Preoperative microbiologic diagnosis before elective intraocular interventions and prevention of infection with tobramycin eyedrops. Results of a multicenter study

Preoperative conjunctival smears of 313 asymptomatic patients before cataract surgery were evaluated in an open multi-center study in 10 German surgical eye care centers from May to August 1987. 230 evaluable isolates of 198 patients (= 61.1%) on agar plates with a 48 h incubation period revealed 190 gram-positive (most frequent isolates: 62.2% coagulase negative Staph., 13.5% coagulase positive Staph.) and 40 gram negative agents (most frequent isolates: 3.0% Proteus sp., 2.2% Pseudomonas sp.). Coinfections with gram-positive organisms were seen in 22%, and with gram-negative organisms in 9% of cases. Newly acquired potentially pathogenic bacteria were demonstrated after one day (5-8 drops 3 mg/ml Tobramycin (Tobramaxin; 1 x ointment in the evening 3 mg/100 mg Tobramycin (Tobramaxin] of topical prophylaxis in 6 of 115 (= 5.2%) previously negative and 22 of 198 (= 11%) previously positive conjunctival cultures. Coagulase negative Tobramycin sensitive Staph. persisted in 41 of 110 patients (= 37.3%) and coagulase positive Tobramycin-sensitive Staph. in 4 of 30 (= 13.3%). Each of the gram-negative bacteria could be eliminated after one day of topical prophylaxis with Tobramycin eye drops and ointment in this study. The statistically determined elimination rate estimated for a one-day topical prophylaxis with Tobramycin in asymptomatic culture-positive persons was 77.5-89.8% (95% confidence interval/Pearson and Clopper). The statistically determined probability for potentially pathogenic bacteria in a previously culture-negative patient after topical preoperative Tobramycin prophylaxis was 3.1-13.2% (95% confidence interval/Pearson and Clopper). Thus, additional supportive antibiotic measures are to be taken pre- and perioperatively by the intraocular surgeon to minimize the risk of postoperative endophthalmitis.     

Endophthalmitis following extracapsular cataract surgery: a review of 32 cases.

Thirty two cases of endophthalmitis following extracapsular cataract surgery that had occurred within our department and had undergone intraocular diagnostic tap between May 1982 and May 1991 were reviewed. An infectious agent was identified in 20 cases (62.5%). The commonest organism was Staphylococcus epidermidis (11 cases) (55%). Proteus was the only gram negative organism identified (four cases) (20%). Both of these organisms were associated with a favourable visual outcome. In the culture positive subgroup 15 eyes (75%) achieved a final acuity of 6/60 or better with 10 eyes (50%) gaining 6/12 or better. Thirteen (65%) of the culture positive cases were managed without vitreal intervention. Of these 11 (85%) achieved 6/60 or better with eight (62%) gaining 6/12 or better. It appears that when an endophthalmitis follows uncomplicated extracapsular cataract surgery delivery of antibiotic by the 'conventional' routes (topical, subconjunctival and systemic) is consistent with a favourable visual result in many cases. A modified anterior chamber diagnostic tap technique is described.     

Acute bacterial endophthalmitis after cataract extraction

In order to evaluate the results, we reviewed all 34 patients treated in our hospital for endophthalmitis after cataract surgery between January 1994 and January 1998. After cultures were taken, all patients received intraocular, subconjunctival and topical vancomycin and ceftazidime. Additionally, twelve patients received the same antibiotics systemically. Besides steroids were administered in all patients. In 79% of the patients the bacterial culture was positive. Coagulase negative Staphylococcus was the most frequently isolated microorganism (48%). After treatment a visual acuity of 0.1 or more was achieved in 62% of the patients. The best final results were achieved in the patients with an initial visual acuity of 1/300 or more, and in the patients from whom a coagulase negative Staphylococcus was isolated.     

