Bilateral Infectious Keratitis Caused by Pseudomonas aeruginosa in a Colon Cancer Patient

Purpose@#To report a case of successful treatment of bilateral infectious keratitis combined with endophthalmitis caused by Pseudomonas aeruginosa in an immunocompromised patient.Case summary: A 66-year-old male with colon cancer and lung metastasis was referred to our clinic with ocular pain and reduced visual acuity in both eyes for 3 days. Visual acuity was “light perception” in both eyes at the first visit. On slit lamp examination, he presented with corneal central necrosis with mucopurulent discharge and anterior chamber hypopyon in both eyes. The left eye especially had vitreous haziness using a B-scan. Pseudomonas aeruginosa was detected in the corneal scrape culture and percutaneous transhepatic biliary drainage culture. After administration of topical eye drops, intravitreal injection, and systemic antibiotics, visual acuity improved from “light perception” to 20/63 in the right eye and to 20/125 in the left eye. @*Conclusions@#Although bilateral corneal ulcers combined with endophthalmitis induced by Pseudomonas aeruginosa are rare it can occur in immunocompromised patients. In the case of corneal ulcers combined with endophthalmitis, thorough ocular examinations and active treatments with intravitreal injections and systemic administration of antibiotics can help to recover vision.

Comparison of the Toxicity of Olopatadine Anti-allergic Ophthalmic Agents on Rabbit Conjunctival Cells

PURPOSE@#To compare the in vitro toxicity of commercial olopatadine anti-allergic ophthalmic agents on cultured rabbit's conjunctival cells according to concentrations and exposure times.@*METHODS@#Rabbit conjunctival cells were exposed to anti-allergic olopatadine ophthalmic agents, (Patanol® [0.1% olopatadine hydrochloride; Alcon, Fort Worth, TX, USA], Pataday® [0.2% olopatadine hydrochloride; Alcon], and Pazeo® [0.7% olopatadine hydrochloride; Alcon]) at concentrations of 5%, 10%, and 15% for periods of 30 minutes, 1, 2, 3, and 6 hours, respectively. Cell proliferation and injury assays were performed using the methylthiazoltetrazolium and lactate dehydrogenase (LDH) leakage assays. We checked the composition of the three anti-allergic agents, and performed light and transmission electron microscopy to compare the morphological changes in cells.@*RESULTS@#The conjunctival cell proliferation was inhibited after 1 hour exposure to each olopatadine ophthalmic agent, with significant cell proliferation inhibited using 15% of each drug. The proliferation of conjunctival cells was inhibited during 6 hours of drug exposure at all concentrations of Pataday® and Pazeo®. The titer of LDH increased from 3 hours after drug exposure, but 15% Pazeo® significantly increased the LDH titer at 2 hours after drug exposure. As the concentration of the drug increased, the LDH titer also significantly increased. The cellular morphological changes of conjunctival cells were in the increasing order of Pazeo®, Pataday®, and Patanol® with a high concentration of olopatadine hydrochloride.@*CONCLUSIONS@#Among the anti-allergic olopatidine ophthalmic agents, higher olopatadine concentrations in the increasing order of Pazeo®, Pataday®, and Patanol® resulted in cytoplasmic damage of conjunctival cells, but there was no severe damage to the cytoplasmic or the nuclear membranes.

Clinical Manifestation and Outcomes of Neuroretinitis in Korea

PURPOSE: In the present study, the clinical characteristics and outcomes of neuroretinitis in Korea were investigated. METHODS: Seven consecutive patients with neuroretinitis from 2012 to 2015 were retrospectively reviewed. RESULTS: The present study included 9 eyes of 7 patients. The subjects consisted of 5 males and 2 females and the mean age was 45.1 ± 13.2 years. Two patients had Influenza-like symptoms and the others had no specific general symptoms. The mean best corrected visual acuity was logMAR 0.48 ± 0.55 (0-1.6) on the initial visit. Four patients 40 years of age or under had no abnormal findings in laboratory work-up. Conversely, 3 patients over 40 years of age were positive for Toxocara based on enzyme-linked immunosorbent assay (ELISA). Two of 3 patients positive for Toxocara were treated with albendazole and 1was not. Eight eyes had good visual recovery over 20/30 except for 1 patient who did not take the albendazole despite being positive for Toxocara detected using ELISA. CONCLUSIONS: Three of 7 patients with neuroretinitis in Korea showed positive results for Toxocara based on ELISA. In cases with seropositive Toxocara ELISA results, albendazole treatment should be considered.

