Endophthalmitis: a bibliographic review

A Descriptive Study of Corneal Graft Failure in Retransplant Patients

OBJECTIVE

To identify the main predictors for corneal graft failure in patients who underwent retransplantation.

METHOD

This is a cross-sectional research with a quantitative and analytical approach, conducted based on data from secondary sources of a Human Eye Tissue Bank (HETB) in Northeast Brazil. Data were collected from the medical charts of all patients transplanted between January 2010 and December 2014. Descriptive statistics were used for the univariate analysis by means of absolute and relative frequencies and means. For the inferential analysis, the chi-square (X²) and the Fisher's Exact tests were used.

RESULTS

A total of 241 records were reviewed, representing 258 keratoplasties, of which 27 (10.46%) were retransplantations due to corneal graft failure. Of the total, 55.56% of the individuals were female, with a mean age of 58.56 years, 55.56% of the population was brown, and the highest relative frequency of housing found was in the Central Mesoregion. Of the corneal graft failure cases, 88.89% were due to late failure, 30.77% of cases were classified as pseudophakic and 11.57% as aphakic. Through inferential analysis, a statistical association was obtained among the variable "corneal graft failure" and mesoregion of the state, presence of glaucoma, vascularization, and classification of the eye.

CONCLUSION

The prognosis of keratoplasty is of multifactorial nature. Factors such as mesoregion of the State (place of residence), glaucoma, corneal vascularization, and aphakic eyes represent predictors for graft failure in the analyzed sample.

High risk and low prevalence diseases: Endophthalmitis

INTRODUCTION

Endophthalmitis is a serious, vision-threatening condition that carries with it a high rate of morbidity.

OBJECTIVE

This review highlights the pearls and pitfalls of endophthalmitis, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

DISCUSSION

Endophthalmitis is a vision-threatening emergency associated with infection and inflammation of vitreous and aqueous humor. Risk factors include ocular trauma or surgery, immunocompromised state, diabetes mellitus, and injection drug use. History and examination include visual changes, ocular pain, and inflammatory findings (e.g., hypopyon). Fever may be present. Diagnosis should be based on the clinical evaluation, though aqueous or vitreous culture performed by the ophthalmology specialist is recommended. Imaging including computed tomography, magnetic resonance imaging, and ultrasound may suggest the disease but cannot exclude the diagnosis. Management includes emergent ophthalmology consultation and evaluation. Treatment for all types of endophthalmitis is injection of intravitreal antibiotics with consideration of vitrectomy in severe cases. Systemic antimicrobials are recommended in specific types of endophthalmitis. Prompt recognition and diagnosis are key to optimizing favorable visual outcomes.

CONCLUSIONS

An understanding of endophthalmitis can assist emergency clinicians in diagnosing and managing this serious disease.

Differential diagnosis of endophthalmitis after intravitreal drug injection for age related macular degeneration: Sterile vs. infectious

The recent release of brolucizumab and the development of new antiangiogenic molecules as abicipar pegol has increased the interest towards inflammatory complications after intravitreal drug injection. Those drugs are associated to a higher rate of inflammatory adverse events compared to classic drugs. In this context it is essential to differentiate between sterile and infectious cases for a fast and effective treatment. The clinical similarities between infectious and sterile cases, the high rate of culture negative patients and the heterogeneity in the terminology used are obstacles for a correct diagnosis and report of these complications. Sterile cases appear early after the injection, before 48 hours; or 20 days after in brolucizumab-related vasculitis cases. Infectious cases show up around the third day after injection and up to a week after it. A severe visual impairment, severe pain, severe hyperemia, hypopyon and a more severe intraocular inflammatory process are signs of a likely infectious origin. If the cause of the inflammation is uncertain we must follow up the patient closely or "tap and inject" antimicrobial agents in order to prevent the eventual complications of an infectious endophthalmitis. On the other hand, sterile endophthalmitis might be observed in mild cases or treated with steroids according to the severity of the inflammation.

Analysis of antibiotic resistance and genetic profile of conjunctival bacteria flora before and after cataract surgery

PURPOSE

To analyze antibiotic resistance and genetic profile of conjunctival bacteria flora before and after cataract surgery with the focus on coagulase-negative staphylococci (CNS) during cataract surgery and discuss the implications of this colonization as a potential risk of acquiring endophthalmitis.

METHODS

After approval of the institutional review board and informed consent from patients had been obtained, conjunctival swabs for culture from 59 patients undergoing cataract surgery were taken of the fellow eye at baseline (C0) and from the eye to be operated before (T0) and after (T1) irrigation with povine-iodine 5%, and at the end of surgery (T2). Genes responsible for virulence (mecA, ica and atlE) and antibiotic profile were determined; strain clonality of persistent colonizing Staphylococcus epidermidis strains was established by the Multi-locus sequence typing (MLST).

RESULTS

The frequency of CNS was significantly reduced in T1 (13.6%) from 81.4% in T0 and 86.4% in C0. The frequency of mecA, ica and atlE genes was 34.4%, 37.5% and 61.4%, respectively; and methicillin phenotypic resistance was 35.4%. S. epidermidis was the most frequent species isolated in every time point. MLST revealed in 7 patients 100% coincidence of the seven alleles of the S. epidermidis isolated previous to povine-iodine 5% disinfection and at the end of the surgery. CNS isolates from T1 or T2 corresponded to the same species, antibiotic and virulence profile as those isolates from C0 or T0.

CONCLUSION

Povidone-iodine 5% prophylaxis before surgery significantly reduced conjunctival contamination; in those that persisted, the source of contamination was mostly the patient's microbiota confirmed by the MLST system.