Endogenous Klebsiella pneumoniae panophthalmitis with perinephric and psoas abscesses in a 42-year-old female: Case in images

@#Endophthalmitis is the inflammation of the intraocular cavities, and panophthalmitis is its most severe form.1 2 3 In panophthalmitis, there is a marked inflammation of the surrounding orbital structures, manifested by severe eyelid edema, proptosis, chemosis and eye movement limitations.4 If left untreated, endophthalmitis could lead to irreversible vision loss and systemic complications.

Two Cases of Unusual Presentation of Postoperative Endophthalmitis Caused by Streptococcus dysgalactiae Subspecies Equisimilis

PURPOSE: To report two cases of postoperative endophthalmitis caused by Streptococcus dysgalactiae subspecies equisimilis (SDSE), which appeared as hyperacute presentation and panophthalmitis. CASE SUMMARY: A 68-year-old male was treated with cataract surgery and was evaluated the next day (less than 24 hours after surgery) because of acute loss of vision. There was severe inflammation and the visual acuity was light perception. The patient underwent pars plana vitrectomy (PPV) with intravitreal antibiotic injection. The vitreous culture revealed SDSE. After PPV, regression of inflammation was observed, although the corneal edema had progressed. The cornea evolved to decompensate due to bullous keratopathy and visual acuity of the eye decreased to no light perception after 3 months. A 87-year-old male who underwent phacoemulsification and intraocular lens implantation 2 days previously was hospitalized due to severe ocular pain and visual loss. There was severe inflammation, and the visual acuity was no light perception. The patient received only intravitreal injections of antibiotics due to severe corneal necrosis. The aqueous humor revealed SDSE. Four days after intravitreal injection, erythema and swelling of the eyelid of the affected eye was observed, and diagnosed as panophthalmitis. After treatment with intravenous antibiotics, cellulitis of the eyelid was resolved. The eye progressed as phthisis after 3 months without recurrence. CONCLUSIONS: Postoperative SDSE endophthalmitis showed aggressive and hyperacute presentation, resulting in blindness despite prompt treatment. SDSE is an emerging organism and should be considered a potential cause of postoperative endophthalmitis.

Panophthalmitis with orbital cellulitis following glaucoma drainage implant surgery in a pediatric patient / Panoftalmite com celulite orbitária após implante de drenagem em glaucoma congênito

ABSTRACT Here we report a case of childhood glaucoma refractory to angle and trabeculectomy surgery. The patient was treated with an Ahmed™ drainage implant that was subsequently complicated by rapid-onset panophthalmitis and orbital cellulitis. Intravenous and intravitreal antibiotic therapy was initiated and the drainage tube was removed. The infectious process resolved within 3 weeks; however, phthisis bulbi developed subsequently.

RESUMO Relato de um caso de uma criança portadora de glaucoma congênito primário, refratário a cirurgias angulares e trabeculectomias prévias, submetido à implante de drenagem do tipo Ahmed®. O paciente evoluiu com panoftalmite e celulite orbitária de aparecimento súbito, sendo submetido à remoção do tubo e antibioticoterapia endovenosa e intravítrea. O processo infeccioso foi resolvido em três semanas, porém o olho evoluiu para phthisis bulbi.

Panoftalmite tardia após trabeculectomia com mitomicina C / Late panophthalmitis after trabeculectomy with mitomycin C

Infecção intraocular é a mais dramática e temível complicação após uma trabeculectomia, com sequelas anatômicas significativas e grave comprometimento funcional, por vezes irreversíveis. Trata-se no presente caso de um paciente do sexo masculino, portador de glaucoma congênito, submetido à trabeculectomia bilateral aos 13 anos de idade, e uma segunda trabeculectomia com mitomicina C aos 32 anos no olho direito (OD), que se apresentou 8 anos após o procedimento com endoftalmite neste olho. Após tratamento anti-inflamatório e antibioticoterápico, tópico e intravítreo, intensivos, o processo foi controlado, restando um olho hipotrófico e amaurótico com catarata e descolamento de retina totais.

