Helen Keller Foundation

Morris, Robert E. MD; Sapp, Mathew R. MD; Oltmanns, Matthew H. MD; West, Matthew R. MD Author Information

Lactococcus (L.) garvieaeis a gram-positive coccus that has been found in various aquatic and terrestrial animals, as well as in dairy products, and is considered a potential zoonotic bacterium. The pathogen has been recognized as an emerging opportunistic human pathogen, often associated with the ingestion of raw seafood. The most common presentation ofL. garvieaeinfection in humans is infective endocarditis, but it has also been found to have associations with other clinical manifestations. The following is a case report of a 6-year-old male with infected bilateral leg abrasions that occurred after playing in a local creek near his home in northern Alabama, which had livestock including goats, cows, and horses. Wound culture indicated that the bacteria wasL. garvieae,which was found to be sensitive to ceftriaxone, levofloxacin, linezolid, tetracycline, tigecycline, and vancomycin and resistant to clindamycin. The patient was treated with oral cephalexin and topical gentamicin for ten days, after which there appeared to be an overall improvement in wound healing.

PurposeAscertain the 1-year outcome of patients who sustained open eye injuries from the Beirut Port ammonium nitrate (AN) explosion, one of the most powerful non-nuclear explosions in history.MethodsRetrospective chart review of the operated eyes in 2 major eye hospitals.ResultsOut of 42 patients with open globe injury that was originally sutured, 29 patients (34 eyes) were followed at the 1-year mark. The initial vision in logMAR (mean ± SD) was 2.93 ± 0.87 (hand motion equivalent) and the final vision was 1.80 ± 1.47 (counting finger 2 m equivalent). No light perception (NLP) vision was noted in 12 eyes on presentation and 10 eyes remained so, while 2 eyes reached light perception (LP) vision. Eight eyes had an intraoperative expulsive choroidal hemorrhage (7 NLP and 1 LP both pre- and postoperatively), and 6 of the 8 developed phthisis. All eyes that developed phthisis had NLP preoperatively and postoperatively. Ocular Trauma Score (OTS) correlated inversely with both initial and final vision (p < 0.001). Zone of injury inversely correlated with initial vision (p = 0.02) and positively with final vision (p < 0.001). Final vision was significantly worse in zone 3 vs. zones 1 and 2 (3.2 ± 0.5) vs. 0.9 ± 1.1) (p < 0.001) injuries, as was the initial vision (3.3 ± 0.5 vs. 2.7 ± 0.8; p = 0.002).ConclusionThe OTS, which provides prognostic information for serious ocular trauma, also yields valuable prognostic information for AN-associated ocular injuries. Expulsive choroidal hemorrhage and NLP vision at presentation remain very poor prognostic signs.

Parker, John S. MD*,†; Morris, Robert E. MD†,‡,§; Rooney, David M. MD§,¶; Parker, Jack S. MD*,† Author Information

Anterior proliferative vitreoretinopathy (PVR) is an important cause of persistent or recurrent retinal detachment (RD). Endoscopy provides 360° panoramic viewing of the vitreous cavity and high-magnification viewing of the anterior vitreous base (AVB). This study describes the 'in vivo' anatomy and pathoanatomy of the AVB using an ocular endoscope in RD and anterior PVR. An intraoperative analysis of over 2000 consecutive eyes undergoing vitrectomy for RD operated with endoscopy-assisted vitrectomy was performed. It was recorded in notes dictated during surgery and in standardized operative reports. Around 1500 surgical videotapes, with the exclusion of diabetic retinopathy and trauma, selected by reviewing the OR reports and notes were retrospectively reviewed. Seven endoscopic criteria associated with anterior PVR complicating RD are described: 'en bloc' stiff anterior vitreous retraction, ciliary detachment, seeding of the AVB by abundant pigmented and/or white granulations, anterior tissue displacement, stiff 'wrinkling' at the vitreoretinal juncture, persistent shallow ciliary/RD under perfluorocarbon liquids and traction-related retinal surface haemorrhages. Causes responsible for failure of conventional vitrectomy for RD are highlighted. Findings in case of hypotony and cyclitic membranes are described. Endoscopy is a significant adjunct to our understanding of the development of anterior loop traction by obviating the two constitutive parts of the AVB, anterior and posterior, their interconnections and their respective connections to the anterior segment and to the retina. It provides a unique evaluation and thorough eradication of the anterior vitreous cortex as a scaffold for anterior PVR. It might be an adjunct to the prevention of anterior PVR.

