Risk Factors for Secondary Glaucoma in Herpetic Anterior Uveitis

2017 Jun 27. pii: S0002-9394(17)30258-1. doi: 10.1016/j.ajo.2017.06.013. [Epub ahead of print]

Risk Factors for Secondary Glaucoma in Herpetic Anterior Uveitis.

Abstract

PURPOSE:

To determine the incidence of elevated intraocular pressure (IOP) and secondary glaucoma in herpetic anterior uveitis (AU), due to either herpes simplex or varicella zoster virus, by using the Standardization of Uveitis Nomenclature (SUN) criteria, and to identify risk factors for the development of glaucoma.

DESIGN:

Retrospective, observational cohort study.

METHODS:

Patients with herpetic AU presenting themselves between 2001 and 2013 at the ophthalmology department of the University Medical Center Groningen were included. Main outcome measures were the incidence of elevated IOP and glaucoma and risk factors for the development of glaucoma.

RESULTS:

Seventy-three herpetic AU patients were included. Ocular complications most commonly seen during follow-up for uveitis were elevated IOP (75%), keratitis (59%), dry eyes (34%), posterior synechiae (34%), cataract (32%), and glaucoma (15%). Glaucoma patients, in comparison to non-glaucoma patients, had a higher number of IOP peaks during their follow-up for uveitis (p<0.001). The majority of patients with elevated IOP (91%) had this already at the start of the uveitis. Nineteen percent of the patients needed glaucoma surgery.

CONCLUSIONS:

Using the SUN criteria, our study confirmed that elevated IOP and secondary glaucoma are major complications in herpetic AU. If an elevated IOP occurred, it was usually already present at the start of a uveitis episode. A risk factor for the development of glaucoma was the number of endured IOP peaks. Future studies are needed to evaluate whether early and prolonged use of antiviral and IOP-lowering medication may prevent glaucoma.

Risk factors, glaucoma, herpetic, uveitis

PMID:
28666730
DOI:
10.1016/j.ajo.2017.06.013

Ocular involvement of Staphylococcus aureus bacteremia: incidence and risk factors

eye,ocular,Staphylococcus aureus,bacteremia,incidence,risk factors
Antimicrob Agents Chemother. 2016 Jan 11. pii: AAC.02651-15. [Epub ahead of print]

Ocular involvement of Staphylococcus aureus bacteremia: incidence and risk factors.

Abstract

Staphylococcus aureus bacteremia (SAB) often leads to ocular infection including endophthalmitis and chorioretinitis. However, the incidence, risk factors, and outcome of ocular infection complicated by SAB are largely unknown. We retrospectively analyzed the incidence and risk factors of ocular involvement in a prospective cohort of patients with SAB at a tertiary-care hospital. Ophthalmologists reviewed the fundoscopic findings and classified the ocular infection as endophthalmitis or chorioretinitis. During the 5 year study period, 1,109 patients had SAB and 612 (55%) who underwent ophthalmic examination within 14 days after SAB were analyzed. Of these 612 patients, 56 (9%, 95% confidence interval [CI], 7-12%) had ocular involvement; 15 (2.5%) with endophthalmitis and 41 (6.7%) with chorioretinitis. In multivariate analysis, infective endocarditis (adjusted odds ratio [aOR], 5.74; 95% CI, 2.25-14.64) and metastatic infection (aOR, 2.38; 95% CI, 1.29-4.39) were independent risk factors for ocular involvement. Of the 47 patients with ocular involvement who could communicate, only 17 (36%) had visual disturbance. Two-thirds (10/15) of the patients with endophthalmitis were treated with intravitreal antibiotics combined with parenteral antibiotics, whereas all the patients with chorioretinitis were treated with systemic antibiotics only. No one became blinded. Among 42 patients with follow-up assessment available, the ocular lesion improved in 29 (69%) but remained stationary in the others. Ocular involvement was independently associated with 30-day mortality after SAB. Ocular involvement is not uncommon in patients with SAB. Routine ophthalmic examination should be considered in patients with infective endocarditis or metastatic infection caused by SAB.

Abstract

Staphylococcus aureus bacteremia (SAB) often leads to ocular infection including endophthalmitis and chorioretinitis. However, the incidence, risk factors, and outcome of ocular infection complicated by SAB are largely unknown. We retrospectively analyzed the incidence and risk factors of ocular involvement in a prospective cohort of patients with SAB at a tertiary-care hospital. Ophthalmologists reviewed the fundoscopic findings and classified the ocular infection as endophthalmitis or chorioretinitis. During the 5 year study period, 1,109 patients had SAB and 612 (55%) who underwent ophthalmic examination within 14 days after SAB were analyzed. Of these 612 patients, 56 (9%, 95% confidence interval [CI], 7-12%) had ocular involvement; 15 (2.5%) with endophthalmitis and 41 (6.7%) with chorioretinitis. In multivariate analysis, infective endocarditis (adjusted odds ratio [aOR], 5.74; 95% CI, 2.25-14.64) and metastatic infection (aOR, 2.38; 95% CI, 1.29-4.39) were independent risk factors for ocular involvement. Of the 47 patients with ocular involvement who could communicate, only 17 (36%) had visual disturbance. Two-thirds (10/15) of the patients with endophthalmitis were treated with intravitreal antibiotics combined with parenteral antibiotics, whereas all the patients with chorioretinitis were treated with systemic antibiotics only. No one became blinded. Among 42 patients with follow-up assessment available, the ocular lesion improved in 29 (69%) but remained stationary in the others. Ocular involvement was independently associated with 30-day mortality after SAB. Ocular involvement is not uncommon in patients with SAB. Routine ophthalmic examination should be considered in patients with infective endocarditis or metastatic infection caused by SAB.

