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Kamath GM, Jeganathan S, Salim S, Antony RM, Kamath AR, Hiran H. Comment on: Case series of central retinal artery occlusion in COVID-19-associated rhino-orbito-cerebral mucormycosis. Indian J Ophthalmol 2024; 72:755-756. [PMID: 38648440 DOI: 10.4103/ijo.ijo_2538_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Affiliation(s)
- Gurudutt M Kamath
- Department of Ophthalmology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sangeetha Jeganathan
- Department of Ophthalmology, Kasturba Medical College, Attavar, Mangalore, Karnataka, India
| | - Sreelakshmi Salim
- Department of Ophthalmology, Kasturba Medical College, Attavar, Mangalore, Karnataka, India
| | - Reeja Mariam Antony
- Department of Ophthalmology, Kasturba Medical College, Attavar, Mangalore, Karnataka, India
| | - Ajay R Kamath
- Department of Ophthalmology, Kasturba Medical College, Attavar, Mangalore, Karnataka, India
| | - Harshitha Hiran
- Department of Ophthalmology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Lambert LH, Finger GE, Tompkins BL. Case Report: Vision-Threatening Fungal Keratitis in a Service Member Stationed at Guantanamo Bay. Mil Med 2024; 189:379-383. [PMID: 37329331 DOI: 10.1093/milmed/usad222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/20/2023] [Accepted: 06/02/2023] [Indexed: 06/19/2023] Open
Abstract
Fungal keratitis is a major cause of corneal blindness worldwide. Compared to other types of infectious keratitis, fungal keratitis has a relatively poor prognosis because of various factors such as delayed patient presentation and diagnosis. Although associated in earlier studies with poverty and low socioeconomic status, military personnel stationed in tropical and subtropical climates, in low-resource settings, are at risk. Here, we report a case of a 20-year-old active duty contact lens-wearing military service member stationed at Guantanamo Bay who developed a severe vision-threatening fungal keratitis in her left eye. Enhancing health and safety precautions in at-risk settings, maintaining vigilance, and leveraging new imaging modalities will be important to ensure early recognition and treatment.
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Affiliation(s)
- Lester H Lambert
- Department of Ophthalmology, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA
| | - Gabriella E Finger
- Optometry Department, Naval Hospital Guantanamo Bay, Hospital Point Road, Guantanamo Bay, Cuba
| | - Brett L Tompkins
- Department of Ophthalmology, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA
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Öner SZ, Küçükakın Yaka S, Akçaoğlu T, Vural C, Yılmaz U, Ergin Ç. [Fungal Keratitis Associated with Curvularia lunata: First Case Report from Türkiye]. MIKROBIYOL BUL 2023; 57:690-697. [PMID: 37885397 DOI: 10.5578/mb.20239957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Fungal keratitis is a medical emergency that is among the most common causes of blindness in developing countries. The type of the agent may vary depending on the geographical conditions under which the patient lives, trauma exposure, the use of contact lenses and profession. Curvularia spp. is a saprophytic genus that rarely causes systemic disease in humans and has 250 species identified to date. They proliferate in soil and plants and spread to the environment with their spores and the formation of blackish and fluffy colonies is its most well-known morphological feature. There may be difficulties in cultivating brown (dematiaceous) fungi. Due to the similarity between the genera, conventional methods remain inadequate for diagnosis. In this report, a case of fungal keratitis associated with C.lunata was presented. Seventy-five years-old female patient admitted to the hospital with the symptoms of stinging pain, blurred vision, and swelling in the right eye. Her symptoms had begun four days ago after her eye was hit by a plant. The patient who had a history of peripheral neuropathy due to diabetes mellitus (DM) was hospitalized with a preliminary diagnosis of keratitis, and in the cultures of the patient's corneal scraping samples, the filamentous, black pigment-forming colonies of the pathogen growing on 5% sheep blood agar and potato dextrose agar showing an aerial hyphal structure, were stained with lactophenol cotton blue and examined under the microscope. The microscopic examination revealed geniculate conidiophores with brown pigmentation. On top of these structures were tetralocular macroconidia, one of which appeared to be larger than the main axis. The fungus was subjected to molecular identification with the prediagnosis of Curvularia/Bipolaris. DNA extraction of the ITS region polymerase chain reaction amplification and Sanger sequencing were performed for molecular identification. Sanger sequencing identified the agent to be Curvularia lunata with a similarity rate of 99.79% (NCBI-GenBank Nucleotide ID: OR365075). In vitro antifungal susceptibility of C.lunata was evaluated by microdilution method. Itraconazole and amphotericin B showed higher activity against C.lunata compared to other antifungals while fluconazole was the least active antifungal. Intrastromal and subconjunctival voriconazole injection was applied to the patient who was unresponsive to empirically initiated oral moxifloxacin and different topical treatments (vancomycin, ceftazidime, flucanozole, ganciclovir, cyclopentolate hydrochloride, hyaluronic acid and trehalose). After injection, right penetrating keratoplasty was applied due to increased thinning of the ulcerated area. No pathogen was detected in cultures taken after keratoplasty. Rare fungi should be considered in cases of keratitis that are difficult to treat. Fungal keratitis caused by brown fungi are clinically similar to each other and effective treatment protocols cannot be implemented without a species identification. Identification of the pathogen will enable genus-specific treatment. This will also help prevent complications that may occur. This article aims to present a case of fungal keratitis associated with C.lunata.
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Affiliation(s)
- Sedef Zeliha Öner
- Pamukkale University Faculty of Medicine, Department of Medical Microbiology, Denizli, Türkiye
| | - Saniye Küçükakın Yaka
- Pamukkale University Faculty of Medicine, Department of Medical Microbiology, Denizli, Türkiye
| | - Tahsin Akçaoğlu
- Pamukkale University Faculty of Medicine, Department of Ophtalmology, Denizli, Türkiye
| | - Caner Vural
- Pamukkale University Faculty of Science and Arts, Department of Biology, Molecular Biology Section, Denizli, Türkiye
| | - Uğur Yılmaz
- Pamukkale University Faculty of Medicine, Department of Ophtalmology, Denizli, Türkiye
| | - Çağrı Ergin
- Pamukkale University Faculty of Medicine, Department of Medical Microbiology, Denizli, Türkiye
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Yoon SJ, Kim SH, Bahk HJ, Ahn YS, Lee JJ, Kim HJ, Lim HJ, Choi MJ, Shin JH, Lee YK. Fungal Endophthalmitis Outbreak after Cataract Surgery, South Korea, 2020. Emerg Infect Dis 2022; 28. [PMID: 36285883 PMCID: PMC9622257 DOI: 10.3201/eid2811.220361] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In November 2020, an unusual increase in fungal endophthalmitis cases after cataract surgery was reported to the Korea Disease Control and Prevention Agency, South Korea. We initiated an outbreak investigation to identify the cause. We identified 156 cases nationwide, 62 confirmed and 94 probable. Most case-patients were exposed during surgery to ocular viscoelastic devices (OVDs) from the same manufacturer (company A). We isolated Fusarium spp. from 50 confirmed cases. Molecular identification of 39 fungal isolates from clinical samples and 13 isolates from OVDs confirmed F. oxysporum caused the infections. The risk ratio for fungal endophthalmitis from company A’s OVDs was 86.0 (95% CI 27.4–256.9), much higher than risk from other manufacturers’ products. We determined this fungal endophthalmitis outbreak was caused by a contaminated lot of OVDs and recommended discontinued use of this product. Early recognition of outbreaks and joint responses from related government agencies can reduce risk for fungal endophthalmitis.