Assessment of the effect of oral clarithromycin on visual outcome following presumed bacterial endophthalmitis

PURPOSE: The use of clarithromycin was assessed as a biofilm reducing agent in the management of bacterial endophthalmitis. METHODS: 84 eyes of 83 patients presenting with clinical signs highly suggestive of bacterial endophthalmitis were treated using a standard regimen of intraocular vancomycin, amikacin and systemic steroids, which in addition included oral clarithromycin. Ocular penetration of oral clarithromycin in healthy and inflamed eyes was also assessed. RESULTS: Comparing visual acuities at presentation and 6 months, 66% of patients demonstrated an improvement. Intraocular samples were culture positive in 58% of eyes. As compared to culture positive cases, more culture negative cases achieved a visual acuity of 6/12 or better (p = 0.0047). As compared to patients receiving the standard protocol but without clarithromycin, a greater number of culture negative cases demonstrated an improvement in vision of > or = + 6 Snellen lines (p = 0.023). The ocular penetration of clarithromycin into the anterior chamber of inflamed eyes appears sufficient to allow anti-biofilm activity against bacteria at the basic pH encountered in eyes with endophthalmitis. CONCLUSIONS: The ocular penetration of clarithromycin appears adequate for anti-biofilm activity in inflamed eyes. The beneficial effects of oral clarithromycin on visual outcome has been demonstrated in culture negative eyes with clinical signs highly suggestive of bacterial endophthalmitis. The final visual outcome for culture positive cases remains poor.     

Topical pefloxacin in bacterial keratitis

Problem: To evaluate the clinical efficacy and safety of topical pefloxacin 0.3% drops as the sole antibiotic used to treat culture positive bacterial corneal ulcers. Methods: Forty two consecutive Gram's smear-positive cases of bacterial corneal ulcers were enrolled for this prospective open labelled clinical trial. All patients underwent a complete clinical and microbiological work up and were put on topical 0.3% pefloxacin drops with supportive cycloplegic, vitamins and antiglaucoma therapy. Of 42 cases, 4 cases of mycotic keratitis and 6 culture negative cases were excluded from the study. Results: Positive microbiologic cultures were obtained in 84.2% (32 of 38) cases. Staphylococcus aureus (14/32; 43.7%) and coagulase negative Staphylococci (12/32; 37.5%) were the two most common organisms isolated. Resolution of the corneal ulcer was achieved in 31 out of 32 cases (96.9%) with a mean duration of 9.3 ± 5.3 days (range 3–21 days). Best corrected visual acuity of 20/200 or better was achieved in 65.6% of cases at 4 weeks post resolution. Corneal deposits were observed in one case which disappeared 8 days following discontinuation of therapy. Conclusions: Topical pefloxacin is effective as a single antibiotic agent for the treatment of bacterial keratitis.     

Tranexamic acid in the treatment of pediatric traumatic hyphema

Background: This study was undertaken to determine whether a difference exists in treatment outcome between patients treated with tranexamic acid (TEA) plus topical steroids and those treated with topical steroids alone. Methods: A retrospective cohort study was conducted to compare treatment results for children with traumatic hyphema treated with TEA and topical steroids versus topical steroids alone. Patients were identified from a chart review of the Children's Hospital of Eastern Ontario eye clinic and the Queen's Department of Ophthalmology emergency eye clinic for charts coded "traumatic hyphema." The primary outcomes measured included visual acuity, rebleed rate, intraocular pressure, and time to hyphema resolution. Covariates were hyphema grade, the need for medications to lower intraocular pressure, and the presence of associated ocular traumatic complications. Analysis was performed with both bivariate analysis and multivariate models. Results: Two hundred and fifteen patients with traumatic hyphema were included in our study. One hundred and thirty-seven patients (63.1%) received TEA plus topical steroids, and the remaining 78 patients received topical steroids alone. There was no significant difference in rebleed rate between the TEA plus topical steroid group (1.6%) and the steroid-alone group (2.6%, p = 0.60). Interpretation: Patients with traumatic hyphema treated with TEA plus topical steroids did not have a significantly lower incidence of rebleed than those treated with topical steroids alone.     

