Emergence of Enterococcus species in the infectious microorganisms cultured from patients with endophthalmitis in South Korea.

PURPOSE: To investigate the microorganisms in culture-proven endophthalmitis and their susceptibilities to antimicrobial agents commonly used in South Korea. METHODS: Medical records of consecutive patients with culture-proven endophthalmitis at eight institutions between 1 January 2004 and 31 July 31 2010 were reviewed. Four categories of endophthalmitis were studied: postoperative, posttraumatic, endogenous, and unspecified. Outcome measures were culture-proven infectious organisms, antimicrobial susceptibilities, and final visual acuity in the patients. RESULTS: A total of 93 microorganisms were identified from 103 patients during the study period. The positive culture rate was 59.2 % (103/174). The most common organisms identified were Enterococcus faecalis (in 20.8 % of patients, 20/96), Staphylococcus epidermidis (18.8 %, 18/96), other coagulase-negative staphylococci (10.4 %, 10/96), Pseudomonas aeruginosa (6.3 %, 6/96), and Klebsiella pneumoniae (6.3 %, 6/96). Two cases of Enterococcus faecium (2.1 %) were recognized. Overall, 70 of 96 (73.0 %) isolates were Gram-positive bacteria, 22 (23.0 %) were Gram-negative bacteria, and 4 (4.2 %) were fungi. The most common organisms resulting in reduced light perception were E. faecalis and K. pneumoniae. CONCLUSIONS: The emergence of E. faecalis in endophthalmitis is mainly caused by the high incidence of E. faecalis in postoperative endophthalmitis. This increase also impacts the final visual acuity of the patients.

Intravitreal antibiotic therapy with vancomycin and aminoglycoside. An experimental study of combination and repetitive injections.

We evaluated the retinal toxic reaction of combined intravitreal therapy with regimens of 1.0 mg of vancomycin hydrochloride and 400 micrograms of amikacin sulfate or 1.0 mg of vancomycin hydrochloride and 100 micrograms of gentamicin sulfate in the rabbit eye. The effects of reinjecting each combination a second or third time, separated by 48-hour intervals, were also examined by ophthalmoscopy and light and transmission electron microscopy. The initial administration of either regimen did not produce toxic reaction. After two injections, five of six eyes with vancomycin-gentamicin therapy and three of six eyes with vancomycin-amikacin therapy displayed focal areas of retinal toxic reaction on histologic study. After three injections, all eyes treated with either regimen showed histologic evidence of more advanced retinal toxic reaction primarily involving the outer retina and retinal pigment epithelium. The present study demonstrates the safety of an initial intravitreal injection of vancomycin and aminoglycoside but shows increasing retinal toxic reaction with repetitive combination therapy.

Photorefractive keratectomy for astigmatism greater than -2.00 diopters in eyes with low, high, or extreme myopia.

PURPOSE: To assess the efficacy of excimer laser photorefractive astigmatic keratectomy (PARK) in correcting astigmatism of more than -2.00 diopters (D) in eyes with low, high, and extreme myopia. SETTING: Pusan National University Hospital, Pusan, Korea. METHODS: Eighty-five patients (110 eyes) whose spherical error ranged from -3.00 to -13.00 D and cylinder ranged from -2.00 to -5.50 D had PARK with a VISX Twenty-Twenty excimer laser; follow-up was 6 months. All cases of myopic astigmatism were treated using the elliptical method and multizone ablation technique. Eyes were divided into 3 groups: low myopia, less than 6.00 D (n = 47); high myopia, from 6.25 to 10.00 D (n = 43); extreme myopia, over 10.25 D (n = 20). Alpins vector analysis was used to calculate the astigmatic change. RESULTS: By vector analysis, the success rate of astigmatic correction was more predictable in the low and high myopia groups than in the extreme myopia group (P < .05). There was little improvement in astigmatism in the extreme myopia group. CONCLUSION: Using PARK to correct astigmatism greater than -2.00 D in eyes with myopia less than -10.00 D tended to result in undercorrection; astigmatic correction in eyes with myopia over 10.25 D was minimal.

The treatment of lacrimal apparatus obstruction with the use of an inner canthal Jones tube insertion via a transcaruncular route.

