1
|
VanderBeek BL, Chen Y, Tomaiuolo M, Deaner JD, Syed ZA, Acharya B, Zhang Q, Schuman JS, Hyman L. Endophthalmitis Rates and Types of Treatments After Intraocular Procedures. JAMA Ophthalmol 2024; 142:827-834. [PMID: 39088207 PMCID: PMC11295066 DOI: 10.1001/jamaophthalmol.2024.2749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/03/2024] [Indexed: 08/02/2024]
Abstract
Importance Long-term trend analyses of overall endophthalmitis rates and treatment patterns are scarce. It is also unknown if the deviation from the recommendations of the Endophthalmitis Vitrectomy Study toward decreased utilization of vitrectomy is associated with different vision outcomes. Objective To determine whether the rate of endophthalmitis after intraocular procedures or the primary treatment (prompt vitrectomy vs tap and inject) for endophthalmitis has changed over the past 20 years. Design, Setting, and Participants This cohort study examined data for cohorts created by querying for different intraocular procedures, including intravitreal injections and surgeries for cataract removal, glaucoma, retinal conditions, and corneal transplants from 2000 to 2022. The data source was a US administrative medical claims database comprising commercial and Medicare Advantage insurance plans. Any intraocular procedure with at least 6 months of data available before and 6 weeks after the procedure was eligible. Exclusion criteria consisted of any previous diagnosis of endophthalmitis or another intraocular procedure during the follow-up period. Main Outcome Measure The main outcomes were rate of postprocedure endophthalmitis and relative rate of prompt vitrectomy (vs tap and inject) as the primary method of treatment. Results Among 2 124 964 patients, the mean (SD) age was 71.4 (10.2) years; 1 230 320 were female and 894 414 male. Over 22 years, 5 827 809 intraocular procedures were analyzed with 4305 cases of endophthalmitis found for an overall endophthalmitis rate of 0.07%. The yearly rate of endophthalmitis varied but generally declined from a high of 7 cases per 3502 procedures (0.20%) in 2000 to a low of 163 cases per 332 159 procedures (0.05%) in 2022. The percentage of cases treated with prompt vitrectomy also varied but generally declined over time with a high of 17 of 35 (48.6%) in 2003 and a low of 60 of 515 (11.6%) in 2021. Multivariable analysis of the endophthalmitis incidence rate ratio (IRR) showed a per-year decrease of 2.7% (IRR, 0.97; 95% CI, 0.97-0.98; P < .001) over the study period. A similar analysis also showed that the incidence rate of prompt surgical treatment decreased by 3.8% per year throughout the study period (IRR, 0.96; 95% CI, 0.95-0.97; P < .001). Conclusions and Relevance This study found that the incidence of endophthalmitis following intraocular procedures appears to have decreased substantially over the past 20 years while prompt vitrectomy is being used less frequently as primary treatment than in the past.
Collapse
Affiliation(s)
- Brian L VanderBeek
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Yineng Chen
- Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Maurizio Tomaiuolo
- Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Jordan D Deaner
- Mid Atlantic Retina, Wills Eye Hospital, Philadelphia, Pennsylvania
- Department of Ophthalmology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
- Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Zeba A Syed
- Department of Ophthalmology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
- Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Binod Acharya
- Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Qiang Zhang
- Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
- Department of Ophthalmology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
- Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Joel S Schuman
- Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
- Department of Ophthalmology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
- Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania
- Drexel University School of Biomedical Engineering, Science and Health Studies, Philadelphia, Pennsylvania
| | - Leslie Hyman
- Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
- Department of Ophthalmology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
- Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| |
Collapse
|
2
|
Das T, Sahoo J, Belenje A, Joseph J, Pandey S, Kapoor A, Pandya R, Behera UC, Dave VP. Design and Validation of Endophthalmitis Infectivity Measurement Algorithm in Post Cataract Acute Endophthalmitis: EMS Report No. 6. Transl Vis Sci Technol 2024; 13:10. [PMID: 39110575 PMCID: PMC11316448 DOI: 10.1167/tvst.13.8.10] [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: 03/05/2024] [Accepted: 06/13/2024] [Indexed: 08/12/2024] Open
Abstract
Purpose We constructed a clinical clue-based algorithm to identify the microbiology-positive post-cataract surgery endophthalmitis. Methods The Endophthalmitis Infectivity Measurement Algorithm (EIMA) was constructed using presenting Snellen vision (Letter score [LS]) and Inflammation Score (IS, from the cornea, anterior chamber, iris, and vitreous). Retrospective data (70% for training; 30% for testing) was fitted into CHAID (Chi-squared Automatic Interaction Detection). EIMA was validated with prospective data. EIMA-categorized disease severity was weighed against the symptom duration to detect infecting micro-organisms. Results EIMA was constructed from 1444 retrospective data. The average LS was 6.03 ± 12.11, median IS was 14 (8-24), and culture positivity was 38%. The accuracy and area under the curve of CHAID were 66.36% and 0.642, respectively. EIMA was validated with 175 prospectively collected data. Microbiology positivity (culture + sequencing) was 58.9%. EIMA sensitivity, specificity, and accuracy against microbiology-positive endophthalmitis were 73.7 (95% confidence interval [CI], 64.19-81.96), 81.9 (95% CI, 71.1-90.02), 77.1 (95% CI, 70.20-83.14), respectively. The positive and negative likelihood ratios were 4.08 (95% CI, 2.46-6.67) and 0.32 (95% CI, 0.22-0.45), respectively. There was higher microbial growth in two days or less than in three- to six-day symptom duration (69.9% vs. 28.2%; P = 0.018) endophthalmitis. Gram-negative infection was higher in two days or less (55.6% vs. 20.2%; P = 0.014), and gram-positive infection was higher in three- to six-day endophthalmitis (62.1% vs. 27.7%; P = 0.027). Conclusions EIMA identified microbiology-positive endophthalmitis three-quarters of the time. Translational Relevance EIMA suggested infectivity and the class of microbial infection could help targeted management of endophthalmitis after cataract surgery.