An intraocular infection is the most terrible complication after a trabeculectomy, usually with significant anatomical consequences and irreversible functional impairment. The case of a 40-year-old male patient with congenital glaucoma, submitted to a trabeculectomy on both eyes at the age of 13, is presented. At the age of 32 a second trabeculectomy with mitomycin C was performed on the right eye. Eight years later he presented with an endophthalmitis in the same eye. Despite intensive local treatment and intravitreous injection, a hypotrophic amaurotic eye resulted with total cataract and retinal detachment.

Ultrastructural study of poxvirus causing myxomatosis in rabbits, in São Paulo and Santa Catarina, Brazil / Estudio ultraestructural del poxvirus causal de mixomatosis en conejos, en São Paulo y Santa Catarina, Brasil

The myxomatosis is a contagious worldwide disease caused by poxvirus which infects domestic and wild rabbits. In the present study we present two distinct outbreaks of myxomatosis when raising rabbits, one for commercial purpose of production of meat and skins and, another one for the commercialization of ornamental rabbits. The observed signs were ocular, auricular, nasal, testis lesions and many times scattered throughout the body of the animals. The lesions were characterized by formation of nodules that by palpation disclosed gummy or gelatinous aspect. At the transmission electron microscopy, all the skin and crust samples were analyzed by negative staining technique. A great number of particles with morphology similar to the poxvirus, some enveloped in a brick-shaped and irregular disposition of tubules on the external membrane, measuring 300x240 nm on the average were visualized. Ultra thin sections revealed the presence of intracytoplasmic inclusion bodies surrounded by membrane containing oval particles, measuring 270 x 130 nm, containing nucleus or an internal biconcave (dumbbell-shaped) core. Immature particles (empty), surrounded by membrane were also observed. In addition, intracytoplasmic electron dense inclusion bodies containing viral particles budding of dense amorphous material and intranuclear fibrillar or "digital" inclusions showing a regular striation and arranged in groups were found in the middle of granular material. The nuclei were deformed with densely condensed chromatin forming amorphous and electron dense inclusion bodies. In the immunocytochemistry technique, the antigen-antibody reaction was strongly marked by the particles of colloidal gold, emphasizing the viral particles. The techniques used in this study were important in the diagnosis of the affected animals.

La mixomatosis es una enfermedad contagiosa de distribución mundial, causada por poxvirus que infecta conejos domésticos y salvajes. En este estudio presentamos dos distintos surtos por mixomatosis que ocurrieron en producciones de conejos, una para fines comerciales de producción de carne y pieles y otra para el comercio de conejos domésticos. Las señales observadas fueron afecciones oculares, nasales, testiculares y, a veces, también distribuida por todo el cuerpo de los animales. Estas se caracterizaban por formación de nódulos que a la palpación tenían un aspecto gelatinoso o gomoso. En la microscopía electrónica de transmisión, por la técnica de contrastación negativa, se pudo observar en todas las muestras examinadas de piel y de costras, un gran número de partículas típicas de poxvirus, con envoltura y forma de ladrillo, mostrando disposición irregular de los túbulos sobre la membrana externa, midiendo 300 x 240 nm en el promedio. Cortes ultrafinos de fragmentos de piel y de costras revelaron la presencia de cuerpos de inclusión intracitoplasmáticas, envueltos por membrana y conteniendo partículas ovales, midiendo 270 x 130 nm, conteniendo núcleo o centro interno bicóncavo (forma de mancuernas). Partículas inmaduras (vacías) envueltas por membrana fueron observadas. También fueron analizados cuerpos de inclusión intracitoplasmáticos, electrodensos, conteniendo partículas virales brotando del material denso y amorfo. Fueron observadas inclusiones intranucleares fibrilares o "digitales" mostrando una estriación periódica y disposición en grupos en medio del material granular. Los núcleos estaban deformados con cromatina densamente condensada formando cuerpos de inclusiones electrodensas y amorfas. En la técnica de imunocitoquímica la reacción antígeno-anticuerpo fue intensamente marcada por las partículas de oro coloidal realzando fuertemente las partículas virales.