Cell culture isolation can miss the laboratory diagnosis of HSV ocular infection

AIM: We compared polymerase chain reaction (PCR) to cell culture isolation for the laboratory diagnosis of ocular herpes simplex virus (HSV) disease. METHODS: Laboratory and medical records of consecutive patients were reviewed for results of 1) HSV PCR testing, 2) HSV cell culture isolation, and 3) clinical diagnosis. PCR results were statistically compared to cell culture isolation and patients initially diagnosed for ocular HSV infection. RESULTS: Of 581 cases submitted for laboratory testing, 520 were PCR negative, cell culture negative (89.6%); 0 were PCR negative, cell culture positive (0%); 27 were PCR positive, cell culture negative (4.6%); and 34 were PCR positive, cell culture positive (5.8%). PCR tested more positive than cell culture isolation (McNemar's,P=0.0001). Of 47 HSV PCR positive cases with complete medical records, 19 were cell culture negative for HSV and 28 were cell culture positive for HSV. Fourteen of 19 cell culture negative cases (74%) (Without PCR, 5 cases of HSV would be missed) and 25 of the 28 cell culture positive cases (89%) (Laboratory testing was necessary for diagnosing 3 cases) were clinically diagnosed with HSV at the initial examination. CONCLUSION: PCR was a more definitive test for diagnosing HSV ocular infection than cell culture isolation. Cell culture isolation alone can miss an atypical presentation of HSV ocular infection.     

Filtration surgery in the treatment of neovascular glaucoma

The disappointing visual acuity results following cyclocryotherapy for neovascular glaucoma have prompted us to consider filtration surgery as a reasonable alternative in the treatment of selected patients. All cases of surgically treated neovascular glaucoma were reviewed. There were 26 operations in 24 eyes with a follow-up ranging from six months to seven years and a mean of 22.8 months. Adequate pressure control was obtained in 16 of the 24 eyes (67%). In the eyes with successful control of intraocular pressure, vision was 20/400 or better in eight of the 16 eyes (50%). Four patients (17%) lost light perception. Approximately one half of the operations were trabeculectomies, and the others were posterior lip sclerectomies. There seemed to be no significant difference in the final intraocular pressure levels, number or degree of complications, or successes within the two subgroups. Panretinal photocoagulation, topical steroids, cycloplegics, and time for these measures to have their effect are important preoperative adjuncts to surgical treatment. We are encouraged by the long-term preservation of vision and control of intraocular pressure in many of these eyes.     

Severe infective keratitis leading to hospital admission in New Zealand

AIM: To identify key risk factors and the management and outcome of severe infective keratitis leading to public hospital admission in New Zealand. METHODS: Over a 2 year period, all admissions of presumed infective keratitis to Auckland Hospital were identified. The clinical records of all 103 cases were retrospectively reviewed with respect to clinical features, risk factors, management, and outcomes. RESULTS: The mean time from first symptoms or signs and presentation to hospital was 8.9 (SD 15.5) days. The majority of subjects, 88%, had at least one of the risk factors commonly associated with infective keratitis including previous ocular surgery (30%), contact lens wear (26%), topical corticosteroid use (25%), and ocular trauma (24%). Corneal scraping was performed in 92% and of a total of 105 scrapes, 71% were positive. Bacteria were isolated in all these cases, the majority being Gram positive organisms (72%). The most common isolates identified were coagulase negative Staphylococcus (16%), Propionibacterium acnes (14%), Staphylococcus epidermidis (11%), and Streptococcus pneumoniae (9%). In addition, yeasts were isolated in 5%, fungi in 4%, virus in 2%, and chlamydia in 1%. Importantly, polymicrobial infection accounted for 33% of culture positive cases. Antimicrobial treatment was changed on the basis of culture results in 17 cases (16.5%). Median initial visual and final best corrected visual acuity was 6/36-6/48 (logMAR 0.86) (IQR 0.39-2.00) and 6/12-6/15 (logMAR 0.360) (IQR 0.15-1.70), respectively. Previous ocular surgery and topical corticosteroid use were significantly associated with poorer visual acuity. The mean hospital stay was 5.8 days and the median 4.0 (IQR 2.0-8.0) days. Longer duration of stay was associated with the presence of hypopyon, larger ulcers, previous ocular surgery, and poor visual acuity. CONCLUSIONS: Infectious keratitis is an important cause of ocular morbidity. A significant proportion of cases have potentially modifiable risk factors. Previous ocular surgery and topical corticosteroid use, in particular, were associated with poorer visual outcomes. Many cases of severe keratitis might be avoided, or their severity reduced, by appropriate education of patients and ophthalmologists.     

