Detection of <Emphasis Type="Italic">Candida</Emphasis> and <Emphasis Type="Italic">Aspergillus</Emphasis> species DNA using broad-range real-time PCR for fungal endophthalmitis

Background  

The goal of this work is to establish a broad-range real-time polymerase chain reaction (PCR) diagnostic system for ocular fungal infection and to measure Candida and Aspergillus DNA in the ocular fluids obtained from unknown uveitis/endophthalmitis patients.     

Broad-range real-time PCR assay for detection of bacterial DNA in ocular samples from infectious endophthalmitis

Background

To evaluate a broad-range real-time polymerase chain reaction (PCR) targeting the bacterial 16S rRNA gene for detection of bacterial DNA in infectious endophthalmitis.

Methods

The bacterial 16S rRNA gene was measured by quantitative real-time PCR. For the assay, bacterial DNA was prepared from 12 Gram-positive and 4 Gram-negative strains. To determine the optimum method for DNA extraction, four extraction procedures were selected by using DNA extraction program cards with and without the use of lysozyme. To evaluate PCR sensitivity, PCR fragments were amplified from Staphylococcus aureus and Escherichia coli DNA.

Results

DNA extraction using the Bacteria card^? without enzymes resulted in detection of all the tested strains at concentrations ≥10⁷?copies/mL. Extraction with the Bacteria card^? with lysozyme resulted in detection of all the tested strains at concentrations ≥10⁶?copies/mL, indicative of no significant difference between the two procedures. DNA extraction using the Virus card^?, both with and without enzymes, resulted in reduced efficiency of detection of all strains compared with use of the Bacteria card^?. The PCR could detect as few as 1–10?colony-forming units (CFU) in diluted vitreous samples per reaction, and all tested bacterial species known to cause endophthalmitis were detected.

Conclusions

Bacterial 16S-specific PCR can comprehensively detect the main causative bacteria of clinically suspected endophthalmitis.     

Assessment of fungal viability after long-wave ultraviolet light irradiation combined with riboflavin administration

Background

Corneal collagen cross-linking (CXL), a technique that combines riboflavin administration with long-wave ultraviolet light irradiation, was primarily developed to increase the biomechanical strength of collagen fibrils of the cornea to avoid the progression of keratoconus. Recently, this method has been proposed to treat selected cases of infectious keratitis.

Methods

To test the protocol used for progressive keratoconus in infectious keratitis, Candida albicans, and Fusarium solani, strains were exposed to irradiation using a wavelength of 365 nm at a power density of 3 mW/cm² for 30 min in the presence of riboflavin photosensitizer. All experiments were performed in triplicate. Qualitative and quantitative measurements of fungal viability used plate cultures and an automated trypan blue dye exclusion method respectively. Fungal cell diameter was also assessed in all groups. Statistical analyses were performed using the triplicate values of each experimental condition.

Results

Experimental findings of photodynamic therapy applied to the cell inactivation of both yeasts and filamentous fungi were compared with control groups. Qualitative results were corroborated with quantitative findings which showed no statistical significance between challenged samples (experimental groups) and the control group (p-value?=?1). In comparison with a control group of live cells, statistical significance was observed when riboflavin solution alone had an effect on the morphologic size of filamentous fungi, while ultraviolet light irradiation alone showed a slight decrease in the cell structure of C. albicans.

Conclusions

The impact of long-wave ultraviolet combined with riboflavin photosensitizer showed no antifungal effect on C. albicans and F. solani. The significant decrease in cell morphology of both filamentous fungi and yeasts submitted to photosensitizing riboflavin and exposure to ultraviolet light, respectively, may be promising in the development and standardization of alternatives for fungal cell inactivation, because of their minimal cytotoxic effects on the corneal surface. The methodological improvement in the preparation and application of individual chemical compounds, such as riboflavin, or physical systems, such as a long-wave light source, as antifungal agents may also assist in establishing promising therapeutic procedures for keratomycosis.     