Collapse
Affiliation(s)
- Taraprasad Das
- Anant Bajaj Retina Institute-Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Jyotiranjan Sahoo
- Institute of Medical Science and Sum Hospital, SOA University, Bhubaneswar, India
| | - Akash Belenje
- Anant Bajaj Retina Institute-Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India
| | - Suchita Pandey
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India
| | - Aditya Kapoor
- Anant Bajaj Retina Institute, Vitreoretinal service, LV Prasad Eye Institute, Vijayawada, India
| | - Rudvij Pandya
- Anant Bajaj Retina Institute, Vitreoretinal service, LV Prasad Eye Institute, Vishkhapatnam, India
| | - Umesh C. Behera
- Anant Bajaj Retina Institute, Vitreoretinal service, LV Prasad Eye Institute, Bhubaneswar, India
| | - Vivek P. Dave
- Anant Bajaj Retina Institute-Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
3
|
Adeghate JO, Yadav S, Kowalski RP, Juhász E, Kristóf K, Olsen KR, Bergren RL, Knickelbein JE, Chhablani J, Martel JN, Anetakis A, Dansingani KK, Rosin B, Gallagher DS, Prensky C, Eller AW, Friberg T, Sahel JA, Errera MH. Coagulase-negative staphylococcal endophthalmitis: clinical severity and outcomes based on speciation. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e371-e377. [PMID: 37321555 DOI: 10.1016/j.jcjo.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/17/2023] [Accepted: 05/25/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To identify characteristics and visual outcomes of coagulase-negative staphylococcal (CoNS) endophthalmitis in the era after the Endophthalmitis Vitrectomy Study. DESIGN Single-centre retrospective analysis. PARTICIPANTS Forty-two samples from 40 patients with documented CoNS endophthalmitis. METHODS Visual acuity outcomes of CoNS endophthalmitis were assessed in relation to species and type of treatment instituted (i.e., pars plana vitrectomy [PPV] versus vitreous tap and injection of intravitreal antibiotics [T&I]) on 42 samples from 40 patients. RESULTS Staphylococcus epidermidis was the most prevalent CoNS in our study. Cataract surgery and intravitreal injections were the most common sources for acute CoNS endophthalmitis. Eyes presenting with hand motion or better vision had similar mean final vision after either intravitreal antibiotics or PPV, whereas those with light perception or worse vision at onset had better outcomes after PPV only. Subanalysis showed that patients with S. epidermidis endophthalmitis (n = 39 eyes) had similar visual outcomes with either intravitreal injections or PPV regardless of visual acuity. Hypopyon and vitritis are not always present. CONCLUSIONS Patients with S. epidermidis endophthalmitis may benefit similarly from either early vitrectomy or intravitreal antibiotic injections regardless of visual acuity. This finding may be a supplement to the complements the management standards set forth by the Endophthalmitis Vitrectomy Study.
Collapse
Affiliation(s)
- Jennifer O Adeghate
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA; Institute of Laboratory Medicine, Semmelweis University, Budapest, Hungary.
| | - Sanya Yadav
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | - Regis P Kowalski
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA; Charles T. Campbell Microbiology Laboratory, University of Pittsburgh, Pittsburgh, PA
| | - Emese Juhász
- Institute of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Katalin Kristóf
- Institute of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | | | | | | | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | - Joseph N Martel
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Boris Rosin
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | | | - Colin Prensky
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | - Andrew W Eller
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | - Thomas Friberg
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | | |
Collapse
|
4
|
Tomaiuolo M, Deaner J, VanderBeek BL, Acharya B, Syed ZA, Zhang Q, Schuman JS, Hyman L. Do Treatment Patterns for Endophthalmitis after Cataract Surgery Follow the Endophthalmitis Vitrectomy Study Recommendations?: An Academy IRIS® Registry Analysis. Ophthalmol Retina 2024:S2468-6530(24)00337-3. [PMID: 39048058 DOI: 10.1016/j.oret.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To evaluate whether treatment patterns for endophthalmitis after cataract surgery in American Academy of Ophthalmology IRIS® (Intelligent Research in Sight) Registry patients are in line with evidence-based guidelines established by the 1995 Endophthalmitis Vitrectomy Study (EVS), which showed that patients who present with light perception (LP) vision have better visual outcomes with immediate vitrectomy (VIT) compared with vitreous tap with antibiotic injection (TAP). DESIGN Retrospective cohort study. SUBJECTS Intelligent Research in Sight Registry patients undergoing cataract surgery between 2014 and 2022 (identified by Current Procedural Terminology codes), presenting with endophthalmitis (identified by International Classification of Diseases 10 codes) within 42 days postcataract surgery, and having a record of being treated with VIT or TAP on the same or 1 day after endophthalmitis diagnosis were identified. METHODS Potential covariates of age, sex, race, ethnicity, geographic region, insurance status, and visual acuity on the day of endophthalmitis diagnosis were evaluated using multivariable logistic regression. MAIN OUTCOME MEASURES Treatment with VIT or TAP. RESULTS Of the 2425 patients who met the inclusion criteria, 14% (345) underwent VIT and 86% (2080) underwent TAP. Notably, 80% of patients (1946) presented with endophthalmitis within 14 days from cataract surgery (median = 6 days). Notably, 66% (173/263) of the patients presenting with LP vision underwent TAP instead of VIT. In a multivariable logistic regression model, receiving VIT instead of TAP was positively associated with poor vision at endophthalmitis presentation (LP - odds ratio [OR] = 5.4; confidence interval [CI], 2.9-10.6; counting fingers, hand motions - OR = 1.9; CI, 1.1-3.6) versus (20/20-20/40) vision; Asian versus White race (OR = 2.6; CI, 1.3-5.2); Hispanic versus non-Hispanic ethnicity (OR = 1.9; CI, 1.1-3.2); living in the West (OR = 1.6; CI, 1.1-2.2) and Midwest (OR = 1.5; CI, 1.1-2.0) (vs. South), but not with age, sex, and insurance coverage (P > 0.05). CONCLUSIONS In the IRIS Registry, treatment patterns for postcataract surgery endophthalmitis did not match evidence-based recommendations of the EVS, a randomized controlled clinical trial. More work is needed to evaluate whether the current treatment patterns are optimal for patients with postcataract surgery endophthalmitis. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Maurizio Tomaiuolo
- Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Jordan Deaner
- Mid Atlantic Retina, Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Brian L VanderBeek
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Binod Acharya
- Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Zeba A Syed
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Qiang Zhang
- Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joel S Schuman
- Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania; Drexel University School of Biomedical Engineering, Science and Health Systems, Philadelphia, Pennsylvania
| | - Leslie Hyman
- Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
| |
Collapse
|
5
|
Sharma A, Wu L, Bloom S, Stanga P, Jung E, Srivastava S, Rohowetz LJ, Flynn HW, Sheth J, Dave VP, Das T, Anwar S, Rezaei KA. RWC Update: Removal of a Dislocated Ganciclovir Implant; The Role of Early Vitrectomy for Endophthalmitis; Inherited Retinal Disease. Ophthalmic Surg Lasers Imaging Retina 2024; 55:363-366. [PMID: 39012194 DOI: 10.3928/23258160-20240627-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
|
6
|
Morris RE, Doherty S, Oltmanns MH, Sapp MR, Wells K, Patel HR. Horse to human: Streptococcus equi septicemia presenting as endogenous endophthalmitis. Am J Ophthalmol Case Rep 2024; 33:101974. [PMID: 38292882 PMCID: PMC10825363 DOI: 10.1016/j.ajoc.2023.101974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/24/2023] [Accepted: 12/01/2023] [Indexed: 02/01/2024] Open
Abstract
Purpose To present a rarely reported systemic infection with streptococcus equi subspecies zooepidemicus (streptococcus equi), transmitted from a horse, and to describe successful treatment when complicated by endogenous endophthalmitis. Observations We diagnosed suspected streptococcus equi septicemia presenting as loss of vision in the right eye of an otherwise healthy polo player/horse trainer. He received immediate intravenous antibiotics and three vitrectomies with two intravitreal antibiotic injections during the first week, to cure infection and subsequent retinal detachment. Blood and initial vitreous cultures rapidly grew streptococcus equi. The septicemia was quickly controlled by systemic antibiotics without developing commonly seen and often fatal meningitis. The right eye recovered 20/30 visual acuity three months post infection. Conclusions Presentation of this rare septicemia as endogenous endophthalmitis illustrates the potentially lifesaving role of early diagnosis by the ophthalmologist. Immediate and recurrent vitrectomy in conjunction with intravitreal and systemic antibiotic therapy resulted in recovery of near normal vision, whereas less timely and interventional treatments have failed heretofore.
