A novel,algorithmic“naming-meshing”system was introduced for the distinction of hypopyon from pseudohypopyon to make an early diagnosis and prompt treatment of anterior chamber collection standardized to encompass a...A novel,algorithmic“naming-meshing”system was introduced for the distinction of hypopyon from pseudohypopyon to make an early diagnosis and prompt treatment of anterior chamber collection standardized to encompass all sediment characteristics.For this reason,a literature review of“hypopyon”and“pseudohypopyon”was conducted in MEDLINE/PubMed,Scopus,and Web of Science from 1966 to May 15,2023.Two issues were clarified:1)which strategies should the ophthalmologist follow when asked to evaluate an eye with anterior chamber sedimentation to distinguish hypopyon from pseudohypopyon,and 2)in which systemic disorders should a non-ophthalmologist order a prompt ophthalmic consultation to distinguish pseudohypopyon from hypopyon.Pathognomonic characteristics of the sediment were examined;scleral show(warm/cold),location(corneal/anterior chamber/capsular/posterior),visibility(macro/micro/occult-angle),orientation(horizontal/vertical/oblique),number(single/double),shape(convex/triangular/pyramidal/ring/lumpy/inverse),and color(white/yellow/pink/brown/black).Associated findings were then assessed;acute/chronic,spontaneous/provoked,unilateral/bilateral,inflammatory/non-inflammatory,suppurative(nonsterile)/non-suppurative(sterile),granulomatous/nongranulomatous,recurrent/non-recurrent,shifting/nonshifting,and transient/persistent.The type of precipitation was named(naming)and matched(meshing)to a potential list of etiologies(inflammatory,infective,therapeutic,masquerades).Given that(pseudo)hypopyon predominantly afflicts younger patients in their most productive years,clinicians supervising such patients should be aware of all sediment characteristics.The ophthalmologist should never ask non-ophthalmologists to run the full battery of tests in a patient with(pseudo)hypopyon,and rather indicate which type of collection is present,what its pathognomonic feature is,and what the most likely diagnoses to be excluded are.展开更多
Background Hypopyon is common in eyes with fungal keratitis.The evaluation of the clinical features,culture results and the risk factors for hypopyon and of the possible correlation between hypopyon and the treatment ...Background Hypopyon is common in eyes with fungal keratitis.The evaluation of the clinical features,culture results and the risk factors for hypopyon and of the possible correlation between hypopyon and the treatment outcome could be helpful for making treatment decisions.Methods The medical records of 1066 inpatients （1069 eyes） with fungal keratitis seen at the Shandong Eye Institute from January 2000 to December 2009 were reviewed retrospectively for demographic features,risk factors,clinical characteristics,laboratory findings and treatment outcomes.The incidence of hypopyon,the fungal culture positivity for hypopyon,risk factors for hypopyon and the effect of hypopyon on the treatment and prognosis were determined.Results We identified 1069 eyes with fungal keratitis.Of the 850 fungal culture-positive eyes,the Fusarium species was the most frequent （73.6%）,followed by Altemaria （10.0%） and Aspergillus （9.0%）.Upon admission,562 （52.6%）eyes with hypopyon were identified.The hypopyon of 66 eyes was evaluated via fungal culturing,and 31 eyes （47.0%）were positive.A total of 194 eyes had ocular hypertension,and 172 （88.7%） of these eyes had hypopyon （P 〈0.001）.Risk factors for incident hypopyon included long duration of symptoms （P 〈0.001）,large lesion size （P 〈0.001） and infection caused by the Fusarium and Aspergillus species （P 〈0.001）.The positivity of fungal culture for hypopyon was associated with duration of symptoms and lesion size.Surgical intervention was more common in cases with hypopyon （P 〈0.001）.Hypopyon was a risk factor for the recurrence of fungal keratitis after corneal transplantation （P=0.002）.Conclusions Hypopyon is common in patients with severe fungal keratitis and can cause ocular hypertension.About half of the hypopyon cases were positive based on fungal culture.Long duration of symptoms,large lesion size and infection with the Fusarium and Aspergillus species were risk factors for hypopyon.The presence of hypopyon increasesthe likelihood of surgical intervention.展开更多
Acanthamoeba keratitis is a serious infection that can lead to loss of vision. It is highly challenging and often poses a diagnostic dilemma, causing delay in diagnosis and treatment. We report herewith the clinical a...Acanthamoeba keratitis is a serious infection that can lead to loss of vision. It is highly challenging and often poses a diagnostic dilemma, causing delay in diagnosis and treatment. We report herewith the clinical and histopathology findings of a patient with an atypical presentation of acanthamoeba keratitis in Bahrain. The patient is a 16-year-old Bahraini teenager who was a cosmetic contact lens wearer. She presented with clinical signs and symptoms of microbial keratitis, which was initially misdiagnosed elsewhere as a case of herpetic corneal infection. Her corneal biopsy confirmed the clinical diagnosis as acanthamoeba keratitis. The patient was started on anti amoebic treatment. The infection got eradicated. The cornea healed with a central scar. Eventually, she underwent penetrating keratoplasty. This case report serves to raise awareness of this rare condition. Clinicians should have a high index of suspicion when diagnosing such cases among contact lens wearers. Early diagnosis and treatment are crucial to prevent serious complications.展开更多
