A Case of Chrysosporium Parvum Endophthalmitis

PURPOSE: To report a case of Chrysosporium parvum endophthalmitis after trauma. METHODS: A 42-year-old healthy woman visited our hospital complaining of ocular pain after trauma sustained with a wire used to tie grapes. She showed corneal laceration and iris prolapse of the right eye on slit lamp examination. She underwent primary suture of the corneal laceration. Two days later, she presented with hypopyon of the anterior chamber. She was treated with topical antibiotics and a topical steroid. On follow-up examination, she again presented with hypopyon of the anterior chamber. She was admitted for microbiologic examination and was again treated with topical antibiotics and a topical steroid. Unfortunately, no organisms were identified by culture. Later, she reported a recurrent history of the inflammation. After 9 months, she presented with increased hypopyon of the anterior chamber and was treated with anterior chamber irrigation and intracameral antibiotics injection on two different occasions. But, still no organisams were identified. After one year, the patient visited our clinic with ocular pain and decreased visual acuity. Her intraocular pressure was 72 mmHg and there was whitish infiltration and hypopyon around 360 degrees of the anterior chamber and angle. At the same time, the intraocular pressure and inflammation were uncontrolled. Ultimately, microscopic examination of specimens obtained directly from tissue after enucleation identified the organism as Chrysosporium parvum. CONCLUSIONS: We experienced a case of Chrysosporium parvum endophthalmitis after trauma. To our knowledge, this was the first report of a case of Chrysosporium parvum endophthalmitis in the world.

Cyclosporin A Induced Optic Neuropathy

PURPOSE: Cyclosporin A (CsA) is widely used as a prophylactic and therapeutic agent against a graft- versus-host disease following bone marrow transplantation. Herein, a case of cyclosporin-induced optic neuropathy, after bone marrow transplantation, is reported, which to our knowledge has never previously been reported. METHODS: A 43-year-old man, with acute myelogenous leukemia, who was treated with bone marrow transplantation one month previously, also with immunosuppressive medication, presented with decreased visual acuity and nystagmus in both eyes. He had been administerd CsA for about one month, from one day before the bone marrow transplantation. A fundus examination, visual field, electroretinography, and brain MRI were performed. RESULTS: At the first ocular examination, his visual acuity was markedly decreased in both eyes. On fundus examination, an edematous optic nerve head, with superficial peripapillary hemorrhage, was noticed in both eyes. A large central scotoma was seen in both eyes on a visual field examination. The amplitude of the b-wave in the scotopic ERG was slightly decreased in both eyes. However, there were no abnormal findings in the other examinations. Cyclosporin-induced optic neuropathy was suspected as the cause of the decreased visual acuity, so the CsA was discontinued and replaced by FK506(tacrolimus). On the second day after the discontinuation of the CsA, the optic disc edema improved, and the visual acuity of both eyes recovered almost too normal. CONCLUSIONS: It is important to monitor the neuro-ophthalmologic and neurologic signs of bone marrow transplant closely in patients taking cyclosporin.

The Long-term Follow-up Results of Patients with Partially Accommodative Esotropia after Conventional Surgery

PURPOSE: To evaluate the changes of clinical features after long-term follow-up observation on patients with partially accommodative esotropia who had undergone conventional surgery. METHODS: Thirty-five patients who maintained orthophoria for at least one year duration after surgery were evaluated. The amount of surgery was measured based on the near angle of deviation after full hyperopic correction. The comparison was made based on the best corrected visual acuity, refractive errors, degree of stereopsis and ocular positions before and after surgery. RESULTS: The mean spherical equivalent was +4.46 D before surgery and +3.66 D at the final examination. Among a total of 70 eyes, the best corrected visual acuity of 0.6 or less was seen in 16 before surgery, and in 12 at the final examination. The average angle of deviation was 50.14 PD before correction and 34.43 PD after correction. The Titmus stereotest after surgery was 80 sec of arc in 6, and even 40 sec of arc in 2 out of the 35 patients. At the final examination, 29 of the 35 patients revealed stable orthophoria, but exophoria, in a range of 15-25 PD, developed in 6 patients. Of these 6, 4 had anisometropic amblyopia, and 1 had bilateral high hyperopia of 8.0 D with refractive amblyopia. CONCLUSIONS: Long-term follow-up observation is essential after surgery for partially accommodative esotropia due to fear of the gradual development of consecutive exotropia, particularly in amblyopia cases, even though acceptable initial postoperative orthophoria has been achieved.