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Kato H, Yoshimura Y, Suido Y, Ide K, Sugiyama Y, Matsuno K, Nakajima H. Prevalence of, and risk factors for, hematogenous fungal endophthalmitis in patients with Candida bloodstream infection. Infection 2018; 46:635-640. [PMID: 29959658 DOI: 10.1007/s15010-018-1163-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/05/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE Endogenous fungal endophthalmitis (EFE) is a severe consequence of candidemia. The prevalence of, and risk factors for, EFE is not well studied. METHODS We retrospectively collected cases of patients with candidemia who had undergone ophthalmological examination between April 2011 and March 2016 in five regional hospitals. We conducted bivariate and multivariate analyses using patients' age, gender, causative Candida species, diabetes status, corticosteroid use, cancer status, neutropenia, intensive care unit admission, presence of central venous catheter (CVC), presence of shock, prior antibiotic use, 30-day mortality, and highest Sequential Organ Failure Assessment (SOFA) score. Data on sustained positive blood culture, β-D glucan, CVC removal, empirical antifungal drug used, and time to appropriate antifungal therapy were also collected if available. RESULTS Of 174 patients with candidemia, 35 (20.1%) were diagnosed with EFE, including 31 (17.8%) with chorioretinitis and 4 (2.3%) with vitritis. Bivariate analysis (EFE group vs. non-EFE group) found that Candida albicans candidemia (77.1 vs. 34.5%, P < 0.001), neutropenia (14.3 vs. 5.8%, P = 0.141), CVC placement (94.3 vs. 71.2%, P = 0.004), and the presence of shock (28.6 vs. 16.5%, P = 0.145) were each higher in the EFE group. Multivariate logistic regression analysis found C. albicans candidemia (adjusted odds ratio 6.48; [95% CI 2.63-15.95]) and CVC placement (7.55 [1.56-36.53]) to be significant risk factors for EFE. CONCLUSIONS Candida albicans is the most common causative agent for Candida EFE. Patients with candidemia and CVC placement should be closely monitored by ophthalmologists.
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Affiliation(s)
- Hideaki Kato
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Yukihiro Yoshimura
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan
| | - Yoshihiro Suido
- Department of Respiratory Medicine, Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa, 251-0052, Japan
| | - Kazuo Ide
- Infection Control Team, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-ku, Yokohama, 245-8575, Japan
| | - Yoshifumi Sugiyama
- Clinical Laboratory Department, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Kasumi Matsuno
- Department of Clinical Laboratory, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan
| | - Hideaki Nakajima
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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202
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Pietrowska K, Dmuchowska DA, Krasnicki P, Mariak Z, Kretowski A, Ciborowski M. Analysis of pharmaceuticals and small molecules in aqueous humor. J Pharm Biomed Anal 2018; 159:23-36. [PMID: 29980016 DOI: 10.1016/j.jpba.2018.06.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/22/2018] [Accepted: 06/24/2018] [Indexed: 01/02/2023]
Abstract
Aqueous humor (AH) is a transparent fluid found in the anterior chamber of the eye. The circulating AH nourishes the cornea and lens and removes the metabolic waste moving through the ocular chambers and drains from the eye to the venous blood. Analysis of drugs in AH is necessary to evaluate their pharmacokinetics parameters, which may be crucial to avoid potential adverse effects. Analysis of endogenous components of AH may help to understand its physiology as well as changes evoked by pathological situation. This review describes analytical methods used for determination of pharmaceuticals and small endogenous molecules in AH, focusing on sample preparation procedures and analytical techniques. Studies on human and animal samples are included. After inspection and filtering of records found in PubMed about 100 research papers were selected to review. In these articles AH samples of human and rabbit origin were studied most often. Sample evaporation and reconstitution in smaller solvent volume was the most popular method for analyte pre-concentration. Acetonitrile, methanol or mixture of both solvents were used most often for protein precipitation.
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Affiliation(s)
- Karolina Pietrowska
- Clinical Research Centre, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland
| | - Diana Anna Dmuchowska
- Department of Ophthalmology, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland
| | - Pawel Krasnicki
- Department of Ophthalmology, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland
| | - Zofia Mariak
- Department of Ophthalmology, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland
| | - Adam Kretowski
- Clinical Research Centre, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland
| | - Michal Ciborowski
- Clinical Research Centre, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland.
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Abstract
PURPOSE To report on a case of Fusarium solani subretinal abscess in a patient with acute myeloid leukemia treated with an allogenic bone marrow transplant. METHODS A 47-year-old male with a history of acute myeloid leukemia with intermediate cytogenetic risk was admitted in our hospital. The disease relapsed after two cycles of chemotherapy. He was then treated with an allogenic bone marrow transplant, with busulfan, cyclophosphamide, and thymoglobulin. One week after the procedure, a sepsis of unknown origin in neutropenia occurred. Blood cultures and sputum were negative for bacteria and fungi. At the eighth week after the procedure, the patient had acute vision loss of the right eye. Funduscopy in the right eye revealed an inferior temporal yellowish white elevated lesion of approximately 10 disk areas and superficial perifoveal and perilesional hemorrhages. RESULTS Vitrectomy was performed and samples from the vitreous and the subretinal abscess material were sent for analysis. Vitreous and subretinal specimens grew colonies of a fungus morphologically consistent with F. solani. CONCLUSION Fusarium solani should be included in the differential diagnosis of subretinal abscesses.
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TLR4 modulates inflammatory gene targets in the retina during Bacillus cereus endophthalmitis. BMC Ophthalmol 2018; 18:96. [PMID: 29661181 PMCID: PMC5902844 DOI: 10.1186/s12886-018-0764-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 04/03/2018] [Indexed: 02/07/2023] Open
Abstract
Background Endophthalmitis is a serious intraocular infection that frequently results in significant inflammation and vision loss. Because current therapeutics are often unsuccessful in mitigating damaging inflammation during endophthalmitis, more rational targets are needed. Toll-like receptors (TLRs) recognize specific motifs on invading pathogens and initiate the innate inflammatory response. We reported that TLR4 contributes to the robust inflammation which is a hallmark of Bacillus cereus endophthalmitis. To identify novel, targetable host inflammatory factors in this disease, we performed microarray analysis to detect TLR4-dependent changes to the retinal transcriptome during B. cereus endophthalmitis. Results C57BL/6 J and TLR4−/− mouse eyes were infected with B. cereus and retinas were harvested at 4 h postinfection, a time representing the earliest onset of neutrophil infiltration. Genes related to acute inflammation and inflammatory cell recruitment including CXCL1 (KC), CXCL2 (MIP2-α), CXCL10 (IP-10), CCL2 (MCP1), and CCL3 (MIP1-α)) were significantly upregulated 5-fold or greater in C57BL/6 J retinas. The immune modulator IL-6, intercellular adhesion molecule ICAM1, and the inhibitor of cytokine signal transduction SOCS3 were upregulated 25-, 11-, and 10-fold, respectively, in these retinas. LIF, which is crucial for photoreceptor cell survival, was increased 6-fold. PTGS2/COX-2, which converts arachidonic acid to prostaglandin endoperoxide H2, was upregulated 9-fold. PTX3, typically produced in response to TLR engagement, was induced 15-fold. None of the aforementioned genes were upregulated in TLR4−/− retinas following B. cereus infection. Conclusions Our results have identified a cohort of mediators driven by TLR4 that may be important in regulating pro-inflammatory and protective pathways in the retina in response to B. cereus intraocular infection. This supports the prospect that blocking the activation of TLR-based pathways might serve as alternative targets for Gram-positive and Gram-negative endophthalmitis therapies in general. Electronic supplementary material The online version of this article (10.1186/s12886-018-0764-8) contains supplementary material, which is available to authorized users.
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205
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Fliney GD, Pecen PE, Cathcart JN, Palestine AG. Trends in treatment strategies for suspected bacterial endophthalmitis. Graefes Arch Clin Exp Ophthalmol 2018; 256:833-838. [DOI: 10.1007/s00417-018-3910-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/07/2017] [Accepted: 01/12/2018] [Indexed: 01/28/2023] Open
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O'Callaghan RJ. The Pathogenesis of Staphylococcus aureus Eye Infections. Pathogens 2018; 7:pathogens7010009. [PMID: 29320451 PMCID: PMC5874735 DOI: 10.3390/pathogens7010009] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/02/2018] [Accepted: 01/04/2018] [Indexed: 02/07/2023] Open
Abstract
Staphylococcus aureus is a major pathogen of the eye able to infect the tear duct, eyelid, conjunctiva, cornea, anterior and posterior chambers, and the vitreous chamber. Of these infections, those involving the cornea (keratitis) or the inner chambers of the eye (endophthalmitis) are the most threatening because of their potential to cause a loss in visual acuity or even blindness. Each of these ocular sites is protected by the constitutive expression of a variety of antimicrobial factors and these defenses are augmented by a protective host response to the organism. Such infections often involve a predisposing factor that weakens the defenses, such as the use of contact lenses prior to the development of bacterial keratitis or, for endophthalmitis, the trauma caused by cataract surgery or intravitreal injection. The structural carbohydrates of the bacterial surface induce an inflammatory response able to reduce the bacterial load, but contribute to the tissue damage. A variety of bacterial secreted proteins including alpha-toxin, beta-toxin, gamma-toxin, Panton-Valentine leukocidin and other two-component leukocidins mediate tissue damage and contribute to the induction of the inflammatory response. Quantitative animal models of keratitis and endophthalmitis have provided insights into the S. aureus virulence and host factors active in limiting such infections.
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Affiliation(s)
- Richard J O'Callaghan
- Department of Microbiology and Immunology, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS 39216, USA.
