Purpose: To investigate the resistance rate of Enterococcus faecalis which is one of the causative strains of endophthalmitis to three fluoroquinolone drugs, the quinolone resistance gene mutation patterns, and the presence of virulence factor genes. Methods: Between April 1, 2014, and January 16, 2018, 416 eyes of 208 patients undergoing cataract surgery, intravitreal injection, or vitrectomy were examined to identify conjunctival commensals. Patients with infective keratitis and infective endophthalmitis were also examined for the presence of E. faecalis. Before the procedure and surgery, samples for identification of conjunctival commensals were collected from the lower conjunctival sac of both eyes. In addition, corneal and vitreous specimens were collected from patients with keratitis and endophthalmitis, respectively. E. faecalis isolated by culturing the samples was tested for drug susceptibility, the presence of gene sequence mutations, and virulence factor genes. Results: In total, 342 strains were identified in samples from the conjunctiva and included six isolates of E. faecalis. The study was conducted with a total of 16 isolates of E. faecalis, including two from cases of keratitis and eight from cases of endophthalmitis. Six of the 16 strains (37.5%) were resistant to quinolone antibiotics. Point mutations were detected mainly in gyrA and parC. The virulence factors esp, efba, asa1, ace, cylA, and gelE were present in the strains and showed no differences between the quinolone-resistant and quinolone-sensitive strains. Gelatinase activity test was negative for all strains. Conclusions The resistance rate of enterococcal clinical isolates identified in the ocular area was 37.5%. The increase in resistance to quinolone antibiotics seems to be related to the presence of mutations in gyrA and parC genes. E. faecalis identified in the eye is thought to possess the virulence factors genes esp, efba, asa1, ace, cylA, and gelE.

No abstract available.
Endophthalmitis ; Enterococcus faecalis ; Enterococcus

PURPOSE: We investigated structural changes in the retina by using optical coherence tomography (OCT) in a feline model of retinal degeneration using iodoacetic acid (IAA).METHODS: We examined 22 eyes of 11 felines over 2 years of age. The felines had fasted for 12 hours and were intravenously injected with IAA 20 mg/kg of body weight. OCT (Spectralis OCT) was performed at the point where the ends of the retinal vessels collected in the lateral direction from the optic nerve head and area centralis. Similarly, OCT was performed four times at 1-week intervals following injections, at which point the felines were sacrificed and histologic examinations were performed. Using OCT, the thickness of each layer of the retina was measured.RESULTS: The average body weight of the three male and eight female felines investigated in this study was 1.61 ± 0.19 kg. The mean total retinal thickness of the felines before injection was 221.32 ± 9.82 µm, with a significant decrease in the retinal thickness at 2, 3, and 4 weeks following injections of 186.41 ± 35.42, 174.56 ± 31.94, and 175.35 ± 33.84 µm, respectively (p = 0.028, 0.027, and 0.027, respectively). The thickness of the outer nuclear layer was 57.49 ± 8.03 µm before injection and 29.26 ± 17.87, 25.62 ± 13.88, and 31.60 ± 18.38 µm at 2, 3, and 4 weeks, respectively, after injection (p = 0.028, 0.028, 0.046, respectively).CONCLUSIONS: In a feline model of retinal degeneration using IAA, the total retinal thickness and the thickness of the outer nuclear layer were shown to decrease significantly on OCT.
Angiography ; Body Weight ; Female ; Humans ; Iodoacetic Acid ; Male ; Optic Disk ; Photoreceptor Cells, Vertebrate ; Retina ; Retinal Degeneration ; Retinal Vessels ; Retinaldehyde ; Tomography, Optical Coherence

No abstract available.
Ceftazidime ; Endophthalmitis ; Humans ; Intravitreal Injections ; Vancomycin

