BILATERAL ENDOGENOUS ENDOPHTHALMITIS FROM STREPTOCOCCUS PNEUMONIAE.

PURPOSE: To report a case of bilateral endogenous endophthalmitis from Streptococcus pneumoniae with devastating sequelae. METHODS: Interventional case report. RESULTS: A 56-year-old man presented with acute bilateral blurred vision and floaters with fever and hemodynamic instability. Previously, he was diagnosed with acute otitis externa and reported manually extracting several of his own teeth. He underwent a vitreous tap and intravitreal antibiotic injections. Blood and vitreous cultures were positive for S. pneumoniae. The patient later developed life-threatening medical sequelae. His final visual acuity was no light perception in the right eye and 20/25 in the left eye. CONCLUSION: Diagnosing endogenous endophthalmitis early is essential to initiating a systemic evaluation for potentially life-threatening medical conditions, including sepsis, endocarditis, and osteomyelitis. A high degree of suspicion, expeditious treatment, and interdisciplinary collaboration are essential to maximizing patient outcomes.

CRYSTALLINE RETINOPATHY FROM HYPEROXALURIA: LONG-TERM FOLLOW-UP.

PURPOSE: To report long-term follow-up in a patient with retinal oxalosis from primary hyperoxaluria. METHODS: Retrospective chart review was performed for this patient. PATIENTS: A 6-year-old girl that presented to our clinic before and after combined kidney/liver transplant. RESULTS: Optical coherence tomography and fundus findings consistent with oxalate crystal deposition. CONCLUSION: Progressive macular changes, including atrophy and fibrosis can occur in crystalline retinopathy, secondary to hyperoxaluria, after combined hepatorenal transplant.

A standardized grading system for scleritis.

OBJECTIVE: This study evaluated the performance of a standardized grading system for scleritis using standard digital photographs. DESIGN: Cross-sectional interobserver agreement study. PARTICIPANTS: Photo archives from the National Eye Institute. METHODS: Three uveitis specialists from 3 different centers graded 79 randomly arranged images of the sclera with various degrees of inflammation. Grading was done using standard screen resolution (1024×768 pixels) on a 0 to 4+ scale in 2 sessions: (1) without using reference photographs and (2) with reference to a set of standard photographs (proposed grading system). The graders were masked to the order of images, and the order of images was randomized. Interobserver agreement in grading the severity of inflammation with and without the use of grading system was evaluated. MAIN OUTCOME MEASURES: Interobserver agreement. RESULTS: The proposed grading system for assessing activity in scleritis demonstrated a good interobserver agreement. Interobserver agreement (pooled κ) was poor (0.289) without photographic guidance and improved substantially when the "grading system" with standardized photographs was used (κ = 0.603). CONCLUSIONS: This system of standardized images for scleritis grading provides significantly more consistent grading of scleral inflammation in this study and has clear applications in clinical settings and clinical research.