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New approaches to the diagnosis and management of microbial endophthalmitis

Okhravi, Narciss; (1999) New approaches to the diagnosis and management of microbial endophthalmitis. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Endophthalmitis is a devastating ocular disease in which, despite adequate antibiotic cover, the final visual outcome for patients remains poor. In the search for other treatment modalities to aid in the management of these cases, the use of clarithromycin, as an anti-biofilm agent, was investigated. Results indicated that a greater number of culture negative cases demonstrated an improvement in vision of 6 Snellen lines when clarithromycin was used. In cases of presumed bacterial endophthalmitis, early diagnosis and appropriate treatment have been noted to be associated with a better visual outcome but currently, confirmation of the diagnosis of endophthalmitis (bacterial and / or fungal) is dependent on conventional techniques of microbiological isolation of organisms which require between 1-12 days. Furthermore, many samples prove to be culture negative. In this study, PCR technology has been successfully applied to the detection of bacteria and fungi in ocular samples from eyes with suspected endophthalmitis. Oligonucleotide primers based on the conserved sequences of the 16S rRNA gene (bacteria) and lanosterol 14 α-demethylase (Candida spp.), have been used to detect the presence of these pathogens. Restriction endonuclease digestion, DNA sequencing and cloning of the PCR product were used to enable species identification. Results demonstrated that PCR-based methods are able rapidly to confirm the presence of pathogens with high specificity and sensitivity. PCR based techniques have also been used to rule out with confidence the presence of pathogens, a unique advantage of this methodology. The use of molecular methods has significantly increased the number of intraocular samples from which a confirmed diagnosis is made and reduced the time to laboratory diagnosis. PCR based methods have demonstrated great potential in the rapid detection and identification of bacteria and Candida spp. in ocular samples and promise to provide a useful diagnostic tool for the future.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: New approaches to the diagnosis and management of microbial endophthalmitis
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Thesis digitised by ProQuest.
Keywords: Health and environmental sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10104378
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