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Blanch RJ, McMaster D, Patterson TJ. Management of open globe injury: a narrative review. Eye (Lond) 2024:10.1038/s41433-024-03246-3. [PMID: 39085596 DOI: 10.1038/s41433-024-03246-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/04/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024] Open
Abstract
Open globe injuries are a significant global cause of visual loss, including unilateral and bilateral blindness. Prognosis is predicted by injury severity, with lower presenting visual acuity and more posterior injuries associated with poor visual outcomes, although even the most severely injured eyes with no perception of light vision may regain some visual function. In addition to severity of the primary injury, the secondary injuries and complications causing poor outcomes include proliferative vitreoretinopathy (PVR) and endophthalmitis. Endophthalmitis is common after open globe injury, affecting up to 16.5% of patients. Systemic antibiotic prophylaxis is commonly used, with a limited evidence base, while intraocular antibiotics are less commonly used but have stronger supporting evidence of efficacy. Endophthalmitis rates are also reduced by prompt primary repair, which may also support recovery of visual acuity. PVR is not prevented or treated by any pharmacologic interventions in current clinical practice, but the incidence of post-traumatic PVR may be reduced by early vitrectomy within the first 4-7 days after injury. Ocular trauma training is often limited in Western ophthalmic surgical training programmes, and patients with ocular trauma often require the input of multiple subspecialists. In this context, it is important that patients have an overview and coordination of the different aspects of their care, with ownership by one lead clinician.
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Affiliation(s)
- Richard J Blanch
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK.
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | | | - Tim J Patterson
- Northern Ireland Medical and Dental Training Agency, Belfast, UK
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2
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Makhoul KG, Bitar RA, Armstrong GW, Weinert MC, Ivanov A, Kahale F, Ta T, Lorch AC. Effect of time to operative repair within twenty-four hours on visual acuity outcomes for open globe injuries. Eye (Lond) 2023; 37:2351-2355. [PMID: 36543944 PMCID: PMC10366134 DOI: 10.1038/s41433-022-02350-6] [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: 09/16/2022] [Revised: 11/17/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Convention is to perform open globe injury (OGI) repair within 24 h to minimize risk of endophthalmitis. However, there are limited data assessing how time to operative repair (OR) within 24 h impacts postoperative visual acuity (VA). METHODS Manual retrospective chart review of 633 eyes at Massachusetts Eye and Ear (MEE) with a diagnosis of OGI between 2012 and 2022. Inclusion criteria were primary repair ≤ 24 h after injury and ≥1 month follow-up. Multivariate regression analysis was conducted with postoperative VA as primary outcome. RESULTS Of the subjects, 489 (77.3%) were male and 496 (78.4%) were white. Demographics of OGI wounds included 320 (50.6%) rupture and 313 (49.4%) laceration; 126 (19.9%) with rAPD, 189 (29.9%) zone 3 injuries, 449 (71.2%) uveal prolapse, and 110 (17.4%) intraocular foreign body. Final postoperative LogMAR VAs consisted of 31% with a VA < 1.7, 9% with a VA of 1.9, 18% with a VA of 2.3, 27% with a VA of 2.7, and 11% with a VA of 3.0. Multivariate analysis showed no significant correlation between time to OR and postoperative VA (p = 0.800) [95%CI: -0.01,0.01]. Older age (p < 0.001) [95%CI: 0.00,0.01], worse presenting VA (p < 0.001) [95%CI: 0.17,0.32], rAPD (p < 0.001) [95%CI: 0.65,1.0], mechanism of rupture (p < 0.001) [95%CI: 0.19,0.54], higher zone of injury (p < 0.001) [95%CI: 0.25,0.45], and uveal prolapse (p = 0.003) [95%CI: 0.09,0.42] were significantly associated with worse final VA. CONCLUSIONS Time to repair of OGIs within 24 h does not influence final VA. Optimization of surgical and patient factors may contribute more significantly to final VA than prioritizing more rapid time to OR.
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Affiliation(s)
- Kevin G Makhoul
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA.
- University of Massachusetts TH Chan School of Medicine, Worcester, MA, USA.
| | - Racquel A Bitar
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
- University of Massachusetts TH Chan School of Medicine, Worcester, MA, USA
| | - Grayson W Armstrong
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Marguerite C Weinert
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Pediatric Ophthalmology, Boston Children's Hospital, Boston, MA, USA
| | - Alexander Ivanov
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Francesca Kahale
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Thong Ta
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Alice C Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Hapca MC, Vesa ȘC, Nicoară SD. Visual Outcomes and Prognostic Factors of Traumatic Endophthalmitis Treated by Pars Plana Vitrectomy: 11 Years Retrospective Analysis. J Clin Med 2023; 12:jcm12020502. [PMID: 36675429 PMCID: PMC9860693 DOI: 10.3390/jcm12020502] [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: 11/20/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Aim: To evaluate the visual outcome of traumatic endophthalmitis and describe the risk factors associated with poor visual acuity and retinal detachment (RD) development over an 11-year period. Methods: Medical records of 34 patients with traumatic endophthalmitis who underwent PPV over a period of 11 years (1 January 2010−31 December 2020) were reviewed. We extracted details regarding demographic data, initial and final best corrected visual acuity (BCVA) using a standard Snellen chart, wound and IOFB characteristics, ocular associated lesions, and treatment. The outcome was evaluated according to the final BCVA which was defined as poor < 0.1 or good ≥ 0.1 Results: Endophthalmitis rate was 29.8% in open globe injuries. The mean age was 43.6 ± 16.5 years and the majority of patients were males (32 out of 34, 94.1%). All patients received systemic (moxifloxacin) and intravitreal antibiotherapy. We performed pars plana vitrectomy (PPV) in all cases. Poor visual outcome was associated with wound size ≥ 3 mm (p = 0.02), the association of IOFB (p = 0.016), and the development of RD (p = 0.00). The presence of IOFB (p = 0.01) and wound size ≥ 3 mm (p = 0.01) were statistically associated with RD development. After treatment, 47.05% of patients achieved final BCVA ≥ 0.1. Conclusion: Wound size ≥ 3 mm, IOFB and RD were risk factors for poor visual outcomes in traumatic endophthalmitis.
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Affiliation(s)
- Mădălina-Claudia Hapca
- Doctoral School of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 8, V. Babeș Str., 400012 Cluj-Napoca, Romania
- Correspondence: (M.-C.H.); (S.-D.N.)
| | - Ștefan Cristian Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Simona-Delia Nicoară
- Doctoral School of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 8, V. Babeș Str., 400012 Cluj-Napoca, Romania
- Department of Ophthalmology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 8, V. Babeș Str., 400012 Cluj-Napoca, Romania
- Ophthalmology Clinic, Emergency County Hospital, 3–5 Clinicilor Str., 400006 Cluj-Napoca, Romania
- Correspondence: (M.-C.H.); (S.-D.N.)
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Yan H, Yang K, Ma Z, Kuhn F, Zhang W, Wang Z, Hu Y, Lu H, Shigeo Y, Sobaci G, Ozdek S, Forlini M, Huang B, Hui Y, Zhang M, Xu G, Wei W, Jiang Y, Park D, Fernandes RB, He Y, Rousselot A, Hoskin A, Sundar G, Liu Y, Wang Y, Shen L, Chen H, Chen H, Han G, Jiang R, Jin X, Lin J, Luo J, Wang Z, Wei Y, Wen Y, Xie Z, Wang Y, Yang X, Yu W, Zheng Z, Sun X, Liang J, Liu Q, Yu J, Wei S, Li Z, Chen L, Wang X, Wei L, Zhang H, Chen S, Liu Y, Guo X, Liu S, Xu X, Tao Y, Chen Y, Chen Y. Guideline for the treatment of no light perception eyes induced by mechanical ocular trauma. J Evid Based Med 2022; 15:302-314. [PMID: 36151612 PMCID: PMC9826528 DOI: 10.1111/jebm.12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/26/2022] [Indexed: 01/11/2023]
Abstract
Severe mechanical ocular trauma with no light perception (NLP) predicts a poor prognosis of visual acuity and enucleation of the eyeball. Since the innovative treatment concept of exploratory vitreoretinal surgery has developed and treatment technology has advanced, the outcomes of severe ocular trauma treatment in NLP patients have greatly improved. However, there remains a lack of unified standards for the determination, surgical indication, and timing of vitrectomy in NLP eye treatment. To address these problems, we aimed to create evidence-based medical guidelines for the diagnosis, treatment, and prognosis of mechanical ocular trauma with NLP. Sixteen relevant recommendations for mechanical ocular trauma with NLP were obtained, and a consensus was reached. Each recommendation was explained in detail to guide the treatment of mechanical ocular trauma associated with NLP.
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Pandit K, Khatri A, Sitaula S, Kharel Sitaula R, Shrestha GB, Joshi SN, Karki P, Rai P, Chaudhary M. Panophthalmitis secondary to retained intraocular foreign body amidst a national lockdown during the COVID-19 pandemic: A case series and review of literature. Ann Med Surg (Lond) 2022; 77:103692. [PMID: 35638076 PMCID: PMC9142660 DOI: 10.1016/j.amsu.2022.103692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022] Open
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Adriono GA, Agustiawan R, Fibrian KC, Ardiani LS, Irawati Y. Variations in clinical manifestations and outcomes of penetrating ocular injuries with intraocular foreign bodies: a case series. J Surg Case Rep 2022; 2022:rjac198. [PMID: 35531439 PMCID: PMC9072000 DOI: 10.1093/jscr/rjac198] [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: 03/09/2022] [Accepted: 04/16/2022] [Indexed: 11/20/2022] Open
Abstract
Intraocular foreign bodies (IOFBs) are the most common emergency cases in ophthalmology causing severe visual impairment to blindness. We present nine male patients with IOFBs, aged 28-64 years old, which displayed a wide spectrum of findings. Based on IOFB location, four cases were intravitreal, two were intraretinal, two were intralenticular and one was intracorneal. The most common material was metal, from hammering projectiles (six patients). The injuries mainly occurred at workplace (five patients). All IOFBs were successfully extracted. Initial visual acuity (VA) ranged from light perception to 20/32; six patients had better final VA, up to 20/20. A wide range of ocular manifestations is associated with IOFBs. Removing retained IOFB procedure is dependent on location, nature, lens opacity and vitreoretinal involvement. Meticulous ocular examination and imaging modality are vital to identify the IOFB presence. Various visual outcomes depend on zone involvement, IOFB size and level of difficulties of surgery.