Collapse
Affiliation(s)
- Robert E. Morris
- Retina Specialists of Alabama, LLC, 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
| | - Sean Doherty
- Retina Specialists of Alabama, LLC, Birmingham, AL, USA
- Helen Keller Foundation for Research and Education, Birmingham, AL, USA
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Matthew H. Oltmanns
- Retina Specialists of Alabama, LLC, 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
| | - Mathew R. Sapp
- Retina Specialists of Alabama, LLC, 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
| | | | | |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Lee CY, Sheu SJ, Chen SN, Cheng CK, Kuo HK, Hwang DK, Lai CH, Chan WC, Hsieh YT, Yang CH. Literature- and Experience-Based Consensus for Acute Post-operative Endophthalmitis and Endogenous Endophthalmitis in Taiwan. Ophthalmol Ther 2024; 13:1-19. [PMID: 37934385 PMCID: PMC10776529 DOI: 10.1007/s40123-023-00835-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/06/2023] [Indexed: 11/08/2023] Open
Abstract
Clinical practices on acute post-operative and endogenous endophthalmitis (EnE) are highly variable among clinicians due to a lack of up-to-date, high-quality evidential support. An expert consensus is thus much needed. A panel consisting of ten retinal specialists in Taiwan was organized. They evaluated relevant literature and developed key questions regarding acute post-operative and EnE that are cardinal for practice but yet to have conclusive evidence. The panel then attempted to reach consensus on all the key questions accordingly. There were eight key questions proposed and their respective consensus statements were summarized as follows: Gram staining and culture are still the standard procedures for the diagnosis of endophthalmitis. Vitrectomy is recommended to be performed earlier than the timing proposed by the Endophthalmitis Vitrectomy Study (EVS). Routine intracameral antibiotic injection for post-cataract surgery endophthalmitis prophylaxis is not recommended because of potential compounding error hazards and a lack of support from high-quality studies. Routine fundus examination is recommended for all patients with pyogenic liver abscess. In EnE, vitrectomy is recommended if diffused and dense vitritis is present, or if the disease progresses. These consensus statements may work as handy guidance or reference for clinical practices of acute post-operative and EnE.
Collapse
Affiliation(s)
- Cheng-Yung Lee
- Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Hospital, No. 25, Ln. 442, Sec. 1, Jingguo Road, North District, Hsinchu City, 300, Taiwan (ROC)
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung Shan S. Road (Zhongshan S. Road), Zhongzheng District, Taipei City, 100225, Taiwan (ROC)
- Department of Ophthalmology, National Taiwan University College of Medicine, No. 1 Jen-Ai Road Section 1, Taipei, 100, Taiwan (ROC)
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, No. 100, Tzyou 1St Road, Sanmin Dist., Kaohsiung City, 80756, Taiwan (ROC)
- School of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Sanmin District, Kaohsiung City, 80708, Taiwan
| | - San-Ni Chen
- Department of Ophthalmology, Eye Center, China Medical University Hospital, China Medical University, No. 2, Yude Road, North District, Taichung City, 404327, Taiwan (ROC)
- School of Medicine, College of Medicine, China Medical University, No. 91 Hsueh-Shih Road, Taichung City, 404333, Taiwan
| | - Cheng-Kuo Cheng
- Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, No. 95, Wenchang Road, Shilin District, Taipei, 111045, Taiwan
- School of Medicine, Fu-Jen Catholic University, No. 510, Zhongzheng Road, Xinzhuang District, New Taipei City, 242062, Taiwan (ROC)
| | - Hsi-Kung Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Road, Niaosong District, Kaohsiung City, 833401, Taiwan
| | - De-Kuang Hwang
- School of Medicine, National Yang-Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong Street, Beitou District, Taipei, 112304, Taiwan (ROC)
- Department of Ophthalmology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City, 11217, Taiwan
| | - Chien-Hsiung Lai
- Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, No.6, Sec. W., Jiapu Road, Puzi City, 613, Chiayi County, Taiwan (ROC)
- Department of Ophthalmology, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan City, 33302, Taiwan (ROC)
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, No.2, Sec. W., Jiapu Road, Puzi City, 61363, Chiayi County, Taiwan (ROC)
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan City, 33302, Taiwan (ROC)
| | - Wei-Chun Chan
- Department of Ophthalmology, Mackay Memorial Hospital, No. 92, Sec.2, Chung-Shan North Road, Taipei, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung Shan S. Road (Zhongshan S. Road), Zhongzheng District, Taipei City, 100225, Taiwan (ROC)
- Department of Ophthalmology, National Taiwan University College of Medicine, No. 1 Jen-Ai Road Section 1, Taipei, 100, Taiwan (ROC)
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung Shan S. Road (Zhongshan S. Road), Zhongzheng District, Taipei City, 100225, Taiwan (ROC).
