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Chang YC, Tsao YT, Wang CT, Hwang YS, Chou HD. Concomitant methicillin-resistant Staphylococcus aureus scleral buckle infection and acute retinal necrosis: A case report. J Fr Ophtalmol 2024; 47:104110. [PMID: 38431518 DOI: 10.1016/j.jfo.2024.104110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/24/2023] [Accepted: 12/12/2023] [Indexed: 03/05/2024]
Affiliation(s)
- Y-C Chang
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Gueishan Dist., Taoyuan City 333, Taiwan
| | - Y-T Tsao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Gueishan Dist., Taoyuan City 333, Taiwan
| | - C-T Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Gueishan Dist., Taoyuan City 333, Taiwan
| | - Y-S Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Gueishan Dist., Taoyuan City 333, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - H-D Chou
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Gueishan Dist., Taoyuan City 333, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Douros S, Mostafavi D, Danias M. Retinal vasculitis following intravitreal pegcetacoplan administration. Am J Ophthalmol Case Rep 2024; 33:101999. [PMID: 38298266 PMCID: PMC10828598 DOI: 10.1016/j.ajoc.2024.101999] [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: 07/31/2023] [Revised: 12/04/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024] Open
Abstract
Purpose To describe a case of retinal vaso-occlusive vasculitis with associated lid edema and conjunctivitis following intravitreal pegcetacoplan administration in a patient with geographic atrophy (GA). Observation A 78 year old Caucasian woman presented with complaints of lid edema, conjunctival injection, loss of vision, and mild ocular discomfort eleven days after receiving an intravitreal pegcetacoplan injection in the left eye for geographic atrophy. Visual acuity on presentation was decreased to 20/400 from 20/200 previously in that eye. Eyelid edema and conjunctival injection were present with minimal anterior chamber reaction. Dilated fundus examination revealed hemorrhages throughout the retina and signs of retinal vasculitis. The patient subsequently developed hyphema and vitreous hemorrhage. Laboratory evaluations for common infectious and inflammatory causes including aqueous and vitreous cultures for bacteria and Herpes simplex PCR were normal or negative. A delayed hypersensitivity to pegcetacoplan was suspected and was treated with topical, oral subconjunctival and intravitreal steroids. Conclusion This index report illustrates a case of retinal vaso-occlusive vasculitis associated with intravitreal pegcetacoplan associated with lid edema and conjunctival injection and subsequent hyphema and vitreous hemorrhage. Therapy with steroids topically, systemically, periocularly and intravitreally were used to treat the inflammatory process and prevent further visual loss.
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Affiliation(s)
- Stella Douros
- Stella Douros, M.D., P.C., Brooklyn, NY, USA
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - David Mostafavi
- SUNY Downstate Medical Center, Brooklyn, NY, USA
- Mostafavi Eye Institute, Staten Island, NY, USA
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3
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Garcia O’Farrill N, Abi Karam M, Villegas VM, Flynn HW, Grzybowski A, Schwartz SG. New Approaches to Overcoming Antimicrobial Resistance in Endophthalmitis. Pharmaceuticals (Basel) 2024; 17:321. [PMID: 38543107 PMCID: PMC10974156 DOI: 10.3390/ph17030321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 04/01/2024] Open
Abstract
Endophthalmitis is a rare but vision-threatening infection characterized by marked inflammation of intraocular fluids and tissues, uncommonly seen following surgery and intravitreal injection. Antimicrobials are used worldwide in the prophylaxis and treatment of bacterial and fungal infections of the eye and are standard treatment in the preoperative and postoperative care of surgical patients. However, antimicrobials are reported to be overprescribed in many parts of the world, which contributes to antimicrobial resistance (AMR). AMR complicates the prophylaxis and treatment of endophthalmitis. This article examines the prevalence and mechanisms of AMR in ocular microorganisms, emphasizing the importance of understanding AMR patterns for tailored treatments. It also explores prophylaxis and management strategies for endophthalmitis, with a discussion on the use of intracameral antibiotic administration. The use of prophylactic intracameral antibiotics during cataract surgery is common in many parts of the world but is still controversial in some locations, especially in the US. Finally, it highlights the role of stewardship in ophthalmology and its benefits in the treatment of endophthalmitis.
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Affiliation(s)
- Noraliz Garcia O’Farrill
- Department of Ophthalmology, University of Puerto Rico School of Medicine, San Juan, PR 00936, USA; (N.G.O.); (V.M.V.)
| | - Mariana Abi Karam
- Department of Ophthalmology, MetroHealth, Cleveland, OH 44109, USA;
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Victor M. Villegas
- Department of Ophthalmology, University of Puerto Rico School of Medicine, San Juan, PR 00936, USA; (N.G.O.); (V.M.V.)
| | - Harry W. Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 61-553 Poznan, Poland;
| | - Stephen G. Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Gavrić AU, Matović K, Benda PZ, Pompe MT, Klobučar P, Mekjavić PJ, Valentinčič NV. Case Series of Vancomycin-Associated Hemorrhagic Occlusive Retinal Vasculitis. Ophthalmic Surg Lasers Imaging Retina 2024:1-2. [PMID: 38530991 DOI: 10.3928/23258160-20240207-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
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5
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Witkin AJ, Jaffe GJ, Srivastava SK, Davis JL, Kim JE. Retinal Vasculitis After Intravitreal Pegcetacoplan: Report From the ASRS Research and Safety in Therapeutics (ReST) Committee. JOURNAL OF VITREORETINAL DISEASES 2024; 8:9-20. [PMID: 38223782 PMCID: PMC10786078 DOI: 10.1177/24741264231220224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Purpose: To analyze post-marketing cases of retinal vasculitis after intravitreal pegcetacoplan. Methods: The American Society of Retina Specialists (ASRS) Research and Safety in Therapeutics (ReST) Committee as well as an expert panel performed a retrospective review of cases of retinal vasculitis reported to the ASRS. Clinical and imaging characteristics were reviewed for evidence of retinal vasculitis and analyzed. Results: Fourteen eyes of 13 patients were confirmed to have retinal vasculitis by review of imaging studies. All cases occurred after the first pegcetacoplan injection. Occlusive retinal vasculopathy was confirmed in 11 eyes (79%). Patients presented a median of 10.5 days (range, 8-23 days) after pegcetacoplan injection. All eyes had anterior chamber inflammation, and 12 eyes (86%) had vitritis. Vasculopathy involved retinal veins (100%) more than arteries (73%), and 12 eyes (86%) had retinal hemorrhages. The median visual acuity (VA) was 20/60 (range, 20/30-5/200) at baseline, 20/300 (range, 20/100-no light perception [NLP]) at vasculitis presentation, and 20/200 (range 20/70-NLP) at the last follow-up. Eight eyes (57%) had more than a 3-line decrease in VA, and 6 eyes (43%) had more than a 6-line decrease in VA from baseline to the final follow-up, including 2 eyes that were enucleated. Six eyes (43%) developed signs of anterior segment neovascularization. Conclusions: There is currently no known etiology for vasculitis in this series. Optimum treatment strategies remain unknown. Infectious etiologies should be considered, and corticosteroid treatments may hasten resolution of inflammatory findings. Continued treatment of affected patients with pegcetacoplan should be avoided.
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Affiliation(s)
| | | | | | - Janet L. Davis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Judy E. Kim
- UT Southwestern Medical Center, Dallas, TX, USA
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6
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Hujanen P, Vaajanen A, Felin T, Lehtonen E, Syvänen U, Huhtala H, Helminen M, Sintonen H, Tuulonen A, Uusitalo-Järvinen H. Immediate sequential bilateral cataract surgery: a 13-year real-life report of 56 700 cataract operations. Br J Ophthalmol 2023; 107:1782-1786. [PMID: 36229178 DOI: 10.1136/bjo-2021-320588] [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: 10/07/2021] [Accepted: 09/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To assess the frequency of immediate sequential bilateral cataract surgery (ISBCS) and endophthalmitis during 13-year period in Tays Eye Centre, Tampere University Hospital, Tampere, Finland. METHODS All cataract surgeries performed between 1 January 2008 and 31 December 2020, and all endophthalmitis cases during the same period were searched from electronic patient records. Numbers and frequencies of ISBCS, and complications, including endophthalmitis and vitreous loss, were recorded and compared with unilateral operations. RESULTS The study included 56 700 cataract surgeries in 34 797 patients of whom 39% (n=13 445) had ISBCS. The median age of the patients was 75 (IQR 68-80, range 0.08-99) years at the time of surgery. The proportion of ISBCS patients increased from 4.2% in 2008 to 46% in 2020. Vitreous loss occurred in 480 (0.9%) of cataract surgeries. There were no postoperative endophthalmitis after cataract surgery (n=0) during the 13-year period. CONCLUSION The proportion of patients undergoing ISBCS increased from 4.2% in 2008 to 46% in 2020. No endophthalmitis were found to be associated with ISBCS.
