Cases reported "Endophthalmitis"

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1/10. Antibiotic-induced endotoxemia in a patient with endogenous endophthalmitis.

    PURPOSE: The aim of the study is to describe a case of suspected endotoxin-induced uveitis associated with septic endogenous endophthalmitis followed by antibiotic-induced endotoxemia. methods: The human leukocyte antigen (HLA) typing of peripheral leukocytes was studied by lymphocytotoxicity technique. Histological and immunohistochemical studies of paraffin embedded specimen were conducted. RESULTS: Findings of HLA typing revealed positive reaction for B 51, Cw 3, DR 8, DR 11, DQ 3. The vitreous body of an eviscerated eye was occupied by the non-specific granulomatous tissue, composed of fibroblast, plasma cells, and sudan black staining positive foamy cells, including melaniferous phagocytes, identified as CD 68 positive macrophage. CONCLUSION: It is suggested that antibiotic-induced endotoxemia of a patient with septic endogenous endophthalmitis produced endotoxin-induced uveitis under an upregulation of HLA and endotoxin activated macrophages may release cytokines, followed by fibrin formation and subsequent granuloma.
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2/10. Clinicopathologic findings in eyes with retained perfluoro-n-octane liquid.

    OBJECTIVE: To describe the clinical and histopathologic findings in five eyes with retained perfluoro-n-octane (PFO) liquid after retinal reattachment surgery. DESIGN: Retrospective, noncomparative, clinicopathologic case series. PARTICIPANTS: Surgical specimens from five eyes were studied. methods: Surgical specimens from eyes with prior intraoperative PFO use submitted to the W. Richard Green eye pathology Laboratory at the Wilmer Ophthalmological Institute were identified and reviewed. MAIN OUTCOME MEASURES: Histopathologic analysis and energy dispersive spectroscopy identified intracellular vacuoles containing PFO. RESULTS: Five cases were identified. Three specimens were obtained at the time of further surgery for recurrent retinal detachment; one at repeat penetrating keratoplasty, and one at removal of retained PFO. Each eye had macroscopic white flake-like material on intraocular structures noted before or during surgery. Histopathologic analysis disclosed an inflammatory response featuring macrophages with intracellular vacuoles containing PFO. Removal of the PFO in all five eyes combined with repeat retinal reattachment surgery in three eyes resulted in resolution of the inflammatory response. CONCLUSIONS: Retention of PFO after surgery elicits an inflammatory response. We suspect that young patients, those with considerable residual vitreous gel, and eyes with larger amounts of retained PFO may be at higher risk for this complication.
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3/10. Perfluorodecalin-induced intravitreal inflammation.

    OBJECTIVE: To report an unusual case of intravitreal inflammation in a human eye caused by the presence of residual perfluorodecalin in a case of giant retinal tear and retinal detachment. methods: The posterior capsule of the lens, which was infiltrated with deposits, was collected during surgery. The specimen was stained with hematoxylin and eosin, with periodic acid-Schiff, and for melanin. Part of it was examined with electron microscopy. Immunohistochemical staining was performed to demonstrate CD68 antigens, cytokeratin, and glial fibrillary acid protein. RESULTS: Vacuolated macrophages and retinal pigment epithelial cells infiltrated the posterior capsule. Electron microscopy showed the presence of membrane-lined vacuoles within the macrophages. A monolayer of epithelial cells covered the cellular infiltration. CONCLUSION: Residual perfluorodecalin can induce an intraocular chronic macrophage response.
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4/10. Chronic endophthalmitis mimicking an endothelial immune reaction after penetrating keratoplasty.

    We describe a patient with chronic inflammation after combined penetrating keratoplasty and cataract surgery. This condition has been considered an unusual endothelial immune reaction. Cytopathological examination of the aqueous humor showed abundant neutrophil granulocytes, a few macrophages, and sparse lymphocytes. The predominance of neutrophil granulocytes but no macrophages or lymphocytes, as found in cases of an endothelial immune reaction, was interpreted as evidence of chronic endophthalmitis. Cytopathological evaluation of aqueous humor can be a helpful tool for differentiating between an endothelial immune reaction and chronic endophthalmitis after combined PKP and cataract surgery.
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5/10. Further evidence for proinflammatory nature of perfluorohexyloctane in the eye.

    BACKGROUND: The authors present a clinicopathological report of their initial experience with perfluorohexyloctane (F6H8), a novel semifluorinated liquid fluorocarbon developed as a long-term vitreous substitute. methods: A retrospective observational review was performed of five patients in whom F6H8 had been used for management of rhegmatogenous retinal detachment. Surgical specimens taken from two patients at the time of F6H8 removal were also submitted for histopathological, immunohistochemical and electron microscopic analysis. RESULTS: Clinical and histological analysis of the present small case series confirmed the propensity of F6H8 to emulsify, and suggested a probable biological reaction to F6H8. Surrounding and engulfing the F6H8 were numerous cells morphologically in keeping with macrophages. Immuno-histochemistry confirmed macrophage phenotype but electron microscopic evaluation showed epithelial ultra-structural features. It is suggested that the finding of macrophagic phenotype in cells with epithelial ultra-structure provides further evidence for a continuum of phenotypic differentiation of the pigment epithelial cells as part of the repair and regeneration that is the proliferative vitreo-retinopathy (PVR) response. CONCLUSIONS: The data do not indicate any benefit of F6H8 over other perfluorocarbons for use in short-term post-operative intraocular tamponade. Although early experience suggests that F6H8 use in primary vitrectomy with minimal PVR is acceptable and produces temporary inflammatory effects only, these cases can often be successfully managed by conventional scleral buckling techniques, or vitrectomy with standard tamponading agents, without the need for F6H8 and subsequent extra surgical procedures. Furthermore in eyes already predisposed to inflammation through prior surgery and/or presence of PVR, the inflammatory effects were not insignificant. The use of F6H8 is not recommended in the clinical setting, except as part of a controlled trial subject to the approval of an ethics committee and informed consent.
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6/10. interleukin-8 expressed in the granulocytes of the eye in a patient with Behcet's disease complicated by lens-induced endophthalmitis.

