Outcome and Prognostic Factors for Traumatic Endophthalmitis over a 5-Year Period

Endoscopic Vitrectomy Combined with 3D Heads-Up Viewing System in Treating Traumatic Ocular Injury

Purpose

To investigate effects and complications of endoscopic vitrectomy combined with 3D heads-up viewing system in treating traumatic ocular injury. Patients and Methods. This is a retrospective interventional case series in a tertiary referral center in Taiwan, and we included patients of traumatic ocular injury, and they underwent endoscopic vitrectomy combined with a 3D heads-up viewing system.

Results

Fourteen eyes of traumatic globe injury from 14 patients were studied over a 30-month period. Preoperative VA ranged from no light perception (NLP) to 6/6. Postoperative visual acuity improved in 11 of the 14 eyes (79%). Until 6 months after surgery, all eyes had attached retina. The median logMAR BCVA was 2.4 at the first visit and 1.19 at the last visit (p = 0.0028). No subject suffered from retinal detachment, endophthalmitis, or other severe complications.

Conclusions

Vitrectomy using endoscopy combined with 3D heads-up viewing system allowed early evaluation and intervention in traumatic ocular injuries. Most of our cases showed both anatomical and visual acuity improvements.

Early Vitrectomy for Endophthalmitis: Are EVS Guidelines Still Valid?

BACKGROUND

Endophthalmitis, a potentially sight-threatening condition, remains a challenge for ophthalmologists worldwide. The endophthalmitis vitrectomy study (EVS) conducted in 1995 compared vitrectomy and intravitreal antibiotic injections to intravitreal antibiotic injections alone for acute post-cataract surgery and secondary intraocular lens endophthalmitis, setting treatment guidelines. However, the landscape of clinical practice has evolved considerably since then, raising questions about the applicability of EVS recommendations today.

SUMMARY

Recent studies have proposed that early and complete vitrectomy (CEVE) could potentially be an effective approach for managing endophthalmitis cases, irrespective of the initial visual acuity. However, it is important to note that the level of rigor in these recent studies may not match that of the EVS study, and as such, this assertion should be considered with caution. Furthermore, the EVS study exclusively focused on post-cataract surgery cases, leaving other endophthalmitis types, like post-intravitreal injection and post-traumatic endophthalmitis, without standardized treatment guidelines. Research exploring the role of early vitrectomy in these contexts yields mixed results, emphasizing the need for further investigation and well-designed prospective trials. Endogenous endophthalmitis, originating from systemic infections, adds complexity to the scenario. While early vitrectomy shows promise in specific cases, conflicting evidence necessitates comprehensive research.

KEY MESSAGES

This review underscores the necessity for tailored treatment strategies, supporting early vitrectomy when clinically indicated, and advocating for prospective trials to clarify its role in diverse endophthalmitis scenarios. As surgical techniques and antimicrobial therapies continue to advance, reevaluating treatment paradigms becomes crucial to enhance patient outcomes and protect ocular health.

Occult intraocular aluminium foreign body causing rhegmatogenous retinal detachment: a case report

BACKGROUND

Ocular trauma is complex and varied, and some occult intraocular foreign bodies (IOFBs) can lead to uncommon symptoms and signs. We report a case of rhegmatogenous retinal detachment (no obvious wound, no pain, no intraocular infection or other symptoms) caused by an occult intraocular aluminium foreign body, which could have been easily missed.

CASE PRESENTATION

A 42-year-old male presented to the outpatient department of our hospital complaining of fluttering black dots and decreased vision in his left eye that began 3 months earlier. He was diagnosed with "floaters" at a community hospital. He denied a history of ocular trauma or previous surgery. The cornea and lens of the left eye were clear. A small patch of pigmentation was noted in the temporal sclera. Fundoscopy revealed macula-off retinal detachment. After mydriasis, elliptical holes were seen in the peripheral retina at 2:30, and a suspicious hyperreflective strip was found under the anterior lip of the retina by Goldmann three-mirror contact lens examination; the strip was confirmed to be an IOFB by orbital CT. The IOFB was removed through pars plana vitrectomy without any complications.