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Goel R, Arora R, Shah S, Chhabra M, Kumar J, Khurana N, Gupta S, Khanam S, Kumar S, Singh S, Meher R, Thakar M, Garg A. Clinico-Radiological-Pathological Correlation of Visual Loss in COVID-Associated Rhino-Orbito-Cerebral Mucormycosis. Ophthalmic Plast Reconstr Surg 2022; 38:242-249. [PMID: 34919070 PMCID: PMC9093237 DOI: 10.1097/iop.0000000000002112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To correlate the clinical, radiological, and histopathological features in Covid-associated Rhino-orbito-cerebral mucormycosis cases presenting with acute visual loss. DESIGN Cross-sectional study. METHODS Covid-associated Rhino-orbito-cerebral mucormycosis cases with unilateral visual loss, planned for exenteration, underwent orbital and ophthalmological ocular examination. The available radiological sequences, doppler ultrasonography and histopathology findings were correlated with clinical manifestations. RESULTS The median age was 51 years and the male: female ratio was 3:1. All except one presented with unilateral ophthalmoplegia. The ocular media were hazy in 2 eyes. In 8 eyes, retinal changes were suggestive of occlusion of CRA (6), combined occlusion of CRA and central retinal vein (1), and myopic degeneration with hypertensive retinopathy (1). The contralateral eye showed retinal ischemic changes in one patient. Radiological imaging showed orbital apex involvement in the 10 affected eyes and one contralateral eye. Ipsilateral cavernous sinus thrombosis, diffusion restriction on MRI of optic nerve, internal carotid artery narrowing/thrombosis, and cortical watershed infarcts were seen in 8, 4, 4, and 2 cases, respectively. The blood flow in CRA and ophthalmic artery was absent or reduced in all the 10 affected eyes and in 1 contralateral eye. On histopathology, orbital fat necrosis, fungal hyphae, acute inflammation, granuloma formation, ischemic thrombosis of ophthalmic artery was observed in 10 specimens. CRA was patent in 9 and thrombosed in 1 eye. Optic nerve was ischemic in 8 and viable in 2 eyes. CONCLUSION Acute visual loss in ROCM cases is associated with orbital apex involvement and thrombotic ischemia of ophthalmic artery. Cessation of flow in CRA possibly occurs secondary to ophthalmic artery thrombosis.
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Affiliation(s)
- Ruchi Goel
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Ritu Arora
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Shalin Shah
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Mohit Chhabra
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Jyoti Kumar
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Swati Gupta
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Samreen Khanam
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Sumit Kumar
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Sonam Singh
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Ravi Meher
- Department of Otorhinolaryngology, Maulana Azad Medical College, New Delhi, India
| | - Meenakshi Thakar
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Anju Garg
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
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Chung IY, Tavassoli S, Wong N, Cleary G. Vitamin A deficiency presenting with fungal keratitis and bilateral corneal perforations. BMJ Case Rep 2022; 15:e247853. [PMID: 35288431 PMCID: PMC8921861 DOI: 10.1136/bcr-2021-247853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- In Young Chung
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Ophthalmology, Austin Health, Heidelberg, Victoria, Australia
| | - Shokufeh Tavassoli
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Ophthalmology, Royal United Hospital NHS Trust, Bath, UK
| | - Nathan Wong
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Ophthalmology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Georgia Cleary
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
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Kaplan NM, Al-Dwairi RA, AlRabadi NN. Fungal keratitis due to Scopulariopsis brevicaulis and a potential promising therapeutic effect of antibacterial agents: A case report. Medicine (Baltimore) 2021; 100:e28203. [PMID: 34889303 PMCID: PMC8663826 DOI: 10.1097/md.0000000000028203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Microbial keratitis is a serious potentially blinding corneal infection. Contact lens wear remains the most common predisposing factor. Fungal keratitis represent only a small fraction of the overall number of cases of contact lens-associated microbial keratitis, however they are proportionally more severe. PATIENT CONCERNS An 18-year-old female, who occasionally used eye cosmetic soft contact lenses, presented with pain, redness, and blurring of vision in her left eye. DIAGNOSIS The left eye showed decreased visual acuity, central corneal ulcer and abscess, and severe ciliary injection. A provisional diagnosis of infectious keratitis was considered. INTERVENTION Corneal scrapings were aseptically collected and directly inoculated onto sterile bacterial and fungal agar plates that were immediately incubated. The patient was admitted and started on topical and systemic antibacterial agents. OUTCOMES The infection showed signs of satisfactory clinical resolution. However, the mold Scopulariopsis brevicaulis was isolated in pure colonies 5 days after presentation. CONCLUSION We report the first case from Jordan of fungal keratitis caused by the mold S brevicaulis. A high index of suspicion is required for fungal keratitis caused by S brevicaulis in immunocompetent patients who wear contact lenses despite its rarity. This fungal infection was successfully treated using antibacterial agents. However, larger studies are recommended to investigate the clinical effectiveness of antimicrobial agents that have both antibacterial and antifungal effects and to assess their role as empirical therapeutic modalities for infectious keratitis.
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Affiliation(s)
- Nasser M. Kaplan
- Department of Pathology and Microbiology, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Rami A. Al-Dwairi
- Department of Special Surgery (Ophthalmology), King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Nasr N. AlRabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Abstract
Mucormycosis is an aggressive and deadly fungal infection, which is invariably associated with an immunocompromised patient. Mucormycosis in the head and neck region presents as skeletal necrosis, with or without soft tissue involvement. Early identification and treatment with combination of surgical debridement and parenteral antifungal therapy is critical for a favourable outcome. This paper reports an unusual presentation of mucormycosis, mimicking a localised sino-orbital pathology involving the infraorbital subcutaneous tissue and the maxillary sinus, in a 35 years old immunocompetent man. Despite aggressive antifungal therapy and surgical management, the course of disease was fatal, reiterating the high mortality associated with mucormycosis.
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Affiliation(s)
- Anuj Dadhich
- Department of Oral and Maxillofacial Surgery, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Kumar Nilesh
- Oral and Maxillofacial Surgery, Krishna Institute of Medical Sciences Deemed University, Karad, India
| | - Rahul Patil
- Oral Pathology, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Harish Saluja
- OMFS, Pravara Rural Dental College, Ahmednagar, Maharashtra, India
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Affiliation(s)
| | - Ahmed B Sallam
- University of Arkansas for Medical Sciences, Little Rock, AR
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10
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Prajna NV, Srinivasan M, Mascarenhas J, Lalitha P, Rajaraman R, McClintic SM, O'Brien KS, Ray KJ, Acharya NR, Lietman TM, Keenan JD. Visual Impairment in Fungal Versus Bacterial Corneal Ulcers 4 Years After Successful Antimicrobial Treatment. Am J Ophthalmol 2019; 204:124-129. [PMID: 30902692 PMCID: PMC8075352 DOI: 10.1016/j.ajo.2019.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 02/19/2019] [Accepted: 03/07/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare longitudinal outcomes of visual acuity after fungal corneal ulcers with those of bacterial ulcers. DESIGN Prospective cohort study. METHODS This study was conducted in a tertiary eye hospital in South India. The population consisted of 100 of 152 individuals whose fungal or bacterial keratitis had been diagnosed 4 years prior and had been enrolled in 1 of 2 concurrent randomized trials. Causative organisms of infectious keratitis were either bacterial or fungal. Presenting visual acuity consisted of best spectacle corrected visual acuity (BSCVA) and hard contact lens-corrected visual acuity (CLVA). RESULTS Fifty study participants with prior fungal keratitis and 50 with prior bacterial keratitis were enrolled. Four years after treatment for keratitis, participants' presenting vision in the better eye was worse than 20/60 for 12 individuals (24.0%) in the fungal group and 10 individuals (20.0%) in the bacterial group. Median BSCVA in the affected eye at the 4-year visit in the fungal group was similar to that in the bacterial group (Snellen equivalent, 20/32 for each), although vision worse than 20/400 was more common in the fungal ulcer group after spectacle correction (odds ratio [OR] 4.19; 95% confidence interval [CI], 1.11-15.8) and contact lens correction (OR, 5.74; 95% CI, 1.37-24.1). CONCLUSIONS In this South Indian population with a previous episode of fungal or bacterial keratitis, correctable bilateral visual impairment was common. Although long-term visual outcomes were, on average, similar between fungal and bacterial ulcers, fungal ulcers were more likely to produce severe visual impairment.
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Affiliation(s)
| | - Muthiah Srinivasan
- Department of Cornea and External Diseases, Aravind Eye Care System, Madurai, India
| | - Jeena Mascarenhas
- Department of Cornea and External Diseases, Aravind Eye Care System, Madurai, India
| | - Prajna Lalitha
- Department of Cornea and External Diseases, Aravind Eye Care System, Madurai, India; Department of Ocular Microbiology, Aravind Eye Care System, Madurai, India
| | - Revathi Rajaraman
- Department of Cornea and External Diseases, Aravind Eye Care System, Coimbatore, India
| | - Scott M McClintic
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Kieran S O'Brien
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Kathryn J Ray
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Nisha R Acharya
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA; Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Thomas M Lietman
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA; Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jeremy D Keenan
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA; Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA.
