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Ong AY, Rigaudy A, Toufeeq S, Robins J, Shalchi Z, Bindra MS, Charbel Issa P. Intravitreal injections as a leading cause of acute postoperative endophthalmitis-a regional survey in England. Eye (Lond) 2023; 37:163-169. [PMID: 34949787 PMCID: PMC9829718 DOI: 10.1038/s41433-021-01886-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 11/18/2021] [Accepted: 11/29/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND To evaluate the characteristics, treatment patterns and outcomes of acute postoperative endophthalmitis. METHODS Patients presenting with acute postoperative endophthalmitis between January 2017 to December 2019 were identified from hospital records in this multicentre retrospective cohort study. Clinical records were reviewed for visual acuity (VA) at various timepoints, cause of endophthalmitis, microbiological results, treatments and complications. RESULTS Forty-six eyes of 46 patients were included. Intravitreal injections were the leading cause of acute postoperative endophthalmitis (n = 29; 63%), followed by cataract surgery (n = 8; 17%), vitreoretinal surgery (n = 7; 15%), and secondary intraocular lens insertion (n = 2, 4%). The absolute risk of endophthalmitis was 0.024% (1:4132) for intravitreal injections, 0.016% (1:6096) for cataract surgery, and 0.072% (1:1385) for vitreoretinal surgery. The majority of patients (n = 38; 83%) had better VA at 6 months compared to presentation, although fewer (n = 13; 28%) maintained similar or better VA compared to before the precipitating surgery. Twenty-four cases yielded positive culture results, of which staphylococcus epidermidis was the most commonly isolated organism. Microbiological yield was not associated with better final visual outcomes. Patients who underwent therapeutic vitrectomy (n = 15; 33%) had poorer VA at presentation, but subsequently achieved visual outcomes comparable to those who received medical treatment alone. There was no difference in time to presentation, visual outcome and retinal detachment rates among the different causative procedures. CONCLUSION Intravitreal injections were the most common cause of endophthalmitis in our region, primarily because of their higher frequency compared to other intraocular procedures. In this cohort, the primary procedure had no effect on presentation, management or visual outcomes.
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Affiliation(s)
- Ariel Yuhan Ong
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Axelle Rigaudy
- Prince Charles Eye Unit, Royal Berkshire NHS Foundation Trust, Windsor, UK
| | - Shafak Toufeeq
- Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Julian Robins
- Milton Keynes University Hospital, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - Zaid Shalchi
- Prince Charles Eye Unit, Royal Berkshire NHS Foundation Trust, Windsor, UK
| | | | - Peter Charbel Issa
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
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Amadeo-Oreggioni GP, Ortiz-Ramirez GY, Baquero-Ospina P, Salcedo-Villanueva G, Fromow-Guerra JJ, Velez-Montoya R. Kocuria Endophthalmitis: Clinical Spectrum and Long-term Outcomes. Ocul Immunol Inflamm 2022; 30:1768-1774. [PMID: 34283674 DOI: 10.1080/09273948.2021.1951304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To expand the knowledge regarding the clinical presentation of Kocuria endophthalmitis. METHODS We included six cases of Kocuria endophthalmitis between January 2018 and December 2020. From all cases, we collected general demographic data, relevant medical, ophthalmological history, microbiological and antibiotic sensitivity results. All cases had a minimum follow-up of 9 months. All cases were treated with intravitreal moxifloxacin and dexamethasone and pars plana vitrectomy. Undiluted vitreous, corneal, conjunctival, and aqueous samples were cultured and analyzed with the Vitek 2 system. RESULTS The prevalence of Kocuria endophthalmitis was 6%. (95%CI: 2.26%-12.73%). The mean age at diagnosis was 60.5 ± 15.5 years. All patients had poor visual acuity, severe pain, and severe conjunctival hyperemia at diagnosis. Only one case had a significant improvement in visual acuity at the end of the follow-up. CONCLUSION Kocuria spp are an emerging cause of endophthalmitis and should be considered as part of the differential diagnosis.
