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PURPOSE: To describe the clinical features, management, and long-term outcome of Infectious crystalline keratopathy (ICK). METHODS: The medical records of clinically diagnosed and microbiologically proven cases of ICK were reviewed from January 2011 to December 2022. Clinical characteristics include the presence of whitish needle-like projections with branching, limited to anterior-mid stroma. Keratoplasty being the most common risk factor, graft-related microbial keratitis during the same period was also studied. The demography, clinical profile, microbiology, treatment, and outcome were analyzed, and compared with secondary graft infiltrate(GI). RESULTS: Medical records of 24 cases with ICK were reviewed. The mean age was 49.3 ± 20.1 years, with 15(62.5%) males. Prior keratoplasty was done in 18 (75%) cases, with a mean graft size of 10.1 ± 1.5 mm, and mean interval between the last graft and presentation was 9.7 ± 6.2 (3-90) months. In comparison to GI (n = 24), ICK patients (n = 18,75%) were less symptomatic, presented late (7.3 ± 6.5 days vs 16.3 ± 19.4, p = 0.003), using frequent topical steroids (> 3 times/day, p = 0.006), smaller infiltrate size < 4 mm (p = 0.008), central (p = 0.02), less associated with epithelial defect (p = 0.0001), hypopyon (p = of 0.0002), corneal perforation (p = 0.0006), and surgical management (p = 0.03). On microbiology, 22 (91.6%) ICK cases were culture positive, 14 (63.6%) gram-positive, 3 (13.6%) gram-negative, 2 (9%) mixed bacteria, and 3 (13.6%) fungus, comparable with GI. CONCLUSION: ICK affects poor ocular surfaces usually following keratoplasty with larger graft size, the use of steroids being the most common association, and it responds to medical management as compared to GI.
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Infecciones Bacterianas del Ojo , Agudeza Visual , Humanos , Masculino , Persona de Mediana Edad , Femenino , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/terapia , Estudios Retrospectivos , Adulto , Anciano , Bacterias/aislamiento & purificación , Antibacterianos/uso terapéutico , Córnea/microbiología , Córnea/patología , Estudios de Seguimiento , Queratitis/microbiología , Queratitis/diagnóstico , Enfermedades de la Córnea/diagnóstico , Enfermedades de la Córnea/microbiología , Enfermedades de la Córnea/cirugía , Enfermedades de la Córnea/terapia , Anciano de 80 o más Años , Adulto Joven , Trasplante de Córnea/métodos , Hongos/aislamiento & purificaciónRESUMEN
INTRODUCTION: The eye consists of both internal and external compartments. Several variables, including microbes, dust, and high temperatures can cause eye illnesses that can result in blindness. Bacterial eye infections continue to be a major cause of ocular morbidity and blindness, and their prevalence is periodically rising. The objective of the study was to detect bacterial pathogens and assess their susceptibility profiles to antibiotics in the ophthalmology unit of Boru-meda Hospital in Dessie, Ethiopia. METHODS: A hospital-based cross-sectional study was conducted from February 1 to April 30, 2021, among 319 study participants with symptomatic ocular or peri-ocular infections who were enrolled using a consecutive sampling technique. After proper specimen collection, the specimen was immediately inoculated with chocolate, blood, and MacConkey agar. After pure colonies were obtained, they were identified using standard microbiological methods. The Kirby Bauer disk diffusion method was used to test antimicrobial susceptibility patterns, based on the guidelines of the Clinical and Laboratory Standards Institute. RESULTS: The majority of participants developed conjunctivitis 126 (39.5%), followed by blepharitis 47 (14.73%), and dacryocystitis 45 (14.1%). Overall, 164 (51.4%) participants were culture positive, six (1.9%) participants had mixed bacterial isolates, giving a total of 170 bacterial isolates with an isolation rate of 53.3%. The predominant species was CoNS 47 (27.6%), followed by S. aureus 38 (22.4%) and Moraxella species 32 (18.8%). The overall Multi-Drug Resistance (MDR) rate was 62.9%, with 33 (44.6%) being gram-negative and 74 (77.1%) being gram-positive isolates. CONCLUSION: Conjunctivitis was the dominant clinical case and CoNS, was the predominant isolate. A higher rate of MDR isolates, particularly gram-positive ones, was observed. Efficient peri-ocular or ocular bacterial infection surveillance, including microbiological laboratory data, is necessary for monitoring disease trends.
