1/19. Post-traumatic endophthalmitis: causative organisms and visual outcome.PURPOSE: Post-traumatic endophthalmitis makes up a distinct subset of intraocular infections. The purpose of the present study was to identify the causative organisms and record the visual outcome after infectious endophthalmitis in eyes with penetrating trauma. methods: We reviewed 18 consecutive cases of culture-positive endophthalmitis that developed after penetrating ocular trauma. All cases were treated with pars plana vitrectomy and intravenous and intraocular antibiotics. RESULTS: The 15 males and 3 females ranged in age from 4 to 43 years (mean 25.1 /- 11 years). Nine (50%) had intraocular foreign bodies. A single species was isolated in 16 cases, and multiple organisms in two. staphylococcus epidermidis and gram-negative organisms were the most frequent and were cultured either alone or in association with other organisms in respectively five (27.7%) and four cases (22.2%). clostridium perfringens was isolated in three cases (16.6%). bacillus was not found as a cause of endophthalmitis. Final visual acuity was better than 20/400 in eight cases (44%). In five cases (27.7%), the eye was saved but visual acuity was counting fingers. Two eyes (11%) had no light perception. The remaining three eyes (16.6%) were enucleated or eviscerated. clostridium perfringens was isolated from two eyes and aspergillus niger from one. Postoperative retinal detachment developed in four eyes, which were successfully operated. CONCLUSIONS: Organisms isolated in this series were similar to those in previous reports of post-traumatic endophthalmitis from other parts of the world, except that the frequency of clostridium perfringens isolation was high and no bacillus species were cultured. In view of its devastating outcome, post-traumatic endophthalmitis must be treated promptly with vitrectomy and intravitreal antibiotics.- - - - - - - - - - ranking = 1keywords = ocular (Clic here for more details about this article) |
2/19. Polymicrobial keratitis after laser in situ keratomileusis.PURPOSE: To report a case of polymicrobial infectious keratitis in one eye of a patient who had undergone bilateral simultaneous laser in situ keratomileusis (LASIK). methods: A 21-year-old healthy female developed infectious keratitis in her right eye after bilateral LASIK surgery. Material obtained from the infective foci was sent for bacterial and fungal cultures and herpes simplex virus antigen detection, and broad spectrum antimicrobial therapy was instituted. RESULTS: staphylococcus epidermidis and fusarium solani were detected on culture and herpes simplex virus antigen was found to be positive. The patient did not respond to medical therapy and subsequently the ulcer perforated. A therapeutic keratoplasty was performed and the final best-corrected visual acuity was 20/40, 1 month after keratoplasty. CONCLUSION: Polymicrobial infectious keratitis, although rare, is a potential sight-threatening complication of LASIK.- - - - - - - - - - ranking = 69.351774427133keywords = keratitis, herpes simplex, simplex, herpes (Clic here for more details about this article) |
3/19. Infectious keratitis after laser refractive surgery.PURPOSE: To report two cases of infectious keratitis, one fungal after photorefractive keratectomy (PRK) and the other bacterial after laser in situ keratomileusis (LASIK). DESIGN: Two interventional case reports. PARTICIPANTS: Case 1 is a male who was seen 3 weeks after PRK with a corneal ulceration. Case 2 involves a female who was seen 7 weeks after LASIK with interface granularity. RESULTS: Cultures in case 1 were identified as scopulariopsis species, and despite intensive treatment, a therapeutic penetrating keratoplasty (PK) was eventually performed. Case 2 had cultures identified as mycobacterium chelonae and also ultimately required a therapeutic PK. CONCLUSIONS: Two unusual infectious keratitides are reported after different laser refractive surgery techniques.- - - - - - - - - - ranking = 47.262720679024keywords = keratitis (Clic here for more details about this article) |
