Open Access Case study

Bilateral Endogenous Endophthalmitis as an Initial Presentation of Klebsiella pneumoniae Bacteremia in Advanced Hepatocellular Carcinoma

Rhuen Chiou Chow, Tengku Ain Kamalden

Ophthalmology Research: An International Journal, Page 34-40
DOI: 10.9734/OR/2015/17730

Aims: To report a case of Klebsiella pneumoniae bacteremia presenting as bilateral endogenous endophthalmitis in a patient with advanced hepatocellular carcinoma and liver failure.

Presentation of Case: We describe a 55 year-old man with diabetes, Hepatitis B, metastatic hepatocellular carcinoma with liver failure who presented with sudden, painful, bilateral rapid loss of vision accompanied with hypopyon, intense anterior chamber fibrinous reaction and vitritis. Systematic workup revealed bilateral endogenous K. pneumonia endophthalmitis secondary to hepatobiliary sepsis. Conservative management with systemic piperacillin/tazobactam, intravitreal and topical ceftazidime and vancomycin led to successful sepsis control, however visual outcome was dismal.

Discussion: Klebsiella endogenous endophthalmitis has become extremely prevalent in southeast Asia, most commonly occurring as a metastatic complication of pyogenic liver abscess. Early systemic and intravitreal antibiotics remain the cornerstone of its management. Despite adequate treatment, visual prognosis is grave.

Conclusion: This highlights the rapidly destructive nature of this virulent organism. Clinicians must be mindful that endophthalmitis can be the initial presenting sign of Klebsiella bacteremia and the search for a primary infective source is paramount. Identification of prognostic factors for poor vision following an attack allows early intervention, in hope to improve patient outcomes.


Open Access Method Article

Collagen Matrix Implant (Ologen)TM in Glaucoma Surgeries; Precautions for a Better Control of Intraocular Pressure

Momen Mahmoud Hamdi, Islam Mahmoud Hamdi

Ophthalmology Research: An International Journal, Page 16-24
DOI: 10.9734/OR/2015/17658

Background: Collagen matrix implant (CM) is used in glaucoma surgery to regulate healing under the conjunctiva.

Purpose: To highlight the precautions that should be taken for a better intraocular pressure (IOP) control with CM in different glaucoma surgeries during and after the operation.

Methods: Thirty five cases of glaucoma were treated surgically with adjunctive OlogenTM.

a) Fifteen subscleral trabeculectomies (SST): for adult Primary Open Angle Glaucoma (POAG).

b) Five SST's for Primary Congenital Glaucoma (PCG).

c) Fifteen Phaco-trabeculectomies for advanced POAG with cataract. One was converted to extracapsular cataract extraction with SST because of a subluxated (270 degree) cataractous lens with advanced glaucoma.

The number of 10/0 nylon stitches to close the scleral flap, the method of closure of the fornix based conjunctival flap and injection of Na hyaluronate at the end of the surgery were evaluated. Postoperatively: Anterior chamber(AC) depth, the need for ocular massage, any additional medications or further surgical intervention were assessed.

Results: Better IOP control was obtained with slightly shallow AC postoperatively and tight conjunctival closure. Ocular massage may be needed as well as medications for cases which experienced tight closures of the scleral flap. Three SST´s and four phaco-trabeculectomies needed supplemental medications after surgeries. Failure in one SST (PCG) and two phacotrabeculectomies was due to presence of additional risk factors in the patients. The rest of cases went successfully with IOP < 21 mm Hg without medications.

Conclusion: CM is a successful adjunct to glaucoma surgeries, intraoperative and postoperative precautions should be taken to maintain proper aqueous drainage and functioning blebs to improve the degree of success.


Open Access Minireview Article

Applications of Thin Films in Ophthalmology

L. Lamprogiannis, A. Karamitsos, V. Karagkiozaki, I. Tsinopoulos, S. Dimitrakos, S. Logothetidis

Ophthalmology Research: An International Journal, Page 9-15
DOI: 10.9734/OR/2015/18081

Nanotechnology provides a revolutionary approach to therapeutic challenges. Drug delivery, gene therapy, novel diagnostic methods and tissue engineering rank among the main fields of current nanomedical research. Thin films, with their unique optical and mechanical properties, are regarded as valuable biomedical tools and research is conducted to incorporate them in a variety of nanomedical devices. Main applications of thin films in ophthalmology include intraocular drug delivery, coatings for intraocular implants, scaffolds for retinal and corneal tissue engineering, novel diagnostic methods and modified intraocular lenses. A variety of chemical substances and nanotechnology techniques are used to fabricate thin films for ophthalmic use and it is clear that this burgeoning field may overcome hurdles and produce significant results that will revolutionize our approach to ocular diseases.


