Important Cause Of Ocular Morbidity Research Articles

Demography, Clinical Features and Outcome of Bacterial Keratitis Presenting in Tertiary Eye Care in Nepal

Background and Objectives: Bacterial keratitis is an important cause of ocular morbidity in developing country like Nepal and this warrants a detail study of it including its outcome.
 Material and Methods: Data of demography, clinical features and risk factors of bacterial keratitis were segregated from our previous cross-sectional study of microbial keratitis and retrospective data of treatment and outcome were taken from electronic medical record.
 Results: Among 123 cases of bacterial keratitis, 111 had bacteria isolated in the culture whereas 12 had bacteria seen only in Gram stain. Average age of patients was 52.6 years; 65(52.8%) were female; 68.3% of total subjects were farmers. Patients had visited the tertiary hospital at an average of 12.9 days since onset of symptoms. Of culture isolates, 55 were Streptococcus pneumonia followed by Staphylococcus aureus (n­­=25) and Streptococcus viridians (n=14). Regarding clinical characteristics, 78(63.4%) cases had hypopyon; 24.3% (n=30) had infiltrate size of >¼ of corneal surface; 16(13.0%) were either perforated or impending to perforate at presentation. Trauma was the main risk factor in 35% (n=43), followed by topical steroid (19.5%, n=24) and dacryocystitis (16.2%, n=20). Patients were treated with combination of fortified cefazoline and amikacin or monotherapy with moxifloxacin or ofloxacin. Overall, 90(73.2%) responded to medical treatment, 19(15.4%) underwent therapeutic penetrating keratoplasty and 3(2.4%) needed evisceration. Smaller sized ulcers had better healing rates (81%) with statistical significance.
 Conclusion: Patients with bacterial ulcers present late in tertiary eye center causing increased morbidity and even loss of eyes. Awareness, protective measures from trauma and proper treatment has to be undertaken for controlling its occurrence and for better prognosis of the ulcers.

The Aspergillus fumigatus UPR is variably activated across nutrient and host environments and is critical for the establishment of corneal infection.

The Aspergillus fumigatus unfolded protein response (UPR) is a two-component relay consisting of the ER-bound IreA protein, which splices and activates the mRNA of the transcription factor HacA. Spliced hacA accumulates under conditions of acute ER stress in vitro, and UPR null mutants are hypovirulent in a murine model of invasive pulmonary infection. In this report, we demonstrate that a hacA deletion mutant (ΔhacA) is furthermore avirulent in a model of fungal keratitis, a corneal infection, and an important cause of ocular morbidity and unilateral blindness worldwide. Interestingly, we demonstrate that A. fumigatus hacA is spliced in infected lung samples, but not in the cornea, suggesting the amount of ER stress experienced by the fungus varies upon the host niche. To better understand how the UPR contributes to fungal cell biology across a spectrum of ER-stress levels, we employed transcriptomics on the wild-type and ΔhacA strains in glucose minimal media (low stress), glucose minimal media with dithiothreitol (high stress), and gelatin minimal media as a proxy for the nutrient stress encountered in the cornea (mid-level stress). These data altogether reveal a unique HacA-dependent transcriptome under each condition, suggesting that HacA activity is finely-tuned and required for proper fungal adaptation in each environment. Taken together, our results indicate that the fungal UPR could serve as an important antifungal target in the setting of both invasive pulmonary and corneal infections.

Demography, clinical features, and outcome of fungal keratitis presenting in tertiary eye care in Nepal