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Antibacterianos , Infecciones Bacterianas del Ojo , Pruebas de Sensibilidad Microbiana , Humanos , Etiopía/epidemiología , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/epidemiología , Estudios Transversales , Masculino , Adulto , Femenino , Persona de Mediana Edad , Adulto Joven , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Adolescente , Hospitales Generales , Bacterias/aislamiento & purificación , Bacterias/efectos de los fármacos , Niño , Anciano , PreescolarRESUMEN
Purpose: To determine the physiological status of the retina of eyes with endophthalmitis by examining the electroretinograms (ERGs) recorded with a portable recording system and to determine whether the pretreatment ERG findings were correlated with the best-corrected visual acuity (BCVA) after the treatment. Methods: We examined the medical records of 118 eyes of 108 patients who were diagnosed and treated for infectious endophthalmitis at Saitama Medical University Hospital, Japan, between January 2015 to November 2022. Of these, we studied the 25 eyes of 21 patients who had been evaluated by electroretinography. In bilateral cases, one eye was analyzed. The eyes were classified into those with postoperative endophthalmitis (group S, n = 12) and those with endogenous endophthalmitis (group E, n = 9). Photopic and flicker ERGs were recorded with the RETeval system. The pretreatment clinical factors studied were the ERG components that might be correlated with the post-treatment BCVA. Results: Eyes in Group E with larger amplitude flicker ERGs (P = 0.0053, ρ = -0.8333) had better BCVA after treatment. In Group S, eyes with larger amplitude flicker ERGs (P = 0.0086, ρ = -0.7173), photopic a-waves (P = 0.0323, ρ = 0.6177), and photopic b-waves (P = 0.0055, ρ = -0.7443) had better BCVA after treatment. Conclusions: Simple and rapid ERG evaluations under light-adapted condition are helpful in evaluating the pretreatment retinal function and to determine the visual prognosis in eyes with endophthalmitis. Translational Relevance: Simple and non-time-consuming ERG evaluations are helpful in evaluating the retinal function in eyes with endophthalmitis and predicting the visual prognosis.
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Electrorretinografía , Endoftalmitis , Retina , Agudeza Visual , Humanos , Endoftalmitis/fisiopatología , Endoftalmitis/diagnóstico , Endoftalmitis/microbiología , Electrorretinografía/métodos , Femenino , Masculino , Agudeza Visual/fisiología , Anciano , Persona de Mediana Edad , Retina/fisiopatología , Adulto , Anciano de 80 o más Años , Estudios Retrospectivos , Infecciones Bacterianas del Ojo/fisiopatología , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Antibacterianos/uso terapéuticoRESUMEN
Purpose: We constructed a clinical clue-based algorithm to identify the microbiology-positive post-cataract surgery endophthalmitis. Methods: The Endophthalmitis Infectivity Measurement Algorithm (EIMA) was constructed using presenting Snellen vision (Letter score [LS]) and Inflammation Score (IS, from the cornea, anterior chamber, iris, and vitreous). Retrospective data (70% for training; 30% for testing) was fitted into CHAID (Chi-squared Automatic Interaction Detection). EIMA was validated with prospective data. EIMA-categorized disease severity was weighed against the symptom duration to detect infecting micro-organisms. Results: EIMA was constructed from 1444 retrospective data. The average LS was 6.03 ± 12.11, median IS was 14 (8-24), and culture positivity was 38%. The accuracy and area under the curve of CHAID were 66.36% and 0.642, respectively. EIMA was validated with 175 prospectively collected data. Microbiology positivity (culture + sequencing) was 58.9%. EIMA sensitivity, specificity, and accuracy against microbiology-positive endophthalmitis were 73.7 (95% confidence interval [CI], 64.19-81.96), 81.9 (95% CI, 71.1-90.02), 77.1 (95% CI, 70.20-83.14), respectively. The positive and negative likelihood ratios were 4.08 (95% CI, 2.46-6.67) and 0.32 (95% CI, 0.22-0.45), respectively. There was higher microbial growth in two days or less than in three- to six-day symptom duration (69.9% vs. 28.2%; P = 0.018) endophthalmitis. Gram-negative infection was higher in two days or less (55.6% vs. 20.2%; P = 0.014), and gram-positive infection was higher in three- to six-day endophthalmitis (62.1% vs. 27.7%; P = 0.027). Conclusions: EIMA identified microbiology-positive endophthalmitis three-quarters of the time. Translational Relevance: EIMA suggested infectivity and the class of microbial infection could help targeted management of endophthalmitis after cataract surgery.