CONCLUSION

Unlike iron and copper IOFBs, aluminium IOFBs are more inert and more likely to be missed. For people with special occupations (construction workers, mechanics, etc.), when abnormal pigmentation of the sclera is found, the possibility of foreign bodies in the eye should be considered. In the process of disease diagnosis and treatment, it is necessary to ask for a detailed history, including occupation history and practice, and perform careful physical and targeted examinations. Such comprehensive analysis regarding the above information will minimize the chance of missed diagnosis.Awareness of occult IOFB in high risk occupations and prompt referral to a retinal surgeon is of outmost importance.

INCIDENCE AND RISK FACTORS OF POSTOPERATIVE ENDOPHTHALMITIS AFTER PRIMARY SURGICAL REPAIR COMBINED WITH INTRAOCULAR FOREIGN BODY REMOVAL

PURPOSE

To analyze the incidence and risk factors of postoperative endophthalmitis after primary surgical repair and intraocular foreign body (IOFB) removal within 24 hours of injury.

METHODS

The records of all patients treated surgically for open globe injury and IOFB removal at the Eye Hospital of Shandong First Medical University between January 1, 2015, and June 30, 2020, were retrospectively reviewed. Variables included time from injury to operation, cause of injury, details of surgical repair, and follow-up. The incidence and risk factors of endophthalmitis after IOFB removal were studied.

RESULTS

During 5 years, 99 patients with IOFB were reviewed. Of these, 19 patients were diagnosed with endophthalmitis on admission, and 5 were suspected of having endophthalmitis during operation. Fifty-four cases had no clinical signs of endophthalmitis on admission and during operation and were treated with operation within 24 hours after the injury. Two patients (2 of 54; 3.70%) developed endophthalmitis after IOFB removal, and the causative agent in both cases was Bacillus cereus.

CONCLUSION

The incidence of infectious endophthalmitis after primary surgical repair combined with IOFB removal (≤24 hours) was 3.70% in patients who received a series of standard treatments, and B. cereus infection might be a risk factor.

Pars-plana vitrectomy combined with retinectomy in severe open-globe injuries: A systematic review and meta-analysis

BACKGROUND

This review summarized prophylactic retinectomy technique and its effect on anatomic and functional outcomes in severe open globe injuries (OGIs).

METHODS

A comprehensive search in PubMed (MEDLINE), Embase, Scopus, and EuropePMC databases was performed up until 8 January 2020. Enrolled studies include case series, studies involving pars plana vitrectomy (PPV) combined with retinectomy in severe penetrating injuries with or without IOFB, perforating injuries, and globe ruptures. Primary outcome was best-corrected visual acuity (BCVA) ⩾20/200 at the end of the study. Secondary outcomes were the rate of proliferative retinopathy (PVR), globe survival rate and retinal reattachment rate.

RESULTS

A total of seven studies, involving 275 eyes with severe OGIs, is included in this study. Meta-analysis indicates that final BCVA ⩾20/200 was achieved in 61% (95% CI 49%-73%). Meta-regression analysis showed that improvement was inversely affected by the presence of pre-operative direct macular injury (p = 0.001) and corneal scar (p = 0.015). The proportion of pre-operative BCVA <20/200 was statistically insignificant to the final BCVA ⩾20/200 (p = 0.569). One study showed that the rate is higher in the retinectomy group than the non-retinectomy group (54% vs 11%). Meta-analysis showed that anatomical success can be achieved in 85% (95% CI 78%-91%) of the patients. Meta-regression analysis indicates that the anatomical success did not vary with age (p = 0.653), retinal detachment (p = 0.525), corneal scar (p = 0.596), and lens involvement (p = 0.450).

CONCLUSION

Early PPV combined with retinectomy was associated with acceptable visual improvement and anatomical success.

Intraocular Foreign Bodies: Clinical Characteristics and Factors Affecting Visual Outcome

Objective

To investigate the clinical characteristics and factors affecting visual outcome in patients with intraocular foreign bodies (IOFBs) and determine the risk factors for the development of endophthalmitis. Study Design. A retrospective case-series study design was adopted.

Subjects

In total, 242 patients (242 eyes) who were hospitalized and underwent surgical treatment for IOFB at the Second Hospital of Hebei Medical University between January 1, 2008, and December 31, 2019, were included.