Retinal Nerve Fiber Layer Thickness Measured with Two Different Spectral Domain Optical Coherence Tomography Devices

PURPOSE: To assess the agreement and compare the performance of glaucoma diagnosis of peripapillary retinal nerve fiber layer (RNFL) thickness measurements between two different spectral-domain optical coherence tomography (SD-OCT) devices. METHODS: Eighty nine eyes of 56 patients with glaucoma and 42 eyes of 25 healthy individuals were imaged with Cirrus and Spectralis OCT in a single visit. Agreement between RNFL thickness measurements was assessed using intraclass coefficient (ICC) and Bland-Altman plots. The discriminating abilities of the two techniques for detection of glaucoma were compared by the area under the receiver operating characteristic curves (AUC) for quadrants and average RNFL thickness. RESULTS: ICC values for agreement between both instruments were good for quadrants and average RNFL thickness (all ≥ 0.81). However, Spectralis OCT measurements were significantly greater than Cirrus OCT for temporal quadrant (difference = 4.27 µm in normal group, 3.91 µm in glaucoma group, p < 0.001 for both). The RNFL thickness parameter with the largest AUCs was the average RNFL thickness for the Spectralis OCT and the Cirrus OCT (0.85 vs. 0.87, p = 0.30). The pair-wise comparison among the receiver operating characteristic curves showed no statistical difference for all parameters. CONCLUSIONS: Although Spectralis OCT measurements were significantly greater than Cirrus OCT for temporal quadrant, agreement of RNFL measurement between both the devices was generally good and there was no statistically significant difference in the performance of glaucoma diagnosis between both instruments.

Clinical Manifestations of Extruded Conjunctival Melanocytic Mass

PURPOSE: To investigate the clinical manifestations and characteristics of extruded conjunctival melanocytic mass. METHODS: A total of 33 patients who had extruded conjunctival melanocytic mass and who underwent excisional biopsy were retrospectively reviewed. RESULTS: Based on the excisional biopsy results, 13 patients (40%) were diagnosed with compound nevus, nine patients (27%) with subepithelial nevus, eight patients (24%) with primary acquired melanosis without atypia, and three patients (9%) with malignant melanoma. Compound nevus was located on the temporal side of the cornea in 54% of affected cases, bulbar conjunctival in 77%, and was partially pigmented (brown) in 61%. The average size of the melanocytic mass was 24 mm when histological analysis showed melanin nevus cells in the conjunctival epithelial layer and subepithelial stromal layer. Subepithelial nevus was located on the temporal side of the cornea (56%) and in the bulbar conjunctival (78%) and had a brown color (78%). The average size of the melanocytic mass was 28 mm when histological analysis showed melanin nevus cells located only in the subepithelial stromal layer and forming nest shapes. Primary acquired melanosis without atypia was located on the temporal side of the cornea (62.5%) and bulbar conjunctival (75%) and had brown color (75%). The average size of melanin nevus cells located only in the basement membrane of the epithelial layer was 30 mm. Three of these masses were malignant melanoma, and all cases were located on the superior side of the cornea and palpebral conjunctiva. All cases were black and had an average size of 53 mm, with malignant cells observed in all layers of the conjunctiva and connective tissue. CONCLUSIONS: A conjunctival melanocytic mass located on the palpebral conjunctiva, extruding onto the surface, and large in size should be suspected as malignant melanoma. In such cases, early biopsy and aggressive resection are required.