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Lee S, Lee JK, Kim SH, Chung EJ. Incidence of Acute Endophthalmitis after Secondary Intraocular Lens Implantation: A Nationwide Cohort Study. Ophthalmologica 2024:1-10. [PMID: 39231453 DOI: 10.1159/000541055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 08/16/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION In this study, we aimed to analyze the incidence of acute endophthalmitis after secondary intraocular lens (IOL) implantation in South Korea. METHODS This study used information from the National Health Insurance Service (NHIS)-National Health Information Database (NHID). We identified patients who underwent secondary IOL implantation or IOL exchange surgeries during 2002-2021 due to diagnoses of IOL dislocation or mechanical complication of IOL. Postoperative endophthalmitis (POE) was defined as patients having received intravitreal antibiotic injection or vitrectomy for acute endophthalmitis diagnosed within 42 days after the claim for secondary IOL surgeries. All statistical analyses were performed with a significance level p < 0.05, and we used the univariate and multivariate Cox proportional hazard model to identify risk factors. RESULTS From 2002 to 2021, 39,364 patients received secondary IOL implantation, and acute POE was diagnosed in 62 patients. The overall incidence of acute POE was 0.16% during the 20-year period. More than half of the patients were diagnosed with POE within the first week after surgery. In the univariate analysis, there was a higher incidence of endophthalmitis in the group with pre-existing glaucoma (hazard ratio [HR], 1.945; 95% confidence interval [CI], 1.036-3.652; p = 0.0385) and the group undergoing concurrent vitrectomy (hazard ratio [HR], 2.329; 95% confidence interval [CI], 1.003-5.405; p = 0.0491). CONCLUSIONS The incidence of acute endophthalmitis after secondary IOL implantation in South Korea was similar to that of other countries. This is the largest retrospective claims data-based study of acute endophthalmitis after secondary IOL implantation in patients in South Korea.
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Affiliation(s)
- Seungyeon Lee
- Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea,
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea,
| | - Jae Kwang Lee
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Seo Hee Kim
- Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Eun Jee Chung
- Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
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Yoshimura A, Ishikawa H, Uchida K, Takesue Y, Mori J, Kinoshita T, Morikawa S, Okamoto F, Sawada T, Ohji M, Kanda T, Takeuchi M, Miki A, Kusuhara S, Ueda T, Ogata N, Sugimoto M, Kondo M, Yoshida S, Ogata T, Kimura K, Mitamura Y, Jujo T, Takagi H, Terasaki H, Sakamoto T, Sugisawa T, Komuku-Yamamoto Y, Gomi F. Risk Factors for Legal Blindness in 237 Japanese Patients with Exogenous Endophthalmitis: A Multicenter Cohort Study from J-CREST. Ocul Immunol Inflamm 2024; 32:1133-1141. [PMID: 36701518 DOI: 10.1080/09273948.2023.2165111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 12/26/2022] [Accepted: 12/31/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE We investigated potential risk factors for visual prognosis in Japanese patients with exogenous endophthalmitis. METHODS In this retrospective observational multicenter cohort study, risk factors for legal blindness at 12 weeks after treatment initiation were evaluated based on patient characteristics, initial BCVA, causative events, pathogens, ocular symptoms, duration from symptom onset to initial treatment, and selected treatments. RESULTS Overall, 23.1% of eyes developed legal blindness. The six risk factors for legal blindness were presence of eye pain, pathogen identification, poor BCVA at the initial visit, longer duration from symptom onset to initial treatment, type of causative event, and type of causative pathogen. Regarding the type of causative pathogen, coagulase-negative staphylococci was associated with a better visual impairment outcome. CONCLUSION Exogenous endophthalmitis remains a severe ocular infection; however, it can be managed with rapid treatment, as well as other advances in medical knowledge and technology.
