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Smith JM, Mathias MT, Oliver SC, Mandava N, Olson JL, Quiroz-Mercado H, Palestine AG. The influence of needle gauge and infection source on vitreous aspirate cultures. Br J Ophthalmol 2015; 100:453-5. [PMID: 26269533 DOI: 10.1136/bjophthalmol-2015-307081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 07/23/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS While the Endophthalmitis Vitrectomy Study (EVS) included only post-cataract surgery patients, the methods and data from that study are widely applied in the management of endophthalmitis of all types. We sought to examine how our experience with in-office vitreous aspiration differed from the EVS in two ways: first, by reviewing microbiological culture yields from vitreous aspirates obtained using 30-gauge needles versus 25-27-gauge needles and second, by reviewing culture yields in cases of endogenous versus non-endogenous endophthalmitis. METHODS Cases of endophthalmitis over a 14-year period were reviewed when vitreous tap was the initial diagnostic procedure. The data included infection source, needle size used to obtain a vitreous aspirate, organism cultured and rates of unsuccessful attempts at vitreous aspiration or dry taps. RESULTS 10 cases were endogenous endophthalmitis, while 36 cases were a mix of postoperative, post-traumatic, post-intravitreal injection and miscellaneous patients. A positive microbiological culture was obtained in 11/36 (31%) of vitreous taps using a 25-27-gauge needle and in 8/10 (80%) taps using a 30-gauge needle (p<0.01). A positive vitreous culture was obtained in 18/36 (50%) of all non-endogenous cases, while a positive result was obtained in 0/10 (0%) cases of endogenous endophthalmitis (p<0.01). CONCLUSIONS The use of a smaller needle in obtaining vitreous samples in endophthalmitis did not lower the microbiological yield. A positive microbiological yield was significantly less likely in cases of endogenous endophthalmitis compared with non-endogenous cases. Vitreous tap as a method for identifying the causative organism in endogenous endophthalmitis was of limited utility.
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Affiliation(s)
- Jesse M Smith
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Marc T Mathias
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Scott C Oliver
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Naresh Mandava
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jeffrey L Olson
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Hugo Quiroz-Mercado
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Vaziri K, Pershing S, Albini TA, Moshfeghi DM, Moshfeghi AA. Risk factors predictive of endogenous endophthalmitis among hospitalized patients with hematogenous infections in the United States. Am J Ophthalmol 2015; 159:498-504. [PMID: 25486541 DOI: 10.1016/j.ajo.2014.11.032] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/20/2014] [Accepted: 11/21/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE To identify potential risk factors associated with endogenous endophthalmitis among hospitalized patients with hematogenous infections. DESIGN Retrospective cross-sectional study. METHODS MarketScan Commercial Claims and Encounters, and Medicare Supplemental and Coordination of Benefit inpatient databases from the years 2007-2011 were obtained. Utilizing ICD-9 codes, logistic regression was used to identify potential predictors/comorbidities for developing endophthalmitis in patients with hematogenous infections. RESULTS Among inpatients with hematogenous infections, the overall incidence rate of presumed endogenous endophthalmitis was 0.05%-0.4% among patients with fungemia and 0.04% among patients with bacteremia. Comorbid human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) (OR = 4.27; CI, 1.55-11.8; P = .005), tuberculosis (OR = 8.5; CI, 1.2-61.5; P = .03), endocarditis (OR = 8.3; CI, 4.9-13.9; P < .0001), bacterial meningitis (OR = 3.8; CI, 1.2-12.0; P = .023), fungal meningitis (OR = 59.1; CI, 14.1-247.8; P < .0001), internal organ abscess (OR = 2.9; CI, 1.2-6.4; P = .02), lymphoma/leukemia (OR = 2.9; CI, 1.6-5.3; P < .0001), skin abscess/cellulitis (OR = 1.75; CI, 1.1-2.8; P = .02), pyogenic arthritis (OR = 4.2; CI, 1.8-9.6; P = .001), diabetes with ophthalmic manifestations (OR = 7.0; CI, 1.7-28.3; P = .006), and urinary tract infection (OR = 0.04; CI, 0.3-0.9; P = .023) were each significantly associated with a diagnosis of endogenous endophthalmitis. Patients aged 0-17 years (OR = 2.61; CI, 1.2-5.7; P = .02), 45-54 years (OR = 3.4; CI, 2.0-5.4; P < .0001), and 55-64 years (OR = 2.9; CI, 1.8-4.8; P < .0001); those having length of stay of 3-10 days (OR = 1.9; CI, 1.1-3.3; P = .01), 11-30 days (OR = 3.1; CI, 1.8-5.5; P < .0001), and 31+ days (OR = 5.3; CI, 2.7-10.4; P < .0001); and those with intensive care unit/neonatal intensive care unit (ICU/NICU) admissions (OR = 1.5; CI, 1.4-1.6; P < .0001) were all more likely to be diagnosed with endogenous endophthalmitis. CONCLUSIONS Endogenous endophthalmitis is rare among hospitalized patients in the United States. Among patients with hematogenous infections, odds of endogenous endophthalmitis were higher for children and middle-aged patients, and for patients with endocarditis, bacterial meningitis, lymphoma/leukemia, HIV/AIDS, internal organ abscess, diabetes with ophthalmic manifestations, skin cellulitis/abscess, pyogenic arthritis, tuberculosis, longer hospital stays, and/or ICU/NICU admission.