Risk factors,microbial profiles and prognosis of microbial keratitis-associated endophthalmitis in high-risk eyes

Background

Microbial keratitis (MK) is a sight-threatening emergency. Delayed diagnosis and treatment may exacerbate the condition and infection may spread to the posterior segment with resultant endophthalmitis. We describe the presentation, management, visual outcomes and microbial profiles of MK-associated endophthalmitis presenting to a tertiary referral centre.

Methods

Prospective collection of data on all patients presenting with presumed MK-associated endophthalmitis from 1997 to 2007, to the Royal Victorian Eye and Ear Hospital. Outcome measures included: visual acuity, microbial profiles, and management strategy.

Results

Thirty-seven cases of MK-associated endophthalmitis were identified over the study period, with a mean age of 73 years and 19 were male. Presenting acuities ranged from Snellen 2/60 to no perception of light (NPL). Thrity-four (91.9 %) patients had a prior history of ocular disease. Identifiable non-ocular risk factors were present in 31 (83.8 %), including steroid use, dementia, nursing home care or relative systemic immunosuppression. A culture positivity rate of 83.8 % was recorded. The most common organisms identified included: Streptococcal species in 12 (32.4 %), Pseudomonas aeruginosa in 11 (29.7 %), and Staphylococcus aureus in eight (21.6 %). Final acuities ranged from 6/36 to NPL. Sixteen (43.2 %) eyes were eviscerated/enucleated as primary treatment. Overall, 23 (62.2 %) patients required evisceration/enucleation, of which nine (39.1 %) were due to Pseudomonas aeruginosa and seven (30.4 %) to Streptococcal species (Streptococcal pneumonia).

Conclusions

MK-associated endophthalmitis is a serious ocular condition occurring more frequently in elderly populations, and those with long standing severe pre-existing ocular disease. Visual outcomes are poor, often requiring evisceration/enucleation.     

23-gauge transconjunctival sutureless vitrectomy in treatment of post-operative endophthalmitis

Purpose

To report the safety and efficacy of 23-gauge (23-G) transconjunctival vitrectomy (TSV) in the surgical management of postoperative endophthalmitis.

Materials and Methods

Ten consecutive patients underwent a 23-G TSV in 2008–2010 after cataract surgery (n?=?5) or filtrating surgery (n?=?5), and were prospectively studied with a minimum follow-up of 6?months. TSV was performed within a median delay of 1?day after the diagnosis, after one or two injections of intravitreal antibiotics (vancomycin, ceftazidime). Conventional cultures (brain heart infusion media) and/or panbacterial PCR were performed on aqueous humor and/or vitreous samples.

Results

Initial visual acuity was less than or equal to hand motion in all cases, and clinical findings included hypopyon (80%), pupillary fibrin membrane (80%), and dense vitreitis (4+, 100%). The bacteria identified were Gram-positive cocci in 60% of the cases (coagulase-negative staphylococci, 20%; streptococcus, 40%) and Gram-negative bacilli in 10% (moraxella lacunata). All patients had central and peripheral vitrectomy (mean duration, 58.6?±?16?min). No intraoperative complications were noted. Two patients developed retinal detachment postoperatively and were reoperated. The final visual vision was 20/400 for two patients and 20/50 or better for the other patients.

Conclusion

23-G TSV allows the surgeon to meet the same objectives as the 20-G technique for the treatment of endophthalmitis.     

Assessment of age changes and repeatability for computer-based rod dark adaptation

Purpose

To characterize the rate of rod-mediated sensitivity decline with age using a PC-driven cathode ray tube (CRT) monitor. To provide data regarding the repeatability of the technique.

Methods

Dark adaptation was monitored for 30 min following a minimum 30 % pigment bleach, using a white 1° stimulus (modulated at 1 Hz), presented 11° below fixation on a CRT monitor. Thirty-three subjects with no ocular pathology and normal fundus photographs were divided into two groups: older (≥45, n?=?16) and younger (<45, n?=?17).