- Department of Ophthalmology, National Taiwan University College of Medicine, No. 1 Jen-Ai Road Section 1, Taipei, 100, Taiwan (ROC).
| |
Collapse
|
9
|
Zhao WF, He W, Han QH, Qi SX. Visual outcome of 25 Gauge vitrectomy for acute post operative infectious endophthalmitis. Technol Health Care 2024; 32:1099-1110. [PMID: 37840508 DOI: 10.3233/thc-230607] [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] [Indexed: 10/17/2023]
Abstract
BACKGROUND The correlation between the change in foveal thickness measured using optical coherence tomography (OCT) following surgery for infectious endophthalmitis and preoperative and postoperative visual acuity is uncertain, and there are few pertinent studies on this topic. OBJECTIVE We explored the variations in macular thickness using OCT after emergency vitrectomy for post-cataract infectious endophthalmitis and the relationship between macular thickness with changes in visual function. METHODS We included 10 cases of post-cataract infectious endophthalmitis. Each patient underwent 25-G vitrectomy. RESULTS The infection in all 10 patients was under control and visual function improved. Postoperative vitreous humor culture was positive in 8 patients, including 7 cases of coagulase-negative Staphylococcus epidermidis and 1 case of Lactobacillus acidophilus. The average age of these 10 patients was 71.60 ± 8.71 years (P< 0.05, two-tailed). There was no significant correlation between time 2 (the time of onset after cataract surgery) and visual prognosis. The average time 1 (the time of the vitrification surgery caused by the onset of the disease) was 1.45 ± 0.76 days (P< 0.05, two-tailed). The postoperative 3dVA ranged from 0.20 to 3.00, with an average visual acuity of 1.87 ± 1.12, which was superior to the preoperative value (P< 0.01, two-tailed). The correlation between the post3dVA and post 1mVA was significant. The post 1mVA ranged from 0.05 to 2.20, with an average visual acuity of 0.94 ± 0.74 (P< 0.05, two-tailed). The correlation between post 1mVA and post3mVA was significant. Also, paired t-tests comparing preoperative and postoperative visual acuity revealed a significant correlation (P< 0.05, two-tailed). The post3mVA was 0-1.00 with an average visual acuity of 0.44 ± 0.41. The postoperative foveal thickness ranged from 176.00 to 514.00 μm, with an average thickness of 281.10 ± 113.12 μm. CONCLUSION Emergency 25-G minimally invasive vitrectomy can improve visual acuity and decrease the reoperation rate for patients who have acquired post-cataract infectious endophthalmitis. There were significant correlations between age, disease onset to operation time, preoperative and postoperative visual acuity, and postoperative macular thickness.
Collapse
Affiliation(s)
- Wei-Feng Zhao
- Department of Ophthalmology, Baodi Clinical College, Tianjin Medical University, Tianjin, China
- Department of Ophthalmology, Baodi Clinical College, Tianjin Medical University, Tianjin, China
| | - Wei He
- Department of Ophthalmology, Baodi Clinical College, Tianjin Medical University, Tianjin, China
- Department of Ophthalmology, Baodi Clinical College, Tianjin Medical University, Tianjin, China
| | - Quan-Hong Han
- Vitreous Retinal Branch, Tianjin Eye Hospital, Tianjin, China
| | - Shi-Xin Qi
- Department of Ophthalmology, Baodi Clinical College, Tianjin Medical University, Tianjin, China
| |
Collapse
|
10
|
Das T, Joseph J, Simunovic MP, Grzybowski A, Chen KJ, Dave VP, Sharma S, Staropoli P, Flynn H. Consensus and controversies in the science of endophthalmitis management: Basic research and clinical perspectives. Prog Retin Eye Res 2023; 97:101218. [PMID: 37838286 DOI: 10.1016/j.preteyeres.2023.101218] [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: 07/25/2023] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 10/16/2023]
Abstract
Infectious endophthalmitis is a severe intraocular infection caused by bacteria, or less commonly by fungi. It can occur after penetrating eye procedures, trauma, or the spread of infection from contiguous structures or via emboli from distant organs. Because of the time-critical nature of the treatment, endophthalmitis is treated with the clinical diagnosis and modified by the microbiological report of the intraocular contents. The current strategy for managing endophthalmitis relies on pre-clinical literature, case series, and one large multi-center randomized clinical trial on post-cataract surgery endophthalmitis. Culture-susceptibility of the microorganisms from undiluted vitreous guides the definitive treatment in non-responsive cases. Strategies to reduce the incidence of endophthalmitis after penetrating eye procedures have been developed concurrently with refined means of treatment. Despite these advances, outcomes remain poor for many patients. Although consensus articles have been published on managing endophthalmitis, treatment patterns vary, and controversies remain. These include (1) the use of newer methods for early and precise microbiological diagnosis; (2) the choice of intravitreal antibiotics; (3) the need for systemic therapy; (4) early and complete vitrectomy. Here, we review the current consensus and address controversies in diagnosing and managing endophthalmitis. This review is intended to familiarize physicians and ophthalmologists with different aspects of endophthalmitis management to make informed decisions.
Collapse
Affiliation(s)
- Taraprasad Das
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V, Prasad Eye Institute, Hyderabad, India.
| | - Joveeta Joseph
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India.
| | - Matthew P Simunovic
- Save Sight Institute, University of Sydney, NSW, 2006, Australia; Sydney Eye Hospital, 8 Macquarie St., Sydney, NSW, 2000, Australia.
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland.
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Vivek Pravin Dave
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V Prasad Eye Institute, Hyderabad, India.
| | - Savitri Sharma
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India.
| | - Patrick Staropoli
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V Prasad Eye Institute, Hyderabad, India.
| | - Harry Flynn
- Bascom Palmer Eye Institute, Miami, FL, USA.
| |
Collapse
|
11
|
Panahi P, Mirzakouchaki-Borujeni N, Pourdakan O, Arévalo JF. Early Vitrectomy for Endophthalmitis: Are EVS Guidelines Still Valid? Ophthalmic Res 2023; 66:1318-1326. [PMID: 37857260 PMCID: PMC10634277 DOI: 10.1159/000534650] [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: 08/09/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
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.
Collapse
Affiliation(s)
- Parsa Panahi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
- Finetech in Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Omid Pourdakan
- Department of Molecular Imaging, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - J Fernando Arévalo
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
12
|
Fabiani C, Agarwal M, Dogra M, Tosi GM, Davis JL. Exogenous Endophthalmitis. Ocul Immunol Inflamm 2023; 31:1386-1395. [PMID: 36534597 DOI: 10.1080/09273948.2022.2152699] [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: 07/31/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Exogenous endophthalmitis (ExE) results from microbial infection as a complication of ocular surgery, penetrating ocular trauma, and intraocular foreign bodies. We herein review the classification of ExE, etiological agents, differential diagnosis and therapeutic challenges. METHODS Narrative Literature Review. RESULTS Identification of the causative agent through ocular fluid analysis is central in the diagnostic work-up of ExE. Prompt intravitreal antimicrobial therapy is key to successful management of ExE and vitrectomy is essential in severe cases. In culture-negative cases, and in the presence of specific features, a diagnosis of sterile intraocular inflammation or toxic syndrome should be suspected. CONCLUSION Strict adherence to treatment guidelines may improve outcomes of ExE, however the ultimate prognosis, especially in severe cases, may depend more on the virulence of the causative organism and associated ocular complications. Accurate differential diagnosis and effective treatment are crucial elements in the management and prognosis of non-infectious masquerades of ExE.
