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Prognostic indicators of corneal ulcer clinical outcomes at a tertiary care center in the Bronx, New York 纽约布朗克斯区一家三级医疗中心的角膜溃疡临床预后指标
IF 2.9 Q2 Medicine Pub Date : 2024-04-24 DOI: 10.1186/s12348-024-00392-3
Sruthi Kodali, Behram Khan, Amanda M. Zong, J. Moon, Anurag Shrivastava, Johanna P. Daily, R. Gibralter
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引用次数: 0
Application of metagenomic next-generation sequencing in the diagnosis of Bartonella neuroretinitis: a case report and literature review 元基因组下一代测序在巴顿氏菌神经视网膜炎诊断中的应用:病例报告和文献综述
IF 2.9 Q2 Medicine Pub Date : 2024-04-19 DOI: 10.1186/s12348-024-00387-0
Pengcheng Li, Zhuyun Qian, Yong Tao
Cat-scratch disease (CSD) is caused by Bartonella henselae infection. In atypical cases of CSD, pathogen determination is challenging. We report a case of Bartonella neuroretinitis with neither a clear history of scratches nor typical general symptoms. The diagnosis was made using metagenomic next-generation sequencing (mNGS), a high-throughput sequencing technology. A female patient presented to the ophthalmologist with complaint of blurred vision in her right eye. Although with history of raising a cat, she reported no clear history of scratches or typical general symptoms, except a fever of unknown origin which resolved spontaneously. The best corrected visual acuity (BCVA) of the right eye was count fingers. Fundus examination showed optic disc oedema, macular exudates and inferior exudative retinal detachment. Laboratory examination results showed increased value of serum C-reactive protein and erythrocyte sedimentation rate. Ocular involvement of toxoplasmosis, syphilis and tuberculosis were excluded. To identify the possible causative pathogen of the disease, mNGS of aqueous humour sample was performed and 521 reads of B. henselae were identified. Serological test results further showed a positive immunoglobulin G (IgG) titre of 1:64. Taking the contact history, clinical manifestations, mNGS and serological results into consideration, the diagnosis of Bartonella neuroretinitis (ocular CSD) was made. After appropriate treatment, the BCVA of the right eye improved to 20/25 in the last follow-up. Fundus examination showed a normal optic disc and macula, and the exudates had reduced. mNGS, a fast and unbiased method, can be used to detect B. henselae (if present) in intraocular fluid samples.; however, the results should be interpreted together with the clinical symptoms and other auxiliary test results.
猫抓病(CSD)是由鸡巴氏杆菌感染引起的。在 CSD 的非典型病例中,病原体的确定具有挑战性。我们报告了一例既无明确抓伤史也无典型全身症状的巴顿氏菌神经视网膜炎病例。诊断是通过高通量测序技术元基因组新一代测序(mNGS)得出的。一名女性患者因右眼视力模糊而就诊于眼科医生。虽然她有养猫的历史,但除了一次不明原因的发烧并自行缓解外,她没有明确的抓伤史或典型的全身症状。右眼的最佳矫正视力(BCVA)为数指。眼底检查显示视盘水肿、黄斑渗出和下部渗出性视网膜脱离。实验室检查结果显示血清 C 反应蛋白和红细胞沉降率升高。排除了弓形虫病、梅毒和肺结核引起的眼部病变。为了确定可能的致病病原体,对眼液样本进行了 mNGS 检测,结果发现了 521 个河南嗜血杆菌的读数。血清学检测结果进一步显示,免疫球蛋白G(IgG)滴度为1:64,呈阳性。根据接触史、临床表现、mNGS 和血清学结果,诊断为巴顿氏菌神经视网膜炎(眼 CSD)。经过适当治疗后,右眼的视力在最近一次随访中改善到了 20/25。眼底检查显示视盘和黄斑正常,渗出物也有所减少。mNGS 是一种快速、无偏见的方法,可用于检测眼内液样本中的鸡毒桿菌(如果存在的话);但检测结果应与临床症状和其他辅助检查结果一并解读。
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引用次数: 0
Piloting Rasch model scoring of the National Eye Institute Visual Function Questionnaire in uveitis 美国国家眼科研究所葡萄膜炎患者视觉功能问卷的 Rasch 模型评分试验
IF 2.9 Q2 Medicine Pub Date : 2024-04-16 DOI: 10.1186/s12348-024-00398-x
Lisa Gittel, Jeany Q. Li, Jennifer Dell, Maximilian W. M. Wintergerst, Carsten Heinz, Robert P. Finger, Jan Henrik Terheyden
