Biotypes and serotypes of Haemophilus influenzae ocular isolates.

AIM: To determine which subtypes of Haemophilus influenzae are most commonly associated with ocular disease, and whether the site of ocular H influenzae infection is correlated with specific subtypes of the organism. METHODS: The biotypes and serotypes of ocular H influenzae isolates collected at the Francis I Proctor Foundation between March 1989 and January 2000 were examined. A total of 62 ocular isolates were retrieved from frozen storage and plated on chocolate agar. Biotypes were assigned based upon the ability of the isolates to produce indole, urease, and ornithine decarboxylase. Capsular subtypes a-f were determined by slide agglutination using commercially available subtype specific antisera. Identified biotypes and serotypes were then analysed with regard to site of infection. RESULTS: Patient age ranged from 1 to 92 years with a median age of 45 years. 38 (61%) of the isolates were biotype II, 23 (37%) were biotype III, and one (2%) was biotype VII. All of the isolates were non-encapsulated and thus serologically non-typable. H influenzae biotype II was found in 28 of 48 (58%) conjunctivitis cases, five of eight (63%) keratitis cases, and two of two (100%) endophthalmitis cases. Biotype III was found in 20 of 48 (42%) conjunctivitis cases, two of eight (25%) keratitis cases, and a single case of dacryocystitis. Biotype VII was associated with one of eight (13%) keratitis cases. CONCLUSION: Most ocular H influenzae isolates appear to be serologically non-typable strains from biotypes II and III, less virulent subtypes that frequently colonise the nasopharynx. In addition, the site of ocular H influenzae infections appears to be largely independent of species subtype.

Alterations in the conjunctival bacterial flora following a single dose of azithromycin in a trachoma endemic area.

BACKGROUND/AIMS: The World Health Organisation has recommended repeated mass treatment of children in trachoma endemic areas with oral azithromycin. While chlamydia, the causative agent of trachoma, remains universally sensitive to azithromycin, there is concern that large scale programmes may alter the bacterial flora and induce resistance in streptococcal species. In this study the effect of a single dose of azithromcyin on the prevalence, species distribution, and resistance of conjunctival bacterial flora was determined. METHODS: Baseline and 14 day follow up bacterial cultures were taken from the conjunctivae of 121 children who reside in a trachoma endemic area of Nepal. 91 children were treated with azithromycin at baseline and 31 children received deferred treatment at the 14 day follow up. RESULTS: Although the prevalence of bacterial pathogens decreased significantly with azithromycin treatment, a significant change in the distribution of specific bacterial pathogens could not be demonstrated. Streptococcal resistance to azithromycin was found significantly more frequently after treatment. No change in the prevalence, distribution, or resistance pattern was found in the untreated control group. CONCLUSION: Repeated mass treatment of trachoma endemic areas with oral azithromycin will have an effect on bacterial flora. However, further work needs to be done to determine if this will have any clinical relevance.

Glycoprotein B subtyping of cytomegalovirus (CMV) in the vitreous of patients with AIDS and CMV retinitis.

A 550-bp region of the cytomegalovirus (CMV) glycoprotein B (gB) gene was amplified by polymerase chain reaction (PCR) from 141 vitreous specimens of 120 patients with AIDS and CMV retinitis from three different metropolitan centers. The distribution of gB subtypes I, II, III, and IV were 19%, 43%, 12%, and 21%, respectively, based on restriction enzyme digestion patterns of PCR-amplified DNA. Two patients had simultaneous infection with two different gB subtypes. The ratio of gB subtypes was similar among the three geographically distinct patient populations. Two of 14 patients with bilateral vitreous specimens had different viral subtypes in each eye. In addition, different gB subtypes were observed in 1 of 6 patients with serial specimens. The ratio of different gB subtypes in the vitreous of patients with CMV retinitis is similar to that previously reported in the peripheral blood of patients with advanced AIDS.

Chronic varicella-zoster virus epithelial keratitis in patients with acquired immunodeficiency syndrome.

OBJECTIVE: To characterize further a chronic epithelial keratitis caused by varicella-zoster virus infection in patients with acquired immunodeficiency syndrome (AIDS). METHODS: Patients with AIDS and chronic epithelial keratitis associated with varicella-zoster virus from 3 institutions were identified. Patient records were reviewed retrospectively for the following data: medical and demographic characteristics, techniques of diagnosis, physical findings, course, response to treatment, and outcome. RESULTS: Sixteen patients were studied. CD4+ T-lymphocyte cell counts were available in 11 patients, with a median of 0.034 x 10(9)/L (range, 0-0.094 x 10(9)/L). Two patients had no history of a zosteriform rash. In the remaining patients, the interval between rash and keratitis ranged from 0 days to 6 years. In all cases, the keratitis was chronic and characterized by gray, elevated, dendriform epithelial lesions that stained variably with fluorescein and rose bengal. The peripheral and midperipheral cornea was most commonly affected, and, in 13 of the 16 patients, the lesions crossed the limbus. Pain was a prominent feature, occurring in 12 of 16 patients. In 9 of 12 patients tested, varicella-zoster virus was identified by culture, direct fluorescent antibody testing, polymerase chain reaction testing, or a combination of these studies, with direct fluorescent antibody testing (6 of 8 positive results) and polymerase chain reaction testing (3 of 3 positive results) appearing to be the most sensitive. Response to antiviral medication was variable. CONCLUSIONS: In patients with AIDS, varicella-zoster virus may cause a chronic infection of the corneal epithelium. The keratitis is characterized by dendriform lesions, prolonged course, and frequently by extreme pain. It can occur without an associated dermatitis.

