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Martínez-Pulgarin DF, Arias JD, Córdoba-Ortega CM, Rangel CM, Varón CL, Villareal E, Villareal D. Primary Vitrectomy versus Tap and Inject for Fungal Endophthalmitis: Meta-Analysis and Comparison with Data from a Reference Centre. Ocul Immunol Inflamm 2024; 32:850-857. [PMID: 38489503 DOI: 10.1080/09273948.2024.2322026] [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: 12/08/2023] [Revised: 02/12/2024] [Accepted: 02/17/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE We aimed to compare the visual outcomes after pars plana vitrectomy (PPV) versus tap and inject (T&I) in fungal endophthalmitis (FE) reported in the literature and to compare the findings from the literature with data from a reference centre. METHODS We performed a systematic review and meta-analysis of studies reporting the use of PPV versus T&I in FE. We also performed a retrospective review of the clinical records of patients with endophthalmitis from a reference centre in Colombia. RESULTS We included 13 studies with 334 eyes; 53.59% received PPV and 46.4% received T&I. The overall relative risk of improving ≥ 2 lines in PPV versus T&I was 0.98 (95% confidence interval [CI] 0.80-1.22; p = 0.88) with a mean difference of final visual acuity of 0.26 (95% CI 0.12-0.63; p = 0.18). There were no significant differences in subgroup analysis. Data from the reference centre included 32 endophthalmitis cases, 15.6% of which had a fungal aetiology (80% received PPV and 20% T&I). There were no significant differences in the subgroup analysis. CONCLUSIONS Based on the findings from the literature and the reference centre, T&I is noninferior to PPV. This is the first meta-analysis in the literature evaluating these effects in FE. It is necessary to execute new prospective randomised controlled studies in patients with endophthalmitis.
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Affiliation(s)
- Dayron F Martínez-Pulgarin
- Retina and Vitreous Department, Clinica FOSCAL Internacional, Floridablanca, Santander, Colombia
- Retina and Vitreous Fellowship Program, Universidad Autonoma de Bucaramanga (UNAB), Bucaramanga, Santander, Colombia
| | - Juan D Arias
- Retina and Vitreous Department, Clinica FOSCAL Internacional, Floridablanca, Santander, Colombia
- Retina and Vitreous Fellowship Program, Universidad Autonoma de Bucaramanga (UNAB), Bucaramanga, Santander, Colombia
| | - Carlos M Córdoba-Ortega
- Retina and Vitreous Department, Clinica FOSCAL Internacional, Floridablanca, Santander, Colombia
- Retina and Vitreous Fellowship Program, Universidad Autonoma de Bucaramanga (UNAB), Bucaramanga, Santander, Colombia
| | - Carlos M Rangel
- Retina and Vitreous Department, Fundación Oftalmológica de Santander Carlos Ardila Lülle FOSCAL, Bucaramanga, Santander, Colombia
| | - Clara L Varón
- Retina and Vitreous Department, Fundación Oftalmológica de Santander Carlos Ardila Lülle FOSCAL, Bucaramanga, Santander, Colombia
| | - Eduardo Villareal
- Retina and Vitreous Department, Fundación Oftalmológica de Santander Carlos Ardila Lülle FOSCAL, Bucaramanga, Santander, Colombia
| | - Donaldo Villareal
- Laboratorio microbiológico y Ocular FOSLAB, FOSCAL Internacional, Floridablanca, Colombia
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Burton E, Reddy V, Venkat AG. Endogenous Fungal Endophthalmitis: A Single-Center Retrospective Study and Review of the Literature. Am J Ophthalmol 2024; 262:97-106. [PMID: 38280676 DOI: 10.1016/j.ajo.2024.01.018] [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: 12/11/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/29/2024]
Abstract
PURPOSE To evaluate factors that inform systemic antifungal choices in patients with endogenous fungal endophthalmitis (EFE). DESIGN Single-institution retrospective case series. METHODS Charts of EFE patients from 2010 to 2023 were reviewed. Patients treated systemically for EFE with a minimum of 14 days of follow-up were included. Outcome measures included time to improvement in vitritis or chorioretinitis, systemic therapy modification, and need for surgical intervention. RESULTS A total of 20 eyes of 16 patients were included. Candida species were most common (43.8%), followed by culture-negative EFE (37.5%) and Aspergillus species (18.8%). In all, 90% of eyes had vitritis and/or macula-involving chorioretinitis. The majority of Candida infections (60%) or culture-negative EFE (75%) were treated initially with oral antifungals. Patients with a history of immune compromise, positive fungal culture, or positive Fungitell assay were more likely to be treated with early intravenous (IV) antifungal therapy. Two patients required systemic antifungal therapy modification because of worsening chorioretinitis, in 1 case due to voriconazole-resistant Aspergillosis that demonstrated chorioretinal lesion growth despite intravitreal amphotericin B injections and systemic voriconazole, and in the second case due to worsening chorioretinitis from Candida dubliniensis infection that regressed upon switch from oral to IV fluconazole. CONCLUSIONS Initial systemic treatment decisions in patients with EFE were driven by systemic culture positivity, systemic symptoms, or comorbidities. Intravitreal antifungal therapy may be insufficient to arrest progression of chorioretinal lesions in some cases. Larger studies are needed to determine whether visible end-organ damage in the form of chorioretinitis may be useful for guiding systemic therapy changes.
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Affiliation(s)
- Eleanor Burton
- From the Department of Ophthalmology, University of Virginia, Charlottesville, Virginia, USA
| | - Vishal Reddy
- From the Department of Ophthalmology, University of Virginia, Charlottesville, Virginia, USA
| | - Arthi G Venkat
- From the Department of Ophthalmology, University of Virginia, Charlottesville, Virginia, USA.