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Affiliation(s)
- Pekko Hujanen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anu Vaajanen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tuukka Felin
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Eemil Lehtonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ulla Syvänen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Mika Helminen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Tays Research Services, Tampere University Hospital, Tampere, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anja Tuulonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Hannele Uusitalo-Järvinen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Das T, Joseph J, Simunovic MP, Grzybowski A, Chen KJ, Dave VP, Sharma S, Staropoli P, Flynn H. Consensus and controversies in the science of endophthalmitis management: Basic research and clinical perspectives. Prog Retin Eye Res 2023; 97:101218. [PMID: 37838286 DOI: 10.1016/j.preteyeres.2023.101218] [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: 07/25/2023] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 10/16/2023]
Abstract
Infectious endophthalmitis is a severe intraocular infection caused by bacteria, or less commonly by fungi. It can occur after penetrating eye procedures, trauma, or the spread of infection from contiguous structures or via emboli from distant organs. Because of the time-critical nature of the treatment, endophthalmitis is treated with the clinical diagnosis and modified by the microbiological report of the intraocular contents. The current strategy for managing endophthalmitis relies on pre-clinical literature, case series, and one large multi-center randomized clinical trial on post-cataract surgery endophthalmitis. Culture-susceptibility of the microorganisms from undiluted vitreous guides the definitive treatment in non-responsive cases. Strategies to reduce the incidence of endophthalmitis after penetrating eye procedures have been developed concurrently with refined means of treatment. Despite these advances, outcomes remain poor for many patients. Although consensus articles have been published on managing endophthalmitis, treatment patterns vary, and controversies remain. These include (1) the use of newer methods for early and precise microbiological diagnosis; (2) the choice of intravitreal antibiotics; (3) the need for systemic therapy; (4) early and complete vitrectomy. Here, we review the current consensus and address controversies in diagnosing and managing endophthalmitis. This review is intended to familiarize physicians and ophthalmologists with different aspects of endophthalmitis management to make informed decisions.
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Affiliation(s)
- Taraprasad Das
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V, Prasad Eye Institute, Hyderabad, India.
| | - Joveeta Joseph
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India.
| | - Matthew P Simunovic
- Save Sight Institute, University of Sydney, NSW, 2006, Australia; Sydney Eye Hospital, 8 Macquarie St., Sydney, NSW, 2000, Australia.
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland.
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Vivek Pravin Dave
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V Prasad Eye Institute, Hyderabad, India.
| | - Savitri Sharma
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India.
| | - Patrick Staropoli
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V Prasad Eye Institute, Hyderabad, India.
| | - Harry Flynn
- Bascom Palmer Eye Institute, Miami, FL, USA.
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8
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Gurtler N, Bughin A, Vaclavik V, Kaisari E, Guex-Crosier Y. Acute bilateral blindness due to diffuse outer retinopathy following clear lens exchange: a case report. BMC Ophthalmol 2023; 23:428. [PMID: 37872478 PMCID: PMC10594781 DOI: 10.1186/s12886-023-03171-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND As the trend of refractive lens exchange for presbyopia continues to grow, our case report shows the first occurrence of an acute bilateral outer retinopathy following uncomplicated sequential clear lens extraction in an otherwise healthy individual. CASE PRESENTATION A 54-year-old male without significant medical history benefited from a sequential bilateral lens exchange for presbyopia. He then experienced a rapid vision loss in both eyes, accompanied by photopsias and myodesopsias, with symptoms appearing respectively 4 and 3 weeks after the surgeries. Multimodal imaging revealed a fulminant outer retinopathy, leading to a total loss of light perception within a few days. Immediate intravenous corticosteroid therapy was administered, permitting to recover a small area of central visual function in both eyes, enabling shape and color distinction. The primary diagnostic hypothesis is a presumed autoimmune retinopathy, triggered by the cataract extraction, while an alternative diagnosis could be a toxic reaction secondary to the use of intracameral cefuroxime and lidocaine during the surgery. CONCLUSION In this report, the authors describe the first recorded instance of outer retinopathy following cataract surgery. This occurrence raises the possibility of auto-immunization leading to retinal atrophy and vision loss as a potential outcome after undergoing cataract surgery.
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Affiliation(s)
- Nicolas Gurtler
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland
| | - Alice Bughin
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland
| | - Veronika Vaclavik
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland
| | - Eirini Kaisari
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland
| | - Yan Guex-Crosier
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland.
- Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1005, Lausanne, Switzerland.
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Velez-Montoya R, Monroy-Esquivel L, Ortiz-Guevara R, Quiroz-Mercado H, Fromow-Guerra J. ALTERNATIVE INTRAVITREAL ANTIBIOTICS: A Systematic Review for Consideration in Recalcitrant or Resistant Endophthalmitis. Retina 2023; 43:1433-1447. [PMID: 36893433 DOI: 10.1097/iae.0000000000003773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
PURPOSE To organize, categorize, and create a quick reference guide for the use of intravitreal antibiotic alternatives to the standard combination of vancomycin and ceftazidime for the treatment of endophthalmitis. METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. The authors searched for all available information regarding intravitreal antibiotics in the last 21 years. Manuscripts were selected according to relevance, level of information, and the available data regarding intravitreal dose, potential adverse effects, bacterial coverage, and relevant pharmacokinetic information. RESULTS The authors included 164 of 1810 manuscripts. The antibiotics were classified according to their class into fluoroquinolones, cephalosporins, glycopeptide and lipopeptide, penicillins and beta-lactams, tetracyclines, and miscellaneous. The authors also included information regarding intravitreal adjuvants for the treatment of endophthalmitis and one ocular antiseptic. CONCLUSION The treatment of infectious endophthalmitis is a therapeutic challenge. The current review summarizes the properties of possible intravitreal antibiotic alternatives that should be considered in cases of suboptimal response to initial treatment.
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Affiliation(s)
- Raul Velez-Montoya
- Retina department, Asociación para Evitar le Ceguera en México IAP, México City, México
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10
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Freire FS, Lang R, Abalem MF, Johnson MW. RETINAL DEPOSITS OF TRIAMCINOLONE-MOXIFLOXACIN AFTER DROPLESS CATARACT SURGERY. Retin Cases Brief Rep 2023; 17:577-580. [PMID: 37643045 DOI: 10.1097/icb.0000000000001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE To report a case of epiretinal crystalline deposits observed on fundus examination and optical coherence tomography 2 years after transzonular intravitreal injection of triamcinolone-moxifloxacin (TriMoxi) during "dropless" cataract surgery. METHODS Observational case report with literature review of toxic effects of intravitreal triamcinolone and differential diagnosis of retinal crystalline deposits. RESULTS A 37-year-old asymptomatic pseudophakic man presented with refractile crystalline retinal deposits that had prompted an extensive systemic embolic workup. The systemic evaluation for emboli was negative. OCT imaging revealed that the crystalline deposits were confined to the anterior surface of the internal limiting membrane. Further historical inquiry determined that transzonular intravitreal triamcinolone-moxifloxacin injection had been performed at the time of cataract surgery 2 years earlier. CONCLUSION Transzonular triamcinolone acetonide delivered during cataract surgery can deposit on the retinal surface for long periods. These epiretinal crystalline deposits are benign and generally do not interfere with visual acuity. Nevertheless, clinicians should be aware of this differential diagnosis because clinical misdiagnosis can lead to unwarranted evaluation and treatment.
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Affiliation(s)
- Francesca S Freire
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
- Department of Ophthalmology, Evangelical Hospital of Belo Horizonte, Belo Horizonte, Brazil; and
| | - Ryan Lang
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Maria Fernanda Abalem
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
- Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil
| | - Mark W Johnson
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
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Garcia-O'Farrill N, Brown GT, Hunter AA. Modified-dropless protocol (nil intraocular) for micro-incision vitrectomy surgery (MIVS): a retrospective pilot study. BMC Ophthalmol 2023; 23:195. [PMID: 37142977 PMCID: PMC10157951 DOI: 10.1186/s12886-023-02943-z] [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: 10/23/2022] [Accepted: 04/25/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Perioperative infection and inflammation prophylaxis after ocular surgery has evolved over the years along with improvements in surgical equipment and a growing interest in alternatives to the standard topical eye drops. The purpose of this study is to evaluate the outcomes of a novel, modified-dropless protocol for 23-gauge (23-G), 25-gauge (25-G) and 27-gauge (27-G) micro-incision vitrectomy surgery (MIVS) that omits any intraocular injections of antibiotics or steroids. METHODS This Institutional Review Board-approved, single-surgeon retrospective study reviewed MIVS post-surgical outcomes in patients who received a modified-dropless protocol from February 2020 to March 2021. A total of 158 charts were reviewed, of which 150 eyes met the eligibility criteria. After each case, patients were administered a 0.5 cc subconjunctival injection of a 1:1 Cefazolin (50 mg/cc):Dexamethasone (10 mg/cc) in the inferior fornix and 0.5 cc of posterior Sub-Tenon's Kenalog (STK). No intravitreal injections were administered, and no pre- or postoperative antibiotic or steroid eye drops were prescribed. For patients allergic to penicillin, separate subconjunctival injections of 0.25 cc each of Vancomycin (10 mg/cc) and Dexamethasone (10 mg/cc) were administered. The primary safety parameter was postoperative cases of endophthalmitis. Secondary endpoints consisted of Best-Corrected Distance Visual Acuity (BCVA), intraocular pressure (IOP), and postoperative complications (retinal detachments, inflammation, need for additional surgery) within three months of surgery. Statistical analysis was performed using chi-square (χ²) tests for categorical values, and a Student's t-test to compare continuous outcomes. RESULTS The majority of surgeries (96%) were performed with the 27G MIVS platform. There were no cases of postoperative endophthalmitis. Mean logMAR BCVA improved from 0.71 (± 0.67) to 0.61 (± 0.60) post-operatively (p = 0.02). Excluding patients who had silicone oil tamponade, postoperative BCVA improved from 0.67 (± 0.66) to 0.54 (± 0.55) (p = 0.003). Mean IOP increased from 14.6 (± 3.8) to 15.3 (± 4.1) (p = 0.05). Ten patients required further medication therapy for an increase in IOP, one had inflammatory signs, and 14 required a second surgical intervention mostly due to recurrences of initial surgical indication. CONCLUSION A modified-dropless postoperative protocol involving subconjunctival and posterior sub-Tenon's injections only may be a safe and convenient alternative to topical eye drops for patients undergoing MIVS, but additional and larger studies are needed.
