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Alshammari AJ, Alqam RA, Aldeej MA, Al-Omair AM, Wazira LA, Shafei JA, Kaki AA, Raffa LH. Retinal Detachment Following Cataract Surgery: A Systematic Review and Meta-analysis of Incidence, Preoperative Risk Factors, and Postoperative Complications. Ophthalmic Surg Lasers Imaging Retina 2024:1-7. [PMID: 39172224 DOI: 10.3928/23258160-20240625-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Cataract surgery is the most common surgical operation in the developed world, for treating cataracts, currently the leading cause of blindness worldwide. Retinal detachment (RD) is a potentially sight-threatening adverse effect of cataract surgery. The overall RD case numbers are high due to the common practice of cataract surgery. The Medline, Scopus, and Directory of Open Access Journals databases were searched for relevant articles using the keywords (phacoemulsification OR cataract surgery) AND (retinal detachment, detached retina). The included studies involved 5,480,448 patients, where 36,886 had RD (pooled incidence: 0.66 events per 100 patients, 95% CI 0.43 to 1.00). Male patients had significantly higher odds of developing RD than female patients (odds ratio = 1.73, 95% CI 1.68 to 1.78, P < 0.001). The RD incidence rate across locations was not significantly different. RD is one of the most significant complications following cataract surgery. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].
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Mihalache A, Patil NS, Popovic MM, Sedrak P, Kertes PJ, Muni RH. Tap and inject of intravitreal antibiotics versus pars plana vitrectomy for post-cataract surgery endophthalmitis: a meta-analysis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:73-78. [PMID: 36803934 DOI: 10.1016/j.jcjo.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/28/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The efficacy and safety of initial tap and inject (T/I) compared with pars plana vitrectomy (PPV) for acute postoperative bacterial endophthalmitis following cataract surgery is unclear. Understanding the comparative safety and efficacy of initial T/I and initial PPV can provide context for treatment decision making in this setting. METHODS A systematic literature search was performed on Ovid MEDLINE, EMBASE, and the Cochrane Library from January 1990 to January 2021. Comparative studies reporting on final best-corrected visual acuity (BCVA) following initial T/I or PPV in patients with infectious endophthalmitis secondary to cataract surgery were included. Cochrane's Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) was used to evaluate the risk of bias, and GRADE criteria were used to assess certainty of evidence. A random-effects model was used for meta-analysis. RESULTS Seven nonrandomized studies reporting on 188 eyes at baseline were included in this meta-analysis. Initial T/I achieved a significantly better BCVA at last study observation than initial PPV (weighted mean difference [WMD] = -0.61 logMAR; 95% CI, -1.19 to -0.03; p = 0.04; I2 = 89%; n = 7 studies; GRADE = very low). The incidence of enucleation was similar between initial T/I and initial PPV (risk ratio [RR] = 0.73; 95% CI, 0.09-6.25; p = 0.78; I2 = 4%; n = 2 studies; GRADE = very low). The risk of retinal detachment was similar between treatment modalities (RR = 0.29; 95% CI, 0.01-5.94; p = 0.42; I2 = 52%; n = 2 studies; GRADE = very low). CONCLUSIONS The quality of evidence in this setting is limited. T/I had a significantly better BCVA at last study observation than initial PPV. Safety profiles were similar between T/I and PPV.
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Affiliation(s)
- Andrew Mihalache
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Nikhil S Patil
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | | | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON.
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Baxter CR, Mccandless MG, Lin AL. Characteristics and Risk Factors for Rhegmatogenous Retinal Detachment Related to Endophthalmitis. JOURNAL OF VITREORETINAL DISEASES 2024; 8:138-143. [PMID: 38465361 PMCID: PMC10924589 DOI: 10.1177/24741264231218509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Purpose: To evaluate the risk factors for the development of concurrent or delayed-onset rhegmatogenous retinal detachment (RRD) related to endophthalmitis as well as the anatomic and visual outcomes with subsequent RRD repair. Methods: In this retrospective case study, a 2-tailed t test (continuous) and Fisher exact test were used to determine statistical significance of the observed findings. The relative risk (RR) and 95% CIs were calculated to assess statistical significance. Results: Of the 170 patients included, 22 were found to have a concurrent or subsequent RRD. Initial treatment with pars plana vitrectomy (PPV) (RR, 3.544; 95% CI, 1.650-7.614), aphakia (RR, 4.150; 95% CI, 1.434-12.011), endogenous endophthalmitis (RR, 2.684; 95% CI, 1.065-6.764), and posterior synechiae (RR, 3.026; 95% CI, 1.408-6.505) were statistically significant risk factors for RRD. Anatomically successful repair was achieved in 77.7% of patients. Conclusions: In addition to preexisting risk factors, the initial treatment of endophthalmitis may be a significant risk factor for RRD development, with a higher incidence of subsequent RRD in patients who have PPV as the initial treatment for endophthalmitis.
