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Dedieu D, Contejean A, Gastli N, Marty-Reboul J, Poupet H, Brezin A, Monnet D, Charlier C, Canouï E. Endogenous endophthalmitis: New insights from a 12-year cohort study. Int J Infect Dis 2024; 146:107116. [PMID: 38801969 DOI: 10.1016/j.ijid.2024.107116] [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: 03/04/2024] [Revised: 05/15/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES To describe the clinical and microbiological characteristics of patients with endogenous endophthalmitis (EE), determine factors associated with outcome and propose a management plan for EE. METHODS Retrospective case series in two tertiary referral centers from 2010 to 2022. RESULTS Sixty-four eyes of 53 patients were included. Bilateral involvement occurred for 11/53 patients (21%). Ocular symptoms were the only first manifestation of the disease in 36/53 (68%) of cases; signs of sepsis were evident in 17/53 (32%). Imaging tests detected at least one extraocular focus of infection in 34/53 patients (64%), with contrast-enhanced thoraco-abdominopelvic computed tomography showing relevant findings in 28/50 (56%) of cases. EE was microbiologically confirmed in 43/53 patients (81%); the organisms involved were: Gram-positive bacteria (19/53, 36%), Gram-negative bacteria (13/53, 25%) and Candida sp. (11/53, 21%). Klebsiella pneumoniae was the most common bacteria (10/32, 31%). Blood cultures were positive in 28/53 patients (53%) and eye samples in 11/41 eyes (27%). All patients were treated with systemic antimicrobial therapy, 39/64 eyes (61%) received anti-infective intravitreal injection(s) and 17/64 eyes (27%) underwent vitrectomy. Four patients (8%) died due to uncontrolled systemic infection. Final visual acuity (VA) was < 20/400 in 28/57 eyes (49%) and ocular structural loss (bulbar phthisis or enucleation/evisceration) was reported in 18/64 eyes (28%). In multivariate analysis, initial VA was the only parameter associated with visual and/or structural loss of the eye (OR = 24.44 (4.33-228.09) and 5.44 (1.33-26.18) respectively). CONCLUSIONS EE remains a severe infection with a poor ocular outcome. We propose a standard protocol to improve diagnosis and medical management.
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Affiliation(s)
- Daphné Dedieu
- Ophthalmology Department, Cochin Port Royal University Hospital AP-HP, Paris, France
| | - Adrien Contejean
- Infectious Diseases Stewardship Unit, Cochin Port Royal University Hospital AP-HP, Paris, France; Hematology department, CH Annecy Genevois, France
| | - Nabil Gastli
- Microbiology Department, Cochin Port Royal University Hospital AP-HP, Paris, France
| | - Jeanne Marty-Reboul
- Medical Information Department, Cochin Port Royal University Hospital, AP-HP, Paris, France
| | - Hélène Poupet
- Microbiology Department, Cochin Port Royal University Hospital AP-HP, Paris, France
| | - Antoine Brezin
- Ophthalmology Department, Cochin Port Royal University Hospital AP-HP, Paris, France; Université Paris Cité, Paris, France
| | - Dominique Monnet
- Ophthalmology Department, Cochin Port Royal University Hospital AP-HP, Paris, France; Université Paris Cité, Paris, France
| | - Caroline Charlier
- Infectious Diseases Stewardship Unit, Cochin Port Royal University Hospital AP-HP, Paris, France; Université Paris Cité, Paris, France; Institut Pasteur, French National Reference Center and WHO Collaborating Center Listeria, Paris, France; Institut Pasteur, Biology of Infection Unit, Paris, France
| | - Etienne Canouï
- Infectious Diseases Stewardship Unit, Cochin Port Royal University Hospital AP-HP, Paris, France.
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Nakayama S, Itagaki H, Abe Y, Matumura N, Endo T. Endogenous endophthalmitis caused by Streptococcus mitis: A case report. Medicine (Baltimore) 2024; 103:e39096. [PMID: 39058852 PMCID: PMC11272333 DOI: 10.1097/md.0000000000039096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
RATIONALE Endogenous endophthalmitis is a rare disease caused by hematogenous intraocular metastasis of bacteria from an infectious source. Diagnosing endogenous endophthalmitis is challenging for non-ophthalmologists. However, ophthalmic diseases can cause irreversible vision loss, making prompt diagnosis and treatment critical. Here we present a rare case of endogenous endophthalmitis initially misdiagnosed as a cataract. PATIENT CONCERNS An 84-year-old Japanese man presented to the emergency department with fever and dysmotility. The patient was aware of a left subconjunctival hemorrhage and cloudy cornea upon arrival at the hospital, but he misunderstood it as a fall-induced subconjunctival hemorrhage and age-related cataracts. DIAGNOSES On the day following admission, petechial hemorrhage on the eyelid conjunctiva and the detection of Streptococcus mitis in the blood culture results led us to suspect endophthalmitis rather than cataracts. A definitive diagnosis of endophthalmitis was made through ophthalmologic examinations, and endophthalmitis was considered secondary to endocarditis. INTERVENTIONS Subsequently, antimicrobial treatment was continued. OUTCOMES However, the patient developed myocardial infarction and died on the ninth day of hospitalization. LESSONS Two important lessons were learned from the examination of this case of endogenous endophthalmitis caused by S mitis. First, endophthalmitis and cataracts can be misdiagnosed. Because the symptoms of endophthalmitis and cataracts, such as decreased vision, photophobia, and blurred vision, are similar, the eye must be cautiously examined. Second, endocarditis caused by S mitis may lead to endogenous endophthalmitis. Although S mitis is not pathogenic, endogenous endophthalmitis may occur in patients with certain risk factors, such as older age, cancer, and immunosuppression.
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Affiliation(s)
- Saki Nakayama
- School of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Hideya Itagaki
- Division of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan
| | - Yoshinobu Abe
- Division of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan
| | - Nobutoshi Matumura
- Division of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan
| | - Tomoyuki Endo
- Division of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan
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Mohzari YA, AlDosary OF, Bamogaddam RF, AlHussaini M, Alyami HA, Alrashed A, Alamer A. Endogenous bacterial endophthalmitis in an HIV patient with uncontrolled diabetes: A case of rare ocular complication. J Infect Public Health 2024; 17:102461. [PMID: 38852231 DOI: 10.1016/j.jiph.2024.05.049] [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: 02/26/2024] [Revised: 05/18/2024] [Accepted: 05/26/2024] [Indexed: 06/11/2024] Open
Abstract
Endogenous bacterial endophthalmitis (EE) is an intraocular infection with a poor prognosis. Timely diagnosis and prompt treatment are crucial to prevent vision loss. In this communication, we describe a case of EE caused by Streptococcus pyogenes (Group A Streptococcus [GAS]) in an HIV-positive patient with poorly controlled type 2 diabetes mellitus (DM). A 60-year-old man with a history of HIV and poorly controlled type 2 diabetes, presented with progressive blurry vision, left eye pain, redness, and headache. EE was diagnosed based on the clinical presentation and gram stain analysis of blood culture. Treatment with vitreous tap, intravitreal, topical antibiotics, and systemic antibiotics significantly improved the patient's symptoms. The case highlights the rarity of GAS as a causative agent of EE, particularly in patients with risk factors such as HIV infection and DM.
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Affiliation(s)
- Yahya Ali Mohzari
- Division of Pharmaceutical Care, Clinical Pharmacy Section, King Saud Medical City, Riyadh, Saudi Arabia
| | - Oweida Fahad AlDosary
- Department of Adult Infectious diseases, King Saud Medical City, Riyadh, Saudi Arabia
| | - Reem F Bamogaddam
- Division of Pharmaceutical Care, Clinical Pharmacy Section, King Saud Medical City, Riyadh, Saudi Arabia
| | - Munira AlHussaini
- Department of Internal Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hamad Al Alyami
- Department of Adult Infectious diseases, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmad Alrashed
- Department of Pharmaceutical Care, Clinical Pharmacy Section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmad Alamer
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.
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4
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Kunavisarut P, Tangkitchot P, Choovuthayakorn J, Patikulsila D, Watanachai N, Chaikitmongkol V, Pathanapitoon K, Rothova A. Clinical and Microbiological Manifestations of Endogenous Endophthalmitis in Tertiary Care Hospital, Northern Thailand. Ocul Immunol Inflamm 2024; 32:652-657. [PMID: 37043614 DOI: 10.1080/09273948.2023.2192270] [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: 01/11/2023] [Accepted: 03/13/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE To determine the characteristics, primary sources, pathogens, risk factors, and visual outcomes in patients with endogenous endophthalmitis (EE). METHODS We performed a retrospective cohort study of 61 consecutive patients with EE (74 affected eyes) and reported on prevalence, clinical courses, prognostic factors and visual outcomes. RESULTS Prevalence of EE was 5% of all patients with endophthalmitis. Among culture-positive cases (89%), Gram-positive species dominating (69%) followed by Gram-negative with 22% and fungal species with 9%. Regarding to visual outcomes, the mean visual acuity (VA, ETDRS letters) at baseline, 3-months, 6-months and 1-year follow-up was 0.85, 9, 8 and 9, respectively. Initial VA of hand movement or better (P 0.007) and bilateral infection (P 0.004) were associated with better visual outcome. CONCLUSION The prognosis for EE remained poor despite aggressive and immediate treatment. The high suspicion, early diagnosis and prompt treatment are important factors that might lead to the better outcome.