Penetrating keratoplasty for keratoconus: complications and long-term success.

A series of 100 penetrating keratoplasties for keratoconus performed between 1968 abd 1986 were reviewed for long-term results. The mean follow-up was 6.1 years with a range of 4-16 years. The systemic associations and the postoperative complications were analysed. Grafting in cases associated with Down's syndrome had a higher incidence of complications. 93% of grafts remained clear and 81% achieved a final corrected visual acuity of 6/12 or better. 21% of eyes developed a homograft reaction, with 50% of rejection episodes occurring in the first year after operation. Factors associated with higher incidence of rejection included loose sutures, traumatic wound dehiscence, and grafts larger than 8.5 mm. Only three grafts with rejection episodes lost graft clarity, while rejection in the rest was successfully reversed with topical steroid therapy. No relationship was found between donor age and long-term graft clarity.     

Pseudophakic endophthalmitis. Diagnosis and management

Eighty-three cases of endophthalmitis occurring in eyes with intraocular lenses are presented. A problem with the cataract section was felt to contribute to development of the endophthalmitis in 22% of patients. Seventy-five percent of eyes were culture positive with a microbiologic spectrum similar to other reported series without lens implants. Staphylococcus epidermidis was the most common organism accounting for 38% of the isolates. Therapeutic vitrectomy was performed in 46 cases (55%), generally in those eyes with the most severe inflammation. Intraocular lenses were removed in 23 cases (28%), usually to facilitate vitrectomy. Only 1 of 57 eyes with bacterial endophthalmitis could not be sterilized while the intraocular lens was retained. Visual acuity of 20/400 or better was achieved in 63% of culture positive cases, in 78% of eyes infected with S. epidermidis, and in 94% of culture negative eyes.     

The enigma of herpes stromal disease.

Herpes stromal disease is due to direct damage as a result of viral replication, virally induced immune mechanisms, or a combination of the two. Viral replication may have a major initiating role in the production of herpes simplex and herpes zoster induced stromal disease, and steroids may initially be harmful in their treatment. On topical antiviral drugs alone, in patients who never previously had had topical steroids, 14 of 15 cases of herpes simplex induced disciform keratitis responded favourably in an average of 44 days of treatment. This compared with one out of 14 responding if steroids had previously been used, 13 of 14 requiring topical steroids and an average 112 days' treatment. In herpes zoster stromal disease cases 78% had epithelial involvement, 54 of 57 responded to topical antivirals alone without the use of steroids, 2% recurred, and treatment averaged a total of 62 days. If steroids were used alone or in combination with antivirals, there was a 50% recurrence rate and 200 day total treatment duration.     