BACKGROUND AND OBJECTIVE: To evaluate the clinical utility of the lacrimal bypass surgery using Bowman's probe in treatment of obstruction of the lacrimal apparatus. PATIENTS AND METHODS: This study evaluated 124 cases of obstruction of the lacrimal passage systems with mean epiphora of 2.7 years. An incision was made on the side of the caruncle, and the lacrimal bone was penetrated between the lacrimal sac and the nasal mucosa by Bowman #0. Insertion of a Jones tube was made at the new lacrimal pathway, a puctum dilator or scissors was introduced through the caruncle and dilated across the lacrimal bone into the nasal cavity. The Jones tube was introduced over the probe into the nasal cavity, and fixed at the caruncle with nonabsorbable suture material. RESULTS: Complete resolution of epiphora was accomplished in 120 (96.8%) of 124 eyes; only 4 (3.2%) eyes failed during a mean of 17.1 months of follow-up. CONCLUSION: This procedure is simple and safe with no facial scarring, short operation time, high success rate, and can be performed under local anesthesia. Therefore, the clinical utility of this procedure seems to be of value in treatment of complicated obstruction of the lacrimal apparatus.

Orbitocranial injury caused by wood.

A rare case of a patient with orbitocranial injury by a wooden foreign body is reported. Penetrating periorbital wound by a wooden stick with entry site at the right upper eyelid was related to the invasion into the temporal lobe. Fortunately, the anterior and posterior segments of eye were unharmed, but right ocular motility was markedly restricted mechanically in all directions. Forced duction test was strong positive, especially the dextroversion of the right eye. Computed tomography scan showed a well-delineated low density from the orbital wall into the temporal lobe. The wooden foreign body was subsequently removed from the orbit and the temporal lobe, through the neurosurgical frontotemporal approach. After the wooden foreign body was removed, the ocular movement of the right eye fully recovered without any intracranial or ocular complications.

Painful ophthalmoplegia secondary to nasopharyngeal carcinoma--a case report.

A case of painful ophthalmoplegia with unilateral ocular pain, fixed eyeball to all directions of gaze, and loss of vision is presented. After intensive steroid therapy, conjunctival chemosis subsided markedly, but no improvement was seen in other clinical signs. We took a CT scan of orbit brain and performed nasopharyngeal biopsy and open biopsy through craniectomy. Based on the results of clinical features and findings of the CT scan and tissues, we diagnosed painful ophthalmoplegia secondary to nasopharyngeal carcinoma metastasized to orbital apex and brain.

Five cases of microphthalmia with other ocular malformations.

We report five cases of complex microphthalmia with other ocular malformations in infants or children, which were evaluated to investigate the relationship between the corneal diameters and total axial length. The size of the globe was measured by using computerized tomographic scans (CT scan), A-scan ultrasonography, or magnetic resonance imaging (MRI). There is a limited range of well-described malformation, including anterior or posterior segment dysgenesis or combined pathology such as corneal opacity, small cornea, iris hypoplasia, lens dislocation, cataract, chorioretinal coloboma, persistent hyperplastic primary vitreous (PHPV), retinal dysplasia, and intraocular tumor. Corneal diameters were correlated significantly with total axial length (r2 = 0.88) and decreased linearly as the total axial length decreased in these cases. However, there was no relationship seen between the total axial length and posterior segment length (r2 = -0.06). The results of this study may aid the clinical ophthalmologist to accurately understand or assess microphthamia combined with other ocular malformations.

Differences in corneal thickness and corneal endothelium related to duration in diabetes.