Methods

The demographic data, cause of injury, characteristics of IOFBs, postinjury ocular manifestations, and surgical details of the subjects were collected, and the factors affecting visual outcome and endophthalmitis development were analyzed.

Results

The most common cause of IOFBs was the propulsion of foreign bodies into the eye due to hammering (149 cases, 61.57%), followed by foreign body penetration (57 cases, 23.55%). Most of the subjects were young adult men who sustained injuries in the work environment. Poorer visual outcomes were found in subjects with initial presenting symptoms visual acuity (PVA) < 0.1, largest IOFB diameter ≥ 3 mm, IOFBs located in the posterior segment, wound length > 5 mm, entrance wound length larger than the largest IOFB diameter, concomitant retinal detachment, concomitant vitreous hemorrhage, concomitant endophthalmitis, and concomitant proliferative vitreoretinopathy (PVR). Factors related to the development of endophthalmitis included lens capsule rupture, time of stage 1 repair surgery ≥ 24 h after trauma, removal of IOFBs ≥ 24 h after trauma, and nonadministration of intravitreal antibiotic injection.

Conclusion

Among patients with IOFBs, initial PVA < 0.1, entrance wound length larger than the largest IOFB diameter, concomitant endophthalmitis, and concomitant PVR were risk factors for poor visual outcomes. Lens capsule rupture was a risk factor for endophthalmitis development, and the administration of intravitreal antibiotic injection was a protective factor against endophthalmitis development.

Immune Inhibitor A Metalloproteases Contribute to Virulence in Bacillus Endophthalmitis

Endophthalmitis is a devastating infection that can cause blindness. Over half of Bacillus endophthalmitis cases result in significant loss of useful vision. Bacillus produces many virulence factors that may contribute to retinal damage and robust inflammation. We analyzed Bacillus immune inhibitor A (InhA) metalloproteases in the context of this disease, hypothesizing that InhAs contribute to Bacillus intraocular virulence and inflammation. We analyzed phenotypes and infectivity of wild type (WT), InhA1-deficient (ΔinhA1), InhA2-deficient (ΔinhA2), or InhA1, A2, and A3-deficient (ΔinhA1-3) Bacillus thuringiensis. In vitro analysis of growth, proteolysis, and cytotoxicity were compared. WT and InhA mutants were similarly cytotoxic to retinal cells. Mutants ΔinhA1 and ΔinhA2 entered log phase growth earlier than WT. Proteolysis by the ΔinhA1-3 mutant was decreased, but this strain grew similar to WT in vitro. Experimental endophthalmitis was initiated by intravitreally infecting C57BL/6J mice with 200 CFU of B. thuringiensis WT or InhA mutants. Eyes were analyzed for intraocular Bacillus and myeloperoxidase concentrations, retinal function loss, and gross histological changes. Eyes infected with ΔinhA1 or ΔinhA2 strains contained greater numbers of bacteria than eyes infected with WT throughout the infection course. Eyes infected with single mutants had inflammation and retinal function loss similar to eyes infected with WT strain. Eyes infected with ΔinhA1-3 cleared the infection. RT-PCR results suggested that there may be compensatory expression of the other InhAs in the single InhA mutant. These results indicate that together, the InhA metalloproteases contribute to the severity of infection and inflammation in Bacillus endophthalmitis.

Clinical Characteristics and Prognostic Factors of Posterior Segment Intraocular Foreign Body: Canadian Experience from a Tertiary University Hospital in Quebec

Purpose

To identify predictive factors for visual outcomes of patients presenting with a posterior segment intraocular foreign body (IOFB).

Methods

A retrospective chart review was performed for all consecutive patients operated for posterior segment IOFB removal between January 2009 and December 2018. Data were collected for patient demographics, clinical characteristics at presentation, IOFB characteristics, surgical procedures, and postoperative outcomes. A multiple logistic regression model was built for poor final visual acuity (VA) as an outcome (defined as final VA 50 letters or worse [Snellen equivalent: 20/100]).

