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Relhan N, Forster RK, Flynn HW. Endophthalmitis: Then and Now. Am J Ophthalmol 2018; 187:xx-xxvii. [PMID: 29217351 PMCID: PMC5873969 DOI: 10.1016/j.ajo.2017.11.021] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE To report historically evolving strategies (then and now) in prevention and management of endophthalmitis. DESIGN A perspective on relevant topics in the prophylaxis and management of endophthalmitis. METHODS This is an author-selected review of studies leading to changes in strategies for endophthalmitis management over the last 100 years. RESULTS The current perspective discusses the trends and strategies over the past century. Historically, 3 endophthalmitis time-periods have existed and include the pre-antimicrobial era, the predominantly systemic antimicrobial era, and the current intravitreal antimicrobial era. The management of endophthalmitis from different etiologies, including endogenous, postinjection, post-cataract surgery, and other anterior segment-related (eg, post-penetrating keratoplasty), bleb-associated, glaucoma drainage device-associated, and open globe injury-associated, are discussed. Specific etiologies may predict most common microbial causes and may guide differing management strategies. Pars plana vitrectomy offers theoretical advantages but is generally reserved for patients with more advanced disease. CONCLUSIONS Despite advances over the past 100 years, endophthalmitis is an important sight-threatening complication. Timely management with the appropriate use of antimicrobial agents may optimize visual outcomes.
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Affiliation(s)
- Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Richard K Forster
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Affiliation(s)
- Rishi P Singh
- Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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Kosobucki BR, Freeman WR. Retinal Disease in HIV-infected Patients. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50098-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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5
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Bachman DM. BK virus retinitis. Ophthalmology 1999; 106:2232. [PMID: 10599646 DOI: 10.1016/s0161-6420(99)90566-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Endophthalmitis is an inflammatory reaction of intraocular fluids or tissues. Infectious endophthalmitis is one of the most serious complications of ophthalmic surgery. Occasionally, infectious endophthalmitis is the presenting feature of an underlying systemic infection. Successful management of infectious endophthalmitis depends on timely diagnosis and institution of appropriate therapy. Recognition of the different clinical settings in which endophthalmitis occurs and awareness of the highly variable presentation it may have facilitate timely diagnosis. Biopsy of intraocular fluid/tissue is the only method that permits reliable diagnosis and treatment. The different presenting clinical settings, a rational approach to diagnosis (i.e., when, what, and how to biopsy), and the treatment of infectious endophthalmitis are reviewed.
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Affiliation(s)
- M S Kresloff
- Department of Ophthalmology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark 07103-2499, USA
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Rickman LS, Freeman WR. Medical and virological aspects of ocular human immunodeficiency virus infection for the ophthalmologist. Semin Ophthalmol 1995; 10:91-110. [PMID: 10155633 DOI: 10.3109/08820539509059986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- L S Rickman
- Division of Infectious Diseases, University of California San Diego School of Medicine, USA
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Campos MS, Campos e Silva LDQ, Rehder JR, Lee MB, O'Brien T, McDonnell PJ. Anaerobic flora of the conjunctival sac in patients with AIDS and with anophthalmia compared with normal eyes. Acta Ophthalmol 1994; 72:241-5. [PMID: 8079632 DOI: 10.1111/j.1755-3768.1994.tb05023.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Relatively few investigations of anaerobic bacteria as ocular flora have been conducted, and their results have been contradictory. The conjunctival sacs of 22 normal subjects and of 14 patients with acquired immunodeficiency syndrome, and 22 anophthalmic sockets were cultured for anaerobic bacteria Thirty-four (77.3%) of the 44 eyes of normal subjects harbored anaerobic bacteria; Propionibacterium acnes was present in 28 eyes (63.6%), Lactobacillus species in 6 eyes (13.6%), and Veillonella species in 7 eyes (15.9%). The finding were very similar for anophthalmic sockets (p = 0.01), with 17 (77.3%) of the 22 sockets harboring anaerobes; Propionibacterium acnes was the organism identified in 16 (72.7%) of these sockets; Veillonella was identified in 4 (18.1%), Peptococcus niger in 3 (13.6%) and P. granulosum in 2 (9.0%) of these sockets. Acquired immunodeficiency syndrome patients had the highest incidence of anaerobic organisms, with positive cultures obtained from 24 (85.7%) of the 28 eyes. Propionibacterium species were isolated from 16 (57.1%) of these eyes. Clostridium species from 10 (35.7%) eyes and Actinomyces species from 8 (28.6%) eyes. It thus appears that anaerobic organisms are common flora in normal conjunctival sacs and in anophthalmic sockets, as well as in the sacs of acquired immunodeficiency syndrome patients, but the latter group had a higher incidence (x2 = 0.87) and a spectrum of organisms that was different from that of the other two groups.