PURPOSE: This study evaluated the differences of corneal thickness and corneal endothelial morphology in diabetes compared with age-matched, healthy control subjects; in addition, we tested for correlation according to the duration of diabetes. METHODS: Ultrasound pachymetry and noncontact specular microscopy were performed on 200 patients with diabetes and 100 control subjects. We compared the values for diabetics and normal persons with ANACOVA to adjust for age. Moreover, we examined the correlation between the subject parameters and the duration of diabetes by using a partial correlation coefficient that controlled for age. RESULTS: The diabetic subjects had thicker corneas, less cell density and hexagonality, and more irregular cell size of the corneal endothelium than did the controls (P < 0.05). Central corneal thickness and the coefficient of variation for cell size were significantly higher for diabetes of over 10 years' duration than for diabetes of under 10 years' duration (P < 0.05). The endothelial cell density and percentage of hexagonal cells were lower for diabetes of over 10 years' duration than for diabetes of under 10 years' (P > 0.05). Central corneal thickness was correlated with duration of diabetes (P < 0.05), but corneal endothelial morphology was not (P < 0.05). CONCLUSIONS: Those patients with diabetic duration of over 10 years have more corneal morphological abnormalities, especially the coefficient of variation in cell size, compared with the normal subjects. The central corneal thickness was significantly correlated with diabetic duration after controlling for age.

Mitomycin c influence on inhibition of cellular proliferation and subsequent synthesis of type I collagen and laminin in primary and recurrent pterygia.

The purpose was to investigate the biological effects of mitomycin C (MMC) on the inhibition of cellular proliferation and the subsequent synthesis of extracellular matrix like type I collagen (PIP) and laminin on primary and recurrent pterygia. The 3H-thymidine assay for cellular proliferation was consistent with the MMC dose and time response of both pterygia. The cellular inhibitory effect of MMC was greater on recurrent pterygial cells than primary ones. The inhibition of laminin by MMC followed the dose and time-response curves, with a stronger effect found in recurrent pterygial cells, but no significant difference between the two types concerning type I collagen synthesis. The inhibition of fibroblast proliferation and subsequent synthesis of laminin by MMC was more marked in recurrent pterygium than the primary one.

Retinoblastoma which developed in microphthalmia.

We report a rare case of retinoblastoma which developed in unilateral microphthalmia. A 4-year-old girl presented with a large, intraocular mass in microphthalmia without a family history of retinoblastoma. The eyeball was enucleated due to rapid growth of the intraocular tumor. Microscopically it proved to be a retinoblastoma with some Flexner-Wintersteiner rosettes. This unusual case shows that retinoblastoma should not be excluded just because the eye is small, particularly if the family history is not available or is incomplete.

Intravitreal antibiotic therapy with vancomycin and aminoglycoside: examination of the retinal toxicity of repetitive injections after vitreous and lens surgery.

The combination of vancomycin and an aminoglycoside antibiotic is frequently injected into aphakic/vitrectomized eyes for the treatment of endophthalmitis. At 2 weeks after lens and vitreous removal, rabbit eyes received an injection of a combination of 1 mg vancomycin and either 400 micrograms amikacin or 100 micrograms gentamicin. Furthermore, the effects of repeating the same combination a second and third time at intervals of 48 h were examined by light and transmission electron microscopy at 7 days to 4 months after the last injection. A single injection of either combination produced no toxicity. After 2 or 3 sets of injections of either combination, 13 of 16 eyes displayed retinal toxicity manifested by macrophages in the subretinal space, disorganization of the outer segments and retinal pigment epithelium, and discontinuities in Bruch's membrane. These results indicate that whereas a single injection of these combinations is not toxic to aphakic/vitrectomized eyes, repetitive injections may result in increasing toxicity.

Clinical efficacy of the polyurethane stent without fluoroscopic guidance in the treatment of nasolacrimal duct obstruction.

PURPOSE: To evaluate the clinical efficacy of the polyurethane (Song) stent in the treatment of nasolacrimal duct obstruction without fluoroscopic guidance, especially at the junction between the lacrimal sac and nasolacrimal duct or at the nasolacrimal duct. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: This study evaluated 59 cases of nasolacrimal duct obstruction in 53 patients, with mean epiphora of 36 months (range, 2 months-17 years). METHODS: Without the assistance of a radiologist, a polyurethane nasolacrimal stent was placed by introducing a guidewire through the superior or inferior punctum into the canaliculus and advancing it across the obstruction into the opening of the inferior meatus of the nasal cavity. The mean follow-up period was 22 months (range, 12 months-48 months). MAIN OUTCOME MEASURES: Patency of the lacrimal passage to irrigation and the duration of this procedure. RESULTS: Complete resolution of epiphora was accomplished in 55 (93.2%) of the 59 eyes. There was recurrence of epiphora in four cases because of obstruction of the stent in three cases and obstruction of the common canaliculus by recurrent dacryocystitis in one case. CONCLUSIONS: Polyurethane stenting without fluoroscopic guidance seems to be a valuable technique for primary management of nasolacrimal duct obstruction before dacryocystorhinostomy.