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Affiliation(s)
- Noraliz Garcia-O'Farrill
- Oregon Eye Consultants LLC, 3783 International Court, Suite 290, Springfield, OR, 97477, USA.
- Cascade Medical Research Institute LLC, 3783 International Court, Suite 290, Springfield, OR, 97477, USA.
| | - Gordon T Brown
- Oregon Eye Consultants LLC, 3783 International Court, Suite 290, Springfield, OR, 97477, USA
- Cascade Medical Research Institute LLC, 3783 International Court, Suite 290, Springfield, OR, 97477, USA
| | - Allan A Hunter
- Oregon Eye Consultants LLC, 3783 International Court, Suite 290, Springfield, OR, 97477, USA
- Cascade Medical Research Institute LLC, 3783 International Court, Suite 290, Springfield, OR, 97477, USA
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12
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Arshinoff SA, Shi RB. Relative efficacy of intracameral moxifloxacin injection methods. J Cataract Refract Surg 2023; 49:538-542. [PMID: 36745844 DOI: 10.1097/j.jcrs.0000000000001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE To determine the amount of moxifloxacin remaining in the anterior chamber (AC), immediately after its injection using 3 current injection methods, assuming mixing and fluid exchange with the AC contents during injection of the drug, and to determine the most desirable injection method. SETTING Department of Ophthalmology and Vision Sciences and Institute of Biomedical Engineering, University of Toronto, Toronto, Canada. DESIGN Mathematical modeling. METHODS Mathematical modeling using first-order mixing methods were used to assess mixing. RESULTS The Kaiser method of injecting 0.5 mL × 100 μg/0.1 mL does not achieve the desired 500 μg level of moxifloxacin in the AC. The "straight from the bottle" method of injecting 0.1 mL × 500 μg/0.1 mL is fraught with potential error, yielding a relatively unreliable final amount in the AC. Injecting 0.5 to 0.6 mL × 150 μg/0.1 mL yields a result closest to the desired goal. CONCLUSIONS Based on the calculation, the most accurate of current methods to deliver 500 μg moxifloxacin intracamerally is the method of 150 μg/0.1 mL × 0.5 to 0.6 mL.
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Affiliation(s)
- Steve A Arshinoff
- From the York Finch Eye Associates, Toronto, Ontario, Canada (Arshinoff); Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (Arshinoff); Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada (Shi); Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Shi)
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Somisetty S, Santina A, Sarraf D, Mieler WF. The Impact of Systemic Medications on Retinal Function. Asia Pac J Ophthalmol (Phila) 2023; 12:115-157. [PMID: 36971705 DOI: 10.1097/apo.0000000000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/02/2023] [Indexed: 03/29/2023] Open
Abstract
This study will provide a thorough review of systemic (and select intravitreal) medications, along with illicit drugs that are capable of causing various patterns of retinal toxicity. The diagnosis is established by taking a thorough medication and drug history, and then by pattern recognition of the clinical retinal changes and multimodal imaging features. Examples of all of these types of toxicity will be thoroughly reviewed, including agents that cause retinal pigment epithelial disruption (hydroxychloroquine, thioridazine, pentosan polysulfate sodium, dideoxyinosine), retinal vascular occlusion (quinine, oral contraceptives), cystoid macular edema/retinal edema (nicotinic acid, sulfa-containing medications, taxels, glitazones), crystalline deposition (tamoxifen, canthaxanthin, methoxyflurane), uveitis, miscellaneous, and subjective visual symptoms (digoxin, sildenafil). The impact of newer chemotherapeutics and immunotherapeutics (tyrosine kinase inhibitor, mitogen-activated protein kinase kinase, checkpoint, anaplastic lymphoma kinase, extracellular signal-regulated kinase inhibitors, and others), will also be thoroughly reviewed. The mechanism of action will be explored in detail when known. When applicable, preventive measures will be discussed, and treatment will be reviewed. Illicit drugs (cannabinoids, cocaine, heroin, methamphetamine, alkyl nitrite), will also be reviewed in terms of the potential impact on retinal function.
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Affiliation(s)
- Swathi Somisetty
- Jules Stein Eye Institute, University of California, Los Angeles, CA
| | - Ahmad Santina
- Jules Stein Eye Institute, University of California, Los Angeles, CA
| | - David Sarraf
- Jules Stein Eye Institute, University of California, Los Angeles, CA
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14
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Romano F, Lamanna F, Gabrielle PH, Teo KYC, Battaglia Parodi M, Iacono P, Fraser-Bell S, Cornish EE, Nassisi M, Viola F, Agarwal A, Samanta A, Chhablani J, Staurenghi G, Invernizzi A. Update on Retinal Vein Occlusion. Asia Pac J Ophthalmol (Phila) 2023; 12:196-210. [PMID: 36912792 DOI: 10.1097/apo.0000000000000598] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/11/2022] [Indexed: 03/14/2023] Open
Abstract
Retinal vein occlusion represents the second leading cause of retinal vascular disorders, with a uniform sex distribution worldwide. A thorough evaluation of cardiovascular risk factors is required to correct possible comorbidities. The diagnosis and management of retinal vein occlusion have changed tremendously in the last 30 years, but the assessment of retinal ischemia at baseline and during follow-up examinations remains crucial. New imaging techniques have shed light on the pathophysiology of the disease and laser treatment, once the only therapeutic option, is now only one of the possible approaches with antivascular endothelial growth factors and steroid injections being preferred in most cases. Nowadays long-term outcomes are better than those achievable 20 years ago and yet, many new therapeutic options are under development, including new intravitreal drugs and gene therapy. Despite this, some cases still develop sight-threatening complications deserving a more aggressive (sometimes surgical) approach. The purpose of this comprehensive review is to reappraise some old but still valid concepts and to integrate them with new research and clinical data. The work will provide an overview of the disease's pathophysiology, natural history, and clinical features along with a detailed discussion on the advantages of multimodal imaging and of the different treatment strategies with the aim of providing retina specialists with the most updated knowledge in the field.
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Affiliation(s)
- Francesco Romano
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Francesca Lamanna
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | - Kelvin Y C Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Maurizio Battaglia Parodi
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierluigi Iacono
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Samantha Fraser-Bell
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Elisa E Cornish
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Marco Nassisi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Viola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, US
- Department of Ophthalmology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anindya Samanta
- Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, US
| | - Jay Chhablani
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
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15
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Rivera PA, Gupta A, Kombo N. Treatment of non-infectious retinal vasculitis. Ther Adv Ophthalmol 2023; 15:25158414231152761. [PMID: 37077655 PMCID: PMC10107051 DOI: 10.1177/25158414231152761] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/05/2023] [Indexed: 02/16/2023] Open
Abstract
Retinal vasculitis (RV) refers to an entity in which the retinal vasculature is inflamed, frequently with indications of inflammation elsewhere in the eye. Non-infectious RV can be idiopathic or associated with systemic disease, ocular conditions, and malignancy. It can also be classified based on the vessel affected: artery, vein, or both. Due to the lack of strong evidence-based treatment trials and algorithms for RV, physicians must often rely on their experience, which creates great variability in treating this entity. This article provides an overview of various treatment modalities used in the management of non-infectious RV, with a focus on immunomodulatory therapies. We outline a potential stepwise approach of starting with steroids to control the acute inflammation and subsequently changing to immunomodulatory therapy (IMT) for long-term treatment.
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Affiliation(s)
- Paola A. Rivera
- Department of Ophthalmology and Visual Science, School of Medicine, Yale University, New Haven, CT, USA
| | - Akash Gupta
- Department of Medicine, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Ninani Kombo
- Department of Ophthalmology and Visual Science, School of Medicine, Yale University, New Haven, CT, USA
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16
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Huang J, Nguyen MT, Tsukikawa M, Chen A. Postoperative Endophthalmitis after Combined Cataract Extraction and iStent Inject Implantation. Case Rep Ophthalmol Med 2023; 2023:3132866. [PMID: 37181077 PMCID: PMC10175009 DOI: 10.1155/2023/3132866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 03/23/2023] [Accepted: 04/26/2023] [Indexed: 05/16/2023] Open
Abstract
Purpose. To report a case of postoperative endophthalmitis after combined cataract extraction and iStent inject implantation. Observation. A 70-year-old male with a nuclear sclerotic cataract and primary open-angle glaucoma underwent an uneventful phacoemulsification cataract extraction with implantation of an intraocular lens and an iStent inject trabecular bypass stent. The patient was prescribed a postoperative regimen of ofloxacin 0.3% and prednisolone acetate 1%, 1 drop four times a day each. On postoperative day five, he presented to the emergency room for eye pain and had 4+ mixed cells in the anterior chamber (AC) without hypopyon or vitritis on exam. Prednisolone 1% eye drops were increased from four times a day to every two hours while awake. Overnight, he developed worsening vision and severe eye pain. The next morning, he was found to have increased AC cells, vitritis, and intraretinal hemorrhages and was diagnosed with endophthalmitis. The patient underwent a vitreous tap and intravitreal injections of vancomycin (1 mg/0.1 mL) and amikacin (0.4 mg/0.1 mL). Cultures grew Staphylococcus epidermidis. Lab work-up revealed underlying neutropenia. Visual acuity eventually recovered to 20/20. Conclusion and Importance. This report highlights a case of endophthalmitis associated with placement of the iStent inject. The infection was well-controlled after administration of intravitreal antibiotics without removal of the iStent inject, and visual acuity eventually recovered to 20/20. Surgeons should be aware of endophthalmitis risk following combined iStent inject placement, and good recovery is possible without removal of the implant.
