Evidence of dengue virus in eviscerated specimens of panophthalmitis secondary to dengue fever: A possible cause-effect phenomenon.

PURPOSE: To report a retrospective series of three cases of infectious panophthalmitis post-dengue fever with ex vivo confirmation of dengue virusribonucleic acid (RNA) in the tissues of the eye. METHODS: Four eyes of three patients, who were diagnosed with panophthalmitis following dengue fever and who underwent evisceration, were included. All demographic and clinical data were recorded. The eviscerated samples were subjected to direct microscopy, culture for bacteria, fungi, and parasites, and molecular virology (dengue virus [DENV] NS1-specific reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay). RESULTS: The time from the development of dengue fever to the occurrence of ocular symptoms was 4.33 ± 1.15 (median 5) days. DENV NS1 RNA, suggestive of the presence of the dengue virus, was confirmed in all evisceration specimens (uveal tissue, cornea). All the patients recovered completely from dengue fever and on follow-up had healthy eviscerated sockets. CONCLUSION: Demonstration of the DENV RNA in the eviscerated specimens of panophthalmitis following dengue fever implicates the DENV in the pathophysiology of the ocular infection.

Bilateral panophthalmitis following toxic epidermal necrolysis: A case report.

A 70 year old man presented with systemic signs of toxic epidermal necrolysis (TEN) following consumption of diclofenac tablets for a prodromal illness a week back. Ophthalmic evaluation showed no perception of light in both eyes along with lid edema, total corneal sloughing, and pus-filled anterior chamber. An amniotic membrane transplant was planned but within a few hours, both eyes developed panophthalmitis with restricted extraocular movements and mild proptosis and had to be eviscerated. This is perhaps the first case showing such devastating sequelae of TEN.

CLOSTRIDIUM PERFRINGENS PANOPHTHALMITIS AFTER INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTION.

PURPOSE: This report describes a fulminant infection with Clostridium perfringens after an intravitreal anti-vascular endothelial growth factor injection. METHODS: This is a retrospective case review. RESULTS: Our patient's rapid infection eventually led to enucleation, despite broad-spectrum antibiotic therapy. CONCLUSION: Reporting rare causes and common clinical findings of C. perfringens ocular infection may lead to earlier detection and intervention.

Panophthalmitis associated with scleral necrosis in dengue hemorrhagic fever.

Dengue is a mosquito-borne flavivirus disease affecting humans. The Aedes aegypti mosquito spreads it. Ophthalmic manifestations of dengue range from subconjunctival hemorrhage to optic neuropathy. Panophthalmitis in dengue fever is a rare finding. We report a case of a 22-year-old male having dengue fever, who presented with pain, redness, swelling and loss of vision in his right eye. He was diagnosed as panophthalmitis with subretinal hemorrhage and required right eye evisceration.

Platelet Transfusion Related Panophthalmitis and Endophthalmitis in Patients with Dengue Hemorrhagic Fever.

Dengue is a vector-borne viral illness of major public health importance. It is endemic in many parts of India and also causes frequent epidemics. Platelet transfusions are given in severe cases of dengue fever to treat and prevent hemorrhagic complications. Here, we report three patients in North India with development of panophthalmitis and endophthalmitis shortly after receiving platelet transfusion.

Culture-positive unilateral panophthalmitis in a serology-positive case of dengue hemorrhagic fever.

Dengue fever, a mosquito-borne disease commonly found in the tropics, is one of the most prevalent forms of Flavivirus infection in humans. Symptomatically, it is characterized by fever, arthralgia, headache, and rash. Ophthalmic manifestations can involve both the anterior and posterior segment. Panophthalmitis is rare in dengue hemorrhagic fever, and there is no report of culture-positive panophthalmitis in this setting. Here, we report a case of a serology-positive 33-year-old male patient of dengue hemorrhagic fever who developed sudden onset pain, redness, and proptosis in the right eye. The patient subsequently developed panophthalmitis in his right eye, and Bacillus cereus was isolated from eviscerated sample. This case provides unique insights into pathogenesis of panophthalmitis in dengue and highlights the management options.