The National Eye Institute Visual Function Questionnaire (NEI VFQ) is a common patient-reported outcome measure (PROM) in uveitis trials. Its psychometric properties using state-of-the-art scoring based on Rasch models, a latent trait model that improves accuracy of PROMs assessment, has not yet been investigated. The study participants were recruited online from uveitis patient organizations, where individuals self-reported their uveitis diagnosis and visual acuity level. These participants then completed the NEI VFQ-25. The visual function (VF) and socioemotional (SE) subscales were psychometrically analysed in terms of item fit, targeting, internal consistency, dimensionality, and differential item functioning (DIF), using Rasch models. Criterion validity was examined based on associations between NEI VFQ person measures and recent visual acuity (VA) levels. Ninety-nine participants recruited online from uveitis patient organizations (68 women, 31 men; mean age 50 ± 15 years; 46.5% self-reported receiving systematic therapy for uveitis, 0.6% NEI VFQ-25 missing data) were included. The mean difficulty of items was lower than the average person ability. None of the items demonstrated misfit to an extent that would induce noise into the measurement. The consistency metrics person reliability and person separation index of the subscales were 0.85 and 2.34 (NEI VFQ-VF), 0.86 and 2.52 (NEI VFQ-SE), respectively. There was no evidence of multidimensionality and none of the items showed DIF by gender. The differences between item and person measures were 1.44 (NEI VFQ-VF) and 1.03 (NEI VFQ-SE). NEI VFQ-25 person measures were significantly lower in participants with visual impairment (all p values ≤ 0.007). Rasch model-based scoring of the re-engineered NEI VFQ-25 demonstrates acceptable internal consistency, item fit and construct validity for assessing two key domains of quality of life in individuals self-reporting uveitis. The PROM was targeted at a higher level of difficulty than present in our heterogeneous sample.
美国国家眼科研究所视觉功能问卷(NEI VFQ)是葡萄膜炎试验中常用的患者报告结果测量法(PROM)。它的心理测量学特性是基于Rasch模型(一种可提高PROMs评估准确性的潜在特质模型)的最新评分方法,但尚未进行过研究。该研究的参与者是从葡萄膜炎患者组织中在线招募的,他们在这些组织中自我报告葡萄膜炎诊断和视力水平。这些参与者随后填写了 NEI VFQ-25。采用 Rasch 模型对视觉功能(VF)和社会情感(SE)子量表的项目拟合度、目标性、内部一致性、维度和差异项目功能(DIF)进行了心理分析。根据 NEI VFQ 个人测量与近期视力(VA)水平之间的关联对标准效度进行了检验。从葡萄膜炎患者组织中在线招募了 99 名参与者(68 名女性,31 名男性;平均年龄为 50 ± 15 岁;46.5% 的参与者自称接受过葡萄膜炎系统治疗,0.6% 的 NEI VFQ-25 数据缺失)。项目的平均难度低于个人平均能力。没有任何一个项目的不匹配程度会导致测量结果出现噪音。各分量表的一致性指标人可靠度和人分离指数分别为 0.85 和 2.34(NEI VFQ-VF)、0.86 和 2.52(NEI VFQ-SE)。没有证据表明存在多维性,也没有任何项目因性别而出现 DIF。项目测量与个人测量之间的差异分别为 1.44(NEI VFQ-VF)和 1.03(NEI VFQ-SE)。视力障碍参与者的 NEI VFQ-25 个人测量值明显较低(所有 p 值均小于 0.007)。对重新设计的 NEI VFQ-25 进行基于 Rasch 模型的评分表明,在评估自我报告葡萄膜炎患者生活质量的两个关键领域时,其内部一致性、项目拟合度和结构效度均可接受。PROM 的目标难度高于我们的异质性样本。
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引用次数: 0
Peripheral ulcerative keratitis associated with tralokinumab therapy: a case report and review of IL-13 inhibitor-associated ocular surface disease 与曲妥珠单抗治疗相关的外周溃疡性角膜炎:病例报告和 IL-13 抑制剂相关眼表疾病综述
IF 2.9 Q2 Medicine Pub Date : 2024-04-16 DOI: 10.1186/s12348-024-00394-1
Nenita Maganti, Samuel A. Whittier, Evan J. Warner