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3
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Li X, Chen Z, Zhang X, Zhou Z, Boost M, Huang T, Zhou X. Fungal Endophthalmitis: Clinical Characteristics, Pathogens, and Factors Affecting Visual Outcome. Antibiotics (Basel) 2024; 13:199. [PMID: 38534634 DOI: 10.3390/antibiotics13030199] [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: 01/04/2024] [Revised: 02/06/2024] [Accepted: 02/16/2024] [Indexed: 03/28/2024] Open
Abstract
AIMS The aims of this study are to investigate the etiology, microbiological spectrum, and risk factors associated with visual outcomes of fungal endophthalmitis (FE) in a tertiary eye specialty hospital in Shanghai, China. METHODS This was a retrospective, single-center case series. The clinical characteristics, etiology, microbiological spectrum, and management, as well as the visual outcomes, were analyzed. Logistic regression was used to analyze the factors related to visual outcomes. RESULTS This study involved 102 eyes of 92 patients with FE, including 63 males (66.3%). The mean age was 44.4 ± 19.8 years. The most common etiology of FE was trauma (56.5%). The predominant fungal species isolated were Aspergillus spp. (31/93, 33.3%). Pars plana vitrectomy (PPV) and intravitreal antifungal agents was performed initially in 86 (84.3%) and 83 (81.4%) eyes, respectively. Only 35 (34.3%) eyes achieved final best corrected visual acuity (BCVA) of 20/400 or better. Ten (9.8%) eyes had a final BCVA of light perception or worse, and five (4.9%) had to be enucleated. The factors determining better visual outcomes included initial visual acuity better than finger-counting (FC) (odds ratio (OR) 5.811, p = 0.036), the absence of corneal infiltrate (OR 10.131, p = 0.002), and Candida species infection (OR 6.325, p = 0.011). CONCLUSIONS Early diagnosis of FE and a timely vitrectomy, combined with an intravitreal injection of an antifungal drug, can mitigate the devastating results of intraocular fungal infection. Not being infected by Aspergillus spp., an initial BCVA that was no worse than FC, and the absence of corneal involvement were related to better visual prognosis.
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Affiliation(s)
- Xiaoxia Li
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Zhi Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Xiuwen Zhang
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Zimei Zhou
- Department of Ophthalmology, BronxCare Health System, Bronx, NY 10456, USA
| | - Maureen Boost
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
| | - Taomin Huang
- Department of Pharmacy, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
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4
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Durand ML, Barshak MB, Sobrin L. Eye Infections. N Engl J Med 2023; 389:2363-2375. [PMID: 38118024 DOI: 10.1056/nejmra2216081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Affiliation(s)
- Marlene L Durand
- From the Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital (M.L.D., M.B.B.), and the Infectious Disease Service (M.L.D., M.B.B.) and the Department of Ophthalmology (M.L.D., L.S.), Massachusetts Eye and Ear - both in Boston
| | - Miriam B Barshak
- From the Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital (M.L.D., M.B.B.), and the Infectious Disease Service (M.L.D., M.B.B.) and the Department of Ophthalmology (M.L.D., L.S.), Massachusetts Eye and Ear - both in Boston
| | - Lucia Sobrin
- From the Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital (M.L.D., M.B.B.), and the Infectious Disease Service (M.L.D., M.B.B.) and the Department of Ophthalmology (M.L.D., L.S.), Massachusetts Eye and Ear - both in Boston
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5
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Azhari J, Tetelbom PS, Sallam AB. The Role of Adjuvant Systemic and Intravitreal Corticosteroids in Fungal Endophthalmitis Treatment. J Fungi (Basel) 2023; 9:1147. [PMID: 38132748 PMCID: PMC10744273 DOI: 10.3390/jof9121147] [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: 09/25/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Endophthalmitis refers to inflammation involving internal ocular structures, including the anterior and posterior eye segments, associated with infectious agents, most commonly bacteria and fungi. This review focuses on endophthalmitis caused by fungi. Medical and surgical management are the two main treatment modalities for fungal endophthalmitis, with medical management utilizing systemic or intravitreal antifungals. The use of systemic or intravitreal corticosteroids as an adjuvant treatment to dampen the severity of inflammation is controversial. Based on the pathobiology of fungal endophthalmitis as well as the mechanism of action of corticosteroids, it was hypothesized that corticosteroids affected the immune response against fungal infection. In vitro studies mostly carried out during the 1980s showed that dexamethasone plays a role in the suppression of phagocytosis of yeasts and demonstrated the facilitation of yeast proliferation by dexamethasone. In vivo studies analysis was compromised entirely of retrospective studies describing steroid use in fungal endophthalmitis, with the outcomes of the patients in these studies varying greatly and often being anecdotally noted, thus difficult to discern any definitive results. Given the limited clinical data and the heterogeneity of the existing studies, additional experimentation human studies with clinical trials or observations over more extended periods analyzing the effect of systemic and intravitreal corticosteroids in fungal endophthalmitis are needed before definitive conclusions can be drawn.
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Affiliation(s)
| | | | - Ahmed B. Sallam
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (J.A.); (P.S.T.)
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Ciociola EC, Powell JC, Barnwell E, Zehden JA, Robbins CB, Soundararajan S, Singh P, Zhang AY, Fekrat S, Greven MA. ENDOGENOUS ENDOPHTHALMITIS ASSOCIATED WITH INJECTION DRUG USE COMPARED WITH OTHER ETIOLOGIES. Retina 2023; 43:1996-2002. [PMID: 37490751 DOI: 10.1097/iae.0000000000003898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
PURPOSE To compare features of endogenous endophthalmitis associated with injection drug use (IDU) to endogenous endophthalmitis from other etiologies. METHODS The authors retrospectively collected data on patients with endogenous endophthalmitis due to IDU or other causes from three academic tertiary care centers over a six-year period. Differences in presenting characteristics, culture results, treatment, and visual acuity were compared between groups. RESULTS Thirty-eight patients (34%) had IDU-associated endogenous endophthalmitis while 75 patients (67%) had endogenous endophthalmitis from other causes. Compared with patients in the non-IDU group, IDU patients were significantly younger, more frequently male, had longer duration of symptoms at diagnosis, and were less likely to have bilateral disease ( P < 0.05 for all). Injection drug use patients were less likely to have a systemic infection source identified (29% vs. 71%, P < 0.001) or have positive cultures (47% vs. 80%, P < 0.001). The IDU group was less likely to be admitted to the hospital (71% vs. 92%, P = 0.005) and less likely to receive treatment with intravenous antimicrobials (55% vs. 83%, P = 0.003). Visual acuity did not significantly differ between groups. CONCLUSION Endophthalmitis related to IDU presents in younger patients with less comorbidities and frequently without positive cultures or an identifiable systemic source; therefore, a high index of suspicion is needed to identify this disease.