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Affiliation(s)
- Johnson Huang
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Minh T. Nguyen
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Mai Tsukikawa
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Andrew Chen
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
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17
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Matović K, Mekjavić PJ, Groznik AL, Fakin A, Petrovič MG, Pfeifer V, Valentinčič NV. Vancomycin-Associated Hemorrhagic Occlusive Retinal Vasculitis: A Case Series and Systematic Review. Ophthalmic Surg Lasers Imaging Retina 2022; 53:702-712. [PMID: 36547956 DOI: 10.3928/23258160-20221026-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study describes three unilateral cases of hemorrhagic occlusive retinal vasculitis (HORV) after cataract surgery and a review of the literature until February 2022, including 21 articles reporting HORV cases. Altogether, 61 eyes (41 patients) were included. Twenty patients had bilateral and 21 patients had unilateral HORV. Prophylactic vancomycin was given to all patients. Additional vancomycin use was associated with the worst outcome. The mean time to HORV was 9 days post-cataract surgery. In bilateral cases, the median time between surgeries was 7 days. Visual acuity was < 20/400 in 48%, with no light perception in 20%. Neovascular glaucoma developed in 43%. Central macular thickening or hyperreflectivity of the inner retinal layers on optical coherence tomography was associated with worse outcomes. Corticosteroid treatment, early panretinal laser photocoagulation, or anti-vascular endothelial growth factor therapy, and prophylaxis alternative to vancomycin is recommended. [Ophthalmic Surg Lasers Imaging Retina 2022;53:702-712.].
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18
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Pan WW, Miller AR, Young BK, Johnson MW, Sassalos TM. Hemorrhagic Occlusive Retinal Vasculitis Associated With Triamcinolone-Moxifloxacin Use During Uncomplicated Cataract Surgery. JAMA Ophthalmol 2022; 141:2798367. [PMID: 36355355 PMCID: PMC9650624 DOI: 10.1001/jamaophthalmol.2022.4697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/22/2022] [Indexed: 11/12/2023]
Abstract
This case series describes the outcomes of cataract extraction with intraocular lens placement in 2 patients.
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Affiliation(s)
- Warren W. Pan
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor
| | - Andrew R. Miller
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor
| | - Benjamin K. Young
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor
| | - Mark W. Johnson
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor
| | - Thérèse M. Sassalos
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor
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19
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Merani R, Johnson MW, McCannel CA, Flynn HW, Scott IU, Hunyor AP. Clinical Practice Update: Management of Infectious Endophthalmitis After Intravitreal Anti-VEGF Injection. JOURNAL OF VITREORETINAL DISEASES 2022; 6:443-451. [PMID: 37009541 PMCID: PMC9954776 DOI: 10.1177/24741264221116487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although infectious endophthalmitis after intravitreal antivascular endothelial growth factor injections is rare, it is the most feared and potentially devastating complication of this procedure. There is no high-level evidence to provide definitive guidance on the management of endophthalmitis occurring after intravitreal injection (IVI). This clinical practice update reviews the published literature regarding post-IVI endophthalmitis and highlights areas in which further research is needed to better guide its management.
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Affiliation(s)
- Rohan Merani
- Concord Repatriation General
Hospital, Sydney, NSW, Australia
- Save Sight Institute, Specialty
of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health,
University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health
Sciences, Macquarie University, Sydney, NSW Australia
| | - Mark W. Johnson
- Department of Ophthalmology and
Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI,
USA
| | - Colin A. McCannel
- UCLA Stein Eye Institute;
Department of Ophthalmology, David Geffen School of Medicine at UCLA,
University of California, Los Angeles, CA, USA
| | - Harry W. Flynn
- Department of Ophthalmology,
Bascom Palmer Eye Institute, Miami, FL, USA
| | - Ingrid U. Scott
- Departments of Ophthalmology and
Public Health Sciences, Penn State College of Medicine, Hershey,
Philadelphia, PA, USA
| | - Alex P. Hunyor
- Save Sight Institute, Specialty
of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health,
University of Sydney, Sydney, NSW, Australia
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20
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Yan H, Yang K, Ma Z, Kuhn F, Zhang W, Wang Z, Hu Y, Lu H, Shigeo Y, Sobaci G, Ozdek S, Forlini M, Huang B, Hui Y, Zhang M, Xu G, Wei W, Jiang Y, Park D, Fernandes RB, He Y, Rousselot A, Hoskin A, Sundar G, Liu Y, Wang Y, Shen L, Chen H, Chen H, Han G, Jiang R, Jin X, Lin J, Luo J, Wang Z, Wei Y, Wen Y, Xie Z, Wang Y, Yang X, Yu W, Zheng Z, Sun X, Liang J, Liu Q, Yu J, Wei S, Li Z, Chen L, Wang X, Wei L, Zhang H, Chen S, Liu Y, Guo X, Liu S, Xu X, Tao Y, Chen Y, Chen Y. Guideline for the treatment of no light perception eyes induced by mechanical ocular trauma. J Evid Based Med 2022; 15:302-314. [PMID: 36151612 PMCID: PMC9826528 DOI: 10.1111/jebm.12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/26/2022] [Indexed: 01/11/2023]
Abstract
Severe mechanical ocular trauma with no light perception (NLP) predicts a poor prognosis of visual acuity and enucleation of the eyeball. Since the innovative treatment concept of exploratory vitreoretinal surgery has developed and treatment technology has advanced, the outcomes of severe ocular trauma treatment in NLP patients have greatly improved. However, there remains a lack of unified standards for the determination, surgical indication, and timing of vitrectomy in NLP eye treatment. To address these problems, we aimed to create evidence-based medical guidelines for the diagnosis, treatment, and prognosis of mechanical ocular trauma with NLP. Sixteen relevant recommendations for mechanical ocular trauma with NLP were obtained, and a consensus was reached. Each recommendation was explained in detail to guide the treatment of mechanical ocular trauma associated with NLP.
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21
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Li T, Wu Y, Cai W, Wang D, Ren C, Shen T, Yu D, Qiang S, Hu C, Zhao Z, Yu J, Peng C, Tang BZ. Vision Defense: Efficient Antibacterial AIEgens Induced Early Immune Response for Bacterial Endophthalmitis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2202485. [PMID: 35794437 PMCID: PMC9443450 DOI: 10.1002/advs.202202485] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/04/2022] [Indexed: 05/28/2023]
Abstract
Bacterial endophthalmitis (BE) is an acute eye infection and potentially irreversible blinding ocular disease. The empirical intravitreous injection of antibiotic is the primary treatment once diagnosed as BE. However, the overuse of antibiotic contributes to the drug resistance of pathogens and the retinal toxicity of antibiotic limits its application in clinic. Herein, a cationic aggregation-induced emission luminogens named with triphenylamine thiophen pyridinium (TTPy) is reported for photodynamic treatment of BE. TTPy can selectively discriminate and kill bacteria efficiently over normal ocular cells. More importantly, TTPy shows excellent antibacterial ability in BE rat models infected by Staphylococcus aureus. Meanwhile, the bacterial killing behavior triggered by TTPy induces innate immune response at an early stage of infection, limiting subsequent robust inflammation and protecting retina from bacterial toxins and inflammation-induced bystander damage. In addition, TTPy performs better antibacterial ability than commercially used Rose Bengal, suggesting its excellent capability of vision salvage in acute BE. This study exhibits an efficient photodynamic antibacterial treatment to BE, which induces an early intraocular immune response and saves useful vision, endowing TTPy a promising potential for clinical application of ocular infections.