Dupilumab and tralokinumab are interleukin-binding monoclonal antibodies used to treat systemic atopic disease. Use of these medications in management of atopic dermatitis (AD) is known to cause conjunctivitis. Dupilumab therapy has also been associated with more severe ocular surface disease, which has not previously been described in association with tralokinumab. This report describes a case of tralokinumab-associated conjunctivitis and peripheral ulcerative keratitis and reviews the spectrum and proposed mechanisms of ocular surface disease triggered by these medications. A 61-year-old male with no rheumatologic or ocular history presented with bilateral papillary conjunctivitis and right eye peripheral ulcerative keratitis (PUK). PUK was arrested using oral corticosteroids and doxycycline, and long-term control of papillary conjunctivitis was achieved using topical tacrolimus ointment, allowing continuation of effective AD management with tralokinumab. This case report documents ulcerative keratitis occurring in association with tralokinumab therapy for AD, which has previously been described with dupilumab but not tralokinumab. This report demonstrates the need for vigilant ocular surface monitoring for patients on tralokinumab and illustrates successful management and long-term control of adverse ocular events associated with this medication.
杜匹鲁单抗和曲妥珠单抗是白细胞介素结合型单克隆抗体,用于治疗全身性特应性疾病。已知使用这些药物治疗特应性皮炎(AD)会引起结膜炎。杜匹鲁单抗治疗也与更严重的眼表疾病有关,但以前未见过与曲妥珠单抗相关的眼表疾病。本报告描述了一例与曲妥珠单抗相关的结膜炎和外周溃疡性角膜炎病例,并回顾了这些药物引发眼表疾病的范围和拟议机制。一名无风湿病史或眼病史的 61 岁男性出现双侧乳头状结膜炎和右眼周围溃疡性角膜炎(PUK)。口服皮质类固醇和多西环素阻止了 PUK 的发生,外用他克莫司软膏长期控制了乳头状结膜炎,并继续使用曲妥珠单抗进行有效的 AD 治疗。本病例报告记录了曲妥珠单抗治疗 AD 时发生的溃疡性角膜炎,此前曾有过使用杜匹单抗而非曲妥珠单抗治疗 AD 的病例。本报告说明了对使用曲妥珠单抗的患者进行警惕性眼表监测的必要性,并说明了与该药物相关的眼部不良事件的成功管理和长期控制。
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引用次数: 0
Mimickers of anterior uveitis, scleritis and misdiagnoses- tips and tricks for the cornea specialist 前葡萄膜炎、巩膜炎和误诊的模仿者--角膜病专家的技巧和窍门
IF 2.9 Q2 Medicine Pub Date : 2024-04-10 DOI: 10.1186/s12348-024-00396-z
Sonny Caplash, Manuel Paez-Escamilla, Mark Westcott, Kunal K. Dansingani, Chad Indermill, Nacima Kisma, Eric Frau, Jose-Alain Sahel, Bahram Bodaghi, Vishal Jhanji, Marie-Helene Errera
Anterior uveitis, inflammation of the anterior chamber and related structures, is a cohort of diseases that can present to almost any general or sub-specialty Ophthalmology practice. Its features classically involve anterior chamber cell and flare. Below the surface of these two signs exist a panoply of diagnoses. The purpose of this review is to provide a general framework for diagnoses of anterior uveitis that are often missed as well as non-uveitic pathologies that often mimic anterior uveitis. Diagnostic deviation in either direction can have vision-threatening and rarely life-threatening consequences for patients. Using a comprehensive literature review we have collected a broad spectrum of etiologies of anterior uveitis that are easily missed and non-uveitic pathologies that can masquerade as anterior uveitis. We present a focused review on specific misdiagnosed anterior uveitis pathologies and some of the conditions that can masquerade as anterior uveitis and scleritis.
前葡萄膜炎是指前房及相关结构的炎症,是几乎所有普通眼科或亚专科眼科都会遇到的一组疾病。其特征通常包括前房细胞和耀斑。在这两种体征的表面之下,存在着一系列的诊断。本综述的目的是为经常被漏诊的前葡萄膜炎以及经常模仿前葡萄膜炎的非葡萄膜病变的诊断提供一个总体框架。无论哪种诊断偏差都会对患者的视力造成威胁,甚至危及生命。通过全面的文献综述,我们收集了容易被漏诊的前葡萄膜炎的各种病因,以及可能伪装成前葡萄膜炎的非葡萄膜病变。我们重点回顾了前葡萄膜炎的具体误诊病因以及一些可伪装成前葡萄膜炎和巩膜炎的病症。
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引用次数: 0
A case of Lomentospora prolificans endophthalmitis treated with the novel antifungal agent Olorofim. 一例用新型抗真菌剂 Olorofim 治疗的 Lomentospora prolificans 眼内炎病例。
IF 2.9 Q2 Medicine Pub Date : 2024-03-22 DOI: 10.1186/s12348-024-00393-2
Michael Dong, Fiona Pearce, Nandini Singh, Ming-Lee Lin

