DOCSLIB.ORG

Xanthomonas Maltophilia Endophthalmitis After Cataract

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Xanthomonas Maltophilia Endophthalmitis After Cataract CASE REPORTS AND SMALL CASE SERIES Report of Cases. Case 1. An 80- later, X maltophilia was isolated from year-old woman was evaluated for in- the culture that was resistant to cefta- Xanthomonas maltophilia creasing pain and decreased vision in zidime but sensitive to amikacin sul- Endophthalmitis After the left eye, 2 weeks after unevent- fate (Table 2). However, her clini- Cataract Surgery ful clear-corneal phacoemulsifica- cal condition continued to improve, tion and posterior chamber intraocu- with resolution of the hypopyon; vi- lar lens (IOL) insertion. Her medical sual acuity returned to 20/50 OS. A Xanthomonas maltophilia, previ- history was unremarkable. Visual small amount of retained lens cor- ously known as Pseudomonas malto- acuity in the affected eye was hand tex was noted at the 6-o’clock posi- philia and Stenotrophomonas malto- movements. Clinical findings in- tion. Gradual tapering of topical philia, is a gram-negative motile cluded a 5% hypopyon and marked medications was begun. bacillus that can be isolated from hu- vitritis. Vitreous tap was performed Three weeks after the initial man, animal, and environmental through the pars plana, and the pa- treatment, she returned with visual sources.1 It may cause potentially life- tient was given intravitreal injec- acuity in the left eye of light percep- threatening opportunistic systemic tions of ceftazidime, 2.25 mg; van- tion and recurrent hypopyon. Vitre- infections.1,2 Most isolates demon- comycin hydrochloride, 1.0 mg; and ous tap was performed and intravit- strate multidrug resistance, making dexamethasone sodium phosphate, real injections of amikacin sulfate, 0.4 it a highly virulent organism. Post- 0.4 mg. On the first day after the ini- mg, and dexamethasone sodium operative endophthalmitis caused by tial treatment, a combined regimen phosphate, 0.4 mg, were given. Cul- X maltophilia is rare. To date, only 2 was started with topical fortified cefta- tures of the vitreous aspirate were case reports have been published.3,4 zidime, vancomycin, and 1% pred- again positive for X maltophilia. Dur- We describe 4 additional patients nisolone acetate, every hour, and 1% ing the next 48 hours, she devel- with postoperative X maltophilia en- atropine sulfate, 3 times daily. No sys- oped worsening intraocular inflam- dophthalmitis treated between Janu- temic antibiotic therapy was used. mation; the visual acuity remained ary 1, 1996, and March 31, 1999, at Gram stain of the vitreous aspirate re- light perception. Pars plana vitrec- the Bascom Palmer Eye Institute, Mi- vealed many neutrophils, but no or- tomy was performed and intravit- ami, Fla (Table 1). ganisms were identified. Three days real injections of amikacin sulfate, 0.4 Table 1. Treatment Outcomes of Xanthomonas maltophilia Endophthalmitis* Visual Acuity Time to Initial Intravitreal Initial Time to Subsequent Treatment Patient No. Surgery Infection, d Treatment (Dosage) PPV Recurrence, d (Dosage) Initial Final 1 PE and PCIOL 14 Vancomycin hydrochloride − 21 Intravitreal injection of amikacin HM 20/50 (1.0 mg), ceftazidime sulfate (0.4 mg), followed by (2.25 mg), and PPV, and repeat intravitreal dexamethasone sodium injection of amikacin sulfate phosphate (0.4 mg) (0.4 mg) 2 PE and PCIOL 26 Vancomycin hydrochloride − None None HM 20/30 (1.0 mg), ceftazidime (2.25 mg), and dexamethasone sodium phosphate (0.4 mg) 3 ECCE and PCIOL 6 Amikacin sulfate and − 45 PPV and intravitreal injection of 20/200 20/30 cefazolin sodium† vancomycin hydrochloride (1.0 mg) and ceftazidime (2.25 mg) 4 ECCE and PCIOL 5 Vancomycin hydrochloride + 7 Intravitreal injection of LP 20/400 (1.0 mg), ceftazidime ceftazidime (2.25 mg) 32 and (2.25 mg), and subsequent PPV for dexamethasone sodium nonclearing vitreous opacities phosphate (0.4 