RESUMEN
BACKGROUND: Microbial keratitis (MK) is a sight-threatening emergency. Delayed diagnosis and treatment may exacerbate the condition and infection may spread to the posterior segment with resultant endophthalmitis. We describe the presentation, management, visual outcomes and microbial profiles of MK-associated endophthalmitis presenting to a tertiary referral centre. METHODS: Prospective collection of data on all patients presenting with presumed MK-associated endophthalmitis from 1997 to 2007, to the Royal Victorian Eye and Ear Hospital. Outcome measures included: visual acuity, microbial profiles, and management strategy. RESULTS: Thirty-seven cases of MK-associated endophthalmitis were identified over the study period, with a mean age of 73 years and 19 were male. Presenting acuities ranged from Snellen 2/60 to no perception of light (NPL). Thrity-four (91.9%) patients had a prior history of ocular disease. Identifiable non-ocular risk factors were present in 31 (83.8%), including steroid use, dementia, nursing home care or relative systemic immunosuppression. A culture positivity rate of 83.8% was recorded. The most common organisms identified included: Streptococcal species in 12 (32.4%), Pseudomonas aeruginosa in 11 (29.7%), and Staphylococcus aureus in eight (21.6%). Final acuities ranged from 6/36 to NPL. Sixteen (43.2%) eyes were eviscerated/enucleated as primary treatment. Overall, 23 (62.2%) patients required evisceration/enucleation, of which nine (39.1%) were due to Pseudomonas aeruginosa and seven (30.4%) to Streptococcal species (Streptococcal pneumonia). CONCLUSIONS: MK-associated endophthalmitis is a serious ocular condition occurring more frequently in elderly populations, and those with long standing severe pre-existing ocular disease. Visual outcomes are poor, often requiring evisceration/enucleation.
Asunto(s)
Úlcera de la Córnea , Endoftalmitis , Infecciones Bacterianas del Ojo , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Australia/epidemiología , Bacterias/aislamiento & purificación , Ceftazidima/uso terapéutico , Úlcera de la Córnea/diagnóstico , Úlcera de la Córnea/epidemiología , Úlcera de la Córnea/microbiología , Endoftalmitis/diagnóstico , Endoftalmitis/epidemiología , Endoftalmitis/microbiología , Enucleación del Ojo , Evisceración del Ojo , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/epidemiología , Infecciones Bacterianas del Ojo/microbiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Vancomicina/uso terapéutico , Agudeza Visual/fisiologíaRESUMEN
From the rise of modern corneal graft surgery in the late 1950s until recently, corneal transplantation for keratoconus almost exclusively consisted of a full-thickness transplant, termed penetrating keratoplasty. This technique involved the removal of all of the layers of the patient's central cornea and replacement with a full-thickness graft. Over approximately the past 20 years, a quiet revolution has occurred with the development of several other types of corneal transplantation surgery for keratoconus. In addition to full thickness grafts, several different types of partial thickness, lamellar grafts, have been developed and are viable alternatives to a full-thickness graft in selected patients. The main aim of these lamellar grafts is to selectively replace the corneal stroma, leaving intact the patient's own Desçemet's membrane and endothelial cells, the main target of allograft transplant rejection. In this article, we review the current options with regard to corneal transplantation for keratoconus and review the evidence comparing newer and more established techniques.
Asunto(s)
Trasplante de Córnea/métodos , Queratocono/cirugía , Trasplante de Córnea/efectos adversos , Células Endoteliales/patología , Rechazo de Injerto , Supervivencia de Injerto , Humanos , Queratoplastia Penetrante/métodos , Agudeza VisualAsunto(s)
Anticuerpos Monoclonales/efectos adversos , Enfermedades de la Retina/inducido químicamente , Enfermedades de la Retina/diagnóstico , Tuberculosis/inducido químicamente , Tuberculosis/diagnóstico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adulto , Artritis Psoriásica/tratamiento farmacológico , Diagnóstico Diferencial , Femenino , Humanos , InfliximabRESUMEN
PURPOSE: To describe, for the first time, the occurrence of a large cyst in the orbital lobe of the lacrimal gland in association with marginal zone B-cell MALT lymphoma in three female patients, two of whom also had primary Sjögren's syndrome. METHODS: Retrospective case note review. RESULTS: Three female patients, aged 35, 41 and 47 years, presented with progressive proptosis caused by an enlarging cyst within the orbital lobe of the lacrimal gland. Two of the patients had primary Sjögren's syndrome. Excision of the cyst and part of the lacrimal gland revealed marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type within the gland or wall of the cyst in all cases. The cysts were partially lined by ductular epithelium. One patient had systemic lymphoma, was treated with chemotherapy and remains in remission one year later; the other two had disease apparently confined to the lacrimal gland and are disease-free at 9 months and at three years after local irradiation, respectively. CONCLUSION: To our knowledge, these are the first reported cases of cysts affecting the orbital lobe of the lacrimal gland in patients with B-cell MALT lymphoma of the gland. Although cystic changes have been described in other exocrine glands, lung and thymus in patients with Sjögren's syndrome, this association has also not been described in the lacrimal gland before.