Effectiveness of in vivo confocal microscopy in detecting filamentous fungi during clinical course of fungal keratitis.

PURPOSE: To determine the effectiveness of laser confocal microscopy in detecting filamentous fungi in the cornea of patients with fungal keratitis (FK) and in evaluating the effectiveness of the treatment. METHODS: The corneas of 6 patients clinically diagnosed with FK were examined with the Heidelberg Retina Tomograph II-Rostock Cornea Module (HRT II-RCM). Three of these patients were also monitored periodically with the HRT II-RCM after antifungal treatment. RESULTS: The HRT II-RCM examination showed interlocking and branching, white, septated, hyphae-like lines in the cornea of all patients. All 6 patients had positive corneal smears and/or laboratory cultures. Three patients were monitored with HRT II-RCM after antifungal treatment. One patient, whose initial smear was negative, was diagnosed by HRT II-RCM before the positive culture results. In another case, the epithelial regeneration was impaired even 3 weeks after the initial treatment and HRT II-RCM revealed a mass of hyphae in the corneal ulcerated lesion. These findings indicated the necessity of surgical debridement. After the surgical debridement, the corneal epithelial defect was healed. HRT II-RCM was able to detect the morphological changes of hyphae after antifungal treatment and helped in the treatment modifications during the clinical course in all 3 patients. CONCLUSIONS: These results indicate that HRT II-RCM can be used to diagnose FK and to monitor the effect of therapy on FK.

[The effectiveness of intravitreal administration of bevacizumab for choroidal neovascularization in retinal angioid streaks].

PURPOSE: To investigate the effectiveness of intravitreal administration of bevacizumab (IVB) for choroidal neovascularization (CNV) in retinal angioid streaks (AS). SUBJECTS AND METHODS: Five eyes of four subjects with CNV in AS were observed for an average followup period of 12 months. The average greatest linear diameter (GLD) of the AS was 4315 microm before treatment. IVB (1.0 mg or 1.25 mg) was performed a total of two times at eight week intervals, and additional bevacizumab was administered whenever exudative changes occurred. RESULTS: Visual acuity improved in one eye (20%), was maintained in two eyes (40%), and worsened in two eyes (40%). Recurrence of CNV was observed in two eyes (40%). Before treatment, the GLD was 2439, 2844, and 3654 microm in the three eyes in which visual acuity was maintained, and 5803 and 6837 microm in the two eyes with worsened visual acuity. Recurrence of CNV was observed in the two eyes with worsened visual acuity. CONCLUSION: Short-term CNV fibrosis and maintenance of visual acuity were achieved with IVB in cases in which the GLD was less than 3500 microm.

Cataract surgery under infliximab therapy in a patient with Behçet's disease.

PURPOSE: To report a case of a successful cataract surgery outcome in a patient with Behçet's disease (BD) without postoperative inflammation under infliximab therapy. CASE: A 40-year-old man who had frequent episodes of hypopyon uveitis despite immunosuppressive therapy underwent cataract surgery. Infliximab (5 mg/kg) was given intravenously to prevent inflammation during the perioperative period. After the initial administration, infliximab was given at 2 and 6 weeks, and then it was given at 8 weeks intervals thereafter. The patient underwent cataract surgery in both eyes at the midpoint of the 8 weeks duration schedule with an uneventful postoperative clinical course for up to 12 months except for the contraction of the anterior capsule in both eyes and posterior capsule opacification in 1 eye. CONCLUSIONS: Infliximab therapy may be effective when performing cataract surgery on BD patients who have uncontrollable uveitis.