Results

Rod recovery was assessed using component S2 of dark adaptation. S2 was significantly slower in the older (0.19?±?0.03 log cd.m^?2.min^?1) compared with the younger group (0.23?±?0.03 log cd.m^?2.min^?1, t?=??4.05, p?<?0.0003), despite no difference in visual acuity and fundus appearance. Faster rates of S2 recovery were correlated with lower threshold at 30 min (T₃₀) (r?=??0.49). Correlation coefficients between first and second measurements for S2 and T₃₀ were 0.49 (p?<?0.009) and 0.84 (p?<?0.0001) respectively. The coefficient of repeatability was 0.07 log cd.m^?2.min^?1 for S2 and 0.35 log cd.m^?2 for T₃₀. The coefficients of variation for S2 and T₃₀ were 15 % and 10 % respectively.

Conclusions

Dark adaptation is slowed in normal ageing. CRT-based dark adaptometry is easily implemented and highly repeatable. The technique described in this article would be useful for documenting visual changes in future clinical trials assessing retinal health in the older eye with and without ocular pathology.     

Reliability of vitreous histological detection of pathogenic fungi in the diagnosis of fungal endophthalmitis

Purpose

To assess the value of histopathologic investigations of vitreous biopsy specimens in the diagnosis of fungal endophthalmitis compared with that of conventional smear and fungal culture.

Methods

In this prospective study, 10 patients with clinically suspected fungal endophthalmitis of any etiology underwent intravitreal sampling and vitrectomy for diagnostic and therapeutic purposes. Infused vitreous biopsy samples were centrifuged and mixed with blood serum for hematoxylin and eosin and periodic-acid Schiff staining, whereas the remaining samples were submitted for smear and fungal culture. All slides were reviewed by an attending pathologist.

Results

Vitreous specimens were obtained from 10 eyes of 10 patients. Positive histological diagnoses of fungal endophthalmitis from vitreous biopsies were made in seven cases (70%). The sensitivity of histological detection of fungi was higher than conventional smear (50%) or culture (40%); all these techniques are complementary.

Conclusions

Specific histopathological detection of pathogenic fungi in clinical vitreous specimens could be helpful for the diagnosis of suspected fungal endophthalmitis. Positive histopathology results were seen in the majority of samples; however, difficulties in determining related fungal etiology limit its application.     

Clinical characteristics of ocular toxocariasis in Eastern China

Purpose

To explore the clinical characteristics of patients with ocular toxocariasis in eastern China.

Methods

The medical records of 35 cases of ocular toxocariasis in Fudan University Eye &; ENT Hospital between May 2009 and April 2011 were retrospectively reviewed and analyzed. UBM, RetCam or fundus imaging, and high-frequency or conventional ultrasonography were performed in these patients.

Results

The mean patient age in our series of ocular toxocariasis was 11.86?±?8.80?years. There were 28 children and seven adults, the majority residing in a rural area (88.57%). All cases were classified into three clinical subtypes: granuloma in the peripheral retina (60% of cases); granuloma in the posterior pole (28.57% of cases); and vitreous inflammation mimicking chronic endophthalmitis (5.71% of cases). We also identified an additional subtype with unique clinical features that we termed “combined type” presenting in 5.71% of our patients. This subtype exhibited granulomas in both the posterior pole and peripheral retina. RetCam fundus imaging was able to identify granulomas in the posterior and peripheral subtypes, 100% and 80.95% of cases respectively. Moreover, UBM combined with conventional ultrasonography identified granulomas in 95% of the peripheral subtype cases and in 100% of the posterior pole subtype cases.

Conclusions

This is the first ocular toxocariasis series described in Chinese patients. Compared with reports from developed countries, the ocular features in our series were more severe and complicated, presenting with poorer visual acuity and a high rate of retinal detachment (45.7%). The application of RetCam and UBM during examination in ocular toxocariasis can provide valuable information in determining the severity of disease and features important in considering surgical procedures in such patients.     

Results of Extensive Surgical Treatment of Seven Consecutive Cases of Postoperative Fungal Endophthalmitis

Purpose

Postoperative endophthalmitis is a dreaded outcome of any intraocular surgery. Fungal endophthalmitis is a particularly severe complication that poses a significant threat of blindness. We experienced seven consecutive cases of postoperative fungal endophthalmitis stemming from a single local clinic in which extensive early intervention resulted in favorable final visual acuity.

