Theodore Paraskevopoulos

Systematic review of 342 cases of endogenous bacterial endophthalmitis

We review a total of 342 cases of endogenous bacterial endophthalmitis reported between 1986 and 2012. Predisposing conditions were present in 60%, most commonly diabetes, intravenous drug use, and malignancy. The most common sources of infection were liver, lung, endocardium, urinary tract, and meninges. Systemic features such as fever were present in 74%, hypopyon in 35%, and an absent fundal view in 40%. Diagnostic delay occurred in 26%. Blood cultures were positive in 56%, and at least one intraocular sample was positive in 58% (comprising 26% anterior chamber samples, 59% vitreous taps, and 41% vitrectomy specimens). Worldwide, Gram negative infections (55%) were more frequent than Gram positive (45%) infections, particularly in Asia. Over the last decade, 11% of eyes were treated with systemic antibiotics alone, 10% intravitreal antibiotics alone, 36% systemic plus intravitreal antibiotics, and 20% systemic plus intravitreal antibiotics plus pars plana vitrectomy. The most commonly used intravitreal antibiotics were vancomycin (for Gram positive infection) and ceftazidime (Gram negative). The median final visual acuity was 20/100, with 44% worse than 20/200. Among all cases, 24% required evisceration or enucleation, and mortality was 4%. Both intravitreal dexamethasone and vitrectomy were each associated with a significantly greater chance of retaining 20/200 or better and significantly fewer eviscerations or enucleations-these warrant further study. For most patients, treatment should include a thorough systemic evaluation and prompt intravitreal and systemic antibiotics.

Large bilateral foveal cysts in the inner retina of a patient treated with tamoxifen, diagnosed with Fourier-domain optical coherence tomography

Purpose To report a case of a patient receiving tamoxifen with visual deterioration and describe the unusual optical coherence tomography (OCT) findings. Method Observational case report. Results A 55-year-old female patient was referred to our department complaining of gradual visual deterioration in both eyes. Medical history was unremarkable apart from breast cancer for which she had received tamoxifen for 10 years (mean dosage 20 mg/day). Best corrected visual acuity was 20/400 in her right eye and 20/40 in her left eye. Fundoscopy in both eyes was without any obvious signs of maculopathy. However, Fourier-domain OCT demonstrated bilateral extensive areas of disruption in inner retinal layers without any signs of crystalline retinopathy. Six months after the cessation of tamoxifen, the situation remains unchanged. Conclusion Patients receiving tamoxifen should be monitored with high-resolution OCT for fundoscopically invisible changes in the inner retinal layers, the progression of which may seriously affect the patient’s vision and subsequently their quality of life.

Ophthalmic Metastasis of Breast Cancer and Ocular Side Effects from Breast Cancer Treatment and Management: Mini Review

Breast cancer is one of the most common malignant diseases occurring in women, and its incidence increases over the years. It is the main site of origin in ocular metastatic disease in women, and, due to its hematogenous nature of metastatic spread, it affects mainly the uveal tissue. The purpose of this paper is to summarize the clinical manifestations of the breast cancer ocular metastatic disease, alongside the side effects of the available treatment options for the management and regression of the systematic and ophthalmic disease.

Corneal Collagen Cross-Linking Mushroom Shape Demarcation Line Profile After Limited Bowman's Membrane Removal by Phototherapeutic Keratectomy

Purpose : To report a corneal collagen cross-linking (CXL) mushroom shape demarcation line profile after limited Bowman’s membrane removal by phototherapeutic keratectomy (PTK). Methods : Case report. Results : A twenty-one-year-old male with progressive keratoconus underwent mechanical epithelial debridement (at an 8.5 mm zone) followed by PTK (at a 5.0 mm zone and in a 10 μm depth) and CXL. No intra- or early postoperative complications were found. Evaluation of the corneal stromal demarcation line depth using anterior segment optical coherence tomography revealed a mushroom shape profile. Conclusion : It seems that removal of the Bowman’s layer leads to greater depth of the corneal stromal demarcation line.

White Balls in the Anterior Chamber: A Potentially Life-Threatening Condition.

