Primera manifestación oftalmológica de una sepsis por Klebsiella. Importancia de la sospecha diagnóstica precoz / Endogenous endophthalmitis as a first clinical manifestation of Klebsiella sepsis. The importance of an early diagnosis

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)

[Dynamic phototherapy as a treatment for central serous chorioretinopathy]. / Traitement des choriorétinopathies séreuses centrales par photothérapie dynamique.

PURPOSE: To analyze the angiographic and tomographic results and the visual acuity of a group of patients presenting acute or chronic serous central chorioretinopathy (CSCR) treated with dynamic phototherapy. This treatment was guided by ICG angiography data. PATIENTS AND METHOD: We conducted a retrospective/prospective nonrandomized study on 31 eyes of 27 patients, including eight acute forms and 23 chronic forms. One or more spots were treated according to the age-related macular degeneration standard protocol on the zones of choroidal hyperpermeability highlighted by ICG angiography. The criteria for success were based on functional signs, visual acuity, persistence of a point of leakage in angiofluorographic follow-up at 3 months, and the OCT study of serous retinal detachment. RESULTS: An increase in visual acuity (3.58+/-3.22 lines, p<0.0001) was observed for all forms of treated CSCR; 90.32% patients presented a reapplication of serous retinal detachment within a period of 7.28+/-3.93 weeks. No retinal pigmentary epithelium tear or choroidal neovascularization was observed. Recurrence occurred in 12.9% patients within a period of 28+/-16.24 weeks; only chronic CSCR cases were concerned. At 8+/-4.2 months, the visual acuity of the patients who had no recurrence remained unchanged (0.356+/-0.4 LogMAR or 20/50-20/40). CONCLUSION: Although the number of patients included in this study is limited, dynamic phototherapy currently seems to be an effective and sure treatment of CRSC. A randomized study on a large series is necessary to confirm these results.