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Cioana M, Naidu S, Far PM, Yeung SC, You Y, Yan P. POSTINTRAVITREAL INJECTION AND POSTCATARACT EXTRACTION ENDOPHTHALMITIS VISUAL OUTCOMES BY ORGANISM: A SYSTEMATIC REVIEW AND META-ANALYSIS. Retina 2024; 44:1608-1618. [PMID: 39167582 DOI: 10.1097/iae.0000000000004143] [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: 08/23/2024]
Abstract
PURPOSE To compare visual outcomes of endophthalmitis following intravitreal injections (IVIs) and cataract extraction by causative organism. METHODS Searches in Cochrane Central Register of Controlled Trials, MEDLINE, and Embase identified articles reporting visual outcomes by causative organisms in post-IVI and cataract extraction endophthalmitis cases from January 2010 to February 2022. A random-effects meta-analysis compared visual improvement among endophthalmitis cases caused by causative organisms. RESULTS Eighty-five out of 3,317 retrieved studies were included. The highest degree of visual acuity improvement in both post-IVI and postcataract extraction endophthalmitis was seen in cases caused by coagulase-negative staphylococci, followed by gram-negative organisms and other gram-positive organisms such as streptococci and enterococci. Culture-negative cases showed more visual acuity improvement than culture-positive cases in post-IVI endophthalmitis. These results remained consistent when accounting for endophthalmitis treatment, IVI type, condition requiring IVI treatment, follow-up period, and initial preprocedural visual acuity. CONCLUSION Coagulase-negative staphylococci and gram-negative organisms show the most visual acuity improvement in both post-IVI and postcataract extraction endophthalmitis. Other gram-positive organisms such as streptococci and enterococci are associated with less visual improvement. This updated systematic review and meta-analysis revealed that the results of the Endophthalmitis Vitrectomy Study are consistent decades later despite advancements in surgical practices and the evolution of microorganisms over time.
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Affiliation(s)
- Milena Cioana
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sumana Naidu
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Parsa M Far
- Department of Ophthalmology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shanna C Yeung
- Department of Ophthalmology and Vision Sciences, the University of British Columbia, Vancouver, British Columbia, Canada
| | - Yuyi You
- Save Sight Institute, the University of Sydney, Sydney, Australia
- Department of Clinical Medicine, Macquarie University, Sydney, Australia
| | - Peng Yan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
- Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada ; and
- Kensington Vision and Research Center, Toronto, Ontario, Canada
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Eichenbaum DA, Freeman WR, Chang MA, Brooks L, Chaudhry N, Dadgostar H, McCannel CA, Michels M, Mittra RA, Wolfe JD, Beindl VC, Jaycock P, Bobbala A, Gune S, Spicer G, Callaway N. Endophthalmitis in Eyes Treated With the Port Delivery System With Ranibizumab: Summary of Cases During Clinical Trial Development. Ophthalmol Retina 2024:S2468-6530(24)00368-3. [PMID: 39154860 DOI: 10.1016/j.oret.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 08/09/2024] [Accepted: 08/09/2024] [Indexed: 08/20/2024]
Abstract
PURPOSE The Port Delivery System with ranibizumab (PDS) is approved in the United States for neovascular age-related macular degeneration. The US Prescribing Information has a Boxed Warning for endophthalmitis and reports the incidence rate in patients developing endophthalmitis after receiving the PDS compared to monthly intravitreal ranibizumab. Endophthalmitis cases noted in the Boxed Warning, treatment outcomes, potential contributing factors, and potential mitigations are summarized. DESIGN Retrospective review of endophthalmitis cases in PDS-treated patients in the phase 2 Ladder (NCT02510794) and phase 3 Archway (NCT03677934) and Portal (NCT03683251) trials. PARTICIPANTS Endophthalmitis cases in the pooled all-PDS safety population (N = 555) including PDS patients in Ladder, Archway, or Portal. METHODS Ladder patients received PDS (10, 40, or 100 mg/mL) with pro re nata refill-exchanges. Archway patients received PDS 100 mg/mL with fixed refill-exchanges every 24 weeks (PDS Q24W). Portal patients received PDS Q24W from day 1. MAIN OUTCOME MEASURES Clinical features, management, and visual outcomes were summarized. Cases were summarized by date of PDS implant and/or refill, other prior invasive procedures/refills, and preceding/concurrent conjunctival complications. RESULTS Twelve endophthalmitis events were reported in 11 patients (11/555 [2.0%]) through March 12, 2021. All were cultured (3 were culture positive) and treated with intravitreal antibiotics. Two cases (2/555 [0.4%]) occurred in the immediate postoperative period (days 5 and 6). Nine cases occurred later (day range: 57-853), including 4 before the first refill-exchange (day range: 57-161). Five patients received between 1-11 refill-exchanges before the event (onset: 6-168 days after last refill-exchange). Seven cases (7/11 [63.6%]) had preceding/concurrent conjunctival complications. At last follow-up, 7 patients recovered vision to study baseline levels or ≥ 20/40; 4 patients experienced vision loss of ≥ 15 ETDRS letters. CONCLUSIONS Endophthalmitis is a serious complication that can endanger vision after any ocular procedure, including PDS implantation. This limited series of endophthalmitis cases notes most, but not all, cases were late onset, associated with conjunctival breach, and recovered vision with treatment. Meticulous attention to PDS surgical techniques with vigilant monitoring of conjunctiva during follow-up may minimize risk of endophthalmitis. Prompt treatment is critical for optimizing patient outcomes.
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Affiliation(s)
- David A Eichenbaum
- Retina Vitreous Associates of Florida, St Petersburg, Florida; Morsani College of Medicine, University of South Florida, Tampa, Florida.
| | - William R Freeman
- Department of Ophthalmology, Jacobs Retina Center at Shiley Eye Institute, University of California San Diego, La Jolla, California
| | | | - Logan Brooks
- Southern Vitreoretinal Associates, Tallahassee, Florida
| | - Nauman Chaudhry
- Retina Group of New England, Yale University School of Medicine, New Haven, Connecticut
| | | | - Colin A McCannel
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, California
| | - Mark Michels
- Retina Care Specialists, PLLC, Palm Beach Gardens, Florida
| | | | - Jeremy D Wolfe
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | | | | | | | - Shamika Gune
- Genentech, Inc., South San Francisco, California
| | - Galin Spicer
- Genentech, Inc., South San Francisco, California
| | - Natalia Callaway
- Genentech, Inc., South San Francisco, California; Stanford University Byers Eye Institute, Palo Alto, California
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Ting MYL, Pocobelli G, Butu DM, Mandal N, Nicholson L, Khan SR. Incidence and outcomes of post-operative endophthalmitis following elective phacoemulsification cataract surgery, between 2015 and 2022. Eye (Lond) 2024:10.1038/s41433-024-03281-0. [PMID: 39068247 DOI: 10.1038/s41433-024-03281-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 12/16/2023] [Accepted: 07/22/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Cataract surgery remains the commonest ophthalmic surgical procedure in the UK. Post-operative endophthalmitis (POE) is a sight-threatening complication. This study presents the incidence and outcomes of POE within Moorfields Eye Hospital NHS Foundation Trust (MEH) in London, UK. METHODS We conducted a retrospective, tertiary-centre study of the incidence and outcomes of POE following elective phacoemulsification cataract surgery between 2015 and 2022. RESULTS We report a rate of 18 out of 154 826 (0.012%) cases of POE within seven weeks of cataract surgery. The age range was 43-87 years (mean age 67.1 years), and the male-to-female ratio was 1:1. Two cases were associated with intraoperative vitreous loss, one with anterior capsular tear extending to posterior capsular tear and the other with posterior capsular tear and dropped fragment. Two cases had a concomitant intravitreal injection, one of Triamcinolone Acetonide and the other of Dexamethasone implant (Ozurdex®), to manage chronic uveitic macular oedema. The majority of samples (89.9%) resulted in Gram-positive species. A final best corrected visual acuity (BCVA) of Snellen 6/36 or better was achieved in 12/18 (66.67%). The time from cataract surgery to suspicion of POE ranged from 3 to 44 days (mean 15.8 days). Eight cases (44.4%) required pars plana vitrectomy (PPV). CONCLUSIONS We demonstrate an incidence of POE of 0.012% following phacoemulsification at MEH from January 2015 to December 2022. Such results are a testament to high-quality surgery, training supervision and post-operative care whilst adhering to local and international standards.
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Affiliation(s)
- Magdalene Y L Ting
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
| | - Giulio Pocobelli
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
- Ophthalmology Unit, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Via Cracovia, 50, Rome, Italy
| | - Diana M Butu
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
| | - Nakul Mandal
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
| | - Luke Nicholson
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
| | - Sharmina R Khan
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK.
- Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK.
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Zhao WF, He W, Han QH, Qi SX. Visual outcome of 25 Gauge vitrectomy for acute post operative infectious endophthalmitis. Technol Health Care 2024; 32:1099-1110. [PMID: 37840508 DOI: 10.3233/thc-230607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND The correlation between the change in foveal thickness measured using optical coherence tomography (OCT) following surgery for infectious endophthalmitis and preoperative and postoperative visual acuity is uncertain, and there are few pertinent studies on this topic. OBJECTIVE We explored the variations in macular thickness using OCT after emergency vitrectomy for post-cataract infectious endophthalmitis and the relationship between macular thickness with changes in visual function. METHODS We included 10 cases of post-cataract infectious endophthalmitis. Each patient underwent 25-G vitrectomy. RESULTS The infection in all 10 patients was under control and visual function improved. Postoperative vitreous humor culture was positive in 8 patients, including 7 cases of coagulase-negative Staphylococcus epidermidis and 1 case of Lactobacillus acidophilus. The average age of these 10 patients was 71.60 ± 8.71 years (P< 0.05, two-tailed). There was no significant correlation between time 2 (the time of onset after cataract surgery) and visual prognosis. The average time 1 (the time of the vitrification surgery caused by the onset of the disease) was 1.45 ± 0.76 days (P< 0.05, two-tailed). The postoperative 3dVA ranged from 0.20 to 3.00, with an average visual acuity of 1.87 ± 1.12, which was superior to the preoperative value (P< 0.01, two-tailed). The correlation between the post3dVA and post 1mVA was significant. The post 1mVA ranged from 0.05 to 2.20, with an average visual acuity of 0.94 ± 0.74 (P< 0.05, two-tailed). The correlation between post 1mVA and post3mVA was significant. Also, paired t-tests comparing preoperative and postoperative visual acuity revealed a significant correlation (P< 0.05, two-tailed). The post3mVA was 0-1.00 with an average visual acuity of 0.44 ± 0.41. The postoperative foveal thickness ranged from 176.00 to 514.00 μm, with an average thickness of 281.10 ± 113.12 μm. CONCLUSION Emergency 25-G minimally invasive vitrectomy can improve visual acuity and decrease the reoperation rate for patients who have acquired post-cataract infectious endophthalmitis. There were significant correlations between age, disease onset to operation time, preoperative and postoperative visual acuity, and postoperative macular thickness.
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Affiliation(s)
- Wei-Feng Zhao
- Department of Ophthalmology, Baodi Clinical College, Tianjin Medical University, Tianjin, China
- Department of Ophthalmology, Baodi Clinical College, Tianjin Medical University, Tianjin, China
| | - Wei He
- Department of Ophthalmology, Baodi Clinical College, Tianjin Medical University, Tianjin, China
- Department of Ophthalmology, Baodi Clinical College, Tianjin Medical University, Tianjin, China
| | - Quan-Hong Han
- Vitreous Retinal Branch, Tianjin Eye Hospital, Tianjin, China
| | - Shi-Xin Qi
- Department of Ophthalmology, Baodi Clinical College, Tianjin Medical University, Tianjin, China
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Kvopka M, Chan W, Baranage D, Sia D. Morganella morganii and Enterococcus faecalis endophthalmitis following intravitreal injection. BMC Ophthalmol 2023; 23:450. [PMID: 37950172 PMCID: PMC10638747 DOI: 10.1186/s12886-023-03198-4] [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: 01/07/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Endophthalmitis following intravitreal injection is a potentially devastating complication of anti-VEGF injections. Post-injection endophthalmitis due to Enterococcus faecalis is rare, and no previous case of Morganella morganii endophthalmitis after intravitreal injection has been reported. CASE PRESENTATION We present the first reported case of Morganella morganii and Enterococcus faecalis endophthalmitis after intravitreal injection in an immunocompetent patient in the absence of recent ocular surgery. Our patient presented with hand movement visual acuity one day after anti-VEGF injection and demonstrated no clinical improvement despite repeated intravitreal ceftazidime and vancomycin injections. A decision was made to proceed with early vitrectomy given failure of intravitreal antibiotics. Visual acuity improved to 6/90 at 12 weeks after vitrectomy without any evidence of disease recurrence. CONCLUSIONS Post-injection endophthalmitis due to concurrent Morganella morganii and Enterococcus faecalis infections can have visually devastating consequences despite repeated empirical and targeted intravitreal antibiotics. Lack of clinical improvement following intravitreal antibiotics should warrant consideration of early vitrectomy. Our experience is a pertinent reminder of the ever-growing threat of uncommon and multi-resistant bacteria that must be considered when treating infections such as post-injection endophthalmitis.
