Temporal Profile of Retinopathy of Prematurity in Extremely Premature Compared to Premature Infants.

PURPOSE: To compare the time course of retinopathy of prematurity (ROP) in premature (≥ 28 to 34 weeks' gestational age) and extremely premature (< 28 weeks' gestational age) infants. METHODS: This study was a retrospective single-center chart review that included 582 eyes (122 premature, 464 extremely premature) of 299 infants (65 premature, 234 extremely premature) diagnosed as having ROP who were born between January 1, 2010, and December 31, 2015. Data collected were analyzed with shared frailty models, chi-square, and Fisher's exact tests. RESULTS: Extremely premature infants were diagnosed as having ROP earlier than premature infants at 33.6 weeks (95% CI [confidence interval]: 33.4 to 33.9) versus 36.0 weeks (95% CI: 34.7 to 36.4, P < .0001). The time from diagnosis to spontaneous regression was more than 4 weeks longer for extremely premature infants than premature infants with stage 1 ROP (82.0 vs 50.0 days, P < .0001), and more than 6 weeks longer for extremely premature infants than premature infants with stage 2 ROP (99 vs 55 days, P < .0001). Extremely premature infants had more bilateral ROP (96.6% vs 87.1%, P < .01) and were three times more likely to require treatment than premature infants (29.7% vs 9.9%, P < .0001). On average, infants who required treatment weighed 137 grams less at birth (P < .0001) and gained 37.7 grams less per week than infants who underwent spontaneous regression (P < .0001). CONCLUSIONS: Extremely premature infants developed ROP earlier, had more bilateral ROP, took longer to achieve spontaneous regression, and required treatment more often than premature infants. Infants who required treatment had a lower birth weight and rate of weight gain than infants who underwent spontaneous regression. [J Pediatr Ophthalmol Strabismus. 2019;56(2):116-123.].

Contact Lens-related Polymicrobial Keratitis from Pantoea agglomerans and Escherichia vulneris.

PURPOSE: To report a case of polymicrobial keratitis caused by Panotea agglomerans, Escherichia vulneris and coagulase-negative Staphylococcus in a patient who cleaned their extended wear contact lenses with only tap water for 2 weeks. METHODS: Case report. RESULTS: An adult presented with a painful red eye after wearing the same contact lenses for two weeks. The patient admitted to taking the contacts out in the evening and cleaning them with tap water before reapplying them in the morning. Exam revealed a 2.5 mm paracentral corneal ulcer in the left eye. Culture results from corneal scrapings were positive for Panotea agglomerans, Escherichia vulneris and coagulase-negative Staphylococcus. CONCLUSIONS: This is the first report of Panotea agglomerans and Escherichia vulneris keratitis in association with contact lens wear. Both strains of Panotea agglomerans and Escherichia vulneris were pansensitive to all tested antibiotics.

Endophthalmitis caused by Pantoea agglomerans: clinical features, antibiotic sensitivities, and outcomes.

PURPOSE: To report the clinical findings, antibiotic sensitivities, and visual outcomes associated with endophthalmitis caused by Pantoea agglomerans. METHODS: A consecutive case series of patients with vitreous culture-positive endophthalmitis caused by P. agglomerans from January 1, 1990 to December 31, 2012 at a large university referral center. Findings from the current study were compared to prior published studies. RESULTS: Of the three study patients that were identified, clinical settings included trauma (n=2) and post-cataract surgery (n=1). Presenting visual acuity was hand motion or worse in all three cases. All isolates were sensitive to ceftazidime, gentamicin, imipenem, and fluoroquinolones. All isolates were resistant to ampicillin. Initial treatment strategies were vitreous tap and intravitreal antibiotic injection (n=1) and pars plana vitrectomy with intravitreal antibiotic injection (n=2). At last follow-up, one patient had no light perception vision, while the other two had best-corrected visual acuity of 20/200 and 20/400. CONCLUSION: All Pantoea isolates were sensitive to ceftazidime, gentamicin, imipenem, and fluoroquinolones. All patients in the current study received at least one intravitreal antibiotic to which P. agglomerans was shown to be sensitive in vitro. In spite of this, the visual outcomes were generally poor.

Clinical and Echographic Features of Retinochoroidal and Optic Nerve Colobomas.

PURPOSE: We reported the clinical and echographic features of colobomas, prevalence of retinal detachment, and associated visual acuity in these patients. METHODS: The study is a nonrandomized consecutive case series of 140 colobomatous eyes in 98 patients (age range, 0-83 years). Coloboma depth, width, volume, and relative coloboma excavation (coloboma depth/axial length) were measured using standardized echographic images. The presence of structural and other ocular abnormalities was noted. The clinical and echographic findings present were correlated with visual acuity of the patient. In addition, these features were correlated with the presence or absence of retinal detachment. RESULTS: Increased relative coloboma excavation was significantly associated with an increased risk of retinal detachment. A relative coloboma excavation (ratio of coloboma depth to axial length) greater than 0.15 was associated with an increased risk of retinal detachment (52%), compared to those with a relative coloboma excavation less than 0.15 (23%, P = 0.014). The presence of any structural abnormality and the presence of a retrobulbar cyst were associated with increased risk of retinal detachment and severe visual impairment (worse than 20/200). Increased coloboma depth, width, volume, and relative coloboma excavation were not associated with increased risk of severe visual impairment. CONCLUSIONS: Clinical and echographic features of colobomas may be used in predicting the risk of retinal detachment. Measuring relative coloboma excavation upon presentation may alter follow-up and assist in the diagnosis of retinal detachment.