Purpose: To report a case of endogenous Lomentospora prolificans endophthalmitis treated with the novel antifungal agent Olorofim.

Case report: A 57-year-old man developed disseminated Lomentospora prolificans with right endophthalmitis on the background of immunosuppression following lung transplantation for interstitial lung disease. He was treated with early vitrectomy, intravitreal voriconazole, and systemic Olorofim, voriconazole and terbinafine. His symptoms improved and remained stable in the right eye. Eight weeks later the patient represented with Lomentopora prolificans endophthalmitis in the left eye when systemic voriconazole and terbinafine treatment were withdrawn. Despite aggressive treatment he ultimately succumbed due to vascular complications of extensive disseminated disease.

Conclusion: We report a rare case of disseminated Lomentosporosis with panophthalmitis in an immunocompromised host with prolonged survival on systemic Olorofim, voriconazole and terbinafine in conjunction with pars plana vitrectomy and intravitreal voriconazole. Early suspicion of an opportunistic fungal infection is critical, as managing disseminated disease is often unsuccessful. Despite presumed inherent resistance, intravitreal and systemic voriconazole appeared to limit disease progression in the right eye. The potential synergistic effects of combined antifungal therapy with orotomides warrant further investigation.

目的:报告一例使用新型抗真菌药物 Olorofim 治疗的内源性 Lomentospora prolificans 眼内炎病例:一名 57 岁的男子因间质性肺病接受肺移植手术,在免疫抑制的背景下出现了播散性多孔单孢子虫并伴有右眼眼内炎。他接受了早期玻璃体切除术、玻璃体内伏立康唑以及全身用药 Olorofim、伏立康唑和特比萘芬治疗。他的右眼症状有所改善并保持稳定。八周后,在停止全身使用伏立康唑和特比萘芬治疗的情况下,患者左眼出现眼内炎。尽管患者接受了积极的治疗,但最终还是因广泛播散性疾病的血管并发症而死亡:我们报告了一例罕见的免疫功能低下的散发性洛门托孢子菌病并伴有泛眼炎的病例,患者在接受全身奥罗芬、伏立康唑和特比萘芬治疗的同时,还接受了玻璃体旁切除术和玻璃体内伏立康唑治疗,并延长了存活时间。早期怀疑机会性真菌感染至关重要,因为治疗播散性疾病往往不会成功。尽管存在假定的固有抗药性,但玻璃体内和全身使用伏立康唑似乎限制了右眼的病情发展。联合抗真菌治疗与口服抗真菌药物的潜在协同作用值得进一步研究。
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引用次数: 0
Intravenous cyclophosphamide therapy for patients with severe ocular inflammatory diseases who failed other immunomodulatory therapies 为其他免疫调节疗法无效的严重眼部炎症患者提供静脉环磷酰胺疗法
IF 2.9 Q2 Medicine Pub Date : 2024-03-11 DOI: 10.1186/s12348-023-00372-z
Irmak Karaca, Elaine M. Tran, SungWho Park, Albert Bromeo, Hassan Khojasteh, Anh Ngọc Tram Tran, Negin Yavari, Amir Akhavanrezayat, Cigdem Yasar, Gunay Uludag Kirimli, Ngoc Tuong Trong Than, Muhammad Hassan, Christopher Or, Hashem Ghoraba, Diana V. Do, Quan Dong Nguyen
Ocular inflammatory diseases, including scleritis and uveitis, have been widely treated with immunomodulatory therapies (IMTs) as a steroid-sparing approach. Such strategy includes conventional therapies (antimetabolites, alkylating agents, and calcineurin inhibitors) as well as biologic agents like adalimumab, infliximab, rituximab, and tocilizumab. Cyclophosphamide (CP) is an alkylating agent and mainly inhibits the functioning of both T and B cells. Though known to have potential adverse events, including bone marrow suppression, hemorrhagic cystitis, and sterility, CP has been shown to be efficacious, especially in