Streptococcus pneumoniae endophthalmitis: clinical settings, antibiotic susceptibility, and visual outcomes.

Streptococcus pneumoniae endophthalmitis is clinically more severe, more difficult to treat, and carry a higher risk of vision loss, evisceration, or enucleation. This study is to investigate the clinical settings, antibiotic susceptibility, and visual outcomes of S. pneumoniae endophthalmitis at a tertiary referral center in Taiwan. S. pneumoniae endophthalmitis was diagnosed in 38 eyes of 38 patients. The main clinical features were postcataract endophthalmitis (n = 13, 34%) and endophthalmitis associated with corneal ulcer (n = 12, 32%), trauma (n = 6, 16%), endogenous etiology (n = 4, 11%), trabeculectomy (n = 2, 5%), and pterygium excision-related scleral ulcer (n = 1, 3%). Presenting visual acuity ranged from counting fingers to no light perception. Pars plana vitrectomy with intravitreal antibiotics was performed in 17 eyes (39%) in primary or secondary treatments. S. pneumoniae isolates were susceptible to vancomycin (38/38, 100%), penicillin (37/38, 97%), ceftriaxone (37/38, 97%), cefuroxime (12/15, 80%), levofloxacin (13/15 ,87%), and moxifloxacin (15/17, 88%). Final visual acuity was better than 20/400 in 3 of 38 eyes (8%), 5/200 to hand motions in 3 eyes (8%), and light perception to no light perception in 32 eyes (84%). Ten eyes (26%) underwent evisceration or enucleation. Although S. pneumoniae isolates were susceptible to vancomycin, S. pneumoniae endophthalmitis had a very poor visual prognosis.

[Bacterial flora of conjunctival sac in patients with cataract. Methods of disinfection and evaluation of their efficiency]. / Mikroflora worka spojówkowego u chorych z zacma--metody dezynfekcji i ocena ich skutecznosci.

PURPOSE: 1) To evaluate the microbacterial flora of the conjunctival sac and the sensitivity of the isolated microorganisms to 0.3% gentamicin solution and 5.0% PVP-Jodi solution, which is used to disinfect conjunctival sac. 2) To evaluate the role of the adhesive foil in prevention of the infection of the operative field. MATERIAL AND METHODS: 170 patients with senile cataract were examined. Before admission to Ophthalmology Department each patient received 0.3% gentamicin solution three times a day. All patients had their conjunctival sac disinfected with the use of 5% PVP-Jodi before surgery. Patients were divided into two groups. In the first group (120 patients), first samples were taken on admission to the Ophthalmology Department. Next in the day of the procedure, in the operation room--first before and second after disinfection of conjunctival sac. Adhesive foil was not used in this group. In the second group (50 patients), we used adhesive foil before surgery and samples were taken before and after disinfection of conjunctival sac. RESULTS: On admission, positive cultures were obtained in 40.0% cases. Most of the bacterial flora were Gram-positive bacteria. The number of the positive cultures before disinfection with 5.0% PVP-Jodi solution diminished to 5.8%, compared with positive results obtained on admission to the Ophthalmology Department. Secondary infection of the conjunctival sac has been revealed in 10% after disinfection with the use of the 5.0% PVP Jodi. It was due to bacterial flora coming from the skin and limbs of the lids (in the group without adhesive foil), whereas positive samples were obtained in 2.0% in the group where adhesive foil was used. CONCLUSIONS: 1) Gentamicin significantly reduces the amount of bacterial flora in conjunctival sac in patients before cataract surgery. 2) Adhesive foil is efficient to protect operative field from infection.

Increased levels of Helicobacter pylori IgG antibodies in aqueous humor of patients with primary open-angle and exfoliation glaucoma.

PURPOSE: A prospective, nonrandomized, comparative study was carried out to investigate the levels of anti- H. pylori-specific IgG antibodies in the aqueous humor and serum of patients with primary open-angle glaucoma (POAG) and patients with exfoliation glaucoma (XFG), and to compare them with those in age-matched cataract patients. METHODS: Aqueous humor was aspirated at the beginning of glaucoma surgery from 26 eyes of 26 patients with POAG, 27 eyes of 27 patients with XFG, and at the beginning of phakoemulsification cataract surgery from 31 eyes of 31 age-matched normotensive cataract patients. Serum samples were obtained the day before surgery from all patients. Anti- H. pylori IgG concentration in the aqueous humor and serum was measured by means of an enzyme-linked immunosorbent assay. RESULTS: The mean concentration (+/- SE) of anti- H. pylori-specific IgG was significantly greater in the aqueous humor samples from patients with POAG (14.27+/-3.86 U/ml) and XFG (14.25+/-3.39 U/ml) than in those from age-matched control cataract patients (4.67+/-1.07 U/ml); ( P=0.006 and P=0.003, respectively). No difference was observed in the levels of H. pylori-specific IgG antibodies between POAG and XFG aqueous humor samples ( P=0.5). Similarly, the serum concentration of anti- H. pylori antibodies was significantly greater in patients with POAG (69.96+/-9.69 U/ml; P=0.013) and XFG (81.37+/-10.62 U/ml; P=0.002) than in the cataract controls (44.16+/-6.48 U/ml). The mean vertical cupping correlated significantly with the titer of anti- H. pylori-specific IgG in the aqueous humor in the POAG patients. CONCLUSION: H. pylori-specific IgG antibody levels are significantly increased in the aqueous humor and serum of patients with POAG and XFG. Moreover, the titer of anti- H. pylori antibody in the aqueous humor might reflect the severity of glaucomatous damage in POAG patients. These findings support a role for H. pylori infection in the pathobiology of these two common glaucomas.