Chorioretinal Biopsy for the Diagnosis of Endogenous Endophthalmitis Due to Escherichia Coli

Cheng, Nicholas; Chandra, Aman; Roufail, Edward; Moodie, Jonathan; Yeoh, Jonathan; Allen, Penelope J; Rosa, Cesar M. Salinas-La; Matthews, Bryan J.

doi:10.1097/icb.0000000000000281

Cited by 4 publications

(3 citation statements)

References 10 publications

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“… 21 , 31 , 32 , 33 , 34 Focal endogenous endophthalmitis secondary to the Escherichia coli septicaemia in Case 2 was considered to be less likely as E. coli endophthalmitis is typically associated with poor visual prognosis. 35 , 36 , 37 , 38 , 39 , 40 A case of bilateral exudative retinal detachment secondary to E. coli septicaemia has been recently reported, however the pattern of chorioretinopathy and other ophthalmic manifestations were not in keeping presentation of the two above reported cases. 41 The bilateral angle closure diagnosed in Case 1 was attributed to anterior rotation of the lens-iris diaphragm occurring due to presumed anterior choroidal thickening as significant posterior choroidal thickening was demonstrated on enhanced depth OCT.…”

Section: Discussionmentioning

confidence: 96%

Two cases of differentiation syndrome with ocular manifestations in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and arsenic trioxide

Newman

Leung

Richards

et al. 2018

American Journal of Ophthalmology Case Reports

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PurposeTo describe two cases of differentiation syndrome presenting with ocular manifestations including bilateral chorioretinopathy in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and arsenic trioxide differentiation therapy.ObservationsThis observational case series identifies two patients at a single tertiary institution diagnosed with differentiation syndrome with associated ophthalmic involvement. Both patients reported bilateral reduction in visual acuity at days fourteen and ten respectively following initiation of differentiation therapy in addition to developing other systemic manifestations of differentiation syndrome. Both patients received the same chemotherapeutic regimen including both all-trans retinoic acid and arsenic trioxide as well as ten days of routine differentiation syndrome prophylaxis with oral prednisolone. Case 1 presented with bilateral pale yellow sub-retinal lesions concentrated at the posterior poles with ocular coherence tomography (OCT) evidence of bilateral multifocal areas of focal RPE elevation and adhesion to the thickened outer retina with interspersed sub-retinal fluid. Fluorescein angiography revealed areas of early hyperflouresence corresponding to the yellow chorioretinal lesions with late diffuse leakage of fluid into the subretinal space. Case 2 presented with a similar characteristic retinal findings on fundoscopy and optical coherence tomography. Both patients experienced rapid improvement in the visual symptoms and marked resolution of the sub-retinal fluid within seven to fourteen days of onset with excellent long-term visual outcome. Both patients achieved molecular remission after induction and received standard consolidation and maintenance therapy without visual disturbance.Conclusion and importanceOcular manifestations of differentiation syndrome have been only recently recognised. We present a case series of two patients with differentiation syndrome with ocular involvement. Common to both presentations was the presence of bilateral reduction in visual acuity with multifocal serous retinal detachment secondary to chorioretinopathy. The visual outcome from both presentations was excellent with rapid normalisation of visual acuity and resolution of the sub-retinal fluid with only the first case having their differentiation therapy temporarily withheld during the acute phase of illness.

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Section: Discussionmentioning

confidence: 96%

Two cases of differentiation syndrome with ocular manifestations in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and arsenic trioxide

Newman

Leung

Richards

et al. 2018

American Journal of Ophthalmology Case Reports

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“…As new techniques have emerged to make retinochoroidal biopsy safer, it has become more accepted in the literature for indications such as posterior uveitis with nonrevealing workup, retinochoroidal inflammation, and sight-threatening disease [8]. However, there remain very few published articles that discuss retinochoroidal biopsy for posterior uveitis, likely reflecting physicians' discomfort in using the technique for this indication [11].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Vitreoretinal Aspergillosis with Transvitreal Retinochoroidal Biopsy