recalcitrant cases and when used intravenous (IV) for a limited period. We conducted a retrospective case-series to assess the safety and efficacy of CP therapy for patients with severe ocular inflammatory diseases who failed other IMTs. Medical records of 1295 patients who presented to the Uveitis Clinic at the Byers Eye Institute at Stanford between 2017 and 2022 were reviewed. Seven patients (10 eyes) who received CP therapy for ocular inflammatory diseases with at least one year of follow-up were included. The mean age of the patients (4 males, 3 females) was 61.6 ± 14.9 (43.0–89.0) years. Clinical diagnoses included necrotizing scleritis (5 eyes), peripheral ulcerative keratitis (2 eyes), orbital pseudotumor (1 eye), HLA-B27 associated panuveitis and retinal vasculitis (2 eyes). Ocular disease was idiopathic in 3 patients, and was associated with rheumatoid arthritis, IgG-4 sclerosing disease, dermatomyositis, and ankylosing spondylitis in 1 patient each. All the patients had history of previous IMT use including methotrexate (5), mycophenolate mofetil (3), azathioprine (1), tacrolimus (1), adalimumab (2), infliximab (4), and rituximab (1). The mean follow-up time was 34.4 ± 11.0 (13–45) months, and mean duration of CP therapy was 11.9 ± 8.8 (5–28) months. Remission was achieved in 5 patients (71.4%). Four patients (57.1%) experienced transient leukopenia (white blood cell count < 4000/mL). CP therapy can be considered a potentially effective and relatively safe therapeutic option for patients with severe ocular inflammatory diseases who failed other IMTs including biologics (TNFa and CD20 inhibitors).
包括巩膜炎和葡萄膜炎在内的眼部炎症疾病已广泛采用免疫调节疗法(IMTs)作为一种节省类固醇的治疗方法。这种策略包括传统疗法(抗代谢药、烷化剂和钙化蛋白抑制剂)以及阿达木单抗、英夫利昔单抗、利妥昔单抗和托珠单抗等生物制剂。环磷酰胺(CP)是一种烷化剂,主要抑制 T 细胞和 B 细胞的功能。尽管已知环磷酰胺有潜在的不良反应,包括骨髓抑制、出血性膀胱炎和不育症,但它已被证明是有效的,尤其是在顽固病例中和在有限的时间内静脉注射(IV)时。我们进行了一项回顾性病例系列研究,以评估 CP 治疗其他 IMT 治疗失败的严重眼部炎症患者的安全性和有效性。我们回顾了 2017 年至 2022 年期间到斯坦福大学拜尔斯眼科研究所葡萄膜炎诊所就诊的 1295 名患者的医疗记录。其中包括7名接受CP疗法治疗眼部炎症疾病且随访至少一年的患者(10眼)。患者(4 男 3 女)的平均年龄为 61.6 ± 14.9 (43.0-89.0) 岁。临床诊断包括坏死性巩膜炎(5 眼)、周围溃疡性角膜炎(2 眼)、眼眶假瘤(1 眼)、HLA-B27 相关性泛葡萄膜炎和视网膜血管炎(2 眼)。3名患者的眼部疾病为特发性,1名患者的眼部疾病与类风湿性关节炎、IgG-4硬化症、皮肌炎和强直性脊柱炎有关。所有患者都曾使用过 IMT,包括甲氨蝶呤(5 例)、霉酚酸酯(3 例)、硫唑嘌呤(1 例)、他克莫司(1 例)、阿达木单抗(2 例)、英夫利昔单抗(4 例)和利妥昔单抗(1 例)。平均随访时间为 34.4 ± 11.0 (13-45) 个月,CP 治疗的平均持续时间为 11.9 ± 8.8 (5-28) 个月。5名患者(71.4%)的病情得到缓解。4名患者(57.1%)出现一过性白细胞减少(白细胞计数< 4000/毫升)。CP疗法可被视为其他IMT(包括生物制剂(TNFa和CD20抑制剂))治疗失败的严重眼部炎症患者的一种潜在有效且相对安全的治疗选择。
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引用次数: 0
Clinical analysis of infectious endophthalmitis following glaucoma filtration surgery. 青光眼滤过手术后感染性眼内炎的临床分析。
IF 2.9 Q2 Medicine Pub Date : 2024-02-29 DOI: 10.1186/s12348-024-00391-4
Liangliang Niu, Yan Luo, Huan Xu, Haili Huang, Rui Jiang, Xinghuai Sun

Background: This study aimed to evaluate the clinical correlative factors and outcomes of treatment of bleb-associated endophthalmitis (BAE) following glaucoma filtration surgery in a Chinese population from the year 2012 to 2022, and to compare them with the clinical course during the coronavirus disease (COVID-19) pandemic period.

