Epidemiology and etiologic diagnosis of infectious keratitis in Uberlandia, Brazil.

PURPOSE: To study risk factors, microbiological characteristics, and clinical course of nonviral infectious keratitis diagnosed in a referral service of ophthalmology. METHODS: A total of 65 charts of patients with microbial keratitis were retrospectively reviewed at the Clinical Hospital of Federal University of Uberlandia, Brazil, from July 2001 through August 2004. All cases were submitted to microbiological tests and treated according to local protocol. Risk factors, clinical course, therapeutic keratoplasty, and visual outcomes were analyzed. RESULTS: The mean age of patients was 45.9 years (2-83 years) and male to female ratio 2.6:1. Symptoms at presentation ranged from 1-3 days in 16 patients out of 65 (24.61%), 4-7 days in 19 cases (19/65; 29.23%), and more than 7 days in 27 patients (27/65; 41.53%). The major risk factor was trauma (28/65; 40%), predominantly by organic material. A total of 32 eyes out of 65 (49.23%) were culture positive. Fungi were the most common isolates (18/32; 56.25%), being headed by Fusarium sp. (11/65; 16.92%), and the most common bacteria was Streptococcus pneumoniae (7/65; 10.77%). Final visual acuity was equal to or better than 20/60 in 20 patients out of 65 (30.77%), between 20/60 and 20/400 in 7 patients (7/65; 10.77%), and worse than 20/400 in 35 patients out of 65 (53.85%). A total of 48 eyes out of 65 (73.84%) presented corneal scar, 12 eyes (12/65; 18.46%) needed therapeutic penetrating keratoplasty, and 2 eyes (2/65; 3.08%) were eviscerated. CONCLUSIONS: The high incidence of fungal keratitis in the studied population shows their vulnerability to such infections, which may result in devastating visual outcomes.

Infectious keratitis secondary to Histoplasma capsulatum: the first case reports in humans

The authors report an unusual case of fungal keratitis caused by Histoplasma capsulatum in a male immunocompetent patient. PCR confirmed the presence of the fungus DNA in the material studied. To our knowledge this is the first reported case in humans described all over the world.

Comparing the fixed combination brimonidine-timolol versus fixed combination dorzolamide-timolol in patients with elevated intraocular pressure.

PURPOSE: To evaluate the efficacy of fixed combination brimonidine-timolol (FCBT) versus fixed combination dorzolamide-timolol (FCDT) given twice daily in patients with primary open angle glaucoma (POAG) or ocular hypertension (OH). DESIGN: Prospective, multicentre, masked-observer, crossover comparison. PARTICIPANTS: Sixteen patients with POAG and 14 with OH. METHODS: The participants of the study were washed out from their previous medication and randomized to fixed FCBT or FCDT for the first 4-week treatment period. Subjects then were washed for 4 weeks and started on the opposite medication for the second 4-week period. Intraocular pressure (IOP) was measured with a Goldmann applanation tonometer at 8:00 a.m., 12:00 noon and 4:00 p.m. at each baseline and at the end of each treatment period. Unsolicited ocular adverse events were also recorded. MAIN OUTCOME MEASURES: Comparison of the IOP lowering effect of FCBT and FCDT. RESULTS: The baseline mean diurnal IOP for all 30 subjects (30 eyes) was 22.9 +/- 1.6 mmHg. Both fixed combinations significantly reduced IOP compared with baseline (p < 0.00001). The mean diurnal IOP following 4 weeks of therapy was 15.0 +/- 2.1 mmHg for FCBT and 15.4 +/- 2.1 mmHg for FCDT (p = 0.510). The mean diurnal IOP reduction was 7.8 +/- 1.9 mmHg for FCBT and 7.4 +/- 1.8 mmHg for FCDT (p = 0.430). Overall, 14 subjects complained about ocular adverse events: two only for FCBT, seven only for FCDT and five for both drugs. Although there was no significant difference between the number of subjects that reported ocular adverse events with FCBT (n = 7) and FCDT (n = 12) (p = 0.359), FCDT caused more ocular stinging upon instillation (n = 9) than FCBT (n = 1) (p = 0.027). CONCLUSION: This study suggests that FCBT and FCDT, each given twice daily, have similar efficacy in patients with POAG or OH.

Infectious keratitis secondary to Histoplasma capsulatum: the first case reports in humans.

The authors report an unusual case of fungal keratitis caused by Histoplasma capsulatum in a male immunocompetent patient. PCR confirmed the presence of the fungus DNA in the material studied. To our knowledge this is the first reported case in humans described all over the world.