Background: Fungal keratitis is an important cause of ocular morbidity in developing countries. Aims and Objectives: To study fungal keratitis in detail along with its outcome. Materials and Methods: This is a retrospective study of fungal keratitis that had presented between October 2013 and March 2015. Results: 168 fungal ulcers were enrolled. 145 had fungus isolated in the culture; 23 had fungal elements seen only in potassium hydroxide mount examination. The average age of patients was 46.7 years. 55.3% were male. 75% were farmers. Patients presented at an average of 23.6 days since the onset of symptoms. In 85 cases (50.6%), trauma was the risk factor followed by steroid use (12.5%, n=21) and diabetes mellitus (7.7%, n=13). 72 out of 85 cases of trauma were due to vegetative matter. 94 (55.9%) ulcers had hypopyon. 56 (33.3%) ulcers had infiltrate size of ≥¼ of corneal surface. 12 (7.1%) ulcers were perforated at presentation. Out of 145 fungal isolates, Aspergillus species and Fusarium species were isolated in equal numbers (n=41, 28.3% each), followed by unidentified hyaline fungus (14.4%, n=21). The ulcers were treated with combination of topical natamycin 5% and fluconazole 0.3% with or without oral fluconazole. 111 (66.1%) fungal ulcers improved with medical treatment, 37 (n=22.0%) underwent therapeutic penetrating keratoplasty, 6 (3.6%) were eviscerated and outcome unknown in 14 (8.3%). Smaller-sized ulcers, ulcers without hypopyon and those presenting within 7 days had better prognosis (>80% healing with medical treatment) with statistical significance. Conclusion: Farmers were constantly at risk of fungal keratitis due to work-related trauma. Fungal ulcers presented late with large sized ulcers and with complications, thus making treatment challenging and necessitating surgical intervention. Timely treatment had better prognosis.

A CLINICAL STUDY ON KERATOMYCOSIS IN PATIENTS ATTENDING TERTIARY CARE HOSPITAL

AIM : To study etiology , epidemiological factors leading to keratomycosis in various subgroups of population like different age and sex groups. To determine spectrum of ocular manifestations in patients with keratomycosis. METHODS : This is a prospective study done in 100 patients of fungal keratitis over a period of 1 year with proper recordings of snellens visual acuity chart, slit lamp biomicroscopy, direct and indirect ophthalmoscopy, conrmed by culture, histology and confocal microscopy, PCR, in patients attending tertiary care hospital , kakinada. This study was conducted in 100 pati RESULTS : ents , of most common age group was 31-40 years i.e, which most exposed to trauma to cornea with vegetative matter, immunocompromised people, over usage of steroids and antibiotics and many factors. Males are more affected and among agricultural workers with mostly unilateral in presentation. Majority presented with pain, redness , foreign body sensations, defective vision. Ulcer is dirty looking, feathery margins with wessely ring and satellite lesions. CONCLUSION: Fungal infections of cornea continue to be an important cause of ocular morbidity, particularly in the communities of agriculture of developing countries. A proper understanding of agent and host factors involved in these infections will improve the outcome of this condition.

A STUDY ON CLINICO-MICROBIOLOGICAL PROFILE OF CONJUNCTIVAL FLORA IN CONGENITAL DACROCYSTITIS

Dacryocystitis is an inammation of the lacrimal sac and duct. It may be congenital or acquired.It is an important cause of ocular morbidity both in children and adults. To isolate & identify the causati PURPOSE- ve bacteria from clinically diagnosed cases of congenital dacryocystitis & to study the organism in relation to clinical prole. -Gram฀s stain MATERIALS & METHODS & Giemsa stain ,Culture media,10 % KOH preparation , MacConkey฀s agar, 5% Sheep Blood agar, Chocolate agar .Biochemical tests on Isolated colonies from the plates were identied by Colony morphology, Gram฀s stain, Oxidase test, Catalase test, and Motility.For further identication isolated colony was inoculated into peptone water and Hiss serum for fastidious bacteria, which was incubated aerobically and inoculated into appropriate medias for biochemical tests like Indole production, Methyl red, Voges-proskauer test, Citrate utilization, Urease hydrolysis, Sugar fermentation, Triple Sugar Iron agar, Nitrate reduction test and Amino acids decarboxylase tests. The specic tests like Inulin fermentation, Optochin sensitivity test and Bile solubility test were done. Antimicrobial susceptibility tests: The standardized Kirby-Bauer disc diffusion test of the Clinical and Laboratory Standards institute (formerly NCCLS) was used for testing. The media used was Mueller-Hinton agar for non-fastidious organisms. 5% Sheep Blood agar added to Mueller-Hinton agar for fastidious organisms and Haemophilus Test Medium was used for testing Haemophilus inuenzae and it was read after 16-18 hours. The zone of inhibition was measured and reported as Susceptible or Resistant. For detection of methicillin resistant Staphylococcus aureus detection disc tests for methicillin resistance was done using 10μg oxacillin disc on Mueller-Hinton agar containing 4% sodium chloride. In our study , femal RESULTS- es are more (7) as compared to males (4)& the culture positive cases were 10 and in 1 case culture showed no bacterial growth. The most frequent Gram-positive isolates are Streptococcus pneumoniae 7 (63.63%) followed by Staphylococcus aureus 1 (9.09%) and the most frequent Gram-negative isolates are Pseudomonas aeruginosa 3 (27.27%). In our study the Gram-positive isolates were most sensitive to CONCLUSION- Vancomycin (100%), followed by Tobramycin and Linezolid (97.14 %). Least sensitive antibiotic against Gram-positive organisms was Penicillin (51.42 %). The Gram-negative organisms were most sensitive to Tobramycin and Gentamicin (100%), followed by Amikacin, Oaxacin (92.59 %), Cefepime (88.88 %). Least sensitive antibiotic against Gram-negative organisms was Ciprooxacin (77.77 %)