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Affiliation(s)
- Cary R. Baxter
- Department of Ophthalmology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Martin G. Mccandless
- Department of Ophthalmology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Albert L. Lin
- Department of Ophthalmology, University of Mississippi Medical Center, Jackson, MS, USA
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Schimansky S, Schwember P, Chervenkoff J, Liyanage SE, Keller J. Retinal detachment after post-operative endophthalmitis: clinical characteristics, outcomes and risk factors. Graefes Arch Clin Exp Ophthalmol 2023; 261:2181-2187. [PMID: 36859736 DOI: 10.1007/s00417-023-06021-4] [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: 10/06/2022] [Revised: 02/01/2023] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
PURPOSE To describe clinical characteristics, risk factors, and outcomes of rhegmatogenous retinal detachment (RRD) following treatment of postoperative endophthalmitis (PE). METHODS Analysis of cross-referenced data from two service reviews of patients with RRD and bacterial PE treated between 01/01/2013 and 01/07/2020. The main outcome measure was final best-corrected visual acuity (BCVA). Secondary measures include proportion of patients with BCVA of ≤ 0.3 logMAR and ≥ 1.0 logMAR, rate of phthsis, and rate of eye removal. RESULTS Ninety-four cases of PE were analysed finding 21 cases of RRD (22%). Seven (35%) experienced recurrent RRD. Seven eyes (35%) were left with permanent silicone oil fill. All RRD cases had vitrectomy. After PE with RRD the median BCVA was 1.1 logMAR, compared with 0.4 logMAR for PE without RRD (p < 0.04). Fifty-seven percent (12/21) of RRD eyes attained BCVA of ≥ 1.0 logMAR vs. 29% (21/73) of PE without RRD (p = 0.01). Nineteen percent (4/21) of eyes with RRD attained BCVA of ≤ 0.3 logMAR, whereas those without RRD did so in 43% (31/73) of cases (p = 0.02). Five eyes with RRD (24%) and 2 eyes without RRD (3%) developed phthisis (p < 0.01). Three non-RRD cases required removal of the eye (4%, p = 0.46). Higher bacterial virulence was associated with worse final BCVA (2.1 logMAR vs. 0.3 logMAR; p < 0.01). RRD rate did not differ by bacterial virulence (OR 1.9; CI95: 0.6-6.9; p = 0.24). CONCLUSIONS RRD following PE leads to worse clinical outcomes. Eyes which developed RRD were more likely to have undergone vitrectomy. Final BCVA was worse in cases with more virulent micro-organisms.
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Affiliation(s)
| | | | | | | | - Johannes Keller
- Bristol Eye Hospital, Lower Maudlin St, Bristol, BS1 2LX, UK.
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Iu LPL, Chan HY, Li GKH, Ho M, Mak ACY, Wong PPY, Kam KW, Chen LJ, Brelen M, Young AL. Acute postoperative endophthalmitis after cataract operation: result of early vitrectomy within 24 hours of presentation. Eye (Lond) 2023; 37:2344-2350. [PMID: 36513854 PMCID: PMC10366129 DOI: 10.1038/s41433-022-02347-1] [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: 04/04/2022] [Revised: 11/10/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To evaluate result of early pars plana vitrectomy (PPV) within 24 hours of presentation for acute postoperative endophthalmitis after cataract operation, and to determine factors that predict visual outcome. METHODS Consecutive patients who developed acute postoperative endophthalmitis within 6 weeks after cataract operation were reviewed. Patients were divided into two groups for analysis: (1) those receiving PPV within 24 hours of presentation (early PPV group), and (2) those receiving initial intravitreal antibiotics only without PPV within 24 hours of presentation (IVA group). RESULTS Out of 41,411 cataract operations, 22 eyes developed acute postoperative endophthalmitis. Presenting VA was hand-movement or worse in 72.7%. The most common organisms were Staphylococcus (40.9%), Streptococcus (13.6%) and Enterococcus (13.6%). 22.7% of eyes had good final VA ≥ 20/30 and 27.3% had poor final VA < 20/400. Early PPV group had significantly lower rate of requiring additional treatments to control infection (25% versus 80%, P = 0.030), higher rate of retinal detachment (25% versus 0%, P = 0.221) and similar final logMAR VA (1.08 ± 1.08 versus 0.80 ± 0.80, P = 0.489) compared to IVA. Multivariate linear regression analysis showed that worse final VA was significantly associated with Streptococcus (ß = 1.92, P = 0.007) and retinal detachment (ß = 1.72, P = 0.005) but not with early PPV (P = 0.225). CONCLUSION Early PPV was superior to initial intravitreal antibiotics alone as it required fewer additional treatments to control infection. Visual outcome was similar between early PPV and initial intravitreal antibiotics alone despite high number of poor presenting VA of light-perception in early PPV group. Streptococcal infection and retinal detachment were major poor prognostic factors for vision.