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Affiliation(s)
- Kamyar Vaziri
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Palm Beach Gardens, Florida
| | - Suzann Pershing
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, Calfornia.
| | - Thomas A Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Palm Beach Gardens, Florida
| | - Darius M Moshfeghi
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Andrew A Moshfeghi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Palm Beach Gardens, Florida; Retina Associates of Kentucky, Lexington, Kentucky
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Shum JWH, Tsang FCW, Fung KSC, Li KKW. Presumed Aggregatibacter aphrophilus endogenous endophthalmitis. Int Ophthalmol 2015; 35:269-73. [PMID: 25680418 DOI: 10.1007/s10792-015-0044-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 01/25/2015] [Indexed: 10/24/2022]
Abstract
We hereby report a case of endogenous endophthalmitis, presumably caused by a rare culprit-Aggregatibacter aphrophilus. A. aphrophilus is a member of the HACEK group, a group of fastidious Gram-negative bacteria with low pathogenicity and a rare cause of human infections. For ophthalmic infection, it has been reported to cause canaliculitis and exogenous endophthalmitis. A middle-aged gentleman with good past health presented with decreased vision (20/200) in his left eye. Other than fever, he was well on presentation, with no apparent focus of infection. Subsequently, he developed an episode of high fever reaching 39.2 °C, with CRP of 233 mg/L. CT abdomen showed presumed kidney abscess and a rare Gram-negative coccobacillus. A. aphrophilus [formerly Haemophilus aphrophilus (Nørskov-lauritsen and Kilian in Int J Syst Evol Microbiol 56:2135-2146, 2006)] was found in blood culture, Vitreous sample was analysed using 16S ribosomal DNA amplification but failed to identify the organism. After appropriate treatment, his vision improved drastically from 20/200 to 20/30. A. aphrophilus isolated from blood cultures during septicemia in a patient with kidney abscess may be associated with metastatic endophthalmitis, which may appear as a first sign. Our case demonstrates that with prompt diagnosis and appropriate treatment, visual prognosis of A. aphrophilus endophthalmitis can be promising.
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Affiliation(s)
- Jennifer W H Shum
- Department of Ophthalmology, United Christian Hospital, Kowloon, Hong Kong SAR, China
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Abstract
PURPOSE To identify the clinical features, treatment outcomes, and prognostic factors of endogenous endophthalmitis in multiple tertiary referral centers of South Korea over a 6-year period. METHODS The authors conducted a retrospective review of medical records of 57 eyes of 43 patients diagnosed with endogenous endophthalmitis from January 2005 to December 2011, which was referred to tertiary referral centers. RESULTS Fifty-seven cases of 43 patients were followed for a mean of 18.7 months (range, 0.5-50 months). The common underlying diseases were diabetes mellitus (46.5%) and liver cirrhosis (20.93%). Liver abscess (39.5%) was the most common infection source. Among prognostic factors, the initial visual acuity was associated with favorable visual outcome significantly (P < 0.001). Endogeneous endophthalmitis with gram-negative bacteria had worse visual outcomes than gram-positive bacteria or fungus (P = 0.014). CONCLUSION Similar to the findings of previous East Asian studies, this study showed that Klebsiella pneumoniae was the most common causative organism of endogenous endophthalmitis and liver abscess was the most common infection focus. Although endogenous endophthalmitis is generally associated with poor visual acuity outcomes, the prognosis depends mainly on the initial visual acuity and the pathogen.