Serratia marcescens endogenous endophthalmitis in an immunocompetent host.

Serratia marcescens,endogenous endophthalmitis,immunocompetent host
BMJ Case Rep. 2016 Jan 20;2016. pii: bcr2015209887. doi: 10.1136/bcr-2015-209887.

Serratia marcescens endogenous endophthalmitis in an immunocompetent host.

Abstract

A systemically well 66-year-old white Caucasian man presented to the urgent care department with a short history of progressive pain and blurring of vision in his left eye. He denied a history of trauma, intraocular surgery or use of illicit drugs. He was diagnosed with endogenous endophthalmitis. Vitreous biopsy grew Serratia marcescens, a Gram negative bacteria. In spite of extensive investigation, there was no obvious source of infection. He had an indwelling urine catheter for prostate hypertrophy, but urine culture was negative. There was no evidence of immunocompromise. He was treated with systemic as well as intravitreal antibiotics. In spite of appropriate treatment, the patient lost vision. S. marcescens endophthalmitis, seen even in immunocompetent people, carries a poor visual prognosis.

BMJ Case Rep. 2016 Jan 20;2016. pii: bcr2015209887. doi: 10.1136/bcr-2015-209887.

Serratia marcescens endogenous endophthalmitis in an immunocompetent host.

Abstract

A systemically well 66-year-old white Caucasian man presented to the urgent care department with a short history of progressive pain and blurring of vision in his left eye. He denied a history of trauma, intraocular surgery or use of illicit drugs. He was diagnosed with endogenous endophthalmitis. Vitreous biopsy grew Serratia marcescens, a Gram negative bacteria. In spite of extensive investigation, there was no obvious source of infection. He had an indwelling urine catheter for prostate hypertrophy, but urine culture was negative. There was no evidence of immunocompromise. He was treated with systemic as well as intravitreal antibiotics. In spite of appropriate treatment, the patient lost vision. S. marcescens endophthalmitis, seen even in immunocompetent people, carries a poor visual prognosis. He was treated with systemic as well as intravitreal antibiotics. In spite of appropriate treatment, the patient lost vision. S. marcescens endophthalmitis, seen even in immunocompetent people, carries a poor visual prognosis.

Varicella Zoster Virus Necrotizing Retinitis in Two Patients with Idiopathic CD4 Lymphocytopenia

Ocul Immunol Inflamm. 2015 Oct 15:1-5. [Epub ahead of print]

Varicella Zoster Virus Necrotizing Retinitis in Two Patients with Idiopathic CD4 Lymphocytopenia.

Abstract

PURPOSE:

Progressive outer retinal necrosis (PORN) associated with varicella zoster virus (VZV) is usually diagnosed in HIV positive or immunosuppressed patients. We report two cases of immunocompetent patients with necrotizing viral retinitis found to have idiopathic CD4 lymphocytopenia.

METHODS:

Clinical presentation, examination, imaging, and laboratory testing of two patients with VZV retinitis are presented.

RESULTS:

An HIV negative patient with history of herpes zoster presented with rapid loss of vision and examination consistent with PORN. PCR testing confirmed VZV. Lymphocytopenia was noted with a CD4 count of 25/mm3. A second HIV negative patient presented with blurred vision and lid swelling and was found to have peripheral VZV retinitis confirmed by PCR. Laboratory workup revealed lymphocytopenia with a CD4 count of 133/mm3.

CONCLUSIONS:

VZV necrotizing retinitis classic for PORN can occur in HIV negative patients. Idiopathic CD4 lymphocytopenia should be considered healthy patients who develop ocular infections seen in the immunocompromised.

KEYWORDS:

Herpetic retinopathy; idiopathic CD4 lymphocytopenia; immunosuppression; progressive outer retinal necrosis

PMID:
26472486
[PubMed – as supplied by publisher]

Varicella Zoster Virus Necrotizing Retinitis in Two Patients with Idiopathic CD4 Lymphocytopenia.

Abstract

PURPOSE:

Progressive outer retinal necrosis (PORN) associated with varicella zoster virus (VZV) is usually diagnosed in HIV positive or immunosuppressed patients. We report two cases of immunocompetent patients with necrotizing viral retinitis found to have idiopathic CD4 lymphocytopenia.

METHODS:

Clinical presentation, examination, imaging, and laboratory testing of two patients with VZV retinitis are presented.

RESULTS:

An HIV negative patient with history of herpes zoster presented with rapid loss of vision and examination consistent with PORN. PCR testing confirmed VZV. Lymphocytopenia was noted with a CD4 count of 25/mm3. A second HIV negative patient presented with blurred vision and lid swelling and was found to have peripheral VZV retinitis confirmed by PCR. Laboratory workup revealed lymphocytopenia with a CD4 count of 133/mm3.

CONCLUSIONS:

VZV necrotizing retinitis classic for PORN can occur in HIV negative patients. Idiopathic CD4 lymphocytopenia should be considered healthy patients who develop ocular infections seen in the immunocompromised.