1/18. aspergillus niger endophthalmitis after cataract surgery.We report a 65-year-old diabetic woman who developed aspergillus niger endophthalmitis after cataract surgery. She presented 9 weeks after extracapsular cataract extraction with a black growth covering the cornea and moderate echoes in the vitreous on ultrasonography. After microbiological confirmation of fungal endophthalmitis, the patient received intravitreal amphoterecin B 5 micro g, topical natamycin 5% hourly, atropine 1% 3 times, and oral antifungal therapy. The patient was told the visual prognosis and was advised to have penetrating keratoplasty and vitrectomy, which she refused.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/18. pseudallescheria boydii keratitis.We treated a case of post-traumatic keratitis caused by the soil saprophyte, pseudallescheria boydii. The injury was caused by a wood splinter which produced a perforating corneal laceration that was primarily repaired. Signs of corneal infection were not evident until the fourth postoperative week. The organism was eradicated by topical miconazole and natamycin. Subsequent penetrating keratoplasty combined with cataract extraction and intraocular lens implantation has achieved a good visual outcome.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/18. Sensitive and rapid polymerase chain reaction based diagnosis of mycotic keratitis through single stranded conformation polymorphism.PURPOSE: To report a method for early and correct diagnosis of mycotic keratitis. DESIGN: Clinical laboratory diagnostic study. methods: Corneal scraping of all the four patients were processed for dna extraction which were amplified by fungal specific primers of internal transcribed spacer region I (ITS1). These products were sequenced and analyzed by single stranded conformation polymorphism (SSCP) for species identification. RESULTS: The dna samples from corneal scrapings of all the four patients were successfully amplified by the primer pair ITS1 and ITS2 and similarity/dissimilarity were established by Jaccard's coefficient. Patient isolate 1 was identified as nectria hematococca, isolate 2 as candida albicans, and isolates 3 and 4 were identified as Bipolaris papendorfii. This led to prompt initiation of antifungal therapy in all the four cases where useful vision could be restored. CONCLUSIONS: Early and correct diagnosis of mycotic keratitis by polymerase chain reaction could be obtained in all the four cases compared with conventional methods, which helped in the prompt initiation of antifungal therapy in patients.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
4/18. Torulopsis candida (Candida famata) endophthalmitis simulating Propionibacterium acnes syndrome.Four months after undergoing extracapsular cataract extraction with implantation of a posterior chamber intraocular lens, a 74-year-old woman developed granulomatous anterior uveitis. Although she initially responded well to corticosteroid therapy, she experienced multiple recurrences on discontinuation of this therapy. Slit-lamp examination showed the ocular inflammation to be associated with white cortical material within the lens capsular sac. She underwent removal of the implant as well as the lens capsular sac. Anaerobic culture yielded no organisms, but fungus cultures yielded Torulopsis candida. Histopathologic and electron microscopic studies showed large numbers of yeast sequestered within the lens capsular sac and mild granulomatous inflammation around the sac. Torulopsis candida is occasionally isolated from specimens as a contaminant, but has not yet been shown to produce human disease. The case reported herein documents potential pathogenicity of Torulopsis candida and reveals the importance of organisms other than anaerobic bacteria in causing delayed and localized intraocular inflammation that is virtually identical to propionibacterium acnes infection.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
5/18. Keratomycotic malignant glaucoma.Malignant glaucoma due to Keratomycosis is a devastating and poorly recognised complication occurring in a small percentage of treated patients. It is characterized, in cases of Keratomycosis by a raised tension, uniform shallowing of the anterior chamber and a fungus-exudate-iris mass covering the pupillary area. Three cases of 'Keratomycotic Malignant glaucoma' are discussed here. Two of these were successfully treated with therapeutic keratoplasty, extracapsular lens extraction and systemic antifungals. The development of malignant glaucoma after a therapeutic keratoplasty which occurred in one case has not previously been reported. All the three cases which developed malignant glaucoma had a pupillary size of 4 mm diameter or less and grew fusarium from the cornea and anterior chamber.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
6/18. Mycotic infection of the capsular bag in postoperative endophthalmitis.A case of mycotic infection after uncomplicated extracapsular cataract extraction with implantation of a posterior chamber modified C-loop intraocular lens (IOL) is reported. Severe postoperative intraocular inflammation, diagnosed by aqueous cultures as secondary to staphylococcus aureus endophthalmitis, did not respond to antibiotic therapy. Despite IOL and capsular bag removal and further antibiotic treatment, the inflammation persisted and phthisis followed. Retrospective electron microscopic examination of the explanted material demonstrated the presence of abundant fungal elements in the capsular bag and spores on the IOL surface. Vitreous taps performed at the time of explantation were negative for bacteria and fungi, confirming the localized nature of the mycotic infection. To our knowledge this report represents the first observation of a mycotic infection confined to the capsular bag after cataract surgery with implantation of a posterior chamber IOL.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
