1/18. Late bleb-related endophthalmitis after trabeculectomy with mitomycin C.To present two cases of delayed-onset postoperative endophthalmitis following trabeculectomy combined with mitomycin C for secondary glaucoma after penetrating keratoplasty. We retrospectively evaluated two patients with late endophthalmitis after trabeculectomy combined with intraoperative mitomycin C application. Both patients underwent trabeculectomy for uncontrolled glaucoma following penetrating keratoplasty and they developed thin-walled cystic blebs. intraocular pressure was normal, and grafts remained clear postoperatively. Severe endophthalmitis with hypopyon developed at 3 and 7 months postoperatively. Both patients had concomitant bleb infection. They underwent vitreous sampling and intravitreal injection of vancomycin and amikacin and were given topical fortified and systemic antibiotic therapy. Intravitreal injection was repeated once in both patients. Cultures grew Streptococcus pneumonias in one and staphylococcus aureus in the other. Although the treatment of endophthalmitis was successful in both patients, only one of them achieved useful vision (20/40). For the other patient who had been infected with S. pneumoniae, vision was light perception. Delayed-onset endophthalmitis following trabeculectomy with mitomycin C application is a severe and vision threatening complication. It seems that the development of thin cystic filtering blebs secondary to intraoperative mitomycin C application may be a predisposing factor for bleb-related late endophthalmitis.- - - - - - - - - - ranking = 1keywords = perception (Clic here for more details about this article) |
2/18. A devastating ocular pathogen: beta-streptococcus Group G.PURPOSE: To report the clinical findings, treatment, and outcomes of four cases of beta-streptococcus Group G (BHS-G) ocular infection. methods: The medical and microbiologic records of four cases of BHS-G ocular infection were retrospectively reviewed. RESULTS: Two cases of BHS-G endophthalmitis and two cases of BHS-G keratitis were recorded. Three patients developed fulminant infection within 12 hours of the onset of symptoms. One patient's history was incomplete. One patient developed endophthalmitis from a contaminated donor button; another following cataract surgery. One developed keratitis in a keratoplasty suture tract; and another patient developed a corneal abscess after being struck with a tree branch. The patient with the contaminated donor button developed overwhelming endophthalmitis resulting in no light perception vision, severe pain, and evisceration. The postoperative cataract patient developed a purulent endophthalmitis and is still hypotonus with light perception vision. The second keratitis patient developed a significant suture abscess with marked stromal loss but eventually healed. The traumatic keratitis patient developed a large ulcer with hypopyon and descemetocele but was lost to follow-up. CONCLUSIONS: This is the first report of a series of BHS-G ocular infections. The ocular infections were characterized by rapid onset, extreme inflammation, and--despite in vitro antibiotic sensitivity--a poor or sluggish response to antibiotic therapy.- - - - - - - - - - ranking = 2keywords = perception (Clic here for more details about this article) |
3/18. endophthalmitis after pediatric strabismus surgery.OBJECTIVE: To report 6 cases of endophthalmitis after pediatric strabismus surgery. methods: Retrospective review of initial signs, clinical findings, treatment, culture results, and visual and anatomical outcomes in 6 eyes of 6 children treated at 2 tertiary care institutions between 1983 and 1998. RESULTS: Four boys and 2 girls aged 8 months to 6 years (median age, 2 years) developed lethargy and asymmetric eye redness, with or without eyelid swelling or fever, within 4 days of surgery. At diagnosis (median, postoperative day 6) clinical findings included periorbital swelling, redness and leukocoria due to vitritis, and, in some cases, hypopyon. Treatment included pars plana vitrectomy and intravitreal and systemic antibiotics in all cases. Vitreous cultures grew streptococcus pneumoniae, haemophilus influenzae, and staphylococcus aureus. Within 6 months of strabismus surgery, visual acuity was no light perception in all eyes and 3 eyes had been enucleated. The 3 remaining eyes were prephthisical. CONCLUSIONS: endophthalmitis after pediatric strabismus surgery is rare. Children may not recognize or verbalize symptoms. Causative organisms are virulent. Visual and anatomical outcomes are poor. lethargy, asymmetric eye redness, eyelid swelling, or fever in the postoperative period, even if initial postoperative examination results are normal, should prompt urgent ocular examination. The diagnosis of endophthalmitis may be made when biomicroscopic or indirect ophthalmoscopic examination confirms the presence of vitreous opacification with or without hypopyon. Arch Ophthalmol. 