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Affiliation(s)
- Lawrence Pui Leung Iu
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
| | - Ho Yan Chan
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Gabriel Ka Hin Li
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Mary Ho
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Andrew Chun Yue Mak
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Posey Po Yin Wong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Marten Brelen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Alvin Lerrmann Young
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
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Zhang WF, Zhao XY, Meng LH, Chen H, Chen YX. Endophthalmitis at a tertiary referral center: Characteristics and treatment outcomes over three decades. Front Cell Dev Biol 2022; 10:952375. [PMID: 36003150 PMCID: PMC9395169 DOI: 10.3389/fcell.2022.952375] [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: 05/25/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose: To explore the incidence, pathogens, treatment, and prognosis of endophthalmitis. Methods: Patients who were diagnosed with endophthalmitis from January 1990 to October 2020 at Peking Union Medical College Hospital were retrospectively reviewed and examined. Subgroup analysis was conducted regarding different initial treatment methods for eyes without concurrent retinal detachment (RD) at presentation. Results: A total of 249 eyes of 233 patients were included in this retrospective study. The most common clinical scenario was exogenous endophthalmitis (60.6%). The most frequent bacteria and fungi were coagulase-negative staphylococci (10.0%) and candida (6.8%), respectively. Retinal with/without choroid detachment was the most common complication after treatment. Patients with endogenous endophthalmitis were more likely to have binocular involvement; there were also more patients with diabetes mellitus or immunosuppressive diseases, and the prognosis of visual acuity (VA) was poorer. There were more eyes with concurrent RD at presentation that underwent serious complications after treatment (p < 0.05), and the visual outcome was worse than that without concurrent RD (p < 0.05). Subgroup analysis was conducted according to different initial treatments in eyes without concurrent RD. Group 1 received pars plana vitrectomy (PPV) with intravitreal injection of antibiotics (IVI) as initial treatment, Group 2 was initially treated with IVI only, and Group 3 was initially treated with nonsurgical treatment. More eyes that initially received IVI alone and nonsurgical treatment required additional treatments, especially additional PPV. VA in both Groups 1 and 2 significantly improved by the final VA. However, there was no significant difference in final VA between the two groups. There was an insignificant trend that serious posttreatment complications were more common in Group 1. In Group 1, 17 eyes received silicone oil or gas tamponade at the same time, whereas 62 did not. Eyes that were initially treated with PPV + IVI while without tamponade needed more additional treatments and additional IVI. Conclusion: Endophthalmitis is a devastating intraocular disease and requires early intervention. Endogenous endophthalmitis has a poorer visual prognosis than exogenous entity. PPV + IVI as an initial treatment may reduce additional therapy.
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Affiliation(s)
- Wen-Fei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin-Yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Li-Hui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huan Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - You-Xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- *Correspondence: You-Xin Chen, ,
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Balasoiu AT, Zlatian OM, Ghenea AE, Davidescu L, Lungu A, Golli AL, Udriștoiu AL, Balasoiu M. A Rare Case of Endophthalmitis with Rhizobium radiobacter, Soon after a Resolved Keratitis: Case Report. Antibiotics (Basel) 2022; 11:905. [PMID: 35884159 PMCID: PMC9311636 DOI: 10.3390/antibiotics11070905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Rhizobium (Agrobacterium) species are plant aerobic bacteria, which in some cases can produce endophthalmitis in humans after corneal trauma. CASE PRESENTATION A 42-year-old female patient presented in the Emergency Department of the Emergency County Hospital of Craiova, Romania, reporting pain, epiphora, and blurry vision in her right eye for about five days. This initial infectious keratitis episode was successfully resolved, but after 20 days she presented again after trauma with a leaf with corneal abscess. In the conjunctival secretion, R. radiobacter was identified. Despite antibiotherapy, the patient's state did not improve, and ultimately the eye was eviscerated. METHODS A search was performed in the ProQuest, PubMed, and ScienceDirect databases for the terms Agrobacterium, Rhizobium, radiobacter, and eye. We eliminated non-human studies, editorials and commentaries, and non-relevant content, and excluded the duplicates. RESULTS In total, 138 studies were initially obtained, and then we selected 26 studies for retrieval. After the selection process, we ended up including 17 studies in our analysis. Most studies reported R. radiobacter endophthalmitis after ocular surgical procedures or outdoor activities that involve exposure to soil. CONCLUSION R. radiobacter is a rare cause of endophthalmitis after eye trauma that generally responds well to usual antibiotherapy, but occasionally can evolve to severe, leading to the loss of the eye.
