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Arboleda A, Durkee H, Miller D, Aguilar MC, Alawa K, Relhan N, Amescua G, Parel JM. Variations in irradiation energy and rose bengal concentration for photodynamic antimicrobial therapy of fungal keratitis isolates. Lasers Med Sci 2024; 39:72. [PMID: 38379056 DOI: 10.1007/s10103-024-04014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/02/2024] [Indexed: 02/22/2024]
Abstract
The purpose is to assess the efficacy of rose bengal photodynamic antimicrobial therapy (PDAT) using different irradiation energy levels and photosensitizer concentrations for the inhibition of fungal keratitis isolates. Seven different fungi (Aspergillus fumigatus, Candida albicans, Curvularia lunata, Fusarium keratoplasticum, Fusarium solani, Paecilomyces variotii, and Pseudallescheria boydii) were isolated from patients with confirmed infectious keratitis. Experiments were performed in triplicate with suspensions of each fungus exposed to different PDAT parameters including a control, green light exposure of 5.4 J/cm2, 2.7 J/cm2 (continuous and pulsed), and 1.8 J/cm2 and rose bengal concentrations of 0.1%, 0.05%, and 0.01%. Plates were photographed 72 h after experimentation, and analysis was performed to assess fungal growth inhibition. PDAT using 5.4 J/cm2 of irradiation and 0.1% rose bengal completely inhibited growth of five of the seven fungal species. Candida albicans and Fusarium keratoplasticum were the most susceptible organisms, with growth inhibited with the lowest fluence and minimum rose bengal concentration. Fusarium solani, Pseudallescheria boydii, and Paecilomyces variotii were inhibited by lower light exposures and photosensitizer concentrations. Aspergillus fumigatus and Curvularia lunata were not inhibited by any PDAT parameters tested. Continuous and pulsed irradiation using 2.7 J/cm2 produced similar results. Rose bengal PDAT successfully inhibits the in vitro growth of five fungi known to cause infectious keratitis. Differences in growth inhibition of the various fungi to multiple PDAT parameters suggest that susceptibilities to PDAT are unique among fungal species. These findings support modifying PDAT parameters based on the infectious etiology.
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Affiliation(s)
- Alejandro Arboleda
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Heather Durkee
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Darlene Miller
- Ocular Microbiology Laboratory, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
- Anne Bates Leach Eye Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mariela C Aguilar
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Karam Alawa
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nidhi Relhan
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Guillermo Amescua
- Anne Bates Leach Eye Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jean-Marie Parel
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA.
- Anne Bates Leach Eye Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA.
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Shrimali T, Malhotra S, Relhan N, Tak V, Choudhary SK, Gupta N, Singh AK. Streptococcus parasanguinis: An emerging pathogen causing neonatal endocarditis: A case report. Access Microbiol 2023; 5:acmi000576.v4. [PMID: 37424549 PMCID: PMC10323779 DOI: 10.1099/acmi.0.000576.v4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023] Open
Abstract
Background. The microbial infection of the endocardium, popularly known as Infective Endocarditis (IE), is typically classified on the basis of anatomy, valve nativity and its associated microbiology. As per the associated microbiology, Staphylococcus aureus is the most common microorganism responsible for the cause of IE. Even though, the Streptococcus group accounts for a smaller percentage of IE, however this doesn't give us the liberty of ignoring the high mortality and morbidity associated with this pathogen. Case presentation. We report an unusual case of neonatal sepsis, complicated with endocarditis, caused by penicillin resistant Streptococcus parasanguinis . The neonate however died of the same despite all efforts. The said baby was given birth by a mother with gestational diabetes mellitus. Conclusion High index of clinical suspicion and prompt diagnosis are the most important factors of patient management, especially in cases of life threatening neonatal infections. In such conditions a coordinated interdepartmental approach is very much needed.
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Affiliation(s)
- Twishi Shrimali
- Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan
| | - Shikhir Malhotra
- Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan
| | - Nidhi Relhan
- Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan
| | - Vibhor Tak
- Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan
| | | | - Neeraj Gupta
- Neonatology, All India Institute of Medical Sciences, Jodhpur, Rajathan
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Kokame GT, Yannuzzi NA, Shantha JG, Yamane M, Relhan N, Gross J, Ryan EH, Flynn HW. INVOLUTION OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION AFTER ENDOPHTHALMITIS. Retin Cases Brief Rep 2021; 15:495-499. [PMID: 30932994 PMCID: PMC6765457 DOI: 10.1097/icb.0000000000000866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To report patients who demonstrated an alteration in the clinical and optical coherence tomography features of neovascular age-related macular degeneration after resolution of endophthalmitis. METHODS Retrospective case series of the subsequent changes in the macula and need for anti-vascular endothelial growth factor therapy in patients with neovascular age-related macular degeneration who developed endophthalmitis after intravitreal injection. RESULTS The study included seven eyes of seven patients with follow-up ranging between 3 months and 11 years. The vitreous cultures (n = 7) before intravitreal antibiotic injection were the following: culture-negative (4) and coagulase-negative Staphylococcus (3). Initial treatment included vitreous tap and injection (4) and pars plana vitrectomy (3). In 5/7 eyes, the optical coherence tomography showed resolution of subretinal fluid and serous pigment epithelial detachment, and there was no additional anti-vascular endothelial growth factor treatment administered. CONCLUSION After successful treatment of endophthalmitis in patients with neovascular age-related macular degeneration, there was relative involution of the maculopathy and reduced anti-vascular endothelial growth factor treatment burden in this series.
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Affiliation(s)
- Gregg T Kokame
- Division of Ophthalmology, Department of Surgery, University of Hawaii School of Medicine, Honolulu, Hawaii
- The Retina Center at Pali Momi, Aiea, Hawaii
- Retina Consultants of Hawaii, Aiea, Hawaii
- Hawaii Macula and Retina Institute, Aiea, Hawaii
- John A. Burns School of Medicine, University of Hawaii School of Medicine, Honolulu, Hawaii
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jessica G Shantha
- The Retina Center at Pali Momi, Aiea, Hawaii
- Retina Consultants of Hawaii, Aiea, Hawaii
- Hawaii Macula and Retina Institute, Aiea, Hawaii
- Department of Ophthalmology, University of California San Francisco, Francis I. Proctor Foundation, San Francisco, California
| | - Maya Yamane
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jeffrey Gross
- Carolina Retina Center, Columbia, South Carolina; and
| | | | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Damasceno NA, Damasceno EF, Yannuzzi NA, Crane AM, Relhan N, Smiddy WE, Flynn HW. The Central Subfoveal Bouquet in Idiopathic Epiretinal Membranes. Clin Ophthalmol 2020; 14:2353-2359. [PMID: 32982149 PMCID: PMC7493214 DOI: 10.2147/opth.s254544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/27/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To report both the unoperated clinical course and the surgical outcomes of eyes with a central foveal bouquet (CB) secondary to idiopathic epiretinal membranes (iERMs). Design Retrospective, consecutive, and observational case series. Methods All patients examined between January 1, 2014, and December 31, 2019, for evaluation of epiretinal membrane with a CB lesion identified on spectral domain optical coherence tomography (SD-OCT) were included. Exclusion criteria included vitreoretinal comorbidities associated with secondary ERMs and an absence of CB lesions on SD-OCT. Patients were divided into two groups: those who were followed with observation (Group I) and those who received surgery (Group II). Each group had 3 different types of mechanical abnormalities of the CB previously described as cotton ball sign, subfoveal detachment, or acquired vitelliform lesion, without a subanalysis discrimination. Main Outcome Measures Best-corrected visual acuity (BCVA) at baseline and last follow-up, subjective metamorphopsia, central retinal thickness (CMT), mechanical stress lesions of the CB, and resolution or evolution of the CB lesions during the follow-up interval. Results Two hundred seventy-six eyes with iERM were reviewed, and 46 eyes met the inclusion criteria. Among these, 21 of 46 (46%) were observed, and 25 of 46 (54%) underwent surgery. Metamorphopsia was identified in 61.9% of patients in Group I and 81.2% of patients in Group II, at baseline. The mean BCVA was 0.19 ± 0.17 (20/30) in Group I and 0.31 ± 0.33 (20/40) in Group II at presentation. At the final exam, patients in Group I achieved a mean BCVA of 0.24 ± 0.18 (20/30), while patients in Group II obtained a mean BCVA of 0.15 ± 0.21 (20/30). Spontaneous resolution of the CB sign occurred in 5 of 21 eyes (23.8%) that were observed, whereas, after surgery, the CB sign resolved in 16 of 25 eyes (61.5%). Mean CMT was 422 ± 84.2μm in Group I and 531 ± 143.9μm in Group II, at baseline, while at the latest follow-up, the mean CMT was 400 ± 40.8μm in the cases followed with observation and 454 ± 148.7μm in the surgical cases. Conclusion The clinical course and surgical outcomes of CB findings in iERM are favorable in terms of visual acuity. However, those receiving surgery had an increase in visual acuity and resolution of the CB abnormality.
