Purpose To report a case of post-operative endophthalmitis following combined cataract extraction and minimally invasive glaucoma surgery with placement of the iStent drainage device. Observation An 87-year-old woman with a nuclear sclerotic cataract and primary open angle glaucoma underwent elective phacoemulsification cataract extraction with iStent placement. Surgery was complicated only by the inability to properly place the second iStent despite several attempts. At 4 days post-operatively she was diagnosed with endophthalmitis. Despite the prompt intravitreal injections of broad spectrum antibiotics, she lost all perception of light. Cultures of anterior chamber aspirates failed to identify a causative organism. Conclusion and importance In what we believe to be the first report of endophthalmitis associated with placement of the iStent, complete loss of vision occurred. Surgeons need to be aware that iStent placement may be complicated by severe endophthalmitis.
Précis: Surgical and clinical success rates were similar among Ahmed FP7, and Baerveldt 250 and 350 glaucoma drainage devices at three years.Purpose: To compare rates of surgical and clinical success in patients with Ahmed FP7 (FP7), Baerveldt 250 (B250), or Baerveldt 350 (B350) glaucoma drainage devices (GDDs).Design: A retrospective cohort study.Methods: A total of 157 eyes of 129 adult patients with FP7, B250, B350 GDDs, and 190 eyes of 99 medically controlled glaucoma patients were enrolled at a tertiary care institution from August 2017 through July 2019. They were followed through April 2020. The main outcome measures included surgical and clinical failure. Surgical failure was defined as intraocular pressure (IOP) outside 5-21 mm Hg, IOP reduced <20% below baseline, additional glaucoma surgery, GDD removal, or no light perception. Eyes that did not meet their goal IOP ranges or required secondary glaucoma interventions were deemed clinical failures.Results: A total of 43 (12.4%) FP7, 36 (10.4%) B250, 78 (22.5%) B350, and 190 (54.8%) medically treated control eyes were enrolled. By the postoperative year 3 visit, 10 (23.2%) FP7, 11 (30.6%) B250, and 32 (41.0%) B350 eyes had met a surgical failure criterion (P = 0.127). There were no significant differences in the numbers of eyes meeting their IOP target ranges (P = 0.510), and rates of secondary glaucoma surgeries (P = 0.270). Overall clinical success was attained among 83.3% FP7, 81.8% B250, and 68.0% B350 eyes (P = 0.447). Conclusions:The GDD groups were similar in their rates of success, based on both the surgical and clinical success definitions.
A 25-year-old woman was referred to the neuro-ophthalmology clinic because of a 6-month history of intermittent diplopia. The double vision occurred every day, multiple times throughout the day, and was provoked after looking to the right. There was no eye pain, headache, ptosis, difficulties swallowing, change in voice, or any other ocular or neurological symptoms.She had no history of strabismus, eye patching, or ocular surgery. Her medical history was notable for a growth hormone-producing pituitary macroadenoma for which she underwent surgical resection 2.5 years prior to presentation, followed by γ-knife radiosurgery (50 Gy) 6 months after the initial surgical procedure. She also had a history of congenital hip dysplasia. Medications included cabergoline, levothyroxine, ethinyl estradiol/ drospirenone, and pasireotide.Her visual acuity was 20/20 OU. Her pupils were equal in size with no relative afferent pupillary defect. Automated perimetry was full in both eyes. The anterior and posterior segments were normal in both eyes. There was no proptosis or ptosis. On initial examination, the eye movements were full, with no ocular deviation in primary, right, or lateral gazes. However, on returning to a primary gaze from a sustained right-gaze position, a large angle exotropia was present, and on attempted left gaze, there was a limitation of adduction of the right eye (Figure). After 10 to 15 seconds, the exotropia resolved, and eye movements returned to normal.
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