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Affiliation(s)
- Andrei Theodor Balasoiu
- Department of Ophthalmology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Ovidiu Mircea Zlatian
- Department of Bacteriology-Virology-Parasitology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Alice Elena Ghenea
- Department of Bacteriology-Virology-Parasitology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Livia Davidescu
- Department of Ophthalmology, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania;
| | - Alina Lungu
- Department of Infectious diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania;
| | - Andreea Loredana Golli
- Department of Epidemiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Anca-Loredana Udriștoiu
- Faculty of Automation, Computers and Electronics, University of Craiova, 200776 Craiova, Romania;
| | - Maria Balasoiu
- Department of Bacteriology-Virology-Parasitology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
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A Multicenter Review Evaluating the Risk of Rhegmatogenous Retinal Detachment Post Endophthalmitis: A Canadian Retina Research Network (CR2N) Investigation. Retina 2022; 42:1503-1511. [DOI: 10.1097/iae.0000000000003486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Babu N, Baliga G, Puthuran GV, Ramasamy K. Retinal detachment in eyes treated with Aurolab aqueous drainage implant for refractory glaucoma - Incidence and outcomes. Indian J Ophthalmol 2022; 70:1287-1293. [PMID: 35326036 PMCID: PMC9240567 DOI: 10.4103/ijo.ijo_1546_21] [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: 11/18/2022] Open
Abstract
Purpose: To analyze the incidence of rhegmatogenous retinal detachment (RRD) in patients who have undergone prior Aurolab aqueous drainage implant (AADI) surgery and report outcomes in terms of anatomic, visual acuity, and intraocular pressure (IOP) findings. Methods: Case records of all patients who underwent RRD repair after AADI surgery from 2013 to 2019 were retrospectively analyzed. Data collected included patient demographics, ocular examination findings at all visits including IOP and best-corrected visual acuity (BCVA) and clinical findings related to RRD both at baseline and postoperatively. Results: Ten eyes of nine patients were included in study. The mean age of patients was 28.2 years (median: 15 years, range: 6–83 years). Mean duration between AADI and RRD was 14 months (median 2.5 months; range 2 days-72 months). All eyes underwent pars plana vitrectomy with silicon oil injection. The preoperative LogMAR BCVA (logarithm of the minimum angle of resolution) was 2.52 ± 0.15 which improved to 2.29 ± 0.58 at final follow-up; however, only one eye had vision ≥ 20/400 largely due to recurrent RRD and advanced glaucomatous disc damage. Postoperatively retina was attached in 6 eyes (60%) and IOP was ≤ 21 mmHg in 5 out of 6 eyes with anatomic success Conclusion: The incidence of RRD following AADI was found to be 0.86% in our study. Pars plana vitrectomy (PPV) with silicon oil tamponade was the preferred approach in the management of these eyes with IOP being well controlled post PPV. However, visual acuity outcomes were largely unsatisfactory due to recurrent RRD and preexisting advanced glaucoma.
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Affiliation(s)
- Naresh Babu
- Department of Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Girish Baliga
- Department of Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - George Varghese Puthuran
- Department of Glaucoma, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Kim Ramasamy
- Department of Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
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Ying Z, Maria C, Spyridon D, Karl-Ulrich BS, Stephan SM, Christos S. Analysis of retinal detachment resulted from post-operative endophthalmitis treated with 23G pars Plana Vitrectomy. BMC Ophthalmol 2021; 21:414. [PMID: 34852777 PMCID: PMC8638527 DOI: 10.1186/s12886-021-02175-z] [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: 02/08/2021] [Accepted: 10/13/2021] [Indexed: 11/21/2022] Open
Abstract
Background To evaluate the rate, risk factors, functional outcome and prognosis in eyes with retinal detachment after post-operative endophthalmitis treated with 23G Pars Plana Vitrectomy. Methods Electronic patient files from 2009 until 2018 were screened for the presence of an endophthalmitis. Included were 116 eyes of 116 patients. This population was evaluated for the rate of retinal detachment after 23G Pars Plana Vitrectomy for endophthalmitis following cataract surgery or intravitreal injection. The main outcome measures were retinal detachment and visual acuity. Results The reasons for endophthalmitis were previous cataract surgery in 78 patients and following intravitreal injection in 38 patients. The first clinical evidence of endophthalmitis was present in median 5 days after the triggering intervention. Twenty-five eyes (21.55%) developed a retinal detachment an average of 25 days after endophthalmitis. RD is significantly associated with preoperative visual acuity (p = 0.001). Conclusions We emphasize the prognostic role of preoperative visual acuity in RD development of the endophthalmitis treated with 23G Pars Plana Vitrectomy.
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Affiliation(s)
- Zheng Ying
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Department of Ophthalmology, Shanghai General Hospital Affiliated to Shanghai Jiaotong University, 100 Haining Road, Shanghai, 200080, China.
