Three consecutive patients with postoperative Candida parapsilosis endophthalmitis presented from a single surgeon and surgery center after uncomplicated cataract surgery. All patients were treated with pars plana vitrectomy (PPV), intraocular lens removal, total capsulectomy, and intraoperative injection of intravitreal antifungal agent. Intraoperative cultures of undiluted vitreous and lens capsule were all positive for the fungus. All patients also received oral antifungal agents postoperatively. Two of these patients received several serial intravitreal antifungal injections after PPV. Following these treatments, all infections were resolved and vision outcomes were favorable at last follow-up.

INTRODUCTION A 32-year-old man presented with a 1-week history of blunt trauma to the right eye from a high-speed golf ball at the golf course. Best-corrected visual acuity was 20/400 in the right eye and 20/20 in the left eye. Examination of the right eye revealed a large, relatively thick submacular hemorrhage (Fig. 1A). A choroidal rupture temporal to the fovea was also visible, partially obscured by the submacular hemorrhage. AUTHORS From New England Retina Associates (NAC, TY, PEL), Hamden, Connecticut; and the Department of Ophthalmology (HWF), Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida. Accepted for publication November 5, 2006. Address correspondence to Nauman A. Chaudhry, MD, New England Retina Associates, 2200 Whitney Avenue, Hamden, CT 06518.

A review of the charts for all patients who developed large submacular hemorrhages following photodynamic therapy for choroidal neovascular membranes secondary to age-related macular degeneration yielded three patients who met the criteria for a large submacular hemorrhage. All three patients were treated for exudative age-related macular degeneration and were taking warfarin for chronic anticoagulation. Before photodynamic therapy, the international normalized ratio ranged from 1.2 to 1.6. All three patients had received at least one previous verteporfin treatment in the study eye. All three hemorrhages were not noted immediately after photodynamic therapy and were documented within 1 to 2 weeks following the procedure. Patients with age-related macular degeneration who are receiving warfarin therapy and undergoing repeat verteporfin treatments appear to be at risk for submacular hemorrhages.

PURPOSE:To report the six-month results of subfoveal choroidal neovascularization that had been treated with combined therapy of high-dose intravitreal triamcinolone acetonide (HDIVTA), photodynamic therapy (PDT), and pegaptanib sodium injection.DESIGN:Retrospective, interventional case series study.METHODS:Medical files of 16 patients with this treatment were reviewed (22 eyes); 13 eyes had had previous treatment with HDIVTA and PDT; nine eyes were newly diagnosed choroidal neovascularization. Patients were treated with an injection of HDIVTA (10 mg), followed by PDT and pegabtanib sodium injection at two-week intervals. The main outcome variables were visual acuity (VA) and macular thickness by optical coherence tomography (OCT).RESULTS:The mean VA improved 2.2 lines (P = .013 in the new treatment group); the previous treatment group (HDIVTA + PDT) improved only 0.7 lines (P = 0.55, Wilcoxon ranked test). The mean of macular thickness before and after treatment was statistically significant in both groups.CONCLUSION:This combination therapy showed improvement and/or stabilization in VA, particularly when used as first-line therapy.

Results. The ratios for skin melanomas (1.2 to 3.9; three tissues and two cell lines) were significantly higher than that for choroidal melanomas (0.1 to 0.63; seven of eight primary tumors and four of four cell lines). Only one choroidal melanoma biopsy had a ratio greater than 1. The PCR products from choroidal melanoma were identical in size and sequence to the SI 00/3, as determined by gel electrophoresis and RNA conformational polymorphism. Because the ratios were also low in choroidal melanoma cell lines, the SI00/8 phenotype appears to be genetically stable.

Cell lines established from the biopsy specimen of a patient with a spindle B choroidal melanoma were transplanted into the posterior choroid of 30 immunosuppressed, pigmented New Zealand rabbits. Growth of the tumor xenografts could be seen 7 to 10 days after transplantation. Tumor xenografts were reproducible and reached an average size of 5 mm in height and 8 mm in their basal dimension by 4 weeks. Histopathology of the original tumor revealed primarily spindle B cells, while the tumor xenografts contained epithelioid, spindle B, and clear cell melanoma cells. Of particular interest was the presence of an extensive and intact vasculature and the absence of a capsule surrounding the lesions in situ. The use of human uveal melanoma cells, the ease of transplantation, and the posterior location of the tumor may make this animal model of use in studies on new diagnostic and therapeutic modalities.