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Affiliation(s)
- M S Campos
- Department of Ophthalmology, Paulista School of Medicine, São Paulo, Brazil
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Rummelt V, Rummelt C, Jahn G, Wenkel H, Sinzger C, Mayer UM, Naumann GO. Triple retinal infection with human immunodeficiency virus type 1, cytomegalovirus, and herpes simplex virus type 1. Light and electron microscopy, immunohistochemistry, and in situ hybridization. Ophthalmology 1994; 101:270-9. [PMID: 8115149 DOI: 10.1016/s0161-6420(94)31336-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE This report describes the histopathologic and virologic findings of the retina from a 55-year-old bisexual patient with the acquired immune deficiency syndrome (AIDS), who had concurrent human immunodeficiency virus type 1 (HIV-1), cytomegalovirus (CMV), and herpes simplex virus type 1 (HSV-1) retinitis, and was treated with ganciclovir. METHODS The eyes were obtained at autopsy and processed for light microscopy and transmission electron microscopy. Immunohistochemical stains for HSV-1, CMV, HIV-1, varicella zoster virus, and glial fibrillary acidic protein were carried out using the peroxidase-antiperoxidase and streptavidin-biotin-alkaline phosphatase techniques. For in situ hybridization, a radiolabeled CMV DNA probe (Eco-RI-Y fragment of strain AD 169) was used. RESULTS Results of histopathologic examination showed a full-thickness necrotizing retinitis with cytomegalic and herpes viral intranuclear inclusions in cells of the neurosensory retina, retinal vascular endothelium, and the retinal pigment epithelium. Some areas of the retina were replaced by glial tissue. The choroid contained only a few chronic inflammatory cells. Immunoperoxidase studies disclosed CMV antigens diffusely distributed throughout all layers of the retina and the retinal pigment epithelium. Herpes simplex virus type 1 antigens were present in retinal cells and the retinal vascular endothelium. Human immunodeficiency virus type 1 antigens were found in mononuclear cells in all layers of the sensory retina. Dual infections with HIV-1 and CMV of individual multinucleated giant cells of glial origin were demonstrated immunohistochemically. Transmission electron microscopy showed herpes viral particles in the vascular endothelium of the retinal vessels and the choriocapillaris. Human immunodeficiency virus particles were identified in the endothelium of the choriocapillaris. CONCLUSIONS The possibility of multiple viral infections of the retina, mimicking classic CMV retinitis, should be considered in the clinical and histologic differential diagnosis of necrotizing retinitis in patients with AIDS.
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Affiliation(s)
- V Rummelt
- Department of Ophthalmology, University of Erlangen-Nürnberg, Germany
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Mansour AM, Ansari NH, Egwuagu CE, Kaspar HG, Harmon MK. Bacterial optic disk mass and toxoplasmic-like encephalitis in an HIV-seropositive subject. Graefes Arch Clin Exp Ophthalmol 1993; 231:668-71. [PMID: 8258404 DOI: 10.1007/bf00921964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- A M Mansour
- Department of Ophthalmology, University of Texas Medical Branch, Galveston 77555-0787
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Yoser SL, Forster DJ, Rao NA. Systemic viral infections and their retinal and choroidal manifestations. Surv Ophthalmol 1993; 37:313-52. [PMID: 8387231 DOI: 10.1016/0039-6257(93)90064-e] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Viruses are one of the most common causes of infections involving the posterior segment of the eye. Such infections can occur either on a congenital or an acquired basis, and may affect primarily the retina or the choroid. Congenital cytomegalovirus (CMV) and rubella infections may result in retinitis. CMV retinitis is also the most common cause of acquired viral retinitis, primarily because of the acquired immunodeficiency syndrome (AIDS). Other types of viral retinitis, such as those caused by herpes simplex or herpes zoster, can occur in immunocompromised or immunocompetent individuals. Retinitis or choroiditis caused by viruses such as measles, influenza, Epstein-Barr virus, and Rift Valley fever virus, typically occurs subsequent to an acute viral systemic illness. The systemic and ocular manifestations, as well as the histopathology, laboratory tests, differential diagnoses, and treatment regimens for each of the individual viruses are discussed in detail.
