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A Review on Pathogens and Necessary Diagnostic Work for Bleb-Related Infections (BRIs). Diagnostics (Basel) 2022; 12:diagnostics12092075. [PMID: 36140477 PMCID: PMC9497804 DOI: 10.3390/diagnostics12092075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022] Open
Abstract
At the present time, as newer techniques and minimally invasive procedures gain popularity among anterior segment surgeons for regulating intraocular pressure, trabeculectomy still has a leading role in glaucoma surgery. Trabeculectomy retains a highly successful and safe profile; however, one of the major complications includes bleb-related infections (BRIs). To date, the most common pathogens remain Gram-positive cocci, but the list of pathogens that have been identified in the literature includes more than 100 microorganisms. Because antibiotic use is more widespread than ever before and our ability to identify pathogens has improved, the pathogen spectrum will broaden in the future and more pathogens causing BRIs will be described as atypical presentations. The scope of this review was to identify all pathogens that have been described to cause bleb-related infections to date, as well as focus on the risk factors, clinical presentation, and various available diagnostic tools used for an appropriate diagnostic workup.
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Patel SN, Mokhashi N, Peck TJ, Cai LZ, Salabati M, Soares RR, Hinkle J, Chaudhary V, Kuriyan AE, Cohen MN, Hsu J, Garg SJ. Seasonal and environmental variations in endophthalmitis after intravitreal anti-vascular endothelial growth factor injection: a six-year review. Curr Eye Res 2022; 47:1288-1293. [PMID: 35759609 DOI: 10.1080/02713683.2022.2093383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE/AIM To evaluate seasonal and environmental variations on the incidence and outcomes of post-injection endophthalmitis. MATERIALS AND METHODS A single-center, retrospective cohort study was conducted including all patients diagnosed with post-injection endophthalmitis between 2013-2018. Associations between climate variables and endophthalmitis incidence were evaluated. RESULTS Of 423,297 injections administered, seasonal distribution in spring, summer, autumn, and winter was 26%, 27%, 25%, and 22%, respectively. Of 171 cases of endophthalmitis identified, seasonal distribution over the spring, summer, autumn, and fall was 25%, 23%, 26%, and 26%, respectively. Endophthalmitis incidence was not correlated with monthly precipitation (p = 0.45), monthly snowfall (p = 0.49), or monthly temperature (p = 0.65). Worse visual outcomes at initial endophthalmitis presentation were correlated with increased precipitation level (p = 0.025), but were not correlated with snowfall level (p = 0.228) or mean monthly temperature (p = 0.132). Although there were no seasonal variations of visual acuity at endophthalmitis presentation (p = 0.894), odds of final visual acuity returning to within two lines of pre-endophthalmitis visual acuity were worse among patients with endophthalmitis diagnosed in the spring (OR, 0.041; p = 0.016). CONCLUSION In contrast to previous work on post-cataract endophthalmitis, seasonal and weather factors were not associated with post-injection endophthalmitis risk or bacterial species isolated. Visual outcomes at initial endophthalmitis presentation were correlated with precipitation, and worse visual outcomes were seen in patients who developed endophthalmitis in the spring.
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Affiliation(s)
- Samir N Patel
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Nikita Mokhashi
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Travis J Peck
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Louis Z Cai
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Mirataollah Salabati
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Rebecca R Soares
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - John Hinkle
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Varun Chaudhary
- Hamilton Regional Eye Institute, St Joseph's Healthcare Hamilton, Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ajay E Kuriyan
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Michael N Cohen
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Jason Hsu
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Sunir J Garg
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
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Romanowski EG, Yadav S, Stella NA, Yates KA, Romanowski JE, Dhaliwal DK, Shanks RMQ. Bacterial Keratitis: Similar Bacterial and Clinical Outcomes in Female versus Male New Zealand White Rabbits Infected with Serratia marcescens. Curr Eye Res 2021; 47:505-510. [PMID: 34854780 DOI: 10.1080/02713683.2021.2013897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Females and males respond differently to a number of systemic viral infections. Differences between females and males with respect to the severity of keratitis caused by Gram-negative bacteria such as Serratia marcescens are less well established. METHODS In this study, we injected female and male New Zealand White rabbit corneas with a keratitis isolate of S. marcescens and evaluated the eyes after 48 hours for a number of clinical and microbiological parameters. RESULTS No statistical differences in bacterial burden and corneal scores were recorded between female and male rabbits although there was a non-significant trend toward a higher frequency of female rabbits demonstrating hypopyons. CONCLUSIONS This data suggests that for experimental bacterial keratitis studies involving Gram-negative rods, a single sex or mixed group of rabbit is sufficient for evaluating pathology and bacterial burdens. This will reduce the number of animals used for subsequent studies.