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Affiliation(s)
- Gitalisa A Adriono
- Department of Ophthalmology, Faculty of Medicine, University of Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Retina Service, JEC Eye Hospitals and Clinics, Jakarta, Indonesia
| | | | | | - Lily S Ardiani
- Research, JEC Eye Hospitals and Clinics, Jakarta, Indonesia
| | - Yunia Irawati
- Department of Ophthalmology, Faculty of Medicine, University of Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Ophthalmic Trauma Service, JEC Eye Hospitals and Clinics, Jakarta, Indonesia
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Bohrani Sefidan B, Tabatabaei SA, Soleimani M, Ahmadraji A, Shahriari M, Daraby M, Dehghani Sanij A, Mehrakizadeh A, Ramezani B, Cheraqpour K. Epidemiological characteristics and prognostic factors of post-traumatic endophthalmitis. J Int Med Res 2022; 50:3000605211070754. [PMID: 35114823 PMCID: PMC8819759 DOI: 10.1177/03000605211070754] [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: 11/25/2022] Open
Abstract
Objective To examine the prognostic factors and features of post-traumatic
endophthalmitis. Methods This retrospective study enrolled adult patients (>18 years old) diagnosed
with post-traumatic endophthalmitis. Their medical records were reviewed and
the patient demographic characteristics, features of injury, management,
outcomes and microbiology data were analysed. Results A total of 131 eyes from 131 patients were enrolled. Post-traumatic
endophthalmitis was more common in male patients (122 of 131 patients:
93.1%), in those aged 30–44 years (51 of 131 patients: 38.9%), in those
injured with a metallic object (86 of 131 patients; 65.6%), in those with a
penetrating injury (90 of 131 patients; 68.7%) and those that were injured
at work (106 of 131 patients; 80.9%). The mean ± SD time of presentation to
the hospital and developing endophthalmitis was 40.60 ± 19.32 h and
5.19 ± 2.55 days, respectively. Of the cultures, 84 of 131 (64.1%) were
negative and 22 of 131 (16.8%) were positive for
Staphylococcus species. Patients with delayed
presentation, an intraocular foreign body, traumatic cataract, retinal
detachment, larger wounds, positive smears and cultures and work-related
injuries had worse outcomes. Conclusion Immediate presentation to an ophthalmic centre and timely diagnosis and
intervention may lead to better outcomes.
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Affiliation(s)
- Bahram Bohrani Sefidan
- Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Tabatabaei
- Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliasghar Ahmadraji
- Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoor Shahriari
- Imam Hossein Medical Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Daraby
- Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Dehghani Sanij
- Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Mehrakizadeh
- Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Ramezani
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kasra Cheraqpour
- Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Ahmadi A, Soleimani M, Haydar AA, Moslemi Haghighi S. How to best manage a patient with Bacillus endophthalmitis: current insights. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1962295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Amin Ahmadi
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali A. Haydar
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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He N, Lv Z. A rare asymptomatic metallic intraocular foreign body retained in the anterior chamber for 15 years: A case report. Medicine (Baltimore) 2021; 100:e26470. [PMID: 34160455 PMCID: PMC8238337 DOI: 10.1097/md.0000000000026470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Intraocular foreign bodies (IOFBs) are common in ocular injuries, but asymptomatic metallic IOFBs retained in the anterior chamber for years are rare. PATIENT CONCERNS A 31-year-old female presented with blurred vision in her right eye after lumbar magnetic resonance imaging. Her best-corrected vision acuity was 0.6 in the right eye and 1.0 in the left eye. Slit-lamp examination revealed a brown granular foreign body in the anterior chamber and pigmentation of the limbus. Lens and retina examination indicated ocular siderosis. Corneal endothelioscopy revealed decreased endothelial cell density. A detailed history showed ocular globe injury 15 years earlier. DIAGNOSES Anterior chamber IOFB with ocular siderosis. INTERVENTIONS Anterior chamber foreign body removal was performed with appropriate incision and forceps. OUTCOMES The anterior chamber IOFB was successfully removed and examined as a magnetic metal foreign body. The best-corrected vision acuity was 1.0 at 1 day postoperatively. An abnormal electroretinogram with a 12% decrease in the "b" wave and a 91% decrease in the "a" wave was observed 3 months postoperatively. There were no intraoperative or postoperative complications during a 3-month follow-up. LESSONS Eye trauma should be examined carefully to exclude IOFBs. Asymptomatic anterior chamber foreign bodies can also cause corneal endothelial injury and ocular siderosis. Careful examination and timely management are needed in such cases.
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Durrani AF, Zhao PY, Zhou Y, Huvard M, Azzouz L, Keil JM, Armenti ST, Dedania VS, Musch DC, Zacks DN. Risk Factors for Endophthalmitis Following Open Globe Injuries: A 17-Year Analysis. Clin Ophthalmol 2021; 15:2077-2087. [PMID: 34040343 PMCID: PMC8141272 DOI: 10.2147/opth.s307718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background/Aims To determine the rate of endophthalmitis and assess risk factors for development of endophthalmitis following open globe injury (OGI). Methods A retrospective chart review of all patients treated for OGI at the University of Michigan from January 2000 to July 2017 was conducted. Exclusion criteria included intravitreal injection or intraocular surgery in the 30 days prior to injury or less than 30 days of follow-up. A total of 586 out of 993 open globe injuries were included in the study. The main outcome measure was the rate of endophthalmitis. Results In this study, 25/586 eyes (4.3%) had endophthalmitis. Of these, 12/25 eyes (48.0%) presented with endophthalmitis and 13/25 eyes (52.0%) developed endophthalmitis after globe closure. Multivariate analysis identified time to globe repair (OR 4.5, CI 1.9-10.7, p = 0.0008), zone I injury (OR 3.6, CI 1.1-11.0, p = 0.0282), and need for additional surgery (OR 5.5, CI 1.5-19.7, p = 0.0092) as factors associated with increased risk of developing endophthalmitis. Subconjunctival antibiotic injection at the time of globe closure (OR 0.3, CI 0.1-0.7, p = 0.0036) was associated with decreased risk of developing endophthalmitis. Conclusion Prompt globe closure and subconjunctival antibiotics may reduce the risk of endophthalmitis in OGI. Furthermore, our practice of a one-time dose of systemic prophylactic antibiotics, and intravitreal antibiotics if intraocular foreign body (IOFB) removal is delayed, was not found to increase the rate of endophthalmitis.
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Affiliation(s)
- Asad F Durrani
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Peter Y Zhao
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Michael Huvard
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lyna Azzouz
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jason M Keil
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stephen T Armenti
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Vaidehi S Dedania
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - David N Zacks
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
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Mitra S, Agarwal T, Naik A, Padhi TR, Basu S, Behera UC. Post-Traumatic Endophthalmitis: Clinico-Microbiological Profile, Antimicrobial Susceptibility and Prognostic Factors at a Tertiary Eye Care Centre in Eastern India. Semin Ophthalmol 2021; 36:742-750. [PMID: 33750256 DOI: 10.1080/08820538.2021.1900290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To analyse clinico-microbiological profile, antimicrobial susceptibilities, and visual prognostic factors in post-traumatic endophthalmitis (PTE).Methods: Retrospective clinico-microbiological data analysis for five years (2014-18). Prognostic factors for visual outcomes were analysed by multivariate logistic regression analysis.Results: Four hundred and eighteen patients with clinically diagnosed PTE were analysed. Culture positivity was found in 46.7% samples (44.5% vitreous, 83.3% non-vitreous). Pathogens isolated were Gram positive cocci (GPC, 49.3%, good susceptibility to vancomycin/cefazolin), Gram negative bacilli (GNB, 28.1%, <90% susceptibility to all antibiotics and 25.8% multidrug resistance), Gram positive bacilli (13.1%) and fungi (9.5%). Poor visual prognosis was associated with culture positivity, fungal or polymicrobial PTE, poor view of fundus and presence of membranes on ultrasound scans.Conclusion: GPC and GNB are the predominant pathogens in PTE, with GNB most commonly multidrug resistant. Culture positivity, polymicrobial and fungal PTE, poor view of fundus and vitreous membranes are markers of poor visual outcome.