文摘A novel,algorithmic“naming-meshing”system was introduced for the distinction of hypopyon from pseudohypopyon to make an early diagnosis and prompt treatment of anterior chamber collection standardized to encompass all sediment characteristics.For this reason,a literature review of“hypopyon”and“pseudohypopyon”was conducted in MEDLINE/PubMed,Scopus,and Web of Science from 1966 to May 15,2023.Two issues were clarified:1)which strategies should the ophthalmologist follow when asked to evaluate an eye with anterior chamber sedimentation to distinguish hypopyon from pseudohypopyon,and 2)in which systemic disorders should a non-ophthalmologist order a prompt ophthalmic consultation to distinguish pseudohypopyon from hypopyon.Pathognomonic characteristics of the sediment were examined;scleral show(warm/cold),location(corneal/anterior chamber/capsular/posterior),visibility(macro/micro/occult-angle),orientation(horizontal/vertical/oblique),number(single/double),shape(convex/triangular/pyramidal/ring/lumpy/inverse),and color(white/yellow/pink/brown/black).Associated findings were then assessed;acute/chronic,spontaneous/provoked,unilateral/bilateral,inflammatory/non-inflammatory,suppurative(nonsterile)/non-suppurative(sterile),granulomatous/nongranulomatous,recurrent/non-recurrent,shifting/nonshifting,and transient/persistent.The type of precipitation was named(naming)and matched(meshing)to a potential list of etiologies(inflammatory,infective,therapeutic,masquerades).Given that(pseudo)hypopyon predominantly afflicts younger patients in their most productive years,clinicians supervising such patients should be aware of all sediment characteristics.The ophthalmologist should never ask non-ophthalmologists to run the full battery of tests in a patient with(pseudo)hypopyon,and rather indicate which type of collection is present,what its pathognomonic feature is,and what the most likely diagnoses to be excluded are.
基金This study was supported by a grant from the National Science Foundation of China （No.30630063）.
文摘Background Hypopyon is common in eyes with fungal keratitis.The evaluation of the clinical features,culture results and the risk factors for hypopyon and of the possible correlation between hypopyon and the treatment outcome could be helpful for making treatment decisions.Methods The medical records of 1066 inpatients （1069 eyes） with fungal keratitis seen at the Shandong Eye Institute from January 2000 to December 2009 were reviewed retrospectively for demographic features,risk factors,clinical characteristics,laboratory findings and treatment outcomes.The incidence of hypopyon,the fungal culture positivity for hypopyon,risk factors for hypopyon and the effect of hypopyon on the treatment and prognosis were determined.Results We identified 1069 eyes with fungal keratitis.Of the 850 fungal culture-positive eyes,the Fusarium species was the most frequent （73.6%）,followed by Altemaria （10.0%） and Aspergillus （9.0%）.Upon admission,562 （52.6%）eyes with hypopyon were identified.The hypopyon of 66 eyes was evaluated via fungal culturing,and 31 eyes （47.0%）were positive.A total of 194 eyes had ocular hypertension,and 172 （88.7%） of these eyes had hypopyon （P 〈0.001）.Risk factors for incident hypopyon included long duration of symptoms （P 〈0.001）,large lesion size （P 〈0.001） and infection caused by the Fusarium and Aspergillus species （P 〈0.001）.The positivity of fungal culture for hypopyon was associated with duration of symptoms and lesion size.Surgical intervention was more common in cases with hypopyon （P 〈0.001）.Hypopyon was a risk factor for the recurrence of fungal keratitis after corneal transplantation （P=0.002）.Conclusions Hypopyon is common in patients with severe fungal keratitis and can cause ocular hypertension.About half of the hypopyon cases were positive based on fungal culture.Long duration of symptoms,large lesion size and infection with the Fusarium and Aspergillus species were risk factors for hypopyon.The presence of hypopyon increasesthe likelihood of surgical intervention.
文摘Acanthamoeba keratitis is a serious infection that can lead to loss of vision. It is highly challenging and often poses a diagnostic dilemma, causing delay in diagnosis and treatment. We report herewith the clinical and histopathology findings of a patient with an atypical presentation of acanthamoeba keratitis in Bahrain. The patient is a 16-year-old Bahraini teenager who was a cosmetic contact lens wearer. She presented with clinical signs and symptoms of microbial keratitis, which was initially misdiagnosed elsewhere as a case of herpetic corneal infection. Her corneal biopsy confirmed the clinical diagnosis as acanthamoeba keratitis. The patient was started on anti amoebic treatment. The infection got eradicated. The cornea healed with a central scar. Eventually, she underwent penetrating keratoplasty. This case report serves to raise awareness of this rare condition. Clinicians should have a high index of suspicion when diagnosing such cases among contact lens wearers. Early diagnosis and treatment are crucial to prevent serious complications.