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Affiliation(s)
- Nadyr A Damasceno
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Ophthalmology, Hospital Naval Marcilio Dias, Rio de Janeiro, RJ, Brazil
| | - Eduardo F Damasceno
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Ophthalmology, Universidade Federal Fluminense, Niteroi, RJ, Brazil
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ashley M Crane
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Grzybowski A, Turczynowska M, Schwartz SG, Relhan N, Flynn HW. The Role of Systemic Antimicrobials in the Treatment of Endophthalmitis: A Review and an International Perspective. Ophthalmol Ther 2020; 9:485-498. [PMID: 32613591 PMCID: PMC7406615 DOI: 10.1007/s40123-020-00270-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Indexed: 12/11/2022] Open
Abstract
Background The optimal management of patients with endophthalmitis is challenging and includes both intravitreal and, in some cases, systemic antimicrobials. Systemic antimicrobials may be administered either intravenously or orally. In this article we review systemic antimicrobial options currently available for the treatment of types of endophthalmitis and the role of systemic antimicrobials (antibiotics and antifungals) in these treatments. Review While systemic antimicrobials are not universally utilized in the management of endophthalmitis, they may be helpful in some circumstances. The blood–retinal barrier affects the penetration of systemic medications into the posterior segment of the eye differently; for example, moxifloxacin and imipenem cross the blood–retinal barrier relatively easily while vancomycin and amikacin do not. However, inflammation, including endophthalmitis, may disrupt the blood–retinal barrier, enhancing the penetration of systemic agents into the eye. Conclusion Systemic antimicrobials may be particularly beneficial in patients with certain types of endophthalmitis; as such, they are standard treatment in the management of endogenous endophthalmitis (fungal and bacterial) and also widely used for prophylaxis and treatment of open-globe injuries. Although systemic antimicrobials are used in some patients with acute-onset postoperative endophthalmitis following cataract surgery, the literature generally does not support this practice. It is noted that there are currently no randomized clinical trials demonstrating a benefit of systemic antibiotics for any category of endophthalmitis.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Poznan, Poland
| | - Magdalena Turczynowska
- Department of Ophthalmology, Stefan Żeromski Specialist Municipal Hospital, Cracow, Poland
| | - Stephen G Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
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Naranjo A, Arboleda A, Martinez JD, Durkee H, Aguilar MC, Relhan N, Nikpoor N, Galor A, Dubovy SR, Flynn HW, Miller D, Parel JM, Amescua G, Leblanc R. Reply to Comment on: Rose Bengal Photodynamic Antimicrobial Therapy for Patients With Progressive Infectious Keratitis: A Pilot Clinical Study. Am J Ophthalmol 2020; 214:198-200. [PMID: 32276724 DOI: 10.1016/j.ajo.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/01/2020] [Indexed: 11/27/2022]
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7
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Damasceno EF, Damasceno NA, Crane AM, Yannuzzi NA, Relhan N, Smiddy WE, Flynn HW. The Clinical Course of Patients with Idiopathic Epiretinal Membranes and Good Visual Acuity Managed Without Surgery. Clin Ophthalmol 2019; 13:2469-2475. [PMID: 31853170 PMCID: PMC6914657 DOI: 10.2147/opth.s218662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/10/2019] [Indexed: 11/23/2022] Open
Abstract
Background/aims To report the clinical course of patients with idiopathic epiretinal membranes (iERMs) and good baseline best-corrected visual acuity (BCVA) managed without surgical treatment. Methods Retrospective, observational case series of patients with iERMs and 20/50 or better BCVA who did not undergo surgery between January 2014 and December 2017 with a 1-year follow-up. Secondary epiretinal membranes were excluded. iERMs were stratified into two groups: Group I (BCVA 20/30 or better) and Group II (BCVA 20/40 to 20/50). The main outcome measures included baseline and final follow-up BCVA, central macular thickness (CMT) on OCT. Results The study included 174 eyes (145 patients): 139 eyes (79.8%) had typical iERMs and 35 eyes (18%) had LMH. For Group I typical iERMs, the logMAR baseline and final mean BCVA were 0.09 ± 0.1 (Snellen equivalent 20/25) and 0.10 ± 0.1 (20/25+) respectively (p = 0.22). In this group, the baseline and final mean CMT were 335 ± 73µm and 342 ± 78µm, respectively (p = 0.47). For Group II typical iERMs, the logMAR baseline and final mean BCVA were 0.3 ± 0.1 (20/44) and 0.4 ± 0.2 (20/45) respectively (p = 0.31). In this group, the baseline and final mean CMT were 386 ± 95µm and 391 ± 93µm, respectively (p = 0.84). Conclusion The clinical course of patients with iERM and good baseline BCVA is generally favorable without surgery and includes stable BCVA and OCT measurements after at least one year.
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Affiliation(s)
- Eduardo F Damasceno
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA.,Department of Ophthalmology, Universidade Federal Fluminense, Niteroi, RJ, Brazil
| | - Nadyr A Damasceno
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA.,Department of Ophthalmology, Hospital Naval Marcilio Dias, Rio de Janeiro, RJ, Brazil
| | - Ashley M Crane
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
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Naranjo A, Arboleda A, Martinez JD, Durkee H, Aguilar MC, Relhan N, Nikpoor N, Galor A, Dubovy SR, Leblanc R, Flynn HW, Miller D, Parel JM, Amescua G. Rose Bengal Photodynamic Antimicrobial Therapy for Patients With Progressive Infectious Keratitis: A Pilot Clinical Study. Am J Ophthalmol 2019; 208:387-396. [PMID: 31493402 DOI: 10.1016/j.ajo.2019.08.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To report clinical outcomes of rose bengal photodynamic antimicrobial therapy (RB-PDAT) as an adjunct treatment for severe, progressive infectious keratitis. DESIGN Consecutive interventional case series. METHODS Patients with progressive infectious keratitis unresponsive to standard medical therapy underwent RB-PDAT at the Bascom Palmer Eye Institute from January 2016 through March 2018. RB-PDAT was performed by applying a solution of rose bengal (0.1% or 0.2% RB in balanced salt solution) to the de-epithelialized cornea for 30 minutes, followed by irradiation with a 6 mW/cm2 custom-made green LED source for 15 minutes (5.4 J/cm2). RESULTS The current study included 18 patients (7 male and 11 female) ranging from 17 to 83 years old. Acanthamoeba was the most frequent microbe (10/17; 59%), followed by Fusarium spp. (4/17; 24%), Pseudomonas aeruginosa (2/17; 12%), and Curvularia spp. (1/17; 6%); 1 patient had no confirmed microbiologic diagnosis. Main clinical risk factor for keratitis included contact lens wear (79%). The average area of epithelial defect prior to first RB-PDAT was 32 ± 27 mm2 and average stromal depth hyperreflectivity measured with anterior segment optical coherence tomography was 269 ± 75 μm. Successful RB-PDAT (avoidance of therapeutic keratoplasty) was achieved in 72% of the cases, with an average time to clinical resolution (decreased pain and inflammation with re-epithelialization and infiltrate resolution) of 46.9 ± 26.4 days after RB-PDAT. Time of follow-up after RB-PDAT was 13.3 ± 5.7 months. CONCLUSION RB-PDAT can be considered as an adjunct therapy for cases of severe, progressive infectious keratitis before performing a therapeutic keratoplasty.
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Brown K, Yannuzzi NA, Callaway NF, Patel NA, Relhan N, Albini TA, Berrocal AM, Davis JL, Fortun JA, Smiddy WE, Sridhar J, Flynn HW, Townsend JH. Surgical Outcomes Of Rhegmatogenous Retinal Detachment In Young Adults Ages 18-30 Years. Clin Ophthalmol 2019; 13:2135-2141. [PMID: 31802843 PMCID: PMC6827499 DOI: 10.2147/opth.s213042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 09/10/2019] [Indexed: 12/03/2022] Open
Abstract
Purpose The purpose of this study is to investigate associations with and surgical outcomes of rhegmatogenous retinal detachment (RRD) in young adults. Methods This is a retrospective consecutive case series of patients aged 18–30 years who underwent surgical repair for RRD between January 1, 2014 and December 1, 2016 at a university referral center. Results The current study includes 38 eyes with RRD. Documented high or moderate myopia was present in 28 (74%) eyes. Connective tissue disease was present in 3 (8%) eyes. Median pre-operative visual acuity (VA) was 20/70. Surgery was performed via scleral buckle (SB) alone in 27/38 (71%) and via combined SB and pars plana vitrectomy (SB/PPV) in 11/38 (29%) eyes. Single surgery anatomical success (SSAS) rate was 20/27 (74%) for SB and 7/11 (64%) for SB/PPV. The retina was reattached at last follow-up in 25/27 (93%) for SB and 11/11 (100%) for SB/PPV. The median postoperative VA was 20/40. Conclusion In the current study of young adults with RRD, the most common association was high or moderate myopia. Visual and anatomic outcomes at last follow-up were generally favorable.
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Affiliation(s)
- Karen Brown
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Natalia F Callaway
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nimesh A Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Thomas A Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Janet L Davis
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jorge A Fortun
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Justin H Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Elhusseiny AM, Relhan N, Smiddy WE. Docetaxel-induced maculopathy possibly potentiated by concurrent hydroxychloroquine use. Am J Ophthalmol Case Rep 2019; 16:100560. [PMID: 31650088 PMCID: PMC6804700 DOI: 10.1016/j.ajoc.2019.100560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 09/16/2019] [Accepted: 09/24/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose To report a case of bilateral non-leaking cystoid macular degeneration induced by docetaxel, possibly potentiated by hydroxychloroquine. Observations A 63-year-old female patient with a long-term history of rheumatoid arthritis controlled on hydroxychloroquine for 33 years with no evidence of retinopathy developed bilateral loss of vision after having been on docetaxel chemotherapy for breast cancer. Optical coherence tomography showed bilateral cystic maculopathy with no angiographic evidence of leakage on fluorescein angiography. The patient was treated conservatively with no further interventions. Marked improvement of the macular degeneration occurred over the subsequent 9 months, but without visual improvement, although a cataract likely confounded final visual acuity measurement. Conclusions and importance Docetaxel-induced maculopathy has been previously reported, but with only four case reports in literature, and most often in conjunction with concurrent therapies or conditions also known to cause macular edema. This is the first case report of docetaxel-induced maculopathy in a setting of hydroxychloroquine therapy which may possibly has potentiated the effect of docetaxel to induce maculopathy. Impaired transcellular retinal pigment epithelial transport might be the cause of non-leaking cystic maculopathy.
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Affiliation(s)
- Abdelrahman M Elhusseiny
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17 Street, Miami, FL, 33136, USA.,Department of Ophthalmology, Kasr Al Ainy School of Medicine, Cairo University, Egypt
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17 Street, Miami, FL, 33136, USA
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17 Street, Miami, FL, 33136, USA
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Affiliation(s)
- Emmett T Cunningham
- a Department of Ophthalmology , California Pacific Medical Center , San Francisco , California , USA.,b The Department of Ophthalmology , Stanford University School of Medicine , Stanford , California , USA.,c The Francis I. Proctor Foundation , UCSF School of Medicine , San Francisco , California , USA
| | - Harry W Flynn
- d Department of Ophthalmology , Bascom Palmer Eye Institute, University of Miami School of Medicine , Miami , Florida , USA
| | - Nidhi Relhan
- d Department of Ophthalmology , Bascom Palmer Eye Institute, University of Miami School of Medicine , Miami , Florida , USA
| | - Manfred Zierhut
- e Centre for Ophthalmology , University Tuebingen , Tuebingen , Germany
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Patel NA, Miller D, Relhan N, Alfonso EC, Flynn HW. Novel Use of Fluorescence In Situ Hybridization for the Rapid Identification of Microorganisms in Endophthalmitis and Keratitis. Ophthalmic Surg Lasers Imaging Retina 2019; 50:S9-S12. [PMID: 31100176 DOI: 10.3928/23258160-20190108-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/28/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate an application of fluorescence in situ hybridization (FISH) for the rapid identification of bacterial and fungal pathogens causing endophthalmitis and keratitis and compare time to detection with other laboratory methods. MATERIALS AND METHODS Culture-positive isolates obtained from vitreous and corneal samples were tested. Organisms tested were Staphylococcus aureus, coagulase-negative staphylococci, Pseudomonas aeruginosa, Candida albicans, C. glabrata, and C. parapsilosis. Inoculi were prepared to a final concentration between 1 × 102 colony-forming units (CFU)/mL to 1 × 108 CFU/mL. Samples were hybridized with peptide nucleic acid probes for pathogens using the QuickFISH protocol (AdvanDx; OpGen, Gaithersburg, MD), and the slides were read with fluorescence microscopy. RESULTS Of the 29 total isolates tested, 28 yielded positive identification. S. aureus was identified in four out of five vitreous samples, whereas coagulase-negative staphylococci were identified in all vitreous samples. Mixed staphylococci culture was identified in all samples. P. aeruginosa was identified in all six keratitis samples. C. albicans, C. glabrata, C. parapsilosis, and mixed fungal culture were identified respectively in eight of eight samples at minimal concentration of 1 × 104 CFU/mL. There were no false-negatives. Time to detection was 20 minutes after the 12- to 18-hour inoculation period and provided an identification 6 hours sooner than by polymerase chain reaction (PCR) and 1 to 2 days sooner than by routine culture. CONCLUSIONS This small study demonstrates the sensitive, specific, and rapid detection of gram-positive bacteria, gram-negative bacteria and fungi using FISH probes in isolates from endophthalmitis and keratitis samples. This method decreases time to identification and reduces labor intensity compared with routine PCR and culture methods. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:S9-S12.].