Adolesan Bir Hastada Granülomatöz Üveit ile Seyreden Oküler Tüberküloz: Nadir Bir Olgu Sunumu

Tuberculosis continues to be a significant global public health issue. Tuberculosis most often affects the lungs. However, children are more likely to have extrapulmonary involvement compared to adults. Ocular involvement is a rare extrapulmonary manifestation of tuberculosis. Ocular tuberculosis may affect any part of the eye and can be remain unnoticed due to the lack of clinically evident symptoms or findings, if there is no history of tuberculosis contact or other systemic signs or if these are not questioned. Here, we present an adolescent case who was diagnosed with pulmonary and ocular tuberculosis when investigating the underlying cause of granulomatous uveitis and successfully controlled with four drug regimen anti-tuberculosis and methylprednisolone treatment. In conclusion, ocular tuberculosis is an important cause of ocular morbidity. Diagnosis and follow-up require a multidisciplinary approach.

Neonatal Conjunctivitis.

Neonatal conjunctivitis is an important cause of ocular morbidity with infectious and noninfectious origins. Common practice in the United States is to administer prophylactic antibiotic ointment at birth; however, prophylaxis is ineffective for some causes. Moreover, recognition of the etiologies that threaten systemic complications to the neonate is critical in providing timely and appropriate treatment. This review summarizes the clinical features, etiology, and treatment recommendations of various forms of neonatal conjunctivitis.

Uveitis in Children

Uveitis in children is an important cause of ocular morbidity and severe vision loss. The diagnosis and the management are challenging in such population due to some unique presentations. Majority of the cases are idiopathic with infectious causes contributing to about one fifth of the cases. Various causes of infectious uveitis include tuberculosis, toxoplasmosis, toxocariasis. Anterior uveitis is the most common anatomical type of uveitis in children followed by almost equal incidence of posterior, intermediate and panuveitis. The examination is often difficult in children and diagnostic evaluation is challenging. The management requires multidisciplinary approach involving the rheumatologist and uveitis specialist. Exclusion of infectious and masquerade causes is of utmost importance before starting any immunomodulatory treatment. The primary aim of the treatment is to reduce the inflammation as early as possible to prevent complications. Corticosteroids are the main pillar stone for the management. The dosage and the route of the steroids should be optimized according to the growth and development of the child as it may have to be given for a longer duration. Steroid sparing agents such as methotrexate, cyclosporine, azathioprine and biologic agents are reserved for children refractory to treatment with steroids. Children tend to develop complications of uveitis more often than in adults, which include band keratopathy, cataract, glaucoma, cystoid macular edema, amblyopia and strabismus.

Evaluation of in vitro activity of five antimicrobial agents on Acanthamoeba isolates and their toxicity on human corneal epithelium.

