Microbiological Profile and Clinical Characteristics of Bacterial Keratitis with Poor Visual Outcome

Purpose@#To compare clinical characteristics between the poor visual outcome (PVO) and good visual outcome (GVO) groups in culture-proven bacterial keratitis. @*Methods@#A total of 230 cases (44 and 186 eyes in the PVO and GVO groups, respectively) of culture-proven bacterial keratitis, treated between January 2007 and December 2020, were reviewed retrospectively. The PVO group included cases with the final best-corrected visual acuity (BCVA) of less than 0.1 and no improvement compared to the initial BCVA. The remaining cases were included in the GVO group. The microbiological profiles, epidemiology, predisposing factors, and clinical characteristics were compared between the PVO and GVO groups, and the risk factors for PVO were analyzed. @*Results@#Staphylococcus spp. and Pseudomonas spp. were common isolates in both the PVO and GVO groups, with no significant differences in the distribution of isolates. There were no significant differences between the groups in terms of sex, seasonal distribution, corneal trauma, and prior topical steroid use, but contact lens wear was significantly less in the PVO group. Significant risk factors for PVO were age ≥60 years (Z = 4.22, two-proportion Z-test), central corneal lesions (Z = 3.80), epithelial defect size ≥5 mm2 (Z = 3.74), prior ocular surgery (Z = 3.63), hypopyon (Z = 3.42), previous ocular surface disease (Z = 3.32), and diabetes (Z = 3.12). @*Conclusions@#In patients with bacterial keratitis, PVO was associated with older age, severe initial corneal findings, previous ocular disease history, and diabetes, but not with the causative pathogen itself.

A Case of Iris Neovascularization in Severe Fungal Keratitis Treated with Intracameral Bevacizumab

Purpose@#We report a case in which iris neovascularization (NVI) improved after intracameral bevacizumab injection in a patient who exhibited fungal keratitis with NVI.Case summary: A 47-year-old man experienced a tree branch-induced injury to his right eye and was treated for keratitis for 1 month. However, his condition deteriorated and he was referred to our hospital. Initial slit lamp biomicroscopy findings showed a large, thick central deep stromal infiltration with a concentric circle shaped feathery-like margin, epithelial defect, satellite lesion, fungal ball, hypopyon, and NVI. Aspergíllus fumigatus was isolated in the corneal scraping culture. Amphotericin B, voriconazole, and natamycin were administered as topical treatment along with systemic amphotericin B. After treatment, the corneal lesions gradually improved, but NVI worsened. After the 5th week, total hyphema occurred; anterior chamber irrigation and intracameral bevacizumab injection were performed. Two weeks postoperatively, the NVI exhibited complete regression; corneal stromal melting with descemetocele appeared after 8 weeks. Penetrating keratoplasty was performed and NVI was no longer observed at 6 months after surgery. @*Conclusions@#For the treatment of iris neovascularization in patients with infectious keratitis, intracameral bevacizumab injection at an appropriate time may be effective.

Comparative Clinical Analysis of Polymicrobial and Monomicrobial Bacterial Keratitis

Purpose@#We comparatively analyzed the microbiological profiles, predisposing factors, clinical aspects, and treatment outcomes of patients with polymicrobial and monomicrobial bacterial keratitis. @*Methods@#A total of 194 cases of culture-proven bacterial keratitis treated between January 2007 and December 2016 were reviewed. Microbiological profiles, the epidemiology, predisposing factors, clinical characteristics, and treatment outcomes were compared between the polymicrobial group (polymicrobial bacterial keratitis [PBK]; 29 eyes, 62 isolates) and monomicrobial (monomicrobial bacterial keratitis [MBK]; 165 eyes, 165 isolates) group. @*Results@#The most common isolates were Enterobacter (24%) in the PBK group and Staphylococcus (22%) in the MBK group. There were no significant differences between the two groups in previous ocular surface disease, previous ocular surgery, prior topical steroid use, epithelial defect size, and hypopyon. Age ≥60 years (PBK vs. MBK, 31% vs. 51%, p = 0.048), symptom duration (4.7 days vs. 8.0 days, p = 0.009), and contact lens use (34% vs. 18%, p = 0.036) were significantly different between the two groups. Regarding treatment outcomes, epithelial healing time ≥10 days, the final best-corrected visual acuity (BCVA), a need for surgical intervention, and the rate of poor clinical outcome were not significantly different between the two groups. Significant risk factors for a poor clinical outcome in all patients were an initial BCVA <0.1 (Z = 6.33, two-proportion Z-test), an epithelial defect size ≥5 mm2 (Z = 4.56), and previous ocular surface disease (Z = 4.36). @*Conclusions@#Polymicrobial bacterial keratitis, compared to monomicrobial bacterial keratitis, was more significantly associated with younger age, contact lens use, and shorter symptom duration.