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207
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Lee M, Choi EY, Lee SC, Kim M. A Case of Fungal Endophthalmitis after Having Received Extraction of Wisdom Tooth in Healthy Woman. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.3.282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Minwoo Lee
- The Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Young Choi
- The Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Chul Lee
- The Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kim
- The Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Yamamoto S, Ikeda M, Fujimoto F, Okamoto K, Wakabayashi Y, Sato T, Tatsuno K, Kaburaki T, Yoshida S, Okugawa S, Koike K, Moriya K. Bilateral Candida endophthalmitis accompanying Candida lusitaniae bloodstream infection: A case report. J Infect Chemother 2017; 24:147-149. [PMID: 29102349 DOI: 10.1016/j.jiac.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/30/2017] [Accepted: 10/03/2017] [Indexed: 01/05/2023]
Abstract
Candida lusitaniae is an uncommon cause of candidiasis in humans. Ocular manifestations of C. lusitaniae infection have not been reported. C. lusitaniae is either intrinsically resistant to amphotericin B or can acquire such resistance. We describe a case of bilateral endophthalmitis due to C. lusitaniae bloodstream infection in a liver transplant patient with rectal cancer. The patient suffered fungemia and endophthalmitis and was treated with liposomal amphotericin B. The isolate was identified as C. lusitaniae by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, the system based on biochemical tests, and sequencing of the internal transcribed spacer region. The minimal inhibitory concentrations were 0.06 μg/mL for amphotericin B and 2.0 μg/mL for fluconazole. Repeat blood cultures were negative and the endophthalmitis improved following treatment with liposomal amphotericin B. However, the treatment was changed to fluconazole due to nephrotoxicity. No recurrence occurred after completion of treatment.
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Affiliation(s)
- Shinya Yamamoto
- Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mahoko Ikeda
- Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan; Department of Infection Control and Prevention, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Fumie Fujimoto
- Department of Infection Control and Prevention, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koh Okamoto
- Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshitaka Wakabayashi
- Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tomoaki Sato
- Department of Infection Control and Prevention, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keita Tatsuno
- Department of Infection Control and Prevention, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shuntaro Yoshida
- Department of Gastroenterology, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shu Okugawa
- Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Kazuhiko Koike
- Department of Gastroenterology, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kyoji Moriya
- Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan; Department of Infection Control and Prevention, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Lin ZN, Chen J, Zhang Q, Li Q, Cai MY, Yang H, Cui HP. The 100 most influential papers about cataract surgery: a bibliometric analysis. Int J Ophthalmol 2017; 10:1586-1591. [PMID: 29062780 DOI: 10.18240/ijo.2017.10.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/17/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To identify the 100 most cited papers in cataract surgery, we performed a comprehensive bibliometric analysis basing on the literature search on the Thomson Reuters Web of Knowledge. METHODS The number of citations, including the total citations, latest 5y citations and average citation number per year (ACY), authorship, year of publication, major topics, journal of publication, country and institution of origin of each paper were recorded and then analyzed. Pearson's correlation analysis was conducted to evaluate the correlation between the published year and the number of citations. The correlation between journal's impact factor (IF) and number of citations was assessed as well. RESULTS The most cited paper was the classic paper done by the European Society of Cataract & Refractive Surgeons (ESCRS) group. This paper focused on the topic of endophthalmitis. Not only the most cited papers originated from the USA, but also some American institutions like Johns Hopkins University, Harvard Medical School, etc. had the most citations. Pearson's correlation analysis indicated that the latest 5y citations and ACY were significantly related with the published year (5y citations: r=0.615, P<0.001; ACY: r=0.657, P<0.001), whereas no association between the total number of citations and published year was found (r=0.045). Moreover, the IFs of journals were found to have no significant effect on the number of total citations. CONCLUSION To our knowledge, this is the first study on the most influential papers in cataract surgery after a comprehensive research of relevant literatures. The present work may provide us concise information concerning the development history of cataract surgery over the past 66y.
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Affiliation(s)
- Ze-Nan Lin
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China.,Centre for Ophthalmology, Eberhard-Karls University of Tuebingen, Tuebingen 72076, Germany
| | - Jie Chen
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Qi Zhang
- Department of Neurosurgery, Eberhard-Karls University of Tuebingen, Tuebingen 72076, Germany
| | - Qian Li
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Min-Yun Cai
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Hai Yang
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Hong-Ping Cui
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
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210
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E Silva FB, Carrijo-Carvalho LC, Teixeira A, de Freitas D, Carvalho FRDS. Toxicity of Intracameral Injection of Fourth-Generation Fluoroquinolones on the Corneal Endothelium. Cornea 2017; 35:1631-1637. [PMID: 27490050 DOI: 10.1097/ico.0000000000000967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of this study was to compare the cellular susceptibility patterns and morphologic changes in the corneal endothelium associated with the use of fourth-generation fluoroquinolones. METHOD Endothelial susceptibility was assessed through intracameral injection of besifloxacin, gatifloxacin, and moxifloxacin. Human umbilical vein endothelial cells (HUVECs) were used as the standard cellular lineage to assess the quantitative toxicity of each antibiotic solution. Qualitative changes in the morphologic character of the corneal structure and the endothelial layer were generated using a combination of ex vivo and in vivo assays. Experimental assays were conducted in triplicate, and the results were statistically analyzed. RESULTS At 1 hour of exposure, all HUVECs exposed to antibiotics showed viability above 85%, after 3 hours of exposure to besifloxacin, gatifloxacin, and moxifloxacin, the percentages of viable cells were 68.3 ± 4.0 (P < 0.001), 90.7 ± 4.2 (P < 0.05), and 93.3 ± 1.5 (P > 0.05), respectively. All fluoroquinolones tested showed toxicity to HUVECs, resulting in significant (P < 0.001) loss of cellular viability after 24 hours of drug exposure. Giant endothelial cells were observed in animals treated with the 3 fluoroquinolones in contrast to the absence of these abnormal cells in the untreated group. Early cellular detachment was seen in the endothelial layer after exposure to gatifloxacin and moxifloxacin. CONCLUSIONS We concluded that injection of fourth-generation fluoroquinolones in the aqueous humor did not adversely affect the corneal endothelium. However, these results suggested that prophylactic intracameral injection of besifloxacin, gatifloxacin, or moxifloxacin, if needed, should be administered as a last therapeutic resource in clinical practice, with careful and constant monitoring of corneal endothelium.
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Affiliation(s)
- Francisco Bandeira E Silva
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo, São Paulo, Brazil
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211
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Razeghinejad MR, Havens SJ, Katz LJ. Trabeculectomy bleb-associated infections. Surv Ophthalmol 2017; 62:591-610. [DOI: 10.1016/j.survophthal.2017.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 01/25/2017] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
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212
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Getahun E, Gelaw B, Assefa A, Assefa Y, Amsalu A. Bacterial pathogens associated with external ocular infections alongside eminent proportion of multidrug resistant isolates at the University of Gondar Hospital, northwest Ethiopia. BMC Ophthalmol 2017; 17:151. [PMID: 28830451 PMCID: PMC5567627 DOI: 10.1186/s12886-017-0548-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/14/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND External ocular infection is a public health problem in Ethiopia. The aim of this study was to determine the prevalence and antimicrobial susceptibility pattern of external ocular bacterial infections. METHODS A cross sectional study was conducted at the University of Gondar Hospital among patients seeking health services at the Department of Ophthalmology from January to April, 2016. All patients with suspected external ocular infections were examined under slit lamp microscope. External ocular samples were collected using aseptic techniques. All samples were investigated by culture and bacteria were identified using standard methods. Drug susceptibility test was done using the Kirby-Bauer Disk diffusion method according to the guidelines of Clinical and Laboratory Standard Institute (CLSI). RESULT A total of 312 samples were collected and 58.3% were culture positive. The proportion of Gram positive bacterial pathogens was (88%), and Staphylococcus aureus (50.3%) was the predominantly isolated pathogen, followed by Coagulase negative staphylococci (CoNS) (33.5%) and Klebsiella species (4.7%). Conjunctivitis was the dominant clinical feature, but a high positive result for bacterial pathogens was observed among patients with dacryocystitis cases. The Gram positive bacterial isolates were susceptible to ciprofloxacin, chloramphinicol, amoxicillin-clavulanate and ceftriaxone. However, 65% of these Gram positive bacterial pathogens showed resistance to penicillin, ampicillin and amoxicillin. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection was 24% and multidrug resistance (MDR) was observed in 87% of the isolated bacteria. CONCLUSION Conjunctivitis was the dominant ophthalmic disease followed by blepharitis. The dominant bacteria species was S. aureus and MRSA infection is increasingly prevalent. The overall MDR bacterial pathogen proportion was very high. The high prevalence of MRSA and MDR bacterial pathogens dictate the need for effective prevention as important as for therapies.
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Affiliation(s)
- Ergibnesh Getahun
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences (CMHS), University of Gondar (UOG), P.O. box 196, Gondar, Ethiopia
| | - Baye Gelaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences (CMHS), University of Gondar (UOG), P.O. box 196, Gondar, Ethiopia.
| | - Abate Assefa
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences (CMHS), University of Gondar (UOG), P.O. box 196, Gondar, Ethiopia
| | - Yared Assefa
- Department of Ophthalmology, School of Medicine, CMHS, UOG, P.O. box 196, Gondar, Ethiopia
| | - Anteneh Amsalu
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences (CMHS), University of Gondar (UOG), P.O. box 196, Gondar, Ethiopia
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Abstract
Endophthalmitis is a rare but severe form of ocular inflammation due to infection of the intraocular cavity that can lead to irreversible visual loss if not treated properly and timely. It can be classified as exogenous or endogenous based on the transmission route of the infectious source. Exogenous endophthalmitis occurs when infecting organisms gain entry into the eye via direct inoculation, while endogenous endophthalmitis occurs when infectious agents hematogenously spread into the eye from a distant focus of infection. The diagnosis of endophthalmitis depends mostly on the clinical findings on ophthalmological examination. Delayed diagnosis of endogenous endophthalmitis can lead to not only visual loss, but also increased risk of mortality. Since ocular and systemic symptoms of endophthalmitis are usually non-specific, early diagnosis relies on the alertness of clinicians. Early diagnosis and proper treatment are keys to saving the eye. Following advances in vitreoretinal pharmacotherapy and surgical technology, early surgical intervention is the current trend in the management of endophthalmitis.
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Affiliation(s)
- Shwu Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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214
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Ryan L, Higgins G, Doyle M. Aeromonas species endogenous endophthalmitis. JMM Case Rep 2017; 4:e005094. [PMID: 29026621 PMCID: PMC5630963 DOI: 10.1099/jmmcr.0.005094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/18/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction: Aeromonas spp. are Gram-negative bacteria classically associated with water sources and a variety of clinical infections in humans. Case presentation: A 79-year-old female patient presented with gastroenteritis with associated Aeromonas spp. bloodstream infection. Two days after admission she developed eye symptoms and was diagnosed with endophthalmitis and underwent emergency evisceration and implant. Aeromonas spp. was also recovered from intra-ocular samples. Conclusion: In this case gastroenteritis caused by Aeromonas spp. was complicated by bloodstream infection which seeded to the eye, resulting in rapidly progressive endogenous endophthalmitis.
