Lysostaphin is effective in treating methicillin-resistant Staphylococcus aureus endophthalmitis in the rabbit

PURPOSE: To determine the effectiveness of lysostaphin treatment of experimental endophthalmitis caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS: In one experiment, rabbits were injected in the mid-vitreous with 50 or 200 CFU of S. aureus; untreated groups and groups injected intra-vitreally at 8 or 24 hours postinfection with vehicle or lysostaphin (0.1 mg/ml) were compared in terms of CFU/ml vitreous at 24 or 48 hours postinfection. Histopathology of untreated and treated eyes was also compared. To quantify the potency of lysostaphin, additional rabbits were injected with 50 CFU of S. aureus and untreated eyes and eyes treated at 8 hours with 0.001, 0.01 or 0.05 mg/ml were compared in terms of CFU/ml vitreous at 24 hours postinfection. RESULTS: Vitreous of untreated eyes or vehicle-treated eyes injected with 50 or 200 CFU of S. aureus contained 5-10 million CFU/ml at 24 or 48 hours postinfection. All eyes treated with lysostaphin at 8 hours postinfection had less than 1 log CFU/ml in the vitreous (P >or= 0.0001). Similarly, eyes treated with lysostaphin at 24 hours postinfection had approximately 1 log of CFU/ml at 48 hours postinfection. None of the untreated eyes were sterile and 88% or 50% of the eyes treated at 8 or 24 hours postinfection, respectively, were sterile. Eyes treated with lysostaphin at 8, but not 24, hours postinfection had less pronounced pathologic changes than the untreated eyes (P = 0.002). A significant reduction in the CFU/ml vitreous at 24 hours postinfection was obtained by treating infected eyes at 8 hours postinfection with lysostaphin at concentrations of >or=0.001 mg/ml (P 相似文献   

Compensatory changes in eye growth and refraction induced by daily wear of soft contact lenses in young marmosets

Several studies have shown that growth of the primate eye responds in a compensatory direction to both positive and negative spectacle lenses--eyes grow more slowly and become hyperopic in response to positive lenses, and eyes grow more rapidly and become myopic in response to negative lenses. On the other hand, extended wear soft contact lenses, whether positively or negatively powered, induce hyperopia (Hung & Smith, 1996. Extended-wear, soft, contact lenses produce hyperopia in young monkeys. Optometry & Vision Science 73, 579-584.). We investigated whether responses in a compensatory direction occurred to soft contact lenses worn on a daily wear basis (8 h per day on an 8:16 h light:dark cycle). Ten infant marmosets (8-13 weeks of age) wore a soft contact lens, in one eye only, for 5-9 weeks. Lens powers used were zero (n = 2), +2 D (n = 1), +2 D followed after 5 weeks of lens wear by +4 D (n = 1) for 4 weeks, +4 D (n = 2), -2 D followed after 5 weeks of lens wear by -4 D (n = 2) for 4 weeks, -4 D (n = 2). At the end of the lens-wear period the positive lens-wearing eyes were more hyperopic relative to the fellow untreated eyes [mean +2.39 +/- 0.24 D (SE)] and the negative lens-wearing eyes were more myopic than the fellow untreated eyes [mean -2.48 +/- 0.91 D (SE)]. Fellow eyes were unaffected by lens wear [mean final refraction +0.45 +/- 0.09 D (SE)]. Plano lenses did not affect eye growth in either marmoset fitted with plano contact lenses.     

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.     

Effects of intravitreal corticosteroid in the treatment of Staphylococcus aureus-induced experimental endophthalmitis

PURPOSE: To investigate whether intravitreal injection of dexamethasone in addition to antibiotics can minimize intraocular tissue injury caused by Staphylococcus aureus endophthalmitis. METHODS: Albino rabbits were infected with an intravitreal injection of 1000 colony-forming units of S. aureus. The rabbits were randomized to receive no treatment (control group; n = 2), intravitreal vancomycin and amikacin (n = 5), or a combination of intravitreal vancomycin, amikacin, and dexamethasone (n = 5) 20 hours following inoculation of bacteria. All rabbits except for the control group also received intravenous imipenem every 8 hours for 4 days. The eyes were evaluated by clinical examination, electroretinogram (ERG), and histologic studies. RESULTS: Eyes treated with intravitreal dexamethasone demonstrated less inflammation on clinical examination compared with eyes that received antibiotics alone. The ERG responses of eyes that received both intravitreal antibiotics and steroid were significantly better at 45 hours, 7 and 14 days following inoculation (P < 0.05) compared to eyes that received antibiotics alone. Histologic studies 14 days following infection demonstrated less tissue destruction for eyes treated with dexamethasone. CONCLUSION: Compared to intravitreal antibiotics alone, intravitreal corticosteroids may improve visual outcome of S. aureus endophthalmitis by reducing inflammation and preserving electrophysiologic retinal function.     