Clinical Analysis of Candida Species Keratitis: Predisposing Factors, Clinical Characteristics, and Treatment Outcomes

Purpose@#To investigate the epidemiology, predisposing factors, clinical characteristics, and treatment results of Candida species keratitis. @*Methods@#Eighteen eyes of 18 patients who were diagnosed with Candida species keratitis (C. albicans [CA], 9 eyes; non-CA [NCA], 9 eyes) via corneal culture and hospitalized at Yeungnam University Hospital were included. The epidemiology, predisposing factors, initial clinical characteristics, and treatment outcomes were analyzed retrospectively. Treatment success was defined as the successful healing of corneal lesions after medical intervention. @*Results@#The mean age was 67.5 ± 15.4 years and polymicrobial infection was observed in seven eyes (39%). The mean duration of symptoms was 23.9 days. The common predisposing factors were previous ocular surface disease (8 eyes, 44%), corneal trauma (8 eyes, 44%), and previous topical steroid use (7 eyes, 39%). Common initial clinical characteristics were round infiltration (13 eyes, 72%), hypopyon (8 eyes, 44%), and an initial best corrected visual acuity (BCVA) of less than 0.1 (13 eyes, 72%).In terms of treatment outcomes, we recorded a mean corneal epithelial healing time of 23.5 ± 18.9 days, a final BCVA <0.1 in 12 eyes (75%), and treatment success in 6 eyes (35%). Surgical treatments were performed in 11 eyes (61%), five of which experienced evisceration or enucleation. There were no significant differences in clinical characteristics or treatment outcomes between the CA and NCA groups. In the treatment failure group, previous topical steroid use (64% vs. 0%, p = 0.04) was more common and symptom durations were relatively longer than in the treatment success group (31.3 vs. 13.5 days, p = 0.08). @*Conclusions@#Our results showed that Candida keratitis is associated with old age, previous ocular disease, and surgical treatment. Compared with the group in which successful outcomes were achieved, the treatment failure group was associated with previous topical steroid use and longer symptom duration.

Clinical Analysis of Bacterial Keratitis According to Culture Positivity

PURPOSE: The purpose of this study was to evaluate the clinical aspects of inpatients with bacterial keratitis according to culture positivity. METHODS: This was a retrospective review of 98 cases of inpatients with bacterial keratitis who were treated between January 2011 and December 2016 in Yeungnam University Hospital. Epidemiology, predisposing factors, clinical characteristics, and treatment outcomes were compared between culture positive (CP, 39 eyes) and culture negative (CN, 59 eyes) groups. Risk factors for poor clinical outcome were evaluated in the total cohort and analyzed using multivariate logistic regression. RESULTS: Pseudomonas spp. (31%) and Staphylococcus spp. (24%) were common in the CP group. There were no significant differences in previous ocular surface disease, contact lens wear, or hypopyon between the two groups. Epithelial defect size ≥5 mm² (51%:31%, p = 0.04) and initial visual acuity <0.1 (Snellen) (51%:31%, p = 0.04) were significantly higher in the CP group than in the CN group. Epithelial healing time ≥14 days (18%:5%, p = 0.08) and poor clinical outcome (28%:20%, p = 0.37) were more common in the CP group than in the CN group. Risk factors for poor clinical outcome were previous ocular surface disease (odds ratio [OR] = 11.29, 95% confidence interval [CI] = 2.01–63.41, p = 0.006) and previous ocular surgery (OR = 6.98, 95% CI = 1.51–32.20, p = 0.01). CONCLUSIONS: The CP group showed relatively worse initial clinical characteristics than the CN group. Treatment outcomes were slightly worse in the CP group than in the CN group; however, this difference was not statistically significant. Previous ocular surface disease and previous ocular surgery were associated with poor clinical outcome.

