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Jia P, Qin J, Cao X, Wu Y, Li Z, Xu R, Shang Y, Gao B. Clinical and pathogenic characteristics of infectious endophthalmitis in children: A retrospective analysis. Medicine (Baltimore) 2024; 103:e38456. [PMID: 38875407 PMCID: PMC11175972 DOI: 10.1097/md.0000000000038456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
Infective endophthalmitis is an ophthalmic infection that in severe cases can cause complete loss of vision. In children, the defense against infection is low and eye tissue is not fully developed, leading to increased vulnerability to endophthalmitis. Children may be unable to understand the symptoms; thus, developing a method for prevention and treatment of this disease in children is important. Therefore, we analyzed the clinical and pathogenic characteristics of infectious endophthalmitis in children and provided evidence for clinical treatment. The clinical data of 78 children (78 eyes) with infectious endophthalmitis were retrospectively analyzed. The clinical characteristics, pathogen distribution, drug sensitivity, clinical medication, and treatments were summarized and analyzed. In total, 74 (94.87%) had ocular infections caused by trauma and 75 (96.15%) were from rural townships. A total of 108 sterile specimens were examined, with a positive detection rate of 37.04%. The sensitivity rates of Gram-positive cocci and bacilli to vancomycin were 100%. The sensitivity rates of Gram-negative bacilli to ceftazidime, piperacillin/tazobactam, amikacin, gentamicin, ciprofloxacin, and levofloxacin were 100%. Of the 78 patients, 53 (67.95%) received intravitreal injection and 54 (69.23%) underwent vitrectomy. Trauma is the main factor leading to infectious endophthalmitis in children, wherein Gram-positive bacteria are the most common pathogens. Thus, a timely understanding of the pathogen and drug sensitivity is needed. Intravitreal injection and vitrectomy are effective treatments.
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Affiliation(s)
- Peipei Jia
- Department of Diabetic Ophthalmology, Hebei Ophthalmology Key Lab, Hebei Eye Hospital, Xingtai, Hebei, China
| | - Jiayin Qin
- Department of Ophthalmology, Peking University International Hospital, Life Science Park of Zhong Guancun, Changping District, Beijing, China
| | - Xiaolu Cao
- Department of Diabetic Ophthalmology, Hebei Ophthalmology Key Lab, Hebei Eye Hospital, Xingtai, Hebei, China
| | - Yixiang Wu
- Department of Diabetic Ophthalmology, Hebei Ophthalmology Key Lab, Hebei Eye Hospital, Xingtai, Hebei, China
| | - Zhiyong Li
- Department of Diabetic Ophthalmology, Hebei Ophthalmology Key Lab, Hebei Eye Hospital, Xingtai, Hebei, China
| | - Rui Xu
- Department of Diabetic Ophthalmology, Hebei Ophthalmology Key Lab, Hebei Eye Hospital, Xingtai, Hebei, China
| | - Yanxia Shang
- Department of Diabetic Ophthalmology, Hebei Ophthalmology Key Lab, Hebei Eye Hospital, Xingtai, Hebei, China
| | - Beibei Gao
- Department of Diabetic Ophthalmology, Hebei Ophthalmology Key Lab, Hebei Eye Hospital, Xingtai, Hebei, China
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Fortuny-Clanchet M, Anaya C, Cairó M, Fenollosa-Romero E, González A, Costa D. Prevalence of anterior uveitis in cases of systemic inflammatory response syndrome in dogs and cats. Vet Ophthalmol 2024. [PMID: 38701003 DOI: 10.1111/vop.13225] [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: 10/26/2023] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE To determine the prevalence of anterior uveitis in dogs and cats hospitalized with a diagnosis of systemic inflammatory response syndrome (SIRS). ANIMALS STUDIED Dogs and cats hospitalized between May 2020 and January 2021 were prospectively included. PROCEDURES Patients were categorized into two different groups: The first group included patients diagnosed with SIRS, and the second group included patients hospitalized without SIRS as a control group. Daily physical and ophthalmological examinations were conducted during hospitalization. Diagnosis of anterior uveitis was made based on the presence of aqueous flare, low intraocular pressure, and other associated ocular signs such as episcleral injection and miosis. A multinomial logistic regression analysis was conducted to investigate factors associated with SIRS and anterior uveitis development. RESULTS The study comprised 42 patients with SIRS and 26 patients without SIRS. Among those with SIRS, 38% developed anterior uveitis, whereas only 7.7% of patients without SIRS showed signs of anterior uveitis. The prevalence of uveitis was significantly higher in animals with SIRS compared to those without SIRS (p < .05). CONCLUSION Anterior uveitis is more prevalent in patients with SIRS than patients without SIRS. Therefore, complete ophthalmic examination is recommended in all patients presenting with this syndrome.
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Affiliation(s)
| | | | | | | | | | - Daniel Costa
- Veterinary Specialty Hospital of Hong Kong, Wan Chai, Hong Kong
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Hasbi A, Mohd Nafeez MN, Tai E, Yaakub A, Shatriah I. Endogenous Endophthalmitis: A 10-Year Review of Cases on the East Coast of Malaysia. Cureus 2024; 16:e60132. [PMID: 38864048 PMCID: PMC11165441 DOI: 10.7759/cureus.60132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/13/2024] Open
Abstract
Purpose Our study aimed to describe the clinical profile of endogenous endophthalmitis, focusing on patient demographics, infection sources, microbial profiles, clinical outcomes, and factors affecting the final visual outcome. Methods A retrospective review was performed on data from 68 eyes of 60 patients diagnosed with endogenous endophthalmitis and hospitalized in two tertiary hospitals on the East Coast of Peninsular Malaysia from January 2011 to December 2020. The analysis encompassed evaluating patient age, gender, laterality, risk factors, infection origins, presenting and final visual acuity, microbial results, treatment responses, and factors affecting final visual outcomes. Results The average age of the patient cohort was 54.9 ± 13.3 years. Females were more likely to have endogenous endophthalmitis than males (33, 55.0% vs. 27, 45.0%). Twenty-seven patients (45.0%) presented with endogenous endophthalmitis in the left eye, while 25 patients (41.7%) had it in the right eye, and eight patients (13.3%) had bilateral involvement. Most patients had underlying predisposing conditions, predominantly diabetes mellitus (53, 88.3%). Infection sources were identified in 42 patients (70.0%), out of which urinary tract infections account for the majority (11, 18.3%). Klebsiella species(14, 22.7%) were the leading pathogens and were significantly associated with liver abscess cases. In this series, the majority of patients had poor presenting and final visual acuity of worse than 3/60 (56, 82.4% and 53, 77.9%, respectively). Thirty-six eyes (52.9%) underwent vitrectomy, resulting in only four eyes (11.11%) achieving final visual acuity better than 6/12. Presenting visual acuity was identified as the factor contributing to the blind final visual outcome (r = 0.707, p < 0.001). Conclusion Females were found to be more commonly affected by endogenous endophthalmitis than males. Klebsiella species were the most commonly isolated microorganisms and were typically associated with liver abscesses. Urinary tract infection was the most common predisposing factor. A majority of the patients had poor presenting and final visual acuity, in which poor visual acuity is a significant indicator of blind visual outcomes.
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Affiliation(s)
- Amirul Hasbi
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
- Department of Ophthalmology, Hospital Sultanah Nur Zahirah, Kuala Terengganu, MYS
| | - Mohd Nazri Mohd Nafeez
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
- Department of Ophthalmology, Hospital Raja Perempuan Zainab II, Kota Bharu, MYS
| | - Evelyn Tai
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Azhany Yaakub
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Ismail Shatriah
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
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Lin ML, Hall AJ. Uveitis masquerade syndromes: An approach to diagnosis. Clin Exp Ophthalmol 2024; 52:91-105. [PMID: 37997019 DOI: 10.1111/ceo.14328] [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: 07/31/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Uveitis masquerade syndromes are a diverse group of clinical entities which mimic conventional immune-mediated uveitis due to the presence of inflammatory signs but are resistant to anti-inflammatory therapy. Misdiagnosis hinders appropriate management in these conditions and may result in poor outcomes. This review discusses commonly encountered neoplastic and non-neoplastic disease processes that masquerade as intraocular inflammation with a focus on relevant clinical features and adjunctive investigations that are helpful in reaching a correct diagnosis.
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Affiliation(s)
- Ming Lee Lin
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Anthony J Hall
- Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
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Xie CA, Singh J, Tyagi M, Androudi S, Dave VP, Arora A, Gupta V, Agrawal R, Mi H, Sen A. Endogenous Endophthalmitis - A Major Review. Ocul Immunol Inflamm 2023; 31:1362-1385. [PMID: 36306406 DOI: 10.1080/09273948.2022.2126863] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 10/31/2022]
Abstract
Endogenous endophthalmitis (EE) is an uncommon but potentially devastating ocular infection involving the inner layers of the eye. The global incidence of EE is on the rise. Common ocular signs and symptoms associated with EE include conjunctival injection, ocular pain, and reduced visual acuity. On clinical examination, a history of prior or coexisting systemic infections, symptoms (e.g., fever, malaise), and localizing features may be noted. Clinical diagnosis is often challenging, resulting in critical delays that contribute to a poor prognosis. Blood cultures and ocular fluid samples can aid in conforming causative pathogen(s), after which empirical antibiotic therapy, both systemic and intravitreal, should be instated. The use of steroids to suppress inflammation remains controversial. Surgical options include pars plana vitrectomy. Overall prognosis varies depending on host and pathogen factors, and early diagnosis and initiation of appropriate treatment are crucial.
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Affiliation(s)
- Cen Amy Xie
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jayanti Singh
- Department of Vitreo-retina and Uvea, Sadguru Netra Chikatsalaya, Chitrakoot, India
| | - Mudit Tyagi
- Department of Vitreo-retina, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, Volos, Greece
| | - Vivek Pravin Dave
- Department of Vitreo-retina, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Atul Arora
- Advanced Eye Centre, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rupesh Agrawal
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Eye ACP programme, Duke NUS Medical School, Singapore
- Ocular Infections and AntiMicrobials Group, Singapore Eye Research Institute, Singapore
| | - Helen Mi
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Alok Sen
- Department of Vitreo-retina and Uvea, Sadguru Netra Chikatsalaya, Chitrakoot, India
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Agi N, Zarbin MA, Bhagat N. Klebsiella Endogenous Endophthalmitis During the COVID-19 Pandemic. JOURNAL OF VITREORETINAL DISEASES 2023; 7:316-321. [PMID: 37920850 PMCID: PMC10170248 DOI: 10.1177/24741264231170462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Purpose: To describe the characteristics of Klebsiella pneumoniae endogenous endophthalmitis (KEE) encountered during the COVID-19 pandemic. Methods: This retrospective consecutive case series evaluated eyes that presented with KEE between March 2020 and July 2022. Results: Seven eyes of 5 patients developed KEE. Between January 2020 and July 2022, KEE was observed in 42% of consecutive EE cases compared with 7.8% during the preceding 13 years. COVID-19 was positive in 4 of 5 patients before they developed KEE. Only 1 patient presented with a VA better than hand motions (20/400). All eyes were treated with urgent vitrectomy and intravitreal and systemic antibiotics. No improvement in vision occurred in any patient; VA remained light perception to no light perception in 60% of eyes. Conclusions: The visual prognosis in KEE is extremely poor. The presence of a preceding COVID-19 infection in 80% of patients may signal a new risk factor for KEE. Patients with a hypervirulent Klebsiella syndrome should be routinely screened for EE.
