Hypertensive choroidopathy in atypical hemolytic-uremic syndrome.

PURPOSE: We present the case of a 22-year-old woman, diagnosed as having atypical hemolytic uremic syndrome with a hypertensive crisis, who presented a bilateral serous retinal detachment. CASE DESCRIPTION: A 22-year-old woman, diagnosed as having atypical hemolytic uremic syndrome, was referred for blurred vision in both eyes, evolving over 7 days. Treatment including hemodialysis, plasma exchange, systemic steroids, antihypertensive medications and eculizumab was started 1 month prior to referral. At presentation, best-corrected visual acuity was 20/40 in the right eye and 20/25 in the left eye. Retinal examination revealed bilateral serous retinal detachment in the posterior pole and some small, flat, variably pigmented lesions. Optical coherence tomography confirmed marked serous retinal detachment in both eyes. Fluorescein and indocyanine green angiography was performed. Treatment for systemic hypertension was changed. Seven days later, dilated fundus examination and optical coherence tomography demonstrated a significant regression of the serous retinal detachment. Her visual acuity improves in both eyes at the last control, showing at fundus examination a complete resolution of the exudative detachment but a persistence of variable flat pigmented lesion. CONCLUSION: Although multiple organ systems are commonly affected in hemolytic uremic syndrome, ocular involvement has only been described in very few cases. Ocular manifestations in atypical hemolytic uremic syndrome include retinal, choroidal and vitreal hemorrhages, retina and/or ischemic signs. Bilateral serous retinal detachment may also be a sign of atypical hemolytic uremic syndrome or even the first manifestation of a hypertensive event.

Treatment of refractory uveitic macular edema: results of a first and second implant of long-acting intravitreal dexamethasone.

PURPOSE: The purpose of this study was to report the functional and anatomical outcomes of a prospective study resulting from repeated dexamethasone intravitreal implants in patients with uveitic refractory macular edema. METHODS: Twelve eyes of 9 patients with intermediate and posterior noninfectious inflammatory uveitis complicated with refractory macular edema were regularly reviewed after a dexamethasone intravitreal implant. Patients were examined at baseline, 30, 90, 135, and 180 days with best-corrected visual acuity (BCVA), complete slit-lamp examination, intraocular pressure (IOP), optical coherence tomography, and fluorescein angiography. After 6 months of follow-up, eyes were reassessed to receive a second implant. RESULTS: BCVA significantly improved when comparing the baseline values after the first and second implant (16.2 and 25.8 letters, respectively, 9.6 letters improvements, p<0.05). BCVA was better after the second implant compared to the first one throughout the follow-up, but without statistical significance. Mean central macular thickness (CMT) was 446.3±129.9 µm at baseline and was significantly reduced until day 135 (p<0.05). CMT reductions after the second injection showed a similar pattern, though differences were not statistically significant. Cataract progression was observed in 4 of 8 phakic eyes (50%) after the first implant, and in 2 of 3 phakic eyes following the second implant, with 1 eye requiring cataract surgery. One eye developed an IOP >30 mmHg 30 days after the second implant, treated topically. CONCLUSION: Repeated dexamethasone intravitreal implants in uveitic patients with refractory macular edema can be used effectively in a clinical setting with an acceptable safety profile.

Severe Ocular Bacterial Infections: A Retrospective Study Over 13 Years.

PURPOSE: To report data of samples collected from January 2000 to August 2013, in the Department of Diagnosis and Laboratory Analysis, Ophthalmic Hospital, Turin, Italy, from different types of ocular infections and their antibiotic susceptibility. METHODS: Collected samples were cultured using both liquid and solid media. Then bacterial isolates were tested for antibiotic susceptibility using the Kirby-Bauer diffusion method and the National Committee for Clinical Laboratory Standards (NCCLS) serum standards. RESULTS: Staphylococcus aureus is the most common bacteria isolated in ocular samples. CONCLUSIONS: In vitro susceptibility tests showed that levofloxacin and moxifloxacin (introduced only in 2010) had the highest efficacy against bacterial isolates.

Corneal endothelium evaluation with 2 noncontact specular microscopes and their semiautomated methods of analysis.

