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Gushansky K. Abiotrophia defectiva Endophthalmitis Post-Keratoplasty - A Case Report and Literature Review. Ocul Immunol Inflamm 2024:1-4. [PMID: 38436925 DOI: 10.1080/09273948.2024.2324142] [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: 11/17/2023] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To report the first case of acute Abiotrophia defectiva endophthalmitis post-keratoplasty and review the current literature. METHODS A 47-year-old male, post-keratoplasty, presented with vision loss and severe anterior chamber reaction. Diagnostic investigations included vitreous cultures and molecular analysis. RESULTS Abiotrophia defectiva was identified. Despite aggressive treatment, visual acuity remained low. We reviewed a total of 14 post-procedural cases of A. defectiva endophthalmitis, focusing on antibiotic and steroidal treatment regimens and long-term prognosis. CONCLUSION We emphasize aggressive treatment of external disease prior to intraocular surgery. In cases of A. defectiva endophthalmitis, we advocate judicious use of steroids.
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Louis AM, Ali AM, Patel SB, Fan KC, Rahman EZ, Pearce WA, Trejo Corona S, Villanueva Boone C, Yu HJ, Wykoff CC. Impact of Prefilled Syringes and Masking on Postintravitreal Injection Endophthalmitis. JOURNAL OF VITREORETINAL DISEASES 2023; 7:382-388. [PMID: 37706081 PMCID: PMC10496810 DOI: 10.1177/24741264231191339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Purpose: To compare rates of endophthalmitis (1) following intravitreal injection of antivascular endothelial growth factor therapies with glass-vial preparation (GVP) vs prefilled syringes (PFS) and (2) before and after masking protocols were implemented. Methods: Medical records within a multicenter retina practice in Houston, Texas, from January 2015 to August 2021 were retrospectively reviewed. The primary outcome was rate of endophthalmitis after intravitreal injection. Results: A total of 307 349 injections were performed during the study period and 101 cases of endophthalmitis were identified (0.033%). PFS use was associated with a decreased risk of endophthalmitis (relative risk [RR], 0.320; 95% CI, 0.198-0.518, P < .001); 54 cases of endophthalmitis occurred in the GVP group of aflibercept and ranibizumab (0.052%) compared with 24 in the PFS group (0.017%). There was no difference in the endophthalmitis rates with or without universal masking (RR, 0.953; 95% CI 0.616-1.473, P = .91). Discussion: PFS use was associated with a significant reduction in the rate of endophthalmitis while the use of surgical face masks did not appear to significantly impact the rate of endophthalmitis.
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Affiliation(s)
- Abigail M. Louis
- McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Amna M. Ali
- McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Sagar B. Patel
- Retina Consultants of Texas, Retina Consultants of America, Bellaire, TX, USA
- Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Kenneth C. Fan
- Retina Consultants of Texas, Retina Consultants of America, Bellaire, TX, USA
- Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Effie Z. Rahman
- Retina Consultants of Texas, Retina Consultants of America, Bellaire, TX, USA
- Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - William A. Pearce
- Retina Consultants of Texas, Retina Consultants of America, Bellaire, TX, USA
- Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | | | | | - Hannah J. Yu
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Charles C. Wykoff
- Retina Consultants of Texas, Retina Consultants of America, Bellaire, TX, USA
- Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
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Reyes-Capo DP, Yannuzzi NA, Smiddy WE, Flynn HW. Trends in Endophthalmitis Associated With Intravitreal Injection of Anti-VEGF Agentsat a Tertiary Referral Center. Ophthalmic Surg Lasers Imaging Retina 2021; 52:319-326. [PMID: 34185586 DOI: 10.3928/23258160-20210528-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To report the incidence and clinical features of infectious endophthalmitis after intravitreal (IV) injection of anti-vascular endothelial growth factor inhibitors (VEGF) between 2018 and 2020 and to compare to prior rates. PATIENTS AND METHODS Retrospective analysis of patients with endophthalmitis after anti-VEGF IV injections treated at Bascom Palmer Eye Institute between January 1, 2018, and December 31, 2020. RESULTS Between 2018 and 2020, the rate of clinically diagnosed endophthalmitis was 0.014% (10/71,858) and of culture-positive was 0.008% (6/71,858). Clinically diagnosed endophthalmitis rates per injection were: aflibercept (0.022%); ranibizumab (0.019%); bevacizumab (0%); and brolucizumab (0%). Clinically diagnosed endophthalmitis rates were similar in the present study compared to those from 2005 to 2017 (P = .84). Fifteen eyes were diagnosed with endophthalmitis (10 in-house, five external referrals). Of culture-positive eyes, the organisms were coagulase-negative Staphylococcus (8/11), Streptococcus species (2/11), and Abiotrophia defectiva (1/11). A universal face-masking policy in 2020 did not lower infection rates (P = .73). CONCLUSION Endophthalmitis rates after IV anti-VEGF remain low and are similar to prior reports. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:319-326.].