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Abstract
RATIONALE Scedosporium species is rare pathogen of ocular infection. The accurate diagnosis is delaying in many cases and the clinical prognosis is poor due to its resistance to antifungal agents. This report describes a patient with infectious scleritis and corneal ulcer caused by Scedosporium auranticum infection who required enucleation to control the infection. PATIENT CONCERNS A 70-year-old woman visited our clinic after experiencing ocular discomfort in her right eye for 4 days after minor ocular trauma, with soil exposure. DIAGNOSES Scedosporium species was isolated from a culture of corneal tissue, Scedosporium aurantiacum was identified in a culture of necrotic tissue. INTERVENTIONS She was started on treatment with antifungal agents, including topical amphotericin B and systemic fluconazole, but her ocular condition did not improve. Although the lesion showed temporary improvement, ocular pain and corneal ulcer recurred 3 months later. Evisceration was performed due to corneal perforation, and enucleation was also performed for dehiscence of the conjunctiva and scleral necrosis. OUTCOMES After enucleation, postoperative systemic voriconazole treatment controlled the infection without recurrence. LESSONS S aurantiacum keratitis is difficult to eradicate, even with several months of treatment with systemic and topical antifungal agents, and tends to progress to scleritis. The infection can be terminated by the orbital enucleation. Infection with this rare organism should be included in the differential diagnosis of patients with severe infectious keratitis.
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Affiliation(s)
- Hyuna Kim
- Department of Ophthalmology, Gyeongsang National University Hospital
| | - Ja-Young Ahn
- Department of Ophthalmology, Gyeongsang National University Hospital
| | - In-Young Chung
- Department of Ophthalmology, Gyeongsang National University Hospital
- Department of Ophthalmology, School of Medicine and Institute of Health Science, Gyeongsang National University, Jinju
| | - Seong-Wook Seo
- Department of Ophthalmology, Gyeongsang National University Hospital
- Department of Ophthalmology, School of Medicine and Institute of Health Science, Gyeongsang National University, Jinju
| | - Woong-Sun Yoo
- Department of Ophthalmology, Gyeongsang National University Hospital
| | - Jong Hee Shin
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seong-Jae Kim
- Department of Ophthalmology, Gyeongsang National University Hospital
- Department of Ophthalmology, School of Medicine and Institute of Health Science, Gyeongsang National University, Jinju
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Debureaux PE, Paccoud O, Guitard J, Baujat B, Ruggeri A, Battipaglia G, Duléry R, Giannotti F, Malard F, Mohty M, Brissot E. Rhino-orbital Mucormycosis presenting as facial cellulitis in a patient with high-risk acute myeloid leukemia in relapse. Curr Res Transl Med 2019; 67:76-78. [PMID: 30686650 DOI: 10.1016/j.retram.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/13/2019] [Accepted: 01/15/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Pierre-Edouard Debureaux
- Sorbonne Université, Université Pierre et Marie Curie, Paris, France; AP-HP, Hôpital Saint-Antoine, Service d'Hématologie Clinique, F-75012, Paris, France
| | - Olivier Paccoud
- Sorbonne Université, Université Pierre et Marie Curie, Paris, France; AP-HP, Hôpital Saint-Antoine, Service des maladies infectieuses et tropicales, F-75012, Paris, France
| | - Juliette Guitard
- Sorbonne Université, Université Pierre et Marie Curie, Paris, France; AP-HP, Hôpital Saint-Antoine, Laboratoire de Parasitologie-Mycologie, F-75012, Paris, France
| | - Bertrand Baujat
- Sorbonne Université, Université Pierre et Marie Curie, Paris, France; AP-HP, Hôpital Tenon, Service de chirurgie ORL, F-75020, Paris, France
| | - Annalisa Ruggeri
- AP-HP, Hôpital Saint-Antoine, Service d'Hématologie Clinique, F-75012, Paris, France
| | - Giorgia Battipaglia
- Sorbonne Université, Université Pierre et Marie Curie, Paris, France; AP-HP, Hôpital Saint-Antoine, Service d'Hématologie Clinique, F-75012, Paris, France
| | - Rémy Duléry
- AP-HP, Hôpital Saint-Antoine, Service d'Hématologie Clinique, F-75012, Paris, France
| | - Federica Giannotti
- Sorbonne Université, Université Pierre et Marie Curie, Paris, France; AP-HP, Hôpital Saint-Antoine, Service d'Hématologie Clinique, F-75012, Paris, France
| | - Florent Malard
- Sorbonne Université, Université Pierre et Marie Curie, Paris, France; AP-HP, Hôpital Saint-Antoine, Service d'Hématologie Clinique, F-75012, Paris, France; INSERM, UMR S 938,Centre de Recherche Saint-Antoine (CRSA), F-75012 Paris, France
| | - Mohamad Mohty
- Sorbonne Université, Université Pierre et Marie Curie, Paris, France; AP-HP, Hôpital Saint-Antoine, Service d'Hématologie Clinique, F-75012, Paris, France; INSERM, UMR S 938,Centre de Recherche Saint-Antoine (CRSA), F-75012 Paris, France
| | - Eolia Brissot
- Sorbonne Université, Université Pierre et Marie Curie, Paris, France; AP-HP, Hôpital Saint-Antoine, Service d'Hématologie Clinique, F-75012, Paris, France; INSERM, UMR S 938,Centre de Recherche Saint-Antoine (CRSA), F-75012 Paris, France.
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13
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Abstract
Since 1991 we have been gaining experience in the surgical removal of submacular subretinal membranes in patients with presumed ocular histoplasmosis syndrome (POHS), idiopathic subretinal neovascularisation, myopia and age-related macular degeneration (AMD). Seventeen patients were operated between 1991 and 1993. Significant improvement of vision was achieved in 4 out of 5 patients with POHS, 3 out of 5 with idiopathic neovascularisation, 2 out of 4 with myopia but none of 3 patients with AMD. The results suggest that subretinal neovascularisation can be successfully removed in POHS and in some forms of idiopathic neovascularisation and myopia but probably not in AMD.
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Affiliation(s)
- S Maas
- Institute of Ophthalmology, St. Radboud Hospital, Nijmegen, The Netherlands
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Zbiba W, Bouayed E, Ben Abdesslem N, Elleuch I, Kharrat M. Ophtalmoplegia complicating sino-orbital mucormycosis. Tunis Med 2018; 96:224-226. [PMID: 30325492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To report a case of complete ophthalmoplegia and blindness in sino-orbital mucormycosis. CASE REPORT A 68-year-old woman with history of diabetes and breast cancer presented with sudden onset of fever, orbital pain and blindness in the right eye. The patient was found to have no light perception, complete ophthalmoplegia, chemosis, corneal ulcer and optic nerve atrophy. In rhinologic examination, necrosis was noticed. Brain and orbit magnetic resonance imaging showed diffuse sinusitis with orbital involvement. The result of the clinical examination was reported as sino-orbitalmucormycosis. The diagnosis was confirmed by pathological specimens. The patient underwent extensive surgical debridement and systemic antifungal treatment. Despite treatment, visual acuity did not recover. CONCLUSION The sino-orbital form of mucormycosis is a rare and insidious fungal infection. Ocular findings may range from orbital pain to ophtalmoplegia and blindness such as in our case. Black scar tissues seen on the nasal mucosa are pathognomonic. Delay in treatment due to late presentation and complications were major determinants in ocular prognosis and survival outcome.
