ABSTRACT
Caso clínico: Paciente diabético que desarrolla una uveítis unilateral con un foco de coriorretinitis en el ojo derecho asociada a fiebre y disminución de la visión. Sospechándose una endoftalmitis endógena se realizaron pruebas complementarias encontrándose abscesos hepáticos con biopsia positiva para Klebsiella. La afectación ocular se fue resolviendo gracias a antibioticoterapia intravenosa y al drenaje percutáneo de los abscesos. Conclusión: La endoftalmitis endógena por Klebsiella es un hallazgo poco frecuente con consecuencias graves. Un diagnóstico y un tratamiento antibioticoterápico tempranos pueden mejorar el cuadro aunque la visión resultante suele ser pobre(AU)
Case report: A diabetic patient who developed a unilateral uveitis with a chorioretinitis patch in his right eye associated with decreased visual acuity and fever. Endogenous endophthalmitis was suspected and complementary tests were performed, finding hepatic abscesses with Klebsiella isolation in the biopsy. The ocular disorder slowly improved with intravenous therapy and guided percutaneous liver drainage. Conclusion: Endogenous Klebsiella endophthalmitis is an uncommon condition with severe complications. An early diagnosis and aggressive antibiotic therapy can ameliorate the final course but the visual outcome still remains poor(AU)
Subject(s)
Humans , Male , Middle Aged , Sepsis/complications , Klebsiella/isolation & purification , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Retinal Hemorrhage/complications , Retinal Hemorrhage/diagnosis , Chorioretinitis/complications , Intravitreal Injections/methods , Early Diagnosis , Sepsis/diagnosis , Liver Abscess/complications , Liver Abscess/diagnosis , Liver Abscess/drug therapy , Endophthalmitis/physiopathology , Uveitis/complications , Antibiotic Prophylaxis/methods , Retinal Hemorrhage/drug therapyABSTRACT
PURPOSE: The purpose of this study was to determine the incidence of infectious endophthalmitis after intravitreal injection of antivascular endothelial growth factor medications using 2% topical lidocaine gel anesthesia. METHODS: Retrospective chart review of 4690 consecutive intravitreal injections of antivascular endothelial growth factor medications using 2% topical lidocaine gel anesthesia. All patients had at least 6 weeks of follow-up. RESULTS: A total of 608 patients underwent intravitreal injection of antivascular endothelial growth factor medications during the study period. There were 428 injections of pegaptanib sodium, 1841 injections of bevacizumab, and 2421 injections of ranibizumab. There were no cases of infectious endophthalmitis. The per-injection infection rate was 0.0% (95% confidence interval, 0.0-0.06%). CONCLUSION: The incidence of infectious endophthalmitis after intravitreal injection of antivascular endothelial growth factor medications using 2% topical lidocaine gel anesthesia is low.
Subject(s)
Anesthesia, Local/methods , Anesthetics, Local/administration & dosage , Angiogenesis Inhibitors/administration & dosage , Endophthalmitis/epidemiology , Eye Infections, Bacterial/epidemiology , Lidocaine/administration & dosage , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Antibodies, Monoclonal, Humanized/administration & dosage , Aptamers, Nucleotide/administration & dosage , Bevacizumab , Endophthalmitis/microbiology , Endophthalmitis/physiopathology , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/microbiology , Eye Infections, Bacterial/physiopathology , Humans , Incidence , Intravitreal Injections , Ranibizumab , Retrospective Studies , Time Factors , Visual Acuity/physiologyABSTRACT
Ocular ischemia and inflammation are two major factors which induce retinal degeneration. Treatment of these diseases has been difficult, though numerous agents have been tried. Natural products could be a good field to venture into because various medicinal plants have been used for centuries to treat circulation stasis, inflammation, visual disturbances, and eyesight failure. Tetramethyl-pyrazine, coumarin, methyl tyramine, rescinnamine, apocynin, and hesperetin are some natural products isolated from Chinese herbs for improving ocular blood flow, particularly in the choroid and retina. For ocular inflammation, at least a dozen natural products are reviewed in this article. Among those, matrine, tetrandrine and osthole draw particular attention, because they are effective mainly as interleukin-1 blockers, but not as arachidonate blockers. As a result, these agents are potent anti-inflammatory agents and are even more potent than the prototype corticosteroid, prednisolone. It is hoped that all aforementioned agents can be used to treat retinopathies resulting from ocular ischemia and/or ocular inflammation. Scoparone, corylifolinin, epigallocatechin-3-0-gallate, esculetin, and lespedezaflavanone A are some natural products which can improve retinal functions measured with electroretinogram's b-wave recovery. Further research should be carried out to relate natural products which can improve ocular blood flow and inflammation to retinal function and vice versa.