Acute retinal necrosis secondary to herpes simplex virus type 2 in neonates.

Acute retinal necrosis (ARN) should be in the differential diagnosis of a neonate who presents with vitritis. This report includes three cases of neonatal ARN at the Bascom Palmer Eye Institute from 2004 to 2009. Medical treatment with acyclovir helped reduce sequelae of herpes simplex virus (HSV) 2 infection. Patients with ARN are at risk for retinal detachment and blindness. Although mothers are screened during pregnancy, they are at risk of reactivation or primary contraction of HSV. A neonate presenting with vitritis should raise suspicion of ARN.

ENDOPHTHALMITIS CAUSED BY SERRATIA MARCESCENS: Clinical Features, Antibiotic Susceptibilities, and Treatment Outcomes.

PURPOSE: To report the clinical features, antibiotic sensitivities, and visual outcomes associated with endophthalmitis caused by Serratia marcescens. METHODS: A consecutive case series of patients with vitreous culture-positive endophthalmitis caused by S. marcescens from July 1, 1993, to June 30, 2012, at a large university referral center. Findings from this study were compared with those of a previous study (January 1980-June 1993) from our institution. RESULTS: Of the 10 study patients who were identified, clinical settings included trabeculectomy bleb-associated (n = 3), post-cataract surgery (n = 2), post-penetrating keratoplasty (n = 2), post-scleral buckle (n = 1), glaucoma drainage implant-associated (n = 1), and post-keratoprosthesis (n = 1). Clinical features included pain (n = 10) and hypopyon (n = 5). Presenting visual acuity was hand motions or worse in seven cases. All isolates were sensitive to gentamicin, ceftazidime, imipenem, and levofloxacin. The MIC 90s of isolates for antibiotics tested in the current period compared with isolates from January 1980 to June 1993 were unchanged. All isolates were resistant to vancomycin. Initial treatment strategies were vitreous tap and intravitreal antibiotic injection (n = 8), pars plana vitrectomy with intravitreal antibiotic injection (n = 1), and evisceration (n = 1). When repeat vitreous fluid was obtained, persistent positive cultures were present in 1 (10%) of 10 patients in this study, compared with 5 (50%) of 10 patients in the previous study. Final visual acuity was no light perception in 6 of 10 patients (60%). CONCLUSION: Outcomes were generally poor with a high rate of complete visual loss in the affected eye.

FEVR-Like Presentation of Homocystinuria.

A male infant with a diagnosis of homocystinuria presented with avascularity of the peripheral retina with a ridge on ophthalmic exam, consistent with a FEVR-like manifestation homocystinuria. Upon follow-up and treatment for homocystinuria, the retinal vascularity improved without the need for prophylactic treatment to the peripheral avascular retina.

Androgen deficiency and dry eye syndrome in the aging male.

PURPOSE: To evaluate the relationship between androgen levels and subjective and objective measures of dry eye syndrome (DES). METHODS: A total of 263 male patients from the Miami Veterans Affairs Medical Center eye clinic aged ≥50 were recruited for this prospective cross-sectional study. Patients completed Dry Eye Questionnaire 5, underwent tear film evaluation, and had serum androgen levels measured. The correlations between androgen levels, DES composite scores, DES symptoms, and global, lipid, and aqueous tear film parameters were evaluated. RESULTS: Two hundred sixty-three patients with a mean age of 69 (50-95) were examined. There was no linear association between composite DES scores (generated using latent class analysis) and androgen levels. However, eyes with high DES scores (0.95-1.0) had higher levels of sex hormone-binding globulin (P = 0.03) and lower levels of dehydroepiandrosterone sulfate (DHEAS) (P = 0.02), androstenedione (A) (P = 0.02), and androstane-3α,17ß-diol glucuronide (P = 0.03) compared to eyes with intermediate (0.05-0.95) or low (0-0.05) scores. There were no strong correlations between tear film measures and androgen levels. Regarding global parameters, a weak inverse correlation was found between corneal staining and A (r = -0.17, P = 0.009). For lipid parameters, a weak correlation existed between tear breakup time (TBUT) and A (r = 0.15, P = 0.02). When considering aqueous and lipid deficiency independently, the association between TBUT and A existed only with aqueous tear deficiency (r = 0.66, P = 0.002). Regarding aqueous parameters, a weak correlation existed between Schirmer test and DHEAS (r = 0.13, P = 0.047) and A (r = 0.21, P = 0.001). CONCLUSIONS: There was a weak correlation between higher levels of androstenedione and healthier global, lipid, and aqueous tear film parameters.