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Affiliation(s)
- Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pavinee Tangkitchot
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Janejit Choovuthayakorn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Direk Patikulsila
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nawat Watanachai
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Voraporn Chaikitmongkol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kessara Pathanapitoon
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Aniki Rothova
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
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Caplash S, Paez-Escamilla M, Westcott M, Dansingani KK, Indermill C, Kisma N, Frau E, Sahel JA, Bodaghi B, Jhanji V, Errera MH. Mimickers of anterior uveitis, scleritis and misdiagnoses- tips and tricks for the cornea specialist. J Ophthalmic Inflamm Infect 2024; 14:14. [PMID: 38594487 PMCID: PMC11004105 DOI: 10.1186/s12348-024-00396-z] [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: 06/17/2023] [Accepted: 03/29/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Anterior uveitis, inflammation of the anterior chamber and related structures, is a cohort of diseases that can present to almost any general or sub-specialty Ophthalmology practice. Its features classically involve anterior chamber cell and flare. Below the surface of these two signs exist a panoply of diagnoses. BODY: The purpose of this review is to provide a general framework for diagnoses of anterior uveitis that are often missed as well as non-uveitic pathologies that often mimic anterior uveitis. Diagnostic deviation in either direction can have vision-threatening and rarely life-threatening consequences for patients. Using a comprehensive literature review we have collected a broad spectrum of etiologies of anterior uveitis that are easily missed and non-uveitic pathologies that can masquerade as anterior uveitis. CONCLUSIONS We present a focused review on specific misdiagnosed anterior uveitis pathologies and some of the conditions that can masquerade as anterior uveitis and scleritis.
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Affiliation(s)
- Sonny Caplash
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Mark Westcott
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Chad Indermill
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Nacima Kisma
- Universite Libre de Bruxelles, Hopital Universitaire de Bruxelles, 808 route de Lennik 1170, Bruxelles, Belgium
| | - Eric Frau
- Department of Ophthalmology, Centre hospitalier National des Quinze-Vingts, Paris, France
| | - Jose-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Bahram Bodaghi
- Department of Ophthalmology, Pitié-Salpêtrière University Hospital, Sorbonne Universités, F-75013, Paris, France
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Marie-Helene Errera
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA.
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6
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Sanchez JM, Davila M, Halpert M, Amer R. Long-term follow-up of a healthy man with endogenous Streptococcus anginosus endophthalmitis. J Ophthalmic Inflamm Infect 2024; 14:6. [PMID: 38296895 PMCID: PMC10830928 DOI: 10.1186/s12348-023-00383-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/22/2023] [Indexed: 02/02/2024] Open
Abstract
We report the long-term follow-up of an immunocompetent patient who presented with slowly progressive endogenous endophthalmitis secondary to Streptococcus anginosus. A 46-year-old healthy man presented with a two-month history of right eye iritis. On examination, visual acuity was 20/60 with intraocular pressure of 6 mm Hg. There was a small layer of hypopyon with non-granulomatous anterior uveitis and vitritis. On funduscopy, fluffy white peripheral retinal and pre-retinal lesions were noted in superonasal periphery. The patient denied any present or past illness. Diagnostic pars plana vitrectomy was performed. Culture and polymerase chain reaction of the vitreous sample were positive for Streptococcus anginosus. Intravitreal vancomycin and ceftazidime and systemic ceftriaxone were administered. Work-up which included blood and urine cultures, chest x-ray, echocardiography and abdominal ultrasound was unyielding. Subsequently and because of persistent post-infectious inflammatory reaction, intravitreal and oral steroids were administered in addition to oral azathioprine later on. After one year of follow-up, visual acuity was 20/20 with near vision of Jaeger 3 + and no signs of active uveitis were seen. Therefore, Streptococcus anginosus should be considered in the differential diagnosis of a slowly progressive endophthalmitis also in immunocompetent individuals.
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Affiliation(s)
| | - Mauricio Davila
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - Michael Halpert
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - Radgonde Amer
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel.
- Department of Ophthalmology, Hadassah University Hospital, POB 12000, 91120, Jerusalem, Israel.
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7
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Ciociola EC, Powell JC, Barnwell E, Zehden JA, Robbins CB, Soundararajan S, Singh P, Zhang AY, Fekrat S, Greven MA. ENDOGENOUS ENDOPHTHALMITIS ASSOCIATED WITH INJECTION DRUG USE COMPARED WITH OTHER ETIOLOGIES. Retina 2023; 43:1996-2002. [PMID: 37490751 DOI: 10.1097/iae.0000000000003898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
PURPOSE To compare features of endogenous endophthalmitis associated with injection drug use (IDU) to endogenous endophthalmitis from other etiologies. METHODS The authors retrospectively collected data on patients with endogenous endophthalmitis due to IDU or other causes from three academic tertiary care centers over a six-year period. Differences in presenting characteristics, culture results, treatment, and visual acuity were compared between groups. RESULTS Thirty-eight patients (34%) had IDU-associated endogenous endophthalmitis while 75 patients (67%) had endogenous endophthalmitis from other causes. Compared with patients in the non-IDU group, IDU patients were significantly younger, more frequently male, had longer duration of symptoms at diagnosis, and were less likely to have bilateral disease ( P < 0.05 for all). Injection drug use patients were less likely to have a systemic infection source identified (29% vs. 71%, P < 0.001) or have positive cultures (47% vs. 80%, P < 0.001). The IDU group was less likely to be admitted to the hospital (71% vs. 92%, P = 0.005) and less likely to receive treatment with intravenous antimicrobials (55% vs. 83%, P = 0.003). Visual acuity did not significantly differ between groups. CONCLUSION Endophthalmitis related to IDU presents in younger patients with less comorbidities and frequently without positive cultures or an identifiable systemic source; therefore, a high index of suspicion is needed to identify this disease.
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Affiliation(s)
- Elizabeth C Ciociola
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jeffrey C Powell
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Eliza Barnwell
- Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina; and
| | - Jason A Zehden
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Cason B Robbins
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Srinath Soundararajan
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Pali Singh
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Alice Yang Zhang
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Margaret A Greven
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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8
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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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9
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Gunalda J, Williams D, Koyfman A, Long B. High risk and low prevalence diseases: Endophthalmitis. Am J Emerg Med 2023; 71:144-149. [PMID: 37393773 DOI: 10.1016/j.ajem.2023.06.029] [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: 03/04/2023] [Revised: 05/16/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023] Open
Abstract
INTRODUCTION Endophthalmitis is a serious, vision-threatening condition that carries with it a high rate of morbidity. OBJECTIVE This review highlights the pearls and pitfalls of endophthalmitis, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Endophthalmitis is a vision-threatening emergency associated with infection and inflammation of vitreous and aqueous humor. Risk factors include ocular trauma or surgery, immunocompromised state, diabetes mellitus, and injection drug use. History and examination include visual changes, ocular pain, and inflammatory findings (e.g., hypopyon). Fever may be present. Diagnosis should be based on the clinical evaluation, though aqueous or vitreous culture performed by the ophthalmology specialist is recommended. Imaging including computed tomography, magnetic resonance imaging, and ultrasound may suggest the disease but cannot exclude the diagnosis. Management includes emergent ophthalmology consultation and evaluation. Treatment for all types of endophthalmitis is injection of intravitreal antibiotics with consideration of vitrectomy in severe cases. Systemic antimicrobials are recommended in specific types of endophthalmitis. Prompt recognition and diagnosis are key to optimizing favorable visual outcomes. CONCLUSIONS An understanding of endophthalmitis can assist emergency clinicians in diagnosing and managing this serious disease.
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Affiliation(s)
- Jonah Gunalda
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
| | - Dustin Williams
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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10
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Xie CA, Singh J, Tyagi M, Androudi S, Dave VP, Arora A, Gupta V, Agrawal R, Mi H, Sen A. Endogenous Endophthalmitis - A Major Review. Ocul Immunol Inflamm 2023; 31:1362-1385. [PMID: 36306406 DOI: 10.1080/09273948.2022.2126863] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 10/31/2022]
Abstract
Endogenous endophthalmitis (EE) is an uncommon but potentially devastating ocular infection involving the inner layers of the eye. The global incidence of EE is on the rise. Common ocular signs and symptoms associated with EE include conjunctival injection, ocular pain, and reduced visual acuity. On clinical examination, a history of prior or coexisting systemic infections, symptoms (e.g., fever, malaise), and localizing features may be noted. Clinical diagnosis is often challenging, resulting in critical delays that contribute to a poor prognosis. Blood cultures and ocular fluid samples can aid in conforming causative pathogen(s), after which empirical antibiotic therapy, both systemic and intravitreal, should be instated. The use of steroids to suppress inflammation remains controversial. Surgical options include pars plana vitrectomy. Overall prognosis varies depending on host and pathogen factors, and early diagnosis and initiation of appropriate treatment are crucial.
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Affiliation(s)
- Cen Amy Xie
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jayanti Singh
- Department of Vitreo-retina and Uvea, Sadguru Netra Chikatsalaya, Chitrakoot, India
| | - Mudit Tyagi
- Department of Vitreo-retina, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, Volos, Greece
| | - Vivek Pravin Dave
- Department of Vitreo-retina, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Atul Arora
- Advanced Eye Centre, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rupesh Agrawal
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Eye ACP programme, Duke NUS Medical School, Singapore
- Ocular Infections and AntiMicrobials Group, Singapore Eye Research Institute, Singapore
| | - Helen Mi
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Alok Sen
- Department of Vitreo-retina and Uvea, Sadguru Netra Chikatsalaya, Chitrakoot, India
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11
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Teixeira FHF, Santos NS, de Carvalho Mendes Paiva A, Carvalho EM, Biancardi AL, Curi ALL. Optical coherence tomography findings in fungal uveitis. Int Ophthalmol 2023; 43:3023-3030. [PMID: 37004606 DOI: 10.1007/s10792-023-02696-0] [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: 07/11/2022] [Accepted: 03/23/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE The purpose of the study was to describe the vitreal, retinal, and choroidal features of eyes affected by endogenous endophthalmitis (EE) and evaluate the effects of systemic antifungal drug treatment and pars plana vitrectomy by using spectral domain optical coherence tomography (SD-OCT). METHODS Medical records and SD-OCT images of eyes diagnosed with EE at a single uveitis tertiary referral center in Brazil were acquired at the time of diagnosis, after 7 days of high-dose antifungal drug treatment, and at follow-up assessments performed 30 days after resolution. RESULTS Thirteen eyes were enrolled in the study. All patients showed hyperreflective round-shaped lesions on SD-OCT and pre-retinal aggregates. Five eyes responded to antifungal systemic oral drugs despite showing vitreous opacity. The response to treatment was observable on optical coherence tomography (OCT) images. CONCLUSION Fungal endophthalmitis showed typical features on SD-OCT, facilitating early diagnosis and treatment despite the absence of vitreous culture or biopsy. This study suggests that OCT images can be used to support diagnosis by physicians who do not have access to vitreoretinal surgery.
