Cases reported "Staphylococcal Infections"

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1/6. Recurrent methicillin-resistant staphylococcus aureus wound ulcer after clear-cornea cataract surgery.

    PURPOSE: To present a case of recurrent, methicillin-resistant staphylococcus aureus (MRSA) wound ulcer after clear-cornea cataract surgery. methods: Case report. RESULTS: An 82-year-old man underwent an uncomplicated phacoemulsification procedure with posterior-chamber intraocular lens (PCIOL) implantation. Two weeks after surgery, a corneal ulcer was present at the wound site. Corneal tissue sample cultures produced methicillin-resistant staphylococcus aureus. The ulcer responded to high-dose vancomycin but recurred twice as vancomycin was tapered. Lamellar keratectomy with conjunctival flap was performed at 6 months after surgery, with no additional ulcer recurrence. CONCLUSIONS: wound infection after clear-cornea cataract surgery occurs infrequently. Management of these infections, however, can provide challenging clinical decisions.
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ranking = 1
keywords = phacoemulsification
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2/6. Orbital abscess following uncomplicated phacoemulsification cataract surgery.

    The case is presented of an 80-year-old woman who developed an orbital abscess after undergoing routine phaco-emulsification cataract surgery to her right eye. She was treated by drainage via an anterior orbitotomy and a sensitive Staphylococcus aureus was cultured. The presenting signs and symptoms resolved and final visual acuity was 6/9 in the right eye. One possible aetiology was the introduction of skin flora to orbital tissues during the peribulbar administration of local anaesthetic for the cataract surgery. Alternatively, secondary haemorrhage with secondary infection may have occurred.
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ranking = 4
keywords = phacoemulsification
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3/6. Post-cataract surgery endophthalmitis treated with core vitrectomy: a case report.

    Postoperative endophthalmitis is one of the most serious complications after cataract surgery though its frequency may be low. We report a case with post-cataract extraction bacterial endophthalmitis treated favorably by core vitrectomy through pars plana with anterior vitrectomy cutter (A-vit). The patient, a 72-year-old woman, presented with blurred vision 7 days after phacoemulsification and aspiration (PEA) and intraocular lens (IOL) implantation. Her initial visual acuity was counting fingers. As hypopyon and corneal edema progressed in a few hours, we decided to perform vitectomy. Firstly, we performed IOL explantation and anterior vitrectomy through the corneal stab incision with A-vit attached to the phaco machine. The inflammation, however, appeared to be severe. Secondly we performed core vitrectomy with the same cutter as we used in the first operation through pars plana as well as intravitreal injection of vancomycin on the following day. The inflammation was gradually subsided and her corrected visual acuity was recovered to 30/20 at 7 months after the vitrectomy. The results is suggest that for cataract surgeons in the facilities that are not equipped with 3-port vitrectomy machine, post-cataract extraction bacterial endophthalmitis of the emergency stage can be successfully treated by core vitrectomy through pars plana as well as intravitreal injection of antibiotics with neither vitreous shaving at the vitreous base nor artificial posterior vitreous detachment.
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ranking = 1
keywords = phacoemulsification
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4/6. Spectrum of clear corneal incision cataract wound infection.

    PURPOSE: To describe the presentation, management, and outcome of 5 patients who presented with main-port or side-port wound infection after uneventful clear corneal cataract surgery. SETTING: Ophthalmic Surgery Centre, Chatswood, and Department of ophthalmology, Prince of wales Hospital, Randwick, australia, and Moorfields eye Hospital NHS Foundation trust, london, United Kingdom. methods: This retrospective case series comprised 5 patients who had uneventful clear corneal phacoemulsification surgery and developed either a main-port or side-port wound infection. The clinical features, microbiologic studies, management, and results are reported. RESULTS: The median age of the patients was 79 years. Infection of the main-port incision occurred in 3 cases and of the side port in 2 cases. The patients presented from a few days to several weeks after uneventful phacoemulsification. In 2 cases, the bacteria pseudomonas aeruginosa and Staphylococcus aureus were isolated. In 1 case, the fungus aspergillus was isolated and required extensive medical and surgical treatment. In the other 2 cases; empiric antimicrobial therapy was given because no organism was isolated in 1 case, and in the other milder case, microbiological investigations were not performed. Final visual acuity was 6/4 in 2 cases and 6/5, 6/12, and 6/18 in 1 case each. CONCLUSIONS: Bacterial or fungal wound infection can present within days or even several weeks following clear corneal cataract surgery. patients with ocular discomfort or blurred vision after such surgery should be advised to report promptly. Rapid identification and appropriate management of patients with clear corneal wound infection can result in good visual outcomes.
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ranking = 2
keywords = phacoemulsification
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5/6. Treatment of acute postoperative endophthalmitis without hospital admission: do we dare?

    INTRODUCTION: We report the successful management of a culture positive case of APE, without the need for hospital admission and discuss the merits of this strategy. CASE: A 79-year-old lady underwent uncomplicated cataract surgery in her left eye using phacoemulsification under topical and intracameral anaesthesia. She reported to eye casualty four days later, with pain and vision reduced to 6/60 in the left eye. A diagnosis of acute postoperative endophthalmitis was made. A vitreous biopsy was performed and antibiotics injected intravitreally on the same day. The patient was discharged on oral and topical antibiotics on the same day and reviewed subsequently in the clinic as an outpatient. Vision steadily improved and at one month following intravitreal injection her vision had improved to 6/9 unaided. The cornea remained clear, with a quiet anterior chamber and a clear view of the fundus. DISCUSSION: Current management of acute postoperative endophthalmitis in the UK includes a vitreous biopsy, administration of antibiotics into the vitreous cavity, admission of patients to a hospital ward and daily review. It is our opinion that under the circumstances where patients are fit and well, without significant co-morbidity, hospital admission is not necessary as demonstrated by the patient in our report.
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ranking = 1
keywords = phacoemulsification
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6/6. endophthalmitis in patients with retained lens fragments after phacoemulsification.

    PURPOSE: To review the treatment and outcomes of patients presenting with concurrent endophthalmitis and retained lens fragments after phacoemulsification. methods: A retrospective chart review was conducted on patients presenting with culture-proven endophthalmitis and retained lens fragments after phacoemulsification between 1990 and 1994. RESULTS: Five patients were identified with culture-proven endophthalmitis and retained lens fragments after phacoemulsification. In all patients, coagulase-negative staphylococci were cultured from the vitreous fluid. One patient also had positive cultures for proteus mirabilis and escherichia coli. The interval between cataract surgery and treatment ranged from 5 days to 6 months. Echography was beneficial in showing retained lens fragments in five of five patients when media opacities obscured the view of the fundus. Four patients had vitrectomy and removal of retained lens fragments during their initial treatment. The fifth patient was treated with intravitreal antibiotics alone and continued to have marked inflammation, eventually requiring vitrectomy for removal of the retained lens fragments. A final visual acuity of 20/400 or better was achieved in four of the five patients. CONCLUSIONS: patients may present with endophthalmitis in the setting of retained lens fragments after phacoemulsification. In such cases, the preferred initial management may be pars plana vitrectomy, removal of retained lens fragments, and injection of intraocular antibiotics. In eyes with endophthalmitis and opaque media, echography is a useful screening modality.
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ranking = 8
keywords = phacoemulsification
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