A profile of destructive surgery in Nepal Eye Hospital.

This is a study profile of the patients undergoing destructive surgery in Nepal Eye Hospital over a period of 2 years (2001-2003). The rationale of the study was to know the incidence and causes for destructive surgery (enucleation/evisceration) and the measures to prevent them. Patients admitted in the ward from emergency and outpatients departments for the purpose of enucleation and evisceration were taken into this study. Their visual acuity, slit-lamp examinations, fundus evaluation were done. Most of the patients had no perception of light with painful blind eyes, panophthalmitis, endophthalmitis, staphylomas, crush injuries and malignancies. After a decision made by the surgeons in the round, a full consent was taken for the operation. Evisceration was done for cases with history of ocular infections and the rest were enucleated. Destructive operation was done for (a) saving the other eye, (b) life saving, (c) painful condition and disfigurement. The incidence of destructive surgery in Nepal Eye Hospital was 1.40%. male : female ratio was 1.41:1. The causes for destructive surgery were panophthalmitis (31.71%), painful blind eye (21.95%), endophthalmitis (14.63%), staphyloma (14.63%), retinoblastoma (12.20%) and crush injuries (4.88%). Number of evisceration (73.17%) was higher than enucleation (26.83%) as most of the cases were sequele of corneal ulcer. Enucleation was mostly seen in children and evisceration in adults. Lastly, the incidences of destructive surgery would be minimized by (a) Prompt treatment of corneal ulcers for reducing panophthalmitis (b) pre, intra, and post operative care in intra ocular surgery for reducing endophthalmitis, and (c) genetic counselling (pre marital) for reducing childhood malignancies. Decision for destructive surgery should be a team work rather than a single surgeon's opinion. It should be done under general anaesthesia or retrobulbar block. Precaution must be taken to prevent the appalling tragedy of enucleating the wrong eye by marking above on the eye to be operated or EUA prior to surgery. Last but not the least, there should be fitting of a prosthesis for cosmesis, psychological support and careful follow-up of the healthy eye.

A Case of Non-Clostridial Gangrenous Panophthalmitis

PURPOSE: To report a case of non-clostridial gangrenous panophthalmitis extended directly from adjacent gangrenous skin infection METHODS: A 62-year-old woman, with diabetes mellitus, was admitted to ICU after explorative laparotomy for panperitonitis, retroperitoneal hemorrhage, and disseminated intravascular coagulation caused by traffic accident. She was referred to the ophthalmologic department because of necrotizing skin infection and panophthalmitis extended directly from an adjacent skin infection, which had developed after superficial abrasion on the left forehead. RESULTS: Necrotizing gangrenous skin infection with subcutaneous emphysema had rapidly progressed to her left face and there was panophthalmitis with subconjunctival gas bubbles. Proteus mirabilis, Serratia marcescens, Enterobacter aerogenes, and Enterococcus faecalis were cultured from the skin wound and aqueous humor, Acinetobacter baumannii, and Serratia marcescens were cultured from sump drainage. She died after 3 days because of sepsis, acute renal failure, and multiple organ failure. CONCLUSIONS: Physicians should always keep in mind that a serious infectious disease like non-clostridial gas gangrene can develop even from a superficial skin wound in immunocompromised patients like diabetics.

Panophthalmitis due to rhizopus in an AIDS patient: a clinicopathological study.

Various opportunistic infections in the eye have been reported earlier in AIDS. We report a case of panophthalmitis in an AIDS patient where the eviscerated tissue on histopathologic and microbiologic examination showed the fungus Rhizopus.

