Molecular epidemiology of Staphylococcus aureus and Enterococcus faecalis in endophthalmitis.

Genomic DNA fingerprint analysis was performed on 39 Staphylococcus aureus and 28 Enterococcus faecalis endophthalmitis isolates collected from multiple clinical centers. Among 21 S. aureus genomic DNA fingerprint patterns identified, five clonotypes were recovered from multiple unrelated patients and accounted for 58.9% (23 of 39) of the isolates analyzed. Compared with strains having unique genomic DNA fingerprint patterns, the S. aureus clonotypes occurring more than once were more likely to result in visual acuities of 20/200 or worse (P = 0.036 [chi2 test]). In contrast to the S. aureus isolates, the E. faecalis endophthalmitis isolates were a clonally diverse population, enriched for the expression of a known toxin, cytolysin, which is plasmid encoded.

Host/parasite interactions in bacterial endophthalmitis.

Bacterial infections within the eye arise as complications of intraocular surgery, penetrating injury, or hematogenous spread from distant anatomical sites. Because: 1) the interior surfaces of the eye are lined with sensitive, nonregenerating tissues, 2) the inner chambers of the eye are relatively sequestered from circulating immunological components, 3) the integrity of blood-ocular barriers provides poor penetration of systemically administered antibiotics, and 4) aqueous and vitreous humor represent rich, relatively acellular culture media; endophthalmitis often progresses rapidly and total loss of vision frequently results. Years of clinical experience have shown that current therapies for endophthalmitis, including antimicrobials, antiinflammatory agents, and vitrectomy, are frequently unsuccessful in ameliorating destruction of intraocular tissues. While bacterial and host factors were thought to play key roles in the course and severity of endophthalmitis, it is only recently that their contributions have been experimentally defined. Molecular-based techniques are gaining increased use in the study of infectious eye diseases. Current findings regarding the host/parasite interactions within the eye are reviewed, and a resulting integrative model of the natural course of endophthalmitis proposed. A molecular-level understanding of the roles of both bacterial and host factors during endophthalmitis will likely reveal potential targets for therapeutic intervention aimed at salvaging vision.

Axial myopia increases the risk of retinal complications after neodymium-YAG laser posterior capsulotomy.

We conducted a retrospective analysis of Q-switched neodymium-YAG laser capsulotomies performed in 122 eyes between April 1984 and June 1987. Retinal complications occurred in 3 (2.5%) of 121 eyes followed up for 1 year and in 2 (3.6%) of 55 eyes followed up for 2 years. Four eyes developed rhegmatogenous retinal detachments and 1 developed an acute symptomatic retinal tear. No patients developed clinical cystoid macular edema (visual acuity 20/30 or worse). These retinal complications were significantly correlated with axial myopia, preexisting vitreoretinal disease, male gender, younger age, vitreous prolapse into the anterior chamber, and spontaneous extension of the capsulotomy.

Endogenous endophthalmitis with lenticular abscess caused by Enterobacter agglomerans (Erwinia species).

We report for the first time a case of metastatic endophthalmitis caused by the gram-negative organism Enterobacter agglomerans (Erwinia species). One day following internal hemorrhoidal ligation, the patient developed anterior uveitis that progressed to panophthalmitis with a lenticular abscess and a necrotic retina. Despite aggressive surgery and appropriate antibiotic therapy, the affected eye lost useful vision.

Serum and vitreous herpes simplex antibodies in noninfected eyes.

Recently, vitreous Herpes simplex virus [HSV] antibody titers have been reported from patients with presumed herpetic retinitis. To help understand the significance of these data, we evaluated the HSV type 1 vitreous and serum antibodies in eight patients undergoing pars plana vitrectomy for diabetic vitreous hemorrhage, diabetic traction detachment, or rhegmatogenous retinal detachment. Undiluted vitreous and diluted serum specimens were tested for HSV IgG antibodies using the fluorescence immunoassay (FIAX) technique. Two patients had undetectable vitreous and serum titers. In the other six patients, the serum (diluted) results ranged from 59 to 191 FIAX units (1:40-1:160 titer), and the vitreous (undiluted) levels ranged from 15 to 56 FIAX units (1:20-1:80 titer). The serum: vitreous ratio corrected for dilution ranged from 220 to 1120. We have shown that an isolated, undiluted vitreous HSV type 1 titer as high as 1:80 occurs without evidence of intraocular herpetic infection. When detectable, the serum titer is, on average, 400 times greater than the vitreous. Further investigation is needed to determine if intraocular HSV antibody production occurs in retinitis and results in a lower serum: vitreous ratio.