A comparative study of corneal endothelial changes induced by different durations of soft contact lens wear.

PURPOSE: To analyze the effect on the morphologic characteristics of the corneal endothelium of the duration of soft contact lens wearing periods. METHODS: Ninety soft contact lens wearers were divided into three groups: short-term users, for less than 5 years (n=60 eyes); intermediate-term users, from 6 years to 10 years (n=60); longterm users, for more than 10 years (n=60). Thirty non-contact lens wearers (60 eyes) were included as controls. All eyes were examined with a specular microscope. Analysis of covariance was used to detect any differences among the controls and the various soft contact lens subgroups. RESULTS: There was a significant correlation between duration of soft contact lens use and morphologic changes of corneal endothelium. All soft contact lens subgroups had a significantly greater coefficient of variation in cell size than non-contact lens users . The proportion of hexagonal cells and the mean corneal endothelial cell density in those using soft contact lenses for more than 6 years were significantly lower than in the control group . Soft contact lens wear was significantly correlated with decreasing corneal endothelial cell densities with time. CONCLUSION: The coefficient of variation in cell size may be a sensitive indicator of early morphologic changes of the corneal endothelium. As the decrease in cell density among the contact lens subgroups was significantly associated with the duration of soft contact lens wearing periods, it will be useful to investigate endothelial cell density for evaluation of corneal endothelial function concerned with contact lens wearing.

Normative measurements of Korean orbital structures revealed by computerized tomography.

PURPOSE: The purposes of this study were to establish criteria for the diameters of normal extraocular muscles, the width of the optic nerve, and the globe position as revealed by CT, and to investigate the effects of age and sex on these parameters in the Korean population. SUBJECTS AND METHODS: Diameters of extraocular muscles (medial, lateral, superior complex, and inferior rectus), distance from the interzygomatic line to the posterior margin of the globe, width of the optic nerve-sheath complex, and length of the interzygomatic line were calculated for 214 patients on axial and direct coronal CT images, and the effects of age and sex were analyzed. RESULTS: Normal range for the diameters as given by mean+/-2SDs of extraocular muscles were medial rectus, 2.2--5.4 mm; lateral rectus, 2.1--4.9 mm; inferior rectus, 2.5--5.7 mm; and superior complex group, 2.6--6.4 mm. The mean optic nerve-sheath complex was 4.1 mm and the values ranged from 2.9 mm to 5.3 mm. The mean length of the interzygomatic line was 103.8 mm. The normal posterior position of the globe as here designed was 11.2 mm behind the interzygomatic line (range, 6.4--15.3 mm). All parameters under study were a little larger in males than females. Statistically, however, there was no significant difference between males' and females' results, nor between the various age groups (p>0.05). CONCLUSION: Our CT results may help clinical ophthalmologists to accurately assess enlargement of the extraocular muscles and the optic nerve as well as aiding in the evaluation of exophthalmos.

Intraocular penetration of rifampin after oral administration.

Rifampin, the most potent anti-staphylococcal drug known, was examined for its penetration into the aqueous and vitreous of rabbits after a single oral dose of 150 mg, 300 mg, or 600 mg. Maximum levels after the 150 mg dose were achieved at 4 h and were 4.2 micrograms/ml in the aqueous and 2.2 micrograms/ml in the vitreous. After the 300 mg dose, maximum levels were also achieved at 4 h, and were 5.0 micrograms/ml in the aqueous and 2.6 micrograms/ml in the vitreous. The 600 mg dose produced maximum levels at 6 h after administration, with 20.0 micrograms/ml in the aqueous and 15.2 micrograms/ml in the vitreous. These levels exceed the minimum inhibitory concentration for many microorganisms and suggest additional investigation into possible applications of systemic rifampin in the prophylaxis and treatment of bacterial endophthalmitis.