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Chin YYB, Yeo TH, Bakthavatsalu M, Zhou WT, Wagle AM, Gopal L, Lim TH. ACUTE ATYPICAL ENDOPHTHALMITIS FOLLOWING INTRAVITREAL SUSTAINED-RELEASE DEXAMETHASONE IMPLANT: A CASE SERIES. Retin Cases Brief Rep 2024; 18:155-158. [PMID: 36730427 PMCID: PMC10898540 DOI: 10.1097/icb.0000000000001369] [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: 08/22/2021] [Accepted: 11/01/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To present three cases of acute endophthalmitis following intravitreal sustained-release dexamethasone (Ozurdex) with atypical presentation and to discuss the management of these patients. METHODS A retrospective case series of three patients with endophthalmitis following intravitreal sustained-release dexamethasone (Ozurdex) implantation who presented between July 2020 and August 2020. RESULTS Two of three patients who were treated with topical steroid and antibiotic therapy alone showed favorable outcomes and were managed without the need for intravitreal antibiotics or implant removal. One patient who showed initial response to topical therapy subsequently required pars plana vitrectomy, implant removal, and a single empirical dose of intravitreal antibiotics and antifungal agent due to persistent inflammation. CONCLUSION Postintravitreal Ozurdex endophthalmitis, although a rare entity, can present with atypical features of a painless white eye and a delayed onset intraocular inflammation. Although all cases of endophthalmitis should be treated as infective until proven otherwise, it is fair to consider a trial of conservative treatment with topical steroids and antibiotics initially with close monitoring. In cases with poor response to topical therapy, pars planar vitrectomy and implant removal should be strongly considered.
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Affiliation(s)
- Yi Yao Brendan Chin
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
| | - Tun Hang Yeo
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
| | | | - Wen Ting Zhou
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
| | - Ajeet Madhav Wagle
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
- International Eye Cataract Retina Centre, Farrer Park Medical Centre, Singapore; and
| | - Lekha Gopal
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
| | - Tock Han Lim
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
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da Cruz NFS, Kawamuro M, Hilgert GR, Pipolo GSR, Maia M. SURGICAL REMOVAL AFTER IATROGENIC SUBRETINAL INJECTION OF AN INTRAVITREAL DEXAMETHASONE IMPLANT. Retin Cases Brief Rep 2022; 16:727-730. [PMID: 32618899 DOI: 10.1097/icb.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To report a rare case of subretinal migration of an intravitreal dexamethasone implant to treat macular edema secondary to diabetic retinopathy in a vitrectomized eye and the surgical outcome. OBSERVATIONS A pars plana vitrectomy and a retinotomy were performed to remove the implant and restore vision. CONCLUSION AND IMPORTANCE Subretinal dislodgement of intravitreal implants is a rare and preventable complication. In the current case, we speculated that this complication might have been related to the injection technique, a possible unrecognized retinal perforation before the injection of the implant, or delayed treatment with the implant. Because a retinal detachment and vitreoretinal proliferation were observed, surgical management was required. Increasing widespread application of any technology may lead to a more significant risk of complications, and ophthalmologists should be aware of this potential risk.
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Affiliation(s)
- Natasha F S da Cruz
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Mariana Kawamuro
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Mauricio Maia
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Department of Ophthalmology, Vision Institute, Federal University of São Paulo, São Paulo, Brazil; and
- Department of Ophthalmology, Brazilian Institute of Fight Against Blindness, São Paulo, Brazil
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Alloiococcus otitidis-Cause of Nonspecific Acute Sinusitis: First Case Report and Review of Literature. Microorganisms 2022; 10:microorganisms10061182. [PMID: 35744700 PMCID: PMC9230643 DOI: 10.3390/microorganisms10061182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 02/04/2023] Open
Abstract
Although most sinus infections are viral, potential bacterial pathogens such as Streptococcus pneumoniae, Haemophilus influenza and Moraxella catarrhalis can migrate during a viral respiratory infection from the nasopharynx into the sinus cavity causing sinusitis. Alloiococcus otitidis is a commensal of the external auditory canal and is considered one of the potential middle ear pathogens. Unlike most otopathogens, A. otitidis is rarely found in the nasopharynx of healthy individuals. This difficult-to-culture organism has not previously been described as a causative agent of sinusitis. Here we describe one case of acute sinusitis due to A. otitidis and review previous knowledge of this controversial organism based on recent literature.