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Affiliation(s)
| | | | - Pablo Baquero-Ospina
- Retina Department, Asociación Para Evitar Le Ceguera En México IAP, México City, Mexico
| | | | | | - Raul Velez-Montoya
- Retina Department, Asociación Para Evitar Le Ceguera En México IAP, México City, Mexico
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Al Busaidi A, Al-Hinai A. Postprocedural Endophthalmitis or Postprocedural Intraocular Inflammation: A Diagnostic Conundrum. Case Rep Ophthalmol 2021; 12:418-424. [PMID: 34054495 PMCID: PMC8136315 DOI: 10.1159/000511970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/02/2020] [Indexed: 11/19/2022] Open
Abstract
We experienced an atypical endophthalmitis occurring post consecutively performed in-office procedures; an intravitreal injection (IVI) of ranibizumab followed by an anterior chamber (AC) paracentesis performed twice in an eye with neovascular glaucoma (NVG). A 52-year-old diabetic male who was asymptomatic developed signs of endophthalmitis and decreased vision without pain in his left eye a few days post-IVI and AC paracentesis. The condition worsened after an initial vitreous tap and injection of antibiotics. Cultures of vitreous and aqueous samples were negative. Complete resolution occurred after a pars plana vitrectomy with IVI of antibiotics and steroid with removal of a dense “yellowish-brown” fibrinous plaque. The absence of pain, presence of a peculiar colored fibrin, mild-to-moderate vitritis without retinitis, negative cultures, and complete recovery despite the fulminant presentation; favor a diagnosis of inflammation over infection. We hypothesize that a micro-leak from a 26-gauge AC tap tract might have served as an entry port for 5% povidone-iodine from the ocular surface thus inciting inflammation. However, an exuberant inflammatory response that can be typically seen in NVG eyes after intraocular procedures cannot be excluded. Various causes of inflammation post-procedures, both toxic and nontoxic should be considered in atypical culture-negative fulminant endophthalmitis cases with good outcome posttreatment. Any minor ocular procedure may carry a risk of such complication. Patient counseling and care must be exercised in performing these procedures.
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Affiliation(s)
- Aisha Al Busaidi
- Department of Ophthalmology, Sultan Qaboos University Hospital, Al Khoudh, Oman
| | - Ahmed Al-Hinai
- Department of Ophthalmology, Sultan Qaboos University Hospital, Al Khoudh, Oman
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Bisorca-Gassendorf L, Januschowski K, Pérez Guerra N, Szurman P, Rickmann A. [Silicone oil droplets in the vitreous body after intravitreal injection]. Ophthalmologe 2021; 119:392-394. [PMID: 33687491 DOI: 10.1007/s00347-021-01358-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Lukas Bisorca-Gassendorf
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland.
| | - Kai Januschowski
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - Núria Pérez Guerra
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - Peter Szurman
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - Annekatrin Rickmann
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
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COMPARATIVE RISK OF ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTION WITH BEVACIZUMAB, AFLIBERCEPT, AND RANIBIZUMAB. Retina 2020; 39:2004-2011. [PMID: 30312260 DOI: 10.1097/iae.0000000000002351] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine whether sterile preloading of anti-vascular endothelial growth factor agents reduces the risk of postintravitreal injection endophthalmitis. METHODS This is a retrospective cohort study using medical claims data from a large, national US insurer. Cohorts were created using intravitreal injections of anti-vascular endothelial growth factor injections from 2005 to 2016. For inclusion, patients had to have at least 6 months of data before the injection and were excluded for any previous diagnosis of endophthalmitis, multiple injected drugs on the day of injection, or intraocular surgery within 15 days of the injection or between an injection and a diagnosis of endophthalmitis. The primary outcome was the odds of endophthalmitis after an intravitreal injection. RESULTS A total of 706,725 bevacizumab, 210,849 ranibizumab, and 177,731 aflibercept injections were given to 130,327 patients. Multivariate analysis showed that ranibizumab and aflibercept together had an increased odds of endophthalmitis (odds ratio = 1.29, 95% confidence interval: 1.04-1.59, P = 0.02) compared with bevacizumab. Individually, ranibizumab (odds ratio = 1.25, 95% confidence interval: 0.97-1.61, P = 0.08) and aflibercept (odds ratio = 1.34, 95% confidence interval: 0.99-1.81, P = 0.06) each had higher odds of endophthalmitis, but neither result met significance. Also, when compared with male patients, female patients had a higher odds of getting endophthalmitis (odds ratio: 1.30, 95% confidence interval: 1.05-1.61, P = 0.02). CONCLUSION The odds of endophthalmitis with aflibercept and ranibizumab combined were higher compared with the sterilely preloaded bevacizumab, arguing for a safety advantage of sterile preloading of anti-vascular endothelial growth factor injections.