| | - Casagrande Maria
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dimopoulos Spyridon
- Department of Ophthalmology, Eberhard Karls University Medical Center, Tübingen, Germany
| | | | - Spitzer Matin Stephan
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Skevas Christos
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Dong LK, Shields RA, Subramanian S, Lee R, Wa CA, Ruby AJ, Hassan TS. FEATURES AND OUTCOMES OF EYES THAT UNDERWENT SURGICAL REPAIR OF RHEGMATOGENOUS RETINAL DETACHMENTS AFTER BEING TREATED FOR ACUTE ENDOPHTHALMITIS. Retina 2021; 41:1612-1617. [PMID: 33394997 DOI: 10.1097/iae.0000000000003091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the etiology, clinical course, and outcomes of eyes that suffered postendophthalmitis rhegmatogenous retinal detachments. METHODS A retrospective, consecutive case series was conducted of patients managed at Associated Retinal Consultants P.C. from January 2013 to December 2019. Patients were identified as having had endophthalmitis by ICD-9/10 codes. Those with endophthalmitis and/or rhegmatogenous retinal detachment not managed at Associated Retinal Consultants from January were excluded. RESULTS Charts of 413 patients were reviewed and 19 met inclusion criteria. Incidence of rhegmatogenous retinal detachment following infectious endophthalmitis was 4.6%. The most common inciting events for endophthalmitis was intravitreal injection (9 of 19) and cataract surgery (7 of 19). Fifteen of 19 patients were treated with an injection of intravitreal antibiotics and 4 underwent immediate vitrectomy with antibiotic injection. Biopsy cultures were obtained in 18 of 19 patients and yielded positive growth in 12 (66.7%). Seventeen of the 19 eyes were operable. Final retinal reattachment rate was 88.2% (15 of 17). Mean final logMAR visual acuity was 1.58 (Snellen 20/765). Factors associated with worse final visual acuity after surgical repair included preceding intravitreal injection (P = 0.001), streptococcus species (P = 0.024), presence of proliferative vitreoretinopathy (P = 0.015), and use of silicone oil during primary rhegmatogenous retinal detachment repair (P = 0.010). CONCLUSION Rhegmatogenous retinal detachments following endophthalmitis occur infrequently. Although most eyes can be repaired surgically, visual outcomes are often poor, particularly in eyes that were infected with streptococcal species and had associated proliferative vitreoretinopathy.
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Affiliation(s)
- Libing K Dong
- Central Michigan University College of Medicine, Mount Pleasant, Michigan
| | - Ryan A Shields
- Associated Retinal Consultants P.C., William Beaumont Hospital, Royal Oak, Michigan
| | - Sam Subramanian
- Ascension Macomb Oakland Hospital, Madison Heights, Michigan ; and
| | - Ramon Lee
- Associated Retinal Consultants P.C., William Beaumont Hospital, Royal Oak, Michigan
| | - Christianne A Wa
- Associated Retinal Consultants P.C., William Beaumont Hospital, Royal Oak, Michigan
| | - Alan J Ruby
- Associated Retinal Consultants P.C., William Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Tarek S Hassan
- Associated Retinal Consultants P.C., William Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
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12
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Granulicatella adiacens endophthalmitis after phacoemulsification cataract surgery. J Cataract Refract Surg 2021; 46:e30-e34. [PMID: 32818359 DOI: 10.1097/j.jcrs.0000000000000355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Two cases of acute postoperative Granulicatella adiacens endophthalmitis following uneventful phacoemulsification surgery are reported. The cases had intracameral cefuroxime as antibiotic prophylaxis, visual acuity (VA) was perception of light and hand movements, respectively, and there was severe anterior chamber inflammation and dense vitritis with no fundal view. Vitreous biopsy identified G adiacens using genome sequencing. Intraoperative findings included extensive retinal hemorrhages, abscesses, occluded retinal vessels, and retinal necrosis. Because of the ischemic retinal appearance, pan-retinal photocoagulation endolaser was performed. Postoperatively both cases developed rhegmatogenous retinal detachment (RRD) anterior to the laser marks and were successfully treated. VA improved to 6/18 and 6/60, respectively. Hyperreflective dots and Henle fiber layer hemorrhage are reported for the first time, to the authors' knowledge, in association with endophthalmitis. The successful outcome suggested that intraoperative pan-retinal photocoagulation could be considered in such ischemic cases to prevent rubeosis and to reduce the risk for postoperative RRD or limit its extent if it recurs.
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Lee T, Robbins CB, Feng HL, Fekrat S. Rhegmatogenous Retinal Detachment in the Setting of Endophthalmitis: Risk Factors and Visual Outcomes. Ophthalmic Surg Lasers Imaging Retina 2021; 52:257-262. [PMID: 34044714 DOI: 10.3928/23258160-20210429-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To investigate risk factors for rhegmatogenous retinal detachment (RRD) and visual acuity (VA) in eyes with RRD after developing endophthalmitis. PATIENTS AND METHODS Retrospective comparative study of 133 eyes with endophthalmitis at a tertiary center between 2009 and 2018. Demographics, exam findings, interventions, and outcomes were assessed. Cases of RRD within 6 months after onset of endophthalmitis were further analyzed. RESULTS Seventeen eyes (12.7%) with endophthalmitis developed RRD. Endogenous etiology was associated with higher rate of RRD (P = .038). Eyes that developed RRD had worse VA (20/3271) at 6 months (20/236; P = .001). Excluding the six eyes with macula-off RRD, VA for the remaining 11 eyes that developed RRD (20/1213) was similar to those without RRD (20/236; P = .095). CONCLUSIONS Endogenous etiology of endophthalmitis was associated with a higher rate of RRD. Eyes with successful RRD repair had outcomes similar to eyes that did not develop RRD. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:257-262.].