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Affiliation(s)
- Elizabeth C Ciociola
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jeffrey C Powell
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Eliza Barnwell
- Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina; and
| | - Jason A Zehden
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Cason B Robbins
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Srinath Soundararajan
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Pali Singh
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Alice Yang Zhang
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Margaret A Greven
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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7
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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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Xie CA, Singh J, Tyagi M, Androudi S, Dave VP, Arora A, Gupta V, Agrawal R, Mi H, Sen A. Endogenous Endophthalmitis - A Major Review. Ocul Immunol Inflamm 2023; 31:1362-1385. [PMID: 36306406 DOI: 10.1080/09273948.2022.2126863] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 10/31/2022]
Abstract
Endogenous endophthalmitis (EE) is an uncommon but potentially devastating ocular infection involving the inner layers of the eye. The global incidence of EE is on the rise. Common ocular signs and symptoms associated with EE include conjunctival injection, ocular pain, and reduced visual acuity. On clinical examination, a history of prior or coexisting systemic infections, symptoms (e.g., fever, malaise), and localizing features may be noted. Clinical diagnosis is often challenging, resulting in critical delays that contribute to a poor prognosis. Blood cultures and ocular fluid samples can aid in conforming causative pathogen(s), after which empirical antibiotic therapy, both systemic and intravitreal, should be instated. The use of steroids to suppress inflammation remains controversial. Surgical options include pars plana vitrectomy. Overall prognosis varies depending on host and pathogen factors, and early diagnosis and initiation of appropriate treatment are crucial.
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Affiliation(s)
- Cen Amy Xie
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jayanti Singh
- Department of Vitreo-retina and Uvea, Sadguru Netra Chikatsalaya, Chitrakoot, India
| | - Mudit Tyagi
- Department of Vitreo-retina, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, Volos, Greece
| | - Vivek Pravin Dave
- Department of Vitreo-retina, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Atul Arora
- Advanced Eye Centre, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rupesh Agrawal
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Eye ACP programme, Duke NUS Medical School, Singapore
- Ocular Infections and AntiMicrobials Group, Singapore Eye Research Institute, Singapore
| | - Helen Mi
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Alok Sen
- Department of Vitreo-retina and Uvea, Sadguru Netra Chikatsalaya, Chitrakoot, India
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Wang H, Chang Y, Zhang Y, Yang R, Shi H, Zhang M. Bilateral endogenous fungal endophthalmitis: A case report. Medicine (Baltimore) 2023; 102:e33585. [PMID: 37083776 PMCID: PMC10118318 DOI: 10.1097/md.0000000000033585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023] Open
Abstract
RATIONALE Endogenous fungal endophthalmitis is a challenging condition. There are no universally accepted diagnostic or management protocols. We share a case of endogenous fungal endophthalmitis who was successfully treated, focusing on the diagnostic and treatment procedures. PATIENT CONCERNS A 31-year-old female with a history of fungal vaginitis and tinea corporis presented with progressive visual decrease in both eyes after having an induced abortion. Her best corrected visual acuity at presentation was 20/1000 in her right eye and 20/250 in her left eye. Upon slit lamp examination, mild inflammatory reaction in the anterior chamber was found. Dilated fundus examination revealed a hazy view of the optic disc and posterior retina, and there was a whitish mass with "string and pearls" just in front of the macular region in each eye. DIAGNOSES Bilateral fungal endogenous endophthalmitis was diagnosed empirically, which was confirmed later by deoxyribonucleic acid sequencing and culture of intraocular fluid. INTERVENTIONS Oral itraconazole and intravitreal voriconazole were administered to the patient at first. The intraocular inflammation was partially responsive to the medication, yet the visual acuity persisted to deteriorate and the vitreous whitish masses became more prominent. Then vitrectomy procedures were carried out and oral itraconazle was switched to intravenous fluconazole. The antifungal treatment lasted for 8 weeks. OUTCOMES The intraocular inflammation alleviated and visual acuity improved after vitrectomy. At the 9-month follow-up visit, the patient's best corrected visual acuity was 20/40 in the right eye and 20/30 in the left eye. There was no intraocular inflammatary reaction, and retinal scar was noticed in each eye. LESSON Early and correct diagnosis, coupled with prompt and aggressive treatment, is crucial for cases of fungal endogenous endophthalmitis. Deoxyribonucleic acid sequencing techniques can contribute to early diagnosis, while vitrectomy may be necessary when antifungal medication is insufficient in controlling the condition.
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Affiliation(s)
- Hao Wang
- Department of TCM Ophthalmology, Hebei Eye Hospital, Hebei province, China
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei province, China
- Hebei Provincial Clinical Research Center for Eye Diseases, Hebei province, China
| | - Yongye Chang
- Department of TCM Ophthalmology, Hebei Eye Hospital, Hebei province, China
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei province, China
- Hebei Provincial Clinical Research Center for Eye Diseases, Hebei province, China
| | - Yifan Zhang
- School of Life Sciences and Food Engineering, Hebei University of Engineering, Hebei province, China
| | - Rong Yang
- Department of TCM Ophthalmology, Hebei Eye Hospital, Hebei province, China
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei province, China
- Hebei Provincial Clinical Research Center for Eye Diseases, Hebei province, China
| | - Huijun Shi
- Department of TCM Ophthalmology, Hebei Eye Hospital, Hebei province, China
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei province, China
- Hebei Provincial Clinical Research Center for Eye Diseases, Hebei province, China
| | - Minglian Zhang
- Department of TCM Ophthalmology, Hebei Eye Hospital, Hebei province, China
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei province, China
- Hebei Provincial Clinical Research Center for Eye Diseases, Hebei province, China
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Gram-Negative Endogenous Endophthalmitis: A Systematic Review. Microorganisms 2022; 11:microorganisms11010080. [PMID: 36677371 PMCID: PMC9860988 DOI: 10.3390/microorganisms11010080] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/20/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Gram-negative bacteria are causative agents of endogenous endophthalmitis (EBE). We aim to systematically review the current literature to assess the aetiologies, risk factors, and early ocular lesions in cases of Gram-negative EBE. Methods: All peer-reviewed articles between January 2002 and August 2022 regarding Gram-negative EBE were included. We conducted a literature search on PubMed and Cochrane Controlled Trials. Results: A total of 115 studies and 591 patients were included, prevalently Asian (98; 81.7%) and male (302; 62.9%). The most common comorbidity was diabetes (231; 55%). The main aetiologies were Klebsiella pneumoniae (510; 66.1%), Pseudomonas aeruginosa (111; 14.4%), and Escherichia coli (60; 7.8%). Liver abscesses (266; 54.5%) were the predominant source of infection. The most frequent ocular lesions were vitreal opacity (134; 49.6%) and hypopyon (95; 35.2%). Ceftriaxone (76; 30.9%), fluoroquinolones (14; 14.4%), and ceftazidime (213; 78.0%) were the most widely used as systemic, topical, and intravitreal anti-Gram-negative agents, respectively. The most reported surgical approaches were vitrectomy (130; 24.1%) and evisceration/exenteration (60; 11.1%). Frequently, visual acuity at discharge was no light perception (301; 55.2%). Conclusions: Gram-negative EBEs are associated with poor outcomes. Our systematic review is mainly based on case reports and case series with significant heterogeneity. The main strength is the large sample spanning over 20 years. Our findings underscore the importance of considering ocular involvement in Gram-negative infections.