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Affiliation(s)
- Tingting Li
- Department of OphthalmologyShanghai Tenth People's HospitalSchool of MedicineTongji UniversityShanghai200072China
| | - Yan Wu
- Department of OphthalmologyShanghai Tenth People's HospitalSchool of MedicineTongji UniversityShanghai200072China
| | - Wenting Cai
- Department of OphthalmologyShanghai Tenth People's HospitalSchool of MedicineTongji UniversityShanghai200072China
| | - Dong Wang
- Center for AIE ResearchShenzhen Key Laboratory of Polymer Science and TechnologyGuangdong Research Center for Interfacial Engineering of Functional MaterialsCollege of Materials Science and EngineeringShenzhen UniversityShenzhen518060China
| | - Chengda Ren
- Department of OphthalmologyShanghai Tenth People's HospitalSchool of MedicineTongji UniversityShanghai200072China
| | - Tianyi Shen
- Department of OphthalmologyShanghai Tenth People's HospitalSchool of MedicineTongji UniversityShanghai200072China
| | - Donghui Yu
- Department of OphthalmologyShanghai Tenth People's HospitalSchool of MedicineTongji UniversityShanghai200072China
| | - Sujing Qiang
- Department of OphthalmologyShanghai Tenth People's HospitalSchool of MedicineTongji UniversityShanghai200072China
| | - Chengyu Hu
- Department of OphthalmologyShanghai Tenth People's HospitalSchool of MedicineTongji UniversityShanghai200072China
| | - Zheng Zhao
- Shenzhen Institute of Molecular Aggregate Science and EngineeringSchool of Science and EngineeringThe Chinese University of Hong KongShenzhen518172China
| | - Jing Yu
- Department of OphthalmologyShanghai Tenth People's HospitalSchool of MedicineTongji UniversityShanghai200072China
| | - Chen Peng
- Department of OphthalmologyShanghai Tenth People's HospitalSchool of MedicineTongji UniversityShanghai200072China
- Department of RadiologyShanghai Public Health Clinical CenterFudan UniversityShanghai201508China
| | - Ben Zhong Tang
- Shenzhen Institute of Molecular Aggregate Science and EngineeringSchool of Science and EngineeringThe Chinese University of Hong KongShenzhen518172China
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22
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Cunningham ET, Moorthy RS, Witkin AJ, Zierhut M. Occlusive Retinal Vasculitis Following Intravitreal Drug Delivery. Ocul Immunol Inflamm 2022; 30:1501-1504. [PMID: 33847216 DOI: 10.1080/09273948.2021.1882243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Emmett T Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| | - Ramana S Moorthy
- Associated Vitreoretinal and Uveitis Consultants, Indianapolis, Indiana, USA
- The Department of Ophthalmology, Indiana University Medical Center, Indianapolis, Indiana, USA
- St. Vincent Hospital and Health Services, Indianapolis, Indiana, USA
| | - Andre J Witkin
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen, Tuebingen, Germany
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23
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Hsu J. The Evolving Landscape of Endophthalmitis: A Wake-up Call for Vitreoretinal Surgeons. Ophthalmol Retina 2022; 6:439-441. [PMID: 35680233 DOI: 10.1016/j.oret.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/15/2022] [Indexed: 06/15/2023]
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Abstract
PURPOSE OF REVIEW This review highlights the complications of both intravitreal injection procedure as well as different intravitreal medications including antivascular endothelial growth factors, antibiotics, antivirals, antifungals, methotrexate, and steroids. Techniques for reducing rates of endophthalmitis will also be discussed. RECENT FINDINGS Intravitreal vancomycin can cause hemorrhagic occlusive retinal vasculitis resulting in severe vision loss. Intravitreal brolucizumab is associated with intraocular inflammation and retinal vasculitis resulting in significant vision loss. Face mask use by both patient and physician is not associated with increased risk of endophthalmitis and may decrease culture positive endophthalmitis. SUMMARY Intravitreal injections continue to be one of the most commonly performed procedures by ophthalmologists. Although the injections are generally well tolerated, sight-threatening complications can occur including endophthalmitis, retinal detachment, and/or retinal vasculitis. Adverse events associated with specific medications are outlined below. Several safety measures have been shown to reduce rates of endophthalmitis, the most concerning complication of this procedure.
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Affiliation(s)
- Dillan Patel
- Department of Ophthalmology, Temple University Hospital
| | - Samir N Patel
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Varun Chaudhary
- Department of Health Research Methods, Evidence and Impact
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Sunir J Garg
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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25
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Arepalli SR, Thomas AS. Occlusive retinal vasculitis: novel insights into causes, pathogenesis and treatment. Curr Opin Ophthalmol 2022; 33:147-156. [PMID: 35239517 DOI: 10.1097/icu.0000000000000843] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Occlusive retinal vasculitis (ORV) has a large differential diagnosis and varied therapeutic approaches. This review highlights existing and novel causes and treatment options for ORV. RECENT FINDINGS Mutations in CAPN5, TREX1, and TNFAIP3 have been associated with dominantly inherited forms of ORV. Various intraocular therapeutics have been shown to occasionally cause ORV; the most recent medications associated with ORV are vancomycin and brolucizumab. In cases of ORV linked to Behçet's disease, clinical trials support the use of tumor necrosis factor alpha inhibitors. SUMMARY Identification of the underlying etiology of ORV is critical to help guide treatment. Treatment in ORV involves both treatment any underlying infection or autoimmune condition, cessation of the any offending causative agent and local treatment of neovascular complications.
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26
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Weinert MC, Armstrong GW. Infectious Disease Prevention and Management in Traumatic Open Globe Injuries. Int Ophthalmol Clin 2022; 62:19-40. [PMID: 35325908 DOI: 10.1097/iio.0000000000000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Endogenous Endophthalmitis-The Clinical Significance of the Primary Source of Infection. J Clin Med 2022; 11:jcm11051183. [PMID: 35268274 PMCID: PMC8911070 DOI: 10.3390/jcm11051183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/05/2022] [Accepted: 02/21/2022] [Indexed: 02/01/2023] Open
Abstract
Endophthalmitis is a severe form of ocular inflammation. The source of pathogens in endogenous endophthalmitis is located inside the body, and infection spreads hematogenously. Although rare, endogenous endophthalmitis is a very serious condition, as this type of inflammation is very devastating for ocular tissues. Prognosis is very poor, and the patients are often in a serious general condition, so they require special care and an individual approach in the treatment process. Thanks to the knowledge of the risks associated with infections of individual tissues and organs as well as potential pathogens and the clinical picture, it is possible to make a correct diagnosis faster and implement the correct treatment. In the case of endogenous endophthalmitis, reaction time is absolutely crucial for prognosis. In this review, we focus primarily on the importance of the primary source of infection for the course of the disease and prognosis.
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28
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Chang DF, Rhee DJ. Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: results of the 2021 ASCRS member survey. J Cataract Refract Surg 2022; 48:3-7. [PMID: 34282070 DOI: 10.1097/j.jcrs.0000000000000757] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
In an online survey of >1200 global cataract surgeons, 66% were using intracameral (IC) antibiotic prophylaxis. This compared with 50% and 30% in the 2014 and 2007 surveys, respectively. Irrigation bottle infusion and intravitreal injection was each used by only 5% of respondents. For IC antibiotics, vancomycin was used by 6% in the United States (52% in 2014), compared with 83% for moxifloxacin (31% in 2014). Equal numbers used compounded moxifloxacin or the Vigamox bottle as the source. There was a decrease in respondents using preoperative (73% from 85%) and postoperative (86% from 97%) topical antibiotic prophylaxis; the latter was not used by 24% of surgeons injecting IC antibiotics. Reasons cited by those not using IC antibiotics include mixing/compounding risk (66%) and being unconvinced of the need (48%). However, 80% believe having a commercially approved IC antibiotic is important; if reasonably priced, this would increase adoption of IC prophylaxis to 93%.
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Affiliation(s)
- David F Chang
- From the University of California, San Francisco, San Francisco, California (Chang); and the Case Western Reserve University, Cleveland, Ohio (Rhee)
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29
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Hsu ST, Ponugoti A, Deaner JD, Vajzovic L. Update on Retinal Drug Toxicities. CURRENT OPHTHALMOLOGY REPORTS 2021; 9:168-177. [PMID: 34956737 PMCID: PMC8688906 DOI: 10.1007/s40135-021-00277-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 12/03/2022]
Abstract
Purpose of Review This review aims to provide an update on the clinical presentations and diagnostic findings of drug-induced retinal toxicities. Recent Findings Several newly FDA-approved medications have been associated with acute retinal toxicities, including brolucizumab, MEK inhibitors, ulixertinib, and FGFR inhibitors. Additionally, as previously believed-to-be well-tolerated medications, such as pentosan sulfate sodium, anti-retroviral therapies, and certain intraoperative ocular medications, are used more frequently or for longer periods of time, associated toxic retinopathies and inflammatory reactions have been reported. Finally, advances in ocular imaging have revealed novel findings in hydroxychloroquine and tamoxifen maculopathies. Summary Discovery of new medications, increased frequency of use, and longer-term use have led to increased reports of retinal toxicities. Advances in retinal imaging have allowed for earlier detection of subclinical changes associated with these medications, which may help prevent progression of disease. However, more research is needed to determine the point at which vision loss becomes irreversible. Risks and benefits must be assessed prior to discontinuation of the offending, but potentially lifesaving, therapy.