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Affiliation(s)
- Michael Kvopka
- Department of Ophthalmology, The Royal Adelaide Hospital, Port Road, 5000, Adelaide, SA, Australia.
| | - WengOnn Chan
- Department of Ophthalmology, The Royal Adelaide Hospital, Port Road, 5000, Adelaide, SA, Australia
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia
| | - Duleepa Baranage
- Department of Ophthalmology, The Royal Adelaide Hospital, Port Road, 5000, Adelaide, SA, Australia
| | - David Sia
- Department of Ophthalmology, The Royal Adelaide Hospital, Port Road, 5000, Adelaide, SA, Australia
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia
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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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Bergamo VC, Nakayama LF, Moraes NSBD, Yu MCZ, Höfling-Lima AL, Maia M. Bacterial endophthalmitis following anti-VEGF intravitreal injections: a retrospective case series. Int J Retina Vitreous 2023; 9:58. [PMID: 37752604 PMCID: PMC10521422 DOI: 10.1186/s40942-023-00490-9] [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: 06/22/2023] [Accepted: 08/14/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND To describe the incidence of endophthalmitis and the treatment outcomes of acute bacterial endophthalmitis following intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in a Brazilian hospital. The analysis was based on the timing of infection after intravitreal injection, culture results, visual acuity, and the presence of epiretinal membrane after a 1-year follow-up period, spanning nine years. METHODS This retrospective case series, conducted over a 9-year period, aimed to evaluate the treatment outcomes of acute endophthalmitis following intravitreal Bevacizumab injections. The inclusion criteria involved a chart review of 25 patients who presented clinical signs of acute endophthalmitis out of a total of 12,441 injections administered between January 2011 and December 2019. Negative culture results of vitreous samples or incomplete data were excluded. Ultimately, 23 patients were enrolled in the study. Eight patients were treated with intravitreal antibiotic injections (IVAI) using vancomycin 1.0 mg/0.05mL and ceftazidime 2.25 mg/0.05mL, while 15 patients underwent pars plana vitrectomy (PPV) followed by intravitreal antibiotic injections at the end of surgery (IVAIES). The main outcome measures were the efficacy of controlling the infection with IVAI as a standalone therapy compared to early PPV followed by IVAIES. Data collected included pre-infection and one-year post-treatment best corrected visual acuity (BCVA), optical coherence tomography (OCT) abnormalities, and enucleation/evisceration rates. To compare groups, Mann-Whitney and ANOVA tests were employed for statistical analysis. RESULTS The incidence rate of bacterial endophthalmitis was 0.185% (1/541 anti-VEGF injections), with the highest infection rates observed in 2014 and 2017. Patients presented clinical symptoms between 2 and 7 days after injection. The most common isolated organisms were coagulase-negative Staphylococci and Streptococci spp. Treatment outcomes showed that both IVAI and PPV + IVAIES effectively controlled the infection and prevented globe atrophy. After one year, the PPV group with BCVA better than Light Perception had a significantly better BCVA compared to the IVAI group (p 0.003). However, PPV group had higher incidence of epiretinal membranes formation compared to the IVAI group. (P 0.035) CONCLUSION: Anti-VEGF injections carry a risk of developing acute bacterial endophthalmitis. Isolated antibiotic therapy could be an effective treatment to control the infection, but performing PPV + IVAIES as a primary treatment showed promising results in terms of improving BCVA after one year, despite a higher rate of epiretinal membrane formation. Further studies are needed to confirm these findings.
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Affiliation(s)
- Vinicius Campos Bergamo
- Retina Division, Department of Ophthalmology, Escola Paulista de Medicina, Federal University of São Paulo, 806, Botucatu Street, São Paulo, 04026-062, Brazil
| | - Luis Filipe Nakayama
- Retina Division, Department of Ophthalmology, Escola Paulista de Medicina, Federal University of São Paulo, 806, Botucatu Street, São Paulo, 04026-062, Brazil
- Laboratory for Computational Physiology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Nilva Simeren Bueno De Moraes
- Retina Division, Department of Ophthalmology, Escola Paulista de Medicina, Federal University of São Paulo, 806, Botucatu Street, São Paulo, 04026-062, Brazil
| | - Maria Cecília Zorat Yu
- Laboratory of Ocular Microbiology, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Ana Luiza Höfling-Lima
- Cornea and External Diseases Division, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Maurício Maia
- Retina Division, Department of Ophthalmology, Escola Paulista de Medicina, Federal University of São Paulo, 806, Botucatu Street, São Paulo, 04026-062, Brazil.
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Iu LPL, Chan HY, Li GKH, Ho M, Mak ACY, Wong PPY, Kam KW, Chen LJ, Brelen M, Young AL. Acute postoperative endophthalmitis after cataract operation: result of early vitrectomy within 24 hours of presentation. Eye (Lond) 2023; 37:2344-2350. [PMID: 36513854 PMCID: PMC10366129 DOI: 10.1038/s41433-022-02347-1] [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: 04/04/2022] [Revised: 11/10/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To evaluate result of early pars plana vitrectomy (PPV) within 24 hours of presentation for acute postoperative endophthalmitis after cataract operation, and to determine factors that predict visual outcome. METHODS Consecutive patients who developed acute postoperative endophthalmitis within 6 weeks after cataract operation were reviewed. Patients were divided into two groups for analysis: (1) those receiving PPV within 24 hours of presentation (early PPV group), and (2) those receiving initial intravitreal antibiotics only without PPV within 24 hours of presentation (IVA group). RESULTS Out of 41,411 cataract operations, 22 eyes developed acute postoperative endophthalmitis. Presenting VA was hand-movement or worse in 72.7%. The most common organisms were Staphylococcus (40.9%), Streptococcus (13.6%) and Enterococcus (13.6%). 22.7% of eyes had good final VA ≥ 20/30 and 27.3% had poor final VA < 20/400. Early PPV group had significantly lower rate of requiring additional treatments to control infection (25% versus 80%, P = 0.030), higher rate of retinal detachment (25% versus 0%, P = 0.221) and similar final logMAR VA (1.08 ± 1.08 versus 0.80 ± 0.80, P = 0.489) compared to IVA. Multivariate linear regression analysis showed that worse final VA was significantly associated with Streptococcus (ß = 1.92, P = 0.007) and retinal detachment (ß = 1.72, P = 0.005) but not with early PPV (P = 0.225). CONCLUSION Early PPV was superior to initial intravitreal antibiotics alone as it required fewer additional treatments to control infection. Visual outcome was similar between early PPV and initial intravitreal antibiotics alone despite high number of poor presenting VA of light-perception in early PPV group. Streptococcal infection and retinal detachment were major poor prognostic factors for vision.
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Affiliation(s)
- Lawrence Pui Leung Iu
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
| | - Ho Yan Chan
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Gabriel Ka Hin Li
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Mary Ho
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Andrew Chun Yue Mak
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Posey Po Yin Wong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Marten Brelen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Alvin Lerrmann Young
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
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Yang Y, Wong Y, Li Y, Duan F, Ma X, Wong H, Sun R, Zeng J, Liu M, Yuan Z, Lin X. Clinical Features, Antibiotic Susceptibilities, and Outcomes of Endophthalmitis Caused by Streptococcal Infection: Children vs. Adults. Antibiotics (Basel) 2023; 12:962. [PMID: 37370281 DOI: 10.3390/antibiotics12060962] [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: 04/27/2023] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Streptococcus spp. are common causative organisms of endophthalmitis. Analysis of the clinical features, antibiotic susceptibilities, and outcomes of streptococcal endophthalmitis in children and adults may guide future management. Sixty-seven patients (67 eyes) with streptococcal endophthalmitis who were admitted to the Zhongshan Ophthalmic Center between January 2013 and December 2022 were retrospectively reviewed. The mean age was 20.7 ± 21.6 years, and 59.7% were children. Streptococcal infection accounted for 13.9% of culture-proven bacterial endophthalmitis cases; the proportion was higher in children than in adults (32.3% vs. 7.6%, p < 0.01) and increased from 8.1% in 2013-2017 to 20.1% in 2018-2022 (p < 0.01). Eye trauma was the most common etiology in both children and adults (82.5% and 66.7%, respectively). Viridans group streptococci were the most common isolates, followed by S. pneumoniae. The susceptibility rates of the streptococci to vancomycin, cefuroxime, and levofloxacin were 100%, 95.5%, and 93.0%, respectively. The overall mean best-corrected visual acuity increased from 2.74 ± 0.19 logMAR initially to 2.32 ± 0.75 logMAR at the last follow-up (p < 0.05). In conclusion, streptococcal infections have increased in cases of bacterial endophthalmitis in recent years and are more common in children. The commonly used antibiotics, vancomycin, cefuroxime, and fluoroquinolone, showed higher antibiotic susceptibility. After prompt treatment, visual outcomes improved.
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Affiliation(s)
- Yao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Yuenying Wong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Yujie Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Fang Duan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xinqi Ma
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Hiufong Wong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Rongsha Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Jieting Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Manli Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Zhaohui Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xiaofeng Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
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10
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Yuan Y, Liu X, Zhou L, Ding W, Zhang L, Zheng J. Case report: A case of acute postoperative endophthalmitis following penetrating keratoplasty due to carbapenem-resistant Klebsiella Pneumoniae and literature review. Front Med (Lausanne) 2023; 10:1110411. [PMID: 37265480 PMCID: PMC10229784 DOI: 10.3389/fmed.2023.1110411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/04/2023] [Indexed: 06/03/2023] Open
Abstract
A 22-year-old lady underwent penetrating keratoplasty for serious keratoconus. The following day, it was complicated by the development of infectious endophthalmitis. The source of infection was identified as carbapenem-resistant Klebsiella pneumoniae. The donor corneal button might be playing a role in infection transmission due to carbapenem-resistant Klebsiella pneumoniae in a sputum culture when the donor was still alive. Nosocomial infections were typically severe, rapidly progressive, and difficult to treat. Finally, the patient underwent therapeutic penetrating keratoplasty again with complete resolution of the infection.
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Affiliation(s)
- Ying Yuan
- Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
- School of Clinical Medical, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Xiaoyuan Liu
- Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
- School of Clinical Medical, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Li Zhou
- Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
- School of Clinical Medical, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Wuchun Ding
- Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
- School of Clinical Medical, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Liying Zhang
- Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
- School of Clinical Medical, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Jinhua Zheng
- Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
- School of Clinical Medical, Guizhou Medical University, Guiyang, Guizhou Province, China
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11
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Levin HJ, Mehta MS, Storey PP, Patel SN, Kuley B, Wibbelsman TD, Obeid A, Garg S, Vander J, Dunn JP, Ho AC. Endophthalmitis following cataract surgery: visual outcomes, microbial spectrum and complications. Curr Opin Ophthalmol 2023; 34:237-242. [PMID: 36943680 DOI: 10.1097/icu.0000000000000951] [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: 03/23/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to update visual outcomes, microbial spectrum and complications in eyes with endophthalmitis following cataract surgery. RECENT FINDINGS A single-institution, retrospective review of eyes treated for endophthalmitis following cataract surgery between 2 January 2014 and 10 January 2017. This study included 112 cases of endophthalmitis following cataract surgery, 58 of which were culture-positive (51.8%). The most isolated organisms were coagulase-negative Staphylococci (56.9%). Oral flora were present in 17.2% of cases. At 6 months, 71.7% of patients achieved visual acuity of at least 20/200 and 51.7% achieved at least 20/40 or better. Visual acuity was better in culture-negative vs. culture-positive cases (∼20/290 vs. ∼20/80, P = 0.03), and in nonoral flora-associated vs. oral flora-associated culture-positive cases (∼CF vs. ∼20/150, P < 0.01). SUMMARY Following postcataract surgery endophthalmitis, approximately 70% of eyes achieved vision of 20/200 or better and half achieved vision of 20/40 or better 6 months after treatment. Poor visual outcomes were seen in eyes with positive bacterial cultures and with oral flora.