Results

Fifty-four patients were included in our study. Ninety-three percent of patients were men, with a mean age of 40.4 ± 12.6 years. Metallic IOFB comprised 88% of cases with a mean ± standard deviation (SD) size of 5.31 ± 4.62 mm. VA improved in 70% of patients after IOFB removal. Predictive factors for poor VA outcome included poor baseline VA, larger IOFB size, high number of additional diagnoses, an anterior chamber extraction, a second intervention, the use of C3F8 or silicone tamponade, and the presence of vitreous hemorrhage, hyphema, and iris damage. Predictive factors for a better visual outcome included first intention intraocular lens (IOL) implantation and the use of air tamponade. In the multiple logistic regression model, both baseline VA (p = 0.009) and number of additional complications (p = 0.01) were independent risk factors for a poor final VA.

Conclusions

A high number of concomitant complications and poor baseline VA following posterior segment IOFB were significant predictive factors of poor visual outcome.

Poor prognostic factors in post-traumatic endophthalmitis following open globe injury

AIM

To demonstrate prognostic factors for poor visual outcome in patients with post-traumatic endophthalmitis (PTE) following open globe injury.

METHODS

A retrospective study was conducted on 66 patients (66 eyes) with PTE following open globe injury from 2005 to 2015. Potential factors accounting for good and poor visual outcome were statistically analyzed by Chi-square test and Logistic regression model.

RESULTS

In 66 cases, 39 cases (59%) had a poor visual outcome. Univariate and multivariate Logistic regression analysis identified retained intraocular foreign body (IOFB) as the only factor significantly associated with poor visual outcome [adjusted odds ratio, 4.62; 95% confidence interval (1.04-20.53); P=0.04]. The most common causative agents were gram-positive organisms (83%), of which Bacillus cereus (33%), was the most common pathogen. All cases received intravitreal antibiotic injections. Oral ciprofloxacin was the most used systemic antibiotic (33%). Pars plana vitrectomy was performed in 83% (55/66) of cases. At 6mo follow-up, mean BCVA was 1.74±0.72 logMAR units.

CONCLUSION

In patients with PTE following open globe injury, the only predictor of poor visual outcome is the presence of IOFB. Bacillus cereus is the most isolated microorganism.

Risk Factors for Post–Open-Globe Injury Endophthalmitis

Purpose:

The objective of our project is to use the National Inpatient Sample Database to identify risk factors for endophthalmitis in cases of open-globe injury (OGI).

Methods:

This is a cross-sectional observational study of 48 627 cases of OGI from the National Inpatient Sample Database. We performed regression analysis using IBM SPSS Statistics 23. Codes from the International Classification of Disease, Ninth Revision were used to identify ocular findings and conditions. Variables with P values less than .05 on univariate analysis were included in the multivariable regression model; Bonferroni correction was applied to these results.

Results:

Of the 48 627 cases of OGI, 37 440 (77.0%) occurred in the adult group (21 years and older). Overall, 1018 (2.1%) cases developed posttraumatic endophthalmitis, with 74.5% cases in the adult group. Endophthalmitis developed in 293 (4.5%) eyes with an intraocular foreign body (IOFB). Results of binary logistic regression showed the clinical findings of traumatic cataracts, hypopyon, vitreous inflammation, corneal ulcers, or IOFBs were associated with an increased risk of developing endophthalmitis after OGI. Conversely, orbital fractures, rupture-type injuries, and intraocular tissue prolapse were associated with a decreased likelihood of being diagnosed with endophthalmitis.

Conclusions:

Endophthalmitis developed in 2.4% of pediatric OGIs and 2.0% of adult OGIs. Traumatic cataract, hypopyon, vitreous inflammation, corneal ulcer, keratitis, retinal detachment, IOFB, and diabetes increased the risk of post-open-globe endophthalmitis.

The cereus matter of Bacillus endophthalmitis

Bacillus cereus (B. cereus) endophthalmitis is a devastating intraocular infection primarily associated with post-traumatic injuries. The majority of these infections result in substantial vision loss, if not loss of the eye itself, within 12-48 h. Multifactorial mechanisms that lead to the innate intraocular inflammatory response during this disease include the combination of robust bacterial replication, migration of the organism throughout the eye, and toxin production by the organism. Therefore, the window of therapeutic intervention in B. cereus endophthalmitis is quite narrow compared to that of other pathogens which cause this disease. Understanding the interaction of bacterial and host factors is critical in understanding the disease and formulating more rational therapeutics for salvaging vision. In this review, we will discuss clinical and research findings related to B. cereus endophthalmitis in terms of the organism's virulence and inflammogenic potential, and strategies for improving of current therapeutic regimens for this blinding disease.

