866 Letters

Correspondence to: Dr Francisco Gonzalez, patient had a history of arterial hypertension. COMMENT Departamento de Fisiologia, Facultad de Medicina, There was no evidence of arteritis or dia- Anterior chamber paracentesis is a commonly Universidad de Santiago, 15705 Santiago de Compostela, Spain. betes. used diagnostic3 and therapeutic4 procedure. Massage of the eye did not improve retinal In the present case the paracentesis was per- Accepted for publication 17 May 1995 circulation. After application of antibiotic formed in an operating theatre under sterile drops (Polyspectran; polymyxin, gramici- conditions with the same precautions as for all 1 Tansley JO. Cyst of the vitreous. Trans Am Ophthalmol Soc 1899; 8: 507-9. dine, and neomycin) three times in 5 other intraocular operations. The intraopera- 2 Traboulsi EI, Jeniffer IL, Pyeritz R, Goldberg minutes and disinfection of the lids, an ante- tive course was uneventful. This case was the HK, Haller JA. A new syndrome of myelinated rior chamber paracentesis was performed only in this operating theatre nerve fibers, vitreoretinopathy, and skeletal with a 29 gauge cannula attached to a 1 ml in a year. The source of the inoculum could malformations. Arch Ophthalmol 1993; 111: 1543-5. syringe under topical anaesthesia in the not be determined. Possible sources are 3 Lusky M, Weinberg D, Kremer I. Vitreous cyst operation room under an operation micro- contamination of the needle or the ocular combined with bilateral juvenile retinoschisis. scope. Approximately 50 p.l of aqueous surface. We have found no other cases of J7Pediatr Ophthalmol 1988; 25: 75-6. 4 Orellana J, O'Malley RE, McPherson AR, Font humour were aspirated. Thereafter the eye- bacterial endophthalmitis following an RL. Pigmented free-floating vitreous cysts in ball was soft, and there was no fistula at the anterior chamber paracentesis in recent two young adults. 1985; 92: puncture site. Retinal circulation, however, literature. However, the presented case is a 297-302. remained diminished. The patient received reminder that even a paracentesis can have 5 Awan KJ. Biomicroscopy and argon laser photo- cystotomy of free-floating vitreous cysts. an antibiotic ointment patch (Polyspectran) serious complications, and should not be Ophthalmology 1985; 92: 1710-1. and oral acetazolamide. After about 6 hours considered an essentially harmless procedure. visual acuity and fundus were unchanged; It should only be performed with strict the anterior chamber had 1 + cells. Twenty indications. four hours after surgery the patient com- HORST HELBIG WALTER NOSKE plained of increasing pain and redness of the MARCUS KLEINEIDAM Bacterial endophthalmitis after anterior right eye. Slit-lamp examination revealed ULRICH KELLNER chamber paracentesis comeal oedema, a 1 mm and MICHAEL H FOERSTER Universitdts-Augenklinik, fibrin in the anterior chamber. Another diag- KZinikum Benjamin Franklin, EDIFOR,-Bacterial endophthalmitis is one of nostic anterior chamber tap was performed. Freie Universitdt Berlin, the most serious complications of ocular A Gram stained smear showed Gram Hindenburgdamm 30, surgery. Extended or complicated intraocular positive cocci. Antibiotic treatment with D-12200 Berlin, Germany surgery is considered to be a risk factor for intravenous vancomycin and vancomycin Correspondence to: H Helbig, Universitats- endophthalmitis.' 2 We report a case of eyedrops was initiated. After a further 12 Augenklinik, Klinikum Benjamin Franklin, Freie bacterial endophthalmitis following an other- hour period, the anterior chamber inflamma- Universitat Berlin, Hindenburgdamm 30, D-12200 wise uneventful anterior chamber para- tion did not improve and B-scan ultra- Berlin, German. centesis. sonography showed anterior vitreous Accepted for publication 24 May 1995 infiltration. A pars plana vitrectomy with application of intraocular vancomycin was 1 Aiello LP, Javitt JC, Canner JK. National out- CASE REPORT performed. Intraoperatively, purulent comes of penetrating keratoplasty. Risks of A 62-year-old woman presented to the material was found infiltrating the anterior endophthalmitis and . Arch emergency department with a 2 hour history vitreous, the anterior and the Ophthalmol 1993; 111: 509-13. chamber, 2 Menikoff JA, Speaker MG, Marmor M, Raskin of sudden loss of vision in her right eye. zonules. The zonules were partially lysed and EM. A case-control study of risk factors for Visual acuity was limited to hand move- the dislocated was removed. No retinal postoperative endophthalmitis. Ophthalmology ments in her right eye. The lids, external eye, infiltration was present. Cultures revealed 1991; 98: 1761-8. 3 Nussenblatt RB, Palestine AG. Diagnostic test- and anterior segment were normal with no coagulase negative staphylococci sensitive to ing. In: . Fundamentals and clinical prac- sign of inflammation. Funduscopy showed a vancomycin. Systemic antibiotic treatment tice. Chicago: Year Book Publishers, 1989: central retinal artery occlusion with a cherry with intravenous vancomycin was continued. 80-93. red spot and reduced arterial circulation. The intraocular inflammation became 4 Augsburger JJ, Magargal LE. Visual prognosis following treatment of acute central retinal Intraocular pressure was 22 mm Hg in quiescent, but visual function did not artery obstruction. Br J Ophthalmol 1980; 64: both eyes. The left eye was normal. The recover. 913-7.