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Peterson JC, Durkee H, Miller D, Maestre-Mesa J, Arboleda A, Aguilar MC, Relhan N, Flynn HW, Amescua G, Parel JM, Alfonso E. Molecular epidemiology and resistance profiles among healthcare- and community-associated Staphylococcus aureus keratitis isolates. Infect Drug Resist 2019; 12:831-843. [PMID: 31043797 PMCID: PMC6469469 DOI: 10.2147/idr.s190245] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To characterize the molecular, epidemiological, and resistance profiles of methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) keratitis isolates. PATIENTS AND METHODS We used a combination of standard microbiological techniques and DNA microarray analysis to characterize the molecular and antibiotic resistance profiles of 75 Staphylococcus aureus keratitis isolates collected over an 11-year period (2006-2016). RESULTS Two major USA clonal complexes (CC), CC5 (n=30, 40%) and CC8 (n=28, 37.3%), accounted for 77.3% of the collected S. aureus isolates. USA100, traditionally healthcare associated (n=18/47, 38.3%), and USA300, traditionally community associated (n=12/47, 25.5%), were the dominant MRSA strains. Four (22.2%) of the USA100 MRSA isolates were recovered from patients with no prior healthcare exposure. Eleven (91.7%) of the USA300 isolates were recovered from patients with documented healthcare risk factors. MSSA isolates were polyclonal (n=13). Ninety-three percent of MSSA infections were of healthcare origin. Thirty-seven of 61 (60.6%) healthcare- and 11 of 14 (78.6%) community-associated strains were resistant to three or more antibiotic classes. Sixty-eight percent (n=51) of isolates harbored three of more resistance determinants (genes). The Panton-Valentine Leucocidin gene was detected in 11 (14.7%) of the study isolates. The majority (72.7%) of the strains were members of the USA300 MRSA clone. CONCLUSION Clonal complexes CC5 and CC8 were the most frequent clones detected among both the MSSA and the MRSA keratitis isolates. USA100 and USA300 clones were the dominant MRSA genotypes. The USA300 MRSA clone has become a leading cause of healthcare-associated keratitis in South Florida. The USA100 MRSA clone has emerged as an increasing cause of community-associated corneal infections in our outpatient population. This shifting epidemiology coupled with the increasing prevalence of multidrug resistance among both MSSA and MRSA keratitis is a cause of concern.
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Affiliation(s)
- Jeffrey C Peterson
- Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA
| | - Heather Durkee
- Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA
| | - Darlene Miller
- Anne Bates Leach Eye Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,
- Ocular Microbiology Laboratory, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,
| | - Jorge Maestre-Mesa
- Anne Bates Leach Eye Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,
- Ocular Microbiology Laboratory, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,
| | - Alejandro Arboleda
- Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mariela C Aguilar
- Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nidhi Relhan
- Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harry W Flynn
- Anne Bates Leach Eye Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,
| | - Guillermo Amescua
- Anne Bates Leach Eye Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,
| | - Jean-Marie Parel
- Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA
- Anne Bates Leach Eye Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,
| | - Eduardo Alfonso
- Anne Bates Leach Eye Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,
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Yannuzzi NA, Gregori NZ, Rosenfeld PJ, Relhan N, Patel NA, Si N, Miller D, Dubovy SR, Smiddy WE, Schwartz SG, Flynn HW. Endophthalmitis Associated With Intravitreal Injections of Anti-VEGF Agents at a Tertiary Referral Center: In-House and Referred Cases. Ophthalmic Surg Lasers Imaging Retina 2019; 49:313-319. [PMID: 29772041 DOI: 10.3928/23258160-20180501-04] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 11/01/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To report the incidence rates, causative organisms, and visual acuity (VA) outcomes in patients with endophthalmitis associated with intravitreal injection of anti-vascular endothelial growth factor inhibitors. PATIENTS AND METHODS Retrospective case series between 2005 and 2017. RESULTS The study included 39 eyes of 39 patients, including 27 (69%) referred and 12 (31%) institutional patients. The use of topical antibiotics after an injection was gradually phased out at the authors' institution, where the preinjection rate of all clinically suspected endophthalmitis was 0.013% (24 of 183,898). The most common isolates were coagulase-negative Staphylococcus and Streptococcus. A VA of 5/200 or better was achieved in 21 of 39 eyes (54%) overall and in two of 15 eyes (13%) infected with Streptococcus. CONCLUSIONS The rate of post-intravitreal injection endophthalmitis is low. Outcomes were generally poor, and the worst were associated with Streptococcus. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:313-319.].
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Stringham JD, Relhan N, Miller D, Flynn HW. Trends in Fluoroquinolone Nonsusceptibility Among Coagulase-Negative Staphylococcus Isolates Causing Endophthalmitis, 1995-2016. JAMA Ophthalmol 2019; 135:814-815. [PMID: 28617914 DOI: 10.1001/jamaophthalmol.2017.1826] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jack D Stringham
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida
| | - Nidhi Relhan
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida
| | - Darlene Miller
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida
| | - Harry W Flynn
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida
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Patel NA, Shah P, Yannuzzi NA, Ansari Z, Zaveri JS, Relhan N, Williams BK, Kuriyan AE, Henry CR, Sridhar J, Haddock L, Fortun JA, Albini TA, Davis JL, Flynn HW. Clinical outcomes of 4-point scleral fixated 1-piece hydrophobic acrylic equiconvex intraocular lens using polytetrafluoroethylene suture. Clin Ophthalmol 2018; 12:2145-2148. [PMID: 30425449 PMCID: PMC6205144 DOI: 10.2147/opth.s174211] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To report the visual outcomes and complications of scleral fixated intraocular lenses (IOLs) using Gore-Tex suture. Methods The current study is a retrospective noncomparative case series including patients who underwent scleral fixation of IOL (Akreos AO60) using Gore-Tex suture from August 2015 to March 2017 at a university teaching center. Primary outcome measures were visual acuity and complications at last follow-up. Results The current study included 49 eyes of 48 patients. Mean follow-up duration postsurgery was 6.9 months (range: 0.9–29.4 months). The indications for secondary IOL surgery were dislocated IOL in 16/49 (33%), subluxed IOL in 9/49 (18%), dislocated or subluxed crystalline lens in 9/49 (18%), traumatic cataract in 8/49 (16%), and complicated cataract surgery in 7/49 (14%). Mean best-corrected logMAR visual acuity improved from 1±0.7 (20/200 Snellen equivalent) preoperatively to 0.5±0.5 (20/63 Snellen equivalent) at last follow-up. There were no intraoperative complications noted. Early postoperative complications included significant persistent corneal edema (longer than 1 week) in 4/49 (8.2%), ocular hypertension (intraocular pressure ≥25 mmHg) in 8/49 (16.3%), hypotony (intraocular pressure ≤5 mmHg) in 6/49 (12.2%), cystoid macular edema 3/21 (6.1%), IOL tilt 2/49 (4.1%), hyphema in 2/49 (4.1%), and vitreous hemorrhage in 5/49 (4.8%). There was one case of recurrent retinal detachment. One patient presented with an erosion of the Gore-Tex suture through the conjunctiva resulting in a purulent scleritis 6 months after the initial surgery, and was managed with removal of the IOL, debridement, and cryotherapy. Forty-one of 49 patients completed 3-month follow-up, among which visual acuity improved, deteriorated, or remained same compared to baseline in 27/49 (55.1%), 8/49 (16.3%), and 6/49 (12.2%) eyes, respectively. Conclusion In the current study, visual acuity outcomes were generally favorable. The complications were largely transient. Significant complications included a suture-related infection, which required removal of the IOL, and a recurrence of a retinal detachment.
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Affiliation(s)
- Nimesh A Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA,
| | - Parth Shah
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA,
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA,
| | - Zubair Ansari
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA,
| | - Jill S Zaveri
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA,
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA,
| | - Basil K Williams
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA,
| | - Ajay E Kuriyan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA,
| | - Christopher R Henry
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA,
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA,
| | - Luis Haddock
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA,
| | - Jorge A Fortun
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA,
| | - Thomas A Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA,
| | - Janet L Davis
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA,
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA,
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Hinkle JW, Relhan N, Flynn HW. Lipemia Retinalis, Macular Edema, and Vision Loss in a Diabetic Patient with a History of Type IV Hypertriglyceridemia and Pancreatitis. Case Rep Ophthalmol 2018; 9:425-430. [PMID: 30386228 PMCID: PMC6206964 DOI: 10.1159/000493384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/30/2018] [Indexed: 12/13/2022] Open
Abstract
Background Lipemia retinalis is a rare but known complication of elevated serum triglycerides. This case describes the clinical course of a diabetic patient who presented with lipemia retinalis and macular edema, which responded to systemic and local treatments. Case Report A 40-year-old female with a history of type II diabetes mellitus, hypertriglyceridemia, and pancreatitis presented with decreased vision in the left eye. She had peripapillary and macular edema, intraretinal hemorrhages, and prominent exudates in the setting of lipemia retinalis due to type IV hypertriglyceridemia. She was treated with serial intravitreal bevacizumab injections for macular edema and systemic lipid lowering therapy, and her visual acuity improved back to baseline. Conclusions In the setting of lipemia retinalis and hypertriglyceridemia, the current patient developed macular edema and vision loss. The macular edema was treated with intravitreal injections of bevacizumab, and the patient experienced a rapid recovery of visual acuity.
