Bacteriological profile of ophthalmic infections in an Israeli hospital.

AIM: To find the optimal antibiotic treatment for ophthalmic infections in an Israeli hospital. METHODS: In a retrospective study from our laboratory, which serves as both a primary and secondary referral center, we analyzed the bacteriological profile and the antibiotic sensitivity of ophthalmic infections using the computerized laboratory reports of 331 consecutive ophthlamic bacteriological cultures from patients with various ophthalmic infections. RESULTS: Microbiological growth was obtained in 113 samples (34.1%). The most commonly isolated organism was coagulase-negative staphylococcus (19.5%), followed by coagulase-positive staphylococcus (16.8%), Enterobacteriaceae (14.2%), Pseudomonas aeruginosa (13.3%), and streptococcal species (8.9%). Pseudomonas species were the most common isolates from the lacrimal pathways (20.0%). Streptococci were the most common isolates cultured from the conjunctiva (27.3%). Coagulase-positive staphylococcus was the most common isolate from corneal ulcers (33.3%), and coagulase-negative staphylococcus from the vitreous (30.8%). The overall antibiotic sensitivity of common ophthalmic pathogens was similar to that reported from other parts of the world. CONCLUSIONS: Although essentially similar to previous series, this report from the Middle East differs as follows. Firstly, Pseudomonas species were the most common isolates from the lacrimal pathways. Secondly, the overall rate of streptococcal isolates was lower than in previous reports. Thirdly, streptococcal species were rarely isolated from corneal samples. Although other studies from the region have described the causative organisms of ocular infections in specific ocular sites, this is the first study from the Middle East to summarize the full bacteriological profile of ocular infections in one medical center.

Lack of effect of prophylactic gentamicin treatment on intraocular and extraocular fluid cultures after pars plana vitrectomy.

BACKGROUND AND OBJECTIVE: To analyze the effect of preoperative prophylatic 0.3% gentamicin sulfate eyedrops on intraocular and extraocular fluid cultures after pars plana vitrectomy. PATIENTS AND METHODS: Forty consecutive patients undergoing pars plana vitrectomy were randomly assigned to receive either 0.3% gentamicin eyedrops or placebo preoperatively. Fluids from the vitreous cavity and from the conjunctival sac were collected for bacteriologic studies. RESULTS: Positive cultures from extraocular fluids were obtained in 30.4% of the gentamicin group and 35.3% of the placebo group (P = .75). Furthermore, 1 (3%) of 40 cultures of intraocular fluid and 13 (33%) of 40 cultures of extraocular fluid were positive. Culture growth positivity was not influenced by the patients' age, by diabetes, or by the duration of the operation. CONCLUSIONS: Prophylactic gentamicin treatment by the method applied in this study is not effective on reducing growth positivity. Contaminated extraocular fluid may play an important role in the pathogenesis of bacterial endophthalmitis following pars plana vitrectomy.

Orbital metastasis of renal cell carcinoma masquerading as Amaurosis fugax.

Renal cell carcinoma (RCC) is the most common malignancy involving the kidney. Only rarely does it metastasize to the eye and orbit, sometimes mimicking other lesions. A 70-year-old woman was referred from neurology because of a right orbital lesion, six months after the start of a neurological investigation because of amaurosis fugax. Six months earlier she had complained of transient visual disturbances in her right eye. After excluding cardiovascular abnormalities and coagulopathies as the source of her complaints, she was diagnosed as having a right senile ptosis. A computed tomography scan, done to complete the workout, detected a right orbital mass. The patient was referred to the oculoplastic unit. A biopsy and then a lateral orbitotomy were performed. Histopathological examination proved it to be a metastatic renal cell carcinoma, seven years after the primary tumor had been diagnosed and treated by nephrectomy. The characteristics of metastatic renal cell carcinoma are discussed, in view of the rarity of metastasis to the eye and, in particular, to the orbit, and its tendency to masquerade as other lesions or symptoms. In this case it presented as amaurosis fugax before other signs appeared.

[Motor vehicle accidents and eye injuries].

The medical records of 24,632 patients treated in our surgical emergency service over a 3-year period were reviewed to determine the frequency and characteristics of ocular trauma caused by motor vehicle accidents (MVA). MVA-related injuries accounted for 13.9% of all visits to the service and involved 1106 of the patients (33%), of whom 77% were young males. At least 1 pathological finding was found in 858 (77.6%) and 169 (15.2%) were admitted. 16 patients sustained very severe ocular injuries which resulted in poor vision.

Coexistence of optic nerve head drusen and pseudotumor cerebri: a clinical dilemma.

The coexistence of optic nerve head drusen and pseudotumor cerebri is a potential clinical problem since diagnosing only one of two clinical abnormalities in a patient may delay or prevent the appropriate treatment. To the best of our knowledge, only four cases of such coexistence have been described. We report three cases diagnosed as having both optic nerve head drusen and pseudotumor cerebri and propose possible explanations. The report draws attention to the need for awareness of this potential coexistence in order to assure proper treatment.

Echothiophate iodide induced transient hyper- and hypothyroidism.

A case of hyper- and hypothyroidism induced by echothiophate iodide eye drops is presented. The thyroid dysfunction was due to excessive iodide intake from the eye drops.

Erythropoietin-induced iritis-like reaction.

The present report describes an iritis-like reaction found in 13 patients treated with recombinant human erythropoietin (Eprex), a drug given to hemodialysis patients for their chronic anemia. Among 120 patients being treated by hemodialysis in two centers affiliated with our medical center, ten out of 30 Eprex-treated patients but none of 90 not being treated with Eprex developed this reaction. The observations described support a causal relation between Eprex treatment and the iritis-like reaction. Further investigative effort is needed to establish the mechanism.

[Purtscher's retinopathy].

A 20-year-old soldier trapped under a minibus for 90 minutes sustained a crush injury to his chest and a maxillofacial fracture. 2 days later he complained of decreased visual acuity in both eyes. Funduscopy revealed Purtscher's retinopathy. The traumatologist should be aware of this type of indirect eye injury, and should request ophthalmological assessment and follow-up in such patients.

[Automated medical data processing for assessing surgical wound infections].

The ability of an automated medical data processing system to identify causative factors of postoperative wound infections was examined. The system provides an ongoing quality control tool in the general surgical ward. Data on 1212 abdominal or inguinal surgical wounds in 1101 patients, collected during a 2-year period, were analyzed. The correlation between rate of infection and the type of operation, operative findings, degree of operating room sterility, adequacy of surgical technique, and level of the surgeon's expertise were determined. The rate of infection was similar to that reported in the literature. The computer required only 6% of the time estimated for obtaining the same data by examining the patients' files. It is recommended that the software be modified to include additional factors in the data base in order to draw more detailed conclusions. It is also recommended that a program be developed to perform a 1-step extraction and analysis of data in general, and in respect to each surgeon. This will make the data processing system a rapid, efficient and user-friendly tool.