11/277. haemophilus influenzae associated scleritis.AIMS: To describe the clinical course and treatment of haemophilus influenzae associated scleritis. methods: Retrospective case series. RESULTS: Three patients developed scleritis associated with ocular H influenzae infection. Past medical history, review of systems, and laboratory testing for underlying collagen vascular disorders were negative in two patients. One patient had arthritis associated with an antinuclear antibody titre of 1:160 and a Westergren erythrocyte sedimentation rate of 83 mm in the first hour. Each patient had ocular surgery more than 6 months before developing scleritis. Two had cataract extraction and one had strabismus surgery. Nodular abscesses associated with areas of scleral necrosis were present in each case. culture of these abscesses revealed H influenzae in all patients. Treatments included topical, subconjunctival, and systemic antibiotics. Scleral inflammation resolved and visual acuity improved in each case. CONCLUSION: H influenzae infection may be associated with scleritis. Accurate diagnosis and treatment may preserve ocular integrity and good visual acuity.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
12/277. An unreported side effect of topical clarithromycin when used successfully to treat mycobacterium avium-intracellulare keratitis.PURPOSE: To report a case of mycobacterium avium-intracellulare (MAI) keratitis successfully treated with topical clarithromycin. An unreported side effect of the topical medication is described. methods: A regular follow-up in the corneal clinic was arranged, and a pertinent literature search performed. RESULTS: The use of topical clarithromycin was successful in treating the keratitis. The patient did not complain of any ocular discomfort. Corneal subepithelial deposits that appeared during treatment with clarithromycin resolved shortly after the therapy was discontinued. CONCLUSION: This case report demonstrates that a rare infection like MAI keratitis can be successfully treated with topical clarithromycin. It also highlights the possible corneal deposition of this drug, which resolved after cessation of therapy.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
13/277. Demonstration of Bartonella grahamii dna in ocular fluids of a patient with neuroretinitis.We describe the clinical and laboratory features of a 55-year-old human immunodeficiency virus-negative female patient who presented with bilateral intraocular inflammatory disease (neuroretinitis type) and behavioral changes caused by a Bartonella grahamii infection. diagnosis was based on the PCR analysis of dna extracted from the intraocular fluids. dna analysis of the PCR product revealed a 100% identity with the 16S rRNA gene sequence of B. grahamii. The patient was successfully treated with doxycycline (200 mg/day) and rifampin (600 mg/day) for 4 weeks. This is the first report that demonstrates the presence of a Bartonella species in the intraocular fluids of a nonimmunocompromised patient and that indicates that B. grahamii is pathogenic for humans.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
14/277. Vibrio ocular infections on the U.S. Gulf Coast.PURPOSE: To describe the epidemiology of Vibrio eye infections. METHOD: We reviewed the records of a patient from our institution with V. vulnificus keratitis and conducted a literature search for other cases of ocular infections with Vibrio species. RESULTS: A 39-year-old fisherman was struck in his left eye with an oyster shell fragment, developed suppurative V. vulnificus keratitis, and was successfully treated with combined cefazolin and gentamicin. Including our patient, 17 cases of eye infections with Vibrio spp. have been reported, and 11 (65%) involved exposure to seawater or shellfish. Of the seven cases due to V. vulnificus (six keratitis and one endophthalmitis), six had known exposure to shellfish or seawater along the U.S. coast of the gulf of mexico. Of five cases of V. alginolyticus conjunctivitis, three had been exposed to fish or shellfish. Three infections with V. parahaemolyticus (one keratitis and two endophthalmitis) were reported; two of these occurred in people exposed to brackish water on or near the Gulf Coast. Two cases of postsurgical endophthalmitis, one with V. albensis and one with V. fluvialis, also were reported. CONCLUSIONS: In addition to septicemia, gastroenteritis, and wound infections, halophilic noncholera Vibrio species can cause sight-threatening ocular infections. Ocular trauma by shellfish from contaminated water is the most common risk factor for Vibrio conjunctivitis and keratitis. Nearly one half of reported vibrio infections of the eye occurred along the U.S. coast of the gulf of mexico.- - - - - - - - - - ranking = 5.5keywords = infection (Clic here for more details about this article) |
