Clinical Results of Bacterial Endophthalmitis: Bacterial Culture and Visual Acuity Outcomes

PURPOSE: To evaluate the clinical characteristics of bacterial culture, and visual outcome in patients with acute endophthalmitis. METHODS: Clinical records of patients treated for acute endophthalmitis in GNUH from 2000 to 2009 were reviewed. The specimens for culture were obtained from the anterior chamber or vitreous. Clinical outcome measures were bacterial culture, culture rate, and final visual acuity. RESULTS: Cultures (total 59 cases) showed bacterial growth in 37 cases (63%). Among 35 cases vitreous specimens, bacteria growth was found in 22 cases (63%), and from the 27 anterior chamber specimens, 12 cases (44%) were culture positive. From these 37 bacterial-positive cultures, 11 (30%) were coagulase negative Staphylococcus species, 16 (43.0%) were other Gram-positive species, 9 (24%) were Gram-negative species, and 1 (3%) produced a polymicrobial culture. Final visual acuity above 0.5 was achieved in 16 of 59 (27%) cases and coagulase negative Staphylococcus species had the greatest proportion being 5 of 11 (45%). CONCLUSIONS: The bacterial culture positivity rate in bacterial endophthalmitis was 63%, and the culture yield rate from the vitreous was higher than the anterior chamber aqueous samples. Coagulase negative Staphylococcus species were the most common causative organisms and showed the best final visual outcome in endophthalmitis.

Surgical Management of Atypical Vogt-Koyanagi-Harada Disease

PURPOSE: To report a case of surgical treatment of bilateral bullous exudative retinal detachment associated with Vogt-Koyanagi-Harada disease. CASE SUMMARY: A 64-year-old woman presented with decreased visual acuity, headache, and hearing loss for 2 months. Visual acuity was hand motion in the right eye and light perception in the left eye. Intraocular pressure was 16 mmHg in the right eye and 24 mmHg in the left eye. Slit lamp examimation disclosed corneal edema, conjunctival ciliary injection with chemosis, rubeosis iridis, and posterior synechia in both eyes. Fundus examination demonstrated bilateral bullous exudative retinal detachment. Lumbar puncture revealed pleocytosis and auditory function test showed neurosensory hearing loss. She was diagnosed as having bilateral bullous exudative retinal detachment associated Vogt-Koyanagi-Harada disease. On hospital day 3, intravitreal triamcinolone injection with external subretinal fluid drainage was performed in the right eye and on hospital day 6, intravitreal triamcinolone injection with external subretinal fluid drainage was performed in the left eye. Two months later, best corrected visual acuity was 0.2 in the right eye and 0.04 in the left eye. CONCLUSIONS: Intravitreal trimacinolone acetonide injection with external subretinal fluid drainage is one of the good treatment for bullous exudative retinal detachment associated with Vogt-Koyanagi-Harada disease.

A Case of Comamonas Acidovorans Corneal Ulcer

PURPOSE: To report a case of a Comamonas acidovarans corneal ulcer treated with antibiotics in Korea. Comamonas acidovarans corneal ulcer has not been previously reported to our knowledge. METHODS: A 70-year-old woman visited our clinic complaining of left ocular pain and decreased visual acuity for six days. We performed a smear and culture on the corneal lesion and treated it with topical and systemic antibiotics. RESULTS: Comamonas acidovorans was cultured from ulcer lesion. Corneal ulcer improved with the administration of ciprofloxacin and tobramycin.

Clinical Analysis of Ocular Injuries induced by Power Lawn Mowers

The authors analysed 22 patients who were admitted to Gyeongsang National University Hospital because of ocular injuries induced by Power lawn mowers from March 1, 1991 to December 31, 1994. All of the patients were males. The average age of the patients was 43.3(range 15-69). Most injuries occured between June and September. Perforating injuries were developed in 8(36.4%) of 22 eyes and non-perforating injuries in 14(63.6%) eyes. The type of injuries were lens damage(10/22), vitreous hemorrhage(8/22), iridodialysis(4/22), intraocular foreign body(3/22), endophthalmitis(2/22), retinal detachment(1/22), and choroidal rupture(1/22). The prognosis was poor when the eyeball was perforated. Therefore safety goggles are absolutely needed for prevention of ocular injuries induced by Power lawn mowers.

Corneal Central Endothelial Cell Loss after Trabeculectomy with Mitomycin C

The effect of mitomycin on the corneal endothelial cell density was evaluated between the mitomycin group of 23 eyes who underwent trabeculectomy with mitomycin and the control group of 20 eyes who underwent trabeculectomy. The mitomycin(0.2 mg/ml) was applied under the scleral flap, Tenon's capsule or conjunctiva during trabeculectomy for 2-5 minutes(average: 4 minutes) and was irrigated with 50ml of balanced salt solution. Average central endothelial cell loss in the mitomycin group was 10.1 +/- 7.1% and 8.4 +/- 8.3% in the control group(P>0.05, t-test). A shallow anterior chamber with iridocorneal touch(Spaeth's grade 1 and 2) was developed in 12(52%) of 23 eyes in the mitomycin group and 9(45%) of 20 eyes in the control group(P>0.05, chi-square). The average central endothelial cell loss was 12.7 +/- 8.3% in 21 eyes with iridocorneal touch and 5.9 +/- 5.4% in 22 eyes that maintained their anterior chamber(P0.05, t-test). In 22 eyes that maintained their anterior chamber, average loss was 7.1 +/- 5.4% in the mitomycin group, and 4.8 +/- 5.4% in the control group(P>0.05, t-test). These findings suggest that intraoperative use of mitomycin(0.2 mg/ml) during trabeculectomy is unlikely to cause profound corneal endothelial cell loss and iridocorneal touch after the filtering surgery is associated with greater loss of endothelial cells.

Muscle Fiber Hypertrophy Following Monocular Medial Rectus Recession and Lateral Rectus Resection in Rats

Compensatory hypertrophy of muscle fibers has been known to occur when burden on a skeletal muscle is increased. However, there have not been reports concerning the response of extraocular muscles following a monocular resection and recession of horizontal muscles, which procedure is a common form of strabismus surgery. A large lateral rectus resection and medial rectus recession was performed in each right eye of 28 rats. After the horizontal muscle surgery, both medial and lateral rectus muscles were obtained from both eyes of each rat with an interval of 2 weeks from the initial operation until 8th week after operation. A mid-portion of an extirpated muscles were frozen and prepared for ATPase staining. With a differential preincubation in two buffered solutions, pH 4.6 and pH 10.3 and ATPase staining, muscle fibers were classified into 3 kinds-global singly innervated fiber(GSIF, alkali-stable), global multi-innervated fiber(GMIF, alkali-labile), and orbital surface layer fiber(OSLF). These muscle fibers were measured using micrometer to find out their diameters and compared with the diameter of extraocular muscle fibers of unoperated rats. All kinds of muscle fibers of a resected lateral rectus showed an increase in their diameteris(p<0.05, Wilcoxon rank sum test) but there was no hypertrophy in the recessed medial rectus the yolk muscle of the resected lateral rectus, medial rectus of the fellow eye also showed hypertrophy of GMIF and OSLF. The lateral rectus of the unoperated fellow eye did not reveal muscle fiber hypertrophy. The postoperative hypertrophy of muscle fibers were observed only at the 2nd and 4th postoperative week specimens. the hypertrophied muscles subsequently returned to the baseline fiber diameter.