Effect of latanoprost on intraocular pressure in mice lacking the prostaglandin FP receptor

PURPOSE: To determine whether latanoprost lowers IOP in prostaglandin FP receptor knockout mice. METHODS: Mean IOP difference between treated and untreated fellow eyes was measured on three separate occasions, 2 hours after a 200-ng dose of latanoprost to the right eye of homozygous (n = 9) and heterozygous (n = 15) FP knockout mice. C57BL/6 (n = 10) and NIH Swiss white mice (n = 17), which have normal FP receptor expression, provided the control population. The investigator was masked to the genotype of the FP knockout mice at the time of IOP measurement. RESULTS: Latanoprost had no effect on IOP in the homozygous FP knockout mice, with an average difference in IOP between treated and untreated fellow eyes of +0.25 mm Hg and a 95% confidence interval (CI) for the difference between means of -0.019 to +0.69. In contrast, latanoprost reduced IOP in the treated eye of the heterozygous FP knockout, C57BL/6, and Swiss white mice with mean differences and 95% CI of the difference in means of -0.52 (-0.91 to -0.14), -1.38 (-2.1 to -0.70), and -1.29 (-1.78 to -0.79) mm Hg, respectively. CONCLUSIONS: FP receptor signaling plays a crucial role in the early IOP response to latanoprost in the mouse eye.     

Role of aqueous and vitreous cultures in diagnosing infectious endophthalmitis in rabbits

Staph.aureus endophthalmitis was induced in both eyes of 32 rabbits. Endophthalmitis developed in all the 64 eyes within 24-36 h. All vitreous cultures were positive while only 21 simultaneous aqueous cultures were positive. Thus, the importance of vitreous cultures in diagnosing bacterial endophthalmitis is emphasised.     

Specular microscopy follow-up of endophthalmitis after cataract operation

INTRODUCTION: Since the first reports of specular microscopic photographs in vivo of the corneal endothelium, endophthalmitis is said to damage endothelial cells irreversibly. PATIENTS AND METHOD: We controlled 29 eyes 1 to 10 years after endophthalmitis following cataract surgery using specular microscopy. We tried to find out, if endophthalmitis leads to significant endothelial damage and we wanted to describe the in-vivo-cytological follow-up of the implanted lenses. RESULTS: Endothelial cell-density of the eyes with endophthalmitis (n = 29) was 2733/mm2 (+/- 680). In those eyes receiving cataract-surgery without endophthalmitis in the fellow eye (n = 14), the endothelial density was 2851/mm2 (+/- 360). If the fellow eye has had no cataract surgery (n = 13), cell density was 3110/mm2 (+/- 750). Hypopyon-iritis after cataract-surgery did not decrease endothelial cell count significantly more than cataract-surgery without hypopyon-iritis (p > 0.05). At the last control at least one year after surgery, 36% of all IOLs were free of any cellular deposits. There was no case of a foreign-body-reaction. CONCLUSION: In our patients, postoperative endophthalmitis has not led to significant endothelial damage. In none of our patients, endophthalmitis has led to chronic foreign-body reaction against the implant or to granulomatous uveitis. Specular microscopy of the corneal endothelium and of the implanted lens may help to differentiate in the case of postoperative inflammation between an infection and a foreign-body-reaction. In the case of a sterile foreign-body-reaction, there are no inflammatory cells on the endothelium or in the anterior chamber.     