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Affiliation(s)
- Laura Ryan
- Department of Microbiology, University Hospital Waterford, Waterford, Ireland
| | - Gareth Higgins
- Department of Ophthalmology, University Hospital Waterford, Waterford, Ireland
| | - Maeve Doyle
- Department of Microbiology, University Hospital Waterford, Waterford, Ireland
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Importance of Lid Hygiene Before Ocular Surgery: Qualitative and Quantitative Analysis of Eyelid and Conjunctiva Microbiota. Eye Contact Lens 2017; 42:366-370. [PMID: 26657662 PMCID: PMC5098457 DOI: 10.1097/icl.0000000000000221] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective: To evaluate the efficacy of a cleansing eyelid wipe in reducing the microbiota present on the ocular surface before cataract surgery. Methods: A single-center, prospective, single-blind phase IV study was conducted at the University Complutense of Madrid. Forty-five adult patients who were scheduled for ocular surgery after treatment with commercially available eyelid wipes were consecutively enrolled. The study lasted 5 days and the patients were examined at day 0 (D0), day 3 (D3), and day 5 (D5). They received instructions to apply the eyelid wipe only to the eye subject to surgery, using the other eye as a control with no treatment. Lid and conjunctival swabs were taken on each day and microbes identified. Ocular surface microbiota was estimated by measuring the area of the agar plate occupied by the grown colonies with respect to the total available area. Results: Measurements at D3 and D5 showed a percent reduction of 58% and 63%, respectively, in the microbial load on the eyelid in the treated eyes (P=0.0011). There was also a reduction, although nonsignificant, in the microbiota of the conjunctiva of 72% and 69% on D3 and D5, respectively. Conclusions: The degree of microbiota reduction was comparable with that obtained after topical application of antibiotics in other studies. The results suggest the use of these eyelid wipes as a complementary prophylactic method before any ocular surgery.
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Modjtahedi BS, Finn AP, Papakostas TD, Durand M, Husain D, Eliott D. Intravenous Drug Use-Associated Endophthalmitis. Ophthalmol Retina 2017; 1:192-199. [PMID: 31047420 DOI: 10.1016/j.oret.2016.10.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To characterize features and outcomes of intravenous drug use (IVDU)-associated endophthalmitis. DESIGN Retrospective cross-sectional study. METHODS A retrospective chart review of all cases of endophthalmitis seen between September 2006 and November 2014 at a single academic referral center was performed. All cases of IVDU-associated endophthalmitis were identified and characterized. MAIN OUTCOME MEASURES Ophthalmic examination findings, microbial results, visual outcomes, and secondary ocular sequelae. RESULTS Thirty patients (32 eyes) with IVDU-associated endophthalmitis were identified, which represented 9% of all endophthalmitis patients (n = 338) and 44% of all endogenous endophthalmitis patients (n = 68). Mean follow-up was 11 months. All eyes had vitritis, 6 had hypopyon, and 2 had subretinal abscesses. Twenty eyes had macular involvement, 8 eyes had no macular involvement, and media opacities precluded macular assessment in 4 eyes. Initial treatment was needle vitreous biopsy with intravitreal antibiotics ("tap and inject") in 25 eyes (78%) and pars plana vitrectomy (PPV) in 6 eyes (19%); 1 patient refused ocular treatment. An organism was identified from at least 1 source in 75% of eyes (24/32): 59% fungal, 16% bacterial, 22% negative cultures, and 3% refused ocular cultures. Mean visual acuity improved significantly between initial examination and final follow-up (1.64 logMAR to 0.91 logMAR, P < 0.0001). At final follow-up, 90% of eyes had improved vision compared with presentation, 31% of eyes had 20/40 or better vision, and 25% of eyes had 20/200 or worse vision. Twenty-one eyes (66%) required PPV for their infection-6 initially and 15 secondarily after tap and inject. Sixty-nine percent of eyes (9/13) that had cultures sent from a secondary PPV had positive cultures, despite almost all receiving appropriate intravitreal antibiotic therapy at the time of the tap and inject. Eight patients (27%) had extraocular signs of infection. Twenty eyes (63%) suffered secondary ocular sequelae. CONCLUSIONS This represents the largest series of IVDU-associated endophthalmitis. Bacterial etiologies constitute an important share of cases. A majority of patients eventually required PPV and there was frequent culture positivity even after tap and inject with appropriate antibiotics; therefore, early PPV may have an important role in management.
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Affiliation(s)
- Bobeck S Modjtahedi
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Avni P Finn
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Thanos D Papakostas
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Marlene Durand
- Infectious Disease Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Deeba Husain
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Dean Eliott
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
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217
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Nguyen VD, Singh AK, Altmeyer WB, Tantiwongkosi B. Demystifying Orbital Emergencies: A Pictorial Review. Radiographics 2017; 37:947-962. [DOI: 10.1148/rg.2017160119] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Viet D. Nguyen
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229
| | - Achint K. Singh
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229
| | - Wilson B. Altmeyer
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229
| | - Bundhit Tantiwongkosi
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229
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218
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Sauer A, Candolfi E, Gaucher D, Creuzot-Garcher C, Bron A, Chiquet C, Berrod JP, Meyer N, Prevost G, Bourcier T. Intraocular Cytokine Levels in Post-Cataract Endophthalmitis and their Association with Visual Outcome. Ocul Immunol Inflamm 2017; 26:964-970. [PMID: 28453374 DOI: 10.1080/09273948.2017.1310253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The host immune reaction during endophthalmitis, studied in particular through the intraocular cytokine network, is essential for the comprehension of the disease and the development of new therapies. Therefore, the purpose of this study was to elucidate the cytokine composition of aqueous humor during endophthalmitis. METHODS In a multicenter case-control study, forty-nine patients with postoperative endophthalmitis and 60 controls (cataract surgery) were included. Visual acuity, local inflammatory grading, medical history and intraocular levels of 27 cytokines and chemokines (measured by multiplex immunoassay) were recorded. RESULTS During endophtalmitis, an increase in total cytokines was observed. The raise of Th1 cytokines was particularly noticeable. Chemokines, such as IL-8, MIP-1 β, MCP-1, G-CSF and IP-10, also increased. Pearson's correlation analyses showed a poor visual prognosis with high levels of IL-8, MCP-1 and VEGF and a low level of IL-10 at admission. CONCLUSION An increase in inflammatory cytokines is noticeable during endophthalmitis, with a particular emphasis on IL-8, MCP-1 and VEGF. Targeted anti-inflammatory and anti-VEGF treatments may be of interest in the future.
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Affiliation(s)
- Arnaud Sauer
- a Fédération de Médecine Translationnelle, Service d'Ophtalmologie , Université de Strasbourg - CHU Strasbourg , Strasbourg , France
| | - Ermanno Candolfi
- b Institut de Parasitologie et de pathologies tropicales, Université de Strasbourg - CHU de Strasbourg , Strasbourg , France
| | - David Gaucher
- a Fédération de Médecine Translationnelle, Service d'Ophtalmologie , Université de Strasbourg - CHU Strasbourg , Strasbourg , France
| | | | - Alain Bron
- c Service d'Ophtalmologie , Centre Hospitalier Universitaire de Dijon , Dijon , France
| | - Christophe Chiquet
- d Service d'Ophtalmologie , Centre Hospitalier Universitaire de Grenoble , Grenoble , France
| | - Jean-Paul Berrod
- e Service d'Ophtalmologie , Centre Hospitalier Universitaire de Nancy , Nancy , France
| | - Nicolas Meyer
- f Service de Méthodologie et Biostatistiques , Hôpitaux Universitaires de Strasbourg , BP 426 , Strasbourg , France
| | - Gilles Prevost
- g Fédération de Médecine Translationnelle de Strasbourg, EA 7290 Virulence bactérienne précoce, Institut de Bactériologie , Université de Strasbourg-CHRU , Strasbourg , France
| | - Tristan Bourcier
- a Fédération de Médecine Translationnelle, Service d'Ophtalmologie , Université de Strasbourg - CHU Strasbourg , Strasbourg , France
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219
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Lai HC, Chang YH, Huang RC, Hung NK, Lu CH, Chen JH, Wu ZF. Efficacy of sevoflurane as an adjuvant to propofol-based total intravenous anesthesia for attenuating secretions in ocular surgery. Medicine (Baltimore) 2017; 96:e6729. [PMID: 28445291 PMCID: PMC5413256 DOI: 10.1097/md.0000000000006729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The incidence of nasal secretions into the operative field is as high as 5% in ophthalmic surgery under general anesthesia. It may induce postoperative endophthalmitis. Secretions under propofol-based total intravanous anesthesia (TIVA) are greater than sevoflurane anesthesia during surgery. Postoperative nausea and vomiting (PONV) after inhalational anesthesia is higher than TIVA and may increase intraocluar pressure. We investigated the effect of sevoflurane combination with propofol-based TIVA on nasopharyngeal secretions and PONV in ocular surgery. METHODS Fifty patients undergoing ocular operations were randomly assigned for propofol-based TIVA or propofol/sevoflurane anesthesia. In the TIVA group (n = 25), anesthesia was induced and maintained with propofol and fentanyl; in the propofol/sevoflurane group (n = 25), 1% sevoflurane anesthesia was added. RESULTS Nasopharyngeal excretion volume was significantly higher in the propofol-based TIVA group than in the propofol/sevoflurane group (31.0 ± 18.1 vs 13.7 ± 12.6 ml; P < .001). No significant difference in extubation time was noted (propofol-based TIVA: 6.4 ± 3.6 vs propofol/sevoflurane: 7.4 ± 3.0 minutes; P = .34). No postoperative endophthalmitis or PONV in both groups was observed. CONCLUSION Sevoflurane attenuated secretions under propofol-based TIVA and did not increase the incidence of PONV or prolonged extubation in ocular surgery.