PURPOSE: Noncontact specular microscopes and semiautomated methods of endothelial analysis are widely used in the clinical practice and for research purposes. In this study, the interexaminer reproducibility between two noncontact specular microscopes using different semiautomated methods was assessed in normal corneas. METHODS: Average cell size (ACS), endothelial cell density (ECD), coefficient of variation (CV), and hexagonality values were independently calculated by two examiners with the Topcon SP 2000P Image-NET retraced method and the Konan CC7000 center method in 49 normal subjects. Interexaminer reproducibility and correlation between instruments/methods were assessed through 95% limits of agreement, intra-class correlation coefficient (ICC), Pearson correlation coefficient, and Spearman rank test. RESULTS: Interexaminer reproducibility was good for ACS and ECD measurements (ICC > 0.85) but weak for CV and hexagonality (ICC < 0.65). Significantly higher ACS and lower ECD values (P < 0.05) were obtained with the Topcon in comparison with the Konan method by both examiners. ACS and ECD mean differences were respectively, +26 microm2 and -184 cell/mm2 for examiner 1 and +36 microm2 and -228 cell/mm2 for examiner 2. No significant difference (P > 0.05) between instruments/methods was found in CV or hexagonality values; however, the correlation for these parameters was low (r < 0.20). CONCLUSIONS: Either instrument or method allows reproducible and accurate ACS and ECD measurements on normal corneas, but the difference between the two instruments is systematic and significant. The difference found were not clinically meaningful however for research/longitudinal study purposes, the data collected with the two systems cannot be used interchangeably.

The Effect of Autologous Platelet Lysate Eye Drops: An In Vivo Confocal Microscopy Study.

Purpose. To determine the effectiveness of autologous platelet lysate (APL) eye drops in patients with primary Sjögren syndrome (SS) dry eye, refractory to standard therapy, in comparison with patients treated with artificial tears. We focused on the effect of APL on cornea morphology with the in vivo confocal microscopy (IVCM). Methods. Patients were assigned to two groups: group A used autologous platelet lysate QID, and group B used preservative-free artificial tears QID, for 90 days. Ophthalmological assessments included ocular surface disease index (OSDI), best corrected visual acuity (BCVA), Schirmer test, fluorescein score, and breakup time (BUT). A subgroup of patients in group A underwent IVCM: corneal basal epithelium, subbasal nerves, Langerhans cells, anterior stroma activated keratocytes, and reflectivity were evaluated. Results. 60 eyes of 30 patients were enrolled; in group A (n = 20 patients) mean OSDI, fluorescein score, and BUT showed significant improvement compared with group B (n = 10 patients). The IVCM showed a significant increase in basal epithelium cells density and subbasal nerve plexus density and number and a decrease in Langerhans cells density (p < 0.05). Conclusion. APL was found effective in the treatment of SS dry eye. IVCM seems to be a useful tool to visualize cornea morphologic modifications.

Terson syndrome and leukemia: a case report.

BACKGROUND: Terson syndrome is defined as intraocular hemorrhage associated with intracranial bleeding. This syndrome can occur in the event of intracranial hemorrhage or elevated intracranial pressure. To our knowledge, it has never been associated with chronic myeloid leukemia. A 45-year-old woman suffering from chronic myeloid leukemia was referred to our clinic with Terson syndrome after intracranial bleeding. We followed this patient for a year, performing visual acuity assessment, fundus examination, color retinography, and A-scan and B-scan ultrasonography. At presentation, her best-corrected visual acuity on the right was 20/63 and on the left was 20/320. In the right eye, retinoscopy showed blurring of the optic margins surrounded by retinal and preretinal hemorrhages, preretinal fibrosis of the optic disc along the vascular arcades, and perivascular retinal infiltrates. In the left eye, the optic disc was surrounded by retinal and preretinal hemorrhages, and massive fibrosis with hard exudates and severe preretinal hemorrhage were observed at the posterior pole. Roth spots and many circular hemorrhages were noted at the periphery of the retina. A-scan and B-scan ultrasonography did not show intraocular leukemic infiltration. The clinical picture remained stable over the following 12 months. In this patient, we observed the ophthalmoscopic features of chronic myeloid leukemia, but also coexistence of features typical of Terson syndrome. To our knowledge, no similar cases have been reported previously.