Retrospective analysis of etiopathogenesis of all cases of endophthalmitis at a large tertiary referral center

Purpose To report a large, consecutive series of endophthalmitis of all causes managed at a tertiary referral retina center. Methods Retrospective chart review of all cases diagnosed with endophthalmitis that received reatment and follow-up between January 2000 and January 2005. Results A total of 67 patients were diagnosed with endophthalmitis. The most common cause was postoperative endopthalmitis after cataract surgery. Initial management was vitreous needle biopsy with intravitreal antimicrobial injection in a majority of cases (79%). Vitreous cultures were positive in 32 eyes (44.4%); the most common isolate was coagulase negative Staphylococci. Final visual acuity was improved in 61% of patients. More than a third (38%) had vision worse than count fingers. Twenty-eight eyes (39%) needed pars plana vitrectomy for secondary complications as a consequence of endophthalmitis. Conclusions Cataract surgery remains the most common cause of endophthalmitis in this large tertiary referral retina center. Endophthalmitis resolved with vitreous needle biopsy and intravitreal injections in more than half of the cases. However, more than a third of patients required additional vitreoretinal surgery for secondary complications. More than a third of patients had nonfunctional vision after the resolution of endophthalmitis, which highlights the severity of this condition in the current expanding era of office-based intravitreal pharmacotherapy for retinal diseases.     

Effect of blood on susceptibility to Staphylococcal endophthalmitis

PURPOSE: The authors examined the effect of blood on susceptibility to experimental endophthalmitis. METHODS: Forty rabbits received an injection of 5-25 colony-forming units of Staphylococcus epidermidis into the vitreous of the right eye. Twenty of these same eyes received a subsequent intravitreal injection of 0.2 mL blood while the remaining 20 received an intravitreal injection of 0.2 mL of a salt solution. All eyes were examined daily for signs of endophthalmitis. Vitreous cultures were obtained on day 2 from 30 of the 40 rabbits. Twenty rabbits were assigned for culture and euthanasia at day 5 and those remaining were cultured and killed at day 7. RESULTS: In rabbits with blood and bacteria, 10 of 15 (67%) were culture positive at 2 days, compared to 2 of 15 (13%) that received salt solution and bacteria (P < 0.01). At days 5 and 7 there was no statistically significant difference in culture results. However, inflammatory scores were significantly higher at days 3-7 in rabbits with blood compared to those with salt solution (P 相似文献   

Open globe injuries with positive intraocular cultures: factors influencing final visual acuity outcomes

PURPOSE: To investigate the clinical features influencing final visual acuity outcomes of eyes with positive intraocular cultures after open globe injuries. DESIGN: Retrospective, consecutive, interventional case series. PARTICIPANTS: Thirty-seven patients. METHODS: The medical records were reviewed of all patients with positive intraocular cultures after open globe injuries treated at Bascom Palmer Eye Institute between January 1, 1995, and December 31, 2001. MAIN OUTCOME MEASURES: Final visual acuity. Clinical features investigated included the following: (1). presence or absence of clinical endophthalmitis; (2). virulence of the cultured organism (coagulase-negative Staphylococci, Corynebacterium, and Propionibacterium acnes were classified as nonvirulent organisms, whereas all other organisms were classified as virulent organisms); (3). presence of intraocular foreign body (IOFB); (4). presence of retinal detachment; (5). interval between ocular injury and surgical repair; (6). severity of vision loss at presentation; (7). zone of injury; (8). wound length; and (9). presence of vitreous hemorrhage. RESULTS: The study included 37 eyes of 37 patients with a mean age of 30 years (range, 18 months-85 years) and a median follow-up of 13 months (range, 1-71 months). Study eyes were stratified into two groups: group 1 eyes (n = 16) were those in which clinical endophthalmitis did not develop, whereas group 2 eyes (n = 21) were those in which clinically diagnosed endophthalmitis developed at some point during their clinical course. Presenting visual acuity was similar in the two groups (mean logarithm of the minimum angle of resolution [logMAR] acuity, 1.91 and 2.22 [Snellen equivalents, 2/162 and 2/331] respectively; P = 0.33). Final acuities in the two groups were different, but not to a statistically significant level (mean logMAR acuity, 1.14 and 2.05 [Snellen equivalents, 20/276 and 2/224], respectively; P = 0.069). In group 1, final visual acuity ranged from 20/20 to no light perception (median acuity, 20/186); 12 eyes (75.0%) achieved a final visual acuity of 20/400 or better. In group 2, final visual acuity ranged from 20/25 to no light perception (median acuity, 7/200); of 20 eyes with known final visual acuity, 10 (50.0%) retained 20/400 or better vision. In group 1, three eyes (19%) eyes had virulent organisms, and 13 eyes (81%) had nonvirulent organisms. In group 2, 12 eyes (57%) had virulent organisms, and nine eyes (43%) had nonvirulent organisms. A final acuity of 20/60 or better was achieved in 14 eyes (41%), and a final acuity of 20/400 or better was achieved in 22 eyes (59%). Better presenting visual acuity (P = 0.038), culture of a nonvirulent organism (P = 0.011), lack of a retinal detachment (P = 0.002), absence of clinical endophthalmitis (P = 0.069), and shorter wound length (P = 0.024) were associated with better visual acuity outcome. In four of six eyes (67%) with both an IOFB and clinical endophthalmitis (group 2), the final visual acuity was no light perception (IOFB was not itself significantly associated with final visual acuity; P = 0.11). CONCLUSIONS: Among eyes with positive intraocular cultures after open globe injury, the visual prognosis is guarded. Clinical features associated with better visual acuity outcomes include better presenting visual acuity, culture of a nonvirulent organism, lack of a retinal detachment, absence of clinical endophthalmitis, and shorter wound length.     

