Staphylococcal native valve endocarditis with iris abscess and intracranial hemorrhage in an adolescent girl.

Native valve infective endocarditis by Staphylococcus aureus is a well-known entity. Metastatic eye abscess and intracranial hemorrhage are rare manifestations of infective endocarditis. We describe an adolescent girl who presented with staphylococcal native valve endocarditis with metastatic iris abscesses and after valve replacement surgery, succumbed to her illness as a result of an intracranial hemorrhage.

Recurrent fungal iris granuloma in a 10-year-old child.

PURPOSE: To report the diagnosis of a case of recurrent iris fungal granuloma presumed to be an iris tuberculoma in a 10-year-old girl. DESIGN: Case report METHODS: Retrospective medical chart review including serological and microbiological investigative results RESULTS: A patient presented with iris mass associated with anterior uveitis. Serological tests were positive for IgM of tuberculosis. Steroids treatment was initiated in conjunction with anti-tuberculosis treatment. The course showed remissions and exacerbation. Fine needle aspiration biopsy (FNAB) of the granuloma proved the etiologic agent to be Aspergillus fumigates. CONCLUSION: Fine needle aspiration biopsy should be used in the diagnosis of iris masses associated with recurrent inflammation.

Irido-lenticular abscess as the initial sign of Candida albicans endogenous endophthalmitis.

A-33-year-old man presented with 9 days of conjunctival erythema, pain, and worsening vision in the left eye. Anterior segment examination was significant for a well-defined, cream-colored iridociliary mass. Ultrasound biomicroscopy demonstrated an iris lesion with ciliary body and lenticular involvement. The authors performed a pars plana vitrectomy and lensectomy with an iris biopsy. Culture of the vitreous cassette and iris mass yielded a diagnosis of Candida albicans endophthalmitis. Clinicians encountering an iris nodule with lenticular involvement, even in an immunocompetent adult, are urged to consider a diagnosis of an endogenous endophthalmitis secondary to C. albicans.

Raman spectroscopy for differential diagnosis of endophthalmitis and uveitis in rabbit iris in vitro.

We developed a diagnostic tool to differentiate between endophthalmitis and uveitis using Raman spectroscopy. Twenty-two New Zealand rabbits with endophthalmitis induced by Staphylococcus aureus (10 animals), noninfectious uveitis induced by lipopolysaccharide from Escherichia coli (10 animals) and controls (two animals) were analyzed. Twenty-four hours after the eyes were inoculated, iris tissue was dissected and subjected to dispersive Raman spectroscopy using an excitation source at 830 nm and a spectrograph/CCD camera to detect a Raman signal with an integration time of 50 s. With the collected spectra of endophthalmitis and uveitis, we developed a routine to classify spectra in each specimen using principal components analysis, using a leave-one-out cross-validation procedure. The mean Raman spectra of tissues with uveitis and endophthalmitis showed several bands in the region of 800-1800 cm(-1), which have been attributed to nucleic acids, amino acids, proteins, and lipids. The bands at 1004, 1339, and 1555 cm(-1) differed significantly (t-test, p<0.05) between diseases. The principal components PC3 and PC4 differed significantly (ANOVA, p<0.05) for the two tissue types, indicating that these PCs can be used to discriminate between the two diseases using Mahalanobis distance as a discriminator. This technique is useful for differentiating the spectral bands of uveitis and endophthalmitis, and the diagnostic model showed sensitivity of 89%, specificity of 100%, and accuracy of 92% using the leave-one-out cross-validation procedure. These results may be clinically relevant for differentiating endophthalmitis from uveitis, and this approach may become a noninvasive method to optimize the diagnosis of inflammatory and infectious vitreoretinal diseases.

Iris abscesses with and without intralenticular fungal invasion in the horse.

OBJECTIVE: To describe clinical and histologic findings in horses with iris abscesses. Design Retrospective medical records study. ANIMALS STUDIED: Medical records of horses that had iris abscesses at the University of Florida Veterinary Medical Center, Peterson & Smith Equine Hospital, and Veterinary Eye Specialists of London, Ontario, from 2005 to 2008 were reviewed. PROCEDURE: Data collected from the medical records included signalment, clinical and histologic descriptions of ocular lesions, therapy, complications, and visual outcomes. RESULTS: The medical records of two Quarterhorses, one pony, one warmblood, one Westphalian, and one Arab horse with unilateral iris abscesses were identified. Mild-to-severe clinical signs of iridocyclitis were present in all six eyes with iris abscesses. The eyes of two horses with iris abscesses were also associated with deep stromal abscesses and responded to medical therapy alone in one case, and medical therapy and corneal transplantation in the other. Iris abscesses in two horses were also associated with intralenticular invasion due to a Cladosporium and a Fusarium-type fungus respectively, and resulted in enucleations. Two horses with iris abscesses and no apparent lens involvement resolved with medical therapy in one case and surgical removal of the iris abscess and medical therapy in the other. CONCLUSIONS: This is the first clinical report of iris abscesses in the horse, and the first histologic report of fungal invasion of the horse lens.