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Dave VP, Sharma S, Yogi R, Reddy S. Apophysomyces elegans: a novel cause of endogenous endophthalmitis in an immunocompetent individual. Int Ophthalmol 2014; 34:1285-9. [DOI: 10.1007/s10792-014-9999-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 08/27/2014] [Indexed: 11/27/2022]
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Do T, Hon DN, Aung T, Hien ND, Cowan CL. Bacterial endogenous endophthalmitis in Vietnam: a randomized controlled trial comparing vitrectomy with silicone oil versus vitrectomy alone. Clin Ophthalmol 2014; 8:1633-40. [PMID: 25210432 PMCID: PMC4155900 DOI: 10.2147/opth.s67589] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background/aims To compare treatment outcomes with and without silicone oil tamponade in patients undergoing pars plana vitrectomy (PPV) for severe endogenous bacterial endophthalmitis (BEE). Methods One hundred and eight consecutive patients with severe BEE (defined by the absence of pupil red reflex at presentation and/or dense vitreous opacity on ultrasound and no improvement after 24–36 hours of medical treatment) were randomly assigned to two treatment groups: Group 1, standard PPV with intravitreal antibiotics; and Group 2, PPV with intravitreal antibiotics and silicone tamponade. Overall success was defined as: a visual acuity ≥ count fingers at 1 meter, with an attached retina, and no intraocular oil. Results Fifty three patients were randomized to Group 1 and 55 patients to Group 2. The mean age of study subjects was 32 years and baseline clinical characteristics were similar in both groups. At the final follow-up visit at 9 months, the overall success rate of Group 2 (67.3%) was significantly better than Group 1 (43.4%; P=0.01). There were also fewer devastating complications (such as inoperable retinal detachment, phthisis bulbi) in Group 2 compared with Group 1 (21.8% versus 43.4%; P=0.01). Conclusion The outcome at 9 months of patients with BEE treated by vitrectomy with silicone oil was better than those treated by vitrectomy alone.
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Affiliation(s)
- Tan Do
- Vietnam National Institute of Ophthalmology, Hanoi, Vietnam
| | - Do N Hon
- Vietnam National Institute of Ophthalmology, Hanoi, Vietnam
| | - Tin Aung
- Singapore National Eye Center, Singapore
| | | | - Claude L Cowan
- Georgetown University Medical Center, Washington, DC, USA
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Khan S, Athwal L, Zarbin M, Bhagat N. Pediatric infectious endophthalmitis: a review. J Pediatr Ophthalmol Strabismus 2014; 51:140-53. [PMID: 24877526 DOI: 10.3928/01913913-20140507-01] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 03/13/2014] [Indexed: 12/28/2022]
Abstract
Infectious endophthalmitis is a rare but severe complication of septecemia, intraocular surgeries, or penetrating eye trauma. The etiology, prognosis, and management of pediatric endophthalmitis resulting from exogenous and endogenous infections are reviewed. Open-globe trauma and glaucoma surgery are the most frequent causes of endophthalmitis in children, whereas endogenous infection is the least common cause. Streptococcus and Staphylococcus species are common bacterial agents in both posttraumatic and postoperative pediatric endophthalmitis, whereas Candida albicans is a commonly reported organism in endogenous endophthalmitis. Additionally, Streptococcus pneumoniae and Haemophilus influenzae appear more likely as pathogens in children than in adults. The clinical manifestations and outcome usually correlate with the virulence of the infecting organism. The visual prognosis of endophthalmitis is generally poor.