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Affiliation(s)
| | - Yun-Hsiang Chang
- Department of Ophthalmology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
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Bevacizumab for treatment of choroidal neovascularization secondary to candida chorioretinitis. Int Ophthalmol 2017; 38:781-785. [DOI: 10.1007/s10792-017-0502-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/23/2017] [Indexed: 11/25/2022]
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221
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Loh J, Lee JY, Kaur d/o Gail Singh R, Pathak S, Agrawal R. Abiotropia defectiva-Related Endophthalmitis in an Immunocompromised Patient and Application of 16s rRNA in Microbiologic Diagnosis. Ocul Immunol Inflamm 2017; 25:278-283. [DOI: 10.3109/09273948.2015.1107594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jiashen Loh
- Department of Infectious Disease, Tan Tock Seng Hospital, Singapore
| | - Jia Ying Lee
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | | | - Smriti Pathak
- Department of Infectious Disease, Tan Tock Seng Hospital, Singapore
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222
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Gilani CJ, Yang A, Yonkers M, Boysen-Osborn M. Differentiating Urgent and Emergent Causes of Acute Red Eye for the Emergency Physician. West J Emerg Med 2017; 18:509-517. [PMID: 28435504 PMCID: PMC5391903 DOI: 10.5811/westjem.2016.12.31798] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 12/30/2016] [Indexed: 11/22/2022] Open
Abstract
Patients commonly present with an acute red eye to the emergency department (ED). It is important to distinguish between benign and sight-threatening diagnoses. Here we provide a comprehensive overview on the acute red eye in the ED.
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Affiliation(s)
| | - Allen Yang
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California
| | - Marc Yonkers
- University of California, Irvine, Medical Center, Gavin Herbert Eye Institute, Department of Ophthalmology, Irvine, California
| | - Megan Boysen-Osborn
- University of California, Irvine, Medical Center, Department of Emergency Medicine, Orange, California
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Lai HC, Tseng WC, Pao SI, Wong CS, Huang RC, Chan WH, Wu ZF. Relationship between anesthesia and postoperative endophthalmitis: A retrospective study. Medicine (Baltimore) 2017; 96:e6455. [PMID: 28328861 PMCID: PMC5371498 DOI: 10.1097/md.0000000000006455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Previous study showed that patients under general anesthesia (GA) had nasopharyngeal secretions on the face at the end of ocular surgery, especially in propofol-based total intravenous anesthesia (TIVA), it might induce postoperative endophthalmitis. Therefore, we conducted a retrospective study to compare the incidence of endophthalmitis after ocular surgery under topical, inhalation anesthesia, and propofol-based TIVA in our medical center from 2011 to 2015.A total of 21,032 patients were included, and we evaluated epidemiologic factors, systemic diseases, other ocular pathologic characteristics, complications during the surgery, technique of ocular surgery, method of antibiotic prophylaxis, vitreous culture, and vision outcome in these patients.Fifteen endophthalmitis cases among 21,032 operations reported, equaling an incidence of 0.071%. The incidence rates under topical, inhalation anesthesia, and propofol-based TIVA were 0.083%, 0.039%, and 0%, respectively (P = 0.39). Moreover, the risk of endophthalmitis under GA (0.024%) was significantly lower than topical anesthesia (0.083%) (P < 0.001). We also found that elder was the risk factor for endophthalmitis following ocular surgery.In conclusion, propofol-based TIVA or inhalation anesthesia did not increase the risk of endophthalmitis after ocular surgery. Thus, GA was not a risk factor for postoperative endophthalmitis. By contrast, elder was the risk factor for postoperative endophthalmitis.
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Affiliation(s)
- Hou-Chuan Lai
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China Department of Ophthalmology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China Department of Anesthesiology, Cathay General Hospital, Taipei, Taiwan, Republic of China
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Kim CH, Chen MF, Coleman AL. Adjunctive steroid therapy versus antibiotics alone for acute endophthalmitis after intraocular procedure. Cochrane Database Syst Rev 2017; 2:CD012131. [PMID: 28225198 PMCID: PMC5419424 DOI: 10.1002/14651858.cd012131.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Endophthalmitis refers to severe infection within the eye that involves the aqueous humor or vitreous humor, or both, and threatens vision. Most cases of endophthalmitis are exogenous (i.e. due to inoculation of organisms from an outside source), and most exogenous endophthalmitis is acute and occurs after an intraocular procedure. The mainstay of treatment is emergent administration of broad-spectrum intravitreous antibiotics. Due to their anti-inflammatory effects, steroids in conjunction with antibiotics have been proposed to be beneficial in endophthalmitis management. OBJECTIVES To assess the effects of antibiotics combined with steroids versus antibiotics alone for the treatment of acute endophthalmitis following intraocular surgery or intravitreous injection. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 11), MEDLINE Ovid (1946 to 8 December 2016), Embase Ovid (1980 to 8 December 2016), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 8 December 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 8 December 2016, ClinicalTrials.gov (www.clinicaltrials.gov); searched 8 December 2016, and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 8 December 2016. We did not use any date or language restrictions in the electronic searches for trials. SELECTION CRITERIA We included randomized controlled trials comparing the effectiveness of adjunctive steroids with antibiotics alone in the management of acute, clinically diagnosed endophthalmitis following intraocular surgery or intravitreous injection. We excluded trials with participants with endogenous endophthalmitis unless outcomes were reported by source of infection. We imposed no restrictions on the method or order of administration, dose, frequency, or duration of antibiotics and steroids. DATA COLLECTION AND ANALYSIS Two review authors independently screened the search results, assessed risk of bias, and extracted data using methods expected by Cochrane. We contacted study authors to try to obtain missing information or information to clarify risk of bias. We conducted a meta-analysis for any outcomes that were reported by at least two studies. Outcomes reported from single studies were summarized in the text. We assessed the certainty of the evidence using GRADE. MAIN RESULTS We included three trials with a total of 95 randomized participants in this review and identified one ongoing trial. The studies were conducted in South Africa, India, and the Netherlands. Out of the 92 analyzed participants, 91 participants were diagnosed with endophthalmitis following cataract surgery. In the remaining participant, endophthalmitis was attributable to penetrating keratoplasty. All studies used intravitreous dexamethasone for adjunctive steroid therapy and a combination of two intravitreous antibiotics that provided gram-positive and gram-negative coverage for the antibiotic therapy. We judged one trial to be at overall low risk of bias and two studies to be at overall unclear risk of bias due to lack of reporting of study methods. None of the three trials had been registered in a clinical trial register.While none of the included studies reported the primary outcome of complete resolution of endophthalmitis as defined in our protocol, one study reported combined anatomical and functional success (i.e. proportion of participants with intraocular pressure of at least 5 mmHg and visual acuity of at least 6/120). Very low-certainty evidence suggested no difference in combined success when comparing adjunctive steroid antibiotics alone (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.80 to 1.45; 32 participants). Low-certainty evidence from two studies showed that a higher proportion of participants who received adjunctive dexamethasone had a good visual outcome (Snellen visual acuity 6/6 to 6/18) at three months compared with those in the antibiotics-alone group (RR 1.95, 95% CI 1.05 to 3.60; 60 participants). Similarly, low-certainty evidence from one study suggested that more participants in the dexamethasone group had a good visual outcome at 12 months compared to those who did not receive dexamethasone (RR 2.00, 95% CI 0.98 to 4.08; 28 participants). Investigators of one study reported improvement in visual acuity, but we could not estimate the effect of adjunctive steroid therapy because the study investigators did not provide standard deviations or standard errors. Two studies reported adverse events (retinal detachment, hypotony, proliferative vitreoretinopathy, and seclusion of pupil). The total numbers of adverse events were 8 out of 30 (26.7%) for those who received dexamethasone versus 6 out of 30 (20.0%) for those who did not. We could only perform a pooled analysis for the occurrence of retinal detachment; any difference between the two treatment groups was uncertain (RR 1.57, 95% CI 0.50 to 4.90; 60 participants) (very low-certainty evidence). No study reported intraocular pressure or cost outcomes. AUTHORS' CONCLUSIONS Current evidence on the effectiveness of adjunctive steroid therapy versus antibiotics alone in the management of acute endophthalmitis after intraocular surgery is inadequate. We found no studies that had enrolled cases of acute endophthalmitis following intravitreous injection. A combined analysis of two studies suggests adjunctive steroids may provide a higher probability of having a good visual outcome at three months than not using adjunctive steroids. However, considering that most of the confidence intervals crossed the null and that this review was limited in scope and applicability to clinical practice, it is not possible to conclude whether the use adjunctive steroids is effective at this time. Any future trials should examine whether adjunctive steroids may be useful in certain clinical settings such as type of causative organism or etiology. These studies should include outcomes that take patient's symptoms and clinical examination into account, report outcomes in a uniform and consistent manner, and follow up at short- and long-term intervals.
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Affiliation(s)
- Carole H Kim
- Stein Eye Institute, UCLA100 Stein PlazaLos AngelesCaliforniaUSA90095
| | - Monica F Chen
- Stein Eye Institute, UCLA100 Stein PlazaLos AngelesCaliforniaUSA90095
| | - Anne L Coleman
- Stein Eye Institute, UCLA100 Stein PlazaLos AngelesCaliforniaUSA90095
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Visual Outcomes and Prognostic Factors after Pars Plana Vitrectomy for Traumatic Endophthalmitis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5851318. [PMID: 28246599 PMCID: PMC5299176 DOI: 10.1155/2017/5851318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 08/08/2016] [Accepted: 08/18/2016] [Indexed: 11/19/2022]
Abstract
Purpose. To evaluate visual outcomes and identify prognostic factors after pars plana vitrectomy (PPV) surgery for traumatic endophthalmitis. Methods. Medical records of 121 consecutive patients (121 eyes) diagnosed with traumatic endophthalmitis that had undergone pars plana vitrectomy were retrospectively reviewed. Results. 121 patients, aged from 6 to 71 years, all underwent PPV surgery. 113 cases had improved best corrected visual acuity (BCVA) after surgery and 60% of them obtained BCVA better than fingers counting (FC). Good final visual prognosis was significantly associated with time between trauma and initial treatment less than 12 hrs (40% versus 98%; P < 0.001), time between trauma and PPV treatment less than 24 hrs (62% versus 98%; P < 0.001), laceration length less than 10 mm (63% versus 96%; P < 0.001), and presenting VA better than LP (42% versus 96%; P < 0.001), while gender, type of laceration, presence of IOFB or retinal detachment, and the use of silicone oil tamponade were not significant factors resulting in better BCVA. Bacteria were identified in 43.8% of specimens and most of the microorganisms were identified as nonvirulent ones. Conclusions. Pars plana vitrectomy surgery was preferred as a primary treatment option for traumatic endophthalmitis. A good final visual prognosis was significantly associated with timely treatment, prompt vitrectomy surgery, shorter length of laceration, and better presenting visual acuity.
