Características clínicas y microbiológicas en queratitis infecciosas bacterianas en un hospital de tercer nivel / Clinical features and microbiological in bacterial keratitis in a tertiary referral hospital

Objetivo: Describir las características clínicas, agentes bacterianos y sensibilidad antibiótica de las queratitis bacterianas en el Servicio de Oftalmología del Hospital Universitario Fundación Jiménez Díaz (HUFJD) de Madrid. Materiales y métodos: Estudio observacional, descriptivo y retrospectivo de los registros clínicos e informes de los raspados corneales en pacientes con queratitis bacterianas en el HUFJD realizados entre los años 2009 y 2014. Resultados: Se tuvo una muestra de 160 pacientes. Las bacterias grampositivas fueron las más prevalentes con un 64,3% (n=103). Staphylococcus coagulasa negativo (20,6%), Staphylococcus aureus (19,4%) y Pseudomonas aeruginosa (12,5%) fueron las bacterias más frecuentes. El factor de riesgo más común fue el uso de lentes de contacto, seguido de enfermedad de la superficie ocular y cirugías oculares previas. Los antibióticos a los que las bacterias fueron más comúnmente sensibles fueron: gentamicina (n=114), cotrimoxazol (n=107), vancomicina (n=106) y ciprofloxacina (n=97) y los antibióticos a los que las bacterias fueron más comúnmente resistentes fueron ampicilina (n=59) y eritromicina (n=45). Conclusiones: En el manejo inicial de las queratitis bacterianas se debería tener en cuenta la sensibilidad y resistencia de las bacterias ante los antibióticos. Recomendamos, con base en nuestros hallazgos, el uso de aminoglucósidos, vancomicina y fluoroquinolonas, e interrumpir el uso de eritromicina, que es ampliamente usada actualmente (AU)

Objective: To describe the clinical features, bacterial agents, and antibiotic sensitivity of bacterial keratitis in the Ophthalmology Department at the University Hospital Fundación Jiménez Díaz (HUFJD) in Madrid. Materials and methods: A retrospective observational descriptive study using clinical records and reports of corneal scrapings in patients with bacterial keratitis at the HUFJD conducted between 2009 and 2014. Results: In a sample of 160 patients, gram-positive bacteria were the most prevalent with 64.3% (n=103). Coagulase negative staphylococcus (20.6%), Staphylococcus aureus (19.4%), and Pseudomonas aeruginosa (12.5%) were the most frequent bacteria. The most common risk factor was the use of contact lenses, followed by disease of the ocular surface, and previous ocular surgeries. The antibiotics to which the bacteria were most commonly susceptible were gentamicin (n=114), cotrimoxazole (n=107), vancomycin (n=106), and ciprofloxacin (n=97). The antibiotics to which the bacteria were most commonly resistant were ampicillin (n=59) and erythromycin (n=45). Conclusions: In the initial management of bacterial keratitis, the sensitivity and resistance of bacteria to antibiotics should be taken into account. Based on our findings, the use of aminoglycosides, vancomycin and fluoroquinolones is recommended, and, although widely used today, the discontinuation of erythromycin (AU)

Clinical features and microbiological in bacterial keratitis in a tertiary referral hospital. / Características clínicas y microbiológicas en queratitis infecciosas bacterianas en un hospital de tercer nivel.

OBJECTIVE: To describe the clinical features, bacterial agents, and antibiotic sensitivity of bacterial keratitis in the Ophthalmology Department at the University Hospital Fundación Jiménez Díaz (HUFJD) in Madrid. MATERIALS AND METHODS: A retrospective observational descriptive study using clinical records and reports of corneal scrapings in patients with bacterial keratitis at the HUFJD conducted between 2009 and 2014. RESULTS: In a sample of 160 patients, gram-positive bacteria were the most prevalent with 64.3% (n=103). Coagulase negative staphylococcus (20.6%), Staphylococcus aureus (19.4%), and Pseudomonas aeruginosa (12.5%) were the most frequent bacteria. The most common risk factor was the use of contact lenses, followed by disease of the ocular surface, and previous ocular surgeries. The antibiotics to which the bacteria were most commonly susceptible were gentamicin (n=114), cotrimoxazole (n=107), vancomycin (n=106), and ciprofloxacin (n=97). The antibiotics to which the bacteria were most commonly resistant were ampicillin (n=59) and erythromycin (n=45). CONCLUSIONS: In the initial management of bacterial keratitis, the sensitivity and resistance of bacteria to antibiotics should be taken into account. Based on our findings, the use of aminoglycosides, vancomycin and fluoroquinolones is recommended, and, although widely used today, the discontinuation of erythromycin.