2000;118:939-944- - - - - - - - - - ranking = 1keywords = perception (Clic here for more details about this article) |
4/18. Orbital abscess: management and outcome.PURPOSE: To discuss the diagnosis, management and outcome of various types of orbital abscess. methods: The medical records of 13 patients diagnosed and treated for orbital abscess were reviewed. The sources of infection included: paranasal sinusitis (n = 5), odontogenic origin of infection (n = 4), one each, temporal fossa abscess, palatal abscess, furuncle on the nose, and secondary to retrobulbar injection of steroid. Computed tomographic scans revealed the presence of an abscess in all 13 cases. Associated findings on CT scan included: sinus disease (n = 8), cavernous sinus thrombosis (n = 2) and subdural empyema (n = 2). All patients were treated with intensive, multiple, intravenous antibiotics and early surgical drainage. RESULTS: Purulent material collected surgically from the orbit cultured staphylococcus aureus (n = 3), two each pseudomonas aeruginosa, proteus mirabilis, acinetobacter species and one each beta-haemolytic Streptococci, citrobacter frundi and enterobacter. Final visual acuity was good in 6 patients (6/12-6/6) and no light perception in 6 others. visual acuity could not be recorded in the infant. The other complications were intracranial abscess (n = 4), cavernous sinus thrombosis (n = 2) and restricted ocular motility (n = 1). CONCLUSIONS: A high index of suspicion is necessary, along with early institution of appropriate diagnostic imaging, and aggressive medical and surgical treatment for a favourable outcome in cases of orbital abscess.- - - - - - - - - - ranking = 1keywords = perception (Clic here for more details about this article) |
5/18. Fulminant orbital cellulitis with complete loss of vision.Bacterial orbital cellulitis is a condition that rarely presents with complete loss of vision. A case is reported of a 69-year-old man who presented with fulminant onset of proptosis, significant ophthalmoplegia and no perception of light. Computed tomography showed no evidence of paranasal sinus disease. Despite treatment with intravenous flucloxacillin, ceftriaxone and metronidazole, and later, penicillin after streptococcus pyogenes was grown from tissue culture, there was no improvement in vision; however ocular motility returned to normal.- - - - - - - - - - ranking = 1keywords = perception (Clic here for more details about this article) |
6/18. Bilateral endogenous endophthalmitis caused by HACEK microorganism.PURPOSE: To report a case of bilateral endogenous endophthalmitis caused by a HACEK group organism (actinobacillus actinomycetemcomitans). methods: An 85-year-old Caucasian female presented with bilateral light perception visual acuity, anterior chamber cells, hypopyon, posterior synechiae, and no red reflex. RESULTS: The patient underwent bilateral vitrectomy, with topical, intravitreal, and systemic antibiotics. Vitreous cultures revealed gram-negative cocco bacilli consistent with actinobacillus actinomycetemcomitans. At final follow-up, visual acuity was 20/25 RE and 20/40 LE. CONCLUSIONS: Prompt diagnosis and treatment of HACEK [Hemophilus sp. (parainfluenzae, aphrophilus, paraphrophilus), actinobacillus actinomycetemcomitans, cardiobacterium hominis, eikenella corodens, and kingella kingae] group bacterial endophthalmitis can yield good results.- - - - - - - - - - ranking = 1keywords = perception (Clic here for more details about this article) |