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Affiliation(s)
- Sanchita Mitra
- Jhaveri Microbiology Centre, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad and Ocular Microbiology Services, Mithu Tulsi Chanrai Campus, Bhubaneswar, India
| | - Tushar Agarwal
- Retina and Uveitis Services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India
| | - Abhijit Naik
- Retina and Uveitis Services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India
| | - Tapas Ranjan Padhi
- Retina and Uveitis Services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India
| | - Soumyava Basu
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
| | - Umesh Chandra Behera
- Retina and Uveitis Services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India
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12
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Silpa-Archa S, Dejkong A, Kumsiang K, Chotcomwongse P, Preble JM, Foster CS. Poor prognostic factors in post-traumatic endophthalmitis following open globe injury. Int J Ophthalmol 2020; 13:1968-1975. [PMID: 33344198 DOI: 10.18240/ijo.2020.12.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/29/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To demonstrate prognostic factors for poor visual outcome in patients with post-traumatic endophthalmitis (PTE) following open globe injury. METHODS A retrospective study was conducted on 66 patients (66 eyes) with PTE following open globe injury from 2005 to 2015. Potential factors accounting for good and poor visual outcome were statistically analyzed by Chi-square test and Logistic regression model. RESULTS In 66 cases, 39 cases (59%) had a poor visual outcome. Univariate and multivariate Logistic regression analysis identified retained intraocular foreign body (IOFB) as the only factor significantly associated with poor visual outcome [adjusted odds ratio, 4.62; 95% confidence interval (1.04-20.53); P=0.04]. The most common causative agents were gram-positive organisms (83%), of which Bacillus cereus (33%), was the most common pathogen. All cases received intravitreal antibiotic injections. Oral ciprofloxacin was the most used systemic antibiotic (33%). Pars plana vitrectomy was performed in 83% (55/66) of cases. At 6mo follow-up, mean BCVA was 1.74±0.72 logMAR units. CONCLUSION In patients with PTE following open globe injury, the only predictor of poor visual outcome is the presence of IOFB. Bacillus cereus is the most isolated microorganism.
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Affiliation(s)
- Sukhum Silpa-Archa
- Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, Rangsit University, Bangkok 10400, Thailand
| | - Akkaranisorn Dejkong
- Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, Rangsit University, Bangkok 10400, Thailand
| | - Kwanchanoke Kumsiang
- Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, Rangsit University, Bangkok 10400, Thailand
| | - Peranut Chotcomwongse
- Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, Rangsit University, Bangkok 10400, Thailand
| | - Janine M Preble
- Department of Ophthalmology Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts 02451, USA.,Ocular Immunology & Uveitis Foundation, Waltham, Massachusetts 02451, USA.,Harvard Medical School, Boston, Massachusetts 02115, USA
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13
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Vingopoulos F, Wang Y, Grob S, Li CYL, Eliott D, Kim LA, Vavvas DG, Miller JB. Open Globe Injury with Intraocular Foreign Body. ACTA ACUST UNITED AC 2020; 5:288-294. [PMID: 34386688 DOI: 10.1177/2474126420965033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To investigate characteristics of Open Globe Injuries (OGI) that presented with Intra-Ocular Foreign Body (IOFB), along with their long-term visual outcomes, complications and need for subsequent surgeries. Methods Retrospective interventional consecutive case series of OGIs with IOFBs that presented to the Eye Trauma service at the Massachusetts Eye and Ear from 2010 to 2015. Data collected included time from injury to OGI repair, location of injury and IOFB, retinal detachment (RD) rate, presenting and final visual acuity (VA) and subsequent surgeries. Results Fifty-seven consecutive cases of OGIs with IOFBs were included. The majority of patients were male (93%), mean age was 37 years and mean follow-up was 28 +/- 22 months. The median time from injury to OGI repair was 0 days (range: 0-16 days). Overall, 38/57 (66.7%) eyes achieved final vision of 20/40 or better and 43/57 (75.4%) vision of 20/150 or better. Zone I injuries were the most common (86%), followed by Zone II (16%), and Zone III (10%). 33 cases had IOFBs in the anterior segment only and 24 cases had posterior segment involvement. In total, 30% of cases (17/57) were complicated by an RD, 58.3% (14/24) in the posterior versus 9.1% (3/33) in the anterior IOFB group.( p<0.01). There were no cases of endophthalmitis. Posterior IOFB and higher zone of injury were found to be risk factors for RD both at presentation (all p<0.05) and post-primary repair.(all p<0.05) Posterior IOFB was associated with higher vitrectomy rates both at presentation (p<0.0001) and post-primary repair (p=0.002) and worse long-term visual outcome (p = 0.014). Conclusion OGIs with IOFB involving the posterior segment are associated with higher complication and re-operation rates and worse visual prognosis compared to those involving the anterior segment only.
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Affiliation(s)
| | - Yvonne Wang
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Seanna Grob
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,Orbit and Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
| | | | - Dean Eliott
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,Retina Service, Massachusetts Eye and Ear, Boston, MA
| | - Leo A Kim
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,Retina Service, Massachusetts Eye and Ear, Boston, MA
| | - Demetrios G Vavvas
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,Retina Service, Massachusetts Eye and Ear, Boston, MA
| | - John B Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston MA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,Retina Service, Massachusetts Eye and Ear, Boston, MA
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14
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Anguita R, Moya R, Saez V, Bhardwaj G, Salinas A, Kobus R, Nazar C, Manriquez R, Charteris DG. Clinical presentations and surgical outcomes of intraocular foreign body presenting to an ocular trauma unit. Graefes Arch Clin Exp Ophthalmol 2020; 259:263-268. [PMID: 32734467 DOI: 10.1007/s00417-020-04859-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/09/2020] [Accepted: 07/23/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To describe, evaluate, and identify the characteristics, prognostic factors, and visual outcomes in patients with intraocular foreign body (IOFB) in a Latin American population. METHODS A retrospective, observational case-series of patients with a diagnosis of IOFB. Variables analyzed included age, gender, initial and final best correct visual acuity (BCVA), ocular trauma score, intraocular pressure, mechanism of injury, material and number of IOFB, zone of injury, timing of primary repair and IOFB removal, complications, and follow up. RESULTS Sixty-one patients with IOFB were identified of which 97% were male with a mean age of 37.9 years (SD 2.16). The most common IOFB location was intravitreal (43%). IOFBs were metallic in 78%, vegetal in 3%, and other materials in 11%. Primary repair and secondary IOFB removal were performed at a mean timepoint of 3 days and 5 days, respectively. Systemic and topical antibiotics were administered to all patients. The initial BCVA was 1.62 logMAR and the final was 0.6 logMAR, which was statistically significant (Pearson's chi-squared test, p value 0.01). No cases of endophthalmitis were seen. CONCLUSION IOFB removal can be delayed when there are no signs of infection or evidence of retinal detachment, without an increased risk of endophthalmitis and a negative impact on visual outcomes. Use of topical and systemic antibiotics appear sufficient to prevent endophthalmitis in these cases.
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Affiliation(s)
- Rodrigo Anguita
- Hospital Del Salvador, Universidad de Chile, Santiago, Chile.
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.
| | - René Moya
- Hospital Del Salvador, Universidad de Chile, Santiago, Chile
- Centro de la visión, Clínica las Condes, Santiago, Chile
| | - Victor Saez
- Hospital Del Salvador, Universidad de Chile, Santiago, Chile
| | - Gaurav Bhardwaj
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Faculty of Medicine and Health, Sydney Medical School, Discipline of Ophthalmology and Eye Health and Save Sight Institute, The University of Sydney, Sydney, Australia
| | | | - Rudolf Kobus
- Hospital Del Salvador, Universidad de Chile, Santiago, Chile
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15
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Mursalin MH, Livingston ET, Callegan MC. The cereus matter of Bacillus endophthalmitis. Exp Eye Res 2020; 193:107959. [PMID: 32032628 PMCID: PMC7113113 DOI: 10.1016/j.exer.2020.107959] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/06/2020] [Accepted: 02/03/2020] [Indexed: 02/06/2023]
Abstract
Bacillus cereus (B. cereus) endophthalmitis is a devastating intraocular infection primarily associated with post-traumatic injuries. The majority of these infections result in substantial vision loss, if not loss of the eye itself, within 12-48 h. Multifactorial mechanisms that lead to the innate intraocular inflammatory response during this disease include the combination of robust bacterial replication, migration of the organism throughout the eye, and toxin production by the organism. Therefore, the window of therapeutic intervention in B. cereus endophthalmitis is quite narrow compared to that of other pathogens which cause this disease. Understanding the interaction of bacterial and host factors is critical in understanding the disease and formulating more rational therapeutics for salvaging vision. In this review, we will discuss clinical and research findings related to B. cereus endophthalmitis in terms of the organism's virulence and inflammogenic potential, and strategies for improving of current therapeutic regimens for this blinding disease.
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Affiliation(s)
- Md Huzzatul Mursalin
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Erin T Livingston
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Michelle C Callegan
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Ophthalmology, Dean McGee Eye Institute, Oklahoma City, OK, USA; Oklahoma Center for Neuroscience, Oklahoma City, OK, USA; Dean A. McGee Eye Institute, Oklahoma City, OK, USA.