Pênfigo ocular cicatricial / Ocular cicatricial pemphigoid

As lesöes oculares induzidas pelo pênfigo ocular cicatricial (POC) säo progressivas, irreversíveis e, em alguns casos, resistentes à terapêutica médica. A propósito de um caso, apresentamos as dificuldades terapêuticas encontradas e a aparente remissäo conseguida com um protocolo de pulsoterapia

A Clinical Study of Evisceration and Enucleation in Kwangju and Chonnam Population

We performed a retrospective study on evisceration and enucleation operated at Chosun University hospital and Chonnam University hospital during the period of 10 years from January 1982 to December 1991. The total number of cases was 550. The incidence was mow common in male. The male and female ratio was 1.85: 1(Male 64.9%, Female 35.1%). The frequency of enucleation and evisceration was as follows trauma; 281 cases(51.1%), glaucoma; 76 cases(13.8%), corneal ulcer; 69 cases(12.6%), panophthalmitis; 43 cases(7.8%), tumor; 33 cases(6.0%), phthisis bulbi, 26 cases(4.7%), others; 22 cases(4.0%). The most frequent cause of the trauma whitch had been eviscerated or enucleated was traffic accident; 129 cases(45.9%), followed by violence; 73 cases(25.9%), industrial accident, 37 cases(13.2%), toy and pencil; 19 cases(6.8%), sports; 12 cases(4.3%), unknown; 11 cases(3.9%). The age-related incidence was peak in the third decades 86 cases(15.6%), followed by fifth decades 85 cases(15.5%) and fourth and sixth decades 82 cases(14.9%), respectively. The mean annual incidince rate was significantly greater among males than females: 2.33 per 100,000 population and 1.93 per 100,000 population, respectively. The overall mean annual rate was 2.13.

A Clinical Study of Evisceration and Enucleation in Kwangju and Chonnam Population

We performed a retrospective study on evisceration and enucleation operated at Chosun University hospital and Chonnam University hospital during the period of 10 years from January 1982 to December 1991. The total number of cases was 550. The incidence was mow common in male. The male and female ratio was 1.85: 1(Male 64.9%, Female 35.1%). The frequency of enucleation and evisceration was as follows trauma; 281 cases(51.1%), glaucoma; 76 cases(13.8%), corneal ulcer; 69 cases(12.6%), panophthalmitis; 43 cases(7.8%), tumor; 33 cases(6.0%), phthisis bulbi, 26 cases(4.7%), others; 22 cases(4.0%). The most frequent cause of the trauma whitch had been eviscerated or enucleated was traffic accident; 129 cases(45.9%), followed by violence; 73 cases(25.9%), industrial accident, 37 cases(13.2%), toy and pencil; 19 cases(6.8%), sports; 12 cases(4.3%), unknown; 11 cases(3.9%). The age-related incidence was peak in the third decades 86 cases(15.6%), followed by fifth decades 85 cases(15.5%) and fourth and sixth decades 82 cases(14.9%), respectively. The mean annual incidince rate was significantly greater among males than females: 2.33 per 100,000 population and 1.93 per 100,000 population, respectively. The overall mean annual rate was 2.13.

Gas gangrene panophthalmitis due to Clostridium welchii

Clostridium welchii panophthalmitis is a rare and devastating infection. Since 1904, only 65 cases have been reported in the literature, 53 of which were reviewed by Leavelle in 1955. Almost all the cases resulted from penetrating ocular injuries with eventual loss of vision and integrity of the globe

A Case of Subconjunctival Granuloma Secondary to Tuberculous Panophthalmitis

Tuberculous panophthalmitis is, at present, a rare disease and a recent study has revaled that the incidence has decreased to less 1 percent in the causes of granulomatous uveitis. But ocular tuberculosis is still one of frequent causes of uveitis in the world. Ocular tuberculosis may be divided in two main groups with regard to clinical manifestations; one is a simple tuberculous infection, and the other is an allergic reaction depending on the immunological reaction of the patient. We have experienced a 14 year old female who had clinical signs of unilateral panophthalmitis with a subconjunctival mass but no evidence of systemic tuberculosis. The pathologic examination revealed that a chronic granulomatous inflammation was present in the retina, choroid, and sclera with caseous necroses. The same pathologic changes were present in the subconjunctival mass which was closely associated with the markedly thin sclera. It may be, therefore, concluded that the subconjunctival granuloma was secondary to the scleral perforation in tuberculous panophthalmitis.

