Ab Interno Gel Implant-associated Bleb-related Infection.

PURPOSE: To examine the presentation and management of 3 cases of bleb-related infection following ab interno gel implant surgery, so as to add to the growing understanding of complications associated with the emerging landscape of newer, minimally invasive glaucoma surgical procedures, and how they are best managed. DESIGN: Multicenter retrospective interventional case series. METHODS: Consecutive cases of bleb-related infection following ab interno gel implant surgery from 2 university-affiliated hospitals were included. Risk factors, visual outcomes, intraocular pressure, and subsequent management were analyzed. RESULTS: We report 3 cases of late bleb-related infection occurring after ab interno gelatin stent insertion (8, 7, and 24 months after surgery). One case had blebitis only; the other 2 had bleb-related endophthalmitis. All cases responded rapidly to management of their infections according to standard bleb-related infection protocol, recovering to within 2 lines of their previous visual acuity (6/9, 6/12, and 6/18). Explantation of the devices was not required. CONCLUSIONS: Bleb-related infections after ab interno gel implant insertion can occur. If infection is treated appropriately, good clinical outcomes are possible.

Human trabecular meshwork sphingolipid and ceramide profiles and potential latent fungal commensalism.

PURPOSE: We determined the profiles of sphingomyelin, sphingoid base, sphingoid base-1-phosphate, and ceramide, and their quantitative differences between control and glaucomatous trabecular meshwork (TM) derived from human donors. METHODS: Control and primary open angle glaucoma (POAG) TM samples were collected from cadaver donors. In addition, POAG TM surgical specimens also were procured. Lipid extraction was performed using suitable modifications of the Bligh and Dyer method. Protein concentrations were determined using Bradford's method. Lipids, identified using standardized class-specific lipid mass spectrometry, were quantified using a two-step ratiometric process. Gomori methenamine silver (GMS) staining was performed for detection of presence of Fusarium in the anterior eye tissue sections. PCR analyses were performed for detection of Fusarium species in the donor TM samples. RESULTS: Several species of sphingomyelin, sphingoid base, sphingoid base-1-phosphate, and ceramide were common between control and POAG TM. Only a subset of species in some of these classes were identified uniquely either in controls or in POAG TM. Several lipid species of fungal origin (many from Fungi imperfecti, Fusarium species) were found to be common between control and POAG TM. The GMS staining and PCR analyses showed presence of DNA belonging to Fusarium species suggesting latent commensalism. CONCLUSIONS: Most sphingolipids and ceramides (except a few unique to a specific donor TM group) were found to be common in the control and POAG TM. Latent commensalism by Fusarium was suggested by identification of Fusarium-specific lipids, which was supported further by PCR amplification and sequencing of DNA.

Endotelitis y trabeculitis herpética con afectación corneal tardía / Herpetic endotheliitis and trabeculitis with delayed corneal involvement

Caso clínico: Varón de 62 años de edad con trasplante renal y tratamiento inmunosupresor que acude por disminución de la visión (20/100) en ojo izquierdo, edema corneal y presión intraocular de 46mmHg. Un mes después aparece queratitis dendrítica marginal inferior. El raspado corneal y la proteína C reactiva demuestran la presencia de un virus del herpes simple (HVS). Discusión: La epiteliopatía corneal autoinmunitaria o endotelitis idiopática corneal se caracteriza por edema corneal y precipitados queráticos. Se cree que el HVS podría ser secretado desde el trabeculum, inervado por el nervio trigémino, apoyado clínicamente por la progresión del edema estromal desde la periferia(AU)

Case report: A 62-year-old man with previous renal transplant and immunosuppressive treatment presented with decreased visual acuity (20/100) in his left eye, corneal oedema and intraocular pressure of 46mmHg. One month later an inferior marginal dendritic keratitis appeared. Corneal scraping and real-time polymerase chain reaction showed herpes simplex virus (HSV). Discussion: The autoimmune corneal endotheliopathy or acute idiopathic corneal endotheliitis is characterised by corneal stromal oedema and keratic precipitates. HSV might be secreted from the trabeculum, innervated by the trigeminal nerve. This hypothesis is supported by the clinical observation that the corneal stromal oedema usually starts from the periphery(AU)

Histological presence of Helicobacter pylori bacteria in the trabeculum and iris of patients with primary open-angle glaucoma.

PURPOSE: To investigate the role of Helicobacter pylori in primary open-angle glaucoma (POAG) pathophysiology by detecting its presence in eye biopsies of POAG patients during trabeculectomy. PATIENTS AND METHODS: Fifty-one consecutive patients who underwent trabeculectomy for POAG not responsive to antiglaucoma therapy, and 35 consecutive anemic controls were examined for H. pylori presence mainly by gastric mucosa histology. In POAG patients, eye biopsies were also obtained and stained for H. pylori presence in situ. RESULTS: Forty-three of 51 (84.3%) POAG patients and 17 of 35 (48.6%) controls were tested H. pylori positive (p = 0.0004). In 5 H. pylori-positive POAG patients, H. pylori bacteria were identified in the trabeculum and iris specimens. CONCLUSION: For the first time, H. pylori bacteria have been detected histologically in eye biopsies of POAG patients.

Involvement of anterior chamber angle structures in disseminated histoplasmosis: report of three cases.

This study describes the involvement of anterior chamber (AC) angle structures in patients with disseminated histoplasmosis. The postmortem eyes from three patients (aged 33, 41, and 42 years, respectively) with disseminated histoplasmosis, two of whom had acquired immunodeficiency syndrome, were examined by light microscopy using hematoxylin-eosin, periodic acid-Schiff (PAS), and Gomori's methenamide silver (GMS) stains. Electron microscopy studies of the choroid were performed in one eye. Significant numbers of budding yeast forms of Histoplasma capsulatum measuring 2-5 microns in diameter were observed within the trabecular meshwork, Schlemm's canal and in the deep intrascleral plexuses. All eyes showed massive involvement of the choroidal vasculature, including the choriocapillaris. The organisms were observed freely as well as in small clusters within the cytoplasm of circulating monocytes. The vessels of the limbal conjunctiva (two eyes) and ciliary body (three eyes) contained many Histoplasma organisms. In one eye, several budding yeast were noted in an iris vessel and in occasional histiocytes within the ciliary muscle. Blood smears containing Histoplasma organisms were observed in two cases. None of the patients had an ophthalmologic examination prior to death. Involvement of the intravascular structures of the eye as well as the AC angle was observed in three patients with disseminated histoplasmosis. The fungus most likely reached the AC angle structures by direct hematogenous dissemination or via the aqueous humor by migration from vessels in the ciliary body and iris. An abnormal retrograde blood flow into the AC angle structures may have also played an important role. We suggested that the intraocular pressure be monitored in cases of suspected disseminated histoplasmosis to detect functional alterations indicative of a blockage in the outflow channels.

Endophthalmitis due to Blastomyces dermatitidis. Case report and review of the literature.

Blastomycosis very rarely affects ocular structures other than the eyelid. It is even more unusual for involvement to occur in the absence of active widespread disease. The authors report a 71-year-old woman with unresponsive endophthalmitis of the right eye who underwent enucleation. Results of microscopic examination of the globe showed severe acute and chronic granulomatous and nongranulomatous endophthalmitis as well as numerous fungi having the histologic features of Blastomyces dermatitidis. Although constitutional symptoms (weight loss, fatigue, night sweats) were noted by the patient, multiple investigations failed to disclose any evidence of systemic disease.