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16
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Justin GA, Baker KM, Brooks DI, Ryan DS, Weichel ED, Colyer MH. Intraocular Foreign Body Trauma in Operation Iraqi Freedom and Operation Enduring Freedom: 2001 to 2011. Ophthalmology 2018; 125:1675-1682. [PMID: 30037644 DOI: 10.1016/j.ophtha.2018.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We update the incidence of intraocular foreign bodies (IOFB) in soldiers admitted to Walter Reed Army Medical Center from 2001 to 2011 after sustaining combat injuries in Operation Iraqi Freedom and Operation Enduring Freedom. DESIGN This consecutive retrospective case series included 890 eyes of 652 patients. METHODS Data were collected in the Walter Reed Ocular Trauma Database. Inclusion criteria were any American soldier or Department of Defense civilian with an IOFB injured in Operation Iraqi Freedom/Operation Enduring Freedom. Closed globe injuries with orbital foreign bodies, injury outside of a combat zone, or non-Department of Defense civilian trauma were the exclusion criteria. MAIN OUTCOME MEASURES Primary outcome measures were final visual outcome and the number, size, and location of IOFBs. Secondary outcome measures included surgical procedures, use of eye protection, associated complications, source of injury and Ocular Trauma Score. RESULTS There were 890 eye injuries in 652 patients evacuated to Walter Reed Army Medical Center between 2001 and 2011. IOFBs were found in 166 eyes of 149 patients (18.6%; 95% confidence interval [CI], 16.2%-21.3%). Most patients had a single IOFB (80.7%). An IOFB was positively associated with Ocular Trauma Score grade 1 or 2 (0-65) injuries (odds ratio [OR], 1.58; 95% CI, 1.07-2.38; P = 0.01). There were 130 eyes (78.33%) that had recorded time from initial visual acuity to final visual acuity and it ranged from 8 to 2421 days (mean, 433.24 days). Thirty-eight (25.16%; 95% CI, 18.89%-32.67%) eyes had no change in visual acuity, 98 (64.90%; 95% CI, 57.00%-72.07%) had improved visual acuity, and 15 (9.93%; 95% CI, 6.01%-15.84%) had decreased visual acuity. IOFB was not found to predict final visual acuity of <20/200 in multivariate analysis when other injury features were known (P = 0.1). Pars plana vitrectomy was completed on 124 eyes (74.70%). Removal of IOFB was performed in 118 eyes (71.08%; average of 31.67 days after initial injury) with a delayed procedure occurring after primary closure and antibiotics owing to a lack of surgical capacity in Iraq and Afghanistan. Retinal detachment occurred in 48 eyes (28.92%) and proliferative vitreoretinopathy in 44 eyes (26.5%). CONCLUSIONS IOFBs occur frequently in combat ocular trauma and are significantly associated with more severe injuries. However, IOFBs were not found to be a significant risk factor for visual acuity of <20/200.
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Affiliation(s)
- Grant A Justin
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, Texas; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
| | - Katherine M Baker
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Daniel I Brooks
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Denise S Ryan
- Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir, Virginia
| | | | - Marcus H Colyer
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland
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17
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Abouammoh MA, Al-Mousa A, Gogandi M, Al-Mezaine H, Osman E, Alsharidah AM, Al-Kharashi A, Abu El-Asrar AM. Prophylactic intravitreal antibiotics reduce the risk of post-traumatic endophthalmitis after repair of open globe injuries. Acta Ophthalmol 2018; 96:e361-e365. [PMID: 28771946 DOI: 10.1111/aos.13531] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 06/11/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate efficacy of prophylactic intravitreal antibiotics in reducing incidence of endophthalmitis after repair of open globe injuries. At King Abdulaziz University Hospital, a standard protocol of intravenous vancomycin and ceftazidime was used in all cases. METHODS Charts of 353 patients who presented between January 2010 and January 2014 with open globe injury were retrospectively reviewed. In addition, the standard protocol in this cohort included prophylactic intravitreal antibiotics in high-risk cases at time of primary repair. High-risk cases were identified based on the presence of one or more of the following risk factors: dirty wound, retained intra-ocular foreign body (IOFB), rural setting, delayed primary repair of >24 hr and ruptured lens capsule. Rate of endophthalmitis in this recent cohort was compared with that of a previous cohort admitted for primary repair between May 1996 and May 2008 (641 patients). In the previous cohort, protocol did not include prophylactic intravitreal antibiotics. RESULTS Rates of clinically suspected endophthalmitis and culture-positive endophthalmitis were higher in previous cohort (24 of 641 eyes; 3.7% and 12 of 641 eyes; 1.9%, respectively) compared to recent cohort (six of 353 eyes; 1.7% and two of 353 eyes; 0.6%, respectively). In high-risk groups, rates of suspected endophthalmitis and culture-positive endophthalmitis were higher in previous cohort (19 of 345 eyes; 5.5% and 12 of 345 eyes; 3.5%, respectively) compared to the recent cohort (five of 200 eyes; 2.5% and two of 200 eyes; 1.0%, respectively). CONCLUSION Prophylactic intravitreal antibiotics reduce risk of endophthalmitis after repair of open globe injuries.
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Affiliation(s)
- Marwan A. Abouammoh
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
| | - Abdullah Al-Mousa
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
| | - Mohammad Gogandi
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
| | - Hani Al-Mezaine
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
| | - Essam Osman
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
| | | | - Abdullah Al-Kharashi
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
| | - Ahmed M. Abu El-Asrar
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
- Dr. Nasser Al-Rashid Research Chair in Ophthalmology; King Saud University; Riyadh Saudi Arabia
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18
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Abstract
The management of 158 posterior segment intraocular foreign bodies (IOFB) was retrospectively analyzed: transscleral magnet extraction via the pars plana was used for 40 magnetic IOFB, transscleral extraction via the IOFB bed for 35 magnetic and 4 non-magnetic IOFB, pars plana vitrectomy (PPV) for 44 magnetic and 32 non-magnetic IOFB, and open-sky vitrectomy for 3 non-magnetic IOFB. Final visual acuity of 0.02 and better was achieved in 104 out of 119 magnetic IOFB (87%) and 24 out of 39 non-magnetic IOFB (62%), and final visual acuity 0.05 and better in 79 magnetic IOFB (66%) and 17 non-magnetic IOFB (44%). Transscleral extraction via the IOFB bed under ophthalmoscopic control and IOFB removal by PPV proved to be the operations of choice for an increasing number of IOFB. For magnetic IOFB, these techniques yielded better final functional results than transscleral magnet extraction via the pars plana. Final visual acuity did not depend on the interval between injury and IOFB removal, and with regard to the risk of endophthalmitis, IOFB need not be considered an absolute indication for immediate intervention. IOFB size up to 5 mm2 and initial visual acuity of 0.5 and better were significant positive factors for both magnetic and non-magnetic IOFB.
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Affiliation(s)
- I Karel
- 2nd Department of Ophthalmology, 1st Medical Faculty, Charles University, Prague, Czech Republic
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19
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Tomic Z, Pavlovic S, Latinovic S. Surgical Treatment of Penetrating Ocular Injuries with Retained Intraocular Foreign Bodies. Eur J Ophthalmol 2018; 6:322-6. [PMID: 8908441 DOI: 10.1177/112067219600600317] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A total of 40 cases of retained intraocular foreign bodies (IOFB) presenting to the University Eye Clinic of Novi Sad between January 1988 and December 1994 were evaluated and surgically treated. The group most affected were males with a mean age of 33 years, who had been occupationally injured, presenting with either corneal or scleral single laceration. Thirty-seven injuries (92%) were due to metallic foreign bodies. Two eyes presented with initial clinical signs of endophthalmitis (5%). Five eyes (12.5%) were war-injuries, with tremendous destruction of all ocular structures. After an average of 12 months follow-up 70% of total eyes achieved postoperative good or useful vision, 50% of these with visual acuity 0.5 or better.
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Affiliation(s)
- Z Tomic
- Department of Ophthalmology, University Hospital, Uppsala, Sweden
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20
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Kuhn F, Halda T, Witherspoon CD, Morris R, Mester V. Intraocular Foreign Bodies: Myths and Truths. Eur J Ophthalmol 2018; 6:464-71. [PMID: 8997594 DOI: 10.1177/112067219600600422] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Over the centuries, the management of eyes with intraocular foreign bodies (IOFB) has posed a special challenge to the physician, and the anxiety created by such injuries has never abated. During the past few decades, several new diagnostic tests, IOFB removal techniques, and methods to treat the complications of the injury have been introduced. Nevertheless, old habits die hard: many of the management options that used to be standard are not appropriate any more but have proved difficult to change. This article reviews over forty of these die-hard myths and confronts them with factual statements published in the peer-review international literature.
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Affiliation(s)
- F Kuhn
- United States Eye Injury Registry, Birmingham, AL, USA
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21
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Al-Mezaine HS, Osman EA, Kangave D, Abu El-Asrar AM. Risk Factors for Culture-Positive Endophthalmitis after Repair of Open Globe Injuries. Eur J Ophthalmol 2018; 20:201-8. [DOI: 10.1177/112067211002000128] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To identify risk factors for the development of culture-positive endophthalmitis after repair of open globe injuries. Methods We retrospectively reviewed the medical records of 629 consecutive patients with open globe injuries admitted to King Abdulaziz University Hospital between May 1996 and January 2008. Results Endophthalmitis developed in 12 (1.9%) patients. The following factors were significantly associated with endophthalmitis by univariate analysis: delayed presentation (>24 hours) (p=0.008), rural address (p=0.013), and dirty wound (p=0.012). Logistic regression analysis identified dirty wound to be associated with the development of endophthalmitis (odds ratio = 11.6; 95% confidence interval [CI] = 2.67–50.6). On logistic regression analysis, presence of retained intraocular foreign body (IOFB) in association with rural address (odds ratio = 11.0; 95% CI = 1.44–83.3) or dirty wound (odds ratio = 9.2; 95% CI = 1.22–69.1) was associated with development of endophthalmitis. Endophthalmitis was a significant negative predictor for final good visual outcome (p=0.00261) and was significantly associated with hypotony (p=0.033). Conclusions Delayed presentation, rural address, and dirty wound were associated with development of endophthalmitis. Retained IOFB in association with rural address or dirty wound was associated with a particularly high risk of endophthalmitis.