7/18. histoplasma capsulatum endophthalmitis after cataract extraction.A 60-year-old white man from an area endemic for histoplasma capsulatum presented with a vitreous wick, hypopyon iritis, and dense vitreitis 2 months after removal of an anterior chamber intraocular lens (IOL) for chronic iritis. A diagnostic vitrectomy was performed and H. capsulatum was cultured and identified 2 weeks later. Despite intravitreal and intravenous amphotericin as well as repeat vitrectomies, the inflammation worsened and the eye was removed. Results of histopathologic examination showed histoplasma organisms along the vitreous wick, over the surface of the iris and ciliary body, and over the retina. No organisms were found in the choroid. Dalen-Fuchs-type nodules similar to those of sarcoid also were noted, but there was no evidence of granulomatous inflammation in the uvea. Because of his unilateral disease with histoplasma in the vitreous wick, negative serology, and an absence of systemic infection, the authors believe that this patient had a previously unreported form of ocular histoplasma, exogenous postoperative histoplasma endophthalmitis.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |
8/18. Treatment of Candida endophthalmitis.A 51-year-old man who was being treated with corticosteroids for chronic extrinsic asthma developed biliary tract sepsis, candidemia, and Candida endophthalmitis with vitreous fluff-ball lesions in both eyes. Extensive vitreous fibrosis and retinal detachment with loss of useful vision occurred in his left eye, which had a vitreous biopsy. Useful vision was maintained in his right eye with two full courses of systemic amphotericin b, 5-flucytosine, and a cataract extraction. Encapsulated Candida organisms remained in the vitreous of his right eye at the time of death. Useful vision can be preserved without aggressive vitreous surgery and intravitreal anti-fungal agents in eyes with intravitreal candida albicans.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
9/18. Fungal feeding-line infections: beware the eyes and teeth.Twenty-four fungal feeding-line infections occurred in 17 patients during 1984-1992. Thirteen were receiving long-term home parenteral feeding and, in them, the first infection occurred after a median of 30 months (range 1-120) continuous feeding with a line that had been in situ for a median of 20 months (range 1-37). Four were receiving short-term feeding through a line that had been inserted 1-2 months previously. At the time of the first infection all patients were febrile and most were anaemic (15/16), however a leucocytosis was rare (three of 16). The fungi isolated were candida albicans(6), Candida parapsilosis(5), candida glabrata(2), Candida guillermondii(2) and other species (2). In 16 patients, the feeding-line was removed at the time of the first infection and no other treatment was given, and no other complications occurred in eight (50%) of these. In 11, the line was reinserted a median of 7 days after removal (range 1-11). Four patients (24%) developed a Candida infection of the eye 1-8 weeks after the diagnosis, uveitis (2) and endophthalmitis (2) which, in one patient, led to complete blindness in one eye. Two patients had recurrent infections which began within a month of dental therapy. In one, the infections stopped after dental extractions and, in the other, after a dental clearance. An ophthalmoscopic examination should be performed in all patients with a fungal feeding-line infection. Recurrent candidal infections may have a dental origin.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
10/18. Surgical management of submacular hemorrhage. A series of 47 consecutive cases.BACKGROUND: The development of a thick submacular hemorrhage usually carries a poor visual prognosis. The surgical removal of submacular blood may improve the otherwise poor outlook in these cases. SUBJECTS AND methods: Forty-seven consecutive patients underwent vitrectomy with surgical removal of submacular hemorrhage. The patient population consisted of two consecutive groups. Group 1 (1989 to 1991) included 23 patients (20 with age-related macular degeneration [ARMD], one with idiopathic submacular hemorrhage, one with presumed ocular histoplasmosis syndrome [POHS], and one with angioid streaks) who underwent mechanical clot extraction. Group 2 (1991 to 1993) included 24 patients (19 with ARMD, two with POHS, two with arterial macroaneurysm, and one with angioid streaks) who underwent tissue plasminogen activator-assisted drainage of thick submacular hemorrhage. The dose of tissue plasminogen activator ranged from 10 to 40 micrograms. All patients had surgery within 72 hours of diagnosis. RESULTS: In group 1, the mean size of the submacular hemorrhage was 11 disc areas (range, 1 to 16 disc areas). Mean follow-up was 40 weeks. Mean postoperative visual acuity for eyes with ARMD was 20/200. (visual acuity improved in six eyes, was stable in seven eyes, and deteriorated in seven eyes.) All three of the eyes without ARMD had visual improvement with a mean postoperative visual acuity of 20/70. overall, visual acuity stabilized or improved in 13 (57%) of 23 patients and decreased in 10 (43%) patients. In group 2, the mean size of the submacular hemorrhage was 11 disc areas (range, 3 to 16 disc areas). Mean follow-up was 24 weeks. Mean postoperative visual acuity for eyes with ARMD was 20/480 (visual acuity was stable in 15 eyes, improved in two eyes, and deteriorated in two eyes). Four of five eyes without ARMD had visual improvement and one was stable, with a mean postoperative visual acuity of 20/60. visual acuity stabilized or improved in 22 (92%) of 24 patients and decreased in two (8%). The degree of clot lysis was variable. CONCLUSIONS: Submacular hemorrhage secondary to ARMD has a poor visual prognosis, with or without surgical drainage. The addition of tissue plasminogen activator-assisted clot lysis does not appear to significantly improve the visual outcome following surgery. The determination of whether surgical intervention is appropriate in these cases requires a prospective, randomized clinical trial.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
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