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Risk Factors Leading to Enucleation or Evisceration in Infectious Endophthalmitis. J Clin Med 2022; 11:jcm11113145. [PMID: 35683532 PMCID: PMC9181767 DOI: 10.3390/jcm11113145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 02/01/2023] Open
Abstract
Endophthalmitis treatment consists of intravitreal antibiotics injections and, in selected circumstances, pars plana vitrectomy. However, severe or refractory cases may require an enucleation or evisceration (ENEV). Our study seeks to identify risk factors leading to enucleation or evisceration in patients with infectious endophthalmitis. A retrospective chart review of subjects with a clinical diagnosis of infectious endophthalmitis was undertaken. The affected eyes were stratified into groups: those that underwent ENEV and those in which the eyeball was preserved (EP). The groups were compared using statistical analyses. In total, 69 eyes diagnosed with infectious endophthalmitis were included in the study. There was a higher frequency of exogenous infectious endophthalmitis in the ENEV group versus the EP group. Postsurgical infectious endophthalmitis was lower in the ENEV than in the EP group. A visual acuity of no light perception was more common in the ENEV compared to the EP group. Panophthalmitis was more frequent in the ENEV versus the EP group. Our findings suggest that eyes with endophthalmitis presenting with a visual acuity of no light perception, panophthalmitis, or exogenous etiology have a higher risk of requiring ENEV. In addition, eyes with a postsurgical etiology may be at a lower risk of requiring ENEV.
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Breazzano MP, Tooley AA, Godfrey KJ, Iacob CE, Yannuzzi NA, Flynn HW. Candida auris and endogenous panophthalmitis: clinical and histopathological features. Am J Ophthalmol Case Rep 2020; 19:100738. [PMID: 32462100 PMCID: PMC7240712 DOI: 10.1016/j.ajoc.2020.100738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 04/24/2020] [Accepted: 05/06/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To report an unusual case of endogenous panophthalmitis involving Candida auris and describe its clinical and histopathological features. FINDINGS A 30 year-old man with history of human immunodeficiency virus, polysubstance abuse, syphilis, and recently treated pneumonia presented with polymicrobial endogenous panophthalmitis. Two separate ocular specimens confirmed simultaneous Pseudomonas aeruginosa and Candida auris involvement. Histopathological analysis demonstrated fulminant polymorphonuclear infiltration of all ocular tissue layers. Despite aggressive management including two intravitreal injections and enucleation, the patient died, ultimately after receiving care at four neighboring urban medical centers. CONCLUSIONS AND IMPORTANCE Candida auris has been a recently and increasingly described pathogen leading to mortality in metropolitan hospitals worldwide. To the authors' knowledge, Candida auris has not previously been reported with endophthalmitis or panophthalmitis. Future cases may be expected with the reported rise in Candida auris. A high suspicion of its contribution to panophthalmitis could be warranted early in the evaluation and management of profoundly immunocompromised patients, particularly those who have had sequential care at multiple neighboring metropolitan hospitals.
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Affiliation(s)
- Mark P. Breazzano
- Lenox Hill Hospital, Northwell Health, New York, NY, USA
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Andrea A. Tooley
- Lenox Hill Hospital, Northwell Health, New York, NY, USA
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Kyle J. Godfrey
- Lenox Hill Hospital, Northwell Health, New York, NY, USA
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Codrin E. Iacob
- Departments of Ophthalmology and Pathology, New York Eye & Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Nicolas A. Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, USA
| | - Harry W. Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, USA
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Breazzano MP, Jonna G, Nathan NR, Nickols HH, Agarwal A. Endogenous Serratia marcescens panophthalmitis: A case series. Am J Ophthalmol Case Rep 2019; 16:100531. [PMID: 31508534 PMCID: PMC6722394 DOI: 10.1016/j.ajoc.2019.100531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE - Two rare and unusual cases of endogenous panophthalmitis from Serratia marcescens are presented with mechanisms for infection explored. Observations - The first patient had history of intravenous drug use (IVDU) without any medical implants. The second patient, in addition to IVDU, had a history of end-stage renal disease with upper extremity arteriovenous fistula graft infection from Serratia marcescens confirmed by wound culture. One patient had a history of licking the needles prior to IV drug injection. Clinical exam in both cases revealed light perception vision, relative afferent pupillary defect, periorbital edema with limited extraocular motility, and hypopyon in the affected eyes. Cultures from the anterior chamber aspirate were positive for Serratia marcescens in the first case and demonstrated Gram-negative rods in the second. Attempted vitreous aspiration was unsuccessful at obtaining specimens. Computed tomography demonstrated orbital fat stranding without abscess, and histopathology showed intense neutrophilic infiltration in all layers of enucleated specimen in case one. CONCLUSIONS AND IMPORTANCE Needle licking may be an underappreciated mechanism for endogenous endophthalmitis in intravenous drug users. This report includes the first case in the literature, to authors' knowledge, of non-nosocomial endogenous Serratia marcescens panophthalmitis with orbital cellulitis. The second case illustrates a rare consequence of the rise in arteriovenous fistula placement and dialysis across the United States, which may predispose to future cases of endogenous Serratia marcescens endophthalmitis. This series supports previous observations of Serratia marcescens endogenous endophthalmitis exhibiting a generally poor visual prognosis.
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Affiliation(s)
- Mark P. Breazzano
- Vanderbilt Eye Institute, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Edward S. Harkness Eye Institute, Columbia University Medical Center, Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Gowtham Jonna
- Vanderbilt Eye Institute, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Retina Consultants of Austin, Austin, TX, USA
| | - Niraj R. Nathan
- Vanderbilt Eye Institute, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hilary H. Nickols
- Vanderbilt Eye Institute, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
- Norton Brownsboro Hospital/CPA Laboratory, Louisville, KY, USA
| | - Anita Agarwal
- Vanderbilt Eye Institute, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- West Coast Retina, California Pacific Medical Center, San Francisco, CA, USA
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