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Affiliation(s)
- Fernando Henrique Flores Teixeira
- Clinical Research Laboratory of National Institute of Infectious Diseases (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, Brazil.
| | - Nathalia Silva Santos
- Clinical Research Laboratory of National Institute of Infectious Diseases (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, Brazil
| | - Alexandre de Carvalho Mendes Paiva
- Clinical Research Laboratory of National Institute of Infectious Diseases (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, Brazil
| | - Erika Moreira Carvalho
- Clinical Research Laboratory of National Institute of Infectious Diseases (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, Brazil
| | - Ana Luiza Biancardi
- Clinical Research Laboratory of National Institute of Infectious Diseases (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, Brazil
| | - André Luiz Land Curi
- Clinical Research Laboratory of National Institute of Infectious Diseases (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, Brazil
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12
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Agi N, Zarbin MA, Bhagat N. Klebsiella Endogenous Endophthalmitis During the COVID-19 Pandemic. JOURNAL OF VITREORETINAL DISEASES 2023; 7:316-321. [PMID: 37920850 PMCID: PMC10170248 DOI: 10.1177/24741264231170462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Purpose: To describe the characteristics of Klebsiella pneumoniae endogenous endophthalmitis (KEE) encountered during the COVID-19 pandemic. Methods: This retrospective consecutive case series evaluated eyes that presented with KEE between March 2020 and July 2022. Results: Seven eyes of 5 patients developed KEE. Between January 2020 and July 2022, KEE was observed in 42% of consecutive EE cases compared with 7.8% during the preceding 13 years. COVID-19 was positive in 4 of 5 patients before they developed KEE. Only 1 patient presented with a VA better than hand motions (20/400). All eyes were treated with urgent vitrectomy and intravitreal and systemic antibiotics. No improvement in vision occurred in any patient; VA remained light perception to no light perception in 60% of eyes. Conclusions: The visual prognosis in KEE is extremely poor. The presence of a preceding COVID-19 infection in 80% of patients may signal a new risk factor for KEE. Patients with a hypervirulent Klebsiella syndrome should be routinely screened for EE.
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Affiliation(s)
- Nathan Agi
- Institute of Ophthalmology and Visual Sciences, Rutgers University–New Jersey Medical School, Newark, NJ, USA
| | - Marco A. Zarbin
- Institute of Ophthalmology and Visual Sciences, Rutgers University–New Jersey Medical School, Newark, NJ, USA
| | - Neelakshi Bhagat
- Institute of Ophthalmology and Visual Sciences, Rutgers University–New Jersey Medical School, Newark, NJ, USA
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13
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Song H, Zhou Y, Chen T, Wang J. Endogenous listeria monocytogenes endophthalmitis in a cirrhotic patient. Clin Case Rep 2023; 11:e07670. [PMID: 37426683 PMCID: PMC10323651 DOI: 10.1002/ccr3.7670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/06/2023] [Accepted: 06/17/2023] [Indexed: 07/11/2023] Open
Abstract
Endogenous endophthalmitis caused by listeria monocytogenes is rare and serious, which is easily misdiagnosed initially. We present one case of endogenous endophthalmitis due to listeria monocytogenes in a cirrhotic patient, whose diagnosis was delayed 17 days after admission.
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Affiliation(s)
- Huping Song
- Department of OphthalmologyShaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital)Xi'anChina
| | - Yunyun Zhou
- Department of OphthalmologyShaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital)Xi'anChina
| | - Tao Chen
- Department of OphthalmologyShaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital)Xi'anChina
| | - Jingbo Wang
- Department of OphthalmologyShaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital)Xi'anChina
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14
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Mohan S, Kandle K, Ganesan S, Prakash VJ, Mistry S, Anand AR, Biswas J. Endogenous fungal endophthalmitis following COVID-19 infection with microbiological and molecular biological correlation - A report of two cases. Indian J Ophthalmol 2023; 71:2272-2275. [PMID: 37202969 PMCID: PMC10391411 DOI: 10.4103/ijo.ijo_2044_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
This case report describes three eyes of two patients, who were diagnosed to have endogenous fungal endophthalmitis post coronavirus disease 2019 (COVID-19) infection. Both patients underwent vitrectomy with intravitreal anti-fungal injection. Intra-ocular samples confirmed the fungal etiology by conventional microbiological investigations and polymerase chain reaction in both cases. The patients were treated with multiple intravitreal and oral anti-fungal agents; however, vision could not be salvaged.
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Affiliation(s)
- Sashwanthi Mohan
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Kaustubh Kandle
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Suganeswari Ganesan
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - V Jaya Prakash
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Suraj Mistry
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - A R Anand
- L and T Microbiology Research Centre, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
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15
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Chua WJ, P Radhakrishnan A, Yusof WM, Chang CY. Bilateral Endogenous Endophthalmitis Secondary to Streptococcus pneumoniae: An Uncommon but Devastating Complication. Cureus 2023; 15:e37655. [PMID: 37200637 PMCID: PMC10188273 DOI: 10.7759/cureus.37655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/20/2023] Open
Abstract
Endophthalmitis is an infection of the vitreous and/or aqueous humours, caused by bacteria or fungi, and can be either exogenous (resulting from trauma or intraocular procedures) or endogenous (hematogenous in origin). Although less common than exogenous endophthalmitis, endogenous endophthalmitis can have serious, vision-threatening consequences. Streptococcus pneumoniae is a rare cause of endogenous endophthalmitis and is associated with a poor prognosis. In this report, we present a rare case of pneumococcal endogenous endophthalmitis that led to a devastating outcome despite both medical and surgical interventions. Early systemic treatment and prompt identification of the primary source are crucial and potentially life-saving.
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Affiliation(s)
- Wen Jun Chua
- Internal Medicine, Hospital Selayang, Selayang, MYS
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16
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Arjamilah MN, Aiman-Mardhiyyah MY, Shatriah I, Tai Li Min E, Ngoo QZ. Bilateral Endogenous Klebsiella pneumoniae Endophthalmitis in Culture-Negative Liver Abscess Requiring Evisceration: A Case Report and Review of Literature. Cureus 2023; 15:e36965. [PMID: 37131551 PMCID: PMC10149085 DOI: 10.7759/cureus.36965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
Endogenous endophthalmitis is a very rare but potentially devastating intraocular inflammation resulting from hematogenous dissemination into the eye from a remote focus of infection. We present a case of a 49-year-old Vietnamese gentleman with underlying hypertension and ischemic heart disease who presented with sudden onset bilateral eye blurring of vision for five days associated with fever, chills, and rigors. He started to have a chesty cough with right-sided pleuritic chest pain for three days as well as shortness of breath, which developed one day prior to admission. Bilateral ocular examinations and B-scan ultrasonography were consistent with endophthalmitis. A systemic workup was performed and showed multiloculated liver abscess and right lung empyema seen radiologically. Bilateral eye vitreous tap and intravitreal antibiotic injection were performed. He underwent ultrasound-guided pigtail catheter insertion and drainage of the subcapsular and pelvic collection. Microbiological findings revealed Klebsiella pneumoniae infection obtained from vitreous and endotracheal aspirate samples. There were no cultures yielded from the intraabdominal collection and peripheral blood. The right eye infection rapidly progressed to panophthalmitis, which subsequently led to globe perforation despite prompt treatment and eventually required evisceration. Thus, despite culture-negative pyogenic liver abscess in a non-diabetic patient, a high index of suspicion, emergent radiographic evaluation, and prompt intervention and treatment are crucial in salvaging the globes.
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17
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Nanayakkara U, Khan MA, Hargun DK, Sivagnanam S, Samarawickrama C. Ocular streptococcal infections: A clinical and microbiological review. Surv Ophthalmol 2023:S0039-6257(23)00036-X. [PMID: 36764397 DOI: 10.1016/j.survophthal.2023.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
Streptococcus is a diverse bacterial genus that is part of the ocular surface microbiome implicated in conjunctivitis, keratitis, endophthalmitis, dacryocystitis, and orbital cellulitis which can lead to decreased visual acuity and require surgical intervention. The pathophysiology of S. pneumoniae is well established and the role of the polysaccharide capsule, pneumolysin, neuraminidases, and zinc metalloproteinases in ocular infections described. Additionally, key virulence factors of the viridans group streptococci such as cytolysins and proteases have been outlined, but there is a paucity of research on the remaining streptococcus species. These virulence factors tend to result in aggressive disease. Clinically, S. pneumoniae is implicated in 2.7-41.2% of bacterial conjunctivitis cases, more predominant in the pediatric population, and is implicated in 1.8-10.7% of bacterial keratitis isolates. Streptococcus bacteria are significantly implicated in acute postoperative, post-intravitreal, and bleb-associated endophthalmitis, responsible for 10.3-37.5, 29.4, and 57.1% of cases, respectively. Group A and B streptococcus endogenous endophthalmitis is rare, but has a very poor prognosis. Inappropriate prescription of antibiotics in cases of non-bacterial aetiology has contributed to increasing resistance, and a clinical index is needed to more accurately monitor this. Furthermore, there is an increasing need for prospective, surveillance studies of antimicrobial resistance in ocular pathogens, as well as point-of-care testing using molecular techniques.
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Affiliation(s)
| | | | | | - Shobini Sivagnanam
- Blacktown Hospital, Sydney, Australia; Australian Clinical Labs, Bella Vista, Sydney, Australia
| | - Chameen Samarawickrama
- University of Sydney, Australia; Translational Ocular Research and Immunology Consortium (TORIC), Westmead Institute for Medical Research, Australia.
