Inhibitory effects of antimicrobial agents against Fusarium species.

We investigated the inhibitory effects of antibacterial, biocidal, and antifungal agents against Fusarium spp. Seven Fusarium spp: four F. falciforme (Fusarium solani species complex), one Fusarium spp, one Fusarium spp. (Fusarium incarnatum-equiseti species complex), and one F. napiforme (Gibberella fujikuroi species complex), isolated from eyes with fungal keratitis were used in this study. Their susceptibility to antibacterial agents: flomoxef, imipenem, gatifloxacin, levofloxacin, moxifloxacin, gentamicin, tobramycin, and Tobracin® (contained 3,000 µg/ml of tobramycin and 25 µg/ml of benzalkonium chloride (BAK), a biocidal agent: BAK, and antifungal agents: amphotericin B, pimaricin (natamycin), fluconazole, itraconazole, miconazole, voriconazole, and micafungin, was determined by broth microdilution tests. The half-maximal inhibitory concentration (IC50), 100% inhibitory concentration (IC100), and minimum inhibitory concentration (MIC) against the Fusarium isolates were determined. BAK had the highest activity against the Fusarium spp. except for the antifungal agents. Three fluoroquinolones and two aminoglycosides had inhibitory effects against the Fusarium spp. at relatively high concentrations. Tobracin® had a higher inhibitory effect against Fusarium spp. than tobramycin alone. Amphotericin B had the highest inhibitory effect against the Fusarium spp, although it had different degrees of activity against each isolate. Our findings showed that fluoroquinolones, aminoglycosides, and BAK had some degree of inhibitory effect against the seven Fusarium isolates, although these agents had considerably lower effect than amphotericin B. However, the inhibitory effects of amphotericin B against the Fusarium spp. varied for the different isolates. Further studies for more effective medications against Fusarium, such as different combinations of antibacterial, biocidal, and antifungal agents are needed.

Rare case of fungal keratitis caused by Corynespora cassiicola.

We describe a 76-year-old male farmer with no diabetes mellitus and no history of ocular trauma from soil or plants who developed a corneal infection from a plant pathogen. The organism was identified as Corynespora cassiicola based on both the morphological characteristics and the sequence of the internal transcribed spacer region of the ribosomal RNA gene. The patient was treated successfully with a combination of topical and systemic voriconazole. This is the first reported case of keratomycosis caused by C. cassiicola.

Assessment of macular function of glaucomatous eyes by multifocal electroretinograms.

PURPOSE: To determine whether significant correlations existed between the morphological and functional parameters of the macular region of eyes with open-angle glaucoma (OAG). METHODS: Forty eyes of 40 OAG patients were studied. The morphological parameters were obtained by optical coherence tomography (OCT), and the functional parameters were acquired by automated Humphrey Field Analyzer (HFA) and multifocal electroretinograms (mfERGs). All of the tests were performed within 6 months of each other. The retinal thickness was determined by OCT in the nine Early Treatment of Diabetic Retinopathy Study (ETDRS) sectors of the macula, the fovea, and the four quadrants of the inner and an outer ring. The amplitudes of the second-order kernel responses of the mfERGs in the central 5° including the amplitude ratio of the nasal to temporal hemispheres (N/T amplitude ratio) were analyzed. The total mean deviation of the HFA corresponding to each OCT region was measured. The correlation between the different parameters was determined by coefficients of correlation and linear regression analyses. RESULTS: The N/T amplitude ratio of the second-order kernel responses of the mfERGs was significantly correlated with the retinal thickness in the inferior quadrant (r = -0.44; P = 0.004). There was a significant correlation between the N/T amplitude ratio and the threshold in the superior quadrant measured by the HFA Central 10-2 program (r = -0.40; P = 0.011) and also between the N/T amplitude ratio and the total deviation in the superior quadrant (r = -0.40; P = 0.010). There were significant correlations between the inferior retinal thickness and the average threshold and the TD in superior (r = 0.70, P < 0.001; r = 0.692, P < 0.001, respectively), nasal (r = 0.53, P < 0.001; r = 0.53, P < 0.001, respectively), and temporal (r = 0.46, P = 0.003; r = 0.44, P = 0.004, respectively) quadrants. CONCLUSIONS: Functional glaucomatous changes determined by mfERGs and perimetry are significantly correlated with the morphological changes determined by OCT.