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Affiliation(s)
- Nathan Agi
- Institute of Ophthalmology and Visual Sciences, Rutgers University–New Jersey Medical School, Newark, NJ, USA
| | - Marco A. Zarbin
- Institute of Ophthalmology and Visual Sciences, Rutgers University–New Jersey Medical School, Newark, NJ, USA
| | - Neelakshi Bhagat
- Institute of Ophthalmology and Visual Sciences, Rutgers University–New Jersey Medical School, Newark, NJ, USA
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Tanwar M, Chakrabarty S, Chowdhury G, Kim U. Mapping prognostic factors for globe survival in panophthalmitis using logistic regression and Cox proportional hazard models: A retrospective study. Indian J Ophthalmol 2023; 71:2812-2817. [PMID: 37417126 PMCID: PMC10491044 DOI: 10.4103/ijo.ijo_3034_22] [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: 11/17/2022] [Revised: 04/08/2023] [Accepted: 05/26/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose The aim of this study was to report the outcomes of panophthalmitis and to identify factors significantly affecting globe survival in the disease. Methods This was a retrospective study on patients with panophthalmitis in a tertiary hospital between January 1, 2017, and December 31, 2019. The demographics, treatment details, culture results, and final outcomes were recorded. Logistic regression and Cox proportional hazards (CPH) were calculated to identify variables associated with globe loss. A P < 0.05 was considered significant. Results Eighty-five eyes of 85 patients (31 culture positive) were eligible for review. The mean age of the participants was 55.21 ± 20.17 years with a male-to-female ratio of 2.04:1. Corneal ulcer (38.82%; n = 33) and open globe injuries (OGIs) (38.82%; n = 33) were the most common etiologies. Pseudomonas aeruginosa (n = 10; 11.76%) was the most common isolate. The mean duration of hospital stay was 7.58 ± 2.32 days. Overall, 44 (51.76%) globes could be salvaged. The need for evisceration (P = 0.901) and hospital stays (P = 0.095) were similar for culture-positive and -negative cohorts. The unadjusted logistic regression and CPH models showed that culture sterility did not affect globe survival [OR = 1.210 (0.501-2.950), P = 0.668; HR = 1.176 (0.617-2.243), P = 0.623]. The adjusted logistic regression and the CPH models showed that corneal ulcers [OR = 10.900 (2.460-48.200), P = 0.002; HR = 5.393 (1.603-18.140), P = 0.006] and OGI [OR = 7.360 (1.650-32.700), P = 0.009; HR = 4.548 (1.321-15.660), P = 0.016] were significantly associated with globe loss. Conclusion Corneal ulcer or OGI as the primary etiology is detrimental to globe survival in panophthalmitis.
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Affiliation(s)
- Meghana Tanwar
- Department of Orbit and Oculoplasty, Aravind Eye Hospital and PG Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Sabyasachi Chakrabarty
- Department of Paediatric Ophthalmology and Strabismus, Vivekananda Mission Ashram Netra Niramay Niketan, Chaithanyapur, West Bengal, India
| | - Gunja Chowdhury
- Department of Orbit and Oculoplasty, Aravind Eye Hospital and PG Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Usha Kim
- Department of Orbit and Oculoplasty, Aravind Eye Hospital and PG Institute of Ophthalmology, Madurai, Tamil Nadu, India
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Thangamathesvaran L, Canner JK, Scott AW, Woreta FA, Breazzano MP. National emergency department trends for endogenous endophthalmitis: an increasing public health challenge. Eye (Lond) 2023; 37:1123-1129. [PMID: 35487961 PMCID: PMC10102014 DOI: 10.1038/s41433-022-02080-9] [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: 11/01/2021] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVE To characterize incidence rates and identify risk factors for admission and mortality in patients with endogenous endophthalmitis (EE) in the United States (US). SUBJECTS/METHODS Patients with EE were identified using the Nationwide Emergency Department (NEDS) Database from 2006 to 2017 in this cross-sectional study. Subjects were required to have diagnoses of both endophthalmitis and septicaemia using contemporary International Classification of Diseases diagnosis codes. Incidence rates, mortality rates and demographics were evaluated. Risk factors for admission and mortality were identified using weighted logistic regression analysis. RESULTS A total of 6400 patients with EE were identified. Incidence increased from 0.10 (95% confidence interval [CI]: 0.07-0.12) per 100,000 in the US population in 2006 to 0.25 (95% CI: 0.21-0.30) in 2017 (p < 0.05). Most were female (55.4%), insured with Medicare (53.5%), were in the first income quartile earnings (29.3%) [bottom 25% income bracket], lived in the South (40.5%), and presented to metropolitan teaching hospitals (66.6%). Mortality increased from 8.6% (95% CI: 3.8-18.3%) in 2006 to 13.8% (95% CI: 9.7-19.2%) in 2017 (p = 0.94). Factors predicting admission included older age (odds ratio [OR] 32.59; [95% CI 2.95-359.78]) and intravenous drug use (OR 14.90 [95% CI: 1.67-133.16]). Factors associated with increased mortality included: human immunodeficiency virus infection/immune deficiencies (OR 2.58 [95% CI: 1.26-5.28]), heart failure (OR 2.12 [95% CI: 1.47-3.05]), and hepatic infections/cirrhosis (OR 1.89 [95% CI: 1.28-2.79]). Pneumonia and renal/urinary tract infections (UTI) were associated with both increased hospital admission [(pneumonia OR 9.64 (95% CI: 1.25-74.35, p = 0.030), renal/UTI OR 4.09 (95% CI: 1.77-9.48)] and mortality [(pneumonia OR 1.64 (95% CI: 1.17-2.29, p = 0.030), renal/UTI OR 1.87 (95% CI: 1.18-2.97)]. Patients with diabetes mellitus (DM) had decreased odds ratio for mortality (OR 0.49 [95% CI: 0.33-0.73]). CONCLUSION EE has increased in incidence throughout US. The two systemic factors that conferred both an increase in mortality and admission were pneumonia, and renal/UTI. Additional exploration of the potential protective association of DM with decreased mortality in this context is needed.
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Affiliation(s)
- Loka Thangamathesvaran
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph K Canner
- Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adrienne W Scott
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark P Breazzano
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA.
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA.
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Boontantrapiwat S, Rojanaporn D, Chokthaweesak W, Kitnarong N. Endogenous panophthalmitis in a patient with COVID-19 during hospitalization in an intensive care unit: A case report. Am J Ophthalmol Case Rep 2022; 28:101707. [PMID: 36128343 PMCID: PMC9479422 DOI: 10.1016/j.ajoc.2022.101707] [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: 06/18/2022] [Revised: 08/29/2022] [Accepted: 09/09/2022] [Indexed: 11/01/2022] Open
Abstract
Purpose Observation Conclusions and importance
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10
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Mamikunian G, Ziegler A, Thorpe E. A Case of Panophthalmitis Secondary to Odontogenic Maxillary Sinusitis. Cureus 2022; 14:e30801. [DOI: 10.7759/cureus.30801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 11/07/2022] Open
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Azzopardi M, Ng B, Chong YJ. Sterile endogenous panophthalmitis with uncontrolled diabetes. BMJ Case Rep 2022; 15:e252875. [PMID: 36307143 PMCID: PMC9621171 DOI: 10.1136/bcr-2022-252875] [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] [Indexed: 11/06/2022] Open
Abstract
A female patient with type 2 diabetes in her 50s presented to casualty with a 1-day history of red, painful right eye. Visual acuity (VA) bilaterally was 6/12, but a right anterior uveitis was noted, with hazy fundal view. She was discharged on topical steroid and mydriatic drops with a 2-day follow-up. VA remained unchanged, but she developed right proptosis, restricted eye movements, lid swelling, relative afferent pupillary defect and an intraocular pressure (IOP) of 39 mm Hg. She was admitted and treated with intravenous and intravitreal antibiotics, intravenous antifungals and IOP-lowering drugs. Blood tests showed raised inflammatory markers and an HbA1c of 127 mmol/mol. Over her admission, right eye vision deteriorated to no light perception. A B-scan ultrasound revealed panophthalmitis and a retinal abscess. All investigations looking for a source were negative. Inflammatory markers settled, but despite aggressive treatment, the panophthalmitis did not improve. She was discharged with a follow-up to consider enucleation.
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Affiliation(s)
- Matthew Azzopardi
- Ophthalmology Department, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Benjamin Ng
- Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Yu Jeat Chong
- Inflammatory Eye Disease Unit, Birmingham and Midland Eye Centre, Birmingham, UK
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El-Gendy AO, Obaid Y, Ahmed E, Enwemeka CS, Hassan M, Mohamed T. The Antimicrobial Effect of Gold Quantum Dots and Femtosecond Laser Irradiation on the Growth Kinetics of Common Infectious Eye Pathogens: An In Vitro Study. NANOMATERIALS (BASEL, SWITZERLAND) 2022; 12:nano12213757. [PMID: 36364531 PMCID: PMC9654226 DOI: 10.3390/nano12213757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 05/29/2023]
Abstract
We studied the antimicrobial effect of gold quantum dots (AuQDs), femtosecond laser irradiation, and the combined effect of laser irradiation and AuQD treatment against common infectious eye pathogens. The INSPIRE HF100 laser system (Spectra Physics) provided a femtosecond laser, which was pumped by a mode-locked femtosecond Ti: sapphire laser MAI TAI HP (Spectra Physics), while a Quanta-Ray nanosecond Nd: YAG laser (Spectra-Physics) was used to precisely synthesize 7.8, 8.7, and 11.6 nm spherical AuQDs. Then, the in vitro growth kinetics and growth rate analysis of E. coli, methicillin-resistant Staphylococcus aureus, Enterococcus faecalis, Listeria monocytogenes, and Candida albicans (treated with the AuQDs, femtosecond laser irradiation, or combined laser and AuQDs treatment) was measured. The biocompatibility of the AuQDs with the retinal epithelial cell lines (ARPE-19) and their toxicity to the cells was assayed. The results showed that (1) in vitro irradiation using a 159 J/cm2 energy density obtained from the 400 nm femtosecond laser suppressed the growth of each of the five pathogens. (2) Similarly, treatment with the AuQDs was antimicrobial against the four bacteria. The AuQDs with an average size of 7.8 nm were more highly antimicrobial and biocompatible and were less cytotoxic than the larger AuQD sizes. (3) The combined femtosecond laser irradiation and AuQD treatment was more highly antimicrobial than each treatment alone. (4) The AuQD treatment did not impair the rate of wound closure in vitro. These findings suggest that combined femtosecond laser irradiation and AuQD treatment is significantly antimicrobial against Candida albicans, Gram-positive L. monocytogenes, S. aureus, and E. faecalis, as well as Gram-negative E. coli. The nontoxicity and biocompatibility of the AuQD particles tested suggest that this form of treatment may be clinically viable.
