Presence Of Hypopyon Research Articles

Marginal keratitis after intravitreal injection of bevacizumab

Aims/Purpose: To report a case of marginal keratitis that developed after intravitreal bevacizumab (Avastin) injection.Methods: A 88‐year‐old woman with Age‐related macular degeneration (AMD) and macular edema in both eyes received four intravitreal injection of bevacizumab (Avastin) in left eye and five in right eye. No previous history of herpes.Results: Two days following the fifth injection of Avastin in the patient's right eye, she experienced sensations akin to having a foreign body, accompanied by redness and a decrease in visual acuity in that eye. Examination with a slit lamp revealed peripheral infiltrates beneath the corneal epithelium, delineated from the limbus by a clear zone. Additionally, there was corneal edema with folds in the endothelium and a mild anterior chamber reaction. No presence of hypopyon was noted. The patient's symptoms showed favorable response to topical steroid and topic and oral antibiotic medicationsConclusions: The intravitreal administration of bevacizumab carries a risk of inducing hypersensitivity reactions like marginal keratitis. To our knowledge, this is the first documented account of marginal keratitis after intravitreal bevacizumab injection.References Farrell DA, Deacon S, Mauger T. "Marginal keratitis following COVID 19 vaccination". IDCases. 2022 Jun 15; 29: e01536. doi: 10.1016/j.idcr.2022.e01536. PMID: 35756698; PMCID: PMC9212909 Aslan Bayhan S, Bayhan HA, Adam M, Gürdal C. Marginal keratitis after intravitreal injection of ranibizumab. Cornea. 2014 Nov; 33(11): 1238‐9. doi: 10.1097/ICO.0000000000000255. PMID: 25222003

Risk Factors for Bacterial Keratitis and Severe Disease in Hydrogel Contact Lens Users: A Multicenter Case-Control Study and Case-Only Analysis.

To assess risk factors for contact lens (CL)-related bacterial keratitis, cases and high-risk controls were enrolled. Using high-risk controls can help elucidate whether certain CL types or modalities are attributable to disease burden if risky wear patterns are similar between the cases and controls. This analysis identified whether such CL factors were associated with the occurrence of bacterial keratitis. In addition, a case-only analysis determined CL factors associated with severe disease. From 2018 to 2021, 158 controls were enrolled at University Hospitals of Cleveland Eye Institute, and 153 bacterial keratitis cases were enrolled across 14 sites in the United States. Cases were soft CL wearers with either culture-proven bacterial keratitis or a corneal infiltrate with an overlying epithelial defect within the central 4 mm of the cornea, uveitis, or significant pain. Fungal, protozoan, or nonsoft CL wear-related microbial keratitis cases were excluded. Controls were recruited from high-risk CL wearers with no history of disease. All participants completed a questionnaire related to demographics, type of CL used, wearing schedule, lens handling practices, and storage case handling. Cases with ulcer/infiltrate size ≥2 mm in size, presence of hypopyon, or had fortified antibiotics prescribed were classified as severe keratitis. Univariate and multivariable logistic regression was used to assess association of CL variables with the occurrence of bacterial keratitis as well as occurrence of severe disease among the cases only. Compared with the control cohort, cases were older (mean age 45.6 vs. 38.9 years), had more males (42.5% vs. 23.6%), and had more current or former smokers (41.7% vs. 12.9%). There were no significant associations between CL material (silicone hydrogel vs. not) or CL type (daily disposable vs. reusable) and occurrence of bacterial keratitis. More than two-thirds (67.3%) of cases were classified as severe. Among cases only, univariate analyses found current smokers to have increased risk of severe disease (OR=2.87; 95% CI 1.13-7.26, P =0.03). Adjusting for age, sex, and smoking among the cases only, daily disposable lenses were protective against severe disease (OR=0.32; 95% CI 0.11-0.89, P =0.03). Reusable lenses increased risk of severe microbial keratitis between 3.0- and 4.4-fold compared with compliant daily disposability. Compared with a high-risk control cohort, no specific lens factors were associated with occurrence of CL-associated bacterial keratitis. Among cases only, current smokers and patients wearing reusable lenses are at increased risk of severe keratitis. Daily disposable lenses were protective even when noncompliance to daily disposability was considered.