[Clinical characteristics and risk factors of glaucoma filtering bleb infections].

PURPOSE: To obtain useful information for the appropriate prevention and treatment of bleb-related infection following trabeculectomy with antiproliferatives. SUBJECTS AND METHODS: Fifty nine eyes of 57 patients who developed bleb-related infection after trabeculectomy at the Department of Ophthalmology of Gifu University Hospital from January, 1985 to December, 2007 were observed for at least 30 days. We describe the characteristics of the clinical findings, risk factors, treatment, and prognosis related to the use of antiproliferatives and the stages. RESULTS: Bleb leak was considered a significant risk factor. It was highly likely that inferior quadrant trabeculectomy induced endophthalmitis. Bleb-related infection was also observed in patients under treatment with topical antibiotics. The large incidence of patients with blebitis observed recently, requires attention since it may be associated with a recurrence of bleb-related infection. There was an increase in the number of patients who complained of either pain or visual acuity loss and an increase in the bacterial detection ratio which was related to the severity of the disease stage. The prognosis of visual acuity was relatively better with blebitis, and the function of the blebs was also maintained. The period between the onset of subjective symptoms and visit to the eye clinic was shorter in patients with endophthalmitis than in those with other stages. The prognosis of both visual function and intraocular pressure was poor. Endophthalmitis was frequently encountered in the patients who had been treated with 5-fluorouracil. CONCLUSIONS: It is important to repair any bleb leak immediately and to maintain the daily hygiene of the bleb. Long-term careful observation is also essential.

Keratitis caused by a rare fungus, Malassezia restricta.

BACKGROUND: Malassezia species rarely cause keratitis, and, thus, the clinical manifestations of Malassezia keratitis are not well known. CASE: We report the clinical findings in a 70-year-old woman who complained of pain in her left eye. Slit-lamp biomicroscopy showed a corneal ulcer with irregular infiltration, which resembled keratitis caused by filamentous fungi. KOH Parker ink stain of a corneal scraping showed mold hyphae and yeast, but cultures on Sabouraud's glucose agar plates and blood agar plates were negative. Treatment with antibacterial agents failed. OBSERVATIONS: Polymerase chain reaction (PCR) and DNA typing of the fungal gene between the internal transcribed spacer 2 (ITS2) and the 5.8S ribosomal DNA of the scraping were performed. PCR amplified a band with a sequence that was 99% homologous with Malassezia restricta. Antifungal agents, topical 5% pimaricin ointment and 0.2% miconazole, and oral itraconazole 150 mg/day, were applied, and the corneal ulcer disappeared within 5 weeks. CONCLUSION: Malassezia restricta can cause keratitis, and the clinical findings resemble keratitis caused by filamentous fungi. PCR and DNA typing of ITS2 and 5.8S ribosomal DNA are valuable techniques for detecting and identifying Malassezia species. Proper identification of Malassezia keratitis permits a prompt and successful treatment by antifungal agents.

Pseudotumor cerebri induced by minocycline therapy for acne vulgaris.

BACKGROUND: We report a case of a young girl who developed pseudotumor cerebri while taking minocycline for acne vulgaris. CASE: A 16-year-old girl without a history of menstrual irregularity, weighing 60 kg (body mass index: 26.0%) presented with a history of 1 week of headache and sudden onset of a horizontal diplopia. OBSERVATION: Examination revealed bilateral papilledema and an abduction deficit in her right eye. Her cerebrospinal fluid had an opening pressure of 400 mm H(2)O and a normal composition. Following normal findings on computed tomography and magnetic resonance imaging, a diagnosis of pseudotumor cerebri was made. She reported receiving minocycline to treat acne vulgaris during the previous 3 weeks. The headache resolved with withdrawal of minocycline. The diplopia and papilledema resolved after two lumbar punctures, although the visual field defects persisted. The minocycline concentrations in the serum and cerebrospinal fluid taken after cessation of the drug were below the detectable level. CONCLUSION: The role of minocycline should be considered and routine ophthalmologic examination during minocycline treatment should be performed when pseudotumor cerebri occurs in patients treated for acne vulgaris.