Veronika Huber-Spitzy

Canaliculitis: Difficulties in Diagnosis, Differential Diagnosis and Comparison between Conservative and Surgical Treatment

The most important clinical features of canaliculitis include a red, swollen eyelid in the area of the affected canaliculus, a unilateral conjunctivitis, a mucopurulent discharge and in some cases dacryoliths visible in the lacrimal punctum. Conservative therapy was found to be little effective: only 10% of the patients could be cured, 40% showed a recurrence after conservative treatment. 20 patients (50%) were treated by canaliculotomy: 16 of these were cured by this surgical treatment, 4 patients complained of epiphora, although diagnostic syringing showed free lacrimal pathways. The surgical treatment of canaliculitis in combination with conservative therapy yields far better results than conservative therapy alone.

Acquired dacryocystitis: Microbiology and conservative therapy

Abstract The dacryocystitis in adults is mainly caused by postsaccal stenosis of the lacrimal ducts. The banking up of the lacrimal fluid leads to an accumulation of germs and following infection. This report describes the clinical and microbiological findings in a large consecutive series of patients that presented at the outpatient clinic of the 2nd Department of Ophthalmology of the University of Vienna with the signs of acute, chronic recurrent or chronic infections of the lacrimal system between 1983 and the end of 1990. Within the bacterial genus Staphylococci (S. aureus, S. epidermidis and S. saprophyticus) were the most frequently isolated organisms (74 cultures = 50% out of samples with positive cultures). It was quite interesting that a significant number of gramnegative rods (37 = 25.5%) could be isolated. Of these microorganisms Escherichia coli was most frequently growing on special media (17 cases = 11.7%) when cultures were obtained from acute inflamed lacrimal sacs of patients who suffered from chronic recurrent infections. Conservative therapy of purulent dacryocystitis constitutes the last possible preparation for a necessary surgical intervention and therefore the authors want to point out the importance of microbiological examinations so as to optimize antibiotic therapy.

Different techniques of extracapsular cataract extraction: bacterial contamination during surgery

This study was performed to investigate the correlation between the contamination of the anterior chamber and the technique of extracapsular cataract extraction (ECCE). Three different methods were used: uncomplicated planned ECCE, phacoemulsification involving suturing method, and sutureless technique. All patients had posterior chamber intraocular lenses implanted. Two hundred and thirty consecutive patients were included in this prospective study, and preoperative smears of the conjunctiva and intraoperative aspirates of the anterior chamber were investigated. Samples of the aqueous humor were taken at the beginning and at the end of the operation. Cultures were incubated and held for 14 days. More than 71% of the preoperative smears were contaminated by coagulase-negative staphylococci, the most commonly isolated bacteria. However, 27% of the patients had culture-positive anterior chamber aspirates intraoperatively, also with coagulase-negative staphylococci as the most frequent organisms. In no case did postoperative endophthalmitis develop. Preliminary results in a small population show that the contamination of the aqueous humor is statistically significantly less frequent if the cataract extraction is performed by phacoemulsification than if it is done without phacoemulsification. Another interesting finding is that anterior chamber contamination is not significantly more frequent, if a sutureless technique is used for cataract surgery.

In vitro Susceptibilities to Topical Antibiotics of Bacteria Isolated from the Surface of Clinically Symptomatic Eyes

Background: The permanent change of resistance patterns of bacteria causing ocular infections makes repeat susceptibility testings against the most recent clinical isolates mandatory. The aim of the present study was to assess the in vitro susceptibility of ocular bacterial isolates of clinically symptomatic eyes admitted to the outpatient clinic of the eye department of a large central hospital to commonly used topical antibiotics. Methods: Ocular isolates (n = 454) were tested for their susceptibility to ofloxacin, ciprofloxacin, norfloxacin, gentamicin, tobramycin, meomycin, bacitracin, erythromycin, tetracycline and chloramphenicol. Results: All three tested fluoroquinolones were found to be very effective against gram-negative organisms but demonstrated some weakness against certain strains of gram-positive germs, in particular coagulase-negative staphylococci and Streptococcus viridans. These germs, however, were very susceptible to bacitracin and chloramphenicol. The relative overall in vitro efficacy was (in decreasing order): chloramphenicol, ciprofloxacin, ofloxacin, norfloxacin, bacitracin, tetracycline, neomycin, erythromycin, tobramycin and gentamicin. Conclusion: Chloramphenicol had the highest overall in vitro efficacy, but has potential lethal side effects. The fluoroquinolones were highly effective, especially being superior to the aminoglycosides tested, but no single antibiotic provided 100% coverage against all of the bacterial isolates that were tested.

Circulating ICAM-1 levels in serum of uveitis patients

Intercellular Adhesion Molecule-1 (ICAM-1) is a cytokine-inducible adhesion molecule expressed on cells of multiple lineages at sites of inflammation. Recently a truncated form of ICAM-1 has been discovered to be circulating in serum. This study reports on circulating serum (cICAM-1) levels in 132 uveitis patients (HLA-B 27 pos. acute anterior uveitis (AAU); HLA-B27 neg. anterior uveitis (AU); intermediate uveitis (IU); heterochromic cyclitis Fuchs (HCF); sarcoidosis; Toxoplasmosis). Measurement of circulating ICAM-1 serum levels was performed using a monoclonal antibody based ELISA, with healthy blood donors serving as the control group. Applying multiple variance analysis and the Student Newmann-Keuls test we found a statistically significant elevation of serum cICAM-1 level in the HLA-B 27 neg. AU group (n:31), in the IU group (n:25) and in patients with sarcoidosis (n:18). Serum levels of HLA-B27 pos. AAU patients, patients with HCF and patients suffering from ocular toxoplasmosis did not differ significantly from levels of the control group.