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Sengillo JD, Chen Y, Perez Garcia D, Schwartz SG, Grzybowski A, Flynn HW. Postoperative Endophthalmitis and Toxic Anterior Segment Syndrome Prophylaxis: 2020 Update. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1548. [PMID: 33313293 PMCID: PMC7729369 DOI: 10.21037/atm-2019-rcs-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Improved surgical techniques have led to an increase in the number of outpatient ophthalmic procedures. In spite of decreased surgical times and overall improved outcomes, endophthalmitis remains one of the most severe complications of ophthalmic surgery. Although there are well known risk factors for postoperative endophthalmitis, some prophylaxis strategies remain controversial. A category of noninfectious postoperative inflammation, known as toxic anterior segment syndrome (TASS), is a rare but important complication of cataract surgery. While several worldwide outbreaks of TASS have occurred, it is challenging to identify an etiology in order to reduce the risk of further cases. Endophthalmitis and TASS cannot be prevented completely, but their rates may be decreased through risk reduction strategies supported by peer-reviewed evidence. This review highlights the current evidence in the prevention strategies for postoperative endophthalmitis and TASS.
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Affiliation(s)
- Jesse D Sengillo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ying Chen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Diley Perez Garcia
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephen G Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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VanderBeek BL, Bonaffini SG, Ma L. Association of compounded bevacizumab with postinjection endophthalmitis. JAMA Ophthalmol 2016; 133:1159-64. [PMID: 26270251 DOI: 10.1001/jamaophthalmol.2015.2556] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Current draft guidelines set forth by the US Food and Drug Administration for compounded or repackaged medications would greatly limit the availability and use of bevacizumab by ophthalmologists across the country. Little evidence beyond highly publicized case reports exists for or against the need for additional regulation of compounded bevacizumab. OBJECTIVE To determine whether the distribution of bevacizumab through compounding pharmacies increases the risk for endophthalmitis compared with the distribution of single-use vials of ranibizumab from the manufacturer. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study using medical claims data from ambulatory care centers across the United States that were submitted to a large, national US insurer. Cohorts were created using information on 530 382 intravitreal injections administered from January 1, 2005, through December 31, 2012. Any individual from this data set who received an intravitreal injection of bevacizumab or ranibizumab (n=383 810) and had at least 6 months of data before and 1 month after the injection was eligible. After exclusions (any previous diagnosis of endophthalmitis, multiple injected drugs given on the index day, or intraocular surgery within 15 days of the injection or between the injection and a diagnosis of endophthalmitis), our analysis involved 383 810 intravitreal injections given to 58 612 patients. Data collection and analysis occurred from February 16 through April 7, 2015. MAIN OUTCOMES AND MEASURES The odds of developing endophthalmitis after an intravitreal injection of bevacizumab compared with ranibizumab. RESULTS In total, 296 565 injections of bevacizumab were given to 51 116 patients and 87 245 injections of ranibizumab were given to 7496 patients. We found 71 cases of endophthalmitis (49 in the bevacizumab cohort and 22 in the ranibizumab cohort) for an endophthalmitis rate of 0.017% (95% CI, 0.012%-0.021%; 1 case per 6061 injections) for bevacizumab and 0.025% (95% CI, 0.015%-0.036%; 1 case per 3968 injections) for ranibizumab. After controlling for age, race, sex, injection-related diagnosis, and year of injection, we found no significant association with development of endophthalmitis after a bevacizumab injection compared with ranibizumab (odds ratio, 0.66 [95% CI, 0.39-1.09]; P = .11). CONCLUSIONS AND RELEVANCE The results of this study suggest bevacizumab as currently used across the United States does not increase the risk for endophthalmitis; therefore, additional regulations on the use of repackaged bevacizumab may be unnecessary.
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Affiliation(s)
- Brian L VanderBeek
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia2Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman S
| | - Sarah G Bonaffini
- currently a medical student at Lake Erie College of Osteopathic Medicine, Bradenton, Florida
| | - Liyuan Ma
- Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia
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AlHadlaq A, AlMalki S, AlShahwan S. Late onset endophthalmitis associated with unexposed glaucoma valved drainage device. Saudi J Ophthalmol 2015; 30:125-7. [PMID: 27330390 PMCID: PMC4908096 DOI: 10.1016/j.sjopt.2015.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/20/2015] [Accepted: 12/20/2015] [Indexed: 11/28/2022] Open
Abstract
We report an extremely rare presentation of late-onset endophthalmitis in a young adult patient with an unexposed Ahmed tube implant. The implant was inserted 11 years prior to presentation. There was no history of trauma or any obvious exposure on clinical examination and the tube plate was filled with purulent material. After aqueous and vitreous tap, the patient underwent intracameral, intravitreal subconjunctival antibiotic injections and was started on systemic antibiotics with good response. Endophthalmitis associated with tube drainage device can present as late as 11 years and even without an unexposed tube.
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Affiliation(s)
- Abdulaziz AlHadlaq
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Salem AlMalki
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Sami AlShahwan
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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