Endophthalmitis Progressing to Panophthalmitis: Clinical Features, Demographic Profile, and Factors Predicting Outcome.

PURPOSE: To describe clinical features, demographic profile and factors predicting outcome of endophthalmitis under care progressing to panophthalmitis at a tertiary eye institute. SETTING: Retrospective consecutive case series. METHODS: All cases diagnosed as endophthalmitis of any etiology and undergoing treatment which progressed to panophthalmitis from January 2005 to December 2015 were included. Case records of all patients coded as endophthalmitis and then panophthalmitis were included. Data were collected regarding the clinical features, demographic profile, and treatment outcomes of those cases. RESULTS: This study included 33 eyes of 33 patients. The mean age at presentation was 42.33 ± 21.66 years (median 40, range 5-75). The commonest etiology of endophthalmitis progressing to panophthalmitis was noted following open globe injury endophthalmitis, seen in 13/33 (39.4%) of eyes followed by endophthalmitis associated with microbial keratitis seen in 8/33 (27.3%) eyes. The time interval in days between the diagnosis of endophthalmitis and progression to panophthalmitis was 4.5 ± 3.88 days (median 3 days, range 1-14 days). Fifteen eyes denied perception of light (PL) at the time of diagnosing panophthalmitis. Culture was positive in 16 cases (48.4%), Streptococcus pneumoniae was the commonest species (4 cases) followed by Pseudomonas aeruginosa (3 cases) and Staphylococcus epidermidis (2 cases). Nine cases (27.27%) were additionally given systemic steroids along with the systemic antibiotics. The odds ratio of a favorable outcome was significantly higher when systemic steroids with antibiotics were administered (OR = 80.5, 95% C.I. 6.311026, p = 0.007), when the patient was of a younger age group (< 40 years) (OR 1.53, 95% C.I. 0.37.87, p = 0.6), when the presenting vision at diagnosis was at least light perception (OR 9.8, 95% C.I. 1.03692.7, p = 0.04), when the smear showed Gram-positive cocci (OR 6.66, 95% C.I. 1.0940.43, p = 0.03), if there was culture positivity (OR 10.5, 95% C.I. 1.1198.9, p = 0.03) and when intravenous antibiotics were administered (OR 21.43, 95% C.I. 1.11411.7, p = 0.04). CONCLUSIONS: Risk of progression of endophthalmitis to panophthalmitis is there even under care. Close observation and keen clinical examination for cases that do not respond well is essential. Intravenous antibiotics and systemic steroids should be considered in all cases of endophthalmitis that progress to panophthalmitis.

Panophthalmitis with orbital cellulitis following glaucoma drainage implant surgery in a pediatric patient.

Here we report a case of childhood glaucoma refractory to angle and trabeculectomy surgery. The patient was treated with an Ahmed™ drainage implant that was subsequently complicated by rapid-onset panophthalmitis and orbital cellulitis. Intravenous and intravitreal antibiotic therapy was initiated and the drainage tube was removed. The infectious process resolved within 3 weeks; however, phthisis bulbi developed subsequently.

Panophthalmitis with orbital cellulitis following glaucoma drainage implant surgery in a pediatric patient / Panoftalmite com celulite orbitária após implante de drenagem em glaucoma congênito

ABSTRACT Here we report a case of childhood glaucoma refractory to angle and trabeculectomy surgery. The patient was treated with an Ahmed™ drainage implant that was subsequently complicated by rapid-onset panophthalmitis and orbital cellulitis. Intravenous and intravitreal antibiotic therapy was initiated and the drainage tube was removed. The infectious process resolved within 3 weeks; however, phthisis bulbi developed subsequently.

RESUMO Relato de um caso de uma criança portadora de glaucoma congênito primário, refratário a cirurgias angulares e trabeculectomias prévias, submetido à implante de drenagem do tipo Ahmed®. O paciente evoluiu com panoftalmite e celulite orbitária de aparecimento súbito, sendo submetido à remoção do tubo e antibioticoterapia endovenosa e intravítrea. O processo infeccioso foi resolvido em três semanas, porém o olho evoluiu para phthisis bulbi.