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Affiliation(s)
| | | | - Dustan Kangave
- Research Center, College of Medicine, King Saud University, Riyadh - Saudi Arabia
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22
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Thevi T, Abas AL. Role of intravitreal/intracameral antibiotics to prevent traumatic endophthalmitis - Meta-analysis. Indian J Ophthalmol 2017; 65:920-925. [PMID: 29044054 PMCID: PMC5678325 DOI: 10.4103/ijo.ijo_512_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Traumatic endophthalmitis is a devastating condition that can occur following an open globe injury and result in loss of vision. The use of prophylactic antibiotics is empirical as most surgeons fear complications associated with the same. No systematic review has been performed in English on the role of intravitreal/intracameral antibiotics in preventing traumatic endophthalmitis. We searched for randomized controlled trials and controlled clinical trials comparing intracameral/intravitreal antibiotics with placebos on PubMed, Google Scholar, Science Direct, and Cochrane Library using keywords open globe/trauma/penetrating/perforating injuries endophthalmitis. The last search was on 5 May 2017. We included patients of all ages with open globe injuries who received intracameral/intravitreal antibiotics, regardless of the dose. Quality of the trials was assessed using Cochrane collaboration tools to assess the risk of bias. The main outcome measures were endophthalmitis and visual acuity. We included three trials. Overall, intravitreal/intracameral antibiotics were noted to significantly reduce the occurrence of endophthalmitis in open globe injuries (relative risk [RR] 0.19, 95% confidence interval [CI] 0.06–0.57). The use of intravitreal/intracameral antibiotics did not have an effect in improving visual acuity (RR 1.17, 95% CI 0.61–2.23). Two trials (Narang 2003; Soheilan 2001) were observed to have no significant effect on visual acuity while another trial (Soheilan 2007) did not list visual acuity as part of its objectives. Intracameral/intravitreal antibiotics reduce the risk of endophthalmitis in open globe injuries; although, there was no improvement in the visual acuity. We, therefore, recommend the use of intravitreal/intracameral injections in open globe injuries to prevent this devastating complication.
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Affiliation(s)
| | - Adinegara Lutfi Abas
- Department of Community Medicine, Melaka Manipal Medical College, Melaka, Malaysia
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23
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Banker TP, McClellan AJ, Wilson BD, Juan FM, Kuriyan AE, Relhan N, Chen FV, Weichel ED, Albini TA, Berrocal AM, Sridhar J, Gregori NZ, Townsend JH, Flynn HW. Culture-Positive Endophthalmitis After Open Globe Injuries With and Without Retained Intraocular Foreign Bodies. Ophthalmic Surg Lasers Imaging Retina 2017; 48:632-637. [DOI: 10.3928/23258160-20170802-05] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/02/2017] [Indexed: 11/20/2022]
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Yao Q, Wu HP, Xiong B, Han P, Zheng CS. A new method of 3-dimensional localization of intraocular foreign bodies using CT imaging: A role of optic nerve. ACTA ACUST UNITED AC 2017; 37:110-114. [PMID: 28224428 DOI: 10.1007/s11596-017-1703-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/16/2016] [Indexed: 10/18/2022]
Abstract
Computed tomography (CT) is considered the most sensitive method for the detection of intraocular foreign bodies (IOFBs). The purpose of this study was to evaluate a new method of 3-dimentional (3D) localization of IOFBs that takes advantage of the anatomical structure of the optic nerve and to assess the clinical outcomes using this new method. Twenty-two trauma patients with IOFBs or suspected IOFBs admitted to our hospital were scanned with multislice CT (MSCT) between July and December 2003. All scanning was performed with a 16-row spiral CT in axial plane using a sequential scanning protocol. During the scanning, the eyeball of the patient was kept stable and was not allowed to rotate internally or externally. Section collimation was set at 16 mm × 0.75 mm. Table feed was 12 mm. Reconstruction index was 0.75 mm. After scanning, the reconstructed images were loaded into a workstation to create the multiplanar reconstruction images with the aid of the 3D software. We compared the localization results with the operative findings. Multiplanar reconstruction images showed IOFBs in all 22 patients. IOFBs occurred in the eyeball of 14 patients, in the wall of the eyeball of 5 patients and in the posterior orbits of 3 patients. Different surgical procedures were designed according to the localization by this new method and all IOFBs were successfully removed. All of these foreign bodies were metallic and the localization of IOFB using MSCT was consistent with that found by operative findings. It was suggested that MSCT is a simple and effective imaging modality for the localization of IOFBs. In our study, we localized the IOFBs more quickly and accurately by taking advantage of the fixed position of the intraocular segment of the optic nerve, and determined the necessary surgical parameters.
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Affiliation(s)
- Qi Yao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Han-Ping Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Chuan-Sheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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25
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Rishi E, Rishi P, Koundanya VV, Sahu C, Roy R, Bhende PS. Post-traumatic endophthalmitis in 143 eyes of children and adolescents from India. Eye (Lond) 2016; 30:615-20. [PMID: 26869162 DOI: 10.1038/eye.2016.9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 12/15/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study was to describe clinical features, risk factors, causative organisms, treatment options, and outcomes of post-traumatic endophthalmitis in children and adolescents. METHODS Retrospective interventional case series. Case records of 143 consecutive eyes presenting with post-traumatic endophthalmitis between 1997 and 2007 were reviewed. Univariate and multivariate analysis were done to analyze factors associated with adverse outcomes. RESULTS Mean age at presentation was 9.2 years (median 8 years, range: 2 months to 18 years). Broomstick and hypodermic needle were most common causes for injuries. Common presenting features were cataract (n=51), hypopyon (n=45) and retinal detachment (n=29). Corneal abscess (n=21; OR: 5, CI: 1.4-18.7) and retinal detachment (n=29, OR: 5, CI: 1.6-11.3) were independent risk factors for poor outcome (P=0.04 and 0.012, respectively). Gram-positive bacteria were isolated in 54% (n=31) of culture-positive cases. Forty-nine (34%) patients had ambulatory vision at final visit. Patients who received treatment within 24 h were 3.6 and 9 times more likely to have better anatomical outcome than those treated at 2-7 days, or >7 days, respectively (P=0.0001). Patients undergoing early vitrectomy were 27 times more likely to have better outcome (P=0.0001). CONCLUSION Post-traumatic endophthalmitis in children is more common in boys <10 years of age and most often caused by injury with organic matter. Corneal abscess and retinal detachment are associated with poor outcome. E. fecalis is the most common causative organism. Early vitrectomy results in better outcomes.
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Affiliation(s)
- E Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralya, Chennai, India
| | - P Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralya, Chennai, India
| | - V V Koundanya
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralya, Chennai, India
| | - C Sahu
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralya, Chennai, India
| | - R Roy
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralya, Chennai, India
| | - P S Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralya, Chennai, India
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27
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Yuksel K, Celik U, Alagoz C, Dundar H, Celik B, Yazıcı AT. 23 gauge pars plana vitrectomy for the removal of retained intraocular foreign bodies. BMC Ophthalmol 2015; 15:75. [PMID: 26178019 PMCID: PMC4504162 DOI: 10.1186/s12886-015-0067-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 07/08/2015] [Indexed: 12/18/2022] Open
Abstract
Background To evaluate the morpho-functional outcomes and safety of transconjuctival 23-gauge pars plana vitrectomy(PPV) for removal of intraocular foreign bodies (IOFBs). Methods A retrospective study of 36 consecutive cases (mean age; 34,2 ± 10,9 years (between 15 and 60), 27 M,9 F) of 23-G PPV for the removal of IOFBs during the period of April 2009 and December 2011 and followed 9,4 ± 6,4(2–27) months were conducted. Visual outcomes, slit lamp biomicroscopy, intraocular pressure (IOP), and posterior segment visualization by indirect ophthalmoscopy, A-B mode ultrasonography, and computed orbital tomography were performed for all cases. Main outcomes including anatomic and visual outcomes, and both intraoperative and postoperative complications were recorded. Results Of the 36 cases available for the study, the IOFBs (size range, 3 to 12 mm) could be removed in all eyes. Mean preoperative LogMAR BCVA was 1.44 ± 138 (range, 1.00 to 0.00) and mean postoperative LogMAR BCVA at final visit was 0,78 ± 0,98 (range, 1.00 to 0.00). (P = 0,007) Anatomic success was obtained in 97.2 % of eyes. 16 patients needed primary wound repair due to the leakage in insertion sites before the PPV, however remaining 20 cases were not. Fibrin reaction was seen in 8 (22.2 %) patients in early postoperative period, intraocular pressure elevation was detected in 12 (33.3 %) patients in which the silicone oil was used as an intravitreal tamponade, one patient with silicone oil tamponade developed band keratopathy and phthisis bulbi. Conclusions 23-Gauge PPV is a feasible, effective approach in the surgical management of the patients with posterior segment intraocular foreign bodies.
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Affiliation(s)
- Kemal Yuksel
- Department of Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Ugur Celik
- Department of Ophthalmology, Gaziosmanpaşa Taksim Training and Research Hospital, Istanbul, Turkey. .,, Merkezefendi Mah. Mevlana Cad. Sedeftepe Evleri. Blok:96 No:26, Zeytinburnu, Istanbul, Turkey.
| | - Cengiz Alagoz
- Department of Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Huseyin Dundar
- Department of Ophthalmology, Diyarbakir Ergani Government Hospital, Diyarbakir, Turkey.
| | - Burcu Celik
- Department of Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Ahmet Taylan Yazıcı
- Department of Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
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Al-Tamimi ER. A peculiar case of a retained inert piece of fireworks as an intraocular foreign body in the anterior chamber. Saudi J Ophthalmol 2014; 28:225-7. [PMID: 25278802 DOI: 10.1016/j.sjopt.2013.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 05/26/2013] [Accepted: 06/17/2013] [Indexed: 11/25/2022] Open
Abstract
This is a descriptive case report of a seven-year-old boy presented in January 2007 with decreased vision in the right eye, for 2 months after sustaining a trauma while he was playing with fireworks during the Eid holiday. He was treated in a suburban hospital for corneal laceration and was prescribed a topical antibiotic and a topical steroid. When the child presented to us, a slit lamp examination revealed a thread in the anterior chamber, his un-aided visual acuity was 6/60 on a Snellen chart. Surgery to remove the foreign body was scheduled, but the patient never attended. The patient was lost to follow-up and returned in January 2011 with an un-aided visual acuity of 6/12, although the foreign body was retained in the anterior chamber (AC) with a quiet eye and good vision. At that time, we decided to follow the patient without any surgical intervention. Again, the patient was lost to follow-up and returned with almost full vision in September 2012, with a visual acuity of 6/6 without correction. Thus, we concluded that thread like IOFBs in the AC can be considered inert materials that may not need any surgical intervention in a quiet eye that does not show any signs of inflammation and where the IOFB is non-mobile and located away from the endothelium.