Purpose: To describe the echographic characteristics of splitting of the outer posterior cortical vitreous in patients with proliferative diabetic retinopathy and vitreous hemorrhage. Methods: The authors retrospectively reviewed the echographic findings in 270 patients who were evaluated at the Doheny Eye Institute between January 1983 to December 1989 for proliferative diabetic retinopathy and vitreous hemorrhage. None of the eyes had undergone pars plana vitrectomy before echographic examination. Results: Forty-five patients (17%) had echographic evidence of splitting of the outer posterior vitreous cortex, a finding the authors have termed posterior vitreoschisis. In all patients, differentiation of the posterior vitreoschisis from a true posterior hyaloid detachment was possible, either on the initial or on serial echographic examination, by the separate detachment of the inner wall of the vitreoschisis cavity and the true posterior hyaloid from the retinal surface. The vitreoschisis cavities often were found to contain unclotted blood. In some eyes, the inner wall of the vitreoschisis cavity was adherent to the apex of the most highly elevated area of traction retinal detachment, suggesting that posterior vitreoschisis may itself result in clinically significant vitreoretinal traction, independent of the presence or extent of true posterior hyaloid separation. Conclusions: The authors' findings suggest that spontaneous splitting of the outer posterior vitreous cortex may occur in patients with proliferative diabetic retinopathy and vitreous hemorrhage, which may mimic a true posterior cortical vitreous detachment on echographic examination. Preoperative recognition of posterior vitreoschisis may be important in the surgical management of these patients.

The poor intraocular penetration of systemically administered antibiotics has raised questions regarding their usefulness as prophylactic agents in the management of penetrating eye injuries. Cefazolin was administered intravenously to rabbits with penetrating eye injuries to determine the influence of trauma on ocular pharmacokinetics. Following a standardized penetrating eye injury in 27 New Zealand white rabbits, animals were divided into three groups that received either three, six, or nine doses of intravenous cefazolin every 8 h. Cefazolin levels were then measured in the traumatized eye, the non-traumatized (control) fellow eye, and in the serum of each animal. In the three treatment groups vitreous concentrations of cefazolin were significantly higher in traumatized eyes than in the non-injured eyes. After three doses, vitreous concentrations of cefazolin in traumatized eyes averaged 9.1 mg/l; mean concentrations of cefazolin in non-injured eyes were 0.6 mg/l (P < 0.0002). After six doses of intravenous cefazolin, vitreous concentrations in traumatized eyes averaged 7.3 mg/l; cefazolin levels in non-injured eyes were 0.6 mg/l in the non-traumatized eyes (P < 0.0005). After nine doses, vitreous cefazolin concentrations in traumatized eyes averaged 9.7 mg/l, while mean levels in the non-traumatized eyes were all 0.05 mg/l (P < 0.0002).

To characterize the anti-melanoma reactivity of CD8+ cytotoxic T lymphocytes (CTL) from choroidal melanoma patients, CTL clones were isolated from the peripheral blood of three patients after mixed lymphocyte/tumor cell culture (MLTC). Clones were derived from lymphocytes stimulated by allogeneic (OCM-1, A24, A28) or autologous (OCM-3, A1, A30) melanoma cells. Their reactivity against a panel of HLA-typed melanoma and nonmelanoma cells was assessed, to determine whether a single CTL clone could recognize and lyse a variety of allogeneic melanoma cell lines. While proportionately more clones derived from autologous MLTC were melanoma-specific than allogeneic MLTC (42% versus 14%), melanoma-specific CTL were recovered from both. Notably, a novel melanoma specificity was identified. These CTL clones were termed non-fastidious because they were capable of lysing melanoma cells with which they had no HLA class I alleles in common. Nonetheless, lysis was mediated by the HLA class I molecule. Since lysis was specific for melanoma cells, these CTL appeared to recognize a shared melanoma peptide(s). Because of their prevalence, we propose that non-fastidious CTL are integral to human anti-melanoma T cell immunity. This reinforces clinical findings that allogeneic melanomas can substitute for autologous tumors in active specific immunotherapy. By circumventing the need for autologous melanoma, it is possible to treat patients after removal of the primary choroidal melanoma in an attempt to prevent metastasis.

Background: Posttraumatic endophthalmitis is a rare complication of penetrating eye injuries that results in blindness in potentially salvageable eyes.Methods: 36 cases of posttraumatic endophthalmitis were evaluated retrospectively to determine which factors were associated with visual loss. All cases were treated with intravenous and intraocular antibiotics. Pars plana vitrectomy was performed in 15 (41.7%) cases as an adjunct to treatment.Results: Patients ranged in age from 18 months to 83 years, and included 30 men (83%) and 6 women (17%). Intraocular foreign bodies were present in 6 patients (16.7%), 9 (25%) had corneal lacerations, 13 (36.1%) had corneoscleral or scleral lacerations, and 8 (22.2%) had ocular trauma of unknown type. Of the 36 eyes, 21 (58.3%) had positive culture results, and 10 of these (27.8%) had multiple organisms. The most common isolates were Staphylococcus species (26.5%), Streptococcus species (20.6%), and Bacillus species (14.7%). In 4 cases the diagnosis was made 6 or more years after injury. Final visual acuity was 20/200 in 8 eyes (22.2%) and 20/300 in 1 eye. In 17 cases (47.2%), the eye was salvaged but visual acuity was 5/200 or worse, and 10 eyes (27.8%) were lost to enucleation or phthisis bulbi.Conclusion: Prompt diagnosis and early treatment with intraocular and systemic antibiotics are important in the successful management of posttraumatic endophthalmitis. The use of pars plana vitrectomy was associated with a good visual outcome when used in select cases.