Rupture is the most severe form of mechanical globe trauma because of the tissue pathologies that occur at the time of injury and because of the post-injury destruction caused by scar formation as part of the body’s normal healing process. The diagnosis is usually straightforward because the wound is visible, often even to the naked eye. However, occult scleral ruptures – conjunctival integrity preserved – are not uncommon; any injury resulting from an impact by a large, blunt object therefore requires careful ocular evaluation. Due to the risk of expulsive choroidal haemorrhage wound closure is typically urgent, but all rules of proper wound toilette and suturing must be followed. The surgeon may elect to perform a staged approach, in which the initial wound-closure surgery is followed by intense topical corticosteroid therapy and then a second, comprehensive intraocular reconstruction a few days later, or to perform primary comprehensive surgery. All tissue pathologies must be properly addressed by an expert ocular traumatologist; in eyes with posterior scleral rupture, prophylactic chorioretinectomy should also be considered.

To report a patient with acute posterior multifocal placoid pigment epitheliopathy (APMPPE) who developed a thalamic infarction and to discuss this unusual presentation. Interventional case report and literature review. A 23-year-old man with APMPPE presented with acute confusion and memory loss. He underwent complete ophthalmologic and neurologic examination, with neuroimaging including magnetic resonance angiography (MRA). Clinical course and angiographic findings. Magnetic resonance imaging (MRI) showed a left posteromedial thalamic infarction, with a corresponding filling defect of the left posterior communicating artery demonstrated by MRA. The patient underwent further treatment with intravenous corticosteroids followed by continued oral therapy with taper over several weeks. Although the association of APMPPE and cerebral vasculitis has been described, this patient is unique due to the subtle clinical presentation and anatomic location. This case emphasizes the importance of appropriate counseling of patients with APMPPE, as well as prompt recognition of clinical symptoms to enable timely intervention and treatment.

The origin of subretinal fluid in eyes with optic pit remains controversial. Case report. The authors found that silicone oil, implanted into an eye that developed proliferative vitreoretinopathy after surgery for optic pit-related macular detachment, has migrated into the subarachnoid space. As this case shows, cerebrospinal fluid may migrate into the submacular space in eyes with optic pits.

Postoperative nausea and vomiting (PONV) is a frequent and unpleasant experience that may increase postoperative complications and costs. For surgical procedures with a high risk of PONV, prevention is preferable to treatment. In this study, the authors explore the dose-response relationship between granisetron administered just prior to the end of surgery and post-operative nausea and vomiting in patients undergoing abdominal hysterectomy. This was a randomized, double-blind, placebo-controlled, pilot study of post-operative nausea and vomiting prevention. Patients undergoing elective open abdominal hysterectomy requiring general anaesthesia received a single dose of granisetron 0.1, 0.2 or 0.3 mg or placebo administered approximately 15 min prior to the end of surgery. The primary efficacy end-point was the proportion of patients with no vomiting in the 0--6 h interval following medication administration. No inferential statistics were planned. The proportion of patients with no vomiting episode in the 0--6 h interval after administration of study medication was higher in each granisetron treatment group (>90%) than in the placebo group (77%). Proportions of patients with no vomiting episodes in the 0--24 h interval were similar across treatment groups. Results of analyses of proportions of patients with no moderate or severe nausea episodes, proportions of those requiring rescue medication and times to first use of rescue medication suggested a treatment effect of granisetron relative to placebo in both the 0--6 and 0--24 h intervals. Similar proportions of patients in each treatment group reported at least one adverse event. Granisetron at doses of 0.1, 0.2 and 0.3 mg administered just prior to the end of surgery suggested a trend of improved efficacy compared to placebo in preventing postoperative nausea and vomiting in the first 6 h after abdominal hysterectomy. This pilot study did not identify a dose-response relationship.