ABSTRACT
Retinal dysplasia occurs in the setting of sporadic and syndromic holoprosencephaly, which often has associated ocular malformations. The pathology of this dysplasia, which includes rosettes, has been previously described. However, its funduscopic findings have not been well documented. The authors present the fundus images of a patient with severe holoprosencephaly with retinal dysplasia and bilateral optic nerve colobomas that resulted in death 2 weeks after birth.
Subject(s)
Abnormalities, Multiple , Coloboma/diagnosis , Holoprosencephaly/diagnosis , Optic Nerve/abnormalities , Retinal Dysplasia/diagnosis , Fatal Outcome , Female , Gestational Age , Humans , Infant, Newborn , Magnetic Resonance ImagingABSTRACT
IMPORTANCE: Optisol-GS, the most common corneal storage medium in the United States, contains antibacterial but no antifungal supplementation. Most postkeratoplasty endophthalmitis and keratitis cases are now of a fungal origin. OBJECTIVE: To assess the efficacy and safety of voriconazole and amphotericin B in reducing Candida species contamination of Optisol-GS under normal storage conditions. DESIGN, SETTING, AND PARTICIPANTS: In vitro laboratory study using 15 pairs of research-grade donor corneas and 20-mL vials of Optisol-GS. INTERVENTIONS: Twenty vials of Optisol-GS were supplemented with either voriconazole at 1×, 10×, 25×, or 50× minimum inhibitory concentration (MIC) or amphotericin B at 0.25×, 0.5×, 1×, or 10× MIC. Known concentrations of Candida albicans and Candida glabrata were each added to a set of vials. Safety studies were performed by separating 15 pairs of donor corneas into unsupplemented Optisol-GS or Optisol-GS plus an antifungal. MAIN OUTCOMES AND MEASURES: Efficacy outcomes were viable fungal colony counts determined from samples taken on days 2, 7, and 14 immediately after removal from refrigeration and after warming to room temperature for 2 hours. Safety outcomes included percentage of intact epithelium and endothelial cell density on days 0, 7, and 14, as well as percentage of nonviable endothelial cells by vital dye staining on day 14. RESULTS: Growth of C albicans and C glabrata was observed in all voriconazole-supplemented vials. In contrast, there was no growth of either organism in amphotericin B-supplemented vials, except at 0.25× and 0.5× MIC on day 2, when viable counts of C glabrata were reduced by 99% and 96%, respectively. Compared with paired controls, with the exception of Optisol-GS plus amphotericin B at 10× MIC, donor corneas in supplemented Optisol-GS appeared to have no difference in endothelial cell density reduction, percentage of intact epithelium, or percentage of nonviable endothelial cells. CONCLUSIONS AND RELEVANCE: The addition of amphotericin B to Optisol-GS may significantly improve activity against contamination with Candida species, the primary cause of fungal infection after corneal transplantation. This study found significant endothelial toxic effects at the maximal concentration of amphotericin B.
Subject(s)
Antifungal Agents/pharmacology , Candidiasis/prevention & control , Chondroitin Sulfates/pharmacology , Cornea , Dextrans/pharmacology , Drug Contamination/prevention & control , Gentamicins/pharmacology , Organ Preservation Solutions/pharmacology , Amphotericin B/adverse effects , Amphotericin B/pharmacology , Antifungal Agents/adverse effects , Candida albicans/drug effects , Candida glabrata/drug effects , Candidiasis/microbiology , Cell Count , Chondroitin Sulfates/adverse effects , Colony Count, Microbial , Complex Mixtures/adverse effects , Complex Mixtures/pharmacology , Culture Media, Serum-Free/adverse effects , Culture Media, Serum-Free/pharmacology , Dextrans/adverse effects , Drug Combinations , Endothelium, Corneal/drug effects , Endothelium, Corneal/microbiology , Endothelium, Corneal/pathology , Gentamicins/adverse effects , Humans , Microbial Sensitivity Tests , Organ Preservation , Organ Preservation Solutions/adverse effects , Pyrimidines/adverse effects , Pyrimidines/pharmacology , Tissue Donors , Treatment Outcome , Triazoles/adverse effects , Triazoles/pharmacology , VoriconazoleABSTRACT
A 3-year-old girl with a history of bilateral retinoblastoma presented with a new right lower periorbital mass that showed calcifications on ultrasound. She had previously undergone systemic and intra-arterial chemotherapy for retinoblastoma but had no evidence of active disease for at least 6 months previously. Her family and oncologists feared that this mass was an extraocular metastasis of her retinoblastoma. On excision, it was diagnosed as a pilomatrixoma, an uncommon benign neoplasm that originates from the matrix of the hair root. This is the first reported case of pilomatrixoma in a patient with retinoblastoma.