[Modern diagnosis and treatment of endophthalmitis]

Endophthalmitis is characterized by inflammation of intraocular fluids and tissues, which can lead to irreversible loss of vision if the disease is not treated timely and properly. Endophthalmitis can be classified as exogenous or endogenous depending on the route of infectious agent transmission. Exogenous endophthalmitis occurs when pathogens enter the eye through direct inoculation, while endogenous endophthalmitis develops when pathogens get into the eye through the hematogenous route from a distant infection focus. Classification of endophthalmitis helps determine the etiology and probable causative organisms of the disease. Diagnosis of endophthalmitis is based on clinical data. Early diagnosis and treatment are keys to preserving the eye. Best results are achieved by rapid initiation of an empirical broad-spectrum antimicrobial therapy.

Timely Use of Conventional Vitrectomy and Endoscope-Assisted Vitrectomy for Endophthalmitis Following Open Ocular Trauma: A Retrospective Study of 18 Patients

Background

Endophthalmitis, or inflammation of the internal tissues of the eye, may follow trauma and results in loss of vision if not treated promptly. Vitrectomy is used to debride the inflamed vitreous. This retrospective study aimed to compare the outcome from conventional vitrectomy (CV) and endoscope-assisted vitrectomy (EAV) performed for endophthalmitis within five days and 10 days after open ocular trauma.

Material/Methods

The clinical data from 18 patients (18 eyes) with endophthalmitis caused by open ocular trauma were analyzed at a single center. CV or EAV was performed based on the degree of vision and the involvement of the vitreous cavity.

Results

Of the 18 patients with endophthalmitis, seven patients underwent EAV, and 11 patients underwent CV. The number of cases with preoperative corneal laceration, edema, bleeding, and formation of corneal nebular opacity was higher in the EAV group compared to the CV group. Four patients had retinal detachment, of which three patients were treated with EAV. Seventeen patients had their sight restored by a single vitrectomy procedure. In 10 cases, the culture of the vitreous fluid was positive for infection, and eight patients had Gram-positive Staphylococcus epidermidis infection. Follow-up showed that vitrectomy performed within five days (P=0.001) and 10 days (P=0.047) of open ocular trauma resulted in significant improvement of visual acuity.

Conclusions

Vitrectomy for endophthalmitis due to open ocular trauma performed within five days of injury restored visual acuity. EAV was shown to be an effective alternative to CV.

Prognostic factors associated with visual outcome of salvageable eyes with posttraumatic endophthalmitis

The purpose of this study is to evaluate the prognostic factors associated with visual outcomes in the salvageable eyes with posttraumatic endophthalmitis. We retrospectively reviewed the medical records of all patients diagnosed with posttraumatic endophthalmitis in our hospital between 2008 and 2015. The following information was collected: age, sex, etiology, past medical history, clinical manifestations, wound location, microbiology, blood leukocyte counts, types of interventions, initial visual acuities and final visual acuities. Univariate and multivariate analyses were used to explore the factors associated with final best-corrected visual acuity. In total, 98 eyes of 98 patients were included in our study. Fifty-seven eyes underwent vitrectomy, 27 of them had silicone oil tamponade, 38 eyes received intravitreal ceftazidime only and 3 eyes received intracameral ceftazidime. In univariate analysis, poor initial visual acuity, presence of intraocular foreign body, number of intravitreal injections, retinal detachment and Zone 3 injury were associated with poor visual outcome. In multivariable analysis, poor initial visual acuity, presence of intraocular foreign body and number of intravitreal injections were independently associated with poor visual outcome. The silicone oil group had fewer repeated intravitreal injections than the group without oil tamponade. We concluded that the visual outcome of salvageable eyes with posttraumatic endophthalmitis is associated with initial visual acuity, presence of intraocular foreign body and number of intravitreal antibiotic injections.

