Clinical Features and Management of Subretinal Abscesses Secondary to Methicillin-Resistant Staphylococcus aureus Endogenous Endophthalmitis.

BACKGROUND AND OBJECTIVE: To describe the clinical features, management, and immediate outcomes of patients with subretinal abscesses secondary to methicillin-resistant Staphylococcus aureus (MRSA) endogenous endophthalmitis. PATIENTS AND METHODS: Eleven eyes of seven patients were identified by retrospective chart review. Demographics, initial presentation, examination findings, imaging, cultures, treatments, and short-term outcomes were reviewed. RESULTS: Eleven eyes of seven patients presented with subretinal abscesses secondary to MRSA endogenous endophthalmitis. Four had history of recurrent MRSA infections or active soft-tissue ulceration. Six underwent vitreous tap for culture without growth. Three had positive blood cultures for MRSA. Six received empiric therapy with intravenous vancomycin, one received oral trimethoprim-sulfamethoxazole, and six received intravitreal vancomycin. Consolidation of abscesses was seen within days of initial treatment. Visual outcomes were contingent on abscess location and time to initial treatment. CONCLUSION: Prompt diagnosis and systemic antibiotic therapy is paramount in the treatment of this rare presentation. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:134-142.].

The value of healthcare data in ophthalmology.

PURPOSE OF REVIEW: The healthcare system creates a vast amount of data that are utilized by a wide variety of entities for a multitude of purposes. Physicians have traditionally been unable to control who has access to their data or how their data are used. The widespread adoption of the Electronic Health Record (EHR) by physicians will create a larger and more valuable healthcare data market with broad implications for the healthcare system. It is, therefore, important for physicians to understand the evolving healthcare data market and the importance of maintaining ownership of and control over their electronic health data. RECENT FINDINGS: Several entities, including private health insurance companies, federal payers, medical societies, and pharmaceutical companies are increasingly utilizing healthcare data to drive reimbursement policies and commercial initiatives. SUMMARY: Given the critical importance that EHR data will play in multiple aspects of the healthcare industry, it is in physicians' interest to maintain ownership and control of the healthcare data that they generate. It would be prudent for physicians to exercise caution before relinquishing data rights to entities that may sell the data to payers or other customers with whom physicians' interests may not be aligned.

Primary subretinal abscess caused by acanthamoeba: clinical and pathologic case report and review of the literature.

PURPOSE: To report the clinical and pathologic findings in a patient with a primary Acanthamoeba subretinal abscess. METHODS: A healthy 40-year-old man was evaluated and treated for a subretinal abscess. A subretinal aspirate was evaluated using hematoxylin-eosin stains and polymerase chain reaction. RESULTS: Results of the histologic examination of the subretinal aspirate demonstrated numerous Acanthamoeba cysts. The diagnosis was confirmed by polymerase chain reaction. The infection was treated with local and systemic antimicrobials. The visual acuity remained stable, and there was no local or systemic spread of the infection. CONCLUSION: To the authors' knowledge, this is the first biopsy-proven case of primary subretinal abscess because of Acanthamoeba. Acanthamoeba should be considered in the differential diagnosis of a subretinal abscess, even in the absence of systemic or corneal symptoms. Aggressive treatment can prevent serious ocular and systemic complications.

Incidence of intraocular pressure spike and other adverse events after vitreoretinal surgery.

PURPOSE: To determine the incidence of significant postoperative intraocular pressure (IOP) elevation and other adverse medical events during the first postoperative day in patients undergoing inpatient vitreoretinal surgery. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Two hundred two consecutive patients were admitted prospectively as inpatients after vitreoretinal surgery (vitrectomy and/or scleral buckling). METHODS: Intraocular pressure was measured preoperatively, 5 to 12 hours postoperatively, and on postoperative day 1. Additionally, pain, nausea, and serious systemic adverse events were monitored. RESULTS: Seventeen patients (8.4%) had a 5- to 12-hour IOP measurement above 29 mmHg. Thirty patients (14.8%) had a postoperative day 1 IOP measurement above 29 mmHg. Three patients (1.5%) required a parenteral narcotic to achieve adequate analgesia. Nine patients (4.5%) utilized a parenteral antiemetic for nausea control. Six patients (3.0%) had a hyperglycemic event. No serious systemic adverse events occurred in the early postoperative period. CONCLUSIONS: The incidence of a significant IOP spike or systemic adverse events in the early postoperative period in patients undergoing vitreoretinal surgery is low.

