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Bilateral Acute Retinal Necrosis Secondary to HSV-2
376 The patient was evaluated by a cornea specialist and scheduled for excisional biopsy with cryotherapy. Conclusion: CIN is a precancerous lesion with characteristic clinical findings. It must, however, be differentiated from other ocular surface conditions. Careful observation, documentation, and proper referral are necessary in managing patients with CIN or other suspicious conjunctival lesions.
Poster 70 Bleb-Associated Pseudomonal Endophthalmitis Nathan Frank, O.D., Seidenberg and Protzko Eye Associates, Havre de Grace, Maryland Background: Endophthalmitis is a severe sight-threatening infection that can present as a delayed postoperative complication following trabeculectomy, months to years after the initial surgery. Infections following trabeculectomy can range from involvement of the bleb itself, to extension into the vitreous leading to endophthalmitis. Many risk factors related to the cause of bleb-associated endophthalmitis have been proposed, ranging from bleb position to underlying lid disease. Case Summary: In this case, a 62-year-old white female underwent a trabeculectomy in March 2010 secondary to steroid induced glaucoma in the left eye. Her postoperative course was complicated by hypotony and mild leakage. She then presented in July 2010 with a painful O.S. Her presenting vision O.S. was 20/80 with an intraocular pressure of 2 mmHg. There was a 1 mm hypopyon and 2+ fibrin in the anterior segment. Blebitis was diagnosed and both oral moxifloxacin twice daily and hourly topical moxifloxacin were prescribed. On next day follow-up, vision O.S. had worsened to LP, fibrin in the anterior segment had increased to 3+, and a new vitritis was seen with ultrasonography. The patient was admitted to the hospital where a vitrectomy and intravitreal injection of vancomycin, ceftazadine, and dexamethasone was applied. Cultures from the vitrectomy where positive for pseudomonas. The patient remained stable with topical fortified tobramycin and moxifloxacin, until 16 days later when a new onset 1.5 mm hypopyon and an infiltrate surrounding 1 of the releasable sutures of the trabeculectomy was noted. A second intravitreal injection was given and the patient was monitored closely for an additional 9 days. She was then referred to Wilmer Eye Institute for additional retinal consultation. The patient ultimately developed a total retinal detachment of the left eye and an evisceration was required due to a poor visual outcome. Conclusion: As this case shows, bleb associated endophthalmitis is a potentially devastating complication following glaucoma filtering surgery with generally a poor visual outcome. Prompt diagnose by the co-managing optometrist and aggressive treatment by a retinal specialist is necessary to control this severe exogenous eye infection.
Optometry, Vol 82, No 6, June 2011 Poster 71 Bilateral Acute Retinal Necrosis Secondary to HSV-2 Nathan Frank, O.D., Seidenberg and Protzko Eye Associates, Havre de Grace, Maryland Background: Acute retinal necrosis (ARN) is a rare and potential vision-threatening retinitis typically caused by either the herpes simplex or varicella-zoster viruses, and is most commonly seen in young immunocompenent patients. ARN is characterized by peripheral necrotizing retinitis, retinal arteritis, and prominent inflammatory reaction in the anterior and posterior segment. Bilateral presentation of ARN is seen in roughly 25 percent of cases. Prompt diagnoses and treatment is imperative to prevent permanent vision loss. Case Summary: In this case, a 45-year-old white female presented for a follow-up visit due to proliferative diabetic retinopathy. She denied eye pain, vision loss, or any visual changes. Her entering visual acuities were 20/30 and intraocular pressure was 16 O.D. and 15 O.S. The anterior segment was unremarkable other than bilateral posterior chamber intraocular lens; the posterior segment examination revealed scattered micro-aneurysms, cotton wool spots, severe exudation, and diffuse retinitis with overlying vasculitis O.S. greater than O.D. The patient was promptly admitted to the hospital for PICC line placement and was placed on intravenous acyclovir for 10 days. Laboratory tests were also ordered once the patient was admitted including: complete blood count, rapid plasma reagin, bacterial and fungal blood cultures, and titers for herpes simplex virus (HSV), cytomegalovirus, and herpes zoster virus. She was monitored closely for any progression and kept on intravenous (IV) acyclovir pending lab results, which came back positive for HSV-2, confirming the diagnoses of acute retinal necrosis. On follow-up, vision remained stable at 20/30 OU, no change was noted in the anterior segment and posterior segment showed reduced retinitis OU. She remained on oral acyclovir 400 mg 5 times per day after the 10-day course of IV antivirals. Conclusion: As this case demonstrates if diagnosed and treated promptly, ARN, although possibly visually threatening, can be well-controlled with IV and oral antiviral medications. Late-stage complications of the disease can progress rapidly leading to possible retinal detachments, optic neuropathy or macular involvement.