Acanthamoeba keratitis (AK) is an important cause of ocular morbidity in both contact lens wearers and non wearers. Medical management comprises prolonged empiric treatment with multiple drugs, leading to adverse effects and suboptimal cure. The present study evaluated the efficiency and safety of common antimicrobial agents used in treatment of AK. Six Acanthamoeba isolates (four AK, two water samples) were axenized and subjected to in vitro susceptibility testing against chlorhexidine, pentamidine isethionate, polymyxin B, miltefosine, and fluconazole to check for trophocidal and cysticidal activity. The safety profile was analysed by observing the cytotoxicity of the highest cidal concentration toward human corneal epithelial cell (HCEC) line. Chlorhexidine had the lowest cidal concentration against both cysts and trophozoites (range 4.16-25 μg/ml) followed by pentamidine isethionate (range 25-166.7 μg/ml). Both agents were nontoxic to HCEC. Polymyxin B (range 25-200 μg/ml) and fluconazole (range 64-512 μg/ml) had relatively higher minimum inhibitory concentrations (MIC); fluconazole was nontoxic even at 1024 μg/ml, but cytotoxicity was observed at 400 μg/ml with polymyxin B. Miltefosine was not effective against cysts at tested concentrations. A. castellanii were more susceptible to all agents (except pentamidine isethionate) than A. lenticulata. Clinical isolates were less susceptible to polymyxin B and fluconazole than environmental isolates, reverse was true for miltefosine. Chlorhexidine and pentamidine isethionate were the most effective and safe agents against both trophozoites and cysts forms of our Acanthamoeba isolates. Fluconazole had higher MIC but was nontoxic. Polymyxin B was effective at high MIC but therapeutic dose was found toxic. Miltefosine, at tested concentrations, could not inhibit cysts of Acanthamoeba. Clinical isolates had higher MICs for polymyxin B and fluconazole.

Chronic Dacryocystitis: Clinico-Bacteriological Profile and its Antibiogram at a Tertiary care Hospital in Belagavi, Karnataka

Chronic dacryocystitis is an infection of the lacrimal sac and occurs due to obstruction of the nasolacrimal duct. It is an important cause of ocular morbidity in India. Objective: 1) To identify various species of aerobic bacteria causing chronic dacryocystitis 2) To determine the antibiotic sensitivity pattern of these bacterial species. At a tertiary care hospital in Belagavi, Karnataka, over two year period, a cross-sectional study was conducted among 60 patients suffering from chronic dacryocystitis. Samples obtained were subjected to microbiological culture and antibiotic sensitivity testing was done on identified isolates. Statistical analysis was done using Microsoft office excel 2010. The Maximum (31.67%) number of patients who belonged to the age group of 45-50 years Female were predominantly affected 50 (83.3%). Majority i.e. 53 (88.34%) had unilateral eye involvement. Of 67 samples collected 42 (62.68%) were culture positive. Gram-positive cocci (65.22%) were the predominant cause of bacterial infection than Gram-negative bacilli (34.78%). Among Gram-positive cocci, Staphylococcus aureus (30.43%) and Streptococcus pneumoniae (21.73%) and among Gram-negative bacilli. Pseudomonas aeruginosa and Klebsiella aerogenes (10.86% each) were the predominant isolates. The most effective antimicrobial agents for Gram-positive cocci were Gentamicin and Vancomycin (93.33% each) and for Gram-negative bacilli were Ticarcillin/Clavulanic acid (87.25%), Ticarcillin, Imipenem, and Ceftazidime/Clavulanic acid (81.25% each). The present study highlights the need for detection of specific etiological agents and their antibiotic sensitivity which will enable the clinician in efficient patient management and avoid irrational antibiotic use.