15/277. mycobacterium chelonae keratitis after laser in situ keratomileusis successfully treated with medical therapy and flap removal.PURPOSE: To report a case of mycobacterium chelonae keratitis after laser in situ keratomileusis successfully treated with medical therapy and flap removal. methods: Case report. A 36-year-old white woman in good health developed a paracentral keratitis in her right eye 1 month after bilateral laser in situ keratomileusis. Initial treatment included topical steroids and then intensive Ocuflox (ofloxacin ophthalmic solution; Allergan, Inc, Irvine, california) without success. Cultures were negative. The keratitis worsened, and she was referred to our institution. Interface infiltration was noted, and the flap was lifted to obtain adequate laboratory studies. Cultures were positive for M chelonae. RESULTS: The keratitis was treated with intensive topical amikacin sulfate 1%, topical clarithromycin 1%, and Ciloxan (ciprofloxacin HCL; Alcon laboratories, Inc, Fort Worth, texas) with minimal improvement in her clinical condition. She developed a toxic reaction to amikacin 1%. In order to improve antibiotic penetration, the hazy, ulcerated corneal flap was removed. The keratitis then resolved with intensive topical clarithromycin 1% and Ocuflox over 5 weeks. The patient now has visual acuity without correction of 20/50, despite superficial corneal haze. CONCLUSION: M chelonae is a rare and insidious cause of infection after laser in situ keratomileusis. diagnosis can be difficult and is often delayed. Aggressive medical management, with flap removal, if needed, may lead to resolution of infection.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
16/277. Postoperative endophthalmitis caused by sequestered acinetobacter calcoaceticus.PURPOSE:To describe postoperative endophthalmitis caused by sequestered acinetobacter calcoaceticus.METHOD:Case report. A 40-year-old woman developed recurrence of inflammation after extracapsular cataract extraction with intraocular lens (IOL) implantation. At last recurrence, the capsular bag was studded with white deposits. Intraocular lens was removed along with capsular bag during pars plana vitrectomy.RESULTS:The capsular bag, when cultured, grew A calcoaceticus. The media remained clear with no evidence of recurrence of infection over a 3-month follow-up. CONCLUSION:Postoperative endophthalmitis similar to that caused by sequestered propionibacterium acnes can be caused by A calcoaceticus.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
17/277. The expanding clinical spectrum of ocular lyme borreliosis.OBJECTIVE: To delineate the clinical manifestations of ocular Lyme borreliosis, while concentrating on new symptoms and findings and the phase of appearance of ophthalmologic disorders. DESIGN: Observational case series. PARTICIPANTS: Ten patients with Lyme borreliosis-associated ophthalmologic findings previously reported from the Helsinki University Central Hospital in addition to 10 new cases that have since been diagnosed. INTERVENTION/TESTING: The patients underwent medical and ophthalmologic evaluation. The diagnosis of Lyme borreliosis was based on medical history, clinical ocular and systemic findings, determinations of antibodies to borrelia burgdorferi by enzyme-linked immunosorbent assay and immunoblot analysis, the detection of dna of B. burgdorferi by polymerase chain reaction, and exclusion of other infectious and inflammatory causes. MAIN OUTCOME MEASURES: Ocular complaints, presenting ophthalmologic findings, and the stage of Lyme borreliosis were recorded. RESULTS: Four patients presented with a neuro-ophthalmologic disorder, five had external ocular inflammation, 10 patients had uveitis, and one had branch retinal vein occlusion. One patient developed episcleritis and one patient developed abducens palsy within 2 months of the infection incident. In the remaining 14 patients in whom the time of infection was traced, the ocular manifestations appeared in the late stage of Lyme borreliosis. Two patients with a neuro-ophthalmologic disorder and one with external ocular inflammation experienced severe photophobia, whereas the main reported symptom of the patients with uveitis was decreased visual acuity. Four patients with external ocular disease and one with a neuro-ophthalmologic disorder experienced severe periodic ocular or facial pain. retinal vasculitis developed in seven patients with uveitis. CONCLUSIONS: Lyme borreliosis can cause a variety of ocular manifestations, which develop mainly in the late stage of the disease. photophobia and severe periodic ocular pain can be characteristic symptoms of Lyme borreliosis. In the differential diagnosis of retinal vasculitis, Lyme borreliosis should be taken into account, especially in endemic areas.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
