Primary Vitrectomy versus Tap and Inject for Fungal Endophthalmitis: Meta-Analysis and Comparison with Data from a Reference Centre.

PURPOSE: We aimed to compare the visual outcomes after pars plana vitrectomy (PPV) versus tap and inject (T&I) in fungal endophthalmitis (FE) reported in the literature and to compare the findings from the literature with data from a reference centre. METHODS: We performed a systematic review and meta-analysis of studies reporting the use of PPV versus T&I in FE. We also performed a retrospective review of the clinical records of patients with endophthalmitis from a reference centre in Colombia. RESULTS: We included 13 studies with 334 eyes; 53.59% received PPV and 46.4% received T&I. The overall relative risk of improving ≥ 2 lines in PPV versus T&I was 0.98 (95% confidence interval [CI] 0.80-1.22; p = 0.88) with a mean difference of final visual acuity of 0.26 (95% CI 0.12-0.63; p = 0.18). There were no significant differences in subgroup analysis. Data from the reference centre included 32 endophthalmitis cases, 15.6% of which had a fungal aetiology (80% received PPV and 20% T&I). There were no significant differences in the subgroup analysis. CONCLUSIONS: Based on the findings from the literature and the reference centre, T&I is noninferior to PPV. This is the first meta-analysis in the literature evaluating these effects in FE. It is necessary to execute new prospective randomised controlled studies in patients with endophthalmitis.

ENDOPHTHALMITIS IN OPHTHALMOLOGICAL REFERRAL CENTRE IN COLOMBIA: AETIOLOGY AND MICROBIAL RESISTANCE.

AIMS: To describe the aetiology and microbial susceptibility profile of endophthalmitis cases treated at an ophthalmological referral centre in Colombia. MATERIAL AND METHODS: A retrospective descriptive study was carried out with all endophthalmitis cases referred to the Fundación Oftalmológica de Santander FOSCAL (Floridablanca, Colombia) from 1 January 2012 to 31 December 2015. RESULTS: 121 eyes of 121 patients were evaluated. 77.7% of them were male and the mean age was 42.9 years. Five of them (4.1%) corresponded to endogenous endophthalmitis, and 116 (95.9%) to exogenous endophthalmitis. Of the latter, 66.9% were associated with trauma (almost one-half of them associated with intraocular foreign body), and 29.5% with intraocular surgery. The most common isolated microorganisms in the exogenous endophthalmitis group corresponded to methicillin-resistant and methicillin-sensitive strains of Staphylococcus epidermidis and Staphylococcus aureus, which were mostly susceptible to imipenem, vancomycin and moxifloxacin and resistant to ceftazidime. CONCLUSION: Endophthalmitis is a potentially sight-threatening condition, especially in cases of inadequate treatment. Therefore, antimicrobial therapy should be guided by vitreous humour culture to assure that the causative microorganism is susceptible to the selected agent. The results of our study lead us to propose vancomycin, moxifloxacin or imipenem as first-line antimicrobial options.

Sífilis ocular en una población Colombiana: manifestaciones clínicas y resultados del tratamiento / Ocular syphilis in a Colombian population: clinical manifestations and treatment outcomes

Diseño de estudio: Retrospectivo observacional descriptivo. Método: Se recolectaron datos de pacientes con sífilis ocular evaluados en un centro de referencia de oftalmología en Colombia desde marzo de 2015 hasta febrero de 2017. Resultados: Dieciséis pacientes fueron diagnosticados con sífilis ocular durante el período estudiado. Cuatro (25%) pacientes tuvieron afectación de ambos ojos, para un total de 20 ojos. Hubo 11 (68.8%) hombres y 5 (31.3%) mujeres. La edad media de presentación fue de 51.1 años (23-86 años). Cuatro pacientes masculinos estaban coinfectados con VIH. La manifestación más frecuente fue la panuveítis en ocho ojos (40%). Seis pacientes (37.5%) presentaron hallazgos dermatológicos sistémicos. El tratamiento incluyó penicilina cristalina y esteroides sistémicos. El seguimiento medio fue de 16.2 meses (12-21 meses). La agudeza visual media mejoró de 1,01 ± 0,71 logMAR a 0,58 ± 0,64 logMAR después del tratamiento. Conclusión: La sífilis es una causa poco común de infl amación intraocular. Sin embargo, la incidencia ha venido en aumento en los últimos años tanto en pacientes VIH positivo como VIH negativo. La panuveítis es el hallazgo ocular más frecuente. El pronóstico visual es bueno si hay un diagnóstico y tratamiento temprano.