Collapse
Affiliation(s)
- Claudia Fabiani
- Department of Medical Sciences, Surgery and Neurosciences, Unit of Ophthalmology, University of Siena, Siena, Italy
| | - Manisha Agarwal
- Department of Vitreoretina and Uvea, Dr Shroff's Charity Eye Hospital New Delhi, Daryaganj, India
| | - Mohit Dogra
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gian Marco Tosi
- Department of Medical Sciences, Surgery and Neurosciences, Unit of Ophthalmology, University of Siena, Siena, Italy
| | - Janet L Davis
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA
| |
Collapse
|
13
|
Sen AC, Mehta SM, Sule A, More AV, Shetty SB, Singh J, Tripathi S, Agrawal R, Talwar D. IMMEDIATE VITRECTOMY vs TAP AND INJECT IN EYES WITH ACUTE POSTCATARACT ENDOPHTHALMITIS AND VISUAL ACUITY ≥HM: A Randomized Clinical Trial. Retina 2023; 43:940-946. [PMID: 36791396 DOI: 10.1097/iae.0000000000003759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
PURPOSE To compare the outcomes of immediate pars plana vitrectomy (PPV) and tap and inject in eyes with postcataract surgery endophthalmitis. METHODS Patients presenting with acute postcataract surgery endophthalmitis and visual acuity between ≥ hand movement and <6/18 were randomized to receive either PPV (Group A) or tap and inject (Group B). RESULTS There were 26 and 31 eyes in Group A and Group B, respectively. The final mean visual acuity at 6 weeks [0.14 (Snellen equivalent 6/7.5) versus 0.22 (Snellen equivalent 6/9.5) LogMAR in Groups A and B, respectively; P = 0.2] was similar. However, eyes in Group A had significantly greater mean letter gain in vision compared with Group B (66.36 vs. 43.36, P = 0.02), and more eyes in Group A (88%) than in Group B (65%) attained a visual acuity of ≥ 6/18 ( P = 0.06). Eyes in Group B needed more reinterventions including delayed vitrectomy after tap and inject than those in Group A (39% vs. 8%; P = 0.09). On subgroup analysis, the mean visual acuity at the final follow-up was significantly better in the immediate PPV group compared with the delayed PPV group ( P = 0.04). CONCLUSION PPV resulted in earlier recovery, lesser interventions, and greater change in visual acuity than tap and inject in eyes with postcataract surgery endophthalmitis presenting with visual acuity of ≥HM.
Collapse
Affiliation(s)
| | - Sonali M Mehta
- Sadguru Netra Chikitsalaya and Post Graduate Institute of Ophthalmology, Chitrakoot
| | - Ashita Sule
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | | | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; and
| | - Dinesh Talwar
- Department of Vitreo-retina, Indraprastha Apollo Hospital & Centre for Sight, New Delhi
| |
Collapse
|
14
|
Kuhn F, Grzybowski A. When is vitrectomy for endophthalmitis needed? Acta Ophthalmol 2023; 101:8. [PMID: 36468294 DOI: 10.1111/aos.15245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/21/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, Alabama, USA.,Department of Ophthalmology, University of Pécs Medical School, Pécs, Hungary
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznań, Poland
| |
Collapse
|
15
|
Sasi S, Faraj H, Barazi R, Kolleri J, Chitrambika P, Rahman Al Maslamani MA, Ali M. Endogenous endophthalmitis due to Serratia marcescens secondary to late-onset empyema Post-Cardiac surgery in an End-Stage renal disease patient on peritoneal dialysis. Clin Case Rep 2023; 11:e6997. [PMID: 36852121 PMCID: PMC9957995 DOI: 10.1002/ccr3.6997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 01/18/2023] [Accepted: 02/12/2023] [Indexed: 02/27/2023] Open
Abstract
Endogenous bacterial endophthalmitis results from bacterial seeding of the eye during bacteremia. A diagnosis of endogenous bacterial endophthalmitis requires clinical findings such as vitritis or hypopyon along with positive blood cultures. Serratia marcescens is the second most common pathogen causing hospital-acquired ocular infections. This report describes a case of endogenous bacterial endophthalmitis caused by S. marcescens in an older adult with end-stage renal disease (ESRD) on peritoneal dialysis, who had late-onset pleural empyema secondary to coronary artery bypass grafting (CABG). A 61-year-old gentleman presented with a two-day history of cloudy vision, black floaters, pain, swelling, and gradual vision loss in his right eye. There was no history of trauma, ocular surgeries, or previous similar episodes. He had myocardial infarction treated with CABG 3 months back. Examination showed a 3 mm hypopyon in the anterior chamber. He had classic signs of endophthalmitis with positive blood cultures for S. marcescens. He was treated with high-dose intravenous meropenem and intravitreal ceftazidime without vitrectomy. Endophthalmitis progressed to complete vision loss in his right eye, requiring evisceration. Endophthalmitis caused by S. marcescens is rare, but long-term outcomes can be severe, causing complete vision loss in about 60% of the patients. It is usually hospital-acquired, and the source can be late-onset empyema several months after cardiac surgery, in an immunocompromised patient. Systemic antibiotics should be supplemented with intravitreal agents with or without pars plana vitrectomy.