Clinical Outcomes of Management of Traumatic Cataract in a Tertiary Care Centre

Background and Objectives : Ocular trauma can lead to development of cataract when natural lens is damaged by either blunt or penetrating injury. The management of traumatic cataract follows the same principle as for senile cataract but associated damage to ocular tissues and several post-operative complications may lead to suboptimal visual outcome. This study was conceptualized to evaluate the visual outcomes following management of traumatic cataracts. Material and Methods : This prospective, longitudinal study was conducted on 80 patients with traumatic cataract in tertiary care centre. Patients were managed surgically and were followed up for a period of six months. Visual acuity was measured at every follow-up visit and any post-operative complications were noted and managed, accordingly. Final visual acuity was assessed at the end of six months. Results: Maximum cases of traumatic cataract (53.75%) were observed in age group of <20 years with male to female ratio of 2.63:1. Maximum patients (92.15%) were implanted posterior chamber intraocular lens, either as a primary or secondary procedure. Uveitis and posterior capsular opacification were most common post-operative complications (30%) and 68.75% cases achieved a final visual acuity of 6/6-6/ 18 at the end of six months. Conclusions Traumatic cataract is an important cause of ocular morbidity specially in young patients. Surgery in cases of traumatic cataract can yield good visual outcomes if posterior segment is not involved and if post-operative complications are managed efficiently.

Predictors of traumatic eye injuries at high-risk for ophthalmic complications in children.

Eye injuries are important cause of ocular morbidity in children. There is lack of data regarding predictors for high-risk injuries that will result in ophthalmic complications. Most cases are managed by the emergency department (ED) physicians without immediate ophthalmologist evaluation. Our aim was to identify predictors for ophthalmological complications and to imply indications for early ophthalmologic consultation in the ED. A retrospective chart review of 834 patients ages 0-18years who presented to the emergency department at Tel Aviv Medical Center between 2015 and 2018 following traumatic eye injuries was performed. All cases which later needed ophthalmological care were considered as high-risk for ophthalmic complications. An increased rate of eye injury was revealed over the years, but high-risk injury rate was stable. High-velocity mechanism, sport injury, orbital, anterior chamber, and retinal involvement were all significantly more common in the high-risk group compared to the low risk group. Only 10 patients, which represent 1.2% of all the patients, had decreased visual acuity on the last follow up, with significantly more injuries of high-velocity mechanism and anterior chamber involvement, in comparison to patients with normal visual acuity on the last follow up.Conclusion: High-velocity mechanism by itself, even with normal visual acuity and eye examination by the ED physician, should prompt to consider an urgent ophthalmologist consult. What is Known: •Traumatic eye injuries are an important cause of ocular morbidity in children. • Most injuries can be handled by a trained ED physician, but there are indications for an urgent ophthalmologist consultation. • It is crucial to discriminate between low and high-risk ocular injuries. What is New: • High-velocity mechanisms stand out as the most likely risk factor for final impaired visual acuity. • Normal visual acuity on presentation is not reassuring. • We recommend urgent ophthalmologist consultation in cases of high-velocity injury, even if visual acuity is preserved at presentation.

Epidemiological profile and visual outcome of ocular trauma in a referral center in northeastern Brazil

Abstract Objectives: To evaluate the epidemiological profile and prognosis of patients with mechanical ocular trauma. Methods: Descriptive cross-sectional observational study of consecutive patients evaluated during a one-year period at a public referral center in Sao Luis, Maranhao, Brazil. The Ocular Trauma Score (OTS) was used to estimate final visual acuity. The variables were analyzed using the chi-square test with a significance level of 5%. Results: Out of a total of 154 patients (mean age of 30.1 years), 27.92% were younger than 16 years, and 81.8% were men, with most coming from the state's countryside (55.2%). Most of the patients were dependents (34%) or rural workers (19%). Regarding the OTS prognosis, 33.77% of the patients were category 5 and 31.16% category 1 or 2, indicating worse prognosis. The best prognoses (visual outcomes) were inversely proportional to age and time to treatment (p<0.001). Conclusion: Ocular trauma remains an important cause of ocular morbidity in childhood and in informal work. Adult supervision and socio-educational measures are mandatory to change this scenario.