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Affiliation(s)
- Ahmed O. El-Gendy
- Laser Institute for Research and Applications LIRA, Beni-Suef University, Beni-Suef 62511, Egypt
- Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt
| | - Yousif Obaid
- Anbar Health Department, Ministry of Health, Ramadi 31001, Iraq
| | - Esraa Ahmed
- Laser Institute for Research and Applications LIRA, Beni-Suef University, Beni-Suef 62511, Egypt
| | - Chukuka S. Enwemeka
- College of Health and Human Services, San Diego State University, San Diego, CA 92182, USA
- Faculty of Health Sciences, University of Johannesburg, Doornfontein 2028, South Africa
| | - Mansour Hassan
- Department of Ophthalmology, Faculty of Medicine, Beni-Suef University, Beni-Suef 62514, Egypt
| | - Tarek Mohamed
- Laser Institute for Research and Applications LIRA, Beni-Suef University, Beni-Suef 62511, Egypt
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Letsoalo HL, Mathebula SD. A case of severe endogenous endophthalmitis with orbital cellulitis post COVID-19. AFRICAN VISION AND EYE HEALTH 2022; 81:748. [PMCID: PMC9557940 DOI: 10.4102/aveh.v81i1.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a novel pandemic viral illness which may lead to severe respiratory diseases. However, its ophthalmic manifestations are still not well understood. There could be serious complications involving various organs in patients with the disease and in those who are recovering, or have recovered, from COVID-19. Endogenous endophthalmitis, was a rare occurrence in the past but has increased in the post-COVID-19 pandemic. Endogenous endophthalmitis results from hematogenous spread from a remote primary source. A 55-year-old man with confirmed COVID-19 presented to a local hospital with unilateral gradual loss of vision and swelling of the left eye that occurred 10 days after discharge from the hospital. Based on detailed ophthalmic examination, this patient with a co-morbidity, namely diabetes mellitus was placed in the intensive care unit where he was given corticosteroids and ventilation for two weeks. Most patients requiring mechanical ventilation may experience disorders of the eye, and it may be difficult to treat these occurrences while the patient remains in ICU. COVID-19 can lead to ocular complications especially in the late stages of infection. Follow-up of post COVID-19 patients is crucial to monitor possible ocular complaints including endophthalmitis as early diagnosis and treatment is essential to salvage vision.
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Affiliation(s)
- Herold L. Letsoalo
- Department of Ophthalmology, Botshilu Private Hospital, Ga-Rankuwa, South Africa
| | - Solani D. Mathebula
- Department of Optometry, Faculty of Health Sciences, University of Limpopo, Sovenga, South Africa
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Lee JJ, Hong SB, Lee NK, Park YJ, Kim SH, Park SW, Byon I, Kim S. Characteristics of Computed Tomography for Identifying Patients at High Risk of Endogenous Endophthalmitis Due to Klebsiella pneumoniae-Related Pyogenic Liver Abscess. J Clin Med 2022; 11:jcm11154376. [PMID: 35955994 PMCID: PMC9369040 DOI: 10.3390/jcm11154376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023] Open
Abstract
Endogenous endophthalmitis (EE) associated with Klebsiella pneumoniae (K. pneumoniae)-related pyogenic liver abscess (PLA) is one of the fatal complications of PLA and leads to loss of vision. Early diagnosis and treatment are important to save the patient’s vision. We investigated the characteristics of computed tomography (CT) in EE associated with K. pneumoniae-related PLA for the identification of the predictors of EE, in order to facilitate early diagnosis. A total of 274 patients diagnosed with K. pneumoniae-related PLA, including 15 patients with EE, were identified between January 2005 and December 2019. The clinical (age, gender, and underlying disease) and radiologic (the location, size, and number of abscesses) features were reviewed. In addition, the involvement of the adjacent vessels, such as the hepatic vein and portal vein, was carefully reviewed. A comparative analysis was performed between the EE and non-EE groups. Uni- and multivariate logistic regression analyses were used to identify the predictors of EE. Diabetes mellitus (DM), the involvement of the left or both hepatic lobes, and the adjacent vessels on the CT were significantly more frequent than those in the non-EE group (p < 0.05 in all), and they were the significant predictors of EE in the logistic regression analyses. In patients with K. pneumoniae-related PLA, the CT findings, such as the locations of the abscess (i.e., left or both lobes) and the involvement of the adjacent vessels, should be considered in addition to the ocular symptoms for an early diagnosis of EE.
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Affiliation(s)
- Jae Jung Lee
- Department of Ophthalmology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Pusan 46241, Korea; (J.J.L.); (S.H.K.); (S.W.P.); (I.B.)
- JRYN Eye Clinic, Pusan 47296, Korea
| | - Seung Baek Hong
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Pusan 46241, Korea; (N.K.L.); (S.K.)
- Correspondence: ; Tel.: +82-51-240-7354
| | - Nam Kyung Lee
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Pusan 46241, Korea; (N.K.L.); (S.K.)
| | - Young Joo Park
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Pusan 46241, Korea;
| | - So Hee Kim
- Department of Ophthalmology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Pusan 46241, Korea; (J.J.L.); (S.H.K.); (S.W.P.); (I.B.)
- Lee Eye Clinic, Pusan 611831, Korea
| | - Sung Who Park
- Department of Ophthalmology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Pusan 46241, Korea; (J.J.L.); (S.H.K.); (S.W.P.); (I.B.)
| | - Iksoo Byon
- Department of Ophthalmology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Pusan 46241, Korea; (J.J.L.); (S.H.K.); (S.W.P.); (I.B.)
| | - Suk Kim
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Pusan 46241, Korea; (N.K.L.); (S.K.)
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KANDİLCİK H. Endoftalmi Gelişen Salmonella Artritli Olgu Sebebiyle Endojen Endoftalmi ve Etkenlerine Kısa bir Bakış. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1100032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Endojen Endoftalmi(EE), yakın ve sıkı takip gerektiren özellikle immunsupresif hastalarda akılda tutulması gereken ve akut müdahale gerektiren bir durumdur. Sepsis ve geçici bakteriyemi durumlarında S. aureus, streptokoklar ve gram negatif çomaklar Endojen Endoftalmi (EE) nedeni olabilir. Gram negatif çomaklardan Salmonella spp enfeksiyonlarında son yıllarda artış görülmektedir.
Biz bu olguda 23 yaşındaki immunsupresif tedavi alan erkek hastada Salmonella septik artritini takiben, literatürde nadiren rastladığımız Salmonella spp. bağlı Endojen Endoftalmi(EE) olgusunu sunmayı planladık.
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Lee CS, Desilets J, Fang W, Hinkle DM. The microbiological spectrum, antimicrobial resistance pattern, and visual outcomes of endogenous endophthalmitis in West Virginia 2009-2019. Int Ophthalmol 2022; 42:3153-3163. [PMID: 35606624 DOI: 10.1007/s10792-022-02315-4] [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: 05/15/2021] [Accepted: 04/18/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To report the microbiological spectrum, antimicrobial resistance patterns, and visual outcomes in patients with endogenous endophthalmitis (EE). METHODS This was a retrospective study of 50 patients with culture-positive EE managed in a tertiary referral center between October 2009 and 2019. Clinical, microbiology analysis, and antimicrobial resistance were reviewed. A multivariable linear regression analysis was used for identifying risk factors associated with worse visual outcomes. RESULTS Fifty organisms were identified, 62% bacterial and 38% fungal. The most common bacterial organism was Staphylococcus aureus (75% methicillin resistant), and Candida was the most common fungal species. Multidrug resistance was observed in methicillin-resistant Staphylococcus aureus (MRSA) isolates against clindamycin, daptomycin, and fluoroquinolones. The distributions of the final visual acuity (VA) between the bacterial and fungal groups were significantly different, and the visual outcomes in the bacterial group tended to be worse (p = 0.01). The distributions of enucleation status were significantly higher in bacterial EE (35%) than fungal EE (5.3%) (p = 0.02). Results from the multivariable linear regression analysis revealed that older age was significantly associated with worse visual outcome (coef = 0.03; p = 0.02), while fungal infections were associated with better outcomes (coef = - 0.87; p = 0.01). Intravenous drug use (coef = 0.87; p = 0.054) was a marginally significant factor associated with worse visual outcomes. CONCLUSION There was a higher prevalence of bacterial organisms than fungal species among EE. Bacterial EE was associated with worse visual outcomes and higher enucleation rates than fungal EE. Multidrug resistance was prevalent among MRSA isolates. Older age and intravenous drug use may be factors associated with poor prognosis.
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Affiliation(s)
- Chang Sup Lee
- 1 Medical Center Drive, West Virginia University Eye Institute, Morgantown, WV, 26506, USA.,University of Southern California Roski Eye Institute, 1450 San Pablo St., Suite 4700, Los Angeles, CA, 90013, USA
| | - Jeffrey Desilets
- 1 Medical Center Drive, West Virginia University Eye Institute, Morgantown, WV, 26506, USA.,Ross Eye Institute, 1176 Main St., Buffalo, NY, USA
| | - Wei Fang
- WVU Health Sciences Center Erma Byrd Biomedical Research Center, 1 Medical Center Drive, West Virginia Clinical and Translational Science Institute, Morgantown, WV, 26506, USA
| | - David M Hinkle
- 1 Medical Center Drive, West Virginia University Eye Institute, Morgantown, WV, 26506, USA. .,Tulane University School of Medicine, 131 S. Robertson Street., 12th floor, 8069, New Orleans, LA, 70112, USA.
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Chelvaraj R, Thamotaran T, Yee CM, Fong CM, Zhe NQ, Azhany Y. The invasive Klebsiella pneumoniae syndrome: Case series. J Taibah Univ Med Sci 2022; 17:332-339. [PMID: 35592799 PMCID: PMC9073889 DOI: 10.1016/j.jtumed.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/12/2021] [Accepted: 10/20/2021] [Indexed: 11/27/2022] Open
Abstract
This case-series aims to report three cases of endogenous endophthalmitis due to invasive Klebsiella pneumoniae syndrome. Case 1 A 34-year-old lady who was admitted for pneumonia developed painful blurring of vision and redness in the right eye (RE) for one week. An examination of the RE revealed visual acuity (VA) of light perception (PL) with positive relative afferent pupillary defect (RAPD), proptosis, and restriction of extraocular movement with hypopyon. The patient was treated for RE panophthalmitis with a lung abscess and was started on systemic and topical antibiotics. The vitreous tap culture grew Klebsiella pneumoniae. Despite treatment, the patient's condition deteriorated, and evisceration was undertaken. Case 2 A 38-year-old lady presented with a acute onset of RE pain associated with blurred vision and redness for two days, and fever for one week. RE VA was hand movement with a positive RAPD and anterior chamber cells of 2+. A B-scan revealed a dome-shaped subretinal mass with exudative retinal detachment. The patient was treated for RE panophthalmitis complicated by a basal ganglia abscess. The urine and vitreous tap cultures grew Klebsiella pneumoniae. She responded to high-dose intravenous and intravitreal antibiotics. Unfortunately, her RE became phthisical. Case 3 A 70-year-old lady presented with painless blurring of vision over the RE. The blood and urine cultures grew Klebsiella pneumoniae. RE VA was PL, and she was treated for endogenous endophthalmitis. The vitreous culture grew Klebsiella pneumoniae. Unfortunately, the RE became phthisical.