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Affiliation(s)
- S. Tammy Hsu
- Duke University School of Medicine, Durham, NC USA
| | | | | | - Lejla Vajzovic
- Duke University School of Medicine, Durham, NC USA
- Department of Ophthalmology, Duke University Eye Center, 2351 Erwin Road, Durham, NC 27710 USA
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Brown GT, Karth PA, Hunter AA. Novel Postoperative Dropless Protocol for Micro-Incision Vitrectomy Surgery. Ophthalmic Surg Lasers Imaging Retina 2021; 52:587-591. [PMID: 34766851 DOI: 10.3928/23258160-20211014-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the outcomes of a novel postoperative dropless protocol for 25-gauge and 27-gauge micro-incision vitrectomy surgery (MIVS). PATIENTS AND METHODS The institutional review board approved a single-center, retrospective study. A total of 493 surgeries were identified, and 451 cases from 369 patients met eligibility criteria. Instead of pre- or postoperative drops, patients were given a novel postoperative dropless protocol consisting of subconjunctival injections of a 1:1 cefazolin:dexamethasone mix at each sclerotomy and intravitreally, and injection of posterior sub-Tenon's Kenalog. Primary outcome measure was cases of postoperative endophthalmitis. RESULTS There was one presumed case of endophthalmitis. Anterior chamber paracentesis sample was negative for culture and Gram stain. For all patients, mean logMAR best-corrected visual acuity improved from 0.65 (±0.69) to 0.57 (±0.61) postoperatively (P = 0.004). Mean intraocular pressure increased from 14.5 (±4.3) to 15.5 (±4.8) postoperatively (P < 0.001). Mean follow-up was 96 days. CONCLUSION This novel postoperative dropless protocol could potentially be a convenient alternative to topical eye drops for patients undergoing MIVS, but further study is required to establish its safety. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:587-592.].
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Granulicatella adiacens endophthalmitis after phacoemulsification cataract surgery. J Cataract Refract Surg 2021; 46:e30-e34. [PMID: 32818359 DOI: 10.1097/j.jcrs.0000000000000355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Two cases of acute postoperative Granulicatella adiacens endophthalmitis following uneventful phacoemulsification surgery are reported. The cases had intracameral cefuroxime as antibiotic prophylaxis, visual acuity (VA) was perception of light and hand movements, respectively, and there was severe anterior chamber inflammation and dense vitritis with no fundal view. Vitreous biopsy identified G adiacens using genome sequencing. Intraoperative findings included extensive retinal hemorrhages, abscesses, occluded retinal vessels, and retinal necrosis. Because of the ischemic retinal appearance, pan-retinal photocoagulation endolaser was performed. Postoperatively both cases developed rhegmatogenous retinal detachment (RRD) anterior to the laser marks and were successfully treated. VA improved to 6/18 and 6/60, respectively. Hyperreflective dots and Henle fiber layer hemorrhage are reported for the first time, to the authors' knowledge, in association with endophthalmitis. The successful outcome suggested that intraoperative pan-retinal photocoagulation could be considered in such ischemic cases to prevent rubeosis and to reduce the risk for postoperative RRD or limit its extent if it recurs.
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Diagnostic and Therapeutic Challenge. Retina 2021; 41:1570-1576. [PMID: 32332425 DOI: 10.1097/iae.0000000000002820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Geus SJ, Hopman J, Brüggemann RJ, Klevering BJ, Crama N. Acute Endophthalmitis after Cataract Surgery: Clinical Characteristics and the Role of Intracameral Antibiotic Prophylaxis. ACTA ACUST UNITED AC 2021; 5:503-510. [DOI: 10.1016/j.oret.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
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Bhojwani D. Commentary: Intravitreal moxifloxacin for acute postoperative endophthalmitis: Is it as safe and efficacious as the age-old recommended intravitreal vancomycin and ceftazidime? Indian J Ophthalmol 2021; 69:330-331. [PMID: 33463585 PMCID: PMC7933857 DOI: 10.4103/ijo.ijo_2489_20] [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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Agarwal A, Nagpal M. Intravitreal moxifloxacin injections in acute post-cataract surgery endophthalmitis: Efficacy and safety. Indian J Ophthalmol 2021; 69:326-330. [PMID: 33463584 PMCID: PMC7933854 DOI: 10.4103/ijo.ijo_587_20] [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: 11/04/2022] Open
Abstract
Purpose The aim of this study was to evaluate the efficacy and safety of intravitreal moxifloxacin injections in the treatment of acute post-cataract surgery endophthalmitis with visual acuity equal to or greater than hand movements. Methods Fifty two patients with post-cataract surgery endophthalmitis who presented within 6 weeks with visual acuity equal to or greater than hand movements received two intravitreal moxifloxacin injections 48 h apart. Patients with prior history of ocular disease or treatment were excluded. Patients were followed up to 3 months either for resolution of endophthalmitis or worsening of disease. Number of patients who achieved visual acuity equal to or better than 20/40 and 20/200 at the third-month follow-up visit were compared with the number of patients at presentation, using Chi-square test. In addition, pretreatment LogMAR visual acuity at the time of presentation was compared with posttreatment visual acuity at end of third month using paired t test. Results Fifty (96.15%) patients showed complete resolution of endophthalmitis while three patients required vitrectomy. Forty-one (78.85%) and 49 (94.23%) patients achieved visual acuity equal to or better than 20/40 and 20/200, respectively, at the third-month follow-up visit as compared to eight (15.38%) and 13 (25%) patients, respectively, at presentation (P < 0.05). In addition, mean LogMAR visual acuity at the time of presentation was 0.755 which improved to 0.307 at the third-month follow-up visit (P < 0.05). None of the patients developed hypersensitivity reactions to intravitreal moxifloxacin. Conclusion Intravitreal moxifloxacin injections showed promising results in acute post-cataract surgery endophthalmitis.
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Affiliation(s)
- Abhishek Agarwal
- Department of Ophthalmology, Shri Jagdamba Charitable Eye Hospital, Andh Vidhalaya Campus, Sri Ganganagar, Rajasthan, India
| | - Manisha Nagpal
- Department of Ophthalmology, Shri Jagdamba Charitable Eye Hospital, Andh Vidhalaya Campus, Sri Ganganagar, Rajasthan, India
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Lee SM, Park JH, Jang CH, Byon I. Intravitreal injection of povidone-iodine for the treatment of vancomycin-resistant Enterococcus faecalis endophthalmitis in rabbit eyes. Exp Eye Res 2021; 208:108614. [PMID: 33971221 DOI: 10.1016/j.exer.2021.108614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/08/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
The aim of this study was to investigate the efficacy of intravitreal povidone-iodine (PI) in the treatment of vancomycin-resistant Enterococcus faecalis (VRE) endophthalmitis. Fifty New Zealand white rabbits were divided into 5 groups (n = 10 in each group). After the induction of endophthalmitis using VRE (minimum inhibitory concentration [MIC] ≥ 40 μg/mL) in the right eye, Group A, B, C, and D received intravitreal injections of 0.1% PI, 0.3% PI, 0.05% vancomycin, and 0.5% vancomycin, respectively. Eyes in Group E were used as controls. Fundus photography, vitreous culture, electroretinography (ERG), and histologic examinations of the retina were conducted on day 14. A marked improvement in endophthalmitis was observed in Group A, B, C and D, compared to Group E. Fundus photographs showed mild vitreous opacities in Group A and B, and moderate vitreous opacity in Group C. All eyes in Group D had a clear vitreous. In vitreous culture, bacterial growth was found in 6 eyes (100, 200, 200, 400, 500, and 500 colony-forming units) in Group C, but not in Groups A, B, or D. ERG and histological examination also indicated intraocular damage in Group C. Our results show that intravitreal injection of PI, even at low concentrations, was effective for treatment of VRE endophthalmitis, although some vitreous opacity remained. Intravitreal vancomycin injection was also useful to treat resistant strains, if used at a higher concentration within the safety threshold.
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Affiliation(s)
- Seung Min Lee
- Department of Ophthalmology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, 50612, South Korea
| | - Jong Ho Park
- BalGeunSeSang Eye Clinic, Busan, 47286, South Korea
| | - Chul Hun Jang
- Pusan National University School of Medicine, Yangsan, 50612, South Korea; Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, 49241, South Korea
| | - Iksoo Byon
- Pusan National University School of Medicine, Yangsan, 50612, South Korea; Department of Ophthalmology, Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, South Korea.
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Gemayel M, Neiweem A, Aebi B, Bracha P, Ciulla T. Microbial Spectrum and Antibacterial Susceptibility of Endophthalmitis Cultures in a Tertiary Referral Center in the Midwestern United States: An Analysis From 295 Patients. JOURNAL OF VITREORETINAL DISEASES 2021; 5:216-220. [PMID: 37006515 PMCID: PMC9979041 DOI: 10.1177/2474126420936454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work evaluates the microbial spectrum and antibiotic susceptibility pattern of endophthalmitis cases in a large tertiary referral center in the Midwestern United States. Methods: This retrospective case series included patients with clinically diagnosed endophthalmitis between April 14, 2006 and April 14, 2016, in whom ocular samples were submitted to the Microbiology Department at Indiana University. The patients were assessed by 11 vitreoretinal surgeons from 6 different sites in Indianapolis, including Indiana University and private practices, who receive patients from urban, suburban, and rural agricultural areas. Submitted specimens were cultured with the following media: blood agar, chocolate agar, MacConkey agar, and thioglycolate broth. Results: A total of 327 specimens from 295 patients were analyzed, with 96 (32.5%) samples from 90 (30.5%) patients meeting the criteria of confirmed growth. Of these 96 positive specimens, 83 (86.5%) organisms were identified as bacterial, and 13 (13.5%) were identified as fungal. Coagulase-negative Staphylococcus was the most common isolate (37.5%). Fifty gram-positive isolates and 10 gram-negative isolates underwent susceptibility testing. All 40 of the gram-positive isolates tested for vancomycin sensitivity were susceptible, whereas all 7 of the gram-negative isolates tested for ceftazidime sensitivity were susceptible. Conclusions: Empiric treatment with vancomycin and ceftazidime remains appropriate in most cases of endophthalmitis in the Midwestern United States, with 100% susceptibility of bacterial organisms tested with these antibiotics in this series. The high fungal culture rates in this study highlight the utility of obtaining vitreous cultures and potential need for antifungal agents in suspicious cases.