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Affiliation(s)
- Ayano Yoshimura
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroto Ishikawa
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
- Department of Ophthalmology, Mirai Eye & Skin Clinic, Osaka, Japan
| | - Kazutaka Uchida
- Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Junya Mori
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Takamasa Kinoshita
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Shohei Morikawa
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Fumiki Okamoto
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoko Sawada
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Masahito Ohji
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Takayuki Kanda
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Masaru Takeuchi
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Akiko Miki
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sentaro Kusuhara
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tetsuo Ueda
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Nahoko Ogata
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Masahiko Sugimoto
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Mineo Kondo
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shigeo Yoshida
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Kurume University School of Medicine, Kurume, Japan
| | - Tadahiko Ogata
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kazuhiro Kimura
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Yoshinori Mitamura
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Tokushima University Graduate School, Tokushima, Japan
| | - Tatsuya Jujo
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hitoshi Takagi
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroto Terasaki
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Taiji Sakamoto
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takaaki Sugisawa
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yuki Komuku-Yamamoto
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Fumi Gomi
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
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Sugisawa T, Ishikawa H, Uchida K, Takesue Y, Mori J, Kinoshita T, Morikawa S, Okamoto F, Sawada T, Ohji M, Kanda T, Takeuchi M, Miki A, Kusuhara S, Ueda T, Ogata N, Sugimoto M, Kondo M, Yoshida S, Ogata T, Kimura K, Mitamura Y, Jujo T, Takagi H, Terasaki H, Sakamoto T, Komuku Y, Gomi F. Risk Factors for Legal Blindness in 77 Japanese Patients with Endogenous Endophthalmitis: A Multicenter Cohort Study from J-CREST. Ocul Immunol Inflamm 2023; 31:1505-1512. [PMID: 36007241 DOI: 10.1080/09273948.2022.2112237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/07/2022] [Accepted: 07/14/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE We investigated potential predictive factors for visual prognosis in Japanese patients with endogenous endophthalmitis. DESIGN Retrospective observational multicenter cohort study. METHODS We examined the characteristics of 77 Japanese patients with endogenous endophthalmitis and performed statistical analyses of these real-world data. The primary endpoint was the identification of factors associated with visual prognosis. We examined differences between patients in the better vision and legal blindness groups at 12 weeks after treatment initiation. RESULTS The five risk factors for visual impairment at 12 weeks after treatment initiation were presence of pressure injuries, severe clinical symptoms (presence of eye pain and ciliary injection), pathogen identification, and poor best-corrected visual acuity at baseline. Staphylococcus aureus and fungus were associated with a better visual impairment outcome. CONCLUSIONS Endogenous endophthalmitis remains a severe ocular infection; however, it can be managed with rapid treatments, as well as other advances in medical knowledge and technology.
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Affiliation(s)
- Takaaki Sugisawa
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroto Ishikawa
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
- Department of Ophthalmology, Mirai Eye & Skin Clinic, Osaka, Japan
| | - Kazutaka Uchida
- Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Junya Mori
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Takamasa Kinoshita
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Shohei Morikawa
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Fumiki Okamoto
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoko Sawada
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Masahito Ohji
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Takayuki Kanda
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Masaru Takeuchi
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Akiko Miki