Methods

The present study is retrospective observational case series of fungal endophthalmitis. The initial case, as diagnosed by fungal culture, resulted in blindness. In the ensuing eight months, seven consecutive cases were referred to our institution. All were presumed to be fungal endophthalmitis as the cases possessed similar inflammatory findings to the preceding case and occurred in the same environment. Extensive surgical and antifungal treatment was immediately administered, including complete vitrectomy with removal of the intraocular lens and lens capsule and Amphotericin B injections.

Results

Retinal infiltration was identified in three cases and the lesion site was photocoagulated with an endolaser. All cases were confirmed fungal endophthalmitis by culture (4 cases: Candida parapsilosis, one case each: Fusarium, Acremonium, Candida tropicalis) and five cases required secondary intraocular lens implantation. Final corrected visual acuity ranged from 20/20 to 40/200 by the Snellen chart.

Conclusions

Early extensive surgical intervention and antifungal agent administration may result in favorable visual outcomes in patients with fungal endophthalmitis following cataract surgery.     

Microbiology and visual outcomes of culture-positive bacterial endophthalmitis in Oxford,UK

Purpose

To review the microbiology of culture-positive cases of bacterial endophthalmitis, and to correlate this with visual outcomes.

Method

Case notes were reviewed for culture-positive cases of bacterial endophthalmitis over a period from November 1999 to June 2012. Cases were identified retrospectively using a local database. The Fisher exact test was used for statistical analysis.

Results

Of the 47 cases of culture-positive bacterial endophthalmitis identified, 81 % occurred postoperatively, 11 % followed intravitreal injection, 6 % had an endogenous source and 2 % followed ocular trauma. Eighty-seven percent of bacteria cultured were Gram-positive. The most commonly identified organisms were coagulase-negative Staphylococci (47 %) and Streptococcus spp. (30 %). Patients were treated with intravitreal vancomycin and either amikacin or ceftazidime. All Gram-negative isolates were sensitive to aminoglycosides and ceftazidime, and all Gram-positive isolates were vancomycin-sensitive. Final visual acuity (VA) was 6/12 or better in 41 % of cases and counting fingers (CF) or worse in 30 %. Endophthalmitis caused by Streptococcus spp. was associated with a poorer final VA (OR for CF or worse?=?14.9, P?coagulase-negative Staphylococci had a better visual outcome (OR for VA of 6/12 or better?=?5.7, P?=?0.013). Five eyes were eviscerated or enucleated. Infection with Haemophilus influenzae was strongly associated with this outcome (OR?=?57, P?Conclusion Over the time period of this study there was no evidence of emerging resistance to empirical antibiotics which are commonly used for the treatment of bacterial endophthalmitis. Infection with coagulase-negative Staphylococci was associated with a good visual outcome, whilst infection with Streptococcus spp. or Haemophilus influenzae was associated with a poor visual outcome.     

Polymerase chain reaction in the diagnosis of bacterial endophthalmitis

BACKGROUND—Microbiological investigations of vitreous fluid (VF) and aqueous humour (AH) specimens have often failed to detect the infecting agent in infectious endophthalmitis, resulting in a clinical dilemma regarding therapy. In this study, the polymerase chain reaction (PCR) was evaluated in the diagnosis of bacterial and Propionibacterium acnes endophthalmitis.
METHODS—58 intraocular specimens (30 VF and 28 AH) from 55 cases of endophthalmitis and 20 specimens (14 VF and 6 AH) as controls from non-infective disorders were processed for microbiological investigations. Nested PCR directed at the 16S rDNA using universal primers for eubacterial genome was done. PCR for P acnes was performed on specimens microbiologically negative by conventional techniques but eubacterial genome positive.
RESULTS—Of the 20 controls from non-infective cases, one (5%) was positive using eubacterial primers and none with P acnes primers. PCR for eubacterial genome showed 100% correlation with 20 (34.5%) bacteriologically positive specimens. Eubacterial genome, was detected in 17 (44.7%) of 38 bacteriologically negative specimens and nine (52.9%) out of the 17 were positive for P acnes genome. Among the 21 eubacterial PCR negative specimens, seven were fungus positive. By inclusion of PCR, microbiologically positive specimens increased from 46.5% to 75.8%. PCR on AH was as sensitive as that on VF for the detection of both eubacterial and the P acnes genome.
CONCLUSION—PCR performed on AH and VF is a reliable tool for the diagnosis of bacterial and P acnes endophthalmitis particularly in smear and culture negative specimens.