Panophthalmitis after spontaneous perforation in glaucomatous eye.

Panophthalmitis is an acute, purulent inflammation of the eyeball that involves all its structures and extends into the orbit. A case of a fifty-seven year old male treated earlier due to glaucoma and trophic ulcus of the cornea, was presented in this paper. He was admitted to hospital with intensive orbital pain and redness of the right eye, elevated body temperature, bulbus protrusion with limited movement, chemosis, edematous cornea, hypopyon, iris of invisible drawing and relief. The ocular fundus was not visible. At the admittance, amaurosis of the right eye was present as well as spontaneous cornea perforation. The patient was treated with antibiotic, corticosteroid, analgesic and antiglaucomatous therapy. Intravitreal administration of antibiotics was impossible due to spontaneous cornea perforation. The patient was discharged from the hospital in a good general condition. The condition of the right eye was stable, there was no danger of eye loss, while infection of the same eye was cured.

Arrow injuries to the eye.

Two male siblings aged 10 and 17 years, respectively, presented to our hospital with two days history of being shot in the right eyes with arrows. The patients presented with severe pains, bleeding, swelling, discharge and loss of vision. There was positive history of application of traditional eye medicine and an unsuccessful attempt was made to remove the arrows. Both patients presented with panophthalmitis. X-rays of the orbits and para nasal sinuses indicated the tip of the arrow was lodged to the apex of the orbit in the younger patient, and the arrow vertically traverses the eye/ orbit and lodged in the roof of the maxillary sinus in the other patient with fluid level in the lower third of the sinus. The patients were placed on broad-spectrum systemic antibiotics, had base line investigations and prepared for exploration. The patients had evisceration with removal of the arrows.

Panoftalmite tardia após trabeculectomia com mitomicina C / Late panophthalmitis after trabeculectomy with mitomycin C

Infecção intraocular é a mais dramática e temível complicação após uma trabeculectomia, com sequelas anatômicas significativas e grave comprometimento funcional, por vezes irreversíveis. Trata-se no presente caso de um paciente do sexo masculino, portador de glaucoma congênito, submetido à trabeculectomia bilateral aos 13 anos de idade, e uma segunda trabeculectomia com mitomicina C aos 32 anos no olho direito (OD), que se apresentou 8 anos após o procedimento com endoftalmite neste olho. Após tratamento anti-inflamatório e antibioticoterápico, tópico e intravítreo, intensivos, o processo foi controlado, restando um olho hipotrófico e amaurótico com catarata e descolamento de retina totais.

An intraocular infection is the most terrible complication after a trabeculectomy, usually with significant anatomical consequences and irreversible functional impairment. The case of a 40-year-old male patient with congenital glaucoma, submitted to a trabeculectomy on both eyes at the age of 13, is presented. At the age of 32 a second trabeculectomy with mitomycin C was performed on the right eye. Eight years later he presented with an endophthalmitis in the same eye. Despite intensive local treatment and intravitreous injection, a hypotrophic amaurotic eye resulted with total cataract and retinal detachment.

Ultrastructural study of poxvirus causing myxomatosis in rabbits, in São Paulo and Santa Catarina, Brazil / Estudio ultraestructural del poxvirus causal de mixomatosis en conejos, en São Paulo y Santa Catarina, Brasil

