Successful treatment of varicella zoster virus retinitis with aggressive intravitreal and systemic antiviral therapy

Aims : To describe the successful treatment of varicella zoster virus retinitis (VZVR) using intravenous cidofovir as part of an aggressive management strategy. Case reports : Two patients with bilateral VZVR were treated with a combination of intravenous cidofovir and ganciclovir with adjuvant intravitreal foscarnet or ganciclovir. Both patients maintained good vision in the less severely affected eye. Retinal detachment did not occur in either patient. Conclusions : VZVR should be treated aggressively with a combination of intravenous and intravitreal therapy to improve visual prognosis. Intravenous cidofovir, in the absence of contra-indications, should be considered as part of this aggressive therapeutic approach, especially in patients with AIDS in whom the prognosis is particularly poor.     

Comparison Between Bactec Peds Plus F Broth and Conventional Medium for Vitreous Culture

Purpose: To evaluate the yield of Bactec Peds Plus F broth for vitreous sample culture in cases with infectious endophthalmitis in comparison to conventional medium.

Patients and Methods: Consecutive cases of clinically suspected endophthalmitis were prospectively enrolled in this study. Cultures of the vitreous sample were performed in both Bactec Peds Plus F broth and conventional mediums.

Results: Forty eyes of 40 patients who were clinically suspected of infectious endophthalmitis with different etiologies were enrolled in this study. The positive culture yield was 50% and 35% in Bactec Peds Plus F broth and conventional mediums, respectively (p = 0.07). The result of Bactec group was not significantly different among patients who had a history of intravitreal antibiotic injection (p > 0.05) (Table 2). However, results of the conventional method were significantly negative in the previous intravitreal antibiotic injection group (p = 0.02). There was no correlation between the methods of vitreous sampling in both culture methods.

Conclusion: Although the difference between two culture methods was not statistically significant in this study, Bactec Peds Plus F broth showed higher positive culture yield in patients with a history of intravitreal antibiotic injection.     

Role of Spectralis HRA+OCT Spectral Domain Optical Coherence Tomography in the Diagnosis and Management of Fungal Choroidal Granuloma

Objective: To report the usefulness of inverted scan technique using Spectral domain Optical Coherence Tomography (OCT) in inflammatory fungal chorioretinitis

Design: Case Report - Interventional

Methods: We present a 53 year old female with sudden painful blurring of vision in left eye. Ocular examination revealed retinochoroiditis.OCT using the inverted scan technique showed a choroidal mass lesion. Polymerase chain reaction was positive for panfungal genome. She was treated with systemic fluconazole.

Results: Symptoms improved and the choroidal mass was diminished in size after one week of therapy.

Conclusions: Inverted OCT scan technique is useful in the diagnosis and management of choroidal inflammatory mass lesion.     

Bilateral Endogenous Endophthalmitis Associated with Methicillin Sensitive Staphylococcus aureus (MSSA) Related Tenosynovitis: Case Report

Endogenous endophthalmitis is a rare, devastating intraocular infection associated with poor outcome often from late diagnosis. We present a case report of acute onset bilateral endogenous endophthalmitis caused by Methicillin Sensitive Staphylococcus Aureus causing tenosynovitis of carpometacarpal joint in a 64 year old man with Type II Diabetes Mellitus. To the best of our knowledge, this is the first case report of endogenous endophthalmitis following tenosynovitis. This case also highlights the fact that prompt diagnosis and treatment is the key for good outcome.     

Comparison of efficiency of intravitreal ceftazidime and intravitreal cefepime in the treatment of experimental Pseudomonas aeruginosa endophthalmitis

In this study, we evaluated the efficiency of cefepime in the treatment of experimental Pseudomonas aeruginosa endophthalmitis. We compared the findings with the standard dose of ceftazidime (1 mg/0.1 ml). Thirty-six New-Zealand White rabbits were divided into 6 equal groups and were treated with different methods (Group 1 = sham, Group 2 = 0.5 mg/0.1 ml cefepime, Group 3 = 1 mg/0.1 ml cefepime, Group 4 = 2 mg/0.1 ml cefepime, Group 5 = 1 mg/0.1 ml ceftazidime, Group 6 = control). The eyes of rabbits in each group were examined clinically on 1^st, 3^rd, and 6^th day of the experiment. At 6^th day, 0.1 ml vitreous humor aspirates were obtained and plated for quantification on the blood agar and the results were expressed as colony-forming unit/ml. Subsequently, the eyeballs were enucleated and the histopathological evaluation was performed. Our findings denoted beneficial effects of cefepime in treatment groups (especially, in Groups 3 and 4). Intravitreal cefepime may be an alternative drug in the treatment of P. aeruginosa endophthalmitis.     