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Affiliation(s)
- Hannah J Levin
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Maitri S Mehta
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
- Department of Ophthalmology, Emory University, Atlanta, Georgia
| | - Philip P Storey
- Austin Retina Associates, University of Texas Dell Medical School, Austin, Texas, USA
| | - Samir N Patel
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Brandon Kuley
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Turner D Wibbelsman
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Anthony Obeid
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sunir Garg
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - James Vander
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - James P Dunn
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Allen C Ho
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
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12
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Ting MYL, Kim SE, Anguita R. Endophthalmitis in Silicone Oil-Filled Eyes. Antibiotics (Basel) 2023; 12:antibiotics12040736. [PMID: 37107098 PMCID: PMC10135016 DOI: 10.3390/antibiotics12040736] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/03/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023] Open
Abstract
Incidences of post pars plana vitrectomy (PPV) endophthalmitis vary between 0.02% and 0.13%, and infectious endophthalmitis in silicone oil-filled eyes is even rarer. We performed a literature review to describe the incidence, protective and predisposing factors, causative pathogens, management options, and prognosis of infectious endophthalmitis in silicone oil-filled eyes. Various studies have elucidated different aspects of this condition. Causative pathogens commonly include commensals. Traditional management involves the removal of silicone oil (SO), intravitreal antibiotics and then SO re-injection. Alternatively, injecting intravitreal antibiotics into silicone oil-filled eyes has also been reported. Visual prognoses are uniformly guarded. Due to the uncommon nature of this condition, studies are limited either by their retrospective design or by small sample sizes. However, observational studies, case series, and case reports can play an important role in rare conditions until larger studies are conducted. This comprehensive review aims to summarise the information available in the literature, to act as a good source for ophthalmologists looking for answers on this topic, and to suggest areas for future development.
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Affiliation(s)
| | - Soyang Ella Kim
- Moorfields Eye Hospital NHS Foundation Trust, City Road, London EC1V 2PD, UK
| | - Rodrigo Anguita
- Moorfields Eye Hospital NHS Foundation Trust, City Road, London EC1V 2PD, UK
- Department of Ophthalmology, Inselspital, University Hospital of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
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13
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Han H, Li S, Xu M, Zhong Y, Fan W, Xu J, Zhou T, Ji J, Ye J, Yao K. Polymer- and lipid-based nanocarriers for ocular drug delivery: Current status and future perspectives. Adv Drug Deliv Rev 2023; 196:114770. [PMID: 36894134 DOI: 10.1016/j.addr.2023.114770] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/21/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
Ocular diseases seriously affect patients' vision and life quality, with a global morbidity of over 43 million blindness. However, efficient drug delivery to treat ocular diseases, particularly intraocular disorders, remains a huge challenge due to multiple ocular barriers that significantly affect the ultimate therapeutic efficacy of drugs. Recent advances in nanocarrier technology offer a promising opportunity to overcome these barriers by providing enhanced penetration, increased retention, improved solubility, reduced toxicity, prolonged release, and targeted delivery of the loaded drug to the eyes. This review primarily provides an overview of the progress and contemporary applications of nanocarriers, mainly polymer- and lipid-based nanocarriers, in treating various eye diseases, highlighting their value in achieving efficient ocular drug delivery. Additionally, the review covers the ocular barriers and administration routes, as well as the prospective future developments and challenges in the field of nanocarriers for treating ocular diseases.
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Affiliation(s)
- Haijie Han
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China; Zhejiang Provincial Key Lab of Ophthalmology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Su Li
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Mingyu Xu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Yueyang Zhong
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China; Zhejiang Provincial Key Lab of Ophthalmology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Wenjie Fan
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Jingwei Xu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China; Zhejiang Provincial Key Lab of Ophthalmology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Tinglian Zhou
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Jian Ji
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Juan Ye
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China; Zhejiang Provincial Key Lab of Ophthalmology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China.
| | - Ke Yao
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China; Zhejiang Provincial Key Lab of Ophthalmology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China.
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14
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Tan CL, Sheorey H, Allen PJ, Dawkins RCH. Endophthalmitis: Microbiology and Organism Identification Using Current and Emerging Techniques. Ocul Immunol Inflamm 2023; 31:393-401. [PMID: 35201917 DOI: 10.1080/09273948.2022.2027468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Endophthalmitis is an ophthalmological emergency requiring timely and appropriate diagnosis and treatment. Microbiological methods of microscopy (Gram's staining) and culture are the current gold standard for organism identification. However, a significant proportion of endophthalmitis remains culture-negative-perhaps the inflammation is non-infectious in origin, results from a novel organism are unidentifiable or because the causative organism is non-culturable often due to pre-treatment with antibiotics. This review outlines the microbiological profile of endophthalmitis, current clinically used methods for organism identification, and the newer molecular techniques of polymerase chain reaction (PCR) and next-generation sequencing (NGS) technology as diagnostic tools for endophthalmitis. They offer the potential to improve organism identification rates and clinical outcomes in infectious diseases, representing an exciting future direction for organism identification in endophthalmitis. Based on the largest ophthalmic hospital in Australia, we highlight the key practical challenges faced by Australian diagnostic laboratories for their use in a clinical setting.
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Affiliation(s)
- Christine L Tan
- Macular Research Unit, Centre for Eye Research Australia, East Melbourne, Australia.,Department of Ophthalmology, The University of Melbourne, Parkville, Australia
| | - Harsha Sheorey
- Department of Microbiology, St Vincent's Hospital, Fitzroy, Australia
| | - Penelope J Allen
- Macular Research Unit, Centre for Eye Research Australia, East Melbourne, Australia.,Department of Ophthalmology, The University of Melbourne, Parkville, Australia.,Vitreo-retinal Unit, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Rosie C H Dawkins
- Macular Research Unit, Centre for Eye Research Australia, East Melbourne, Australia.,Department of Ophthalmology, The University of Melbourne, Parkville, Australia.,Vitreo-retinal Unit, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
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15
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Blom K, Jørstad ØK, Faber RT, Stene-Johansen I, Holberg-Petersen M, Hermansen NO, Bragadóttir R. Primary vitrectomy or intravitreal antibiotics followed by early vitrectomy for acute endophthalmitis: A prospective observational study. Acta Ophthalmol 2023; 101:100-108. [PMID: 35751448 PMCID: PMC10084037 DOI: 10.1111/aos.15207] [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: 02/10/2022] [Revised: 03/30/2022] [Accepted: 06/05/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND/AIMS To compare outcomes of acute endophthalmitis (EO) managed with either primary vitrectomy (PV) or primary intravitreal antibiotics (vancomycin and ceftazidime) followed by early vitrectomy (PIAEV) combined with polymerase chain reaction (PCR)-based diagnostics. METHODS This was a prospective, comparative observational study of acute EO cases admitted to a regional vitreoretinal service over 18 months. Depending on whether immediate vitrectomy (within 6 h) was achievable, the EO cases were treated with either (1) PV or (2) PIAEV. Microbiology samples were collected either (A) before or (B) after administration of intravitreal antibiotics. The samples were analysed with broad-range 16S PCR and culture. RESULTS The study included 41 EO cases. There were 19 post-injection EO, 18 post-cataract EO, three post-vitrectomy EO, and one blebitis-related EO. Fifteen of 19 PV cases and 15 of 21 PIAEV had a clinically meaningful improvement in best-corrected visual acuity (BCVA) of at least 15 letters at 3 months (p = 0.58). One patient was lost to follow-up. Twenty-three cases were culture- and PCR-positive, and seven additional cases were culture-negative but PCR-positive (p = 0.02). PCR increased the diagnostic yield for samples collected both before and after administration of intravitreal antibiotics. CONCLUSION Primary vitrectomy or PIAEV allowed for vitrectomy for all cases of acute EO in a large region. Most eyes in both groups achieved a clinically meaningful improvement in BCVA. By combining culture with PCR in connection with the vitrectomy procedure, intravitreal antibiotics could be injected before microbiological sampling, thereby improving the door-to-treatment time without sacrificing microbial identification.
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Affiliation(s)
- Kathrine Blom
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | - Ragnheiður Bragadóttir
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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16
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Muqit MM, Mehat M, Bunce C, Bainbridge JW. Early vitrectomy for exogenous endophthalmitis following surgery. Cochrane Database Syst Rev 2022; 11:CD013760. [PMID: 36398614 PMCID: PMC9672977 DOI: 10.1002/14651858.cd013760.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Endophthalmitis is a sight-threatening emergency that requires prompt diagnosis and treatment. The condition is characterised by purulent inflammation of the intraocular fluids caused by an infective agent. In exogenous endophthalmitis, the infective agent is foreign and typically introduced into the eye through intraocular surgery or open globe trauma. OBJECTIVES To assess the potential role of combined pars plana vitrectomy and intravitreal antibiotics in the acute management of exogenous endophthalmitis, versus the standard of care, defined as vitreous tap and intravitreal antibiotics. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 5); Ovid MEDLINE; Ovid Embase; the International Standard Randomised Controlled Trial Number registry; ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. There were no restrictions to language or year of publication. The date of the search was 5 May 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared pars plana vitrectomy and intravitreal injection of antibiotics versus intravitreal injection of antibiotics alone, for the immediate management of exogenous endophthalmitis. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane. Two review authors independently screened search results and extracted data. We considered the following outcomes: visual acuity improvement and change in visual acuity at three and six months; additional surgical procedures, including vitrectomy and cataract surgery, at any time during follow-up; quality of life and adverse effects. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We identified a single RCT that met our inclusion criteria. The included RCT enrolled a total of 420 participants with clinical evidence of endophthalmitis, within six weeks of cataract surgery or secondary intraocular lens implantation. Participants were randomly assigned according to a 2 x 2 factorial design to either treatment with vitrectomy (VIT) or vitreous tap biopsy (TAP) and to treatment with or without systemic antibiotics. Twenty-four participants did not have a final follow-up: 12 died, five withdrew consent to be followed up, and seven were not willing to return for the visit. The study did not report visual acuity according to the review's predefined outcomes. At three months, 41% of all participants achieved 20/40 or better visual acuity and 69% had 20/100 or better acuity. The study authors reported that there was no statistically significant difference in visual acuity between treatment groups (very low-certainty evidence). There was low-certainty evidence of a similar requirement for additional surgical procedures (risk ratio RR 0.90, 95% confidence interval 0.66 to 1.21). Adverse effects included: VIT group: dislocated intraocular lens (n = 2), macular infarction (n = 1). TAP group: expulsive haemorrhage (n = 1). Quality of life and mean change in visual acuity were not reported. AUTHORS' CONCLUSIONS: We identified a single RCT (published 27 years ago) for the role of early vitrectomy in exogenous endophthalmitis, which suggests that there may be no difference between groups (VIT vs TAP) for visual acuity at three or nine months' follow-up. We are of the opinion that there is a clear need for more randomised studies comparing the role of primary vitrectomy in exogenous endophthalmitis. Moreover, since the original RCT study, there have been incremental changes in the surgical techniques with which vitrectomy is performed. Such advances are likely to influence the outcome of early vitrectomy in exogenous endophthalmitis.