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Mailhac A, Durand H, Boisset S, Maubon D, Berger F, Maurin M, Chiquet C, Bidart M. MALDI-TOF mass spectrometry for rapid diagnosis of postoperative endophthalmitis. J Proteomics 2016; 152:150-152. [PMID: 27989942 DOI: 10.1016/j.jprot.2016.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/28/2016] [Indexed: 10/20/2022]
Abstract
This study describes an innovative strategy for rapid detection and identification of bacteria causing endophthalmitis, combining the use of an automated blood culture system with MALDI-TOF mass spectrometry methodology. Using this protocol, we could identify 96% of 45 bacterial strains isolated from vitreous samples collected in acute post-operative endophthalmitis patients.
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Affiliation(s)
- Adriane Mailhac
- Department of Ophthalmology, Grenoble Alpes University Hospital, France
| | | | - Sandrine Boisset
- Bacteriological Laboratory, Department of Infectious Agents, Biology Institute, Grenoble Alpes University Hospital, France
| | - Danièle Maubon
- Parasitology and Mycology Laboratory, Department of Infectious Agents, Biology Institute, Grenoble Alpes University Hospital, France; TIMC-IMAG-TheREx, UMR 5525 CNRS-UGA, Grenoble Alpes University, France
| | | | - Max Maurin
- Bacteriological Laboratory, Department of Infectious Agents, Biology Institute, Grenoble Alpes University Hospital, France
| | | | - Marie Bidart
- Braintech Lab, UMR1205, Grenoble Alpes University, France; Clinical Proteomic and Transcriptomic Plateform, Research Department, Grenoble Alpes University Hospital, France; Biochemistry and Genetic Laboratory, Department of Biochemistry, Toxicology and Pharmacology, Biology Institute, Grenoble Alpes University, France.
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SYSTEMIC ORAL ANTIBIOTICS AS A PROPHYLACTIC MEASURE TO PREVENT ENDOPHTHALMITIS IN PATIENTS WITH OPEN GLOBE INJURIES IN COMPARISON WITH INTRAVENOUS ANTIBIOTICS. Retina 2016; 36:360-5. [PMID: 26815932 DOI: 10.1097/iae.0000000000000727] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the use of systemic oral and intravenous antibiotics as a prophylactic measure to prevent endophthalmitis in patients with open globe injuries. METHODS This prospective study was conducted on 1,255 consecutive patients with open globe injuries due to sharp or blunt trauma in a hospital setting in Tehran, Iran from January, 2011 to May, 2013. The patients were randomly divided into two groups and either received intravenous or oral systemic antibiotics as a measure to prevent endophthalmitis. The patients who developed endophthalmitis were followed for 1 year. RESULTS In the first group, 12 patients (1.8%) developed endophthalmitis until postoperative Day 3 and 2 more patients (0.3%) developed endophthalmitis until the end of Week 1. These numbers in group receiving oral antibiotics were 8 (1.3%), 5 (0.8%), and 13 patients, respectively, showing no statistically significant difference between the 2 groups. There was also no statistically significant difference in the visual acuity of patients developing endophthalmitis in these 2 groups 1 year postoperatively. CONCLUSION No statistically significant difference in the occurrence of postoperative endophthalmitis or the visual acuity 1 year after operation among patients with open globe injuries receiving intravenous or oral systemic antibiotics as a prophylactic measure was observed.
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Khattab RA, Abdelfattah MM. Study of the prevalence and association of ocular chlamydial conjunctivitis in women with genital infection by Chlamydia trachomatis, Mycoplasma genitalium and Candida albicans attending outpatient clinic. Int J Ophthalmol 2016; 9:1176-86. [PMID: 27588273 DOI: 10.18240/ijo.2016.08.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/31/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To determine the association between chlamydial conjunctivitis and genital infection by Chlamydia trachomatis, Mycoplasma genitalium and Candida albicans, in addition to the possible relationship between cultured bacterial pathogens and oculogenital chlamydial infection. METHODS This study was performed on 100 (50 symptomatic and 50 asymptomatic) women attending the Gynecological and Obstetric outpatient clinic of Alzahra hospital, Alazhar University. Simultaneously a conjunctival swab was taken from these patients. Polymerase chain reaction (PCR) was done on DNA extracted from both vaginal and conjunctival swab samples. Culture for both vaginal and conjunctival swabs was also done. RESULTS Candida albicans was the predominant organism isolated by culture in 20% and 40% of conjunctival and vaginal swabs respectively. By the PCR method, ocular Chlamydia trachomatis was present in 60% of symptomatic women, while genital Chlamydia trachomatis infection was present in 30% of symptomatic women. The results of this method also indicated that 25/50 (50%) vaginal swabs were positive with PCR for Candida albicans versus 15/50 (30%) were PCR positive in conjunctival swab. Mycoplasma genitalium was present in only 10% of vaginal swabs. Concomitant oculogenital PCR positive results for Chlamydia trachomatis and Candida albicans were 30% and 28% respectively. CONCLUSION Ocular Chlamydia trachomatis was associated with genital Chlamydia trachomatis in a high percentage of women followed by Candida albicans. Cultured bacterial organisms do not play a role in enhancement of Chlamydia trachomatis infection.
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Affiliation(s)
- Rania Abdelmonem Khattab
- Microbiology and Immunology Department, Faculty of Pharmacy, Cairo University, Kasr Al-Aini, Cairo 11562, Egypt
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Plotas P, Makri OE, Georgalas I, Pharmakakis N, Vantarakis A, Georgakopoulos CD. Efficacy of Topical Ofloxacin 0.3 % Administration on Conjunctival Bacterial Flora in Diabetic Patients Undergoing Intravitreal Injections. Semin Ophthalmol 2016; 32:738-742. [PMID: 27487463 DOI: 10.3109/08820538.2016.1170165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This prospective, randomized case series study aims to evaluate the efficacy of ofloxacin 0.3% eye drops in eradication of conjunctival bacterial flora in diabetic patients undergoing intravitreal injections (IVI). METHODS Ninety-two diabetic patients (92 eyes) scheduled to undergo intravitreal injection of ranibizumab due to diabetic macular edema were enrolled in the study. Patients were randomly assigned to three different groups. Group 1 (n=32) received ofloxacin eye drops the day before before IVI (four times); patients in Group 2 (n=29) were administered ofloxacin one hour before IVI (every 15 minutes), while Group 3 (n=31) comprised patients that received combined administration of ofloxacin both one day and one hour before IVI (eight doses). Samples were collected from the injection site before and after antibiotic administration. Culture results from BACTEC broth and positive cultures in blood agar and Sabouraud's dextrose agar plates were measured. RESULTS In Group 1, BACTEC broth positive cultures decreased from 84.4% at baseline to 50% after ofloxacin administration (p=0.007), and blood agar positive cultures reduced from 65.63% to 34.38% (p=0.02). In Group 2, positive cultures significantly decreased in BACTEC broth (from 79.3% at baseline to 48.28%; p=0.027) and in blood agar (from 68.97% to 37.13%; p=0.034). In Group 3, positive cultures decreased from 77.42% at baseline to 32.26% (p=0.0008) and from 58.06% at baseline to 22.58% (p=0.009) in BACTEC broth and blood agar, respectively. No microorganisms were isolated from Sabouraud's dextrose agar plates. CONCLUSIONS The combined one day/one hour (eight doses) ofloxacin administration in diabetic patients is extremely effective in reducing conjunctival bacterial flora. The application of topical ofloxacin for one day or one hour before IVI is also significantly effective.
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Affiliation(s)
- Panagiotis Plotas
- a Department of Ophthalmology, Medical School , University of Patras , Patras , Greece.,b Laboratory of Public Health, School of Medicine , University of Patras , Patras , Greece
| | - Olga E Makri
- a Department of Ophthalmology, Medical School , University of Patras , Patras , Greece
| | - Ilias Georgalas
- c Department of Ophthalmology , University of Athens , Athens , Greece
| | - Nikolaos Pharmakakis
- a Department of Ophthalmology, Medical School , University of Patras , Patras , Greece
| | - Apostolos Vantarakis
- b Laboratory of Public Health, School of Medicine , University of Patras , Patras , Greece
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230
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Cho H, Shin YU, Siegel NH, Yu HG, Sobrin L, Patel A, Durand ML, Miller JW, Husain D. Endogenous Endophthalmitis in the American and Korean Population: An 8-year Retrospective Study. Ocul Immunol Inflamm 2016; 26:496-503. [PMID: 27459423 DOI: 10.1080/09273948.2016.1195000] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To study the clinical features of endogenous endophthalmitis (EE) in sample patient populations from the USA and South Korea over an 8-year period. METHODS We reviewed data from 128 eyes of 60 American and 48 Korean patients diagnosed with EE and compared their clinical characteristics. RESULTS Fungemia and liver abscess were the most common extraocular infection sources among American (26.7%) and Korean patients (33.3%), respectively. Klebsiella pneumoniae and Candida species were the most common pathogens of EE in the Korean and the American patients, respectively. Endophthalmitis caused by fungi had a better visual prognosis than that caused by bacteria (p = 0.001). Vitrectomy was beneficial for eyes with EE due to virulent bacteria presenting with worse than counting finger vision. CONCLUSIONS The predisposing conditions and responsible organisms for EE vary in different regions of the world. The visual prognosis was strongly influenced by the underlying pathogen.