    BACKGROUND: interleukin-8 (IL-8) is believed to be involved in the progression of intraocular inflammation. We sought the source of IL-8 in the enucleated eye of the present patient. CASE: A 40-year-old Japanese man was diagnosed as having Behcet's disease. His vision deteriorated due to persistent uveitis and secondary glaucoma. His left eye had lens-induced endophthalmitis. OBSERVATIONS: The left eye had to be enucleated, and it was investigated by an immunohistochemical analysis using antibodies for CD 1a (dendritic cells), CD 3 (T cells), CD 68 (monocytes/macrophages), interferon-gamma, or IL-8. Fibrovascular tissue had formed on and beneath the lens where inflammatory cells had infiltrated. Most of the mononuclear inflammatory cells were T cells. A large number of macrophages were observed especially around the lens. interferon-gamma-positive cells were scattered, while IL-8 was observed only in the accumulated granulocytes, but not in either mononuclear cells or macrophages. CONCLUSION: IL-8 is thus considered to play a role in the progression of intraocular inflammation, and granulocytes are thought to be a possible source of IL-8 in endophthalmitis.
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7/10. immunohistochemistry of the inflammatory response in propionibacterium acnes endophthalmitis.

    Specimens were obtained from two patients with culture-proven propionibacterium acnes endophthalmitis who had undergone vitrectomy. Wright's and Giemsa stains were performed using cytospin preparations of the dilute vitreous and revealed a predominance of polymorphonuclear leukocytes (80% to 90%). The remaining inflammatory cells in the vitreous were mostly macrophages (10% to 15%); very few lymphocytes were present (less than 5%). Immunohistochemical studies using monoclonal antibodies confirmed the paucity of lymphocytes. Most lymphocytes were CD4 helper/inducer T cells. Almost no CD8 suppressor/cytotoxic T lymphocytes or B lymphocytes were found. The inflammatory response in these two patients is most characteristic of acute inflammation and consistent with an underlying bacterial infection, despite a clinical picture of persistent, low-grade inflammation. infection with P acnes has been shown to inhibit CD8 T cells and may play a role in the persistent inflammation in cases of P acnes endophthalmitis.
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8/10. Chronic vitritis with macrophagic inclusions. A sequela of treated endophthalmitis due to a coryneform bacterium.

    A 75-year-old woman was treated successfully for endophthalmitis due to a coryneform bacterium contracted from a contaminated corneal graft. We were able to study the involved eye histologically when the patient died unexpectedly 5 1/2 weeks after treatment. The vitreous contained a moderate number of macrophages filled with PAS-positive particles. Ultrastructurally, the PAS-positive particles corresponded to degenerating bacterial cell walls. The striking resemblance of the macrophages in this case to macrophages in Whipple's disease is intriguing because corynebacterium has been the most frequently implicated bacterial genus in the pathogenesis of Whipple's disease.
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9/10. Pseudo-endophthalmitis caused by intravitreal lipid transudation in association with proliferative diabetic retinopathy and hyperlipidemia.

    A 20-year-old woman with a 13-year history of insulin-dependent diabetes mellitus presented with a history of malaise, fever, a non-healing ulcer of the great toe, and an insect bite incurred during recent travel to a foreign country. Milky white infiltrates accompanied by inflammatory cells located within close proximity to neovascular fronds in both vitreous cavities led to the suspicion of bilateral metastatic endophthalmitis. Studies conducted during hospitalization failed to show evidence of systemic blood born infection. A diagnostic vitrectomy in one eye failed to grow organisms, though lipid laden macrophages were identified by electron microscopy. The clinical appearance improved in both eyes during her hospitalization coincident with improved diabetic control. It was later concluded that the milky white infiltrates were associated with hyperlipidemia as a consequence of poorly controlled diabetes and a familial tendency toward hyperlipidemia.
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10/10. Sympathetic ophthalmia. Immunopathological findings.

    Ocular tissue from six patients with a clinical diagnosis of sympathetic ophthalmia (SO) was examined using immunohistochemical techniques. All patients presented with a history of bilateral panuveitis after penetrating ocular injury or multiple intraocular surgeries and clinical features of SO. In four cases, classic histopathological features of SO were observed, including granulomatous uveal tract infiltration and subretinal pigment epithelium (RPE) collections of inflammatory cells (Dalen-Fuchs nodules). bone marrow derived monocytes were the major cellular components in these granulomas. In two cases, histopathology failed to demonstrate typical Dalen-Fuchs nodules or granulomas in the choroid. However, the choroidal infiltrates were composed primarily of T-helper and B lymphocytes, without macrophages or epithelioid cells. The eyes examined in this report indicate that a varied spectrum of immunopathological and histopathological findings may occur in clinically diagnosed SO.
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