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Affiliation(s)
- John W Hinkle
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nidhi Relhan
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Harry W Flynn
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Russell JF, Scott NL, Hinkle JW, Yannuzzi NA, Miller D, Relhan N, Flynn HW. Endogenous Endophthalmitis: Has the Opioid Crisis Impacted the Rates and Severity of Intravenous Drug-Related Cases? ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2474126418788498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Endogenous endophthalmitis is an intraocular infection associated with systemic illness and/or intravenous drug use (IVDU). Rising national rates of IVDU may have impacted rates and outcomes of endogenous endophthalmitis. The purpose of the current study is to compare rates and treatment outcomes in endogenous endophthalmitis with and without a history of IVDU. Methods: This is a single-center retrospective consecutive case series of 21 eyes of 17 patients with a diagnosis of endogenous endophthalmitis from May 2014 to December 2016. Clinical characteristics and treatment outcomes were compared between IVDU and non-IVDU groups. Results: A history of IVDU was present in 3 of 17 patients (18%), whereas the other 82% had systemic comorbidities. There was no statistically significant difference in presenting visual acuity (VA) between the IVDU and non-IVDU groups (20/630 vs 20/500, P = .75). Pars plana vitrectomy was performed at some point in the clinical course of 80% of eyes (4/5) in the IVDU group and 56% of eyes (9/16) in the non-IVDU group. Staphylococcus or Candida were the predominant causative organisms isolated in the IVDU and non-IVDU groups. Statistical analyses revealed trends towards worse last VA in the non-IVDU group compared with the IVDU group (20/1000 vs 20/110, P = .10). Conclusions: Compared with historical data from the same institution, there has not been an increase in the rates of IVDU-associated endogenous endophthalmitis at this tertiary referral center. VA outcomes are often poor in both groups, but there may be a better prognosis for IVDU-associated endogenous endophthalmitis.
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Affiliation(s)
- Jonathan F. Russell
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Nathan L. Scott
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - John W. Hinkle
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Nicolas A. Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Darlene Miller
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
| | - Harry W. Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, FL, USA
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Palioura S, Relhan N, Leung E, Chang V, Yoo SH, Dubovy SR, Flynn HW. Delayed-onset Candida parapsilosis cornea tunnel infection and endophthalmitis after cataract surgery: Histopathology and clinical course. Am J Ophthalmol Case Rep 2018; 11:109-114. [PMID: 29998210 PMCID: PMC6038826 DOI: 10.1016/j.ajoc.2018.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/09/2018] [Accepted: 06/18/2018] [Indexed: 11/06/2022] Open
Abstract
Purpose To describe a patient with late post-operative endophthalmitis and clear cornea tunnel infection caused by Candida parapsilosis that was masquerading as chronic anterior uveitis. Observations A 62-year old woman with history of uncomplicated cataract surgery 7 months prior and chronic postoperative anterior uveitis, presented with an endothelial plaque, hypopyon, and infiltrates in the capsular bag and within the clear corneal tunnel. Anterior chamber cultures identified C. parapsilosis and pathology of the endothelial plaque showed fungus. Anterior chamber washout, scraping of the endothelial plaque, serial intracameral and intravitreal injections with amphotericin B (10 mcg) failed to control the infection. Pars plana vitrectomy, removal of the intraocular lens and capsular bag, a corneal patch graft, and administration of intravitreal antifungal agents were performed. One year later the patient remains free of recurrence and her best-corrected vision is 20/25 with a rigid gas permeable contact lens. Conclusions and Importance: Persistent intraocular and intracorneal inflammation after cataract surgery should raise suspicion of endophthalmitis caused by fungi non-responsive to topical and intravitreal antibiotics. Surgical intervention and removal of the nidus of infection, which is often the intraocular lens and capsular bag, may be necessary for a successful outcome.
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Affiliation(s)
- Sotiria Palioura
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ella Leung
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Victoria Chang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonia H Yoo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sander R Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Brown KR, Dubovy SR, Relhan N, Flynn HW. Clinicopathologic Correlation of a Subretinal Proliferative Vitreoretinopathy Band in a Patient with Chronic Recurrent Retinal Detachment. Case Rep Ophthalmol 2018; 9:279-282. [PMID: 29928223 PMCID: PMC6006635 DOI: 10.1159/000488931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/04/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose Proliferative vitreoretinopathy is a well-known cause of failure of retinal detachment surgery. The purpose of this case report is to illustrate the clinical occurrence and histopathology of a horizontal subretinal band (“clothesline” configuration) creating recurrent and persistent retinal detachment. Observations A 67-year-old Hispanic female with diabetes type 2 and a history of retinal detachment surgery in the left eye (OS) presented with decreased vision OS. Best corrected visual acuity at this recent presentation was 20/80 OS. Clinical examination disclosed a recurrent inferior retinal detachment and a subretinal “clothesline” fibrotic band. Surgical removal of the subretinal band was performed. Histopathological evaluation of longitudinal and transverse sections of the band revealed a cable-like configuration composed predominantly of glial differentiation, RPE differentiation, and collagen, based on morphology and immunohistochemical staining. There was focal smooth muscle and neuroendocrine cell differentiation, as detected with smooth muscle actin (SMA) and S100 staining, respectively. Cross-sections demonstrated pigmented fibrocellular tissue with foci of cells staining positive for S100 and keratin peripherally around the tissue, suggestive of RPE differentiation. Scattered foci of SMA-positive cells suggested mild myoblastic differentiation. Conclusions and Importance This case report presents further information on the structure and orientation of the cellular components of subretinal band proliferative vitreoretinopathy. Cells suggestive of Müller cell differentiation compose the central aspect of the band, alongside collagen fibers. RPE differentiation is variably present peripherally in the band, likely reflective of proliferating RPE encircling the subretinal fibrous tissue. A mild amount of myofibroblastic differentiation was present within the band of tissue, correlating with the clinical findings of subretinal tissue contraction and localized retinal detachment.
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Affiliation(s)
- Karen R Brown
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Sander R Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
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Medina CA, Ortiz AG, Relhan N, Smiddy WE, Townsend JH, Flynn HW. Reply. Retina 2018; 38:e30-e31. [DOI: 10.1097/iae.0000000000002061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE To report historically evolving strategies (then and now) in prevention and management of endophthalmitis. DESIGN A perspective on relevant topics in the prophylaxis and management of endophthalmitis. METHODS This is an author-selected review of studies leading to changes in strategies for endophthalmitis management over the last 100 years. RESULTS The current perspective discusses the trends and strategies over the past century. Historically, 3 endophthalmitis time-periods have existed and include the pre-antimicrobial era, the predominantly systemic antimicrobial era, and the current intravitreal antimicrobial era. The management of endophthalmitis from different etiologies, including endogenous, postinjection, post-cataract surgery, and other anterior segment-related (eg, post-penetrating keratoplasty), bleb-associated, glaucoma drainage device-associated, and open globe injury-associated, are discussed. Specific etiologies may predict most common microbial causes and may guide differing management strategies. Pars plana vitrectomy offers theoretical advantages but is generally reserved for patients with more advanced disease. CONCLUSIONS Despite advances over the past 100 years, endophthalmitis is an important sight-threatening complication. Timely management with the appropriate use of antimicrobial agents may optimize visual outcomes.
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Affiliation(s)
- Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Richard K Forster
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Kothari N, Relhan N, Flynn HW. Optical coherence tomography angiography showing perifoveal capillary stability 30 years after fluorescein angiography. Am J Ophthalmol Case Rep 2018; 9:31-33. [PMID: 29468214 PMCID: PMC5786860 DOI: 10.1016/j.ajoc.2017.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 11/01/2017] [Accepted: 12/18/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - Harry W. Flynn
- Corresponding author. Bascom Palmer Eye Institute, 900 NW 17th Avenue, Miami, FL 33136, USA.Bascom Palmer Eye Institute900 NW 17th AvenueMiamiFL33136USA
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Shivaramaiah HS, Relhan N, Pathengay A, Mohan N, Flynn HW. Endophthalmitis caused by gram-positive bacteria resistant to vancomycin: Clinical settings, causative organisms, antimicrobial susceptibilities, and treatment outcomes. Am J Ophthalmol Case Rep 2018; 10:211-214. [PMID: 29552670 PMCID: PMC5854869 DOI: 10.1016/j.ajoc.2018.02.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 02/14/2018] [Accepted: 02/26/2018] [Indexed: 12/27/2022] Open
Abstract
Purpose To report the clinical settings, causative organisms, antimicrobial susceptibilities, and treatment outcomes of patients with endophthalmitis caused by gram-positive bacteria resistant to vancomycin. Methods Retrospective case series of all patients with culture-proven endophthalmitis caused by gram-positive bacteria resistant to vancomycin between January 2010 and December 2016 in LV Prasad Eye Institute, Visakhapatnam, India. Results The current study included 14 patients. The clinical settings were post-cataract surgery in 8/14 (57.1%) and open globe injury in 6/14 (42.8%). Primary intervention for all patients included tap and intravitreal antibiotic injection. During subsequent follow-up, pars plana vitrectomy was performed in 6 patients and one patient underwent penetrating keratoplasty. Mean number of intravitreal antibiotic injections performed were 3.4 per patient. The most common organisms isolated were coagulase-negative Staphylococci in 6/14 (42.8%), Staphylococcus aureus in 5/14 (35.7%), Streptococcus sp in 2/14 (14.2%) and Bacillus sp in 1/14 (7.14%). In addition to vancomycin, resistance to multiple drugs (three or more groups of antibiotics) was found in all 14 cases. Antimicrobial susceptibility results showed susceptibility to amikacin in 7/14 (50.0%), gatifloxacin in 6/14 (42.8%), moxifloxacin in 3/13 (23.0%), cefazoline in 5/14 (35.7%), cefuroxime in 3/14 (21.4%), ciprofloxacin in 2/14 (14.2%) and linezolid in 5/5 (100%). The mean duration of follow-up was 30.7 weeks (6 weeks–90 weeks). At last follow-up, visual acuity (VA) of 20/200 or better was recorded in 7/14 (50%) and VA < 5/200 occurred in 7/14 (50%). Conclusion and importance Antimicrobial susceptibility testing may help in selection of suitable antimicrobial agents for repeat intravitreal injection. Inspite of retreatment with intravitreal antibiotics, these patients generally had poor VA outcomes.
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Affiliation(s)
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Avinash Pathengay
- Retina and Uveitis Services, LV Prasad Eye Institute, Visakhapatnam, 530013, India
| | - Nitin Mohan
- Microbiology Services, LV Prasad Eye Institute, Visakhapatnam, 530013, India
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
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Grzybowski A, Schwartz SG, Matsuura K, Ong Tone S, Arshinoff S, Ng JQ, Meyer JJ, Liu W, Jacob S, Packer M, Lutfiamida R, Tahija S, Roux P, Malyugin B, Urrets-Zavalia JA, Crim N, Esposito E, Daponte P, Pellegrino F, Graue-Hernandez EO, Jimenez-Corona A, Valdez-Garcia JE, Hernandez-Camarena JC, Relhan N, Flynn HW, Ravindran RD, Behnding A. Endophthalmitis Prophylaxis in Cataract Surgery: Overview of Current Practice Patterns Around the World. Curr Pharm Des 2017; 23:565-573. [PMID: 27981903 DOI: 10.2174/1381612822666161216122230] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/08/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acute-onset postoperative endophthalmitis after cataract surgery remains a rare but important cause of visual loss. There is no global consensus regarding the optimal strategies for prophylaxis of endophthalmitis and practices vary substantially around the world, especially with respect to the use of intracameral antibiotics. The European Society of Cataract & Refractive Surgeons in a randomized clinical trial (2007) reported an approximately 5-fold reduction in endophthalmitis rates associated with the use of intracameral cefuroxime. Despite this report, the use of intracameral antibiotics has not been universally adopted. METHODS Various endophthalmitis prophylaxis patterns around the world (including the United States, Canada, Australia/New Zealand, Japan, China, India, Indonesia, South Africa, Argentina, Russia, Sweden and Mexico) are compared. Each contributing author was asked to provide similar information, including endophthalmitis rates based on published studies, current practice patterns, and in some cases original survey data. Various methods were used to obtain this information, including literature reviews, expert commentary, and some new survey data not previously published. RESULTS Many different practice patterns were reported from around the world, specifically with respect to the use of intracameral antibiotics. CONCLUSION There is no worldwide consensus regarding endophthalmitis prophylaxis with cataract surgery.