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Affiliation(s)
- Eric G Romanowski
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sanya Yadav
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nicholas A Stella
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kathleen A Yates
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John E Romanowski
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Deepinder K Dhaliwal
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert M Q Shanks
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Morettin CE, Roberts DK, Newman TL, Yang Y, McMahon JM, Roberts MF, Teitelbaum BA, Winters JE. Time-of-Year Variation in Intraocular Pressure. J Glaucoma 2021; 30:952-962. [PMID: 34402464 PMCID: PMC8563404 DOI: 10.1097/ijg.0000000000001930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/29/2021] [Indexed: 11/26/2022]
Abstract
PRÉCIS In this study conducted in Chicago, IL, intraocular pressure (IOP) level was found to have a subtle, but measurable, annual pattern. Reasonable evidence is presented for a time-of-year variation in IOP. Adequate numbers of subjects must be studied to detect this small variation. PURPOSE The aim was to investigate the relationship between IOP and time of year. METHODS During a separate investigation, patients from 2011 to 2018 (dataset A, N=3041) in an urban, academic facility in Chicago, IL received an examination that included Goldmann applanation tonometry. Regression analyses assessed the relationship between time of year and IOP. Two additional datasets, 1 collected in a similar manner during 1999 and 2002 (dataset B, N=3261) and another consisting of all first visits during 2012 and 2017 (dataset C, N=69,858), were used to confirm and further investigate trends. RESULTS For dataset A, peak mean IOP occurred in December/January (15.7±3.7/15.7±3.8 mm Hg) and lowest in September (14.5±3.1 mm Hg). The analysis suggested conventional quarterly analysis (January to March, etc.) can conceal time-of-year relationships because of inadequate statistical power and timing of IOP variation. Multiple linear regression analysis, with a November-to-October reordering, detected an annual, downward IOP trend (P<0.0001). Analysis of dataset B confirmed this trend (P<0.001). Fourier analysis on datasets A and B combined supported a 12-month IOP cycle for right/left eyes (P=0.01/P=0.005) and dataset C provided stronger evidence for an annual periodicity (P<0.0001). Harmonics analysis of dataset C showed a repeating pattern where IOP trended downward around April, and then back upward around October. CONCLUSIONS This analysis strongly supports a demonstrable annual, cyclical IOP pattern with a trough to peak variation of ≈1 mm Hg, which has a seasonal relationship.