Fungal Keratitis. Part 2. Diagnosis and Treatment

The problem of diagnosis and treatment of fungal keratitis (FK) is very acute. Due to the slow development of clinical features and the absence of clear pathognomonic signs, this disease is characterized by a late start of the introduction of adequate etiotropic therapy. Often this leads to the development of large corneal defects requiring surgical intervention. Diagnostic methods are divided into invasive and non-invasive. Invasive methods include the study of scrapings from the surface of the cornea from the site of ulceration, biopsy of the corneal stroma or moisture of the anterior chamber using microscopic, cultural methods or polymerase chain reaction (PCR). Non-invasive techniques include confocal microscopy and optical coherence tomography of the anterior segment. They allow you to dynamically monitor the course of the pathological process and the response to ongoing therapy. Promising methods are also the detection of (1,3)-β-D-glucans in tears, the detection of the pathogen using MALDI-TOF MS. The gold standard for the treatment of FK in the world is the topical application of 5 % Natamycin (approved by the FDA, but not available in Russia). Fluconazole, Voriconazole and Amphotericin B, available in Russia, are also widely used, but their topical use is possible only in off label format. In the presence of hypopyon or an increase in the size and depth of the infiltrate, despite ongoing treatment, immediate surgical treatment is required in order to preserve the integrity of the eyeball. Such treatments include penetrating keratoplasty, anterior lamellar keratoplasty, amniotic membrane transplantation, conjunctival flaps, corneal collagen cross-linking (with unproven efficacy), and argon laser. A promising method for the treatment of FK can be the use of Ag(10 %):InP/ZnS MPA quantum dots as monotherapy or as a bioconjugate with known antifungal drugs.

The Presence of Pigmentation on Central Anterior Lens Capsule in the Human Leukocyte Antigen B27-Associated Anterior Uveitis and Its Value in Clinical Diagnosis

ABSTRACT Purpose To report on the value of presence of pigmentation on central anterior lens capsule (PioLe) in HLA B27- associated anterior uveitis (HLA B27-AU). Methods 268 patients (320 eyes) with AU were reviewed. Two diagnostic models to predict probability of HLA-B27-AU were developed. The first model included 6 variables (age, gender, unilaterality, presence of non-granulomatous keratic precipitates, hypopyon, and intraocular pressure (IOP). The second model was developed to investigate the added value of PioLe into the first model. Results Unilaterality, presence of hypopyon, IOP <21 mmHg and PioLe were characteristic for HLA-B27 positive patients (P≤0.003 for all). All of 6 variables had area under receiver operating characteristic curves (AuROC) ≤ 60, but PioLe reached even higher value (65.5). Diagnostic model I and II had AuROC 76.3% (95%CI, 68.4%-84.2%) and 80.0% (95%CI, 72.6%-87.5%), respectively. Conclusions Unilaterality, hypopyon, IOP <21 mmHg and presence of PioLe are clinical signs suggesting HLA B27- AU.

Clinical profile and treatment outcomes of Fusarium keratitis.

Purpose:To determine the seasonality, clinical profile, and treatment outcome of Fusarium keratitis.Methods:A retrospective medical chart review of 97 patients with culture-proven Fusarium keratitis at a tertiary eye care institution from January 2018 to December 2019.Results:The median (SD) age at enrollment was 44.6 (16) years; 75 (79.8%) of them were male. Presence of infiltrate less than 4 mm2 at baseline indicated 4.4 times the odds of achieving final BCVA more than 20/60 (95% CI: 1.4–13.3; P = 0.008). The absence of surgical management indicated 8.1 times the odds of achieving final BCVA of more than 20/60 (95% CI: 0.9–71.5; P = 0.06). The visual acuity at presentation, duration between symptoms and presentation, history of ocular trauma, previous use of topical medications, and presence of hypopyon were not identified as significant predictors of final BCVA in the multivariable regression analysis.Conclusion:Smaller infiltrate size and absence of surgical management are the significant predictors of good visual outcome. Visual outcome of Fusarium keratitis is poor, and a significant number of patients did not respond to anti-fungal therapy and had to undergo surgeries. To the best of our knowledge, this is the largest case series on Fusarium keratitis to date.