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Affiliation(s)
- Andrzej Grzybowski
- Professor of Ophthalmology, Department of Ophthalmology Poznan City Hospital, Ul. Szwajcarska 3, 60- 285, Poznan. Poland
| | - Stephen G Schwartz
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn. Poland
| | - Kazuki Matsuura
- Department of Ophthalmology, Nojima Hospital, Tottori. Japan
| | - Stephan Ong Tone
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON. United States
| | - Steve Arshinoff
- Division of Ophthalmology, McMaster University, Hamilton, ON. Canada
| | - Jonathon Q Ng
- Eye and Vision Epidemiology Research Group, The University of Western Australia Perth. Australia
| | - Jay J Meyer
- Department of Ophthalmology, University of Auckland. New Zealand
| | - Wu Liu
- Department of Ophthalmology, Beijing Tongren Hospital Eye Center, Capital Medical University Beijing. China
| | | | - Mark Packer
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon. United States
| | | | | | - Paul Roux
- Visionmed Eye and Laser Clinic, Johannesburg. South Africa
| | - Boris Malyugin
- S. Fyodorov Eye Microsurgery State Institution, Moscow. Russian Federation
| | - Julio A Urrets-Zavalia
- Department of Ophthalmology, University Clinic Reina Fabiola, Catholic University of Cordoba. Argentina
| | - Nicolas Crim
- Department of Ophthalmology, University Clinic Reina Fabiola, Catholic University of Cordoba. Argentina
| | - Evangelina Esposito
- Department of Ophthalmology, University Clinic Reina Fabiola, Catholic University of Cordoba. Argentina
| | - Pablo Daponte
- Argentine Council of Ophthalmology, Buenos Aires. Argentina
| | - Fernando Pellegrino
- Department of Ophthalmology, Santa Lucia Hospital, University of Buenos Aires. Argentina
| | | | - Aida Jimenez-Corona
- Instituto de Oftalmologia Fundacion Conde de Valenciana, Mexico City. Mexico
| | | | | | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL. United States
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL. United States
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Yannuzzi NA, Patel NA, Relhan N, Tran KD, Si N, Albini TA, Berrocal AM, Davis JL, Smiddy WE, Townsend J, Miller D, Flynn HW. Clinical Features, Antibiotic Susceptibilities, and Treatment Outcomes of Endophthalmitis Caused by Staphylococcus epidermidis. Ophthalmol Retina 2017; 2:396-400. [PMID: 31047321 DOI: 10.1016/j.oret.2017.08.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To report the clinical features, antibiotic susceptibilities, and visual acuity outcomes with endophthalmitis caused by methicillin-sensitive Staphylococcus epidermidis and methicillin-resistant S. epidermidis. DESIGN Retrospective case series. PARTICIPANTS All patients seeking treatment at a tertiary referral center between 2006 and 2016 with endophthalmitis caused by S. epidermidis. METHODS All records were reviewed for patients with a clinical diagnosis of endophthalmitis and positive vitreous culture results for S. epidermidis. Data were compared with the prior series at the same institution. MAIN OUTCOME MEASURES Clinical settings, antibiotic susceptibilities, and visual acuity. RESULTS Among 96 eyes of 96 patients, the most common postprocedural clinical settings were cataract surgery (47/96 [49%]), intravitreal injection (21/96 [22%]), trauma (8/96 [8%]), glaucoma surgery (7/96 [7%]), and penetrating keratoplasty (5/96 [5%]). The initial treatment included intravitreal vancomycin and ceftazidime in 89 of 96 eyes (93%) and intravitreal vancomycin and amikacin in 7 of 96 eyes (7%). A vitreous tap and injection with antibiotics was performed as the initial treatment in 83 of 96 eyes (86%) and pars plana vitrectomy was performed in 13 of 96 eyes (14%). All isolates were sensitive to vancomycin in both decades. In the most recent series, visual acuity at last follow-up was 5/200 or better in 68 of 96 eyes (71%) compared with 71 of 86 eyes (83%) in the prior study. In the current study, susceptibility to methicillin and moxifloxacin was present in 45 of 96 eyes (47%) and 29 of 85 eyes (34%), respectively, compared with 34 of 86 eyes (40%) and 27 of 39 eyes (69%) in the prior study. Final visual acuity was not significantly different between those eyes that were methicillin or fluoroquinolone sensitive and those that were resistant. CONCLUSIONS In the current and prior series, all S. epidermidis isolates were sensitive to vancomycin. Visual acuity outcomes were not dependent on methicillin or fluoroquinolone sensitivity.
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Affiliation(s)
- Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nimesh A Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Kimberly D Tran
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nancy Si
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Thomas A Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Janet L Davis
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Justin Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Darlene Miller
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Relhan N, Schwartz SG, Grzybowski A, Flynn HW. Re: Haripriya et al.: Endophthalmitis reduction with intracameral moxifloxacin prophylaxis: an analysis of 600 000 surgeries ( Ophthalmology . 2017;124:768-775). Ophthalmology 2017; 124:e77-e78. [DOI: 10.1016/j.ophtha.2017.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/17/2017] [Indexed: 11/24/2022] Open
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Dave VP, Pathengay A, Relhan N, Sharma P, Jalali S, Pappuru RR, Tyagi M, Narayanan R, Chhablani J, Das T, Flynn HW. Endophthalmitis and Concurrent or Delayed-Onset Rhegmatogenous Retinal Detachment Managed With Pars Plana Vitrectomy, Intravitreal Antibiotics, and Silicone Oil. Ophthalmic Surg Lasers Imaging Retina 2017; 48:546-551. [PMID: 28728182 DOI: 10.3928/23258160-20170630-05] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/01/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The current study describes the treatment outcomes in patients with endophthalmitis and concurrent or delayed-onset retinal detachment managed with pars plana vitrectomy, intravitreal antibiotics, and silicone oil. PATIENTS AND METHODS In this noncomparative, retrospective case series, the medical records of patients diagnosed with endophthalmitis and retinal detachment from January 1991 through December 2014 at a tertiary eye care center in South India were reviewed. All patients received silicone oil for the management of retinal detachment either concurrently or during follow-up treatment. RESULTS A total of 93 patients were included in the current study. Retinal detachment was diagnosed at presentation in 20 of 93 patients (21.5%) (concurrent group: Group 1) and during follow-up in the remaining 73 of 93 patients (78.5%) (delayed-onset group: Group 2). In Group 1, the initial treatment consisted of vitrectomy, intravitreal antibiotics, and silicone oil injection in 19 of 20 patients. In Group 2, patients did not receive silicone oil during initial treatment but underwent silicone oil injection during subsequent surgery for repair of retinal detachment. Rates of complete retinal reattachment and visual acuity of 20/400 or better were 73.7% and 30.0%, respectively, in Group 1 and 98.5% and 39.7%, respectively, in Group 2. The median visual acuity at last follow-up in 44 eyes undergoing silicone oil removal was 20/100 (logMAR 0.7), whereas in the remaining 49 eyes that did not undergo silicone oil removal, median visual acuity was 20/2000 (logMAR 2.0). CONCLUSION In these patients with endophthalmitis with concurrent or delayed-onset retinal detachment, the use of silicone oil can be a useful adjunct. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:546-551.].
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McClellan AJ, Daubert JJ, Relhan N, Tran KD, Flynn HW, Gayer S. Comparison of Regional vs. General Anesthesia for Surgical Repair of Open-Globe Injuries at a University Referral Center. Ophthalmol Retina 2017; 1:188-191. [PMID: 28944317 DOI: 10.1016/j.oret.2016.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE This study compares the clinical features and physician selection of either Regional Anesthesia (peribulbar or retrobulbar block) with Monitored Anesthesia Care (RA-MAC) or General Anesthesia (GA) for open globe injury repair. DESIGN A non-randomized, comparative, retrospective case series at a University Referral Center. PARTICIPANTS All adult repairable open globe injuries receiving primary repair between January 1st, 2004 and December 31st, 2014 (11 years). Exclusion criteria were patients less than 18 years of age and those treated with primary enucleation. METHODS Data was gathered via retrospective chart review. MAIN OUTCOME MEASURES Data collected from each patient was age, gender, injury type, location, length of wound, presenting visual acuity, classification of anesthesia used, duration of the procedure performed, months of clinical follow-up, and final visual acuity. RESULTS During the 11 years study period, 448 patients were identified who had open globe injuries with documented information on zone of injury. Globe injury repair was performed using RA-MAC in 351/448 (78%) patients and general anesthesia in 97/448 (22%) patients. Zone 1, 2 and 3 injuries were recorded in 241, 135, and 72 patients respectively. The rates in specific zones, of RA-MAC versus GA were as follows: Zone 1 - 213/241 (88%) vs 28/241 (12%), Zone 2 - 104/135 (77%) vs 31/135 (23%) and Zone 3 - 34/72 (47%) vs 38/72 (53%). Open globe injuries repaired under RA-MAC had significantly shorter wound length (p<0.001), more anterior wound location (p<0.001) and shorter operative times (p<0.001). RA-MAC cases also had a better presenting and final visual acuity (p<0.001). Neither class of anesthesia conferred a greater visual acuity improvement (p=0.06). The use of GA did not cause any delay in the time elapsed from injury until surgical repair (p=0.74). CONCLUSIONS RA-MAC is a reasonable alternative to GA for the repair of open globe injuries in selected adult patients. RA-MAC was selected more often for Zone 1 and Zone 2 injuries. For eyes with Zone 3 injuries, there are equal selection ratio for RA-MAC and GA.