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18
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Sasi S, Faraj H, Barazi R, Kolleri J, Chitrambika P, Rahman Al Maslamani MA, Ali M. Endogenous endophthalmitis due to Serratia marcescens secondary to late-onset empyema Post-Cardiac surgery in an End-Stage renal disease patient on peritoneal dialysis. Clin Case Rep 2023; 11:e6997. [PMID: 36852121 PMCID: PMC9957995 DOI: 10.1002/ccr3.6997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 01/18/2023] [Accepted: 02/12/2023] [Indexed: 02/27/2023] Open
Abstract
Endogenous bacterial endophthalmitis results from bacterial seeding of the eye during bacteremia. A diagnosis of endogenous bacterial endophthalmitis requires clinical findings such as vitritis or hypopyon along with positive blood cultures. Serratia marcescens is the second most common pathogen causing hospital-acquired ocular infections. This report describes a case of endogenous bacterial endophthalmitis caused by S. marcescens in an older adult with end-stage renal disease (ESRD) on peritoneal dialysis, who had late-onset pleural empyema secondary to coronary artery bypass grafting (CABG). A 61-year-old gentleman presented with a two-day history of cloudy vision, black floaters, pain, swelling, and gradual vision loss in his right eye. There was no history of trauma, ocular surgeries, or previous similar episodes. He had myocardial infarction treated with CABG 3 months back. Examination showed a 3 mm hypopyon in the anterior chamber. He had classic signs of endophthalmitis with positive blood cultures for S. marcescens. He was treated with high-dose intravenous meropenem and intravitreal ceftazidime without vitrectomy. Endophthalmitis progressed to complete vision loss in his right eye, requiring evisceration. Endophthalmitis caused by S. marcescens is rare, but long-term outcomes can be severe, causing complete vision loss in about 60% of the patients. It is usually hospital-acquired, and the source can be late-onset empyema several months after cardiac surgery, in an immunocompromised patient. Systemic antibiotics should be supplemented with intravitreal agents with or without pars plana vitrectomy.
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Affiliation(s)
- Sreethish Sasi
- Infectious Diseases Division, Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Hazem Faraj
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Raja Barazi
- Department of PharmacyHamad Medical CorporationDohaQatar
| | - Jouhar Kolleri
- Department of Clinical ImagingHamad Medical CorporationDohaQatar
| | - P. Chitrambika
- Department of AnesthesiologyHamad Medical CorporationDohaQatar
| | | | - Maisa Ali
- Infectious Diseases Division, Department of Internal MedicineHamad Medical CorporationDohaQatar
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19
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Goenadi CJ, Chew KL, Gopal L, Chen DZ. Clinical outcome of bacterial endogenous endophthalmitis in 15 patients. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023. [DOI: 10.47102/annals-acadmedsg.2022407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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20
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Lee JJ, Jo YJ, Lee JS. Clinical characteristics and risk factors for visual prognosis according to the types of infectious endophthalmitis. PLoS One 2022; 17:e0278625. [PMID: 36454919 PMCID: PMC9714883 DOI: 10.1371/journal.pone.0278625] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/19/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Endophthalmitis is a fatal ophthalmological emergency that needs prompt diagnosis and treatment. This study aimed to evaluate the clinical characteristics and investigate risk factors for the visual prognosis of the different types of endophthalmitis. METHODS This retrospective study included 239 eyes diagnosed with endophthalmitis at the Pusan National University Hospital between January 2006 and December 2020. All patients were classified into six groups based on the etiology of endophthalmitis: post-cataract surgery, post-vitrectomy, post-glaucoma surgery, post-intravitreal injection, endogenous, and post-trauma. Demographics and clinical characteristics such as age, sex, laterality, initial symptoms, the interval between the primary causable event and diagnosis of endophthalmitis, initial and final visual acuity, management, and culture results were reviewed and statistically analyzed. Risk factors for poor visual prognosis were also analyzed according to the type of endophthalmitis. RESULTS Of the 239 cases of endophthalmitis, the most common cause was post-cataract surgery, that occurs within two weeks post-surgery. Gram-positive Staphylococcus was cultured most frequently. Fusarium was characteristically cultured from delayed post-cataract surgery endophthalmitis (14 days-6 weeks post-surgery). Post-vitrectomy endophthalmitis occurred within 3.3 days post-surgery, but post-glaucoma surgery endophthalmitis developed a long period after surgery, averaging 2,742 days. Post-intravitreal injection endophthalmitis occurred most frequently following bevacizumab injection, and Staphylococcus was most commonly isolated. For endogenous endophthalmitis, the pyogenic liver abscess was the most common underlying disease, and Klebsiella was isolated most frequently. Post-traumatic endophthalmitis mostly occurred in young men. Advanced age and poor initial visual acuity were risk factors for poor visual prognosis (P = 0.041, odds ratio = 1.024 and P < 0.001, odds ratio = 3.904, respectively, using logistic regression analysis). CONCLUSION Advanced age and initial visual acuity were risk factors for poor visual prognosis in cases of endophthalmitis caused by various etiologies. Early diagnosis and treatment of endophthalmitis are required, especially in older patients.
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Affiliation(s)
- Jae Jung Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Pusan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Pusan, Republic of Korea
| | - Yeon Ji Jo
- Department of Ophthalmology, Pusan National University School of Medicine, Pusan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Pusan, Republic of Korea
| | - Jong Soo Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Pusan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Pusan, Republic of Korea
- * E-mail:
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21
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Mamikunian G, Ziegler A, Thorpe E. A Case of Panophthalmitis Secondary to Odontogenic Maxillary Sinusitis. Cureus 2022; 14:e30801. [DOI: 10.7759/cureus.30801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 11/07/2022] Open
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22
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El-Gendy AO, Obaid Y, Ahmed E, Enwemeka CS, Hassan M, Mohamed T. The Antimicrobial Effect of Gold Quantum Dots and Femtosecond Laser Irradiation on the Growth Kinetics of Common Infectious Eye Pathogens: An In Vitro Study. NANOMATERIALS (BASEL, SWITZERLAND) 2022; 12:nano12213757. [PMID: 36364531 PMCID: PMC9654226 DOI: 10.3390/nano12213757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 05/29/2023]
Abstract
We studied the antimicrobial effect of gold quantum dots (AuQDs), femtosecond laser irradiation, and the combined effect of laser irradiation and AuQD treatment against common infectious eye pathogens. The INSPIRE HF100 laser system (Spectra Physics) provided a femtosecond laser, which was pumped by a mode-locked femtosecond Ti: sapphire laser MAI TAI HP (Spectra Physics), while a Quanta-Ray nanosecond Nd: YAG laser (Spectra-Physics) was used to precisely synthesize 7.8, 8.7, and 11.6 nm spherical AuQDs. Then, the in vitro growth kinetics and growth rate analysis of E. coli, methicillin-resistant Staphylococcus aureus, Enterococcus faecalis, Listeria monocytogenes, and Candida albicans (treated with the AuQDs, femtosecond laser irradiation, or combined laser and AuQDs treatment) was measured. The biocompatibility of the AuQDs with the retinal epithelial cell lines (ARPE-19) and their toxicity to the cells was assayed. The results showed that (1) in vitro irradiation using a 159 J/cm2 energy density obtained from the 400 nm femtosecond laser suppressed the growth of each of the five pathogens. (2) Similarly, treatment with the AuQDs was antimicrobial against the four bacteria. The AuQDs with an average size of 7.8 nm were more highly antimicrobial and biocompatible and were less cytotoxic than the larger AuQD sizes. (3) The combined femtosecond laser irradiation and AuQD treatment was more highly antimicrobial than each treatment alone. (4) The AuQD treatment did not impair the rate of wound closure in vitro. These findings suggest that combined femtosecond laser irradiation and AuQD treatment is significantly antimicrobial against Candida albicans, Gram-positive L. monocytogenes, S. aureus, and E. faecalis, as well as Gram-negative E. coli. The nontoxicity and biocompatibility of the AuQD particles tested suggest that this form of treatment may be clinically viable.
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Affiliation(s)
- Ahmed O. El-Gendy
- Laser Institute for Research and Applications LIRA, Beni-Suef University, Beni-Suef 62511, Egypt
- Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt
| | - Yousif Obaid
- Anbar Health Department, Ministry of Health, Ramadi 31001, Iraq
| | - Esraa Ahmed
- Laser Institute for Research and Applications LIRA, Beni-Suef University, Beni-Suef 62511, Egypt
| | - Chukuka S. Enwemeka
- College of Health and Human Services, San Diego State University, San Diego, CA 92182, USA
- Faculty of Health Sciences, University of Johannesburg, Doornfontein 2028, South Africa
| | - Mansour Hassan
- Department of Ophthalmology, Faculty of Medicine, Beni-Suef University, Beni-Suef 62514, Egypt
| | - Tarek Mohamed
- Laser Institute for Research and Applications LIRA, Beni-Suef University, Beni-Suef 62511, Egypt
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23
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Chun LY, Dahmer DJ, Amin SV, Hariprasad SM, Skondra D. Update on Current Microbiological Techniques for Pathogen Identification in Infectious Endophthalmitis. Int J Mol Sci 2022; 23:11883. [PMID: 36233183 PMCID: PMC9570044 DOI: 10.3390/ijms231911883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Infectious endophthalmitis is a vision-threatening medical emergency that requires prompt clinical diagnosis and the initiation of treatment. However, achieving precision in endophthalmitis management remains challenging. In this review, we provide an updated overview of recent studies that are representative of the current trends in clinical microbiological techniques for infectious endophthalmitis.
