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J.D. Luna, M. Arrambide, L.A. Gramajo, M. Falco, M.S. Novara, C.P. Juarez; Pneumosis Oculi and Pneumoencephalus Produced by a Gas Producing Microorganism Following Vitreous Surgery . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4208.
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To report four consecutive cases of endoftalmitis caused by a gas producing microorganism following vitrectomy surgery. Elevated intraocular pressure and migration of the gas into the subarachnoid space and cerebral ventricles were documented.
Four consecutive patients underwent pars plana vitrectomy surgery for proliferative diabetic retinopathy and/or tractional retinal detachment. Perfluorocarbon liquid (PFCL) and injection of silicone oil were used in all 4 patients. All surgery were uneventfully successful, until 4 to 10 days (mean 5.25 days) they developed pain and elevated intraocular pressure secondary to an intraocular gas producing microorganism (Bacillus species). Computed tomography(CT) and magnetic resonance imaging (MRI) were performed. Combined aggressive antibiotic and surgical approach were done in all patients.
The CT imaging and MRI, showed intraocular gas bubbles migrated from the eye trough lamina cribosa into the subarachnoid space, the sella cisterna superioris and the cerebral ventricles in two of the four patients. In the other two patients intraocular gas were detected in the afected eye. Fulminate clinical presentations and poor visual outcomes are the rule, but a combined aggressive medical and surgical approach may conserve vision.
Gas producing microorganism endophthalmitis are extremely rare following vitreous surgery. Contaminated PFCL combined with low oxigen concentration conditions produced by the silicone oil could have facilitated this devastating clinical condition.
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