Comparison of two methods for obtaining and transporting corneal samples in suspected infectious keratitis.

BACKGROUND AND PURPOSE: The purpose of this study is to compare two alternative methods of collecting and transporting media for the diagnosis of corneal ulcers, as not all clinical settings have conventional culture materials and transport media available. METHODS: In this open-label, prospective, comparative, and randomized study, patients with clinical suspicion of infectious keratitis with high risk of loss of vision had corneal specimens collected using two methods and transport media: Eswab scraping with Amies transport medium and 23-gauge needle scraping in BACTEC Peds broth. The order of each collection method was randomized. The samples were processed by standard methods, comparing the positivity frequencies for both by parametric and nonparametric tests, according to normality criteria. RESULTS: Corneal infiltrates from 40 eyes of 40 patients were analyzed. Culture positivity rate was 50% for Eswab and 35% for 23-gauge needle (P=0.258). The overall growth rate of the two methods combined was not higher than with the swab alone. The results obtained with a swab were not influenced by the collection sequence (P=0.112); however, the positivity rate was significantly higher when the sample taken with the needle was performed first (P=0.046). CONCLUSIONS: The single sample Eswab method of collection and transportation for the diagnosis of high risk corneal ulcers is a valid alternative and can be used in cases in which, for various reasons, there is no access to the full set of traditional culture materials.

Réplica: Oclusión venosa central de la retina isquémica como posible diagnóstico diferencial de la retinopatía Purtscher-like / Reply: Ischemic central retinal venous occlusion as a possible differential diagnosis of Purtscher-like retinopathy

No disponible

Estudio multimodal y tratamiento de la retinopatía tipo Purtscher / Response to anti-VEGF therapy in macular oedema secondary to acute retinal necrosis

Paciente de 52 años con múltiples factores de riesgo cardiovascular remitido por pérdida visual unilateral, aguda e indolora. En la fundoscopia destaca importante inflamación papilar con tortuosidad a este nivel y hemorragias. Las pruebas de imagen muestran edematización tanto del disco óptico como macular y afectación en capas internas retinianas. La angiografía con fluoresceína y la angiografía por tomografía de coherencia óptica de control muestran áreas de isquemia central y periférica. Dados los hallazgos clínicos y los antecedentes del paciente, se llega al diagnóstico de retinopatía de tipo Purtscher y se decide tratamiento con dexametasona intravítrea. La retinopatía de tipo Purtscher es una entidad de rara frecuencia que se presenta en pacientes con múltiples enfermedades sistémicas pero sin antecedentes traumáticos, lo que la diferencia de la retinopatía de Purtscher. En el pronóstico es importante el diagnóstico y la intervención precoz. No existen protocolos terapéuticos, pero con la terapia intravítrea con dexametasona se han obtenido buenos resultados

A 52-year-old patient with multiple cardiovascular risk factors referred for unilateral, acute, and painless visual loss. In the fundoscopic image there was significant papillary inflammation with tortuosity at this level and haemorrhages. Ophthalmological examination showed papillary inflammation, macular oedema, and involvement in retinal inner layers. The control fluorescein angiography and optical coherence tomography angiography showed areas of central and peripheral ischaemia. Given the clinical findings and background of the patient, the diagnosis of Purtscher-like retinopathy was reached and treatment with intravitreal dexamethasone was decided. Purtscher-like retinopathy is a rare entity that occurs in patients with multiple systemic pathologies, but without a traumatic background, which differentiates it from Purstcher's retinopathy. The diagnosis and early intervention are important in the prognosis. There are no therapeutic protocols, but good results have been obtained with intravitreal therapy with dexamethasone

Multimodal imaging and treatment of Purtscher-like retinopathy. / Estudio multimodal y tratamiento de la retinopatía tipo Purtscher.

A 52-year-old patient with multiple cardiovascular risk factors referred for unilateral, acute, and painless visual loss. In the fundoscopic image there was significant papillary inflammation with tortuosity at this level and haemorrhages. Ophthalmological examination showed papillary inflammation, macular oedema, and involvement in retinal inner layers. The control fluorescein angiography and optical coherence tomography angiography showed areas of central and peripheral ischaemia. Given the clinical findings and background of the patient, the diagnosis of Purtscher-like retinopathy was reached and treatment with intravitreal dexamethasone was decided. Purtscher-like retinopathy is a rare entity that occurs in patients with multiple systemic pathologies, but without a traumatic background, which differentiates it from Purstcher's retinopathy. The diagnosis and early intervention are important in the prognosis. There are no therapeutic protocols, but good results have been obtained with intravitreal therapy with dexamethasone.