Clostridium beijerinckii endophthalmitis secondary to penetrating ocular injury.

Endophthalmitis occurs in five to 10% of injuries involving intraocular foreign bodies. A 52 year old abattoir worker sustained such penetrating ocular trauma and developed fulminant endophthalmitis. Clostridium beijerinckii was isolated from the vitreous humor. Intravitreal vancomycin and amikacin and intravenous penicillin and clindamycin were given. Despite therapeutic vancomycin and amikacin levels in the vitreous, vision was lost and enucleation was ultimately required.     

眼内炎患者硅油充填前房后眼压升高对角膜内皮的影响

 目的 评价眼内炎玻璃体切除术后硅油充填前房后眼压升高对角膜内皮细胞计数的影响。设计 回顾性病例系列研究。研究对象 2006年11月至2011年11月于北京同仁医院眼科中心眼外伤组就诊的眼内炎患者19例（19眼）均行晶状体玻璃体切除联合硅油注入术,术后硅油完全充填前房。方法 对19例（19眼）患者行硅油取出术。依据硅油取出术前眼压分组：眼压＞21 mm Hg为高眼压组（A组）（12眼）;眼压≤21 mm Hg为正常眼压及低眼压组（B组）（7眼）。硅油取出术后1个月行角膜内皮细胞计数检查,并进行统计学分析。主要指标 硅油取出术前眼压及硅油取出术后1个月角膜内皮细胞密度。结果 硅油取出术后1个月,角膜内皮细胞密度≥1000个/mm2者：A组2眼（2/12,16.7%),B组5眼（5/7,71.4%）;角膜内皮细胞密度<1000个/mm2者：A组10眼（10/12,83.3%),B组2眼(2/7,28.6%）;两组比较差异有统计学意义（P=0.045）。角膜内皮细胞密度≥1400个/mm2者：A组1眼（1/12,8.3%）,B组5眼（5/7,71.4 %）;角膜内皮细胞密度＜1400个/mm2者：A组11眼（11/12,91.6%）,B组2眼（2/7,28.6%）。两组比较差异具有统计学意义（P=0.01）。结论 硅油充填前房合并眼压升高可以导致角膜内皮细胞严重丢失。 （眼科, 2012, 21: 348-351）     

Clinical and visual outcomes following endogenous endophthalmitis: 175 consecutive cases from a tertiary referral center in Taiwan

BackgroundTo elucidate the linkage between organisms and visual outcome in cases of endogenous endophthalmitis.MethodsPatients who presented with signs of endogenous endophthalmitis between January 2008 and December 2015 and underwent a vitreous tapping were enrolled. The patients’ demographics and clinical findings were recorded. The outcomes include visual acuity and enucleation.ResultsA total of 175 consecutive patients with endogenous endophthalmitis were enrolled. Forty-four percent of the patients had a known distal focus of infection. The most common focus was liver abscess (24.6%), and the major intravitreal isolate was Klebsiella pneumoniae (34.4%). In this series, 51.4% of the intravitreal cultures were positive. The visual acuity of fungal ophthalmitis were better than in bacterial ophthalmitis. Multivariate logistic regression showed that Gram negative vitreous isolates, compared with the negative vitreous culture, were associated with higher risk of enucleation (Odds ratio [OR]: 10.424, 95% confidence interval [95% CI]: 3.019–35.995). The use of intravitreal antibiotics, compared non-users, was associated with a reduced risk of enucleation (OR:0.084, 95% CI: 0.026–0.268). Trans pars plana vitrectomy was not associated with risk of enucleation (OR: 0.307, 95% CI: 0.035–2.693). The post-treatment VA was positively correlated with the presenting VA (r = 0.718, p = 0.0001).ConclusionOur study demonstrated that liver abscess is the most common source of endogenous endophthalmitis in Taiwan. The visual outcome is good when the presenting visual acuity is relatively well preserved and when the infecting organism is fungus. The use of intra-vitreal antibiotics reduces the risk of enucleation.     

Histopathological clues in the diagnosis of fungal infection by Scedosporium in a case of endophthalmitis starting as conjunctivitis

Cutaneous fungal infections can result in disastrous episodes if improperly diagnosed and treated, especially in immunosuppressed patients. Although dermatopathologists are highly familiar with some filamentous fungi – such as Aspergillus and Zygomycetes – they are not so aware of other less common species. We report a case of ocular infection by Scedosporium apiospermum that started as conjunctivitis and resulted in Phthisis bulbi and subsequent exeresis of the left eye. We describe some of the main morphological features of the fungus as well as the important morphological clues for the differential diagnosis with some similar species, such as Aspergillus, Scopulariopsis, Fusarium, Paecilomyces and Zygomycetes.