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Affiliation(s)
- Christina E. Morettin
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, IL, USA
| | - Daniel K. Roberts
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, IL, USA
- University of Illinois at Chicago, School of Medicine, Department of Ophthalmology and Visual Sciences, Chicago, IL, USA
- University of Illinois at Chicago, School of Public Health, Division of Epidemiology and Biostatistics, Chicago, IL, USA
| | - Tricia L. Newman
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, IL, USA
| | - Yongyi Yang
- Illinois Institute of Technology, Department of Electrical and Computer Engineering, Chicago, IL, USA
| | - Janice M. McMahon
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, IL, USA
| | - Mary Flynn Roberts
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, IL, USA
| | - Bruce A. Teitelbaum
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, IL, USA
| | - Janis E. Winters
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, IL, USA
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Kim SH, Yu MH, Lee JH, Yoon JS, Rah SH, Choi M. Seasonal variation in acute post-cataract surgery endophthalmitis incidences in South Korea. J Cataract Refract Surg 2021; 45:1711-1716. [PMID: 31856980 DOI: 10.1016/j.jcrs.2019.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Previous studies have reported conflicting results on the influence of seasons on post-cataract surgery endophthalmitis incidences. This study aimed to investigate the seasonality associated with the incidence of postoperative endophthalmitis, and to evaluate its association with climate variables in South Korea. SETTING South Korea. DESIGN Retrospective cohort study. METHODS The postoperative endophthalmitis incidences were identified using the Health Insurance Review and Assessment Service claim data from July 2014 to June 2017. The monthly climate data were obtained from the Korea Meteorological Administration. The incidences of endophthalmitis were analyzed by the month of the year, and by the season. The association between postoperative endophthalmitis and the climatic variables, including mean temperature, relative humidity, precipitation, and hours of sunshine, was investigated. RESULTS The incidences were the highest in July, and they were the most prevalent during the summer months, although fewer cataract surgeries were performed in the summer months than during the rest of the year. The postoperative endophthalmitis incidences tended to increase with increasing relative humidity and increasing precipitation. CONCLUSIONS The incidences of post-cataract surgery endophthalmitis peaked during the hot and humid months. Understanding the seasonal and climatic influences on postoperative infection might help in risk stratification and outcome improvisation after the cataract surgery is performed.
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Affiliation(s)
- Soo Han Kim
- Department of Ophthalmology, Wonju Severance Christian Hospital, Wonju, South Korea
| | - Min Heui Yu
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Jong Ha Lee
- Department of Ophthalmology, Konyang University College of Medicine, Myunggok Medical Research Center, Daejeon, South Korea
| | - Jung Suk Yoon
- Department of Ophthalmology, Konyang University College of Medicine, Myunggok Medical Research Center, Daejeon, South Korea
| | - Sang Hoon Rah
- Department of Ophthalmology, Wonju Severance Christian Hospital, Wonju, South Korea
| | - Moonjung Choi
- Department of Ophthalmology, Konyang University College of Medicine, Myunggok Medical Research Center, Daejeon, South Korea.
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Impact of Topically Administered Steroids, Antibiotics, and Sodium Hyaluronate on Bleb-Related Infection Onset: The Japan Glaucoma Society Survey of Bleb-Related Infection Report 4. J Ophthalmol 2017; 2017:7062565. [PMID: 29138694 PMCID: PMC5613473 DOI: 10.1155/2017/7062565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/23/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the impact of topically administered ophthalmic medications on the onset and severity of bleb-related infections. Methods Data obtained from 104 eyes of 104 patients with bleb-related infections were analyzed. We assigned an infection stage to each eye (stage 1-4) and analyzed the onset severity. Results Steroids and antibiotics were routinely administered to 13 (12.5%) and 42 (40.4%) eyes, respectively. The median stage of steroid-administered eyes was 3 versus 1 for eyes without steroid administration (P = 0.012). The median duration from surgery to infection for the steroid-administered eyes was 2.0 years versus 5.8 years for eyes without steroid administration (P = 0.030). The median duration from surgery to infection for the antibiotic-administered eyes was 6.4 years versus 3.9 years for eyes without antibiotic administration (P = 0.025). Multiple logistic regression analysis revealed that infections were severe in the steroid-administered eyes (odds ratio: 4.57). No infections developed within 16 weeks postoperatively. No relationship was detected between sodium hyaluronate and the analyzed factors. Conclusions Topical steroid administration beyond the immediate postoperative period may affect severe and earlier onset bleb-related infections. Conversely, topical antibiotic administration may be effective in suppressing earlier onset bleb-related infections.
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Razeghinejad MR, Havens SJ, Katz LJ. Trabeculectomy bleb-associated infections. Surv Ophthalmol 2017; 62:591-610. [DOI: 10.1016/j.survophthal.2017.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 01/25/2017] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
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