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11
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Chen KJ, Wu WC, Chen YP, Liu L. Intravenous drug use-related endophthalmitis. Clin Exp Ophthalmol 2022; 50:575-578. [PMID: 35322521 DOI: 10.1111/ceo.14076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yen-Po Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Ophthalmology, Tucheng Municipal Hospital, New Taipei, Taiwan
| | - Laura Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Cox JT, Wu F, Rossin EJ, Tang WM, Eliott D. Bacillary Layer Detachment Associated With Endogenous Fungal Endophthalmitis. JOURNAL OF VITREORETINAL DISEASES 2022; 6:316-319. [PMID: 37007928 PMCID: PMC9976034 DOI: 10.1177/24741264221101224] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To recognize the novel finding of a bacillary layer detachment (BALAD) secondary to endogenous fungal endophthalmitis. Methods: Chart review, literature review. Results: BALAD is a recently described condition in which the photoreceptor layer splits at the level of the inner segment myoid. We describe a case of BALAD associated with endogenous fungal endophthalmitis and subsequent development of choroidal neovascularization, although it is unclear if BALAD contributed to neovessel formation. Conclusions: BALAD is generally seen in the setting of inflammatory or infectious retinal diseases. This is the first report of BALAD secondary to endogenous fungal endophthalmitis.
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Affiliation(s)
- Jacob T. Cox
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Frances Wu
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Elizabeth J. Rossin
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | | | - Dean Eliott
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Chen KJ, Chen YP, Chen YH, Liu L, Wang NK, Chao AN, Wu WC, Hwang YS, Chou HD, Kang EYC, Chen YT, Sun MH, Lai CC. Infection Sources and Klebsiella pneumoniae Antibiotic Susceptibilities in Endogenous Klebsiella Endophthalmitis. Antibiotics (Basel) 2022; 11:866. [PMID: 35884120 PMCID: PMC9311537 DOI: 10.3390/antibiotics11070866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/19/2022] [Accepted: 06/25/2022] [Indexed: 12/10/2022] Open
Abstract
Endogenous endophthalmitis is an uncommon intraocular infection with potentially devastating consequences on vision. Klebsiella pneumoniae is highly prevalent in East Asian countries, with an increasing incidence recently worldwide. This retrospective study investigates infection sources and antibiotic susceptibilities of K. pneumoniae in patients with endogenous K. pneumoniae endophthalmitis (EKE) in Northern Taiwan. One hundred and fifty-seven patients with EKE were reviewed between January 1996 and April 2019. Pyogenic liver abscess (120/157, 76.4%) was the most common infection source, followed by pneumonia (13, 8.3%), urinary tract infection (7, 4.5%), and intravenous drug use (4, 2.5%). Bilateral involvement was identified in 12.1% (19/157) of patients, especially in patients with pyogenic liver abscess (16/120, 13.3%), pneumonia (2/13, 15.4%), and urinary tract infection (1/7, 14.3%). The antibiotic susceptibility rates were 98.1%, 92.5%, 97.5%, 96.8%, 100%, 99.3%, and 100% for amikacin, cefuroxime, ceftazidime, ceftriaxone, carbapenems, ciprofloxacin, and levofloxacin, respectively. Four extended-spectrum β-lactamase-producing multidrug-resistant (MDR) K. pneumoniae isolates were identified. In conclusion, pyogenic liver abscess was the major infection source in EKE. In addition, K. pneumoniae was still highly susceptible to ceftazidime and amikacin, and the MDR K. pneumoniae isolates were not common in EKE.
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Affiliation(s)
- Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (H.-D.C.); (E.Y.-C.K.); (Y.-T.C.); (M.-H.S.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yen-Po Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (H.-D.C.); (E.Y.-C.K.); (Y.-T.C.); (M.-H.S.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Ophthalmology, Tucheng Municipal Hospital, Tucheng, New Taipei 236, Taiwan
| | - Yi-Hsing Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (H.-D.C.); (E.Y.-C.K.); (Y.-T.C.); (M.-H.S.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Laura Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (H.-D.C.); (E.Y.-C.K.); (Y.-T.C.); (M.-H.S.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA;
| | - An-Ning Chao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (H.-D.C.); (E.Y.-C.K.); (Y.-T.C.); (M.-H.S.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (H.-D.C.); (E.Y.-C.K.); (Y.-T.C.); (M.-H.S.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (H.-D.C.); (E.Y.-C.K.); (Y.-T.C.); (M.-H.S.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hung-Da Chou
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (H.-D.C.); (E.Y.-C.K.); (Y.-T.C.); (M.-H.S.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Eugene Yu-Chuan Kang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (H.-D.C.); (E.Y.-C.K.); (Y.-T.C.); (M.-H.S.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yen-Ting Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (H.-D.C.); (E.Y.-C.K.); (Y.-T.C.); (M.-H.S.); (C.-C.L.)