mg) *PPV indicates pars plana vitrectomy; PE, phacoemulsification; PCIOL, posterior chamber intraocular lens implant; minus sign, no initial PPV was performed; HM, hand movements; ECCE, extracapsular cataract extraction; plus sign, an initial PPV was performed; and LP, light perception. †Dosages not known. ARCH OPHTHALMOL / VOL 118, APR 2000 WWW.ARCHOPHTHALMOL.COM 572 ©2000 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/30/2021 mg,anddexamethasonesodiumphos- sistent anterior chamber reaction Palmer Eye Institute for further phate,0.4mg,wereadministered.Dur- (2+) with retained lens cortex at the management of his condition. ing the vitrectomy, the silicone plate 5-o’clock position and was given a Best-corrected visual acuity was posterior chamber IOL dislocated into sub-Tenon injection of dexametha- 20/200 OS. The cornea was slightly the vitreous cavity but was positioned sone sodium phosphate, 40 mg, by edematous, with anterior chamber into the anterior chamber with a plan her ophthalmologist. Two days later, cells (2+ to 3+) but no hypopyon. The to exchange the IOL at a later date. At the visual acuity in the left eye de- posterior chamber IOL was in the bag the 9-month follow-up visit, visual creased to hand movements. Clini- with fluffy white cortical material for acuity was 20/50 OS and the vitritis cal findings included a 5% hypo- about 3 clock-hours. Dilated fun- resolved (Figure). pyon, vitritis, and no view of the dus examination revealed vitritis (2+) Case 2. A 70-year-old woman retina. A vitreous aspirate was per- with optic disc hyperemia and cys- was referred with increasing pain and formed, and she was given intravit- toid macular edema. The patient un- redness in her left eye. One month real injections of ceftazidime, 2.25 derwent an uncomplicated pars plana earlier, she underwent phacoemul- mg; vancomycin hydrochloride, 1.0 vitrectomy, partial capsulectomy, and sification and insertion of a poste- mg; and dexamethasone sodium received intravitreal injections of rior chamber IOL. Her early postop- phosphate, 0.4 mg. Cultures of the ceftazidime, 2.25 mg, and vancomy- erative course was uneventful, and vitreous aspirates were positive for X cin hydrochloride, 1.0 mg. Several she recovered 20/25 OS visual acu- maltophilia that was resistant to cefta- days later, X maltophilia was iso- ity by week 2. However, she had per- zidime but sensitive to amikacin lated from the culture of vitreous as- (Table 2). However, the patient had pirates that was sensitive to ceftazi- an excellent response to intravitreal dime but resistant to amikacin (Table Table 2. In Vitro Antibiotic ceftazidime treatment and 3 months 2). The vitritis resolved; visual acu- Sensitivities of Xanthomonas later, best-corrected visual acuity was ity improved to 20/30 OS at the maltophilia in Our Study* 20/30 OS and the vitritis resolved. 8-month follow-up visit. Case 3. A 46-year-old man Case 4. A 48-year-old man un- Patient No. developed pain and irritation 5 derwent an uneventful extracapsu- days after undergoing extracapsular lar cataract extraction with insertion Antibiotic 1 234 cataract extraction and posterior of posterior chamber IOL in his right Ceftazidime R R S S chamber IOL implantation in his eye in Nicaragua. Because of the Amikacin S S R R Gentamicin R R R R left eye. In Venezuela, he was diag- marked intraocular inflammation on Tobramycin S S R R nosed as having postoperative the fifth postoperative day, a clinical Ciprofloxacin S S R S endophthalmitis and was treated diagnosis of postoperative endoph- Imipenem R R R R with vitreous tap and intravitreal thalmitis was made and he was treated Polymyxin B S S S S injections of amikacin and cefazo- with subconjunctival gentamicin and Sulfamethoxazole- S SSR lin sodium. Vitreous cultures were topical tobramycin-prednisone drops trimethoprim reported to yield gram-negative every hour. Seventy-two hours after *All isolates were resistant to vancomycin. rods and