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Algoritmos , Extracción de Catarata , Endoftalmitis , Endoftalmitis/microbiología , Endoftalmitis/diagnóstico , Humanos , Extracción de Catarata/efectos adversos , Estudios Retrospectivos , Enfermedad Aguda , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/diagnóstico , Estudios Prospectivos , Sensibilidad y Especificidad , Femenino , AncianoRESUMEN
OBJECTIVES: To investigate the epidemiological characteristics and clinical outcomes of culture-proven bacterial and fungal keratitis at a single tertiary referral centre on Jeju Island, South Korea. DESIGN: A retrospective study design. SETTING: Data from a solitary referral centre on Jeju Island spanning January 2011 to December 2022. PARTICIPANTS: Among the 245 patients clinically diagnosed with infectious microbial keratitis, 110 individuals had culture-positive results. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the identification of causative microbial profiles and epidemiological characteristics, while the secondary outcome was the correlation of these factors with treatment outcomes. RESULTS: Of 245 patients, 110 (44.9%) had culture-positive infectious keratitis, showing 69 bacterial, 32 fungal, 4 superimposed bacterial and 5 cases with coinfection by bacteria and fungus. The most common pathogen was Pseudomonas species in 14.4% of the bacterial keratitis cases, followed by Staphylococcus epidermidis (9%), Staphylococcus aureus (8%) and Moraxella species (7%). The total treatment success rate for bacterial keratitis was 67.5%. The frequency of methicillin-resistant Staphylococcus on Jeju Island did increase during the study period. Fusarium species had the highest incidence at 22.2%, followed by Candida (16.7%) and Colletotrichum species (11.1%). 56.7% of fungal keratitis patients were successfully treated. An initial large corneal lesion (>3 mm) showed a statistically significant association with treatment failure. CONCLUSION: The incidence of Moraxella and Colletotrichum species in our study was higher than that reported in other districts with different climates and environments. The results reported here reflect the unique environmental features of Jeju Island, characterised by high humidity and temperatures.
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Infecciones Fúngicas del Ojo , Queratitis , Humanos , Estudios Retrospectivos , República de Corea/epidemiología , Femenino , Masculino , Persona de Mediana Edad , Queratitis/epidemiología , Queratitis/microbiología , Adulto , Anciano , Infecciones Fúngicas del Ojo/epidemiología , Infecciones Fúngicas del Ojo/microbiología , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/epidemiología , Infecciones Bacterianas del Ojo/microbiología , Antibacterianos/uso terapéutico , Incidencia , Centros de Atención Terciaria/estadística & datos numéricosRESUMEN
Standard bacteriological examinations, which involve culturing microorganisms at 37 °C, are commonly used in clinical practice for diagnosing infectious diseases. However, the growth temperature of microorganisms on the ocular surface (OS) during infectious keratitis (IK) may not coincide with the laboratory standard, which is due to the characteristic features of heat exchange in the eye. PURPOSE: This exploratory study examines the distribution and properties of OS microorganisms isolated under different temperature cultivation conditions in patients with IK and healthy volunteers without ophthalmic pathology. MATERIAL AND METHODS: Fifteen participants