| | - Ming-Hui Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (H.-D.C.); (E.Y.-C.K.); (Y.-T.C.); (M.-H.S.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (H.-D.C.); (E.Y.-C.K.); (Y.-T.C.); (M.-H.S.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
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Chen KJ, Sun MH, Chen YP, Chen YH, Wang NK, Liu L, Chao AN, Wu WC, Hwang YS, Lai CC. Endogenous Fungal Endophthalmitis: Causative Organisms, Treatments, and Visual Outcomes. J Fungi (Basel) 2022; 8:641. [PMID: 35736124 PMCID: PMC9225322 DOI: 10.3390/jof8060641] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/04/2022] Open
Abstract
Endogenous fungal endophthalmitis (EFE) is a vision-threatening intraocular infection and a rare complication of fungemia. Early diagnosis and prompt aggressive treatment are crucial to avoid vision loss. We retrospectively reviewed the data of 37 patients (49 eyes) with EFE who were treated at a tertiary referral hospital from January 2000 to April 2019. The most common risk factor was diabetes (24 patients; 65%), followed by recent hospitalization, urinary tract disease, liver disease, and immunosuppressive therapy. Two or more risk factors were detected in 24 patients (65%), and yeasts (29 patients; 78%) were more commonly detected than mold (8 patients; 22%). The most common fungal isolates were Candida spp. (78%), especially Candida albicans (70%). Moreover, 24 eyes in 21 patients underwent vitrectomy, and 2 eyes underwent evisceration. Retinal detachment (RD) occurred in 17 eyes (35%) in 14 patients, and eyes without RD exhibited significantly superior visual outcomes (p = 0.001). A comparison of the initial VA between the better (20/200 or better) and worse groups (worse than 20/200) revealed that better initial VA was related to a superior visual outcome (p = 0.003). Therefore, to achieve superior visual outcomes, early diagnosis and prompt treatment are necessary for patients with EFE.
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Affiliation(s)
- Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ming-Hui Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yen-Po Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Ophthalmology, Tucheng Municipal Hospital, New Taipei 236, Taiwan
| | - Yi-Hsing Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA;
| | - Laura Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - An-Ning Chao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
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15
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The Diagnosis and Treatment of Fungal Endophthalmitis: An Update. Diagnostics (Basel) 2022; 12:diagnostics12030679. [PMID: 35328231 PMCID: PMC8947249 DOI: 10.3390/diagnostics12030679] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/26/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
In recent, large case series of fungal endophthalmitis (FE) that were published by Asian authors, the most frequent etiologic agents for all types of FE are molds (usually Aspergillus species, while Fusarium is the prevalent etiology in keratitis-related FE). Candida was the organism found in most cases of endogenous FE. However, we must keep in mind that prevalence of fungal species varies with the geographical area. Lately, polymerase chain reaction (PCR) was increasingly used for the diagnosis of FE, allowing for very high diagnostic sensitivity, while the costs become more affordable with time. The most important shortcoming of PCR—the limited number of pathogens that can be simultaneously searched for—may be overcome by newer techniques, such as next-generation sequencing. There are even hopes of searching for genetic sequences that codify resistance to antifungals. We must not forget the potential of simpler tests (such as galactomannan and β-d-glucan) in orienting towards a diagnosis of FE. There are few reports about the use of newer antifungals in FE. Echinocandins have low penetration in the vitreous cavity, and may be of use in cases of fungal chorioretinitis (without vitritis), or injected intravitreally as an off-label, salvage therapy.
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Robbins CB, Feng HL, Zhang W, Fekrat S, Grewal DS. Mycobacterium chelonae Endogenous Endophthalmitis in a Person Addicted to Intravenous Drugs Presenting as an Intraretinal Peripapillary Granuloma With Tractional Retinal Detachment. JOURNAL OF VITREORETINAL DISEASES 2022; 6:151-154. [PMID: 37008669 PMCID: PMC9976012 DOI: 10.1177/24741264211018303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report a case of Mycobacterium chelonae endogenous endophthalmitis in a 28-year-old man with recent intravenous drug use that presented as an intraretinal peripapillary granuloma extending from the optic nerve head with an associated macular tractional retinal detachment. Methods: Case report. Results: Anterior chamber tap yielded aqueous cultures positive for M chelonae. A diagnostic and therapeutic vitrectomy was performed after inpatient hospitalization for 3 weeks to relieve a progressively worsening tractional retinal detachment. Conclusions: Atypical causes of endophthalmitis, including nontuberculous mycobacterium, in the population of individuals addicted to intravenous drugs may present with intraretinal peripapillary granuloma associated with a macular tractional retinal detachment. Surgical debulking to relieve anteroposterior traction is an effective treatment option to improve long-term visual outcomes.
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Affiliation(s)
- Cason B. Robbins
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
| | - Henry L. Feng
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
| | | | - Sharon Fekrat
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
| | - Dilraj S. Grewal
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
- Dilraj S. Grewal, MD, Department of Ophthalmology, Duke Eye Center, Duke University, 2351 Erwin Rd, Durham, NC 27710, USA.
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17
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Shivaji S, Jayasudha R, Prashanthi GS, Arunasri K, Das T. Fungi of the human eye: Culture to mycobiome. Exp Eye Res 2022; 217:108968. [PMID: 35120870 DOI: 10.1016/j.exer.2022.108968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 11/02/2021] [Accepted: 01/26/2022] [Indexed: 11/04/2022]
Abstract
The focus of the current review is multi-fold and compares the diversity and abundance of fungi on the ocular surface by the conventional culture-based method with the more sensitive, high throughput, culture-independent NGS method. The aim is to highlight the existence of a core ocular mycobiome and explore the transition of the ocular fungal microbiota from the normal eye to the diseased eye. PubMed, Google Scholar and Medline were used to search for publications and reviews related to cultivable fungi and the mycobiome of the normal and diseased eye. The conventional cultivable approach and the NGS approach confirm that the eye has its own mycobiome and several confounding factors (age, gender, ethnicity etc.) influence the mycobiome. Further, dysbiosis in the mycobiome appears to be associated with ocular diseases and thus impacts the health of the human eye. Considering that the mycobiome of the eye is influenced by several confounding factors and also varies with respect to the disease status of the eye there is a need to extensively explore the mycobiome under different physiological conditions, different ethnicities, geographical regions etc. Such studies would unravel the diversity and abundance of the mycobiomes and contribute to our understanding of ocular health. Research focused on ocular mycobiomes may eventually help to build a targeted and individualized treatment.
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Affiliation(s)
- Sisinthy Shivaji
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Rajagopalaboopathi Jayasudha
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Gumpili Sai Prashanthi
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Kotakonda Arunasri
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Taraprasad Das
- Srimati Kanuri Santhamma Centre for Vitreo Retinal Diseases, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
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Fungal Endophthalmitis: A Comprehensive Review. J Fungi (Basel) 2021; 7:jof7110996. [PMID: 34829283 PMCID: PMC8623405 DOI: 10.3390/jof7110996] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 12/27/2022] Open
Abstract
Endophthalmitis is a serious ophthalmologic condition involving purulent inflammation of the intraocular spaces. The underlying etiology of infectious endophthalmitis is typically bacterial or fungal. The mechanism of entry into the eye is either exogenous, involving seeding of an infectious source from outside the eye (e.g., trauma or surgical complications), or endogenous, involving transit of an infectious source to the eye via the bloodstream. The most common organism for fungal endophthalmitis is Candida albicans. The most common clinical manifestation of fungal endophthalmitis is vision loss, but other signs of inflammation and infection are frequently present. Fungal endophthalmitis is a clinical diagnosis, which can be supported by vitreous, aqueous, or blood cultures. Treatment involves systemic and intravitreal antifungal medications as well as possible pars plana vitrectomy. In this review, we examine these essential elements of understanding fungal endophthalmitis as a clinically relevant entity, which threatens patients’ vision.