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Affiliation(s)
- Lindsay Y. Chun
- Department of Ophthalmology and Visual Science, The University of Chicago Hospitals and Health System, Chicago, IL 60637, USA
| | - Donavon J. Dahmer
- College of Medicine, University of South Alabama, Mobile, AL 36688, USA
| | - Shivam V. Amin
- Department of Ophthalmology and Visual Science, The University of Chicago Hospitals and Health System, Chicago, IL 60637, USA
| | - Seenu M. Hariprasad
- Department of Ophthalmology and Visual Science, The University of Chicago Hospitals and Health System, Chicago, IL 60637, USA
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, The University of Chicago Hospitals and Health System, Chicago, IL 60637, USA
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24
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Zhang X, Brodie FL, Postel EA, Seidelman JL. Endogenous Methicillin-Resistant Staphylococcus Aureus (MRSA) Endophthalmitis: A Six-year Series at a Tertiary Care Center. Ocul Immunol Inflamm 2022; 30:1572-1576. [PMID: 33945390 DOI: 10.1080/09273948.2021.1906911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the clinical outcomes of methicillin-resistant Staphylococcus aureus (MRSA) endophthalmitis. METHODS Clinical courses were reviewed for 17 eyes (15 patients) with endogenous MRSA endophthalmitis based on positive blood and vitreous culture or clinical suspicion between 2013 to 2019 at Duke University Hospitals. RESULTS Of 17 eyes, initial VA ranged from 20/40 to light perception. Of 15 patients, 9 had predisposing risk factors for bacteremia. All eyes received intravitreal vancomycin, 13 also received ceftazidime, and 2 also received amikacin instead of ceftazidime. Nine eyes developed retinal detachment; 6 underwent vitrectomy. Final VA ranged from 20/20 to no light perception and was ≥20/200 in 8 eyes. Eleven eyes had improved VA, 2 eyes were unchanged, and 4 were worse. CONCLUSIONS This study is the largest series on endogenous MRSA endophthalmitis to date. Patients had a higher proportion of final VA ≥20/200, similarly high rate of RD, and fewer enucleations compared to prior reports.
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Affiliation(s)
- Xinxin Zhang
- Duke University Eye Center, Duke University, Durham, North Carolina, USA
| | - Frank L Brodie
- Duke University Eye Center, Duke University, Durham, North Carolina, USA
| | - Eric A Postel
- Duke University Eye Center, Duke University, Durham, North Carolina, USA
| | - Jessica L Seidelman
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, North Carolina, USA.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina, USA
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25
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Muacevic A, Adler JR. Staphylococcus lugdunensis Endophthalmitis Following Intravitreal Anti-vascular Endothelial Growth Factor Injections. Cureus 2022; 14:e30439. [PMID: 36407209 PMCID: PMC9671385 DOI: 10.7759/cureus.30439] [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] [Accepted: 10/18/2022] [Indexed: 11/23/2022] Open
Abstract
Staphylococcus lugdunensis is a rare causative organism of endophthalmitis following intravitreal injections. It presents an aggressive disease course with potentially devastating outcomes. In this case, the patient presented late with a severely painful, red eye with a reduced visual acuity from 6/18 to light perception following bilateral intravitreal injections of anti-vascular endothelial growth factor. Strict adherence to the bilateral intravitreal injection protocol meant prevention of infection in the right eye. Intravitreal vancomycin was administered without delay and an emergency vitreous biopsy was performed, confirming S. lugdunensis as the causative organism. An intense course of oral and topical steroids was chosen due to the aggressiveness of this organism. Early vitreo-retinal opinion was sought but the patient was deemed not suitable for vitrectomy due to initial improvements in visual acuity to hand movements. The patient showed improvements in the visual acuity to 1/60, and remains on a weaning regime of oral and topical steroids with no further complications.
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Letsoalo HL, Mathebula SD. A case of severe endogenous endophthalmitis with orbital cellulitis post COVID-19. AFRICAN VISION AND EYE HEALTH 2022; 81:748. [PMCID: PMC9557940 DOI: 10.4102/aveh.v81i1.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a novel pandemic viral illness which may lead to severe respiratory diseases. However, its ophthalmic manifestations are still not well understood. There could be serious complications involving various organs in patients with the disease and in those who are recovering, or have recovered, from COVID-19. Endogenous endophthalmitis, was a rare occurrence in the past but has increased in the post-COVID-19 pandemic. Endogenous endophthalmitis results from hematogenous spread from a remote primary source. A 55-year-old man with confirmed COVID-19 presented to a local hospital with unilateral gradual loss of vision and swelling of the left eye that occurred 10 days after discharge from the hospital. Based on detailed ophthalmic examination, this patient with a co-morbidity, namely diabetes mellitus was placed in the intensive care unit where he was given corticosteroids and ventilation for two weeks. Most patients requiring mechanical ventilation may experience disorders of the eye, and it may be difficult to treat these occurrences while the patient remains in ICU. COVID-19 can lead to ocular complications especially in the late stages of infection. Follow-up of post COVID-19 patients is crucial to monitor possible ocular complaints including endophthalmitis as early diagnosis and treatment is essential to salvage vision.
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Affiliation(s)
- Herold L. Letsoalo
- Department of Ophthalmology, Botshilu Private Hospital, Ga-Rankuwa, South Africa
| | - Solani D. Mathebula
- Department of Optometry, Faculty of Health Sciences, University of Limpopo, Sovenga, South Africa
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Darland H, Schutte B, Horne J, Jerabek J, Millner PG. Bilateral Endogenous Bacterial Endophthalmitis Secondary to Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia. Cureus 2022; 14:e29418. [PMID: 36304340 PMCID: PMC9586553 DOI: 10.7759/cureus.29418] [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] [Accepted: 09/21/2022] [Indexed: 11/28/2022] Open
Abstract
Endogenous bacterial endophthalmitis (EBE) is a rare but vision-threatening complication of bacteria spreading contiguously through the blood-ocular border. The condition is frequently associated with a poor visual prognosis and has even resulted in death. We present a case of a 48-year-old female with bilateral endogenous methicillin-resistant Staphylococcus aureus (MRSA)endophthalmitis further complicated by septic emboli, endocarditis, osteomyelitis, and septic polyarthralgia. Her vision did not return despite aggressive antibiotic therapy and urgent bilateral vitrectomy. This case presents an interesting and rare clinical vignette resulting in infection and damage of multiple organ systems that required aggressive management and carefully orchestrated multidisciplinary care.
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Lee JJ, Hong SB, Lee NK, Park YJ, Kim SH, Park SW, Byon I, Kim S. Characteristics of Computed Tomography for Identifying Patients at High Risk of Endogenous Endophthalmitis Due to Klebsiella pneumoniae-Related Pyogenic Liver Abscess. J Clin Med 2022; 11:jcm11154376. [PMID: 35955994 PMCID: PMC9369040 DOI: 10.3390/jcm11154376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023] Open
Abstract
Endogenous endophthalmitis (EE) associated with Klebsiella pneumoniae (K. pneumoniae)-related pyogenic liver abscess (PLA) is one of the fatal complications of PLA and leads to loss of vision. Early diagnosis and treatment are important to save the patient’s vision. We investigated the characteristics of computed tomography (CT) in EE associated with K. pneumoniae-related PLA for the identification of the predictors of EE, in order to facilitate early diagnosis. A total of 274 patients diagnosed with K. pneumoniae-related PLA, including 15 patients with EE, were identified between January 2005 and December 2019. The clinical (age, gender, and underlying disease) and radiologic (the location, size, and number of abscesses) features were reviewed. In addition, the involvement of the adjacent vessels, such as the hepatic vein and portal vein, was carefully reviewed. A comparative analysis was performed between the EE and non-EE groups. Uni- and multivariate logistic regression analyses were used to identify the predictors of EE. Diabetes mellitus (DM), the involvement of the left or both hepatic lobes, and the adjacent vessels on the CT were significantly more frequent than those in the non-EE group (p < 0.05 in all), and they were the significant predictors of EE in the logistic regression analyses. In patients with K. pneumoniae-related PLA, the CT findings, such as the locations of the abscess (i.e., left or both lobes) and the involvement of the adjacent vessels, should be considered in addition to the ocular symptoms for an early diagnosis of EE.
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Affiliation(s)
- Jae Jung Lee
- Department of Ophthalmology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Pusan 46241, Korea; (J.J.L.); (S.H.K.); (S.W.P.); (I.B.)
- JRYN Eye Clinic, Pusan 47296, Korea
| | - Seung Baek Hong
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Pusan 46241, Korea; (N.K.L.); (S.K.)
- Correspondence: ; Tel.: +82-51-240-7354
| | - Nam Kyung Lee
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Pusan 46241, Korea; (N.K.L.); (S.K.)
| | - Young Joo Park
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Pusan 46241, Korea;
| | - So Hee Kim
- Department of Ophthalmology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Pusan 46241, Korea; (J.J.L.); (S.H.K.); (S.W.P.); (I.B.)
- Lee Eye Clinic, Pusan 611831, Korea
| | - Sung Who Park
- Department of Ophthalmology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Pusan 46241, Korea; (J.J.L.); (S.H.K.); (S.W.P.); (I.B.)
| | - Iksoo Byon
- Department of Ophthalmology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Pusan 46241, Korea; (J.J.L.); (S.H.K.); (S.W.P.); (I.B.)
| | - Suk Kim
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Pusan 46241, Korea; (N.K.L.); (S.K.)
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Lee CS, Desilets J, Fang W, Hinkle DM. The microbiological spectrum, antimicrobial resistance pattern, and visual outcomes of endogenous endophthalmitis in West Virginia 2009-2019. Int Ophthalmol 2022; 42:3153-3163. [PMID: 35606624 DOI: 10.1007/s10792-022-02315-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 04/18/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To report the microbiological spectrum, antimicrobial resistance patterns, and visual outcomes in patients with endogenous endophthalmitis (EE). METHODS This was a retrospective study of 50 patients with culture-positive EE managed in a tertiary referral center between October 2009 and 2019. Clinical, microbiology analysis, and antimicrobial resistance were reviewed. A multivariable linear regression analysis was used for identifying risk factors associated with worse visual outcomes. RESULTS Fifty organisms were identified, 62% bacterial and 38% fungal. The most common bacterial organism was Staphylococcus aureus (75% methicillin resistant), and Candida was the most common fungal species. Multidrug resistance was observed in methicillin-resistant Staphylococcus aureus (MRSA) isolates against clindamycin, daptomycin, and fluoroquinolones. The distributions of the final visual acuity (VA) between the bacterial and fungal groups were significantly different, and the visual outcomes in the bacterial group tended to be worse (p = 0.01). The distributions of enucleation status were significantly higher in bacterial EE (35%) than fungal EE (5.3%) (p = 0.02). Results from the multivariable linear regression analysis revealed that older age was significantly associated with worse visual outcome (coef = 0.03; p = 0.02), while fungal infections were associated with better outcomes (coef = - 0.87; p = 0.01). Intravenous drug use (coef = 0.87; p = 0.054) was a marginally significant factor associated with worse visual outcomes. CONCLUSION There was a higher prevalence of bacterial organisms than fungal species among EE. Bacterial EE was associated with worse visual outcomes and higher enucleation rates than fungal EE. Multidrug resistance was prevalent among MRSA isolates. Older age and intravenous drug use may be factors associated with poor prognosis.