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Affiliation(s)
- Heeyoon Cho
- a Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA
- b Department of Ophthalmology , Hanyang University Medical College , Seoul , Republic of Korea
| | - Yong Un Shin
- b Department of Ophthalmology , Hanyang University Medical College , Seoul , Republic of Korea
| | - Nicole H Siegel
- c Department of Ophthalmology , Boston University School of Medicine , Boston , Massachusetts , USA
| | - Hyeong Gon Yu
- d Department of Ophthalmology , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Lucia Sobrin
- a Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA
| | - Achal Patel
- c Department of Ophthalmology , Boston University School of Medicine , Boston , Massachusetts , USA
| | - Marlene L Durand
- a Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA
- e Infectious Disease Unit, Department of Medicine , Massachusetts General Hospital, Harvard Medical School , Boston , Massachusetts , USA
| | - Joan W Miller
- a Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA
| | - Deeba Husain
- a Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA
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231
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Chen SC, Lee YY, Chen YH, Lin HS, Wu TT, Sheu SJ. Klebsiella pneumoniae Infection Leads to a Poor Visual Outcome in Endogenous Endophthalmitis: A 12-year Experience in Southern Taiwan. Ocul Immunol Inflamm 2016; 25:870-877. [PMID: 27438458 DOI: 10.1080/09273948.2016.1193616] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare the characteristics, visual outcome, and prognostic factors of patients with endogenous endophthalmitis and to determine the association of endophthalmitis with Klebsiella pneumoniae infection. METHODS We retrospectively analyzed records of patients diagnosed with endogenous endophthalmitis from January 2002 to August 2013. RESULTS A total of 86 patients were diagnosed with endogenous endophthalmitis; 48 patients were infected with K. pneumoniae, 28 patients were infected with other pathogens, and 10 were culture-negative. Diabetes mellitus was more prevalent among patients infected with K. pneumoniae. Liver abscess and urinary tract infection were the leading sources of infection in patients with and without a K. pneumoniae infection, respectively. In patients with endogenous endophthalmitis, poor initial vision (p<0.001) and K. pneumoniae infection (p = 0.048) were significantly associated with a poor visual outcome. CONCLUSIONS Poor initial vision and K. pneumoniae infection were significantly associated with poorer visual outcome for patients with endogenous endophthalmitis.
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Affiliation(s)
- Shih-Chou Chen
- a Department of Ophthalmology , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan
| | - Ying-Yen Lee
- a Department of Ophthalmology , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan
| | - Ya-Hsin Chen
- a Department of Ophthalmology , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan
| | - Huey-Shyan Lin
- b Program of Health-Business Administration , Fooyin University , Kaohsiung , Taiwan
| | - Tsung-Tien Wu
- a Department of Ophthalmology , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan.,c School of Medicine , National Yang-Ming University , Taipei , Taiwan
| | - Shwu-Jiuan Sheu
- a Department of Ophthalmology , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan.,c School of Medicine , National Yang-Ming University , Taipei , Taiwan
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232
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Wang SY, Ghodasra DH, Amin SR, Mian SI, Jayasundera KT. Fungal Endophthalmitis Associated With DSAEK and Thermal Sclerostomy. Ophthalmic Surg Lasers Imaging Retina 2016; 47:691-3. [DOI: 10.3928/23258160-20160707-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 04/18/2016] [Indexed: 11/20/2022]
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233
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Lafond M, Aptel F, Mestas JL, Lafon C. Ultrasound-mediated ocular delivery of therapeutic agents: a review. Expert Opin Drug Deliv 2016; 14:539-550. [DOI: 10.1080/17425247.2016.1198766] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Maxime Lafond
- Inserm, LabTAU, Lyon, France
- Univ Lyon, Université Lyon 1, Lyon, France
| | - Florent Aptel
- Department of Ophthalmology, University Hospital of Grenoble, Université Grenoble Alpes, Grenoble, France
| | - Jean-Louis Mestas
- Inserm, LabTAU, Lyon, France
- Univ Lyon, Université Lyon 1, Lyon, France
| | - Cyril Lafon
- Inserm, LabTAU, Lyon, France
- Univ Lyon, Université Lyon 1, Lyon, France
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234
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Gao Y, Chen N, Dong XG, Yuan GQ, Yu B, Xie LX. Surgical management of fungal endophthalmitis resulting from fungal keratitis. Int J Ophthalmol 2016; 9:848-53. [PMID: 27366686 DOI: 10.18240/ijo.2016.06.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/19/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To report the fungal organisms, clinical features, surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis (EFE) secondary to keratitis, and evaluate the role of surgery in the treatment. METHODS The clinical records of 27 patients (27 eyes) with culture-proven EFE resulting from fungal keratitis treated at Shandong Eye Institute from January 2007 to January 2015 were retrospectively reviewed. Information about fungal culture results, clinical features, surgical procedures, and final visual acuity was obtained. RESULTS There were 39 positive culture results from samples of cornea, hypopyon, vitreous and lens capsule, accounting for 56%, 26%, 15% and 2.5%, respectively. Fusarium was identified in 44% (12/27) of the eyes, followed by Aspergillus in 22% (6/27). Posterior segment infection was involved in 78% (21/27) of the patients. The corneal infection was larger than 3 mm ×3 mm in 89% (24/27) of the patients, and 22% (6/27) of them had the entire cornea, and even the sclera involved. Three eyes had silicone oil tamponade, and two eyes had retinal detachment. Twenty-two eyes (81.5%) underwent penetrating keratoplasty (PKP), and over half of them (54.5%) were operated within 3d from the onset of antifungal therapy. Fourteen eyes (52%) underwent intracameral antifungal drug injection, and three of them required repeated injections. Fifteen eyes (55.6%) underwent pars plana vitrectomy (PPV). The rate of the eyes undergoing PPV as the initial surgical procedure was 60% (9/15), lower than 77% in PKP. Intravitreal injection was given in 59% of the eyes (16/27), and 75% of them required repeated injections. The final visual acuity was 20/100 or better in 37% of the eyes, and better than counting fingers in 55.6% of the eyes. Five eyes (18.5%) were eviscerated. In the two eyes with concurrent retinal detachment, one achieved retinal reattachment, and the other was eviscerated. In the three eyes with silicone oil tamponade, two eyes received silicone oil removal, and the other one was eviscerated. CONCLUSION Fusarium and Aspergillus are the dominant pathogens in EFE resulting from keratitis. Aggressive antifungal surgeries including multiple intravitreal injections, PKP and core vitrectomy (especially in the initial surgery) are helpful procedures to improve prognosis of severe EFE secondary to keratitis.
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Affiliation(s)
- Yan Gao
- Qingdao University Medical College, Qingdao 266071, Shandong Province, China; Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Nan Chen
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Xiao-Guang Dong
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Gong-Qiang Yuan
- Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Jinan 250021, Shandong Province, China
| | - Bin Yu
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Li-Xin Xie
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
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235
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Hashemian H, Mirshahi R, Khodaparast M, Jabbarvand M. Post-cataract surgery endophthalmitis: Brief literature review. J Curr Ophthalmol 2016; 28:101-5. [PMID: 27579452 PMCID: PMC4992095 DOI: 10.1016/j.joco.2016.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/11/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To investigate recent evidence in prophylaxis and management of post-cataract surgery endophthalmitis. METHODS We conducted a literature search using Pubmed database for post cataract surgery endophthalmitis, and relevant articles were selected from original English papers published since 2015. RESULTS Forty-nine articles were published regarding post-cataract surgery endophthalmitis from January 2015 to February 2016. A low incidence of post-cataract surgery endophthalmitis has been reported. A growing number of articles are focusing on preventing endophthalmitis using intracameral antibiotics. CONCLUSION Based on the current evidence, intracameral antibiotics seems to be effective in preventing endophthalmitis after cataract surgery.
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Affiliation(s)
- Hesam Hashemian
- Ophthalmology Research Center, Department of Ophthalmology, Tehran University of Medical Sciences, Farabi Eye Hospital, Iran
| | - Reza Mirshahi
- Ophthalmology Research Center, Department of Ophthalmology, Tehran University of Medical Sciences, Farabi Eye Hospital, Iran
| | - Mehdi Khodaparast
- Ophthalmology Research Center, Department of Ophthalmology, Tehran University of Medical Sciences, Farabi Eye Hospital, Iran
| | - Mahmoud Jabbarvand
- Ophthalmology Research Center, Department of Ophthalmology, Tehran University of Medical Sciences, Farabi Eye Hospital, Iran
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236
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Coburn PS, Wiskur BJ, Miller FC, LaGrow AL, Astley RA, Elliott MH, Callegan MC. Bloodstream-To-Eye Infections Are Facilitated by Outer Blood-Retinal Barrier Dysfunction. PLoS One 2016; 11:e0154560. [PMID: 27195776 PMCID: PMC4873292 DOI: 10.1371/journal.pone.0154560] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/15/2016] [Indexed: 12/30/2022] Open
Abstract
The blood-retinal barrier (BRB) functions to maintain the immune privilege of the eye, which is necessary for normal vision. The outer BRB is formed by tightly-associated retinal pigment epithelial (RPE) cells which limit transport within the retinal environment, maintaining retinal function and viability. Retinal microvascular complications and RPE dysfunction resulting from diabetes and diabetic retinopathy cause permeability changes in the BRB that compromise barrier function. Diabetes is the major predisposing condition underlying endogenous bacterial endophthalmitis (EBE), a blinding intraocular infection resulting from bacterial invasion of the eye from the bloodstream. However, significant numbers of EBE cases occur in non-diabetics. In this work, we hypothesized that dysfunction of the outer BRB may be associated with EBE development. To disrupt the RPE component of the outer BRB in vivo, sodium iodate (NaIO3) was administered to C57BL/6J mice. NaIO3-treated and untreated mice were intravenously injected with 108 colony forming units (cfu) of Staphylococcus aureus or Klebsiella pneumoniae. At 4 and 6 days postinfection, EBE was observed in NaIO3-treated mice after infection with K. pneumoniae and S. aureus, although the incidence was higher following S. aureus infection. Invasion of the eye was observed in control mice following S. aureus infection, but not in control mice following K. pneumoniae infection. Immunohistochemistry and FITC-dextran conjugate transmigration assays of human RPE barriers after infection with an exoprotein-deficient agr/sar mutant of S. aureus suggested that S. aureus exoproteins may be required for the loss of the tight junction protein, ZO-1, and for permeability of this in vitro barrier. Our results support the clinical findings that for both pathogens, complications which result in BRB permeability increase the likelihood of bacterial transmigration from the bloodstream into the eye. For S. aureus, however, BRB permeability is not required for the development of EBE, but toxin production may facilitate EBE pathogenesis.
