Corneal perforation requiring corneal grafting: a rare complication of gonococcal eye infection

Sexually transmitted infections and HIV in ophthalmology

The ocular and periocular manifestations of sexually transmitted infections are heterogeneous in etiology, manifestations, and complications. Etiologic agents include bacteria, viruses, parasites, and protozoa, which are most frequently transmitted via direct ocular contact with an active lesion or infected bodily fluid, autoinoculation, or dissemination from a distant site. Vertical transmission most commonly occurs perinatally during vaginal delivery. The complications of ophthalmia neonatorum can be severe, with the potential for permanent blindness or life-threatening systemic involvement if untreated. Clinical features, diagnostic modalities, and therapeutic regimens vary based on etiology and are summarized in this review. Prompt diagnosis is imperative, given the severe sequelae that may result from ocular involvement in these infections, including permanent vision loss. A multidisciplinary approach, involving both ophthalmology and dermatology, to diagnosis and management is essential to mitigate the risk of morbidity associated with sexually transmitted infections resulting in eye disease.

Ocular Bacterial Infections: A Ten-Year Survey and Review of Causative Organisms Based on the Oklahoma Experience

Ocular infections can be medical emergencies that result in permanent visual impairment or blindness and loss of quality of life. Bacteria are a major cause of ocular infections. Effective treatment of ocular infections requires knowledge of which bacteria are the likely cause of the infection. This survey of ocular bacterial isolates and review of ocular pathogens is based on a survey of a collection of isolates banked over a ten-year span at the Dean McGee Eye Institute in Oklahoma. These findings illustrate the diversity of bacteria isolated from the eye, ranging from common species to rare and unique species. At all sampled sites, staphylococci were the predominant bacteria isolated. Pseudomonads were the most common Gram-negative bacterial isolate, except in vitreous, where Serratia was the most common Gram-negative bacterial isolate. Here, we discuss the range of ocular infections that these species have been documented to cause and treatment options for these infections. Although a highly diverse spectrum of species has been isolated from the eye, the majority of infections are caused by Gram-positive species, and in most infections, empiric treatments are effective.

Five-year review of ocular Neisseria gonorrhoeae infections presenting to ophthalmology departments in Greater Glasgow & Clyde, Scotland

INTRODUCTION

As gonococcal infections continue to increase, we wanted to review the number and clinical course of recent ocular gonococcal cases presenting to ophthalmology departments in NHS Greater Glasgow and Clyde.

METHODS

A 5-year retrospective review of adult ocular gonococcal cases, where the diagnosis of Neisseria gonorrhoeae was made on microbiological culture, was undertaken.

RESULTS

Fifteen cases were identified (80% male). Average age was 26 years (range 17-42; median 24). Most common presenting features included purulent discharge (14/15; 93%), haemorrhagic conjunctivitis (10/15; 67%) and pre-septal cellulitis (9/15; 60%). Corneal involvement was documented in 5 (33%), with marginal ulceration in 1 (7%) but none had corneal perforation. Most common systemic treatment was IV ceftriaxone, alone or in combination with another antibiotic (6/15; 40%), followed by IM ceftriaxone, alone or in combination with another antibiotic (5/15; 33%). Median time from presentation to treatment was 1 day (0-23). All patients were referred or recommended to attend sexual health services. Seven patients (47%) attended and received complete sexually transmitted infection (STI) testing and contact tracing: 3 patients had systemic treatment initiated or changed at this visit and 1 patient had concurrent syphilis identified.

CONCLUSIONS

This series confirms purulent conjunctivitis and cellulitis as the main presenting features of ocular gonococcal infection requiring hospital review. Early identification with appropriate systemic antibiotic treatment avoided corneal melting in this cohort. As concurrent STIs were identified and/or treatments changed in 4/7 (57%) following sexual health review, we recommend a shared care approach between ophthalmology, microbiology and sexual health services to effectively address all management issues.

In Vitro Models of Eye Infection with Neisseria gonorrhoeae

Prophylaxis with silver nitrate and later antibiotics has significantly reduced the cases of infant blindness from gonococcal infection at birth to the point where it has all but been forgotten in the developed world as the devastating disease that it was in the pre-antibiotic era. As a result, while it is known that the bacteria are transmitted to the eyes during passage through the infected birth canal, little is known about Neisseria gonorrhoeae colonization of the eye and the establishment and progression of keratitis. Treatment failures due to rising antimicrobial resistance necessitate investigations into all aspects of gonococcal disease, including eye infections, so that new treatment strategies can be developed. Here we present models for N. gonorrhoeae eye infection using excised bovine corneas and coculture of gonococci with primary human corneal epithelial cells. These models can be used to explore the interactions of the bacteria with corneal tissues and cells and to investigate novel therapeutics against infection.

[Autokeratoplasty in perforation of the ectatic leukoma of the only functionally perspective eye]

Treatment and rehabilitation of patients with destructive lesions of the cornea is a serious problem for ophthalmologists due to severity of the outcome of the disease - the formation of leukomas with a persistent decrease in vision, or even a complete loss of visual functions. The article presents a clinical case of a patient with posttraumatic ectaticized leukoma of the functionally promising eye, which course was complicated by perforation. The authors, in the absence of the donor cornea, faced a complex clinical task - the risk of functional and anatomical death of the single eyeball in the absence of adequate care for the patient. After enucleation of the subatrophic blind right eye, we took a corneal specimen with a scleral rim of 12 mm trepan. To collect the material, we used an original method of introducing viscoelastic into the vitreal cavity of the hypotonic enucleated eyeball through the intersected optic nerve. This allowed to create the normotony of the enucleated eyeball and perform trepanation of the corneoscleral disc. Trepanation of the sharply ectatic cornea of the left eye was performed after paracentesis and massage of the dome of ectatic cornea with a spatula, which led to the 'subsidence' of the hyperinflated tissue. The corneoscleral disc was fixated with interrupted suture with a 9-0 thread. The postoperative period proceeded smoothly. The autograft has taken with active vascularization. For optical rehabilitation, the patient is scheduled to undergo a keratoprosthetic operation in a planned manner.

Adult conjunctivitis secondary to dual infection with Chlamydia trachomatis and Neisseria gonorrhoeae - A case report

PURPOSE

Although Chlamydia trachomatis and Neisseria gonorrhoeae are the commonest sexually transmitted infections in England, reports of ocular co-infection in the literature are limited. We report such a case which responded well to treatment, and discuss the literature and evidence currently available with regards to management of these cases.

OBSERVATIONS

The patient is a 48-year-old bisexual gentleman who presented to the eye clinic of a UK hospital with redness, discharge and blurred vision in his left eye for one week. Initially he had mucopurulent discharge but his cornea was clear. He did not comply with prescribed treatment and returned two days later with bilateral symptoms and corneal thinning in his left eye peripherally.PCR tests for Chlamydia trachomatis and Neisseria gonorrhoeae were positive and the patient was commenced on intravenous ceftriaxone, oral and topical levofloxacin eye drops. After 48 hours of inpatient treatment the patient showed clinical improvement.

CONCLUSIONS AND IMPORTANCE

Ophthalmologists should be aware of the possibility that Chlamydia trachomatis and Neisseria gonorrhoeae can cause co-infection in adult conjunctivitis, and of the straightforward method of treatment for such individuals. Delayed diagnosis and treatment of affected patients can lead to corneal complications and potential blindness. It is advisable to discuss these cases with the local microbiology service wherever possible, and referral to a sexual health service is imperative.