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Background: Progressive outer retinal necrosis (PORN) is a necrotizing chorioretinopathy caused by herpes simplex virus, varicella-zoster virus, or cytomegalovirus. Objective: To describe the clinical morphology of PORN presenting with asymmetrical isolated bilateral retrobulbar optic neuropathy. Method: The medical records of a 45-year-old human immunodeficiency virus infected patient presenting with bilateral visual loss at King Chulalongkorn Memorial Hospital were reviewed with respect for the privacy of patient. Result: Gradual visual loss progressed to no light perception in the right eye and 20/200 in the left eye within 1 month. The patient was initially diagnosed with retrobulbar optic neuritis in both eyes. The investigations included MRI, vitreous tapping, lumbar puncture, and serological testing. MRI elicited enhancement around both optic nerves, which suggested optic neuritis. Thereafter, multifocal areas of retinal necrosis developed with rapid progression and additional cutaneous zoster lesions were established. These findings led to a diagnosis of PORN. The patient was promptly treated with intravenous ganciclovir, anti-retroviral therapy, and vitrectomy with endophotocoagulation and silicone injection. Unfortunately, his visual prognosis in the left eye was still poor Conclusion: PORN was uncommonly present with bilateral isolated optic neuropathy before retinal lesions developed. Retrobulbar optic neuropathy from herpetic infection in immunocompromised patients should be considered despite a normal fundus at initial presentation. Early diagnosis and prompt intervention may preserve vision. This case demonstrates the importance of careful physical examination and follow up of retinal lesions.

To study the profiles and antimicrobial susceptibility pattern of isolated bacteria from visual threatening ocular infection.This is a retrospective review of all microbiological culture reports from visual threatening ocular infection patients admitted at King Chulalongkorn Memorial Hospital from 2005 to 2009. The culture reports with antimicrobial susceptibility pattern were analyzed and correlated with clinical presentation.There were 682 specimens from 282 patients (286 eyes). Three most common diagnoses were corneal ulcer, endophthalmitis and scleritis, which yielded positive culture of 31.1% (38/122 eyes), 24.2% (25/103 eyes), and 55.6% (5/9 eyes), respectively. Overall, positive cultures were demonstrated from 77 eyes (27%). Pseudomonas aeruginosa was the most common causative pathogens of corneal ulcer and scleritis, while Enterococcus faecalis was the most common pathogens of endophthalmitis. All isolated Pseudomonas spp. were susceptible to ciprofloxacin with 4% resistance to both gentamicin and amikacin. Enterococcus faecalis demonstrated 50% of intermediate resistance to ciprofloxacin. There was no methicillin-resistant Staphylococcus aureus identified.Overall positive cultures obtained from visual threatening ocular infection from a 5 year-review were 27%. Microbial profile remained stable from 2005 to 2009, and antimicrobial resistance was not obviously observed in our study. The findings may be used as guidelines for the prompt management of antimicrobial agents used in presumed severe bacterial ocular infection, in order to prevent devastating ocular tissue damage.