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Seo JH, Kim JA, Choi B, Kim KH, Park HN, Seok H, Sohn TS. Hyperglycemic hyperosmolar state associated with invasive rhino-orbital aspergillosis in a patient with end-stage renal disease. Korean J Intern Med 2017; 32:936-938. [PMID: 26968192 PMCID: PMC5583439 DOI: 10.3904/kjim.2015.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/01/2015] [Accepted: 06/16/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Tae Seo Sohn
- Correspondence to Tae Seo Sohn, M.D. Department of Internal Medicine, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, 271 Cheonboro, Uijeongbu 11765, Korea Tel: +82-31-820-3652 Fax: +82-31-847-2719 E-mail:
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Talukder AK, Sultana Z, Jahan I, Khanam M, Bhuiyan SI, Rahman MB. Management of Infective Corneal Ulcer: Epidemiology Needs To Be Evaluated As Priority Basis. Mymensingh Med J 2016; 25:415-420. [PMID: 27612884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Because of known and unknown etiology, management of ocular devastating situation like corneal ulcer is still a challenge for the Ophthalmologists. The cross sectional study was designed for detection of predisposing factor and identification of causal agent. To serve the above purpose, a cross sectional study was performed among 140 patients of the corneal ulcer at Dr K Zaman BNSB Eye Hospital, Mymensingh and Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh. Detail history of patient was taken and recorded in a pretest questionnaire sheet. Two pieces of sample were collected from each corneal ulcer patient. One sample was examined in KOH wet mount for fungus. Other sample was nourished into nutrient broth and for further culture and identification. Bacterial corneal ulcer was higher among the patient of age group ≥46 years (61.9%) followed by 31-45 years (21.5%). P value is 0.261. Males were found predominant (58.5%). P value is 0.13. Agricultural related work was identified as most risky occupation in 83.1% of the total bacteria positive samples. P value is 0.01. Trauma was noted as most predominant influencing factor (56.9%). P value is <0.05. Bacteria were identified in 65(46.4%) and fungus in 40(28.6%) samples. Pseudomonas species were predominant (52.3%) followed by Staphylococcus species (26, 2%) and Streptococcus species (21.5%). No mixed infection was identified. For easier and earlier diagnosis of corneal ulcer, information about epidemiology is very essential. History should be taken meticulously followed by the laboratory procedures.
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Affiliation(s)
- A K Talukder
- Dr Md Abdul Khaleque Talukder, Associate Professor (Ex), Department of Ophthalmology, Mymensingh Medical College, Mymensingh, Bangladesh. E-mail:
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Tangpagasit W, Reanpinyawat T. Outcome of Urgent Penetrating Keratoplasty for Corneal Ulcer at Thammasat University Hospital. J Med Assoc Thai 2016; 99:71-76. [PMID: 27455827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the eye integrity preservation after urgent penetrating keratoplasty (PKP) for corneal ulcer at Thammasat University Hospital. MATERIAL AND METHOD A retrospective review of patients who underwent urgent PKP between September 2005 and January 2015 was conducted. Demographic data, predisposing factors, organisms, indication for surgery, time of urgent corneal graft registry, and preservation rate of eye integrity were analyzed. RESULTS Fifty-five patients (55 eyes) registered for urgent corneal graft registry from eye bank and 22 eyes underwent urgent PKP There were 14 males (63.6%) and 8 females (36.4%). A mean age was 55.9±15.4 years. The most common predisposing factor was ocular trauma in 11 eyes (50.0%) and the most common indication for surgery was severe corneal ulcer in 11 eyes (50.0%). The mean time of urgent corneal graft registiy was 22.1±1 7.2 days (3-70 days). The present study could preserve eye integrity in post urgent PKP in 18 eyes (81.8%). Other 4 eyes (18.2%) could not preserve the eye integrity. In 33 eyes who did not underwent urgent PKP 20 eyes (60.6%) could preserve eye integrity, 10 eyes (30.3%) underwent primary evisceration and 3 eyes (9.1%) underwent primary enucleation due to extensive ocular infection. CONCLUSION Urgent PKP of corneal ulcer could provide satisfactory in eye integrity preservation.
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Burek A, Turno-Kręcicka A. [Diagnostic challenges in presumably endogeneous fungal endophthalmitis]. Klin Oczna 2016; 118:250-253. [PMID: 30088393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Endogenous fungal endophthalmitis is a vision-threatening condition. Fungi are responsible for most cases of endogenous endophtalmitis, with intravenous catheters, bladder catheters, parenteral nutrition, abdominal surgery, long-term use of steroids and antibiotics, as well as immunosuppressive therapy known as its predisposing factors. Three cases of endogenous endophthalmitis in patients with predisposing factors.
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Abstract
Advanced purulent corneal ulcer, as well as abscess, is a serious vision-threatening condition notable for its fulminant course and possible loss of the eye due to endophthalmitis. Its leading causes, pathogenesis, and classifications are described and analyzed in this paper.
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Affiliation(s)
- Evg A Kasparova
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - Evg A Kasparova
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
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Xue C, Xia Y, Chen Y, Yang L, Huang Z. [Treatment of large corneal perforations with acellular multilayer of corneal stromal lenticules harvested from femtosecond laser lenticule extraction]. Zhonghua Yan Ke Za Zhi 2015; 51:655-659. [PMID: 26693649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To describe a novel surgical technique for the treatment of large corneal perforations by using acellular multilayer of corneal stromal lenticules. METHODS Prospective study. The acellular tissue used for the repair was harvested from myopic patients during the femtosecond laser (FS) refractive surgery. Informed consent, blood test and donor eligibility were obtained in each case. Three or four layers of lenticules were stacked up and stored at -80°C in pure sterile glycerin. The diameter is 6.0 to 6.5 mm and central thickness was 300 to 400 µm. If the diameter of the corneal ulcer perforation was larger than 3 mm and corneal grafts were not available, we used this kind of patches to seal the perforations. It was a retrospective case series study. Five cases of corneal ulcer perforation were enrolled in this study. One was neuropathic keratitis, one was atopic keratoconjunctivitis, and the other three were fungal keratitis. Acellular multilayer of stromal lenticules were used in these cases for emergent therapy. RESULTS The sealing of the perforation and the re-establishment of the anterior chamber were achieved successfully in all the cases. For the pericentral perforations, visual recovery was achieved. And efficient palliative management was done for the central perforations. CONCLUSIONS The reported technique seems to represent a good alternative emergency procedure for the management of large corneal perforations. It is a very useful method for Chinese hospitals where the shortage of cornea donors is a very serious problem and the amount of FS surgeries are increasing.
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Affiliation(s)
- Chunyan Xue
- Department of Ophthalmology, Nanjing General Hospital of PLA, Nanjing 210002, China
| | - Yuan Xia
- Department of Ophthalmology, Nanjing General Hospital of PLA, Nanjing 210002, China
| | - Yueqin Chen
- Department of Ophthalmology, Nanjing General Hospital of PLA, Nanjing 210002, China
| | - Liping Yang
- Department of Ophthalmology, Nanjing General Hospital of PLA, Nanjing 210002, China
| | - Zhenping Huang
- Department of Ophthalmology, Nanjing General Hospital of PLA, Nanjing 210002, China;
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Antequera P, Garcia-Conca V, Martín-González C, Ortiz-de-la-Tabla V. Multidrug resistant Fusarium keratitis. Arch Soc Esp Oftalmol 2015; 90:382-384. [PMID: 25443198 DOI: 10.1016/j.oftal.2014.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/26/2014] [Accepted: 04/08/2014] [Indexed: 06/04/2023]
Abstract
CASE REPORT We report a case of keratitis in a female contact lens wearer, who developed a deep corneal abscess. The culture of a corneal biopsy scraping was positive for multiresistant Fusarium solani. The patient has a complicated clinical course and failed to respond to local and systemic antifungal treatment, requiring eye enucleation. CONCLUSION Fusarium keratitis may progress to severe endophthalmitis. Clinical suspicion is paramount in order to start antifungal therapy without delay. Therapy is complex due to the high resistance of this organism to usual antifungal drugs.
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Affiliation(s)
- P Antequera
- Servicio de Microbiología, Hospital Universitario San Juan, Alicante, España
| | - V Garcia-Conca
- Servicio de Oftalmología, Hospital Universitario San Juan, Alicante, España
| | - C Martín-González
- Servicio de Microbiología, Hospital Universitario San Juan, Alicante, España
| | - V Ortiz-de-la-Tabla
- Servicio de Microbiología, Hospital Universitario San Juan, Alicante, España.