were read as possible the first treatment, the patient was Sensitivities tested using the automated Vitek Escherichia coli. Initially, the seen by us. Visual acuity in the oper- test system (bioMerieux Vitek Inc, St Louis, Mo) patient showed improvement in ated eye was light perception with a and confirmed using the conventional disc clinical signs but developed recur- 20% hypopyon and no view of the diffusion method and the “E” test (AB Biodisk, Newark, NJ). R indicates resistant; rent inflammation after 6 weeks posterior pole. The patient under- S, sensitive. and was referred to the Bascom went pars plana vitrectomy with Case 1. Left, Three weeks after the initial treatment with iniravitreal injections of antibiotics, the clinical examination showed recurrent hypopyon and pupillary fibrin. Visual acuity in the left eye was light perception. Right, Nine months following pars plana vitrectomy and treatment with intravitreal antibiotics, the anterior segment inflammation has resolved. Note the silicone plate posterior chamber intraocular lens positioned in the anterior chamber. ARCH OPHTHALMOL / VOL 118, APR 2000 WWW.ARCHOPHTHALMOL.COM 573 ©2000 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/30/2021 intravitreal injection of ceftazidime, rate cultures yielded X maltophilia favorable clinical response to initial 2.25 mg; vancomycin hydrochlo- that was sensitive to ceftazidime but intravitreal therapy despite organ- ride, 1.0 mg; and dexamethasone resistant to all aminoglycosides, qui- ism resistance. Intravitreal injection sodium phosphate, 0.4 mg. In addi- nolones, and other b-lactam antibi- of antibiotics provides high initial tion, he was started on a regimen of otics. Treatment included removal of concentrations of antibiotics that are topical fortified ceftazidime, vanco- the ganciclovir implant, pars plana vi- well in excess of the minimum in- mycin, and 1% prednisolone trectomy, and administration of in- hibitory concentrations against sus- acetate, every hour, and 1% atro- travitreal and systemic ceftazidime. ceptible organisms. However, in pa- pine sulfate, 3 times daily. Vitreous Kaiser et al4 recently reported a tient 4, the organism was sensitive to cultures were positive for X malto- case of X maltophilia endophthalmi- the ceftazidime but endophthalmi- philia that was sensitive to ceftazi- tis 6 days after cataract extraction in tis still recurred.
Load more

Recommended publications
  • Acute Keratoconus-Like Corneal Hydrops Secondary to Ocular
    perim Ex en l & ta a l ic O p in l h Journal of Clinical & Experimental t C h f a o l m l a o Ke et al., J Clin Exp Ophthalmol 2017, 8:6 n l o r g u y o Ophthalmology J DOI: 10.4172/2155-9570.1000694 ISSN: 2155-9570 Case Report Open Access Acute Keratoconus-Like Corneal Hydrops Secondary to Ocular Massage Following Trabeculectomy Hongmin Ke, Chengguo Zuo and Mingkai Lin* State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 Xianlie Nan Road, Guangzhou, China *Corresponding author: Mingkai Lin, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, 54 Xianlie Nan Road, Guangzhou, China, 510060, E- mail: [email protected] Received date: November 13, 2017; Accepted date: November 21, 2017; Published date: November 23, 2017 Copyright: © 2017 Ke H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Purpose: To report a case of acute keratoconus-like corneal hydrops in a patient with long-term ocular massage following trabeculectomy. Methods: Case report and review of medical literature. Results: A rare complication of acute keratoconus-like corneal hydrops occurred in a patient following the use of ocular massage to maintain satisfactory aqueous humor filtration after trabeculectomy. The patient had a history of high myopia but denied previous ocular trauma, allergic disease and a family history of keratoconus. Slit-lamp examination demonstrated keratoconus-like corneal hydrops with formation of epithelial microcystic, and intrastromal cleft.