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Affiliation(s)
- Elham R Al-Tamimi
- Department of Ophthalmology, King Fahd Hospital of the University, University of Dammam, Saudi Arabia
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29
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Outcome and Prognostic Factors for Traumatic Endophthalmitis over a 5-Year Period. J Ophthalmol 2014; 2014:747015. [PMID: 25302113 PMCID: PMC4181772 DOI: 10.1155/2014/747015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 08/11/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose. To evaluate the outcome and identify the prognostic factors of traumatic endophthalmitis over a 5-year period. Methods. We reviewed the medical records of all the traumatic endophthalmities that we treated in our department over the last 5 years (2009–2013). We extracted the following parameters: age, gender, wound anatomy, associated ocular lesions, treatment, and initial and final visual acuities. We used the program SPSS version 20.0.0. for the statistical analysis of our data. Results. During the last 5 years, we treated 14 traumatic endophthalmities, representing 46.66% of all types of endophthalmities. The infection rate in open globe injuries was 8.13% and 34.78%, if an intraocular foreign body (IOFB) was associated. All the patients were males with the median age of 37 years. Initial visual acuities varied between light perception and 0.4 and the timing of treatment from a few hours to 10 days. We administered antibiotic and anti-inflammatory drugs, systemically and intravitreally, in all cases. We performed pars plana vitrectomy in 64.28% of cases. In 57.14% of cases, the final visual acuity was 0.1 or more. Conclusions. IOFBs increased significantly the risk for endophthalmitis. The worse prognostic factors were retinal detachment at presentation and delayed treatment. This trial is registered with IRCT2014082918966N1.
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Ahmed S, Kuruvilla O, Yee DC, Aggarwal H, Li Y, Edwards P, Qiao X, Gao H. Intraocular penetration of systemic antibiotics in eyes with penetrating ocular injury. J Ocul Pharmacol Ther 2014; 30:823-30. [PMID: 25167230 DOI: 10.1089/jop.2014.0056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To determine whether penetrating scleral or corneal injury can enhance intraocular penetration of systemic moxifloxacin, vancomycin, and ceftazidime. METHODS Thirty rabbits were divided into 3 groups for each antibiotic and then further subdivided to receive either scleral or corneal injury to the right eye. The left eye served as a control. Intravenous antibiotics were given following injury, and eyes were subsequently enucleated. Vitreous antibiotic concentration was determined by high-performance liquid chromatography analysis. Plasma concentration was measured for comparison. RESULTS Intravitreal moxifloxacin concentration was unchanged by injury. Minimum inhibitory concentration (MIC90) was achieved in the vitreous against the most common gram-positive endophthalmitis-causing organisms. Intravitreal vancomycin levels were not enhanced by injury and did not reach the MIC90 for gram-positive organisms commonly causing intraocular infection. Intravitreal ceftazidime was increased in the injured eyes, 67% and 73% higher in scleral and corneal injury eyes. It reached MIC90 of many gram-negative bacteria. CONCLUSIONS Intravitreal antibiotic penetration of systemic antibiotics with or without penetrating ocular injury varies depending on the antibiotic. For prevention or treatment of gram-positive-bacteria-causing endophthalmitis, intravitreal vancomycin is necessary and provides the most reliable coverage. Systemic ceftazidime can be used for many gram-negative bacteria, but intravitreal injection is recommended for better coverage, especially for more-potent organisms. Systemic moxifloxacin can be considered for most gram-positive and -negative infections due to its excellent intraocular penetration and broad coverage, but the patient's previous history of its topical use and increasing resistance patterns must be considered.
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Affiliation(s)
- Shareef Ahmed
- Department of Ophthalmology, Henry Ford Medical Center , West Bloomfield, Michigan
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Traumatic endophthalmitis, retinal detachment, and metallosis after intraocular foreign body injuries. Int Ophthalmol Clin 2014; 53:93-104. [PMID: 24088936 DOI: 10.1097/iio.0b013e31829ceee1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Post-traumatic endophthalmitis comprises 25-30% of all endophthalmitis cases. Post-traumatic endophthalmitis is an important clinical condition that may have serious anatomical and functional consequences. The type of pathogenic microorganism, nature of the injury, the presence of a foreign body, and the geographical region in which the trauma occurred are all important factors influencing both treatment and prognosis. Unlike postoperative endophthalmitis, there is not a confirmed treatment protocol recommended by the Endophthalmitis-Vitrectomy Study Group in traumatic cases. In this study, we examine the incidence, risk factors, diagnosis, microbiological features, and treatment principles of post-traumatic endophthalmitis in order to guide clinicians who often encounter eye trauma related to this potential complication.
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Affiliation(s)
- Gokcen Gokce
- a Department of Ophthalmology , Sarıkamis Military Hospital , Kars , Turkey
| | - Gungor Sobaci
- b Department of Ophthalmology , Gulhane Military Medical Academy , Ankara , Turkey , and
| | - Cem Ozgonul
- c Department of Ophthalmology , Anittepe Dispensary , Ankara , Turkey
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Jacobs DJ, Grube TJ, Flynn HW, Greven CM, Pathengay A, Miller D, Sanke RF, Thorman J. Intravitreal moxifloxacin in the management of Ochrobactrum intermedium endophthalmitis due to metallic intraocular foreign body. Clin Ophthalmol 2013; 7:1727-30. [PMID: 24039392 PMCID: PMC3770343 DOI: 10.2147/opth.s44212] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A healthy 34-year-old man presented with Ochrobactrum intermedium endophthalmitis due to a metallic intraocular foreign body. After vitrectomy, lensectomy, removal of the metallic intraocular foreign body, intravitreal vancomycin and ceftazidime, and systemic ciprofloxacin, intraocular inflammation worsened. Repeat vitreous culture confirmed persistent endophthalmitis due to multidrug-resistant O. intermedium. The endophthalmitis successfully resolved after the administration of intravitreal moxifloxacin.
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Affiliation(s)
- David J Jacobs
- Trinity Regional Eyecare, Minot, ND, USA ; School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA
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Cornut PL, Youssef EB, Bron A, Thuret G, Gain P, Burillon C, Romanet JP, Vandenesch F, Maurin M, Creuzot-Garcher C, Chiquet C. A multicentre prospective study of post-traumatic endophthalmitis. Acta Ophthalmol 2013; 91:475-82. [PMID: 22313810 DOI: 10.1111/j.1755-3768.2011.02349.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Study the clinical and microbiological characteristics and the prognostic factors of post-traumatic endophthalmitis. METHODS Seventeen eyes were included between 2004 and 2010, with clinical and microbiological data collected prospectively. Conventional cultures and panbacterial PCR were performed on aqueous and vitreous samples. RESULTS Clinical signs of endophthalmitis were observed soon after trauma (1.5 ± 2.5 days). Laceration with an intraocular foreign body (IOFB) was noted in 53% of the patients. At admission, all patients had aqueous humour (71%) and/or vitreous (53%) samples. Fifteen patients (88%) underwent a pars plana vitrectomy. Bacteria were identified in 77% of the cases: Staphylococcus epidermidis (n = 5), Streptococcus (n = 4), Bacillus (n = 2), Pseudomonas stuzeri (n = 1), and Streptococcus salivarius and Gemella haemolysans (multibacterial infection, n = 1). Progression toward phthisis was observed in 35% of the cases; 41% of the patients recuperated visual acuity (VA) ≥20/40. A good final visual prognosis (≥20/40) was significantly associated with initial VA better than light perception (0% versus 70%, p = 0.01) and absence of pupillary fibrin membrane (80% versus 20%, p = 0.05). There was no correlation between visual prognosis and age, the type of laceration (corneal or scleral) or presence of an IOFB. We found a statistical trend toward an association between bacterial virulence and poor final VA. CONCLUSION This series showed that better final VA outcomes were associated with initial VA better than light perception, S. epidermidis or culture-negative cases and absence of retinal detachment during the clinical course.