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Affiliation(s)
- Wallace J Brownlee
- Department of Neurology, Auckland District Health Board, Auckland, New Zealand.
| | - Veronica M Playle
- Department of General Medicine, Auckland District Health Board, Auckland, New Zealand
| | | | - Neil E Anderson
- Department of Neurology, Auckland District Health Board, Auckland, New Zealand
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Lyall DAM, Gregory ME, McDonnell J, De Villiers F, Tejwani D. Bilateral endogenous Serratia marcescens endophthalmitis secondary to endocarditis following cardiac surgery. Scott Med J 2013; 58:e1-6. [PMID: 23728762 DOI: 10.1177/0036933013482647] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Endogenous endophthalmitis is a sight-threatening condition caused by microorganisms crossing the blood-ocular barrier and inducing profound intraocular inflammation. CASE REPORT A 65-year-old female experienced bilateral loss of vision after developing infective endocarditis as a complication of combined Bentall procedure and coronary artery bypass grafting. She was diagnosed with bilateral endogenous endophthalmitis secondary to Serratia marcescens. Despite aggressive treatment with intravitreal injections of antibiotics and steroids, intensive topical and systemic antibiotic therapy, there was permanent loss of sight in both eyes. CONCLUSION The case highlights the importance of early recognition of the symptoms and signs of endogenous endophthalmitis in any patient with systemic infection by all clinicians and the necessity of prompt ophthalmological referral if a useful level of vision is to be preserved.
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Affiliation(s)
- D A M Lyall
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, UK.
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Hassan A, Poon W, Baker M, Linton C, Mühlschlegel FA. Confirmed Candida albicans endogenous fungal endophthalmitis in a patient with chronic candidiasis. Med Mycol Case Rep 2012; 1:42-4. [PMID: 24371735 DOI: 10.1016/j.mmcr.2012.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 05/18/2012] [Accepted: 06/04/2012] [Indexed: 11/19/2022] Open
Abstract
We present a case of a confirmed Candida albicans endogenous endophthalmitis in a 35-year-old diabetic white female patient with a long standing history of severe chronic vaginal C. albicans infection. The patient had recently undergone ureteric stenting and received intravenous broad-spectrum antibiotics for renal stones complicated by urinary sepsis. Pan-fungal polymerase chain reaction (PCR) analysis of vitreous aspirate confirmed the presence of C. albicans. Samples showed no microbial growth.
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Affiliation(s)
- A Hassan
- Clinical Microbiology Service, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, Kent TN24 0LZ, UK ; Department of Ophthalmology, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, Kent TN24 0LZ, UK
| | - W Poon
- Department of Ophthalmology, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, Kent TN24 0LZ, UK
| | - M Baker
- Clinical Microbiology Service, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, Kent TN24 0LZ, UK
| | - C Linton
- Mycology Reference Laboratory, Health Protection Agency, Microbiology Services, Bristol BS2 8EL, UK
| | - F A Mühlschlegel
- Clinical Microbiology Service, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, Kent TN24 0LZ, UK ; School of Biosciences, University of Kent, Canterbury, Kent CT2 7NJ, UK
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Review of Clinical Features, Microbiological Spectrum, and Treatment Outcomes of Endogenous Endophthalmitis over an 8-Year Period. J Ophthalmol 2012; 2012:265078. [PMID: 23533699 PMCID: PMC3594912 DOI: 10.1155/2012/265078] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 11/08/2011] [Accepted: 12/19/2011] [Indexed: 12/01/2022] Open
Abstract
Purpose. To evaluate the clinical features, microbiological spectrum, and treatment outcomes of endogenous endophthalmitis. Methods. Retrospective review of consecutive cases with infective endogenous endophthalmitis presenting from 2000 to 2007. The main outcome measure was the visual outcome at the latest follow-up visit. Other outcome measures included microbiological investigations, anatomical and clinical outcomes. Results. 22 eyes of 21 patients were included, and the mean follow-up duration was 2.7 years. Eyes with fungal endogenous endophthalmitis were more likely to have visual acuity of finger counting or better at presentation compared with those with bacterial endogenous endophthalmitis (odds ratio = 15.0, P = 0.013). Gram-negative microorganisms accounted for 50% of infections, while fungal and gram-positive organisms accounted for 27.3% and 22.7%, respectively. Despite treatment, the visual outcome was poor in general as 10 (45.5%) eyes had no light perception at the latest follow-up visit and 6 (27.3%) eyes required enucleation or evisceration. Contrary to previous studies, fungal endogenous endophthalmitis did not appear to have better visual outcome compared with bacterial endogenous endophthalmitis. Conclusion. Gram-negative microorganisms were the main causative pathogens of endogenous endophthalmitis in Hong Kong. The visual prognosis of endogenous endophthalmitis is generally poor as almost 50% of eyes were blind despite treatment.