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Desilets J, Lee CS, Fang W, Hinkle DM. Mortality risk associated with endophthalmitis in West Virginia. Int Ophthalmol 2021; 41:2887-2895. [PMID: 33861381 PMCID: PMC8422286 DOI: 10.1007/s10792-021-01849-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To explore how endophthalmitis presented from 2009 to 2019 in a West Virginia population particularly affected by the national opioid crisis. The analysis explores the relationship between the type of endophthalmitis and mortality, accounting for factors including age, gender, type of organism, and intravenous drug use (IVDU). METHODS The electronic health record of West Virginia University (WVU) Medicine was queried for all patients managed for endophthalmitis from October 2009 to October 2019. For each of the included subjects, age, gender, history of IVDU, culture results, concomitant endocarditis, type of endophthalmitis, and the date of diagnosis were extracted. Mortality data were obtained from WVU's electronic medical record, the Social Security Death Index, and public obituaries. Mortality results were represented by a Kaplan-Meier Survival curve following each patient for one year from the date of diagnosis. Results were analyzed using unadjusted and adjusted Cox Proportional Hazard models. RESULTS One-year mortality was 14 out of 113 endogenous cases (12.4%) compared to 6 out of 173 exogenous cases (3.5%). Endogenous endophthalmitis cases had significantly higher mortality than exogenous ones within one year of diagnosis (p = 0.0034). The unadjusted Cox proportional hazards model revealed that the type of endophthalmitis (endogenous vs. exogenous) was the only variable with a significant impact on 1-year mortality with a hazard ratio of 3.78 (p = 0.01). However, the hazard ratio for endogenous infections rose to 10.91 (CI 3.544-33.595) when the other variables of age, gender, organism, and IVDU were controlled (p < 0.01). The Cox proportional hazard ratios for age group, gender, organism type, and history of IVDU were not significantly different when adjusted for all other variables. CONCLUSION Endogenous cases, which were significantly overrepresented in West Virginia, were associated with a significantly higher 1-year mortality rate than the exogenous ones. Age, gender, organism type, and history of IVDU have less, if any, modifying effect on mortality.
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Affiliation(s)
| | - Chang Sup Lee
- WVU Eye Institute, 1 Medical Center Drive, Morgantown, WV, USA
| | - Wei Fang
- West Virginia Clinical and Translational Science Institute, WVU Health Sciences Center Erma Byrd Biomedical Research Center, 1 Medical Center Drive, Morgantown, WV, USA
| | - David M Hinkle
- WVU Eye Institute, 1 Medical Center Drive, Morgantown, WV, USA.
- Tulane University School of Medicine, 131 S. Robertson Street, 12th floor #8069, New Orleans, LA, 70112, USA.
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20
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Mir TA, Papudesu C, Fang W, Hinkle DM. Incidence of Drug Use-Related Endogenous Endophthalmitis Hospitalizations in the United States, 2003 to 2016. JAMA Ophthalmol 2021; 139:18-26. [PMID: 33151291 DOI: 10.1001/jamaophthalmol.2020.4741] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Complications arising from the nationwide opioid epidemic led to an increase in health care use. Few studies have investigated whether this is reflected in hospital admissions for endogenous endophthalmitis. Objective To report changing trends in epidemiology, risk factors, hospital course, and costs associated with drug use-related endogenous endophthalmitis hospitalizations in the United States from 2003 to 2016. Design, Setting, and Participants Nationwide, retrospective cross-sectional study using the National Inpatient Sample. A total of 56 839 patients admitted with a diagnosis of endogenous endophthalmitis were included. Data were analyzed between 2003 and 2016. Exposures Inpatient admission for endogenous endophthalmitis during the years 2003 to 2016. Main Outcomes and Measures The Nationwide Inpatient Sample was queried to identify all inpatient admissions with a diagnosis of endogenous endophthalmitis in the United States between the years 2003 and 2016. Analyses were performed to identify national and regional trends in incidence and prevalence of associated infectious and noninfectious comorbidities in patients with or without a history of drug dependence or use. Median and cumulative inflation-adjusted costs for admissions were calculated. Results Of all patients, 55.6% were White, 13.6% were Black, and 10.6% were Hispanic. There were an estimated 56 839 endogenous endophthalmitis-related hospitalizations; 13.7% of these patients (n = 7783) had a history of drug dependence or use. The drug-using population was significantly younger (49.6 vs 57.5 years; difference, 7.9; 95% CI, 6.93-8.88; P < .001) and more likely to be male (61.8% [n = 35 127] vs 49.0% [n = 21 712]; difference, 12.8%; 95% CI, 11.6%-14.0%; P < .001). The incidence of endogenous endophthalmitis associated with drug dependence or use increased from 0.08 per 100 000 in 2003 to 0.32 per 100 000 population in 2016 across all 4 US geographic regions. Conclusions and Relevance A 4-fold increase in drug use-related endogenous endophthalmitis hospitalizations was observed in the United States from 2003 to 2016, resulting in substantial health care use burden. These findings support the hypothesis that clinicians should maintain a high index of suspicion for endophthalmitis when evaluating patients with intraocular inflammation in the setting of drug dependence or use.