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Affiliation(s)
| | | | - Catey Bunce
- The Royal Marsden NHS Foundation Trust, London, UK
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17
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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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18
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Chen KJ, Sun MH, Tsai ASH, Sun CC, Wu WC, Lai CC. Staphylococcus lugdunensis Endophthalmitis: Case Series and Literature Review. Antibiotics (Basel) 2022; 11:1485. [PMID: 36358140 PMCID: PMC9686588 DOI: 10.3390/antibiotics11111485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 10/27/2023] Open
Abstract
Staphylococcus lugdunensis endophthalmitis is an uncommon intraocular infection with potentially visually devastating consequences. S. lugdunensis endophthalmitis have been reported following cataract surgery, trauma, intravitreal injections of anti-vascular endothelial growth factor agents and dexamethasone implant. We report four cases of postoperative S. lugdunensis endophthalmitis after cataract extraction (three patients) and combined pars plana vitrectomy and cataract extraction (one patient). The onset of presentation of endophthalmitis was acute (within 2 weeks) in two patients, subacute (2 to 6 weeks) in one patient, and chronic (more than 6 weeks) in one patient. All patients had presenting visual acuity (VA) of hand motions or worse and were treated with pars plana vitrectomy with intravitreal antibiotics. The final VA was 20/50 in two patients, 4/200 in one patient with pre-existing myopic maculopathy, and no light perception in one patient with retinal detachment. In antibiotic susceptibility testing, S. lugdunensis isolates were resistant to penicillin (3/4, 75%), but all were susceptible to vancomycin, oxacillin, teicoplanin, tigecycline, and sulfamethoxazole-trimethoprim. S. lugdunensis may be associated with acute or chronic endophthalmitis. Favorable visual outcomes can be achieved with prompt diagnosis and management.
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Affiliation(s)
- Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou branch, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ming-Hui Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou branch, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | | | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou branch, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou branch, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou branch, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
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19
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Sinisi F, Della Santina M, Loiudice P, Figus M, Casini G. The Role of Silicone Oil in the Surgical Management of Endophthalmitis: A Systematic Review. J Clin Med 2022; 11:jcm11185445. [PMID: 36143089 PMCID: PMC9505397 DOI: 10.3390/jcm11185445] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
(1) Background: We aimed to systematically review the current literature to evaluate if in patients with postoperative endophthalmitis treated with pars plana vitrectomy, silicone oil tamponade could provide a useful contribution to the control and eradication of infection and if it could influence anatomical recovery and functional outcome. (2) Randomized controlled trials, cross-sectional studies, case series, and case reports published in the English language in peer-reviewed journals were included. No restriction was placed based on the study location. We used medical subject headings (MeSH) and text words. We searched MEDLINE (OVID and PubMed), Google Scholar, ISI Web of Science (Thom-on-Reuters), and the Cochrane Library (Wiley) from January 1995 to the present. To ensure literature saturation, we scanned the reference lists of included studies or relevant reviews identified through the search. Risk of Bias was assessed using the Newcastle-Ottawa scale for longitudinal studies and Cochrane risk-of-bias tool for randomized trials. (3) Results: abstracts of 75 articles were selected for full-text reading; after full-text reading, 44 articles were taken into consideration in the systematic review. 5 out of 7 in vitro experimental studies demonstrated antimicrobial activity against different species of bacteria and fungi. The use of SO as endotamponade associated with PPV led to better visual acuity and a lower rate of retinal detachment and the need for additional surgery. (4) Conclusions: Silicone oil reduces the risk of postoperative retinal detachment, especially in case of undetected retinal breaks, produces compartmentalization of the eye, may lead to early visual recovery, allows laser photocoagulation, prevents severe postoperative hypotony and has antimicrobic activity due to an inhibitory effect for several species of pathogens. Concerns regarding possible toxic effects on the retina and optic disc, compartmentalization and impaired washout of pathogen toxins have been reported. It may also influence intravitreal antibiotic distribution and clearance.
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Affiliation(s)
- Fabrizio Sinisi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Marco Della Santina
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Pasquale Loiudice
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
- Complex Operative Ophthalmology Unit, “F. Lotti” Hospital, 56025 Pontedera, Italy
- Correspondence:
| | - Michele Figus
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Giamberto Casini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
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20
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Zhang WF, Zhao XY, Meng LH, Chen H, Chen YX. Endophthalmitis at a tertiary referral center: Characteristics and treatment outcomes over three decades. Front Cell Dev Biol 2022; 10:952375. [PMID: 36003150 PMCID: PMC9395169 DOI: 10.3389/fcell.2022.952375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose: To explore the incidence, pathogens, treatment, and prognosis of endophthalmitis. Methods: Patients who were diagnosed with endophthalmitis from January 1990 to October 2020 at Peking Union Medical College Hospital were retrospectively reviewed and examined. Subgroup analysis was conducted regarding different initial treatment methods for eyes without concurrent retinal detachment (RD) at presentation. Results: A total of 249 eyes of 233 patients were included in this retrospective study. The most common clinical scenario was exogenous endophthalmitis (60.6%). The most frequent bacteria and fungi were coagulase-negative staphylococci (10.0%) and candida (6.8%), respectively. Retinal with/without choroid detachment was the most common complication after treatment. Patients with endogenous endophthalmitis were more likely to have binocular involvement; there were also more patients with diabetes mellitus or immunosuppressive diseases, and the prognosis of visual acuity (VA) was poorer. There were more eyes with concurrent RD at presentation that underwent serious complications after treatment (p < 0.05), and the visual outcome was worse than that without concurrent RD (p < 0.05). Subgroup analysis was conducted according to different initial treatments in eyes without concurrent RD. Group 1 received pars plana vitrectomy (PPV) with intravitreal injection of antibiotics (IVI) as initial treatment, Group 2 was initially treated with IVI only, and Group 3 was initially treated with nonsurgical treatment. More eyes that initially received IVI alone and nonsurgical treatment required additional treatments, especially additional PPV. VA in both Groups 1 and 2 significantly improved by the final VA. However, there was no significant difference in final VA between the two groups. There was an insignificant trend that serious posttreatment complications were more common in Group 1. In Group 1, 17 eyes received silicone oil or gas tamponade at the same time, whereas 62 did not. Eyes that were initially treated with PPV + IVI while without tamponade needed more additional treatments and additional IVI. Conclusion: Endophthalmitis is a devastating intraocular disease and requires early intervention. Endogenous endophthalmitis has a poorer visual prognosis than exogenous entity. PPV + IVI as an initial treatment may reduce additional therapy.
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Affiliation(s)
- Wen-Fei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin-Yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Li-Hui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huan Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - You-Xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- *Correspondence: You-Xin Chen, ,
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21
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Wu XN, Chen YH, Sharief L, Al-Janabi A, Al Qassimi N, Lightman S, Tomkins-Netzer O. Emerging Antibiotic Resistance Patterns Affect Visual Outcome Treating Acute Endophthalmitis. Antibiotics (Basel) 2022; 11:antibiotics11070843. [PMID: 35884097 PMCID: PMC9311540 DOI: 10.3390/antibiotics11070843] [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: 04/25/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Examining the effect of antibiotic resistance, use of intravitreal antibiotics and systemic corticosteroids on visual outcome of eyes with acute endophthalmitis. Methods: We included 226 eyes with acute endophthalmitis, treated using a standardized protocol. Visual outcome up to 12 months was assessed related to biopsy results, antibiotics resistance and treatment regimens. Results: Vitreous biopsies were more likely to be culture-positive (41.1%) than anterior chamber biopsies (21.6%, p < 0.0001). Antibiotic resistance for amikacin was found in 19 eyes (24.7%), vancomycin in 29 eyes (31.5%) and moxiflocacin in 14 eyes (16.1%). At presentation 91.53% of eyes had BCVA < 20/40, reducing by 1 month to 69.94% (p < 0.0001) and remaining stable at 12 months. There was no difference in visual outcome for those receiving early systemic corticosteroids. Endophthalmitis following cataract surgery (OR 1.66, 1.04−2.66 95% CI, p = 0.03) and receiving intravitreal vancomycin (OR 3.15, 1.18−8.42 95% CI, p = 0.02) were associated with a greater chance of final BCVA ≥ 20/40. Conclusion: Using vitreous taps with intravitreal antibiotics, despite an increase in resistance to both vancomycin and moxifloxacin, results in a final BCVA > 20/200 in half of eyes and ≥20/40 in a third. Early treatment with intravitreal antibiotics should not be delayed.
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Affiliation(s)
- Xia-Ni Wu
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK; (X.-N.W.); (Y.-H.C.); (L.S.); (A.A.-J.); (N.A.Q.); (S.L.)
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK
| | - Yi-Hsing Chen
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK; (X.-N.W.); (Y.-H.C.); (L.S.); (A.A.-J.); (N.A.Q.); (S.L.)
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 10507, Taiwan
| | - Lazha Sharief
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK; (X.-N.W.); (Y.-H.C.); (L.S.); (A.A.-J.); (N.A.Q.); (S.L.)
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK
| | - Ahmed Al-Janabi
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK; (X.-N.W.); (Y.-H.C.); (L.S.); (A.A.-J.); (N.A.Q.); (S.L.)
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK
| | - Nura Al Qassimi
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK; (X.-N.W.); (Y.-H.C.); (L.S.); (A.A.-J.); (N.A.Q.); (S.L.)
| | - Sue Lightman
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK; (X.-N.W.); (Y.-H.C.); (L.S.); (A.A.-J.); (N.A.Q.); (S.L.)
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK
| | - Oren Tomkins-Netzer
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK; (X.-N.W.); (Y.-H.C.); (L.S.); (A.A.-J.); (N.A.Q.); (S.L.)
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Ruth and Bruch Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3200003, Israel
- Correspondence:
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22
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Lv F, Wang H, Zhang D, Wu S. Clinical Characteristics, Treatment, and Visual Prognosis in Pediatric Endophthalmitis: A 232-Case Retrospective Study. Appl Bionics Biomech 2022; 2022:8523747. [PMID: 38469036 PMCID: PMC10927339 DOI: 10.1155/2022/8523747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 09/02/2023] Open
Abstract
Objective In infective endophthalmitis, once the patient's vision is seriously damaged, the damage to children's vision is particularly serious. The main purpose of this study is to investigate the etiology, epidemiology, treatment, and visual prognosis of children's endophthalmitis and to conduct an in-depth analysis. Study Design. This study collected case data from the Beijing Tongren Hospital Capital Medical University in the period from January 1, 2002 to January 1, 2018. The basic conditions for inclusion in the collection range were patients who were less than or equal to 14 years old and had a history of infectious endophthalmitis. A retrospective study and analysis of etiology, epidemiology, treatment, and visual prognosis were performed. Kappa and Chi square test were used for statistical analysis. Results A total of 232 cases were collected, with an average age of 6.33 ± 2.89 years (range 8months to 14 years). The most common etiologies were ocular trauma (93.5%) and previous ocular surgery (5.2%). Overall, 81 samples were sent to the microbiology department for direct smear and culture, from which 21 organisms were isolated. 28 cases (39.5%) were culture-positive. The most organism was Gram-positive organisms. In treatment, the proportion of PPV use combined with silicone oil filling had increased gradually in three phases, while the other treatments were almost decreased or nearly similar. The final visual result is 22 (9.5) in 20/200 or better, 65 (28.0) in CF-20/200, 38 (16.4) in hand move (HM), 27 (11.6) in light perception (LP), 21 (9.1) in no light perception (NLP), and 59 (25.4) did not match (NM). Conclusion Penetrating ocular trauma is the most common cause of infectious endophthalmitis in children. The detection rate of microorganisms is low and helpless for the treatment. In this study, it was found that despite the aggressive treatments such as antibacterial and vitrectomy, the ultimate improvement in vision was highly undesirable.
