Lenticular fungal infection caused by Aspergillus in a patient with traumatic corneal laceration: a case report.

BACKGROUND: To report a case of lenticular infection caused by Aspergillus, which was diagnosed 13 weeks after traumatic corneal laceration. CASE PRESENTATION: A 60-year-old woman presented with traumatic corneal laceration including anterior lens capsule rupture and traumatic cataract after being hit with a chestnut in the right eye. There were multiple injuries due to tiny thorns of the chestnut, including the conjunctiva, sclera, cornea, and anterior lens capsule. But no visible foreign body was detected by slit-lamp examination. Topical corticosteroid was prescribed to resolve the conjunctival inflammation induced by the thorns of chestnut, which could have caused persistent irritation. As conjunctival injection and edema being decreased during outpatient clinical follow-up, embedded conjunctival foreign body was detected and surgically removed (1st surgery). Approximately 10 weeks after the trauma, severe inflammation of the anterior segment accompanied with hypopyon developed suddenly and at the same time embedded scleral foreign body was revealed. After removal of scleral foreign body (2nd surgery), unspecified mold species was cultured from the scleral foreign body in SDA (Sabouraud dextrose agar) plate. Suspicious corneal foreign body was removed as 3rd surgery and phacoemulsification of traumatic cataract was planned as 4th surgery. Aspergillus was finally detected from removed anterior capsule and fibrotic membrane during the operation. Fungal infection resolved successfully after administration of topical (1% voriconazole and 5% natamycin) and systemic (fluconazole) antifungal agents and phacoemulsification of traumatic cataract. CONCLUSION: Chestnut thorns can damage multiple ocular tissues simultaneously. Lens capsular rupture could result in fungal inoculation and lead to delayed lenticular fungal infection with complicated cataract formation. In cases of ocular trauma due to organic substances such as thorns and branches, the possibility of fungal infection should be considered.

CANDIDA ENDOPHTHALMITIS FROM THE REACTIVATION OF A DORMANT LENTICULAR FUNGAL ABSCESS IN A PREMATURE INFANT.

BACKGROUND/PURPOSE: To report a case of fungal endophthalmitis from reactivation of a dormant lenticular fungal abscess in a severely premature infant. METHODS: Single retrospective case report. RESULTS: A female born at 23 and 6/7 weeks and weighing 620 g was diagnosed at age 29 weeks post menstrual age with persistent tunica vasculosa lentis, lenticular opacity, and aggressive posterior retinopathy of prematurity, and received bilateral intravitreal injection of bevacizumab. At the time of injection she was receiving systemic antibiotics for sepsis and fungemia. The retinopathy of prematurity regressed, as did the tunica vasculosa lentis, but a small plaque remained on the lens. At 5.5 months of age, patient presented with hypopyon and elevated intraocular pressure. Culture of intraocular fluid demonstrated Candida albicans. CONCLUSION: Candida lenticular abscess is a rare complication of systemic fungemia in premature infants. Bevacizumab-induced regression of tunica vasculosa lentis may have decreased the ability of systemically administered antifungal medications to reach the colonized lens.

Candida species lens abscesses in infants with a history of neonatal Candida sepsis.

We report 3 patients who were delivered prematurely and who developed a lens opacity with signs of ocular inflammation at a postgestational age of 10-52 weeks. All patients had been treated for Candida sepsis as neonates. Each patient underwent lensectomy and anterior vitrectomy. In 2 infants Candida albicans was cultured from the lens/anterior chamber membrane; in 1 Candida parapsilosis was cultured from a lens aspirate. Despite eradication of the fungal infection, outcomes were poor: 2 eyes developed glaucoma, and 1 developed a retinal detachment with subsequent phthisis.

Propionibacterium acnes in capsular bag distension syndrome.

We report a case of capsular bag distension syndrome that developed 6 years after uneventful phacoemulsification with implantation of a foldable, single-piece acrylic intraocular lens (IOL) (AcrySof MA60BM). Slitlamp microscopy revealed a deep anterior chamber with no flare or cells. The posterior capsular bag was distended by a homogeneous milky substance between the back of the IOL and the capsular bag. Using a pars plana approach, a 23-gauge bimanual capsulotomy and anterior vitrectomy were performed. Microbiological analysis revealed Propionibacterium acnes in the material inside the capsular bag. The postoperative period was uneventful. Four weeks after surgery, visual acuity was restored and there were no signs of intraocular inflammation. The origin of late capsular bag distension is not fully understood; it may involve an infectious component with propionibacteria. A surgical approach and removal of the potentially infectious material can be considered as an alternative to neodymium:YAG capsulotomy.