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Wang T, Moinuddin O, Abuzaitoun R, Hwang M, Besirli C, Wubben TJ, Zacks DN. Retinal Detachment After Endophthalmitis: Risk Factors and Outcomes. Clin Ophthalmol 2021; 15:1529-1537. [PMID: 33880012 PMCID: PMC8053519 DOI: 10.2147/opth.s302757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/09/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze the risk factors, clinical course, and visual and anatomic outcomes of retinal detachment (RD) after endophthalmitis. Patients and Methods This retrospective study included 108 patients diagnosed with endophthalmitis between August 2014 and May 2019 at a single tertiary referral center. Sixteen patients developed RD after endophthalmitis. Retrospective analysis was performed to compare the cohort of endophthalmitis alone versus the cohort that developed RD after endophthalmitis, with analysis of potential risk factors for RD after endophthalmitis and treatment outcomes. Results The incidence of RD after endophthalmitis was 14.8% (N=16/108). The median time to develop RD after endophthalmitis was 27 days (range: 1-581 days, IQR: 25.3). Thirteen (81.3%) cases of RD occurred less than 2 months after the diagnosis of endophthalmitis. The incidence of aphakia (p=0.023) and posterior synechia (PS) (p=0.014) were significantly higher in the RD group. The mean initial and final visual acuity (VA) of the endophthalmitis alone group was 1.9±0.8 logMAR and 1.2±1.0 logMAR (p<0.0001), respectively, and 1.9±0.9 logMAR and 1.3±1.2 logMAR (p=0.07) in the RD group, respectively. Enucleation or evisceration occurred in 31.3% of cases with RD after endophthalmitis. The rate of final retinal re-apposition for the RD cohort was 56.3%. Conclusion The anatomic and functional outcomes for RD after endophthalmitis remain poor, with significant risk for permanent vision loss. Aphakia and posterior synechiae were seen more often in cases with RD after endophthalmitis.
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Affiliation(s)
- Tiantian Wang
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI, USA.,Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Omar Moinuddin
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI, USA
| | - Rebhi Abuzaitoun
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI, USA
| | - Min Hwang
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI, USA
| | - Cagri Besirli
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI, USA
| | - Thomas J Wubben
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI, USA
| | - David N Zacks
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI, USA
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Mautone L, Skevas C, Spitzer MS. [Treatment of postoperative endophthalmitis : Operate or only inject?]. Ophthalmologe 2021; 118:219-229. [PMID: 33566160 DOI: 10.1007/s00347-021-01320-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Postoperative endophthalmitis is among the most feared complications encountered after intraocular surgery. A prompt diagnosis and initiation of treatment are crucial for the visual prognosis, which also depends on the causative microorganism. Despite advances in prevention and the availability of more epidemiological data, most of the evidence for treatment dates back to a single study, the early vitrectomy study (EVS) carried out in the early 1990s. The EVS showed that vitrectomy with intravitreal antibiotics was superior to intravitreal antibiotics alone, only when visual acuity was light perception or below. The addition of systemic antibiotics did not have any benefits. Over the last 30 years, however, surgical techniques have continued to evolve and the medicinal options have also been expanded. Moreover, the EVS examined only endophthalmitis after cataract surgery and strictly speaking the results cannot be transferred to endophthalmitis from other causes. OBJECTIVE This review discusses the current evidence for the different treatment modalities of the most important types of postoperative endophthalmitis. CONCLUSION The EVS provided important guidelines for the initial management of endophthalmitis and these guidelines remain relevant to this day; however, in view of the refinement of surgical techniques, novel treatment options, especially the nowadays continuously growing number of intravitreal injections and even some new antibiotics, it would be desirable if new controlled trials addressing the treatment of endophthalmitis would be performed.
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Affiliation(s)
- L Mautone
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Gebäude W40, Martinistr. 52, 20246, Hamburg, Deutschland
| | - C Skevas
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Gebäude W40, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - M S Spitzer
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Gebäude W40, Martinistr. 52, 20246, Hamburg, Deutschland
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Al-Lozi A, Cai S, Chen X, Perez VL, Venkateswaran N. Granulicatella Adiacens as an Unusual Cause of Microbial Keratitis and Endophthalmitis: A Case Series and Literature Review. Ocul Immunol Inflamm 2021; 30:1181-1185. [PMID: 33426987 DOI: 10.1080/09273948.2020.1860233] [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: 10/22/2022]
Abstract
Purpose: To report two cases of microbial keratitis and/or endophthalmitis involving Granulicatella adiacens.Methods: Case series.Results: 24-year-old female with a history of Herpes simplex virus 1 (HSV-1) and Candida parapsilosis keratitis presented with a geographic epithelial defect and infiltrate in the left eye. Cultures were positive for HSV-1 and G. adiacens. Keratitis resolved with topical vancomycin and oral valacyclovir. A 65-year-old female with a history of type II diabetes and failed therapeutic penetrating keratoplasty presented with inferior corneal graft haze and vitreous inflammation of the right eye. Therapeutic penetrating keratoplasty and pars plana vitrectomy were performed, and the corneal button returned positive for G. adiacens. The patient was treated with topical and intravitreal vancomycin as well as topical and systemic steroids.Conclusions: These cases expand the literature on G. adiacens keratitis and endophthalmitis and corroborate the role of steroid use and prior surgery as paramount risk factors.