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Affiliation(s)
- Andrew J McClellan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th Street, Miami, Florida, USA 33133
| | - Jacquelyn J Daubert
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th Street, Miami, Florida, USA 33133
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th Street, Miami, Florida, USA 33133
| | - Kimberly D Tran
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th Street, Miami, Florida, USA 33133
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th Street, Miami, Florida, USA 33133
| | - Steven Gayer
- Department of Anesthesiology, University of Miami, Miller School of Medicine, 1611 NW 12th Ave, Miami, FL 33136
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Pathengay A, Panchal B, Choudhury H, Basu S, Relhan N, Flynn HW. A novel clinical sign in intraocular tuberculosis: Active chorioretinitis within chorioretinal atrophy. Am J Ophthalmol Case Rep 2017; 7:59-61. [PMID: 29152599 PMCID: PMC5687513 DOI: 10.1016/j.ajoc.2017.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Purpose To report a novel clinical sign in patients with intraocular tuberculosis. The current study is an observational consecutive case series of patients diagnosed with intraocular tuberculosis managed at a tertiary eye care centre from June 1, 2012 to December 31, 2015. Observations The diagnosis of intraocular tuberculosis was made in 6 patients based on ocular features suggestive of tuberculosis along with a positive tuberculin skin testing and chest X-ray consistent with tuberculosis. All patients presented with decreased visual acuity ranging from 20/25 to 20/400, anterior chamber reaction, vitritis, multifocal choroiditis and vasculitis. All patients had an area of active chorioretinitis within the zone of pre-existing chorioretinal atrophy, apart from various other signs suggestive of intraocular inflammation. All patients were started on anti-tubercular therapy for a period of 9 months alone or in combination with oral corticosteroids tapered over 3–4 months. A prompt response to the treatment with resolution of chorioretinitis within the chorioretinal atrophy occurred in all patients. In addition, there was resolution of vitritis and improvement in the visual acuity ranging from 20/20 to 20/40 at last follow-up. Conclusions and importance and Importance: Active chorioretinitis within an area of chorioretinal atrophy is a novel clinical sign that may indicate intraocular tuberculosis.
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Affiliation(s)
- Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Stephen G Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Patel N, Miller D, Relhan N, Flynn HW. Peptide Nucleic Acid-Fluorescence In Situ Hybridization for Detection of Staphylococci From Endophthalmitis Isolates: A Proof-of-Concept Study. Invest Ophthalmol Vis Sci 2017; 58:4307-4309. [PMID: 28800650 PMCID: PMC5555249 DOI: 10.1167/iovs.17-21535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Rapid identification of pathogens causing endophthalmitis may improve treatment outcomes through early administration of species-specific medication. The current study reports a new molecular application of peptide nucleic acid–fluorescence in situ hybridization (PNA-FISH) with Staphylococcus-specific molecular PNA probes for the potential rapid detection of common pathogens causing endophthalmitis. Methods An experimental study was designed to evaluate the proof of concept at the microbiology laboratory of the Bascom Palmer Eye Institute. Stored culture-positive staphylococci endophthalmitis isolates obtained from prior vitreous samples (n = 15), along with broth as negative controls (n = 5) were used. Inoculum was prepared to a final concentration of 1 × 105 colony-forming units/mL to ensure that the isolates were viable. Smears of samples were fixed and hybridized using QuickFISH protocol with probes for Staphylococcus. Results With PNA-FISH technique, Staphylococcus aureus was identified in 9 of 10 samples and coagulase-negative staphylococci were identified in 10 of 10 samples. Detection time was 20 minutes. Conclusions This study serves a proof of concept using a new microbial detection system with FISH probes, and may have the potential for clinical use in the rapid and accurate identification of isolates from patients with endophthalmitis.
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Affiliation(s)
- Nimesh Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Darlene Miller
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
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Banker TP, McClellan AJ, Wilson BD, Juan FM, Kuriyan AE, Relhan N, Chen FV, Weichel ED, Albini TA, Berrocal AM, Sridhar J, Gregori NZ, Townsend JH, Flynn HW. Culture-Positive Endophthalmitis After Open Globe Injuries With and Without Retained Intraocular Foreign Bodies. Ophthalmic Surg Lasers Imaging Retina 2017; 48:632-637. [DOI: 10.3928/23258160-20170802-05] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/02/2017] [Indexed: 11/20/2022]
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Kasi SK, Grant S, Flynn HW, Albini TA, Relhan N, Heier JS, Gayer S, Garg SJ. Venous Air Embolism During Pars Plana Vitrectomy: A Case Report and Review of the Literature. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/2474126417718097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Purpose: Presumed venous air embolism (PVAE) is a rare and potentially fatal complication of pars plana vitrectomy that is poorly described and understood but requires improved awareness among ophthalmologists and vitreoretinal surgeons. Methods: A case report is presented along with a systematic review of published reports of PVAE during ocular surgery. Results: An otherwise healthy adult male undergoing retinal detachment repair under local anesthesia with monitored anesthesia care died from a PVAE. Literature search yielded 2 experimental models, 6 individual case reports, and several editorials. Review of existing reports reveals that PVAE can affect patients of any age or gender with no medical predilection and occurs in cases of trauma, endoresection, or retinal detachment repair. It is typically associated with a drop in end-tidal carbon dioxide during fluid–air exchange and can present similar to a hemorrhagic choroidal detachment. Analysis suggests that venous air embolism can be prevented by ensuring full engagement of the infusion cannula into the vitreous cavity prior to fluid–air exchange. Conclusion: Presumed venous air embolism is a potentially fatal complication of ocular surgery and in some cases may be recognized by ophthalmologists as a choroidal detachment during fluid–air exchange in pars plana vitrectomy. It is imperative to immediately stop the air infusion line if venous air embolism is suspected.
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Affiliation(s)
- Sundeep K. Kasi
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, and Thomas Jefferson University, Philadelphia, PA, USA
| | - Scott Grant
- Retina Consultants of Orange County, Fullerton, CA, USA
| | - Harry W. Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, FL, USA
| | - Thomas A. Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, FL, USA
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, FL, USA
| | - Jeffrey S. Heier
- Ophthalmic Consultants of Boston and Tufts University School of Medicine, Boston, MA, USA
| | - Steven Gayer
- Department of Anesthesiology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, FL, USA
| | - Sunir J. Garg
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, and Thomas Jefferson University, Philadelphia, PA, USA
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Schwartz SG, Relhan N, O'Brien TP, Flynn HW. A New Complication Associated with the Use of Prophylactic Intracameral Antibiotics: Hemorrhagic Occlusive Retinal Vasculitis. Ophthalmology 2017; 124:578-579. [DOI: 10.1016/j.ophtha.2017.01.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 12/22/2016] [Accepted: 01/09/2017] [Indexed: 01/07/2023] Open
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Yannuzzi NA, Si N, Relhan N, Kuriyan AE, Albini TA, Berrocal AM, Davis JL, Smiddy WE, Townsend J, Miller D, Flynn HW. Endophthalmitis After Clear Corneal Cataract Surgery: Outcomes Over Two Decades. Am J Ophthalmol 2017; 174:155-159. [PMID: 27889501 DOI: 10.1016/j.ajo.2016.11.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/11/2016] [Accepted: 11/14/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the clinical features, causative organisms, and visual acuity (VA) outcomes associated with acute-onset endophthalmitis after clear corneal cataract surgery over the past 2 decades. DESIGN Retrospective case series. METHODS Clinical and microbiology records were reviewed for 63 eyes of 63 patients who presented to a tertiary referral center between 2006 and 2015 with culture-positive endophthalmitis occurring within 6 weeks of clear corneal cataract surgery. RESULTS The mean time between surgery and diagnosis of endophthalmitis was 8 days (median 6 days). The initial treatment included intravitreal vancomycin and ceftazidime in 59 of 63 (94%) eyes and intravitreal vancomycin and amikacin in 4 of 63 (6%) eyes. Intravitreal dexamethasone was used in 50 of 63 (79%) eyes. A vitreous tap and injection with antibiotics was performed as the initial treatment in 57 of 63 (90%) eyes and pars plana vitrectomy in 6 of 63 (10%) eyes. Coagulase-negative Staphylococcus was isolated in 39 of 63 (62%) eyes, Staphylococcus aureus in 7 of 63 (11%) eyes, and Streptococcus species in 7 of 63 (11%) eyes. A VA of ≥20/40 was achieved in 24 of 63 (38%) eyes. None of the gram-positive isolates were vancomycin resistant. Twenty-four of 49 isolates (49%) were sensitive to cephalothin, cefazolin, and cefuroxime. Sensitivity to fluoroquinolones included 22 of 52 (42%) to levofloxacin, 20 of 54 (37%) to ciprofloxacin, 16 of 47 (34%) to moxifloxacin, and 3 of 13 (23%) to gatifloxacin. CONCLUSION Causative organisms and visual outcomes are similar to those reported in the prior decade. In the current study, a number of isolates were resistant to cephalosporins and fluoroquinolones.
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Affiliation(s)
- Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nancy Si
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Ajay E Kuriyan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Thomas A Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Janet L Davis
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Justin Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Darlene Miller
- Department of Microbiology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Abstract
PURPOSE To present the management options for vitreomacular traction (VMT) and to recommend an individualized approach to treatment selection. DESIGN Presented at the American Academy of Ophthalmology Annual Meeting, 2016, Chicago, October 15, 2016 (The Charles Schepens Lecture). PARTICIPANTS None. METHODS Review of published literature and clinical trials. MAIN OUTCOME MEASURES Visual and anatomic outcomes of various treatment options for VMT were reviewed. RESULTS The management options for VMT include pars plana vitrectomy, pneumatic vitreolysis, enzymatic vitreolysis, and observation. The surgical management using pars plana vitrectomy offers the most effective approach for VMT, but there are inherent risks and cost issues. Pneumatic vitreolysis is reported to be cost-effective and may be an anatomically successful nonsurgical option for management. Enzymatic vitreolysis with intravitreal ocriplasmin is another nonsurgical option, but both short- and long-term side effects may occur. Observation in selected patients can be associated with stable visual outcomes during long-term follow-up. CONCLUSIONS The final management decision should be individualized for specific patients depending on the patient's clinical findings, potential risks, probable benefits, and costs of each option.
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Affiliation(s)
- Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida
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Relhan N, Albini TA, Pathengay A, Kuriyan AE, Miller D, Flynn HW. Endophthalmitis caused by Gram-positive organisms with reduced vancomycin susceptibility: literature review and options for treatment. Br J Ophthalmol 2015; 100:446-52. [PMID: 26701686 DOI: 10.1136/bjophthalmol-2015-307722] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/28/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Endophthalmitis caused by Gram-positive organisms with reduced vancomycin susceptibility and/or resistance is an important clinical issue worldwide. PURPOSE To review the published literature on endophthalmitis caused by Gram-positive organisms with reduced vancomycin susceptibility and/or vancomycin resistance. METHODS The data were analysed from a PubMed search of endophthalmitis cases caused by Gram-positive organisms with reported reduced vancomycin susceptibility and/or vancomycin resistance from 1990 to 2015. RESULTS From 18 publications identified, a total of 27 endophthalmitis cases caused by Gram-positive organisms with reduced vancomycin susceptibility and/or vancomycin resistance were identified. The aetiologies of endophthalmitis were exogenous in 19/27 cases (11 post-cataract surgery, 2 post-penetrating keratoplasty, 1 post-glaucoma surgery, 4 post-open globe injury, 1 post-intravitreal injection of ranibizumab), and endogenous in 4/24 cases; no details were available about the four remaining patients. The causative organisms included Enterococcus species (7/27), coagulase-negative staphylococci (4/27), Staphylococcus aureus (4/27), Bacillus species (4/27), Streptococcus species (3/27), Leuconostoc species (3/27), Staphylococcus hominis (1/27), and unidentified Gram-positive cocci (1/27). Visual acuity of 20/400 or better at the final follow-up was recorded in 10/26 patients (38.5%; data were not available for one patient). Treatment options include fluoroquinolones, penicillin, cephalosporins, tetracyclines, and oxazolidinones. CONCLUSIONS In the current study, visual acuity outcomes were generally poor. Enterococcus and Staphylococcus species were the most common organisms reported and postoperative endophthalmitis after cataract surgery was the most common clinical setting.