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Affiliation(s)
- Chang Sup Lee
- 1 Medical Center Drive, West Virginia University Eye Institute, Morgantown, WV, 26506, USA.,University of Southern California Roski Eye Institute, 1450 San Pablo St., Suite 4700, Los Angeles, CA, 90013, USA
| | - Jeffrey Desilets
- 1 Medical Center Drive, West Virginia University Eye Institute, Morgantown, WV, 26506, USA.,Ross Eye Institute, 1176 Main St., Buffalo, NY, USA
| | - Wei Fang
- WVU Health Sciences Center Erma Byrd Biomedical Research Center, 1 Medical Center Drive, West Virginia Clinical and Translational Science Institute, Morgantown, WV, 26506, USA
| | - David M Hinkle
- 1 Medical Center Drive, West Virginia University Eye Institute, Morgantown, WV, 26506, USA. .,Tulane University School of Medicine, 131 S. Robertson Street., 12th floor, 8069, New Orleans, LA, 70112, USA.
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Clinical characteristics of endogenous Klebsiella pneumoniae endophthalmitis: a 13-year experience. Int Ophthalmol 2022; 42:2533-2539. [DOI: 10.1007/s10792-022-02301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/10/2022] [Indexed: 11/27/2022]
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Verma S, Azad SV, Venkatesh P, Kumar V, Surve A, Balaji A, Vohra R. Role of Intralesional Antibiotic for Treatment of Subretinal Abscess – Case Report and Literature Review. Ocul Immunol Inflamm 2022; 30:487-490. [DOI: 10.1080/09273948.2020.1811880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Saurabh Verma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | | | - Pradeep Venkatesh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Abhidnya Surve
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Akshaya Balaji
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Rajpal Vohra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Fungal Endophthalmitis: A Comprehensive Review. J Fungi (Basel) 2021; 7:jof7110996. [PMID: 34829283 PMCID: PMC8623405 DOI: 10.3390/jof7110996] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 12/27/2022] Open
Abstract
Endophthalmitis is a serious ophthalmologic condition involving purulent inflammation of the intraocular spaces. The underlying etiology of infectious endophthalmitis is typically bacterial or fungal. The mechanism of entry into the eye is either exogenous, involving seeding of an infectious source from outside the eye (e.g., trauma or surgical complications), or endogenous, involving transit of an infectious source to the eye via the bloodstream. The most common organism for fungal endophthalmitis is Candida albicans. The most common clinical manifestation of fungal endophthalmitis is vision loss, but other signs of inflammation and infection are frequently present. Fungal endophthalmitis is a clinical diagnosis, which can be supported by vitreous, aqueous, or blood cultures. Treatment involves systemic and intravitreal antifungal medications as well as possible pars plana vitrectomy. In this review, we examine these essential elements of understanding fungal endophthalmitis as a clinically relevant entity, which threatens patients’ vision.
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A rare presentation of Klebsiella pneumoniae endogenous panophthalmitis with optic neuritis and orbital cellulitis from a urinary tract infection. IDCases 2021; 26:e01289. [PMID: 34646733 PMCID: PMC8496094 DOI: 10.1016/j.idcr.2021.e01289] [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: 08/14/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022] Open
Abstract
This case illustrates the rare presentation of endogenous Klebsiella pneumoniae endophthalmitis with concomitant orbital cellulitis from an acute pyelonephritis. A 59-year-old Caucasian female with type 2 diabetes mellitus was transferred from a regional hospital with decreased visual acuity, periorbital edema, photophobia, proptosis and pain of the right eye, as well as suprapubic discomfort. Initial ocular examination and B-scan ultrasonography were consistent with endophthalmitis and orbital cellulitis which lead to a vitreous tap and intravitreal antibiotics injection and systemic antibiotherapy. Vitreous and blood cultures confirmed Klebsiella pneumoniae as the causative organism. An orbital MRI showed a panophthalmitis with optic neuritis and further imaging confirmed a concomitant pyelonephritis secondary to a septic nephrolithiasis. The patient was given treatment with high-does intravenous antibiotics, oral and topical corticotherapy, and an early core pars plana vitrectomy (PPV), performed 5 days after presentation with repeat injections of antibiotics and dexamethasone. Unfortunately, two weeks following PPV, despite an initial stable postoperative course, the patient deteriorated and presented with purulent discharge from one of the vitrectomy port incision site. An emergency evisceration was performed in order to control the infection, revealing a large subretinal abscess and necrosed sclerotic tissue around the prior vitrectomy incision sites. Conclusion: This is the first case report of Klebsiella pneumoniae endophthalmitis or panophthalmitis presenting with orbital cellulitis and optic neuritis from an urinary tract infection. Prognosis is poor despite treatment including early vitrectomy.
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Choukrani H, Maaroufi A, Ould Mohamed Sidi B, Bennouna MG, Drighil A, Habbal R. Infective endocarditis secondary to coagulase-negative staphylococcus revealed by endogenous endophthalmitis: Case report. Ann Med Surg (Lond) 2021; 70:102788. [PMID: 34557297 PMCID: PMC8445831 DOI: 10.1016/j.amsu.2021.102788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/25/2021] [Accepted: 09/02/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Endogenous endophthalmitis is a rare disease which remains a diagnostic and therapeutic emergency. Infective endocarditis is the first etiology, and coagulase-negative staphylococcus is most often incriminated in endocarditis on prosthesis and rarely on native valve. CASE REPORT We report the case of a 70 year old female patient, who has a chronic renal failure on haemodialysis, admitted to the ophthalmology department in endogenous endophthalmitis. Blood cultures, intravitreal sampling and culture of the haemodialysis catheter were positive for a multi-sensitive coagulase-negative staphylococcus. On transthoracic and transoesophageal ultrasound, vegetation was found in the right atrium along the path of the haemodialysis catheter and in the aortic and mitral valves. The patient received intravenous antibiotic and intravitreal injections of antibiotics. The evolution was marked by a systemic improvement but the ocular prognosis was poor and the evisceration decision was taken. DISCUSSION Endogenous endophthalmitis is related to a metastatic infectious process secondary to haematogenous microbial dissemination. The germs involved are Gram-positive bacteria and occurs very frequently in predisposed conditions. A primary infectious site is found in 90% of cases and this is most frequently endocarditis. Coagulase-negative staphylococci are responsible for 20-45% of endocarditis in prosthetic valves and the prevalence in native valve endocarditis is considered low. CONCLUSION Endogenous endophthalmitis remains an emergency. The search for a source of infection, primarily endocarditis, is systematic. The improvement of the prognosis depends essentially on the eviction and early treatment of infectious foci in people at risk.
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Affiliation(s)
- Hanane Choukrani
- Service de Cardiologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
| | - Anass Maaroufi
- Service de Cardiologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
| | - Boutar Ould Mohamed Sidi
- Service de Cardiologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
- Faculté de Médecine et de Pharmacie, Université Hassan II, B.P5696, Casablanca, Morocco
| | - Mohamed Ghali Bennouna
- Service de Cardiologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
- Faculté de Médecine et de Pharmacie, Université Hassan II, B.P5696, Casablanca, Morocco
| | - Abdennasser Drighil
- Service de Cardiologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
- Faculté de Médecine et de Pharmacie, Université Hassan II, B.P5696, Casablanca, Morocco
| | - Rachida Habbal
- Service de Cardiologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
- Faculté de Médecine et de Pharmacie, Université Hassan II, B.P5696, Casablanca, Morocco
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Mishra A, Giri S, Rauniyar R, Poudel S, Nepal AS, Chaudhary G, Khanal S, Paudel S. Endogenous endophthalmitis and multifocal brain abscess-An interesting case. Clin Case Rep 2021; 9:e04913. [PMID: 34631092 PMCID: PMC8493369 DOI: 10.1002/ccr3.4913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/12/2021] [Accepted: 09/24/2021] [Indexed: 11/13/2022] Open
Abstract
We present an unusual case that staphylococcal brain abscess can present in an immunocompetent with endogenous endophthalmitis secondary to a septic foci and early prevention of dissemination with appropriate management to prevent its complications.
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Affiliation(s)
- Aman Mishra
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Subarna Giri
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Robin Rauniyar
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Sagar Poudel
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Amit Sharma Nepal
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Gajendra Chaudhary
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Shambhu Khanal
- Department of Internal MedicineMaharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Sunanda Paudel
- Department of NeurologyMaharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
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Sinha P, Sinha U, Raj A, Pati BK. Bilateral endogenous endophthalmitis complicated by scleral perforation: an unusual presentation. BMJ Case Rep 2021; 14:e244547. [PMID: 34548299 PMCID: PMC8458360 DOI: 10.1136/bcr-2021-244547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2021] [Indexed: 11/04/2022] Open
Abstract
Endogenous endophthalmitis complicated by necrotising scleritis has rarely been reported in the literature. We, hereby, report a case of bilateral scleral perforation with endogenous endophthalmitis in an 87-year-old female patient with diabetes who presented as bilateral orbital cellulitis. Systemic workup ruled out autoimmune aetiology. The culture and sensitivity of exudates exuding from the scleral perforation showed Escherichia coli The Patient was managed conservatively with parenteral and topical antibiotics along with steroid, but the vision could not be salvaged. The report emphasizes on atypical presentation of endogenous endophthalmitis. In old and immunosuppressed individuals presenting with a clinical picture of bilateral orbital cellulitis with profound vision loss, endogenous endophthalmitis should be ruled out.