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Affiliation(s)
- Fantao Lv
- Department of Ophthalmology, Beijing Luhe Hospital Capital Medical University, Beijing 101199, China
| | - Haiyan Wang
- Department of Ophthalmology, Beijing Luhe Hospital Capital Medical University, Beijing 101199, China
| | - Dawei Zhang
- Department of Ophthalmology, Beijing Luhe Hospital Capital Medical University, Beijing 101199, China
| | - Shengwei Wu
- Department of Ophthalmology, Beijing Luhe Hospital Capital Medical University, Beijing 101199, China
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23
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Wang CT, Chang YH, Chen KJ, Chou HD. Postvitrectomy endophthalmitis caused by Morganella morganii: a case report and literature review. BMC Infect Dis 2022; 22:265. [PMID: 35303817 PMCID: PMC8932139 DOI: 10.1186/s12879-022-07248-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Postvitrectomy endophthalmitis is a rare and serious complication following vitreoretinal surgeries. Morganella morganii, an emerging gram-negative, facultative anaerobic rod, is related to severe nosocomial infections in various organs and thus has gained importance in recent decades. Morganella morganii infection following intraocular surgery is rarely reported.
Case presentation We report an immunocompetent patient with Morganella morganii-related endophthalmitis after vitrectomy for retinal detachment who presented with hand motion visual acuity, hypopyon and a unique retrolental exudative membrane. Initially, the patient was unresponsive to empirical intravitreal ceftazidime and vancomycin but recovered with vision preservation (20/63) after surgical removal of the membrane and silicone oil tamponade. Conclusions Morganella morganii intraocular infection is often devastating, likely due to its high multidrug-resistance rate via intrinsic ß-lactamase production, multiple acquired traits related to additional genetic mechanisms, and fimbrial adhesion, urease production, and type III secretion system-associated biofilm formation. The above characteristics of M. morganii may lead to an inadequate response to empirical intravitreal antibiotics, and early surgical intervention should be considered.
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Affiliation(s)
- Chung-Ting Wang
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Yin-Hsi Chang
- 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 City, Taiwan
| | - Kuan-Jen Chen
- 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 City, Taiwan
| | - Hung-Da 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 City, Taiwan.
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24
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Sousa DC, Jalil A, Patton N, Dhawahir-Scala F, Kim J, Charles S, Turner G, Ivanova T. Early Pars Plana Vitrectomy in Acute Endophthalmitis: The Manchester Series. Ophthalmic Surg Lasers Imaging Retina 2022; 53:96-102. [PMID: 35148220 DOI: 10.3928/23258160-20220121-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Current literature lacks good-quality evidence regarding the outcomes of early pars plana vitrectomy (PPV) for acute exogenous endophthalmitis. The aim for this study was to analyze and discuss the outcomes of PPV for endophthalmitis in a UK tertiary hospital. PATIENTS AND METHODS This study was a retrospective case series. The clinical records of consecutive patients who had PPV for acute exogenous endophthalmitis were reviewed. Demographic data, etiology, timing of onset, timing of PPV, intraand postoperative complications, baseline and final best-corrected visual acuity (BCVA), therapeutic regimens, and microbiology details were collected. Primary efficacy and safety outcome measures were BCVA improvement of two or more logMAR lines and intra- or postoperative complications, respectively. RESULTS Forty-one patients with a median age of 76 (interquartile range, 64 to 82) years were studied. The most common etiology was intravitreal injection (41%), followed by phacoemulsification (34%). Median interval to PPV was 1.0 (interquartile range, 1.0 to 3.0) days. In a multivariate model controlling for age, baseline BCVA, microbiology positivity, and etiology (post-intravitreal injection), PPV after 24 hours was seven times more likely to achieve significant BCVA improvement (odds ratio, 7.47; 95% confidence interval, 1.12 to 49.66; P = .038). PPV within 24 hours of presentation was associated with more intraoperative complications. CONCLUSIONS Favorable outcomes may be achieved with current antibiotic regimens and PPV for endophthalmitis. The series suggests that an early surgical intervention may be associated with poorer functional outcomes. Tap and inject at presentation, followed by a semi-urgent PPV as required, seems to be a sensible approach. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:96-102.].
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25
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Baba R, Umazume K, Koike N, Goto H. Study of the Correlation Between Severity of Endophthalmitis and Posterior Vitreous Detachment Using a Rabbit Endophthalmitis Model. Invest Ophthalmol Vis Sci 2022; 63:6. [PMID: 35103754 PMCID: PMC8819486 DOI: 10.1167/iovs.63.2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We have reported that the absence of posterior vitreous detachment (PVD) is related to the onset and severity of infectious endophthalmitis, based on clinical experience. To demonstrate clinical findings in animal models, we created endophthalmitis models for the presence or absence of PVD and examined differences in severity. Method We estimated a rabbit infectious eye model with and without PVD using Pseudomonas aeruginosa (PVD(+) and PVD(-) groups). After injection of bacteria inoculation for 3, 6, 12, and 24 hours, we evaluated the clinical score of the anterior chamber (n = 14). Removing the vitreous and retina from the enucleated eyeballs, the number of bacteria was counted using each specimen (n = 12). In addition, the number of inflammatory cells approximately 3 mm2 around the optic disc and histopathologic grading of intraocular inflammation was compared from histopathologic images (n = 7). Electroretinogram (ERG) was performed in experimentally infected rabbit eyes in both groups at three times after injection of the bacterial suspension. Results There was no difference between the two groups in the clinical score of the anterior chamber of each time phase, but the bacterial cultures showed significantly fewer bacteria in the PVD(-) group 24 hours after bacterial inoculation (P < 0.05). Furthermore, the number of inflammatory cells was significantly less in the PVD group (P < 0.05). As a result of ERG, the decreases of a- and b-waves in amplitude were significantly greater in the PVD(-) group than in the PVD(+) group. Conclusions The present study confirms using animal models that the absence of PVD contributed to the severity of bacterial endophthalmitis.
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Affiliation(s)
- Ryo Baba
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Kazuhiko Umazume
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Naohito Koike
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
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26
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Tabatabaei SA, Aminzade S, Ahmadraji A, Soleimani M, Sefidan BB, Kasaee A, Cheraqpour K. Early and complete vitrectomy versus tap and inject in acute post cataract surgery endophthalmitis presenting with hand motion vision; a quasi-experimental study. BMC Ophthalmol 2022; 22:16. [PMID: 34998363 PMCID: PMC8742950 DOI: 10.1186/s12886-022-02247-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Based on endophthalmitis vitrectomy study, intravitreal injection of antibiotics is preferred for initial management of cases of acute post cataract surgery endophthalmitis (APCE) with presenting vision of hand motions (HM). This study aimed to compare outcomes of early and complete vitrectomy (VIT) and vitreous tap and antibiotic injection (T&I) in cases of APCE presented with vision of HM. METHODS In this prospective study, cases of APCE with vision of HM between 2018 and 2020 were enrolled. According to the time of presentation, the patients were arranged into two groups (VIT vs. T&I). Demographic data, elapsed time to developing endophthalmitis, past medical history, microbiology results, complications, and final visual acuity were recorded and analyzed. RESULTS Seventy-six eyes of 76 patients were enrolled. Fifty-three eyes underwent T&I and twenty-three were arranged into the VIT group. Past medical history of 34.2% of patients was significant for diabetes mellitus. There was a statistically significant lower logMAR in VIT group compared to T&I group (diff = 0.14, 95% CI: 0.04 to 0.24, P-value = 0.007). The comparison of the diabetic and non-diabetic patients in both groups showed that the visual outcome was better in non-diabetic cases compared to the diabetic subjects. There was no statistically significant difference between the diabetic and non-diabetic groups regarding the superiority of procedure. CONCLUSION Based on our results, we could recommend that it's maybe better to do early and complete vitrectomy as the initial management of APCE with the vision of HM. Past medical history of diabetes mellitus is not a determining factor for choosing initial management between vitrectomy and antibiotic injection.
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Affiliation(s)
- Seyed Ali Tabatabaei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Soran Aminzade
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Aliasghar Ahmadraji
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Mohammad Soleimani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Bahram Bohrani Sefidan
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Abolfazl Kasaee
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran.
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27
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Placide J, Ip CS, Le BHA, Ali SF, Ghergherehchi LM. An Update on the Management of Traumatic Pediatric Open Globe Repair: Prognostication and Complication Management. Int Ophthalmol Clin 2022; 62:203-218. [PMID: 34965235 DOI: 10.1097/iio.0000000000000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Shao EH, Yates WB, Ho IV, Chang AA, Simunovic MP. Endophthalmitis: Changes in Presentation, Management and the Role of Early Vitrectomy. Ophthalmol Ther 2021; 10:877-890. [PMID: 34694563 PMCID: PMC8589908 DOI: 10.1007/s40123-021-00406-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/29/2021] [Indexed: 11/25/2022] Open
Abstract
Endophthalmitis is a sight-threatening condition, and its timely and appropriate management is essential in preventing permanent vision loss. Recent changes in clinical practice in endophthalmitis and advances in modern vitreoretinal surgery may limit the applicability of established randomised clinical trial evidence to current management. This review discusses the epidemiology, pathophysiology, changing patient presentation, diagnosis and advances in the management of endophthalmitis, presenting the existing literature on this topic and results from Sydney Eye Hospital.
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Affiliation(s)
- Emily H Shao
- Retinal Unit, Sydney Eye Hospital, 8 Macquarie St., Sydney, NSW, 2000, Australia.,Save Sight Institute, Sydney Eye Hospital, University of Sydney, South Block, Sydney, NSW, 2006, Australia
| | - William B Yates
- Retinal Unit, Sydney Eye Hospital, 8 Macquarie St., Sydney, NSW, 2000, Australia.,Save Sight Institute, Sydney Eye Hospital, University of Sydney, South Block, Sydney, NSW, 2006, Australia
| | - I-Van Ho
- Retinal Unit, Sydney Eye Hospital, 8 Macquarie St., Sydney, NSW, 2000, Australia
| | - Andrew A Chang
- Retinal Unit, Sydney Eye Hospital, 8 Macquarie St., Sydney, NSW, 2000, Australia.,Save Sight Institute, Sydney Eye Hospital, University of Sydney, South Block, Sydney, NSW, 2006, Australia
| | - Matthew P Simunovic
- Retinal Unit, Sydney Eye Hospital, 8 Macquarie St., Sydney, NSW, 2000, Australia. .,Save Sight Institute, Sydney Eye Hospital, University of Sydney, South Block, Sydney, NSW, 2006, Australia.
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29
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Brotherton T, Nwankwo E, Das D, Fritz A. Endogenous endophthalmitis due to methicillin-resistant Staphylococcus aureus bacteremia in a patient with COVID-19. Proc AMIA Symp 2021; 35:197-198. [DOI: 10.1080/08998280.2021.1990823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Tim Brotherton
- Department of Internal Medicine, Saint Louis University Hospital, Saint Louis, Missouri
| | - Eugene Nwankwo
- Department of Internal Medicine, Saint Louis University Hospital, Saint Louis, Missouri
| | - Debapria Das
- Department of Cardiology, Saint Louis University Hospital, Saint Louis, Missouri
| | - Adam Fritz
- Department of Internal Medicine, Saint Louis University Hospital, Saint Louis, Missouri
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30
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Endophthalmitis following Intravitreal Injection, Cataract Surgery, and Vitrectomy: Clinical Features and Visual Outcomes. J Ophthalmol 2021; 2021:9985821. [PMID: 34589235 PMCID: PMC8476286 DOI: 10.1155/2021/9985821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe and compare the clinical features and visual outcomes of endophthalmitis following intravitreal injections (IVI), cataract surgery, and pars plana vitrectomy (PPV). Methods This is a single-centre, retrospective study. All included patients had acute postoperative endophthalmitis secondary to one of these three procedures. Visual acuity (VA), comorbidities, time to presentation, and treatment were assessed. The primary outcome was visual outcome. A poor outcome was considered if final VA was worse than or equal to counting fingers (CF) and a good outcome was classified as VA better than CF. Results Over 12 years, a total of 61 patients were included. Twenty-seven cases were post-cataract endophthalmitis; twenty-five were post-IVI and nine post-PPV. Endophthalmitis post-PPV had a worse visual outcome (88.9% of patients with VA worse than or equal to CF 95% CI 51.3 to 100.0%) than endophthalmitis following cataract surgery (25.9% of patients with VA worse than or equal to CF 95% CI 11.0 to 39.9%) and the IVI subgroup (44.0% of VA worse than or equal to CF 95% CI 24.0 to 67.0%) (p=0.001 and p=0.047). There were no significant differences in the proportion of patients with a poor visual outcome between endophthalmitis following cataract surgery and IVI (p=0.171). Conclusions The number of patients with poor visual outcomes following acute endophthalmitis was similar in endophthalmitis following IVI and cataract surgery, but better than endophthalmitis following vitrectomy.