The epidemiology of diffuse lamellar keratitis

PURPOSE: To report the incidence and outcomes of diffuse lamellar keratitis (DLK) after LASIK and to analyze potential causative factors. METHODS: Retrospective review of 15,119 cases (11,232 primary procedures and 3887 enhancements) from 7168 patients undergoing LASIK from May 1995 through October 2002, comparing preoperative data and postoperative outcomes for each case developing DLK to patients in the study population and a control series of eyes that did not develop DLK. RESULTS: We identified 61 eyes (0.40%) that developed DLK after LASIK. Three study groups were identified based on sterilization protocols used: (1) steam autoclave without reservoir (8348 cases), (2) cassette autoclave with reservoir (6771 cases), (3) steam autoclave without reservoir and new instrument cleaner (1758 cases). Significantly more eyes developed DLK with Protocol 2 (47 cases, 0.94%) than with Protocol 1 (11 cases; 0.1%; P < 0.0001) or Protocol 3 (3 cases, 0.2%; P < 0.0005). There was no significant difference in the incidence of DLK in Protocol 1 versus Protocol 3. DLK was significantly more common after primary procedures than with enhancement procedures only under Protocol 2. No individual developed DLK after more than 1 procedure. Treatment protocols included frequent topical steroids only (24 cases, 39.3%), frequent topical steroids and oral steroids (19 cases, 31.2%), or topical and oral steroids combined with lifting and irrigating beneath the flap (18 cases, 29.5%). Final refractions and visual acuities were not significantly different in eyes that developed DLK and those that did not. CONCLUSIONS: DLK is a nonspecific inflammatory response to multiple stimuli that cannot be attributed solely to individual variation in the inflammatory response, the microkeratome, or material deposited by the microkeratome. Sterilizers with reservoirs may cause some cases of DLK. With appropriate diagnosis and treatment, DLK should resolve without sequelae, yielding visual outcomes comparable to cases with uneventful postoperative courses.     

Microsporidial keratoconjunctivitis in healthy individuals: a case series

PURPOSE: To present a series of 6 cases of microsporidial keratoconjunctivitis in healthy, nonimmunocompromised individuals. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Six individuals with unilateral keratoconjunctivitis. METHODS: Cornea epithelial scrapings were taken and evaluated by modified trichome staining. Blood was taken for human immunodeficiency virus (HIV) enzyme-linked immunosorbent assay in all cases and for CD4 and CD8 T-lymphocyte counts in 5 cases. MAIN OUTCOME MEASURES: The individuals were evaluated based on symptoms, visual acuity, slit-lamp biomicroscopy, and pathologic examination of the corneal scrapings. RESULTS: All cases occurred in men whose ages ranged from 16 to 37 years. Initial symptoms included unilateral pain and redness. All experienced subsequent worsening of symptoms and blurring of vision after using topical steroids prescribed by general practitioners. Slit-lamp biomicroscopy revealed coarse, multifocal, punctate epithelial keratitis in all 6 cases, anterior stromal infiltrates in 2 cases, with accompanying conjunctivitis in all cases. Modified trichrome staining of corneal epithelial scrapes revealed pinkish to red spores characteristic of microsporidia in all cases. Results of an HIV enzyme-linked immunosorbent assay were negative in all cases, and CD4 and CD8 T-lymphocyte counts and ratios were normal in all 5 tested cases. On diagnosis, topical steroid therapy was stopped in all cases. Treatment with topical Fumidil B (bicyclohexylammonium fumagillin; Leiter's Park Ave Pharmacy, San Jose, CA) together with oral albendazole was given in 3 cases, oral albendazole alone in a single case, and broad-spectrum antibiotic treatment with topical norfloxacin or chloramphenicol in two cases. Two cases had keratic precipitates with mild cellular activity in the anterior chamber and one such case was restarted subsequently on topical steroids. All six cases showed resolution of epithelial keratitis but with residual visually inconsequential subepithelial scars by the end of 1 month of treatment. CONCLUSIONS: Microsporidial keratoconjunctivitis can occur more commonly than expected in healthy, nonimmunocompromised individuals. Topical steroids seem to contribute to the persistence of this infection and may be a predisposing factor in these cases by creating a localized immunocompromised state. The clinical course is variable and may be self-limiting with cessation of topical steroid use.     