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Affiliation(s)
- Radtthiga Chelvaraj
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Malaysia
| | - Tinesh Thamotaran
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Malaysia
| | - Cheong M. Yee
- Department of Ophthalmology, Hospital Raja Permaisuri Bainun, Jalan Hospital, Ipoh, Malaysia
| | - Chong M. Fong
- Department of Ophthalmology, Hospital Raja Permaisuri Bainun, Jalan Hospital, Ipoh, Malaysia
| | - Ngoo Q. Zhe
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Malaysia
| | - Yaakub Azhany
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Malaysia
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18
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Khatwani PR, Goel NP, Trivedi KY, Aggarwal SV. Unveiling endophthalmitis post COVID-19 - A case series. Indian J Ophthalmol 2021; 69:2869-2871. [PMID: 34571655 PMCID: PMC8597453 DOI: 10.4103/ijo.ijo_1616_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Since December 2019, coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has become a global pandemic. There has been a resurgence in complications involving various organs in patients recovered from COVID-19, and endophthalmitis is one of them. Endophthalmitis—an inflammation of intraocular tissues leading to loss of vision or even loss of eye—has been a rare occurrence in the past, but has been on the rise in the post-COVID-19 times. Here we report seven such cases.
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Affiliation(s)
- Paras R Khatwani
- Department of Ophthalmology, Vitreoretinal Unit, M and J Western Regional Institute of Ophthalmology, Ahmedabad, Gujarat, India
| | - Nikita P Goel
- Department of Ophthalmology, Vitreoretinal Unit, M and J Western Regional Institute of Ophthalmology, Ahmedabad, Gujarat, India
| | - Kinjal Y Trivedi
- Department of Ophthalmology, Vitreoretinal Unit, M and J Western Regional Institute of Ophthalmology, Ahmedabad, Gujarat, India
| | - Somesh V Aggarwal
- Department of Ophthalmology, Vitreoretinal Unit, M and J Western Regional Institute of Ophthalmology, Ahmedabad, Gujarat, India
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Sinha P, Sinha U, Raj A, Pati BK. Bilateral endogenous endophthalmitis complicated by scleral perforation: an unusual presentation. BMJ Case Rep 2021; 14:e244547. [PMID: 34548299 PMCID: PMC8458360 DOI: 10.1136/bcr-2021-244547] [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] [Accepted: 09/05/2021] [Indexed: 11/04/2022] Open
Abstract
Endogenous endophthalmitis complicated by necrotising scleritis has rarely been reported in the literature. We, hereby, report a case of bilateral scleral perforation with endogenous endophthalmitis in an 87-year-old female patient with diabetes who presented as bilateral orbital cellulitis. Systemic workup ruled out autoimmune aetiology. The culture and sensitivity of exudates exuding from the scleral perforation showed Escherichia coli The Patient was managed conservatively with parenteral and topical antibiotics along with steroid, but the vision could not be salvaged. The report emphasizes on atypical presentation of endogenous endophthalmitis. In old and immunosuppressed individuals presenting with a clinical picture of bilateral orbital cellulitis with profound vision loss, endogenous endophthalmitis should be ruled out.
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Affiliation(s)
- Prerna Sinha
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Upasna Sinha
- Department of Radiology, AIIMS Patna, Patna, Bihar, India
| | - Amit Raj
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Binod Kumar Pati
- Department of Microbiology, All India Institute of Medical Sciences, Patna, Bihar, India
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20
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Abdelkader MFSO, Elshafei AMK, Nassar MM, Abu Elela MA, Abdallah RMA. Combined endophthalmitis and orbital cellulitis in patients with corona virus disease (COVID-19). J Ophthalmic Inflamm Infect 2021; 11:27. [PMID: 34523045 PMCID: PMC8440116 DOI: 10.1186/s12348-021-00258-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/14/2021] [Indexed: 01/24/2023] Open
Abstract
Purpose To document the presentation of unilateral combined endophthalmitis and orbital cellulitis in patients with COVID-19 infection and study their prognosis. Patients and methods This interventional case series study included 9 patients referred to the Ophthalmology Department, Minia University Hospital with unilateral combined endophthalmitis and orbital cellulitis between April 2020 and March 2021. In addition to the COVID-19 work-up, all patients were subjected to full ophthalmological evaluation and managed according to their ophthalmic and systemic disease. Results The patients were 5 females and 4 males. They had clinical, laboratory and imaging findings that confirmed COVID-19 infection. All patients had unilateral endophthalmitis with orbital cellulitis and profound visual loss in the affected eye. Three patients died due to respiratory failure, while 6 patients recovered systemically. The survived patients developed atrophia bulbi in 4 patients and in 2 patients, the globe retained normal size but with complete visual loss. Conclusion Combined endophthalmitis and orbital cellulitis can be one of the early presentations of patients with COVID-19 infection with poor visual prognosis. Trial registration Clinical registration: clinicaltrials.gov identifier: NCT04456556.
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Affiliation(s)
| | | | | | - Mostafa A Abu Elela
- Department of Clinical pathology, Faculty of Medicine, Minia University, El-Minia, Egypt
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Qi M, He L, Zheng P, Shi X. Clinical Features and Mortality of Endogenous Panophthalmitis in China: A Six-Year Study. Semin Ophthalmol 2021; 37:208-214. [PMID: 34280072 DOI: 10.1080/08820538.2021.1954205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To report the clinical features, treatment strategy, and mortality of patients with endogenous panophthalmitis (EP). METHODS Fifteen patients (16 eyes) diagnosed with EP from December 2012 to December 2018 were investigated with a standard protocol at a tertiary medical center of the largest eye center in Northern China. Mortality was followed up. RESULTS All participants were Han Chinese. The mean age was 58.3, 62.5% were male, and 93.3% were unilaterally involved. The average number of predisposing factors was 3.0. The top two predisposing factors were diabetes mellitus (DM, 93.3%) and pyogenic liver abscess (PLA, 66.7%). All patients initially presented at an ophthalmic emergency due to severe ocular symptoms. All patients were co-managed by relevant specialists and were admitted to medical or surgical wards instead of the eye center unless the systemic condition was well controlled. Only four eyes were eligible for vitrectomy. The mean follow-up duration was 12.5 months. The mortality rate was 0%. The predominant causative organism was Klebsiella pneumoniae (80.0%), and there were no positive fungal cases. CONCLUSIONS EP is a rare, life-threatening disease. DM and PLA could predispose its development. The predominant causative organism was Klebsiella pneumoniae. The interdisciplinary cooperation system of the management of EP may reduce the mortality rate.Abbreviations :EP: endogenous panophthalmitis; EE: endogenous endophthalmitis; DM: diabetes mellitus; PLA: pyogenic liver abscess; ACI: acute cerebral infarction; UTI: urinary tract infection; ICU: intensive care unit; VA: visual acuity; LP: light perception; HM: hand motion; NLP: no light perception; K. pneumoniae: Klebsiella pneumoniae; CT: computed tomography; MRI: magnetic resonance imaging; CRP: C-reactive protein; PCT: procalcitonin; FBG: fasting blood glucose; WBC: white blood cell; NEUT: neutrophil proportion; BDG: 1,3-β-D-glucan; GM: galactomannan; IVI: intravitreal injection; PPV: pars plana vitrectomy; ILAS: invasive liver abscess syndrome; cps: capsular polysaccharide; CSF: cerebrospinal fluid; SD: standard deviation.
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Affiliation(s)
- Meng Qi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Lei He
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Pengfei Zheng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Xiangyu Shi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
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22
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Reddy AJ, Tak N, Martel JB. Case Study of Endogenous Streptococcal Endophthalmitis in the Critical Care Setting. Cureus 2021; 13:e16192. [PMID: 34258133 PMCID: PMC8257035 DOI: 10.7759/cureus.16192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 11/15/2022] Open
Abstract
We report a rare case of orbital cellulitis and endogenous endophthalmitis, sepsis, meningitis with a brain abscess and a septic knee secondary to Streptococcus pneumonia. The problems of diagnosis, utility of CT and MRI scanning in the intensive care setting is discussed. The patient was admitted in an obtundated state to the ICU, was noted to have sepsis with blood culture positivity for S pneumoniae. She was noted to have meningitis, a septic knee, a brain abscess and conjunctival injection. CT and MRI scanning did not reveal any ocular or orbital abnormalities. Patient began with a sore throat and knee pain. Despite antibiotic treatment, she became septic with blood culture positivity for S. pneumoniae. She was noted to have knee cellulitis and a brain abscess.
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Affiliation(s)
- Akshay J Reddy
- Opthalmology, California Northstate University College of Medicine, Elk Grove, USA
| | - Nathaniel Tak
- Ophthalmology, California Northstate University College of Medicine, Elk Grove, USA
| | - James B Martel
- Ophthalmology, California Northstate University College of Medicine, Elk Grove, USA
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Villasmil RJ, Lattanzio N, Burns K, Alkayali T. More Than Meets the Eye: Infective Endocarditis Presenting as Endogenous Endophthalmitis. Cureus 2021; 13:e14745. [PMID: 34084673 PMCID: PMC8163352 DOI: 10.7759/cureus.14745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Endogenous endophthalmitis (EE) is a potentially blinding ophthalmological emergency with poor visual prognosis requiring a high index of clinical suspicion to obtain a prompt diagnosis. The main factors associated with poor visual outcomes include the virulence of the causative organism and timing of intervention. Infective endocarditis can present with nonspecific ocular complaints and remains an important risk factor for developing EE. We report an unusual case of EE in a 78-year-old male caused by infective endocarditis secondary to Streptococcus viridans resulting in bioprosthetic aortic valve abscess with dehiscence.
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Affiliation(s)
- Ricardo J Villasmil
- Internal Medicine, Florida State University College of Medicine Internal Medicine Residency Program, Sarasota, USA
| | - Natalia Lattanzio
- Internal Medicine, Florida State University College of Medicine Internal Medicine Residency Program, Sarasota, USA
| | - Katherine Burns
- Internal Medicine, Florida State University College of Medicine Internal Medicine Residency Program, Sarasota, USA
| | - Talal Alkayali
- Internal Medicine, Florida State University College of Medicine Internal Medicine Residency Program, Sarasota, USA
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Mir TA, Papudesu C, Fang W, Hinkle DM. Incidence of Drug Use-Related Endogenous Endophthalmitis Hospitalizations in the United States, 2003 to 2016. JAMA Ophthalmol 2021; 139:18-26. [PMID: 33151291 DOI: 10.1001/jamaophthalmol.2020.4741] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Complications arising from the nationwide opioid epidemic led to an increase in health care use. Few studies have investigated whether this is reflected in hospital admissions for endogenous endophthalmitis. Objective To report changing trends in epidemiology, risk factors, hospital course, and costs associated with drug use-related endogenous endophthalmitis hospitalizations in the United States from 2003 to 2016. Design, Setting, and Participants Nationwide, retrospective cross-sectional study using the National Inpatient Sample. A total of 56 839 patients admitted with a diagnosis of endogenous endophthalmitis were included. Data were analyzed between 2003 and 2016. Exposures Inpatient admission for endogenous endophthalmitis during the years 2003 to 2016. Main Outcomes and Measures The Nationwide Inpatient Sample was queried to identify all inpatient admissions with a diagnosis of endogenous endophthalmitis in the United States between the years 2003 and 2016. Analyses were performed to identify national and regional trends in incidence and prevalence of associated infectious and noninfectious comorbidities in patients with or without a history of drug dependence or use. Median and cumulative inflation-adjusted costs for admissions were calculated. Results Of all patients, 55.6% were White, 13.6% were Black, and 10.6% were Hispanic. There were an estimated 56 839 endogenous endophthalmitis-related hospitalizations; 13.7% of these patients (n = 7783) had a history of drug dependence or use. The drug-using population was significantly younger (49.6 vs 57.5 years; difference, 7.9; 95% CI, 6.93-8.88; P < .001) and more likely to be male (61.8% [n = 35 127] vs 49.0% [n = 21 712]; difference, 12.8%; 95% CI, 11.6%-14.0%; P < .001). The incidence of endogenous endophthalmitis associated with drug dependence or use increased from 0.08 per 100 000 in 2003 to 0.32 per 100 000 population in 2016 across all 4 US geographic regions. Conclusions and Relevance A 4-fold increase in drug use-related endogenous endophthalmitis hospitalizations was observed in the United States from 2003 to 2016, resulting in substantial health care use burden. These findings support the hypothesis that clinicians should maintain a high index of suspicion for endophthalmitis when evaluating patients with intraocular inflammation in the setting of drug dependence or use.