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31
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Assembly of Two New Coordination Polymers: Luminescent Properties and Application Values on Postoperative Infectious Endophthalmitis. J Inorg Organomet Polym Mater 2021. [DOI: 10.1007/s10904-021-02107-w] [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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32
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Spelta S, Di Zazzo A, Antonini M, Bonini S, Coassin M. Does Endogenous Endophthalmitis Need a More Aggressive Treatment? Ocul Immunol Inflamm 2021; 29:937-943. [PMID: 31951759 DOI: 10.1080/09273948.2019.1705497] [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] [Indexed: 12/22/2022]
Abstract
Topic: To focus on endogenous endophthalmitis management, particularly etiology-based medical and surgical therapy.Methods: Literature search of published studies from July 1990 to February 2019 on endogenous endophthalmitis available on PubMed was made without any language constraints.Results: A total of 78 articles were retrieved from 728 initially analyzed and 62 studies were included. Although the superiority of vitrectomy over tap and inject techniques is controversial, the most recent publications favor an early surgical approach for endogenous endophthalmitis. Vitrectomy is useful in severe cases complicated by marked vitreous opacity, retinal detachment, poor initial visual acuity, and more virulent pathogens. Oral or intravenous antibiotics are also necessary to treat systemic infection. Vitrectomy is superior to blood cultures in diagnosing the etiology of infection.Conclusions: Endogenous endophthalmitis is an important cause of visual acuity impairment. Prompt treatment with appropriate use of pharmacological or surgical therapy is mandatory to preserve visual function.Abbreviations: IOP: intra-ocular pressure; AIDS: acquired immune deficiency syndrome; EVS: endophthalmitis vitrectomy study; CEVE: complete and early vitrectomy for endophthalmitis.
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Affiliation(s)
- Sara Spelta
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Antonio Di Zazzo
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Marco Antonini
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Stefano Bonini
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Marco Coassin
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
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Wang T, Moinuddin O, Abuzaitoun R, Hwang M, Besirli C, Wubben TJ, Zacks DN. Retinal Detachment After Endophthalmitis: Risk Factors and Outcomes. Clin Ophthalmol 2021; 15:1529-1537. [PMID: 33880012 PMCID: PMC8053519 DOI: 10.2147/opth.s302757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/09/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze the risk factors, clinical course, and visual and anatomic outcomes of retinal detachment (RD) after endophthalmitis. Patients and Methods This retrospective study included 108 patients diagnosed with endophthalmitis between August 2014 and May 2019 at a single tertiary referral center. Sixteen patients developed RD after endophthalmitis. Retrospective analysis was performed to compare the cohort of endophthalmitis alone versus the cohort that developed RD after endophthalmitis, with analysis of potential risk factors for RD after endophthalmitis and treatment outcomes. Results The incidence of RD after endophthalmitis was 14.8% (N=16/108). The median time to develop RD after endophthalmitis was 27 days (range: 1-581 days, IQR: 25.3). Thirteen (81.3%) cases of RD occurred less than 2 months after the diagnosis of endophthalmitis. The incidence of aphakia (p=0.023) and posterior synechia (PS) (p=0.014) were significantly higher in the RD group. The mean initial and final visual acuity (VA) of the endophthalmitis alone group was 1.9±0.8 logMAR and 1.2±1.0 logMAR (p<0.0001), respectively, and 1.9±0.9 logMAR and 1.3±1.2 logMAR (p=0.07) in the RD group, respectively. Enucleation or evisceration occurred in 31.3% of cases with RD after endophthalmitis. The rate of final retinal re-apposition for the RD cohort was 56.3%. Conclusion The anatomic and functional outcomes for RD after endophthalmitis remain poor, with significant risk for permanent vision loss. Aphakia and posterior synechiae were seen more often in cases with RD after endophthalmitis.
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Affiliation(s)
- Tiantian Wang
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI, USA.,Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Omar Moinuddin
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI, USA
| | - Rebhi Abuzaitoun
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI, USA
| | - Min Hwang
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI, USA
| | - Cagri Besirli
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI, USA
| | - Thomas J Wubben
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI, USA
| | - David N Zacks
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI, USA
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Sepetis AE, Clarke B, Gupta B. Bilateral endophthalmitis following bilateral same-day anti-VEGF injections. Acta Ophthalmol 2021; 99:e131-e133. [PMID: 32533656 DOI: 10.1111/aos.14504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/18/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Anastasios E. Sepetis
- Department of Ophthalmology University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Benjamin Clarke
- Department of Ophthalmology University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Bhaskar Gupta
- Department of Ophthalmology University Hospital Southampton NHS Foundation Trust Southampton UK
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Cardoso JF, Perasoli FB, Almeida TC, Marques MBDF, Toledo CR, Gil PO, Tavares HDS, Da Paz MC, Mussel WDN, Magalhães JT, Silva GND, Da Silva-Cunha A, Granjeiro PA, Klibanov AM, Da Silva GR. Vancomycin-loaded N,N-dodecyl,methyl-polyethylenimine nanoparticles coated with hyaluronic acid to treat bacterial endophthalmitis: Development, characterization, and ocular biocompatibility. Int J Biol Macromol 2020; 169:330-341. [PMID: 33310092 DOI: 10.1016/j.ijbiomac.2020.12.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 02/08/2023]
Abstract
Vancomycin-loaded N,N-dodecyl,methyl-polyethylenimine nanoparticles coated with hyaluronic acid (VCM-DMPEI nanoparticles/HA) were synthesized as an adjuvant for the treatment of bacterial endophthalmitis. The nanoparticles were formulated by experimental statistical design, thoroughly characterized, and evaluated in terms of bactericidal activity and both in vitro and in vivo ocular biocompatibility. The VCM-DMPEI nanoparticles/HA were 154 ± 3 nm in diameter with a 0.197 ± 0.020 polydispersity index; had a + 26.4 ± 3.3 mV zeta potential; exhibited a 93% VCM encapsulation efficiency; and released 58% of the encapsulated VCM over 96 h. VCM and DMPEI exhibited a synergistic bactericidal effect. The VCM-DMPEI nanoparticles/HA were neither toxic to ARPE-19 cells nor irritating to the chorioallantoic membrane. Moreover, the VCM-DMPEI nanoparticles/HA did not induce modifications in retinal functions, as determined by electroretinography, and in the morphology of the ocular tissues. In conclusion, the VCM-DMPEI nanoparticles/HA may be a useful therapeutic adjuvant to treat bacterial endophthalmitis.
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Affiliation(s)
- Jéssica Ferreira Cardoso
- School of Pharmacy, Federal University of Ouro Preto, Ouro Preto, Minas Gerais 35.400-000, Brazil
| | | | - Tamires Cunha Almeida
- School of Pharmacy, Federal University of Ouro Preto, Ouro Preto, Minas Gerais 35.400-000, Brazil
| | | | - Cibele Rodrigues Toledo
- School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31.270-901, Brazil
| | | | | | - Mariana Campos Da Paz
- Federal University of São João del-Rei, Divinópolis, Minas Gerais 35.501-296, Brazil
| | - Wagner Da Nova Mussel
- Chemistry Department, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31.270-901, Brazil
| | | | - Glenda Nicioli Da Silva
- School of Pharmacy, Federal University of Ouro Preto, Ouro Preto, Minas Gerais 35.400-000, Brazil.
| | - Armando Da Silva-Cunha
- School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31.270-901, Brazil.
| | | | - Alexander M Klibanov
- Departments of Chemistry and Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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36
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Bao Z, Yu A, Shi H, Hu Y, Jin B, Lin D, Dai M, Lei L, Li X, Wang Y. Glycol chitosan/oxidized hyaluronic acid hydrogel film for topical ocular delivery of dexamethasone and levofloxacin. Int J Biol Macromol 2020; 167:659-666. [PMID: 33278439 DOI: 10.1016/j.ijbiomac.2020.11.214] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022]
Abstract
In the present study, we fabricated a glycol chitosan/oxidized hyaluronic acid hydrogel film with promising potential for the dual ophthalmic delivery of dexamethasone (Dex) and levofloxacin (Lev). Utilizing different oxidation degrees of oxidized hyaluronic acid (OHA), several blank hydrogel films and Lev-loaded hydrogel films were successfully fabricated. With an increase in the oxidation degree of OHA, the swelling ratio of the hydrogel films decreased accordingly. The hydrogel films displayed a stepwise release of Lev and Dex, with Lev rapidly released from the hydrogel film, followed by a sustained release of Dex. Lev-loaded hydrogel films revealed a potent capacity to inhibit bacterial growth in different bacterial strains. In lipopolysaccharide-activated RAW264.7 macrophages, the formulated hydrogel films displayed potent in vitro anti-inflammatory activity by significantly downregulating various inflammatory cytokines. Overall, the fabricated hydrogel film acting as a dual drug delivery system might be a promising vehicle for the treatment of postoperative endophthalmitis.
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Affiliation(s)
- Zhishu Bao
- Institute of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, PR China
| | - Ailing Yu
- Institute of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, PR China
| | - Hui Shi
- Institute of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, PR China
| | - Yuhan Hu
- Institute of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, PR China
| | - Bo Jin
- Institute of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, PR China
| | - Dan Lin
- Institute of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, PR China
| | - Mali Dai
- Institute of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, PR China
| | - Lei Lei
- Institute of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, PR China
| | - Xingyi Li
- Institute of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, PR China.
| | - Yuqin Wang
- Institute of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, PR China.
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Muqit MMK, Mehat M, Bunce C, Bainbridge JW. Early vitrectomy for exogenous endophthalmitis following surgery. Hippokratia 2020. [DOI: 10.1002/14651858.cd013760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Crosby NJ, Westcott M, Michael E, Cunningham WJ, Welch S, Polkinghorne PJ. Comparative Outcomes of Primary Vitrectomy Versus Tap and Inject for Endophthalmitis Following Phacoemulsification Cataract Surgery. Ocul Immunol Inflamm 2020; 30:727-733. [PMID: 33054484 DOI: 10.1080/09273948.2020.1826539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To compare functional and anatomical outcomes, rates of culture positivity and number of procedures in eyes with endophthalmitis following phacoemulsification surgery, treated with either primary vitrectomy and intravitreal antibiotics or vitreous tap and antibiotic injection (T&I). METHODS Patients developing endophthalmitis after phacoemulsification surgery between 2007 and 2016 were identified, and outcomes were compared between the two treatment groups. RESULTS 19 patients underwent a primary vitrectomy and 22 underwent a T&I. There was a significant improvement in visual acuity after T&I (p=.003) and primary vitrectomy (p=.00005). The median improvement in visual acuity was significantly greater for the primary vitrectomy group than the T&I group (p=.024). 64% of eyes were culture positive with the initial T&I, and 63% with primary vitrectomy (p=1.00). Two eyes initially culture negative with a T&I, and three eyes that were culture positive with a T&I were subsequently culture positive with a vitrectomy 24-72 hours later. 68% of patients who underwent a T&I required an additional procedure, compared to 26% of the vitrectomy group (p=.01). The T&I group underwent a mean of 2.3 procedures each, and the primary vitrectomy group underwent 1.5 (p=.03). CONCLUSIONS Eyes with endophthalmitis treated with a primary vitrectomy demonstrated greater visual improvement and needed fewer procedures than those initially treated with a T&I. Viable bacteria were only seen in subsequent procedures in the T&I group, indicating that primary vitrectomy was superior at sterilizing the eye.