Incidence of presumed postoperative endophthalmitis in Dublin for a 5-year period (1997--2001)

PURPOSE: To evaluate the incidence of presumed endophthalmitis following cataract surgery over a 5-year period in a busy ophthalmic hospital. SETTING: Ophthalmology unit in the Royal Victoria Eye and Ear Hospital, Dublin, Ireland. METHODS: A retrospective series of 8736 consecutive cases of cataract extraction with intraocular lens implantation carried out during a period of 5 years from 1997 to 2001 were studied. All cases requiring readmission due to suspected postoperative infection were investigated as part of the study. RESULTS: A total of 8763 patients had a cataract procedure. Forty three of them were readmitted with suspected endophthalmitis, giving a total suspected endophthalmitis rate of 0.5%. Of the 43 readmitted cases, 29 cases (67%) had hypopyon and 14 cases (32%) had fibrinous uveitis. Of those with hypopyon, 83% received intravitreal antibiotics. Of those with fibrinous uveitis, none received intravitreal antibiotics. There was a difference in the numbers achieving visual acuity of 6/12 or better between the 2 groups (33% and 14% of patients, respectively). In cases that had a vitreous biopsy, 10 (42%) were culture positive and of these, the most common organism found was Staphylococcus aureus (50%). Fourteen of the 43 cases (32.5%) that presented with fibrinous uveitis were treated with topical, subconjunctival, and systemic antibiotics with steroids. Visual acuity of 6/12 or better was achieved in 6 patients (14%). CONCLUSIONS: The incidence of suspected endophthalmitis following cataract surgery in a 5-year period in a busy Irish ophthalmic unit was 0.49%. Culture-positive endophthalmitis was 0.1%, but only 56% of cases with presumed endophthalmitis had a vitreous biopsy performed. The visual outcome was better in patients who were treated with intravitreal antibiotics at the first sign of symptoms. These findings support the hypothesis that infection is the most likely cause of postoperative endophthalmitis and that it may present as hypopyon or fibrinous uveitis. Prompt investigation and treatment of such patients with a standard endophthalmitis protocol should be instituted to save vision.     

Comparison of the effect of topical corticosteroids and nonsteroidals on postoperative corneal astigmatism

A controlled study compared the effects of a topical steroid (1% prednisolone acetate) and a topical nonsteroidal anti-inflammatory agent (0.03% flurbiprofen) on postoperative changes in corneal astigmatism in a series of patients having phacoemulsification and posterior chamber lens implantation through a 6.5 mm scleral pocket incision. The incisions were closed with a continuous running 10-0 monofilament nylon suture under tonometric and keratometric control. The results of the study showed that both agents demonstrated similar postsurgical astigmatic decay curves; however, the group receiving the nonsteroidal agent had an earlier decay of iatrogenically induced astigmatism. Approximately 80% of cases receiving the nonsteroidal agent completed the postoperative course without the use of topical steroids, indicating that in some cases steroids may be avoided after cataract removal.     

Traumatic flap dislocation after laser in situ keratomileusis

PURPOSE: To report our experience in treating cases of flap dislocation caused by trauma after laser in situ keratomileusis (LASIK). PATIENTS AND METHODS: We did a retrospective review of the case records of 16,319 patients (31,655 eyes) who underwent LASIK in Minamiaoyama Eye Clinic. Ten eyes of 9 patients were treated for flap dislocation. Conditions of the trauma occurrence, main findings of the eyes, treatments and clinical results are described. RESULTS: Dislocation occurred during a period of 5 days to 4 years after LASIK. Accidents happened when working, when playing with children or pets, or when fighting. The main findings were folds or microstriae, diffuse lamellar keratitis (DLK), and epithelial ingrowth, including partial splitting of the flap (1 eye) and only a crack in the epithelium of the flap edge (1 eye). Seven flaps were lifted, irrigated and repositioned, and observed after fitting the patients with soft contact lenses. Three flaps were treated with eye drops of hyaluronic acid only, or with systemic steroids, topical steroids, and antibiotics. Uncorrected visual acuity recovered to more than 1.0 in 7 eyes, and best corrected visual acuity (BCVA) was more than 1.0 in all eyes. However, 3 eyes lost one line and 1 eye lost two lines of BCVA. CONCLUSION: Many cases of flap dislocation showed recovery of good visual acuity with adequate and prompt treatment. However, it is possible to leave irregular astigmatism untreated which has a bad effect on visual acuity, depending on the affected part and the seriousness of the injury. The connection between patient and clinic is important for proper and prompt treatment.     