A 7-year-old boy was referred to our department by pediatrician who noticed small white balls in the anterior chamber of the right eye (Figure 1). Visual acuity at presentation was counting fingers in the right eye and 20/20 in the left eye. Clinical examination of the right eye revealed high intraocular pressure (40 mmHg) and white cystic-like lesions in the anterior chamber with co-existent inferior/inferonasal crystalline lens deficit/coloboma (Figure 2; available at www.jpeds.com). Dilated fundus examination of both eyes was unremarkable. In view of the clinical presentation, the differential diagnosis included phacolytic glaucoma, in which the white lesions would be lens particles associated with the coloboma of the crystalline lens, cysticercosis, or intraocular tumor with atypical presentation. Parasitological examinations of the white cystic lesions were negative and cytologic examinations confirmed the

THE IMPACT OF ENDOTHELIAL DYSFUNCTION IN THE DEVELOPMENT OF DIABETIC RETINOPATHY: ROLE OF INFLAMMATION

Diabetic Retinopathy (DR) is a leading cause of blindness. Measurement of endothelial function and arterial stiffness are associated with adverse cardiovascular outcomes. We investigated the possible association of DR with endothelial function, arterial stiffness and inflammation. We enrolled 100

Transient Anisocoria after Corneal Collagen Cross-Linking

Purpose. To report a case with transient anisocoria after corneal collagen cross-linking (CXL). Methods. Case report. Results. A 24-year-old male underwent corneal collagen cross-linking (CXL) in his right eye for keratoconus. At the end of the procedure, the pupil of the treated eye was irregular and dilated, while the pupil of the fellow eye was round, regular, and reactive (anisocoria). The following day, pupils were round, regular, and reactive in both eyes. Conclusion. Anisocoria may be a transient and innocuous complication after CXL. A possible cause for this complication might be the anesthetic drops used before and during the surgical procedure or/and the ultraviolet A irradiation during the treatment.

High prevalence of ophthalmic disorders in Down’s syndrome

Jensen and Bulova’s otherwise excellent review of the care of adults with Down’s syndrome did not mention the ocular manifestations of Down’s syndrome, which are common and can seriously reduce quality of life.1 All ocular structures can be affected,2 and the prevalence of ophthalmic disorders in Down’s syndrome is estimated at 77%.3 Anatomical …

White pupillary reflex in a 3 year old boy

A 3 year old boy was referred to our department by his general practitioner because of a “white reflex of his right eye” that had been noted in recent family photos. Direct ophthalmoscopy performed by his GP reported clear optical media (cornea, aqueous humour, crystalline lens, and vitreous) and a possible white retinal lesion in the right posterior pole. He had no medical history of note. His best corrected visual acuity after refraction was 20/100 in the right eye and 20/20 in the left eye. Cycloplegic refraction—a procedure used to determine the refractive error after temporarily paralysing the ciliary body with cycloplegic eye drops—showed a 4.00 dioptre difference in hypermetropia between his eyes (more pronounced in the right eye than in the left). Slit lamp examination showed a white pupillary reflex (leucocoria) in the right eye, but no inflammatory cells or proteins in the anterior chamber (no anterior chamber reaction). Gonioscopy was used to visualise the iridocorneal angle and applanation tonometry (Perkins tonometer) was used to determine intraocular pressure under general anaesthesia. Intraocular pressure was 12 mm Hg in both eyes and the iridocorneal angle was within normal limits in both eyes. Fundoscopic examination showed a yellow-white round mass, 5 mm in diameter and temporal to the fovea, in the right eye, with a clear vitreous (figure⇓). There were no pathological features in the left eye. B scan ultrasonography showed a right hyperechogenic mass with areas of calcification. The poor vision in his right eye was mainly attributed to his previously undetected hypermetropic anisometropia (the condition in which the hypermetropic refractive error differs greatly between the two eyes). However, subtle macular changes (slit subretinal fluid or atrophic changes of the outer layers) as a result of the nearby tumour could not be excluded.

Bevacizumab must be specially prepared for intraocular use

Torjesen clearly sums up the results of a recent trial showing that off-label use of bevacizumab (Avastin) is as effective as the more expensive licensed treatment for wet age related macular degeneration—ranibizumab (Lucentis).1 2 This will provide an …