Your Questions (Jun - Dec 2013)

Your questions and comments about any aspect of your eye health not covered in this website are most welcome. To submit your question or comment, please click here.

December 2013

Naresh from Calcutta, India, asks:
I will appreciate some suggestions to treat endophthalmitis and pththisis bulbi (phthisical eye) as a result of adverse reaction due intravitreal injection of Avastin. I later learned from the manufacturer that Avastin is not approved for ophthalmic use and its use will lead to endophthalmitis and complete blindness.

Vitrectomy and intravitreal injection of antibiotic like vancomycin did not help to restore the vision. Prior to injection, the visison was 6/12. It had deteriorated to 6/12 due to macular edema. Is there any scope for stem cell therapy treatment or any other regenerative medicine? Can intravitreal injection of omega 3 oil or Lucentis help to normalise the size of the eyeball? Can intraocular pressure be increased from 5 to 20 by silicon oil injection?

Brian replies:
Dear Naresh, thank you for your questions and I am sorry to hear that you have run into problems with your eye. You are quite right in that Avastin (Bevacizumab) is currently not approved for use in the eye. Having said that, it is very widely used throughout the world for the treatment of age-related macular degeneration and diabetic retinopathy. Many studies have shown Avastin to be effective and safe for use in the eye, so I do not think that the Avastin per se was the cause of your problem. I have personally administered many intravitreal Avastin injections without any issues so far.

Endophthalmitis refers to severe inflammation affecting the whole eye, usually due to infection after an intraocular procedure. I suspect that the endophthalmitis was due to the act of injecting, rather than from the Avastin. Endophthalmitis after intravitreal injections occurs in less than 1 in 1000 cases, so it is very unfortunate that it occurred in your case.

If your eye is becoming phthisical, then it is unlikely that stem cell therapy or intravitreal injections of Lucentis (Ranibizumab) or omega 3 oil will be of benefit. Silicon oil can help to maintain the pressure in the eye, but it may cause other problems too, including uveitis and intractable glaucoma. Unfortunately, there isn't really any scope for visual restoration. Management of a phthisical eye mainly revolves around pain control and keeping the eye comfortable.

October 2013

Nancy from Columbus, USA, asks:
I had eye surgery four weeks ago tomorrow - had some partial detachment of the retina in my left eye at the top but basically good vision. The doctor opted to operate and put a buckle on my eye - they ought to outlaw those things. My eye hemorrhaged during surgery and basically filled with blood - so we don't know what is going and I went from seeing to being blind in my left eye. We are waiting for the blood to settle. What will this mean?

Brian replies:
Dear Nancy, thank you for your question. There are 2 types of surgery for retinal detachment: vitrectomy and scleral buckling. Both have their good points and bad points, but in general, scleral buckling is performed more in those with less extensive retinal detachment while vitrectomy is reserved for those with more extensive detachment.

Unfortunately, bleeding during or after surgery can occur with either technique. As the blood clears over the next few months, your vision will also slowly improve. An ultrasound scan can be performed to check if the retina is still detached or not. Alternatively, if you cannot wait a few months for the blood to clear from the eye, an option would be to undergo vitrectomy surgery to physically remove the blood, similar to surgical treatment for diabetic vitreous hemorrhage.

God bless and good luck!

June 2013

Dee from Raleigh, USA, asks:
On March 27th 2013, I (77 year old female) had right eye cataract surgery. Vision was clear for 4 days following. On the 5th day, vision became cloudy with only shadows in gray. I went to the surgeon, and was sent to the Retina Specialist. I was diagnosed with endophthalmitis and given only a 50:50 chance of retaining vision. Injections of antibiotics and steroid were given into my eye.

After more than two months, my vision started to return and is near after surgery perfect. I do have many thick floaters and was told they will absorb into the body in the long term. Infection was cultured as Staphylococcus. Not knowing how this occurred, whether from my body or the operating room or staff, I was anxious about having the left eye done.

I have decided to do that with many precautions being taken by me and Doctor. I hope the hospital staff will recognize this. It's a big step for me to do this especially after what previously occurred.

Brian replies:
Dear Dee, thank you for your question. Endophthalmitis is a rare complication after modern cataract surgery, occurring in less than 1 every 1000 cases. It can be difficult to determine how the infection occurred in the first place for your right eye.

I think if you are having trouble with your left vision as a result of interference from the cataract, then it will be worth going ahead with surgery. No surgery is completely free of risk, but I am sure that your ophthalmologist will take all necessary precautions to prevent any complications (including infection) from occurring.

Good luck!

Disclaimer: Replies to your questions are only general in nature, and in no way are to be considered as replacement for a proper ophthalmology consultation and examination. If you require a more specific evaluation, please consult your ophthalmologist for a full eye examination.

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