Collapse
Affiliation(s)
- Sreethish Sasi
- Infectious Diseases Division, Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Hazem Faraj
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Raja Barazi
- Department of PharmacyHamad Medical CorporationDohaQatar
| | - Jouhar Kolleri
- Department of Clinical ImagingHamad Medical CorporationDohaQatar
| | - P. Chitrambika
- Department of AnesthesiologyHamad Medical CorporationDohaQatar
| | | | - Maisa Ali
- Infectious Diseases Division, Department of Internal MedicineHamad Medical CorporationDohaQatar
| |
Collapse
|
16
|
Najafabadi FF, Salehi A, Vaezi MH, Ghanbari H, Najafabadi MF, Koosha N, Jafarzadeh Z. Early Vitrectomy: An Effective Treatment for Acute Postcataract Surgery Endophthalmitis. Adv Biomed Res 2023; 12:79. [PMID: 37200764 PMCID: PMC10186043 DOI: 10.4103/abr.abr_44_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/07/2021] [Accepted: 04/28/2021] [Indexed: 05/20/2023] Open
Abstract
Background Endophthalmitis is a rare but a high morbid complication after cataract surgery, and a gold standard treatment is not recommended yet. In this study, we aim to evaluate the effect of early vitrectomy on the visual acuity of patients with postcataract endophthalmitis. Materials and Methods This study was a single-arm clinical trial on 27 patients with postcataract surgery endophthalmitis. Early vitrectomy was the intervention. Visual acuity as the primary outcome was evaluated and compared at baseline, at discharge, and 1 and 3 months after the intervention. Results From 27 patients who included in our study, six patients gain favorable visual acuity of 5/10 and above (success rate = 22%), and four of them have no improvement in their visual acuity. Retinal detachment was reported as a complication in just one case. Negative culture was a predictor for success in terms of visual acuity after the surgery. All patients who gain favorable results, presented in the first 15 days after the cataract surgery. Conclusion The result of our study showed that, considering complete, early vitrectomy for the treatment of postcataract surgery endophthalmitis, especially for those who presented in the first 15 days of cataract surgery and for those who have negative culture is promising.
Collapse
Affiliation(s)
- Farhad Fazel Najafabadi
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Salehi
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hadi Vaezi
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Address for correspondence: Dr. Mohammad Hadi Vaezi, Isfahan Eye Research Center, Feiz Hospital, Isfahan Univesity of Medical Sciences, Isfahan, Iran. E-mail:
| | - Heshmatollah Ghanbari
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Nima Koosha
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Jafarzadeh
- Department of Ophthalmology, Shahrekord University of Medical Sciences, Shahr-e Kord, Iran
| |
Collapse
|
17
|
Merani R, Johnson MW, McCannel CA, Flynn HW, Scott IU, Hunyor AP. Clinical Practice Update: Management of Infectious Endophthalmitis After Intravitreal Anti-VEGF Injection. JOURNAL OF VITREORETINAL DISEASES 2022; 6:443-451. [PMID: 37009541 PMCID: PMC9954776 DOI: 10.1177/24741264221116487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although infectious endophthalmitis after intravitreal antivascular endothelial growth factor injections is rare, it is the most feared and potentially devastating complication of this procedure. There is no high-level evidence to provide definitive guidance on the management of endophthalmitis occurring after intravitreal injection (IVI). This clinical practice update reviews the published literature regarding post-IVI endophthalmitis and highlights areas in which further research is needed to better guide its management.
Collapse
Affiliation(s)
- Rohan Merani
- Concord Repatriation General
Hospital, Sydney, NSW, Australia
- Save Sight Institute, Specialty
of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health,
University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health
Sciences, Macquarie University, Sydney, NSW Australia
| | - Mark W. Johnson
- Department of Ophthalmology and
Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI,
USA
| | - Colin A. McCannel
- UCLA Stein Eye Institute;
Department of Ophthalmology, David Geffen School of Medicine at UCLA,
University of California, Los Angeles, CA, USA
| | - Harry W. Flynn
- Department of Ophthalmology,
Bascom Palmer Eye Institute, Miami, FL, USA
| | - Ingrid U. Scott
- Departments of Ophthalmology and
Public Health Sciences, Penn State College of Medicine, Hershey,
Philadelphia, PA, USA
| | - Alex P. Hunyor
- Save Sight Institute, Specialty
of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health,
University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
18
|
Combined Therapeutic Penetrating Keratoplasty and Pars Plana Vitrectomy for the Treatment of Infectious Keratitis Endophthalmitis: Mexican Endophthalmitis Study Group Protocol 4. Cornea 2022:00003226-990000000-00110. [PMID: 36441843 DOI: 10.1097/ico.0000000000003114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to assess the role of combined surgical treatment of therapeutic penetrating keratoplasty and pars plana vitrectomy in the anatomical and functional outcome of infectious keratitis endophthalmitis. METHODS This study reviewed the medical records of 4 participating centers in the United States and Mexico. This study included patients with a clinical diagnosis of infectious keratitis endophthalmitis who had been treated with an early therapeutic penetrating keratoplasty and pars plana vitrectomy as the main treatment for endophthalmitis. From each medical record, the study retrieved demographic data, relevant medical and drug history, baseline clinical manifestation of endophthalmitis, best-corrected visual acuity, and the need for enucleation/evisceration for the control of the infection or any other reason through the follow-up. RESULTS The study included 48 patients (50.15 ± 20.6 years). The mean follow-up time was 13 ± 0.5 months. The mean best-corrected visual acuity at baseline was 2.1 ± 0.25 logarithm of the minimum angle of resolution. At month 12 was 2.09 ± 0.61 logarithm of the minimum angle of resolution ( P = 0.9). The overall prevalence of enucleation/evisceration was 8.3% (95% confidence interval: 2.32%-19.98%). The prevalence of a vision of no-light perception was 20.8% (95% confidence interval: 2.32%-19.98%). CONCLUSIONS Combined surgery for severe cases of infectious keratitis endophthalmitis eradicates the infection in most cases, while significantly improving the overall outcomes.
Collapse
|
19
|
Sen S, Kannan NB. Commentary: Usage of intravitreal steroids in endophthalmitis: Horns of a dilemma. Indian J Ophthalmol 2022; 70:2841-2842. [PMID: 35918924 PMCID: PMC9672774 DOI: 10.4103/ijo.ijo_3161_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sagnik Sen
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Naresh Babu Kannan
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| |
Collapse
|
20
|
Panigrahi PK, Minj A. Comment on: Real-life comparison of three intravitreal antibiotic drug regimens in endophthalmitis. Indian J Ophthalmol 2022; 70:3162. [PMID: 35919007 DOI: 10.4103/ijo.ijo_1181_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Pradeep K Panigrahi
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha O Anusandhan (deemed to be) University, Bhubaneswar, Odisha, India
| | - Anita Minj
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha O Anusandhan (deemed to be) University, Bhubaneswar, Odisha, India
| |
Collapse
|
21
|
Zou C, Zhang T, Wang X, Zhuang H, Jiang R. Treatment of long-term endophthalmitis developing after intraocular lens implantation in children: a retrospective study. BMC Ophthalmol 2022; 22:301. [PMID: 35820855 PMCID: PMC9277780 DOI: 10.1186/s12886-022-02519-3] [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: 04/29/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background To discussed the risk factor and the management of vitrectomy for long-term endophthalmitis developing after intraocular lens (IOL) implantation in children. Methods We retrospectively investigated the clinical characteristics and surgical outcomes of long-term endophthalmitis developing after IOL implantation in children. Results Four eyes of four children were included in the study. The mean time to endophthalmitis development after IOL implantation was 3.0 ± 0.8 years. The corneal or scleral sutures may have been caused the infection. All 4 patients underwent vitrectomy and received intravitreal antibiotics with or without IOL removal. At the last follow-up, the outcomes were satisfactory; the fundus was clear, the retina remained attached, the visual acuity improved, and there were no severe complications. Conclusions The use of scleral sutures and the exposure of conceal sutures may induce the onset of long-term endophthalmitis after IOL implantation. Complete vitrectomy and appropriate use of antibiotics are effective in the treatment of long-term endophthalmitis developing after IOL implantation in children.