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sentaro Kusuhara
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tetsuo Ueda
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Nahoko Ogata
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Masahiko Sugimoto
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Mineo Kondo
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shigeo Yoshida
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Kurume University School of Medicine, Kurume, Japan
| | - Tadahiko Ogata
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kazuhiro Kimura
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Yoshinori Mitamura
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Tokushima University Graduate School, Tokushima, Japan
| | - Tatsuya Jujo
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hitoshi Takagi
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroto Terasaki
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Taiji Sakamoto
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuki Komuku
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Fumi Gomi
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
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Weber C, Stasik I, Herrmann P, Schmitz-Valckenberg S, Holz FG, Liegl R. Early Vitrectomy with Silicone Oil Tamponade in the Management of Postoperative Endophthalmitis. J Clin Med 2023; 12:5097. [PMID: 37568501 PMCID: PMC10419538 DOI: 10.3390/jcm12155097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Background: Early vitrectomy for postsurgical endophthalmitis may improve visual acuity outcomes. Silicone oil as a tamponade has some potential benefits in the management of endophthalmitis. This study aims to evaluate the use of a silicone oil tamponade in the surgical management of endophthalmitis. Material and Methods: All patients with a pars plana vitrectomy with silicone oil tamponade for postsurgical endophthalmitis at the Department of Ophthalmology, University of Bonn, Germany, between 2017 and 2021 were retrospectively reviewed. We included all preoperative data, including BCVA at diagnosis, clinical findings, and symptoms. For every follow-up visit, we looked at BCVA and complications. Results: In total, 82 patients were included in this study. The mean follow-up was 13.1 months (range 1-58 months). An intravitreal injection was the cause in 42 patients (51.2%) and cataract surgery in 29 patients (35.4%). The mean interval between the causing event and the date of onset was 8.8 days (range, 1-59 days). The most prevalent pathogen was Staphylococcus epidermidis in 16 patients (19.5%). In 47 patients (57.3%), no pathogen was found. The initial best-corrected visual acuity was 2.1 logMAR and improved significantly to 1.0 logMAR after six months (p < 0.001) and 1.1 logMAR after 1 year (p < 0.001). In a multivariate analysis, a low BCVA at diagnosis (p = 0.041) was a significant predictor for poor visual acuity outcomes. A total of 17 patients (20.1%) developed postoperative complications. Five patients (6.1%) needed an anterior chamber washout with repeated injections of antibiotics. Two patients (2.4%) had persistent fibrin and were treated with YAG-laser treatment. Three patients (6.7%) developed a retinal detachment. Two patients (2.4%) had persistent corneal decompensation with endothelial cell loss and received perforating keratoplasty. We performed a matched-pair analysis (n = 30, each group n = 15) to compare a silicone oil tamponade with BSS at the end of surgery. The visual acuity outcome showed no significant differences (BCVA after one year: 1.17 logMAR in eyes with silicone oil and 0.90 logMAR in eyes with BSS; p = 0.684). Conclusions: In our study, a vitrectomy with silicone oil tamponade in the surgical management of postoperative endophthalmitis led to a significant improvement in visual acuity and had a low complication rate. Low BCVA at diagnosis was significantly associated with poor visual acuity outcomes. A comparison of silicone oil and BSS at the end of surgery showed similar results.
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Affiliation(s)
- Constance Weber
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (C.W.); (I.S.); (P.H.); (S.S.-V.); (F.G.H.)
| | - Isabel Stasik
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (C.W.); (I.S.); (P.H.); (S.S.-V.); (F.G.H.)
| | - Philipp Herrmann
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (C.W.); (I.S.); (P.H.); (S.S.-V.); (F.G.H.)
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (C.W.); (I.S.); (P.H.); (S.S.-V.); (F.G.H.)
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, UT 84132, USA
| | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (C.W.); (I.S.); (P.H.); (S.S.-V.); (F.G.H.)
| | - Raffael Liegl
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (C.W.); (I.S.); (P.H.); (S.S.-V.); (F.G.H.)