Intraocular Foreign Bodies: Clinical Characteristics and Prognostic Factors Influencing Visual Outcome and Globe Survival in 373 Eyes

Aim

To describe epidemiologic and clinical characteristics and prognostic factors influencing visual outcome after intraocular foreign bodies (IOFBs) injury.

Methods

Medical records of 370 patients (373 eyes) with IOFBs were reviewed to identify the factors influencing visual acuity by univariate and multivariate analyses.

Results

The majority of patients (97.0%) were men, with a mean age of 38.1 years. The most common cause of ocular injury was hammering (52.6%); magnetic IOFBs occurred in 84.7% of these cases. Factors associated with poor visual outcome (defined as <1.3 logMAR) included the following: age ≥50 years (P=0.046); worse presenting visual acuity (P < 0.001); complications of retinal breaks (P=0.006) and endophthalmitis (P=0.032); vitrectomy (P=0.035); and intraocular C₃F₈ gas tamponade (P=0.038). Excellent visual outcome (defined as ≥0.5 logMAR) was associated with age <50 years (P=0.003); better presenting visual acuity (PVA) (P < 0.001); wound length <4 mm (P=0.005); absence of vitreous hemorrhage (P=0.026) and retinal breaks (P < 0.001); nonvitrectomy surgery (P=0.043); and use of balanced saline (P=0.029).

Conclusions

Multiple prognostic factors were identified that may predict visual outcome and globe survival after IOFBs injury. Age, initial presenting visual acuity, wound length, complications (vitreous hemorrhage, retinal breaks, and endophthalmitis), surgical approach, and intraocular tamponade were significant predictors of visual outcome.

POSTTRAUMATIC ENDOPHTHALMITIS: An 18-Year Case Series

PURPOSE

To describe the demographics, characteristics, management, and visual outcomes of eyes diagnosed with endophthalmitis after open globe injury.

METHODS

Retrospective cohort analysis of all patients diagnosed with endophthalmitis after open globe injury from 1997 to 2015 at University Hospital, Newark, NJ.

RESULTS

Twenty-six eyes were identified (all male patients; mean age: 37 ± 15 years). Cultures were positive in 16 eyes (62%), with Staphylococcus species (7 eyes, 44%) being the most common organism. Twelve eyes (46%) presented with open globe injury and concurrent endophthalmitis; 14 eyes (54%) developed endophthalmitis a mean of 14 days after open globe repair (OGR; 1 outlier of 98 days excluded). All eyes were managed with systemic and intravitreal antibiotics. The presence of intraocular foreign body (P < 0.05) and delayed primary OGR (P < 0.03) were significantly more common with concurrent versus post-OGR endophthalmitis. Four (29%) eyes in the post-OGR endophthalmitis group had corneal wound leak after OGR. Four (15%) eyes with no light perception vision were enucleated. Ten (40%) of 25 eyes with documented best-corrected visual acuity had final best-corrected visual acuity ≥20/200; final best-corrected visual acuity ranged from no light perception to 20/20.

CONCLUSION

The presence of intraocular foreign body and delayed presentation were significantly more common with concurrent endophthalmitis. Twenty-nine percent of eyes that presented with endophthalmitis after OGR had a wound leak. Final best-corrected visual acuity ≥20/200 was achieved in 40% of cases.

Visual Outcomes and Prognostic Factors after Pars Plana Vitrectomy for Traumatic Endophthalmitis

Purpose. To evaluate visual outcomes and identify prognostic factors after pars plana vitrectomy (PPV) surgery for traumatic endophthalmitis. Methods. Medical records of 121 consecutive patients (121 eyes) diagnosed with traumatic endophthalmitis that had undergone pars plana vitrectomy were retrospectively reviewed. Results. 121 patients, aged from 6 to 71 years, all underwent PPV surgery. 113 cases had improved best corrected visual acuity (BCVA) after surgery and 60% of them obtained BCVA better than fingers counting (FC). Good final visual prognosis was significantly associated with time between trauma and initial treatment less than 12 hrs (40% versus 98%; P < 0.001), time between trauma and PPV treatment less than 24 hrs (62% versus 98%; P < 0.001), laceration length less than 10 mm (63% versus 96%; P < 0.001), and presenting VA better than LP (42% versus 96%; P < 0.001), while gender, type of laceration, presence of IOFB or retinal detachment, and the use of silicone oil tamponade were not significant factors resulting in better BCVA. Bacteria were identified in 43.8% of specimens and most of the microorganisms were identified as nonvirulent ones. Conclusions. Pars plana vitrectomy surgery was preferred as a primary treatment option for traumatic endophthalmitis. A good final visual prognosis was significantly associated with timely treatment, prompt vitrectomy surgery, shorter length of laceration, and better presenting visual acuity.