Keywords: polymerase chain reaction; bacterial endophthalmitis; infectious endophthalmitis     

Clinical features of infectious posterior segment uveitis

Objective

To assess the clinical findings and microbiology investigations in patients with suspected infectious posterior segment uveitis (PSU).

FRIENDS Group: clinical and microbiological characteristics of post-filtering surgery endophthalmitis

Purpose

To study the clinical and microbiological characteristics as well as the prognostic factors for post-filtering surgery endophthalmitis.

Methods

Twenty-three eyes were included in the study in four tertiary centres between 2004 and 2010. The clinical and microbiological data were collected prospectively (minimum follow-up, 6 months). Microbiological diagnosis was based on conventional cultures and panbacterial PCR (16SrDNA amplification and sequencing).

Results

The onset of endophthalmitis was early (<6 weeks) in 22 % of the cases and delayed in 78 %. Elevated intraocular pressure and hypopyon were more frequent in delayed than in early presentations (p?=?0.04). By combining the results of culture and panbacterial PCR, a bacterial species could be identified in 73.9 % of the cases, including 56.5 % of commensal species of the digestive tract such as Moraxella spp., oropharyngeal streptococci and Enterococcus faecalis. Good final visual acuity (VA?≥?20/40) was correlated with initial VA greater than light perception (p?=?0.05). Poor final VA (≤20/400) was correlated with a higher virulence of the infecting bacterial species (p?=?0.006), and was noted in all patients with early-onset endophthalmitis.

Conclusion

Acute early- or delayed-onset post-filtering surgery endophthalmitis is frequently caused by bacteria of the digestive tract (e.g., Streptococcus and Enterococcus spp.). The combination of conventional cultures and panbacterial PCR allowed us to identify the causative microorganism in three-quarters of the cases, i.e., 21 % more cases than through culture alone. Despite adequate antibiotic and surgical treatment, the anatomical and visual prognosis remains poor.     

Management of recurrent postoperative fungal endophthalmitis

Aim:

To report the management of recurrent postoperative fungal endophthalmitis (POFE) after failed pars plana vitrectomy (PPV) and antifungal therapy.

Settings and Design:

Tertiary Care Referral Centre in North India. Retrospective, single institution, interventional case-series.

Materials and Methods:

Six patients with microbiologically proven recurrent post-operative fungal endophthalmitis refractory to conventional management were included. The final recurrence was managed with intraocular lens (IOL) explantation and re-PPV. Main outcome measures included preserved globe anatomy, visual acuity and retinal status. ‘Anatomical success’ was defined as preserved anatomy of the globe, and absence of signs of inflammation. ‘Functional success’ was defined as an attached retina and a best corrected visual acuity of better than 20/400.

Results:

Of the six cases of POFE, five were culture positive [Aspergillus flavus (1), Aspergillus fumigatus (2), Candida albicans (1) and Candida glabrata (1)] and one was smear positive for yeast. All recurred (mean recurrences, 4) despite a mean of 2.17 PPVs and intravitreal amphotericin B. No recurrences were observed after IOL explantation with re – PPV (median follow-up, 37 months). Pre-study defined criteria for successful ‘anatomical’ and ‘functional’ outcomes were achieved in 83.3% and 50% respectively.

Conclusion:

This report highlights the effective role of combined IOL explantation with PPV in managing recurrent POFE.     

Children with dry eye type conditions may report less severe symptoms than adult patients

Background

To compare the symptom scores of children with those of adults with the same degree of mild ocular surface signs.