Ocular manifestations of graft versus host disease.

PURPOSE OF REVIEW: A review of the current literature regarding the ocular manifestations and management of graft versus host disease is presented. RECENT FINDINGS: A variety of systemic and topical anti-inflammatory or immunomodulatory agents, including prednisolone acetate, cyclosporine A, FK506, autologous serum, and retinoic acid show promise in controlling ocular graft versus host disease. SUMMARY: Graft versus host disease is a common manifestation of allogeneic stem cell transplantation. Ocular manifestations are found in a majority of patients and may be the presenting symptom. Ocular findings include keratoconjunctivitis sicca, pseudomembranous conjunctivitis, corneal ulceration and perforation, and microvascular retinopathy. Systemic and local therapy may be used to control ocular disease.

Hypopyon uveitis and relapsing polychondritis: a report of 2 patients and review of autoimmune hypopyon uveitis.

OBJECTIVE: To report hypopyon uveitis as an ophthalmic finding associated with relapsing polychondritis. DESIGN: Interventional case reports. PARTICIPANTS: Two patients with hypopyon uveitis as a manifestation of relapsing polychondritis. METHODS: Complete ocular and systemic examinations as well as chart reviews were performed for 2 patients with hypopyon uveitis as a manifestation of relapsing polychondritis at presentation. MAIN OUTCOME MEASUREMENTS: Clinical observation and response to treatment in 2 patients with hypopyon uveitis secondary to relapsing polychondritis. RESULTS: A 70-year-old white male had unilateral hypopyon uveitis accompanied by a migratory polyarthralgia at presentation. Fifteen months later, he sought treatment for chondritis of the right auricle and was diagnosed with relapsing polychondritis. A 42-year-old white female with known relapsing polychondritis had bilateral hypopyon uveitis at presentation during a systemic relapse. Both patients had resolution of the hypopyon with topical and systemic steroids. CONCLUSIONS: Relapsing polychondritis should be considered in the differential diagnosis of sterile hypopyon uveitis. Steroids and systemic immunosuppression can be used to treat the uveitis.

Clinicopathologic findings from lacrimal sac biopsy specimens obtained during dacryocystorhinostomy.

PURPOSE: To retrospectively review the pathologic diagnoses and clinical characteristics of patients undergoing dacryocystorhinostomy (DCR). METHODS: Specimens accessioned between 1991 and 2001 in a single ophthalmic pathology laboratory were reviewed. All of the specimens included a lacrimal sac biopsy specimen. The pathologic diagnoses were recorded. The clinical features of the patients with significant pathologic abnormalities were reviewed to determine if the pathology was suspected before or at the time of the DCR. RESULTS: There were 377 DCR specimens from 316 patients representing 1.8% of 21,018 ophthalmic pathology specimens accessioned between 1991 and 2001. Diagnoses, in decreasing order of frequency, were nongranulomatous inflammation (321, 85.1%), granulomatous inflammation consistent with sarcoidosis (8, 2.1%), lymphoma (7, 1.9%), papilloma (4, 1.11%), lymphoplasmacytic infiltrate (4, 1.1%), transitional cell carcinoma (2, 0.5%), and single cases of adenocarcinoma, undifferentiated carcinoma, granular cell tumor, plasmacytoma, and leukemic infiltrate. A total of 31 (8.2%) specimens from 25 (7.9%) of patients demonstrated significant pathology. Among 17 specimens (4.5%) from 14 patients with neoplasms whose clinical histories were available, 8 (2.1%) were not suspected before surgery. CONCLUSIONS: Nongranulomatous inflammation consistent with chronic dacryocystitis is the most common diagnosis in lacrimal sac specimens obtained at DCR. Neoplasms resulting in chronic nasolacrimal duct obstruction occurred in 4.6% of cases and were unsuspected before surgery in 2.1% of patients. We recommend pathologic examination of DCR specimens.