Methods: This was a retrospective analysis of consecutive cases of BAE treated at the Eye & ENT Hospital of Fudan University, Shanghai, China, between January 1, 2012, and December 31, 2022. The clinical presentation, treatment modality, microbiological data, clinical course, and outcomes of visual acuity (VA) and intraocular pressure (IOP) in all BAE cases were collected and analyzed.

Results: A total of 28 eyes with BAE were examined, predominantly in male patients (71.4%, p = 0.023). Most patients underwent trabeculectomy (89.3%, p ≤ 0.001), while a smaller proportion underwent Ex-PRESS implantation (10.7%). Primary open-angle glaucoma (POAG) was the most common type of glaucoma (39.3%, p ≤ 0.001). Most patients (96.4%) presented with poor visual acuity, worse than 20/400, and IOP ranged from 3-60 mmHg. Treatment, including initial tap-and-inject procedure of antibiotics (Ceftazidime and Norvancomycin) or initial pars plana vitrectomy (PPV), was initiated 5.0 ± 7.1 days after BAE onset. Streptococcus was the most common causative organism (53.6% of cases, p ≤ 0.001). The visual acuity significantly improved from 2.58 ± 0.27 to 2.14 ± 0.85 (reported in logMAR) after treatment (p ≤ 0.001), and most patients maintained normal tension during follow-up. Poisson regression model analysis showed the annual incidence of BAE during the COVID-19 pandemic period was significantly twice greater than that of previous years.

Conclusions: BAE may cause irreversible visual impairment. POAG filtering surgery with male sex and the COVID-19 pandemic period might be potentially relevant factors for BAE. Culture positivity was closely related to BAE prognosis, with Streptococcus species being the leading pathogenic organisms. Online outpatient services, early diagnosis, and timely treatment may rescue vision and maintain IOP control in the presence of BAE.

研究背景本研究旨在评估2012年至2022年中国人群青光眼滤过手术后眼泡相关性眼内炎(BAE)的临床相关因素和治疗结果,并与冠状病毒病(COVID-19)流行期间的临床过程进行比较:这是一项回顾性分析,研究对象是2012年1月1日至2022年12月31日期间在中国上海复旦大学附属眼耳鼻喉科医院接受治疗的连续BAE病例。收集并分析了所有BAE病例的临床表现、治疗方式、微生物学数据、临床过程以及视力(VA)和眼压(IOP)的结果:共检查了 28 例 BAE 患者,其中男性患者居多(71.4%,P = 0.023)。大多数患者接受了小梁切除术(89.3%,p ≤ 0.001),而小部分患者接受了 Ex-PRESS 植入术(10.7%)。原发性开角型青光眼(POAG)是最常见的青光眼类型(39.3%,p ≤ 0.001)。大多数患者(96.4%)视力较差,低于 20/400,眼压在 3-60 mmHg 之间。治疗包括最初的抗生素(头孢他啶和诺万古霉素)点滴注射或最初的玻璃体旁切除术(PPV),在 BAE 发病后 5.0 ± 7.1 天开始。链球菌是最常见的致病菌(53.6%的病例,P≤0.001)。治疗后,视力从 2.58 ± 0.27 显著提高到 2.14 ± 0.85(以对数MAR表示)(p ≤ 0.001),大多数患者在随访期间保持正常张力。泊松回归模型分析表明,在COVID-19大流行期间,BAE的年发病率是往年的两倍:结论:BAE可能导致不可逆的视力损伤。结论:BAE可能会导致不可逆的视力损伤。POAG滤过手术、男性和COVID-19大流行期间可能是BAE的潜在相关因素。培养阳性与 BAE 的预后密切相关,链球菌是主要致病菌。在线门诊服务、早期诊断和及时治疗可在出现 BAE 时挽救视力并维持眼压控制。
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引用次数: 0
Immune recovery uveitis in Whipple's disease: an unusual ocular presentation. 惠普尔病的免疫恢复性葡萄膜炎:一种不寻常的眼部表现。
IF 2.9 Q2 Medicine Pub Date : 2024-02-13 DOI: 10.1186/s12348-024-00390-5
Hippolyte Lequain, Stéphane Abramowicz, Julien Seiller, Amro Abukhashbah, Carole Burillon, Emmanuelle Vignot, Olivier Brunet, Pascal Sève

Purpose: To describe an unusual case of Whipple's disease (WD) complicated by uveitis, and subsequent paradoxical worsening after effective antibiotic treatment targeting Tropheryma whipplei (TW).

