Digital journal of ophthalmology : DJO最新文献

Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive malignancy that primarily involves the serosal surfaces of the abdomen and pelvis and has a poor prognosis. Orbital involvement is extremely rare. We report the case of a 2-month-old boy who presented with a right infraorbital mass consistent with a DSRCT and causing mass effect and superonasal globe displacement. To our knowledge, this is the first case of orbital DSRCT in an infant.

Background: The concentration and dosing of povidone-iodine (PI) solution used in surgical site prophylaxis are variable. Prior in vitro work has demonstrated that dilute PI solutions (<1%) had greater bactericidal activity than stock solutions (10%). Studies using pathologic clinical isolates from the eye have yielded mixed results. The purpose of the current study was to evaluate the efficacy of different concentrations of PI on pathologic ocular surface isolates.

Methods: We conducted an in vitro microbiology study using clinical isolates from corneal ulcers. Bacteria were recovered from trypticase soy agar with 5% sheep erythrocytes, chocolate agar, and thioglycollate broth media. A standardized concentration of each bacterial sample (1 × 10⁸ cfu/ml) was exposed to various dilutions of PI. Quantitative cultures were performed to determine the number of organisms surviving PI exposure.

Results: None of the isolates survived exposure to the PI 0.25% solution for 30 seconds. Micrococcus luteus and Staphylococcus aureus survived both 30-second and 1-minute exposure to PI 5% and 10%. The exposure time required to produce no growth was variable with concentrations of <0.25%. In some isolates, the 10% solution was faster than the more dilute solutions (0.1%, 0.05%).

Conclusions: Our results are consistent with prior in vitro studies of PI, from nonocular sources, and suggest that PI has similar bactericidal action on pathologic bacteria from the ocular surface. In vitro exposure to dilute PI (0.25%) resulted in no growth after 30 seconds, whereas 10% and 5% solutions took longer to kill several of the isolates. Future investigations of PI use in ophthalmology as an antimicrobial agent should include the study of low-concentration PI (0.25%).

We describe a case of penetrating eye injury that resulted in a post-injury day 1 hypopyon, leading to concern for endophthalmitis and phacoanaphylaxis. A Gram stain prepared by the clinical microbiology laboratory was interpreted as Gram-positive cocci (GPC). However, when cultures returned negative, further investigation with microbiology and pathology found that what was thought to be GPC was actually iris melanin pigment. Although endophthalmitis following ocular trauma remains an important diagnosis to consider, this microbiologic masquerade of iris melanin pigment as GPC should be considered in cases where Gram stain is positive yet cultures return negative.

Purpose: Understanding patients' attitudes toward novel therapeutic options can help guide providers in personalizing treatment regimens for glaucoma patients. This study aimed to determine factors associated with acceptance of new drug delivery options among glaucoma patients.

Methods: A total of 199 patient volunteers participated in an interviewer-administered survey from June to August 2016 at the Glaucoma Service of Massachusetts Eye and Ear. The questionnaire was designed to determine acceptance of 6 drug delivery approaches: (1) triple combination eye drop, (2) microdose eye spray, (3) drug-eluting contact lens, (4) drug-eluting periocular ring insert, (5) injectable subconjunctival drug insert, and (6) injectable anterior chamber implant. Other factors analyzed included self-reported demographics, disease severity, and prior ocular history.

Results: The average respondent age was 63.2 ± 15.1 years; 48% were female. For approaches 1-6 listed above, overall acceptance rates were, respectively, 85%, 54%, 31%, 43%, 32%, and 30%. Patients with greater disease severity and prior incisional glaucoma surgery were more likely to pursue alternatives to traditional eye drops.

Conclusions: There is limited acceptance of alternatives to traditional eye drop medications among glaucoma patients. Understanding motivating factors and potential barriers to patient acceptance of novel drug delivery approaches is important in how providers will incorporate these glaucoma treatment options into practice.

We report the case of a 29-year-old man, a tattoo artist by profession, with a history of schizophrenia, who was admitted to our hospital after injecting tattoo pigments in the anterior chamber of both eyes using a dermograph. The patient was diagnosed with penetrating ocular injury with secondary glaucoma, endotheliitis, and uveitis. Anterior chamber washout was performed immediately. At 4 months' follow-up the patient had a visual acuity of 20/25 in each eye and 360° peripheral anterior synechiae; there still were traces of tattoo pigment at the trabecular meshwork and endothelial corneal layer.

Background: Steroids are known to play a role in the pathogenesis of glaucoma, but little is known about the effect of inhaled corticosteroids (ICS). The purpose of this study was to investigate whether there is a clinically significant association between inhalational steroids and intraocular pressure (IOP).

Methods: This was a cross-sectional, case-control study performed at St John's Medical College, Bengaluru, India, from October 2013 to July 2015 of 200 patients using 800 mcg of budesonide or its equivalent dose of ICS and 200 healthy controls not using any form of steroids. Patients using ICS for a period of at least 6 months with no usage of oral or topical steroids within the last 3 months were included as cases. Age- and sex-matched controls were recruited from among the general patient population of the ophthalmological department. IOP and central corneal thickness (CCT) were analyzed. Cases were divided into two subgroups. Group 1 had IOP of <21 mm Hg and cup-to-disc ratio of <0.5. Group 2 had IOP of ≥21 mm Hg or cup-to-disc ratio of ≥0.5 or cup-disc asymmetry ≥0.2. These two subgroups were analyzed to determine whether there was an increased risk of developing ocular hypertension or glaucoma with extended use of ICS.

Results: A total of 400 subjects participated, with 200 in each group. The mean IOP of cases was 15.31 ± 3.27 mm Hg, statistically significantly higher than the mean of 13.39 mm Hg ± 1.95 in controls (P < 0.001). The mean CCT in cases was 522.02 ± 30.47 μm, lower than the mean of 528.73 ± 29.09 μm of the control group (P > 0.001). Of the 200 cases, 11 (5.5%) had ocular hypertension and 2 (1%) had open-angle glaucoma. There was no statistically significant correlation between duration of inhaled steroids usage and increase in IOP (P = 0.62). There was no development of ocular hypertension or glaucoma among the controls.

Conclusions: Our findings suggest a probable association between ICS and IOP and that it may be advisable to measure baseline IOPs and CCT and to follow patients on ICS at regular intervals.