[Panophthalmitis and results of HIV tests. Experience at the Cocody University Hospital Center in Abidjan, Ivory Coast]

PURPOSE

We assessed the frequency of panophthalmitis in HIV-infected patients.

MATERIALS AND METHODS

Thirty-seven cases of panophthalmitis were screened out of 420 hospitalized patients of ophthalmology department of Cocody Teaching University Hospital, Abidjan, Ivory Coast, from January to October 1995. HIV-tests were performed in 11 patients.

RESULTS

Mean age was 40 years (from 10 months to 75 years). Four patients (36.4% of tested patients) were infected by HIV. Contrary to seronegative patients, panophthalmitis cases in HIV-infected patients occurred spontaneously without any apparent exogenous cause (foreign bodies). Most of patients were young (from 18 to 47 years old).

CONCLUSION

We draw the attention of eye specialists of the frequency of panophthalmitis without exogenous apparent cause in HIV patients. It would be interesting to perform a transvitreal needle biopsy in order to search for intraocular toxoplasmosis that should be the first cause.

Postmortem diagnosis of Fusarium panophthalmitis by the polymerase chain reaction

PURPOSE

We undertook this study to determine if a polymerase chain reaction-based test that we developed for the filamentary fungus, Fusarium, could be used to detect the organism in postmortem ocular tissues.

METHODS

We applied the polymerase chain reaction to amplify a target fragment of Fusarium DNA from formalin-fixed ocular tissues from a patient with endogenous Fusarium panophthalmitis.

RESULTS

By using the polymerase chain reaction-based test, we were able to amplify the target fragment of DNA from the infected eyes, but not from uninfected control eyes.

CONCLUSIONS

The technique appears to hold promise to be a sensitive, specific, and rapid method of diagnosing Fusarium infections.

Endophthalmitis and orbital cellulitis after radial keratotomy

PURPOSE

To report the findings concerning three patients with endophthalmitis and one with panophthalmitis and orbital cellulitis radial keratotomy surgery.

METHODS

One man referred with panophthalmitis and orbital cellulitis and three women referred with endophthalmitis were treated.

RESULTS

After radial keratotomy surgery, during which no microperforation or macroperforation had been reported, a severe Pseudomonas panophthalmitis and orbital cellulitis developed in the man. All vision was lost in that eye. Staphylococcus epidermidis endophthalmitis developed in one woman, Streptococcus pneumoniae endophthalmitis in the second woman and Pseudomonas endophthalmitis in the third woman, after undergoing radial keratotomy procedures during which microperforations occurred. In the latter patient, bilateral simultaneous surgery was performed, but only one eye became infected. The latter two infections resulted in light perception and hand motion vision respectively. In three cases, an initial keratitis was located in the inferior cornea.

CONCLUSIONS

Severe bacterial endophthalmitis can occur after radial keratotomy surgery, even in the absence of microperforation during the procedure. Any evidence of postoperative keratitis must be regarded seriously and treated aggressively. Despite use of this approach, the effect on final visual acuity can be devastating.

Safety of a clean air storage hood for ophthalmic instruments in the operating room

PURPOSE

Evaluation of the safety of a laminar flow clean air hood for the sterile storage of ophthalmic instruments in an operating room.

METHODS

A ten-year retrospective study of 10,524 surgical procedures performed with instruments stored in a clean air hood was conducted at the Mayo Clinic. Cases of postoperative endophthalmitis were identified through review of the diagnostic indices maintained by the ophthalmology department and the institution and through review of individual patient records.

RESULTS

The incidence of endophthalmitis in surgical cases in which instruments stored in a clean air hood were used was 0.076% (eight of 10,524 cases). No clusters of infection were identified.

CONCLUSIONS

The use of a laminar flow clean air hood provides access to surgical instruments in a high-volume operating room without exposing patients to an increased risk of endophthalmitis.

Gas gangrene panophthalmitis. A case from Greenland

A case of clostridium perfringens gas gangrene panophthalmitis developed after a penetrating eye injury. The affected eye became amaurotic, but the panophthalmitis was controlled by minimal surgical debridement and systemic antibiotic therapy with penicillin, fucidic acid and metronidazole. Elective enucleation was performed 15 days after the trauma for cosmetic reasons. The enucleated eye was examined histopathologically and showed massive retinal necrosis but no signs of bacteriae.

Clostridium bifermentans panophthalmitis after penetrating eye injury

BACKGROUND

Intraocular and orbital anaerobic infections usually result from penetrating eye injuries with soil-contaminated foreign bodies. The outcome of these infections almost always has been loss of the globe, despite appropriate antibiotic and surgical treatment. The most prevalent etiologic microbe of anaerobic panophthalmitis is Clostridium perfringens.

CASE REPORT

To the authors' knowledge, this is the first report of panophthalmitis caused by Clostridium bifermentans after penetrating eye injury. The patient had severe signs and symptoms of intraocular and orbital infection, with early total loss of visual function. Parenteral and intravitreal therapy with penicillin and clindamycin, administered according to antibiotic sensitivity studies of cultures from the anterior chamber and vitreous, did not restore vision.

CONCLUSIONS

Due to the early devastating outcome, penetrating eye injuries with soil-contaminated foreign bodies should be regarded as being at high risk for clostridial infection and should be treated promptly with vitrectomy and antibiotic therapy for aerobic and anaerobic infection.