Methods: Case report.

Results: A 53-year-old male presented with bilateral knee arthritis, weight loss, chronic low-grade fever, and cognitive disorders. He was under treatment with tumor necrosis factor α inhibitors (TNFi) for seronegative spondyloarthritis. Given this unusual clinical presentation, further investigations were performed and revealed blood, saliva, stool, synovial fluid and cerebrospinal fluid positivity for TW, confirming the diagnosis of systemic WD. Ophthalmologic examination revealed bilateral posterior uveitis and an aqueous humor sample confirmed the presence of intraocular TW. TNFi were stopped, and the patient was subsequently treated with adequate antibiotics (ceftriaxone, followed by doxycycline and hydroxychloroquine), and subconjunctival corticosteroid injections. After a transient improvement of the ocular symptoms, he presented a recurrence of posterior segment inflammation, leading to repeated PCR testing for TW which were negative. Therefore, paradoxical worsening of the inflammation in the context of immune recovery uveitis (IRU) was thought to be the culprit. The patient was treated with systemic corticosteroid therapy, allowing for rapid improvement of the ocular findings.

Conclusions: This case underlines the possibility of IRU complicating WD. Ophthalmologists, rheumatologists, and internists should be aware of this rare complication, particularly in the context of previous immunosuppressive therapy.

目的:描述一例Whipple病(WD)并发葡萄膜炎的罕见病例,该病例在针对Tropheryma whipplei(TW)进行有效抗生素治疗后,病情出现反常恶化:病例报告:一名 53 岁的男性患者出现双侧膝关节炎、体重减轻、长期低烧和认知障碍。他因血清阴性脊柱关节炎正在接受肿瘤坏死因子α抑制剂(TNFi)治疗。鉴于这种不寻常的临床表现,对他进行了进一步检查,结果显示血液、唾液、粪便、滑膜液和脑脊液中的TW阳性,确诊为全身性WD。眼科检查发现双侧后葡萄膜炎,眼房水样本证实存在眼内 TW。患者停用了TNFi,随后接受了适当的抗生素治疗(头孢曲松,随后是强力霉素和羟氯喹)和结膜下皮质类固醇注射。在眼部症状短暂改善后,他的后节段炎症又复发了,因此需要反复进行 TW PCR 检测,但结果呈阴性。因此,免疫恢复性葡萄膜炎(IRU)的炎症恶化被认为是罪魁祸首。患者接受了全身皮质类固醇治疗,眼部症状迅速好转:本病例强调了IRU并发WD的可能性。眼科医生、风湿免疫科医生和内科医生应注意这种罕见的并发症,尤其是在既往接受过免疫抑制治疗的情况下。
{"title":"Immune recovery uveitis in Whipple's disease: an unusual ocular presentation.","authors":"Hippolyte Lequain, Stéphane Abramowicz, Julien Seiller, Amro Abukhashbah, Carole Burillon, Emmanuelle Vignot, Olivier Brunet, Pascal Sève","doi":"10.1186/s12348-024-00390-5","DOIUrl":"10.1186/s12348-024-00390-5","url":null,"abstract":"<p><strong>Purpose: </strong>To describe an unusual case of Whipple's disease (WD) complicated by uveitis, and subsequent paradoxical worsening after effective antibiotic treatment targeting Tropheryma whipplei (TW).</p><p><strong>Methods: </strong>Case report.</p><p><strong>Results: </strong>A 53-year-old male presented with bilateral knee arthritis, weight loss, chronic low-grade fever, and cognitive disorders. He was under treatment with tumor necrosis factor α inhibitors (TNFi) for seronegative spondyloarthritis. Given this unusual clinical presentation, further investigations were performed and revealed blood, saliva, stool, synovial fluid and cerebrospinal fluid positivity for TW, confirming the diagnosis of systemic WD. Ophthalmologic examination revealed bilateral posterior uveitis and an aqueous humor sample confirmed the presence of intraocular TW. TNFi were stopped, and the patient was subsequently treated with adequate antibiotics (ceftriaxone, followed by doxycycline and hydroxychloroquine), and subconjunctival corticosteroid injections. After a transient improvement of the ocular symptoms, he presented a recurrence of posterior segment inflammation, leading to repeated PCR testing for TW which were negative. Therefore, paradoxical worsening of the inflammation in the context of immune recovery uveitis (IRU) was thought to be the culprit. The patient was treated with systemic corticosteroid therapy, allowing for rapid improvement of the ocular findings.</p><p><strong>Conclusions: </strong>This case underlines the possibility of IRU complicating WD. Ophthalmologists, rheumatologists, and internists should be aware of this rare complication, particularly in the context of previous immunosuppressive therapy.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10861419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139723030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Triple Gram-negative bacterial endophthalmitis following intravitreal injection. 玻璃体内注射后的三重革兰氏阴性菌眼内炎。
IF 2.9 Q2 Medicine Pub Date : 2024-02-09 DOI: 10.1186/s12348-023-00376-9
Samy Zaher, Hector Rodriguez-Villalobos