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Hsiao YC, Tsai IL, Kuo CT, Yang TL. Diagnosis of microsporidial keratitis with in vivo confocal microscopy. J Xray Sci Technol 2013; 21:103-110. [PMID: 23507856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
As a rare cause of microbial keratitis, microsporidial keratitis (MK) is first described in a patient with acquired immunodeficiency syndrome. As increased use of topical steroid creates a localized immunosuppressive environment of the eyes, MK occurs more commonly than expected in immunocompetent patients nowadays. Owing to initial insidious growth of pathogens and nonspecific ocular symptoms of infected patients, its frequent misdiagnosis has posed a major clinical challenge in recent decades. Without appropriate treatments, MK can progress deeply into corneal stroma, anterior and posterior segments, subsequently deteriorating vision severely and ultimately requiring corneal transplant. Related risk factors for the occurrence of MK in immunocompetent individuals include contact lens wear, topical steroid use, previous corneal trauma, and a history of laser refractive surgery. The conventional standard of MK diagnosis is based on a tissue biopsy by superficial corneal scrapping. In vivo confocal laser scanning microscopy can obtain images through the cornea in a plane paralleling to the vertical axis. This approach provides an effective method of identifying tissue layers that correspond to corneal histologic structures. This current study investigates the efficacy of \textit{in vivo} confocal laser scanning microscopy in diagnosing MK in immunocompetent patients. The clinical presentations of enrolled patients, including features of slit lamp biomicroscopy and the histopathological results of corneal scrapping, were described. In these patients, the confocal microscopy identified multiple small intracellular hyper-reflective dots in the cytoplasm of corneal epithelial cells and stromal keratocytes. Additionally, the confocal microscopic images clearly revealed the enhanced cytoplasm of cell with intracellular round hyper-reflective dots. The size and morphology of hyper-reflective dots were compatible with the spores of microsporidia found in corneal tissue. Moreover, vision recovered after topical use of antimicrobial medicine. This observation suggests that in vivo confocal laser scanning microscopy provides a rapid, non-invasive, and high resolution scheme for diagnosing MK. In addition to diminishing the risk of secondary infection from epithelial defect created by superficial debridement, this approach facilitates early diagnosis and appropriate treatments. Furthermore, from a series of images taken during the clinical courses, this method is highly promising for use in monitoring treatment effects and identifying the recurrence of MK.
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Affiliation(s)
- Ya-Chuan Hsiao
- Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, Taipei, Taiwan
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Sa HS, Ko KS, Woo KI, Peck KR, Kim YD. A case of sino-orbital infection caused by the Schizophyllum commune. Diagn Microbiol Infect Dis 2012; 73:376-7. [PMID: 22673964 DOI: 10.1016/j.diagmicrobio.2012.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 05/04/2012] [Accepted: 05/05/2012] [Indexed: 11/19/2022]
Abstract
Schizophyllum commune, a basidiomycetous fungus, is a rare cause of mycotic disease in humans. We describe the first case of sino-orbital infection caused by S. commune in an immunocompetent woman who presented with maxillary sinusitis and inferior orbital tumor. Identification of the organism was confirmed by rRNA sequencing.
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MESH Headings
- Adult
- DNA, Fungal/chemistry
- DNA, Fungal/genetics
- DNA, Ribosomal/chemistry
- DNA, Ribosomal/genetics
- DNA, Ribosomal Spacer/chemistry
- DNA, Ribosomal Spacer/genetics
- Eye Infections, Fungal/complications
- Eye Infections, Fungal/diagnosis
- Female
- Genes, rRNA
- Head/diagnostic imaging
- Humans
- Microscopy
- Mycoses/diagnosis
- Mycoses/microbiology
- RNA, Fungal/genetics
- RNA, Ribosomal/genetics
- RNA, Ribosomal, 5.8S/genetics
- Schizophyllum/isolation & purification
- Sequence Analysis, DNA
- Sinusitis/complications
- Sinusitis/diagnosis
- Tomography, X-Ray Computed
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Affiliation(s)
- Ho-Seok Sa
- Department of Ophthalmology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
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Affiliation(s)
- Yohei Funakoshi
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital, Japan
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Imtirat A, Levy J, Lifshitz T. [Treatment of fungal keratitis by penetrating keratoplasty]. Harefuah 2010; 149:166-194. [PMID: 20684168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Fungal keratitis is basically treated by medications. Several cases of fungal keratitis were reported around the world to have been treated successfully by corneal graft--penetrating keratoplasty (PKP). Studies have shown that PKP is a useful treatment, preserves eye globe integrity, and rehabilitates vision in patients with advanced fungal keratitis. AIM To study the use of penetrating keratoplasty for the treatment of severe fungal keratitis that could not be cured by antifungal medication. METHODS The authors conducted a retrospective analysis of all cases (five cases) of severe fungal keratitis treated and followed-up at the Department of Ophthalmology, Soroka University Medical Center during 2007 and 2008, in which therapeutic PKP was performed. There were one male and 4 females. The age range was between 27 and 78 years. The follow-up period ranged from 4 to 15 months. RESULTS Corneal graft remained clear during follow-up in most patients. There was no recurrence of fungal infection and the visual acuity ranged from counting fingers (FC) from 50 cm to 6/36. Complications in some patients included graft rejection in one patient with re-graft which remained clear during follow-up period of 6 months, another patient had a minimal partial graft rejection and incipient cataract which didn't necessitate further intervention. DISCUSSION AND CONCLUSIONS PKP is an effective treatment for fungal keratitis that does not respond to antifungal medication. Early surgical intervention before deterioration is recommended.
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Affiliation(s)
- A'hed Imtirat
- Department of Ophthatmology, Soroka University Medical Center Ben-Gurion University of the Negev.
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Miller GL, Gupta N, Howarth D, Oestreicher J, Yücel YH. A tale of two corneal tattoos. Can J Ophthalmol 2009; 44:470-2. [PMID: 19606181 DOI: 10.3129/i09-091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Abstract
The authors report a case series of presumed ocular histoplasmosis syndrome (POHS) from India. Patients with progressive diminution of vision and having subretinal neovascularisation (SRNVM) were evaluated thoroughly to look for signs of POHS. Three patients had features suggestive of POHS, which to the best of the authors' knowledge is the first case series reported from India. This study shows that patients with clinical features suggestive of POHS do exist in India. A thorough fundus examination of young adults with supposedly idiopathic SRNVM may help to uncover more cases of POHS in India.
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Affiliation(s)
- Rajesh Sinha
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Postelmans L, Pasteels B, Coquelet P, Caspers L, Verougstraete C, Leys A, Wirix M, Mauget-Faÿsse M, Quanranta M, Snyers B, Smets E. Photodynamic Therapy for Subfoveal Classic Choroidal Neovascularization Related to Punctate Inner Choroidopathy (PIC) or Presumed Ocular Histoplasmosis-Like Syndrome (POHS-Like). Ocul Immunol Inflamm 2009; 13:361-6. [PMID: 16419421 DOI: 10.1080/09273940590951124] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of photodynamic therapy with verteporfin (PDT) for subfoveal classic choroidal neovascularization (CNV) related to punctate inner choroidopathy (PIC) or presumed ocular histoplasmosis-like syndrome (POHS-like). METHODS Retrospective review of 16 eyes from 14 patients with subfoveal classic CNV associated with PIC or POHS-like and treated with PDT. RESULTS The mean visual acuity increased from 4.5/10 (range: 1/10-9/10) to 7/10 (range: 2/10-10/10) after a mean follow-up of 21 months (range: 8-32 months) and a mean number of 2 PDT (range: 1-6). Visual acuity remained stable or improved in 13 of the 16 eyes (81%) and decreased in three. CONCLUSION This nearly two-year follow-up study suggests that PDT could be helpful for patients with subfoveal classic CNV related to PIC or POHS-like.
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Affiliation(s)
- Laurence Postelmans
- Department of Ophthalmology, Centres Hospitaliers Universitaires Brugmann et Saint-Pierre, ULB, Bruxelles, Belgium.
