The effect of climatic and seasonal factors on the microbial keratitis profile.

PURPOSE: To compare retrospective data on microbial keratitis (MK) from two different climatic regions in Turkey over 11 years. STUDY DESIGN: Retrospective cohort. METHODS: This retrospective cohort study included patients diagnosed with presumed MK at two referral centers. Center A was located in the subtropical region of Turkey, whereas Center B was located in a continental temperate climate zone. Clinical and laboratory data were also recorded. The results were evaluated for seasonal variations. RESULTS: This study included data from 665 patients with presumed MK (351 and 314 patients from centers A and B, respectively). The most common predisposing factors were ocular trauma in Center A, prior ocular surgery, and systemic disease in Center B. Severe keratitis was related to prior ocular surgery, presence of systemic disease, and fungal infection at presentation. The culture positivity rate was higher in spring and lower in summer at both centers. Gram-positive bacteria were the most commonly isolated bacteria in both centers in all seasons. The fungal and mixed keratitis ratios were higher in Center A than in Center B. In Center A, filamentous fungi were common pathogens that were found year-round, and peaks were observed in July and October. CONCLUSION: The results of this study show that climatic and seasonal factors may affect the microbial profile of keratitis. Fungal keratitis appears to be a climatic disease. Understanding the regional profile of MK can aid clinicians in their disease management.

A rare devastating complication of LASIK: bilateral fungal keratitis.

Purpose. To report an unusual case of severe bilateral fungal keratitis following laser in situ keratomileusis (LASIK). Method. A 48-year-old man developed bilateral diffuse corneal infiltration two weeks after LASIK. The corneal scrapings revealed fungal filaments but cultures were negative. Results. The corneal ulceration was improved on the left eye whereas spontaneous perforation occurred and finally evisceration was needed on the right eye despite topical and systemic antifungal treatment. Conclusions. Fungal keratitis, especially with bilateral involvement, is a very rare and serious complication of LASIK surgery. Clinical suspicion is crucial because most of fungal keratitis are misdiagnosed as bacterial keratitis and can lead serious visual results, even eye loss.

Intraocular pressure, quality of block, and degree of pain associated with ropivacaine in peribulbar block: a comparative randomized study with bupivacaine-lidocaine mixture.

PURPOSE: To compare the effects of ropivacaine and bupivacaine-lidocaine combination on intraocular pressure, quality of block, and degree of postoperative pain in peribulbar block. METHODS: The study group involved 32 patients undergoing elective cataract surgery under peribulbar block. Patients were divided into two groups according to the local anesthetic used: Group 1 (n = 16), ropivacaine 0.75%; and Group 2 (n = 16), bupivacaine 0.5%-lidocaine 2% mixture. Intraocular pressure was measured at four time points: before block (control), 1 min after block, 5 min after block, and 15 min after block with Tonopen. Quality of block was evaluated using a three-point scoring system based on the reduction of globe motility. Patients were asked their degree of intraoperative pain by using a five-point verbal rating score after the surgery. RESULTS: Mean values of intraocular pressure after block were significantly lower in Group 1 in comparison to Group 2 (p < 0.05, Mann Whitney test). The quality of block was better in Group 2, and the degree of postoperative pain was lower in Group 1 (p < 0.05, Mann-Whitney test). CONCLUSIONS: Ropivacaine used in peribulbar block is better than bupivacaine-lidocaine mixture under the same standard conditions in terms of reducing intraocular pressure and postoperative pain in intraocular surgery.

Brush technique in ocular surface cytology.

New techniques are being searched for the evaluation of cellular morphology and population of ocular surface. Impression cytology is one of the most preferred techniques in ocular surface sampling in dry eye, keratitis, and conjunctivitis. We evaluated and compared the efficacy of impression and brush cytology in 63 patients. All of the samples collected by the brush technique were sufficient for diagnosis: 88% of the slides revealed abundant cells and 12% adequate number of cells. In 21% of the samples observed by impression cytology the cell number was inadequate for diagnosis. In 58% of them the cells were abundant and in 21% few cells were observed. This study proved the value of brush cytology in collecting ocular surface cells.

Effect of clomipramine and lithium on fenfluramine-induced hormone release in major depression.

Prolactin (PRL) and cortisol responses to oral administration of d-1 fenfluramine hydrochloride (60 mg) and placebo were examined in patients with endogenous major depressive disorder on three separate occasions: prior to treatment with clomipramine (CMI), after 4 weeks of CMI administration (175-250) mg/day), and 3 weeks after addition of lithium (Li) carbonate (serum level 0.5-0.9 mmol) to the treatment regimen. CMI significantly increased baseline PRL levels which were further elevated following Li supplementation. PRL response to fenfluramine (minus elevated baseline PRL levels) but not to placebo, was significantly increased by CMI administration, reflected over the 6-hr time course examined and in peak minus baseline values. Following addition of Li, the degree of enhancement was diminished although the peak minus baseline value remained significant relative to the pretreatment response. Cortisol levels were not increased by fenfluramine and were not altered by CMI or CMI + Li administration. The effect of CMI extends previous observations regarding the action of antidepressant treatment on serotenergically mediated hormone release. Methodological considerations relevant to the effect of CMI + Li are discussed.