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Affiliation(s)
- Pierre-Loïc Cornut
- Department of Ophthalmology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University Hospital, Université Lyon I, Lyon, France
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Spectrum of intra-ocular foreign bodies and the outcome of their management in Brunei Darussalam. Int Ophthalmol 2012; 33:277-84. [PMID: 23229396 DOI: 10.1007/s10792-012-9687-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 11/26/2012] [Indexed: 12/22/2022]
Abstract
To review the etiologies, prognostic factors and treatment outcomes of intraocular foreign bodies (IOFBs) occurring in the population of Brunei Darussalam, and provide guidelines to prevent and manage such injuries. A retrospective review was performed for all cases of traumatic IOFBs managed in our centre during a 3-year period between May 2008 and April 2011. The mechanism of injury, management, complications and visual outcomes were analyzed. Majority of the patients were males (93 %) and the mean age was 36 years. The main causes of trauma were metal hammering and grass cutting (43 % each). Other causes include road traffic accidents and firecracker explosion (7 % each). The visual outcome was ≥6/18 in 50 % and 'No perception of light' in 29 %. Causes of poor visual outcome were retinal detachment with proliferative vitreoretinopathy (21 %), endophthalmitis (21 %) and globe maceration (7 %). Prognostic factors associated with significantly worse final visual outcome included posterior location of the IOFB (p = 0.05) and larger IOFB size (p < 0.001). The time from injury to surgery did not correlate with a worse visual prognosis. In Brunei Darussalam, the commonest causes of IOFBs are hammering metal and cutting grass using power tools. The visual outcome varies between 6/6 and NPL. Poor visual outcome is related to the severity of the initial ocular injury, posterior segment IOFB and endophthalmitis.
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36
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Pinto A, Brunese L, Daniele S, Faggian A, Guarnieri G, Muto M, Romano L. Role of Computed Tomography in the Assessment of Intraorbital Foreign Bodies. Semin Ultrasound CT MR 2012; 33:392-5. [DOI: 10.1053/j.sult.2012.06.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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37
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Risk factors for endophthalmitis and retinal detachment with retained intraocular foreign bodies. J Ophthalmol 2012; 2012:758526. [PMID: 22619702 PMCID: PMC3350973 DOI: 10.1155/2012/758526] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 02/29/2012] [Indexed: 12/27/2022] Open
Abstract
Purpose. To analyze risk factors for endophthalmitis and retinal detachment (RD) in patients with retained intraocular foreign bodies (IOFBs). Design. A retrospective, interventional, consecutive case series. Participants. All patients treated at Bascom Palmer Eye Institute for traumatic IOFBs between 1999 and 2008. Methods. Analysis of visual outcome, mechanism of injury, management, and postoperative course. Results. 108 eyes with IOFBs were identified. Endophthalmitis occurred in 7 eyes (6.4%) at presentation, and risk was higher with vegetable matter exposure (P = 0.003). All eyes with posterior segment IOFBs received intravitreal antibiotics and there were no cases of endophthalmitis after initial management. RD was identified in 6 of 108 eyes (5.5%) at presentation. Risk factors were entry more than 5 mm behind the limbus (P < 0.001) and posterior segment IOFB (P = 0.028). Postoperative RD occurred in 11 of 102 eyes (10.7%). Risk factors for postoperative RD were preoperative endophthalmitis (P = 0.001), posterior segment IOFB (P = 0.008), and retinal impact sites (P = 0.028). Conclusions. Risk factors for endophthalmitis included vegetable matter exposure and delay to initial management. Risk factors for RD were posterior entry site, posterior segment IOFB, endophthalmitis, and retinal impact sites. No eyes developed endophthalmitis after presentation.
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Abstract
PURPOSE To study predisposing factors of endophthalmitis in patients with open-globe injury. METHODS All 2,340 patients with open-globe injury admitted to our center over 5 years were studied retrospectively, and patients with endophthalmitis were compared with other patients. RESULTS The number of endophthalmitis cases among patients with open-globe injury was 117 eyes, accounting for an incidence of 5.1%. The risk of endophthalmitis was significantly higher among male patients with pure corneal injuries (6.8%), intraocular foreign bodies (9.3%), traumatic lens rupture (7.1%), trauma resulting from needles (22.2%), and shorter lacerations. The existence of hyphema or iris prolapse was associated with lower rates of endophthalmitis. The mean gap between injury time and operation time was longer in the endophthalmitis group (2.1 ± 1.8 vs. 1.1 ± 1.3 days). Patients with endophthalmitis had significantly lower ocular trauma scores compared with other patients. CONCLUSION Posttraumatic endophthalmitis is more likely among patients with open-globe injury that are needle related and among those who have intraocular foreign bodies, traumatic lens rupture, smaller wounds, or wounds exclusively in the cornea. Lower ocular trauma scores in this group of patients with penetrating trauma indicated a greater risk of poor visual prognosis. Therefore, it is suggested that necessary measures and immediate treatment be undertaken in high-risk patients.
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Ahmed Y, Schimel AM, Pathengay A, Colyer MH, Flynn HW. Endophthalmitis following open-globe injuries. Eye (Lond) 2012; 26:212-7. [PMID: 22134598 PMCID: PMC3272210 DOI: 10.1038/eye.2011.313] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 10/31/2011] [Indexed: 02/06/2023] Open
Abstract
The incidence of traumatic endophthalmitis may be decreasing due to earlier wound closure and prompt initiation of antibiotics. Risk factors for endophthalmitis include retained intraocular foreign body, rural setting of injury, disruption of the crystalline lens, and a delay in primary wound closure. The microbiology in the post-traumatic setting includes a higher frequency of virulent organisms such as Bacillus species. Recognizing early clinical signs of endophthalmitis, including pain, hypopyon, vitritis, or retinal periphlebitis may prompt early treatment with intravitreal antibiotics. Prophylaxis of endophthalmitis in high-risk open-globe injuries may include systemic broad-spectrum antibiotics, topical antibiotics, and intravitreal antibiotics to cover both Gram-positive and Gram-negative bacteria. For clinically diagnosed post-traumatic endophthalmitis, intravitreal vancomycin, and ceftazidime are routinely used. Concurrent retinal detachment with endophthalmitis can be successfully managed with vitrectomy and use of intravitreal antibiotics along with a long acting gas or silicone oil tamponade. Endophthalmitis is a visually significant complication of open-globe injuries but early wound closure as well as comprehensive prophylactic antibiotic treatment at the time of injury repair may improve visual acuity outcomes.
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Affiliation(s)
- Y Ahmed
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - A M Schimel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - A Pathengay
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - M H Colyer
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - H W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
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Al-Thowaibi A, Kumar M, Al-Matani I. An overview of penetrating ocular trauma with retained intraocular foreign body. Saudi J Ophthalmol 2011; 25:203-5. [PMID: 23960924 DOI: 10.1016/j.sjopt.2011.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Revised: 01/01/2011] [Accepted: 01/02/2011] [Indexed: 11/17/2022] Open
Abstract
Penetrating trauma is one of the common causes of ocular morbidity world wide. Violation of the globe integrity, also known as a ruptured globe is an ocular emergency that universally threatens vision. Prompt recognition and management is prudent. Here we report a case of a 26-year-old-female, university teacher, who presented with pain and sudden loss of vision in the left eye of 2 h duration subsequent to a test tube blast in the chemical laboratory. Examinations revealed a ruptured globe with vitreous haemorrhage and an intraocular glass foreign body in the left eye. Primary repair was done with good post operative visual recovery. We report this case to emphasize that protective measures should be taken to prevent such eye traumas.
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Affiliation(s)
- Awwadh Al-Thowaibi
- Department of Ophthalmology, Alhad Military Hospital, Taif, Saudi Arabia
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Akesbi J, Adam R, Rodallec T, Barale PO, Ayello-Scheer S, Labbé A, Laroche L, Sahel JA, Nordmann JP. [Intraocular foreign bodies (IOFB) of the posterior segment: retrospective analysis and management of 57 cases]. J Fr Ophtalmol 2011; 34:634-40. [PMID: 21890233 DOI: 10.1016/j.jfo.2011.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 06/18/2011] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the influence of prognostic factors and the type of tamponade agent in surgical management of intraocular foreign bodies (IOFBs) for better visual outcome. PATIENTS AND METHODS Fifty-seven consecutive cases were retrospectively reviewed at the XV-XX National Hospital (Paris) between 1 January 2004 and 31 December 2007. Univariate and multivariate analyses were performed to identify prognostic variables. Several parameters were measured: pre- and postoperatively: best corrected visual acuity (BCVA), material and size of the foreign body, entry site, time from trauma to surgical removal, IOFB location, initial retinal detachment, choice of vitreous tamponade agent (none, gas, silicone oil), postoperative visual outcome, and complications (siderosis, endophthalmitis, and vitreoproliferative retinal detachment). RESULTS Metal IOFBs accounted for the majority with 80.7% (n=46). The inferior retinal segment was the most frequent location found: 47.4% (n=27). Initial and final mean BCVAs were, respectively, 1.47 (±0.99) and 1.03 (±0.96) (LogMar scale). The mean follow-up was 20.7 months (range, 12-60 months). Initial retinal detachment was found in 24.56% (n=14), with a statically worse prognosis. The BCVA was better in the group with gas tamponade (n=16) than in the group with silicone tamponade (n=21) and the group without a tamponade agent (n=20). Initial BCVA was the most important predictive factor for final BCVA. Time to surgery was a predictive factor of final visual outcome with a cut-off in the first week. The scleral or corneoscleral entry site had a better prognosis than the corneal site. Five cases of siderosis (8.7%) related to delayed management and two cases of endophthalmitis (3.5%) were found (despite use of prophylactic systemic antibiotics). No statistical difference was found regarding the IOFB location on the retina, its size, or the material. Finally, the retina remained detached in nine cases (15.78%). A final BCVA of 20/40 or more was obtained in 39.3 and 17.5% had light perception or worse. CONCLUSION The prognosis of an IOFB injury is for the most part uncertain due to a complex combination of parameters. Nevertheless, good postoperative results can be achieved without a silicone tamponade agent. The main prognostic factors related to better visual outcome were initial BCVA, time to surgery (first week), initially attached retina, and the scleral entry site. The main complications were vitreoproliferative retinal detachment, endophthalmitis, and siderosis. The location, type, and size of IOFBs were not statistically significant predictive factors in this study.