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Saleem M, Rahman A, Afza N. Natamycin treatment of experimental Candida albicans induced keratomycosis in rabbits. W INDIAN MED J 2007; 56:526-529. [PMID: 18646497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The efficacy of topical natamycin 5% was studied using a reproducible model of keratomycosis produced by Candida albicans in the rabbits. METHOD Candida albicans was isolated from infected human eye and 4 x 10(5) cells of the Candida albicans was injected into the corneal stroma of the eyes of 15 rabbits. All eyes developed a corneal ulcer without pretreatment with immunosuppressive agents. Forty-eight hours after inoculation, the animals were divided into two groups: test group I, 10 eyes receiving notamycin drops in a 5% suspension; control group II, five eyes receiving 0.9% normal saline solution. The rabbits' corneas were removed for Candida albicans recovery and placed in 1 ml of sterile 0.9% normal saline solution, minced within two hours with scalpel and thoroughly homogenized with a piston and mortar Serial dilutions of this corneal solution from 10(-1) - 10(-4) were made in 0.9% sterile saline solution and 100 microl aliquots were plated onto tryptic soy agar. All cultures of cornea from the treated eyes were negative after seven days of inoculation while five cultures were still positive in the control eyes at the end of the experiment. RESULT It was found that 5% natamycin was effective in treating experimental Candida albicans induced keratomycosis in rabbits. CONCLUSION It is concluded that natamycin has a significant effect (p < 0.01) against Candida albicans in treating experimental keratomycosis.
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Affiliation(s)
- M Saleem
- Pharmaceutical Research Center, Pakistan Council of Scientific Industrial Research Laboratories Complex, Karachi-75280, Pakistan.
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Almony A, Thomas MA, Atebara NH, Holekamp NM, Del Priore LV. Long-term follow-up of surgical removal of extensive peripapillary choroidal neovascularization in presumed ocular histoplasmosis syndrome. Ophthalmology 2007; 115:540-545.e5. [PMID: 17988741 DOI: 10.1016/j.ophtha.2007.08.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 07/02/2007] [Accepted: 08/29/2007] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To report the long-term visual outcomes of surgical removal of extensive peripapillary choroidal neovascularization associated with presumed ocular histoplasmosis syndrome (POHS). DESIGN Long-term retrospective review. Follow-up ranged from 14 to 139 months (mean, 68). PARTICIPANTS Forty consecutive eyes (in 35 patients) undergoing surgical removal of extensive peripapillary choroidal neovascularization associated with POHS at the Barnes Retina Institute between May 1992 and December 2003 were included in this review. Patient age ranged from 5 to 73 years (median, 34.5). All eyes were ineligible for laser treatment by Macular Photocoagulation Study criteria. INTERVENTION Pars plana vitrectomy and surgical removal of choroidal neovascularization were performed. MAIN OUTCOME MEASURES Determination of Snellen best-corrected visual acuity (BCVA), funduscopic examination, and intravenous fluorescein angiography were done before surgery and at regular intervals after surgery. RESULTS In the 23 eyes with subfoveal extension of peripapillary choroidal neovascularization, preoperative BCVA ranged from 20/25 to counting fingers (CF) at 2 feet (median, 20/200). Final postoperative BCVA ranged from 20/15 to CF at 2 feet (median, 20/50). Of 23 eyes, 18 achieved stable or improved BCVA from the preoperative to the final postoperative examination; only 5 eyes had > or =2 lines of decreased BCVA. Overall, 11 of 23 eyes achieved > or =20/40 BCVA at the final postoperative examination. In the 17 eyes in which choroidal neovascularization remained extrafoveal, preoperative BCVA ranged from 20/20 to 20/400 (median, 20/60). Final BCVA ranged from 20/20 to 20/200 (median, 20/20). Of 17 eyes, 15 achieved stable or improved BCVA from preoperative to final postoperative examination; only 2 eyes had > or =2 lines of decreased BCVA. Overall, 14 of 17 eyes achieved > or =20/40 BCVA at the final postoperative examination. CONCLUSIONS The data from this small retrospective study suggest that surgical removal may provide visual benefit in selected cases of extensive peripapillary choroidal neovascularization associated with POHS. Surgical removal of extensive peripapillary choroidal neovascularization does appear preferable to photoablation. Given the likelihood of multiple treatments with photodynamic therapy or anti-vascular endothelial growth factor therapies, surgical removal provides a potentially efficacious treatment with low recurrence rates and good visual results.
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Affiliation(s)
- Arghavan Almony
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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Submacular Surgery Trials Research Group. Evaluation of minimum clinically meaningful changes in scores on the National Eye Institute Visual Function Questionnaire (NEI-VFQ) SST Report Number 19. Ophthalmic Epidemiol 2007; 14:205-15. [PMID: 17896299 DOI: 10.1080/09286580701502970] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate responsiveness of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) to changes in visual acuity and to provide estimates of minimum clinically meaningful changes in NEI-VFQ scores. METHODS Data were combined from three clinical trials of submacular surgery for subfoveal choroidal neovascularization. Patients who completed NEI-VFQ interviews and visual acuity measurements at baseline and 2 years later contributed data for analysis. Data were analyzed using anchor-based (relating 2-year change in NEI-VFQ to 2-year change in visual acuity using correlation and linear regression) and distribution-based (standardized response mean) methods. RESULTS Of 1,015 patients enrolled, 828 patients completed NEI-VFQ interviews and had visual acuity measurements at baseline and 2 years later. Median age of patients was 75 years (range 18 to 94); all patients had subfoveal choroidal neovascularization in at least one eye. Median overall NEI-VFQ score at baseline was 69.9 (mean, 66.5). Based on anchor-based methods, a 2-line change in visual acuity of the better-seeing eye translated to a 3.4-point change in the overall NEI-VFQ score and from 2.4-point to 7.0-point changes in most subscale scores. The NEI-VFQ was sensitive to both gains and losses in visual acuity; the standardized response mean for the overall NEI-VFQ score in patients with a 2-line gain was 0.6 and for patients with 2-line loss was -0.3. In the subgroup of patients with a 2-line loss of visual acuity in the better-seeing eye, patients who had overall NEI-VFQ scores at baseline greater than the median (59.8) had an standardized response mean of -0.9 for the overall NEI-VFQ score and patients who had overall NEI-VFQ scores at baseline at or below the median had a standardized response mean of 0.2 for the overall NEI-VFQ score. A 4-point change in the overall NEI-VFQ and a 5-point change in individual subscale scores corresponded to a small clinically meaningful change. CONCLUSIONS The NEI-VFQ was responsive to 2-year changes in visual acuity but was less responsive to changes among patients with poorer NEI-VFQ scores at baseline. Based on this analysis, a 4-point change in the overall NEI-VFQ and a 5-point change in individual subscale scores may be considered minimum clinically meaningful within-person changes in NEI-VFQ scores.
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Abstract
PURPOSE To report a case of Aspergillus flavus-induced keratomycotic malignant glaucoma. METHODS A 48-year-old woman presented with a severe corneal ulcer. She had received topical steroids for 10 days before presentation. RESULTS Microbiological studies revealed A. flavus as the offending pathogen. Nonresponsive high intraocular pressure with associated shallow anterior chamber was present. With a diagnosis of keratomycotic malignant glaucoma, the patient underwent therapeutic keratoplasty with cataract extraction with posterior chamber wash. However, there was a recurrence of malignant glaucoma in the postoperative period. Patient underwent limited pars plana vitrectomy. CONCLUSIONS Keratomycotic malignant glaucoma is a rare complication of severe fungal ulcer. We believe that the use of topical steroids in this case probably led to increased fungal penetration, with the formation of a lens-iris fungal mass and subsequent malignant glaucoma. Nonresponse to medical therapy warrants urgent surgical intervention. To the best of our knowledge, Aspergillus-induced keratomycotic glaucoma has never been reported previously. This report also highlights that therapeutic keratoplasty with cataract extraction alone may not be sufficient for management of such cases, and a limited pars plana vitrectomy may be needed.
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Affiliation(s)
- Vandana Jain
- Department of Cornea and External Diseases, Aditya Jyot Eye Hospital Pvt Ltd, Wadala, Mumbai, India.
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Adán A, Navarro M, Casaroli-Marano RP, Ortiz S, Molina JJ. Intravitreal bevacizumab as initial treatment for choroidal neovascularization associated with presumed ocular histoplasmosis syndrome. Graefes Arch Clin Exp Ophthalmol 2007; 245:1873-5. [PMID: 17786466 DOI: 10.1007/s00417-007-0637-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 04/30/2007] [Accepted: 05/07/2007] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To report a case of juxtafoveal choroidal neovascularization in a patient with presumed ocular histoplasmosis syndrome (POHS) who was treated with intravitreal injection of bevacizumab (Avastin) as initial treatment. METHODS A 23-year-old woman with POHS presented with sudden dimness of vision and metamorphopsia in the right eye. The patient was examined with ophthalmoscopy, fluorescein angiography, and optical coherence tomography (OCT). RESULTS Fundus examination, fluorescein angiography, and OCT of the right eye revealed a juxtafoveal choroidal neovascularization. Intravitreal injection of bevacizumab was performed with a postoperative improvement of visual acuity and resolution of the distortion. CONCLUSIONS This case report describes a case of juxtafoveal choroidal neovascularization associated with POHS that responded remarkably well to intravitreal injection of bevacizumab.