Fungal Keratitis in a Tertiary Hospital in Malaysia

BackgroundFungal keratitis is one of the commonest causes of corneal blindness in developing countries including Malaysia. We aim to evaluate the sociodemographic background, clinical features, predisposing factors, laboratory findings, management, complications, and visual outcome of patients with fungal keratitis in a tertiary hospital in Malaysia.MethodsA retrospective review of medical and microbiology records of all patients treated for corneal ulcer from 2015 to 2019 at Hospital Sultanah Bahiyah was performed. Sociodemography, predisposing risk factors, clinical characteristics, causative organisms, and final visual outcome were analyzed.ResultsWe identified 103 patients with a diagnosis of fungal keratitis. The majority of the patients were of Malay ethnicity (85.4%) and male gender (81.6%), with an age range of 21 to 60 years (94.1%). Ocular trauma was the main predisposing factor in 82 (79.6%) patients. Poor visual improvement was observed in groups with ulcer more than 4mm (67.5%), presence of hypopyon (50.9%), and high intraocular pressure (75.0%) upon presentation. Fusarium spp. (19.4%) was the commonest fungus isolated followed by Aspergillus spp. (5.8%). All patients were prescribed either topical, oral, intracameral, or combined therapy, whereas 20 (19.4%) patients required surgical intervention, of which 16 (15.5%) underwent penetrating keratoplasty and three (2.9%) required evisceration.ConclusionThe epidemiological, socioeconomic, and predisposing factors may facilitate timely diagnosis and prompt treatment to achieve a better visual outcome and minimize complications including corneal blindness.

An 18-Year Overview of Serratia marcescens Ocular Infection.

Serratia marcescens is a frequent ocular bacterial pathogen implicated in keratitis, endophthalmitis, and conjunctivitis. We evaluated the risk factors and treatment outcomes of ocular infections due to S. marcescens. In this retrospective observational study, all S. marcescens-positive cases between February 2002 and February 2020 were reviewed for ocular risk factors that included log of minimal angle of resolution visual acuity (VA), medical management, and time to epithelial defect closure. Fifty-one patients were identified (72.5% females, 46.8±23.3 years). Forty-six patients had complete medical records, and 5 had microbiology data available. The most prevalent ocular risk factors were, contact lens (CL) use (68.6%), corneal disease (52.9%), and history of ocular surgery (41.2%). Mean presenting VA was 1.3±1.0. About half of the patients presented with a central ulcer (49%, 25), large infiltrate (20.4±31.8 mm2 mean), and hypopyon (43.1%, 22). All cases were reported to be susceptible to ciprofloxacin. Defect closure occurred in 52.3±117.1 days and final VA was 0.86±0.88. Adjunctive treatments were required in 14 cases (27.5%). One patient underwent surgical intervention. Features associated with poor VA outcomes included, history of glaucoma (P=0.038), older age at presentation (P<0.001), presence of hypopyon (0.045), poor VA at presentation (0.0086), time to epithelial defect closure (0.0196), and large infiltrate size (P=0.0345). S. marcescens keratitis and conjunctivitis is associated with CL use and history of ocular surface disease. Worse outcomes were associated with older age, infiltrate size, presence of hypopyon, worse initial VA, longer time to epithelial defect closure, and history of glaucoma.

Clinical Features of Acute Anterior Uveitis with Complicated Course in a Slovenian Patient Population.