    [Show full text]
  • Endogenous Endophthalmitis: Diagnosis and Treatment
    UVEITIS OPHTHALMIC PEARLS Endogenous Endophthalmitis: Diagnosis and Treatment ndogenous endophthalmitis Pathogenesis 1 (EE) is an uncommon intraoc- The infectious agent travels via the Eular infection with potentially bloodstream and multiplies in the cho- devastating visual consequences. An roid, eventually infiltrating the retina endogenous source is responsible for and spreading into the vitreous.4 roughly 2% to 8% of all endophthal- A diagnosis of EE merits a systemic mitis.1 Prompt diagnosis and treatment workup for the source of infection, are essential to obtain the best visual although in 44% of cases no source is outcomes. The underlying infection found.2 EE has been most commonly should also be investigated and man- associated with liver abscesses, sinus aged, although it remains unidentified infections, endocarditis, meningitis, or in many cases. presence of indwelling catheters. Etiology Diagnosis About half of reported EE cases are Presentation. Patient presentation YEAST INFECTION. Fundus photo of caused by bacteria and half by fungi.2 ranges from asymptomatic to symp- a white, fluffy chorioretinal infiltrate In North America and Europe, the toms typical of severe uveitis, including erupting into the vitreous. Vitreous fluid most frequently identified causative a red, painful eye with photophobia, grew Candida albicans. bacteria are Staphylococcus aureus and floaters, or reduced vision. Although EE Streptococcus pneumoniae, while in East is most often unilateral, up to a third of conditions, infectious and noninfec- Asia, Klebsiella pneumoniae is chiefly cases have bilateral involvement.5 tious, should be considered in formu- responsible.1 Among fungal etiologies, Ocular examination. Symptomat- lating the diagnosis. See “Differential Candida albicans (Fig. 1) is the most ic patients may have reduced visual Diagnosis” on the next page.
    [Show full text]
  • Shift Work: a Risk Factor for Central Serous Chorioretinopathy
    Shift Work: A Risk Factor for Central Serous Chorioretinopathy ELODIE BOUSQUET, MYRIAM DHUNDASS, MATHIEU LEHMANN, PIERRE-RAPHAE¨L ROTHSCHILD, VIRGINIE BAYON, DAMIEN LEGER, CIARA BERGIN, ALI DIRANI, TALAL BEYDOUN, AND FRANCINE BEHAR-COHEN PURPOSE: To investigate if shift work or sleep distur- and focal serous detachments of the neurosensory retina bances are risk factors for central serous chorioretinop- and retinal pigment epithelium alterations. The role of athy (CSCR). choroid hyperpermeability in the pathogenesis of CSCR DESIGN: Prospective case-control study. has been well documented recently with multimodal imag- 2 METHODS: Forty patients with active CSCR and 40 ing modalities. In CSCR patients, a thick choroid has controls (age- and sex-matched) were prospectively been reported not only in the affected eye but also in the recruited from the Ophthalmology Department of Hoˆtel fellow eye, which is consistent with bilateral choroidal Dieu Hospital, Paris, between November 2013 and hyperpermeability.2,3 December 2014. All patients were asked to complete a To date, several risk factors for CSCR have been questionnaire addressing previously described risk factors identified,3 and the most consistent is corticosteroid and working hours, as well as the Insomnia Severity exposure from therapeutic administration or from endog- Index (ISI), a validated instrument for assessing sleep enous overproduction, as in Cushing syndrome.4–6 disturbances. Corticosteroids were recently shown to induce RESULTS: The mean age of the CSCR group was 44
