ABSTRACT
Rhino-orbital fungal infections are serious and life threatening complications of immunocompromised host. The authors reported two cases of rapid progressive proptosis and eyelid necrosis of immunocompromised patients who suffered from highly malignant T-celled lymphoblastic leukemia/lymphoma and congenital heart disease with multiple anomalies. Although early diagnosis was made and prompt treatments including medical and surgical interventions were performed, both patients died.
Subject(s)
Aspergillosis/complications , Mucormycosis/complications , Orbital Diseases/microbiology , Adolescent , Aspergillosis/diagnosis , Child, Preschool , Ethmoid Sinusitis/diagnostic imaging , Ethmoid Sinusitis/epidemiology , Exophthalmos/diagnostic imaging , Exophthalmos/epidemiology , Fatal Outcome , Humans , Immunocompromised Host , Lymphoma, T-Cell/epidemiology , Male , Mucormycosis/diagnosis , Pseudomonas Infections/epidemiology , Pseudomonas aeruginosa , RadiographyABSTRACT
OBJECTIVE: To compare the pupillary response to a single drop and three drops of a combination of eye drops (0.2% cyclopentolate and 1.0% phenylephrine) in preterm infants. DESIGN: Prospective comparative study. MATERIAL AND METHOD: Preterm infants scheduled to undergo their first retinopathy of prematurity (ROP) screening in the Neonatal Intensive Care Unit, Songklanagarind Hospital, between 1 August 2007 and 30 August 2008, were enrolled in the present study. An eyelid speculum was placed after the topical anesthetic, 0.5% tetracaine, application to measure the baseline horizontal pupil diameter with a Vernier caliper. Then each eye was randomized to either receive a drop of mixture of 0.2% cyclopentolate and 1.0% phenylephrine single dose for group A, or triple doses of 10-minute interval for group B. The pupil diameter was measured at 45 and 60 minutes after instillation and a fundus examination was performed afterward. RESULTS: Seventy preterm infants, 45 males and 25 females, were included in the present study. The mean gestational age was 30.49 +/- 2.34 weeks (range of 24-36 weeks) and the mean birth weight was 1,368.00 +/- 438.99 grams (range of 640-2,850 grams). At baseline, the mean pupil diameter was 2.18 +/- 0.44 mm in group A and 2.19 +/- 0.44 mm in group B (p = 0.90). The mean pupil diameter at 45 minutes after instillation was 5.50 +/- 0.80 mm in group A and 6.02 +/- 0.56 mm in group B (p < 0.01). At 60 minutes after instillation, the mean pupil diameter was 6.13 +/- 0.82 mm in group A and 6.77 +/- 0.41 mm in group B (p < 0.01). CONCLUSION: The pupil size of preterm infants was significantly larger after three drops of the eye drop mixture (0.2% cyclopentolate and 1.0% phenylephrine) than after a single drop. However, a dilated pupil diameter > or = 6 mm was adequate for the peripheral retina examination.