Demographics and Pattern of Ocular Diseases in Patients with Chronic Kidney Disease at the University of Port Harcourt Teaching Hospital

Aims: To determine the demographics and pattern of ocular diseases in patients with Chronic Kidney Disease at the University of Port Harcourt Teaching Hospital.&#x0D; Study Design: This was a hospital-based cross-sectional study.&#x0D; Place and Duration of Study: This study was carried out at the Dialysis clinic of the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria from February 2013 to February 2014.&#x0D; Methodology: The Sample size was estimated to be 85 adult patients and cconsecutive adult patients with chronic renal failure who are having haemodialysis were enrolled into the study. The patients who met the inclusion criteria were randomly booked at the Dialysis Clinic and had no prior knowledge of the study; hence there was no bias in case selection. Ethical approval was obtained from the institutions ethical committee. Each participant had a comprehensive ocular examination including fundus photography. Subjects needing further evaluation and treatment were referred to the Eye Clinic of the Ophthalmology Department of the University of Port Harcourt Teaching Hospital, Port Harcourt.&#x0D; Results: A total of 170 eyes of 85 persons were examined in this study (100% coverage). A total of 30 (35.4%) females and 55 (64.6%) males were examined giving a male to female ratio of 1.8:1.&#x0D; Approximately half of the study subjects (54.1%) had no previous eye problem prior to developing chronic renal failure while about a quarter (n= 20, 23.5%) had refractive error and difficulty in reading near prints .After diagnosis of chronic kidney disease however a total of 40 (47%) of study subjects had visual impairment while 2(2.4%) were blind and 43(50.6%) of the study population however had normal vision.&#x0D; Conclusion: Chronic Kidney disease is an important cause of ocular morbidity in our environment with majority of those affected being males in the third to fifth decades of life. Posterior segment disorders were the commonest disorders seen.

Establishing and characterizing lacrispheres from human lacrimal gland for potential clinical application.

Lacrimal gland (LG) dysfunction leading to dry eye syndrome (DES) is an important cause of ocular morbidity. One of the potential and promising long-term management therapies for restoration of LG function could be transplantation of autologous ex vivo expanded stem cells. The present study was aimed at exploring the 2D and 3D cultures of human LG, identifying inherent stem cells and evaluating their secretory potential. Fresh human lacrimal gland (HuLG) (n = 5) from patients undergoing therapeutic exenteration was harvested after ethical approval and informed consent. The gland was enzymatically digested and the isolated cells plated in Hepato-STIM media supplemented with l-glutamine, epidermal growth factor, fibroblast growth factor, and N-2 supplement. The native HuLG and the cultured spheres (DIV14-16) were evaluated for presence of stem cells (CD117 expression, quiescence, BrdU label retention, cell cycle, colony forming efficiency) and differentiation (secretion of tear proteins). Under the established culture conditions, suspension 3D cultures of human "lacrispheres" could be maintained and propagated for 3-4weeks. The spheres consist of both acinar as well as ductal cells with evidence of stem cells (0.8 ± 0.05% CD117+ cells), BrdU label retention (9.31 ± 0.41%), G0/G1 profile similar to native lacrimal cells at isolation (76.9 versus 79.9%) and colony forming units (3.1%). The lacrispheres also secreted quantifiable levels of tear proteins (lysozyme, lactoferrin, scIgA) into the conditioned media. The study provides promising, first-of-its-kind evidence for the generation of lacrispheres from fresh HuLG, with enriched population of stem cells and secretory competent differentiated cells. The dual properties of these spheres make them a highly suitable source of transplantable cells for restoring the structure and function of damaged lacrimal gland.

Role of Biofilms in Fungal Keratitis- An Overview

Biofilms are generally defined as a community of sessile microbes held together by a polymeric extracellular matrix ECM adherent to a surface that are phenotypic ally distinct from their plank tonic counterparts Fungal keratitis is an important cause of ocular morbidity in the form of corneal opacity and visual loss especially in developing countries Predisposing factors for fungal keratitis include tropical or subtropical climate agricultural work contact lens users and corneal trauma Fungal keratitis is most commonly caused by filamentous fungi like Fusarium spp F solani and F oxysporum followed by Aspergillus spp and dematiaceous fungi Fungal biofilm formation plays an important role in the development of fungal keratitis Here in this review we will be discussing the formation of biofilms and its role in fungal keratitis