4/19. Diagnostic yield of vitrectomy in eyes with suspected posterior segment infection or malignancy.PURPOSE: To determine the yield of diagnostic pars plana vitrectomy in eyes with suspected posterior segment inflammation or malignancy when clinical examination and systemic laboratory testing did not yield a specific diagnosis. DESIGN: Non-comparative interventional case series PARTICIPANTS: Eighty-seven consecutive patients (90 eyes) who underwent diagnostic pars plana vitrectomy from 1989 through 1999. INTERVENTIONS: Vitreous samples were analyzed in a directed manner based on the preoperative clinical examination and systemic laboratory testing. MAIN OUTCOME MEASURES: diagnosis from each test performed on the vitreous samples. RESULTS: Diagnostic vitrectomy was performed alone in 6 eyes (7%) and as part of a therapeutic procedure in the remaining 84 eyes. The diagnostic tests performed most frequently included cytopathology (83%), microbiologic culture and sensitivity (43%), polymerase chain reaction (PCR) (36%), and intraocular antibody levels for T. canis (14%). Of these, intraocular antibody testing and PCR had the highest positive yield, 46% and 39%, respectively. overall, directed vitreous analysis identified a specific cause in 35 eyes (39%). Of the 65 cases in which an underlying infection was suspected preoperatively, the procedure yielded a specific diagnosis in 27 (42%). When intraocular malignancy was considered preoperatively (71 eyes), a diagnosis of intraocular lymphoma was obtained in seven (10%). This difference between these diagnostic yields was significant (P = 0.02, Fisher's exact test). CONCLUSIONS: Diagnostic vitrectomy with directed vitreous fluid analysis yields a specific cause and guides subsequent therapy in a high percentage of cases. This procedure is a valuable adjunct in cases that cannot be diagnosed by less invasive methods.- - - - - - - - - - ranking = 1keywords = ocular (Clic here for more details about this article) |
5/19. Bacillary angiomatosis with cytomegaloviral and mycobacterial infections of the palpebral conjunctiva in a patient with AIDS.We report the clinical and histopathologic findings of bacillary angiomatosis involving the palpebral conjunctiva with concomitant infection by cytomegalovirus and Mycobacterium species in a patient with acquired immune deficiency syndrome. After debulking, the conjunctival tissue was studied with the use of light and electron microscopy; stains for bacteria, acid-fast bacilli, and bartonella species; and immunohistochemical studies for cytomegalovirus and herpes simplex virus. We observed the typical histopathologic findings of bacillary angiomatosis, the presence of bacilli stained by the Steiner and Steiner method, and the electron microscopic demonstration of bacilli consistent with bartonella species. immunohistochemistry confirmed infection with cytomegalovirus, which had been suggested by characteristic cytologic abnormalities. Acid-fast bacilli were also found in the excised tissue. patients with bacillary angiomatosis of the conjunctiva may have infections with multiple additional microorganisms.- - - - - - - - - - ranking = 1.5919827382493keywords = herpes simplex, simplex, herpes (Clic here for more details about this article) |
6/19. Six cases of scleritis associated with systemic infection.Isolated scleritis (without keratitis) associated with infections is uncommon, and correct diagnosis and appropriate therapy for it are often delayed. Six patients with infection-associated scleritis were seen at our institution between May 1983 and May 1990 (these patients represented 4.6% of all patients with scleritis [six of 130 patients] in that period). Three of these cases were associated with systemic infections. One was associated with syphilis, one was associated with tuberculosis, and one was associated with toxocariasis. Three cases resulted from local infections. One was associated with infection with proteus mirabilis, one was associated with infection with herpes zoster virus, and one was associated with infection with Aspergillus. The Aspergillus infection developed after trauma and the P. mirabilis-induced infection developed after strabismus surgical procedures. Four of the six cases were initially misdiagnosed and inappropriately managed. Correct diagnosis was made seven days to four years after onset of symptoms. review of systems, scleral biopsy, culture, and laboratory investigation were used to make the diagnosis. Differential diagnosis of scleritis must include infective agents.- - - - - - - - - - ranking = 9.5982772275041keywords = keratitis, herpes (Clic here for more details about this article) |
