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Endophthalmitis is a severe condition caused by inflammation of the ocular cavity that often is associated with infection of the internal structures of the eye. The source of infection can include bacteria disseminated through the bloodstream and contamination of the cornea at the time of ocular surgery or trauma. Complications include rapid, reversible vision loss that can progress quickly to panophthalmitis, requiring surgical removal of the eye. Clostridium perfringens, an anaerobic gram-positive bacillus found in soil and bowel flora, is an infrequent cause of endophthalmitis. Although the majority of cases are caused by penetrating injury with soil-contaminated foreign bodies, C. perfringens endophthalmitis has been reported in patients after cataract surgery. This report describes two cases of C. perfringens endophthalmitis that occurred within 24 hours after transplant of contaminated corneas. These cases demonstrate the potential for transmission of Clostridium infection from donor to recipient. Clinicians should be aware of potential infection risks associated with transplantation of corneal tissues and report any infections to the appropriate eye bank.

Objective: To study the distribution, current trends, and patterns of resistance to antimicrobial agents of bacterial keratitis isolates in South Florida., Design: Retrospective, observational, case series., Participants: The microbiology records of all patients with bacterial keratitis seeking treatment at the Bascom Palmer Eye Institute from January 1, 1990 through December 31, 1998 were reviewed., Main Outcome Measures: In vitro laboratory minimum inhibitory concentration testing of the corneal isolates to the fluoroquinolones (ofloxacin and ciprofloxacin) and to the aminoglycosides (tobramycin and gentamicin) was performed using the Vitek (Automatic Microbial System Biomerieux Vitek, Inc., Hazelwood, Missouri) method., Results: During this 9-year period, 2920 consecutive corneal cultures were obtained, and a pathogen was recovered in 1468 cultures (50%). The number of corneal ulcers scraped, positive cultures, recovered bacterial isolates, and ratio of gram-positive to gram-negative isolates per year remained approximately equal throughout the study period. Staphylococcus aureus and Pseudomonas aeruginosa represented 19.4% and 25.7%, respectively, of the total bacterial isolates during this period. However, we documented a gradual increase in the number of S. aureus keratitis isolates (29% of gram-positive organisms in 1990 versus 48% in 1998, P = 0.01) coupled with a decrease in the number of P. aeruginosa isolates (54% of gram-negative organisms in 1990 versus 46% in 1998). A decrease in the incidence of contact lens-associated keratitis and P. aeruginosa isolates in this group of patients was documented. Serratia marcescens and P. aeruginosa were most commonly isolated in contact lens-associated keratitis (18% each). There was increasing laboratory resistance of S. aureus keratitis isolates to the fluoroquinolones (11% in 1990 to 28% in 1998), but resistance patterns to the aminoglycosides remained unchanged. There was a three-fold increase in the percentage of resistant S. aureus isolates to fluoroquinolones between 1990 and 1994 and between 1995 and 1998. Both fluoroquinolones and aminoglycosides exhibited low in vitro effectiveness against P. aeruginosa throughout the study period., Conclusions: The increased recovery of S. aureus keratitis isolates and decreased laboratory effectiveness against fluoroquinolones to these pathogens present an important therapeutic challenge.

Objective: This study aimed to review the clinical features, therapeutic response, and histopathology of cases of nontuberculous mycobacterial keratitis at the Bascom Palmer Eye Institute., Design and Participants: Retrospective review of medical records, clinical photographs, histopathology, and microbiology of 24 cases of nontuberculous acid-fast keratitis over the past 15 years., Results: Causal organisms included Mycobacterium chelonae (16), M. fortuitum (3), M. avium-intracellulare (2), M. nonchromogenicum (1), M. triviale (1), and M. asiaticum (1). Clinically, the keratitis had a superficial location except in those patients with a history of surgery. Amikacin was the most commonly used antibiotic (63%). Three patients were treated with Clarithromycin. In one patient, it was stopped because of toxicity; the other two had resolution of their infiltrates. Fifty-five percent did not respond to topical antimicrobial therapy. The organisms as a group were sensitive to amikacin and Clarithromycin and resistant to the fluoroquinolones. Sixty-four percent of the group that failed to respond to medical treatment were treated with steroids after the diagnosis was known, in comparison to 44% of the group treated successfully with medications. The histopathology of the patients treated with steroids showed minimal inflammation despite a large number of organisms, in contrast to the dense infiltrates seen in the specimens from patients not treated with topical steroids., Conclusion: Nontuberculous mycobacterial keratitis is a chronic insidious infection that is often unresponsive to medical therapy. The authors recommend that steroids be withheld. Based on the authors' experience of three patients, topical Clarithromycin may hold promise as a therapeutic agent. Lamellar keratectomy or penetrating keratoplasty should be considered in those patients who do not respond to medical therapy or those who have recurrent exacerbations on attempted weaning of topical antibiotic therapy.

Purpose: To describe current practice patterns in treating infectious keratitis., Methods: A questionnaire was designed that asked ophthalmologists to describe the diagnostic equipment accessible to their practice for performing smears and obtaining scrapings for microbial culture and sensitivity testing. The questionnaire also presented two hypothetical cases of patients with infectious keratitis. Bacterial keratitis was relatively early and less severe in the first patient, and it was more advanced and more severe in the second patient. Recipients were asked about their diagnostic and therapeutic approach. The survey was mailed to 300 ophthalmologists in Florida, Illinois, and New York., Results: One hundred twenty-four completed surveys (45%) were returned. Six surveys were from cornea specialists, who were excluded from the analysis. Only 18 practices (15%) maintained access to Gram stain supplies, and 58 (50%) maintained culture supplies. Whereas 56% of respondents would treat the patient with the less severe bacterial keratitis without obtaining samples for cultures, only 13% would treat the patient with the more severe condition in this manner (P<0.00001). Of the respondents, 82% would treat the patient with the less severe bacterial keratitis with a fluoroquinolone, compared with 62% for the patient with the more severe infection (P=0.002). The mean frequency of fluoroquinolone administration for the patient with more-severe bacterial keratitis was one drop every 0.88 hours, compared with one drop every 1.48 hours for the patient with the less severe infection., Conclusions: Ophthalmologists appear to treat suspected infectious keratitis differently, depending on perceived severity; they choose different antibiotic regimens; and are more likely to forgo scrapings for Gram staining and cultures for ulcers that appear less severe. The justification for this approach should be established.

A total of 151 eyes from healthy psittacine birds were examined by bacteriologic cultural methods. Bacterial growth was not found in 41% of eyes cultured, Staphylococcus epidermidis was found in 25%, alpha-hemolytic streptococci in 25%, Corynebacterium spp in 7%, and Staphylococcus aureus in 5%. Each of the following organisms were found in 1% of the eyes; Pasteurella spp, Actinobacillus spp, Escherichia coli, Klebsiella spp, Enterobacter spp, Pseudomonas spp, Proteus spp, and Bacillus spp. More than one bacterial species was found in numerous eyes. Psittacines from an import station had a greater occurrence of ocular bacterial growth than did birds from private owners. The frequency of ocular bacterial growth and types of bacteria isolated were similar to studies from dogs and cats.