    [Show full text]
  • The Efficacy of Intravitreal Conbercept for Chronic Central Serous Chorioretinopathy
    Hindawi Journal of Ophthalmology Volume 2019, Article ID 7409426, 5 pages https://doi.org/10.1155/2019/7409426 Research Article The Efficacy of Intravitreal Conbercept for Chronic Central Serous Chorioretinopathy Jianbo Mao,1 Caiyun Zhang,1 Chenyi Liu,2 Lijun Shen ,1 Jimeng Lao,1 Yirun Shao,1 Yiqi Chen,1 and Jiwei Tao1 1Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China 2Chicago College of Optometry, Midwestern University, Downers Grove, IL, USA Correspondence should be addressed to Lijun Shen; [email protected] Received 11 February 2019; Revised 10 April 2019; Accepted 25 April 2019; Published 7 May 2019 Academic Editor: Elad Moisseiev Copyright © 2019 Jianbo Mao et al. (is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. To evaluate the efficacy and safety of conbercept for patients with chronic central serous chorioretinopathy (CSC). Methods. A retrospective clinical study. (irty-one patients (35 eyes) with chronic CSC were given intravitreal injections of conbercept and followed up for at least 6 months. Observed indicators included best-corrected visual acuity (BCVA), central macular thickness (CMT), and resolution of subretinal fluid (SRF). Serial changes in BCVA and CMT were analyzed by using repeated measures analysis of variance. Results. During the 6-month follow-up, the mean number of injections required and performed was 1.77 ± 0.60. (e logMAR BCVA was 0.48 ± 0.26 at the baseline, 0.34 ± 0.26, 0.30 ± 0.26, 0.27 ± 0.26, 0.24 ± 0.26, and 0.23 ± 0.26 at 2-week and 1-, 2-, 3-, and 6-month follow-ups, respectively (F � 27.173, P < 0:05).
    [Show full text]
  • Endophthalmitis
    RETINA HEALTH SERIES | Facts from the ASRS The Foundation American Society of Retina Specialists Committed to improving the quality of life of all people with retinal disease. Endophthalmitis is an infection inside the eye SIGNS AND SYMPTOMS that can either be acute or chronic, meaning that it can develop very rapidly which is most common, or develop Endophthalmitis causes the white slowly and persist for long periods of time of the eye to be inflamed. There may be a white or yellow discharge on or inside the eyelid, and the cornea may show a white cloud- iness. There may also be a layer of white cells (hypopyon) present within the anterior chamber of the eye between the iris and the cornea. (Figure 1) Endophthalmitis is usually a very serious problem and prompt examination by an ophthalmologist is essential to make an appropriate diagnosis and initiate treatment. Other symptoms include: • Eye pain and redness • Decreased vision • Trouble looking at bright lights (photophobia), usually sudden onset Figure 1 Hypopyon is an accumulation of white blood cells in the anterior chamber of the eye and corneal WHAT IS THE RETINA? infiltrate associated with infectious endophthalmitis. Image courtesy of ©Retina Image Bank, contributed by Aleksandra V. Rachitskay, MD, Cole Eye Institute, Cleveland Clinic. 2014. Image 16250. Causes: Acute cases of endophthalmitis are caused by gram-positive (or less frequently gram-negative) bacteria and are most often seen within 6 weeks after surgery or trauma to the eye. Chronic cases that occur outside of the 6-week window are often related to a previous surgery and are commonly caused by slowly progressive infections such as Propionibacterium acnes or fungus.
