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Retinitis Pigmentosa
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
The progression of pigmentary changes often results in scotomas in the visual field; increasing visual field constriction causes progressive visual field impairment. Pallor of the disc and atrophy of the macula are common. Patients may also develop open angle glaucoma, posterior subcapsular cataract, myopia and vitreous detachment. There is no effective therapy for retinitis pigmentosa.
Flashing Lights and Floaters
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
A vitreous detachment occurs when the ageing vitreous body, which is 4 mL in volume and occupies almost the entirety of the posterior segment, collapses forward and pulls its posterior aspect free from the retina. This can either be a smooth collapse with no retinal tears or haemorrhages, or the blood vessels and retina can be damaged in the separation, resulting in pigment and blood released into the vitreous cavity, and even parts of the retina itself in the form of an operculated tear. Blood and inflammatory debris from diabetes, infection or inflammation of the posterior segment may also cause floaters (see Chapter 14). Diabetic retinopathy is a common cause of posterior segment haemorrhage.
Implantation of a sustained-release ganciclovir implant
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
April Harris, Stephen A Meffert, Mandi D Conway
The Foscarnet–Ganciclovir Cytomegalovirus Retinitis Trial reported the 6-month cumulative risks of retinal detachment in patients receiving intravenous ganciclovir and foscarnet as 28% and 27%, respectively.4 The incidence of retinal detachment in eyes receiving ganciclovir implants has been reported as ranging from 11% to 23%.18,24 Although eyes with ganciclovir implants appear to have a lower incidence of retinal detachment, the NEI trial did note a nonstatistically significant trend toward earlier occur-rence of detachments in implant eyes compared with those receiving intravenous therapy. The investigators noticed a correlation between postoperative vitreous detachment and the subsequent development of a retinal detachment. They postulated that surgical manipulation of the vitreous might lead to premature posterior vitreous separation that, in turn, can induce retinal tears at the borders of quiescent retinitis.18 Repair of retinal detachments in patients with CMV retinitis is usually accomplished with vitrectomy and silicone oil tamponade (see Chapter 55).
Idiopathic Vitritis after Boston Type 1 Keratoprosthesis Implantation: Incidence, Risk Factors and Outcomes in a Multicentric Cohort
Published in Ocular Immunology and Inflammation, 2022
Clemence Bonnet, Ismael Chehaibou, Reza Ghaffari, Nicholas J. Jackson, Cristina Bostan, Jean-Pierre Hubschman, Mona Harissi-Dagher, Anthony J. Aldave
Retinal detachments were more frequent after keratoprosthesis implantation following vitritis than after procedures without vitritis, partially explaining the higher percentage of eyes that lost 20/200 CDVA and experienced KPro retention failure following the development of vitritis.23 The presence of vitreous inflammation may play a role in the occurrence of retinal detachment by enhancing posterior vitreous detachment and morphological changes of the vitreous base, thereby increasing the risk of retinal breaks.24 Given that retinal detachments are more difficult to diagnose and repair following KPro implantation, and are associated with a poor prognosis, some authors have advocated performing a total pars plana vitrectomy at the time of aphakic KPro implantation, although they have not demonstrated a decrease in the incidence of vitritis or retinal detachment when compared to partial pars plana vitrectomy or anterior vitrectomy at the time of KPro implantation.25,26
Role of Intralesional Antibiotic for Treatment of Subretinal Abscess – Case Report and Literature Review
Published in Ocular Immunology and Inflammation, 2022
Saurabh Verma, Shorya Vardhan Azad, Pradeep Venkatesh, Vinod Kumar, Abhidnya Surve, Akshaya Balaji, Rajpal Vohra
After appropriate sensitivity testing, the patient was started on empirical treatment with intravenous vancomycin (40 mg/kg/day) and ceftriaxone (100 mg/kg/day) in two divided doses. Topical concentrated antibiotics, steroid and cycloplegics, were also initiated at a high frequency. On the same day, 25-gauge (G) vitreous cutter assisted pars plana vitreous biopsy was sent along with the intravitreal injection of vancomycin (1 mg/0.1 ml) and ceftazidime (2.25 mg/0.1 ml). However, there was no improvement in media clarity and inflammation over the next 3 days. Culture report came positive for Citrobacter species. 25-G pars plana vitrectomy (PPV) was thus performed. After core vitrectomy, posterior vitreous detachment (PVD) was induced and limited peripheral vitrectomy was done. After sufficient clearing of media, a 41-G needle (DORC, international Netherland) was used to inject a combination of piperacillin and tazobactam (122 µg/0.05 ml) directly into the subretinal abscess through a relatively avascular area. Fluid air exchange was done and internal tamponade was provided with 1000 centistroke (cs) silicon oil.
Clinical Features of Endogenous Endophthalmitis Secondary to Minimally Invasive Upper Urinary Tract Calculus Removal
Published in Ocular Immunology and Inflammation, 2022
Bingsheng Lou, Yi Sun, Jialiu Lin, Zhaohui Yuan, Liwen He, Chongde Long, Xiaofeng Lin
All patients received oral voriconazole 6–8 weeks. As shown in Table 2, pars plana vitrectomy (PPV) alone or in combination with other procedures was performed in 11 patients 15 eyes), and 1 patient (2 eyes) was given only repeated intravitreal fluconazole because of lung infection and spinal canal abscess. All 15 eyes underwent complete vitrectomy. During surgery, induced posterior vitreous detachment (PVD) was performed in 6 eyes without natural PVD developed, and no complications of retinal break or retinal detachment ocurred. Epiretinal membrane (ERM) around the retinal exudates existed in 5 eyes. Retinal tears occurred in 2 eyes due to the peeling of ERM (Case 2, Case 6 OS). ERM could not be completely removed and retinal reattachment failed because of the severe and extensive adhesion between the membrane and the detached retina in Case 10. Endophthalmitis reoccurred at 2 weeks postoperatively in one eye (Case 12), another vitrectomy combined with lensectomy and silicon oil replacement was conducted. Macular epiretinal membrane developed at 4 months postoperatively in one eye (Case 1, OS), and ERM removal was performed. Silicon oil was removed 3 to 9 months (mean, 6 ± 2.3 months) after silicon oil tamponade. Significant cataract developed in case 3 and case 4 (OD), and phacoemulsification was conducted with silicon oil removal. No complications such as retinal detachment occurred after silicon oil removal.