Clinical Analysis of Staphylococcus Keratitis According to Coagulase Positivity

PURPOSE: To analyze clinical aspects in a cohort of patients with Staphylococcus keratitis according to coagulase positivity (coagulase negative Staphylococcus [CNS], coagulase positive Staphylococcus [CPS]). METHODS: Epidemiology, predisposing factors, clinical characteristics, treatment outcomes, and antibiotic susceptibility were comparatively analyzed in 138 cases of culture-proven Staphylococcus keratitis (94 eyes with CNS and 44 eyes with CPS) over 20 years (1998–2017) at Yeungnam University Hospital. Poor clinical outcomes were defined as a final corrected visual acuity <0.1, a decreased visual acuity after treatment, complications, or surgical treatment. Risk factors for poor clinical outcomes were evaluated in the total cohort and analyzed using multivariate logistic regression. RESULTS: The most common predisposing factors were corneal trauma in the CNS group (47.9%) and previous ocular surface disease in the CPS group (31.8%). No significant differences were observed in mean age, sex, previous ocular surface disease, epithelial defect size, and hypopyon between the two groups. Methicillin susceptibility (39.4% vs. 72.7%, p < 0.001) was significantly lower in the CNS group, and poor clinical outcomes (28.0% vs. 43.9%, p = 0.076) were more common in the CPS group. The significant risk factors for poor clinical outcomes were initial best-corrected visual acuity <0.1, epithelial defect size ≥ 5 mm², symptom duration ≥10 days, and hypopyon. CONCLUSIONS: No significant differences were observed in epidemiological factors and initial clinical characteristics between the two study groups, but predisposing factors and methicillin susceptibility differed between the two groups. Treatment outcomes were relatively worse in the CPS group than in the CNS group, but the difference was not statistically significant. Poor clinical outcomes were more associated with long symptom duration and poor initial clinical characteristics than with coagulase positivity.

A Case of Isolated Conjunctival Lymphangioma Mimicking a Recurrent Conjunctival Cyst

PURPOSE: To report a case of isolated conjunctival lymphangioma mimicking a recurrent conjunctival cyst. CASE SUMMARY: A 39-year-old male with a conjunctival cyst in the right eye lasted for 1 month visited our hospital. He had previously undergone aspiration of the cyst at another hospital 1 week before visiting our hospital. However, the cyst recurred, and he was referred to our hospital. On slit lamp biomicroscopy, yellow-colored turbid fluid and a hemorrhage were observed in the conjunctival cyst, but no specific finding was found in the fundus photography. The patient was initially treated with topical antibiotics and steroids. Three weeks later, absorption of the hemorrhage was noted, but there was no change in the size of the cyst. Therefore, surgical removal and histological examination of the cyst were performed. The histological examination revealed that the lesion was positive for CD 31 and D2-40, and the cyst was diagnosed as a cystic conjunctival lymphangioma. Thereafter, brain magnetic resonance imaging was performed to screen for orbital lymphangioma and systemic disease that could accompany a conjunctival lymphangioma. However, no specific findings were observed. There was no recurrence of the conjunctival cyst at 1 year and 6 months after surgical removal, and no other ophthalmic or systemic complication was observed. CONCLUSIONS: An isolated conjunctival lymphangioma is a rare lesion. In the diagnosis of lymphangioma, systemic examination is recommended for the identification of comorbid diseases, such as orbital lymphangioma.