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Affiliation(s)
- Tahreem A Mir
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut.,West Virginia University School of Medicine, Morgantown
| | | | - Wei Fang
- West Virginia Clinical and Translational Science Institute, West Virginia University Health Sciences Center Erma Byrd Biomedical Research Center, Morgantown
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21
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Budoff G, Zarbin MA, Bhagat N. Endogenous Endophthalmitis in an Urban University Setting: Characteristics, Treatment, and Outcomes. JOURNAL OF VITREORETINAL DISEASES 2021; 5:135-141. [PMID: 37009077 PMCID: PMC9979060 DOI: 10.1177/2474126420951979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This work describes the characteristics, treatment, and outcomes of endogenous endophthalmitis (EE) cases over 13 years at a tertiary care hospital. Methods: This retrospective case series included EE cases from 2006 to 2018. Eyes were categorized by cultured organism and initial treatment status. Results: Forty-five eyes of 38 patients were identified with EE. Mean age was 48 ± 12 years and approximately three-fourths were male. Mean visual acuity (VA) at presentation was logMAR 1.86 ± 0.83. More than 50% of patients had a history of intravenous drug use. In a quarter of patients, no systemic source of infection was identified; 90% of these patients had a history of intravenous drug use. Bilateral infections occurred in 18% of participants. Of positive cultures, 29%, 56%, and 13% were fungal, gram-positive, and gram-negative in etiology, respectively. Eyes with fungal infections had a better presenting VA and were more likely to have better than 20/100 final VA vs those with bacterial infections. All patients received IV antibiotics; additionally 29% of eyes underwent initial combined pars plana vitrectomy with intravitreal antibiotic injection while 51% of eyes initially received bedside intravitreal antibiotic injection. There was no significant difference in final VA with respect to initial mode of treatment. Conclusions: Initial treatment of intravitreal antibiotics with or without pars plana vitrectomy did not show any difference in the average final VA in eyes with EE. Eyes with fungal infections had more favorable visual outcomes than those with bacterial infections. Almost 1 in 5 EE eyes were enucleated.
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Affiliation(s)
- Greg Budoff
- Institute of Ophthalmology and Visual Science, Rutgers–New Jersey Medical School, Newark, NJ, USA
- Stein Eye Institute, University of California, Los Angeles, CA, USA
| | - Marco A. Zarbin
- Institute of Ophthalmology and Visual Science, Rutgers–New Jersey Medical School, Newark, NJ, USA
| | - Neelakshi Bhagat
- Institute of Ophthalmology and Visual Science, Rutgers–New Jersey Medical School, Newark, NJ, USA
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Endogenous endophthalmitis in patients with intravenous opioid use: demographics and associated comorbidities. Int Ophthalmol 2021; 41:1513-1520. [PMID: 33506370 DOI: 10.1007/s10792-021-01709-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/09/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE To identify risk factors for endogenous endophthalmitis (EE) in hospitalized adults, under 65 years of age, with a history of intravenous opioid use and non-ocular infection. METHODS The National Inpatient Sample Database was used to identify cases of EE with a recent history of intravenous opioid use disorder with associated non-ocular infection. Systemic and ocular comorbidities were identified using codes from the International Classification of Diseases, Ninth Revision (ICD-9). Descriptive and regression analyses were performed to evaluate the risk factors for EE using IBM SPSS 23. RESULTS Of the 605,859 inpatients, 21-65 years age, who had a history of recent opioid-IVDU and an associated IVDU-associated systemic infection, 363 (0.1%) had EE. Systemic comorbidities such as diabetes mellitus, mitral valve disease, aortic valve disease, history of cardiac valve transplantation, chronic kidney disease/renal failure, cirrhosis, active or previous radiation therapy, and history of solid organ transplantation were significantly more prevalent in patients with EE. A significantly increased risk of EE in intravenous opioid users was noted if they were of male gender (OR = 1.84), Asian/Pacific Islander ethnicity (OR = 4.41), had history of cirrhosis (OR = 2.33), active or history of radiation therapy (OR = 14.74), history of solid organ transplantation (OR = 5.91), candidemia (OR = 15.22), and infectious endocarditis (OR = 4.83). Conversely, concurrent alcohol use disorder (OR = 0.35) decreased the risk of EE. CONCLUSION Various demographic variables and systemic comorbidities increased the risk of developing EE in inpatients with a history of intravenous opioid use with associated non-ocular infection.
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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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Danielescu C, Anton N, Stanca HT, Munteanu M. Endogenous Endophthalmitis: A Review of Case Series Published between 2011 and 2020. J Ophthalmol 2020; 2020:8869590. [PMID: 33149945 PMCID: PMC7603614 DOI: 10.1155/2020/8869590] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/13/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022] Open
Abstract
This is a literature review of 31 case series of endogenous endophthalmitis (EE) published in the last ten years, identified from a literature search of several databases (PubMed, EMBASE, and the Cochrane Library). While diabetes mellitus and malignancies remain the most frequently associated medical conditions, intravenous drug use is a significant risk factor (especially in the last years, in studies from Western countries). Ophthalmologic screening is recommended for candidaemia, but not in patients with sepsis of other aetiologies (however, the physician treating patients with sepsis must be well aware of EE). The most frequent Gram-positive microorganisms that cause EE are Staphylococcus and Streptococcus; the most frequent Gram-negative organism is Pseudomonas, and yeasts, probably Candida, usually cause fungal infections. In all-cause EE, prognostic factors of better visual outcomes are initial VA better than counting fingers, performing a pars plana vitrectomy (PPV), performing an intravitreal injection within the first 24 hours after clinical diagnosis, and the presence of a focal type of EE. In endogenous fungal endophthalmitis, more than 1/4 of patients have bilateral involvement. Blood samples have a low rate of positivity. Yeasts remain the most prevalent cause. Many authors report using azoles and echinocandins for systemic therapy (and voriconazole for intravitreal injections). Although PPV was performed in small proportions of eyes, the anatomical success rate is quite high. Klebsiella pneumoniae is an important cause of EE in Southeast Asia (and probably an emergent etiology in other regions), which is frequently associated with diabetes. There is a robust association with pyogenic liver abscess (PLA) (but in up to half of the cases, the diagnosis of EE precedes that of PLA). Blood cultures have a high diagnostic yield, while vitreous samples have a low yield. K. pneumoniae may carry antibiotic resistance. Anatomical and functional success rates are small, but they may be improved with PPV.
