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PubMed2002

Prophylaxis of ophthalmia neonatorum--a nationwide survey of the current practice in Austria.

UNLABELLED: The aim of this study was to analyze the current practice of Ophthalmia neonatorum prophylaxis in Austria. Questionnaires were sent to 107 hospitals with obstetric units, as well as to 490 registered community midwives, together looking after a yearly total of approximately 70,000 births. The overall return of the hospitals and midwives was 91.6% and 7.6%, respectively. RESULTS: Ophthalmia neonatorum prophylaxis is being applied by 93.8% of all respondents (hospitals 96.9%, and community midwives 82.3%). The three most frequently applied substances were Erythromycin (41.8%), Gentamicin (21.3%) and Silver nitrate (19.7%). Other substances were Tetracycline, Povidone-Iodine, Neomycin and Chloramphenicol. The reported overall-observation of chemical conjunctivitis after application of a prophylactic agent was 42.3% (55/133), typically after the use of Silver nitrate, Erythromycin or Tetracycline. The agent was determined by pediatricians (29%), in accordance to governmental decree (15%), by hospital policy (12%), effectiveness against Chlamydia and Gonococci (9%), by pharmacists (3%) and ophthalmologists (3%). 18% did not give any reason for the choice of agent. CONCLUSION: The rationale for prophylaxis and the substances used in Austria show heterogeneity. Seven prophylactic agents are used, two antiseptics and five antibiotics. 25% of the routine applicants are using substances (Gentamicin, Neomycin or Chloramphenicol) for which no evidence based efficacy for prophylaxis of Ophthalmia neonatorum has been demonstrated through clinical trials. However, 83.5% of the maternity units do not want changes in their current routine, unless there is a nation-wide agreement for Ophthalmia neonatorum prophylaxis.

Anti-Infective Agents, Local↗
PubMed1997

[Sympathetic ophthalmia, one missing disease?].

Between 1992-1996 were treated ten cases with sympathetic ophthalmia, representing 0.16% from all hospitalized patients, in Ophthalmological Clinic from Craiova. The disease appeared after corneo-scleral penetrating wounds with membranes hernia at four cases; three from them was complications after cataract surgery and required long treatments; other two patients had glaucoma with closed angle in irreversible stages; another one presented herpetic cornea perforated ulceration with uveitis. Since ocular trauma until appearance of sympathetic ophthalmia, the time was two months at eight cases and two years at two cases. Under clinical aspect seven cases evolved like an anterior uveitis, two cases like a panuveitis and one like a uveopapillitis. Pathologic exam on the removed eye was not specific for sympathetic ophthalmia and only the clinical examination established the diagnosis. Under corticotherapy and immunomodulator therapy, sympathetic ophthalmia evolves this days benign. The disease should not be underestimated. It is not a disappeared disease..

Adrenal Cortex Hormones↗
PubMed1996

[A clinical analysis of 30 cases of sympathetic ophthalmia].

PURPOSE: To study the clinical characteristics of 30 patients with sympathetic ophthalmia in order to find out the valuable clues for future investigation. METHODS: The incidence, cause, location of injury, and prognosis of the 30 patients were analyzed retrospectively. RESULTS: Patients with sympathetic ophthalmia occupied 0.72% of the in-patients with eye trauma in our hospital between 1982 and 1997. In most cases the disease related with perforating injury at the limbus or the sclera, but in a few cases it may be associated with blunt trauma, tumors or even intraocular operation. Diffuse uveitis in sympathizing eye happened in 63.3% of the patients. CONCLUSION: Development of sympathetic ophthalmia always related to the damaged ocular structure. Association of sympathetic ophthalmia with hereditary background and the melanin-protein may be worthy of study in future.

Adolescent↗
PubMed1990

Sympathetic ophthalmia and subretinal neovascularization.

We report a case of sympathetic ophthalmia with subretinal neovascularization of the macula. The subretinal neovascularization developed after penetrating trauma to the fellow eye. The occurrence of subretinal neovascularization in sympathetic ophthalmia is not surprising since disintegrative changes and breaks in Bruch's membrane have been reported in sympathetic ophthalmia. Subretinal neovascularization has also been reported in Vogt-Koyanagi-Harada syndrome, which is histopathologically similar to sympathetic ophthalmia.

Adolescent↗
PubMed1975

[Recent details of the frequency and immunologic reactivity of sympathetic ophthalmia (author's transl)].