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Affiliation(s)
- S L Yoser
- Doheny Eye Institute, University of Southern California School of Medicine, Los Angeles
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Dunn JP, Holland GN. HUMAN IMMUNODEFICIENCY VIRUS AND OPPORTUNISTIC OCULAR INFECTIONS. Infect Dis Clin North Am 1992. [DOI: 10.1016/s0891-5520(20)30490-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ugen KE, McCallus DE, Von Feldt JM, Williams WV, Greene MI, Weiner DB. Ocular tissue involvement in HIV infection: immunological and pathological aspects. Immunol Res 1992; 11:141-53. [PMID: 1431423 DOI: 10.1007/bf02918619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The CNS afflictions in AIDS are myriad and suggest a tropism of HIV to neural tissue. Ocular involvement is a frequent manifestation of the HIV infection, resulting in a high incidence of blindness within this patient population. Ocular lesions include cotton wool spots, presumably from HIV-induced microvasculopathy, retinal hemorrhage in cytomegalovirus retinitis and conjunctival Kaposi's sarcoma. These manifestations have been noted in up to 71% of AIDS patients. In fact, ocular disease is often the presenting symptom in an HIV-infected individual. Despite the high incidence of ocular involvement in AIDS patients, the etiology and pathogenesis of these manifestations are not well understood. The immunosuppressive action of HIV is the most likely primary cause for the development of ocular complications in AIDS. Here we review some of the important immunological and pathological features of AIDS affliction in the eye.
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Affiliation(s)
- K E Ugen
- Wistar Institute of Anatomy and Biology, Philadelphia, Pa. 19104
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Abstract
Patients with acquired immunodeficiency syndrome (AIDS) are at high risk for developing retinitis. The most common forms of retinitis in such patients are those caused by cytomegalovirus (CMV) and Toxoplasma; however, retinitis or choroiditis can also be caused by other viral, protozoal, bacterial, and fungal agents. Differential diagnosis of these infections is based on a number of factors, including ophthalmoscopic appearance, underlying disease, clinical history, and severity of underlying immunosuppression. Rapid and accurate diagnosis is essential in preserving functional vision, as some forms of retinitis are rapidly progressive and since appropriate treatment varies by diagnosis.
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Affiliation(s)
- M D de Smet
- National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892
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Davis JL, Solomon D, Nussenblatt RB, Palestine AG, Chan CC. Immunocytochemical staining of vitreous cells. Indications, techniques, and results. Ophthalmology 1992; 99:250-6. [PMID: 1553217 DOI: 10.1016/s0161-6420(92)31984-0] [Citation(s) in RCA: 92] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Diagnostic vitrectomy is often performed because of suspected infection or malignancy. Giemsa, Gram, and Papanicolaou stains are used routinely to identify the components in the vitreous. Immunocytochemical staining of cellular components of vitreous specimens has the potential to significantly increase the amount of useful information that can be gained from histopathologic study. Vitreous specimens from 14 patients undergoing diagnostic or therapeutic vitrectomy for infection, suspected primary intraocular lymphoma, or uveitis were examined by immunocytochemical staining using monoclonal antibodies specific for leukocyte subclass antigens and immunoglobulin. The three classes of disorders showed characteristic patterns of staining, which were useful in confirming microbiologic and clinical diagnoses. Infections showed more pronounced neutrophils and macrophages, primary intraocular lymphomas demonstrated light chain restriction of the malignant B lymphocytes, and uveitis was characterized by the predominance of T lymphocytes. The routine use of immunocytochemical staining is recommended to characterize cellular infiltrates and increase the diagnostic yield from vitrectomy specimens.
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Affiliation(s)
- J L Davis
- Laboratory of Immunology, National Eye Institute, Bethesda, MD 20892
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Abstract
Seven cases of bilateral, scattered, yellow-white choroidal lesions have been seen in AIDS patients since January 1988. One resulted from presumed extension of cryptococcal meningitis into the optic nerve and choroid. All the remaining six patients had pneumocystis pneumonia at some time during the course of the disease and were receiving aerosolised pentamidine therapy. None died quickly of disseminated Pneumocystis carinii infection, unlike previously reported patients. Mycobacterial infection was also present in five of these six patients. The differential diagnosis of this entity in AIDS patients is discussed.
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Affiliation(s)
- M A Rosenblatt
- Department of Ophthalmology, Mt Sinai School of Medicine, New York, NY
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