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Affiliation(s)
- Alfredo Adán
- Department of Ophthalmology, Hospital Clinic de Barcelona, Universidad de Barcelona, Calle Villarroel 170, 08036 Barcelona, Spain.
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Wakabayashi T, Oda H, Kinoshita N, Ogasawara A, Fujishiro Y, Kawanabe W. Retrobulbar Amphotericin B Injections for Treatment of Invasive Sino-orbital Aspergillosis. Jpn J Ophthalmol 2007; 51:309-11. [PMID: 17660997 DOI: 10.1007/s10384-007-0437-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Accepted: 03/01/2007] [Indexed: 10/23/2022]
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Chung PC, Lin HC, Hwang YS, Tsai YJ, Ngan KW, Huang SCM, Hsiao CH. Matrix metalloproteinases (MMP-8, MMP-9) and the tissue inhibitors of metalloproteinases (TIMP-1, TIMP-2) in patients with fungal keratitis. Cornea 2007; 26:232-4. [PMID: 17251822 DOI: 10.1097/01.ico.0000248384.16896.7d] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To study the infiltrating cells and quantify the levels of matrix metalloproteinases (MMP-8, MMP-9) and tissue inhibitor of metalloproteinases (TIMP-1, TIMP-2) in the cornea, tear, and serum of patients with fungal keratitis. METHODS Experimental study. Infected corneal tissue from 4 patients with fungal keratitis (group 1) scheduled to undergo therapeutic keratoplasty accounted for the histopathologic and cytospin smear analysis. Ten patients with fungal keratitis from group 2 served for the quantification of MMPs and TIMPs. Five patients with keratoconus undergoing penetrating keratoplasty and 5 cadaver corneas were chosen as controls for group 2. Corneal buttons obtained during keratoplasty, 15 to 20 microL of tears collected using the capillary flow method, and 3 mL of blood was obtained from patients with fungal keratitis and patients with keratoconus. Corneal button sections from group 1 were stained with hematoxylin and eosin and Grocott methenamine silver nitrate for the histopathologic studies and Giemsa staining for the cytospin smear analysis. Enzyme-linked immunosorbent assay was used for the quantification of total MMP-8, MMP-9, TIMP-1, and TIMP-2 in the corneal homogenates, tear, and serum samples of group 2. RESULTS Corneal sections from group 1 revealed dense fungal filaments and a large proportion (91.4% +/- 38%) of polymorphonuclear leukocytes (PMNs). Significant elevation in the levels of MMP-8 and MMP-9 (P < 0.05) in the fungal keratitis corneas was observed in group 2 compared with the cadaver and keratoconus corneas. The ratio of MMP/TIMP was also higher in the fungal keratitis corneas. CONCLUSIONS Infiltrating PMNs in the cornea of patients with fungal keratitis contributed to the increased activities of MMP-8 and MMP-9, thereby enhancing tissue destruction and derangement.
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Affiliation(s)
- Pei-Chen Chung
- Department of Ophthalmology, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Ben Salah S, Makni F, Cheikrouhou F, Ben Zina Z, Mlik M, Feki J, Colin J, Ayadi A. [Acanthamoeba keratitis: about the first two Tunisian cases]. Bull Soc Pathol Exot 2007; 100:41-2. [PMID: 17402694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Acanthamoeba keratitis is a rare but severe corneal infection which, despite improvements in diagnosis and treatment, still culminates in prolonged morbidity and significant loss of visual acuity. We present the case report of the first identification of Acanthamoeba as a causative agent of keratitis in Tunisia. Case no 1: A 20-year-old girl, nearsighted corrected with soft contact lenses, suffering from a deep corneal inflammation and poor visual acuity The ophthalmological examination showed bilateral dendritiform epithelial keratitis. The illness did not respond to topical and general antibiotic treatment and developed bilateral corneal abscess. Microscopic examination and culture of samples from cornea scraping revealed the presence of trophozoit and cysts of Acanthamoeba associated with Fusarium oxysporum. As the treatment with local Ketoconazol and antibiotherapy didn't show any result, two transfixiant keratoplasty were carried out and treatment by Désomédine, PHMB (polyhexamethylene biguanide) and Voriconazol was started. After two months, the patient felt better, vision was also improved (2/10) and infiltrates became smaller Case no 2: A 19-year-old girl, nearsighted with soft contact lenses consulted for a bilateral corneal ulceration and poor vision (1/20). Trophozoit and cysts of Acanthamoeba were found in the contact lens solution. She was treated quickly with Désomédine. Visual acuity improved to 7/10 but the corneal ulceration left a residual opacity
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Affiliation(s)
- S Ben Salah
- Service d'ophtalmologie, CHU Habib-Bourguiba, Sfax, Tunisie
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Knopf HLS, Carter K, Council MD, Brantley MA. Peripapillary Hemorrhage. Compr Ophthalmol Update 2007; 8:53-4. [PMID: 17394760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Affiliation(s)
- James Kirszrot
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Boston, MA 02114, USA
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Saperstein DA, Rosenfeld PJ, Bressler NM, Rosa RH, Sternberg P, Aaberg TM, Aaberg TM, Weisberger A. Verteporfin Therapy for CNV Secondary to OHS⁎. Ophthalmology 2006; 113:2371.e1-3. [PMID: 17157140 DOI: 10.1016/j.ophtha.2006.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Accepted: 07/03/2006] [Indexed: 10/23/2022] Open
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Bharathi MJ, Ramakrishnan R, Meenakshi R, Mittal S, Shivakumar C, Srinivasan M. Microbiological diagnosis of infective keratitis: comparative evaluation of direct microscopy and culture results. Br J Ophthalmol 2006; 90:1271-6. [PMID: 16837544 PMCID: PMC1857439 DOI: 10.1136/bjo.2006.096230] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To determine the sensitivity, specificity and predictive values of potassium hydroxide (KOH) wet mount, Gram stain, Giemsa stain and Kinyoun's acid-fast stain in the diagnosis of infective keratitis. METHODS A retrospective analysis of all patients with clinically diagnosed infective keratitis presenting between September 1999 and September 2002 was carried out. Corneal scrapes were taken and subjected to direct microscopy and culture. RESULTS 3298 eyes of 3295 consecutive patients with infective keratitis were evaluated, of which 1138 (34.51%) eyes had fungal growth alone, 1069 (32.41%) had bacterial growth alone, 33 (1%) had Acanthamoeba growth alone, 83 (2.5%) had mixed microbial growth and the remaining 975 (29.56%) had no growth. The sensitivity of KOH wet mount was higher (99.3%; 95% confidence interval (CI) 98.6 to 99.6) in the detection of fungi, 100% (95% CI 90.4 to 100) in the detection of Nocardia and 91.4% (95% CI 75.8 to 97) in the detection of Acanthamoeba) than that of Gram-stained smears (89.2% (95% CI 87.3 to 90.8) in fungi, 87% (95% CI 73.0 to 94.6) in Nocardia and 60% (95% CI 42.2 to 75.6) in the detection of Acanthamoeba) in the detection of fungi, Nocardia and Acanthamoeba. 1764 of 3295 (53.54%) patients presented more than 7 days after onset of illness and 84.69% of the eyes had corneal ulcers with size >2 mm in diameter. Positivities of KOH (44.46%; p<0.001) and Gram-stained smears (77.37%; p<0.001) were found to be higher among eyes with larger ulcers (>2 mm) than among eyes with smaller ulcers (<2 mm). CONCLUSION KOH smear is of greater diagnostic value in the management of infective keratitis, and it is recommended in all clinics without exception for establishing timely treatment.
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Affiliation(s)
- M J Bharathi
- Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India.