were divided into two groups. Group 1 (n=10) consisted of patients with signs of unilateral infectious keratitis, while group 2 (n=5) served as the control group. A novel microbiological method was employed to isolate pure cultures of microorganisms. This method involved cultivating microorganisms at two temperature regimes (37 °C and 24 °C) and subsequently identifying them using biochemical, immunological, and physicochemical techniques, including mass spectrometry. Scanning electron microscopy (SEM) with lanthanide staining used as the reference method. The temperature status of the ocular surface was assessed using non-contact infrared thermography. RESULTS: The study demonstrated the presence of psychrotolerant microorganisms on the ocular surface, which exhibited growth at a relatively low temperature of 24 °C. These psychrotolerant microorganisms were found to be isolated from the ocular surface displaying signs of temperature dysregulation. Among such microorganisms are Acinetobacter lwoffii, Achromobacter xylosoxidans, Bacillus licheniformis, Enterococcus faecalis, Klebsiella oxytoca, Klebsiella pneumoniae, Micrococcus luteus, Pseudomonas luteola, Streptococcus spp. CONCLUSION: When identifying the causative agent of infectious keratitis, it is crucial to consider the divergence of growth temperature of ocular surface microorganisms. The presence of psychrotolerant microorganisms on the ocular surface, which can effectively grow at room temperature, should be taken into account, especially in cases of temperature dysregulation.
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Infecciones Bacterianas del Ojo , Queratitis , Humanos , Queratitis/microbiología , Queratitis/diagnóstico , Masculino , Femenino , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/diagnóstico , Adulto , Persona de Mediana Edad , Temperatura , Córnea/microbiología , Termografía/métodosRESUMEN
PURPOSE: To investigate whether the clinical characteristics, treatment and prognosis of endogenous infectious endophthalmitis (EIE) have changed over the past 5 years. METHODS: Retrospectively analyze all articles about EIE published in the PubMed, Web of Science, and Embase databases from 2017 to 2021. RESULTS: A total of 128 patients and 147 eyes (46 left and 60 right) were included in the study. The mean age at diagnosis was 51 ± 19 years. The most common risk factors were diabetes and intravenous drug use. From 2017 to 2021, Klebsiella was the most common pathogenic microorganism (22%), and vitreous culture had the highest positivity rate. The most common complaint was blurred vision. The mean visual acuity (logMAR) at onset was 2.84, and the clinical symptoms were vitreal inflammation and opacity (63%), ocular pain (37%), and conjunctival congestion (36%). The ocular inflammation could be reduced by intraocular antibiotics or vitrectomy. However, the visual prognosis, with a mean logMAR of 2.73; only 50% of the eyes reached a visual acuity level of finger count and above. Changes in diagnostics over the past 5 years have mainly manifested as more diverse microorganism culture methods. In addition to conventional culture methods, PCR, sputum culture and aqueous humour culture are also commonly used for the diagnosis of pathogenic bacteria, improving the positive culture rate and visual prognosis. CONCLUSION: The prognosis of EIE is poor. It is recommended to pay attention to the pathogenic bacteria culture results and accompanying systemic diseases and to diagnose and treat patients as soon as possible.