Diffuse toxoplasmic retinochoroiditis in a patient with AIDS.

Ocular toxoplasmosis typically presents as a focal necrotizing retinochoroiditis. We report a case of diffuse necrotizing retinochoroiditis due to toxoplasmosis in a patient with the acquired immunodeficiency syndrome (AIDS). The appearance at initial presentation was similar to the acute retinal necrosis syndrome. We recommend that toxoplasmosis be considered in the differential diagnosis of diffuse retinal necrosis in patients with AIDS. Although systemic disseminated toxoplasmosis is not rare in AIDS, this is, to our knowledge, the first reported case of diffuse ocular involvement.

Granulocytic sarcoma of the orbit. A clinicopathologic study.

A 9-year-old Latin American girl developed proptosis of the left eye associated with pain in the left ear of one month's duration. Ophthalmoscopic examination of the left eye disclosed retinal striae with venous tortuosity and papilledema. CT scan of the orbit showed a nonenhancing, irregular intraconal mass. CT scan of the brain demonstrated an enhancing left temporoparietal mass. Craniotomy revealed a 7 cm, extra-axial mass that was attached to the dura mater. Histologic examination, including a positive Leder stain, established the diagnosis of granulocytic sarcoma. At that time, the results of the laboratory studies, including complete cell blood count, were normal. Periodic clinical and hematologic evaluation was recommended. Twenty-five days after craniotomy, examination of the peripheral blood disclosed 56% myeloblasts and the bone marrow contained 30% blast cells. The problem in histologic differential diagnosis and a review of the literature is discussed.

Intraocular argon laser photocoagulation in the management of severe proliferative vitreoretinopathy.

We surgically repaired seven eyes with severe proliferative vitreoretinopathy with intraocular argon laser photocoagulation. Five of the seven retinas were still attached six or more months postoperatively. Endolaser photocoagulation was used in conjunction with pars plana vitrectomy, periretinal membrane stripping, fluid-air exchange, and planned retinotomies. The advantages of endolaser photocoagulation include easier management of posterior retinotomies in an air-filled eye, isolation of anterior traction and retinal breaks by creating an encircling demarcation line posterior to the problem, and less manipulation of existing scleral buckling material.

Endogenous endophthalmitis among patients with candidemia.

Thirty-eight patients with fungemia were examined prospectively for development of endophthalmitis. Endophthalmitis was present in 10 of 27 (37%) patients with Candida albicans fungemia. Only one patients with nonalbicans fungemia developed endophthalmitis. Of the preselected factors studied, only hemodialysis and parenteral hyperalimentation correlated with an increased incidence of endophthalmitis. Antibody titers by latex agglutination were of little predictive value for endophthalmitis. Antigen titers by latex agglutination were performed in four cases with endophthalmitis. Antigenemia was demonstrated in three of the four patients, all of whom had negative antibody serologies. Although inconclusive, the preliminary data indicate the test may prove to be of clinical value. Periodic ophthalmoscopic examinations should be considered mandatory in the evaluation of patients with fungemia.

'Cholesteatoma' of the orbit.

'Cholesteatoma' of the orbit is a variant of pseudotumor histologically characterized by masses of cholesterol crystals. We propose the term "epidermoid or true cholesteatoma" for lesions containing epithelial elements and refer to those nonepithelium-containing pseudotumors as "cholesterol granulomas." Important clinical features distinguish between epidermoid cholesteatomas and cholesterol granulomas of the orbit and justify a separation of these two pathologic entities.

Use of mailed questionnaire data in a study of swine congenital malformations.

A study was designed to evaluate the representativeness and accuracy of data collected on swine birth defects by mailed questionnaire. The study was conducted in the three contiguous counties of Johnson, Lafayette and Pettis in west central Missouri. A personal interview survey and an examination of malformed pigs were used to validate mailed questionnaire data which estimated the frequency and distribution of malformations observed in pigs over a six month period. This period between April and September 1970 was defined as the study period. The results were compared to a previous six month period (April-September 1969), or baseline period, when only the mailed questionnaire was used. The frequency and distribution of the reported malformations by type did not differ significantly (at the p=0.05 level) between the study period (70.4% response) and the baseline period (31.3% response). Evaluation of this and additional data collected during the study suggested that the mailed questionnaire can be used effectively to estimate the frequency and distribution of swine malformations within a defined geographic area.