In vivo confocal microscopic evaluation of corneal langerhans cells in dry eye patients.

PURPOSE: To assess inflammatory involvement of cornea in dry eye by means of confocal microscopy, evaluating the presence and distribution of Langherans cells (LCs). METHODS: 98 eyes of 49 subjects were enrolled: 18 subjects affected by Sjögren Syndrome Dry Eye (SSDE), 17 with Non-Sjögren Syndrome Dry Eye (NSSDE), 14 healthy volunteeers. Dry eye symptoms, tear film, ocular surface damage and corneal confocal microscopy were analized. RESULTS: A significant increase of LCs density was observed at sub-basal nerve plexus (SSDE = 79 cells/mm(2) andNDE = 22 cells/mm(2); p = 0,0031) and sub-epithelial nerve plexus (SSDE = 38 cells/mm(2) and NDE = 3 cells/mm(2); p = 0,0169) in central cornea of SSDE group. An increased number of LCs from the center to the periphery of the cornea was observed, significant only in healthy volunteers group. In dry eye patients there was an increase in LCs density in both peripheral and central cornea with a significant difference between NDE (14,66 cells/mm(2)) and SSDE (56,66 cells/mm(2)) only in central cornea (p = 0,0028). In SSDE group, mean density of LCs in central cornea results also superior to NSSDE group (29,33 cells/mm(2)). There was no correlation between LCs density and dry eye symptoms, tear film deficiency and ocular surface damage. CONCLUSION: This study demonstrates the activation of an inflammatory and immunological reaction in cornea of NSSDE and SSDE patients. Confocal microscopy can be an important diagnostic tool in evaluation and follow-up of dry eye disease.

In vitro susceptibility to different topical ophthalmic antibiotics of bacterial isolates from patients with conjunctivitis.

PURPOSE: To test in vitro the susceptibility to different commercially-available topical antibiotics of isolates from patients with conjunctivitis, evaluated at the Microbiology Service of Turin Ophthalmic Hospital between January 2005-February 2007. METHODS: Bacterial isolates were cultured using both liquid and solid media. The four most frequent isolates were analyzed and their in vitro susceptibility to levofloxacin, ofloxacin, norfloxacin, lomefloxacin, tobramycin, netilmycin, ampicillin, and chloramphenicol was tested, using the Kirby-Bauer diffusion method and National Committee for Clinical Laboratory Standards (NCCLS) serum standards. RESULTS: The four most common bacteria isolates were: Staphylococcus aureus (27%), viridians Streptococci (22%), Staphylococcus epidermidis (16%) and Streptococcus pneumoniae (13%). The in vitro susceptibility to levofloxacin was highest (p<0.01) for all bacterial isolates. CONCLUSIONS: In vitro susceptibility tests showed that levofloxacin had the highest cumulative efficacy against bacterial isolates. Netilmycin showed the highest efficacy against staphylococcus aureus, the most common bacterial isolate in this study.

The trabecular bypass stent in a pseudophakic glaucoma patient: A 1-year follow-up.

PURPOSE: To describe the 1-year success of a trabecular stent implant in a pseudophakic glaucoma patient. The stent is implanted through a small corneal incision under gonioscopic control. Intraocular pressure control was reported in cultured human anterior segment. DESIGN: Observational case report. METHODS: We report the case of a patient who was implanted and followed-up for 1 year at the Dipartimento di Fisiopatologia Clinica. The main outcome measures were intraocular pressure and visual field. RESULTS: The patient's intraocular pressure was controlled with topical beta-blockers for 6 months and without therapy for 6 months. Two diurnal curves demonstrated achievement of target pressure during the day. The 1-year visual field was unchanged. CONCLUSIONS: We are not aware of previous reports of trabecular stent implantation in pseudophakic patients. The trabecular stent had minimal peri-operative morbidity. Identification of the implantation site is challenging and reduction of efficacy over time may occur.