BackgroundTo assess the sensitivity, specificity, positive predictive value and negative predictive value of anterior chamber tap for the diagnosis of bacterial endophthalmitis on a population with high prevalence.MethodsRetrospective, single centre, case series study. We reviewed all medical records with clinical diagnosis of bacterial endophthalmitis in our hospital from January 1st, 2000 to December 31st 2014. From each record, we documented general demographic data, best corrected visual acuity and vitreous and aqueous tap microbiological results. All cases were further divided according to the endophthalmitis aetiology to perform individual calculations of sensitivity, specificity, positive predictive value, negative predictive value, accuracy and prevalence. We used the results of the vitreous tap as the gold standard for diagnosis of bacterial endophthalmitis. We excluded those records in which the aqueous and vitreous samples were not taken simultaneously or had an incomplete microbiological report. Significance were assessed with chi squared statistics, with an alpha value of 0.05 for statistical significance.ResultsA total of 190 cases fulfilled the inclusion/exclusion criteria. Positive culture rate from vitreous samples was 64.74%. Positive culture rate from aqueous sample was 32.11%. Bacteria isolated from aqueous samples matched those isolated from vitreous samples 78.68% of the time. The overall sensitivity was 38.21%, specificity: 75.51%, positive predictive value: 79.66%, negative predictive value: 32.74% (p = 0.08). Subgroup analysis showed that anterior chamber taps in cases of post-surgical endophthalmitis had a moderate to low sensitivity (37.73%), high specificity (93%) and high positive predictive value (95%) (p < 0.04).ConclusionThe sensitivity and specificity of anterior chamber tap are low and should not be used for critical therapeutic decisions in patients with suspected bacterial endophthalmitis. In cases of post-surgical endophthalmitis, the result of an anterior chamber tap could be used for therapeutic guidance, but only in conjunction with clinical presentation and in the absence of a better method for diagnosis.

Purpose: To evaluate the clinical response of treatment-resistant choroidal neovascularization (CNV) to photodynamic therapy (PDT) combined with bevacizumab (BVZ) therapy. Methods: Retrospective, non-comparative evaluation of eyes diagnosed with CNV secondary to age-related macular degeneration that had no response after at least 3 intravitreal BVZ injections, who were treated with combined PDT+BVZ therapy, followed by subsequent monthly BVZ for a 6 months period. Main outcome measures were best-corrected visual acuity (BCVA) and central macular thickness (CMT) during a 6 month follow-up period after combined therapy. Results: Eleven patients (54.5% female, mean age 62 years) were included. Using ICG angiography, lesions were classified as polypoidal choroidal vasculopathy (PCV) 54.5%, arteriolized CNV 18.2% (2), and non-differentiable 27.3% (3). BCVA (logMAR) at baseline was 0.63 (20/85), increasing to 0.32 (20/40) 6 months after treatment (p = 0.04). Mean CMT before the intervention was 469 µm, decreasing to 289 µm 6 months after treatment (p = 0.01). Conclusion: Combined PDT+BVZ therapy appears to be effective in treatment-resistant CNV, with an improvement of BCVA and CMT after a 6-month period that was not observed with BVZ monotherapy. A high incidence of PCV and arteriolized CNV was observed in this group or treatment-resistant CNV cases. Terapia fotodinámica combinada con bevacizumab intravítreo para el tratamiento de neovascularización coroidea refractaria a tratamiento con monoterapia con bevacizumab, Serie de casos.

con bevacizumab intravítreo (BVZ) en neovascularizaciones coroideas (NVC) resistentes al tratamiento. Métodos: Evaluación retrospectiva, no comparativa, de ojos con diagnóstico de NVC secundaria a degeneración macular relacionada con la edad sin respuesta clínica después de al menos 3 inyecciones intravítreas de BVZ, a los que se administró TFD+BVZ combinados y posteriormente BVZ mensual durante un periodo de 6 meses. Las variables principales de desenlace incluyeron agudeza visual corregida (AVC) y grosor macular central (GMC) durante un seguimiento de 6 meses posteriores al tratamiento combinado. Resultados: Se incluyeron once pacientes (54.5% femenino, media de edad 62 años). Utilizando angiografía con ICG, las lesiones se clasificaron como vasculopatía coroidea polipoidea (VCP) en 54.4%, NVC arteriolizada en 18.2% (2) y no diferenciable en 27.3% (3). La AVC (logMAR) en la basal fue de 0.63 (20/85), mejorando a 0.32 (20/40) después del tratamiento (p = 0.04). La media de GMC antes de la intervención fue de 469 µm, mejorando a 289 µm seis meses después del tratamiento (p = 0.01). Conclusión: La terapia combinada con TFD+BVZ parece ser efectiva en casos de NVC resistentes a tratamiento, con mejoría de la AVC y el GMC después de un periodo de 6 meses de tratamiento que no se observó con la monoterapia con BVZ. En este grupo se observó una alta incidencia de VCP y NVC arteriolizada o casos de NVC resistentes al tratamiento. La adecuada clasificación del tipo de NVC asociada a una elevada resistencia puede ser útil para el tratamiento.

PurposeTo report a case of occlusive retinal vasculopathy, secondary to hyperhomocysteinemia.ObservationsA 43-year-old male was examined at the retina outpatient clinic due to complaints of bilateral decrease in visual acuity. The patient underwent a comprehensive ophthalmological examination, wide-field fundus photographs and fluorescein angiography, as well as spectral domain optical coherence tomography with enhanced-deep imaging. The patient had a significant medical history of chronic kidney disease and progressive bilateral vision loss over the last two years, which worsened in the left eye during the past 3 months. Fundus examination revealed a vitreous hemorrhage in the left eye and bilateral proliferative retinopathy. Blood glucose and systemic blood pressure were unremarkable. Plasma homocysteine was reported at >500 μmol/L, which is higher than the corrected reference range by age.Conclusion and ImportanceHyperhomocysteinemia is a rare but well-known disease, capable of accelerating atherosclerotic disease and generating a prothrombotic state that can lead to multiple systemic complications. Despite its low incidence, the disease should be part of the differential diagnosis in patients with bilateral proliferative retinopathy, in the absence of diabetes mellitus and systemic hypertension.

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