Collapse
Affiliation(s)
- Chen Zou
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83# Fenyang Road, Shanghai, China
| | - Ting Zhang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83# Fenyang Road, Shanghai, China
| | - Xin Wang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83# Fenyang Road, Shanghai, China
| | - Hong Zhuang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83# Fenyang Road, Shanghai, China
| | - Rui Jiang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83# Fenyang Road, Shanghai, China.
| |
Collapse
|
22
|
The Diagnosis and Treatment of Fungal Endophthalmitis: An Update. Diagnostics (Basel) 2022; 12:diagnostics12030679. [PMID: 35328231 PMCID: PMC8947249 DOI: 10.3390/diagnostics12030679] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/26/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
In recent, large case series of fungal endophthalmitis (FE) that were published by Asian authors, the most frequent etiologic agents for all types of FE are molds (usually Aspergillus species, while Fusarium is the prevalent etiology in keratitis-related FE). Candida was the organism found in most cases of endogenous FE. However, we must keep in mind that prevalence of fungal species varies with the geographical area. Lately, polymerase chain reaction (PCR) was increasingly used for the diagnosis of FE, allowing for very high diagnostic sensitivity, while the costs become more affordable with time. The most important shortcoming of PCR—the limited number of pathogens that can be simultaneously searched for—may be overcome by newer techniques, such as next-generation sequencing. There are even hopes of searching for genetic sequences that codify resistance to antifungals. We must not forget the potential of simpler tests (such as galactomannan and β-d-glucan) in orienting towards a diagnosis of FE. There are few reports about the use of newer antifungals in FE. Echinocandins have low penetration in the vitreous cavity, and may be of use in cases of fungal chorioretinitis (without vitritis), or injected intravitreally as an off-label, salvage therapy.
Collapse
|
23
|
Sborgia G, Niro A, Pastore V, Favale RA, Sborgia A, Gigliola S, Giuliani G, Grassi MO, Coassin M, Aiello F, Iaculli C, Reibaldi M, Boscia F, Alessio G. Mid-term safety and effectiveness of intravitreal dexamethasone implant to treat persistent cystoid macular edema in vitrectomized eyes for bacterial endophthalmitis. Graefes Arch Clin Exp Ophthalmol 2022; 260:2703-2710. [PMID: 35254512 DOI: 10.1007/s00417-022-05615-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the mid-term safety and effectiveness of intravitreal dexamethasone implant (DEX-i) for treating unresponsive to medical therapy cystoid macular edema (CME) in vitrectomized eyes for endophthalmitis. METHODS Retrospective and interventional case series study conducted on vitrectomized eyes for endophthalmitis that developed a CME that did not adequately respond to medical therapy, who underwent 0.7-mg DEX-i. Main outcome measures were changes in central retinal thickness (CRT) and best corrected visual acuity (BCVA). RESULTS Eleven eyes were included in the study. Microbiological findings of vitreous biopsies were 7 (63.6%) staphylococcus epidermidis; 3 (27.3%) Pseudomonas aeruginosa; and 1 (9.1%) Propionibacterium acnes. Median (interquartile range, IqR) duration of CME was 4.0 (3.0-4.0) months. Median (IqR) time between vitrectomy and DEX-i was 9.0 (9.0-11.0) months. Median CRT was significantly decreased from 548.0 (412.8-572.5) µm at baseline to 308.0 (281.3-365.5) µm at month 6 (p = 0.0009, Friedman test). Median BCVA significantly improved from 38.0 (30.5-44.8) letters at baseline to 50.0 (46.8-53.0) letters at month 6 (p < 0.0001, Friedman), with 9 (81.8%) eyes gaining ≥ 10 letters. Elevation of intraocular pressure was observed in one (9.1%) eye, which was successfully controlled with medical therapy. No recurrence of endophthalmitis or other complications was observed. Eight (72.7%) eyes required an additional DEX-i, while 3 (27.3%) were successfully controlled with only one DEX-i. CME recurrence occurred in 5 (62.5%) Gram-positive and 3 (100.0%) Gram-negative bacteria (p = 0.2357). CONCLUSION In vitrectomized eyes for endophthalmitis affected by CME unresponsive to medical therapy, DEX-i had an acceptable safety profile and achieved favorable outcomes. The possibility of suppressing mechanisms for infection control should be taken into account, although correct management of endophthalmitis and long time without reactivation before DEX-i reduce the risk.
Collapse
Affiliation(s)
- Giancarlo Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "SS Annunziata", ASL Taranto, Via F. Bruno, 1, 74010, Taranto, Italy.
