Fatal orbital necrotizing fasciitis secondary to stenotrophomonas maltophilia associated stomatitis.

An 81-year-old woman with diabetes mellitus presented with signs of orbital cellulitis and a gangrenous ulcer on the right palate. Biopsy analysis confirmed a diagnosis of necrotizing fasciitis. Surgical debridement of necrotic tissues and enucleation of the right eye were performed. Stenotrophomonas maltophilia was isolated from the specimens. The patient remained stable under antibiotic therapy and underwent reconstructive surgery. To the best of our knowledge, this represents a rare case of orbital necrotizing fasciitis developing secondary to S. maltophilia infection. Orbital necrotizing fasciitis is rare; the early clinical features may be similar to those of cellulitis. To prevent devastating complications, the former condition must be kept in mind, particularly in immunocompromised patients.

The effect of topical anti-muscarinic agents on subfoveal choroidal thickness in healthy adults.

PurposeTo investigate the effects of tropicamide and cyclopentolate, which are two anti-muscarinic agents commonly used in the ophthalmologic practice, on subfoveal choroidal choroidal thickness (ChT) in healthy adults.MethodsA total of 74 healthy adult subjects were enrolled in the study. Subjects were randomly divided into two groups: (1) cyclopentolate group (n=37) in which the right eye (study eye) of each subject received topical cyclopentolate 1%, and the fellow eye (control eye) received artificial tears and (2) tropicamide group (n=37) in which the right eye (study eye) of each subject received topical tropicamide 1% and the fellow eye (control eye) received artificial tears. Each topical medication was applied three times with 10-min intervals. ChT measurements were performed at baseline and 40 min after the last drops of the topical medications by enhanced depth imaging (EDI) optical coherence tomography (OCT).ResultsIn the cyclopentolate group, subfoveal ChT significantly increased in the study eyes (P=0.013), whereas it did not significantly change in the control eyes (P=0.417). On the other hand, in the tropicamide group, no significant subfoveal ChT changes were observed in either the study eyes (P=0.715) or the control eyes (P=0.344).ConclusionsThe current study demonstrated that cyclopentolate caused significant choroidal thickening, whereas tropicamide had no significant effect on ChT in healthy adults. As a result, mydriasis by cyclopentolate may complicate ChT measurements by EDI OCT. Use of tropicamide may provide more reliable results for evaluation of ChT in ocular pathologies.