Aspergillus iris granuloma: a case report with review of literature.

We report the case of a 25-year-old male patient who presented with complaints of redness, photophobia, and decreased vision in the right eye of a week's duration. Slit-lamp biomicroscopic examination revealed a cream-colored, irregular elevated inferior iris mass, extending on to the anterior lens surface. Differential diagnoses of a fungal granuloma, a medulloepithelioma, and an amelanotic melanoma were considered. An excisional biopsy of the mass was performed through a superior clear corneal incision. Polymerase chain reaction analysis of the aqueous humor showed a positive pan fungal genome. Histopathology of the biopsied mass showed a giant cell granuloma with surrounding numerous branching, septate hyphae. Culture growth revealed Aspergillus fumigatus We report this case because of the rarity of Aspergillus iris granuloma as a primary presentation of endogenous Aspergillosis and review the relevant literature. Absence of a significant systemic history compounded the diagnostic dilemma in our patient. Definitive differentiation of this rare entity from a foreign body, amelanotic melanoma, and other inflammatory conditions such as sarcoidosis and tuberculosis, may be possible only on microbiological and histo-pathological evaluation.

Iris root abscess and necrotizing sclerokeratitis caused by Mycobacterium abscessus and presenting as hemorrhagic anterior uveitis.

PURPOSE: To report a case of an iris abscess and necrotizing sclerokeratitis caused by Mycobacterium abscessus and presenting as hemorrhagic uveitis. METHODS: An 86-year-old white woman was diagnosed with hemorrhagic anterior uveitis and treated with high-frequency topical steroids. The inflammation progressed to involve the cornea and the sclera, and the treatment was changed to intensive antibiotics. There was no improvement. Direct microscopy of a biopsy specimen of the lesion wrongly identified Nocardia as the cause, but antibiotic sensitivity suggested clarithromycin as a suitable therapeutic agent. Therapy was changed but there was continued deterioration. The eye could not be saved and the causative organism was subsequently discovered to be M. abscessus. RESULTS: The eye was enucleated 6 months after initial presentation. CONCLUSIONS: Ocular infection with M. abscessus is an extremely rare cause of necrotizing sclerokeratitis and may present as a hemorrhagic uveitis. There is a high risk of misdiagnosis and late detection, which may have severe consequences.

Iris atrophy in patients with newly diagnosed multibacillary leprosy: at diagnosis, during and after completion of multidrug treatment.

AIM: To describe the prevalence and incidence of iris atrophy in patients with multibacillary (MB) leprosy. METHODS AND PATIENTS: Prospective longitudinal cohort study. 301 newly diagnosed patients with MB leprosy were followed up during the 2 years of treatment with multidrug therapy (MDT) and for a further 5 years with biannual ocular examinations. Incidence of iris atrophy was calculated as the number of patients with iris atrophy per person-year (PY) of follow-up among those who did not have iris atrophy at baseline. Stepwise multiple regression confirmed the presence of specific associations of demographic and clinical characteristics (p<0.05) with iris atrophy, detected by univariate analysis. RESULTS: Iris atrophy was present in 6 (2%) patients at enrolment. During MDT, with 445 PYs of follow-up, 9 patients developed iris atrophy (IR 0.02, 95% CI 0.01 to 0.04) that was associated with cataract (HR 15.13, 95% CI 3.71 to 61.79, p<0.001) and corneal opacities (HR 6.83, 95% CI 1.62 to 28.8, p = 0.009). After MDT, with 2005 PYs of follow-up, 60 patients developed iris atrophy (IR 0.03, 95% CI 0.023 to 0.039) that was associated with age (per decade; HR 1.40, 95% CI 1.10 to 1.78, p = 0.006), skin smear positivity (HR 3.50, 95% CI 1.33 to 9.24, p = 0.011), cataract (HR 3.66, 95% CI 1.85 to 7.25, p<0.001), keratic precipitates (HR 2.76, 95% CI 1.02 to 7.47, p = 0.046) and corneal opacity (HR 3.95, 95% CI 1.86 to 8.38, p<0.001). CONCLUSIONS: Iris atrophy continues to develop in 3% of patients with MB leprosy every year after they complete a 2-year course of MDT, and is associated with age, increasing loads of mycobacteria, subclinical inflammation, cataract and corneal opacity.

Listeria monocytogenes-induced endogenous endophthalmitis: bioultrasonic findings.

