SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Authors report the case of a patient in whom a sympathetic ophthalmia with posterior onset under the aspect of a massive CRSC was diagnosed. The clinical and therapeutic aspects are described in detail.
A case of gonococcal ophthalmia neonatorum in a preterm boy (gestational age 29 weeks) delivered by caesarean section 22 hours after rupture of the membranes is described. The neonate made an uneventful recovery after treatment with ampicillin, gentamicin and methicillin for concomitant cutaneous infection.
Crede's method was evaluated using of ofloxacin (OFLX) and gentamicin (GM) to show the clinical significance of chemoprophylaxis against ophthalmia neonatorum occurring through vertical infection. The obtained results are summarized as follows. 1. OFLX and GM were separately instilled using Crede's original method to 260 cases selected from all the cases of delivery encountered in this hospital during a period of 6 months from 1987 to 1988. Both groups had similar backgrounds. 2. OFLX and GM were effective in 123 of 129 cases and in 116 of 131 cases, respectively. No side effects were found. 3. OFLX to which recent isolates of Staphylococci and Escherichia coli from obstetric clinics were sensitive was more effective for the prevention than GM to which many isolates were tolerant. These findings indirectly proved the clinical significance of Crede's method. 4. Cases showing ineffectiveness of the prophylaxis may have been due to nosocomial infections.
From a public health point of view gonococcal ophthalmia neonatorum (GCON) is important as it can rapidly lead to blindness. The frequency of GCON is determined by the prevalence of maternal gonococcal infection. In most industrialized countries the prevalence of gonorrhoea in pregnant women is less than 1%; in developing countries the rates are between 3% and 15%, more than 50% being due to penicillinase-producing Neisseria gonorrhoeae strains (PPNG). The rate of transmission from mother to newborn is between 30% and 50%. Strategies for the control of GCON include: (1) prevention of gonococcal infection in women of childbearing age, (2) detection and treatment of gonococcal infection in pregnant women, (3) eye prophylaxis in the newborn at birth, and (4) diagnosis and treatment of GCON. Eye prophylaxis by the instillation immediately after birth of either 1% silver nitrate eye drops or 1% tetracycline eye ointment is very effective. This reduces the GCON incidence by 80% to 95% and is highly cost-effective, particularly in high-risk settings.
The authoresses present the results of treatment of 5 patients with sympathetic ophthalmia caused by injury of the eye. In 3 patients the removal of the excited eye and several years lasting conservative treatment--between others by immunosuppressive compounds--led to the arrest of the inflammatory process and enabled to preserve a good visual acuity in the saved eye. In 2 persons the function of either eye however could not be saved.
Neodymium:YAG cyclotherapy has been demonstrated to lower intraocular pressure dramatically in patients with uncontrolled glaucoma, with potentially fewer side-effects than cyclocryotherapy. We report the clinical course and histopathological features of a case of sympathetic ophthalmia occurring soon after YAG cyclotherapy.
Recent surveys have stressed the importance of Chlamydia trachomatis as a cause of ophthalmia neonatorum. Advances in diagnostic techniques should enable this organism to be readily identified. Precise identification of the aetiological agent is important because of the differing antibacterial sensitivities of the pathogens. Neisseria gonorrhoeae and C. trachomatis require systemic therapy. Investigation and treatment of both parents is necessary to prevent recurrence in subsequent pregnancies.
The incidence of gonococcal ophthalmia neonatorum (GON) in the area served by the Peninsula Maternity and Neonatal Services in Cape Town is 273/100,000 live births. Two prophylactic agents, 1% silver nitrate ophthalmic solution and 0.5% erythromycin ophthalmic ointment, were introduced in routine eye care of the newborn in the main academic obstetric units. These agents resulted in a significant decrease in the incidence of GON to 34/100,000 live births. The alternative forms of prophylaxis against GON are discussed and the need for reinstitution of prophylaxis is emphasised.
Four patients with sympathetic ophthalmia (SO) simulating Vogt-Koyanagi-Harada disease (VKH) were studied. They all had penetrating wounds of the globe and developed bilateral uveitis, as well as two or more extraocular manifestations, e.g., vitiligo, poliosis, dysacousia and/or meningitis. Histopathologically, the enucleated globes revealed features that were identical to those observed in Harada's disease: mainly, a granulomatous choroiditis with formations of chorioretinal adhesions and migration of pigment into the disorganized retina. The study indicated that the only reliable feature that could differentiate SO from VHK disease was the history of a penetrating wound in the former and the absence of such trauma in the latter.
Vermont birth certificates and hospital medical charts for 1979 were reviewed to determine whether infants born at home or in hospitals had documentation of prophylaxis against gonococcal ophthalmia neonatorum. Of the 139 home births recorded in 1979, 78 infants (54.0 percent) received no prophylaxis, compared with 97 (1.4 percent) of 7,156 infants born in hospitals (P less than 0.0001). Ophthalmic medications that have not been recommended for use for neonatal prophylaxis were being used in two hospitals in the State. A followup review of 7,668 Vermont birth certificates for 1980 indicated that hospital practices improved in that year, after the hospitals received a reminder on proper prophylactic procedures from the Vermont Department of Health.