18/277. oxacillin-resistant staphylococcus aureus endophthalmitis after ganciclovir intraocular implant.PURPOSE: To describe a patient who developed oxacillin-resistant staphylococcus aureus endophthalmitis after insertion of a ganciclovir intraocular implant. METHOD: Case report. RESULTS: A 42-year-old man with acquired immunodeficiency syndrome (AIDS) and a history of cytomegalovirus retinitis was admitted with right-sided eye pain and decreased visual acuity 10 days after receiving a second ganciclovir intraocular implant in the right eye. A therapeutic vitrectomy, right eye, was performed on the day of admission. A vitreal tap produced frank pus and white, fluffy debris. Cultures of the vitreal fluid grew oxacillin-resistant S aureus, sensitive only to vancomycin, rifampin, and trimethoprim/sulfamethoxazole. The patient was successfully treated with removal of both ganciclovir implants in the right eye and a 4-week course of vancomycin and rifampin. However, the infection left the patient blind in the infected eye. CONCLUSION: Bacterial endophthalmitis is an infrequent but serious complication of the ganciclovir intraocular implant.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
19/277. Mycobacterium keratitis after laser in situ keratomileusis.PURPOSE: The authors report two cases of Mycobacterium keratitis following LASIK. methods: The case reports are based on a retrospective review of clinical history and associated findings. RESULTS: Two patients developed infectious keratitis after undergoing laser in situ keratomileusis (LASIK). In case #1, the infection developed after manipulation of the lamellar flap to remove epithelium from the stromal bed. In case #2, prior radial keratotomy may have been a contributing factor to development of the infection. Corneal infiltrates appeared as focal, white, stromal deposits. Cultures isolated mycobacterium fortuitum from case #1 and mycobacterium chelonae from case #2. Topical fortified amikacin, clarithromycin, tobramycin, and ciprofloxacin eventually controlled the infection. Topical prednisolone acetate and bandage contact lenses were necessary to control inflammation and pain. Infiltrates were slow to resolve until focal necrosis eroded through the flaps leading to rapid clearing of the infiltrates; however, scarring of the cornea developed at the site of necrosis. Visual recovery was good in the first case but limited in the second. CONCLUSIONS: Mycobacterium keratitis complicating LASIK may be difficult to eradicate until the sequestered stromal infiltrate drains. Rapid recognition of the causative organism and aggressive medical and surgical management of the infection may improve the outcome.- - - - - - - - - - ranking = 2keywords = infection (Clic here for more details about this article) |
20/277. prevalence of serologic evidence of cat scratch disease in patients with neuroretinitis.OBJECTIVE: To determine the prevalence of bartonella henselae seropositivity in patients with a clinical diagnosis of neuroretinitis. DESIGN: Retrospective, clinic-based, cross-sectional study. PARTICIPANTS: Eighteen consecutive patients seeking treatment at the Casey Eye Institute from November 1993 through November 1998 who had neuroretinitis. methods: The billing and photographic records of the Casey Eye Institute were searched for patients with a primary or secondary diagnosis of neuroretinitis or Leber's idiopathic stellate neuroretinitis. charts were then reviewed to determine the results of B. henselae antibody titers and other pertinent clinical information. MAIN OUTCOME MEASURES: Results of B. henselae serologic testing. RESULTS: Fourteen of 18 patients with neuroretinitis had serologic studies. Nine of the 14 tested patients (64.3%) were found to have elevated IgM or IgG for B. henselae, suggesting current or past infection. patients with positive serologic analysis results tended to have worse vision at presentation. There were no other obvious differences between seropositive and seronegative groups in this study, including duration or quality of recovery. CONCLUSIONS: At our tertiary care ophthalmology institution, most tested patients with neuroretinitis had evidence of past or present cat-scratch disease based on positive serologic analysis for B. henselae, a much greater prevalence than is expected to be found in the general population or in patients with idiopathic uveitis. Further study is indicated to clarify the prevalence of cat-scratch disease in neuroretinitis and the role and efficacy of antibiotics in treatment.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
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