Dry eye syndrome, posttraumatic stress disorder, and depression in an older male veteran population.

PURPOSE: To evaluate whether veterans with posttraumatic stress disorder (PTSD) or depression have differences in dry eye symptoms and signs compared to a population without these conditions. METHODS: Male patients aged ≥50 years with normal eyelid, conjunctival, and corneal anatomy were recruited from the Miami Veterans Affairs Eye Clinic (N = 248). We compared dry eye symptoms (determined by the Dry Eye Questionnaire 5 [DEQ5] score) to tear film indicators obtained by clinical examination (i.e., tear osmolarity, corneal staining, tear breakup time, Schirmer's, meibomian gland quality, orifice plugging, lid vascularity) between patients with PTSD or depression and those without these conditions. Student's t-tests, χ(2) analyses, and linear and logistic regressions were used to assess differences between the groups. RESULTS: DEQ5 scores were higher in the PTSD (mean = 13.4; standard error [SE] = 1.1; n = 22) and depression (mean = 12.0; SE = 0.8; n = 40) groups compared to the group without these conditions (mean = 9.8; SE = 0.4; n = 186; P < 0.01 and P = 0.02, respectively). More patients in the PTSD and depression groups had severe dry eye symptoms, defined as a DEQ5 score ≥ 12 (77% and 63% vs. 41%; P < 0.01 and P = 0.02, respectively). No significant differences in tear film indicators were found among the three groups. Multivariable logistic regression indicated that a PTSD diagnosis (odds ratio [OR] = 4.08; 95% confidence interval [CI] = 1.10-15.14) and use of selective serotonin reuptake inhibitors (OR = 2.66; 95% CI = 1.01-7.00) were significantly associated with severe symptoms. CONCLUSIONS: Patients with PTSD have ocular surface symptoms that are not solely explained by tear indicators. Identifying underlying conditions associated with ocular discomfort is essential to better understand the mechanisms behind ocular pain in dry eye syndrome.

Long-term effects of cataract surgery on tear film parameters.

PURPOSE: To examine the differences in tear film parameters more than 3 months postsurgery in eyes with cataract surgery (surgical eyes) versus eyes without cataract surgery (nonsurgical eyes). METHODS: 29 patients were seen at the Miami Veterans Affairs Medical Center (VAMC) who had cataract surgery by phacoemulsification in one eye more than 3 months prior to the study date and had no history of surgical intervention in their fellow eye. Tear film parameters were measured in both eyes and compared using McNemar tests for dichotomous variables and paired and single sample t-tests for continuous variables. RESULTS: Mean patient age was 73 (standard deviation (SD): 11); 26 patients (90%) identified themselves as White and 7 (24%) as Hispanic. The mean number of days between surgery and this study was 952 (SD: 1109). There were no statistical differences between the surgical eye and the nonsurgical eye with respect to any of the measured tear film parameters. Confidence intervals around these differences were narrow enough to exclude a substantial effect of cataract surgery. The elapsed time between cataract surgery and measurement of the tear parameters did not appear to affect the difference in parameters between the two eyes. CONCLUSION: We found that eyes that had cataract surgery more than 3 months prior to testing had no differences in their tear film parameters compared to eyes without a history of surgery.

Ocular surface parameters in older male veterans.

PURPOSE: To characterize ocular surface discomfort and tear film parameters in a veteran population. METHODS: Male patients seen in the Miami Veterans Affairs eye clinic aged 50 years or older were recruited to participate in the study. All patients had normal eyelid, corneal, and conjunctival anatomy. Patients filled out the Dry Eye Questionnaire 5 (DEQ5) and underwent measurement of tear film parameters. The main outcome measures were the frequency of ocular surface symptoms and the correlation between symptoms and global, aqueous, and meibomian gland parameters. RESULTS: A total of 263 men participated in the study; 48% had DES based on the presence of severe symptoms. Many men had objective abnormalities in tear function measurements. Using Schirmer information, lid plugging, and meibomian quality to define objective DES, 176 patients (68%) had one or more abnormalities. Of these, 22 (8%) had aqueous tear deficiency, 124 (47%) lipid tear deficiency, and 30 (11%) a mixed pattern. When examining associations between individual clinical parameters and DEQ5 score, the only significant, but weak, correlations were with the global parameters conjunctival and corneal staining (r = 0.16) and TBUT (r = -0.15). Neither specific aqueous nor meibomian gland measurements were significantly correlated with the presence of symptoms. When considering all measured parameters in a regression model, 8% of the variability in symptoms was explained by the tear parameters. CONCLUSIONS: We found that ocular surface symptoms were prevalent in our population. Measurement of standard tear film parameters could not explain the degree of symptoms. This study highlights the need for future research regarding the mechanisms behind ocular surface discomfort in patients with tear film disturbances.