Severe Ocular Bacterial Infections: A Retrospective Study Over 13 Years.

PURPOSE: To report data of samples collected from January 2000 to August 2013, in the Department of Diagnosis and Laboratory Analysis, Ophthalmic Hospital, Turin, Italy, from different types of ocular infections and their antibiotic susceptibility. METHODS: Collected samples were cultured using both liquid and solid media. Then bacterial isolates were tested for antibiotic susceptibility using the Kirby-Bauer diffusion method and the National Committee for Clinical Laboratory Standards (NCCLS) serum standards. RESULTS: Staphylococcus aureus is the most common bacteria isolated in ocular samples. CONCLUSIONS: In vitro susceptibility tests showed that levofloxacin and moxifloxacin (introduced only in 2010) had the highest efficacy against bacterial isolates.

Vascularized solid iris lesion in a 3 year old child: 5 years of follow up.

BACKGROUND: Iris tumors are rare in young patients. When an iris lesion occurs in a pediatric patient, it can be difficult to classify because of the wide spectrum of iris proliferations. CASE PRESENTATION: We report on an unusual case of a vascularized iris lesion in a three year old Caucasian patient, with no symptoms and no visual impairment. We evaluated in a 50-month follow up with non-invasive diagnostic tools in order to avoid eye biopsy. CONCLUSION: We focused attention on the differential diagnoses and underlined the role of non-invasive diagnostic tools in a child to avoid or postpone the eye biopsy. We performed a review of the literature to identify the best medical practice in pediatric iris lesions with atypical characteristics.

Micro-Bypass Implantation for Primary Open-Angle Glaucoma Combined with Phacoemulsification: 4-Year Follow-Up.

Purpose. To report the long-term follow-up results in patients with cataract and primary open-angle glaucoma (POAG) randomly assigned to cataract surgery combined with micro-bypass stent implantation or phacoemulsification alone. Methods. 36 subjects with cataract and POAG were randomized in a 1 : 2 ratio to either iStent implantation and cataract surgery (combined group) or cataract surgery alone (control group). 24 subjects agreed to be evaluated again 48 months after surgery. Patients returned one month later for unmedicated washout assessment. Results. At the long-term follow-up visit we reported a mean IOP of 15,9 ± 2,3 mmHg in the iStent group and 17 ± 2,5 mmHg in the control group (p = NS). After washout, a 14,2% between group difference in favour of the combined group was statistically significant (p = 0,02) for mean IOP reduction. A significant reduction in the mean number of medications was observed in both groups compared to baseline values (p = 0,005 in the combined group and p = 0,01 in the control group). Conclusion. Patients in the combined group maintained low IOP levels after long-term follow-up. Cataract surgery alone showed a loss of efficacy in controlling IOP over time. Both treatments reduced the number of ocular hypotensive medications prescribed. This trial is registered with: NCT00847158.

Parry Romberg syndrome with a wide range of ocular manifestations: a case report.

BACKGROUND: Parry-Romberg syndrome (PRS) is a rare disorder characterized by unilateral facial atrophy affecting the skin, subcutaneous tissue, muscles, and sometimes extending to the osteocartilaginous structures. Ocular involvement is relatively rare. CASE PRESENTATION: We present a case of a 23-year-old female caucasian patient with Parry Romberg syndrome and extensive ocular involvement: enophthalmos, uveitis, iris atrophy. Ultrasound biomicroscopy (UBM) demonstrated hypotrophy of the ciliary body. The ciliary body atrophy has been previously reported just once and can be an explanation for the hypotony, frequently present in these patients. CONCLUSIONS: Parry Romberg syndrome is a rare multidisciplinary disease. Our case presents a full spectrum of ocular manifestations. The pathogenesis of hypotonia is discussed.

Terson syndrome and leukemia: a case report.

BACKGROUND: Terson syndrome is defined as intraocular hemorrhage associated with intracranial bleeding. This syndrome can occur in the event of intracranial hemorrhage or elevated intracranial pressure. To our knowledge, it has never been associated with chronic myeloid leukemia. A 45-year-old woman suffering from chronic myeloid leukemia was referred to our clinic with Terson syndrome after intracranial bleeding. We followed this patient for a year, performing visual acuity assessment, fundus examination, color retinography, and A-scan and B-scan ultrasonography. At presentation, her best-corrected visual acuity on the right was 20/63 and on the left was 20/320. In the right eye, retinoscopy showed blurring of the optic margins surrounded by retinal and preretinal hemorrhages, preretinal fibrosis of the optic disc along the vascular arcades, and perivascular retinal infiltrates. In the left eye, the optic disc was surrounded by retinal and preretinal hemorrhages, and massive fibrosis with hard exudates and severe preretinal hemorrhage were observed at the posterior pole. Roth spots and many circular hemorrhages were noted at the periphery of the retina. A-scan and B-scan ultrasonography did not show intraocular leukemic infiltration. The clinical picture remained stable over the following 12 months. In this patient, we observed the ophthalmoscopic features of chronic myeloid leukemia, but also coexistence of features typical of Terson syndrome. To our knowledge, no similar cases have been reported previously.

In vitro susceptibility to different topical ophthalmic antibiotics of bacterial isolates from patients with conjunctivitis.