Purpose To report on patients who needed hospitalization due to acute anterior uveitis (AAU) and within this group to compare clinical features and outcomes of treatment of HLA-B27+ and HLA-B27− AAU in the population of Slovenian patients. Methods Retrospective study of hospitalized patients with AAU in the last 39 months at the Eye Hospital in Ljubljana. The data of AAU patients were retroactively studied and compared on the basis of HLA-B27 antigen presence: visual acuity upon admission, visual outcome, the presence of hypopyon, fibrinous reaction, posterior iris synechiae, and complications, such as elevated intraocular pressure, cataract, and cystoid macular edema (CME). We compared the investigations in the diagnostic process, the associated systemic disease, and the treatment administered. Statistical analyses included Student's t-test Fisher's exact test, and the Kolmogorov–Smirnov test. A p value of <0.05 was considered statistically significant. Results A total of 37 hospitalized patients with AAU were included. HLA-B27 antigen was detected in 73% of patients. In the HLA-B27+ group, women were more commonly affected, while the males were more affected in the HLA-B27− group. The occurrence of fibrin was significantly more common in HLA-B27+ patients, as well as hypopyon and posterior synechiae; only fibrin reached the statistical significance (p < 0.05). The incidence of cataracts, ocular hypertension, and glaucoma did not differ significantly between the two groups. HLA-B27+ AAU was more often associated with systemic diseases, and patients in this group were more frequently treated with systemic immunomodulatory drugs, however, no difference reached the statistical significance. We did not notice any major differences in the final visual acuity in the comparing groups. Conclusion Almost ¾ of AAU patients that required hospitalization were HLA-B27+. In this group, disease was more severe, more frequently associated with ocular complications and systemic disease, but final visual acuity was the same in both groups. HLA-B27 typing has no prognostic value in our group of complicated AAU patients, but it eases the decision about necessary diagnostics and treatment.

Moraxella keratitis: epidemiology and outcomes.

We aimed to assess the prevalence, risk factors, and visual outcome of Moraxella keratitis. We retrospectively reviewed the medical charts of patients diagnosed with Moraxella spp. keratitis at the Quinze-Vingts National Ophthalmology Hospital, Paris, France, between January 2016 and December 2018. Definitive microbiological identification was performed on archival strains using matrix-assisted laser desorption ionization time of flight coupled to mass spectrometry. One hundred one culture-proven cases of Moraxella keratitis were identified. The most common isolates were Moraxella lacunata (50%) and Moraxella nonliquefasciens (38%). Systemic predisposing factors, principally diabetes mellitus (13%) were identified in 28% of patients, and 87% of patients had ocular surface conditions, including blepharitis (25%), prior ocular surgery (21%), glaucoma (17%), exposure keratopathy (16%), and trauma (16%). Severely affected inpatients were treated empirically with fortified antibiotics including vancomycin, piperacillin, and gentamicin. The presence of hypopyon and being over the age of 60years were associated with a poorer final visual acuity (p < 0.05). Adjuvant treatment, mostly amniotic membrane transplantation, was required for 31 eyes. The prognostic factors significantly associated with the need for adjuvant treatment were a larger infiltrate and hypoesthesia. The clinical features including ulcer healing, treatment duration, and infiltrate size were not different between Moraxella species. Keratitis caused by Moraxella spp. are rare in France but may threaten sight. The early identification of patients with a poor ocular surface, particularly those with neurotrophic keratopathy and anesthetic cornea, is crucial to prevent delayed healing of ulcers and the need for adjuvant treatment.

Variables Associated With Culture-Positive Endophthalmitis After Intravitreal Injection of Vascular Endothelial Growth Factor Inhibitors

Purpose: This work identifies predictive variables associated with culture-positive cases of acute endophthalmitis after vascular endothelial growth factor (VEGF) inhibitor injection. Methods: A retrospective review of cases of endophthalmitis following intravitreal anti-VEGF injection was performed. All patients received a vitreous biopsy or anterior chamber aqueous biopsy (if vitreous biopsy was not successful) that was sent for microbial cultures before initiation of treatment. Results: During a 10-year period, 258 357 anti-VEGF agent injections were performed, of which 40 patients (0.016%) developed presumed endophthalmitis. Sixty percent (n = 24) of the presumed endophthalmitis patients had a positive culture. In multivariable logistic analysis, patients who had a best-corrected visual acuity (BCVA) worse than 20/400 were 35.3 times (adjusted odds ratio [AOR], 95% CI, 2.2-576.1, P = .012) more likely to have a positive culture compared with those who had a BCVA of 20/400 or better. Patients who had pain at initial presentation were 27.0 times (AOR, 95% CI, 1.4-523.9, P = .029) more likely to have a positive culture compared with those who did not have pain at initial presentation. Age, sex, clinical diagnosis, smoking status, anti-VEGF agent injected, duration between last anti-VEGF injection and symptoms of endophthalmitis, duration between endophthalmitis symptoms and initial treatment, intraocular pressure at initial presentation, and presence of hypopyon were not associated with a difference in positive-culture yield. Conclusions: Visual acuity worse than 20/400 and pain at time of initial presentation secondary to endophthalmitis following anti-VEGF injection were strongly associated with a positive culture. Our data support consideration of vitrectomy in cases in which microbe identification is paramount.