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Affiliation(s)
- Tahreem A Mir
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut.,West Virginia University School of Medicine, Morgantown
| | | | - Wei Fang
- West Virginia Clinical and Translational Science Institute, West Virginia University Health Sciences Center Erma Byrd Biomedical Research Center, Morgantown
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Brill DA, Farley ND, Albert DC, Sassalos TM, Sangave AA, Desai UR. BILATERAL ENDOGENOUS ENDOPHTHALMITIS FROM STREPTOCOCCUS PNEUMONIAE. Retin Cases Brief Rep 2021; 15:163-165. [PMID: 29994996 PMCID: PMC7899744 DOI: 10.1097/icb.0000000000000760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To report a case of bilateral endogenous endophthalmitis from Streptococcus pneumoniae with devastating sequelae. METHODS Interventional case report. RESULTS A 56-year-old man presented with acute bilateral blurred vision and floaters with fever and hemodynamic instability. Previously, he was diagnosed with acute otitis externa and reported manually extracting several of his own teeth. He underwent a vitreous tap and intravitreal antibiotic injections. Blood and vitreous cultures were positive for S. pneumoniae. The patient later developed life-threatening medical sequelae. His final visual acuity was no light perception in the right eye and 20/25 in the left eye. CONCLUSION Diagnosing endogenous endophthalmitis early is essential to initiating a systemic evaluation for potentially life-threatening medical conditions, including sepsis, endocarditis, and osteomyelitis. A high degree of suspicion, expeditious treatment, and interdisciplinary collaboration are essential to maximizing patient outcomes.
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Affiliation(s)
- Daniel A Brill
- Department of Ophthalmology, Henry Ford Hospital, Detroit, Michigan
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Kaur T, Vig V, Kaur I, Arora S. Fungal choroidal abscess in a case of aggressive retinopathy of prematurity. JOURNAL OF CLINICAL OPHTHALMOLOGY AND RESEARCH 2021. [DOI: 10.4103/jcor.jcor_213_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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COMMUNITY-ASSOCIATED METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS SUBRETINAL ABSCESS IN A NONBACTEREMIC PATIENT TREATED WITH INTERNAL DRAINAGE AND RETINECTOMY. Retin Cases Brief Rep 2021; 15:84-88. [PMID: 29746442 DOI: 10.1097/icb.0000000000000746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a case of community-associated methicillin-resistant Staphylococcus aureus subretinal abscess that continued to progress, despite intravitreal and systemic antibiotic therapy. METHODS Retrospective chart review of a 77-year-old female patient with well-controlled diabetes mellitus who developed a left eye endophthalmitis and subretinal abscess from methicillin-resistant S. aureus colonization in the absence of any systemic focus of infection. RESULTS The abscess and endophthalmitis resolved after the second pars plana vitrectomy that included drainage of a subretinal abscess after the failure of initial pars plana vitrectomy, and intravitreal and systemic antibiotics. Retinal detachment due to proliferative vitreoretinopathy necessitated the third pars plana vitrectomy 2 weeks after the second pars plana vitrectomy. CONCLUSION The authors present an unusual case of methicillin-resistant S. aureus subretinal abscess in a patient with methicillin-resistant S. aureus colonization with negative blood, aqueous humor culture, and vitreous culture but a positive culture from subretinal aspirate.
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Hsieh MC, Chen SN, Cheng CY, Li KH, Chuang CC, Wu JS, Lee ST, Chiu SL. Clinicomicrobiological profile, visual outcome and mortality of culture-proven endogenous endophthalmitis in Taiwan. Sci Rep 2020; 10:12481. [PMID: 32719314 PMCID: PMC7385165 DOI: 10.1038/s41598-020-69251-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
This is a retrospective study in consecutive cases with cultured-proven endogenous endophthalmitis (EE) treated at the largest tertiary medical center in middle Taiwan in the past 10 years. 83 eyes of 70 patients were enrolled. The mean interval between systemic diseases to the diagnosis of EE was 8.84 ± 6.94 days. The mean initial visual acuity (VA) in the logarithm of minimal angle of resolution (logMAR) was 1.63 ± 0.87. Type 2 diabetes mellitus was the most common predisposing medical illness (N = 53, 63.86%). The most common infectious sources were intra-abdominal abscess (N = 36, 43.37%), and the second most reason was urinary tract infection. The causative pathogen was Gram-negative predominant (N = 64, 77.11%). After aggressive treatment, 34.94% of eyes regain useful vision, and only six eyes underwent enucleation or evisceration. The binary multivariate logistic regression model revealed that female gender (95% CI 1.002–19.036, p = 0.05, OR 4.37), initial VA logMAR (95% CI 0.089–0.550, p = 0.01, OR 0.22), and more intravitreal injections (95% CI 0.368–0.927, p = 0.023, OR 0.58) were independent risk factors influencing final outcomes. Based on the results mentioned above, early diagnosis is recommended to gain better outcomes. The mean interval between systemic diseases to the diagnosis of EE was 8.84 ± 6.94 days in our sample population, clinicians should maintain a higher index of suspicion during this period when encountering patients with bacteremia or fungemia.
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Affiliation(s)
- Ming-Chieh Hsieh
- Department of Ophthalmology, Changhua Christian Hospital, No. 135, Nanxiao St., Changhua City, Changhua County, 500, Taiwan, ROC
| | - San-Ni Chen
- Department of Ophthalmology, Changhua Christian Hospital, No. 135, Nanxiao St., Changhua City, Changhua County, 500, Taiwan, ROC.,Department of Optometry, Da-Yeh University, Changhua City, Taiwan, ROC.,School of Medicine, Chung-Shan Medical University, Taichung, Taiwan, ROC
| | - Chieh-Yin Cheng
- Department of Ophthalmology, Changhua Christian Hospital, No. 135, Nanxiao St., Changhua City, Changhua County, 500, Taiwan, ROC
| | - Kun-Hsien Li
- Department of Ophthalmology, Changhua Christian Hospital, No. 135, Nanxiao St., Changhua City, Changhua County, 500, Taiwan, ROC
| | - Chih-Chun Chuang
- Department of Ophthalmology, Changhua Christian Hospital, No. 135, Nanxiao St., Changhua City, Changhua County, 500, Taiwan, ROC
| | - Jian-Sheng Wu
- Department of Ophthalmology, Changhua Christian Hospital, No. 135, Nanxiao St., Changhua City, Changhua County, 500, Taiwan, ROC
| | - Sheng-Ta Lee
- Department of Ophthalmology, Changhua Christian Hospital, No. 135, Nanxiao St., Changhua City, Changhua County, 500, Taiwan, ROC
| | - Shin-Lin Chiu
- Department of Ophthalmology, Changhua Christian Hospital, No. 135, Nanxiao St., Changhua City, Changhua County, 500, Taiwan, ROC. .,Department of Optometry, Da-Yeh University, Changhua City, Taiwan, ROC.
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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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Recurrent fungal endophthalmitis after intravitreal injections of bevacizumab. Am J Ophthalmol Case Rep 2020; 17:100591. [PMID: 32395665 PMCID: PMC7206407 DOI: 10.1016/j.ajoc.2020.100591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 11/26/2019] [Accepted: 01/02/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose We intend to describe an uncommon case of recurrent post-cataract fungal endophthalmitis after intravitreal injections of Bevacizumab. Observations A 73-year-old male, who underwent an uncomplicated cataract surgery 8 months ago, presented to our department with postoperative endophthalmitis 5 days after his fifth intravitreal injection (IVI) of bevacizumab for treatment of cystoid macula edema caused by central retinal venous occlusion 6 months ago. The visual acuity (VA) was 0.1 (20/200). The patient underwent an emergency pars plana vitrectomy. Culture of vitreous tap was negative. Eight weeks later, the patient presented again with recurrent endophthalmitis 2 days after his sixth IVI of bevacizumab. VA was hand motion. The patient was treated with an emergency anterior and posterior segment washout with intracapsular posterior intraocular lens (pIOL) extraction. Culture of pIOL revealed Saccharomyces cervisiae fungi in the capsular bag. Six months later, clinical findings were stable with no signs of intraocular inflammation, VA was 0.3 (20/60). Conclusions and Importance we assume that this is a rare case of chronic late-onset post-cataract fungal endophthalmitis, which was activated by repeated intravitreal injections of Bevacizumab.
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Singh RB, Saini C, Shergill S, Agarwal A. Window to the circulatory system: Ocular manifestations of cardiovascular diseases. Eur J Ophthalmol 2020; 30:1207-1219. [PMID: 32340480 DOI: 10.1177/1120672120914232] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The changes in the cardiovascular system are associated with ocular manifestations, often as a consequence of pathological alteration in the ocular vasculature. The ease of visualization of these retinal changes makes the eye a window to the cardiovascular system. Certain congenital cardiac defects lead to changes in the retinal vascularity due to increased tortuosity and dilatation. In adults, the arterial dissection of internal carotid and vertebral arteries present as amaurosis fugax with or without oculo-sympathetic palsy. The patients with untreated infective endocarditis present with Roth spots, retinitis, embolic retinopathy, or sub-retinal abscesses. Hypoperfusive, hypertensive, or "mixed" retinopathy is a hallmark sign in patients of untreated infective endocarditis. Giant cell arteritis can present with ischemic ocular symptoms that may precipitate in irreversible vision loss. Systemic vascular manifestations such as coronary artery disease may manifest in a wide range of symptoms from amaurosis fugax to vision loss depending upon the size and location of retinal emboli. Rare cardio-oncological pathologies such as myxomas result in vision loss secondary to central retinal artery occlusion. A high clinical suspicion in patients with history of cardiovascular diseases can help in early diagnosis and management of impending, adverse cardiovascular and cerebrovascular events. In this review, we comprehensively discuss the spectrum of cardiac and vascular diseases with ocular manifestations as well as highlight the typical ocular presentations associated with these pathologies.
