A CASE REPORT OF CHRONIC ENDOPHTHALMITIS SECONDARY TO AQUAMICROBIUMterrae.

PURPOSE: Chronic postoperative endophthalmitis is a known complication of cataract surgery. Here, we report a case of chronic endophthalmitis following uncomplicated cataract surgery secondary to the atypical bacterium Aquamicrobium terrae . METHODS: Retrospective case report of a single patient with endophthalmitis secondary to A. terrae. RESULTS: A 61-year-old healthy patient presented with recurrent iridocyclitis following uncomplicated cataract surgery. Repeated attempts to taper off topical steroid eyedrops were unsuccessful. Anterior chamber paracentesis cultures and vitrectomy cultures grew the same gram-negative bacillus, A. terrae , on six different occasions. The patient was treated initially with a series of intravitreal ceftazidime injections and adjuvant oral minocycline with recurrence of inflammation necessitating pars plana vitrectomy with intraocular lens removal and total capsulectomy. Inflammatory episodes recurred until residual capsule fragments were ablated using endoscopic vitrectomy. Since ablation over 18 months ago, no further recurrences have occurred and the patient has excellent visual outcome. CONCLUSION: A. terrae is a gram-negative bacillus recovered from polluted soil. This is the first case of postoperative endophthalmitis secondary to A. terrae and the first description of human infection caused by this newly identified microbe.

Quantitative Comparison of Fundus Images by 2 Ultra-Widefield Fundus Cameras.

PURPOSE: To compare the relative number of retinal pixels and retinal area imaged using the Optos P200DTx (Optos PLC) and Zeiss Clarus 500 (Carl Zeiss Meditec AG) ultra-widefield (UWF) fundus cameras. DESIGN: Single-center retrospective cross-sectional analysis. PARTICIPANTS: Seventy-eight eyes of 46 patients. METHODS: Eyes were imaged with Optos P200DTx, single-capture, and Zeiss Clarus 500, 2 capture montages when possible, UWF fundus cameras. Relative number of pixels encompassing all foveal-centered retinal quadrants were measured. Retinal area was measured with Zeiss Clarus 500 images that were registered to the Optos P200DTx images. Patients and technicians were asked for preferences between the machines. Imaging session times were recorded. MAIN OUTCOME MEASURES: Relative number of retinal pixels and retina area captured by each fundus camera. RESULTS: Optos P200DTx consistently captured more relative pixels compared with Zeiss Clarus 500: 510.4 versus 355.6 (P < 0.001) in total with a similarly statistically significant trend in all 4 quadrants (P < 0.001 for each). For area calculation, 70 of the 78 images achieved successful registration. Optos captured a larger total retinal area: 765.6 versus 566.5 mm2 (P < 0.001) with a similarly statistically significant trend in all 4 quadrants. In the subset of 52 of 70 registered and montaged Zeiss Clarus 500 images, similar results were found. For peripheral pathologic features, Optos P200DTx captured unique findings in 28 images, and Zeiss Clarus 500 captured unique findings 1 image (P < 0.001). Among the 48 imaging sessions in which technicians preferred Optos P200DTx for 28 sessions (58%) and Zeiss Clarus 500 for 20 (42%; P = 0.15). Among patients who responded with a preference, 24 preferred Optos P200DTx and 20 preferred Zeiss Clarus 500 (P = 0.52). Average imaging session time was 4.6 minutes (standard deviation, 3.0 minutes) for Optos P200DTx and 5.2 minutes (standard deviation, 3.0 minutes) for Zeiss Clarus 500 (P = 0.17). CONCLUSIONS: In the current study, the Optos P200DTx captured statistically significantly more retinal area in all 4 quadrants compared with the Zeiss Clarus 500. No statistically significant difference was found in patient or technician preference or image acquisition time between devices.

Treatment of Acute Zonal Occult Outer Retinopathy With Intravitreal Steroids.

BACKGROUND AND OBJECTIVE: To report on the use of intravitreal steroids in the management of acute zonal occult outer retinopathy (AZOOR), a rare disorder affecting the outer retina. PATIENTS AND METHODS: Retrospective case series of nine eyes of five patients with AZOOR who received intravitreal triamcinolone acetonide (IVTA), dexamethasone intravitreal implant, and/or fluocinolone acetonide implant. Treatment response was determined by reported symptoms and multimodal imaging findings. Patients were observed for at least 1 year following intravitreal steroid treatment (range: 14 months to 63 months). RESULTS: Seven eyes received IVTA, six eyes received the dexamethasone intravitreal implant, and one eye received the fluocinolone acetonide implant. All patients experienced disease stability or improvement based on symptomatic response and multimodal imaging findings after intravitreal steroids. One eye developed central serous retinopathy, and another eye a choroidal neovascular membrane. Five of nine eyes experienced ocular hypertension. All phakic eyes developed cataracts. CONCLUSION: Intravitreal steroids effectively achieved disease stability in patients with AZOOR. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:504-509.].

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.].

Multimodal Imaging of Choroidal Neovascularization Associated with Sclerochoroidal Calcification.

We report a case of a choroidal neovascular membrane (CNVM) associated with sclerochoroidal calcification (SCC). An asymptomatic, 72-year-old male was referred to our institution for yellow-white placoid retinal lesions of both eyes. B-scan ultrasonography confirmed the diagnosis of SCC, and indocyanine green angiography confirmed the presence of an associated CNVM. Due to enlargement of a hemorrhagic pigment epithelial detachment associated with the CNVM over the course of 7 months, the patient was treated with a series of bevacizumab injections followed by photodynamic therapy (PDT). Due to persistence of the CNVM following PDT, the lesion was finally treated with argon laser photocoagulation. We describe the clinical course of this rare complication of SCC.

Cone and rod loss in Stargardt disease revealed by adaptive optics scanning light ophthalmoscopy.

IMPORTANCE: Stargardt disease (STGD1) is characterized by macular atrophy and flecks in the retinal pigment epithelium. The causative ABCA4 gene encodes a protein localizing to photoreceptor outer segments. The pathologic steps by which ABCA4 mutations lead to clinically detectable retinal pigment epithelium changes remain unclear. We investigated early STGD1 using adaptive optics scanning light ophthalmoscopy. OBSERVATIONS: Adaptive optics scanning light ophthalmoscopy imaging of 2 brothers with early STGD1 and their unaffected parents was compared with conventional imaging. Cone and rod spacing were increased in both patients (P < .001) with a dark cone appearance. No foveal cones were detected in the older brother. In the younger brother, foveal cones were enlarged with low density (peak cone density, 48.3 × 103 cones/mm2). The ratio of cone to rod spacing was increased in both patients, with greater divergence from normal approaching the foveal center, indicating that cone loss predominates centrally and rod loss increases peripherally. Both parents had normal photoreceptor mosaics. Genetic testing revealed 3 disease-causing mutations. CONCLUSIONS AND RELEVANCE: This study provides in vivo images of rods and cones in STGD1. Although the primary clinical features of STGD1 are retinal pigment epithelial lesions, adaptive optics scanning light ophthalmoscopy reveals increased cone and rod spacing in areas that appear normal in conventional images, suggesting that photoreceptor loss precedes clinically detectable retinal pigment epithelial disease in STGD1.