Causative Microorganisms of Infectious Endophthalmitis: A 5-Year Retrospective Study

This study aimed to identify the microbial etiology of infectious endophthalmitis and to determine the antibacterial susceptibilities of bacterial isolates at an eye hospital in South China. A retrospective analysis was carried out on 330 patients with clinically diagnosed infectious endophthalmitis who underwent microbiological evaluation from January 2010 to December 2014. Of the 330 patients, 193 patients (58.5%) had posttraumatic endophthalmitis, 67 patients (20.3%) had postoperative endophthalmitis, 61 patients (18.5%) had endogenous endophthalmitis, and 9 patients (2.7%) had postcorneal infective endophthalmitis. Of the 105 cases (31.8%) of culture-positive endophthalmitis, 79 cases (75.2%) had bacterial growth and 26 cases (24.8%) had fungal growth. In posttraumatic endophthalmitis, Gram-positive bacteria were the predominant species, followed by Gram-negative bacteria and fungi. In endogenous endophthalmitis, Gram-negative bacteria were the predominant species, followed by fungi and Gram-positive bacteria. In postsurgical endophthalmitis, all infections were bacterial. However, in postcorneal infective endophthalmitis, all infections were fungal. Overall, levofloxacin showed the highest activity against bacterial isolates. There was a significant difference in the susceptibility to tobramycin between the isolates from posttraumatic and postoperative endophthalmitis (p < 0.05). The results of this study identify the microbial spectrum of infectious endophthalmitis in this clinical setting.

Emerging techniques for pathogen discovery in endophthalmitis

PURPOSE OF REVIEW

Despite the inability to detect certain organisms and relatively low yield, microbial culture is the current gold standard for the diagnosis of most intraocular infections. Research on alternative molecular diagnostic methods has produced an array of strategies that augment and improve pathogen detection. This review summarizes the most recent literature on this topic.

RECENT FINDINGS

The yield of traditional microbial culture has not improved since the Endophthalmitis Vitrectomy Study results were published 20 years ago. Advances in PCR methods have enabled quantification of pathogen load and screening for multiple organisms at once. More recently, deep sequencing techniques allow highly sensitive detection of any DNA-based life form in a specimen. This offers the promise of not only improved detection of traditional organisms but can also identify organisms not previously associated with endophthalmitis.

SUMMARY

Molecular diagnostic methods enhance the results of microbial culture and may become the new standard in the diagnosis of intraocular infections.

Endophthalmitis: state of the art

Endophthalmitis is an uncommon diagnosis but can have devastating visual outcomes. Endophthalmitis may be endogenous or exogenous. Exogenous endophthalmitis is caused by introduction of pathogens through mechanisms such as ocular surgery, open-globe trauma, and intravitreal injections. Endogenous endophthalmitis occurs as a result of hematogenous spread of bacteria or fungi into the eye. These categories of endophthalmitis have different risk factors and causative pathogens, and thus require different diagnostic, prevention, and treatment strategies. Novel diagnostic techniques such as real-time polymerase chain reaction (RT-PCR) have been reported to provide improved diagnostic results over traditional culture techniques and may have a more expanded role in the future. While the role of povidone-iodine in prophylaxis of postoperative endophthalmitis is established, there remains controversy with regard to the effectiveness of other measures, including prophylactic antibiotics. The Endophthalmitis Vitrectomy Study (EVS) has provided us with valuable treatment guidelines. However, these guidelines cannot be directly applied to all categories of endophthalmitis, highlighting the need for continued research into attaining improved treatment outcomes.