Journal of Ophthalmic Inflammation and Infection最新文献

Background: Microbial keratitis is a vision-threatening corneal infection frequently encountered in tertiary eye care settings. Early identification of risk factors and prompt empirical treatment are essential for preventing permanent visual impairment and maintaining anatomical integrity. This study aimed to define the clinical and microbiological profiles of microbial keratitis and to evaluate empirical treatment responses and surgical outcomes.

Methods: This was a descriptive, retrospective study conducted through a review of clinical records over a five-year period (2020-2025). A total of 73 patients diagnosed with microbial keratitis at a tertiary eye care center were included. Data on demographic characteristics, predisposing risk factors, clinical presentation, microbiological culture results, and treatment modalities were collected. The patients' responses to empirical medical therapy and the need for surgical interventions, including penetrating keratoplasty, pars plana vitrectomy and evisceration were evaluated.

Results: Positive microbial cultures were obtained in 58.9% of the cases. Among these, Staphylococcus spp. was the most commonly isolated organism (36.9%), followed by Streptococcus spp. (21.7%), Klebsiella spp. (11.0%), Pseudomonas aeruginosa (9.0%) and fungal pathogens (4.3%). Trauma was identified as the most frequent predisposing risk factor across all age groups. Clinical improvement was observed in 65.8% of patients following topical empirical therapy. Surgical intervention was required in 25 patients due to clinical deterioration, including penetrating keratoplasty, re-keratoplasty, pars plana vitrectomy and evisceration. Endophthalmitis developed in 7 patients (9.5%) with causative organisms including Staphylococcus (44.4%), Streptococcus (33.3%), Klebsiella (11.1%) and Pseudomonas aeruginosa (11.1%). The anatomical success rate following treatment was 85.7%.

Conclusions: Initiation of empirical therapy targeting regionally prevalent pathogens may may contribute to better visual outcomes in selected cases. In cases unresponsive to medical management, early intervention with penetrating keratoplasty prior to limbal involvement or corneal perforation may improve prognosis and reduce the incidence of severe complications such as endophthalmitis.

Background: Cataract surgery in uveitic eyes with persistent hypotony is considered high-risk and is often deferred. This report describes the perioperative management and visual outcomes in such complex cases.

Objective: To evaluate the effectiveness of a tailored surgical and immunosuppressive approach for patients with uveitis, cataracts, and chronic hypotony (IOP ≤ 5 mmHg).

Methods: A retrospective review of two cases: a 21-year-old female with chronic intermediate non-granulomatous uveitis and a 17-year-old male with Vogt-Koyanagi-Harada (VKH) disease. Both developed bilateral cataracts and persistent hypotony. A multi-step protocol was implemented, involving aggressive immunosuppression (azathioprine/methotrexate plus adalimumab) and an average of two periocular triamcinolone acetonide (40 mg/mL) injections per eye to elevate IOP to a safe surgical threshold (≥ 8 mmHg). After achieving ≥ 3 months of quiescent inflammation and normalized IOP, patients underwent lens aspiration with intravitreal triamcinolone injection and were intentionally left aphakic.

Results: Preoperative IOP was successfully elevated to a mean of 10 mmHg. One eye experienced an intraoperative complication (dropped nucleus) requiring pars plana vitrectomy; this eye later developed corneal decompensation necessitating penetrating keratoplasty. Postoperative inflammation resolved within one week in all eyes. On long-term follow-up (mean 24 months), inflammation remained controlled on maintenance immunosuppression. At the two-year follow-up, best-corrected visual acuity was 20/30 in three eyes and 20/50 in the eye that required additional surgeries. IOP was maintained at ≥ 8 mmHg in all eyes.

Conclusion: A meticulously planned, multi-modal approach-involving aggressive control of inflammation, targeted reversal of hypotony with periocular steroids, and strategic surgical timing with intentional aphakia-can lead to successful anatomical and visual outcomes in high-risk uveitic patients with cataracts and persistent hypotony.

Background: Identifying underlying disease associations in patients with scleritis remains a clinical challenge. This study aimed to assess the contribution of systemic examination, longitudinal follow-up, and additional investigations to the identification of associated diseases in patients with scleritis.

Methods: We retrospectively reviewed 98 patients with scleritis in whom no associated disease had been identified at presentation, assessed in two internal medicine departments in Lyon between July 2011 and September 2023. Data were collected at the initial presentation, prior to the identification of any underlying disease. The primary outcome was the contribution of systemic examination to the identification of associated diseases.

Results: After a median follow-up of 42 months [15.5-100], an associated disease was identified in 37 patients (37.8%), including 23 systemic diseases (23.5%), 12 infectious diseases (12.2%), and 2 cases of drug-induced scleritis (2.0%). Systemic examination contributed to the identification of an associated disease in 20 patients (20.4%), mainly through ear, nose and throat (ENT) and dermatological assessments. In 70% of these patients, systemic manifestations preceded the first episode of scleritis, while in the remaining 30% they developed during follow-up. In three patients, scleritis was the initial and sole manifestation, and the diagnosis was established through additional investigations during follow-up. The positive predictive value (PPV) of non-specific anti-neutrophil cytoplasmic antibodies (ANCA) was 29%, with a negative predictive value (NPV) of 98%. When specific ANCA testing was performed, the PPV increased to 86%. Repeating laboratory investigations during follow-up did not yield additional diagnoses.

Conclusion: Systemic examination contributed to the identification of an associated disease in one-fifth of patients. Scleritis may be the first clinical manifestation of an underlying systemic disease, supporting the need for systematic and prolonged follow-up. These findings also underline the diagnostic value of specific ANCA testing, whereas repeating laboratory investigations after an initial negative assessment appears of limited utility.

Purpose: To report a case of intriguing choroidal lesions in a patient with Birdshot chorioretinopathy.

Case presentation: A case report of a 51-year-old female with previous medical history of Birdshot chorioretinopathy presenting with de novo choroidal lesions, diffuse choroidal thickening and serous retinal detachment in the right eye is presented. Several medical evaluation visits were conducted, including ophthalmological and hematological follow-up. The multimodal imaging was suggestive of a lymphoproliferative process, presumably uveal lymphoid hyperplasia and the patient was referred to Hematology. A systemic work-up was conducted to rule out systemic malignancy and the choroidal biopsy was declined by the patient. The patient was treated with a short course of steroids due to an unrelated Bell's palsy, with complete resolution of the choroidal thickening and the neurosensory detachment. After a 4-year follow-up, the patient remained asymptomatic with no signs of relapse in the multimodal imaging.

Conclusion: As underline by this case report, uveal lymphoid hyperplasia may be considered in patients with Birdshot chorioretinopathy, emphasizing the importance of individualized management and long-term follow-up in such complex clinical scenarios.