Purpose: To describe a puzzling case of endophthalmitis caused by three unusual bacteria after intravitreal injection, its outcome, and underlying questions.

Findings: A 70-year-old female patient was diagnosed with acute endophthalmitis following intravitreal aflibercept injection for age-related macular degeneration. A standard tap and inject procedure was performed. Microbiological analyses on the anterior chamber and vitreous samples yielded the presence of three non-fermenting Gram-negative rods: Pseudomonas stutzeri, Stenotrophomonas maltophilia, and Ochrobactrum anthropi. The outcome was favorable after intravitreal injections of vancomycin and ceftazidime, with an almost complete recovery of the visual acuity to its baseline level. No potential source of infection was identified.

Conclusion: Endophthalmitis following intravitreal injection can be caused by a wide variety of bacteria, including some rare Gram-negative species. They can sometimes co-exist in a single patient, but their virulence may vary greatly. Due to the variable antibiotic susceptibility and frequent multiresistance associated with non-fermenting Gram-negative rods, a prompt microbiological approach is required. Favorable outcome can be achieved with standard management.

目的:描述一例在玻璃体内注射后由三种不同寻常的细菌引起眼内炎的疑难病例、其结果以及潜在的问题:一名 70 岁的女性患者因老年性黄斑变性在玻璃体内注射阿弗利百普后被诊断为急性眼内炎。对患者进行了标准的敲击和注射程序。对前房和玻璃体样本进行微生物学分析后发现了三种非发酵革兰氏阴性杆菌:三种非发酵革兰氏阴性杆菌分别是:Stutzeri 假单胞菌、Stenotrophomonas maltophilia 和 Ochrobactrum anthropi。在玻璃体内注射万古霉素和头孢他啶后,疗效良好,视力几乎完全恢复到基线水平。没有发现潜在的感染源:结论:玻璃体内注射后的眼内炎可由多种细菌引起,包括一些罕见的革兰氏阴性菌。这些细菌有时会同时存在于一名患者体内,但其毒性可能会有很大差异。由于非发酵革兰氏阴性杆菌对抗生素的敏感性不一,而且经常产生多重耐药性,因此需要及时采取微生物治疗方法。规范的治疗可以取得良好的疗效。
{"title":"Triple Gram-negative bacterial endophthalmitis following intravitreal injection.","authors":"Samy Zaher, Hector Rodriguez-Villalobos","doi":"10.1186/s12348-023-00376-9","DOIUrl":"10.1186/s12348-023-00376-9","url":null,"abstract":"<p><strong>Purpose: </strong>To describe a puzzling case of endophthalmitis caused by three unusual bacteria after intravitreal injection, its outcome, and underlying questions.</p><p><strong>Findings: </strong>A 70-year-old female patient was diagnosed with acute endophthalmitis following intravitreal aflibercept injection for age-related macular degeneration. A standard tap and inject procedure was performed. Microbiological analyses on the anterior chamber and vitreous samples yielded the presence of three non-fermenting Gram-negative rods: Pseudomonas stutzeri, Stenotrophomonas maltophilia, and Ochrobactrum anthropi. The outcome was favorable after intravitreal injections of vancomycin and ceftazidime, with an almost complete recovery of the visual acuity to its baseline level. No potential source of infection was identified.</p><p><strong>Conclusion: </strong>Endophthalmitis following intravitreal injection can be caused by a wide variety of bacteria, including some rare Gram-negative species. They can sometimes co-exist in a single patient, but their virulence may vary greatly. Due to the variable antibiotic susceptibility and frequent multiresistance associated with non-fermenting Gram-negative rods, a prompt microbiological approach is required. Favorable outcome can be achieved with standard management.</p>","PeriodicalId":16600,"journal":{"name":"Journal of Ophthalmic Inflammation and Infection","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10857997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139706933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Ophthalmic Inflammation and Infection
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