Clostridium septicum endophalmitis associated with colon adenocarcinoma.

Endogenous Clostridium septicum endophthalmitis is a rare, devastating infection that has been shown to be associated with colonic and hematologic malignancies. We present a case of clostridial endophthalmitis that resulted in expedient identification of colon adenocarcinoma.

Short-Term Outcomes of KeraSys Patch Graft for Glaucoma Drainage Devices: A Case Series.

Purpose. Tube-related exposure is a known complication of glaucoma drainage device (GDD) surgery. Our objective is to report the early (approximately 1 year) tube exposure rate of implants covered with a keraSys (IOP Inc., Costa Mesa, CA, USA) tissue reinforcement graft. Patients and Methods. A retrospective, noncomparative, consecutive case series of 42 eyes with GDD implantation with keraSys patch grafts was performed. Main outcome measurements included patch-related complications: patch exposure, tube exposure, wound dehiscence, and patch migration. Results. Forty-two eyes were followed for an average of 15.24 ± 10.44 months (range 1.0-32.3 months). Four (10%) eyes experienced patch-related complications: two with exposure 8 months postoperatively, one with exposure 13 months postoperatively, and one with exposure 4 weeks postoperatively. Conclusion. The effectiveness of the keraSys patch graft is limited by the higher than expected early exposure rate found in this case series. These results should be confirmed in other studies.

Histologic assessment of dermatochalasis: elastolysis and lymphostasis are fundamental and interrelated findings.

OBJECTIVE: To determine the presence, degree, and extent of lymphatic, elastic, and collagen fiber alterations in dermatochalasis (DC) specimens. DESIGN: Case control study of patients with DC compared with age-, gender-, and site-matched controls. PARTICIPANTS: A total of 25 eyelid specimens were studied; 15 of these were blepharoplasty specimens (experimental) and 10 were entropion/ectropion specimens of patients without DC (controls). METHODS: The number and maximal dilation of lymphangiectasia was measured by light microscopy, immunohistochemistry with lymphatic marker D2-40, and elastic tissue content by Verhoeff-van Gieson histochemistry. The number of macrophages was compared between patients with DC and controls in CD68 immunostained specimens. MAIN OUTCOME MEASURES: Lymphatic density, edema, and inflammation. RESULTS: Dermatochalasis eyelid specimens showed increased lymphangiectasia density (5.6 vs. 2.4 lymphatics/high power field; P<0.05), maximal lymphatic dilation (127 vs. 51.5 µm; P<0.05), loss of elastic fibers (2.2 vs. 8.9 fibers/high power field; P<0.05), and greater disruption of collagen networks and edema compared with controls (increased stromal collagen bed of 752 vs. 269 µm; P<0.05; increased intercollagen space of 32.5 vs. 11.8 µm; P<0.05). Macrophages were present in greater quantities in DC specimens (28.6 vs. 11.9 macrophages/high power field; P<0.05). CONCLUSIONS: Patients with DC show an increase in number and maximal dilation of lymphatic vessels in conjunction with widely spaced collagen bundles. This finding coexists with loss of elastic fibers, components known to be essential to the structure and function of the lymphatic system. Governed by macrophages, the pathogenesis of DC may begin with subclinical inflammation leading to elastolysis and secondary lymphostasis. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Utilization patterns for diagnostic imaging in the evaluation of epiphora due to lacrimal obstruction: a national survey.

PURPOSE: To evaluate current physician patterns for diagnostic lacrimal imaging in patients with epiphora related to lacrimal obstruction. METHODS: An invitation was sent to members of the American Society of Ophthalmic Plastic and Reconstruction Surgeons in September 2008 to participate in a short web-based questionnaire. The survey focused on basic demographic information and the use and indications for various types of diagnostic imaging modalities in the evaluation of epiphora. Specific imaging modalities queried included facial x-ray, lacrimal ultrasound, CT, MRI, contrast dacryocystography, and radionuclide dacyroscintigraphy. Responses were analyzed using standard statistical methods. RESULTS: Less than 5% of respondents use lacrimal imaging of any type for the majority of their patients with epiphora thought due to lacrimal obstruction. When lacrimal imaging was used, CT was the most common type overall. CT was the preferred modality for all indications surveyed when an imaging modality was elected, except when confirming the site or type of obstruction in which case dacryocystography was preferred. Excluding CT, a majority of respondents indicated that they "never" (0%) used any of the specific lacrimal imaging studies surveyed, including dacyroscintigraphy, which was never used by over 75% of respondents. CONCLUSIONS: The low overall imaging rate suggests that most lacrimal problems are diagnosed with office testing alone. For most specific indications, respondents indicated a preference for CT. No difference in imaging frequency was found for the majority of our respondents when considering external versus endonasal dacryocystorhinostomy. Most respondents favored external approach dacryocystorhinostomy.