West Nile Virus Retinopathy and Associations with Long Term Neurological and Neurocognitive Sequelae.

West Nile virus (WNV) has emerged as an important vector-borne pathogen in North America, with more than 3 million estimated to have been infected. Retinopathy from WNV infection has been previously reported in acute cases, though those prior reports did not evaluate the risk of retinopathy based on clinical severity of neurologic disease. The purpose of this cross-sectional study was to perform comprehensive ophthalmological and neurological examinations on 111 patients with a history of West Nile virus infection and describe the ocular manifestations. Out of 111 patients, 27 (24%) had evidence for West Nile virus associated retinopathy (WNVR); this observation was higher (49%) in those patients who initially presented with encephalitis. Individuals with WNVR had more frequent involvement of the macula and peripheral involvement compared to those patients without WNVR (p<0.05). WNVR was also associated with a greater likelihood of abnormal reflexes on neurological exam, poorer learning, greater dependence in activities of daily living, and lower quality of life (p<0.05). WNVR was seen more frequently in elderly patients (age > 60 years), and was associated with higher rates of diabetes mellitus and a history of encephalitis (p<0.05). A multivariable logistic regression revealed that only a history of encephalitis was independently associated with WNVR [Adjusted Odds Ratio = 4.9 (1.8-13.2); p = 0.001]. Our study found that WNVR occurs in one fourth of patients with a history of WNV infection and is more frequently observed in those with apparent severe neurological sequelae (e.g., encephalitis). The clinical relevance of WNVR was supported by its associations with dependence in activities of daily living and lower quality of life. This unique evaluation of WNV patients included fundoscopic examinations and their associations with neurologic impairment. Our findings can be used during ophthalmological consultation for the evaluation, treatment and rehabilitation phases of care for WNV patients.

Risk factors associated with retinal hemorrhage in suspected abusive head trauma.

PURPOSE: To determine risk factors associated with retinal hemorrhage (RH) in pediatric abusive head trauma (AHT) suspects. METHODS: Records of children aged 0-3 years hospitalized for suspected AHT from January 2007 to November 2011 were retrospectively reviewed in this case-control study. Children were classified into case and control groups based on RH presence. Medical history, presenting symptoms, reasons, and characteristics of injury were recorded. Logistic regression analysis was performed to identify risk factors. RESULTS: A total of 168 children (104 males) were included. Of these, 103 were classified as cases and 65 as controls. The mean age (with standard deviation) was 9.3 ± 8.3 months (range, 1 day-36 months). Of the 103 cases, 22 (21%) had subretinal hemorrhage, 9 (9%) had retinoschisis, and 1 (1%) had vitreous hemorrhage. Children presenting with lethargy or altered mental status (P < 0.0001), subdural hemorrhage (P < 0.0001), and other radiologic findings (eg, cerebral ischemia, diffuse axonal injury, hydrocephalus, or solid organ injury; P = 0.01546) were likely to have RH. All 23 children with skull or nonskull fracture without intracranial hemorrhage did not have RH (P < 0.0001 both categories). CONCLUSIONS: Retinal hemorrhages were almost never found in the absence of intracranial hemorrhage and not found in the setting of fracture without intracranial hemorrhage.

Microbial contamination of immersion biometry ultrasound equipment.

PURPOSE: To investigate the prevalence of microorganisms on ultrasound biometry equipment and cleaning habits. DESIGN: Observational case series. PARTICIPANTS: Thirty-four university-based and private ophthalmology clinics. METHODS: In a prospective multicenter study, clinics representative of every region of the country sampled their fixed immersion biometry equipment (i.e., ultrasound probe, immersion shell, and infusion tubing) for bacteria and fungi. Assessment of the cleaning habits for this equipment was conducted by way of a standard questionnaire that included type of fluid and delivery method, frequency of fluid change, method of cleaning the probe and shell, and frequency of tubing change and/or cleaning. MAIN OUTCOME MEASURES: Frequency (prevalence), descriptive statistics, and type of microorganisms. RESULTS: Eighteen samples (53% [18/34]) grew organisms from either the probe/shell or tubing. Positive cultures were found in 32% (11/34) of the immersion shell/probes and in 31% (10/32) of the infusion tubing samples. The bacteria most commonly cultured from both probe/shell and tubing was coagulase-negative Staphylococcus, whereas Penicillium species was the most commonly cultured fungus (exclusively from the probe/shell). Overall, fungi (Penicillium and Alternaria species) were cultured in 12% of the probe/shell samples. Only 14% of the study sites adequately disinfected the probe/shell according to Centers for Disease Control and Prevention (CDC) guidelines, which recommend a 5-minute soak in antiseptic. CONCLUSIONS: The bacteria and fungi that colonize biometry equipment are not being adequately eliminated by the cleaning/disinfecting techniques employed in most ophthalmology clinics. These results also may apply to contact biometry, pachymetry, and tonometry equipment as well. Clinicians should follow the CDC recommendations for disinfecting instruments that come in contact with the eye, and the infusion tubing should be changed after each patient.