Clinical features and treatment outcomes of endogenous Klebsiella endophthalmitis:a 12-year review

AIM:To identify the clinical features and treatment outcomes of endogenous Klebsiella pneumoniae endophthalmitis and investigate prognostic factors of poor visual outcome.METHODS:The clinical records of all patients diagnosed with endogenous Klebsiella endophthalmitis between January 2007 to December 2018 in Prince of Wales Hospital,Hong Kong,China were retrospectively reviewed.Thorough ophthalmological examination findings were recorded in the case note,including visual acuity testing,slit-lamp examination,indirect ophthalmoscopy and B-scan ultrasonography if media opacity precluded fundus viewing.RESULTS:A total of 18 eyes in 14 patients were identified.Bilateral involvement was noted in 4 patients(28.6%).Hepatobiliary sepsis was the source in 9 patients(64.3%).Culture of intraocular fluid was positive in 5 out of 18 eyes(27.8%).Mortality was noted in 2 patients(14.3%).Mean final visual acuity was 20/1500.Six out of 16 eyes had total loss of sight(37.5%)and 3 eyes required evisceration(18.8%).Multivariate linear regression revealed poor presenting visual acuity(P=0.031)and lack of fundus view due to vitritis(P=0.02)as prognostic factors of poor visual outcome.CONCLUSION:Visual outcome of endogenous Klebsiella endophthalmitis is poor.Poor presenting visual acuity and lack of fundus view predict poor visual outcome.High index of suspicion for endophthalmitis is important in Klebsiella sepsis patients with complaints of ocular symptoms.Ophthalmological screening is recommended in noncommunicable patients with Klebsiella sepsis.

Corneal blindness and current major treatment concerngraft scarcity

According to World Health Organization, the global prevalence of blindness in 2010 was 39 million people, among which 4% were due to corneal opacities. Often, the sole resort for visual restoration of patients with damaged corneas is corneal transplantation. However, despite rapid developments of surgical techniques, instrumentations and immunosuppressive agents, corneal blindness remains a prevalent global health issue. This is largely due to the scarcity of good quality corneal grafts. In this review, the causes of corneal blindness, its major treatment options, and the major contributory factors of corneal graft scarcity with potential solutions are discussed.

Evaluation of the association of C5 with neovascular age-related macular degeneration and polypoidal choroidal vasculopathy

Background:Neovascular age-related macular degeneration(AMD)and polypoidal choroidal vasculopathy(PCV)are sight-threatening maculopathies with both environmental and genetic risk factors.We have previously shown relative risks posed by genes of the complement pathways to neovascular AMD and PCV.Methods:In this study,we investigated the haplotype-tagging single nucleotide polymorphisms(SNPs)in the complement component 5(C5)gene in 708 unrelated Chinese individuals:200 neovascular AMD patients,233 PCV patients and 275 controls.Six tagging SNPs in C5 were genotyped.Univariate single SNP association analysis,haplotype-based association analysis and gene-gene interaction analysis between C5 and other AMD-associated genes were performed.Results:The results revealed none of the six tagging SNPs of the C5 gene had a significant association with neovascular AMD or PCV(P>0.05).We also found insignificant haplotype-based association,and no significant SNPSNP interaction between C5 and other genes(including C2-CFB-RDBP-SKIV2L,SERPING1,CETP,ABCG1,PGF,ANGPT2,CFH and HTRA1)for neovascular AMD and PCV.Conclusions:This study showed no statistical significance in the genetic association of C5 with neovascular AMD or PCV in a Hong Kong Chinese population.Further studies in large samples from different populations are warranted to elucidate the role of C5 in the genetic susceptibility of AMD and PCV.