PURPOSE: To report bioultrasonic findings in Listeria monocytogenes-induced endophthalmitis (LMIE) that have not been described previously. DESIGN: Interventional case report. METHODS: To rule out intraocular tumor, ultrasound biomicroscopy was performed in a patient referred for a 2-day history of uveitis with elevated intraocular pressure, dark hypopyon, and pigment dispersion in the anterior chamber. RESULTS: Ultrasound biomicroscopy examination showed increased iris thickness with rarefaction of tissue and irregular echogenicity as well as iris pigment epithelial detachment. A small choroidal detachment was also detected. The anterior chamber and vitreous sample confirmed the LMIE diagnosis. CONCLUSIONS: The detection of both pigment epithelial detachment and changes in the iris tissue could explain why black hypopyon frequently develops in LMIE with significant pigment dispersion in some cases.

Iris abscess as an unusual presentation of endogenous endophthalmitis in a patient with bacterial endocarditis.

PURPOSE: To report the clinical findings and management of a case of endogenous endophthalmitis in a patient with bacterial endocarditis presenting with a septic metastasis to the iris. DESIGN: Observational case report. METHODS: Review of clinical findings and treatment. RESULTS: A 37-year-old intravenous drug user hospitalized with bacterial endocarditis secondary to methicillin-sensitive Staphylococcus aureus bacteremia presented with a painful red left eye, hypopyon, and iris abscess. Roth spots were noted in the fundus of the right eye. Aqueous culture was positive for methicillin-sensitive S aureus. The patient was treated with intravitreal, topical, and intravenous antibiotics. The hypopyon and iris abscess resolved within 2 weeks, and the patient achieved a final visual acuity of 20/25 in the left eye. CONCLUSIONS: Septic metastasis to the iris is a rare occurrence. To our knowledge this is the first reported case of an iris abscess secondary to bacterial endocarditis.

Ocular involvement in tuberculoid leprosy--a case report.

Leprosy is rarely diagnosed in our part of the world. In our 26-year-old patient, borderline lepromatous leprosy was first diagnosed in 1992 and was treated with Rifoldin, Lemprene and Dapson according to the standard WHO scheme of treatment. Ophthalmic examination showed minor epithelial lesions of the cornea in both eyes, a reduced corneal reflex in the left eye and a scleral leproma nasally and close to the limbus, also in the left eye. In 1995, the patient was examined again and was treated as above for lepromata of the left eyebrow nasally and of both lower legs. Ophthalmic examination revealed conjunctival irritation, anterior uveitis with leprosy pearls on the pupillary margin and secondary glaucoma. The glaucoma was treated with hypotonics, the uveitis was treated with topical cortisone. The intra-ocular pressure normalised and the uveitis improved. Of the two main types of leprosy, lepromatous leprosy and tuberculoid leprosy, our patient had the second, milder form.

First isolation of Borrelia burgdorferi from an iris biopsy.

The persistence of Borrelia burgdorferi in six patients is described. Borrelia burgdorferi has been cultivated from iris biopsy, skin biopsy, and cerebrospinal fluid also after antibiotic therapy for Lyme borreliosis. Lyme Serology: IgG antibodies to B. burgdorferi were positive, IgM negative in four patients; in two patients both IgM and IgG were negative. Antibiotic therapy may abrogate the antibody response to the infection as shown by our results. Patients may have subclinical or clinical disease without diagnostic antibody titers. Persistence of B. burgdorferi cannot be excluded when the serum is negative for antibodies against it.

Interstitial keratitis and iridoschisis in congenital syphilis.

Bilateral interstitial keratitis and iridoschisis are reported in four cases with extraocular stigmata of congenital syphilis and positive syphilis serology. The iridoschisis was extensive in two cases giving the iris an unusual ragged appearance, while it was slight in one case. Iridoschisis may suggest the diagnosis of congenital syphilis, especially when interstitial keratitis is mild. Chronic open-angle glaucoma should be excluded in all patients with interstitial keratitis and iridoschisis.

Presence of Langerhans cells in the central cornea linked to the development of ocular herpes in mice.

Recurrences of herpetic stromal keratitis are believed to be initiated by reactivation of herpes simplex virus infection, probably in the trigeminal ganglion. Genetic features of the virus and the host as well as the immune status of the host influence the outcome of infection. Following infection on the snout with HSV-1, mice with normal corneas usually develop mild anterior segment disease. We studied the induction of herpetic infection in mice that had abnormal corneas, containing center due to trauma or a spontaneous dystrophy. The corneal abnormality led to more frequent herpetic stromal keratitis and more severe anterior chamber reaction. In addition, we found that snout-infected mice with dystrophic corneas had an increased risk of dying from viral infection. Our data suggest that not only the strain of virus and the genetic background of the mouse, but also the state of the cornea itself, can contribute to susceptibility to ocular herpes infection.

Cryptococcosis of the anterior segment in acquired immune deficiency syndrome.

Cryptococcosis is a rare form of human ocular infection, usually occurring in immunocompromised patients. Unilateral or bilateral posterior segment involvement is the rule. The authors describe a unique case of intraocular cryptococcosis presenting as an iris inflammatory mass in a patient with acquired immune deficiency syndrome. Diagnosis was established by anterior chamber paracentesis and confirmed by histopathologic examination of the enucleated eye.