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Affiliation(s)
- Prerna Sinha
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Upasna Sinha
- Department of Radiology, AIIMS Patna, Patna, Bihar, India
| | - Amit Raj
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Binod Kumar Pati
- Department of Microbiology, All India Institute of Medical Sciences, Patna, Bihar, India
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Abstract
PURPOSE To analyze the 100 most cited articles pertaining to endophthalmitis using bibliometric analysis. METHODS An all-time Web of Science literature search and refined to peer-reviewed articles in the field of ophthalmology with the keyword "endophthalmitis" was completed. Total citation count of articles published pertaining to endophthalmitis, topic, incidence rate, publishing journals, year published, language, country of origin, number of authors, names of the first and last authors, study type, and number of patients/eyes studied. RESULTS The top 100 most cited articles pertaining to endophthalmitis had a mean citation count of 362.92, with a range of 175 to 3583. They were published in 20 peer-reviewed journals, with Ophthalmology publishing the most (n = 42). Thirteen different countries were represented, with the majority (n = 77) originating from the USA. The most common study type was clinical experiences (n = 52), though eight of the top ten were clinical trials. The number of patients varied widely, represented by a mean of 9680, but with a median of only 229. The majority (n = 67) examined the incidence of endophthalmitis which included 24 articles after anti-vascular endothelial growth factor injections, 18 after ocular surgeries/procedures, 15 after intraocular steroid injections, eight after chemotoxic drug use, and three after ocular injuries. CONCLUSION This bibliographic study serves as a unique historical analysis of the top 100 cited scholarly articles pertaining to endophthalmitis with many of the articles related to post-procedural endophthalmitis.
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Sugantheran J, Zunaina E, Md Kasim WM, Talib N. Invasive Klebsiella syndrome with coexisting fungal endophthalmitis. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2021; 16:94-97. [PMID: 34386173 PMCID: PMC8346748 DOI: 10.51866/cr1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Endogenous endophthalmitis accounts for approximately 5 - 10% of all endophthalmitis cases. We report a case of a middle-aged gentleman with underlying uncontrolled diabetes mellitus who presented with fever and generalised body weakness for one week. He was diagnosed with invasive Klebsiella syndrome based on blood culture with presence of bilateral pleural effusion, liver abscess, renal impairment and sphenoidal sinusitis. The patient developed sudden bilateral painless reduced vision on day two of admission. Ocular examination revealed bilateral severe anterior chamber reaction and severe vitritis that obscured the view of the fundus. Ocular B-scan ultrasonography showed multiple loculations in the posterior segment in both eyes. There was soft tissue density with calcification in the left sphenoid sinus on computed tomography of the orbit. He was treated for bilateral endogenous endophthalmitis with multiple intravitreal antibiotic injections, but showed no improvement. Functional endoscopic sinus surgery was performed and revealed that the left sphenoid sinus was filled with fungal balls. Following drainage of sphenoidal pus, there was resolution of vitritis and fundus examination showed features of underlying fungal infection with a "string of pearls" present along the vascular arcade of both eyes. The patient was diagnosed with bilateral endogenous endophthalmitis secondary to invasive Klebsiella syndrome with coexisting fungal endophthalmitis secondary to sphenoid mycetoma. In addition to repeated intravitreal antibiotic injections, he was also treated with systemic and topical antifungal therapy. At three months post treatment, the infection resolved and his vision improved from counting fingers to 6/36 bilaterally. Key messages: A middle-aged gentleman presented with bilateral endogenous endophthalmitis secondary to invasive Klebsiella syndrome with coexisting fungal endophthalmitis secondary to sphenoid mycetoma. A high index of suspicion is required for early diagnosis of fungal endophthalmitis.
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Affiliation(s)
- Jayanthi Sugantheran
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Embong Zunaina
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Wan Mariny Md Kasim
- Department of Ophthalmology, Hospital Serdang, Jalan Puchong Kajang, Malaysia
| | - Norlaila Talib
- Department of Ophthalmology, Hospital Serdang, Jalan Puchong Kajang, Malaysia
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Agarwal M, Sachdeva M, Pal S, Shah H, Kumar R M, Banker A. Endogenous Endophthalmitis A Complication of COVID-19 Pandemic: A Case Series. Ocul Immunol Inflamm 2021; 29:726-729. [PMID: 34255587 DOI: 10.1080/09273948.2021.1945111] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To report six patients with endogenous endophthalmitis as a complication of COVID-19 infection. METHODS A multicentric retrospective database review of patients with a diagnosis of endogenous endophthalmitis and a history of COVID-19 infection. RESULTS Four of six patients were diabetics. All presented after an average duration of 40 days (Range 17-90 days) of COVID-19 infection. Two of six patients had bilateral involvement. Five of six patients had received intravenous corticosteroid for COVID-19. Two of six vitreous samples showed fungi (Candida and Bipolaris species), two showed bacteria (Staphylococcus species) and two samples were culture negative. Control of infection with good visual outcome in four out of eight eyes. CONCLUSIONS COVID-19 patients with a history of hospitalization and prolonged use of systemic corticosteroids and comorbidities, for example, diabetes mellitus have a high risk of endogenous endophthalmitis. A high index of clinical suspicion with timely intervention can salvage many eyes.
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Affiliation(s)
- Manisha Agarwal
- Vitreoretina Department, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Mani Sachdeva
- Vitreoretina Department, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Surendra Pal
- Vitreoretina department, Sankara Eye Hospital, Bengaluru, India
| | - Harita Shah
- Vitreoretinal department, Banker's Retina Clinic & Laser Centre, Ahmedabad, India
| | - Madhu Kumar R
- Vitreoretina department, Sankara Eye Hospital, Guntur, India
| | - Alay Banker
- Vitreoretinal department, Banker's Retina Clinic & Laser Centre, Ahmedabad, India
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40
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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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Peck TJ, Ammar MJ, Dunn JP. Cryptococcal Meningitis Presenting as Endophthalmitis in an Otherwise Asymptomatic Patient. JOURNAL OF VITREORETINAL DISEASES 2021; 5:354-358. [PMID: 37007590 PMCID: PMC9976237 DOI: 10.1177/2474126420971986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Cryptococcus neoformans is a budding yeast that has a tropism for the central nervous system where it may cause meningitis, which has a high mortality rate. Endophthalmitis is rare and typically occurs in the setting of meningitis and disseminated disease. This report describes an atypical presentation of cryptococcal endophthalmitis and outlines the appropriate workup and management for this disease. Methods: A case report is presented. Results: A 66-year-old man on chemotherapy who presented with blurry vision without any extraocular symptoms was diagnosed with cryptococcal endophthalmitis and found to have underlying bloodstream and central nervous system infection on subsequent workup. He was treated with intravenous and intravitreal antifungals and remained systemically well, although a large subretinal mass lesion remained stable at 2-month follow-up. Conclusions: Cryptococcal endophthalmitis may be the initial presentation of disseminated cryptococcal disease. If vitreous cultures grow Cryptococcus, clinicians should presume that meningitis is present, regardless of symptoms, until proven otherwise.
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Affiliation(s)
- Travis J. Peck
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael J. Ammar
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - James P. Dunn
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
- The Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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García-Sánchez CJ, Pinilla-Martínez D, Ramallo-Solís I, De La Portilla-De Juan F. Clostridium septicum endophthalmitis as the first manifestation of a colon adenocarcinoma: A case report. Anaerobe 2021; 71:102406. [PMID: 34214691 DOI: 10.1016/j.anaerobe.2021.102406] [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: 02/21/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022]
Abstract
Clostridium septicum endophthalmitis is an extremely rare infection with only a few cases reported in the literature. It has an endogenous origin and is associated with gastrointestinal and haematological malignancies. We present the case of a 62-year-old male who presented this infection as the first manifestation of a colon adenocarcinoma.
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Affiliation(s)
| | - Diego Pinilla-Martínez
- General and Gastrointestinal Surgery Division, Virgen del Rocío University Hospital - Sevilla, Spain
| | - Irene Ramallo-Solís
- General and Gastrointestinal Surgery Division, Virgen del Rocío University Hospital - Sevilla, Spain.
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Dave VP, Pathengay A, Panchal B, Jindal A, Datta A, Sharma S, Pappuru RR, Joseph J, Jalali S, Das T. Clinical presentations, microbiology and management outcomes of culture-proven endogenous endophthalmitis in India. Indian J Ophthalmol 2021; 68:834-839. [PMID: 32317456 PMCID: PMC7350439 DOI: 10.4103/ijo.ijo_1091_19] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose: To report the clinical presentation, microbiology, and management outcome of endogenous endophthalmitis in Indian patients. Methods: Retrospective chart review of culture-positive (vitreous/urine/blood) endogenous endophthalmitis cases treated in tertiary eye care facility in India was done. Results: The study included 173 eyes of 117 patients. Mean patient age was 25.41 ± 20.46 years (median 24 years). Pre-disposing systemic illness could not be elicited in 79 (67.63%) patients. Commonest predisposing systemic condition in patients where it could be detected (n = 79) was pyrexia of unknown origin (25/79 = 32.0%). Following treatment, 45 out of 173 (26.0%) eyes regained vision of ≥20/400. Commonest isolated organism from vitreous was Streptococcus pneumoniae (36 eyes, 20.8%) and fungi were isolated in 24 (13.8%) eyes, the commonest being Candida spp. (8/24, 33.33%). Favorable functional outcome was seen in 26% eyes and favorable anatomic outcome in 43% eyes. Those with an underlying systemic illness were older (P = 0.02), had greater urine culture positivity (P = 0.003), lesser vitreous culture positivity (0.001), greater gram negative etiology (P = 0.0006), and greater fungal etiology (P = 0.01) as compared to those cases without underlying systemic illness. Conclusion: Endogenous endophthalmitis in India often presents in young immunocompetent individuals without any underlying systemic illness and with negative blood or urine microbiologic work up. Underlying systemic illness leads to greater gram-negative and fungal etiology. Overall visual outcome is poor inspite of prompt management.