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Affiliation(s)
- Phillip S. Coburn
- Department of Ophthalmology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Brandt J. Wiskur
- Oklahoma Center for Neuroscience, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Frederick C. Miller
- Department of Cell Biology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
- Department of Family and Preventative Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Austin L. LaGrow
- Department of Ophthalmology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Roger A. Astley
- Department of Ophthalmology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Michael H. Elliott
- Department of Ophthalmology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
- Oklahoma Center for Neuroscience, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
- Department of Physiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Michelle C. Callegan
- Department of Ophthalmology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
- Oklahoma Center for Neuroscience, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
- Department of Microbiology and Immunology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
- * E-mail:
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237
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Lai HC, Tai HW, Wu ZF. Excess nasopharyngeal secretions in ocular surgery under propofol-based total intravenous anesthesia. J Clin Anesth 2016; 34:257-8. [PMID: 27687387 DOI: 10.1016/j.jclinane.2016.04.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/23/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Hou-Chuan Lai
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, #325, Section 2, Chenggung Road, Neihu 114, Taipei, Taiwan, ROC
| | - Hui-Wen Tai
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, #325, Section 2, Chenggung Road, Neihu 114, Taipei, Taiwan, ROC
| | - Zhi-Fu Wu
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, #325, Section 2, Chenggung Road, Neihu 114, Taipei, Taiwan, ROC.
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238
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Current Perspectives of Prophylaxis and Management of Acute Infective Endophthalmitis. Adv Ther 2016; 33:727-46. [PMID: 26935830 DOI: 10.1007/s12325-016-0307-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Indexed: 12/23/2022]
Abstract
Endophthalmitis is an intraocular inflammatory condition which may or may not be caused by infective agents. Noninfectious (sterile) endophthalmitis may be attributable to various causes including postoperative retained soft lens matter or toxicity following introduction of other agents into the eye. Infectious endophthalmitis is further subdivided into endogenous and exogenous. In endogenous endophthalmitis there is hematogenous spread of organisms from a distant source of infection whereas in exogenous endophthalmitis direct microbial inoculation may occur usually following ocular surgery or penetrating eye injury with or without intraocular foreign bodies. Acute infective endophthalmitis is usually exogenous induced by inoculation of pathogens following ocular surgery, open-globe injury and intravitreal injections. More infrequently the infective source is internal and septicemia spreads to the eye resulting in endogenous endophthalmitis. Several risk factors have been implicated including immunosuppression, ocular surface abnormalities, poor surgical wound construction, complicated cataract surgery with vitreous loss and certain types of intraocular lens. Comprehensive guidelines and recommendations on prophylaxis and monitoring of surgical cases have been proposed to minimize the risk of acute endophthalmitis. Early diagnosis and prompt management of infective endophthalmitis employing appropriately selected intravitreal antibiotics are essential to optimize visual outcome.
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239
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Landré C, Baillif S. [Endogenous bacterial and fungal endophthalmitis at Nice University Medical Center: A 15-year case review]. J Fr Ophtalmol 2016; 39:346-54. [PMID: 27016334 DOI: 10.1016/j.jfo.2015.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/06/2015] [Accepted: 11/12/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate epidemiology, diagnostic and therapeutic management strategies and visual outcomes of cases of bacterial and fungal endogenous endophthalmitis managed in the Nice University Medical Center between January 2000 and June 2015. METHODS Three hundred twenty-three charts of patients with endophthalmitis treated at the Nice University Medical Center over this period were retrospectively reviewed to select the ones with endogenous endophthalmitis. Demographic characteristics, medical history, clinical presentation, diagnostic and therapeutic management, microbiology, and final outcomes were analyzed. RESULTS Twenty-two eyes of 20 patients were selected, constituting 6.20% of all cases of endophthalmitis. The mean age was 69years, and 75% of patients were male. The most common risk factors were diabetes, malignancies and cardiac diseases. Bacterial isolates were found in 16 cases (80%), fungal isolates in 3 (15%) and co-infection in 1 case. Gram-positive organisms accounted for 70.6% of cases (mostly Staphylococcus aureus [25%], Streptococcus agalactiae [25%] and Streptococcus pneumoniae [16.7%]). Candida albicans was the most common fungal organism. There was one bacterial and fungal co-infection. Two patients died, 4 eyes were enucleated or eviscerated (20%), and 4 patients (20%) attained a final visual acuity of 1/10 or better. CONCLUSION Endogenous endophthalmitis is a rare and serious condition with a poor prognosis. Gram-positive microorganisms, mostly S. aureus, were the main causative pathogens found.
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Affiliation(s)
- C Landré
- Service d'ophtalmologie, hôpital Pasteur 2, centre hospitalo-universitaire de Nice, 30, avenue de la Voie-Romaine, 06000 Nice, France
| | - S Baillif
- Service d'ophtalmologie, hôpital Pasteur 2, centre hospitalo-universitaire de Nice, 30, avenue de la Voie-Romaine, 06000 Nice, France.
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240
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Incidence and Risk Factors of Ocular Infection Caused by Staphylococcus aureus Bacteremia. Antimicrob Agents Chemother 2016; 60:2012-7. [PMID: 26824952 DOI: 10.1128/aac.02651-15] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 01/04/2016] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus aureusbacteremia (SAB) often leads to ocular infections, including endophthalmitis and chorioretinitis. However, the incidence, risk factors, and outcomes of ocular infections complicated by SAB are largely unknown. We retrospectively analyzed the incidence and risk factors of ocular involvement in a prospective cohort of patients with SAB at a tertiary-care hospital. Ophthalmologists reviewed the fundoscopic findings and classified the ocular infections as endophthalmitis or chorioretinitis. During the 5-year study period, 1,109 patients had SAB, and data for 612 (55%) who underwent ophthalmic examinations within 14 days after SAB onset were analyzed. Of those 612 patients, 56 (9% [95% confidence interval [CI], 7 to 12%]) had ocular involvement, including 15 (2.5%) with endophthalmitis and 41 (6.7%) with chorioretinitis. In a multivariate analysis, infective endocarditis (adjusted odds ratio [aOR], 5.74 [95% CI, 2.25 to 14.64]) and metastatic infection (aOR, 2.38 [95% CI, 1.29 to 4.39]) were independent risk factors for ocular involvement. Of the 47 patients with ocular involvement who could communicate, only 17 (36%) had visual disturbances. Two-thirds of the patients with endophthalmitis (10/15 patients) were treated with intravitreal antibiotics combined with parenteral antibiotics, whereas all of the patients with chorioretinitis were treated only with systemic antibiotics. No patients became blind. Among 42 patients for whom follow-up assessments were available, the ocular lesions improved in 29 (69%) but remained the same in the others. Ocular involvement was independently associated with death within 30 days after SAB onset. Ocular involvement is not uncommon among patients with SAB. Routine ophthalmic examinations should be considered for patients with infective endocarditis or metastatic infections caused by SAB.
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241
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Álvarez-Ramos P, Del Moral-Ariza A, Alonso-Maroto JM, Marín-Casanova P, Calandria-Amigueti JM, Rodríguez-Iglesias M, Rodríguez de la Rúa E. First Report of Acute Postoperative Endophthalmitis Caused by Rothia Mucilaginosa after Phacoemulsification. Infect Dis Rep 2016; 8:6320. [PMID: 27103973 PMCID: PMC4815942 DOI: 10.4081/idr.2016.6320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/12/2016] [Accepted: 01/25/2016] [Indexed: 01/18/2023] Open
Abstract
We aimed at reporting the first case of rapidly progressive acute postoperative endophthalmitis after phacoemulsification cataract surgery in an immunocompetent patient caused by Rothia mucilaginosa. An immunocompetent patient manifested endophthalmitis signs 48 hours after an uncomplicated cataract surgery by phacoemulsification. A bacteria of the family Micrococcaceae was cultured in the vitreous biopsy, namely R. mucilaginosa. The patient did not show a favorable clinical response after vitrectomy and systemic, intravitreal, and topical fortified antibiotics. The patient’s eye was very painful, and consequently, it deemed necessary to perform an evisceration. R. mucilaginosa may be an aggressive etiologic agent for postoperative endophthalmitis. Although the isolated R. mucilaginosa was susceptible to empirical treatment, it was impossible to control the infection with standard treatment, probably due to its ability to create a biofilm around the intraocular lens.
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Affiliation(s)
| | | | | | | | | | | | - Enrique Rodríguez de la Rúa
- Ophthalmology Unit, University Hospital Puerta del Mar, Cádiz; Ophthalmology Unit, University Hospitals Virgen Macarena y Virgen del Rocío, Sevilla, Spain
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242
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Radhakrishnan R, Cornelius R, Cunnane MB, Golnik K, Morales H. MR imaging findings of endophthalmitis. Neuroradiol J 2016; 29:122-9. [PMID: 26915896 DOI: 10.1177/1971400916633480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Endophthalmitis is a sight-threatening ophthalmologic emergency. The clinical diagnosis is often challenging, and delayed diagnosis may exacerbate the poor visual prognosis. B-scan ultrasonography or spectral domain optical coherence tomography are imaging aids at the clinician's office. Cross-sectional imaging such as CT and particularly MRI can also help in the assessment of disease extent or complications. MR imaging findings are rarely described in the literature. Here, we discuss the spectrum of imaging findings of endophthalmitis and correlate them with key anatomic and pathophysiologic details of the globe. Early disease is often subtle on MR imaging with thick uveal enhancement, while advanced disease demonstrates retinal/choroidal detachment, vitreal exudates and peribulbar inflammation. Other noninfectious inflammatory diseases of the globe can show similar findings; however, MR diffusion-weighted images help identify infectious exudates and evaluate response to therapy. Knowledge of the spectrum of imaging findings of this disease is important for radiologists and help in the management decision process.