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Affiliation(s)
- Niall J Crosby
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand.,Uveitis Service, Moorfields Eye Hospital, London, UK
| | - Mark Westcott
- Uveitis Service, Moorfields Eye Hospital, London, UK.,Visual Science, University College London Institute of Ophthalmology, London, UK
| | - Eugene Michael
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - William J Cunningham
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Sarah Welch
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Philip J Polkinghorne
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
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Wang Y, Wang X, Di Y. Surgery combined with antibiotics for the treatment of endogenous endophthalmitis caused by liver abscess. BMC Infect Dis 2020; 20:661. [PMID: 32894069 PMCID: PMC7487656 DOI: 10.1186/s12879-020-05390-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/02/2020] [Indexed: 01/01/2023] Open
Abstract
Backgrounds Endogenous endophthalmitis is a serious disease caused by intraocular infection that can rapidly progress to cause blindness. This study evaluated the clinical features, surgical and antibiotics treatment strategies, and treatment outcomes in patients with endophthalmitis caused by liver abscess. Methods Between April 2014 and April 2019, the clinical data of 16 patients (19 eyes) with endophthalmitis associated with liver abscess who underwent surgery at Shengjing Hospital were retrospectively analyzed. Furthermore, we evaluated the final visual outcomes in the patients to determine the efficacy of surgery. Results Fifteen patients (18 eyes) underwent intravitreal injection followed by vitrectomy after admission. One patient (1 eye) only underwent intravitreal injection. Of the 16 patients, 3 patients (3 eyes) had recurrent intraocular inflammation and eventually underwent evisceration. Systemic antibiotics were administered for all patients based on the results of vitreous humor culture, blood culture, and antibiotic susceptibility tests. Outpatient follow-ups were performed until the patients were stable (6 months). Of the 19 eyes, 1 eye (5%) had visual acuity restored to 20/200, 6 eyes (31%) had visual acuity restored to counting fingers (CF), 2 eyes (11%) had visual acuity restored to hand motion (HM), 4 eyes (22%) showed only light perception (LP), and the remaining 6 eyes (31%) showed no light perception (NLP). Drug susceptibility tests suggested that the carbapenems exhibited significant effects in the inflammatory reaction. Conclusion Endogenous endophthalmitis caused by liver abscess is a very serious condition, and the final visual outcome is poor. Timely surgical intervention combined with antibiotic treatment is essential, and the primary disease must be treated to control disease progression at the earliest.
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Affiliation(s)
- Yue Wang
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Heping district, Sanhao Road 36, Shenyang, 110004, People's Republic of China
| | - Xue Wang
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Heping district, Sanhao Road 36, Shenyang, 110004, People's Republic of China
| | - Yu Di
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Heping district, Sanhao Road 36, Shenyang, 110004, People's Republic of China.
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Endogenous Vancomycin-Resistant Enterococcus gallinarum Endophthalmitis in Hematologic Malignancy. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Dib B, Morris RE, Oltmanns MH, Sapp MR, Glover JP, Kuhn F. Complete and Early Vitrectomy for Endophthalmitis After Cataract Surgery: An Alternative Treatment Paradigm. Clin Ophthalmol 2020; 14:1945-1954. [PMID: 32753837 PMCID: PMC7358185 DOI: 10.2147/opth.s253228] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/11/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose In this study, we report the treatment outcomes of complete and early vitrectomy for endophthalmitis (CEVE) after cataract surgery as the predominate initial treatment, accompanied by systemic antibiotics and retreatment of persistent or recurrent purulence (CEVE+). Patients and Methods Clinical features and microbiological factors were retrospectively reviewed in 62 eyes of 62 patients who were treated for acute postcataract endophthalmitis (APCE) occurring within three weeks of cataract surgery at Retina Specialists of Alabama, between 2007 and 2017. Results Visual acuity on presentation included light perception (LP) in 18 eyes (29%) and hand motion (HM) in 23 eyes (37%). Initial treatment was maximum possible vitrectomy in 48 eyes (77%) and tap-and-inject in 14 eyes (23%), with 38 eyes (61%) receiving two or more treatments. Cultures for the first intervention were positive in 49 eyes (79%) and virulent in 18 eyes (29%). At a median follow-up time of five months, final visual acuity was ≥20/40 in 49 eyes (79%), between 20/50 and 5/200 in seven eyes (11%), and <5/200 in six eyes (10%). Virulence was the strongest predictor of poor visual outcome. Retinal detachment occurred in four eyes (6%), likely from necrotic retinal defects in each case. Conclusion Complete and early vitrectomy is a safe and effective initial treatment for APCE. When accompanied by systemic antibiotics and retreatment (CEVE+) of recurrent media opacification, it improves recovery of 20/40 or better visual acuity by approximately 50% compared to a predominantly tap-and-inject treatment paradigm. We recommend CEVE for fundus-obscuring APCE (~75% of all cases) whenever the view is inadequate to rule out macular distress. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/rsl1lGF27D4
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Affiliation(s)
- Bernard Dib
- Retina Specialists of Alabama, Birmingham, AL, USA.,Helen Keller Foundation for Research and Education, Birmingham, AL, USA.,University of Alabama at Birmingham (UAB), Department of Ophthalmology, Birmingham, AL, USA.,UAB Callahan Eye Hospital, Birmingham, AL, USA
| | - Robert E Morris
- Retina Specialists of Alabama, Birmingham, AL, USA.,Helen Keller Foundation for Research and Education, Birmingham, AL, USA.,University of Alabama at Birmingham (UAB), Department of Ophthalmology, Birmingham, AL, USA.,UAB Callahan Eye Hospital, Birmingham, AL, USA
| | - Matthew H Oltmanns
- Retina Specialists of Alabama, Birmingham, AL, USA.,Helen Keller Foundation for Research and Education, Birmingham, AL, USA.,University of Alabama at Birmingham (UAB), Department of Ophthalmology, Birmingham, AL, USA.,UAB Callahan Eye Hospital, Birmingham, AL, USA
| | - Mathew R Sapp
- Retina Specialists of Alabama, Birmingham, AL, USA.,Helen Keller Foundation for Research and Education, Birmingham, AL, USA.,University of Alabama at Birmingham (UAB), Department of Ophthalmology, Birmingham, AL, USA.,UAB Callahan Eye Hospital, Birmingham, AL, USA
| | - Jay P Glover
- Retina Consultants of Nashville, Nashville, TN, USA
| | - Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, AL, USA.,Milos Eye Hospital, Belgrade, Serbia.,Zagorskiego Eye Hospital, Krakow, Poland
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Patel SN, Storey PP, Levin H, Pancholy M, Obeid A, Wibbelsman TD, Kuley B, Ho AC, Hsu J, Garg SJ, Vander JF, Dunn JP. Endophthalmitis after Cataract Surgery: Changes in Management Based on Microbiologic Cultures. Ophthalmol Retina 2020; 5:16-22. [PMID: 32599176 DOI: 10.1016/j.oret.2020.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the utility of microbiologic culture data for the management of endophthalmitis after cataract surgery. DESIGN Retrospective, single-center, cohort study. PARTICIPANTS All patients treated for endophthalmitis after cataract surgery between January 1, 2014, and December 31, 2017, at a single institution. METHODS Endophthalmitis cases were determined from billing records and confirmed with chart review. A change in clinical management was defined as additional intravitreal antibiotic injections or pars plana vitrectomy. MAIN OUTCOME MEASURES A change in clinical management within 2 weeks of initial endophthalmitis culture and treatment; visual acuity (VA). RESULTS A total of 111 eyes of 111 patients were treated for endophthalmitis after cataract surgery, of which 57 (51%) were culture-positive. After initial treatment of endophthalmitis, a change in clinical management after vitreous culture occurred in 9 of 111 eyes (8%), including 6 of 57 (11%) culture-positive eyes compared with 3 of 54 (6%) culture-negative eyes (P = 0.49). Change in clinical management for culture-positive eyes was based on declining vision (3 eyes), worsening clinical examination results (2 eyes), and retinal detachment (1 case). Change in clinical management for culture-negative endophthalmitis eyes was based on worsening clinical examination results (2 eyes) and declining vision (1 eye). No additional interventions were initiated on the basis of positive culture results. At final follow-up, mean logarithm of the minimum angle of resolution (logMAR) VA was 1.09 (∼20/250) for the culture-positive eyes compared with 0.59 (∼20/80) for culture-negative eyes (adjusted difference, 0.394; 95% confidence interval, 0.02-0.77, P = 0.03). Rhegmatogenous retinal detachments (RRDs) or retinal tears occurred in 19 of 111 eyes (17%) after developing endophthalmitis, and culture-positive eyes developed a secondary RRD in 11 of 57 eyes (19%) compared with 3 of 54 (6%) culture-negative eyes (P = 0.03). CONCLUSIONS After endophthalmitis related to cataract surgery, vitreous cultures may have prognostic value for final visual outcomes but have a limited effect on clinical management.
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Affiliation(s)
- Samir N Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Hannah Levin
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Maitri Pancholy
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anthony Obeid
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Turner D Wibbelsman
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Brandon Kuley
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Allen C Ho
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sunir J Garg
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James F Vander
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James P Dunn
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Youssef A, Dudhipala N, Majumdar S. Ciprofloxacin Loaded Nanostructured Lipid Carriers Incorporated into In-Situ Gels to Improve Management of Bacterial Endophthalmitis. Pharmaceutics 2020; 12:E572. [PMID: 32575524 PMCID: PMC7356176 DOI: 10.3390/pharmaceutics12060572] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/21/2022] Open
Abstract
Bacterial endophthalmitis (BE) is a potentially sight-threatening inflammatory reaction of the intraocular fluids or tissues caused by bacteria. Ciprofloxacin (CIP) eye drops are prescribed as first-line therapy in BE. However, frequent administration is necessary due to precorneal loss and poor ocular bioavailability. The objective of the current research was to prepare CIP containing nanostructured lipid carriers (CIP-NLCs) loaded an in situ gel system (CIP-NLC-IG) for topical ocular administration for enhanced and sustained antibacterial activity in BE treatment. CIP-NLCs were prepared by the hot homogenization method and optimized based on physicochemical characteristics and physical stability. The optimized CIP-NLC formulation was converted into CIP-NLC-IG with the addition of gellan gum as a gelling agent. Furthermore, optimized CIP-NLC and CIP-NLC-IG were evaluated for in vitro release and ex vivo transcorneal permeation studies, using commercial CIP ophthalmic solution (CIP-C) as the control. The optimized CIP-NLC formulation showed particle size, polydispersity index, zeta potential, assay and entrapment efficiency of 193.1 ± 5.1 nm, 0.43 ± 0.01, -32.5 ± 1.5 mV, 99.5 ± 5.5 and 96.3 ± 2.5%, respectively. CIP-NLC-IG with 0.2% w/v gellan gum showed optimal viscoelastic characteristics. The in vitro release studies demonstrated sustained release of CIP from CIP-NLC and CIP-NLC-IG formulations over a 24 h period. Transcorneal flux and permeability increased 4 and 3.5-fold, and 2.2 and 1.9-fold from CIP-NLC and CIP-NLC-IG formulations, respectively, when compared to CIP-C. The results demonstrate that CIP-NLC-IG could be considered as an alternate delivery system to prolong the residence time on the ocular surface after topical administration. Thus, the current CIP ophthalmic formulations may exhibit improved ocular bioavailability and prolonged antibacterial activity, which may improve therapeutic outcomes in the treatment of BE.