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Affiliation(s)
- Vivek Pravin Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Avinash Pathengay
- Vitreoretina and Uveitis Service, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Bhavik Panchal
- Vitreoretina and Uveitis Service, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Animesh Jindal
- Vitreoretina and Uveitis Service, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Agniv Datta
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Savitri Sharma
- Jhaveri Microbiology Center, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Rajeev Reddy Pappuru
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Subhadra Jalali
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Taraprasad Das
- Vitreoretina and Uveitis Service, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
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Singh SR, Bhattacharyya A, Dogra MR, Singh R, Dogra M. Endogenous endophthalmitis due to Staphylococcus aureus in a lactating woman. Indian J Ophthalmol 2021; 68:2595-2597. [PMID: 33120705 PMCID: PMC7774152 DOI: 10.4103/ijo.ijo_740_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Endogenous endophthalmitis (EE) is a rare but fulminant intraocular infection that needs prompt recognition and management. Bacteria are the commonest causative organisms and they may colonize the eye secondary to hematogenous spread from a focus anywhere in the body. EE in the peripartum period is an infrequent occurrence with no cases reported to occur secondary to a peurperal mastitis. We report a case of EE due to Staphylococcus aureous in a lactating female and describe its clinical presentation and management.
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Affiliation(s)
- Simar R Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anusuya Bhattacharyya
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Mangat R Dogra
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mohit Dogra
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Bariya S, Bhattacharya A, Narang S. Metastatic endophthalmitis presenting as subretinal abscess following a forearm furuncle. BMJ Case Rep 2021; 14:e241827. [PMID: 33986012 PMCID: PMC8126320 DOI: 10.1136/bcr-2021-241827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/03/2022] Open
Abstract
Metastatic endophthalmitis (ME) is rare form of secondary uveitis commonly prevalent in immunocompromised patients. A 55-year-old immunocompetent woman presented with painful decrease in left eye vision (referred to us as cytomegalovirus retinochoroiditis). Ocular examination revealed diffuse yellowish-white retinitis lesion (diagnosed as subretinal abscess on macular optical coherence tomography). Vitreous tap was unremarkable, but vitreous biopsy from the posterior vitreous overlying the subretinal abscess confirmed the growth of methicillin-sensitive Staphylococcus aureus (MSSA). Detailed systemic examination revealed a forearm furuncle, which yielded MSSA on culture. The infection followed relentless course despite aggressive treatment with pars plana vitrectomy and antibiotics (topical, systemic and intravitreal). This case is presented due to rarity of presentation of ME as subretinal abscess following skin infection, which became a management challenge. Due to its rapid progression and irreversible damage to ocular tissue, high index of suspicion and aggressive management is needed in such cases. The disease course, management and prognosis of such cases are dismal in majority of the patients.
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Affiliation(s)
- Sonia Bariya
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Anusuya Bhattacharya
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Subina Narang
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
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46
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Tamez H, Patel SN. Retinal Artery Occlusion After a Dog Bite in a 55-Year-Old Man. JAMA Ophthalmol 2021; 139:798-799. [PMID: 33956084 DOI: 10.1001/jamaophthalmol.2020.5282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Heather Tamez
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Shriji N Patel
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
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Abstract
PURPOSE To review the clinical features, microbiology spectrum, management, and outcomes of patients with endogenous endophthalmitis in Western Australia over a 16-year period. METHODS This is a retrospective chart review of all patients with endogenous endophthalmitis who presented to all tertiary ophthalmology departments between 2000 and 2015 in Western Australia. RESULTS Sixty-six eyes of 57 patients with endogenous endophthalmitis were identified, and follow-up data were available for a mean of 554 days. The average frequency was 1.6 per 1,000,000 population per year. Diabetes mellitus (33%) and intravenous drug use (30%) were the most common risk factors. Concurrent systemic infections included urinary tract infection (28%), pneumonia (23%), and endocarditis (21%). Among culture-positive cases (93%), 57% were bacterial and 43% were fungal. Visual acuity improved in 33 (50%) and declined in 15 eyes (22.7%). Baseline visual acuity and the presence of Gram-negative or filamentous fungi were the only predictors of final visual acuity (P = 0.023 and P = 0.001). CONCLUSION The population frequency of endogenous endophthalmitis has not changed over 16 years despite the changing profile of pathogen and risk factors. Similar to previous studies in Asian and Western countries, visual and anatomical prognosis depends on initial visual acuity and isolated pathogen. Gram-negative and filamentous fungi culture predicted a worse visual outcome.
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48
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Amarasekera S, Doss M, Banaee T, Kowalski RP, Eller AW. Endogenous Endophthalmitis: Recommendation for Empiric Dual Antibacterial and Antifungal Therapy. JOURNAL OF VITREORETINAL DISEASES 2021; 5:208-215. [PMID: 37006521 PMCID: PMC9979032 DOI: 10.1177/2474126420939725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work compares clinical presentation and course of bacterial and fungal causes of endogenous endophthalmitis (EE). Methods: A single-institutional study of consecutive patients diagnosed with EE was conducted at the University of Pittsburgh Medical Center between September 2015 and September 2018. Exclusion criteria included history of ocular trauma, intraocular surgery or injection 6 months before presentation, or primary external ocular infection. Data included demographics, medical and ocular history, clinical examination, culture data, therapeutic interventions, final corrected visual acuity (VA), and mortality. Results: Thirty-six eyes of 26 patients were diagnosed with EE during a 3-year period. Median age at diagnosis was 55.5 years (range, 19-86 years). Based on ocular and systemic cultures, 19 patients had bacterial EE and 6 patients had fungal EE; findings from all cultures remained negative in 1 patient. All patients had risk factors for EE. Presenting VA, subjective symptom report, and objective measures of intraocular inflammation were similar between bacterial and fungal causes. Overall, EE presented indolently and was initially misdiagnosed in 19% of cases. Complications including final VA less than 20/200, retinal detachment, enucleation, or death within 6 months of diagnosis were equivalent between bacterial and fungal cases. Conclusions: The presentation of EE is remarkably different from that of exogenous endophthalmitis. Without a high index of suspicion, the indolent presentation of EE may lead to misdiagnosis. No clinical features reliably differentiated bacterial and fungal sources. This highlights the importance of considering empiric therapy for antibacterial and antifungal coverage on initial presentation.
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Affiliation(s)
- Sohani Amarasekera
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mallika Doss
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Touka Banaee
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Regis P. Kowalski
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Charles T. Campbell Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrew W. Eller
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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49
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Villasmil RJ, Lattanzio N, Burns K, Alkayali T. More Than Meets the Eye: Infective Endocarditis Presenting as Endogenous Endophthalmitis. Cureus 2021; 13:e14745. [PMID: 34084673 PMCID: PMC8163352 DOI: 10.7759/cureus.14745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Endogenous endophthalmitis (EE) is a potentially blinding ophthalmological emergency with poor visual prognosis requiring a high index of clinical suspicion to obtain a prompt diagnosis. The main factors associated with poor visual outcomes include the virulence of the causative organism and timing of intervention. Infective endocarditis can present with nonspecific ocular complaints and remains an important risk factor for developing EE. We report an unusual case of EE in a 78-year-old male caused by infective endocarditis secondary to Streptococcus viridans resulting in bioprosthetic aortic valve abscess with dehiscence.
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Affiliation(s)
- Ricardo J Villasmil
- Internal Medicine, Florida State University College of Medicine Internal Medicine Residency Program, Sarasota, USA
| | - Natalia Lattanzio
- Internal Medicine, Florida State University College of Medicine Internal Medicine Residency Program, Sarasota, USA
| | - Katherine Burns
- Internal Medicine, Florida State University College of Medicine Internal Medicine Residency Program, Sarasota, USA
| | - Talal Alkayali
- Internal Medicine, Florida State University College of Medicine Internal Medicine Residency Program, Sarasota, USA
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50
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Mir TA, Papudesu C, Fang W, Hinkle DM. Incidence of Drug Use-Related Endogenous Endophthalmitis Hospitalizations in the United States, 2003 to 2016. JAMA Ophthalmol 2021; 139:18-26. [PMID: 33151291 DOI: 10.1001/jamaophthalmol.2020.4741] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Complications arising from the nationwide opioid epidemic led to an increase in health care use. Few studies have investigated whether this is reflected in hospital admissions for endogenous endophthalmitis. Objective To report changing trends in epidemiology, risk factors, hospital course, and costs associated with drug use-related endogenous endophthalmitis hospitalizations in the United States from 2003 to 2016. Design, Setting, and Participants Nationwide, retrospective cross-sectional study using the National Inpatient Sample. A total of 56 839 patients admitted with a diagnosis of endogenous endophthalmitis were included. Data were analyzed between 2003 and 2016. Exposures Inpatient admission for endogenous endophthalmitis during the years 2003 to 2016. Main Outcomes and Measures The Nationwide Inpatient Sample was queried to identify all inpatient admissions with a diagnosis of endogenous endophthalmitis in the United States between the years 2003 and 2016. Analyses were performed to identify national and regional trends in incidence and prevalence of associated infectious and noninfectious comorbidities in patients with or without a history of drug dependence or use. Median and cumulative inflation-adjusted costs for admissions were calculated. Results Of all patients, 55.6% were White, 13.6% were Black, and 10.6% were Hispanic. There were an estimated 56 839 endogenous endophthalmitis-related hospitalizations; 13.7% of these patients (n = 7783) had a history of drug dependence or use. The drug-using population was significantly younger (49.6 vs 57.5 years; difference, 7.9; 95% CI, 6.93-8.88; P < .001) and more likely to be male (61.8% [n = 35 127] vs 49.0% [n = 21 712]; difference, 12.8%; 95% CI, 11.6%-14.0%; P < .001). The incidence of endogenous endophthalmitis associated with drug dependence or use increased from 0.08 per 100 000 in 2003 to 0.32 per 100 000 population in 2016 across all 4 US geographic regions. Conclusions and Relevance A 4-fold increase in drug use-related endogenous endophthalmitis hospitalizations was observed in the United States from 2003 to 2016, resulting in substantial health care use burden. These findings support the hypothesis that clinicians should maintain a high index of suspicion for endophthalmitis when evaluating patients with intraocular inflammation in the setting of drug dependence or use.
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Affiliation(s)
- Tahreem A Mir
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut.,West Virginia University School of Medicine, Morgantown
| | | | - Wei Fang
- West Virginia Clinical and Translational Science Institute, West Virginia University Health Sciences Center Erma Byrd Biomedical Research Center, Morgantown
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