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Antibacterianos , Endoftalmitis , Infecciones Bacterianas del Ojo , Agudeza Visual , Endoftalmitis/diagnóstico , Endoftalmitis/microbiología , Endoftalmitis/terapia , Humanos , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/terapia , Pronóstico , Antibacterianos/uso terapéutico , Vitrectomía/métodos , Estudios Retrospectivos , Cuerpo Vítreo/microbiología , Bacterias/aislamiento & purificación , Factores de Riesgo , Masculino , FemeninoRESUMEN
PURPOSE: Invasive fungal orbital infections (IFOI) may be difficult to differentiate from sinogenic bacterial orbital cellulitis (OC). This study investigates the features differentiating OC from IFOI on magnetic resonance imaging (MRI). METHODS: Retrospective study of adult patients with sinogenic OC and IFOI with pre-intervention MRI. Patients without post-septal involvement, non-sinogenic OC (e.g.: secondary to trauma) and poor-quality scans were excluded. Independent Sample's t test and Fisher's exact test were conducted with p < 0.05 deemed statistically significant. RESULTS: Eleven cases each of OC (Mean age: 41.6 ± 18.4 years-old, Male: 10) and IFOI (Mean age: 65.0 ± 16.6 years-old, Male: 9) between 2006 and 2023. IFOI patients were older, more likely immunocompromised and had a lower mean white-cell count (p value = 0.005, 0.035 and 0.017, respectively). The ethmoid and maxillary sinuses were most commonly involved in both entities. Pre-septal and lacrimal gland involvement were more common in OC (p = 0.001 and 0.008, respectively). Infiltrative OC orbital lesions were poorly demarcated, whilst those in IFOI were expansile/mass-like invading the orbit from the adjacent paranasal sinuses. Specific IFOI features included loss-of-contrast-enhancement (LoCE) of paranasal sinus tissues with orbital extension. Extra-orbital and -sinonasal extension indicative of IFOI included contiguous skull base or pterygopalatine fossa involvement, retro-antral and masticator space stranding and vasculitis. CONCLUSION: This study describes the key MRI features of IFOI including differentiating markers from OC. These specific features, such as LoCE of the paranasal and orbital soft tissues, the location and pattern of contiguous soft-tissue involvement, provide expedient identification of IFOI which necessitate early surgical intervention for microbiological confirmation of an invasive fungal pathology.
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Infecciones Bacterianas del Ojo , Infecciones Fúngicas del Ojo , Imagen por Resonancia Magnética , Celulitis Orbitaria , Humanos , Masculino , Celulitis Orbitaria/microbiología , Celulitis Orbitaria/diagnóstico , Estudios Retrospectivos , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/microbiología , Adulto , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Anciano , Diagnóstico Diferencial , Femenino , Adulto Joven , Anciano de 80 o más Años , Infecciones Fúngicas Invasoras/diagnóstico , Infecciones Fúngicas Invasoras/microbiología , Infecciones Fúngicas Invasoras/diagnóstico por imagenRESUMEN
Bacterial ocular infections represent a common public health problem affecting people of all age groups. These infections can lead to damage of ocular structures or even a loss of vision. The spectrum of isolated bacteria and their susceptibilities to antibiotics, however, shows geographical variabilities, which can affect the success of most empirically-administered antimicrobial therapies. The aim of this study was thus to analyse bacterial aetiology in culture-positive acute and chronic ocular infections and its antimicrobial susceptibility profile in a large cohort of patients in the Czech Republic. The study also focused on corynebacteria identification, particularly on the prevalence of Corynebacterium macginleyi. A total of 2500 bacterial isolates obtained from 2015 to 2020 in University Hospital Hradec Kralove were included in the study. A total of 2320 (92.8%) bacterial isolates were Gram-positive and 180 (7.2%) were Gram-negative. Staphylococcus aureus was the predominant pathogen, isolated from 15.3% of ocular infections, followed by Enterobacterales, Streptococcus pneumoniae and Haemophilus influenzae, isolated in 2.9%, 1.6% and 1.0%, respectively. Corynebacterium macginleyi was confirmed as the most prevalent species of corynebacteria. Most bacteria showed good susceptibility to fluoroquinolones, chloramphenicol, and aminoglycosides. Gram-positive bacteria were also susceptible to tetracycline. To conclude, this study presents a 5-year assessment of bacterial aetiology of ocular infections in the East Bohemian region. The survey showed clear differences in the susceptibilities of several bacteria to select antibiotics compared to studies from other geographical regions in Europe. This clearly shows that local surveillance of the aetiology and antimicrobial susceptibility of bacteria is essential for adequate empirical therapy of ocular infections.