Serie pediátrica en una campaña oftalmológica en Turkana (Kenia) / Pediatric case series in an ophthalmic camp in Turkana (Kenya)

Introducción: Turkana es el distrito más grande de Kenia, situado en el extremo noroeste. Su población está en torno a 850.000 habitantes seminómadas dedicados principalmente al pastoreo. En torno al 60% de la población vive por debajo del umbral de la pobreza. La proporción de médicos por habitante es de 1:75.000.La última campaña realizada en Turkana en noviembre de 2011, con un objetivo puramente quirúrgico, contó con cinco oftalmólogos. La selección previa fue realizada acertadamente por personal local en áreas rurales y en Lodwar. Se realizaron 128 cirugías (123 pacientes) sobre 371 pacientes vistos en consulta. Objetivo: Describir la población pediátrica atendida en la última campaña del proyecto oftalmológico en Turkana. Método: Descripción del perfil de afecciones oculares presentadas por los niños atendidos durante esta campaña quirúrgica. Se expondrá la actitud diagnóstico-terapéutica tomada con relación a las limitaciones impuestas por las características del lugar y de la población. Resultados: De un total de 371 pacientes vistos en consulta, 54 eran menores de 15 años (14,5%); cuatro fueron intervenidos, del total de 123 pacientes operados (3,25%). En dos niños más se indicó la cirugía, por lo que seis de los 54 casos se podrían considerar quirúrgicos (11,1%).De los 54 niños atendidos, 17 sufrían enfermedades distintas a defectos de refracción o problemas leves de superficie ocular: cataratas traumáticas, impétigo, neuropatías, proptosis, distrofias retinianas, tumores dermoides, nictalopía… En 4 de los 17 niños, la causa eran traumatismos (23,5%). Conclusiones: Las campañas quirúrgicas en países en vías de desarrollo están en auge, aunque suelen ir enfocadas a tratar afecciones concretas como las cataratas o el tracoma. Esta serie muestra la necesidad de ir equipados para intervenir a menores de edad y de estar preparados para la complejidad de la situación que pueda surgir (AU)

Introduction: Turkana is the largest district in Kenya, situated in the Northwest of the country. It features a semi-nomadic population of 850,000. Around 60% of population lives below the poverty threshold. The ratio of doctors is 1:75,000 inhabitants. Five ophthalmologists took part in the last deployment in November. Local staff had previously selected the patients from the rural areas, as well as in Lodwar, the capital of the district. Of the 371 patients who attended the clinic, 128 required surgery. Objetive: To describe the pediatric population attended to in the last «Turkana Eye Project» Camp. Methods: Description of the ophthalmic pathologies of the children seen in the clinic in this surgical camp, and the diagnostic and therapeutic options according to the limitations of the environment. Results: Of the 371 patients, 54 were younger than 15 years old (14.5%). Four children had surgery (3.25% of the 128 patients). In 2 more cases surgery was the indicated but not performed. Therefore, of the total of 54 cases, 6 could be considered as surgical (11.1%), and 17 suffered ophthalmic problems other than refraction defects, or mild ocular surface pathologies: traumatic cataracts, neuropathies, impetigo, exophthalmos, retinal dystrophies, dermoid cysts, or nyctalopia. The etiology was traumatic in four of the 17 children (23.5%). Conclusion: Surgical camps are increasing in the developing countries. They are usually focused on particular pathologies, such as cataracts or trachoma. Our case series shows the importance of pediatric teams and the need to be prepared to face complex pediatric pathologies (AU)

[Pediatric case series in an ophthalmic camp in Turkana (Kenya)]. / Serie pediátrica en una campaña oftalmológica en Turkana (Kenia).

INTRODUCTION: Turkana is the largest district in Kenya, situated in the Northwest of the country. It features a semi-nomadic population of 850,000. Around 60% of population lives below the poverty threshold. The ratio of doctors is 1:75,000 inhabitants. Five ophthalmologists took part in the last deployment in November. Local staff had previously selected the patients from the rural areas, as well as in Lodwar, the capital of the district. Of the 371 patients who attended the clinic, 128 required surgery. OBJETIVE: To describe the pediatric population attended to in the last «Turkana Eye Project¼ Camp. METHODS: Description of the ophthalmic pathologies of the children seen in the clinic in this surgical camp, and the diagnostic and therapeutic options according to the limitations of the environment. RESULTS: Of the 371 patients, 54 were younger than 15 years old (14.5%). Four children had surgery (3.25% of the 128 patients). In 2 more cases surgery was the indicated but not performed. Therefore, of the total of 54 cases, 6 could be considered as surgical (11.1%), and 17 suffered ophthalmic problems other than refraction defects, or mild ocular surface pathologies: traumatic cataracts, neuropathies, impetigo, exophthalmos, retinal dystrophies, dermoid cysts, or nyctalopia. The etiology was traumatic in four of the 17 children (23.5%). CONCLUSION: Surgical camps are increasing in the developing countries. They are usually focused on particular pathologies, such as cataracts or trachoma. Our case series shows the importance of pediatric teams and the need to be prepared to face complex pediatric pathologies.