Background: Syphilis is a sexually transmitted disease caused by Treponema pallidum. It can remain dormant in the individual throughout life. The manifestations of ocular involvement are similar to other infl ammatory eye conditions. It is crucial to make an early diagnosis and management in order to avoid complication. Objective: to describe the clinical characteristics and the results of the treatment of patients with ocular syphilis. Study design: observational retrospective study. Method: Retrospective cohort of patients with ocular syphilis evaluated in an ophthalmology reference center in Colombia from March 2015 to February 2017. Results: Sixteen patients were diagnosed with ocular syphilis during the studied period. Four (25%) patients had involvement of both eyes, for a total of 20 eyes. There were 11 (68.8%) men and 5 (31.3%) women. The mean age of presentation was 51.1 years (23-86 years). Four male patients were coinfected with HIV. Th e most frequent manifestation was panuveitis in eight eyes (40%). Six patients (37.5%) presented systemic dermatological fi ndings. Treatment included crystalline penicillin and systemic steroids. The mean follow-up was 16.2 months (12-21 months). The mean visual acuity improved from 1.01 ± 0.71 logMAR to 0.58 ± 0.64 logMAR after treatment. Conclusion: Syphilis is a rare cause of intraocular inflammation. However, the incidence has been increasing in recent years in both HIV positive and HIV negative patients. Panuveitis is the most frequent ocular finding. The visual prognosis is good if there is an early diagnosis and treatment.

An unusual case of bilateral anterior uveitis related to moxifloxacin: the first report in Latin America.

Objective: To report a case of bilateral anterior uveitis secondary to oral moxifloxacin. Methods: Case report. Results: A 54-year-old female presented bilateral anterior uveitis following a 10-day course of oral moxifloxacin. She developed a bilateral anterior uveitis associated with pigment dispersion syndrome and iris transillumination. Conclusions: Drug-induced uveitis is one of the causes of anterior uveitis. Uveitis related to fluoroquinolones is a rare entity, there are few cases reported in the literature, this is the first case reported in Latin America.

Iatrogenic central retinal artery occlusion after carotid body tumor embolization and excision.

Objective: To report a case of iatrogenic central retinal artery occlusion after embolization and surgical resection of carotid body paraganglioma. Methods: Case report Results: One adult female patient presented with persistent unilateral visual loss after embolization with Embosphere® and Contour® microparticles of carotid body tumor. Fluorescein angiography revealed intraluminal microspheres in the central retinal artery ramifications. OCT revealed intraretinal spherical, hyporeflective particles with posterior shadowing. Conclusions: Central retinal artery occlusion should be assessed as a possible complication after surgical repair of head and neck paragangliomas.

Immune recovery uveitis in a patient with previously undiagnosed cytomegalovirus retinitis.

A 40-year-old man presented to the emergency service of the Department of Ophthalmology, Fundación Oftalmológica de Santander, Floridablanca, Colombia, with blurred vision in his right eye. Anamnesis revealed that he also had newly diagnosed stage C HIV. He had recently started highly active antiretroviral therapy (HAART). Examination disclosed intraocular inflammation, along with plain white peripheral non-exudative lesions with sparse haemorrhaging. The differential diagnosis included cytomegalovirus (CMV) retinitis and immune recovery uveitis (IRU). On follow-up, the patient's left eye presented with decreased visual acuity and increased vitreous haze. A vitrectomy with vitreous tap was performed for microbiological studies. PCR for CMV in the vitreous sample was negative. The patient was discharged with the final diagnosis of IRU. In HIV patients with uveitis, the knowledge of characteristic signs and symptoms of particular entities such as opportunistic infections and IRU will enable the clinician to give the appropriate treatment.

The importance of fundus eye testing in rubella-induced deafness.

OBJECTIVE: The purpose of this study was to establish a new approach to improve detection of deafness due to rubella. METHODS: Colombian institutes for the deaf were visited by a medical team to perform in all enrolled individuals an ophthalmological examination with emphasis in fundus eye by a retina specialist. In cases where ocular alterations compatible with CRS were found, a medical interview by a clinical geneticist analyzing pre-and postnatal history and a thorough medical examination was done. RESULTS: A total of 1383 deaf institutionalized individuals were evaluated in 9 Colombian cities in the period of 2005 to 2006, finding a total of 463 positive cases for salt-and-pepper retinopathy (33.5%), in which rubella could be the etiology of deafness. Medellin, Cartagena, Bucaramanga and Barranquilla were the cities with the highest percentage of Congenital rubella, corresponding to 22.8% of analyzed population. The analysis performed on cases in which reliable prenatal history was obtained in a second appointment (n=88) showed association between positive viral symptoms during pregnancy and salt-and-pepper retinopathy in 62.5% of cases, while both (retinopathy and viral symptoms) were absent in 29.5% of cases; showing a correlation in 92% of cases. CONCLUSIONS: The frequency of deafness by rubella obtained by this study is significantly high compared with previous Colombian studies and with international reports. It was possible to correlate the antecedent of symptoms during pregnancy with the presence of salt-and-pepper retinopathy in this deaf population when reliable prenatal history was available, therefore eye testing with emphasis in fundus examination is a good indicator of rubella induced deafness. We propose a new approach in the search of deafness causes, based on a thorough ophthalmologic examination in all deaf people.

