Ocular non-Hodgkin's lymphoma: a clinical study of nine cases.

BACKGROUND: Primary oculocerebral large cell malignant non-Hodgkin's lymphoma, formerly called ocular reticulum cell sarcoma, runs a uniformly fatal course. Once the central nervous system (CNS) is involved, survival without treatment is very limited. Although treatment does not substantially improve the long term survival, it provides short term improvement in these patients. METHODS: The charts of all patients with ocular involvement of non-Hodgkin's lymphoma followed during the period 1984-93 were reviewed. The diagnosis of non-Hodgkin's lymphoma was made by different diagnostic approaches: CNS biopsy, anterior chamber tap, vitrectomy, haematology, and necropsy. RESULTS: Eight patients had oculocerebral large cell and one had small cell non-Hodgkin's lymphoma. Five patients with pure ocular localisation had initially received steroid treatment for intermediate uveitis. First diagnosis was made on CNS biopsy in three, anterior chamber tap in one, vitreous aspirate in three, haematology in one, and necropsy in one case. CONCLUSION: Ocular non-Hodgkin's lymphoma is a difficult diagnosis. Vitrectomy allows cytological diagnosis in most but not all cases. When no treatment is given, patients survive for only a few weeks once the CNS is involved. Although the disease is eventually fatal, treatment by means of radiotherapy, steroid administration, and vitrectomy can allow these patients to lead a normal professional and social life during the years between recurrences.

Methicillin resistance of bacteria isolated from vitreous fluid from patients undergoing vitrectomy.

PURPOSE: The aim of this study was to compare the resistance patterns of bacteria in vitreous fluid from patients undergoing vitrectomy for diagnostic reasons, with bacteria of other nosocomial infections. METHODS: Vitreous fluid samples (n=144) were obtained from 133 patients undergoing vitrectomy for endophthalmitis, and 11 for uveitis as suspected endophthalmitis. They were Gram stained and cultured. Antibiotic susceptibility tests were run on all isolates. RESULTS: Gram stains were positive in 45/144 cases (31%), among which 38/45 (84%) were confirmed by a positive culture. Cultures were positive in 74/144 patients (51%) with mainly coagulase-negative staphylococci (n = 44) and Staphylococcus aureus (n = 13). In 133 patients endophthalmitis occurred after lens implantation (80 cases) and in 53 cases there was another origin (e.g. corneal transplantation, endogenous). In 26/80 post-lens implantation infections, culture remained negative; 32 infections occurred with coagulase-negative staphylococci, 10 with Staphylococcus aureus, 9 with streptococci and 3 with gram-negative bacteria. For endophthalmitis, ophthalmologists in our institution give an intraocular injection of vanccmycin and ceftazidim after vitrectomy. Among the 44 isolates of coagulase-negative staphylococci, 12 (27%) were resistant to methicillin. This is in contrast to other hospital-related coagulase-negative staphylococcus infections in general, and the resistance rate is 75% in our hospital. Only 2/13 Staphylococcus aureus isolates were methicillin-resistant. CONCLUSIONS: We conclude that isolates of coagulase-negative staphylococci from vitreous fluid are less resistant to methicillin than those isolated in other nosocomial infections.

Intracapsular and extracapsular pseudophakic endophthalmitis: a comparison.

A hundred and four cases of post cataract endophthalmitis with positive vitreous cultures are discussed. Functional results depend largely on the infecting agent but even after Staphylococcus epidermidis infections some eyes may be lost. Although post lens surgery endophthalmitis carries the best prognosis in the endophthalmitis group, 40% of the eyes are lost, sometimes caused by a delayed vitrectomy decision. Comparing intracapsular and extracapsular lens surgery two big differences were noted: (1) the bacteriology, and (2) the functional results. The bacteriological spectrum of the ICCE was composed of 1/3 of S. epidermidis, 70% of Gram + cocci and 80% of Gram+organisms. After extracapsular lens extraction the majority of cases (60%) were caused by S. epidermidis (statistical significance 0.01). The difference in functional result is explained by the difference in bacteriology: if only the S. epidermidis cases are compared, functional results between both categories are nearly equal. ECCE seems to make the eye more vulnerable to infection by a low virulent agent.

Endophthalmitis after lens extraction.

This article describes most features of endophthalmitis after lens extraction: symptomatology, differential diagnosis, prognosis, treatment and prevention. Literature findings are compared to the author's proper extensive experience with endophthalmitis. Cultures have been positive in 153 cases. A hundred and fifteen of them were seen after previous ocular surgery. Amongst these cases 104 were seen after cataract surgery.