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Fulltext The clinical spectrum of ocular bartonellosis: a retrospective study at a tertiary centre in Malaysia

Tey MS, Govindasamy G, Vendargon FM

J Ophthalmic Inflamm Infect, 2020 Nov 16;10(1):31.
PMID: 33191467 DOI: 10.1186/s12348-020-00224-0

BACKGROUND: Cat scratch disease (CSD) is a systemic illness caused by the gram-negative bacillus, Bartonella henselea, which can occasionally involve the ocular structures. The objective of this study is to evaluate the various clinical presentations of ocular bartonellosis at our institution. A retrospective review of the clinical records of 13 patients (23 eyes) with ocular manifestations of Bartonella infections over a 3-year period between January 2016 to December 2018 was undertaken at our institution.
RESULTS: The diagnosis was made based on clinical findings and in addition, with the support of the evidence of Bartonella hensalae IgG and/or IgM. Small retinal white lesions were the most common ocular findings in this series of patients (82.6% of eyes, 76.9% of patients). Neuroretinitis was the second most common finding (47.8% of eyes, 69.2% of patients), followed by exudative retinal detachment involving the macula (34.8% of eyes, 53.8% of patients) and Parinaud's oculoglandular syndrome (17.4% of eyes, 23.1% of patients). Other findings like isolated optic disc oedema without macular star (8.7% of eyes, 15.4% of patients) and vitritis (4.3% of eyes, 7.7% of patients) were also observed. Ten patients (76.9%) had bilateral ocular involvement. Most of the patients were young, immunocompetent and had systemic symptoms like fever prior to their ocular symptoms. The visual acuity (VA) at initial presentation ranged from 6/6 to hand movement (mean, 6/20), and at final visit 6/6 to 6/60, (mean, 6/9). 91.7% of patients were treated with antibiotics. Only 2 patients received oral corticosteroids together with antibiotics due to very poor vision on presentation. The visual prognosis of ocular bartonellosis is generally good with 16 (88.9%) of 23 eyes having VA of 6/12 or better at final follow-up visit.
CONCLUSION: Small foci of retinal white lesions were the most common manifestation of ocular bartonellosis in this series, followed by neuroretinitis, though an array of other ocular findings may also occur. Therefore, we should consider bartonella infection as a possible differential diagnosis in those patients.
Fulltext Bilateral Serous Retinal Detachment in Pregnancy

Phang DSK, Ariffin N, Abd Aziz H, Vendargon FM, Sonny Teo KS

Cureus, 2022 Oct;14(10):e30019.
PMID: 36348857 DOI: 10.7759/cureus.30019

Serous retinal detachment is a rare complication of pregnancy. A 30-year-old primigravida with preeclampsia presented with bilateral blurring of vision and metamorphopsia for a one-week duration. She was referred by the Obstetrics and Gynecology department for visual assessment. Her best corrected visual acuity was 6/7.5 in both eyes. Fundus examination revealed bilateral serous retinal detachment involving maculae. She was treated conservatively and her blood pressure normalized after delivery. There was a partial resolution of subretinal fluid one-month post-delivery and a complete resolution of subretinal fluid three months later. Her final best corrected visual acuity was 6/6 and N5 in both eyes. The management of serous retinal detachment is conservative with a good visual outcome.
Fulltext Postoperative Fungal Keratitis Managed by Anterior Chamber Washout and Intracameral Amphotericin-B: A Report of Two Cases

Maniam A, Chee Min L, Kiet Phang L, Vendargon FM, Othman O

Cureus, 2021 Dec;13(12):e20769.
PMID: 35111454 DOI: 10.7759/cureus.20769

Keratomycosis is a significant cause of mono-ocular blindness, especially in tropical regions. Fungal keratitis developing in corneal incisions is very rare. We report the experience of treating two patients diagnosed with recalcitrant candida keratitis post-phacoemulsification with anterior chamber washout and deep debridement. The first patient was a 68-year-old woman who underwent left eye phacoemulsification nine months ago with a postoperative best corrected visual acuity of 6/6. The second patient was a 73-year-old man who had uneventful right eye phacoemulsification six months prior with a postoperative best corrected visual acuity of 6/9. Both patients used topical steroids postoperatively for more than three months and noted a drop in vision. Both patients had deep stromal infiltration and endothelial plaque at the primary corneal wound. They were unresponsive to topical, intracameral, and systemic antifungal therapy. Both patients underwent anterior chamber evacuation of hypopyon and endothelial plaque removal. Evacuation of hypopyon and removal of endothelial plaque was done with a 23G vitrectomy cutter using a low-powered vacuum controlled at 200 mmHg. The fluid inside the tubing was sent for culture analysis. We used viscoelastic coating on the endothelium to minimize the damage during the operations. Intracameral amphotericin B 15 µg/0.1 ml was given at the end of the operation. Postoperatively, both patients had clear corneas. The first patient's visual acuity improved 6/18, and the second patient's visual acuity improved to 6/9. Both cultures isolated Candida parapsilosis sensitive to amphotericin. These patient cases highlight that evacuation of the anterior chamber infiltration in recalcitrant fungal keratitis and intracameral injection of amphotericin B can be an effective adjuvant therapy.
Fulltext A Rare Complication of Herpes Zoster Ophthalmicus (HZO)

Phang DSK, Ettikan JV, Abd Aziz H, Vendargon FM, Sonny Teo KS

Cureus, 2023 Mar;15(3):e35693.
PMID: 37012964 DOI: 10.7759/cureus.35693

Retrobulbar optic neuritis is a rare complication of herpes zoster ophthalmicus (HZO). We report a case of a 27-year-old man who presented with a progressive left blurring of vision for one week. A history of vesicular rashes in the left trigeminal nerve area preceded his condition. On examination, we noted that his left eye visual acuity was hand movement, and his optic nerve function was reduced. Findings from examining the anterior segment and intraocular pressure were unremarkable. The fundus examination results were normal. A blood investigation was positive for human immunodeficiency virus (HIV). MRI showed hyperintense features of the intraorbital segment of the optic nerve in the T2-weighted image. An abnormal high signal on a T2 weighted image may be present, which may be a clue for varicella zoster associated complications, such as HZO-related optic neuritis. Therefore, a diagnosis of retrobulbar optic neuritis was made, and antiviral treatment was initiated. He received two weeks of IV acyclovir and switched to the oral route for one month. After the completion of the treatment, his visual acuity remained the same.