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Cruz-Iñigo YJ, Klein K, Reddy RK. CASE REPORT OF ABIOTROPHIA DEFECTIVA ENDOPHTHALMITIS AFTER REPEATED INJECTIONS OF DEXAMETHASONE INTRAVITREAL IMPLANT (OZURDEX). Retin Cases Brief Rep 2022; 16:170-173. [PMID: 31479011 DOI: 10.1097/icb.0000000000000925] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To present a case of endophthalmitis caused by Abiotrophia defectiva after repeated injections of dexamethasone intravitreal implant (Ozurdex), in a patient already on systemic immunosuppressive therapy, and discuss the management of this challenging situation. METHODS Case report and review of literature. RESULTS A 70-year-old female patient with history of idiopathic pulmonary fibrosis presented for urgent evaluation due to left eye vision loss and mild discomfort 12 days after receiving her seventh dexamethasone implant injection. Ocular history was pertinent for recurrent macular edema resulting from a remote branch vein occlusion. Twelve days after her last injection, visual acuity decreased from 20/30 to counting fingers at 5 feet. Slit-lamp examination showed anterior chamber cell without fibrinoid membranes or hypopyon. Within hours, the patient's clinical appearance progressed. A vitreous tap followed by intravitreal injection of vancomycin (1 mg/0.1 mL) and ceftazidime (2.25 mg/0.1 mL) was performed. The culture from the vitreous sample revealed heavy growth of A. defectiva. Owing to limited improvement, patient was taken to the operating room, and the presence of a full-thickness scleral defect at the site of most recent dexamethasone implant injection was confirmed. Vitrectomy with removal of implant, closure of all sclerotomies, including nonhealing full-thickness scleral defect, and repeated intravitreal antibiotic injection were performed. At the 3-month follow-up, no inflammation was observed, but visual acuity remained poor. CONCLUSION Intravitreal dexamethasone implant-associated endophthalmitis in the setting of systemic immunosuppression is a rare and challenging situation. Both local and systemic immunosuppression may delay wound healing, predisposing to wound leakage and consequent endophthalmitis. Despite repeated intravitreal antimicrobial injection and vitrectomy with implant removal, A. defectiva endophthalmitis carried a poor visual outcome.
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Lappan R, Jamieson SE, Peacock CS. Reviewing the Pathogenic Potential of the Otitis-Associated Bacteria Alloiococcus otitidis and Turicella otitidis. Front Cell Infect Microbiol 2020; 10:51. [PMID: 32117817 PMCID: PMC7033548 DOI: 10.3389/fcimb.2020.00051] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/27/2020] [Indexed: 12/20/2022] Open
Abstract
Alloiococcus otitidis and Turicella otitidis are common bacteria of the human ear. They have frequently been isolated from the middle ear of children with otitis media (OM), though their potential role in this disease remains unclear and confounded due to their presence as commensal inhabitants of the external auditory canal. In this review, we summarize the current literature on these organisms with an emphasis on their role in OM. Much of the literature focuses on the presence and abundance of these organisms, and little work has been done to explore their activity in the middle ear. We find there is currently insufficient evidence available to determine whether these organisms are pathogens, commensals or contribute indirectly to the pathogenesis of OM. However, building on the knowledge currently available, we suggest future approaches aimed at providing stronger evidence to determine whether A. otitidis and T. otitidis are involved in the pathogenesis of OM. Such evidence will increase our understanding of the microbial risk factors contributing to OM and may lead to novel treatment approaches for severe and recurrent disease.