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Affiliation(s)
- Michael Gemayel
- Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ashley Neiweem
- Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brent Aebi
- Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Peter Bracha
- Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas Ciulla
- Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
- Midwest Eye Institute, Indianapolis, IN, USA
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Multimodal imaging characteristics in eyes with vitreoretinal lymphoma treated with intravitreal rituximab. Int Ophthalmol 2021; 41:2711-2722. [PMID: 33834345 DOI: 10.1007/s10792-021-01828-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To characterize the imaging features in eyes with vitreoretinal lymphoma (VRL) using ultra-widefield fundus photography (UWF-FP), swept-source optical coherence tomography (SSOCT) and fundus autofluorescence (FAF) that are correlated to ongoing treatment with intravitreal Rituximab(IVR). METHODS Retrospective observational imaging-based study of 15 treatment-naive eyes with VRL treated with IVR. All patients with primary VRL underwent vitreous biopsy using 23/25G microincision vitrectomy system for confirmation of diagnosis. All eyes received monthly IVR (1 mg/0.1 mL) injections till disease remission. Baseline clinical characteristics, treatment details, outcomes, and sequential imaging features on UWF-FP, FAF, and SSOCT were analyzed. OUTCOME MEASURES Baseline features and changes in UWF-FP, FAF patterns, and SSOCT features in response to treatment RESULTS: Clinically, patients presented with sub-RPE deposits (n = 15), superficial retinal hemorrhages (n = 2), 'giant' RPE (retinal pigment epithelium) holes (n = 2), and anterior segment reaction (n = 1). Eyes were treated with mean 5.7 IVR injections (median: 5; range 1-13) over a mean 7.2 ± 4.9 months. During the course of treatment, two eyes developed superficial retinal hemorrhages with spontaneous resolution, 2 eyes developed CME, and 4 eyes developed characteristic 'leopard skin' pigmentation. Hyper-autofluorescence corresponding to areas of active lesions decreased with each treatment cycle and was finally replaced by hypo-autofluorescence. Serial OCTs showed regression of sub-RPE/subretinal deposits (n = 15), ellipsoid zone disruption (n = 9), and its resolution with treatment (n = 3), epiretinal membrane (ERM; n = 6), choroidal hyperreflective foci (HRF; n = 4), disorganization of retinal inner layers (DRIL; n = 3), RPE-rip (n = 2), cystoid macular edema (CME; n = 2), and hyperreflective lesions in the choroid (n = 1). Complete resolution was observed in all eyes with extensive hypo-AF. The central foveal thickness decreased from 237 ± 113 μ to 182 ± 114 μ (p = 0.1) and subfoveal choroidal thickness decreased from 258 ± 66 μ to 220 ± 64 μ (p = 0.12) at final follow-up. The mean baseline BCVA was logMAR 0.9 ± 0.9 that deteriorated to mean logMAR 1 ± 1 final visit (p = 0.7). The mean recurrence-free follow-up was 5.9 ± 5.1 months CONCLUSION: Multimodal imaging provides novel insights into features of VRL, a better understanding of regression patterns, and prognostication of outcomes when treated with intravitreal rituximab. Larger, multicentric studies with longer follow-up will help unravel imaging biomarkers to understand these aspects better.
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Clinical management of an outbreak of nutritionally variant streptococcus endophthalmitis following intravitreal bevacizumab injection. Int J Retina Vitreous 2021; 7:18. [PMID: 33663619 PMCID: PMC7934535 DOI: 10.1186/s40942-021-00287-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The management of an outbreak of endophthalmitis associated with intravitreal bevacizumab represents a challenging real-time process involving identification of cases, treatment and mitigation measures during the outbreak. We summarize the clinical presentation and management of a cluster of endophthalmitis cases from contaminated bevacizumab, in addition to mathematical probabilistic assessment of the number of cases that define an outbreak. METHODS A retrospective study was conducted to assess the management of an endophthalmitis outbreak after intravitreal bevacizumab (IVB) administration. Demographic data, clinical information, individual patient management and public health reporting measures were reviewed. Outcomes of patients who received prophylactic antibiotics for endophthalmitis prevention were also reviewed. Binomial tail probability calculations were performed to determine the likelihood of clusters of endophthalmitis that could inform when an outbreak was evolving that would warrant more public health notification measures and communication. RESULTS Forty-five eyes of 42 patients who received IVB from a single batch were reviewed. Four cases of endophthalmitis from Granulicatella adiacens, a nutritionally-variant Streptococcus species, were treated successfully with intravitreal antibiotics ± vitrectomy. Thirty-four of the remaining 41 eyes were treated with prophylactic intravitreal vancomycin with no additional cases of endophthalmitis. Outbreak management also included CDC, ASRS and public health authority notification. Binominal tail probabilities demonstrated the rarity of clusters from a single batch (i.e. ~ 1/10,000 for 2 cases; 1/2 million for 3 cases). However, given the U.S. scale of IVB administration, there is an 87% chance of a cluster ≧ 2 and a 1% chance of a cluster ≧ 3 cases annually, which may guide outbreak management. A process diagram was developed to incorporate patient management and public health measures when an outbreak is suspected. CONCLUSION Intravitreal antibiotics and vitrectomy were effective in the individual management of cases of endophthalmitis, and no serious adverse events occurred with prophylactic intravitreal vancomycin for at-risk eyes. Best practices for outbreaks should be evaluated, given their likelihood within the U.S. and the sight-threatening consequences of endophthalmitis.
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Hikichi T. Three Japanese cases of intraocular inflammation after intravitreal brolucizumab injections in one clinic. Jpn J Ophthalmol 2021; 65:208-214. [PMID: 33543351 DOI: 10.1007/s10384-021-00819-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/07/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To report the development of intraocular inflammation (IOI) in three Japanese patients in the same clinic after intravitreal injections (IVI) of brolucizumab to treat neovascular age-related macular degeneration. CASES REPORTS The major findings were: (1) all three eyes had a history of treatment with multiple anti-vascular endothelial growth factor (VEGF) agents; (2) the time to the onset of IOI after the first IVI of brolucizumab varied, i.e., onset occurred after the first IVI in two cases and after the second IVI in one case; (3) the degree of vitreous opacities resulting from the IOI varied among the three cases and directly affected the degree of the decrease in the visual acuity (VA) and the timing of the VA recovery; (4) an injection of triamcinolone acetonide into the sub-Tenon's capsule (STTA) resulted in resolution of the IOI and improvement of the VA; and (5) the sheathed retinal vessels indicating vasculitis improved associated with reduction of the IOI after STTA. COMMENTS Although all three cases responded well to the injection of triamcinolone acetonide into the sub-Tenon's capsule, physicians should fully disclose to patients both the potential for this adverse effect, especially those patients with a history of anti-VEGF therapy, and the benefits of therapy with brolucizumab. Immediate steroid therapy is recommended to possibly reduce deterioration of the visual function caused by persistent IOI.
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Affiliation(s)
- Taiichi Hikichi
- Hikichi Eye Clinic, Kita-7 Nishi-5 7-1 Kita-Sky-Building, 14 Floor, Kita-ku, Sapporo, 060-0807, Japan.
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Affiliation(s)
- David F Chang
- University of California, San Francisco, San Francisco, California
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Effectiveness of immediate vitrectomy and intravitreal antibiotics for post-injection endophthalmitis. Graefes Arch Clin Exp Ophthalmol 2021; 259:1609-1615. [PMID: 33502628 DOI: 10.1007/s00417-021-05071-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/29/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To show that an immediate vitrectomy with an intravitreal injection of antibiotics can be an effective approach for the treatment of acute endophthalmitis following intravitreal injections. METHODS We reviewed all cases of clinical endophthalmitis caused by an intravitreal injection that were treated in our department between March 2012 and November 2019. Only patients that underwent a vitrectomy within 6 h after presentation to the clinic and with a documented visual acuity shortly before the causative event were included. Baseline best-corrected visual acuity (BCVA) before the causative event was compared to BCVA measured within a follow-up period of 8 months (up to 14 months). RESULTS In total, 30 eyes of 30 patients were included. The BCVA before the intraocular infection was a mean value of 0.55 logMAR, and the BCVA on the day of the endophthalmitis decreased significantly to 1.66 logMAR. Within 2 months following the pars plana vitrectomy (PPV), the mean BCVA improved to 0.83 logMAR. Eight months following PPV (mean value, 8.20 months; SD, 3.59 months), the mean BCVA was 0.63 logMAR. In the last follow-up interval most of the eyes recovered, and the BCVA did not differ significantly from baseline. Two eyes underwent further pars plana surgery during the follow-up period. No enucleation was required. CONCLUSION In this study, we have shown that an immediate vitrectomy with subsequent intravitreal injection of antibiotics is an effective option for treating post-injection endophthalmitis and frequently results in recovery of vision; thus, it should be performed as early as possible, where available.
