Usefulness of smear microscopy for therapeutic decision-making in patients with infectious keratitis.

PURPOSE: To determine the usefulness of smears in the diagnosis of infectious keratitis by comparing smears and 2 different culture methods. STUDY DESIGN: Retrospective, observational study. METHODS: The foci of 73 patients diagnosed with infectious keratitis at Hiroshima University Hospital between July 2011 and September 2015 were abraded, and smear microscopy and culturing were performed. The microorganism detection rates and other parameters were compared. RESULTS: Microorganisms were detected in 47 of 73 specimens. Microorganisms were identified in 32 of 69 cases cultured on plain medium (detection rate, 46.4%) compared with 22 of 61 cases cultured on swab transport medium (detection rate, 36.1%). There was no significant difference in the microbial detection rate between the plain medium method and the swab transport medium method (P = 0.23). Smear microscopy and culture findings were concordant in 21 (28.8%) cases, and different microorganisms were detected in 9 cases. In 17 cases, the culture was negative, despite the presence of microorganisms on smear microscopy, and in 7 cases, the culture was positive, despite the absence of microorganisms on smear microscopy. The positivity rate of microbial detection was significantly higher when no antimicrobial agents had been administered previously (odds ratio 7.50, P = 0.017). CONCLUSION: Smear microscopy of abrasions from lesions is useful for the initiation of treatment for infectious keratitis. However, culture studies should be conducted at the same time to confirm antimicrobial sensitivity. If possible, smear microscopy should be performed before the initiation of antimicrobial therapy.

Influence of discontinuation of prophylactic antimicrobial agent for trabeculectomy.

BACKGROUND: There is no unified view of the necessity of prophylactic antimicrobial agents in trabeculectomy. Preoperative prophylactic antimicrobial agent injection and cefazolin sodium (CEZ) for trabeculectomy were discontinued at the Hiroshima University Hospital. In this study, we evaluated whether discontinuation of preoperative administration of CEZ in ophthalmology affects the incidence of postoperative infections. METHODS: We retrospectively investigated patient background, concomitant medications, subconjunctival dexamethasone sodium phosphate (DEX) injection at the end of the surgery, and the incidence of infective endophthalmitis within 6 weeks after surgery in the CEZ and non-CEZ groups. We also performed propensity score matching for background matching. Statistical analysis was performed using the Mann-Whitney U-test and Fisher's exact test. RESULTS: The incidence of postoperative endophthalmitis was not significantly different between 629 and 751 patients in the CEZ and no-CEZ groups, respectively (0 in the CEZ group and 2 in the no-CEZ group, P = 0.504). More patients in the CEZ group were taking diabetes drugs preoperatively (P = 0.028) and fewer patients were receiving subconjunctival DEX at the end of surgery (P < 0.001) than those in the non-CEZ group. Propensity scores were calculated using the risk factors for postoperative infection as covariates, and matching (580 patients in the CEZ group and 580 patients in the non-CEZ group) showed no significant difference in the incidence of postoperative endophthalmitis (P = 0.500). CONCLUSIONS: There was no significant difference in the incidence of endophthalmitis after trabeculectomy between the CEZ and non-CEZ groups, suggesting a decreased need for CEZ injections before trabeculectomy.

Successful recovery from misdirection syndrome in nanophthalmic eyes by performing an anterior vitrectomy through the anterior chamber.

PURPOSE: To determine the effectiveness of iridectomy, capsulotomy and anterior vitrectomy through the anterior chamber to treat misdirection syndrome in pseudophakic nanophthalmic eyes. METHODS: This was a non-comparative study of seven nanophthalmic eyes from four consecutive patients. All eyes developed misdirection syndrome after successful cataract surgery. Treatment for misdirection syndrome involved capsulotomy and anterior vitrectomy through a peripheral iridectomy from the anterior chamber using a 25-gauge vitreous cutter. The best-corrected visual acuity, intraocular pressure and anterior and posterior segment findings were recorded before and after surgery. RESULTS: Resolution of the aqueous misdirection was achieved in all but one eye. The single case of recurrence was observed after a mean follow-up of 45.6 ± 21.5 months and was caused by closure of the capsule hole by Elschnig's pearls. This eye was successfully treated by enlargement of the lens capsule hole with a vitreous cutter. The mean intraocular pressure before surgery was 28.7 ± 4.4 mmHg, and this was significantly reduced to 13.7 ± 1.3 mmHg at the final visit. All but one patient, who had uveal effusion, maintained their best-corrected visual acuity. CONCLUSION: In this study, we investigated an alternative option for the treatment of misdirection syndrome in nanophthalmic eyes. We undertook a lens capsulotomy and anterior vitrectomy through a peripheral iridectomy from the anterior chamber using a 25-gauge vitreous cutter, which was able to create a communication hole between the anterior and posterior chambers.

