Post-traumatic endophthalmitis prophylaxis: a systematic review and meta-analysis

Purpose

The goal of this study is to determine if certain aspects of endophthalmitis prophylaxis strategies are superior to others.

Design

This investigation is a systematic review and meta-analysis.

Methods

All studies specifying a type of prophylaxis strategy and resulting rates of endophthalmitis were included. Time course, method of administration, and antibiotic regimen, and confounding factors were collected and included for meta-regression.

Results

Time courses greater than 24 h did not significantly improve outcomes. Likewise, intraocular and/or intravenous antibiotic administration methods did not significantly outperform oral administration. No antibiotic regimens performed differently from vancomycin/ ≥ 3rd generation cephalosporin except for ciprofloxacin monotherapy which yielded significantly worse outcomes.

Conclusions

Future antibiotic strategies should strongly consider the risks of antibiotic treatment > 24 h and administration methods other than the oral antibiotic forms. In addition, providers should be wary of using ciprofloxacin monotherapy for endophthalmitis prophylaxis when treating open globe injuries.

FROSTED BRANCH ANGIITIS IN METHIMAZOLE-INDUCED ANTINEUTROPHIL CYTOPLASMIC ANTIBODY-POSITIVE VASCULITIS

PURPOSE

To describe an unusual case of frosted branch angiitis that developed in a patient with acute onset systemic vasculitis possibly triggered by the antithyroid medication methimazole.

METHODS

We conducted a thorough review of the medical records of a 16-year-old female patient who presented with frosted branch angiitis. During the initial hospital admission, the patient underwent an extensive systemic workup to determine the etiology of her disease and ophthalmologic testing including fundus photographs and fluorescein angiography.

RESULTS

Our patient presented with a unilateral acute onset loss of vision, whose fundus examination revealed the pathognomonic features of frosted branch angiitis. Extensive systemic workup revealed an antineutrophilic cytoplasmic antibody-positive vasculitis, possibly triggered by methimazole.

CONCLUSION

This case is the first reported frosted branch angiitis associated with a drug-induced antineutrophilic cytoplasmic antibody-positive vasculitis triggered by methimazole.

Activated protein C resistance, factor V Leiden, and central retinal vein occlusion in young adults

OBJECTIVE

To confirm the relationship between resistance to activated protein C (APC), factor V Leiden, and central retinal vein occlusion in young adults as reported in a recent study of patients younger than 50 years.

PATIENTS AND METHODS

Patients younger than 50 years with central retinal vein occlusion were identified from the medical records of the Wills Eye Hospital Retina and Retina Vascular Services. Blood samples were taken from each patient and analyzed for resistance to APC and identification of factor V Leiden.

RESULTS

Only 1 (4.7%) of 21 patients evidenced resistance to APC and the presence of factor V Leiden. This patient was also the only one to report a family history of thrombotic disease.

CONCLUSIONS

We were unable to confirm the high percentage of resistance to ACP among young adult patients with central retinal vein occlusion. The finding of resistance to APC in only 1 (4.7%) of 21 patients is similar to that found in the general population.