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Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Chhavi Saini
- Department of Ophthalmology, Government Medical College & Hospital, Chandigarh, India
| | | | - Aniruddha Agarwal
- Department of Ophthalmology, Advanced Eye Center, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Zhou YL, Wang YX, Yao TT, Yang Y, Wang ZY. Traumatic endophthalmitis and the outcome after vitrectomy in young children. Int J Ophthalmol 2020; 13:406-411. [PMID: 32309176 DOI: 10.18240/ijo.2020.03.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 12/25/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To explore the traumatic endophthalmitis in young children and the outcome of pars plana vitrectomy (PPV). METHODS Twenty-two eyes of 22 cases of young children consecutive pediatric traumatic endophthalmitis treated and followed up between September 2014 and May 2018 were included. Aqueous humor or vitreous samples were taken for bacterial culture and sensitivity tests. Intravitreal antibiotics (norvancomycin and ceftazidime) injection, combined with 23-gauge PPV, were administered in 22 eyes. Silicone oil (SO; 5000 centistoke) tamponade or perfluoropropane gas (C3F8) was used in all patients. Main outcome measures were best-corrected visual acuity (BCVA) and retinal attachment, the ratio of penetrating injury, and the existence of intraocular foreign body. RESULTS The mean age of patients was 6.9±2.2 (range, 3-10)y. All injured eyes suffered from penetrating ocular injury with retained intraocular foreign body in one eye. Bacterial culture was positive in only 2 eyes. The mean follow-up time was 21.1±4.7 (range, 12-30)mo. In the primary PPV, intravitreal antibiotics was administrated in all eyes, SO in 18 eyes, and C3F8 in 4 eyes. The secondary operation of SO removal and C3F8 endotamponade was performed in 16 eyes and a second SO endotamponade due to emulsification of the oil and retinal detachment (RD) was operated in 7 eyes underwent 3 to 11.5mo after primary PPV. A third operation was done in 7 eyes. The final intraocular pressure (IOP) was 8.9±1.8 (range, 6.9-11.4) mm Hg. The final BCVAs were 20/200 or better in 5, counting fingers in 2, and light perception to hand movement in 8 eyes. Whose (66.7%) had retinal injury exhibited worse BCVA (P=0.019, Fisher's exact test). Eyes underwent SO tamponade exhibited worse final BCVA than that with C3F8 in the primary PPV (P=0.026, Fisher's exact test). CONCLUSION Traumatic endophthalmitis in children is generally more severe and associated with more complicated surgical procedures. Most patients have retinal injury need multiple operations and the final BCVA is poor. Prevention of ocular trauma, especially in children, is still critical.
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Affiliation(s)
- Ya-Li Zhou
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Yi-Xiao Wang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Teng-Teng Yao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Yuan Yang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Zhao-Yang Wang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
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Tsirouki T, Steffen J, Dastiridou A, Praidou A, Androudi S. Endophthalmitis in HIV Infection. Ocul Immunol Inflamm 2020; 28:1060-1065. [PMID: 31944150 DOI: 10.1080/09273948.2019.1699580] [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] [Indexed: 10/25/2022]
Abstract
Purpose: The role of HIV infection in exogenous and endogenous endophthalmitis has not been clarified. We aim to assess the potential role of HIV as a risk factor or a poor prognostic feature in this sight-threatening condition. Methods: Literature review. Review of evidence: Evidence for endophthalmitis in HIV patients is based on scarce retrospective case series and case reports. Infrequency of literature on this topic is owed to the diversity of the different types of endophthalmitis as well as the rarity of the coexistence of the two conditions. Conclusions: Endophthalmitis in HIV patients are a rare but potentially devastating condition. Many forms of endophthalmitis tend to occur in severely immunosuppressed HIV patients with low CD4 counts. Therefore, the early introduction of cART with full immune reconstitution is an essential part of the prevention of endophthalmitis in the HIV population.
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Affiliation(s)
- Theodora Tsirouki
- Department of Ophthalmology, University of Thessaly , Larissa, Greece
| | - Jonel Steffen
- Division of Ophthalmology, University of Cape Town , Cape Town, South Africa
| | - Anna Dastiridou
- Department of Ophthalmology, University of Thessaly , Larissa, Greece
| | - Anna Praidou
- Department of Ophthalmology, Agios Dimitrios Hospital , Thessaloniki, Greece
| | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly , Larissa, Greece
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Babu N, Kohli P. Commentary: Controversies related to endogenous endophthalmitis. Indian J Ophthalmol 2020; 68:840. [PMID: 32317457 PMCID: PMC7350450 DOI: 10.4103/ijo.ijo_2226_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Maitray A, Rishi E, Rishi P, Gopal L, Bhende P, Ray R, Therese KL. Endogenous endophthalmitis in children and adolescents: Case series and literature review. Indian J Ophthalmol 2019; 67:795-800. [PMID: 31124489 PMCID: PMC6552604 DOI: 10.4103/ijo.ijo_710_18] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: To study the clinical and microbiological profile, treatment modalities, and anatomical and functional outcomes among children and adolescents with endogenous endophthalmitis (EE) at a tertiary eye care centre in India. Methods: Medical records of subjects <18 years, presenting with EE from 1997 to 2007 were reviewed. Cases where the causative organism was identified were included. Treatment regimen included systemic antibiotics, vitrectomy, intravitreal antibiotics, and enucleation. Systemic evaluation to identify the source of infection was done by an internist. Microbiological analysis of blood, urine, and ocular specimens was done. The favorable anatomical outcome was defined as the attached retina, with controlled intraocular pressure and clear media at the last follow up. The favorable functional outcome was defined as vision >3/60 on the final follow up. Univariate regression analysis was done to identify factors predicting functional outcome. Results: Thirty eyes of 30 subjects (23 (77%) males) were studied. The mean age at presentation was 6.8 years (range=1–16 years). Fever was evident in four (13%) and blood culture was negative in all cases. Gram-positive organisms were identified in 11 (37%) eyes, fungi in 3 (10%), and toxocara in 8 (27%) eyes. Twenty-three (77%) eyes underwent vitrectomy. Favorable functional and anatomical outcomes were achieved in 9 (30%) and 12 (40%) eyes, respectively. Eyes undergoing vitrectomy showed significant correlation with good functional outcome (P = 0.05). Conclusion: EE is under-reported and not well studied in children. The absence of systemic features may be evident in a developing country with over the counter availability of antibiotics. Gram-positive infections are common and vitrectomy is a beneficial modality of treatment.
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Affiliation(s)
- Aditya Maitray
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ekta Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Lingam Gopal
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Pramod Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Rupak Ray
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Kuzhanthai Lily Therese
- Department of Microbiology, Larsen and Toubro Microbiology Research Centre, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Weng TH, Chang HC, Chung CH, Lin FH, Tai MC, Tsao CH, Chien KH, Chien WC. Epidemiology and Mortality-Related Prognostic Factors in Endophthalmitis. Invest Ophthalmol Vis Sci 2019; 59:2487-2494. [PMID: 29847653 DOI: 10.1167/iovs.18-23783] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose Endophthalmitis describes any intraocular inflammation that involves both the posterior and anterior segments and is divided into endogenous and exogenous types according to its pathogenesis. The incidence of endophthalmitis and its risk factors have been extensively evaluated. However, few studies have explored the mortality rate in patients diagnosed with endophthalmitis. Methods We obtained data entered into the National Health Insurance Research Database (NHIRD) from 2000 to 2013. The data collected included all discharge diagnoses of endophthalmitis in inpatients. Baseline characteristics, comorbidities, and prognostic factors were evaluated. Results This study identified 7764 patients who were diagnosed with endophthalmitis in Taiwan from 2000 to 2013. The mortality rate was 0.97% (75/7764), and the mean age was 63.57 ± 15.72 years. Epidemiological characteristics were compared as "with or without" for different systemic comorbidities, and the results indicated that the adjusted odds ratio (AOR) was significantly higher in cases comorbid with renal disease (AOR 2.864, P = 0.001), septicemia (AOR 8.886, P < 0.001), pneumonia (AOR 2.072, P = 0.030), and tumors (AOR 7.437, P < 0.001). However, comorbidity with diabetes mellitus (DM) lowered the AOR by 0.500-fold (P = 0.026). There was no significant difference in ORs between patients comorbid with hypertension, depression, anxiety, hyperlipidemia, thyrotoxicosis, liver disease, or injury (all P > 0.05). Conclusions Among inpatients with endophthalmitis, predictors of mortality include renal disease, septicemia, pneumonia, neoplasia, a greater burden of comorbidity (especially catastrophic illness), longer hospital stays (more than 11 days), and higher medical costs. Interestingly, DM decreased the OR for inpatient mortality.
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Affiliation(s)
- Tzu-Heng Weng
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsu-Chieh Chang
- Department of Nursing, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Huei Tsao
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ke-Hung Chien
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Manoharan V, Sanghvi C. A case of endogenous endophthalmitis with subretinal abscess secondary to splenic abscess. JRSM Open 2019; 10:2054270419830692. [PMID: 30967958 PMCID: PMC6444789 DOI: 10.1177/2054270419830692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Early diagnosis and treatment of endophthalmitis will optimise visual prognosis. Blood culture sensitivities should tailor antibiotic choice.
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Modjtahedi BS, Finn AP, Barb SM, MacLachlan MJ, van Zyl T, Papakostas TD, Eliott D. Characteristics and Outcomes of Endogenous Endophthalmitis. ACTA ACUST UNITED AC 2019; 3:61-72. [DOI: 10.1016/j.oret.2018.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 08/18/2018] [Accepted: 08/29/2018] [Indexed: 12/28/2022]
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Gilsdorf JR. Into Darkness and Silence: What Caused Helen Keller’s Deafblindness? Clin Infect Dis 2018; 67:1445-1449. [DOI: 10.1093/cid/ciy385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/27/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Janet R Gilsdorf
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor
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40
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Takayama K, Kaneko H, Ito Y, Kataoka K, Iwase T, Yasuma T, Matsuura T, Tsunekawa T, Shimizu H, Suzumura A, Ra E, Akahori T, Terasaki H. Novel Classification of Early-stage Systemic Hypertensive Changes in Human Retina Based on OCTA Measurement of Choriocapillaris. Sci Rep 2018; 8:15163. [PMID: 30310137 PMCID: PMC6181956 DOI: 10.1038/s41598-018-33580-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 09/24/2018] [Indexed: 11/09/2022] Open
Abstract
The traditional classification of hypertensive retinopathy was based on the Keith-Wagener-Barker (KWB) grading, which is a subjective scaling system, and it is difficult to distinguish between the first and second grades. Retinal and choroidal vasculatures are affected by systemic hypertension, although retinal vasculature changes with age, axial length, intraocular pressure, and retinal diseases. It is necessary to establish a new objective method to assess hypertensive vascular changes. In the present study, we have examined the vasculature of the macular choriocapillaris in order to establish a new objective method to assess hypertensive vascular changes using optical coherence tomography angiography (OCTA). Choriocapillaris vessel density (VD), vessel length, and vessel diameter index in a 3 × 3 mm macular area were measured by OTCA in a total of 567 volunteers (361 healthy subjects and 206 subjects with systemic hypertension) who attended a basic health check-up. Ocular factors, systemic factors, and medications were evaluated. We detected significant differences in normative choriocapillaris vasculature between the left and right eyes in 53 healthy subjects and revealed correlations between age, intraocular pressure, axial length, and choriocapillaris vasculature in 308 healthy subjects. Normative foveal VD was correlated with age only and the efficiency was weak. The analysis of 206 right eyes (KWB grade 0, 159 eyes; grade 1, 35 eyes; and grade 2, 12 eyes) revealed that foveal VD was strongly correlated with KWB grade only (P < 0.001). This is the first report suggesting that OCTA for foveal choriocapillaris measurement by OCTA would might provide the advantage of evaluating be objective method for evaluating the progression of systemic hypertension.