| | - Valentina Pastore
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Rosa Anna Favale
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Alessandra Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Samuele Gigliola
- Eye Clinic, Hospital "SS Annunziata", ASL Taranto, Via F. Bruno, 1, 74010, Taranto, Italy
| | - Gianluigi Giuliani
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Maria Oliva Grassi
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Marco Coassin
- Ophthalmology, University Campus Bio Medico of Rome, 00128, Rome, Italy
| | - Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Cristiana Iaculli
- Department of Ophthalmology, Policlinico Riuniti Di Foggia, University of Foggia, 71122, Foggia, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Torino, 10126, Turin, Italy
| | - Francesco Boscia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Giovanni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| |
Collapse
|
24
|
Tabatabaei SA, Aminzade S, Ahmadraji A, Soleimani M, Sefidan BB, Kasaee A, Cheraqpour K. Early and complete vitrectomy versus tap and inject in acute post cataract surgery endophthalmitis presenting with hand motion vision; a quasi-experimental study. BMC Ophthalmol 2022; 22:16. [PMID: 34998363 PMCID: PMC8742950 DOI: 10.1186/s12886-022-02247-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Based on endophthalmitis vitrectomy study, intravitreal injection of antibiotics is preferred for initial management of cases of acute post cataract surgery endophthalmitis (APCE) with presenting vision of hand motions (HM). This study aimed to compare outcomes of early and complete vitrectomy (VIT) and vitreous tap and antibiotic injection (T&I) in cases of APCE presented with vision of HM. METHODS In this prospective study, cases of APCE with vision of HM between 2018 and 2020 were enrolled. According to the time of presentation, the patients were arranged into two groups (VIT vs. T&I). Demographic data, elapsed time to developing endophthalmitis, past medical history, microbiology results, complications, and final visual acuity were recorded and analyzed. RESULTS Seventy-six eyes of 76 patients were enrolled. Fifty-three eyes underwent T&I and twenty-three were arranged into the VIT group. Past medical history of 34.2% of patients was significant for diabetes mellitus. There was a statistically significant lower logMAR in VIT group compared to T&I group (diff = 0.14, 95% CI: 0.04 to 0.24, P-value = 0.007). The comparison of the diabetic and non-diabetic patients in both groups showed that the visual outcome was better in non-diabetic cases compared to the diabetic subjects. There was no statistically significant difference between the diabetic and non-diabetic groups regarding the superiority of procedure. CONCLUSION Based on our results, we could recommend that it's maybe better to do early and complete vitrectomy as the initial management of APCE with the vision of HM. Past medical history of diabetes mellitus is not a determining factor for choosing initial management between vitrectomy and antibiotic injection.
Collapse
Affiliation(s)
- Seyed Ali Tabatabaei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Soran Aminzade
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Aliasghar Ahmadraji
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Mohammad Soleimani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Bahram Bohrani Sefidan
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Abolfazl Kasaee
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran.
| |
Collapse
|
25
|
Wakabayashi T, Miller SC, Patel SN, Fliotsos MJ, Justin GA, Agrawal R, Chen A, Hoskin AK, Blanch R, Cavuoto K, Meeralakshmi P, Rousselot Ascarza A, Chen RWS, Colyer M, Woreta FA, Yonekawa Y. Global Preferred Practice Patterns for the Management of Exogenous Endophthalmitis: A Survey by the American Society of Ophthalmic Trauma. Curr Eye Res 2021; 47:802-808. [PMID: 34886727 DOI: 10.1080/02713683.2021.2016857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE : To investigate the global practice patterns for the management of exogenous endophthalmitis. METHODS : This cross-sectional study was conducted to assess global practice patterns for the management of exogenous endophthalmitis. An online survey comprised of questions regarding the management of exogenous endophthalmitis was distributed to institutions who are members of International Globe and Adnexal Trauma Epidemiology Study Group (IGATES) or invited affiliates of the American Society of Ophthalmic Trauma and the Asia Pacific Ophthalmic Trauma Society. Responses were gathered from August 2020 to January 2021. RESULTS Of 42 institutions, 36 responses were received (86% response rate), of which 33 (79%) were included in the analysis. Included centers were from Asia (36%), North America (36%), South America (12%), Africa (9%), Europe (3%), and Australia (3%). Oral antibiotics were administered in 19 (58%) institutions, with moxifloxacin as the preferred agent (n=9, 27%). The preferred method for obtaining cultures was vitreous tap (n=25, 76%). Most institutions (n=26, 79%) routinely administered intravitreal vancomycin and ceftazidime, while intravitreal steroids were routinely administered at 11 centers (33%). Indications for performing vitrectomy included; decreased visual acuity (n=14, 39%); all cases of exogenous endophthalmitis (n=4, 12%); non-response to medical therapy (n=4, 12%); or no view of the fundus (n=4, 12%), indicating significant variation in surgical indications. More than half (n=17, 52%) of responding institutions routinely admitted patients with exogenous endophthalmitis to the hospital. Institutions in the United States were less likely to administer oral antibiotics (27% vs. 73%, P = 0.024) and to admit patients (9% vs. 73%, P < 0.001) compared to other countries. CONCLUSIONS : This study highlights the global variations in the management of exogenous endophthalmitis, especially as it pertains to surgical indications. Further establishment of evidence-based guidelines may be beneficial to provide more uniform guidance to optimize outcomes.
Collapse
Affiliation(s)
- Taku Wakabayashi
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University School of Medicine, Philadelphia, PA, USA
| | - Sarah C Miller
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Samir N Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University School of Medicine, Philadelphia, PA, USA
| | - Michael J Fliotsos
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Grant A Justin
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Singapore Eye Research Institute, Singapore.,Lee Kong Chian School of Medicine, Singapore
| | - Ariel Chen
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Annette K Hoskin
- Sight Institute, University of Sydney, Sydney. Australia and Lions Eye Institute, Sydney, Australia.,Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Richard Blanch
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Neuroscience & Ophthalmology Research Group, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Kara Cavuoto
- Bascom Palmer Eye Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Andrés Rousselot Ascarza
- Consultorios Oftalmológicos Benisek-Ascarza, Ciudad Autónoma de Buenos Aires, C1115ABB Buenos Aires, Argentina
| | - Royce W S Chen
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Marcus Colyer
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
26
|
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 [Response To Letter]. Clin Ophthalmol 2021; 15:3705-3707. [PMID: 34511874 PMCID: PMC8421778 DOI: 10.2147/opth.s334148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 11/23/2022] Open
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
| |
Collapse
|
27
|
Agrawal S. Complete and Early Vitrectomy for Endophthalmitis [Letter]. Clin Ophthalmol 2021; 15:3155-3156. [PMID: 34345162 PMCID: PMC8325011 DOI: 10.2147/opth.s327705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022] Open
|
28
|
Abstract
We recently co-authored a report on the ten-year (2007-2017) results achieved at our center (Retina Specialists of Alabama) in the treatment of Acute Post-Cataract Endophthalmitis (APCE). Of all eyes, 77.4% were initially treated with Complete and Early Vitrectomy for Endophthalmitis (CEVE). Visual acuity of ≥ 20/40 was restored in 79% of all eyes versus 53% of eyes reported in the Endophthalmitis Vitrectomy Study. We believe that CEVE is the initial treatment of choice whenever the fundus is obscured by endophthalmitis vitreous opacity.
Collapse
Affiliation(s)
- Robert E Morris
- Retina Specialists of Alabama, Birmingham, AL, USA.,Helen Keller Foundation for Research and Education, Birmingham, AL, USA
| | - Ferenc Kuhn
- Retina Specialists of Alabama, Birmingham, AL, USA.,Helen Keller Foundation for Research and Education, Birmingham, AL, USA.,University of Halle, Halle, Germany.,School of Medicine, University of Pécs, Pécs, Hungary
| |
Collapse
|