实验室诊断技术在真菌性角膜炎诊断敏感性的对比研究

目的：分析真菌涂片、真菌培养和病理检查在诊断真菌性角膜炎上的相关性及临床意义。
　　方法：收集2012-01/2014-12诊断为真菌性角膜炎的患者110例110眼,对真菌涂片、真菌培养及病理检查结果进行回顾性分析总结。真菌涂片行角膜刮片,用10%氢氧化钾制成湿片镜检,同时行革兰染色镜检;真菌培养采用马铃薯葡萄糖琼脂培养基( PDA)培养;病理检查的标本为角膜移植切除手术标本,采用石蜡切片,使用苏木素-伊红( HE)、六胺银、过碘酸-雪夫( PAS)染色镜检。
　　结果：真菌涂片阳性者50例(45.5%);真菌培养阳性者55例(50.0%);病理检查阳性者88例(80.0%)。真菌涂片与病理检查均为阳性者50例,真菌涂片与病理检查均阴性者22例,真菌涂片与病理检查的符合率为65.5%。真菌培养与病理检查均为阳性者55例,真菌培养与病理检查均阴性者22例,真菌培养与病理检查的符合率为70 .0%。真菌涂片结果阴性者60例中,有38例经病理检查确诊为阳性,占63.3%;真菌培养结果阴性者55例中,有33例经病理检查确诊为阳性,占60 .0%。
　　结论：病理检查的敏感性最好,真菌涂片、真菌培养及病理检查联合应用能够提高真菌性角膜炎的诊断水平,降低漏诊、误诊。     

Endophthalmitis in a pediatric population.

A study of 22 consecutive cases of suspected endophthalmitis in children disclosed that 68% (15/22) were male with a mean age of 7.4 years. In contrast to adult populations, 86% (19/22) followed trauma in this series. Cultures were performed in 18 cases yielding positive results in 8 cases. Anterior chamber paracentesis was positive in 6/10 attempts, vitreous cultures in 1/4, and wound cultures in 2/7. Gram-positive organisms were recovered in 75% (6/8) of the cultures, stressing the importance of coverage for these organisms before culture results are known. Although cultures should be obtained as soon as possible, the initiation of antibiotics beforehand should not deter one from obtaining cultures as 75% (6/8) of patients with positive cultures had preculture antibiotics. Fourteen patients were diagnosed within 48 hours of the precipitating event, and all of these cases followed trauma. Three of 7 patients with positive cultures and 1 of 10 patients with negative cultures had final visual acuities of 20/200 or better. The lack of correlation between a positive culture and a poor visual outcome suggests that the final visual acuity depends not only on the endophthalmitis, but also on the extent of trauma.     

细胞分离培养在实验室诊断眼部单纯疱疹病毒感染疾病的误诊和漏诊情况

目的:对比聚合酶链反应(PCR)和细胞分离培养在实验室诊断眼部单纯疱疹病毒(HSV)感染疾病的作用。方法:我们对连续患者的实验室结果(PCR实验,细胞分离培养及临床诊断)及病历进行回顾性研究在诊断眼部HSV感染疾病过程中,PCR检测结果、细胞分离培养及首诊结果进行了统计比较。结果:患者581例经过检查后,520例PCR检查阴性,细胞培养阴性(89.6%);0例PCR检查阴性,细胞培养阳性(0%);27例PCR检查阳性,细胞培养阴性(4.6%);34例PCR检查阳性,细胞培养阳性(5.8%)。PCR检测阳性率高于细胞分离培养(McNemars,P=0.0001)。47例PCR检查为HSV初诊感染阳性患者中,19例患者中有14例为细胞培养阴性结果(74%),5例HSV患者因缺PCR检测结果将被误诊;28例患者中有25例患者细胞培养阳性(占89%),3例HSV患者因缺PCR检测结果将被漏诊。结论:PCR诊断眼部HSV感染优于细胞分离培养。细胞分离培养对于眼部HSV感染的非典型表现不易诊断。