[Rebound tonometry in a clinical setting. Comparison with applanation tonometry]. / Tonometría de rebote en la práctica clínica. Comparación con tonometría de aplanación.

PURPOSE: Rebound tonometry has recently been modified for its use in humans. The purpose of our study was to determine the precision of the ICare(R) rebound tonometer (RBT) as compared with the Goldmann applanation tonometer (GAT). METHODS: Patients were recruited from our Hospital's Glaucoma Unit. In each patient, intraocular pressure (IOP) was measured without anaesthesia using the RBT and ten minutes later using the GAT. Central corneal thickness (CCT) was measured by pachymetry. RESULTS: Sixty-eight patients were recruited (132 eyes). Mean IOP readings with RBT were 18.9 +/- 7.2 (SD) mmHg and were 15.5 +/- 5.7 mmHg with GAT (p<0.001). There was a good correlation between both instruments (r = 0.87, p<0.001). In most cases (84.6%) the IOP measured with the RBT was greater than that measured with the GAT. The mean difference between both instruments was 3.4 +/- 3.6 mmHg. There was a trend towards greater differences between those obtained using the RBT than the GAT when IOP values were higher. A statistically significant correlation was found between IOP readings with both tonometers and CCT, with higher differences being seen as the CCT increased. CONCLUSION: The RBT can be employed in a clinical setting taking into account that it usually overestimates IOP as compared with the GAT. It could be especially useful in glaucoma screening campaigns since it can be operated by a trained technician.

Tonometría de rebote en la práctica clínica. Comparación con tonometría de aplanación / Rebound tonometry in a clinical setting. comparison with applanation tonometry

Objetivo: La tonometría de rebote ha sido recientemente adaptada para su utilización en humanos. El objetivo de nuestro estudio es determinar la precisión del tonómetro de rebote (TRB) ICare(R) en comparación con el tonómetro de aplanación Goldmann (TAG). Métodos: Se reclutaron pacientes de la Unidad de Glaucoma de nuestro centro. En cada paciente se midió la presión intraocular (PIO) con el TRB sin anestésico y tras diez minutos con el TAG. Se empleó la paquimetría para determinar el grosor corneal central (ECC). Resultados: Se reclutaron 68 pacientes (132 ojos). La media de PIO obtenida con el TRB fue de 18,9 [Desviación estándar (DE) 7,2 mmHg] y de 15,5 (DE 5,7 mmHg) con el TAG (p<0,001). Existe una buena correlación entre los dos aparatos (r = 0,87, p<0,001). En la mayoría de los casos (84,6%) la PIO obtenida con el TRB fue mayor que la obtenida con el TAG. La diferencia media entre los dos instrumentos fue de 3,4 (DE 3,6 mmHg). Se aprecia una tendencia a la sobreestimación de la PIO con el TRB, siendo ésta mayor para valores de PIO más elevados medidos con TAG. Se encontró una correlación estadísticamente significativa de la PIO obtenida con ambos tonómetros y el ECC, con mayor sobreestimación con TRB cuanto mayor es la paquimetría. Conclusiones: El TRB puede ser aplicado en la práctica clínica teniendo en cuenta que habitualmente sobreestima la PIO con respecto al TAG. Podría ser especialmente útil en campañas de screening de glaucoma al poder ser manejado por técnicos entrenados

Purpose: Rebound tonometry has recently been modified for its use in humans. The purpose of our study was to determine the precision of the ICare(R) rebound tonometer (RBT) as compared with the Goldmann applanation tonometer (GAT). Methods: Patients were recruited from our Hospital’s Glaucoma Unit. In each patient, intraocular pressure (IOP) was measured without anaesthesia using the RBT and ten minutes later using the GAT. Central corneal thickness (CCT) was measured by pachymetry. Results: Sixty-eight patients were recruited (132 eyes). Mean IOP readings with RBT were 18.9 ± 7.2 (SD) mmHg and were 15.5 ± 5.7 mmHg with GAT (p<0.001). There was a good correlation between both instruments (r = 0.87, p<0.001). In most cases (84.6%) the IOP measured with the RBT was greater than that measured with the GAT. The mean difference between both instruments was 3.4 ± 3.6 mmHg. There was a trend towards greater differences between those obtained using the RBT than the GAT when IOP values were higher. A statistically significant correlation was found between IOP readings with both tonometers and CCT, with higher differences being seen as the CCT increased. Conclusion: The RBT can be employed in a clinical setting taking into account that it usually overestimates IOP as compared with the GAT. It could be especially useful in glaucoma screening campaigns since it can be operated by a trained technician