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.     

Endophthalmitis caused by Pseudomonas aeruginosa

OBJECTIVE: To investigate the clinical settings and treatment outcomes for endophthalmitis caused by Pseudomonas aeruginosa. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: The medical records were reviewed of all patients treated for P. aeruginosa endophthalmitis at a single institution between January 1, 1987, and December 31, 2001. MAIN OUTCOME MEASURES: Final visual acuity and rate of enucleation or evisceration. RESULTS: The study included 28 eyes of 28 patients with a median age of 75 years (range, 5-93 years). The clinical setting of endophthalmitis included: cataract surgery (n = 9), corneal ulcer (n = 7), penetrating keratoplasty (n = 5), bleb associated (n = 2), glaucoma drainage implant (n = 2), pars plana vitrectomy (n = 1), iris cyst removal (n = 1), and trauma (n = 1). In acute-onset postoperative cases (n = 10), the median interval between surgery and presentation with endophthalmitis was 4 days (range, 1-26 days). The median duration of symptoms was 1 day, and all patients were treated on the day of diagnosis. Eleven patients (39%) had hand motions or better vision in the infected eye at the time of initial diagnosis. Because of no light perception visual acuity, necrosis of cornea and sclera, and intractable pain, 7 eyes (25%) underwent evisceration or enucleation as initial treatment; of the remaining 21 eyes, intravitreal antibiotics were administered in all cases and intravitreal dexamethasone was administered in 15 cases (71%). Pars plana vitrectomy was performed in 12 patients (43%). The organism was sensitive to the initial antibiotics administered in all but 2 cases. Final visual acuity was 5/200 or better in 2 of 28 eyes (7%). Nineteen patients (68%) had a final visual acuity outcome of no light perception, and no patient achieved a final visual acuity of better than 20/400. Overall, 18 of the 28 eyes (64%) were either eviscerated or enucleated. CONCLUSIONS: Endophthalmitis caused by P. aeruginosa is associated with poor visual outcomes despite prompt treatment with intravitreal antibiotics to which the organisms were sensitive.     

Vitrectomy for endophthalmitis after intraocular lens implantation

PURPOSE: To report the results of vitrectomy and intraocular lens (IOL) removal for the treatment of endophthalmitis after IOL implantation. METHODS: We reviewed 14 eyes of 14 patients who underwent pars plana vitrectomy because of postoperative endophthalmitis. Culture results, surgical methods, and visual outcome are presented. RESULTS: The cultures grew Enterococcus faecalis (n = 3), Staphylococcus epidermidis (n = 2), Propionibacterium acnes (n = 1), and gram-negative bacillus (n = 3). The eyes infected with E. faecalis had poor visual outcome. Eleven eyes treated by the combination of pars plana vitrectomy and IOL removal did not have a recurrence. The remaining 3 eyes on which only vitrectomy was performed had a recurrence, and the additional procedures consisting of vitrectomy and IOL removal could result in eradicating endophthalmitis. CONCLUSIONS: A higher rate of E. faecalis was detected and these eyes had severe inflammation and poor visual outcome. Combined vitrectomy and IOL removal may be a more certain method to prevent recurrence.     