Methods

This study included patients with at least one ocular surface symptom and sign. Data obtained from 45 subjects aged 8.79?±?2.95 yr (Mean ± SD) (pediatric group) and 45 adults aged 52.87?±?10.87 yr (adult group) who were matched to each pediatric patient based on ocular surface signs were analyzed. Demographic data including age and sex; parameters of ocular surface signs including fluorescein staining score, tear film breakup time and Schirmer test score; symptom scores including ocular surface disease index (OSDI) and visual analog scale (VAS) were assessed and compared between the two groups.

Results

Significant differences emerged in sex ratio as well as in age between the two groups (P?<?0.001, for both). Regarding ocular surface signs and tear film tests, the study revealed no significant differences in fluorescein staining score (1.44?±?1.95 vs. 1.40?±?1.68 P?=?0.913), tear film break up time (4.96?±?1.94 vs. 3.82?±?1.85 s, P?=?0.612) and Schirmer score (12.79?±?9.05 vs. 10.11?±?8.45 mm / 5 min, P?=?0.370). Regarding dry eye symptoms, both OSDI and VAS were significantly lower in the pediatric group (P?=?0.001 and?<?0.001, respectively) than in the adult group.

Conclusion

Pediatric patients with mild ocular surface damage may report fewer dry eye symptoms compared to adult patients with similar stages of ocular surface damage.     

Systemic T Cell Response to Toxoplasma gondii Antigen in Patients with Ocular Toxoplasmosis

Purpose

Analysis of systemic cellular response to Toxoplasma antigen in patients with ocular toxoplasmosis.

Methods

Activated (CD25⁺) T cells were detected by flow cytometry after a 7-day culture of whole blood from patients with ocular (n = 16) or asymptomatic (n = 14) toxoplasmosis, and controls (n = 10), in the presence of soluble Toxoplasma antigen (ST-Ag). Interferon (IFN)-γ, interleukin (IL) 4, and IL-10 were measured in culture supernatants by enzyme-linked immunosorbent assay.

Results

Higher percentages of CD25⁺ T cells were detected in ST-Ag-activated cultures from Toxoplasma-infected patients, with or without ocular lesions (37.0 ± 19.1% or 41.1 ± 19.3%, respectively) than from controls (3.2 ± 1.2%) (P < 0.0001). Differences were not statistically significant between asymptomatic and ocular toxoplasmosis (P > 0.4) or among congenital, acquired, and undetermined ocular toxoplasmosis (P > 0.2). Higher levels of IFN-γ were detected in ST-Ag-stimulated blood cultures from infected patients than in those from controls (P < 0.0001), with no difference between patients with asymptomatic or ocular toxoplasmosis (P > 0.05). IL-10 was detected only in activated culture supernatants from three patients with ocular toxoplasmosis and two patients with asymptomatic toxoplasmosis. IL-4 was never produced in ST-Ag-activated cultures.

Conclusions

Systemic cellular response to ST-Ag does not differ between the patients with ocular and asymptomatic toxoplasmosis with regard to activation markers and type 1 cytokine production.?Jpn J Ophthalmol 2006;50:103–110 © Japanese Ophthalmological Society 2006     

22例眼内容剜出的原因及病理学分析

目的分析眼内容剜出的病理学分类以进一步探讨眼内容剜出的原因。方法对本院2001年1月至2007年8月眼病理室存档的22例（22只眼）眼内容剜出病例进行临床分析及组织病理学分析。结果感染性眼内炎12例（54．55％）,其中真菌性眼内炎7例;眼球萎缩7例（31．82％）;角巩膜葡萄肿2例（9．09％）;绝对期青光眼1例（4．55％）。结论感染性眼内炎尤其是真菌性眼内炎是眼内容剜出的首要原因,早期正确的诊治可避免眼内容剜出。     

Associated factors and treatment outcome of presumed noninfectious endophthalmitis occurring after intravitreal triamcinolone acetonide injection

Background

To investigate the associated factors and treatment outcomes in patients with presumed noninfectious endophthalmitis after intravitreal triamcinolone acetonide (IVTA) injection.