Varicella zoster virus ocular disease.

Our understanding of the spectrum of diseases caused by VZV continues to evolve with new and atypical presentations. Newer diagnostic studies are implicating VZV as the cause of a host of inflammatory conditions, some of which present sine herpete. Finally, the continued development of antiviral drugs and vaccines will allow safer and more effective treatment of VZV and its complications.

Small-diameter, round, eccentric penetrating keratoplasties and corneal topographic correlation.

PURPOSE: The purpose of the study is to report the outcome and postoperative topographic analysis of seven patients who underwent small-diameter, round, eccentric penetrating keratoplasty. METHODS: Seven patients underwent small-diameter, round, eccentric penetrating keratoplasty for a variety of corneal disorders (cataract wound necrosis and dehiscence or fistula, three patients; penetrating keratoplasty wound infection, two patients; corneal rheumatoid melt and perforation, one patient; localized fungal keratitis, one patient). Full-thickness corneal transplants ranged in size from 3.0 to 5.5 mm. The graft wound and sutures spared the visual axis in all cases. Patients were observed for 7 to 42 months (mean, 21 months). All patients had postoperative topographic analysis. One of these also had preoperative analysis. RESULTS: All grafts tectonically were effective in treating the intended condition. Best-corrected visual acuity was 20/30 or better in the four patients without pre-existing corneal transplants or dry eyes; 20/60 and 5/200 in the patients with previous central penetrating keratoplasties; and 20/40 in the patient with rheumatoid melt. There was no clinically significant regular or irregular astigmatism induced centrally by the eccentric graft in the four patients where visual acuity was 20/30 or better. Irregular astigmatism was noted in the other three patients. CONCLUSION: Small-diameter, eccentric penetrating keratoplasties may be used successfully to treat various peripheral corneal disorders. In some cases, this can be performed without inducing high or irregular astigmatism or both centrally.

The efficacy of topical metronidazole in the treatment of ocular rosacea.

PURPOSE: The purpose of the study is to investigate the efficacy of metronidazole topical gel in the treatment of ocular rosacea. METHODS: Ten patients with ocular rosacea were treated prospectively with lid hygiene and topical metronidazole applied to the lid margin in one eye and lid hygiene alone in the fellow eye. The treatment period was 12 weeks. A masked observer graded the ocular findings at the initial visit and at the conclusion of the treatment period. Pretreatment scores were compared with post-treatment scores with respect to ocular surface, eyelid margin, and combined eyelid plus ocular surface. RESULTS: Eight of ten treated eyes improved, whereas only five of ten control eyes improved. There was a statistically significant improvement in the eyelid score in both the treated and control groups (P = 0.003, P = 0.025, respectively), but no significant improvement in the ocular surface score in either group. When the pretreatment and post-treatment eyelid and ocular surface scores were combined, there was a significant improvement in the treated eyes but not in the control eyes (P = 0.022, P = 0.10, respectively). No adverse effects of the metronidazole treatment were encountered in this study. CONCLUSION: Metronidazole topical gel may be a safe and effective means of treating rosacea blepharitis.

Bacterial contamination of anaerobic vitreous cultures: using techniques employed for endophthalmitis.

PURPOSE: To investigate the occurrence of contaminated cultures of vitreous specimens from non-infected eyes obtained using anaerobic techniques employed for endophthalmitis. METHODS: Vitreous specimens were obtained using meticulous sterile techniques employed for endophthalmitis from seventeen patients undergoing pars plana vitrectomy for non-infective indications: vitreous hemorrhage (12 eyes), retinal detachment (3), Coat's disease (1), and congenital dislocated lens(1). Vitreous specimens were inoculated in the operating room onto an anaerobic blood agar plate and into thioglycolate broth. Bacterial growth occurring before 10 days was considered positive. RESULTS: Three organisms were isolated from three separate eyes. One colony of Staphylococcus species was isolated on an anaerobic blood agar plate on day 3. A single colony of Propionibacterium acnes grew on an anaerobic blood agar plate on day 6. Alpha-hemolytic streptococci grew from thioglycolate broth on day 10. CONCLUSIONS: Growth as detected in this study might represent contaminating rather than an infecting organism in an eye suspected of having endophthalmitis.

Corneal anesthetic abuse and Candida keratitis.

