RESUMEN
The development of potent antibiotic alternatives with rapid bactericidal properties is of great importance in addressing the current antibiotic crisis. One representative example is the topical delivery of predatory bacteria to treat ocular bacterial infections. However, there is a lack of suitable methods for the delivery of predatory bacteria into ocular tissue. This work introduces cryomicroneedles (cryoMN) for the ocular delivery of predatory Bdellovibrio bacteriovorus (B. bacteriovorus) bacteria. The cryoMN patches are prepared by freezing B. bacteriovorus containing a cryoprotectant medium in a microneedle template. The viability of B. bacteriovorus in cryoMNs remains above 80% as found in long-term storage studies, and they successfully impede the growth of gram-negative bacteria in vitro or in a rodent eye infection model. The infection is significantly relieved by nearly six times through 2.5 days of treatment without substantial effects on the cornea thickness and morphology. This approach represents the safe and efficient delivery of new class of antimicrobial armamentarium to otherwise impermeable ocular surface and opens up new avenues for the treatment of ocular surface disorders.
Asunto(s)
Bdellovibrio bacteriovorus/fisiología , Infecciones del Ojo/microbiología , Inyecciones Intraoculares/métodos , Administración Tópica , Animales , Bdellovibrio bacteriovorus/crecimiento & desarrollo , Córnea/anatomía & histología , Córnea/fisiología , Modelos Animales de Enfermedad , Infecciones del Ojo/diagnóstico por imagen , Infecciones del Ojo/terapia , Bacterias Gramnegativas/fisiología , Inyecciones Intraoculares/instrumentación , Masculino , Ratones , Ratones Endogámicos C57BL , Agujas , Tomografía de Coherencia ÓpticaRESUMEN
PURPOSE: Sudden visual impairment in children occurs sporadically but, when present, needs urgent attention. Optimal management strategies and timely recognition are required. Often psychogenic disorders are the cause in school-age children; however, this is a diagnosis of exclusion. Therefore, MRI plays an important role in ruling out pathology along the optic pathways or helping with the diagnosis of underlying life threatening diseases, such as hydrocephalus or intracranial mass. The purpose of this study was first to evaluate non-traumatic (tumoural and non-tumoural) causes of acute vision impairment; and, second, to assess whether conventional cerebral and orbital MR imaging is helpful for children with sudden visual impairment. PATIENTS AND METHODS: We retrospectively analysed the MRI scans and clinical findings of 95 children (47 male, 48 female; median age: 12.5 years, range: from 2 to 17 years) who presented symptoms of monocular or bilateral acute vision impairment. RESULTS: Patients with acute visual impairment were usually older than 7 years. In 36% of the patients a correlation between the MRI findings and the clinical symptoms was found. The most common causes of visual impairment were: infectious diseases (16%), migraine (12%), autoimmune diseases (11%), optic nerve neuritis with unknown aetiology (8%), neoplasms (8%), idiopathic intracranial hypertension (5%) and orthostatic hypotension (4%). Still, in 23% of the patients the cause remained unclear. CONCLUSION: Acute vision impairment is frequently caused by infectious diseases, migraine, autoimmune diseases or tumours in children. MRI is highly recommended, especially in the case of children younger than 5 years of whom clinical assessment can be difficult.
Asunto(s)
Neoplasias Encefálicas/diagnóstico por imagen , Infecciones del Ojo/diagnóstico por imagen , Hidrocefalia/diagnóstico por imagen , Hipotensión Ortostática/diagnóstico por imagen , Trastornos Migrañosos/diagnóstico por imagen , Neuritis Óptica/diagnóstico por imagen , Seudotumor Cerebral/diagnóstico por imagen , Trastornos de la Visión/diagnóstico por imagen , Enfermedad Aguda , Adolescente , Neoplasias Encefálicas/complicaciones , Niño , Preescolar , Infecciones del Ojo/complicaciones , Infecciones del Ojo/diagnóstico , Femenino , Humanos , Hidrocefalia/complicaciones , Hipotensión Ortostática/complicaciones , Hipotensión Ortostática/diagnóstico , Imagen por Resonancia Magnética , Masculino , Trastornos Migrañosos/complicaciones , Trastornos Migrañosos/diagnóstico , Neuritis Óptica/complicaciones , Seudotumor Cerebral/complicaciones , Estudios Retrospectivos , Trastornos de la Visión/etiologíaRESUMEN
The use of point-of-care ultrasound in the emergency department has expanded considerably in recent years, allowing enhanced evaluation of the patient with an emergent eye or vision complaint. The technique is simple and quick to perform, and can yield clinical information that may not be readily obtainable through physical or slit-lamp exams. Ocular bedside sonography can aid in the diagnosis of retinal and vitreous hemorrhage, retinal and vitreous detachments, ocular infections, foreign bodies, retrobulbar hematoma, or ocular vascular pathology. Optic nerve sheath diameter can be measured in patients with a suspected intracranial process as a surrogate for intracranial pressure, and may aid emergency diagnosis and management. This article reviews common emergency ophthalmic pathologies diagnosed with ultrasound in the emergency setting and a mnemonic for the use of bedside ocular ultrasound is proposed to aid in thoroughly scanning the eye and its surrounding structures.