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Antibacterianos , Bacterias , Pruebas de Sensibilidad Microbiana , Humanos , Antibacterianos/farmacología , Adulto , Persona de Mediana Edad , Femenino , Masculino , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Bacterias/clasificación , Anciano , Adulto Joven , Adolescente , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/epidemiología , Anciano de 80 o más Años , Niño , Preescolar , República Checa/epidemiología , Farmacorresistencia Bacteriana , LactanteRESUMEN
PURPOSE: This study aimed to investigate the demographics, clinical characteristics, and management outcomes of patients with acute infectious endophthalmitis (AIE). METHODS: This retrospective chart review was conducted on all patients admitted with the clinical diagnosis of infectious endophthalmitis from 2017 to 2022. Demographic data, patients' clinical characteristics, the type of acute infectious endophthalmitis (post-operative, post-traumatic, bleb-associated, and endogenous endophthalmitis), the type of surgical procedure in the post-operative cases, the microbiologic analysis results of vitreous samples, therapeutic measures, and visual outcomes of patients were recorded. RESULTS: In this study, 182 participants, including 122 male (67%) and 60 (33%) female, were involved. The mean age of patients was 54.56 ± 21 years, with a range of 1-88 years old. The most prevalent type of AIE was post-operative (59.9%), followed by endogenous (19.2%), post-traumatic (17%), and bleb-associated (3.8%). The most common type of intraocular surgery in the post-operative subgroups of AIE patients was phacoemulsification (57.8%). The median (interquartile range) of the primary and final BCVA of patients was 1.5 (1.35, 1.85) and 0.65 (0.35, 1.35), respectively. Vitreous haziness grade (OR, 2.89; 95% CI, 1.11-5.74; p = 0.009) and the primary VA (OR, 60.34; 95% CI, 2.87-126.8; p = 0.008) revealed statistical significance for final vision loss. CONCLUSION: AIE is a devastating condition with poor visual outcomes, which presents with acute inflammatory signs and symptoms regardless of its type. However, prompt and appropriate treatment leads to visual recovery to a functional level in many patients.
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Endoftalmitis , Infecciones Bacterianas del Ojo , Agudeza Visual , Humanos , Endoftalmitis/diagnóstico , Endoftalmitis/microbiología , Endoftalmitis/epidemiología , Endoftalmitis/terapia , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Adulto , Anciano de 80 o más Años , Adolescente , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/epidemiología , Infecciones Bacterianas del Ojo/terapia , Adulto Joven , Enfermedad Aguda , Niño , Preescolar , Lactante , Antibacterianos/uso terapéutico , Cuerpo Vítreo/microbiología , Cuerpo Vítreo/patología , Vitrectomía/métodosRESUMEN
Objective: This case report aimed to describe the unusual clinical presentation and histopathological features of post-injection endophthalmitis. Methods: A 56-year-old male phakic patient with diabetic retinopathy received an intravitreal injection (Bevacizumab as per the patient) for neovascular glaucoma elsewhere and presented to our center one day after the dose with hypopyon. The eye was relatively white without pain or lid oedema. The patient was treated as a case of post-injection endophthalmitis with two doses of intravitreal antibiotics 48 hours apart. During the follow-up, he developed a Covid infection. After one week, when the media cleared, white exudates were seen in the vitreous cavity with a relatively healthy retina. He was taken up for pars plana vitrectomy and vitreous biopsy for histopathological study. Results: The microscopic examination of vitreous aspirate revealed crystalline deposits without any microorganisms. Two control slides, one with a mixture of intravitreal antibiotics, which were previously injected, and the other with fresh Triamcinolone were also examined. Although the findings of the drug mixture did not match the vitreous aspirate, they matched with triamcinolone, which established it as a case of pseudo endophthalmitis due to triamcinolone injected elsewhere. Discussion: Initially, it seemed like a straightforward case of post-injection endophthalmitis, but a further examination of the vitreous aspirate showed that it was pseudoendophthalmitis due to an intravitreal triamcinolone injection. Despite the patient being phakic, neovascularization or elevated intraocular pressure may have led to the disruption of the blood-ocular barrier and the migration of Triamcinolone into the anterior chamber. Conclusion: The case's uniqueness lies in being the first reported case of pseudo endophthalmitis in a phakic patient with an intact lens iris diaphragm. The case also highlighted the judicious use of available resources and out-of-the-box thinking to reach a diagnosis that may not always be obvious. Abbreviations: TA = Triamcinolone acetonide, AC = Anterior chamber, IVB = Intravitreal Bevacizumab, PL = Perception of light.