Poster 72 Occult Globe Rupture in a Young Male With Hyphema: A Case Report Ethan Arndt, O.D., Chinle Comprehensive Health Care Facility, Navajo Area, Indian Health Service Background: Occult globe ruptures are an infrequent but serious presentation of blunt ocular trauma. The optometrist should be aware of the indicators which may be helpful in predicting a ruptured globe. Overlooking less apparent
Poster 70 Bleb-Associated Pseudomonal Endophthalmitis Nathan Frank, O.D., Seidenberg and Protzko Eye Associates, Havre de Grace, Maryland Background: Endophthalmitis is a severe sight-threatening infection that can present as a delayed postoperative complication following trabeculectomy, months to years after the initial surgery. Infections following trabeculectomy can range from involvement of the bleb itself, to extension into the vitreous leading to endophthalmitis. Many risk factors related to the cause of bleb-associated endophthalmitis have been proposed, ranging from bleb position to underlying lid disease. Case Summary: In this case, a 62-year-old white female underwent a trabeculectomy in March 2010 secondary to steroid induced glaucoma in the left eye. Her postoperative course was complicated by hypotony and mild leakage. She then presented in July 2010 with a painful O.S. Her presenting vision O.S. was 20/80 with an intraocular pressure of 2 mmHg. There was a 1 mm hypopyon and 2+ fibrin in the anterior segment. Blebitis was diagnosed and both oral moxifloxacin twice daily and hourly topical moxifloxacin were prescribed. On next day follow-up, vision O.S. had worsened to LP, fibrin in the anterior segment had increased to 3+, and a new vitritis was seen with ultrasonography. The patient was admitted to the hospital where a vitrectomy and intravitreal injection of vancomycin, ceftazadine, and dexamethasone was applied. Cultures from the vitrectomy where positive for pseudomonas. The patient remained stable with topical fortified tobramycin and moxifloxacin, until 16 days later when a new onset 1.5 mm hypopyon and an infiltrate surrounding 1 of the releasable sutures of the trabeculectomy was noted. A second intravitreal injection was given and the patient was monitored closely for an additional 9 days. She was then referred to Wilmer Eye Institute for additional retinal consultation. The patient ultimately developed a total retinal detachment of the left eye and an evisceration was required due to a poor visual outcome. Conclusion: As this case shows, bleb associated endophthalmitis is a potentially devastating complication following glaucoma filtering surgery with generally a poor visual outcome. Prompt diagnose by the co-managing optometrist and aggressive treatment by a retinal specialist is necessary to control this severe exogenous eye infection.
Optometry, Vol 82, No 6, June 2011 Poster 71 Bilateral Acute Retinal Necrosis Secondary to HSV-2 Nathan Frank, O.D., Seidenberg and Protzko Eye Associates, Havre de Grace, Maryland Background: Acute retinal necrosis (ARN) is a rare and potential vision-threatening retinitis typically caused by either the herpes simplex or varicella-zoster viruses, and is most commonly seen in young immunocompenent patients. ARN is characterized by peripheral necrotizing retinitis, retinal arteritis, and prominent inflammatory reaction in the anterior and posterior segment. Bilateral presentation of ARN is seen in roughly 25 percent of cases. Prompt diagnoses and treatment is imperative to prevent permanent vision loss. Case Summary: In this case, a 45-year-old white female presented for a follow-up visit due to proliferative diabetic retinopathy. She denied eye pain, vision loss, or any visual changes. Her entering visual acuities were 20/30 and intraocular pressure was 16 O.D. and 15 O.S. The anterior segment was unremarkable other than bilateral posterior chamber intraocular lens; the posterior segment examination revealed scattered micro-aneurysms, cotton wool spots, severe exudation, and diffuse retinitis with overlying vasculitis O.S. greater than O.D. The patient was promptly admitted to the hospital for PICC line placement and was placed on intravenous acyclovir for 10 days. Laboratory tests were also ordered once the patient was admitted including: complete blood count, rapid plasma reagin, bacterial and fungal blood cultures, and titers for herpes simplex virus (HSV), cytomegalovirus, and herpes zoster virus. She was monitored closely for any progression and kept on intravenous (IV) acyclovir pending lab results, which came back positive for HSV-2, confirming the diagnoses of acute retinal necrosis. On follow-up, vision remained stable at 20/30 OU, no change was noted in the anterior segment and posterior segment showed reduced retinitis OU. She remained on oral acyclovir 400 mg 5 times per day after the 10-day course of IV antivirals. Conclusion: As this case demonstrates if diagnosed and treated promptly, ARN, although possibly visually threatening, can be well-controlled with IV and oral antiviral medications. Late-stage complications of the disease can progress rapidly leading to possible retinal detachments, optic neuropathy or macular involvement.
Poster 72 Occult Globe Rupture in a Young Male With Hyphema: A Case Report Ethan Arndt, O.D., Chinle Comprehensive Health Care Facility, Navajo Area, Indian Health Service Background: Occult globe ruptures are an infrequent but serious presentation of blunt ocular trauma. The optometrist should be aware of the indicators which may be helpful in predicting a ruptured globe. Overlooking less apparent