RESUMEN
PURPOSE: To report the investigation of an outbreak of multidrug-resistant (MDR) Pseudomonas aeruginosa endophthalmitis in 13 patients after cataract surgery and to emphasize on the importance of clinical profile, risk factors, and treatment outcomes. METHODS: This was a hospital-based, retrospective case study with 13 consecutive patients who had man- ual small-incision cataract surgery with intraocular lens (IOL) implantation and developed acute postoperative Pseudomonas aeruginosa endophthalmitis. The anterior chamber taps, vitreous aspirates, and environ- mental surveillance specimens were inoculated for culturing. Antibiotic susceptibility testing was performed using the agar diffusion method. Pulsed-field gel electrophoresis (PFGE) was used to determine the relation- ship between bacterial isolates recovered from study patients and contaminated surveillance samples. RESULTS: Pseudomonas aeruginosa was isolated from all 13 eyes with acute postoperative endophthalmitis and the trypan blue solutions used during surgery. Sensitivity tests revealed that all isolates had an identical resistance to multiple drugs and were only susceptible to imipenem. Genomic DNA typing of Pseudomonas aeruginosa isolates recovered from patients and trypan blue solutions showed an identical banding pattern on the PFGE. Despite the prompt use of intravitreal antibiotics and early vitrectomy with IOL explantation in some patients, the outcome was poor in about 50% of patients. CONCLUSION: Positive microbiology and genomic DNA typing results proved that the contaminated trypan blue solutions were the source of infection in this outbreak. Postoperative endophthalmitis caused by Pseudomonas aeruginosa is often associated with a poor visual prognosis despite prompt treatment with intravitreal antibiotics.
Asunto(s)
Coroides/patología , Enfermedades Hereditarias del Ojo/diagnóstico , Retina/patología , Degeneración Retiniana/diagnóstico , Agudeza Visual , Diagnóstico Diferencial , Electrorretinografía , Femenino , Angiografía con Fluoresceína , Fondo de Ojo , Humanos , Tomografía de Coherencia Óptica , Adulto JovenRESUMEN
An 18-year-old boy presented to us with bilateral retinal hemangioblastoma and von Hippel-Lindau disease with history of cerebral capillary hemangioblastoma and embryonic cell carcinoma of left testes. The vision in the right eye was already lost with development of secondary closed angle glaucoma, optic atrophy with subsequent development of bullous keratopathy. The multiple retinal angiomatous lesions in the seeing left eye were treated with various modalities like triple freeze thaw cryopexy, focal lasers and transpupillary thermo therapy in multiple sittings over a period of almost 20 years since detection. One particular angiomatous lesion in the left eye was showing resistance to all the above mentioned modalities and was finally successfully treated with verteporfin and photodynamic therapy to achieve complete regression without any post-treatment complication and with a sustained 20/20 vision till a follow-up of 15 months.
Asunto(s)
Hemangioblastoma/tratamiento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes/uso terapéutico , Porfirinas/uso terapéutico , Neoplasias de la Retina/tratamiento farmacológico , Enfermedad de von Hippel-Lindau/complicaciones , Adolescente , Diagnóstico Diferencial , Estudios de Seguimiento , Hemangioblastoma/complicaciones , Hemangioblastoma/diagnóstico , Humanos , Masculino , Neoplasias de la Retina/complicaciones , Neoplasias de la Retina/diagnóstico , Factores de Tiempo , Verteporfina , Enfermedad de von Hippel-Lindau/diagnósticoRESUMEN
Cysticercosis is one of the most common parasitic infestations in humans. Neurocysticercosis (NCC) is the commonest parasitosis of the central nervous system (CNS), endemic in developing countries and is also seen in developed nations with high rates of immigration from prevalent areas. Co-infection of ocular tissue is also significant and often ophthalmologists come across these lesions in their clinical practice. The mode of treatment in NCC and that of intraocular cysticercosis is somewhat different as far as antiparasitic treatment is concerned. This case report highlights the proper management of this parasitic infestation which involved both eye and brain.