Clinical utility of antimicrobial susceptibility measurement plate covering formulated concentrations of various ophthalmic antimicrobial drugs

PURPOSE

The purpose of this study was to evaluate the clinical utility of SG17, an ophthalmic antimicrobial susceptibility measurement plate.

DESIGN

This was a multicenter, retrospective, observational study.

PATIENTS AND METHODS

Using clinical isolates from patients with ocular infections, drug susceptibility testing using the Clinical Laboratory and Standards Institute standards was routinely conducted at five facilities. The minimum inhibitory concentrations of the isolated strains were determined using SG17 at the Research Foundation for Microbial Diseases of Osaka University. The records of antimicrobial drugs used and the therapeutic course were evaluated for all cases. The susceptibility results from SG17 and routine methods used at each facility were compared.

RESULTS

A total of 112 bacterial strains were isolated from 92 patients. Of these cases, keratitis was the most common (52.2%), followed by conjunctivitis (21.7%) and others (26.1%). Principal signs and symptoms resolved in all patients, indicating that therapeutic effects had been achieved. With SG17, drug susceptibility was determined in 98.9% of isolates compared with 30.4% of isolates determined using conventional methods. By adapting the Clinical Laboratory and Standards Institute standards to SG17 results, we found that 91.3% of patients were susceptible and 7.6% were resistant. In five patients, drugs with a resistant evaluation were initially administered with no effect, and the patients were then switched to drugs with a susceptible evaluation with final resolution, indicating agreement of clinical results with SG17.

CONCLUSION

SG17 can be used to determine drug susceptibility to antimicrobial agents currently used in ophthalmic practice. SG17 is useful for selecting antimicrobial drugs.

A classic temporal optic disc pit showing progression in the corresponding optic nerve fiber and visual field defects

PURPOSE

We report a rare case with a classic temporal optic disc pit (ODP) showing the progression of an associated nerve fiber layer defect (NFLD) with the corresponding visual field defect (VFD).

METHODS

We describe the patient's medical records and review the pertinent literature.

RESULTS

A 54-year-old woman had a temporal ODP, which was considered to be congenital, associated with both NFLD expanded to both the upper and lower sides of the horizontal line and corresponding VFD and a small ODP-like excavation at the 6.5 o'clock position on the disc edge with a narrow NFLD OD. During the 5-year follow-up period, both the NFLD and VFD associated with the temporal pit progressed without serous retinal detachment. The small ODP-like excavation located at the 6.5 o'clock position also showed progressive NFLD in the temporal lower quadrant with advanced VFD, which suggested that the excavation might be associated with glaucoma.

CONCLUSION

Based on the observation that the VFD occupied the two temporal quadrants with no step, an NFLD with corresponding VFD associated with a classic temporal ODP, although not considered to be related to glaucoma, can progress.

[A case of secondary retinal detachment caused by ocular toxocariasis]

PURPOSE

We report a case with bullous retinal detachment secondary to ocular toxocariasis.

CASE

A 68-year-old man, who was a professional dog breeder, visited an ophthalmologist because of visual field defect in the left eye, and was referred to our clinic. The patient had bilateral cataract and bullous retinal detachment in the left eye. Fundus examinations after cataract surgery revealed no break but a white mass in the temporal lower peripheral retina of the left eye. Initial treatment with systemic corticosteroids was ineffective. Retinal detachment was treated by retinal cryocoagulation, scleral buckling, and subretinal fluid drainage. Subretinal fluid obtained during the operation showed high antibody titer for Toxocara canis.

CONCLUSION

Ocular toxocariasis can cause bullous retinal detachment. To confirm the diagnosis, examination of the antibody titer of Toxocara canis in the subretinal fluid is useful.

Congenital microcoria associated with late-onset developmental glaucoma

PURPOSE

To demonstrate that developmental glaucoma (instead of the term goniodysgenetic glaucoma is used in this paper), defined as glaucoma with goniodysgenesis resulting from a fetal maldevelopment of the iridocorneal angle, develops in association with congenital microcoria.

METHODS

Three subjects descended from a family with autosomal dominant congenital microcoria and goniodysgenesis were followed up for more than 25 years.

RESULTS

The extended family consisted of 3 generations including 8 males and 10 females. In the second generation, 2 of 7 subjects who presented with a history of congenital microcoria had late-onset goniodysgenetic glaucoma. In the third generation, all 3 descendants of the second generation subjects with congenital microcoria had congenital microcoria with goniodysgenesis. Two of these subjects developed late-onset goniodysgenetic glaucoma in both eyes during the 25-years follow-up period. They were both treated with a trabeculectomy in both eyes to control the glaucoma. Histologically, the iridocorneal angle tissues from the patients showed thick juxtacanalicular connective tissue with accumulations of a basement membrane-like extracellular matrix.

CONCLUSION

Congenital microcoria are considered to be frequently associated with the incidence of late-onset goniodysgenetic glaucoma.

[Diagnosis and treatment of cervical dysplasia]

Between 1981 and 1986, 219 patients with cervical dysplasia were treated at the Kyushu University Hospital. All patients were diagnosed by cervical smear, colposcopy, and cervical biopsy and/or endo cervical curettage. They have been followed for more than one year (average 37 months). Of the 219 patients, 63 had mild dysplasia, 99 had moderate dysplasia, and 57 had severe dysplasia. One hundred and forty patients were treated with carbon dioxide laser. The remission rate was 95.0% after one treatment and 98.6% after two treatments. The laser therapy is effective, but a certain rate of recurrence is to be expected. Recently, 23 patients were treated with the cryotherapy and the remission rate was 83%.

[Evaluation of paraaortic lymph node metastasis in patients with primary epithelial carcinoma of the ovary]

From 1979-1986, 110 patients with an ovarian cancer have been treated at Kyushu University Hospital. Sixty-eight of these patients with untreated primary adenocarcinoma of the ovary underwent a paraaortic lymph node (PAN) biopsy at the time of their initial surgery. Twenty-two of these 68 patients were found (32.4%) to have a positive PAN. Microscopic PAN metastases were present in 4 patients, who, macroscopically, seemed to have the disease confined to the pelvis. The incidence of a positive PAN was seen to correlate with the clinical stage and degree of differentiation of the primary tumor. Positive PANs were more frequent in cases of a serous rather than a mucinous carcinoma. All 5 patients with a metastatic adenocarcinoma originating from the stomach or the colon had a positive PAN. It thus has been concluded that a PAN evaluation is important for the management of ovarian cancer.