Analysis of Inpatients with Contact Lens Related Bacterial Keratitis: Causative Microorganisms, Clinical Aspects, and Prognostic Factors

PURPOSE: To investigate causative microorganisms, clinical characteristics, and prognostic factors for inpatients with contact lens related bacterial keratitis. METHODS: Seventy-three eyes of inpatients with contact lens related bacterial keratitis and hospitalized at Yeungnam University Hospital between January 1998 and December 2011 were reviewed retrospectively. Their bacteriological profiles and clinical characteristics were evaluated. RESULTS: Females in their 20s (35/73 eyes, 47.9%) were the most common gender and age group. Thirty eyes (30/45 eyes, 66.7%) used daily-wear soft contact lenses. The most common predisposing factor was sleeping while wearing contact lenses (30 eyes, 41.1%). Positive culture rate was 53.4%. The ratio of gram-positive and -negative bacteria was 8.3%: 91.6%. The most commonly-isolated microorganisms were Pseudomonas spp. (39.6%), followed by Serratia spp. (29.2%). The characteristics of the corneal lesions were: a central lesion in 49 eyes (67.1%), a lesion less than 5 mm2 in size in 54 eyes (74.0%), and hypopyon in 8 eyes (11.0%). The mean log MAR BCVA improved from 0.93 +/- 0.88 on the initial visit to 0.25 +/- 0.48 on the final visit. Twelve eyes (16.4%) had a BCVA of 0.3 or less after remission medical treatment. A BCVA less than 0.1 on the initial visit was a significant risk factor for poor visual outcome (p = 0.005) after remission medical treatment. CONCLUSIONS: BCVA less than 0.1 on the initial visit, epithelial defect sized over 5 mm2, epithelial healing time over 10 days, and central corneal lesion were associated with poor visual outcome after remission medical treatment in contact lens related bacterial keratitis.

A Case of Multiple Eyelid Trichilemmoma Associated with Cowden Syndrome

PURPOSE: To report a case of multiple eyelid trichilemmomas associated with Cowden syndrome. CASE SUMMARY: A 27-year-old woman presented with multiple upper and lower eyelid skin masses that developed over several years. The masses were as large as whitish millet, and were around the upper and lower eyelid margin and the face. The patient had previously undergone subtotal thyroidectomy for a thyroid mass and a mass excision for extremity hemangioma. Excisional biopsy was performed for the diagnosis, and trichilemmoma was diagnosed based on histopathologic examination. Consequently, multiple trichilemmoma associated with Cowden syndrome was diagnosed, and breast evaluations for existence of further masses were recommended. On breast examinations, intraductal papilloma and fibroadenoma were detected. CONCLUSIONS: The trichilemmoma was a hair-follicle benign tumor that also appeared on the skin around the eyelid. If multiple trichilemmoma is diagnosed, an association with Cowden syndrome should be considered as well as presence of masses in other organs.

Dietary related risk factors and quality of life in patients with gastroesophageal reflux disease / 대한내과학회지

BACKGROUND: The prevalence of gastroesophageal reflux disease (GERD) is increasing in Korea. The aim of this study is to evaluate the dietary habit which is commonly known as risk factor of GERD and the quality of life in GERD patients. METHODS: This study enrolled 52 patients (ERD; erosive reflux disease 38, NERD; non-erosive reflux disease 14) as patient group. They were completed the questionnaires about dietary habit and quality of life. All datas were compared with 23 healthy volunteer group who visited same hospital for health screening. RESULTS: Patient group had more dietary risk factors such as unbalanced diet, irregular diet, using lots of sauces, having snacks or meals within 3 hours of bedtime and suffering from epigastric discomfort after alcohol drinking (p<0.05). Patient group preferred to have spicy food, soft drink, coffee and tea, fried food, instant food and noodles (p<0.05). ERD group more frequently had snacks or meals just before sleep, suffered from discomfort after drinking, and preferred to have fried food (p<0.05). GERD patients reported significantly worse scores on 6 SF-36 scales, such as physical function, role limitations-physical, role limitations-emotional, mental health, social function, and general health perception. CONCLUSIONS: We found that ERD patients had more snacks or meals within 3 hours of bedtime and fried food. Also, they were suffering from epigastric discomfort after alcohol drinking. Patients with GERD experienced decrements in health-related quality of life compared with the control subjects.