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Affiliation(s)
- Ahmed Youssef
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Kafrelsheikh University, Kafrelsheikh 33516, Egypt;
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA;
| | - Narendar Dudhipala
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA;
| | - Soumyajit Majumdar
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA;
- Research Institute of Pharmaceutical Sciences, University of Mississippi, Oxford, MS 38677, USA
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Clinical Review of Microbial Corneal Ulcers Resulting in Enucleation and Evisceration in a Tertiary Eye Care Center in Hungary. J Ophthalmol 2020; 2020:8283131. [PMID: 32509342 PMCID: PMC7254073 DOI: 10.1155/2020/8283131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/13/2020] [Accepted: 04/30/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To analyse the clinical and microbiological characteristics and preexisting ophthalmic and systemic conditions of infectious keratitis resulting in enucleation/evisceration in a large tertiary referral center in a developed country (Hungary) over a period of 12 years. Patients and Methods. A retrospective review of enucleated/eviscerated eyes undergoing surgery between 2007 and 2018 at the Department of Ophthalmology of Semmelweis University, Budapest, Hungary, with infectious keratitis as the primary indication for enucleation or evisceration. For each subject, clinical history, B-scan ultrasound report, and microbiological analyses were reviewed. Results There were 48 enucleated/eviscerated eyes from 47 patients (29 females (61.7%), age at the time of surgery 66.4 ± 18.5 years). Indication for surgery was hopeless, unmanageable keratitis (62.5%), and keratitis with endophthalmitis (37.5%). The most common preexisting ophthalmic conditions were previous cataract surgery (60.4%), previous therapeutic penetrating keratoplasty (PKP) (56.3%), corneal perforation (52.1%), glaucoma (41.7%), and long-term topical steroid usage (31.3%). In order to treat keratitis, before enucleation or evisceration, 20 eyes (41.7%) underwent PKP, 12 eyes (25.0%) amniotic membrane transplantation, 8 eyes (16.7%) conjunctival autograft transplantation, 6 eyes (12.5%) tarsorrhaphy, and 4 eyes (8.3%) vitrectomy to salvage the eye prior to the final treatment of enucleation or evisceration. The most frequent preexisting systemic diseases were hypertension (62.5%), cardiac disease (20.8%), diabetes mellitus (20.8%), and rheumatoid arthritis (14.6%). Staphylococcus aureus (17.0%) and Propionibacterium acnes (12.8%) were the most commonly isolated gram-positive bacteria, and Pseudomonas aeruginosa was the most frequently isolated gram-negative pathogen bacterium (10.6%). Six globes (12.5%) had positive fungal cultures (1 case of Candida albicans, Candida parapsilosis, Trichosporon inkin, Acremonium sp., Fusarium sp., and Penicillium sp.). Conclusions Staphylococcus aureus, Propionibacterium acnes, and Pseudomonas aeruginosa keratitis with or without endophthalmitis represent the most common indication for ocular enucleation/evisceration in patients with microbial keratitis in a tertiary referral center in Hungary. The incidence of enucleation and evisceration related to mycotic keratitis does not seem to have increased within the last decade. Most frequent preexisting systemic diseases in cases of enucleation and evisceration are hypertension, cardiac disease, diabetes mellitus, and rheumatoid arthritis.
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Abstract
PURPOSE Chronic postoperative endophthalmitis is a known complication of cataract surgery. Here, we report a case of chronic endophthalmitis following uncomplicated cataract surgery secondary to the atypical bacterium Aquamicrobium terrae. METHODS Retrospective case report of a single patient with endophthalmitis secondary to A. terrae. RESULTS A 61-year-old healthy patient presented with recurrent iridocyclitis following uncomplicated cataract surgery. Repeated attempts to taper off topical steroid eyedrops were unsuccessful. Anterior chamber paracentesis cultures and vitrectomy cultures grew the same gram-negative bacillus, A. terrae, on six different occasions. The patient was treated initially with a series of intravitreal ceftazidime injections and adjuvant oral minocycline with recurrence of inflammation necessitating pars plana vitrectomy with intraocular lens removal and total capsulectomy. Inflammatory episodes recurred until residual capsule fragments were ablated using endoscopic vitrectomy. Since ablation over 18 months ago, no further recurrences have occurred and the patient has excellent visual outcome. CONCLUSION A. terrae is a gram-negative bacillus recovered from polluted soil. This is the first case of postoperative endophthalmitis secondary to A. terrae and the first description of human infection caused by this newly identified microbe.
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Fan KC, Lin J, Yannuzzi NA, Al-Khersan H, Patel NA, Maestre-Mesa J, Zaidi M, Miller D, Flynn HW. In vitro Susceptibilities of Methicillin-Susceptible and Resistant Staphylococci to Traditional Antibiotics Compared to a Novel Fluoroquinolone. J Ophthalmic Inflamm Infect 2020; 10:9. [PMID: 32103368 PMCID: PMC7044395 DOI: 10.1186/s12348-020-0200-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 02/03/2020] [Indexed: 12/20/2022] Open
Abstract
Background To assess the in-vitro efficacy of delafloxacin, a new fourth generation fluoroquinolone, against Staphylococcus vitreous isolates from patients with clinically diagnosed endophthalmitis. This is the first investigation of delafloxacin in ocular tissues. Methods Intravitreal isolates of culture-proven S. aureus and S. epidermidis were identified between 2014 and 2018. Minimum inhibitor concentrations (MIC) were determined using ETEST strips. The antibiotic susceptibilities were tested against a panel of drugs including glycopeptides such as vancomycin, as well as traditional and newer fluoroquinolones (levofloxacin, moxifloxacin, and delafloxacin). Results Of 45 total isolates identified between 2014 and 2018, 13% (6) were methicillin-resistant S. aureus (MRSA), 9% (4) were methicillin-sensitive S. aureus (MSSA), 53% (24) were methicillin-resistant S. epidermidis (MRSE), and 24% (11) were methicillin-sensitive S. epidermidis (MSSE). Among the fluoroquinolones, resistance rates were 61% for levofloxacin, 50% for moxifloxacin, and 12% for delafloxacin. Inter-class comparisons between delafloxacin and the two other fluoroquinolones demonstrated higher Gram-positive susceptibility to delafloxacin (p < 0.01). MIC90 values were lowest for delafloxacin (1.0 μg/mL) compared to levofloxacin (8.0 μg/mL) and moxifloxacin (8.0 μg/mL). Vancomycin was 100% effective against all isolates with MIC90 value of 0.75 μg/mL. Conclusion Compared to levofloxacin and moxifloxacin, the newer fluoroquinolone delafloxacin demonstrated the lowest MICs values and lowest rates of resistance for Gram-positive in-vitro S. epidermidis and S. aureus vitreous isolates.
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Affiliation(s)
- Kenneth C Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - James Lin
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Nimesh A Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jorge Maestre-Mesa
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Mustafa Zaidi
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Darlene Miller
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
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Grandi G, Bianco G, Boattini M, Scalabrin S, Iannaccone M, Fea A, Cavallo R, Costa C. Bacterial etiology and antimicrobial resistance trends in ocular infections: A 30-year study, Turin area, Italy. Eur J Ophthalmol 2019; 31:405-414. [PMID: 31875683 DOI: 10.1177/1120672119896419] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Bacterial ocular infections can result in loss of all or part of the ocular structures, contributing to a high disability charge. Local surveillance of etiology and susceptibility patterns is crucial for an appropriate empiric management of ocular infections. The aim of this study was to analyze of bacterial spectrum in culture-proven ocular infections and trends of antimicrobial susceptibility patterns. METHODS A monocentric retrospective study was performed including ocular infection cases diagnosed at the Microbiology Unit of Turin Ophthalmic Hospital between 1988 and 2017. Spectrum of pathogens that caused bacterial culture-proven ocular infections and trends of antimicrobial susceptibility patterns were analyzed. RESULTS A total of 15,517 culture-positive isolates were identified as causative agents of ocular infections. Gram-positive bacteria were deemed to cause infection in 73.5% of cases. Staphylococcus spp. and Pseudomonas spp., coagulase-negative staphylococci, Staphylococcus aureus were the leading causative pathogens of keratitis, endophthalmitis, and conjunctivitis, respectively. Statistically significant changes in temporal trends were observed for all analyzed microorganism groups except for Enterobacteriaceae group. Overall, fluoroquinolones and chloramphenicol demonstrated to be the most effective antimicrobials in vitro toward bacterial ocular infections, followed by tetracycline, ampicillin, and aminoglycosides. Enterobacteriaceae isolates showed higher multi-drug resistance rate, followed by coagulase-negative staphylococci. Analysis of resistance rates over time highlighted increasing resistance trend for aminoglycosides among Gram-negative and for both aminoglycosides and fluoroquinolones among Gram-positive pathogens, especially for S. aureus. CONCLUSION This study provided a 30-year assessment of bacterial ocular infections in an urban area of Italy, giving support to epidemiological consciousness and guiding empiric antimicrobial therapy.
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Affiliation(s)
- Giuseppe Grandi
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gabriele Bianco
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Matteo Boattini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Simona Scalabrin
- Eye Clinic, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Marco Iannaccone
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonio Fea
- Eye Clinic, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
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Kitsche M, Herber R, Pillunat LE, Terai N. Clinical and visual outcome of endophthalmitis patients: a single-center experience. Graefes Arch Clin Exp Ophthalmol 2019; 258:183-189. [PMID: 31637487 DOI: 10.1007/s00417-019-04480-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/15/2019] [Accepted: 09/13/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To report the clinical and visual outcome and the therapeutical management in a large cohort of endophthalmitis patients. METHODS In a monocentric, observational study, we retrospectively analyzed the data of all patients with endophthalmitis who were referred to the department of ophthalmology of the Carl Gustav Carus Hospital Dresden between 2006 and 2018. RESULTS In total, data of 104 patients (49 female, 55 male) were included in the present analysis. The most frequent clinical scenario for endophthalmitis was postcataract surgery (30.8%). The most frequent treatment at presentation was a pars plana vitrectomy (ppV) in 42 patients, followed by an intravitreal antibiotic in 41 patients. Out of 41 patients who received an intravitreal antibiotic, 35 patients (85%) needed additional treatment. In contrast, out of 42 patients who received a ppV as the initial treatment, 19 patients (42%) needed additional therapy, which was significantly different (p < 0.0001). The best presenting visual acuity improved significantly after treatment (p < 0.0001). CONCLUSION The results of the present study suggest that, compared with an intravitreal antibiotic, a ppV as the initial therapy of endophthalmitis might reduce the number of additional treatments. From our data, it can be hypothesized that a ppV should be performed as early as possible to achieve the best visual outcome in most endophthalmitis patients. Prospective studies are now needed to address this issue in greater detail and to confirm our findings.
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Affiliation(s)
- Marcel Kitsche
- Department of Ophthalmology, Carl Gustav Carus University Hospital Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Robert Herber
- Department of Ophthalmology, Carl Gustav Carus University Hospital Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Lutz E Pillunat
- Department of Ophthalmology, Carl Gustav Carus University Hospital Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Naim Terai
- Department of Ophthalmology, Carl Gustav Carus University Hospital Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Intraocular Biopsy and ImmunoMolecular Pathology for "Unmasking" Intraocular Inflammatory Diseases. J Clin Med 2019; 8:jcm8101733. [PMID: 31635036 PMCID: PMC6832563 DOI: 10.3390/jcm8101733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/05/2019] [Accepted: 10/15/2019] [Indexed: 12/15/2022] Open
Abstract
Intraocular inflammation can hide a variety of eye pathologies. In 33% of cases, to obtain a correct diagnosis, investigation of the intraocular sample is necessary. The combined analyses of the intraocular biopsy, using immuno-pathology and molecular biology, point to resolve the diagnostic dilemmas in those cases where history, clinical tests, and ophthalmic and systemic examinations are inconclusive. In such situations, the teamwork between the ophthalmologist and the molecular pathologist is critically important to discriminate between autoimmune diseases, infections, and intraocular tumors, including lymphoma and metastases, especially in those clinical settings known as masquerade syndromes. This comprehensive review focuses on the diagnostic use of intraocular biopsy and highlights its potential to enhance research in the field. It describes the different surgical techniques of obtaining the biopsy, risks, and complication rates. The review is organized according to the anatomical site of the sample: I. anterior chamber containing aqueous humor, II. iris and ciliary body, III. vitreous, and IV. choroid and retina. We have excluded the literature concerning biopsy for choroidal melanoma and retinoblastoma, as this is a specialized area more relevant to ocular oncology.
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Damm LJ, Boden KT, Januschowski K. [Importance of vitrectomy in endophthalmitis : How immediate vitrectomy can restore visual acuity]. Ophthalmologe 2019; 116:569-571. [PMID: 30076431 DOI: 10.1007/s00347-018-0768-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This article presents a case of endophthalmitis after intravitreal injection with bevacizumab (Avastin®) in a patient suffering from exudative age-related macular degeneration (AMD). Within 1h after diagnosis the patient underwent vitrectomy with intravitreal injection of antibiotics combined with corticosteroids and 4 weeks after the endophthalmitis the visual acuity increased to 0.5. This case report demonstrates that an immediate vitrectomy combining intravitreal injection of medication can lead to a good visual outcome even in the case of severe endophthalmitis.
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Affiliation(s)
- L-J Damm
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland.
| | - K T Boden
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - K Januschowski
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
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