A rare case of orbital mucormycosis with gas gangrene panophthalmitis

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[Panophthalmitis as a nosocomial infection]

The submitted paper deals with an epidemic of severe postoperative panophthalmitis, its development, course, causes and sequelae incl. epidemiological characteristics. The disease developed in four patients 40 hours after operation of cataract. Despite treatment all four patients developed septicaemia and therefore the affected eyeballs were eviscerated. From smears of the conjunctival sac of the affected patients and from the contents of the eviscerated eyeball Proteus mirabilis and Enterobacter cloaceae were cultivated. The authors draw attention to the epidemiological association with the eye lotion BSS which was used from which Proteus mirabilis and E. coli were cultivated and with the Ringer solution from which Enterobacter cloaceae and Klebsiella pneumoniae were cultivated. An epidemiological analysis of the epidemic was made and provisions were defined to rule out its recurrence.

Bacillus cereus panophthalmitis associated with intraocular gas bubble

It has become increasingly apparent that Bacillus cereus can cause a severe and devastating form of endophthalmitis following penetrating trauma by a metallic object. B. cereus is an uncommon aetiological agent in non-clostridial gas-forming infections. The patient studied in this single case report showed evidence of intraocular gas mimicking gas gangrene infection. The physiology of non-clostridial bacteria producing gas from anaerobic metabolic conditions is reviewed. Further intraocular and systemic complications which may be avoided by accurate and early diagnosis and the use of recommended treatment with antibiotics such as clindamycin.

Endogenous Bacillus cereus panophthalmitis

Over the past seven years we have treated three cases of drug abusers in whom endogenous Bacillus cereus endophthalmitis rapidly progressed to panophthalmitis. Ocular features of infection with this organism include severe pain, chemosis, proptosis, corneal infiltration and ring abscess, subretinal exudation, retinal hemorrhages, and perivasculitis. The process becomes fulminant in an explosive manner and may be accompanied by fever and leukocytosis. Ophthalmologists should be cognizant of the apparent susceptibility of drug abusers to Bacillus cereus infections and should consider this organism in any severe, rapidly evolving intraocular infectious process.

Metastatic bacterial endophthalmitis: a contemporary reappraisal

Metastatic bacterial endophthalmitis remains a challenge to the clinician despite the success of antibiotics in reducing its frequency and severity. Controversy currently surrounds the management of this condition because of uncertainty about the value of and indications for vitreous surgery. We review 72 cases of metastatic endophthalmitis from the past decade, including five not previously published. The spectrum of causative bacteria changed significantly during this period, with displacement of meningococcus by Bacillus cereus as the most frequently reported agent and an increasing incidence of infection by organisms of low pathogenicity in immunologically compromised hosts. We propose a new classification scheme for metastatic endophthalmitis based on the location (anterior or posterior segment) and extent (focal or diffuse) of the primary intraocular infection. Focal and anterior cases appear to have a good prognosis, while posterior diffuse disease nearly always leads to blindness. Our analysis of outcomes suggests that systemic antibiotics are more valuable in metastatic than in postoperative or traumatic endophthalmitis and that intraocular antibiotic injection and vitrectomy make only a limited contribution to successful treatment in metastatic infection. We recommend a clinical approach to metastatic endophthalmitis that minimizes exposure of patients to the risks of invasive procedures.

Panophthalmitis and otitis interna in fire-bellied toads

Microbiologic and histologic studies were made of fire-bellied toads with signs of ocular and central nervous system disease. Providencia alcalifaciens, Citrobacter freundii, Aeromonas hydrophila, and other gram-negative bacilli were isolated from the eyes and multiple tissues of ill toads. The histologic evaluations revealed severe panophthalmitis and otitis interna.

Histopathology in botryomycosis-like panophthalmitis due to Staphylococcus aureus. A light microscopic and electron microscopic study. A case report

A Swedish farmer's wife aged 46 developed a unilateral panophthalmitis 6 weeks after a visit to Gambia in Africa. Vitreous puncture revealed growth of Staphylococcus aureus, but in spite of adequate treatment the eye had to be enucleated 5 weeks after the onset of symptoms. Gram-positive microorganisms in botryomycosis-like granules in the vitreal abscesses were at first suspected to be Histoplasma capsulatum. Electron microscopic examination revealed microorganisms, consistent with staphylococci. There was extensive proliferation of mesosomes, most probably due to the intense treatment. The poor nutrition and slow resorption of the dead microorganisms from the avascular vitreous did possibly also play a part in the proliferation of the mesosomes.

Panophthalmitis caused by Vibrio parahaemolyticus

We report a case of Vibrio parahaemolyticus panophthalmitis which resulted from contamination of a wound with water from a pond in inland Georgia. The pond was on the property of an oil refinery which receives crude oil from southern Mississippi. Cultures of the pond water 5 years later did not yield V. parahaemolyticus, but did yield non-O1 V. cholerae and had 0.28% sodium chloride content. V. parahaemolyticus may have been introduced into the pond along with oil transported from the Gulf of Mexico, and growth of this halophilic species may have been supported by salt from spilled crude oil.

Bacillus cereus endogenous panophthalmitis

A case of severe suppurative endogenous panophthalmitis caused by Bacillus cereus resulted from intravenously administered medications. This is the first, to our knowledge, well-documented case of endogenous endophthalmitis associated with this organism. It is recommended that if on Gram's stain of the anterior chamber fluid, Gram-positive rods are seen, chloramphenicol should be administered in addition to penicillin because of the possibility of B cereus infection.