7/18. bartonella henselae infection associated with neuroretinitis, central retinal artery and vein occlusion, neovascular glaucoma, and severe vision loss.PURPOSE: To report a case of bartonella henselae infection. DESIGN: Observational case report. methods: review of the clinical, laboratory, photographic, and angiographic records of a patient with cat scratch disease associated with central retinal artery and vein occlusion, neovascular glaucoma, and severe vision loss. RESULTS: A 21-year-old man had no light perception in the left eye secondary to concurrent central retinal artery and vein occlusion believed to have resulted from infection with bartonella henselae. Forty days later, he developed neovascular glaucoma in the left eye. CONCLUSION: Ocular complications associated with bartonella henselae infection may include central retinal artery and vein occlusion, neovascular glaucoma, and severe vision loss.- - - - - - - - - - ranking = 1keywords = perception (Clic here for more details about this article) |
8/18. A case of endogenous enterococcus faecalis endophthalmitis.A case of successful treatment by vitrectomy and lensectomy of early-stage endogenous endophthalmitis caused by enterococcus faecalis was reported. The case was a 50-year-old man with poorly controlled diabetes. Following T-tube drainage for a necrotic cholecystitis operation, he developed iridocyclitis in both eyes as well as fever. At the time of his first visit to our clinic, his right eye had already lost light perception. His left eye had visual acuity recognizing hand movement, marked uveitis, complicated cataract, and dense vitreous opacity. As gram-positive cocci were isolated from the aspirated vitreous, lensectomy and vitrectomy under irrigation with antibiotics were conducted. After the administration of systemic postoperative antibiotics and human immunoglobulin, the patient showed remarkable improvement in the state of his ocular fundus. By 60 days after the surgery, the visual acuity of his left eye recovered to 0.2. Endogenous enterococcus faecalis endophthalmitis has rarely been reported in japan. The diagnosis and treatment of this disease with reference to the above findings were discussed.- - - - - - - - - - ranking = 1keywords = perception (Clic here for more details about this article) |
9/18. A case of enterococcus faecalis endophthalmitis with corneal ulcer.Although there have been a few reported cases of Enterococcal endophthalmitis, this is an unusual case of endophthalmitis complicated with corneal ulcer caused by enterococcus faecalis. A 67-year-old male patient with diabetes mellitus underwent secondary intraocular lens implantation. Post-operative recovery was uneventful until a wound rupture was noted 3 weeks after the operation. On day 12 after the repair of the wound, endophthalmitis accompanied by wound necrosis and a full-thickness corneal ulcer was detected. His vision was light perception, and enterococcus faecalis was identified by culture in samples of conjunctival sac, anterior chamber and vitreous humor. After 3 rounds of intravitreal antibiotics injection, the vitreous opacity disappeared on ultrasonographic finding but corneal opacity and corneal neovascularization still remained.- - - - - - - - - - ranking = 1keywords = perception (Clic here for more details about this article) |
10/18. Recurrent enterococcus faecalis endophthalmitis after phacoemulsification.We present the first reported case of late recurrence of postoperative enterococcus faecalis endophthalmitis after cataract surgery in a 45-year-old diabetic man. culture-positive E faecalis endophthalmitis was diagnosed 2 days after uneventful phacoemulsification. Early vitrectomy with intravitreal and subconjunctival vancomycin and amikacin and topical vancomycin resulted in apparently complete clinical resolution after 4 months and a best corrected visual acuity of 20/25. Recurrent endophthalmitis with hypopyon occurred 7 months postoperatively and resolved with intravitreal vancomycin and topical prednisolone acetate 1%. However, the patient had a similar relapse at 9 months that resulted in deterioration of visual acuity to no light perception despite a repeat vitrectomy, intraocular lens explantation, capsular bag removal, and intravitreal antibiotics. The late recurrences could have been the result of persistent sequestration of the organism in the capsular bag.- - - - - - - - - - ranking = 1keywords = perception (Clic here for more details about this article) |
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