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Shokohi T, Nowroozpoor-Dailami K, Moaddel-Haghighi T. Fungal keratitis in patients with corneal ulcer in Sari, Northern Iran. Arch Iran Med 2006; 9:222-7. [PMID: 16859055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Fungal keratitis is a suppurative, ulcerative, and sight-threatening infection of the cornea that sometimes leads to loss of the eye. The objectives of this study were to improve facilities for laboratory diagnosis, to determine the predominant causative microorganisms, and to identify the predisposing factors of mycotic keratitis patients. METHODS A prospective study of corneal ulcer was conducted in Sari between May 2004 and March 2005. Patients who presented with clinically suspected corneal ulcer to the Ophthalmology Department of Bou-Ali Sina University Hospital in Sari were included in this study. Each patient was examined with slit lamp. Data were collected by examining and questioning the patients. Using standard techniques, corneal scraping was performed by an ophthalmologist. The specimens collected were then smeared on two slides, which were stained with Gram stain (for bacterial keratitis) and 10% potassium hydroxide with or without Calcofluor white stain (for fungal keratitis), and studied under light microscope. The specimens were also inoculated directly on blood agar, Sabouraud dextrose agar, and potato dextrose agar in C-shaped streaks. RESULTS A total of 22 patients met the inclusion criteria of this study, among whom 10 (45.5%) were females and 12 (54.5%) were males. The mean +/- SD age of patients was 61.5 +/- 17.7 (range: 15 - 83) years. In direct microscopy, branching, and septate hyphae were identified in 7 (31.8%) patients. Two (28.6%) fungi (Aspergillus fumigatus and Fusarium spp.) were isolated. Five (31.8%) patients with fungal keratitis were males and 2 (28.6%) were females. The mean +/- SD age of patients with fungal keratitis was 60.4 +/- 12.1 (range: 39 - 73) years. Three (42.85%) patients with fungal keratitis were farmers. The mean interval between the onset of symptom and diagnosis was 26.4 (range: 1 - 93) days. Trauma with plant debris and straws were noted in two (28.6%) patients with fungal keratitis. Five (71.4%) patients received topical antibiotics. Analyses, using potassium hydroxide with or without Calcofluor white as the gold-standard test, revealed a sensitivity of 71.4% for potassium hydroxide, and 42.9% for Gram stain. CONCLUSION Infections of the cornea due to filamentous fungi are frequent causes of corneal damage and should always be kept in mind. The direct microscopy method is an essential tool in the diagnosis of fungal keratitis. Therefore, wet mount preparation with potassium hydroxide with or without Calcofluor white or only KOH can be relied upon as the single most important screening test for rapid diagnosis of fungal corneal ulcer.
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Affiliation(s)
- Tahereh Shokohi
- Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
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Pagliani L, Campi L, Cavallini GM. Orbital actinomycosis associated with painful ophthalmoplegia. Actinomycosis of the orbit. Ophthalmologica 2006; 220:201-5. [PMID: 16679798 DOI: 10.1159/000091767] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2004] [Accepted: 06/24/2004] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate a case of orbital actinomycosis presenting as Tolosa-Hunt syndrome in a patient with a history of carcinomas of the kidney and breast. METHODS A woman with ingravescent painful ophthalmoplegia was brought to our observation. Brain and orbital and total body CT scans showed the presence of two orbital neoformations and a miliary pattern of dissemination in the lung. The initial diagnosis, which pointed to secondary localisations of the previous kidney and breast tumours, was changed to orbital and pulmonary actinomycosis following microbiological analysis of lung biopsy samples. RESULTS Prolonged antibiotic therapy with synthetic penicillin completely resolved the case. CONCLUSIONS Actinomycosis is a very rare infection that may also affect the orbit and its association with a pulmonary dissemination is highly unusual. It is important to consider this type of infection among the causes of painful ophthalmoplegia.
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Affiliation(s)
- Livio Pagliani
- Dipartimento Misto di Neuroscienze, Testa, Collo e Riabilitazione, Università degli Studi di Modena e Reggio Emilia, Struttura Complessa di Oftalmologia, Modena, Italia
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Gibold X, Husson A, Corbain V, Vidal M, Gourdon F, Laurichesse H, Beytout J, Irthum P, Ferrier A, Lesens O. Cryptococcose neuroméningée révélée par une baisse de l'acuité visuelle chez un patient atteint de neurosarcoïdose et porteur d'une dérivation ventriculoatriale. Rev Med Interne 2006; 27:330-2. [PMID: 16426708 DOI: 10.1016/j.revmed.2005.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Accepted: 12/06/2005] [Indexed: 11/17/2022]
Abstract
INTRODUCTION HIV infection is the main cause of cryptococcal neuromeningitis but other diseases may be associated with this infection. CASE REPORT We report a case of cryptococcal neuromeningitis in a patient with sarcoidosis and ventriculoatrial shunting. The patient was successfully treated by effective therapy without device withdrawal. CONCLUSION The relationship between cryptococcosis and sarcoïdosis has been already described and may be not fortuitous. However it remains a very rare complication of sarcoidosis. Because of its potential severity (mortality rate of 40%), the diagnosis of cryptococcosis should be evoked as a differential diagnosis of neuro-sarcoidosis.
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Affiliation(s)
- X Gibold
- Service des Maladies Infectieuses et Tropicales, Hôtel-Dieu, CHU, 63000 Clermont-Ferrand, France
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Kaliamurthy J, Jesudasan CAN, Prasanth DA, Thomas PA. Keratitis due to Cylindrocarpon lichenicola. J Postgrad Med 2006; 52:155-7. [PMID: 16679691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
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Abstract
AIMS To estimate the propensity of keratomycosis for parallel or secondary bacterial infection and to explore affinities among fungal and bacterial co-isolates. METHODS A retrospective review of laboratory records over 24 years yielded 152 episodes of culture positive fungal keratitis. After collating 65 corneal specimens having bacterial co-isolates, polymicrobial co-infection was defined as detection of concordant bacteria on smear and culture or on two or more different media. RESULTS 30 (20%) keratomycoses met laboratory criteria for polymicrobial infection. The risk of bacterial co-infection was 3.2 (95% confidence interval, 1.7 to 5.8) times greater with yeast keratitis than with filamentous fungal keratitis. CONCLUSIONS Bacterial co-infection occasionally complicates fungal keratitis, particularly candidiasis.
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Affiliation(s)
- J C Pate
- Department of Opthalmology and Visual Science, University of Kentucky College of Medicine, Lexington, KY, USA
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Affiliation(s)
- Sheeja Susan John
- The Department of Ophthalmology, Medical College, Kottayam, Kerala, India.
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Abstract
PURPOSE OF REVIEW Presumed ocular histoplasmosis syndrome remains a significant cause of visual morbidity. We review recent literature on the pathogenesis and particularly on the treatment of complications of presumed ocular histoplasmosis syndrome. RECENT FINDINGS The pathogenesis of presumed ocular histoplasmosis syndrome remains mysterious; although some recent molecular evidence suggests a direct link between Histoplasma capsulatum and presumed ocular histoplasmosis syndrome, other reports document nearly identical disease occurring in the absence of H. capsulatum seropositivity. Treatment options have advanced rapidly in the past few years. Small case series and clinical trials suggest excellent efficacy for photodynamic therapy in the treatment of subretinal neovascularization associated with presumed ocular histoplasmosis syndrome. Preliminary studies also suggest efficacy of intravitreal corticosteroids. A large randomized controlled clinical trial failed to show efficacy for subretinal surgery in the management of presumed ocular histoplasmosis syndrome, however. SUMMARY Despite continued debate on the etiology of presumed ocular histoplasmosis syndrome, there have been significant advances in treatment of the blinding complications of presumed ocular histoplasmosis syndrome.
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Affiliation(s)
- Anita G Prasad
- Department of Ophthalmology and Visual Sciences, Washington University Medical School, St Louis, Missouri 63110, USA
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Abstract
We report the case of a 50-year-old woman with a branch retinal artery occlusion caused by acute Candida albicans chorioretinitis, diagnosed based on ophthalmoscopic and angiographic examinations. Although vasculitis is frequent during Candida endophthalmitis, branch obstruction is rare. The thrombosis is probably related to perivascular inflammation rather than septic embolus. We propose antiaggregant therapy when the infection is near the retinal vessels.
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Affiliation(s)
- O Gualino
- Service d'Ophtalmologie, CHU Rangueil, Toulouse, France
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