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Lingappan A, Wykoff CC, Albini TA, Miller D, Pathengay A, Davis JL, Flynn HW. Endogenous fungal endophthalmitis: causative organisms, management strategies, and visual acuity outcomes. Am J Ophthalmol 2012; 153:162-6.e1. [PMID: 21917234 DOI: 10.1016/j.ajo.2011.06.020] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 06/29/2011] [Accepted: 06/29/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE To report the causative organisms, management strategies, and visual outcomes in endogenous fungal endophthalmitis. DESIGN Observational case series. METHODS Microbiologic and medical records were reviewed retrospectively for all patients with culture-positive endogenous fungal endophthalmitis between January 1, 1990, and July 1, 2009. RESULTS Study criteria were met in 65 eyes of 51 patients with mean follow-up of 18 months. Yeasts were the most common causative organism in 38 (75%) patients compared with molds in 13 (25%) patients. Retinal detachment occurred in 17 eyes (26%). Visual acuity of 20/200 or better was present in 28 (56%) eyes with yeasts and in 5 (33%) eyes with molds at the last follow-up. CONCLUSIONS Yeasts were the most common cause of culture-proven unilateral or bilateral endogenous fungal endophthalmitis. Endogenous fungal endophthalmitis generally is associated with poor visual acuity outcomes, especially when caused by molds. Retinal detachment is a frequent occurrence during follow-up.
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Connell PP, Wickremasinghe S, Devi U, Waters MJ, Allen PJ. Self-induced Elizabethkingia meningoseptica endophthalmitis: a case report. J Med Case Rep 2011; 5:303. [PMID: 21745367 PMCID: PMC3143104 DOI: 10.1186/1752-1947-5-303] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 07/11/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Endophthalmitis is a sight-threatening condition defined as any inflammation of the internal ocular spaces. It is classified as either endogenous or exogenous depending on the route of infection. Exogenous endophthalmitis results from direct inoculation as a complication of intra-ocular surgery, penetrating ocular trauma, intra-ocular foreign bodies, corneal ulceration and following a breach of ocular barriers from a periocular infection. We report a rare case of exogenous endophthalmitis with both unusual etiology and microbiology. CASE PRESENTATION A 41-year-old Caucasian man with a history of depressive illness presented to our eye department with painful acute visual loss on a background history of chronic uveitis. Ocular examination revealed a dense fibrinous panuveitis with a suspicion of a focal lesion in the posterior segment. Microbiological sampling from his anterior chamber and posterior segment revealed a culture of Elizabethkingia meningoseptica. On closer questioning, he volunteered the occurrence of multiple episodes of deliberate needle ocular penetration. Following vitrectomy for associated retinal detachment, a final Snellen visual acuity of 6/60 was obtained. CONCLUSIONS Elizabethkingia meningoseptica endophthalmitis is a rare condition, and visual results to date are poor.
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Affiliation(s)
- Paul P Connell
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, University of Melbourne, 32 Gisborne Street, East Melbourne, Victoria 3002, Australia.
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Post-traumatic Infectious Endophthalmitis. Surv Ophthalmol 2011; 56:214-51. [DOI: 10.1016/j.survophthal.2010.09.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 09/15/2010] [Accepted: 09/21/2010] [Indexed: 12/25/2022]
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Whist E, Hollenbach E, Dunlop A. Severe acute endogenous endophthalmitis with Staphylococcus epidermidis in a systemically well patient. OPHTHALMOLOGY AND EYE DISEASES 2011; 3:25-8. [PMID: 23861621 PMCID: PMC3661436 DOI: 10.4137/oed.s5883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endogenous endophthalmitis is a devastating intraocular infection caused by haematogenous spread of bacteria or fungi, usually in people with immune deficiency. This case report is unusual as a systemically well patient with normal immune function and no identifiable locus of infection rapidly developed a fulminant endogenous endophthalmitis from an organism which does not usually produce aggressive virulence determinants. Endogenous bacterial endophthalmitis is an ongoing diagnostic and therapeutic dilemma for ophthalmologists as it is relatively rare, often initially presents as uveitis, and requires a high index of suspicion for prompt diagnosis and treatment. The treatment of endogenous endophthalmitis is still controversial due to a lack of clinical trials. Potential treatments include systemic antibiotics, peri-ocular injections, intravitreal injection of antibiotics and possibly corticosteroids, pars plana vitrectomy, or a combination of some of these.