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Affiliation(s)
- Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Thomas A Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Avinash Pathengay
- Retina and Uveitis Department, L V Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, Andha Pradesh, India
| | - Ajay E Kuriyan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Darlene Miller
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Relhan N, Jalali S, Pehre N, Rao HL, Manusani U, Bodduluri L. High-hyperopia database, part I: clinical characterisation including morphometric (biometric) differentiation of posterior microphthalmos from nanophthalmos. Eye (Lond) 2015; 30:120-6. [PMID: 26493039 DOI: 10.1038/eye.2015.206] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 09/04/2015] [Indexed: 11/09/2022] Open
Abstract
UNLABELLED PURPOSE To characterise and differentiate posterior microphthalmos (PM) and nanophthalmos (NO) using morphometric parameters.Patients and methodsConsecutive case database of patients with hyperopia >+7.00 D sphere was analysed retrospectively for clinical and biometric characterisation. Thirty-eight consecutive high-hyperopic subjects (75 eyes) with axial lengths <20.5 mm underwent uniform comprehensive ocular evaluation. Twenty-five subjects were diagnosed as PM and 13 as NO based on the horizontal corneal diameter. Parameters analysed included visual acuity, refraction, horizontal corneal diameter, anterior chamber depth, lens thickness, axial length, fundus changes, and associated ocular pathology. PRIMARY OUTCOME MEASURES ocular biometry difference between PM and NO. SECONDARY OUTCOME MEASURES differences in associated ocular pathologies between PM and NO.RESULTS Hyperopia ranged from +7 to +17 D and was similar in the two groups. Lens thickness was statistically more in NO than in PM group (4.53±0.75 mm vs 3.82±0.48 mm, P <0.001), whereas anterior chamber depth was more in the PM than in NO group (3.26±0.36 mm, vs 2.59±0.37 mm, P<0.001). NO had higher association with angle-closure glaucoma (66.7% vs 0%) and pigmentary retinopathy (38.5 vs 8.0%) but lesser association with macular folds (0% vs 24%) as compared with PM. NO was associated with poorer visual acuity.CONCLUSION PM and NO have significant differences in lens thickness, anterior chamber depth, prevalence of glaucoma, pigmentary retinopathy, macular pathology, and visual acuity while being similar in hyperopic refraction.
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Affiliation(s)
- N Relhan
- Srimati Kannuri Santhamma Centre for Vitreo- Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - S Jalali
- Srimati Kannuri Santhamma Centre for Vitreo- Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - N Pehre
- Kode Venkatadri Chowdary, David Brown Children's Eye Care Centre, L V Prasad Eye Institute, Tadigadapa, Vijayawada, India
| | - H L Rao
- Center for Clinical Epidemiology and Biostatistics, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - U Manusani
- Srimati Kannuri Santhamma Centre for Vitreo- Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - L Bodduluri
- Srimati Kannuri Santhamma Centre for Vitreo- Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
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Relhan N, Pathengay A, Raval V, Nayak S, Choudhury H, Flynn HW. Clinical experience in treatment of diffuse unilateral subretinal neuroretinitis. Clin Ophthalmol 2015; 9:1799-805. [PMID: 26491239 PMCID: PMC4599188 DOI: 10.2147/opth.s86989] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the clinical features, management, and outcomes of patients with diffuse unilateral subacute neuroretinitis (DUSN). Methods A noncomparative, consecutive analysis of case series from two tertiary care campuses of LV Prasad Eye Institute, India, between January 2011 and April 2014 was performed. Medical records of the patients presenting with DUSN (early or late stage) were reviewed. Results The current study included 13 patients. The majority (10/13, 76.92%) of the patients were aged 20 years or less. All patients had unilateral eye involvement. Visual acuity at presentation was 20/200 or worse in 9/13 (69.23%) patients. A delay in diagnosis occurred in 6/13 patients, and initial diagnosis in these patients included retinitis pigmentosa (4 patients) and posterior uveitis (2 patients). Clinical features included early presentation (prominent vitritis, localized retinitis, and vasculitis) in 7/13 (53.85%) patients and late presentation (attenuation of vessels, retinal pigment epithelium atrophic changes, and optic atrophy) in 6/13 (46.15%) patients. Worm could not be identified in any of the cases. All the patients received laser photocoagulation of retina and oral albendazole treatment for a period of 30 days. With treatment, visual acuity improved in seven patients (six early stage, one late stage) and remained unchanged in six patients. Mean follow-up period was 8.69 months (range, 1–21 months). The mean central foveal thickness in the affected eye, done by optical coherence tomography, during the late stage of the disease was 188.20±40 µm (range, 111–242 µm), which was significantly thinner than the fellow eye, 238.70±36.90 µm (range, 186–319 µm), P=0.008. Conclusion DUSN is a serious vision threatening disease, which may progress to profound vision loss in the later stage of the disease. Visualization of subretinal worm is usually not possible. Treatment with high-dose albendazole therapy and laser photocoagulation may alter the blood–retinal barrier and may be useful in achieving visual recovery.
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Affiliation(s)
- Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA ; Kode Venkatadri Chowdry Campus, Vijayawada, Andhra Pradesh, India
| | - Avinash Pathengay
- Kode Venkatadri Chowdry Campus, Vijayawada, Andhra Pradesh, India ; Retina and Uveitis Services, LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, Andhra Pradesh, India
| | - Vishal Raval
- Kode Venkatadri Chowdry Campus, Vijayawada, Andhra Pradesh, India
| | - Sameera Nayak
- Kode Venkatadri Chowdry Campus, Vijayawada, Andhra Pradesh, India
| | - Himadri Choudhury
- Retina and Uveitis Services, LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, Andhra Pradesh, India
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Abstract
Diabetic retinopathy is a common microvascular complication of diabetes mellitus. It affects a substantial proportion of US adults over age 40. The condition is a leading cause of visual loss. Much attention has been given to expanding the role of current treatments along with investigating various novel therapies and drug delivery methods. In the treatment of diabetic macular edema (DME), intravitreal pharmacotherapies, especially anti-vascular endothelial growth factor (anti-VEGF) agents, have gained popularity. Currently, anti-VEGF agents are often used as first-line agents in center-involved DME, with recent data suggesting that among these agents, aflibercept leads to better visual outcomes in patients with worse baseline visual acuities. While photocoagulation remains the standard treatment for proliferative diabetic retinopathy (PDR), recent FDA approvals of ranibizumab and aflibercept in the management of diabetic retinopathy associated with DME may suggest a potential for pharmacologic treatments of PDR as well. Novel therapies, including small interfering RNAs, chemokines, kallikrein-kinin inhibitors, and various anti-angiogenic agents, are currently being evaluated for the management of diabetic retinopathy and DME. In addition to these strategies, novel drug delivery methods such as sustained-release implants and refillable reservoir implants are either under active evaluation or have recently gained FDA approval. This review provides an update on the novel developments in the treatment of diabetic retinopathy.
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Affiliation(s)
| | - Stephen G. Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136, USA
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Churgin D, Relhan N, Davis JL, Albini TA. Perivascular hypofluorescence in frosted branch angiitis. Ophthalmic Surg Lasers Imaging Retina 2015; 46:396-7. [PMID: 25856830 DOI: 10.3928/23258160-20150323-30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/28/2014] [Indexed: 11/20/2022]
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Hegde S, Relhan N, Pathengay A, Bawdekar A, Choudhury H, Jindal A, Flynn HW. Coexisting choroidal neovascularization and active retinochoroiditis-an uncommon presentation of ocular toxoplasmosis. J Ophthalmic Inflamm Infect 2015; 5:22. [PMID: 26185543 PMCID: PMC4499335 DOI: 10.1186/s12348-015-0051-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/22/2015] [Indexed: 11/10/2022] Open
Abstract
Background Choroidal neovascularization during the active stage of Toxoplasma retinochoroiditis is an uncommon clinical presentation. The authors retrospectively reviewed medical charts of patients with coexisting choroidal neovascular membrane and active Toxoplasma retinochoroiditis. Findings Three patients presented with coexisting choroidal neovascular membrane and active Toxoplasma retinochoroiditis. All lesions had adjacent subretinal hemorrhage. The diagnosis was confirmed based on clinical presentation, fundus fluorescein angiography (FFA), and optical coherence tomography (OCT) findings. The patients were managed with a combination of treatments including intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), oral anti-Toxoplasma treatment, and oral corticosteroids. In all patients, the retinitis lesion resolved in 6 weeks and the coexisting choroidal neovascular membrane resolved over 6 to 12 weeks. Conclusions Recurrences in Toxoplasma retinochoroiditis are common as satellite lesions adjacent to an old atrophic scar. Coexisting choroidal neovascularization with active Toxoplasma retinochoroiditis is an important presentation and should be suspected in the presence subretinal hemorrhage and managed with a combination of anti-Toxoplasma treatment and intravitreal anti-VEGF.
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Affiliation(s)
- Sharat Hegde
- GMRV Campus, LV Prasad Eye Institute, Visakhapatnam, India
| | - Nidhi Relhan
- Retina and Uveitis services, GMR Varalakshmi Campus, 11-113/1, Hanumantha waka Junction, Visakhapatnam, 530 040, Andhra Pradesh India
| | - Avinash Pathengay
- GMRV Campus, LV Prasad Eye Institute, Visakhapatnam, India ; Retina and Uveitis services, GMR Varalakshmi Campus, 11-113/1, Hanumantha waka Junction, Visakhapatnam, 530 040, Andhra Pradesh India
| | | | | | - Animesh Jindal
- GMRV Campus, LV Prasad Eye Institute, Visakhapatnam, India
| | - Harry W Flynn
- Retina and Uveitis services, GMR Varalakshmi Campus, 11-113/1, Hanumantha waka Junction, Visakhapatnam, 530 040, Andhra Pradesh India
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Mithal K, Pathengay A, Bawdekar A, Jindal A, Vira D, Relhan N, Choudhury H, Gupta N, Gupta V, Koday NK, Flynn HW. Filamentous fungal endophthalmitis: results of combination therapy with intravitreal amphotericin B and voriconazole. Clin Ophthalmol 2015; 9:649-55. [PMID: 25926714 PMCID: PMC4403700 DOI: 10.2147/opth.s80387] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To report outcomes of exogenous fungal endophthalmitis treated with combination of intravitreal antifungal agents. Design Retrospective, non-randomized, interventional, consecutive case series. Methods Twelve eyes of twelve consecutive cases of filamentous fungal endophthalmitis were treated with a combination of intravitreal amphotericin-B and intravitreal voriconazole (AmB-Vo Regime) along with pars plana vitrectomy at a single center. Clinical characteristics, microbiology results, treatment strategy, visual, and anatomical outcomes were analyzed. Results Ten cases out of the twelve were postoperative endophthalmitis of which nine were part of a post cataract surgery cluster. The remaining included endophthalmitis following keratitis post pterygium excision (1) and following open globe injury (2). The most common fungus was Aspergillus terreus, which was isolated in 8/12, followed by A. flavus in 2/12 and Fusarium solani in 1/12. The presenting visual acuity ranged from light perception (LP) to counting fingers. The visual acuity at final follow-up was 20/400 or better in 7/12 eyes (58.33%) and 20/60 in 2/12 eyes (range 20/60 to LP). All eyes with corneal involvement had final visual acuity 20/400 or worse. Globe salvage was achieved in all cases. Conclusion Combining intravitreal amphotericin-B and voriconazole could be a novel treatment strategy in the management of endophthalmitis caused by filamentous fungus. Eyes with corneal involvement had poor visual outcome either with or without therapeutic penetrating keratoplasty.