When giving details of the frequency of Sympathetic Ophthalmia a clear distinction must be made between this disorder and the Phacogenic Ophthalmia also affecting the second eye. The latter is found with lens damage, whereas genuine Sympathetic Ophthalmia in relation to enucleation, eye damage and eye opening surgery at Heidelberg University between 1937 and 1973 is less than 1%, a figure markedly below figures quoted in the earlier literature. In two out of three patients with recent genuine Sympathetic Ophthalmia we found an augmented stimulation index in the LTT with retina antigen, not choroid antigen, as compared to control groups. This can be regarded as due to an individually augmented immunologic reactivity towards eye specific tissue antigens.

Antigen-Antibody Reactions↗
PubMed1984

Sympathetic ophthalmia: induced by vitrectomy not by trauma.

A case of sympathetic ophthalmia that occurred after corneoscleral laceration due to blunt trauma and after vitrectomy was encountered, and the patient was treated without enucleation of the exciting eye; this is the sixteenth case of sympathetic ophthalmia reported to occur after vitrectomy. In the reported cases including the present one, the intervals between the primary trauma or primary intraocular surgery and secondary vitrectomy and the onset of sympathetic ophthalmia were compared with those in patients who suffered from this disease without vitrectomy. The statistical analysis by the probit method revealed that the onset of sympathetic ophthalmia was critically influenced by the secondarily delivered operation, ie, vitrectomy (P less than 0.05).

Aged↗
PubMed1997

[Ophthalmia neonatorum caused by Chlamydia trachomatis. Rapid diagnosis and therapy].

BACKGROUND: In up to 73% of ophthalmia neonatorum, Chlamydia trachomatis is the causative agents. Untreated sequelae to the eyes and organs may be the result. The aim of this study was to determine the bacterial spectrum of ophthalmia neonatorum with special regard to chlamydia and their diagnostic tests. MATERIALS AND METHODS: We compared the results of 15 newborn with ophthalmia neonatorum. For the diagnosis we used a rapid diagnostic test, Immunofluorescent Antibody Staining and Culture on McCoy cells. Bacteria that were cultured on culture media were also identified. RESULTS: In 66% the newborn showed a positive rapid diagnostic test result that was confirmed by Immunofluorescent Antibody Staining. In 5 patients all tests were negative. CONCLUSIONS: In this study C. trachomatis was the most frequent pathogen. In the culture media we isolated mostly gram-positive cocci but not Neisseria gonorrhoeae. We point out the value of an exact rapid diagnosis and specific treatment to avoid sequelae to the eye and organs.

Chlamydia trachomatis↗
PubMed1979

Staphylococcal ophthalmia neonatorum and the staphylococcal scalded skin syndrome.

A 3-week-old infant had neonatal ophthalmia neonatorum, treated in a routine manner which rapidly developed into an advanced case of staphylococcal scalded skin syndrome. The infant had sudden onset of widespread erythematous and tender areas of skin with subsequent exfoliation of large surface areas. We emphasize the recognition of this syndrome and the understanding that it may rapidly become a serious consequence of staphylococcal ophthalmia neonatorum. We stress the need for initial microbiologic studies and early antibiotic therapy for ophthalmia neonatorum.

Anti-Bacterial Agents↗
PubMed1983

Histocompatibility antigens in sympathetic ophthalmia.

Twenty patients with histopathologically confirmed sympathetic ophthalmia (Group 1) and eight patients with "presumed sympathetic ophthalmia," based on a clinical history of bilateral uveitis occurring within four months of a perforating ocular injury (Group 2), were typed for HLA-A, HLA-B, and HLA-C antigenic determinants by a micro-lymphocytotoxicity technique. HLA antigenic determinants found in Groups 1 and 2 were compared to a control group of 107 patients with sequelae of perforating ocular injuries from accidents, intraocular surgery, or corneal ulcers (Group 3). HLA-A11 antigen showed an increased frequency of 30% in Group 1 (relative risk = 11.0; P less than .002) and an increased frequency of 32% in Groups 1 + 2 (relative risk = 10.5; P less than .0005) compared to Group 3 (frequency = 4%). This finding was validated against a second control group of 453 healthy subjects without ocular disease or trauma (Group 4). This association suggests that a genetic factor may play an important role in the pathogenesis of sympathetic ophthalmia.

HLA Antigens↗
PubMed2001

Laser photocoagulation for choroidal neovascularization associated with sympathetic ophthalmia.

PURPOSE: To present a case of choroidal neovascularization associated with sympathetic ophthalmia successfully treated with photocoagulation. DESIGN: Interventional case report. METHODS: A 41-year-old man with a history of penetrating injury right eye, as well as sympathetic ophthalmia left eye, developed a classic choroidal neovascular membrane that threatened the center of the fovea. RESULTS: The patient was treated with argon laser photocoagulation. He has maintained stable visual acuity without evidence of recurrence of the membrane with 4 years' follow-up. CONCLUSION: Thermal laser should be considered as a treatment option in cases of choroidal neovascularization associated with sympathetic ophthalmia.

