RESUMEN
Diphtheroids, members of the coryneform family of bacteria, increasingly have been recognized as the cause of serious ocular diseases. After isolation of coryneform group A-4 from two patients with delayed endophthalmitis after cataract extraction and intraocular lens implantation, 10(7) organisms were injected into the vitreous of seven New Zealand white rabbits, producing endophthalmitis in all eyes inoculated. Coryneform group A-4 subsequently was isolated in six of seven eyes receiving 10(7) organisms, proving Koch's postulates. Five of these seven eyes were treated with a single dose of intravitreal gentamicin, and three eyes remained culture positive. Eyes inoculated with 10(5) or 10(2) coryneform group A-4 organisms had transient anterior chamber and vitreal inflammation; all vitreous cultures were negative. These studies demonstrate that coryneform group A-4 endophthalmitis can be reproduced in an animal model and that gentamicin may not sterilize an eye infected with this organism. Future studies are needed to determine the optimum antibiotic regimen for treatment of this type of endophthalmitis.
Asunto(s)
Infecciones por Corynebacterium/tratamiento farmacológico , Endoftalmitis/microbiología , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Animales , Modelos Animales de Enfermedad , Endoftalmitis/tratamiento farmacológico , Fondo de Ojo , Gentamicinas/uso terapéutico , Conejos , Cuerpo Vítreo/efectos de los fármacos , Cuerpo Vítreo/microbiologíaRESUMEN
Recent clinical studies have emphasized the importance of diphtheroids, previously regarded as nonpathogenic bacteria or contaminants, as causes of ocular disease. We encountered two patients with endophthalmitis following cataract extraction and anterior chamber intraocular lens implantation. Both patients had previously been treated with subconjunctival and/or oral corticosteroids for presumed sterile endophthalmitis. Vitreous cultures in each case yielded pure growth of a diphtheroid that was subsequently identified as coryneform group A-4. The clinical response to standard intraocular therapy with gentamicin and cefazolin was delayed, although both patients eventually had restoration of functional vision. A comparison of the antibiotic minimum inhibitory and minimum bactericidal concentrations of the isolates may help to explain the delayed response to therapy seen in these two patients.
Asunto(s)
Infecciones por Corynebacterium , Endoftalmitis/etiología , Anciano , Extracción de Catarata , Cefazolina/uso terapéutico , Infecciones por Corynebacterium/tratamiento farmacológico , Endoftalmitis/patología , Femenino , Gentamicinas/uso terapéutico , Humanos , Lentes Intraoculares , Penicilinas/uso terapéutico , Complicaciones PosoperatoriasAsunto(s)
Coroides/patología , Infiltración Leucémica/diagnóstico , Órbita/patología , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Médula Ósea/patología , Coroides/diagnóstico por imagen , Terapia Combinada , Exoftalmia/patología , Neoplasias del Ojo/diagnóstico , Fondo de Ojo , Humanos , Lactante , Infiltración Leucémica/terapia , Masculino , Órbita/diagnóstico por imagen , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Retinoblastoma/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Six adult patients with acquired, chronic, complete sixth nerve palsy had vertical rectus muscle transposition to the lateral rectus muscle insertion with intraoperative injection of botulinum toxin into the ipsilateral medial rectus muscle. Five of six patients were orthophoric in primary gaze, and the remaining patient achieved single binocular vision with a small head turn. This method compares favorably with previously described transposition procedures for sixth nerve palsy in terms of amount of correction and size of the window of single binocular vision with a lower risk of anterior segment ischemia.