Asunto(s)
Servicio de Urgencia en Hospital , Oftalmopatías/diagnóstico por imagen , Sistemas de Atención de Punto , Ojo/diagnóstico por imagen , Infecciones del Ojo/diagnóstico por imagen , Lesiones Oculares/diagnóstico por imagen , Humanos , UltrasonografíaRESUMEN
Assessment of patients with infectious endophthalmitis is frequently limited by media opacities, and ocular ultrasonography is routinely performed in this setting. We examined the literature to assess the level of evidence for the utility of ocular ultrasonography in these patients. Common ultrasonographic findings reported include low amplitude mobile echoes, vitreous membranes, and thickening of the retina and choroid. Based on the available evidence, we conclude that ocular ultrasound may be a useful adjunct in guiding treatment and minimizing complications. While positive findings may be confirmatory in cases in which the clinical suspicion is high, ocular ultrasound alone cannot be used to prove or to exclude the diagnosis of infectious endophthalmitis.
Asunto(s)
Endoftalmitis/diagnóstico por imagen , Endoftalmitis/microbiología , Oftalmopatías/diagnóstico por imagen , Infecciones del Ojo/diagnóstico por imagen , Cuerpo Vítreo/patología , Coroides/patología , Humanos , Hipertrofia , Retina/patología , Ultrasonografía , Cuerpo Vítreo/microbiologíaRESUMEN
Infection, inflammation, and systemic diseases affecting the globe encompass a broad range of pathologies which may ultimately lead to progressive vision loss. Clinical symptomatology varies from the inexorably silent progressive visual loss to an acute presentation of ocular pain and/or red eye. Most are diagnosed by clinical ophthalmologic examination with selective use of ultrasound, computed tomography, and magnetic resonance imaging for confirmation of the diagnosis, assessment of disease extent, and signs of associated systemic disease. Knowledge of the differential diagnoses of vision loss, ocular pain, and redness makes imaging analysis of this diverse group of processes more precise.
Asunto(s)
Oftalmopatías/diagnóstico por imagen , Oftalmopatías/patología , Inflamación/diagnóstico por imagen , Inflamación/patología , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , Medios de Contraste , Diagnóstico Diferencial , Ojo/diagnóstico por imagen , Ojo/patología , Oftalmopatías/complicaciones , Infecciones del Ojo/diagnóstico por imagen , Infecciones del Ojo/patología , Humanos , Infecciones/complicaciones , Infecciones/diagnóstico , Inflamación/complicaciones , Intensificación de Imagen Radiográfica/métodosRESUMEN
PURPOSE: To evaluate the role of corneal structural resistance as a surgical failure factor in deep lamellar keratoplasty (DLK). METHOD: A total of 10 eyes of 10 patients underwent DLK at the Ophthalmic Hospital in Rome. The big bubble technique was performed for deep stromal dissection by air injection. Seven patients were affected by advanced keratoconus and corneal thinning ranging from 441 to 235 microm. Two patients were affected by central corneal opacity from herpetic keratitis, and one patient suffered from corneal leucoma caused by bacterial keratitis. Clinical follow-up comprising final astigmatism and visual acuity findings were evaluated with a minimum follow-up of 12 weeks. RESULTS: DLK was successfully performed in eight eyes, five of which were affected by moderate to advanced keratoconus and three by post-infective corneal opacity. In these patients preoperative ultrasonic pachymetry ranged between 441 and 287 microm. In the remaining two patients a perforation of the Descemet's membrane (DM) occurred while attempting to separate it from the overlying stroma by the big bubble technique, requiring a penetrating keratoplasty (PK) to be performed. In both cases preoperative ultrasonic pachymetry was below 250 microm. Both perforations occurred at a different site than the needle site and at the operative time of the big-bubble injection. DISCUSSION: An ultrastructurally weakened DM may suffer a loss of resistance to a stressing force, becoming unable to tolerate the big bubble technique, and thus being perforated. Since the weakening of the DM is related to end-stage keratoconus corneal thinning, the preoperative corneal thickness rather than the surgeon's ability can play a major role in surgical failure of DLK. Our study reveals a very high risk of perforation of the DM when pre-operative total pachymetry is below limit of 250 microm.
