EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78716
March 2012 Tears Again advanced Liposome Spray ® RECOMMENDED FOR MGD As seen in The International Workshop on Meibomian Gland Dysfunction mycobacterial infections, there aren't necessarily clinical signs to point the way to a diagnosis. In- stead, it is more what isn't happen- ing that is indicative. "If a patient is presenting with an infection that seems to be recalcitrant to typical antimicrobial therapy, if it's a pro- longed time, that really should alert you to mycobacterial infection," Dr. Girgis said. If after culture it is determined to be a mycobacterial infection, treatment needs to be tailored ac- cordingly. Typically, Dr. Girgis finds that such infections are the result of mycobacterial abscesses and che- lonae, which were sometimes com- bined. "They were most susceptible to amikacin and clarithromycin and less sensitive to the quinolones and linezolid," Dr. Girgis said. Even the amikacin and clar- ithromycin, which were often used together, may not be enough. "In our study, 69% of patients required some kind of surgical intervention in order to help with resolution of the infection," Dr. Girgis said. That could involve anything from simple amputation of a LASIK flap to the need for penetrating keratoplasty. "Surgical intervention was the hall- mark in almost 70% of those eyes in addition to prolonged therapy with these antimicrobial agents," she said. "The average time that it took between when the infection was di- agnosed to when it cleared in our study was about 146 days." Overall, Dr. Girgis hopes that practitioners keep the idea of my- cobacterial infection at the forefront when facing a challenging case. "I think that the take-home is prompt recognition of the fact that my- cobacteria should be on your differ- ential diagnosis, particularly in an infection that's not clearing or that seems to be prolonged and or associ- ated with a biomaterial," she said. Secondly, she urged prompt Gram- staining culture analysis to try to identify the species, and once a my- cobacterial infection is identified, recognition of the fact that removal of any biomaterial as well as possible surgical intervention may be neces- sary. EW Editors' note: Dr. Girgis has no financial interests related to this article. Contact information Girgis: 504-621-7683, dgirgis@uwhealth.org Improv ves TBUT and T T ear Fi Film Stability Save the Date! Saturday, April 21, 2012 7:00 – 9:30 AM McCormick Place 2012 ASCRS•ASOA Symposium and Congress www.eyeworld.org CME credit is not available for Corporate Mornings programs. *Nichols KK, Foulks GN, Bron AJ, Glasgow BJ, Dogru M, Tsubota K, Lemp MA, Sullivan DA. The International Workshop on Meibomian Gland Dysfunction, Investigative Ophthalmology & Visual Science, Special Issue 2011, Vol. 52, No. 4 © 2011 OCuSOFT, Inc. Rosenberg, TX 77471 "Dry Eye sufferers (particularly those with lipid deficiency) and Meibomian Gland Dysfunction patients do very well with Tears Again [advanced Liposome] Spray. Individuals that have difficulty instilling eye-drops should also be considered." Marguerite McDonald, MD, FACS For FREE samples and more information, call (800) 233-5469 or visit ASCRS Booth #1101 www.tearsagainspray.com OCuSOFFT OCuSOFT Lid Scrub Eyelid Cleansers Ideal to Use in ConjuIIdeal to Use in Conjunction with ® T ® Eyeli unction with id Cleansers Improves TBUT and Tear Film Stability So Soothes, Moisturizes and Protects oothes, Moisturizes and Protects and Protects Available at CVS pharmacy ay