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Affiliation(s)
- Rupa Radhakrishnan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, USA
| | - Rebecca Cornelius
- Department of Radiology, University of Cincinnati Medical Center, USA
| | | | - Karl Golnik
- Department of Ophthalmology, University of Cincinnati Medical Center, USA
| | - Humberto Morales
- Department of Radiology, University of Cincinnati Medical Center, USA
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243
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Coburn PS, Wiskur BJ, Astley RA, Callegan MC. Blood-Retinal Barrier Compromise and Endogenous Staphylococcus aureus Endophthalmitis. Invest Ophthalmol Vis Sci 2016; 56:7303-11. [PMID: 26559476 DOI: 10.1167/iovs.15-17488] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To test the hypothesis that blood-retinal barrier compromise is associated with the development of endogenous Staphylococcus aureus endophthalmitis. METHODS To compromise the blood-retinal barrier in vivo, streptozotocin-induced diabetes was induced in C57BL/6J mice for 1, 3, or 5 months. Diabetic and age-matched nondiabetic mice were intravenously injected with 108 colony-forming units (cfu) of S. aureus, a common cause of endogenous endophthalmitis in diabetics. After 4 days post infection, electroretinography, histology, and bacterial counts were performed. Staphylococcus aureus-induced alterations in in vitro retinal pigment epithelial (RPE) cell barrier structure and function were assessed by anti-ZO-1 immunohistochemistry, FITC-dextran conjugate diffusion, and bacterial transmigration assays. RESULTS We observed one bilateral infection in a control, nondiabetic animal (mean = 1.54 × 103 ± 1.78 × 10² cfu/eye, 7% incidence). Among the 1-month diabetic mice, we observed culture-confirmed unilateral infections in two animals (mean = 5.54 × 10² ± 7.09 × 10² cfu/eye, 12% incidence). Among the 3-month diabetic mice, infections were observed in 11 animals, three with bilateral infections (mean = 2.67 × 10² ± 2.49 × 10² cfu/eye, 58% incidence). Among the 5-month diabetic mice, we observed infections in five animals (mean = 7.88 × 10² ± 1.08 × 10³ cfu/eye, 33% incidence). In vitro, S. aureus infection reduced ZO-1 immunostaining and disrupted the barrier function of cultured RPE cells, resulting in diffusion of fluorophore-conjugated dextrans and transmigration of live bacteria across a permeabilized RPE barrier. CONCLUSIONS Taken together, these results indicated that S. aureus is capable of inducing blood-retinal barrier permeability and causing endogenous bacterial endophthalmitis in normal and diabetic animals.
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Affiliation(s)
- Phillip S Coburn
- Department of Ophthalmology The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Brandt J Wiskur
- Oklahoma Center for Neuroscience, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Roger A Astley
- Department of Ophthalmology The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Michelle C Callegan
- Department of Ophthalmology The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States 2Oklahoma Center for Neuroscience, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States 3Department
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244
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Balta Ö, Acar U, Akbaş Kocaoğlu F, Örnek F. Review of 306 evisceration surgeries performed between 2005 and 2013. Turk J Med Sci 2016; 46:463-7. [PMID: 27511512 DOI: 10.3906/sag-1501-24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 07/10/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The purpose of the present study was to evaluate the reasons for eye evisceration surgeries performed from 2005 to 2013 in our clinic. MATERIALS AND METHODS The medical records of patients who underwent evisceration surgery over the past 9 years were retrospectively evaluated. Detailed data were reviewed, with a focus on the first precipitating factor for evisceration. RESULTS Of the 306 patients who underwent evisceration surgery in the studied period, 111 (36.27%) were female (with a mean age of 41.56 ± 21.38 years) and 195 (63.73%) were male (with a mean age of 37.76 ± 21.92 years). The most common cause of evisceration was ocular trauma (184 patients; 60.1%). Male patients experienced significantly more trauma, while glaucoma was more common in female patients. CONCLUSIONS Eye removal is devastating for both patients and their relatives, and its most important and preventable cause is ocular trauma.
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Affiliation(s)
- Özgür Balta
- Department of Ophthalmology, Dr Nafiz Körez Sincan State Hospital, Ankara, Turkey
| | - Uğur Acar
- Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fatma Akbaş Kocaoğlu
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Firdevs Örnek
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey
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245
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Hong M, Wang Q, Tang Z, Wang Y, Gu Y, Lou Y, Zheng M. Association of Genotyping of Bacillus cereus with Clinical Features of Post-Traumatic Endophthalmitis. PLoS One 2016; 11:e0147878. [PMID: 26886446 PMCID: PMC4757555 DOI: 10.1371/journal.pone.0147878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/08/2016] [Indexed: 11/19/2022] Open
Abstract
Bacillus cereus is the second most frequent cause of post-traumatic bacterial endophthalmitis. Although genotyping of B. cereus associated with gastrointestinal infections has been reported, little is known about the B. cereus clinical isolates associated with post-traumatic endophthalmitis. This is largely due to the limited number of clinical strains available isolated from infected tissues of patients with post-traumatic endophthalmitis. In this study, we report successful isolation of twenty-four B. cereus strains from individual patients with different disease severity of post-traumatic endophthalmitis. Phylogenetic analysis showed that all strains could be categorized into three genotypes (GTI, GTII and GTIII) and the clinical score showed significant differences among these groups. We then further performed genotyping using the vrrA gene, and evaluated possible correlation of genotype with the clinical features of B. cereus-caused post-traumatic endophthalmitis, and with the prognosis of infection by conducting follow-up with patients for up to 2 months. We found that the disease of onset and final vision acuity were significantly different among the three groups. These results suggested that the vrrA gene may play a significant role in the pathogenesis of endophthalmitis, and genotyping of B. cereus has the potential for predicting clinical manifestation and prognosis of endophthalmitis. To the best of our knowledge, this is the first report of isolation of large numbers of clinical isolates of B. cereus from patients with endophthalmitis. This work sets the foundation for future investigation of the pathogenesis endophthalmitis caused by B. cereus infection.
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Affiliation(s)
- Meng Hong
- Department of Clinical Laboratory Medicine, the Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, 325027, China
- Key Laboratory of Laboratory Medicine, Ministry of Education, Zhejiang Provincial Key Laboratory of Medical Genetics, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Qian Wang
- Key Laboratory of Laboratory Medicine, Ministry of Education, Zhejiang Provincial Key Laboratory of Medical Genetics, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Zhide Tang
- Department of Clinical Laboratory Medicine, the Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Youpei Wang
- Department of Clinical Laboratory Medicine, the Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Yunfeng Gu
- Department of Clinical Laboratory Medicine, the Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Yongliang Lou
- Key Laboratory of Laboratory Medicine, Ministry of Education, Zhejiang Provincial Key Laboratory of Medical Genetics, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
- * E-mail: (MZ); (YL)
| | - Meiqin Zheng
- Department of Clinical Laboratory Medicine, the Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, 325027, China
- * E-mail: (MZ); (YL)
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246
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BacillusPanophthalmitis with Posterior Extension to the Prechiasmatic Optic Nerve. Case Rep Ophthalmol Med 2016; 2016:7652803. [PMID: 27994900 PMCID: PMC5138454 DOI: 10.1155/2016/7652803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/02/2016] [Indexed: 11/18/2022] Open
Abstract
A rare case ofBacilluspanophthlamitis with extension to the prechiasmatic optic nerve secondary to hematogenous spreading after intravenous drug use is presented. A 27-year-old man with a recent history of trauma to the left eye presented with severe left eye pain following a binge of intravenous drug use. Visual acuity (VA) was LP. On examination he had chemosis, proptosis, elevated intraocular pressure, and a complete hyphema. CT-scan identified preseptal swelling, but no evidence of any posterior extension of the anterior process or orbital fractures. Topical and systemic therapy were initiated. On follow-up clinical examination less than 12 hours after presentation he had signs of a keratitis with worsening ophthalmoplegia and repeat imaging demonstrated posterior extension to the prechiasmatic optic nerve. Shortly after the cornea ruptured with cultures growingBacillus. The patient underwent enucleation and has had no further progression of infection. To the best of our knowledge, this is the first report ofBacilluspanophthalmitis presenting with signs of trauma with posterior extension to the prechiasmatic optic nerve.
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247
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Red eye emergencies in primary care. Nurse Pract 2015; 40:46-53; quiz 53-4. [PMID: 26545092 DOI: 10.1097/01.npr.0000473384.55251.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Severe red eye conditions can be the result of intraocular inflammation, corneal insults or inflammation, and acute glaucoma. These pathologies require the knowledge and assessment tools of an ophthalmologist. This article will discuss red eye emergencies that the NP should promptly recognize and refer to ophthalmology.
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248
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Affiliation(s)
| | - Tom Elliott
- Consultant Microbiologist in the Microbiology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham B15 2WB
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249
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Abstract
Open globe injury (OGI) is a severe form of eye trauma estimated at 2-3.8/100,000 in the United States. Most pediatric cases occur at home and are the result of sharp object penetration. The aim of this article is to review the epidemiology, diagnosis, management, and prognosis of this condition by conducting a systematic literature search with inclusion of all case series on pediatric OGI published between 1996 and 2015. Diagnosis of OGI is based on patient history and clinical examination supplemented with imaging, especially computed tomography when indicated. Few prospective studies exist for the management of OGI in pediatric patients, but adult recommendations are often followed with success. The main goals of surgical management are to repair the open globe and remove intraocular foreign bodies. Systemic antibiotics are recommended as medical prophylaxis against globe infection, or endophthalmitis. Other complications are similar to those seen in adults, with the added focus of amblyopia therapy in children. Severe vision decline is most likely due to traumatic cataracts. The ocular trauma score, a system devised to predict final visual acuity (VA) in adults, has proven to be of prognostic value in pediatric OGI as well. Factors indicating poor visual prognosis are young age, poor initial VA, posterior eye involvement, long wound length, globe rupture, lens involvement, vitreous hemorrhage, retinal detachment, and endophthalmitis. A thorough understanding of OGI and the key differences in epidemiology, diagnosis, management, and prognosis between adults and children is critical to timely prevention of posttraumatic vision loss early in life.
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Affiliation(s)
- Xintong Li
- Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Marco A Zarbin
- Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Neelakshi Bhagat
- Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, NJ, USA
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250
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Salvetti AP, Pellegrini M, Bottoni F, Staurenghi G. Endogenous bacterial endophthalmitis masquerading as an intraocular tumor. Saudi J Ophthalmol 2015; 30:71-4. [PMID: 26949365 PMCID: PMC4759503 DOI: 10.1016/j.sjopt.2015.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/19/2015] [Accepted: 11/10/2015] [Indexed: 11/26/2022] Open
Abstract
A 40-year-old female patient referred for a possible intraocular tumor was found to have an endogenous bacterial endophthalmitis in her right eye. Fundus examination revealed an amelanotic dome shaped choroidal mass and an exudative retinal detachment. Enhanced Depth Imaging-Optical Coherence Tomography (EDI-OCT), fundus autofluorescence (FAF) and ultrasounds were suggestive of a possible choroidal melanoma. A multimodal imaging approach and a thorough anamnesis were instrumental in establishing the correct diagnosis.
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Affiliation(s)
- Anna Paola Salvetti
- Eye Clinic, Department of Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Italy
| | - Marco Pellegrini
- Eye Clinic, Department of Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Italy
| | - Ferdinando Bottoni
- Eye Clinic, Department of Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Italy
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