Outcome of cataract surgery in children with presumed trematode-induced granulomatous anterior uveitis.

PURPOSE: To examine the 6-month visual outcomes and complications following cataract surgery in patients with persumed trematode induced granulomatous anterior uveitis. SETTING: Assiut university hospital, Assiut, Egypt. DESIGN: This is a retrospective non comparative case series study. METHODS: Patients presenting with significant cataract secondary to uveitis caused by trematode induced anterior chamber granuloma were included in this study. Cases with active anterior uveitis, within the last 3 months preceding surgery, and those with a history of trauma, were excluded from this study. Data collected included demographic characteristics, history of the condition including when uveitis started, treatment received and history of other health conditions that may be relevant to uveitis.Complete opthalmologic examination including assessment of best corrected visual acuity (BCVA) and OCT macula, if possible, were done. These was repeated 1 week, 1 month, 3 months and 6 months after surgery. Specular microscopy was performed preoperatively and 3 months after surgery. Patients underwent cataract surgery with posterior chamber intra ocular lens and statistical analysis was performed to compare preoperative and postoperative BCVA and corneal endothelial cell counts. Postoperative complications were recorded. RESULTS: Five eyes of 5 patients were included in the study. All study eyes showed improvement in the post-operative visual acuity. A statistically significant improvement was observed in VA in the sixth postoperative month compared to the baseline measurements (p = 0.004). No statistically significant difference was observed between the preoperative and postoperative endothelial cell counts (p = 0.696). Cystoid macular edema did not occur as a postoperative complication. CONCLUSION: Visual outcomes of cataract surgery in eyes with persumed trematode induced granulametous anterior uveitis are favorable. No sight threatening complication was observed in our series.

Appearance of herpes simplex keratitis on anterior segment optical coherence tomography.

PURPOSE: To describe the anterior segment AS-OCT findings of herpetic simplex keratitis. METHODS: Forty-two eyes of 42 patients with proven herpetic keratitis of varying severity were included in this prospective, observational, non-comparative case series study. All subjects underwent ophthalmologic examination and AS-OCT imaging. RESULTS: Twenty-five of the 42 eyes (59.5%) had sub-epithelial infiltrates. In 11 of these cases, the overlying epithelium appeared intact, but in 14 cases, hydropic changes, heaping, and defects were observed. Seventeen eyes (40.5%) showed stromal involvement: six cases with scar at presentation and one case associated with uveitis. Stromal infiltrates were also seen, in ten cases, as a diffuse or local lentiform or spindle-shaped hyper-reflective area in the stroma. CONCLUSION: Herpetic keratouveitis has characteristic features on AS-OCT images. This study demonstrates that herpetic keratitis also has characteristic AS-OCT features, including sub-epithelial infiltration and specific stromal hyper-reflective patterns. These features are not unique to herpetic keratitis, but AS-OCT imaging may provide useful supplementary information for diagnosing and monitoring herpetic keratitis.

Bacterial and fungal keratitis in Upper Egypt: in vitro screening of enzymes, toxins and antifungal activity.

PURPOSE: This work was conducted to study the ability of bacterial and fungal isolates from keratitis cases in Upper Egypt to produce enzymes, toxins, and to test the isolated fungal species sensitivity to some therapeutic agents. MATERIALS AND METHODS: One hundred and fifteen patients clinically diagnosed to have microbial keratitis were investigated. From these cases, 37 bacterial isolates and 25 fungal isolates were screened for their ability to produce extra-cellular enzymes in solid media. In addition, the ability of fungal isolates to produce mycotoxins and their sensitivity to 4 antifungal agents were tested. RESULTS: Protease, lipase, hemolysins, urease, phosphatase, and catalase were detected respectively in 48.65%, 37.84%, 59.46%, 43.24%, 67.57%, and 100% out of 37 bacterial isolates tested. Out of 25 fungal isolates tested during the present study, 80% were positive for protease, 84% for lipase and urease, 28% for blood hemolysis, and 100% for phosphatase and catalase enzymes. Thirteen fungal isolates were able to produce detectable amounts of 7 mycotoxins in culture medium (aflatoxins (B1, B2, G1, and G2), sterigmatocystin, fumagillin, diacetoxyscirpenol, zearalenone, T-2 toxin, and trichodermin). Among the antifungal agents tested in this study, terbinafine showed the highest effect against most isolates in vitro. CONCLUSION: In conclusion, the ability of bacterial and fungal isolates to produce extracellular enzymes and toxins may be aid in the invasion and destruction of eye tissues, which, in turn, lead to vision loss.

Spectral domain anterior segment optical coherence tomography in microbial keratitis.

PURPOSE: To investigate the spectral domain anterior segment optical coherence tomography (SDAS-OCT) patterns in microbial keratitis (fungal and bacterial keratitis). DESIGN: Prospective, cross-sectional, observational study. METHODS: Twenty eyes of 20 patients with proven fungal and bacterial microbial keratitis, at different stages of the disease, underwent SDAS-OCT imaging. RESULTS: Eight eyes presented with proven bacterial keratitis (3 Staphylococcus Aureus, 2 Pseudomonas Aeruginosa and 3 Staphylococcus Epidermidis). Twelve eyes presented with proven fungal keratitis of Aspergillus species. Twelve different SDAS-OCT presentations of fungal and bacterial keratitis were found in this study. Our findings in fungal keratitis grasped two unique patterns of early localized and diffuse necrotic stromal cystic spaces. CONCLUSION: SDAS-OCT imaging provided a range of characteristic patterns that could be used as an additional tool in diagnosis and management of bacterial and fungal microbial keratitis.

Prevalence of pseudoexfoliation syndrome and pseudoexfoliation glaucoma in Upper Egypt.

BACKGROUND: Pseudoexfoliation (PXF) is a recognized risk factor for developing cataract, glaucoma and lens dislocation. PXF is also associated with increased risk of complications during cataract surgery due to poor mydriasis and zonular weakness. The aim of this study is to report the prevalence of pseudoexfoliation among Upper Egyptians attending the ophthalmology clinic of Assiut University Hospital. METHODOLOGY: A retrospective, chart review study conducted in the period from February 2002 to August 2009. A total of 7738 patients aged 40 years or older attending the general ophthalmic clinics were included in this study. A detailed evaluation including ophthalmic and general history, slit lamp biomicroscopy, intraocular pressure measurement, gonioscopy and dilated eye examination were performed. Patients with pseudoexfoliative material on the anterior lens surface and / or the pupillary margin in either or both eyes were labeled as having PXF. RESULTS: Out of the 7738 patients included, three hundred twenty (4.14%) subjects had PXF. Mean age of PXF group was 68.15 years (SD 8.16, range 40-92 years). PXF was bilateral in 82.2% of cases. It was significantly associated with cataract, glaucoma and hearing loss. Of the PXF patients, 65% had cataract, 30.3% had glaucoma and 8.1% had hearing loss. CONCLUSION: Pseudoexfoliation appears to be a common disorder in older individuals in Upper Egypt.

Severe ocular injuries from improperly disposed medical syringes in children.

This report describes ocular injuries caused by syringes in children. The records of 12 children injured with syringes were reviewed. There were seven cases of endophthalmitis, two cases of panophthalmitis, one case of retinal detachment, one case of endophthalmitis with retinal detachment, and one case of traumatic cataract. All patients received treatment within 24 hours of presentation. Patients presented an average of 8.4 days after injury. Final visual acuity ranged from no light perception to counting fingers at 90 cm in eight patients and could not be assessed in four patients. Improperly disposed syringes may pose a significant risk for ocular injury and visual loss in children, especially when presentation is delayed.