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Iqbal KM, Hay MW, Emami-Naeini P. Medication-induced Uveitis: An Update. J Ophthalmic Vis Res 2021; 16:84-92. [PMID: 33520131 PMCID: PMC7841282 DOI: 10.18502/jovr.v16i1.8254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 12/04/2020] [Indexed: 01/21/2023] Open
Abstract
Drug-induced uveitis is an uncommon but important cause of ocular inflammation. Uveitis can be seen in association with various systemic, topical, and intraocular medications. In this article, we review common medications associated with uveitis. Most cases of drug-induced uveitis resolve with termination of the suspected medication with or without administration of topical or systemic steroids. It is important for clinicians to readily identify medications that may cause uveitis in order to provide rapid treatment, avoid consequences of longstanding inflammation, and prevent costly and excessive laboratory testing.
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Affiliation(s)
- Kashif M Iqbal
- (KM Iqbal and MW Hay contributed equally to this paper.)
| | - Madeline W Hay
- University of California Riverside School of Medicine, Riverside, CA
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Sarkar S, Kasturi N, Bardoloi N. Minimizing topical medication in cataract surgery. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2021. [DOI: 10.4103/tjosr.tjosr_61_21] [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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Alasil T, Wong JJY, Adelman RA, Tom D, Coady PA. HEMORRHAGIC OCCLUSIVE RETINAL VASCULITIS AFTER INTRACAMERAL VANCOMYCIN USE IN CATARACT SURGERY AFTER INTRAVENOUS EXPOSURE. Retin Cases Brief Rep 2021; 15:52-55. [PMID: 29474222 DOI: 10.1097/icb.0000000000000725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To report a case of hemorrhagic occlusive retinal vasculitis after cataract surgery. METHODS A 74-year-old woman presented with blurry vision and distorted vision, which started 2 days after an uncomplicated cataract surgery in the left eye. Intracameral vancomycin was injected during the case. The patient reported being treated with systemic vancomycin in the past. RESULTS The visual acuity was 20/80 in the left eye. She had trace cells in the anterior chamber with no hypopyon and intraocular lens implant within the capsular bag in the left eye. Dilated fundus examination revealed no vitritis, There were large patches of peripheral retinal hemorrhages and retinal ischemia. The patient was diagnosed with hemorrhagic occlusive retinal vasculitis likely secondary to hypersensitivity reaction to intracameral vancomycin. The patient was started on oral prednisone, and the topical difluprednate course was escalated. Within 3 weeks, vision improved to 20/30 in the left eye. She underwent pan retinal photocoagulation targeting the ischemic areas in the periphery. CONCLUSION The patient had previous exposure to systemic vancomycin, which may have sensitized her immune system. Later on, the hypersensitivity reaction took place after exposure to intracameral vancomycin during cataract surgery. Our hemorrhagic occlusive retinal vasculitis case had a favorable visual outcome, and recognition of this entity will ensure that vancomycin will not be used for infection prophylaxis in the fellow eye at the time of cataract surgery.
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Affiliation(s)
- Tarek Alasil
- Department of Ophthalmology, Yale University, New Haven, Connecticut
| | - James J Y Wong
- Ophthalmology Division, WCHN Norwalk Hospital Campus, Norwalk, Connecticut
- Ophthalmology Division, Stamford Health, Stamford, Connecticut; and
| | - Ron A Adelman
- Department of Ophthalmology, Yale University, New Haven, Connecticut
| | - David Tom
- Department of Ophthalmology, Yale University, New Haven, Connecticut
- New England Retina Associates, Hamden, Connecticut
| | - Patrick A Coady
- Department of Ophthalmology, Yale University, New Haven, Connecticut
- New England Retina Associates, Hamden, Connecticut
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Abstract
PURPOSE OF REVIEW Prevention and management of postcataract endophthalmitis remain quite relevant for anterior segment and vitreoretinal surgeons. Although the Endophthalmitis Vitrectomy Study, published in 1996, remains the only level 1 evidence for the management of postcataract endophthalmitis, recent advances have resulted in an evolution of practice patterns. The aim of this review is to summarize the literature regarding postcataract endophthalmitis with a focus on the last 18 months. RECENT FINDINGS The IRIS registry indicates the rates of endophthalmitis are decreasing in the United States, and the outcomes appear to be improving. Intracameral moxifloxacin has become more widely accepted and intracameral vancomycin has been shown to be associated with retinal vasculitis. The role of systemic antibiotics and vitrectomy is unclear and practice patterns vary widely. SUMMARY Although practice patterns vary, prevention and treatment of endophthalmitis after cataract surgery continues to improve. More uniform guidelines regarding surgical and medical therapy are necessary but the standard of prompt referral to a vitreoretinal specialist for immediate intravitreal antibiotics remains the most important intervention in the management of postcataract endophthalmitis.
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Vancomycin-associated retinal hemorrhages in pediatric age group: A case report. Am J Ophthalmol Case Rep 2020; 20:100880. [PMID: 32913922 PMCID: PMC7471596 DOI: 10.1016/j.ajoc.2020.100880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/27/2020] [Accepted: 08/16/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose To report a case of possible post-lensectomy vancomycin-induced retinal hemorrhages in a 9-month-old infant to raise awareness of this rare postoperative complication in the pediatric age group. Observation A retinal vascular occlusion-like findings were noted bilaterally after sequential uneventful parsplicata lensectomy in a 9-month-old infant during the very early postoperative follow-up (1–2 days). The case was recorded with no remarkable intraoperative events and received intraoperative vancomycin 20μg/ml in irrigating solution (a routine endophthalmitis prophylactic protocol). Conclusions and Importance Vancomycin-associated hemorrhagic occlusive retinal vasculitis (HORV) is a rare reported postoperative complication of intraocular prophylactic vancomycin injection. Although all documented cases were reported in elderly patients aged 50 years and above, all presented with almost common findings of occlusive retinal vasculitis. To the best of author's knowledge, this is the first reported case of presumed HORV in pediatric age group. The author finds this of utmost importance to demonstrate the case to expand awareness of this possible complication in the pediatric age group as well.
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Toxische Retinopathien. Ophthalmologe 2020; 117:1247-1266. [DOI: 10.1007/s00347-020-01260-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Meyer BI, Berry DE, Cribbs BE, Hendrick A, Jain N, Hubbard GB, O'Keefe G, Patel PS, Shantha JG, Yan J, Yeh S, Rao P. Outcomes of Infectious Endophthalmitis in Patients with Systemic Antibiotic Allergies to Penicillins, Cephalosporins, or Vancomycin. Ophthalmol Retina 2020; 5:901-909. [PMID: 33271346 DOI: 10.1016/j.oret.2020.11.015] [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: 08/17/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The mainstay empiric treatments of bacterial endophthalmitis are intravitreal vancomycin and ceftazidime. In the United States, up to 10% of the general population has a reported penicillin (PCN) allergy. Despite low cross-reactivity between PCN and later-generation cephalosporins, some providers alter the intravitreal antibiotic choice for endophthalmitis because of concern for allergic reactions. We evaluated the management strategies of infectious endophthalmitis in the setting of self-reported systemic antibiotic allergies and the association with adverse reactions after standard intravitreal antibiotic administration. DESIGN Single-center, retrospective cohort study. PARTICIPANTS All patients with endophthalmitis between 2005 and 2019 and documented PCN, PCN-analog, cephalosporin, or vancomycin allergy who received intravitreal antibiotics on the basis of International Classification of Diseases 9th and 10th Revisions, and Current Procedural Terminology codes. METHODS Retrospective chart review. MAIN OUTCOME MEASURES Any allergic reaction after intravitreal injection, additional surgical interventions required for treatment, and visual function at last recorded visit. RESULTS Of the 65 patients included in this cohort, the most common causes of endophthalmitis were postcataract extraction surgery (n = 23, 35.4%) and postintravitreal injection (n = 11, 16.9%). All patients (65/65) received intravitreal vancomycin, and 81.5% (53/65) received intravitreal ceftazidime. Of the 53 patients who received intravitreal ceftazidime, 46 (86.8%) had allergies to PCNs alone, 5 (9.4%) had a cephalosporin allergy alone, and 2 (3.8%) had reported allergies to both PCN and cephalosporin antibiotics. Two patients (3.1%) with a documented vancomycin allergy received intravitreal vancomycin without complication. No patients exhibited any systemic or local allergic reactions or complications after intravitreal injection. CONCLUSIONS There were no documented allergic reactions in this cohort of patients with systemic antibiotic allergies who were treated for infectious endophthalmitis. Our findings are consistent with previous reports of a low allergic cross-reactivity between PCN and later-generation cephalosporins. Ophthalmologists should use evidence-based practices and a careful informed consent process when choosing intravitreal antibiotics for patients with specific antibiotic allergies. In the routine patient with suspected bacterial endophthalmitis, PCN allergy may not be an absolute contraindication to intravitreal cephalosporin use.
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Affiliation(s)
| | - Duncan E Berry
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | - Blaine E Cribbs
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | - Andrew Hendrick
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | - Nieraj Jain
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | - G Baker Hubbard
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | - Ghazala O'Keefe
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | - Purnima S Patel
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | | | - Jiong Yan
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | - Steven Yeh
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | - Prethy Rao
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; Institute for Research in Ophthalmology, Poznan, Poland
| | - Piotr Brona
- Department of Ophthalmology, Poznan City Hospital, Poznan, Poland
| | - Luis Zeman
- Department of Ophthalmology, Hospital de Clínicas, Universidad de Buenos Aires, Argentina
| | - Michael W Stewart
- Department of Ophthalmology Mayo Clinic Florida, Jacksonville Florida, USA.
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