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Affiliation(s)
- Amal Al-Lozi
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Sophie Cai
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Xi Chen
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Victor L Perez
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Nandini Venkateswaran
- Department of Ophthalmology, Duke University, Durham, NC, USA.,Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Dib B, Morris RE, Oltmanns MH, Sapp MR, Glover JP, Kuhn F. Complete and Early Vitrectomy for Endophthalmitis After Cataract Surgery: An Alternative Treatment Paradigm. Clin Ophthalmol 2020; 14:1945-1954. [PMID: 32753837 PMCID: PMC7358185 DOI: 10.2147/opth.s253228] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/11/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose In this study, we report the treatment outcomes of complete and early vitrectomy for endophthalmitis (CEVE) after cataract surgery as the predominate initial treatment, accompanied by systemic antibiotics and retreatment of persistent or recurrent purulence (CEVE+). Patients and Methods Clinical features and microbiological factors were retrospectively reviewed in 62 eyes of 62 patients who were treated for acute postcataract endophthalmitis (APCE) occurring within three weeks of cataract surgery at Retina Specialists of Alabama, between 2007 and 2017. Results Visual acuity on presentation included light perception (LP) in 18 eyes (29%) and hand motion (HM) in 23 eyes (37%). Initial treatment was maximum possible vitrectomy in 48 eyes (77%) and tap-and-inject in 14 eyes (23%), with 38 eyes (61%) receiving two or more treatments. Cultures for the first intervention were positive in 49 eyes (79%) and virulent in 18 eyes (29%). At a median follow-up time of five months, final visual acuity was ≥20/40 in 49 eyes (79%), between 20/50 and 5/200 in seven eyes (11%), and <5/200 in six eyes (10%). Virulence was the strongest predictor of poor visual outcome. Retinal detachment occurred in four eyes (6%), likely from necrotic retinal defects in each case. Conclusion Complete and early vitrectomy is a safe and effective initial treatment for APCE. When accompanied by systemic antibiotics and retreatment (CEVE+) of recurrent media opacification, it improves recovery of 20/40 or better visual acuity by approximately 50% compared to a predominantly tap-and-inject treatment paradigm. We recommend CEVE for fundus-obscuring APCE (~75% of all cases) whenever the view is inadequate to rule out macular distress. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/rsl1lGF27D4
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Affiliation(s)
- Bernard Dib
- Retina Specialists of Alabama, Birmingham, AL, USA.,Helen Keller Foundation for Research and Education, Birmingham, AL, USA.,University of Alabama at Birmingham (UAB), Department of Ophthalmology, Birmingham, AL, USA.,UAB Callahan Eye Hospital, Birmingham, AL, USA
| | - Robert E Morris
- Retina Specialists of Alabama, Birmingham, AL, USA.,Helen Keller Foundation for Research and Education, Birmingham, AL, USA.,University of Alabama at Birmingham (UAB), Department of Ophthalmology, Birmingham, AL, USA.,UAB Callahan Eye Hospital, Birmingham, AL, USA
| | - Matthew H Oltmanns
- Retina Specialists of Alabama, Birmingham, AL, USA.,Helen Keller Foundation for Research and Education, Birmingham, AL, USA.,University of Alabama at Birmingham (UAB), Department of Ophthalmology, Birmingham, AL, USA.,UAB Callahan Eye Hospital, Birmingham, AL, USA
| | - Mathew R Sapp
- Retina Specialists of Alabama, Birmingham, AL, USA.,Helen Keller Foundation for Research and Education, Birmingham, AL, USA.,University of Alabama at Birmingham (UAB), Department of Ophthalmology, Birmingham, AL, USA.,UAB Callahan Eye Hospital, Birmingham, AL, USA
| | - Jay P Glover
- Retina Consultants of Nashville, Nashville, TN, USA
| | - Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, AL, USA.,Milos Eye Hospital, Belgrade, Serbia.,Zagorskiego Eye Hospital, Krakow, Poland
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Negretti GS, Chan W, Pavesio C, Muqit MMK. Vitrectomy for endophthalmitis: 5-year study of outcomes and complications. BMJ Open Ophthalmol 2020; 5:e000423. [PMID: 32258421 PMCID: PMC7103804 DOI: 10.1136/bmjophth-2019-000423] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/28/2020] [Accepted: 02/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background/Aims To analyse the complications and outcomes of vitrectomy surgery for endophthalmitis. Methods This was a retrospective case series. All cases that underwent 23-gauge vitrectomy surgery for endophthalmitis at a tertiary centre between 1 February 2013 and 1 February 2018 were included. Main outcome measures were as follows: visual acuity (VA) at final visit and post-vitrectomy complications. Results 33 patients were included in the study with 20 men and 13 women, average age 63 years. Main post-surgical causes for endophthalmitis included phacoemulsification (n=9), trabeculectomy (n=5), intravitreal injection (n=5), corneal graft (n=4), vitreoretinal surgery (n=3) and endogenous endophthalmitis (n=6). Average follow-up was 18 months (SD 14). 21/33 (64%) patients had baseline perception of light VA. Analysis of exogenous endophthalmitis cases only demonstrated: mean LogMAR VA improved significantly from 2.68 to 1.66 (p=0.001). At final follow-up, 12% had VA of 6/12 or better, and 28% had VA of 6/36 or better. Vitrectomy within 7 days resulted in improved final VA outcomes (1.49 vs 2.16 LogMAR, p=0.032). Complications included retinal detachment (24.2%), macular hole (3%), hypotony (6%), suprachoroidal haemorrhage (3%) and enucleation/evisceration (6%). Conclusion Vitrectomy for endophthalmitis leads to VA gains in some cases. Surgical outcomes may be improved with early vitrectomy performed within 7 days of the initial event for exogenous endophthalmitis. Patients should be advised of the potential risk of severe complications with/and without surgery.