    [Show full text]
  • Treatment of Postkeratitis Fusarium Endophthalmitis with Amphotericin B Lipid Complex
    Cornea 19(6): 853–856, 2000. © 2000 Lippincott Williams & Wilkins, Inc., Philadelphia Treatment of Postkeratitis Fusarium Endophthalmitis with Amphotericin B Lipid Complex David Goldblum, M.D., Beatrice E. Frueh, M.D., Stefan Zimmerli, M.D., and Matthias Bo¨hnke, M.D. Purpose. The authors report the first case of Fusarium solani tients treated with amphotericin B develop some degree of renal keratitis that progressed to fungal endophthalmitis and was suc- impairment. Patients who receive a cumulated dose of more than cessfully treated with amphotericin B lipid complex (ABLC). 4–5 g of the drug are particularly at risk.5 Method. The case of a 34-year-old immunocompetent woman Three new lipid formulations of amphotericin B with reduced who developed a contact lens-related F. solani keratitis requiring nephrotoxicity are now available for clinical use. Amphotericin B emergency penetrating keratoplasty (PKP) was analyzed. The im- lipid complex (ABLC) (Abelcet®; The Liposome Company, munocompetent patient developed fungal endophthalmitis (ante- rior chamber tap positive for F. solani three months after PKP) and Princeton, NJ, U.S.A.) is a concentration of ribbon-like structures was eventually treated with ABLC. Results. Systemic amphoteri- of a bilayered membrane formed by combining a 7:3 ratio of cin B (total, 0.42 g) and ketoconazole in addition to topical nata- dimyristoyl phosphatidylcholine and dimyristoyl phosphatidyl- mycin and amphotericin did not prove to be effective in eradicat- glycerol with amphotericin B. Amphotericin B colloidal dispersion ing the mycosis in the anterior chamber. Under ABLC treatment (Amphocil®; Sequus Pharmaceuticals, Menlo Park, CA, U.S.A.) (total, 8.79 g), the anterior chamber inflammation resolved com- is composed of disc-like structures of cholesteryl sulfate com- pletely.
    [Show full text]
  • Incidence of Post-Cataract Endophthalmitis at Aravind Eye
    ARTICLE Incidence of post-cataract endophthalmitis at Aravind Eye Hospital Outcomes of more than 42000 consecutive cases using standardized sterilization and prophylaxis protocols Ravilla D. Ravindran, MS, DO, Rengaraj Venkatesh, DO, DNB, David F. Chang, MD, Sabyasachi Sengupta, DO, Jamyang Gyatsho, MS, Badrinath Talwar, MS, DNB PURPOSE: To report the incidence of postoperative endophthalmitis at a high-volume eye hospital in southern India using a modified cost-effective sterilization protocol. SETTING: Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India. METHODS: In this retrospective observational series at a single eye hospital, records of patients who had cataract surgery using a modified sterilization protocol from January 2007 through August 2008 and developed postoperative endophthalmitis within the first 3 postoperative months were drawn from a computerized database. The patient’s socioeconomic status, the surgeon’s experi- ence, and the type of cataract procedure performed were analyzed as possible risk factors using the chi-square test/Fischer exact test. RESULTS: During the study period, 42426 cataract surgeries were performed. From these, 38 cases of presumed postoperative endophthalmitis were identified (incidence 0.09%). Thirty-five of the 38 cases were in the manual large- and small-incision extracapsular cataract extraction (ECCE) group, which had a statistically higher rate than the phacoemulsification group (P Z .016). There was no sta- tistical difference in the endophthalmitis rates between private patients and charity patients for either surgical method (manual ECCE or phacoemulsification). CONCLUSIONS: The modified sterilization and asepsis protocol adopted to facilitate high-volume cataract surgery in a clinical setting appeared to be safe and effective in preventing postsurgical endophthalmitis.