Peddada

Khan

Rubin³

et al. 2018

Case Reports in Ophthalmological Medicine

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Diagnosing culture-proven endophthalmitis is complicated by the insufficient yield of intraocular samples and the variety of etiologies which mimic true endophthalmitis. In cases of impending vision loss where vitreous biopsy cannot provide a definitive diagnosis, transvitreal retinochoroidal biopsy can be an effective next step. Our case is a 48-year-old male with B-cell acute lymphoblastic leukemia that presented with counting fingers vision, redness, and tearing of the left eye. Exam showed cell and flare with hypopyon as well as dense vitritis. The patient underwent diagnostic pars plana vitrectomy and vitreous culture was negative at the time. Flow cytometry demonstrated no malignant cells. However, the patient's vision and mental status continued to clinically decline despite being started on intravitreal and systemic antibiotic and antifungal therapy. Neuroimaging revealed rim-enhancing brain lesions. Transvitreal retinochoroidal biopsy was performed in an elevated area of the retina. The biopsy helped rule out malignancy and showed acute-angle, septate, branching hyphae characteristic of Aspergillus fumigatus. Ultimately, the vitreous biopsy, cultures, and a biopsy from the left frontal lobe brain abscess all confirmed this diagnosis as well. Transvitreal retinochoroidal biopsy can play a role in the diagnosis of a case of posterior uveitis and can be particularly effective in diagnosing a fungal endophthalmitis.

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“…Performing a chorioretinal biopsy is an uncommon, yet necessary diagnostic procedure that is required in select cases of infiltrative or infectious uveitis of unknown etiology. 6 , 7 Systemic disorders that affect the uveal tract are numerous and commonly involve neoplastic, infectious, or inflammatory etiologies. 8 In a proposed, yet controversial treatment for end-stage age-related macular degeneration (AMD), several investigators report varying levels of success using a surgical incision to create a choroid–Bruch's–retinal pigment epithelial (CBR) graft that is translocated to the submacular space.…”

Section: Introductionmentioning

confidence: 99%

Creating a Full-thickness Choroidal Incision: An Ex Vivo Analysis of Human and Porcine Tissue Contraction Dynamics

LoBue

Yamada

Choi

et al. 2017

Trans. Vis. Sci. Tech.

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PurposeWe hypothesized that the elastic nature of the choroid leads to tissue contraction following a full-thickness, sharp incision. Furthermore, we sought to quantify, measure, and compare tissue contraction in ex vivo porcine globes and human globes of various ages using predetermined variables.MethodA full-thickness, ex vivo choroidal incision was performed in either pig (n = 97) or human (n = 30) specimens. Variables included trephine diameter (1.5, 2.0, or 2.5 mm) versus a straight surgical blade, and temperature (1.7 °–4.4° vs. 36.6°F). Central centripetal and surround centrifugal tissue contractions were measured. Mean percentage tissue contraction was assessed as a ratio of trephine diameter to final tissue contraction measured immediately following each incision using a standardized device.ResultsFor trephination in pig specimens, centripetal contraction ranged from 38% to 50% with a mean of 44%. Centrifugal contraction was approximately 15%. Human choroidal contraction was 39% and 15%, respectively, with a statistically significant inverse relationship to age (R2 = 0.35, P ≤ 0.01). Asymmetric contraction was noted when incisions were closer to choroidal attachment sites to the sclera, such as near vortex ampullae. Linear incisions resulted in contraction that correlated with incision length (R2 = 0.35, P ≤ 0.001).ConclusionsA full-thickness choroidal incision results in significant tissue contraction. For circular incisions, the centripetal contraction approaches 50% of the original incision size. For linear incisions, the contraction corresponds directly with incision length. In human specimens, there is less contraction with advancing age.Translational RelevanceOur findings have clinical relevance for choroidal biopsy, traumatic injury, and choroidal translocation surgery.

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Chorioretinal Biopsy for the Diagnosis of Endogenous Endophthalmitis Due to Escherichia Coli

Cited by 4 publications

References 10 publications

Two cases of differentiation syndrome with ocular manifestations in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and arsenic trioxide

Two cases of differentiation syndrome with ocular manifestations in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and arsenic trioxide

Diagnosis of Vitreoretinal Aspergillosis with Transvitreal Retinochoroidal Biopsy

Creating a Full-thickness Choroidal Incision: An Ex Vivo Analysis of Human and Porcine Tissue Contraction Dynamics

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