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Affiliation(s)
- J Akesbi
- Service 2, Centre hospitalier national d'ophtalmologie (CHNO) des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France.
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Intraocular foreign bodies in china: clinical characteristics, prognostic factors, and visual outcomes in 1,421 eyes. Am J Ophthalmol 2011; 152:66-73.e1. [PMID: 21529762 DOI: 10.1016/j.ajo.2011.01.014] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 01/05/2011] [Accepted: 01/06/2011] [Indexed: 01/26/2023]
Abstract
PURPOSE To investigate epidemiologic and clinical characteristics, prognostic factors, and visual outcomes of posttraumatic intraocular foreign body (IOFB). DESIGN Retrospective, consecutive case series. METHODS Information from 1,421 eyes (1299 inpatients) with IOFB selected from all open-globe injury cases (4,968 eyes of 4,865 inpatients) in 15 tertiary hospitals in China over a 5-year period were collected from a standardized preformulated database of eye injuries. Factors affecting retinal lesions or detachment, development of endophthalmitis, and visual outcome were analyzed statistically. RESULTS IOFBs represented 28.60% of all open-globe injuries. Of the 1,421 eyes, endophthalmitis developed in 232 (16.76%), and independent protective factors included primary repair within 24 hours (odds ratio [OR], 0.59; P = .006) and self-sealing wounds (OR, 0.69; P = .013). At discharge or follow-up, the enucleation rate was 7.53%, best-corrected visual acuity (VA) improved in 54.33%, and 4.85% had no light perception. Wound length of at least 3 mm and IOFB located in the posterior segment increased the risk of retinal lesion or detachment, and both (OR, 1.66; P < .001; OR, 4.04; P < .001) were significant negative predictors for visual outcome, along with wound larger than IOFB in largest length (OR, 2.38; P = .002) and endophthalmitis (OR, 2.01; P = .0003). Better initial VA (OR, 0.76; P < .001) was a protective factor for final VA. CONCLUSIONS For IOFBs, primary wound closure by repair within 24 hours or self-sealing independently reduces the risk of endophthalmitis. Worse presenting VA, larger wounds, IOFB in posterior segment, wound larger than IOFB in largest length, and endophthalmitis predict worse visual outcome.
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Post-traumatic Infectious Endophthalmitis. Surv Ophthalmol 2011; 56:214-51. [DOI: 10.1016/j.survophthal.2010.09.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 09/15/2010] [Accepted: 09/21/2010] [Indexed: 12/25/2022]
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Lee NE, Chung IY, Park JM. A case of Pantoea endophthalmitis. KOREAN JOURNAL OF OPHTHALMOLOGY 2010; 24:318-21. [PMID: 21052515 PMCID: PMC2955278 DOI: 10.3341/kjo.2010.24.5.318] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 12/17/2009] [Indexed: 11/25/2022] Open
Abstract
A previously healthy 50-year-old man was transferred to our hospital for evaluation of acute inflammation in his right eye after ocular trauma while using a grass mower. Slit lamp examination showed 1 mm-length full thickness corneal laceration without leakage, 4+ cells and inflammatory membrane in the anterior chamber, 10% hypopyon, posterior synechiae formation, and cataract change. Upon orbital computerized tomography, a metallic intraocular foreign body in the lens was indentified. Vitrectomy, phacoemulsification, foreign body removal, anterior chamber irrigation, and intravitreal antibiotics injections of vancomycin and ceftazidime were performed. In a culture of humor from the anterior chamber grew Pantoea species. More procedures were performed, including intravitreal antibiotics injection of ceftazidime. Upon administering a course of intravenous ceftazidime, fortified ceftazidime and moxifloxacin eye drops, and oral prednisolone, the patient improved.
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Affiliation(s)
- Na Eun Lee
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
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Schroeder A, Turjeman K, Schroeder JE, Leibergall M, Barenholz Y. Using liposomes to target infection and inflammation induced by foreign body injuries or medical implants. Expert Opin Drug Deliv 2010; 7:1175-89. [DOI: 10.1517/17425247.2010.517519] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Ugarte M, Nicol DA, Jones NP, Charles SJ. Chronic intraocular copper foreign body and candida: a unique combination. Ocul Immunol Inflamm 2010; 17:356-60. [PMID: 19831572 DOI: 10.3109/09273940903075370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe a case of unilateral intermediate uveitis, retained copper intraocular foreign body (IOFB) and fungus. METHODS Interventional case report. RESULTS Brown-orange discoloration of the iris, lens and opacified vitreous was observed. Computed tomography revealed a retained IOFB, which was composed of copper. IOFB was removed during vitrectomy and cataract surgery. Copper deposition was demonstrated on the anterior capsule. Incidentally, dimorphic fungus were found in the vitreous. CONCLUSIONS The presence of intraocular copper might have reduced the virulence of the fungus preventing endophthalmitis.
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Affiliation(s)
- Marta Ugarte
- Manchester Academic Health Sciences Centre, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.
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Weichel ED, Bower KS, Colyer MH. Chorioretinectomy for perforating or severe intraocular foreign body injuries. Graefes Arch Clin Exp Ophthalmol 2009; 248:319-30. [PMID: 20155279 DOI: 10.1007/s00417-009-1236-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 10/14/2009] [Accepted: 10/22/2009] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To report the outcomes of chorioretinectomy versus non-chorioretinectomy in combat ocular injuries where a foreign body penetrated the choroid or perforated the globe. METHODS Retrospective, comparative, consecutive interventional case series of 32 perforating or severe intraocular foreign body combat ocular trauma injuries sustained by United States military soldiers and treated at a single institution from March 2003 to March 2009. Final best-corrected visual acuity (BCVA) in 19 non-chorioretinectomy-treated eyes was compared to 13 chorioretinectomy-treated eyes. The chorioretinectomy group was repaired with a 20 gauge three-port pars plana vitrectomy (PPV) by removing the choroid and/or retina at the impact or perforation site of the foreign body following evacuation from a combat zone. The main outcome measures were best-corrected visual acuity and rates of globe survival, retina reattachment and proliferative vitreoretinopathy. RESULTS Thirty-two eyes of 31 patients with a mean age of 29 +/- 9 years (range, 19-53 years) were followed for a median of 463 +/- 226 days (range, 59-1022 days). The mean time of injury to the operating room in the chorioretinectomy group was 12.6 +/- 9.8 days, compared to that of the non-chorioretinectomy group of 22.1 +/- 16.4 days (P = 0.05) Final BCVA > or =20/200 occurred in seven of 13 (54%) of the chorioretinectomy group, compared to two of 19 (11%) in the non-chorioretinectomy group (P = 0.04). Globe survival rates were higher in the chorioretinectomy group [11 of 13 (85%) vs 9 of 19 (45%); P = 0.06], as well as the final retinal reattachment rate [8 of 13 (62%) vs 8 of 19 (42%); P = 0.47]. The proliferative vitreoretinopathy rate was eight of 13 (62%) in the chorioretinectomy group, compared to 14 of 19 (74%) in the non-chorioretinectomy group (P = 0.70). Graft failure occurred in five of six eyes (83%) of non-chorioretinectomy cases, requiring temporary keratoprosthesis and penetrating keratoplasty. CONCLUSION Chorioretinectomy is a surgical option that may improve final BCVA and increase globe survival rates when a foreign body penetrates the choroid or perforates the globe.
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Affiliation(s)
- Eric D Weichel
- Ophthalmology Service, Walter Reed Army Medical Center, 6900 Georgia Avenue, Washington, DC, 20307, USA.
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Cebulla CM, Flynn HW. Endophthalmitis after open globe injuries. Am J Ophthalmol 2009; 147:567-8. [PMID: 19327442 DOI: 10.1016/j.ajo.2008.12.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 12/05/2008] [Accepted: 12/09/2008] [Indexed: 12/25/2022]
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Krause L, Bechrakis NE, Heimann H, Kildal D, Foerster MH. Incidence and outcome of endophthalmitis over a 13-year period. CANADIAN JOURNAL OF OPHTHALMOLOGY 2009; 44:88-94. [PMID: 19169320 DOI: 10.3129/i08-160] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of the study was to assess the functional results and long-term visual prognosis in patients treated for acute endophthalmitis (AE). DESIGN Observational clinical series. PARTICIPANTS Evaluation of 120 eyes of 114 patients with AE treated between 1991 and 2004. METHODS This retrospective institutional analysis included 120 eyes of 114 patients (52 male, 68 female) with AE and a minimum follow-up of half a year. The patients had a mean follow-up of 23 months (6-135 months) and a mean age of 61 years (8 months-94 years) at the time of treatment. Treatment included intraocular injection of antibiotics alone (n = 18, 15%) and vitrectomy combined with intraocular and topical postoperative antibiotics (n = 85, 70%). RESULTS The most frequent complications were vitreous or retinal hemorrhages (n = 17, 14%), retinal detachment (n = 17, 14%), choroidal detachment (n = 3, 3%), secondary glaucoma (n = 7, 6%), and recurrent endophthalmitis (n = 3, 3%). Four eyes had to be enucleated because of recurrent and uncontrollable infection. Positive microbiological results were achieved in 67 of 88 specimens (76%). The most common isolate was Staphylococcus. At the end of follow-up, visual acuity was reduced (more than 2 lines) in 18 eyes (15%), stable in 22 (18%), and improved (more than 2 lines) in 72 eyes (60%). CONCLUSIONS AE is a rare but severe disease with a potentially deleterious outcome in affected eyes. In our series, 78% of all eyes had stable or improved postoperative visual acuity following various treatment regimens, depending on the severity of each case.
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Affiliation(s)
- Lothar Krause
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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