    [Show full text]
  • A Spectral Domain Optical Coherence Tomography Study
    Eye (2017) 31, 1488–1495 © 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved 0950-222X/17 www.nature.com/eye 1 1 1 1 1 CLINICAL STUDY Atrophy of retinal XLu, W Chen ,HXia, K Zheng , C Jin , DSC Ng2 and H Chen1 inner layers is associated with poor vision after endophthalmitis: a spectral domain optical coherence tomography study Abstract Purpose To investigate the retinal structural can be open globe trauma, intraocular surgery, changes in endophthalmitis and their keratitis, or endogenous.1 The reported association with visual outcome. incidence of endophthalmitis is 2.1% after open Patients and methods Forty-five eyes of globe injury,2 0.06 ~ 0.2% after cataract surgery,3 45 patients diagnosed with endophthalmitis 0.039% after vitrectomy,4 and 0.049% after were included. Spectral domain optical intravitreal injection.5 Although endophthalmitis coherence tomography (SD-OCT) was can be adequately managed with intravitreal fl performed after in ammation was controlled. injection of antibiotics and/or pars plana The relationship between SD-OCT features vitrectomy, impairment of vision has been and best-corrected visual acuity (BCVA) at the observed in some patients.6 This could be due to last follow-up was analyzed. damage of the retinal structure. Results The structural changes included Spectral domain optical coherence 1Joint Shantou inner segment ellipsoid (ISe) disruption tomography (SD-OCT) allows visualization of International Eye Center, (49%), atrophy of retinal inner layers (24%), the cross-sectional structure of retina in vivo.7 Shantou University, epimacular membrane (24%), and macular It is now widely being used to investigate the Chinese University of Hong edema (24%).
    [Show full text]
  • Dry Eye Disease Management for IMPROVING PATIENT OUTCOMES
    CME MONOGRAPH Visit https://tinyurl.com/DEDOutcomesCME for online testing and instant CME certificate. CURRENT PERSPECTIVES Dry Eye Disease Management FOR IMPROVING PATIENT OUTCOMES FACULTY TERRY KIM, MD (CHAIR) • ROSA BRAGA-MELE, MD, MEd, FRCSC JESSICA CIRALSKY, MD • CHRISTOPHER J. RAPUANO, MD Original Release: May 1, 2019 • Expiration: May 31, 2020 This continuing medical education activity is jointly provided by New York Eye and Ear Infirmary of Mount Sinai and MedEdicus LLC. This continuing medical education activity is supported through an unrestricted educational grant from Shire. Distributed with LEARNING METHOD AND MEDIUM Jessica Ciralsky, MD, had a financial agreement or affiliation during the This educational activity consists of a supplement and ten (10) study past year with the following commercial interests in the form of Consultant/ questions. The participant should, in order, read the learning objectives Advisory Board: Allergan; and Shire. contained at the beginning of this supplement, read the supplement, Terry Kim, MD, had a financial agreement or affiliation during the past answer all questions in the post test, and complete the Activity year with the following commercial interests in the form of Consultant/ Evaluation/Credit Request form. To receive credit for this activity, Advisory Board: Actavis; Aerie Pharmaceuticals, Inc; Alcon; Allergan; please follow the instructions provided on the post test and Activity Avedro, Inc; Avellino Labs; Bausch & Lomb Incorporated; BlephEx; Evaluation/Credit Request form. This educational
    [Show full text]
  • CORNEAL ULCERS Diagnosis and Management
    CORNEAL ULCERS Diagnosis and Management System requirement: • Windows XP or above • Power DVD player (Software) • Windows Media Player 10.0 version or above • Quick time player version 6.5 or above Accompanying DVD ROM is playable only in Computer and not in DVD player. Kindly wait for few seconds for DVD to autorun. If it does not autorun then please do the following: • Click on my computer • Click the drive labelled JAYPEE and after opening the drive, kindly double click the file Jaypee CORNEAL ULCERS Diagnosis and Management Namrata Sharma MD DNB MNAMS Associate Professor of Ophthalmology Cornea, Cataract and Refractive Surgery Services Dr. Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences, New Delhi India Rasik B Vajpayee MS FRCSEd FRANZCO Head, Corneal and Cataract Surgery Centre for Eye Research Australia Royal Victorian Eye and Ear Hospital University of Melbourne Australia Forewords Hugh R Taylor Peter R Laibson ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • Ahmedabad • Bengaluru • Chennai • Hyderabad • Kochi • Kolkata • Lucknow • Mumbai • Nagpur Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd B-3 EMCA House, 23/23B Ansari Road, Daryaganj New Delhi 110 002, India Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672 Rel: +91-11-32558559, Fax: +91-11-23276490, +91-11-23245683 e-mail: [email protected] Visit our website: www.jaypeebrothers.com Branches • 2/B, Akruti Society, Jodhpur Gam Road Satellite Ahmedabad 380 015, Phones: +91-79-26926233,
    [Show full text]
  • Postoperative Infectious Endophthalmitis: Evolving Trends and Feature Techniques
    RETINA SURGERY RETINA POSTOPERATIVE INFECTIOUS ENDOPHTHALMITIS: EVOLVING TRENDS AND FEATURE TECHNIQUES Practices have changed since publication of the EVS in the 1990s. BY DAVID R.P. ALMEIDA, MD, MBA, PHD, AND ERIC K. CHIN, MD Infectious endophthalmitis is a Acute-onset endophthalmitis (within 6 weeks of an intra- devastating vision-threatening ocular procedure) is typically caused by coagulase-negative condition involving inflam- Staphylococcus and Streptococcus species, and less commonly mation of the entire globe by gram-negative organisms.1 Chronic or delayed-onset and its intraocular contents endophthalmitis (beyond 6 weeks after intraocular surgery) is (Figure 1). The most com- typically due to Propionibacterium acnes, but may also involve mon form of infectious endo- coagulase-negative Staphylococcus or fungi.2 Bleb-associated phthalmitis tends to result endophthalmitis can occur months to years after filtering from direct inoculation of an organism from outside the body surgery and is most commonly caused by Streptococcus, (ie, exogenous as opposed to endogenous), most commonly Haemophilus, or gram-positive organisms. We previously after cataract surgery or intravitreal injection. It tends to pres- reviewed 10 years of endophthalmitis cases (n = 758) and found ent acutely within 3 to 21 days after the procedure. gram-positive organisms to be the causative pathogen in 80% A B Figure 1. Postoperative exogenous endophthalmitis presenting as panuveitis. Anterior segment may present with corneal edema, marked anterior chamber cellular reaction, and fibrin inflammatory membrane over the pseudophakic posterior chamber intraocular lens (A). The posterior segment typically has vitritis (seen on echography; B) with retinal hemorrhages. SEPTEMBER 2016 | RETINA TODAY 27 FEATURE RETINA SURGERY RETINA Figure 2.
    [Show full text]
  • Complex Endophthalmitis and Phacoallergic Uveitis
    Br J Ophthalmol: first published as 10.1136/bjo.62.2.105 on 1 February 1978. Downloaded from British Journal of Ophthalmology, 1978, 62, 105-109 Release of prostaglandins in experimental immune- complex endophthalmitis and phacoallergic uveitis AMJAD RAHI, PRIMAL BHATTACHERJEE, AND ROOPNARAIN MISRA From the Department of Pathology and Experimental Ophthalmology, Institute of Ophthalmology, University of London SUMMARY Prostaglandins-E were demonstrated in the aqueous humour, the anterior uvea, and the choroid of rabbits in which type III allergic reactions were produced by two different methods. In general the levels of prostaglandins were found to be higher in those animals in which the immune complexes were formed from autologous rather than heterologous tissue antigens. Autocoids are endogenous autopharmacological (Bhattacherjee, 1977; Bhattacherjee and Phylactos, agents which are intimately concerned with the 1977). It is also well established that prostaglandins, general inflammatory processes in the eye and else- particularly the E-type, are released in a variety of where in the body. One group of autocoids, the experimental and clinical allergic conditions (Giroud prostaglandins (PGs), belong to a family of 20- and Willoughby, 1970; Brocklehurst, 1975). Since carbon unsaturated fatty acids, and although they at least 4 distinct types of allergic reactions, each were first discovered several decades ago (Goldblatt, with a different pathogenetic mechanism, have been copyright. 1933) it is only recently that prostaglandins have recognised,
    [Show full text]