Endophthalmitis Prevention, Diagnostic Procedures and Treatment

Endophthalmitis is a severe inflammation of the inner eye's structures, caused by an exogenous or endogenous infection with microorganisms which can multiply rapidly. It occurs most frequently after intraocular surgery. Moreover, it can also be a consequence of a penetrant eye injury or a hematogenous dissemination of microorganisms. The most common pathogens of this inflammation are bacteria, next to fungi and less frequently parasites.

The occurrence, severity and clinical presentation of endophthalmitis depend on the way of infection, the number and virulence of pathogenic bacteria, as well as the patient's immunity state. The type of endophthalmitis can suggest the possible causative agent. Furthermore, it can help determine therapeutic approach or antibiotics to choose. The more virulent are the causative agents, the early the symptoms and signs of endophthalmitis appear. Such types of endophthalmitis have a bad course and poor prognosis concerning visual function. In these cases the red fundus reflex is lost quite at the beginning of the disease. Patients treated with prompt vitrectomy and intravitreal injections of antibiotics have statistically better visual outcomes and less likelihood of severe visual loss.

Sports-Related Concussion: The Eyes Have It

Concussion is a form of mild traumatic brain injury (TBI) owing to structural, metabolic and functional changes involving white mater tracts of the central nervous system in the absence of macroscopic findings. Sports-related concussion is a rapidly evolving condition stimulating interest among lay and scientific communities. 

Recent studies have shown a high rate of under reporting of concussion signs and symptoms by athletes and side line personnel. Accordingly, reliable and validated testing strategies are necessary to insure timely detection and removal from play for individuals suspected of concussion. Vision and visual motor problems are commonly reported among athletes following concussion. This is to be expected as it is estimated that approximately 50% of the brain is devoted to vision and visual motor processing. As such, testing of vision and ocular motility function are critical to the evaluation of a concussed individual.

Balancing Patient and Practitioner Goals in Contact Lens Fitting

Patients generally are seeking three things from their contact lens wearing experience, vision, comfort, and convenience. In addition, some individuals will be looking to seek these goals with a minimum of “out of pocket” expense. As an eye care provider our goal in contact lens fitting is to provide for optimal ocular health while also establishing a vision correction modality that maximizes clear binocular vision. However, there may be situations when we need to strike a balance between what patients can and will do, as contrasted with what might otherwise seem the ideal situation.

There is a wealth of published data that clearly indicates that patients do not always replace their lenses with the frequency we would like. Sometimes this is due to negligence, but often the underlying motivation is simply cost. We need to remind ourselves that the replacement period for most contact lenses is not dictated by the FDA, but is based on recommendations made by the manufacturer. The following is taken from the package insert of a commonly prescribed silicone hydrogel lens.

Ergonomic Challenges of Employees Using Computers at Work

Ergonomically designed workstations have direct bearing on the comfort and safety of office computer users. Tremendous usage of computers in most offices of emerging economies have however, not seen accompanying applications of ergonomics in the design of computer workstations despite the numerous benefits. Injuries and discomforts therefore have higher propensity to occur since most offices formally designed for paper based work now accommodate computer workstations, without corresponding redesigning.

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Contact Lenses: Out with the Old/In with the New?

To answer this question: I certainly hope not, at least not always. Without a doubt over the past several years the contact lens industry has brought forth numerous new materials, designs, and modes of contact lens manufacturing. But that should not translate into a universal switch from the “old” to the “new”. I would like to share some specific instances where older lens materials and designs should still have a place in your practice.

Although without a question newer more oxygen permeable rigid gas permeable (RGP) materials have been key to the introduction of such modalities as overnight wear of Ortho keratology lenses, these materials often have some less advantageous attributes. Although we often only consider oxygen permeability (Dk) and lens wettability when selecting a RGP material, one should also consider that such materials often have lower material hardness and greater modulus.

Mini Monoka Stent Insertion for the Management of Epiphora Secondary to Canalicular Obstruction or Stenosis

A retrospective study was performed selecting consecutive patients at Hobart Eye Surgeons, from Oct 2007 to Mar ’08 who had Mini Monoka stents inserted for epiphora secondary to confirmed obstruction/stenosis in either inferior or common canaliculus. 

These patients had their stents routinely removed after six weeks. There were a total of 36 eyes (31 patients) included in the study and 31 eyes (83.7%) showed subjective improvement in epiphora. One patient was lost to follow up and 5 eyes showed no improvement. In this first case series which used Mini Monoka stents to treat epiphora, there was a high success rate in improvement of epiphora. Further research is warranted to further validate its use into routine clinical practice.

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Concomitant Intraocular and Orbital Space-Occupied Lesions

Concomitant intraocular and orbital space-occupied lesions are relatively rare and this is the first report stressing the underlying causes of concomitant intraocular and intra orbital lesions. In this paper, we present cases showing both intraocular and orbital soft tissue masses and highlight their clinical, pathological and imaging features. 

Based upon the findings, the presence of a lesion involving both the orbit and eye should be included when a diagnosis of retinoblastoma, idiopathic inflammatory pseudo tumor, lymphoma, and/or Sturge- Weber syndrome is proposed.

Photodynamic Therapy with Verteporfin, a Novel Treatment Option for Retinal Arterial Macro aneurysm

First described by Robertson in 1973. RAMs are acquired, localised dilatations of an arteriole within the radius of the 3rd branch of the retinal arterial tree. Current treatment options are controversial and of unproven benefit.

We present the case of a 76-year old gentleman with progressive vision loss from a unilateral RAM who responded favourably to treatment with PDT using Verteporfin. To the best ofour knowledge, there are no previously published reports on the use of PDT in treating RAM.

In accordance with the declaration of Helsinki, the patient provided informed consent prior to participation. We certify that all applicable institutional and governmental regulations concerning the use of human volunteers were followed during this research.

Best treatment for Retinal arterial macro aneurysms (RAM)

Retinal arterial macro aneurysms (RAM) are acquired hemorrhagic or exudative focal dilations of retinal arterial branches. Treatment options that are currently available didn’t have proven benefit or high success rate. Recent studies have shown that photo dynamic therapy (PDT) is highly effective and can be used as an adjunct in the management of RAM.

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