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Mursalin MH, Astley R, Coburn PS, Miller FC, Callegan MC. Roles of CCL2 and CCL3 in intraocular inflammation during Bacillus endophthalmitis. Exp Eye Res 2022; 224:109213. [PMID: 36063964 PMCID: PMC9826602 DOI: 10.1016/j.exer.2022.109213] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/18/2022] [Accepted: 08/04/2022] [Indexed: 01/11/2023]
Abstract
Bacillus cereus (B. cereus) endophthalmitis is a vision-threatening bacterial infection. Uncontrolled inflammatory responses are the hallmark of this disease which cause irreversible damage to the retina. We recently reported C-X-C chemokines as a vital modulators which impacted the pathogenesis of this disease. Here, we investigated the impact of two highly upregulated C-C chemokines, CCL2 and CCL3, on intraocular inflammation this disease. B. cereus was injected into the eyes of C57BL/6J (WT), CCL2-/-, and CCL3-/- mice to induce endophthalmitis. Infected eyes were examined for bacterial growth, retinal function, and inflammation. Bacterial growth in CCL2-/- and CCL3-/- mice were similar, but retained retinal function was greater in CCL2-/- and CCL3-/- eyes compared to that of C57BL/6J eyes. The retinal architecture of infected eyes of CCL2-/- mice were conserved for a longer period of time than in infected CCL3-/- eyes. Infected CCL2-/- and CCL3-/- eyes had less inflammation than did infected C57BL/6J eyes. Based on these results, we assessed the efficacies of intravitreal anti-CCL2 or anti-CCL3 with or without the antibiotic gatifloxacin. Compared to infected untreated eyes, there was significantly less inflammation and greater retention of retinal function in eyes treated with anti-CCL2 or anti-CCL3 with gatifloxacin. This study showed that B. cereus endophthalmitis in CCL2-/- mice had a better clinical outcome than in CCL3-/- mice. Intravitreal administration of anti-CCL2 and anti-CCL3 with gatifloxacin significantly reduced inflammation and provided protection of retinal function. These results suggest that CCL2 and CCL3 are prospective anti-inflammatory targets that should be tested along with other antibiotics for treating Bacillus and perhaps other forms of endophthalmitis.
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Affiliation(s)
- Md Huzzatul Mursalin
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Roger Astley
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Dean McGee Eye Institute, Oklahoma City, Oklahoma, USA
| | - Phillip S. Coburn
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Dean McGee Eye Institute, Oklahoma City, Oklahoma, USA
| | - Frederick C. Miller
- Department of Cell Biology and Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michelle C. Callegan
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Dean McGee Eye Institute, Oklahoma City, Oklahoma, USA
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Zhang WF, Zhao XY, Meng LH, Chen H, Chen YX. Endophthalmitis at a tertiary referral center: Characteristics and treatment outcomes over three decades. Front Cell Dev Biol 2022; 10:952375. [PMID: 36003150 PMCID: PMC9395169 DOI: 10.3389/fcell.2022.952375] [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: 05/25/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose: To explore the incidence, pathogens, treatment, and prognosis of endophthalmitis. Methods: Patients who were diagnosed with endophthalmitis from January 1990 to October 2020 at Peking Union Medical College Hospital were retrospectively reviewed and examined. Subgroup analysis was conducted regarding different initial treatment methods for eyes without concurrent retinal detachment (RD) at presentation. Results: A total of 249 eyes of 233 patients were included in this retrospective study. The most common clinical scenario was exogenous endophthalmitis (60.6%). The most frequent bacteria and fungi were coagulase-negative staphylococci (10.0%) and candida (6.8%), respectively. Retinal with/without choroid detachment was the most common complication after treatment. Patients with endogenous endophthalmitis were more likely to have binocular involvement; there were also more patients with diabetes mellitus or immunosuppressive diseases, and the prognosis of visual acuity (VA) was poorer. There were more eyes with concurrent RD at presentation that underwent serious complications after treatment (p < 0.05), and the visual outcome was worse than that without concurrent RD (p < 0.05). Subgroup analysis was conducted according to different initial treatments in eyes without concurrent RD. Group 1 received pars plana vitrectomy (PPV) with intravitreal injection of antibiotics (IVI) as initial treatment, Group 2 was initially treated with IVI only, and Group 3 was initially treated with nonsurgical treatment. More eyes that initially received IVI alone and nonsurgical treatment required additional treatments, especially additional PPV. VA in both Groups 1 and 2 significantly improved by the final VA. However, there was no significant difference in final VA between the two groups. There was an insignificant trend that serious posttreatment complications were more common in Group 1. In Group 1, 17 eyes received silicone oil or gas tamponade at the same time, whereas 62 did not. Eyes that were initially treated with PPV + IVI while without tamponade needed more additional treatments and additional IVI. Conclusion: Endophthalmitis is a devastating intraocular disease and requires early intervention. Endogenous endophthalmitis has a poorer visual prognosis than exogenous entity. PPV + IVI as an initial treatment may reduce additional therapy.
