Physicians should suspect atypical mycobacterial infection following periocular surgery when delayed infection with erythematous nodules is noted, says the Atypical Mycobacterial Study Group. They point out that atypical mycobacterial infections have a predilection for fat, making the orbital region an anatomic site predisposed to such infections.

The group retrospectively analyzed a case series of patients from seven ophthalmic plastic and reconstructive practices. Thirteen patients had infections: eight followed blepharoplasty, two involved the anophthalmic socket, one had orbital cellulitis following orbital fracture repair and implant, two involved the lacrimal system, one followed silicone tube insertion and one followed dacryocystorhinostomy with silicone tube intubation.

Sequelae of infection included eyelid retraction and ectropion requiring surgical repair (two patients) and enophthalmos (one patient). Twelve of the 13 patients required extensive antibiotic therapy.

The group recommends that results of culture and sensitivity laboratory studies, biopsy results and clinical response guide administration of systemic antibiotics (usually clarith-romycin) and length of treatment. Expeditious surgical removal of any implants is also recommended, as is consultation with an infectious disease specialist in selected cases.

(Ophthal Plast Reconstr Surg 2003;19:182-188)
Mauriello Jr. J, for the Atypical Mycobacterial Study Group

Broad-spectrum Antibiotics Needed After PRK
Antibiotic prophylaxis in photorefractive keratectomy should be broad spectrum and include gram-positive coverage, recommends a research team from New York and Baltimore.

Recognizing infectious keratitis as a rare but potentially devastating complication of PRK, the research team sought to reveal risk factors, microbial culture results and visual outcomes related to the infection. They conducted a retrospective chart review of three referral refractive and cornea disease practices. Patients with infectious keratitis underwent microbial culturing and sensitivity testing, were treated with fluoroquinolones, fortified antibiotics, or both, and were followed for a minimum of four months.

Bacterial keratitis developed in 13 eyes of 12 patients after PRK. Six ulcers developed in the right eye, five ulcers in the left eye, and bilateral corneal ulcerations developed in one patient. All 13 eyes were culture positive. The most common organisms found were S. aureus, S. epidermidis, Streptococcus pneumoniae and Streptococcus viridans. No gram-negative organisms, opportunistic bacteria, fungi or amoebas were cultured. All patients responded to medical therapy. Final visual acuity ranged from 20/20 to 20/100, with a minimal healing time of four months.

(Ophthalmology 2003;110:743-747)
Donnenfeld E, O'Brien T, Solomon R, Perry H, Speaker M, Wittpenn J

Measurement of Visual Function in Glaucoma Patients
A correlation exists between visual field defects and decreased contrast sensitivity in patients who have a visual acuity of 20/40 or better, says a study published by investigators in Chicago.

The researchers evaluated 250 eyes of 144 patients with a diagnosis of glaucoma, suspected glaucoma, or ocular hypertension and a visual acuity of 20/40 or better. For measurements, they used the Lighthouse Visual Acuity Chart, the Pelli-Robson chart and the 24-2 full-threshold Humphrey Visual Field test.

They found a significant correlation (P < 0.001, n = 127) between the visual field mean deviations and the contrast sensitivity scores. They noted a smaller correlation (P < 0.001, n = 127) between the visual field mean deviation and the logMAR visual acuity values, and between the contrast sensitivity scores and logMAR visual acuity values (P< 0.001, n = 12).

In a subgroup of patients with chronic open-angle glaucoma, the correlation between the mean visual field deviation and the contrast sensitivity score was higher at 0.689 (P </= 0.001, n = 62).

(J Glaucoma 2002;12:134-138)
Hawkins A, Szlyk J, Ardickas Z, Alexander K, Wilensky J

Anti-VEGF Therapy for CNV Looks Promising
In its publication of Phase-II study results, the Eyetech Study Group reports that anti-vascular endothelial growth factor therapy may represent a two-pronged attack on choroidal neovascularization by means of its antiangiogenic and anti-permeability properties.

This study reports the results of using multiple intravitreal injections of the anti-VEGF aptamer (pegy that binds VEGF) in patients with subfoveal CNV secondary to AMD with or without photodynamic therapy. Twenty-one patients were treated with intravitreal injection with and without PDT. No drug-related serious adverse events were revealed. Nearly 88 percent of patients who received the anti-VEGF aptamer alone showed stabilized or improved vision three months after treatment. A quarter of the eyes demonstrated a three-line or greater improvement in vision during this period. Sixty percent of patients who received both the anti-VEGF aptamer and PDT gained three lines of vision at three months. 

(Ophthalmology 2003;110:979-986)
The Eyetech Study Group