Without preventive measures, gonococcal ophthalmia will develop in approximately 28% of infants born to women with gonorrhea, a disease that is relatively frequent and largely asymptomatic in pregnant women. In addition, in some settings conjunctivitis caused by Chlamydia trachomatis may be more frequent than gonococcal conjunctivitis among neonates. The Canadian Paediatric Society therefore recommends that, as soon as possible after birth, all infants receive prophylaxis with silver nitrate, tetracycline or erythromycin, administered according to specific guidelines.
Gonococcal ophthalmia of the newborn still exists in 1981. On the occasion of a case recently observed it is reminded that 1% silver nitrate remains the best prophylactic means.
Eight cases of sympathetic ophthalmia diagnosed by histopathologic examinations of the enucleated exciting eyes were collected and the fundus fluorescein angiographic (FFA) findings of the sympathized eyes in acute stages were analyzed. The manifestations of the FFA were divided into three types. We suggest that if one eye has a history of trauma and the other eye loses visual acuity rapidly accompanied with uveitis signs after certain incubation period, the fundus fluorescein angiography should be examined to achieve a clinically objective diagnostic basis so that the patients are treated in time.
A case of sympathetic ophthalmia (SO) is reported. A long lasting stable result was obtained for this patient treated basically with traditional Chinese medicine. His exciting eye was investigated under light and transmission electron microscopes. Prominent granulomatous lesions in the choroid, Dalen-Fuchs nodules (DFNs) and disruption of outer and inner basement membrane of Bruch's membrane under DFNs are found, plasma cells are not few and melanocytes and retinal pigment epithelial cells are possibly the target cells. In various cells, nuclear bodies (NBs) are ubiquitous and sometimes multiple in an individual cell nucleus. Microtubule-like structures are present inside and outside the NBs and parallel lines composed of relatively uniform high electron dense granules as lattice-like structures can be seen. It was surmised that a virus induced autoimmune process might be involved in the pathogenesis of SO.
Gonococcal opthalmia (proved by cultures) occurred in 11 infants delivered at the Jewish Hospital and Medical Center of Brookly (JHMCB) during a three and one-half-year period. Two more infant had conjunctivitis with presumptive evidence of gonococci (Gram stain of eye discharge). Silver nitrate was instilled in the eyes of the neonates by registered nurses. Maternal histories of these infants showed lack of prenatal care in ten, history of gonorrhea in pregnancy in three, and positive serology (STS) in two; ten of the mothers were unmarried. The over-all incidence of gonorrhea at the JHMCB prenatal clinic screening program is very low (0.02 per cent). Prevention of neonatal gonorrheal ophthalmia depends on: vigorous screening of mothers at delivery as well as during prenatal visits, careful attention to instillation of silver nitrate in the neonates' eyes, development of serologic tests for gonorrhea, and improved bacteriologic methods for culturing the organism.
Ophthalmia neonatorum is the most common infection in the first month of life and can have serious systemic as well as ophthalmic morbidity. This article discusses the differential diagnosis and treatment of conjunctivitis in the neonate. Controversies in method of prophylaxis are reviewed.
A case of sympathetic ophthalmia is presented in which a single lesion located posteriorly at the level of the retinal pigment epithelium caused a serous macular detachment. We believe that this lesion represented an atypical Dalen-Fuchs nodule. Most reports of the fluorescein angiographic appearance of Dalen-Fuchs nodules describe multiple sites of choroidal leakage during the early phases, which may coalesce during the late phases of the angiogram. The lesion we detected was hypofluorescent in early phases of the fluorescein angiogram and showed late staining. The early hypofluorescence seen in the lesion may be explained by an intact retinal pigment epithelium over the presumed Dalen-Fuchs nodule, blockage of choroidal fluorescence by the nodule, and areas of granulomatous inflammation in the inner choroid and choriocapillaris. The staining in the late phases of the fluorescein angiogram may be explained by accumulation of fluorescein into the presumed Dalen-Fuchs nodule.
Crede's method was evaluated using norfloxacin (NFLX) and gentamicin (GM) to show the clinical significance of chemoprophylaxis against ophthalmia neonatorum occurring through vertical infections. The obtained results are summarized as follows. 1. NFLX and GM were separately instilled using Crede's original method in 171 cases selected from all cases of delivery encountered in this hospital during a period of 5 months in 1991. The two groups had similar backgrounds. 2. NFLX and GM were effective in 70 of 71 cases and in 96 of 100 cases, respectively. No side effects were found in either groups. 3. From 4 of 5 ineffective cases were isolated staphylococci, which were sensitive to NFLX and GM.