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Affiliation(s)
- Guy Simon Negretti
- Department of Vitreoretinal Surgery, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - WengOnn Chan
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Carlos Pavesio
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mahiul Muhammed Khan Muqit
- Department of Vitreoretinal Surgery, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, United Kingdom
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Abdelhadi AM, Helaly HA, Abuelkeir A. Evaluation of Retinal Detachment After Diabetic Vitrectomy: Causes and Ways of Management. Clin Ophthalmol 2020; 14:53-60. [PMID: 32021068 PMCID: PMC6957106 DOI: 10.2147/opth.s235757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the causes and the ways of management of rhegmatogenous retinal detachment (RRD) after pars plana vitrectomy (PPV) performed in diabetic patients with advanced diabetic eye disease. Methods Retrospective review of the records of the patients who had undergone PPV for complicated proliferative diabetic retinopathy (PDR) was done. Cases with RRD after the PPV were analyzed in the study (n = 32). Preoperative, operative, and postoperative data of the patients were recorded. All patients were recruited for a final follow-up visit. Results This retrospective case-control study included 400 eyes of 345 patients. Prolonged surgical duration increased the risk of developing RRD (odds ratio = 1.6342, p = 0.0321). The presence of intraoperative retinal breaks increased the risk of developing postoperative RRD (odds ratio = 2.2308, p = 0.0380). Also, complex diabetic detachment that needed for bimanual dissection of the membranes during surgery were associated with a higher risk of developing postoperative RRD (odds ratio = 2.7311, p = 0.0401). Conclusion Rhegmatogenous retinal detachment following diabetic vitrectomy needs a further vitrectomy for the management and usually has poor visual outcome. Prolonged surgical duration, the presence of intraoperative retinal breaks, and the need for bimanual dissection of the membranes (major complex cases) during surgery were associated with higher risk of developing RRD postoperatively.
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Affiliation(s)
- Ahmed M Abdelhadi
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hany Ahmed Helaly
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amr Abuelkeir
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Lee CS, Khan M, Patrie J, Bajwa A, Shildkrot YE. Pars Plana Vitrectomy for Endophthalmitis: Microbiologic Spectrum and Clinical Outcomes. Ocul Immunol Inflamm 2020; 29:871-876. [PMID: 31906757 DOI: 10.1080/09273948.2019.1698750] [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] [Indexed: 10/25/2022]
Abstract
Purpose: To report visual outcomes, microbiologic spectrum, and antibiotic resistance in endophthalmitis patients undergoing pars plana vitrectomy (PPV).Methods: Retrospective study of 32 patients who underwent PPV with microbial analysis. Linear mixed models were utilized to compare visual acuity (VA).Results: Streptococcal species and coagulase-negative staphylococcus (CoNS) were the most common organisms. No resistance to vancomycin or fluoroquinolones was observed. Culture-negative individuals had better VA and lower incidences of retinal detachment (RD) and hypotony and better VA than culture-positive group at post-surgical month 3 (p = .025) and marginally at month 12 (p = .098). CoNS endophthalmitis (final logMAR VA 0.80) was associated with better VA than Streptococcal endophthalmitis (final logMAR VA 2.36) (p = .001). Secondary RD was observed in 33.3% of non-cataract endophthalmitis.Conclusion: No organisms were resistant to vancomycin or fluoroquinolones. Culture-negative endophthalmitis had better VA and lower rates of RD and hypotony than culture-positive group. A high rate of RD was observed in non-cataract endophthalmitis.
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Affiliation(s)
- Chang Sup Lee
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Miraj Khan
- Department of Biology, University of Virginia, Charlottesville, Virginia, USA
| | - Jim Patrie
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Asima Bajwa
- Department of Ophthalmology, University of Virginia, Charlottesville, Virginia, USA
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van Meurs JC, van Dissel JT. Another perspective on the treatment of postoperative endophthalmitis: Unclear evidence for the role of vitrectomy. Acta Ophthalmol 2018; 96:e1042-e1043. [PMID: 29862645 DOI: 10.1111/aos.13810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jan C. van Meurs
- The Rotterdam Eye Hospital and ErasmusMC; Rotterdam The Netherlands
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