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Affiliation(s)
- Kei Takayama
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan. .,Department of Ophthalmology, Nagoya University Graduate School of Medicine, 54 Tsurumai-cho, Showa-ku, 466-8550, Japan.
| | - Hiroki Kaneko
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 54 Tsurumai-cho, Showa-ku, 466-8550, Japan
| | - Yasuki Ito
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 54 Tsurumai-cho, Showa-ku, 466-8550, Japan
| | - Keiko Kataoka
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 54 Tsurumai-cho, Showa-ku, 466-8550, Japan
| | - Takeshi Iwase
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 54 Tsurumai-cho, Showa-ku, 466-8550, Japan
| | - Tetsuhiro Yasuma
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 54 Tsurumai-cho, Showa-ku, 466-8550, Japan
| | - Toshiyuki Matsuura
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 54 Tsurumai-cho, Showa-ku, 466-8550, Japan
| | - Taichi Tsunekawa
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 54 Tsurumai-cho, Showa-ku, 466-8550, Japan
| | - Hideyuki Shimizu
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 54 Tsurumai-cho, Showa-ku, 466-8550, Japan
| | - Ayana Suzumura
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 54 Tsurumai-cho, Showa-ku, 466-8550, Japan
| | - Eimei Ra
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 54 Tsurumai-cho, Showa-ku, 466-8550, Japan
| | - Tomohiko Akahori
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 54 Tsurumai-cho, Showa-ku, 466-8550, Japan
| | - Hiroko Terasaki
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 54 Tsurumai-cho, Showa-ku, 466-8550, Japan
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Michael NDB, Gunaseelan S, Tuan Jaffar TN, Noordin Z, Hussein A. Endogenous Endophthalmitis: A Five-year Review of Cases at the Raja Perempuan Zainab II Hospital, Kelantan, Malaysia. Cureus 2018; 10:e3066. [PMID: 30280062 PMCID: PMC6166918 DOI: 10.7759/cureus.3066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Endogenous endophthalmitis (EE) is a type of intraocular inflammation secondary to hematogenous spread from a distant infective source within the body and usually occurs in immunocompromised patients. Objectives The aim of this study was to profile the patient characteristics, sources of infection, microbial profiles, and visual outcomes of patients with EE in Raja Perempuan Zainab II Hospital in Kelantan, Malaysia. Materials and methods Data from 18 eyes of 17 patients diagnosed with EE and admitted to the eye ward of Raja Perempuan Zainab II Hospital from January 2012 to December 2016 were retrospectively reviewed. Factors analyzed included patient age, sources of infection, visual acuity, microbial profiles, and treatment outcomes. Results The mean age of the 17 patients was 53.2 years. Twelve patients (70.6%) had EE of left eye, four (23.5%) had EE of right eye, and one (5.9%) had EE involving both the eyes. Sixteen patients (91.1%) had at least one predisposing condition, the most common of which was diabetes mellitus in 15 patients (88.2%). A source of infection was identified in 12 of the 17 patients, with urinary tract infection being the most common (five patients, 29.4%). Organisms were successfully isolated from 10 (58.8%) patients, including seven (41.2%) with Gram-negative and three (17.6%) with Gram-positive organisms. All patients presented with a visual acuity worse than 6/60. Nine (52.9%) patients underwent vitrectomy, with only two of these patients achieving a final visual acuity better than 6/60. Eleven patients became nonperceptive to light, with four of them undergoing evisceration. Conclusions EE is a rare but often devastating ocular condition. Visual outcomes are often poor especially in patients infected with Gram-negative bacteria.
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Affiliation(s)
- Ngu Dau Bing Michael
- Ophthalmology Department, School of Medical Sciences/Universiti Sains Malaysia, Kelantan, MYS
| | - Shakiran Gunaseelan
- Ophthalmology Department, School of Medical Sciences/Universiti Sains Malaysia, Kelantan, MYS
| | | | - Zamri Noordin
- Ophthalmology Department, Raja Perempuan Zainab Il Hospital, Kelantan, MYS
| | - Adil Hussein
- Ophthalmology Department, School of Medical Sciences/Universiti Sains Malaysia, Kelantan, MYS
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Hagiya H, Semba T, Morimoto T, Yamamoto N, Yoshida H, Tomono K. Panophthalmitis caused by Streptococcus dysgalactiae subsp. equisimilis: A case report and literature review. J Infect Chemother 2018; 24:936-940. [PMID: 29752197 DOI: 10.1016/j.jiac.2018.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/10/2018] [Accepted: 04/17/2018] [Indexed: 11/19/2022]
Abstract
Lancefield group G β-hemolytic Streptococcus dysgalactiae subspecies equisimilis (SDSE) has become a leading causative pathogen of invasive streptococcal infection. In this report, we describe a case of disseminated SDSE infection complicated by endogenous endophthalmitis, resulting in panophthalmitis and blindness. A 65-year-old man who underwent mitral valve replacement surgery two months previously was hospitalized due to high fever and right visual loss. A systemic investigation revealed endophthalmitis complicated by mediastinal abscess, prosthetic infective endocarditis, cerebral emboli and hemorrhage, and multiple arthritis. The patient underwent various surgeries, including vitrectomy, mediastinal lavage, mitral valve replacements, joint lavages, as well as an intensive antibiotic treatment. His general condition gradually improved, but the ocular infection developed to panophthalmitis, which ultimately required ophthalmectomy. A literature review regarding Group G-associated endogenous endophthalmitis suggested that the disease occurs in elderly people, is frequently complicated with endocarditis, and yields poor visual prognosis regardless of appropriate antibiotic treatment and surgical therapies. In this aging society, invasive infections with SDSE should be much more recognized among medical practitioners in order to improve patient prognosis.
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Affiliation(s)
- Hideharu Hagiya
- Division of Infection Control and Prevention, Osaka University Hospital, Japan.
| | - Takuya Semba
- Department of Ophthalmology, Osaka University Hospital, Japan
| | | | - Norihisa Yamamoto
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Hisao Yoshida
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
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Teh SW, Mok PL, Abd Rashid M, Bastion MLC, Ibrahim N, Higuchi A, Murugan K, Mariappan R, Subbiah SK. Recent Updates on Treatment of Ocular Microbial Infections by Stem Cell Therapy: A Review. Int J Mol Sci 2018; 19:ijms19020558. [PMID: 29438279 PMCID: PMC5855780 DOI: 10.3390/ijms19020558] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/03/2017] [Accepted: 12/12/2017] [Indexed: 02/06/2023] Open
Abstract
Ocular microbial infection has emerged as a major public health crisis during the past two decades. A variety of causative agents can cause ocular microbial infections; which are characterized by persistent and destructive inflammation of the ocular tissue; progressive visual disturbance; and may result in loss of visual function in patients if early and effective treatments are not received. The conventional therapeutic approaches to treat vision impairment and blindness resulting from microbial infections involve antimicrobial therapy to eliminate the offending pathogens or in severe cases; by surgical methods and retinal prosthesis replacing of the infected area. In cases where there is concurrent inflammation, once infection is controlled, anti-inflammatory agents are indicated to reduce ocular damage from inflammation which ensues. Despite advances in medical research; progress in the control of ocular microbial infections remains slow. The varying level of ocular tissue recovery in individuals and the incomplete visual functional restoration indicate the chief limitations of current strategies. The development of a more extensive therapy is needed to help in healing to regain vision in patients. Stem cells are multipotent stromal cells that can give rise to a vast variety of cell types following proper differentiation protocol. Stem cell therapy shows promise in reducing inflammation and repairing tissue damage on the eye caused by microbial infections by its ability to modulate immune response and promote tissue regeneration. This article reviews a selected list of common infectious agents affecting the eye; which include fungi; viruses; parasites and bacteria with the aim of discussing the current antimicrobial treatments and the associated therapeutic challenges. We also provide recent updates of the advances in stem cells studies on sepsis therapy as a suggestion of optimum treatment regime for ocular microbial infections.
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Affiliation(s)
- Seoh Wei Teh
- Department of Biomedical Science, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
| | - Pooi Ling Mok
- Department of Biomedical Science, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
- Genetics and Regenerative Medicine Research Centre, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Aljouf University, 72442 Sakaka, Aljouf Province, Saudi Arabia.
| | - Munirah Abd Rashid
- Department of Ophthalmology, Faculty of Medicine, UKM Medical Center, 56000 Cheras, Kuala Lumpur, Malaysia.
| | - Mae-Lynn Catherine Bastion
- Department of Ophthalmology, Faculty of Medicine, UKM Medical Center, 56000 Cheras, Kuala Lumpur, Malaysia.
| | - Normala Ibrahim
- Department of Psychiatry, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
| | - Akon Higuchi
- Department of Chemical and Materials Engineering, National Central University, No. 300, Jhongda RD., Jhongli, 32001 Taoyuan, Taiwan.
| | - Kadarkarai Murugan
- Department of Zoology, Thiruvalluvar University, Serkkadu, 632 115 Vellore, India.
| | - Rajan Mariappan
- Biomaterials in Medicinal Chemistry Laboratory, Department of Natural Products Chemistry, School of Chemistry, Madurai Kamaraj University, Madurai, 625 021 Tamil Nadu, India.
| | - Suresh Kumar Subbiah
- Genetics and Regenerative Medicine Research Centre, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
- Department of Medical Microbiology and Parasitology, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
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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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Ziakas NG, Tzetzi D, Boboridis K, Georgiadis NS. Endogenous Group G Streptococcus Endophthalmitis following a Dental Procedure. Eur J Ophthalmol 2018; 14:59-60. [PMID: 15005587 DOI: 10.1177/112067210401400110] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To report a case of bilateral endogenous endophthalmitis due to group G Streptococcus after a dental procedure. METHODS Case report of a 69-year-old woman who presented with pain, decreased vision, bilateral uveitis, and a unilateral hypopyon 1 week after treatment for an abscessed tooth. Results Bilateral endophthalmitis was diagnosed, and group G Streptococcus was cultured from the vitreous samples. CONCLUSIONS To our knowledge, this is the second reported case of endogenous endophthalmitis following a dental procedure. Furthermore, it was due to group G Streptococcus, which is a rare cause of this condition.
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Affiliation(s)
- N G Ziakas
- Department of Ophthalmology, Aristotle University of Thessaloniki, Greece.
