Fluctuation of Bacteria on Bleb Surface After Trabeculectomy With Adjunctive Mitomycin C.

PURPOSE: To determine whether the bacterial and floral patterns on the bleb surface are affected by the season in eyes that had undergone trabeculectomy with adjunctive mitomycin C. PATIENTS AND METHODS: Forty-four glaucoma patients who had an avascular or a hypovascular cystic filtering bleb were studied. Swabs of the bleb surface were taken 4 times in 1 year. The samples were cultured, and all organisms isolated were identified and tested for antibiotic sensitivity and resistance. RESULTS: Of the 176 specimens, 48 tested positive in cultures. Out of the 44 glaucoma eyes that had undergone trabeculectomy, 30 (68.2%) eyes were culture positive. A total of 58 strains were isolated. The organisms isolated were 22 strains of Staphylococcus epidermidis, 21 strains of Propionibacterium acnes, 8 strains of Corynebacterium sp., 5 strains of Staphylococcus sp., and 1 strain of both Neisseria sp., and Candida parapsilosis. Fifteen eyes had a positive culture ≥2 times, and in 10 of these eyes, the same strain was isolated. There was no resistance to vancomycin by S. epidermidis, P. acnes, and Corynebacterium sp. All of the isolates of S.epidermidis were sensitive to minocycline and amikacin. The rate of bacterial detection in the spring was 13.6%, summer was 20.5%, autumn was 45.5%, and winter was 29.5%. The increase in the incidence of bacterial presence during autumn was significant (P=0.006; the Fisher exact probability test). CONCLUSIONS: It is not rare to detect the bacterial organisms on the bleb surface in glaucomatous eyes that had undergone trabeculectomy. The prevalence varied with the season and was highest in the autumn.

[Three cases of acute conjunctivitis caused by human adenovirus in medical workers].

We report three cases of acute conjunctivitis due to different types of human adenovirus (HAdV) in medical workers. Case 1: A 37-year-old man had epidemic keratoconjunctivitis and urethritis caused by human adenovirus type 37 (HAdV-37). Case 2: A 27-year-old woman had acute conjunctivitis due to human adenovirus type 15 (HAdV-15), Case 3:A 32-year-old woman had acute follicular conjunctivitis leading to a serotype of human adenovirus-53 serotype (HAdV-53). Note that HAdV-37 infection may cause keratoconjunctrivitis and urethritis. HAdV-15, -37, and -53 are important causative agents of nosocomial outbreak, and the application of a rapid diagnostic kit or PCR to a rapid diagnosis and proper infection-control measures can significantly reduce infection spread.

Gemella species-associated late-onset endophthalmitis after trabeculectomy with adjunctive mitomycin C.

PURPOSE: To report 2 cases of delayed-onset, bleb-related endophthalmitis induced by Gemella species. METHODS: Interventional case report. RESULTS: Two patients developed bleb-related ocular infection attributable to Gemella haemolysans and Gemella morbillorum after trabeculectomy with adjunctive mitomycin C. Both patients had thin-walled cystic filtering blebs before ocular infection. One patient underwent urgent vitrectomy with intravitreal injection of ceftazidime and vancomycin. The other received an intraocular injection of vancomycin and ceftazidime. After surgical intervention, 2 cases were administered topical levofloxacin and sulfobenzylpenicillin, and intravenous cefpirome. The DNA from the microorganism was sequenced and identified as G. haemolysans and G. morbillorum. CONCLUSIONS: Gemella species should be added to the long list of organisms that may rarely cause bleb-associated endophthalmitis.

Polymicrobial endogenous endophthalmitis.

PURPOSE: We report a case of polymicrobial endogenous endophthalmitis caused by group G streptococcus and Staphylococcus capitis. METHODS: Standard ophthalmologic examinations. RESULTS: A 72-year-old woman presented with signs of uveitis. Treatment with broad-spectrum antibiotics was prescribed, and vitrectomy with intravitreal antibiotic administration was then performed. Blood cultures were positive for group G streptococcus and coagulase-negative staphylococcus. Cultures of vitreous aspirate yielded group G streptococcus and S. capitis. Uveitis was resolved with antibiotic treatment and vitrectomy, with best-corrected visual acuity of 20/20 at 6 months. CONCLUSIONS: Endogenous endophthalmitis can be caused by two intravitreal organisms (e.g., group G streptococcus and S. capitis). Early treatment with broad-spectrum antibiotics and vitrectomy with intravitreal injections of antibiotic might be considered in similar cases.