No abstract available.
Central Serous Chorioretinopathy ; Dexamethasone

Purpose: To report a patient with relentless placoid chorioretinitis who showed recurrent multiple placoid lesions and retinal pigment epithelial atrophic changes in both eyes for more than 16 months.Case summary: A 21-year-old man visited our clinic because of visual disturbance in both eyes. The best-corrected visual acuities were 20/50 and 20/20 in the right and left eyes, respectively. The fundus showed multiple whitish placoid lesions from the posterior pole to the mid-periphery. There were no anterior chamber inflammation signs. To exclude systemic and infectious etiologies, laboratory workup was performed. All tests were negative except for the serological types HLAB13 and B51. Based on clinical estimation, we made a diagnosis of acute posterior multifocal placoid pigment epitheliopathy or posterior uveitis and prescribed oral methylprednisolone for the patient. However, multiple white dot lesions occurred repeatedly in both eyes for 7 months. With the oral methylprednisolone and immunosuppressive treatment, the best-corrected visual acuity of both eyes was maintained at 20/20 without further recurrence 16 months after the first visit. The lesions left atrophic findings in the retinal pigment epithelium. We diagnosed the patient with relentless placoid chorioretinitis, based on the prolonged clinical course and widespread lesion distribution. Conclusions Relentless placoid chorioretinitis should be considered in patients with chronically progressive multiple white dot lesions and retinal pigment epithelium atrophic changes between the central pole and the periphery. Aggressive immunosuppressive treatment should be performed to improve the patient's visual outcome.

Purpose: To report a patient with relentless placoid chorioretinitis who showed recurrent multiple placoid lesions and retinal pigment epithelial atrophic changes in both eyes for more than 16 months.Case summary: A 21-year-old man visited our clinic because of visual disturbance in both eyes. The best-corrected visual acuities were 20/50 and 20/20 in the right and left eyes, respectively. The fundus showed multiple whitish placoid lesions from the posterior pole to the mid-periphery. There were no anterior chamber inflammation signs. To exclude systemic and infectious etiologies, laboratory workup was performed. All tests were negative except for the serological types HLAB13 and B51. Based on clinical estimation, we made a diagnosis of acute posterior multifocal placoid pigment epitheliopathy or posterior uveitis and prescribed oral methylprednisolone for the patient. However, multiple white dot lesions occurred repeatedly in both eyes for 7 months. With the oral methylprednisolone and immunosuppressive treatment, the best-corrected visual acuity of both eyes was maintained at 20/20 without further recurrence 16 months after the first visit. The lesions left atrophic findings in the retinal pigment epithelium. We diagnosed the patient with relentless placoid chorioretinitis, based on the prolonged clinical course and widespread lesion distribution. Conclusions Relentless placoid chorioretinitis should be considered in patients with chronically progressive multiple white dot lesions and retinal pigment epithelium atrophic changes between the central pole and the periphery. Aggressive immunosuppressive treatment should be performed to improve the patient's visual outcome.

48-year-old woman was admitted to emergency room due to left flank pain. It was diagnosed with left ureteral stone and underwent extracorporeal shock wave lithotripsy (ESWL). However, 12 hours later, the patient complained acute upper abdominal pain with pulmonary edema and low blood pressure. A diagnosis of moderate acute pancreatitis with local complication was considered and we decided conservative therapy including fluid resuscitation, inotropics and antibiotics. It was suggested that ESWL was responsible for the acute pancreatitis. The patient gradually recovered and was discharged on 13th day of admission. ESWL is considered the standard treatment for urolithiasis. Although, it has proved to be safe and effective, serious complications have been reported in 1% of patients, including acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, and cardiac arrhythmia. Although the possibility of post-ESWL acute pancreatitis is extremely low, physicians should take care of this complication.
Abdominal Pain ; Anti-Bacterial Agents ; Arrhythmias, Cardiac ; Diagnosis ; Emergency Service, Hospital ; Female ; Flank Pain ; Hematoma ; Humans ; Hypotension ; Lithotripsy* ; Lung Injury ; Middle Aged ; Pancreatitis* ; Pulmonary Edema ; Resuscitation ; Shock* ; Ureter ; Urolithiasis* ; Venous Thrombosis