Bleb-Related Endophthalmitis: A 15-Year Review

Purpose: The purpose of this study is to describe the patient characteristics, management, and outcomes of bleb-related endophthalmitis (BRE). Methods: A retrospective chart review was conducted of patients who presented to a tertiary care facility from 2001 to 2016 with BRE. Collected data included demographics, medical and ocular history, visual acuity (VA), intraocular pressure (IOP), presence of hypopyon, treatment, microbiology, visual outcomes particularly of VA and IOP, and complications. Results: Thirty-six eyes (36 patients: 21 females, mean 66.8 years old, 78% with primary open-angle glaucoma) presented an average of 4.5 years (range, 2 days-33 years) after glaucoma surgery (30 trabeculectomies with mitomycin C, 6 tube shunts) with endophthalmitis. Mean VA and IOP at presentation were hand motion (HM; logMAR 2.1) and 19.9 mmHg, respectively, with 82% displaying hypopyon and 87% with purulent blebitis. Eighteen (50%) eyes (mean VA HM) underwent vitreous tap and injection (T/I) of intravitreal antibiotics (vancomycin 1 mg/0.1 cc and ceftazidime 2.25 mg/0.1 cc), and 18 (50%) eyes (mean VA HM) underwent pars plana vitrectomy (PPV) with intravitreal antibiotic injection. Eight (45%) eyes initially treated with T/I required a subsequent PPV, and 5 (28%) eyes treated initially with PPV underwent a second PPV. All patients also received systemic antibiotics (33 intravenous [IV] and 3 oral) and topical medications. Average time to documented resolution was 15 days, with mean VA of HM and IOP of 13.6 mmHg. Thirty-one (86%) eyes had vision worse than 20/200 at resolution, and those presenting with light perception or no light perception (NLP) vision (n = 6) had worse vision final VA (logMAR 2.6) than those with initial vision of HM or better (final VA logMAR 1.7). Three (8.6%) eyes were enucleated, with 4 worsening to NLP during the course of the infection. Conclusions: BRE is a visually devastating infection requiring prompt diagnosis and management. Despite aggressive treatment with antibiotics, visual prognosis is poor.

Clinical Characteristics and Outcomes of Moraxella Keratitis.

Changing trends of infective keratitis have been identified worldwide. The aim of this study was to define the clinical associations, characteristics, and outcomes of patients with culture-proven Moraxella keratitis from a large tertiary corneal unit in the United Kingdom. Patients with confirmed Moraxella isolates presenting between January 2004 and November 2016 were analyzed. Patient-related factors were examined, including patient demographics, date of presentation, clinical presentation, predisposing factors, best-corrected visual acuity (BCVA), treatment plans, and clinical outcomes. Eighty-six patients were identified, of whom 61 (70.9%) had at least one recognized predisposing factor. The median BCVA at presentation was 2.60 logarithm of the minimum angle of resolution (logMAR), which improved to median = 0.60 logMAR at final visit (P < 0.001). Visual improvement of more than 2 Snellen lines was achieved in 60.7% of eyes. A significant relationship (P = 0.003) between final vision and the presence of hypopyon was found, where for a fixed BCVA at presentation those with a hypopyon achieved a better final visual acuity of 0.69 logMAR. Our study showed that although most patients presented with at least one predisposing factor, some of the more traditionally perceived risk factors may need to be reconsidered. We have shown that with aggressive treatment, favorable visual outcomes can be achieved in most patients. Interestingly, the presence of hypopyon at presentation was linked to a better visual outcome, likely because such patients had more to gain in visual potential.

Potential predictors for frequent relapse in human leukocyte antigen-B27-associated uveitis.