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Affiliation(s)
- Kopal Mithal
- Retina and Uveitis Services, LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India
| | - Avinash Pathengay
- Retina and Uveitis Services, LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India
| | - Abhishek Bawdekar
- Retina and Uveitis Services, LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India
| | - Animesh Jindal
- Retina and Uveitis Services, LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India
| | - Divya Vira
- Cornea Services, LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Himadri Choudhury
- Retina and Uveitis Services, LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India
| | - Namrata Gupta
- Retina and Uveitis Services, LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India
| | - Varun Gupta
- Retina and Uveitis Services, LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India
| | - Nagendra K Koday
- Ocular Microbiology Service, LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Relhan N, Albini T, Pathengay A, Flynn HW. Bilateral endogenous endophthalmitis caused by vancomycin-resistant Staphylococcus epidermidis in a neonate. J Ophthalmic Inflamm Infect 2015; 5:11. [PMID: 25883685 PMCID: PMC4392039 DOI: 10.1186/s12348-015-0039-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neonatal bilateral endogenous endophthalmitis is rare and often results in devastating visual outcome. FINDINGS An 18-day-old neonate presented with whitening of the cornea in the left eye. The child was examined under anesthesia, and a diagnosis of bilateral endogenous endophthalmitis was made. Vitreous biopsy from the left eye showed no growth. Blood samples showed growth of Staphylococcus epidermidis which was multidrug resistant (including vancomycin) but sensitive to piperacillin-tazobactam. The patient was managed with bilateral intravitreal injections of piperacillin-tazobactam and systemic cefpodoxime. Systemic and topical antibiotics were given for 3 and 8 weeks, respectively, and infection was controlled. At 2-year follow-up, the right eye is fixing and following to light with clear view of the fundus and the left eye has a clear cornea with red glow of the fundus. CONCLUSIONS Vancomycin-resistant S. epidermidis may be a cause of endogenous endophthalmitis. Intravitreal piperacillin-tazobactam and systemic cefpodoxime were used to eliminate the infection in this neonate.
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Affiliation(s)
- Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA ; Kode Venkatadri Chowdry Campus, Tadigadapa, Vijayawada, 521137 Andhra Pradesh India
| | - Thomas Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Avinash Pathengay
- Kode Venkatadri Chowdry Campus, Tadigadapa, Vijayawada, 521137 Andhra Pradesh India ; Retina and Uveitis Department, L V Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, 530040 India
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
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Relhan N. In Response to: "Bhat SS, Undrakonda V, Mukhopadhyay C, Parmar PV. Outbreak of multidrug-resistant acute postoperative endophthalmitis due to Enterobacter aerogenes.". Ocul Immunol Inflamm 2014; 23:462. [PMID: 25356796 DOI: 10.3109/09273948.2014.974621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Nidhi Relhan
- a Department of Ophthalmology , Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine , Miami , Florida , USA
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Relhan N, Pathengay A, Albini T, Priya K, Jalali S, Flynn HW. A case of vasculitis, retinitis and macular neurosensory detachment presenting post typhoid fever. J Ophthalmic Inflamm Infect 2014; 4:23. [PMID: 25246983 PMCID: PMC4169056 DOI: 10.1186/s12348-014-0023-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 08/20/2014] [Indexed: 11/10/2022] Open
Abstract
Background Ocular and extraocular immune-mediated phenomena are known to occur following febrile illness. Vasculitis, retinitis and neurosensory detachment are not well-recognized sequelae of typhoid fever. Findings We report a case of vasculitis, retinitis and macular neurosensory detachment presenting post typhoid fever. A 27-year-old female presented with decreased vision in right eye with history of typhoid fever (treated adequately 6 weeks prior). Her best corrected visual acuity in right eye was 20/125, N36. Fundus showed a patch of vasculitis and retinitis superior to the disc associated with macular neurosensory detachment and disc pallor. With oral steroids, the inflammation resolved and visual acuity improved to 20/20 at 6 weeks. Conclusions Immune-mediated vasculitis and retinitis following typhoid fever may respond well to systemic steroids.
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Affiliation(s)
- Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami 33136, FL, USA ; Srimati Kannuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad 500034, Telangana, India
| | - Avinash Pathengay
- Retina and Uveitis Department, L V Prasad Eye Institute, GMR Varalaxmi Campus, Visakhapatnam 530 040, Andhra Pradesh, India
| | - Thomas Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami 33136, FL, USA
| | - Krishna Priya
- Srimati Kannuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad 500034, Telangana, India
| | - Subhadra Jalali
- Srimati Kannuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad 500034, Telangana, India
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami 33136, FL, USA
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Radhika M, Mithal K, Bawdekar A, Dave V, Jindal A, Relhan N, Albini T, Pathengay A, Flynn HW. Pharmacokinetics of intravitreal antibiotics in endophthalmitis. J Ophthalmic Inflamm Infect 2014; 4:22. [PMID: 25667683 PMCID: PMC4306439 DOI: 10.1186/s12348-014-0022-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 07/21/2014] [Indexed: 12/21/2022] Open
Abstract
Intravitreal antibiotics are the mainstay of treatment in the management of infectious endophthalmitis. Basic knowledge of the commonly used intravitreal antibiotics, which includes their pharmacokinetics, half-life, duration of action and clearance, is essential for elimination of intraocular infection without any iatrogenic adverse effect to the ocular tissue. Various drugs have been studied over the past century to achieve this goal. We performed a comprehensive review of the antibiotics which have been used for intravitreal route and the pharmacokinetic factors influencing the drug delivery and safety profile of these antibiotics. Using online resources like PubMed and Google Scholar, articles were reviewed. The articles were confined to the English language only. We present a broad overview of pharmacokinetic concepts fundamental for use of intravitreal antibiotics in endophthalmitis along with a tabulated compendium of the intravitreal antibiotics using available literature. Recent advances for increasing bioavailability of antibiotics to the posterior segment with the development of controlled drug delivery devices are also described.
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Affiliation(s)
- Medikonda Radhika
- Retina and Uveitis Department, L V Prasad Eye Institute, GMR Varalaxmi Campus, 11-113/1, Hanumantha waka Junction, Visakhapatnam 530040, Andhra Pradesh, India
| | - Kopal Mithal
- Retina and Uveitis Department, L V Prasad Eye Institute, GMR Varalaxmi Campus, 11-113/1, Hanumantha waka Junction, Visakhapatnam 530040, Andhra Pradesh, India
| | - Abhishek Bawdekar
- Retina and Uveitis Department, L V Prasad Eye Institute, GMR Varalaxmi Campus, 11-113/1, Hanumantha waka Junction, Visakhapatnam 530040, Andhra Pradesh, India
| | - Vivek Dave
- Srimati Kannuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, KAR Campus, Hyderabad 500034, Andhra Pradesh, India
| | - Animesh Jindal
- Retina and Uveitis Department, L V Prasad Eye Institute, GMR Varalaxmi Campus, 11-113/1, Hanumantha waka Junction, Visakhapatnam 530040, Andhra Pradesh, India
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami 33136, FL, USA
| | - Thomas Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami 33136, FL, USA
| | - Avinash Pathengay
- Retina and Uveitis Department, L V Prasad Eye Institute, GMR Varalaxmi Campus, 11-113/1, Hanumantha waka Junction, Visakhapatnam 530040, Andhra Pradesh, India
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami 33136, FL, USA
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Mithal K, Mathai A, Pathengay A, Jalali S, Relhan N, Motukupally SR, Sharma S, Das T. Endophthalmitis following intravitreal anti-VEGF injections in ambulatory surgical centre facility: incidence, management and outcome. Br J Ophthalmol 2013; 97:1609-12. [DOI: 10.1136/bjophthalmol-2013-303222] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Khera M, Pathengay A, Jindal A, Jalali S, Mathai A, Pappuru RR, Relhan N, Das T, Sharma S, Flynn HW. Vancomycin-resistant Gram-positive bacterial endophthalmitis: epidemiology, treatment options, and outcomes. J Ophthalmic Inflamm Infect 2013; 3:46. [PMID: 23607574 PMCID: PMC3637534 DOI: 10.1186/1869-5760-3-46] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/12/2013] [Indexed: 11/16/2022] Open
Abstract
Background The purpose of this study is to evaluate the microbiological profile and treatment outcomes of vancomycin-resistant Gram-positive bacterial endophthalmitis. Medical records of all patients with Gram-positive bacterial endophthalmitis resistant to vancomycin presenting between 1 January 2005 and 31 December 2010 were reviewed in this noncomparative, consecutive, retrospective case series. Favorable outcome was defined as a best-corrected visual acuity of ≥20/200. Results Out of 682 culture-positive endophthalmitis isolates, 448/682 (65.6%) were associated with Gram-positive bacteria. In vitro resistance to vancomycin was noted in 7/448 (1.56%). Three cases were posttraumatic, three were postoperative, and one was endogenous in origin. Four Bacillus isolates, two Staphylococcus isolates, and an Enterococcus isolate were resistant. Isolates resistant to vancomycin were sensitive in vitro to ciprofloxacin in 6/7 (86%) patients. Presenting visual acuity was light perception in all seven cases. Favorable outcome was achieved in only 1/7 (14.3%) cases. Conclusions Vancomycin-resistant endophthalmitis is uncommon and usually associated with poor visual outcome. Bacillus sp. is the most frequent Gram-positive bacteria resistant to vancomycin. Fluoroquinolones like ciprofloxacin may be considered as a useful alternative in vancomycin-resistant endophthalmitis.
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Affiliation(s)
- Manav Khera
- LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam 530040, India.
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