Ocular features of west nile virus infection in North America: a study of 14 eyes.

PURPOSE: To present a case series of ocular findings of West Nile virus infection (WNVI) in North America. DESIGN: Retrospective, noncomparative, observational case series. PARTICIPANTS: All patients were referred to the authors for WNVI with ocular involvement between the years 2002 and 2005. METHODS: Chart review was performed on all participants. All participants underwent complete ophthalmic evaluation during each examination, including best-corrected Snellen visual acuity measurement, tonometry, slit-lamp biomicroscopy of the anterior and posterior segments, and dilated fundus examination with indirect ophthalmoscopy. Fundus photography and fluorescein angiography were also performed on all eyes. Relevant ocular findings associated with WNVI were recorded and tabulated. MAIN OUTCOME MEASURES: The authors studied the characteristics, frequency, and locations of ocular lesions found in participants' eyes. RESULTS: There were 14 eyes (7 patients) with ocular West Nile virus lesions from 2002 to 2005. Average patient age was 58.4 years (range, 32-85 years). Ocular findings in descending order of frequency included multifocal chorioretinal target lesions in 12 eyes (85.7%), retinal hemorrhages in 7 eyes (50.0%), vitritis in 6 eyes (42.9%), chorioretinal linear streaks in 4 eyes (28.6%), perivascular sheathing and vasculitis in 4 eyes (28.6%), narrowed retinal vessels in 4 eyes (28.6%), disc edema in 4 eyes (28.6%), optic atrophy in 2 eyes (14.3%), vascular occlusion in 2 eyes (14.3%), and VIth nerve palsy in 1 eye (7.1%). Peripheral fundus lesions were found in all 14 eyes (100%), whereas posterior fundus lesions were found in 8 eyes (57.1%). Five patients (71.4%) were diabetic. Diabetic retinopathy was present in 7 eyes (70%). CONCLUSIONS: Multifocal choroiditis is the most common ocular manifestation associated with WNVI, with a typically benign clinical course. Less frequent ocular lesions, including optic neuritis and occlusive vasculitis, frequently induce persistent and likely permanent visual deficit. Diabetic patients and those older than 50 years of age are more vulnerable to the more severe features of WNVI, including more serious ocular lesions.

Characteristics of sixty myopic eyes with pre-laser in situ keratomileusis retinal examination and post-laser in situ keratomileusis retinal lesions.

PURPOSE: A survey of eyes with pre-laser in situ keratomileusis (LASIK) retinal examinations and characteristics of post-LASIK retinal breaks and retinal detachments (RDs). METHODS: A survey of worldwide vitreoretinal surgeons (424 physicians). Surveyed information included demographics, best-corrected visual acuity, degree of myopia, pre- and post-LASIK retinal findings, follow-up time, and treatment outcome. RESULTS: Sixty eyes with pre-LASIK retinal examinations developed post-LASIK retinal breaks and RDs. There was an average of 2.3 breaks per eye, yielding a total of 140 breaks in the 60 eyes. Forty eyes also had RDs besides the retinal breaks. Large percentages of eyes had substantial myopia (mean myopia, -9.5 +/- 5.8 diopters [D]) and complex vitreoretinal complications. Forty percent developed vitreoretinal complications within 6 months after LASIK. The 20 eyes that developed more extensive RDs (>3 clock hours) had a significantly higher mean myopia than did the 6 eyes that developed limited RD (< or = 3 clock hours) within 12 months after LASIK (-8.92 +/- 6.82 D versus -3.50 +/- 1.97 D, P = 0.03). There were significant statistical differences in distribution of retinal breaks and tears between the temporal and nasal quadrants (P < 0.001, P < 0.001, respectively, chi2, but not between the superior and inferior quadrants. CONCLUSION: Distributions of retinal breaks in this study were comparable with results found in non-LASIK eyes in young myopes. Treatment for post-LASIK vitreoretinal complications was highly successful. The vulnerability of such highly myopic eyes for vitreoretinal complications warrants their close monitoring.

Intravitreally injected human immunoglobulin attenuates the effects of Staphylococcus aureus culture supernatant in a rabbit model of toxin-mediated endophthalmitis.

OBJECTIVE: To determine whether human immunoglobulin attenuates the toxic effects of Staphylococcus aureus culture supernatant in a rabbit model of endophthalmitis. METHODS: Immunoglobulin binding to products of S aureus strain RN4220 was tested by Western blot analysis using known toxins (beta-hemolysin and toxic shock syndrome toxin-1) and a concentrated culture supernatant containing S aureus exotoxins (pooled toxin). To induce endophthalmitis, pooled toxin was injected into the rabbit vitreous. For immunoglobulin treatment, immunoglobulin and pooled toxin were either mixed and injected simultaneously or immunoglobulin was injected immediately after or 6 hours after pooled toxin injection. Severity of endophthalmitis was graded according to a 9-day course with clinical examination (slitlamp biomicroscopy or indirect ophthalmoscopy) and evaluation of histologic sections. RESULTS: The toxic effects of pooled toxin were markedly reduced when immunoglobulin was mixed with pooled toxin and injected simultaneously. Delayed injection of immunoglobulin diminished its ability to reduce toxicity. Clinical and histologic signs of toxicity were partially attenuated when immunoglobulin was injected immediately after pooled toxin, but only minimal clinically detectable reductions in toxicity were observed when immunoglobulin injection was delayed for 6 hours. CONCLUSION: Pooled human immunoglobulin can attenuate the toxic intravitreal effects of a concentrated culture supernatant containing S aureus exotoxins. Clinical Relevance Immunoglobulin may represent a novel adjuvant in the treatment of bacterial endophthalmitis. To optimize the potential therapeutic benefit, maximizing the mixture of immunoglobulin with bacterial products and early intervention are likely to be important.