To identify potential predictors for frequent relapse in a cohort of patients with human leukocyte antigen (HLA)-B27-associated uveitis in a tertiary referral center at the initial visit. This retrospective cohort study comprised 130 patients diagnosed with HLA-B27-associated uveitis. Subjects were divided into two groups according to the frequency of uveitis attacks (number/year): frequent relapse (FR) (who relapsed more than twice a year, 38) and infrequent relapse (IR) group (who relapsed twice or less than twice a year, 92). The FR group presented more often with hypopyon or posterior synechiae at the initial presentation. Interestingly, posterior segment involvements including vitritis, vasculitis, or cystoid macular edema were not significantly different between the groups. In terms of laboratory findings, the erythrocyte sedimentation rate (ESR) was higher in the FR group. Multivariate Cox hazards analysis showed male sex, the presence of hypopyon, and ESR to be potential predictive factors for frequent relapse. We found that male sex, hypopyon at presentation, and high ESR are potential predictors for frequent relapse in HLA-B27-associated uveitis. Identifying patients at higher risk of relapse could provide important information for patients, allowing patients to understand their condition and increase their acceptance of strict management.

Endophthalmitis after Intravitreal Injection of Vascular Endothelial Growth Factor Inhibitors: Management and Visual Outcomes

We describe the presentation of patients developing endophthalmitis after intravitreal injection with vascular endothelial growth factor (VEGF) inhibitors. Moreover, we evaluate the management by comparing the outcomes of immediate tap and injection of intravitreal antibiotics (TAI) versus initial surgical pars plana vitrectomy (PPV). Finally, we analyze the predictive factors of visual outcomes at 6-month follow-up. Retrospective, single-center, nonrandomized interventional study. Patients developing endophthalmitis after receiving an intravitreal injection of anti-VEGF agent between 2006 and2016. All patients received a vitreous biopsy sent for cultures before the initiation of treatment: TAI group versus PPV with intravitreal antibiotics (PPV group). Best-corrected visual acuity (BCVA) at 6-month follow-up after treatment for endophthalmitis. A total of 258 357 intravitreal injections occurred over the course of the 10-year period, of which 40 patients (0.016%) had endophthalmitis within 3 weeks after injection. In total, 34 patients (85.0%) had pain and 25 patients (62.5%) had hypopyon on initial examination. Among 24 culture-positive cases, 66.7% of the causative organisms were coagulase-negative Staphylococcus, followed by Streptococcus species (10.0%). The best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution [logMAR]) at 6-month follow-up was significantly worse for patients who had a positive culture for Streptococcus species (4.0; standard deviation [SD], 0.8) (approximately light perception) compared with those who had a positive culture for coagulase-negative Staphylococcus (0.4; SD, 0.3) (∼20/50) (P < 0.0001). Compared with the TAI group, a higher proportion of samples were culture-positive in the PPV group (90.9% vs. 48.3%, P= 0.03). There was no statistically significant difference in BCVA at 6-month follow-up between the TAI and PPV groups. Younger age (<85 years) and lower intraocular pressure (IOP) (≤25 mmHg) at presentation were predictive of achieving a BCVA of 20/400 or better at 6-month follow-up after treatment. Initial management (TAI vs. PPV), duration of symptoms, presence of pain, presence of hypopyon, presenting BCVA, and culture status (positive vs. negative) were not found to be predictive of visual outcomes at 6-month follow-up. No significant difference in BCVA at 6-month follow-up was detected between the TAI and PPV groups. Younger age and lower IOP at presentation were associated with better visual outcomes at 6-month follow-up.

Bleb related infections: clinical characteristics, risk factors, and outcomes in an Asian population.