Asunto(s)
Opacidad de la Córnea/cirugía , Lámina Limitante Posterior/lesiones , Infecciones del Ojo/cirugía , Enfermedad Iatrogénica , Queratitis/cirugía , Queratocono/cirugía , Queratoplastia Penetrante/métodos , Adulto , Opacidad de la Córnea/diagnóstico por imagen , Opacidad de la Córnea/patología , Infecciones del Ojo/diagnóstico por imagen , Infecciones del Ojo/patología , Femenino , Humanos , Queratitis/microbiología , Queratitis/patología , Queratocono/diagnóstico por imagen , Queratocono/patología , Masculino , Microscopía Confocal , Factores de Riesgo , Rotura , Insuficiencia del Tratamiento , UltrasonografíaAsunto(s)
Citratos/farmacocinética , Infecciones del Ojo/diagnóstico por imagen , Infecciones del Ojo/metabolismo , Neoplasias del Ojo/diagnóstico por imagen , Neoplasias del Ojo/metabolismo , Galio/farmacocinética , Órbita/diagnóstico por imagen , Órbita/metabolismo , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Humanos , Cintigrafía , Radiofármacos/farmacocinéticaRESUMEN
OBJECTIVE: To present a delayed complication of endoscopic orbital decompression that has not been reported previously in the literature. DESIGN: Retrospective non-comparative small case series. PARTICIPANTS: Three patients with dysthyroid orbitopathy. INTERVENTION: The medical records of patients with dysthyroid orbitopathy who underwent endoscopic orbital decompression and subsequently developed orbital infection were reviewed. RESULTS: Three patients with dysthyroid orbitopathy developed orbital infection (cellulitis or abscess) originating from the frontal sinus more than 2 years after their endoscopic orbital decompression surgery. Management required drainage of the abscess, administration of antibiotics, and creation of adequate frontal sinus drainage. CONCLUSIONS: Delayed orbital infection can occur after endoscopic orbital decompression for dysthyroid orbitopathy when the frontal sinus ostium is obstructed by orbital fat or scar tissue. Infection within the frontal sinus can cause secondary orbital cellulitis or abscess. Early signs and symptoms of a frontal sinus infection can be easily misdiagnosed as progression of the patient's thyroid eye disease. Awareness of this possible complication followed by appropriate early intervention will prevent a potentially blinding condition. Furthermore, ever since this complication was observed, the authors' surgical technique of endoscopic decompression has been modified to leave the most anterosuperior portion of the lamina papyracea to prevent fat prolapse and scar formation into the region of the frontal recess.
Asunto(s)
Descompresión Quirúrgica/efectos adversos , Endoscopía/efectos adversos , Infecciones del Ojo/etiología , Enfermedad de Graves/cirugía , Órbita/cirugía , Enfermedades Orbitales/etiología , Absceso/diagnóstico por imagen , Absceso/etiología , Absceso/terapia , Adulto , Anciano , Antibacterianos/uso terapéutico , Celulitis (Flemón)/diagnóstico por imagen , Celulitis (Flemón)/etiología , Celulitis (Flemón)/terapia , Drenaje/métodos , Infecciones del Ojo/diagnóstico por imagen , Infecciones del Ojo/terapia , Femenino , Enfermedad de Graves/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Órbita/diagnóstico por imagen , Enfermedades Orbitales/diagnóstico por imagen , Enfermedades Orbitales/terapia , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
Pseudomonas aeruginosa orbital infections have been described very rarely in patients with neutropenia after chemotherapy. We report the case of a woman with the unusual association of Sjögren's disease and myelodysplasia, who suffered from a Pseudomonas aeruginosa orbital phlegmon after chemotherapy for her myelodysplastic syndrome. Partial intestinal antibiotic decontamination with ciprofloxacine did not prevent the infection. She was treated successfully with intravenous ceftazidime, netilmicin and granulocyte-colony stimulating factor (G-CSF). The normalization of the granulocyte count seems to play a crucial role for recovery. We present the clinical and radiological findings, discuss the therapy and review the literature concerning ocular infections due to Pseudomonas. Other infections due to this germ in immunocompromised hosts are briefly reviewed.
Asunto(s)
Síndromes Mielodisplásicos/microbiología , Enfermedades Orbitales/microbiología , Infecciones por Pseudomonas/inmunología , Pseudomonas aeruginosa , Síndrome de Sjögren/microbiología , Anciano , Anemia/complicaciones , Anemia/microbiología , Citarabina/administración & dosificación , Infecciones del Ojo/diagnóstico por imagen , Infecciones del Ojo/inmunología , Femenino , Humanos , Huésped Inmunocomprometido , Inmunosupresores/administración & dosificación , Leucopenia/complicaciones , Leucopenia/microbiología , Síndromes Mielodisplásicos/complicaciones , Síndromes Mielodisplásicos/tratamiento farmacológico , Infecciones por Pseudomonas/diagnóstico por imagen , Síndrome de Sjögren/complicaciones , Síndrome de Sjögren/tratamiento farmacológico , Tomografía Computarizada por Rayos XRESUMEN
Real-time sonography is a well-accepted technique for evaluating abnormalities of the eye. Most previous reports on sonography of the eye have been in adults [1]. In this pictorial essay, we illustrate normal and abnormal findings of ocular sonography in children.