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.     

Study of the resistance pattern and alteration in the conjunctival flora of patients exposed to repeated antibiotics

AIM: To investigate and analyze the changes in the conjunctival flora of patients exposed to repeated antibiotic usage. In addition, determining the effects of this repeated exposure on the resistance pattern of the conjunctival flora. METHODS: This study included 40 patients, admitted to the Retina Unit of the Research Institute of Ophthalmology. All chosen patients had a minimum of 4 consecutive, monthly intravitreal injections (IVI), some were extended to 6mo or 1y as required. The patients were randomly divided into 3 groups and each group received one kind of antibiotic which was either ofloxacin, moxifloxacin or ceftazidime. All bacterial isolates were tested for antibiotic susceptibility using Kirby-Bauer disc diffusion technique. RESULTS: In this study the conjunctival normal flora at base line culture varied from a predominance of Staphylococcus epidermidis (51.2%), followed by Staphylococcus aureus 14% to Micrococcus species 12.8% and other coagulase negative staphylococci (CONS) 13%. Our results showed an increase in the percentage of Staphylococcus epidermidis among ceftazidime treated eyes during the four visits in comparison to baseline cultures of patients randomized to ceftazidime. In contrast, there was no noticeable increase in Staphylococcus aureus percentage from baseline. In fluoroquinolone treated eyes, we also observed an increase in percentage of Staphylococcus epidermidis from base line. In contrast to ceftazidime treated eyes, the Staphylococcus aureus percentage in fluoroquinolone treated eyes showed an increase from baseline. However, the pattern of the ocular flora composition changed with the exposure to the old and newer generation of fluoroquinolones. We noticed an increase of Staphylococcus epidermidis in moxifloxacin treated eyes than that in ofloxacin treated eyes from baseline. There was no observed difference in the pattern of Staphylococcus aureus regarding exposure to older and newer generations of fluoroquinolones. CONCLUSION: Repeated use of ophthalmic antibiotics not only alters the composition of the normal ocular flora, but also selects for resistant strains.     

Deep sclerectomy with mitomycin C in failed trabeculectomy

AIM: To evaluate the success rate and complications associated with deep sclerectomy with mitomycin C (MMC) and a reticulated hyaluronic acid implant in previously failed trabeculectomy. METHODS: This prospective study included 20 eyes with a previously failed trabeculectomy, which were treated with deep sclerectomy with 0.2 mg/ml MMC application under the conjunctiva and superficial scleral flap. Intraocular pressure (IOP), glaucoma medications, visual acuity, and complications were recorded preoperatively and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. RESULTS: The mean preoperative IOP was 25.8+/-7.3 mmHg; the IOP significantly decreased to 14.6+/-3.2 mmHg 1 year postoperative. At each interval, the mean IOP was significantly lower than preoperatively (P=0.000). At 1 year, the complete success rate (IOP相似文献   

A cluster of patients with acute-onset endophthalmitis following cataract surgery.

BACKGROUND AND OBJECTIVE: To describe a cluster of patients who had acute-onset endophthalmitis following cataract surgery. PATIENTS AND METHODS: Ten patients with endophthalmitis following cataract surgery who were referred from three different anterior segment surgeons were evaluated. RESULTS: Presenting visual acuities ranged from 20/30 to light perception (median, 20/80). All 10 eyes demonstrated vitritis, 8 of 10 eyes had hypopyon, and the remaining 2 eyes had significant anterior segment fibrin. All patients were treated with intravitreal injections of vancomycin and ceftazidime, as well as subconjunctival steroids. Vitreous cultures were positive in 2 of 10 eyes, and both grew Staphylococcus epidermidis, aqueous cultures were negative in 8 of 8 eyes (not performed in 2 patients). Follow-up ranged from 13 to 85 days (median, 37 days). All eyes showed complete resolution of inflammation and visual acuity improved to 20/40 or better in 9 eyes (90%). CONCLUSIONS: Acute-onset endophthalmitis may occur in a cluster of patients within a short time frame. Early diagnosis and treatment may result in favorable visual outcomes.     