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Affiliation(s)
- Wen-Fei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin-Yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Li-Hui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huan Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - You-Xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- *Correspondence: You-Xin Chen, ,
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Ishikawa H, Uchida K, Takesue Y, Mori J, Kinoshita T, Morikawa S, Okamoto F, Sawada T, Ohji M, Kanda T, Takeuchi M, Miki A, Kusuhara S, Ueda T, Ogata N, Sugimoto M, Kondo M, Yoshida S, Ogata T, Kimura K, Mitamura Y, Jujo T, Takagi H, Terasaki H, Sakamoto T, Sugisawa T, Komuku Y, Gomi F. Clinical Characteristics and Outcomes in 314 Japanese Patients with Bacterial Endophthalmitis: A Multicenter Cohort Study from J-CREST. Pathogens 2021; 10:pathogens10040390. [PMID: 33805010 PMCID: PMC8063932 DOI: 10.3390/pathogens10040390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 12/25/2022] Open
Abstract
Bacterial endophthalmitis is an intraocular infection that causes rapid vison loss. Pathogens can infect the intraocular space directly (exogenous endophthalmitis (ExE)) or indirectly (endogenous endophthalmitis (EnE)). To identify predictive factors for the visual prognosis of Japanese patients with bacterial endophthalmitis, we retrospectively examined the bacterial endophthalmitis characteristics of 314 Japanese patients and performed statistics using these clinical data. Older patients, with significantly more severe clinical symptoms, were prevalent in the ExE group compared with the EnE group. However, the final best-corrected visual acuity (BCVA) was not significantly different between the ExE and EnE groups. Bacteria isolated from patients were not associated with age, sex, or presence of eye symptoms. Genus Streptococcus, Streptococcus pneumoniae, and Enterococcus were more prevalent in ExE patients than EnE patients and contributed to poor final BCVA. The presence of eye pain, bacterial identification, and poor BCVA at baseline were risk factors for final visual impairment.
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Affiliation(s)
- Hiroto Ishikawa
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya 6638501, Japan; (T.S.); (Y.K.); (F.G.)
- Correspondence: ; Tel.: +81-798-45-6462
| | - Kazutaka Uchida
- Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya 6638501, Japan;
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya 6638501, Japan;
| | - Junya Mori
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo 0608604, Japan; (J.M.); (T.K.)
| | - Takamasa Kinoshita
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo 0608604, Japan; (J.M.); (T.K.)
| | - Shohei Morikawa
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba 3058576, Japan; (S.M.); (F.O.)
| | - Fumiki Okamoto
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba 3058576, Japan; (S.M.); (F.O.)
| | - Tomoko Sawada
- Department of Ophthalmology, Shiga University of Medical Science, Otsu 5202192, Japan; (T.S.); (M.O.)
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Otsu 5202192, Japan; (T.S.); (M.O.)
| | - Takayuki Kanda
- Department of Ophthalmology, National Defense Medical College, Tokorozawa 3598513, Japan; (T.K.); (M.T.)
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Tokorozawa 3598513, Japan; (T.K.); (M.T.)
| | - Akiko Miki
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe 6500017, Japan; (A.M.); (S.K.)
| | - Sentaro Kusuhara
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe 6500017, Japan; (A.M.); (S.K.)
| | - Tetsuo Ueda
- Department of Ophthalmology, Nara Medical University School of Medicine, Kashihara 6348522, Japan; (T.U.); (N.O.)
| | - Nahoko Ogata
- Department of Ophthalmology, Nara Medical University School of Medicine, Kashihara 6348522, Japan; (T.U.); (N.O.)
| | - Masahiko Sugimoto
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu 5148507, Japan; (M.S.); (M.K.)