Blepharitis — a diagnostic and therapeutic challenge

Over the last few years the number of patients with chronic bilateral blepharitis has increased dramatically. From January 1985 until the end of 1989, a total of 407 patients with this diagnosis underwent ophthalmological and dermatological investigations at our out-patient clinic. Keratoconjunctivitis sicca (KCS) in conjunction with blepharitis occurred in 14.5% of the patient population who also suffered from acne rosacea. A comparison of the spectrum of microorganisms that have previously been isolated from affected sites with data obtained in the present study revealed that the range of microorganisms associated with this chronic localized inflammation has apparently shifted in recent years. The prevalence of Staphylococcus aureus, which was considerable in the pre-antibiotic era, has markedly decreased, although a distinct entity of staphylococcal blepharitis seems to remain, either alone or in combination with seborrheic blepharitis (62.8% of our patients). The clinical picture, microbiological findings and therapy for this condition are presented.

HLA typing from human donor eyes

A method for HLA-ABC and HLA-DR typing of human donor eyes using pigmented retinal epithelial and uveal cells cultured in the presence of human recombinant γ-interferon is described.

Treatment of traumatic tattoos with various sterile brushes

BACKGROUND Various types of brushes are efficient for the removal of foreign material accidentally projected into the skin by explosive or abrasive trauma. OBJECTIVE To evaluate how different times between injury and treatment influenced esthetic results, we retrospectively evaluated 14 patients subjected to the brushing technique. METHODS Two groups were identified. Group I had been treated within 24 hours of injury. In group II debridement had been performed later. RESULTS Cosmetic results were strikingly better in group I. CONCLUSION Our results demonstrate that debridement of traumatic tattoos should be carried out as soon as possible to achieve favorable cosmetic results.

Diagnosis and therapy of bacterial endophthalmitis, and serum levels of inflammation markers.

SummaryA review of 27 cases of bacterial endophthalmitis diagnosed and treated at the Specialized Outpatient Department for Infectious Eye Diseases at the 2nd Department of Ophthalmology of the University of Vienna over a period of eight years (January 1983–April 1991) is presented. In 70% of the cases the patients had undergone surgical intervention. Conjunctival samples were routinely taken for microbiological investigations (aerobic as well as anaerobic cultures). In 19 patients (70.4%) aqueous specimens were obtained, in 22 cases (81.5%) vitreous specimens collected during vitrectomy for the removal of infected material were used for microbiological diagnosis. The results for the patient population described showed the poor reliability of conjunctival cultures from intraocular infections with only 36.84% being identical with those of the vitreous specimens. In the most recent 11 patients three serological parameters of inflammation were tested on various occasions: C-reactive protein, PMN- elastase and light immunoglobulin chain assembling (kappa/lambda). Clinical results, microbiological findings and therapeutic approaches are presented and discussed.ZusammenfassungIm Rahmen der Spezialambulanz für infektiöse Augenkrankheiten der 2. Universitäts-Augenklinik wurden in einem Zeitraum von über acht Jahren (vom 1. 1. 1983 bis zum 30. 4. 1991) insgesamt 27 Patienten mit der Diagnose einer „infektiösen Endophthalmitis“ behandelt. Routinemäßig wurden Bindehautabstriche durchgeführt und auf aerobe und anaerobe Bakterien und Pilze untersucht. Bei 19 Patienten (70,4% wurden diagnostische Vorderkammer-Punktionen durchgeführt, bei 22 (81,5%) dann im Rahmen einer Vitrektomie zur Entfernung der infizierten Massen Glaskörper-Proben zum Keimnachweis herangezogen. Auffallend ist bei diesem Patientenkollektiv, daß der Bindehaut-Abstrich im Falle einer intraokulären Infektion äußerst unsichere Resultate zeigt, die nur in 36,84% mit den tatsächlich verantwortlichen Mikroorganismen identisch waren. Bei den letzten 11 Patienten (40,7%) haben wir auch mehrmals Entzündungsparameter im Serum getestet. C-reaktives Protein, Elastase und die leichten Immunglobulin-Ketten (Kappa, Lambda). Klinische Ergebnisse, Mikrobiologie und Therapiemöglichkeiten werden präsentiert und diskutiert.

Corneal Wound Healing after Superficial Foreign Body Injury: Vitamin A and Dexpanthenol versus a Calf Blood Extract

A prospective randomized double-blind clinical study was performed to investigate corneal wound healing after treatment either with an eye gel containing calf blood extract or an eye ointment containing vitamin A and dexpanthenol. A total of 54 outpatients were included in this study, all treated for corneal foreign body injury. The size of the corneal lesions was measured by planimetry on days 0, 1, and on the following days until complete epithelial healing occurred. Results showed the calf blood extract eye gel to be statistically more effective in promoting corneal wound healing, especially in patients with wound areas larger than 6 mm2.