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Incidence of Endophthalmitis after Intravitreal Anti-Vascular Endothelial Growth Factor Injections in an Operating Room in China. J Ophthalmol 2021; 2020:5163484. [PMID: 33815833 PMCID: PMC7988740 DOI: 10.1155/2020/5163484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 10/01/2020] [Accepted: 10/24/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the rate of presumed endophthalmitis (EO) after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections performed in an operating room (OR) under sterile conditions in mainland China. Methods Retrospective single-center study between September 2012 and December 2017 at Beijing Tongren Eye Center, Beijing, China. Intravitreal injection database was reviewed. All anti-VEGF injections were performed using a standardized sterile technique in an OR. Injection protocols included antibiotics for 3 days pre-injection, topical 5% povidone-iodine rinsing before the procedure, and post-injection antibiotics for 3 days. Results A total of 37,830 intravitreal injections were performed at Beijing Tongren Eye Center. Three cases were managed as presumed EO (0.0079%). Positive cultures were documented in 2 of 3 cases. EO incidence following ranibizumab and conbercept administration was 0.0088% (3 in 33,930) and 0% (0 in 3,900), respectively. No significant difference was detected between the two drugs (P = 0.745). Conclusions Very low EO rates were seen in mainland China using a standardized sterile technique in an OR. However, EO could not be completely avoided.
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Steinmetz RL, Steinmetz CZ, Reyes-Capo DP, Brooks HL, Sengillo JD, Miller D, Flynn HW. Nutritionally variant streptococci causing endophthalmitis associated with intravitreal anti-vascular endothelial growth factor injection. Am J Ophthalmol Case Rep 2021; 21:101019. [PMID: 33553806 PMCID: PMC7851176 DOI: 10.1016/j.ajoc.2021.101019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/04/2020] [Accepted: 01/13/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To describe the clinical course and microbial properties of the first two reported cases of nutritionally variant Streptococci (Granulicatella adiacens and Abiotrophia defectiva) endophthalmitis following intravitreal anti-vascular endothelial growth factor injection (IVI). Observations A 74 year-old female developed Granulicatella adiacens endophthalmitis following IVI. The patient underwent a pars plana vitrectomy and visual acuity recovered to 20/30 in six weeks. Similarly, an 88 year-old male developed Abiotrophia defectiva endophthalmitis after IVI. After a pars plana vitrectomy, the visual acuity recovered to 20/60 at five weeks. Conclusions and Importance Endophthalmitis due to Streptococcus species has traditionally resulted in uniformly poor visual outcomes. However, nutritionally variant Streptococci, now reclassified as Granulicatella and Abiotrophia species, appear to have a less aggressive clinical course and better visual acuity outcomes. To the authors’ knowledge, these are the first reports of nutritionally variant Streptococci following IVI related endophthalmitis.
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Affiliation(s)
| | | | - Daniela P Reyes-Capo
- Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th St., Miami, FL, USA
| | - H Logan Brooks
- Southern Vitreoretinal Associates, 2439 Care Dr., Tallahassee, FL, USA
| | - Jesse D Sengillo
- Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th St., Miami, FL, USA
| | - Darlene Miller
- Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th St., Miami, FL, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th St., Miami, FL, USA
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Chihaia M, Richardson-May J, Al-Saffar L, Kettledas H, Rashid M. Abiotrophia defectiva endophthalmitis following routine cataract surgery: the first reported case in the United Kingdom. Access Microbiol 2020; 2:acmi000124. [PMID: 32974588 PMCID: PMC7494195 DOI: 10.1099/acmi.0.000124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/04/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Abiotrophia defectiva is a fastidious organism that has been implicated in severe infections such as endocarditis in immunocompetent patients. Modern tools are available to aid identification, but the main challenge remains clinical suspicion of A. defectiva. Case presentation An otherwise fit and well 65-year-old female presented with reduced vision, red eye and discomfort 2 days following routine left cataract surgery. She had visual acuity of light perception only, significant anterior chamber inflammation (including hypopyon) and limited fundal view. She was diagnosed with post-operative endophthalmitis and 0.1 ml of ceftazidime (2 mg/0.1 ml) and 0.1 ml vancomycin (2 mg/0.1 ml) were injected intravitreally after vitreous aspiration. Subconjunctival cefuroxime was also injected. A repeat injection was performed on day three of admission. Gram staining revealed Gram-positive long-chain cocci, which were identified as A. defectiva. The patient was discharged on oral ciprofloxacin 500 mg twice a day with oral prednisolone 60 mg once a day; this was tapered and stopped at 8 weeks post-discharge. The left eye received dexamethasone 0.1 % 6 times a day (again, tapered over 8 weeks), moxifloxacin 5 % 6 times a day and atropine 1 % twice a day. Vision improved to 6/12 unaided (6/9.5 with pinhole) at 9 weeks post-operatively, with a clear fundal view. Conclusion We present a case of A. defectiva endophthalmitis following routine cataract surgery. To our knowledge, this is the first reported case in the UK and the fourth globally, which with prompt treatment ended with a good visual outcome.
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Affiliation(s)
- Madalina Chihaia
- Trust Grade Registrar, Ophthalmology, Royal Bournemouth Hospital, Dorset, Bournemouth, UK
| | - James Richardson-May
- Specialty Registrar Year 2, Ophthalmology, Royal Bournemouth Hospital, Dorset, Bournemouth, UK
| | - Layth Al-Saffar
- Consultant Microbiologist, Ophthalmology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Hiron Kettledas
- Consultant Ophthalmologist, Dorset County Hospital, Dorchester, UK
| | - Mohammed Rashid
- Consultant ophthalmologist, Royal Bournemouth Hospital, Bournemouth, UK
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