The myxomatosis is a contagious worldwide disease caused by poxvirus which infects domestic and wild rabbits. In the present study we present two distinct outbreaks of myxomatosis when raising rabbits, one for commercial purpose of production of meat and skins and, another one for the commercialization of ornamental rabbits. The observed signs were ocular, auricular, nasal, testis lesions and many times scattered throughout the body of the animals. The lesions were characterized by formation of nodules that by palpation disclosed gummy or gelatinous aspect. At the transmission electron microscopy, all the skin and crust samples were analyzed by negative staining technique. A great number of particles with morphology similar to the poxvirus, some enveloped in a brick-shaped and irregular disposition of tubules on the external membrane, measuring 300x240 nm on the average were visualized. Ultra thin sections revealed the presence of intracytoplasmic inclusion bodies surrounded by membrane containing oval particles, measuring 270 x 130 nm, containing nucleus or an internal biconcave (dumbbell-shaped) core. Immature particles (empty), surrounded by membrane were also observed. In addition, intracytoplasmic electron dense inclusion bodies containing viral particles budding of dense amorphous material and intranuclear fibrillar or "digital" inclusions showing a regular striation and arranged in groups were found in the middle of granular material. The nuclei were deformed with densely condensed chromatin forming amorphous and electron dense inclusion bodies. In the immunocytochemistry technique, the antigen-antibody reaction was strongly marked by the particles of colloidal gold, emphasizing the viral particles. The techniques used in this study were important in the diagnosis of the affected animals.

La mixomatosis es una enfermedad contagiosa de distribución mundial, causada por poxvirus que infecta conejos domésticos y salvajes. En este estudio presentamos dos distintos surtos por mixomatosis que ocurrieron en producciones de conejos, una para fines comerciales de producción de carne y pieles y otra para el comercio de conejos domésticos. Las señales observadas fueron afecciones oculares, nasales, testiculares y, a veces, también distribuida por todo el cuerpo de los animales. Estas se caracterizaban por formación de nódulos que a la palpación tenían un aspecto gelatinoso o gomoso. En la microscopía electrónica de transmisión, por la técnica de contrastación negativa, se pudo observar en todas las muestras examinadas de piel y de costras, un gran número de partículas típicas de poxvirus, con envoltura y forma de ladrillo, mostrando disposición irregular de los túbulos sobre la membrana externa, midiendo 300 x 240 nm en el promedio. Cortes ultrafinos de fragmentos de piel y de costras revelaron la presencia de cuerpos de inclusión intracitoplasmáticas, envueltos por membrana y conteniendo partículas ovales, midiendo 270 x 130 nm, conteniendo núcleo o centro interno bicóncavo (forma de mancuernas). Partículas inmaduras (vacías) envueltas por membrana fueron observadas. También fueron analizados cuerpos de inclusión intracitoplasmáticos, electrodensos, conteniendo partículas virales brotando del material denso y amorfo. Fueron observadas inclusiones intranucleares fibrilares o "digitales" mostrando una estriación periódica y disposición en grupos en medio del material granular. Los núcleos estaban deformados con cromatina densamente condensada formando cuerpos de inclusiones electrodensas y amorfas. En la técnica de imunocitoquímica la reacción antígeno-anticuerpo fue intensamente marcada por las partículas de oro coloidal realzando fuertemente las partículas virales.

Ocular melanoma presenting as a case of panophthalmitis in a 78-year-old Nigerian woman (masquerade syndrome): an uncommon finding in Benin City, Nigeria.

Theodore states that the term 'masquerade syndrome' first appeared in the ophthalmic literature in 1967 to describe a conjunctival carcinoma that presented as chronic conjunctivitis. Since then, the masquerade syndrome label has been applied to a group of disorders that mimic ocular inflammatory disease. Although some benign conditions can be considered masquerade syndromes, most often the term refers to malignant entities. Tsai and O'Brien also report that ocular oncology, the subspecialty that concerns itself with ocular and orbital malignancies, is by nature a field of uncommon disorders. A discussion of the masquerade syndrome therefore becomes a study in uncommon presentations of uncommon diseases. Nevertheless, the subject deserves wide attention because, in many cases, the diseases that masquerade are not only vision-threatening but potentially fatal. Significant morbidity and mortality can be averted by early recognition and diagnosis of the masquerade. In this article, we present a case of a 78-year-old Nigerian woman who had an ocular melanoma that presented as a panophthalmitis, a rare case of masquerade syndrome in our environment.