Characteristics of corneal topographic and pachymetric patterns in patients with pellucid marginal corneal degeneration.

PURPOSE: To determine the characteristics of the shape of the cornea in patients with pellucid marginal corneal degeneration (PMD) and to compare these characteristics to those of eyes with keratoconus and eyes of normal subjects. METHODS: This was a retrospective, cross-sectional case-series in which 49 eyes of 33 patients with PMD, 51 eyes of 51 patients with keratoconus and 53 eyes of 53 subjects with normal corneas (controls) were examined and compared. For all eyes, we obtained the topographic patterns of the axial power maps, anterior and posterior elevation maps and pachymetric maps using a rotating Scheimpflug camera. The eyes were classified into the respective patterns by visual inspection of these maps. RESULTS: In eyes with PMD, the most common axial power map pattern was the crab claw pattern (78 %) followed by the inferior steepening pattern (18 %). In eyes with keratoconus, the most common pattern was the inferior steepening pattern (67 %). The most common pattern in the elevation maps for both surfaces was the asymmetric island in eyes with PMD and keratoconus. Although the decentered pattern, including the decentered oval (27 %) and decentered round (20 %) pattern, on pachymetric map was specific to eyes with PMD, the incidence of these patterns was relatively low. CONCLUSIONS: The similarity in the topographic and pachymetric patterns in eyes with PMD and keratoconus suggests that they may be a continuity of the same disorder with different phenotypes.

Interface fluid syndrome after laser in situ keratomileusis following herpetic keratouveitis.

We report an unusual case of a 28-year-old man who developed interface fluid with herpetic keratouveitis and elevated intraocular pressure (IOP) after laser in situ keratomileusis (LASIK) in the left eye. The IOP was unmeasurable with the Goldmann applanation tonometer; rebound tonometry showed an IOP of 30 mm Hg in the central cornea and 58 mm Hg in the superior cornea. Medical treatment of the elevated IOP resulted in resolution of the accumulated interface fluid. This case highlights the inaccuracy of IOP measurements in the central cornea with interface fluid or central corneal edema caused by elevated IOP after LASIK and shows the efficacy of IOP measurements at the peripheral cornea using rebound tonometry. It also shows that uveitis can be a risk factor for interface fluid syndrome after LASIK.

Comparison of drug permeabilities across the blood-retinal barrier, blood-aqueous humor barrier, and blood-brain barrier.

Drugs vary in their ability to permeate the blood-retinal barrier (BRB), blood-aqueous humor barrier (BAB), and blood-brain barrier (BBB) and the factors affecting the drug permeation remain unclear. In this study, the permeability of various substances across BRB, BAB, and BBB in rats was determined using the brain uptake index (BUI), retinal uptake index (RUI), and aqueous humor uptake index (AHUI) methods. Lipophilic substances showed high permeabilities across BBB and BRB. The RUI values of these substances were approximately four-fold higher than the BUI values. The AHUI versus lipophilicity curve had a parabolic shape with AHUI(max) values at log D(7.4) ranging from -1.0 to 0.0. On the basis of the difference on the lipophilicities, verapamil, quinidine, and digoxin showed lower permeability than predicted from those across BBB and BRB, whereas only digoxin showed a lower permeability across BRB. These low permeabilities were significantly increased by P-glycoprotein inhibitors. Furthermore, anion transporter inhibition increased the absorption of digoxin to permeate into the retina and aqueous humor. In conclusion, this study suggests that efflux transport systems play an important role in the ocular absorption of drugs from the circulating blood after systemic administration.