PURPOSE: Topical corneal anesthetic abuse is a self-inflicted injury, causing profound corneal morbidity. Superimposed infection is an important complicating factor. The authors report four patients with confirmed topical anesthetic abuse of the cornea, in whom Candida keratitis developed. METHODS: A retrospective review of the medical records of four patients with confirmed topical corneal anesthetic abuse and fungal keratitis. RESULTS: A 21-year-old woman, two 28-year-old women, and a 35-year-old man were included in the study. All these patients sustained a corneal injury, prompting the chronic use of topical anesthetics (0.5% proparacaine hydrochloride in 3 patients, and 0.5% tetracaine hydrochloride and 0.4% benoxinate hydrochloride in the other). Corneal findings included epithelial defects in all patients, focal infiltrate in one patient, and ring-shaped stromal infiltrate in three patients. Topical anesthetic was discontinued, all patients initially were treated empirically with antibacterial agents, and three patients received topical corticosteroids. Subsequent corneal cultures grew Candida spp, Candida albicans specifically in three patients, and local and systemic antifungal therapy was started. Corneas in two patients re-epithelialized; a conjunctival flap was performed on another patient with a descemetocele; and the remaining patient was lost to follow-up, although repeat fungal cultures yielded no growth. CONCLUSIONS: Corneal superinfection with Candida may occur during topical anesthetic abuse. Therapy includes discontinuation of the anesthetic and institution of antifungal therapy.

American Uveitis Society Meeting October 30, 1995 Marriott Marquis Hotel, Atlanta, GA, USA.

1 Retinal vascular occlusion and scleroderma. Tessler H, Flores-Guevara J, Goldstein D, Chicago, IL, USA. 2 MHC Class II antigen expression in ciliary body in spontaneous and experimental uveitis. Kalsow C, Zhavoronkova M, Dwyer A, Rochester, NY & Scottsville, NY, USA. 3 IL-10 in the vitreous of patients with intraocular lymphoma. Whitcup S, Solomon D, Nussenblatt R, Chan C-C, Bethesda, MD, USA 4 Iris juvenile xanthogranuloma studied by immunohistochemistry. Shields J, Shields C, Eagle R, DePotter P, Collins M, Philadelphia, PA, USA. 5 Outcomes analysis in with JRA-associated uveitis. Dana M-R, Merayo-Lloves J, Foster C, Boston MA, USA. 6 Persistent glaucoma secondary to periocular steroids. Akduman L, Conway M, Burchfield J, Kolker A, Black D, DelPriore L, Kaplan H, St. Louis, MO, USA 7 The use of itraconazole in ocular histoplasmosis Callanan D, Fish G, Dallas, TX, USA 8 Succesful treatment of macular hole secondary to sympathetic ophthalmia. Cano J, Diaz M, Navea A, Ruiz C, Castilla M. Barcelona, Spain. 9 HLA-DR2+ intermediate uveitis. Pulido J, Tang W, Han D, Mieler W. Milwaukee, WI, USA. 10 Vein occlusion in AIDS misdiagnosed as CMV retinitis. Park K, Marx J, Rao N. Los Angeles, CA, USA. 11 HIV-associated foveal hemorrhage. Crews K, Zimmerman P, Lohner S. Salt Lake City, UT, USA. 12 Cytomegalovirus papillitis in patients with AIDS. Patel S, Rutzen A, Marx J, Thach A, Chong L, Rao N, Los Angeles, CA, USA. 13 Recurrence rate of CMV retinitis following the ganciclovir implant and pars plans vitrectomy and silicone oil. Marx J, Thach A, Rao N, Chong L. Los Angeles, CA, USA.

Disappearance of crystals in Schnyder's crystalline corneal dystrophy after epithelial erosion.

PURPOSE: A 40-year-old woman with Schnyder's crystalline corneal dystrophy had two episodes of epithelial erosion. METHODS: We reviewed the patient's medical record and photographic file. RESULTS: In the areas underlying the epithelial erosion, the crystalline opacities disappeared. The crystals recurred in the subsequent five years but were not as dense. CONCLUSIONS: Crystals in the subepithelial or Bowman's layer may lead to epithelial destabilization and corneal epithelial erosion. Disappearance of the crystalline opacities may occur after disruption of the epithelium.

Relationship between corneal edema and topography.

We found that corneal edema can occur without significant concomitant changes in central and peripheral corneal topography. We examined the relationship between corneal edema and corneal topography in 10 subjects with normal ocular examinations. Baseline pachymetry and topographic measurements for both eyes of each patient were obtained. The right eye of each subject was exposed to an anoxic environment for 2 hours using a nitrogen chamber goggle. The left eye served as control. Optical pachymetry and computerized corneal topographic measurements were taken for both eyes immediately after removal of the nitrogen chamber goggle. All corneas exposed to the nitrogen chamber were thickened in all areas after removal of goggles. Average percent thickening per area was: 16.4% centrally, 6.3% nasally, 6.0% temporally, 6.3% superiorly, and 9.2% inferiorly. Corneas exposed to the nitrogen chamber demonstrated no significant topographic changes, except in the nasal area where the corneal power lessened. Furthermore, there was no significant correlation between corneal thickening in any area measured and changes in corneal topography. Control corneas did not thicken or demonstrate significant topographic changes.