Bacteriology and antibiotic susceptibility of chronic dacryocystitis

Introduction: Chronic dacryocystitis is an inflammation of lacrimal sac usually diagnosed clinically. It is an important cause of ocular morbidity. It is a constant threat of infection to orbital soft tissues and cornea as it acts as a reservoir of infection. Objectives: · To identify the current spectrum of bacterial isolates from lacrimal sac mucosa in cases of chronic dacryocystitis and to · Determine the antibiotic susceptibility pattern of the isolates. Design: Hospital based cross sectional study. Materials and Methods: The study was conducted at a tertiary care teaching hospital in North Karnataka. Bacteriological profile of chronic dacryocystitis was evaluated from April 2014 to October 2016. A total of 108 patients with chronic dacryocystitis were evaluated. Sample were taken directly from the lacrimal sac while making posterior flap of the lacrimal sac during external dacryocystorhinostomy (Ex DCR) and excised sac during dacryocystectomy (DCT) for chronic dacryocystitis was directly inoculated on culture plates for identification and sensitivity of the pathogens. Results: All the patients were in age group of 30 and above. Male to female ratio was 1:2. Out of 108 patients, 42.6% were culture positive. The most common isolates were Coagulase negative staphylococci (67.39%) followed by Staphylococcus aureus (17.39%). Conclusion: Majority of the chronic dacryocystitis cases were caused by Coagulase negative staphylococci followed by Staphy­lococcus aureus. Isolation of Methicillin Resistant Coagulase Negative Staphylococci was noteworthy and may be indicative of a trend in lacrimal sac infections in this area. These i¬ndings will help us to revise the pre and post-operative antibiotic usage protocols at our institute. Keywords: Chronic dacryocystitis, Coagulase negative Staphylococci (CONS), DCR, DCT, Methicillin resistant coagulase negative staphylococci (MRCONS), Nasolacrimal duct

Retinopathy of prematurity in Indonesia: Incidence and risk factors.

Retinopathy of prematurity (ROP) is a vaso-proliferative disease of the eye, which mainly affects preterm newborn infants with an incompletely vascularized retina. The incidence of ROP has increased in industrialized countries due to the increased survival of extremely low birth weight (ELBW) infants. ROP is also increasing in developing countries like Indonesia, where it is most likely due to the improved survival of ELBW infants. To ascertain the incidence of ROP and possible risk factors associated with the development of ROP in preterm infants in Indonesia. We reviewed the literature on the incidence and potential risk factors for the development of ROP in Indonesia, obtained data from three referral eye clinics and added data from our institution. The reported incidence of all stages of ROP in infants with a gestational age of <32 weeks ranged from 18-30%. One study showed that ROP also occurred at older gestational ages. Blindness due to ROP was seen in infants up to 35 weeks and with a birth weight of 2000 g. Retinopathy of prematurity is an important cause of ocular morbidity and blindness in Indonesia. The overall incidence of ROP in infants born below 32 weeks in Indonesia is higher than in developed countries, and it is seen in infants with older gestational ages. This might be due to a less strict monitoring during the use of oxygen in Indonesia compared to industrialized countries.

Non-traumatic corneal perforations: aetiology, treatment and outcomes

PurposeTo report aetiology, characteristics, treatment and main outcomes of non-traumatic corneal perforations in a single referral centre.MethodsA retrospective review of clinical records of patients diagnosed with non-traumatic corneal perforation. The...

Resistome and pathogenomics of multidrug resistant (MDR) Pseudomonas aeruginosa VRFPA03, VRFPA05 recovered from alkaline chemical keratitis and post-operative endophthalmitis patient

Eye infections due to Pseudomonas aeruginosa is an important cause of ocular morbidity. We presents the whole genomic comparative analysis of two P. aeruginosa VRFPA03 and VRFPA05 isolated from alkaline chemical injury mediated keratitis and post-cataract surgery endophthalmitis patients, respectively. The blaDIM-1 gene in VRFPA03 and the blaGes-9 gene in VRFPA05 were identified and reported for the first time from an ocular isolate. The current study revealed novel integrons In1107 and In1108, comprised of multidrug-resistant genes. Ocular virulence factors mainly mediated by exoenzymes T, Y, and U and exotoxin A, elastase B, and phenazine-specific methyltransferase. Genomic analysis uncovered multiple known and unknown factors involved in P. aeruginosa mediated ocular infection, which may lead to drug discovery and diagnostic markers to improve human vision care.