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Affiliation(s)
- Rachael Lappan
- The Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Sarra E Jamieson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Christopher S Peacock
- The Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
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Al Zamil W, Yassin SA. Acute Bacterial Endophthalmitis Following Dexamethasone Intravitreal Implant: A Case Report. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 7:110-113. [PMID: 31080392 PMCID: PMC6503689 DOI: 10.4103/sjmms.sjmms_57_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A 54-year-old male presented to our ophthalmology clinic with a diagnosis of the right central retinal vein occlusion with macular edema. The patient was treated with dexamethasone intravitreal implant. Three days after the implant insertion, the patient experienced pain, redness and blurred vision in the same eye. With a provisional diagnosis of acute endophthalmitis, a combination of ceftazidime 2.25 mg/0.1 ml and vancomycin 1 mg/0.1 ml was injected intravitreally. One week after the treatment, endophthalmitis signs and symptoms subsided. This report presents a case of endophthalmitis following dexamethasone intravitreal implant, with a favorable outcome after treatment with intravitreal antibiotic injection without removal of the implant.
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Affiliation(s)
- Waseem Al Zamil
- Department of Ophthalmology, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sanaa A Yassin
- Department of Ophthalmology, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Acute Onset of Exogenous Endophthalmitis after Dexamethasone Implant Injection Treated without Implant Removal. Case Rep Ophthalmol Med 2018; 2018:4614802. [PMID: 30581640 PMCID: PMC6276387 DOI: 10.1155/2018/4614802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/27/2018] [Accepted: 09/17/2018] [Indexed: 11/21/2022] Open
Abstract
We present a case of acute endophthalmitis after intravitreal dexamethasone implant injection and discuss the management of this rare and challenging case in which the implant could not be removed. A 50-year-old woman with a history of branch retinal vein occlusion in the right eye was treated with intravitreal dexamethasone implant injection for macular oedema. Four days after injection, the patient was admitted to the department with acute pain, decreased vision, and redness. A diagnosis of acute post-intravitreal injection endophthalmitis was made. A 23-guage (23G) vitrectomy was performed immediately to remove the implant, and a vitreous tap for culture and polymerase chain reaction was acquired during the procedure. We were unable to remove the dexamethasone implant during the vitrectomy because of dense membrane formation. At the end of the procedure, we injected intravitreal antibiotics (vancomycin and amikacin), and the patient was treated with fortified topical antibiotics and steroids. At the time of writing, 5 years later, the patient retains a best corrected visual acuity of 10/10 (6/6) with dexamethasone implant therapy maintenance. Intravitreal dexamethasone implant-associated endophthalmitis is a rare and challenging condition. Immediate 23G pars plana vitrectomy, even without removal of the implant, can lead to favourable visual results.
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9
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Management of bacterial postoperative endophthalmitis and the role of vitrectomy. Surv Ophthalmol 2018; 63:677-693. [DOI: 10.1016/j.survophthal.2018.02.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 02/04/2018] [Accepted: 02/06/2018] [Indexed: 11/20/2022]
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Chan CL, Richter K, Wormald PJ, Psaltis AJ, Vreugde S. Alloiococcus otitidis Forms Multispecies Biofilm with Haemophilus influenzae: Effects on Antibiotic Susceptibility and Growth in Adverse Conditions. Front Cell Infect Microbiol 2017; 7:344. [PMID: 28824879 PMCID: PMC5539592 DOI: 10.3389/fcimb.2017.00344] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/14/2017] [Indexed: 11/13/2022] Open
Abstract
Otitis media with effusion (OME) is a biofilm driven disease and commonly accepted otopathogens, such as Haemophilus influenzae, Streptococcus pneumonia, and Moraxella catarrhalis, have been demonstrated to form polymicrobial biofilms within the middle ear cleft. However, Alloiococcus otitidis (A. otitidis), which is one of the most commonly found bacteria within middle ear aspirates of children with OME, has not been described to form biofilms. The aim of this study was to investigate whether A. otitidis can form biofilms and investigate the impact on antibiotic susceptibility and survivability in polymicrobial biofilms with H. influenzae in vitro. The ability of A. otitidis to form single-species and polymicrobial biofilms with H. influenzae was explored. Clinical and commercial strains of A. otitidis and H. influenzae were incubated in brain heart infusion with and without supplementation. Biofilm was imaged using confocal laser scanning microscopy and scanning electron microscopy. Quantification of biofilm biomass and viable bacterial number was assessed using crystal violet assays and viable cell counting in both optimal growth conditions and in adverse growth conditions (depleted media and sub-optimal growth temperature). Antimicrobial susceptibility and changes in antibiotic resistance of single-species and multi-species co-culture were assessed using a microdilution method to assess minimal bactericidal concentration and E-test for amoxicillin and ciprofloxacin. A. otitidis formed single-species and polymicrobial biofilms with H. influenzae. Additionally, whilst strain dependent, combinations of polymicrobial biofilms decreased antimicrobial susceptibility, albeit a small magnitude, in both planktonic and polymicrobial biofilms. Moreover, A. otitidis promoted H. influenzae survival by increasing biofilm production in depleted media and at suboptimal growth temperature. Our findings suggest that A. otitidis may play an indirect pathogenic role in otitis media by altering H. influenzae antibiotic susceptibility and enhancing growth under adverse conditions.