Visual outcome of endophthalmitis in Sweden

A retrospective study of 62 cases of clinically diagnosed endophthalmitis (EO) reported from 24 clinics in Sweden was carried out. Both culture negative and positive cases were included. The function of the eye was lost in 34% of all cases, while vision better than 0.1 was preserved in 41% cases. Staph. epidermidis positive and culture negative cases were associated with better visual results. The majority of eyes with cultures positive for Staph. aureus were lost or became blind. Intravitreal injection of antibiotics and vitrectomy was generally reserved for more severe cases often involving a delay in their institution. A combination of topical and systemic steroids gave better results than no steroids or only topical steroid administration.     

The effect of experimental glaucoma and optic nerve transection on amacrine cells in the rat retina

PURPOSE: To detect alterations in amacrine cells associated with retinal ganglion cell (RGC) depletion caused by experimental optic nerve transection and glaucoma. METHODS: Intraocular pressure (IOP) was elevated unilaterally in 18 rats by translimbal trabecular laser treatment, and eyes were studied at 1 (n = 6), 2 (n = 5), and 3 (n = 7) months. Complete optic nerve transection was performed unilaterally in nine rats with survival for 1 (n = 4) and 3 (n = 5) months. Serial cryosections (five per eye) were immunohistochemically labeled with rabbit anti-gamma-aminobutyric acid (GABA) and anti-glycine antibodies. Cells in the ganglion cell and inner nuclear layers that labeled for GABA or glycine were counted in a masked fashion under bright-field microscopy. Additional labeling with other RGC and amacrine antigens was also performed. RGC loss was quantified by axon counts. RESULTS: Amacrine cells identified by GABA and glycine labeling were not significantly affected by experimental glaucoma, with a mean decrease of 15% compared with bilaterally untreated control cells (557 +/- 186 neurons/mm [glaucoma] versus 653.9 +/- 114.4 neurons/mm [control] of retina; P = 0.15, t-test). There was no significant trend for amacrine cell counts to be lower in eyes with fewer RGCs (r = -0.39, P = 0.11). By contrast, there was highly significant loss of GABA and glycine staining 3 months after nerve transection, both in the treated and the fellow eyes (P < 0.0001, t-test). However, there was a substantial number of remaining amacrine cells in transected retinas, as indicated by labeling for calretinin and calbindin. CONCLUSIONS: Experimental glaucoma causes minimal change in amacrine cells and their expression of neurotransmitters. After nerve transection, neurotransmitter presence declines, but many amacrine cell bodies remain. Differences among optic nerve injury models, as well as effects on "untreated" fellow eyes, should be recognized.     

Optical coherence tomography analysis of bilateral end-stage choroidal neovascularization where one eye is treated with photodynamic therapy

BACKGROUND: To compare retinal thickness and subretinal hyper-reflectivity using Stratus optical coherence tomography (OCT3) between the eyes of patients with bilateral end-stage exudative age-related macular degeneration (AMD), where one eye has been treated with photodynamic therapy (PDT). METHODS: Patients with PDT-treated stable choroidal neovascularization (CNV), defined as a fibrotic lesion not requiring treatment for 6 months, in one eye and an untreated end-stage CNV (disciform) scar in their fellow eye, underwent refraction protocol logMAR visual acuity (VA) in letters, slit-lamp biomicroscopy, fluorescein angiography and OCT3 scan. Subretinal scar thickness was measured as Outer High Reflectivity Band Thickness (OHRBT) and retinal thickness as neuroretinal foveal thickness (NFT) on OCT3. RESULTS: Thirty-two eyes of 16 patients were studied. Mean OHRBT was 255.62 microm in treated eyes and 350.8 microm in untreated eyes (P = 0.001). Mean NFT was 130.3 microm in the treated eye and 79.9 microm in the untreated eye (P = 0.017). Mean VA was 42 letters in treated eyes and 15 letters in untreated eyes (P < 0.005). CONCLUSION: Based on OCT3 findings, eyes with AMD treated with PDT have a thinner fibrous scar and better preserved retinal thickness when compared with untreated fellow eyes with end-stage fibrotic scarring.