Endogenous Pseudomonas endophthalmitis in an immunocompetent patient.

PURPOSE: To report an unusual case of community-acquired Pseudomonas aeruginosa pneumonia in an immunocompetent host complicated by orbital cellulitis, panophthalmitis, and subcutaneous nodules. METHODS: An otherwise healthy 47-year-old woman presented with a 24-hour history of fever, cutaneous nodules, right sided pleuritic chest pain, and eyelid edema with severe vision loss in her right eye. A chest X-ray demonstrated a homogeneous infiltrate in the right upper lobe. Ophthalmic examination revealed signs of metastatic orbital cellulitis and panophthalmitis. Culture specimens from blood, sputum, skin, and vitreous showed a significant growth of P. aeruginosa species. RESULTS: Intravenous antibiotic therapy led to resolution of the pneumonia, cutaneous nodules, and orbital cellulitis. Despite intravitreal and topical antibiotics, the patient finally required enucleation. CONCLUSION: This case represents a rare combination of manifestations in an immunocompetent patient with P. aeruginosa infection. It highlights the accelerated course that may result from P. aeruginosa infection, the difficulties of treatment, and the poor prognosis in the case of eye involvement.

Suprachoroidal septic effusion leading to panophthalmitis following strabismus surgery.

We describe a case of endophthalmitis following strabismus surgery. Drainage of the suprachoroidal effusion with injection of antibiotics was unsuccessful in salvaging vision. Endophthalmitis following strabismus surgery may present with findings simulating a choroidal effusion or hemorrhage. Treating physicians should be alert to signs and symptoms of this severe complication of strabismus surgery in preverbal children.

Orbital cellulitis, panophthalmitis, and ecthyma gangrenosum in an immunocompromised host with pseudomonas septicemia.

PURPOSE: To describe a case of Pseudomonas aeruginosa septicemia complicated by orbital cellulitis, panophthalmitis, and ecthyma gangrenosum. DESIGN: Observational case report. METHODS: An immunosuppressed 62-year-old man developed an unusual skin rash and a painful, swollen right eye with decreased vision. He had myelodysplastic syndrome and P. aeruginosa septicemia. The skin rash manifested as ecthyma gangrenosum. Metastatic orbital cellulitis and panophthalmitis was diagnosed. RESULTS: Despite intravitreal and topical gentamicin, the patient eventually required enucleation. CONCLUSIONS: This case represents a rare combination of events: an immunocompromised man developed pneumonia, P. aeruginosa septicemia, and endogenous seeding of the Pseudomonas to the skin, orbit, and eye. Early recognition of endogenous ophthalmic disease is imperative. The prognosis of combined orbital cellulitis and panophthalmitis is poor.

[Effectiveness of present-day therapy of purulent lesions of the cornea]. / Effektivnost' sovremennoi terapii gnoinykh porazhenii rogovoi obolochki.

The treatment of 313 patients (317 eyes) with purulent injuries of the cornea was studied. The medication therapy was found to be effective in 173 patients (176 eyes), which made up 56.2%. The purulent process in the cornea was arrested after the therapeutic penetrating and lamellar keratoplasty in 62 patients (63 eyes or 20.1%). 74 patients (74 eyes or 23.7%) were cured through the loss of an organ: enucleation was made for 63 patients, evisceroenucleation--for 8 patients and evisceration--for 3 persons. Before the onset of purulent pathology, all removed eyes were blind due to different diseases and traumas. Pathomorphological examinations of 63 enucleated eyes showed, in 76.2% of cases, purulent-and-inflammatory changes only in anterior eye segment, and in 23.8% of cases they showed that the purulent process extended into the posterior segment structures of the eyeball; it is noteworthy that the signs of developing endophthalmitis were found only in 6.3% of cases. The obtained morphological data are indicative of that not all therapeutic possibilities were used to preserve the injured but unpromising (in the optic sense) eyes. We conclude that the absolute indication for removing an eye with purulent pathology of the cornea is the generalizing process, i.e. endophthalmitis or panophthalmitis.