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Affiliation(s)
- Ciprian Danielescu
- Department of Ophthalmology, “Gr. T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Nicoleta Anton
- Department of Ophthalmology, “Gr. T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Horia Tudor Stanca
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Mihnea Munteanu
- Department of Ophthalmology, “Victor Babes” University of Medicine and Pharmacy, Timisoara 300041, Romania
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25
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Candida Infections in Immunocompetent Hosts: Pathogenesis and Diagnosis. CURRENT FUNGAL INFECTION REPORTS 2020. [DOI: 10.1007/s12281-020-00392-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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26
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Rammohan R, Suneetha V, Sen S, Rameshkumar G, Lalitha P. Fungal Infections of the Eye. CURRENT CLINICAL MICROBIOLOGY REPORTS 2020. [DOI: 10.1007/s40588-020-00142-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Endogenous endophthalmitis and other ocular manifestations of injection drug use. Curr Opin Ophthalmol 2019; 30:506-512. [PMID: 31589187 DOI: 10.1097/icu.0000000000000606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The United States has experienced a dramatic rise in opioid and injection drug use over the past 2 decades. A public health emergency was declared in 2017 and subsequently, there have been several new reports on the rise of endogenous endophthalmitis specifically associated with injection drug use. The purpose of this review is to provide a current perspective of the ocular harms posed by injection drug use. RECENT FINDINGS The opioid epidemic has prompted several new studies from New England, one of the US regions most heavily affected, that examine the trends and characteristics of injection drug use-associated endogenous endophthalmitis. Patients may delay seeking care and may be infected with a variety of rare and atypical microbes, and as a result clinical appearance may vary widely. Injection drug use also leads to embolic phenomena such as talc retinopathy and septic emboli from endocarditis. HIV is highly associated with injection drug use and although HAART has drastically reduced the morbidity and mortality of HIV-associated infections, a variety of ocular disease may accompany an immunocompromised patient. SUMMARY Healthcare providers must remain vigilant in the recognition of injection drug use patients with vision loss and ocular inflammation to ensure prompt medical and/or surgical treatment.
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Budoff G, Thangamathesvaran L, Zarbin MA, Bhagat N. Bacterial Endogenous Endophthalmitis in Bacteremic Inpatients. ACTA ACUST UNITED AC 2019; 3:971-978. [DOI: 10.1016/j.oret.2019.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 01/24/2023]
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Jenkins TL, Talcott KE, Matsunaga DR, Ryan ME, Obeid A, Chung CA, Garg SJ. Endogenous Bacterial Endophthalmitis: A Five-Year Retrospective Review at a Tertiary Care Academic Center. Ocul Immunol Inflamm 2019; 28:975-983. [DOI: 10.1080/09273948.2019.1642497] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Thomas L. Jenkins
- Ophthalmology, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Katherine E. Talcott
- Ophthalmology, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Douglas R. Matsunaga
- Ophthalmology, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Martha E. Ryan
- Ophthalmology, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Anthony Obeid
- Ophthalmology, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Christine A. Chung
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Sunir J. Garg
- Ophthalmology, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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30
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Modjtahedi BS, Finn AP, Barb SM, MacLachlan MJ, van Zyl T, Papakostas TD, Eliott D. Characteristics and Outcomes of Endogenous Endophthalmitis. ACTA ACUST UNITED AC 2019; 3:61-72. [DOI: 10.1016/j.oret.2018.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 08/18/2018] [Accepted: 08/29/2018] [Indexed: 12/28/2022]
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31
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Russell JF, Scott NL, Hinkle JW, Yannuzzi NA, Miller D, Relhan N, Flynn HW. Endogenous Endophthalmitis: Has the Opioid Crisis Impacted the Rates and Severity of Intravenous Drug-Related Cases? ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2474126418788498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Endogenous endophthalmitis is an intraocular infection associated with systemic illness and/or intravenous drug use (IVDU). Rising national rates of IVDU may have impacted rates and outcomes of endogenous endophthalmitis. The purpose of the current study is to compare rates and treatment outcomes in endogenous endophthalmitis with and without a history of IVDU. Methods: This is a single-center retrospective consecutive case series of 21 eyes of 17 patients with a diagnosis of endogenous endophthalmitis from May 2014 to December 2016. Clinical characteristics and treatment outcomes were compared between IVDU and non-IVDU groups. Results: A history of IVDU was present in 3 of 17 patients (18%), whereas the other 82% had systemic comorbidities. There was no statistically significant difference in presenting visual acuity (VA) between the IVDU and non-IVDU groups (20/630 vs 20/500, P = .75). Pars plana vitrectomy was performed at some point in the clinical course of 80% of eyes (4/5) in the IVDU group and 56% of eyes (9/16) in the non-IVDU group. Staphylococcus or Candida were the predominant causative organisms isolated in the IVDU and non-IVDU groups. Statistical analyses revealed trends towards worse last VA in the non-IVDU group compared with the IVDU group (20/1000 vs 20/110, P = .10). Conclusions: Compared with historical data from the same institution, there has not been an increase in the rates of IVDU-associated endogenous endophthalmitis at this tertiary referral center. VA outcomes are often poor in both groups, but there may be a better prognosis for IVDU-associated endogenous endophthalmitis.
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Affiliation(s)
- Jonathan F. Russell
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Nathan L. Scott
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - John W. Hinkle
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Nicolas A. Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Darlene Miller
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Harry W. Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
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Relhan N, Forster RK, Flynn HW. Endophthalmitis: Then and Now. Am J Ophthalmol 2018; 187:xx-xxvii. [PMID: 29217351 PMCID: PMC5873969 DOI: 10.1016/j.ajo.2017.11.021] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE To report historically evolving strategies (then and now) in prevention and management of endophthalmitis. DESIGN A perspective on relevant topics in the prophylaxis and management of endophthalmitis. METHODS This is an author-selected review of studies leading to changes in strategies for endophthalmitis management over the last 100 years. RESULTS The current perspective discusses the trends and strategies over the past century. Historically, 3 endophthalmitis time-periods have existed and include the pre-antimicrobial era, the predominantly systemic antimicrobial era, and the current intravitreal antimicrobial era. The management of endophthalmitis from different etiologies, including endogenous, postinjection, post-cataract surgery, and other anterior segment-related (eg, post-penetrating keratoplasty), bleb-associated, glaucoma drainage device-associated, and open globe injury-associated, are discussed. Specific etiologies may predict most common microbial causes and may guide differing management strategies. Pars plana vitrectomy offers theoretical advantages but is generally reserved for patients with more advanced disease. CONCLUSIONS Despite advances over the past 100 years, endophthalmitis is an important sight-threatening complication. Timely management with the appropriate use of antimicrobial agents may optimize visual outcomes.
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Affiliation(s)
- Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Richard K Forster
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Fliney GD, Pecen PE, Cathcart JN, Palestine AG. Trends in treatment strategies for suspected bacterial endophthalmitis. Graefes Arch Clin Exp Ophthalmol 2018; 256:833-838. [DOI: 10.1007/s00417-018-3910-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/07/2017] [Accepted: 01/12/2018] [Indexed: 01/28/2023] Open
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