Methods

Among 219 consecutive cases of 186 patients who had undergone IVTA injection for macular diseases, presumed noninfectious endophthalmitis was diagnosed if the patient showed severe inflammation in the anterior chamber and vitreous cavity within 7 days after injection but no organism was isolated on microbiological examination. Clinical features and previously performed surgical procedures were evaluated to assess their association with presumed noninfectious endophthalmitis using logistic regression. After surgical or medical treatment for endophthalmitis, the visual outcome was evaluated in all patients.

Results

Noninfectious endophthalmitis developed in six of 219 eyes (2.7 %). Previous vitrectomy, history of IVTA injection, and pseudophakia were significantly associated with the occurrence of presumed noninfectious endophthalmitis after IVTA injection (p?=?0.049, 0.034, and 0.009, respectively). Internal limiting membrane (ILM) peeling during vitrectomy also showed statistically significant association (odds ratio?=?13.6, p?=?0.017). Five of six patients (83.3 %) regained pre-injection vision.

Conclusion

In addition to previous vitrectomy, history of IVTA injection, internal limiting membrane (ILM) peeling, and pseudophakia may render the eye vulnerable to presumed noninfectious endophthalmitis following IVTA injection. Visual outcome shows generally good prognosis after treatment.     

Clinical background comparison of patients with and without ocular inflammatory attacks after initiation of infliximab therapy

Purpose

To examine the factors affecting the efficacy of infliximab (IFX) as a treatment for uveitis in Beh?et’s disease.

Methods

Clinical records of 29 patients with refractory uveoretinitis were examined retrospectively for the period between 6?months before the initiation of IFX therapy to 12?months thereafter. The patients were divided into two groups based on the absence (Group 1) or occurrence (Group 2) of ocular inflammatory attacks during the observation period after IFX therapy, and the clinical records of the groups were compared

Results

The mean age at onset of ocular inflammation in Group 1 patients (n?=?17) was lower than that in Group 2 patients (n?=?12) (p?=?0.023). Compared to Group 2 patients, the period from onset to IFX therapy in Group 1 was longer (p?=?0.037), and the frequency of ocular inflammatory attacks before IFX therapy was lower (p?=?0.013). The rates of ocular fundus attacks before IFX therapy were 0.82?±?0.28 in Group 1 and 0.96?±?0.10 in Group 2 (p?=?0.040). Three of 33 (9.1?%) eyes in Group 1 and nine of 24 eyes (37.5?%) in Group 2 had an improved best-corrected visual acuity of >0.2 logarithm of the minimal angle resolution (p?<?0.01).

Conclusions

Patients in Group 1 tended to have fewer intraocular attacks (fewer fundus attacks in particular) prior to IFX therapy and have a longer period from onset of intraocular inflammation to IFX therapy. The improvement of the BCVA in Group 2 tended to be better.     

Retro-mode imaging and fundus autofluorescence with scanning laser ophthalmoscope of retinal dystrophies

Background

To evaluate results after seven years using prophylactic intracameral cefazolin for the prevention of endophthalmitis in cataract surgery.

Methods

A prospective, observational study of all patients submitted to cataract surgery over the period January 1996 to December 2009. All cases of postoperative endophthalmitis over that period were reviewed. The patients were classified in two groups: Group 1 (11,696 patients) operated on between January 1996 and December 2002, Group 2 (13,305 patients) between January 2003 and December 2009 (in whom a 1 mg/0.1 bolus of intracameral cefazolin was instilled).

Results

During the study period, 76 cases of endophthalmitis were observed in Group 1, and seven in Group 2. The rate of postoperative endophthalmitis reduced from 0.63% to 0.05% with a cefazolin injection. The relative risk (RR) for endophthalmitis in Group 1 against group 2 was 11.45 [95% CI 5.72-22.84, p < 0.001].

Conclusions

An intracameral bolus injection of cefazolin (1 mg in 0.1 ml solution) at the conclusion of the cataract surgery significantly reduced the rate of postoperative endophthalmitis.