Traumatic intralenticular abscess: a case series.

PURPOSE: To report the clinical presentation, management and outcome of eyes with traumatic intralenticular abscess. METHODS: In this interventional case series, records of eight patients (eight eyes) with intralenticular abscess developing following trauma were reviewed. All patients underwent extracapsular cataract extraction with intracameral antibiotics with or without pars plana vitrectomy. Main outcome measures studied were resolution of infection and final visual outcome. RESULTS: Lens abscess developed in six eyes following penetrating injury and in two eyes following intraocular penetration of caterpillar hair. Gram positive cocci were cultured from the lens aspirate in five eyes and Staphylococcus epidermidis was the most common organism isolated. Cataract extraction resulted in control of the infection in all eyes and seven eyes (87.5%) had a favourable visual outcome. CONCLUSION: Early lens extraction with intracameral antibiotics in eyes with intralenticular abscess allows control of infection with good visual outcome.

Phacoemulsification in isolated endogenous Candida albicans anterior uveitis with lens abscess in an intravenous methadone user.

We report the clinical course of a 31-year-old former intravenous drug user on methadone substitution therapy who injected methadone mixed with orange juice. She developed isolated metastatic Candida albicans anterior uveitis, which was treated with adequate systemic and local antifungal therapy. The uveitis regressed, but despite adequate local and systemic treatment, a lens abscess developed. Phacoemulsification and endocapsular intraocular lens implantation were performed, and the patient recovered 20/20 visual acuity in the affected eye. In patients with a history of injection drug use, persisting intravenous drug or substitution therapy abuse must be considered. Quick diagnosis and adequate treatment can prevent the development of widespread C albicans endophthalmitis, which has a poor visual prognosis. Early administration of antifungal and surgical therapy is crucial for achieving good functional results.

Evidence of enhanced bacterial invasion during Diplostomum spathaceum infection in European grayling, Thymallus thymallus (L.).

Farmed grayling, Thymallus thymallus (L.), are susceptible to atypical Aeromonas salmonicida (aAS) infections. Interactions between bacteria and parasites were studied using grayling subjected to concomitant exposure to aAS bacteria and the digenean parasite Diplostomum spathaceum. Atypical AS was detected from fish by a combination of bacterial cultivation and polymerase chain reaction techniques. A detection level of 17 aAS cells per 100 mg intestine tissue sample was obtained. Concomitant bacterial exposure did not enhance the severity of grayling eye rupture and nuclear extrusion induced by D. spathaceum, but D. spathaceum invasion into grayling increased the proportion of fish carrying aAS in their heart tissue. However, the number of aAS cells detected in heart tissue was low. Atypical AS did not cause acute disease or mortality during 15 days post-exposure. There was a higher prevalence of aAS in grayling heart samples than in intestinal samples, indicating that the intestine is not favoured by aAS. We suggest that heart tissue would be a good organ from which to isolate aAS when tracing latent carrier fish. We conclude that penetrating diplostomids can enhance bacterial infections in fish and that diplostomids can cause serious eye ruptures in grayling.

Exogenous Pseudomonas endophthalmitis: a cause of lens enucleation.

Pseudomonas aeruginosa eye infection, although uncommon, may be a devastating disease if not recognised and treated appropriately, especially in premature infants. The case is presented of a premature baby who lost her right eye from invasive exogenous Ps aeruginosa eye infection.

Intralenticular infections.

Antecedent trauma resulting in endophthalmitis is not uncommon. However, primary intralenticular infection is a rare occurrence. Primary intralenticular fungal infection has not been previously reported. The authors present two cases: one of Paecilomyces infection and the other of Staphylococcus epidermidis infection limited to the crystalline lens. Both cases illustrate a delay in diagnosis.

Intralenticular abscess.

Intralenticular abscess is an uncommon complication of surgery or trauma. A case of intralenticular abscess following penetrating trauma is presented. In this case, the offending organism was identified as Propionibacterium acnes. This organism is considered to be a cause of slowly progressing endophthalmitis and has been implicated as a cause of the so-called toxic lens syndrome.

Congenital syphilis of the eye with lens involvement.

Pathological examination of a girl with congenital syphilis revealed a focal granulomatous reaction involving the anterior uvea and lens. Krajian's (silver) stain exhibited spiral forms that were morphologically compatible with Treponema pallidum within the lens cortex. These findings have been rarely reported in early congenital lues.