Pathogen Surveillance for Acute Infectious Conjunctivitis.

Importance: Acute infectious conjunctivitis is a common ocular condition with major public health consequences. Objective: To assess regional variations and microbial etiologies of acute infectious conjunctivitis to guide treatment. Design, Setting, and Participants: In this cross-sectional study, patients with presumed acute infectious conjunctivitis were enrolled in the study at 5 sites (Honolulu, Hawaii; Los Angeles, San Francisco, and San Diego, California; and Petah-Tikva, Israel) from March 2021 to March 2023. Patients with allergic or toxic conjunctivitis were excluded. Main Outcomes and Measures: Pathogens were identified by unbiased RNA deep sequencing. Results: In all, 52 patients (mean [range] age, 48 [7-80] years; 31 females [60%]) were enrolled at 5 sites (6 patients from Honolulu, 9 from San Diego, 11 from Los Angeles, 13 from San Francisco, and 13 from Petah-Tikva). RNA deep sequencing detected human adenovirus species D in one-quarter of patients (13 of 52). A wide range of pathogens, including human coronavirus 229E, SARS-CoV-2, and herpes simplex virus type 1, was also identified, as well as several bacteria and fungi. Moreover, 62% (32 of 52) of patients presented with purulent discharge, while only 8% (4 of 52) of patients had confirmed bacterial pathogens. Conclusion and Relevance: In this cross-sectional study, pathogens associated with acute infectious conjunctivitis varied between all 5 sites in the US and Israel. Purulent discharge was a common presenting sign in this study, with a low specificity for bacteria-associated conjunctivitis, suggesting that further diagnostic workup may be necessary to inform antibiotic stewardship. Additional research on cost-effectiveness of using RNA deep sequencing is needed to ascertain whether it is better to monitor patients clinically until resolution of disease.

Clinic-based ultra-wide field retinal imaging in a pediatric population.

BACKGROUND: Pediatric retinal disorders, although uncommon, can be challenging to assess in the clinic setting and often requires an exam under anesthesia. The purpose of our study was to evaluate the use of ultra-wide field retinal imaging in children without sedation in an outpatient clinic. METHODS: We performed a retrospective case series of patients 18 years or younger who received ultra-wide field imaging over a one year period. The age, gender, and clinical course were documented. Color fundus and red-free images were reviewed to assess field of view. Ultra-wide field autofluorescence (UWF-FAF) was evaluated for abnormal autofluorescence patterns and ultra-wide field fluorescein angiography (UWF-FA) was assessed for angiographic phase and field of view. RESULTS: A total of 107 eyes of 55 patients with a mean age of 11.1 years (SD 3.7 years, range 3-18 years) were evaluated. Twenty-seven (49%) patients were male. The most common diagnosis was retinopathy of prematurity (7 of 55 patients, 12.7%) followed by trauma (7.4%), Coats disease (7.4%), and rhegmatogenous retinal detachment (7.4%). The number of quadrants visualized anterior to the equator correlated with patient age (r = 0.4, p < 0.01). On UWF-FA, 6 of 14 patients (43%) had images of the arterial phase captured and 14 of 14 patients (100%) had images of the venous phase or later captured. CONCLUSIONS: We demonstrated that UWF imaging is obtainable in children as young as 3 years old without sedation. UWF fundus photography, UWF-FAF and UWF-FA were useful clinical adjuvants to examination and provide additional information for documenting and monitoring pediatric retinal diseases.

PARACENTRAL ACUTE MIDDLE MACULOPATHY AND DEEP RETINAL CAPILLARY PLEXUS INFARCTION SECONDARY TO REPERFUSED CENTRAL RETINAL ARTERY OCCLUSION.