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Affiliation(s)
- Chun L Chan
- Department of Surgery, Otolaryngology-Head and Neck Surgery, Adelaide UniversityAdelaide, SA, Australia
| | - Katharina Richter
- Department of Surgery, Otolaryngology-Head and Neck Surgery, Adelaide UniversityAdelaide, SA, Australia
| | - Peter-John Wormald
- Department of Surgery, Otolaryngology-Head and Neck Surgery, Adelaide UniversityAdelaide, SA, Australia
| | - Alkis J Psaltis
- Department of Surgery, Otolaryngology-Head and Neck Surgery, Adelaide UniversityAdelaide, SA, Australia
| | - Sarah Vreugde
- Department of Surgery, Otolaryngology-Head and Neck Surgery, Adelaide UniversityAdelaide, SA, Australia
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Mahalingam P, Topiwalla TT, Ganesan G. Drug-resistant coagulase-negative staphylococcal endophthalmitis following dexamethasone intravitreal implant. Indian J Ophthalmol 2017; 65:634-636. [PMID: 28724830 PMCID: PMC5549425 DOI: 10.4103/ijo.ijo_810_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A 60-year-old female came to our hospital with defective vision due to persistent diabetic macular edema and was treated with intravitreal ozurdex implant in the right eye. Three days later, the patient presented with diminution of vision, ocular pain, congestion, and hypopyon with no fundus view. B-scan ultrasonography showed vitritis, and diagnosis of endophthalmitis was made. Subsequently, 25-gauge pars plana vitrectomy was performed along with intravitreal vancomycin and amikacin and removal of implant. On culture, there was growth of coagulase-negative staphylococcus which was resistant to ofloxacin antibiotic. A week following treatment, there was significant improvement in the patient's sign and symptoms with improvement in vision. Our case demonstrated that acute endophthalmitis can occur following dexamethasone intravitreal implant.
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12
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Acute bacterial endophthalmitis following intravitreal dexamethasone implant: A case report and review of literature. Saudi J Ophthalmol 2017; 31:51-54. [PMID: 28337065 PMCID: PMC5352935 DOI: 10.1016/j.sjopt.2016.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 11/02/2016] [Accepted: 12/06/2016] [Indexed: 11/24/2022] Open
Abstract
Endophthalmitis following intravitreal dexamethasone (DEX) implant has been rarely reported. This report describes the case of a 70-year-old male who underwent intravitreal DEX implant injection under aseptic conditions, for diabetic macular edema. He developed a clinical picture suggestive of endophthalmitis within 2 weeks of the injection, and vitreous culture grew coagulase negative Staphylococcus. He was treated with intravitreal antibiotics followed by pars plana vitrectomy and removal of the implant. This was followed by resolution of the infection with a favorable final visual outcome. The challenges faced during surgical management of this case are discussed.