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu 5148507, Japan; (M.S.); (M.K.)
| | - Shigeo Yoshida
- Department of Ophthalmology, Kurume University School of Medicine, Kurume 8300011, Japan;
| | - Tadahiko Ogata
- Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University, Ube 7558505, Japan; (T.O.); (K.K.)
| | - Kazuhiro Kimura
- Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University, Ube 7558505, Japan; (T.O.); (K.K.)
| | - Yoshinori Mitamura
- Department of Ophthalmology, Tokushima University Graduate School, Tokushima 7708503, Japan;
| | - Tatsuya Jujo
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki 2168511, Japan; (T.J.); (H.T.)
| | - Hitoshi Takagi
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki 2168511, Japan; (T.J.); (H.T.)
| | - Hiroto Terasaki
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 8908520, Japan; (H.T.); (T.S.)
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 8908520, Japan; (H.T.); (T.S.)
| | - Takaaki Sugisawa
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya 6638501, Japan; (T.S.); (Y.K.); (F.G.)
| | - Yuki Komuku
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya 6638501, Japan; (T.S.); (Y.K.); (F.G.)
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya 6638501, Japan; (T.S.); (Y.K.); (F.G.)
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Welch S, Bhikoo R, Wang N, Siemerink MJ, Shew W, Polkinghorne PJ, Niederer RL. Better visual outcome associated with early vitrectomy in the management of endophthalmitis. Br J Ophthalmol 2021; 106:1145-1149. [PMID: 33712482 DOI: 10.1136/bjophthalmol-2020-316846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/29/2021] [Accepted: 02/26/2021] [Indexed: 11/04/2022]
Abstract
AIMS To examine the role of early vitrectomy in the management of endophthalmitis from all causes. METHODS Retrospective study of 290 consecutive subjects diagnosed with endophthalmitis at Auckland District Health Board between 1 January 2006 and 31 July 2019. Main outcome measure was visual acuity at 9-month follow-up and proportion of subjects with severe vision loss (≤20/200). RESULTS Median age at presentation was 70.4 years and 151 subjects (52.1%) were women. Cataract surgery was the most common cause of endophthalmitis in 92 subjects (31.7%) followed by intravitreal injection in 57 (19.7%), endogenous endophthalmitis in 48 subjects (16.6%), non-surgical trauma in 42 subjects (14.5%), glaucoma surgery in 24 subjects (8.3%), vitrectomy in 22 subjects (7.6%) and corneal in 5 subjects (1.7%). Culture was positive in 136 (46.9%) with gram-positive organisms most common (76.5%). Early vitrectomy was performed in 82 subjects (28.3%). Median visual acuity at 9 months was 20/100 (IQR 20/30 to light perception), and severe vision loss occurred in 100 (43.5%). Retinal detachment occurred in 35 eyes (12.1%) and 26 eyes were enucleated. On multivariate analysis, younger age, poor presenting visual acuity and culture-positive endophthalmitis were associated with worse outcomes, and early vitrectomy was associated with better outcomes. CONCLUSIONS Early vitrectomy (within 24 hours) is associated with better visual outcomes at 9 months, while younger age, poor presenting visual acuity and culture-positive endophthalmitis are associated with poorer visual acuity outcomes.