PURPOSE: To report a case of reperfused central retinal artery occlusion causing a globular pattern of paracentral acute middle maculopathy with en face optical coherence tomography (OCT). METHODS: Retrospective case report. Widefield fluorescein angiography, en face OCT, and OCT-angiography were performed. Retinal capillary plexus vessel density (mm) was measured using OCT-angiography analysis and was defined as total vessel length (mm) per area (mm). RESULTS: A 76-year-old female presented with decreased vision in the left eye for 1 day. Widefield fluorescein angiography revealed delayed venous filling in the early phase and selective arterial staining in the late phase. Spectral domain OCT demonstrated paracentral acute middle maculopathy. Optical coherence tomography-angiography showed an ischemic deep retinal capillary plexus that colocalized with a globular shaped hyper-reflective pattern identified with structural en face OCT. Quantitative vessel density analysis comparing the fellow eye to the affected eye at presentation demonstrated 43% reduction in the superficial capillary plexus vessel density and 33% reduction of the deep capillary plexus in the affected eye. At 2 months follow-up, the reduction of superficial capillary plexus vessel density improved to 33%, whereas the deep capillary plexus vessel density reduced further to 35% compared with the fellow eye. CONCLUSION: The authors report a case of reperfused central retinal artery occlusion leading to a globular shaped paracentral acute middle maculopathy lesion with en face OCT. Quantitative OCT-angiography vessel density analysis in the chronic phase revealed disproportionate reduction of deep capillary plexus vessel density. The globular pattern of paracentral acute middle maculopathy with en face OCT can be an important clue to the diagnosis of central retinal artery occlusion.

Tumores oculares: fatores de atraso no atendimento oftalmológico / Ocular tumors: contributing factors to delayed ophtalmological assessment

Introduçäo: os pacientes de tumores oculares podem ter pior prognóstico visual e sistêmico na ocorrência de atraso diagnóstico e tratamento empreendida por esses pacientes e descrever as características demográficas e clínicas dos mesmos. Material e métodos: entrevista com pacientes portadores de tumores oculares de diagnóstico recente atendidos em hospital universitário no período de maio/95 a maio/96. Resultados: foram avaliados 37 pacientes. Os tumores malignos encontrados com maior frequência foram retinoblastoma, carcinoma epidermoide de conjuntiva e melanoma de coróide. A trajetória desde o início do quadro ocular até a terapêutica desenvolveu-se em quatro etapas principais, com problemas diferentes relatados em cada uma delas. As etapas de 1 a 3, relacionadas ..

Tempo de realizaçäo da prova da prono-posiçäo em quarto escuro / Realization time of the prone position test in a dark room

Vinte e dois olhos contralaterais de 22 pacientes portadores de glaucoma agudo primário unilateral foram submetidos à PPQE durante 10, 30 e 50 minutos com o objetivo de tentar reduzir o tempo de duraçäo deste teste. Os autores observaram que a PPQE aumenta o PIO qualquer que seja o tempo utilizado e que a reduçäo do tempo de prova para 30 minutos deve ser confirmada através de outros estudos.

Avaliaçäo da pressäo intra-ocular em olhos glaucomatosos com pressäo intra-ocular normalizada pelo tratamento / IOP evaluation in glaucomatous eyes under treatment

Com o objetivo de verificar quais as formas de tratamento do glaucoma que podem evitar picos de pressäo e garantir níveis médios de pressäo intra-ocular (PIO) mais baixos, estudamos pacientes submetidos à trabeculoplastia e apenas ao uso de medicaçäo hipotensora ocular. A PIO foi avaliada pelo prova de sobrecarga hídrica. Encontramos uma diminuiçäo significativa da PIO nos três grupos de pacientes após o tratamento, sendo maior no grupo da trabeculectomia em comparaçäo aos outros dois grupos. Este grupo também teve na prova de sobrecarga hídrica (com) menor elevaçäo pressórica, sugerindo ser esta modalidade de tratamento a mais eficaz em evitar picos pressóricos em olhos supostamente bem controlados com o tratamento instituido

Ferimento perfurante ocular: 400 casos admitidos na clínica oftalmológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo / Penetrating ocular injury: 400 cases admitted in the ophthalmologic clinic of the Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo

Foi realizado um estudo retrospectivo de 400 casos de ferimento perfurante ocular admitidos na Clínica Oftalmológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de janeiro de 1991 a dezembro de 1992. Houve maior incidência de ferimento perfurante no sexo masculino (79,5 por cento) e o grupo etário de 21 a 30 anos foi o mais exposto ao trauma. Os acidentes de trânsito representaram 30,8 por cento, seguidos pelos acidentes domésticos (27,8 por cento), ocupacionais (22,8 por cento), lazer e esporte (10,2 por cento) e violência (8,5 por cento). O atendimento inicial ocorreu no primeiro dia para 82,6 por cento dos casos e após o terceiro dia para 8,2 por cento dos pacientes. Os ferimentos perfurantes oculares constituíram causa importante de incapacidade visual funcional: apenas 61 de 283 olhos alcançaram acuidade visual de 20/40 ou melhor. Medidas preventivas necessitam ser tomadas para reduzir a indicência de perfurações oculares.