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13
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TWO CASES OF ACUTE ENDOPHTHALMITIS AFTER INTRAVITREAL DEXAMETHASONE IMPLANT INJECTION. Retin Cases Brief Rep 2017; 10:154-6. [PMID: 26426482 DOI: 10.1097/icb.0000000000000213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To present two cases of acute endophthalmitis after intravitreal dexamethasone implant injection and discuss the management of intravitreal implant-associated endophthalmitis. METHODS Two patients, who underwent intravitreal dexamethasone implant injection for macular edema secondary to diabetic retinopathy in one and branch retinal vein occlusion in the other, were admitted with decreased vision, pain, and redness in their treated eyes, 3 days and 5 days after the injection, respectively. The clinical findings of both patients were consistent with acute endophthalmitis. RESULTS After obtaining aqueous and vitreous samples, the patients were treated with intravitreal antibiotic injection and topical fortified antibiotics. Both patients revealed favorable clinical response and functional vision was recovered. CONCLUSION Intravitreal dexamethasone implant-associated endophthalmitis is an uncommon and a challenging situation. Intravitreal antibiotics may lead to favorable visual outcomes without the need for a pars plana vitrectomy and implant removal in selected cases.
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Fassbender Adeniran JM, Jusufbegovic D, Schaal S. Common and Rare Ocular Side-effects of the Dexamethasone Implant. Ocul Immunol Inflamm 2016; 25:834-840. [DOI: 10.1080/09273948.2016.1184284] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Janelle M. Fassbender Adeniran
- Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Denis Jusufbegovic
- Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Shlomit Schaal
- Department of Ophthalmology and Visual Sciences, University of Massachusetts School of Medicine, Worcester, Massachusetts, USA
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Bernard Y, Bonnin N, Farguette F, Chiambaretta F. [Tolerability and short-term efficacy of the Ozurdex® dexamethasone intravitreal implant for treatment of uveitic cystoid macular edema: A retrospective study of 52 injections performed at the Clermont-Ferrand teaching hospital]. J Fr Ophtalmol 2015; 39:1-4. [PMID: 26616298 DOI: 10.1016/j.jfo.2015.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/28/2015] [Accepted: 07/02/2015] [Indexed: 11/26/2022]
Abstract
Macular edema is the main cause of decreased visual acuity in uveitis and determines the visual prognosis. We retrospectively analyzed the tolerability and efficacy of the dexamethasone intravitreal implant in the management of uveitis. Twenty-five patients with uveitic cystoid macular edema were all treated with the Ozurdex(®) dexamethasone intravitreal implant from January 2012 to August 2014. The main outcome measures were visual acuity recovery, changes in macular thickness and resolution of the vitritis. Thirty-two eyes of 25 patients received 52 injections of Ozurdex(®). Both complete regression of the macular edema and resolution of the vitritis occurred in 100 % patients. Visual acuity improved in 62 % of patients: the mean reduction in macular thickness was 252 (±171μm); the mean time between injections was 6.7 (±3.8) months. Secondary ocular hypertension was seen in 33 % of patients. No patient required secondary surgery although a selective laser trabeculoplasty was required for one patient. The dexamethasone intravitreal implant Ozurdex(®) resulted in continuous and complete regression of uveitic cystoid macular edema. It allows evaluation of the potential visual recovery of treated eyes. The tolerability and duration of action provide a rationale for considering Ozurdex(®) as a first-line therapy for uveitis which remains uncontrolled despite optimal systemic treatment.
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Affiliation(s)
- Y Bernard
- Service de neuroradiologie, pôle radiologie, CHU de Clermont-Ferrand, EA 7281 R2D2, biochemistry laboratory, medicine faculty, Auvergne university, 63000 Clermont-Ferrand, France
| | - N Bonnin
- RMND-M2O pole, ophthalmology department, Clermont-Ferrand university hospital, 63000 Clermont-Ferrand, France; Service de neuroradiologie, pôle radiologie, CHU de Clermont-Ferrand, EA 7281 R2D2, biochemistry laboratory, medicine faculty, Auvergne university, 63000 Clermont-Ferrand, France.