Adult↗
PubMed2004

Intravitreal triamcinolone acetonide for treatment of sympathetic ophthalmia.

PURPOSE: To report on the treatment of long-standing sympathetic ophthalmia by intravitreal triamcinolone acetonide. DESIGN: Clinical interventional case report. METHODS: A 47-year-old patient who suffered from sympathetic ophthalmia and who was treated with intensive systemic immunosuppressive therapy received an intravitreal injection of 25 mg of triamcinolone acetonide. Before injection, intraocular pressure ranged between 5 and 8 mm Hg; visual acuity measured 6/20. RESULTS: Within the first 4 weeks after the injection, visual acuity improved from 6/20 to 6/12, intraocular pressure increased to values between 10 mm Hg and 13 mm Hg, and intraocular flare measurements decreased by approximately 50%. Systemic immunosuppressive treatment was reduced to 10 mg prednisolone/day at the first postoperative day and could not be stopped due to an adrenal insufficiency. Three months after the injection, visual acuity regressed to 6/20, intraocular pressure was reduced to values between 5 mm Hg and 10 mm Hg, and anterior chamber flare increased. The patient received a second intravitreal injection of 25 mg of triamcinolone acetonide after which intraocular pressure increased again to values between 10 mm and 13 mm Hg, and anterior chamber flare decreased. After the injection, perimetry revealed a marked enlargement of the originally constricted visual field with a decrease in mean visual field defect from approximately 11 dB to values lower than 7 dB. CONCLUSIONS: Intravitreal injections of triamcinolone acetonide may be an additional tool in the treatment for sympathetic ophthalmia.

Humans↗
PubMed1998

Sympathetic ophthalmia associated with antecedent adherent leucoma--a rare association.

PURPOSE: To report a rare association of sympathetic ophthalmia with an antecedent adherent leucoma. METHOD: A 40-year-old patient with an adherent leucoma developed sympathetic ophthalmia in the fellow eye, 15 years after the occurrence of a perforated corneal ulcer. RESULTS: Intravenous pulse dexamethasone therapy followed by tapering oral prednisolone led to complete resolution of the disease process in the sympathising eye. CONCLUSION: Patients with an adherent leucoma subsequent to a perforated corneal ulcer may remain at an increased risk of developing sympathetic ophthalmia during their lifetime.

Administration, Oral↗
PubMed1986

Single-dose therapy of gonococcal ophthalmia neonatorum with ceftriaxone.

We conducted a randomized clinical trial comparing a single intramuscular dose of 125 mg of ceftriaxone with a single intramuscular dose of 75 mg of kanamycin followed by topical gentamicin for seven days, and with a single intramuscular dose of 75 mg of kanamycin followed by topical tetracycline for seven days, in the treatment of gonococcal ophthalmia neonatorum in Nairobi, Kenya. Of 122 newborns with culture-proved gonococcal ophthalmia neonatorum, 105 returned for follow-up. Sixty-one infants (54 percent) received ceftriaxone, 32 received kanamycin plus topical gentamicin, and 29 received kanamycin plus topical tetracycline. Sixty-six (54 percent) of the Neisseria gonorrhoeae isolates were penicillinase producing. All 55 newborns who received ceftriaxone and returned for follow-up were clinically and microbiologically cured. One of 26 returning newborns who received kanamycin plus tetracycline and 2 of 24 returning newborns who received kanamycin plus gentamicin had persistent or recurrent gonococcal conjunctivitis. Ceftriaxone also eradicated oropharyngeal gonococcal infection in 18 newborns, whereas oropharyngeal infection persisted in 2 of 8 newborns who had received kanamycin (P not significant). We conclude that 125 mg of ceftriaxone as a single intramuscular dose is very effective therapy for gonococcal ophthalmia neonatorum, with marked efficacy against extraocular infection and without the need for concomitant topical antimicrobial therapy.

Ceftriaxone↗
PubMed2005

Sympathetic ophthalmia after a hyphema due to nonpenetrating trauma.