PurposeComparison of the demographic, ocular, systemic and microbiological characteristics of eyes with bleb related infection (BRI) and bleb related endophthalmitis (BRE).MethodsRetrospective chart review of patients with BRI from January 1996–July 2013. Identification done via the center’s longstanding endophthalmitis audit, BRI audit and laboratory database identifying all conjunctival swabs from blebs. Blebitis was defined as anterior segment inflammation with mucopurulent material in or around the bleb, with anterior chamber cells but no hypopyon. BRE was defined by the presence of hypopyon or vitreous inflammation.ResultsTwenty-nine patients with blebitis and 10 with BRE were identified. Mean age of subjects (n=39) was 68.4 (±13.3) with a preponderance of men (74.4%) and Chinese ethnicity (74.4%). BRE patients were 10.7 years older than blebitis patients (P=0.026). 28 (71.8%) subjects had primary open angle glaucoma. The presenting intraocular pressure (IOP) dropped in blebitis but almost doubled in BRE (P=0.011) compared to average preinfective IOP. Two weeks after treatment, IOPs in both groups returned to close to preinfective levels. Subjects with blebitis more often had an avascular bleb (88.0%) while those with BRE trended toward a moderately vascular bleb (50%). The distribution of causative microorganisms between the groups was similar.ConclusionOur study indicates that risk factors are similar in both groups even though the visual outcome and clinical course, in the form of IOP findings and bleb vascularity, can diverge significantly. The decreased IOP in blebitis subjects represents objective evidence of subclinical leaks or bleb sweating.

Comparative study of impression smear with conventional mechanical corneal scrapping by potassium hydroxide (10%KOH) in diagnosis of fungal keratitis

Background: Diagnosis of fungal keratitis remains a challenge to an ophthalmologist due to variety of presentation of patients. If a prompt, aggressive and early treatment is not started disease turns indolent resulting in sloughing of cornea, serious loss of vision, possible perforation and loss eye. Methods: This observational study was conducted in upgraded department of ophthalmology, BRD Medical College, Gorakhpur, India among 50 patients of suspected fungal keratitis. Results: Fungal keratitis is more common in young males of rural area. Most of fungal corneal (>5 mm) with presence of hypopyon, pigmentation and satellite lesion as consistent features. KOH smear with impression smear technique was positive in 36 (72.0%), out of total 50 cases. KOH smear with conventional mechanical scrapings was positive in 35 (70.0%), out of total 50 cases. Sensitivity of impression smear technique as compared to conventional scraping was 100.0%. Sensitivity of mechanical scraping technique as compared to impression smear technique was 92.11%. Conclusions: Impression cytology is a recent diagnostic tool in fungal keratitis. It has various advantages over mechanical scraping like no expensive equipments like slit lamp and operation microscope required. Impression smear KOH mount is comparative to conventional mechanical corneal scraping KOH examination in making and tentative diagnosis of fungal keratitis and can be accurately replied upon for initiation antifungal therapy.

Effect of Internal Limiting Membrane Peeling in Visual Outcome of Endophthalmitis after Pars Plana Vitrectomy

Purpose: To evaluate the clinical course and prognostic factors of visual acuity in post-vitrectomy endophthalmitis. Methods: A total of 9 patients diagnosed with post-vitrectomy endophthalmitis between 2004 and 2013 were enrolled in this retrospective study. To evaluate factors affecting final visual acuity, the following was investigated: best corrected visual acuity (BCVA) before first vitrectomy, BCVA at presentation, presence of diabetes mellitus, type of port used on first pars plana vitrectomy, whether cataract operation was performed simultaneously, whether removal of internal limiting membrane was performed at first pars plana vitrectomy, interval period from initial vitrectomy to treatment of endophthalmitis, presence of hypopyon, whether culture was proven, and type of organism isolated. Results: All 9 eyes received intravitreal antibiotic injections and additional pars plana vitrectomy was performed in 7 eyes. Six eyes were culture-proven. Staphylococcus epidermidis was cultured from 5 eyes and Escherichia coli was cultured from 1 eye. BCVA before first vitrectomy, presence of diabetes mellitus, type of port used on first pars plana vitrectomy, whether cataract operation was performed simultaneously, interval from initial vitrectomy to treatment of endophthalmitis, whether culture proven, and type of organism isolated did not affect final visual acuity. BCVA at presentation was an important factor for final visual acuity. Removal of internal limiting membrane at initial vitrectomy was a poor prognostic factor in final visual acuity (p = 0.02). Conclusions: Endophthalmitis after pars plana vitrectomy showed very poor final visual acuity and better BCVA at presentation resulted in better final visual acuity. Poor visual acuity was observed in patients who had the internal limiting membrane removed at first vitrectomy. J Korean Ophthalmol Soc 2015;56(2):213-218

Correlation of Pseudomonas aeruginosa genotype with antibiotic susceptibility and clinical features of induced central keratitis.