7/19. Spectrum of clear corneal incision cataract wound infection.PURPOSE: To describe the presentation, management, and outcome of 5 patients who presented with main-port or side-port wound infection after uneventful clear corneal cataract surgery. SETTING: Ophthalmic Surgery Centre, Chatswood, and Department of ophthalmology, Prince of wales Hospital, Randwick, australia, and Moorfields eye Hospital NHS Foundation trust, london, United Kingdom. methods: This retrospective case series comprised 5 patients who had uneventful clear corneal phacoemulsification surgery and developed either a main-port or side-port wound infection. The clinical features, microbiologic studies, management, and results are reported. RESULTS: The median age of the patients was 79 years. Infection of the main-port incision occurred in 3 cases and of the side port in 2 cases. The patients presented from a few days to several weeks after uneventful phacoemulsification. In 2 cases, the bacteria pseudomonas aeruginosa and staphylococcus aureus were isolated. In 1 case, the fungus Aspergillus was isolated and required extensive medical and surgical treatment. In the other 2 cases; empiric antimicrobial therapy was given because no organism was isolated in 1 case, and in the other milder case, microbiological investigations were not performed. Final visual acuity was 6/4 in 2 cases and 6/5, 6/12, and 6/18 in 1 case each. CONCLUSIONS: Bacterial or fungal wound infection can present within days or even several weeks following clear corneal cataract surgery. patients with ocular discomfort or blurred vision after such surgery should be advised to report promptly. Rapid identification and appropriate management of patients with clear corneal wound infection can result in good visual outcomes.- - - - - - - - - - ranking = 0.25keywords = ocular (Clic here for more details about this article) |
8/19. Ocular complications in renal allograft recipients.Ocular complications in renal allograft recipients are a significant cause of morbidity. Of 80 renal transplant recipients, 42 (52.5%) developed ocular complications. These included posterior subcapsular cataract in 22 patients (27.5%), opportunistic ocular infections by CMV, cryptococcus, mucormycosis, herpes simplex and herpes zoster in five (6.25%), steroid-induced raised intraocular pressure in four (5%) and primary disease-related vascular complications in ten (12.5%). Our findings highlight the importance of regular ocular examination of all allograft recipients in the post-transplant period.- - - - - - - - - - ranking = 2.7377158299485keywords = herpes simplex, ocular, simplex, herpes (Clic here for more details about this article) |
9/19. Microbial keratitis--the false negative.The investigation of presumed microbial keratitis includes microscopy and culture of corneal specimens obtained by scraping the infiltrated cornea. Routine microscopy fails to identify the infecting organism in about 15% of cases. We discuss the problems presented by 20 such eyes which required further investigation. We present a diagnostic algorithm aimed at reducing the delay in identifying the pathogen and increasing the rate of positive culture. This is important since unusual pathogens may require treatment with drugs other than the 'first line' broad spectrum combination of an aminoglycoside and a cephalosporin. The algorithm allows sequential restaining and reculturing of specimens for more thorough investigation. In addition to the use of special stains and culture conditions, it presents indications for further corneal scrapes and biopsies. Uncontrolled infection resulted in five perforations and penetrating keratoplasty was indicated in 11 cases. The visual outcome for these patients was poor with fewer than 30% achieving 6/12 acuity. The delay in diagnosis increases morbidity and this should be significantly reduced by adopting the algorithm we propose.- - - - - - - - - - ranking = 47.262720679024keywords = keratitis (Clic here for more details about this article) |
10/19. Endogenous endophthalmitis simulating retinoblastoma. The 1993 David and Mary Seslen Endowment Lecture.BACKGROUND: Among conditions that can simulate retinoblastoma, endogenous endophthalmitis is quite rare. methods: Case records of six children with unusual forms of endogenous endophthalmitis, all of whom were referred to the authors because retinoblastoma was a strong diagnostic consideration, were reviewed. The clinical features that may help differentiate atypical endophthalmitis from retinoblastoma were investigated. RESULTS: The final diagnosis in these cases included idiopathic subretinal abscess, streptococcal endophthalmitis, idiopathic retinovitreal abscess, cytomegalovirus endophthalmitis, candida endophthalmitis, and meningococcal endophthalmitis. All of the affected children presented primarily with ocular findings without serious systemic infection. Although these conditions closely simulated retinoblastoma, they were more likely to have signs of concurrent or prior inflammation. CONCLUSION: Differentiation between infectious conditions and retinoblastoma can sometimes be difficult, but clues as to the diagnosis can be obtained from careful clinical examination.- - - - - - - - - - ranking = 0.25keywords = ocular (Clic here for more details about this article) |
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