Open Access Original Research Article

A Prospective Study of Neuro-Cognitive Enhancement with Carotenoids in Elderly Adult Males with Early Age Related Macular Degeneration

Kelly G. Hoffmann, Stuart P. Richer, James S. Wrobel, Eugenia Chen, Carla J Podella

Ophthalmology Research: An International Journal, Page 1-8
DOI: 10.9734/OR/2015/17131

Background: Diets rich in carotenoids may reduce cognitive impairment. Little is known about dietary zeaxanthin.

Objective: Evaluate zeaxanthin carotenoid supplementation against change in cognitive status.

Methods: American Psychological Association (APA) certified cognitive evaluation from the Zeaxanthin and Vision Function Study (USFDA Investigative New DrugIND#78,973), a 1 year prospective randomized controlled trial (RCT) of elderly males with mild age related macular degeneration. Neurocognitive testing Repeatable Battery for the Assessment of Neuropsychological Status Update RBANS and Trail Making A & B. Subjects evaluated at baseline and 1 year after dietary isomer RR zeaxanthin (8 mg/d) alone or combined with lutein (9 mg/d) using one way ANOVA, (P<0.05) and T testing.

Results: n=50 subjects completed both study visits. Delayed memory in the zeaxanthin group improved from RBANS score of 91.8 (SD 16) to 99.4 (SD 12), P = 0.04. 

Conclusions: Zeaxanthin, typically minimally present in the US diet, may nonetheless be important in the context of emerging relationships in primates between dietary xanthophyll carotenoids and cognitive function. Additional larger scale RCTs is indicated to investigate the clinical utility of this carotenoid in nutritional neuroscience.

Open Access Original Research Article

Cytomegalovirus Retinitis: Current State in People with HIV-AIDS in Peru

Bety Yáñez

Ophthalmology Research: An International Journal, Page 25-33
DOI: 10.9734/OR/2015/17957

Purpose: To describe the incidence and progression of cytomegalovirus retinitis (CMVR) in public hospital patients from Peru.

Study Design: Prospective study conducted in HIV-AIDS diagnosed patients.

Place and Duration of Study: Department of Ophthalmology and Department of Tropical Medicine, Hospital Nacional Dos de Mayo, from 2004 to 2013.

Methodology: Descriptive statistics were obtained for age, gender, associated disease, CMVR location and ganciclovir treatment. Data were analyzed by the Pearson Chi. Square test, Mann-Whitney test, and the two-tailed exact Fischer's Exact test. SPSS version 20.0 for Windows software program was used

Results: 2627 patients were evaluated, 75 had CMVR diagnosis. Active CMVR was found in 68 eyes (90.7%). Median age at diagnosis of CMVR was 37 years (IQR 30-41 years). Median CD4 level of 25 cells/μL (IQR 12.2-57.7 cells/μL), viral load > 1000,000 in 39 (52%) patients. Median mortality  rate was 7.1 deaths per 1000 PY and mean survival time from HIV diagnosis to death was 29,5 months (95%  8,7-43,0 months) and from CMVR diagnosis, 6,2 months (95%  IC 2,0-8,0 months). Duration since HIV diagnosis to CMVR onset was 12 months (IQR 3-48 months).  Tuberculosis (TB) was present in 23 (30.7%) patients. Incidence rate of HIV patients with CMVR was 28.2 cases per 1000 PY. 51 patients received ganciclovir: endovenous 34 (91.17%), intravitreal 6 (26.5%) and orally 4 (11.8%).

Conclusion: CMVR has a high prevalence in young people with an elevated value of HIV-TB co-infection (30.7%). CMVR diagnosis was a predictor for early mortality, including highly active antiretroviral therapy (ART).