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Affiliation(s)
- Sarah Welch
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Riyaz Bhikoo
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Nancy Wang
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Martin J Siemerink
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - William Shew
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Philip J Polkinghorne
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand.,Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand .,Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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Gao Z, Zhang Y, Gao X, Zhang X, Ma T, Li G, Wang J, Yan H. Clinical analysis and predictive factors associated with improved visual acuity of infectious endophthalmitis. BMC Ophthalmol 2020; 20:256. [PMID: 32600279 PMCID: PMC7325235 DOI: 10.1186/s12886-020-01517-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/12/2020] [Indexed: 11/21/2022] Open
Abstract
Background To describe the clinical characteristics and analyze the predictive factors associated with improved visual acuity of 359 patients with infectious endophthalmitis. Methods This study retrospectively analyzed 359 eyes of 359 patients with infectious endophthalmitis from January 2014 to December 2018. The findings summarized some epidemiological characteristics of these patients, including age, sex, occupation, patient visit time, etiology, causative organisms, therapy, and best-corrected visual acuity. Multivariate logistic regression was performed to predict the relative factors of improved visual acuity (VA). Results Overall, 283 (78.83%) patients were male. The mean age was 48.0 ± 18.27 years. Ocular trauma, especially open globe injuries (246, 68.5%) was the most common etiology of infectious endophthalmitis in this study. The etiologies of infectious endophthalmitis were open globe injuries (68.5%), intraocular surgery (22.6%), and corneal ulcer-associated (6.7%) and endogenous causes (2.2%). In the etiology classification and visual acuity improvement group, had statistically significant differences in factors such as age, sex, patient visit time, pre-therapy visual acuity, etc. The average Logarithm of the Minimum Angle of Resolution (logMAR) best-corrected visual acuity on pre-therapy was 2.28 ± 0.60, and it had significantly improved to 1.67 ± 0.83 post-therapy (P < 0.05). Logistic regression analysis showed that visit time > 7 day (P = 0.034, OR = 0.522, 95% CI: 0.286–0.953), pre-therapy VA ≦logMAR 2.3 (P = 0.032, OR = 1.809, 95% CI: 1.052–3.110), post-surgical (vs. posttraumatic; P = 0.023, OR = 2.100, 95% CI: 1.109–3.974), and corneal ulcer-associated etiologies (vs. posttraumatic; P = 0.005, OR = 0.202, 95%CI: 0.066–0.621) were significantly associated with improved visual acuity after adjusting for possible confounding factors. Conclusions Among the patients with infectious endophthalmitis, middle-aged male, especially farmers and workers, accounted for a large proportion. Open globe injuries were the main cause and the gram-positive bacteria were the major causative organisms. The final visual outcomes seemed to vary according to the type of endophthalmitis, but early treatment and good initial visual acuity were important factors for visual acuity improvement.
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Affiliation(s)
- Zhao Gao
- Department of Ophthalmfology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Tianjin, 300052, China.,Department of Vitreoretinopathy, Shanxi Eye Hospital, Taiyuan, 030001, Shanxi, China
| | - Yunda Zhang
- Department of Vitreoretinopathy, Shanxi Eye Hospital, Taiyuan, 030001, Shanxi, China
| | - Xiaohong Gao
- Department of Vitreoretinopathy, Shanxi Eye Hospital, Taiyuan, 030001, Shanxi, China
| | - Ximei Zhang
- Department of Vitreoretinopathy, Shanxi Eye Hospital, Taiyuan, 030001, Shanxi, China
| | - Tao Ma
- Department of Vitreoretinopathy, Shanxi Eye Hospital, Taiyuan, 030001, Shanxi, China
| | - Gaiyun Li
- Department of Vitreoretinopathy, Shanxi Eye Hospital, Taiyuan, 030001, Shanxi, China
| | - Jingjing Wang
- Department of Medical Services, Shanxi Eye Hospital, Taiyuan, 030001, Shanxi, China
| | - Hua Yan
- Department of Ophthalmfology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Tianjin, 300052, China.
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Eckardt keratoprosthesis for combined pars plana vitrectomy and therapeutic keratoplasty in a patient with endophthalmitis and suppurative keratitis. J Cataract Refract Surg 2020; 46:474-477. [PMID: 32050221 DOI: 10.1097/j.jcrs.0000000000000098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This is a case report on the use of Eckardt keratoprosthesis for pars plana vitrectomy in a patient with endophthalmitis and suppurative keratitis that developed after cataract surgery. A 79-year-old woman developed acute-onset infectious endophthalmitis and suppurative keratitis after cataract surgery that failed to respond to treatment with antibiotic eyedrops and intravitreal antibiotic injection. Using a temporary keratoprosthesis that enabled sufficient visualization, vitrectomy was performed, followed by therapeutic keratoplasty using a cryopreserved donor cornea. The patient's vision was improved from light perception to counting fingers at 30 cm, 3 months postoperatively. There was no recurrence of infection or other significant complications.
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