RESUMO
BACKGROUND: Klebsiella pneumoniae endophthalmitis is rare and despite immediate management, visual outcome is generally poor. We report a case of endogenous K. pneumoniae endophthalmitis that was treated successfully. CASE: An 80-year-old woman with a liver abscess was diagnosed at an early stage with endogenous K. pneumoniae endophthalmitis. She underwent par plana vitrectomy and lensectomy within 8 h after the onset of ocular symptoms. Secondary implantation of a sulcus-fixated intra-ocular lens (IOL) was performed 12 months later. Final visual acuity OS was 20/20. CONCLUSIONS: The present case highlights the potential benefit of early and broad vitrectomy with lensectomy in the management of endogenous K. pneumoniae endophthalmitis.
Assuntos
Endoftalmite/cirurgia , Infecções Oculares Bacterianas/cirurgia , Infecções por Klebsiella/cirurgia , Klebsiella pneumoniae , Idoso de 80 Anos ou mais , Endoftalmite/diagnóstico , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/diagnóstico , Feminino , Humanos , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/microbiologia , Cristalino/cirurgia , VitrectomiaRESUMO
PURPOSE: To evaluate the relation between induced changes in ocular higher order aberrations and changes in the contrast sensitivity function in patients undergoing excimer laser photorefractive keratectomy (PRK). METHODS: Myopic PRK using excimer laser was performed in 31 patients (56 eyes). The preoperative refractive error was -6.2 +/- 2.9 diopters. Before and 1 month after surgery, we measured the ocular higher order aberrations for a 4-mm pupil, and three indices of contrast sensitivity function. From the data collected, the area under the log contrast sensitivity function (AULCSF) was calculated. RESULTS: PRK significantly reduced AULCSF (P = 0.004), low-contrast visual acuity (P = 0.004), and letter-contrast sensitivity (P = 0.013). Coma-like (P < 0.001) and spherical-like (P < 0.001) aberrations were significantly increased by surgery. The change in AULCSF by surgery significantly correlated with the change in coma-like (r = -0.468, P < 0.001) and spherical-like (r = -0.291, P = 0.033) aberrations. The change in low-contrast visual acuity by PRK significantly correlated with the change in coma-like aberration (r = 0.599, P < 0.007), but not with change in spherical-like aberrations (r = 0.136, P = 0.326). There were significant correlations between changes in letter-contrast sensitivity and changes in coma-like (r = -0.450, P < 0.001) and spherical-like (r = -0.255, P = 0.048) aberrations. CONCLUSIONS: PRK significantly increases ocular higher order aberrations, which compromise contrast sensitivity function after surgery.
Assuntos
Astigmatismo/fisiopatologia , Sensibilidades de Contraste/fisiologia , Miopia/fisiopatologia , Ceratectomia Fotorrefrativa/métodos , Refração Ocular/fisiologia , Adolescente , Adulto , Astigmatismo/cirurgia , Feminino , Seguimentos , Humanos , Lasers de Excimer , Masculino , Pessoa de Meia-Idade , Miopia/cirurgia , Estudos Prospectivos , Resultado do TratamentoRESUMO
PURPOSE: To quantitatively assess changes in regular and irregular corneal astigmatism in patients having overnight orthokeratology. SETTING: Matsumoto Eye Clinic, Ibaraki, Japan. METHODS: A prospective study was conducted of 64 eyes of 39 patients having overnight orthokeratology for myopia. Inclusion criteria were an uncorrected visual acuity (UCVA) of 20/20 or better after treatment and a minimum follow-up of 3 months. Using Fourier series harmonic analysis, videokeratography data were decomposed into spherical component, regular astigmatism, asymmetry (tilt or decentration), and higher-order irregularity. RESULTS: Orthokeratology significantly reduced the manifest refraction from -2.60 diopters (D) +/- 1.13 (SD) to -0.17 +/- 0.31 D (P<.0001, paired t test) and improved the UCVA from 0.82 +/- 0.30 to -0.11 +/- 0.06 logMAR (P<.0001). Regular astigmatism increased significantly from 0.53 +/- 0.23 D preoperatively to 0.63 +/- 0.40 D postoperatively (P =.0206). The asymmetry component increased significantly from 0.35 +/- 0.22 D to 0.64 +/- 0.40 D (P<.0001). Higher-order irregularity did not change significantly: 0.14 +/- 0.11 D before treatment and 0.17 +/- 0.20 D after treatment (P =.2166). The amount of myopic correction correlated significantly with the increase in the asymmetry component (Pearson correlation coefficient, R = 0.40, P =.0009) but not with the increase in regular astigmatism (R = 0.24, P =.055). CONCLUSIONS: Irregular corneal astigmatism significantly increased, even in clinically successful orthokeratology cases. The effect of the changes on visual function should be studied further.