| | - F Farguette
- Service de neuroradiologie, pôle radiologie, CHU de Clermont-Ferrand, EA 7281 R2D2, biochemistry laboratory, medicine faculty, Auvergne university, 63000 Clermont-Ferrand, France
| | - F Chiambaretta
- RMND-M2O pole, ophthalmology department, Clermont-Ferrand university hospital, 63000 Clermont-Ferrand, France; Service de neuroradiologie, pôle radiologie, CHU de Clermont-Ferrand, EA 7281 R2D2, biochemistry laboratory, medicine faculty, Auvergne university, 63000 Clermont-Ferrand, France
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Use of Intravitreal Dexamethasone Implant in Patients with Cataract and Macular Edema Undergoing Phacoemulsification. Eur J Ophthalmol 2014; 25:168-72. [DOI: 10.5301/ejo.5000523] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2014] [Indexed: 12/13/2022]
Abstract
Purpose To study the safety and efficacy of intravitreal dexamethasone implant in patients with cataract and macular edema undergoing phacoemulsification and intraocular lens (IOL) implantation. Methods Twenty-four eyes with macular edema secondary to diabetic retinopathy (diabetic macular edema [DME]) and retinal vein occlusion (RVO) were retrospectively reviewed. These eyes underwent phacoemulsification with IOL implantation and intravitreal dexamethasone implant 0.7 mg at the same setting between September 2012 and September 2013. Demographic data, best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), surgical time, and complications were recorded. Results Twelve eyes had DME and 12 eyes had RVO (10 central RVO and 2 branch RVO). Median baseline logMAR BCVA was 1.0 (Snellen 20/200) and mean baseline CMT was 530.2 ± 218.9 µm. Median follow-up duration was 13 months. At last follow-up, median visual acuity improved significantly to 0.523 (Snellen 20/66) (p = 0.003) and CMT decreased to 300.7 ± 78.1 µm (p = 0.000). Median surgical time was 23 minutes. There were no intraoperative complications. In 12 eyes, macular edema recurred, requiring further treatment, and median time to recurrences was 21 weeks. One eye had raised IOP after second dexamethasone implant for recurrent macular edema. No major complication such as vitreous hemorrhage, retinal detachment, or endophthalmitis occurred. Conclusions Combined cataract surgery with intravitreal dexamethasone implant seems to be safe and effective in treating patients with cataract and macular edema in this small case series. A larger prospective study with longer follow-up is necessary to demonstrate the long-term benefit of this combined procedure.
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Arıkan Yorgun M, Mutlu M, Toklu Y, Cakmak HB, Cağıl N. Suspected bacterial endophthalmitis following sustained-release dexamethasone intravitreal implant: a case report. KOREAN JOURNAL OF OPHTHALMOLOGY 2014; 28:275-7. [PMID: 24882964 PMCID: PMC4038736 DOI: 10.3341/kjo.2014.28.3.275] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/07/2014] [Indexed: 12/26/2022] Open
Abstract
A 58-year-old man admitted to our opthalmology department with the complaint of branch retinal vein occlusion. He was treated with intravitreal Ozurdex in the right eye. Two days after the injection, the patient presented with ocular pain and the visual acuity was hand movement. A diagnosis of endophthalmitis was made. We performed emergent pars plana vitrectomy (PPV) and the implant was removed from the vitreous cavity using a retinal forceps. A combination of vancomycin 1.0 mg and amikacin 0.4 mg was injected intravitreally. However, because of the blurring in the vitreus one week after the procedure, phacoemulsification and a repeat PPV was performed. Five days after the last procedure the signs and symptoms of endophthalmitis were resolved. Our case demonstrated that endophthalmitis could develop after intravitreal implantation of Ozurdex. Surgical removal of the implant and immediate vitrectomy seems to be a useful treatment option in these cases.
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Affiliation(s)
- Mücella Arıkan Yorgun
- Ophthalmology Department, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Melek Mutlu
- Ophthalmology Department, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Yasin Toklu
- Ophthalmology Department, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Hasan Basri Cakmak
- Department of Ophthalmology, Yıldırım Beyazıt University, Ankara, Turkey
| | - Nurullah Cağıl
- Department of Ophthalmology, Yıldırım Beyazıt University, Ankara, Turkey
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Han HC, Bang JW, Yum JH, Kim JH, Lee DH, Lee JH. A Case of Acute Endophthalmitis Following a Dexamethasone Intravitreal Implant. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.12.1939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Hyun Cheol Han
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jong Wook Bang
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jung Hoon Yum
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jin Hyoung Kim
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Do Hyung Lee
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jong Hyun Lee
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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