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Inhibidores de la Angiogénesis , Bevacizumab , Endoftalmitis , Glaucoma Neovascular , Inyecciones Intravítreas , Humanos , Masculino , Persona de Mediana Edad , Glaucoma Neovascular/diagnóstico , Glaucoma Neovascular/etiología , Endoftalmitis/diagnóstico , Endoftalmitis/microbiología , Inhibidores de la Angiogénesis/administración & dosificación , Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab/administración & dosificación , Cuerpo Vítreo/patología , Cuerpo Vítreo/microbiología , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , COVID-19/complicaciones , COVID-19/diagnóstico , Vitrectomía/métodos , Glucocorticoides/uso terapéutico , Glucocorticoides/administración & dosificación , SARS-CoV-2 , Retinopatía Diabética/diagnósticoAsunto(s)
Bacillus cereus , Endoftalmitis , Infecciones Bacterianas del Ojo , Hemofilia A , Humanos , Endoftalmitis/microbiología , Endoftalmitis/diagnóstico , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Bacillus cereus/aislamiento & purificación , Masculino , Hemofilia A/complicaciones , Hemofilia A/diagnóstico , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/microbiología , Antibacterianos/uso terapéutico , Cuerpo Vítreo/microbiología , NiñoRESUMEN
Ocular syphilis is a re-emerging inflammatory eye disease with a clear gender imbalance, disproportionately affecting men. We investigated the impact of gender on the presentation, management practices and clinical outcomes of this condition. Data generated from a study of patients consecutively diagnosed with ocular syphilis who attended a subspecialist uveitis service at one of four hospitals in Brazil over a 30-month period were disaggregated for analysis by gender. Two-hundred and fourteen eyes (161 men and 53 women) of 127 patients (96 men and 31 women) were included. Posterior uveitis was the most common presentation in both men and women (80.1% vs. 66.7%, p > 0.05), but men were significantly more likely to have vitritis as a feature of their disease (49.4% versus 28.8%, p = 0.019). Three eyes of women had nodular anterior scleritis (p = 0.015). Men were more likely to undergo a lumbar puncture to assess for neurosyphilis (71.9% vs. 51.6%, p = 0.048), but men and women undergoing a lumbar puncture were equally likely to have a cerebrospinal fluid abnormality (36.2% vs. 25.0%, p = 0.393). All patients were treated with aqueous penicillin G or ceftriaxone, and there was a trend towards more men receiving adjunctive systemic corticosteroid treatment as part of their management (65.2% vs. 46.7%, p = 0.071). There were no significant differences in the age of presentation, bilaterality of disease, anatomical classification of uveitis, initial or final visual acuity, and rates of ocular complications between men and women. Our findings indicate that ocular syphilis has comparable outcomes in men and women, but that there are differences in the type of ocular inflammation and management practices between the genders.
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Sífilis , Humanos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Sífilis/tratamiento farmacológico , Sífilis/diagnóstico , Factores Sexuales , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/diagnóstico , Brasil/epidemiología , Antibacterianos/uso terapéutico , Uveítis/tratamiento farmacológico , Uveítis/diagnóstico , Anciano , Resultado del TratamientoRESUMEN
PURPOSE: To study the risk factors, clinical features, and treatment outcomes of patients with culture-negative keratitis (CNK). METHODS: A retrospective data review of 933 patients with CNK was performed from January 2018 to December 2020. The variables such as the history of injury, visual acuity, slit-lamp findings with measurements of size and depth of ulcer, microbiological evaluation, duct patency, blood glucose levels, and treatment were considered, and clinical outcome was analyzed. RESULTS: Of the 933 patients with CNK, 763 (81.8%) were medically managed, with a mean treatment duration of 2.08 ± 1.7 weeks. Among them, 622 (66.7%) were both smear and culture-negative, and 311 (33.3%) showed only smear positivity. Smear-positive patients showed a positive correlation with the history of injury. A higher incidence of fungal growth on repeat culture was observed. Surgical interventions were done only in 18.2% of the patients; the rest were treated with topical medications alone. CONCLUSION: High clinical suspicion, differentiation of causative organisms based on clinical findings, and initiating empirical therapy with broad-spectrum antibiotics and antifungals improve the ultimate prognosis in patients with CNK, even though a standard protocol for empirical medical treatment may differ among institutions and surgeons based on their clinical experience and geographical variations.