A Case of Subconjunctival Granuloma Secondary to Tuberculous Panophthalmitis

Tuberculous panophthalmitis is, at present, a rare disease and a recent study has revaled that the incidence has decreased to less 1 percent in the causes of granulomatous uveitis. But ocular tuberculosis is still one of frequent causes of uveitis in the world. Ocular tuberculosis may be divided in two main groups with regard to clinical manifestations; one is a simple tuberculous infection, and the other is an allergic reaction depending on the immunological reaction of the patient. We have experienced a 14 year old female who had clinical signs of unilateral panophthalmitis with a subconjunctival mass but no evidence of systemic tuberculosis. The pathologic examination revealed that a chronic granulomatous inflammation was present in the retina, choroid, and sclera with caseous necroses. The same pathologic changes were present in the subconjunctival mass which was closely associated with the markedly thin sclera. It may be, therefore, concluded that the subconjunctival granuloma was secondary to the scleral perforation in tuberculous panophthalmitis.

A Case Ocular Tubereulosis Associated with Seleral Perftration

Tuberculosis, once thought to be the most common cause of uveal is now thought to be a relatively rare cause of ocular disease. This is because of a decreased incidence of tuberculosis as well as a lessened emphasis on its diagnosis. Tuberculosis of uveal tract has long been a controversial subject in ophthalmology. Several factors have been implicated including the marked pleomorphism of the lesions, owing to variations in the virulence of the invading organisms, host resistance, and the presence or absence of host immunity. Solitary choroidal tuberculoma is rare and characterized as gradually growing until it resembles a tumor projecting as a round white or yellowish globular mass into the cavity of the eye. It may progress continuously and so finally, in the absence of treatment, the sclera is involved and perforation results which is followed by phthisis bulbi or pyogenic infection and panophthalmitis. We have experienced a 19-year old female who had a solitary choroidal tumor like lesion, which about 17 months later resulted in scleral perforation, in the posterior pole of the left eye. We performed enucleation of the left eyeball under the clinical diagnosis of the maligant melanoma associated with scleral perforation and obtained the histopathological diagnosis of ocular tuberculosis.

La histopatología oftalmológica en el Paraguay / Ophtalmic histopathology in Paraguay

Fueron examinados treinta y tres globos oculares enucleados y veinte y nueve biopsias de párpados, conjuntiva, córneas y órbitas. La causa más frecuente de enucleación es la ptisis bulbi, glaucoma absoluto, úlcera de córneas, endoftalmitis y epitelización de la cámara anterior. En la biopsias de la córneas fueron encontrados pseudo tumor inflamatorio, leucemia linfoide y rabdomiosarcoma embrionario. Entre las lesiones de párpados podemos mencionar: epitelioma basocelular, carcinoma epidermoide, quiste dermoide y otros. Se han comparado los diagnósticos clínicos y histopatológicos. Finalmente, la frecuencia de las enfermedades halladas en este estudio son comparadas con las de otros centros especializados

Trauma ocular na infância / Ocular trauma in childhood

48,7% dos ferimentos oculares examinados num determinado período eram em pacientes com idade de 0 a 15 anos. A gravidade destes ferimentos é maior na infância pelo risco de instalçäo de ambliopia e pelas complicaçöes usuais dos ferimentos como infecçäo, catarata, glaucoma e deslocamento de retina entre outras. As principais medidas clínicas, terapêuticas e preventivas säo enfatizadas