Eyeworld

JANUARY/FEBRUARY 2020 | EYEWORLD | 67 C PRESENTATION SPOTLIGHT by Stefanie Petrou Binder, MD Contributing Writer O ut-of-the-ordinary case studies are not only instructional but they can help clinicians decide what to do if they ever find themselves in a similar bind. Chiara Bonzano, MD, discussed a challenging case of neu- rotrophic ulcer after retinal surgery and how she managed this patient. Dr. Bonzano reported in a presentation the case of a 55-year-old Caucasian male who came to the corneal department because of blurry vision that he experienced in the week prior. The patient was on antiviral therapy that was prescribed by an outside ophthalmologist, without any sign of visual improvement. Upon Successful management of neurotrophic corneal ulcer About the doctor Chiara Bonzano, MD Clinica Oculistica Policlinico San Martino University of Genoa Genoa, Italy continued on page 68 examination, she identified a neurotrophic cor- neal ulcer, with evidence of confluent chorio- retinal scarring from endolaser treatments that the patient received in two meridians. The complicated patient history revealed a 23-gauge pars plana vitrectomy and a Den- siron 68 tamponade (Fluoron), undertaken for a primary inferior rhegmatogenous retinal detachment. The patient was on antiglaucoma medication (bimatoprost QD) to keep IOP under control following the vitrectomy. Within 12 weeks of the initial surgery, oil removal was carried out and barrier endolaser was applied to the affected eye as augmentation. Six weeks lat- er, cystoid macular edema occurred. The patient The Odyssey's smooth surface seemed contrary to biofilm formation. "I would have expected that the roughest one would show us the most extensive biofilm formation," Dr. Hadjiargyrou said. "When looking at the occluders with the highest power, there were small furrows in the smoothest occluder that mimicked the size of the bacteria," said fellow study researcher Henry Perry, MD. "Therefore, the smoothest occluder may actually have provided a better substrate for bacteria." The study results were surprising to Ming Wang, MD. "The fact that simple changes be- tween the surface design of these devices could affect bacteria growth is something that has not been previously explored, to my knowledge," he said. Clinical implications? Because the study was in vitro and only evaluat- ed one bacterial strain, Dr. Wang does not think there are clinical implications from the research yet. "It would be very interesting to see a fol- low-up study designed to monitor for bacterial growth in vivo, in a clinical setting," he said. However, Dr. Wang does think that over- all, ophthalmologists may want to treat un- controlled blepharitis before using a silicone permanent plug. "If not, the existing bacteria overgrowth and biofilm from blepharitis may colonize on the plug, leading to more long-term issues," he said. Temporary punctal occlusion could be another option as this type of occlusion will eventually dissolve and would not significantly gather bacteria, Dr. Wang said. Careful patient selection for punctal occlud- ers is also critical, Dr. Perry said. "Since occlud- ers function best in patients who have aqueous deficiency, Schirmer 1 testing [without anesthe- sia] is essential," he said. Clinically, Dr. Perry has found little differ- ence among the occluders in the study. They all performed well for months and sometimes for years. Dr. Perry occasionally uses occluders with patients; he more commonly uses dissolv- ing intracanalicular plugs in addition to punctal cautery. continued from page 66

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