Curvularia lunata endophthalmitis after penetrating ocular trauma.

PURPOSE: To report a case of Curvularia lunata endophthalmitis that responded to amphotericin B and itraconazole METHODS: Observational case report of one patient with C. lunata endophthalmitis after penetrating ocular injury with vegetable material. RESULTS: One young adult male patient presented with visual loss after penetrating ocular trauma with vegetable material. Biomicroscopy revealed keratitis and secondary endophthalmitis. Vitreous cultures after vitrectomy were positive for C. lunata and Staphylococcus epidermidis. Patient responded well to intravitreal amphotericin B and moxifloxacin. CONCLUSION: Fungal endophthalmitis should be suspected after trauma with vegetable material. Curvularia lunata may produce endophthalmitis and keratitis. Amphotericin B and itraconazole should be considered suitable agents for its treatment.

Screening program for Waardenburg syndrome in Colombia: clinical definition and phenotypic variability.

A screening program to detect Waardenburg syndrome (WS) conducted between 2002 and 2005, among 1,763 deaf individuals throughout Columbia identified 95 affected individuals belonging to 95 families, giving a frequency of 5.38% of WS among the institutionalized deaf population. We confirmed the clinical diagnosis of WS in the 95 propositi and, through the family evaluation, we also identified 45 non-institutionalized affected relatives. Audiologic, ophthalmologic, and genetic studies were performed to confirm the diagnosis. Following the classification of the WS consortium, based on the Waardenburg Index (WI), to define the type of WS. We classified 62.1% of the propositi as WS2 and 37.9% as WS1. We present here the results of the study of clinical manifestations, analyzing the presence, severity, and symmetry of clinical findings among this affected population. Overall, among the 95 propositi, in addition to sensorineural deafness in all, the most frequent features were broad nasal root (58.9%), a first degree relative affected (37.9%), heterochromia irides (36.8%), skin hypopigmentation (31.6%), white forelock (28.0%), intense blue iris (27.4%), synophrys (12.6%), premature graying (10.5%), ptosis of the eyelids (9.5%), and hypoplasia alae nasi (1.1%). The majority of individuals had normal psychomotor development (87%), while the remaining 13% had developmental delay. Among the latter, 9.4% corresponded to WS2 and 3.6% to WS1. Our data confirm an interesting inter- and intrafamilial variability in the phenotypic manifestations as well as extremely variable expression.

Análisis clinicogenético de una familia colombiana con vitreorretinopatía exudativa familiar o enfermedad de Criswick-Schepens / Clinical-genetic analysis of a Colombian family with familiar exudative vitreo retinopathy (fevr) or Criswick-Schepens disease

Introducción. La vitreorretinopatía exudativa familiar es un trastorno genético, bilateral, asimétrico y progresivo, de herencia variable. Materiales y métodos. Se practicó un examen oftalmológico completo a 32 individuos de una familia con diagnóstico de vitreorretinopatía exudativa familiar. Previa firma del consentimiento informado, se tomó una muestra para extracción de ADN y se obtuvo la secuencia del gen FZD4. Resultados. Se encontraron 11 personas afectadas y 21 que no lo estaban. Se confirmó una herencia autosómica dominante y se identificó la mutación 1501delCT en el gen FZD4. Se descartó la hipótesis de que algunos familiares presentaran manifestaciones parciales de la enfermedad. Discusión. Se hace una descripción clínica y se reportan los hallazgos de angiografía, tomografía óptica de coherencia y ecografía ocular. Se define una herencia autosómica dominante y se identifica la mutación causal en el gen FZD4. La caracterización molecular de la familia permitió practicar una correcta y completa asesoría genética en todas las personas evaluadas.

Etiología de la ceguera y visión subnormal en Colombia: frecuencia de enfermedad genética / Ethiology of blindness and subnormal vision in Colombia: incidence of genetic disease

La Unidad de Genética clínica del Instituto de Genética Humana de la universidad Javeriana y la Fundación oftalmológica Nacional, realizaron un estudio piloto, para determinar las diferentes causas de la ceguera y visión subnormal en población institucionalizada en Colombia. Se evaluaron 1295 personas ciegas o con visión subnormal, adscritos a 23 institutos de 17 ciudades del país. Se realizó una completa evaluación médica general y genética, personal y familiar. Se determinaron las diferentes etiologías de la limitación visual en esta población, clasificándolas en tres grandes grupos : causa genética, causa no genética y causa indeterminada. El 31.3/100 correspondió a causas adquiridas o no genéticas. El 48.5/100 a causas genéticas, mientras que en el 20.2/100 no se pudo determinar la etiología básica de la patología.