Nd:YAG laser and/or surgical excision were evaluated prospectively over periods ranging from 6 months to 3 years. Ultrasound biomicroscopy features and postoperative outcomes in each were evaluated.



Results:  Laser iridotomy of the cyst offers a non-invasive method of therapy in these cases but has a high rate of recurrence. The outcomes in most cases were poor, with worse results and more complications encountered in younger age groups.



Conclusions:  Iris inclusion cysts have overall poor surgical outcomes as the result of the extensive proliferation of epithelial cells, which may explain why the condition takes a rapid course in younger patients and why severe complications are encountered postoperatively in this age group.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1600-0420.2007.00975.x

Post-traumatic inclusion cysts of the iris: a longterm prospective case series.

Purpose: To evaluate the role of prophylactic scleral buckling procedure with pars plana vitrectomy for the removal of retained intraocular foreign bodies (RIOFB) in the prevention of postoperative retinal detachment.



Methods: In a prospective, clinical, controlled study, 28 patients with RIOFB without retinal detachment were randomly divided into two groups of 15 (group I) and 13 (group II) patients. All patients underwent a standard three-port pars plana vitrectomy with foreign body removal. In addition to this standard procedure, patients assigned to group I had a 360° encircling scleral buckle placed at the time of surgery. Group II patients did not have any scleral buckling. All patients were followed up for an average period of 11.8 months. Both groups were comparable with respect to age, sex, duration of injury, nature of injury, and site, size and type of RIOFB.



Results: The retinal detachment rate was found to be 6.6% in group I and 30.8% in group II (P = 0.24). Prophylactic scleral buckling reduced the risk of retinal detachment by 24% but this was not found to be statistically significant.



Conclusion: Prophylactic scleral buckle placement with pars plana vitreous surgery for RIOFB may reduce the risk of late onset retinal detachment. A larger study would seem warranted.

Role of prophylactic scleral buckling in the management of retained intraocular foreign bodies.

Sonographic diagnosis of an unusual retained intraocular foreign body

Bilateral macular holes: an unusual feature of alport syndrome.

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