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Antibacterianos , Infecciones Bacterianas del Ojo , Infecciones Fúngicas del Ojo , Agudeza Visual , Humanos , Estudios Retrospectivos , Femenino , Masculino , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Persona de Mediana Edad , Agudeza Visual/fisiología , Adulto , Infecciones Fúngicas del Ojo/microbiología , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Infecciones Fúngicas del Ojo/terapia , Antibacterianos/uso terapéutico , Bacterias/aislamiento & purificación , Antifúngicos/uso terapéutico , Queratitis/microbiología , Queratitis/diagnóstico , Queratitis/tratamiento farmacológico , Factores de Riesgo , Estudios de Seguimiento , Hongos/aislamiento & purificación , Córnea/microbiología , Córnea/patología , AncianoAsunto(s)
Infecciones Bacterianas del Ojo , Humanos , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/diagnóstico , Pronóstico , Córnea/microbiología , Córnea/patología , Úlcera de la Córnea/microbiología , Úlcera de la Córnea/diagnóstico , Queratitis/microbiología , Queratitis/diagnóstico , Bacterias/aislamiento & purificaciónRESUMEN
Endogenous bacterial endophthalmitis (EE) is an intraocular infection with a poor prognosis. Timely diagnosis and prompt treatment are crucial to prevent vision loss. In this communication, we describe a case of EE caused by Streptococcus pyogenes (Group A Streptococcus [GAS]) in an HIV-positive patient with poorly controlled type 2 diabetes mellitus (DM). A 60-year-old man with a history of HIV and poorly controlled type 2 diabetes, presented with progressive blurry vision, left eye pain, redness, and headache. EE was diagnosed based on the clinical presentation and gram stain analysis of blood culture. Treatment with vitreous tap, intravitreal, topical antibiotics, and systemic antibiotics significantly improved the patient's symptoms. The case highlights the rarity of GAS as a causative agent of EE, particularly in patients with risk factors such as HIV infection and DM.
Asunto(s)
Antibacterianos , Diabetes Mellitus Tipo 2 , Endoftalmitis , Infecciones por VIH , Infecciones Estreptocócicas , Streptococcus pyogenes , Humanos , Endoftalmitis/microbiología , Endoftalmitis/tratamiento farmacológico , Endoftalmitis/diagnóstico , Masculino , Persona de Mediana Edad , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Antibacterianos/uso terapéutico , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/diagnóstico , Streptococcus pyogenes/aislamiento & purificación , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/complicacionesRESUMEN
PURPOSE: This study aimed to evaluate how the SARS-CoV-2 pandemic and associated lockdown measures influenced microbial keratitis in Taiwan by comparing demographic data, predisposing factors, pathogen profiles, and treatment outcomes in 2019 and 2020. METHODS: Data from patients diagnosed with microbial keratitis at National Chung Kung University Hospital between January 2019 and December 2020 were examined, focusing on patient demographics, predisposing factors, isolated pathogens, antibiotic usage, and clinical progress. RESULTS: No significant differences were found in patient sex, laterality, or average age between the two years. Predisposing factors, such as contact lens use and chronic ocular/systemic disorders, remained unchanged. While fungal isolates slightly increased during the lockdown, bacterial isolates remained consistent. Medical treatment effectiveness, treatment strategies, and antibiotic susceptibility for common bacteria showed no significant alterations. CONCLUSION: Despite the challenges posed by the SARS-CoV-2 pandemic and lockdown measures, this study revealed minimal changes in microbial keratitis trends in Taiwan. This highlights the importance of maintaining access to medical care during crises and offers insights into potential treatment strategies for patients facing difficulties in receiving timely care. Further research should investigate the pandemic's impact on healthcare access and patient outcomes in various populations and regions.