PURPOSE: To test in vitro the susceptibility to different commercially-available topical antibiotics of isolates from patients with conjunctivitis, evaluated at the Microbiology Service of Turin Ophthalmic Hospital between January 2005-February 2007. METHODS: Bacterial isolates were cultured using both liquid and solid media. The four most frequent isolates were analyzed and their in vitro susceptibility to levofloxacin, ofloxacin, norfloxacin, lomefloxacin, tobramycin, netilmycin, ampicillin, and chloramphenicol was tested, using the Kirby-Bauer diffusion method and National Committee for Clinical Laboratory Standards (NCCLS) serum standards. RESULTS: The four most common bacteria isolates were: Staphylococcus aureus (27%), viridians Streptococci (22%), Staphylococcus epidermidis (16%) and Streptococcus pneumoniae (13%). The in vitro susceptibility to levofloxacin was highest (p<0.01) for all bacterial isolates. CONCLUSIONS: In vitro susceptibility tests showed that levofloxacin had the highest cumulative efficacy against bacterial isolates. Netilmycin showed the highest efficacy against staphylococcus aureus, the most common bacterial isolate in this study.

Ganglion cell complex and retinal nerve fiber layer measured by fourier-domain optical coherence tomography for early detection of structural damage in patients with preperimetric glaucoma.

AIMS: To evaluate the capability of Fourier-domain optical coherence tomography (FD-OCT) to detect structural damage in patients with preperimetric glaucoma. METHODS: A total of 178 Caucasian subjects were enrolled in this cohort study: 116 preperimetric glaucoma patients and 52 healthy subjects. Using three-dimensional FD-OCT, the participants underwent imaging of the ganglion cell complex (GCC) and the optic nerve head. Sensitivity, specificity, likelihood ratios, and predictive values were calculated for all parameters at the first and fifth percentiles. Areas under the curves (AUCs) were generated for all parameters and were compared (Delong test). For both the GCC and the optic nerve head protocols, the OR logical disjunction (Boolean logic operator) was calculated. RESULTS: The AUCs didn't significantly differ. Macular global loss volume had the largest AUC (0.81). Specificities were high at both the fifth and first percentiles (up to 97%), but sensitivities were low, especially at the first percentile (55%-27%). CONCLUSION: Macular and papillary diagnostic accuracies did not differ significantly based on the 95% confidence interval. The computation of the Boolean OR operator has been found to boost diagnostic accuracy. Using the software-provided classification, sensitivity and diagnostic accuracy were low for both the retinal nerve fiber layer and the GCC scans. FD-OCT does not seem to be decisive for early detection of structural damage in patients with no functional impairment. This suggests that there is a need for analysis software to be further refined to enhance glaucoma diagnostic capability.

Do antiglaucomatous prostaglandins induce melanogenesis in human conjunctiva?: an impression cytology pilot study.

PURPOSE: To determine the effect of antiglaucomatous prostaglandin analogs on conjunctival melanogenesis. METHODS: For this pilot study, 30 glaucomatous patients treated with prostaglandin drops (alone and in association to beta-blockers) and 30 control subjects (15 healthy volunteers and 15 patients treated with beta-blockers) were included in this transversal, single masked, case-control, observational study. Skin complexion, eye color, conjunctival pigmentation, lacrimal tests, and corneal fluorescein staining were evaluated. Immunoreactivity for Tyrosinase was assayed on conjunctival imprints. RESULTS: Twenty percent of patients treated with prostaglandins and 10% of the control subjects clinically manifested conjunctival pigmentation (P=0.279). Only 4% (8/198) of the conjunctival specimens were positive to Tyrosinase immunostaining, with no statistically significant difference among the groups (P=0.449). In all cases, the proportion of positive cells was below 4%. When compared with subjects having negative specimens, those with positive immunostains did not show any statistically significant difference in skin complexion, eye color or exposure to irritants, and ultraviolet (P>0.05). CONCLUSIONS: According to our preliminary results, prostaglandin antiglaucomatous analogs do not significantly enhance pigmentation in the superficial layers of the conjunctiva. The existence of the Tyrosinase enzyme in the superficial layers of the conjunctiva suggests that basal melanocytes may transfer their melanogenic apparatus to superficial epithelial cells.

Micropulse diode laser trabeculoplasty (MDLT): A phase II clinical study with 12 months follow-up.

OBJECTIVE: This pilot study evaluates the pressure lowering potential of subthreshold micropulse diode laser trabeculoplasty (MDLT) for a clinically meaningful duration in patients with medically uncontrolled open angle glaucoma (OAG). DESIGN: prospective interventional case series. PARTICIPANTS: Thirty-two eyes of 20 consecutive patients with uncontrolled OAG (12 bilateral and 8 unilateral). METHODS: Confluent subthreshold laser applications over the inferior 180 degrees of the anterior TM using an 810 nm diode laser in a micropulse operating mode. The intraocular pressure (IOP) was measured at baseline and at 1 hour, 1 day, 1 week, 3, 6, 9, and 12 months post-treatment. Flare was measured with a Kowa FM 500 flare-meter at baseline and at 3 hours, 1 day, 1 week, and 12 months post-treatment. After treatment, the patients were maintained on their pre-treatment drug regimen. MAIN OUTCOME MEASURES: Criteria for treatment response were IOP reduction >/=3 mm Hg and IOP