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Maling S, King C, Davies N. A British Ophthalmological Surveillance Unit Study on metastatic endogenous endophthalmitis. Eye (Lond) 2018; 32:743-748. [PMID: 29328066 DOI: 10.1038/eye.2017.284] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/16/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeEndogenous endophthalmitis (EE) is a rare but serious ocular infection caused by the seeding of bacteria into the eye from a source elsewhere in the body. Studies suggest that EE accounts for 2 to 8% of all endophthalmitis.MethodsA prospective observational study was conducted using the British Ophthalmological Surveillance Unit reporting system. Questionnaires were sent to reporting Ophthalmologists in the UK to assess incidence, underlying aetiology, eye findings, management, and final outcomes in endogenous endophthalmitis over a 12-month period within the British Isles.ResultsSixty two cases reported with 48 initial questionnaires returned and 25 6-month follow-up questionnaires returned. The median age of patients affected was 57 years with youngest aged 2 years and oldest aged 85 years. Twenty three were male and 24 were female. The median visual acuity in the affected eye was 3 logMAR (range -0.1 to 5). Blood cultures were taken in 36 patients, 58% of which were positive. Vitreous biopsy was taken in 35 patients, 23% of which were culture positive. The visual function as assessed by visual acuity had significantly improved at 6 months with a median acuity of 0.18 logMAR (P=0.003).ConclusionsThe survey demonstrates the severe nature of endogenous endophthalmitis in patients with active infection or with risk factors for infection. Our study has demonstrated that at least half of the patients who were treated had significant vision improvement.
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Affiliation(s)
- S Maling
- Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - C King
- Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - N Davies
- Chelsea and Westminster Hospital, London, UK
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Li YH, Chen YH, Chen KJ, Wang NK, Sun MH, Chao AN, Liu L, Lin YJ, Wu WC, Hwang YS, Lai CC, Chen TL. Infectious Sources, Prognostic Factors, and Visual Outcomes of Endogenous Klebsiella pneumoniae Endophthalmitis. Ophthalmol Retina 2018; 2:771-778. [PMID: 31047528 DOI: 10.1016/j.oret.2017.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/16/2017] [Accepted: 11/20/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the infectious sources and prognostic factors for poor visual outcome, including subjective symptoms, presenting clinical features, laboratory data, and treatments, in patients diagnosed with endogenous Klebsiella pneumoniae endophthalmitis (EKE) at a tertiary referral center in Northern Taiwan. DESIGN Retrospective, single-institution, consecutive case series. PARTICIPANTS One hundred ten consecutive patients (124 eyes) diagnosed with EKE. METHODS One hundred ten patients (124 eyes) were reviewed retrospectively between January 1996 and April 2013. MAIN OUTCOME MEASURES Visual acuity (VA), subjective symptoms, presenting clinical features, laboratory data, treatments, and requirement of evisceration or enucleation. RESULTS Of the 110 patients with EKE, 74 (67.3%) were men. Diabetes was the most commonly associated systemic disease (75/110 [68.2%]), and liver abscess was the major infection source (85/110 [77.3%]). In addition, 91 of 124 eyes (73.4%) had final VA worse than counting fingers (CF; poor visual outcome), and 20 eyes required evisceration or enucleation. The binary multivariate logistic regression (forward-Wald) model revealed that poor initial VA worse than CF (odds ratio [OR], 8.8; 95% confidence interval [CI], 2.2-36; P = 0.002), positive vitreous culture results (OR, 9.8; 95% CI, 1.7-56.1; P = 0.010), posterior focal EKE (OR, 0.15; 95% CI, 0.03-0.8; P = 0.027), and the presence of intravitreal dexamethasone administration (OR, 0.19; 95% CI, 0.04-0.9; P = 0.030) were the significant independent factors for visual outcomes. CONCLUSIONS Liver abscess was the major infection source, and EKE typically has poor visual prognosis. Early diagnosis and prompt treatment may salvage useful vision in some eyes. Early diagnosis with fair initial VA and intravitreal antibiotic and dexamethasone combination therapy may have beneficial effects on visual outcomes.
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Affiliation(s)
- Ya-Han Li
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Ophthalmology, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Yi-Hua Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Nan-Kai Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Hui Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - An-Ning Chao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Laura Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Jr Lin
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tun-Lu Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Jung H, Kim SW, Chang HH, Lee SA, Kim Y, Hwang S, Kim SJ, Lee JM. Analysis of Klebsiella as a Prognostic Factor of Ocular Outcomes in Endogenous Endophthalmitis with Decision Tree Analysis. Infect Chemother 2018; 50:238-251. [PMID: 30270583 PMCID: PMC6167506 DOI: 10.3947/ic.2018.50.3.238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/10/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Endogenous endophthalmitis (EE) is a fulminant ocular disease. This study was conducted to explore frequent pathogens and significant prognostic factors associated with poor ocular outcomes. MATERIALS AND METHODS A retrospective analysis was performed in a tertiary hospital in Korea. Thirty-nine patients, treated between January 2000 and June 2017, were eligible for the analysis. Ocular outcomes were classified as follows: 1) no light perception (NLP), 2) light perception (LP), 3) hand motion (HM), 4) counting fingers (CF), and 5) 20/200 or better. Logistic regression and decision tree analyses were used to identify risk factors that were associated with poor outcomes. RESULTS Pathogens were identified in 23 (58.9%) samples from blood, liver aspirate, and/or vitreous humor. Klebsiella pneumoniae was the most frequent organism (12/39, 30.8%), followed by Candida species (3/39, 8.3%). The most common combined infection was liver abscess (16/39, 41.0%). Acute pyelonephritis occurred in 30.8% of cases (12/39). Final ocular outcomes were as follows: 35.9% (14/39) NLP, 15.4% (6/39) LP, 15.4% (6/39) HM, 7.7% (3/39) CF, and 25.6% (10/39) 20/200 or better. K. pneumoniae was a poor prognostic factor in univariate (odds ratio [OR], 13.3; 95% confidence interval [CI], 2.1-130.9) and multivariate (OR, 17.5; 95% CI, 2.1-398.8) regression analyses (NLP and LP vs. HM, CF, and 20/200 or better). Other factors did not reach statistical difference. Decision tree analysis identified K. pneumoniae as a node that divided ocular outcomes (P = 0.017). CONCLUSIONS In conclusion, K. pneumoniae is the most frequent causative pathogen of EE. Considering the poor prognosis and rapid progression of K. pneumoniae EE, physicians should test for K. pneumoniae EE in patients who experience acute systemic infections with ocular signs and symptoms.
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Affiliation(s)
- Hyejin Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Shin Woo Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea.
| | - Hyun Ha Chang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Sang Ah Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Yoonjung Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Soyoon Hwang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Su Jeong Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Jong Myung Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
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Bjerrum SS, la Cour M. 59 eyes with endogenous endophthalmitis- causes, outcomes and mortality in a Danish population between 2000 and 2016. Graefes Arch Clin Exp Ophthalmol 2017; 255:2023-2027. [PMID: 28791473 DOI: 10.1007/s00417-017-3760-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/12/2017] [Accepted: 07/17/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To study the epidemiology of patients with endogenous endophthalmitis in Denmark. MATERIAL AND METHODS Retrospective and prospective case series of 59 eyes in patients with endogenous endophthalmitis in Denmark between 2000 and 2016. RESULTS The age of the patients ranged from 28 to 90 years with a median of 66 years. Sixty-two percent of the eyes had a final VA (visual acuity) ≤ 0.1 while 8% had a final VA ≥ 1.0. Positive cultures were obtained in 51% of the cases from the blood and in 43% from the vitreous. Streptococcus species and Staphylococcus aureus were the most commonly identified microorganisms. The sources of endogenous endophthalmitis were diverse and were not identified in 36% of the patients. Diabetes (36%) was the most predisposing medical illness. A total of 15% of the patients died within the first year after surgery for endophthalmitis and half of the patients died during follow up. The mortality of patients was 22.6 times higher compared to a Danish background population. Culture positive patients had a higher mortality compared to culture negative patients. CONCLUSIONS Endogenous endophthalmitis is a heterogeneous condition which is reflected in the age, the visual outcome and the mortality of the patients. The epidemiology of the disease is very different in Scandinavia compared to Asia. The visual prognosis remains grave and the majority of the eyes lose useful vision.
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Affiliation(s)
- Søren Solborg Bjerrum
- Department of Ophthalmology, Rigshospitalet Glostrup, Nordre Ringvej 57, 2600, Glostrup, Copenhagen, Denmark.
| | - Morten la Cour
- Department of Ophthalmology, Rigshospitalet Glostrup, Nordre Ringvej 57, 2600, Glostrup, Copenhagen, Denmark
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Nagasako Y, Inagaki K, Serizawa S, Hamada M, Echizen N, Takahashi O, Deshpande GA, Ohkoshi K. Risk Factors Associated with Retinal Lesions Resulting from Widespread Systemic Infection. Ophthalmol Retina 2017; 1:333-338. [PMID: 31047520 DOI: 10.1016/j.oret.2016.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/22/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To clarify the prevalence, microbiologic features, and risk factors of endogenous intraocular infections in patients with positive fungal or bacterial blood culture results. DESIGN Retrospective case series. PARTICIPANTS Inpatients (n = 433) with positive blood culture results who underwent an ophthalmology consultation between January 2006 and September 2012 in Japan. METHODS We retrospectively reviewed the ophthalmology consultations of 433 inpatients with positive blood culture results. Clinical features of patients with confirmed chorioretinitis or endophthalmitis were analyzed through descriptive statistical methods and univariate and multivariate models. MAIN OUTCOME MEASURES Correlation of clinical features with retinal lesions of disseminated bacteremia or fungemia. RESULTS Among 433 inpatients with positive blood culture results, 116 (26.8%) were unresponsive and 27 (6.2%) had subjective ocular symptoms. Eighty-four (19.4%) had candidemia, including 16 (3.7%) with retinal lesions. Additionally, 34 patients (7.8%) had chorioretinitis or endophthalmitis in 1 eye (17 patients [3.9%]) or both eyes (17 eyes [3.9%]; 51 eyes total). Of these 34 patients, 20 (58.8%) and 17 (50%) had systemic bacterial and fungal infections, respectively (both infections were noted in 3 patients [8.8%]). Staphylococcus aureus was the most common bacteria. Candida albicans was the most common fungus, followed by Candida glabrata. Catheter-related bloodstream infections were the most common source of infection among the 34 patients with chorioretinitis or endophthalmitis, followed by infective endocarditis, urinary tract infection, and soft-tissue and bone disease. Among the 114 bacteremic patients who underwent an ophthalmology consultation because of suspicion of infective endocarditis, only 16 (14%) had infective endocarditis, of whom only 1 (0.88%) had retinal lesions. Nineteen of 34 patients (55.9%) with retinal lesions survived sepsis. Among them, only 1 patient (5.3%) with bacteremia lost significant vision (no light perception), and the remaining 18 patients (94.7%) regained vision. No patient with candidemia had vision loss. Multivariate analysis revealed that candidemia, infective endocarditis, broad-spectrum antibiotic use, and eye symptoms were independent predictors of retinal lesions (all P < 0.05). CONCLUSIONS An ophthalmology consultation may be useful for patients with candidemia, infective endocarditis, broad-spectrum antibiotic use, or ocular symptoms. However, routine ophthalmologic evaluation may be less efficient for bacteremic patients without definitive infective endocarditis lacking other risk factors.
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Affiliation(s)
- Yuki Nagasako
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan; Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
| | - Keiji Inagaki
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan; St. Luke's International University, Tokyo, Japan
| | - Satoshi Serizawa
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan
| | - Masafumi Hamada
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan
| | - Nariaki Echizen
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan
| | - Osamu Takahashi
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan
| | - Gautam A Deshpande
- Center for Clinical Epidemiology, St. Luke's International University, Tokyo, Japan
| | - Kishiko Ohkoshi
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan; St. Luke's International University, Tokyo, Japan
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