To determine the association of type III secretion system (T3SS) genotype with antibiotic susceptibility, serotypes, and clinical manifestation of centrally located Pseudomonas aeruginosa keratitis. Clinical characteristics of P. aeruginosa keratitis cases from 2001 to 2011 were analyzed. Each strain was serotyped and genotyped for T3SS exotoxin genes. Antibiotic sensitivity and minimum inhibitory concentrations were determined with agar dilution method. Prognostic factors affecting final visual outcomes and time to re-epithelialization were analyzed using linear and Cox regression models. Forty-four invasive and 28 cytotoxic strains were identified. Invasive strains occurred mostly in males (P = 0.03) with older age (P = 0.009) and ocular surgery or trauma history (P = 0.006), poor presenting (P = 0.04) and final (P < 0.0001) best spectacle-corrected visual acuity (BSCVA), and larger infiltration size (P = 0.03). Cytotoxic strains were associated with contact lens wear (P < 0.0001). Poor prognostic factors for final BCVA after adjusting for sex, age, and contact lens wear included invasive strains (P = 0.02), larger infiltration area (P = 0.02), deeper infiltrations (P = 0.02), and presence of hypopyon (P = 0.09). Factors affecting complete re-epithelialization time included invasive strains (P = 0.02), infiltration area (P = 0.01), depth (P = 0.02), and hypopyon (P = 0.03) after adjusting for age and sex. Serotypes 2, 6, and 11 were more commonly found among all isolates. A trend to increased fluroquinolone resistance is noted for invasive strains, although not reaching statistically significant difference. Cytotoxic strains are associated with contact lens wear while invasive strains are related to poor prognosis and increased resistance to fluoroquinolones. Clinicians should be aware of the two different genotypes of P. aeruginosa affecting prognosis.

Triple Infection Keratitis

To analyze the demographics, risk factors, and clinical and microbiological characteristics of triple infection keratitis. Retrospective case series. Five patients (five eyes) with triple infection keratitis were identified. Eyes with polymicrobial keratitis were identified from January 2002 to December 2010. Only culture-positive cases and eyes infected by three different organisms were included. Demographics, risk factors, clinical and microbiological characteristics, and treatment outcomes were analyzed. The size of the corneal infiltrate, presence of hypopyon, pre- and post-treatment best-corrected visual acuity, antibiotic regimen and sensitivity, types of isolated pathogens, duration of infection, and treatment outcomes. The mean age was 39 years (SD, ±23.4; range, 21-74). Use of topical steroids was the commonest risk factor (80%). Multiple risk factors were identified in four eyes. The average size of corneal infiltrate was 23.5 mm (SD, ±35.2; range, 2.08-85.5), and all eyes developed hypopyon. A total of 15 organisms belonging to 10 species (bacteria=7, fungi=3) were isolated. Pseudomonas aeruginosa and Candida albicans were the most frequently isolated bacteria (n=3) and fungi (n=3), respectively. All patients had at least one type of fungal isolate. Infection resolved with medical treatment in four eyes and one eye had to be eviscerated as the patient developed panophthalmitis. The average time taken for infection to resolve was 30 days (SD, ±19.3; range, 13-61). A high index of suspicion of polymicrobial keratitis should be made in patients with multiple and systemic risk factors. Use of topical steroid was the most common risk factor. Prolonged course of disease, relatively large infiltrate, and presence of hypopyon and fungal isolates are typical features of triple infection keratitis.

Open globe injury in a 3-year-old child presenting 3 days later!!!

Open globe injuries are a very common cause of unilateral visual loss, with children accounting for up to 20% of all these injuries. The principles of management of ocular injuries are the same for children and adults. However, the management in the case of a child is made much more difficult due to variable cooperation with assessment and continuing therapy as well as the subsequent possibility of amblyopia further complicating the treatment. Here we report the successful management of a 3-year-old child who was brought to this center with a full thickness penetrating injury to her cornea, with a pencil, and the presence of hypopyon, 3 days after the occurrence of the injury.