PURPOSE: To report a case of sympathetic ophthalmia occurring after nonpenetrating ocular trauma. METHODS: Interventional case report. RESULTS: An 18-year-old white male presented with sympathetic ophthalmia four weeks after a hyphema from a nonpenetrating bungee cord injury. Vision was 20/20; there were keratic precipitates, anterior chamber cells, vitritis, and discrete yellow deep choroidal lesions consistent with Dalen-Fuch's nodules OU. The uveitis was treated with topical, oral, and periocular corticosteroids and the oral immunosuppressives cyclosporine and mycophenolate mofetil. Vision remained 20/20 OU for the first year of follow-up; vision OD then deteriorated to 20/50 over the next year with the formation of a posterior subcapsular cataract OD. CONCLUSION: Sympathetic ophthalmia may result from nonpenetrating ocular trauma. Ophthalmologists should be aware of this as prompt intervention is warranted.

Adolescent↗
PubMed1996

In vitro activity of human milk against the causative organisms of ophthalmia neonatorum in Benin City, Nigeria.

The aim of the study was to evaluate the in vitro activity of term human milk on the organisms of Ophthalmia neonatorum and was a prospective study of consecutive neonates with the organism. The study was undertaken in a special care baby unit/lying-in ward in Benin City, Nigeria, and consisted of 22 neonates with ophthalmia neonatorum. Bacterial organisms grown on blood agar, were obtained from eye swabs of neonates with ophthalmia neonatorum. Inoculated isolates were incubated with known antibiotic discs, term colostrum, and mature milk. Bacteria were isolated in 77 per cent (17/22) of the neonatal eye swabs, 59 per cent of which were Staphylococcus aureus and 41 per cent coliform organisms. Sensitivity of Staphylococcus aureus to gentamicin was 100 per cent and for coliform organisms 42 per cent. The sensitivity of Staphylococcus aureus to term colostrum was 50 per cent and to mature milk 0. Coliform organisms had a sensitivity of 57 per cent to colostrum and 28 per cent to mature milk. The zone of inhibition of colostrum against Staphylococcus aureus and coliform organisms was between 3 and 5 mm, while for mature milk, there was partial or no inhibition, respectively, to coliform organisms and Staphylococcus aureus. The mean duration of inhibition was 6 hours for colostrum and 3 hours for mature milk. Colostrum has about half the in vitro inhibitory activity of gentamicin (recommended as a first line topical agent, based on the bacteriological sensitivity of this study) against Staphylococcus aureus and coliform organisms. The inhibitory activity of colostrum is > or = 50 per cent against Staphylococcus aureus and coliform organisms for a mean duration of 6 hours. Mature milk had no inhibitory activity against Staphylococcus aureus and only 28 per cent inhibition, for a mean duration of 3 hours to coliform organisms.

Bacteria↗
PubMed1996

Visual prognosis and sympathetic ophthalmia.

Sympathetic ophthalmia is probably the ocular disorder best known to practitioners outside of ophthalmology. It is characterized by a bilateral, nonnecrotizing granulomatous panuveitis that occurs after intentional or unintentional trauma to the exciting eye. So far, the identity of the inciting antigen has not been delineated with certainty. The sequelae from sympathetic ophthalmia have declined markedly in this century as a result of earlier diagnosis, use of corticosteroids, and better management of ocular injuries, in large part due to improved surgical techniques. Cases of sympathetic ophthalmia, however, still occur with their severe sight-threatening complications, which impose on ophthalmologists the importance of prompt diagnosis and aggressive treatment in order to achieve good visual outcome.

Humans↗
PubMed1971

Gonococcal ophthalmia neonatorum despite treatment with antibacterial eye-drops.

Over a five-year period, 1964-8, 48 cases of gonococcal ophthalmia neonatorum were notified to the department of venereology in Glasgow. Thirty-seven babies were born in hospital and 11 at home. The conjunctivitis, usually recorded as a "sticky eye," developed between 1 and 13 days of birth, 36 by the fourth day.Diagnosis by culture of Neisseria gonorrhoeae was delayed in some cases up to 30 days after the appearance of the signs for those born in hospital and 15 days for those born at home, usually because of the blind use of antibacterial eye-drops which produced temporary alleviation of the signs without eradicating the infection; chloramphenicol was noteworthy in this respect.A "sticky eye" will resolve without the use of antibacterial agents, ophthalmia neonatorum will not. When it is decided to use an antibacterial agent pretreatment conjunctival smears for immediate staining and swabs for culture should be taken and the case notified to the medical officer of health.Gonococcal ophthalmia is a preventable disease. In view of the obstetricians' already heavily committed clinical work load there is need for venereologists to collaborate, on consultation and within the maternity hospitals wherever possible, in the screening of antenatal patients for candidiasis and trichomoniasis as well as for gonorrhoea. Some target groups, those with a pathological vaginal discharge or with certain adverse social factors, warrant more thorough investigation, while all those treated require further examination to ensure cure.

Anti-Infective Agents↗