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Affiliation(s)
- Eline Whist
- Department of Ophthalmology, The Royal Newcastle Centre, New Lambton NSW 2305, Australia
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Cornut PL, Chiquet C. [Endogenous bacterial endophthalmitis]. J Fr Ophtalmol 2010; 34:51-7. [PMID: 21145128 DOI: 10.1016/j.jfo.2010.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 08/19/2010] [Indexed: 11/17/2022]
Abstract
Endogenous bacterial endophthalmitis, also called metastatic bacterial endophthalmitis, remains a diagnostic and therapeutic challenge. It is a rare and potentially sight-threatening ocular infection that occurs when bacteria reach the eye via the bloodstream, cross the blood-ocular barrier, and multiply within the eye. It usually affects immunocompromised patients and those suffering from diabetes mellitus, malignancy, or cardiac disease, but has also been reported after invasive procedures or in previously healthy people. In most cases, the ocular symptoms occur after the diagnosis of septicemia or systemic infection. Ocular symptoms include decreased vision, redness, discharge, pain, and floaters. The ocular inflammatory signs may be anterior and/or posterior. Bilateral involvement occurs in nearly 25% of cases. A wide range of microorganisms are involved, with differences in their frequency according to geography as well as the patient's age and past medical history, because of variations in the predisposing conditions and the source of the sepsis. The majority of patients are initially misdiagnosed, and ophthalmologists should be aware of this because prompt local and general management is required to save the eye and/or the patient's life.
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Affiliation(s)
- P-L Cornut
- Service d'ophtalmologie, hôpital Édouard-Herriot, CHU de Lyon, hospices civils de Lyon, université Claude-Bernard Lyon-I, 5, place d'Arsonval, 69437 Lyon cedex 3, France
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Connell PP, O'Neill EC, Fabinyi D, Islam FMA, Buttery R, McCombe M, Essex RW, Roufail E, Clark B, Chiu D, Campbell W, Allen P. Endogenous endophthalmitis: 10-year experience at a tertiary referral centre. Eye (Lond) 2010; 25:66-72. [PMID: 20966972 DOI: 10.1038/eye.2010.145] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Endogenous endophthalmitis (EE) is a sight-threatening emergency and the aetiology is often multifactorial. Delayed diagnosis may exacerbate the poor visual prognosis. We describe the management and visual outcomes of EE presenting to a tertiary referral centre. PATIENTS AND METHODS A prospective consecutive case series of 64 patients presenting with presumed EE from 1997 to 2007 to the Royal Victorian Eye and Ear Hospital were included. All data were collected in a standardized manner. Outcome measures included: visual acuity, microbial profiles, and vitrectomy rate. RESULTS In total, 64 cases of EE were identified over the study period with a mean age of 57.5 years, and 53.5% were male. Presenting acuities ranged from Snellen 6/6 to no perception of light (NPL). Identifiable risk factors were present in 78.1%, with the majority related to intravenous drug abuse. A 64.1% culture positivity rate was recorded. A vitrectomy rate of 57, 56, and 21% was recorded in documented bacterial, fungal, and no growth cases, respectively. Final Snellen acuities ranged from 6/6 to NPL. A total of 5 out of 64 eyes were enucleated, of which 3 identified Klebsiella species. Better visual outcome was documented in fungal cases. CONCLUSION EE is a serious ocular condition and has a varied aetiology. Visual outcomes are often poor, irrespective of the method of management. Fungal aetiology often confers a better prognosis, and vitrectomy is advocated for bacterial proven cases.
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Affiliation(s)
- P P Connell
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, VIC, Australia.
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Arevalo JF, Jap A, Chee SP, Zeballos DG. Endogenous endophthalmitis in the developing world. Int Ophthalmol Clin 2010; 50:173-87. [PMID: 20375870 DOI: 10.1097/iio.0b013e3181d26dfc] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J Fernando Arevalo
- Clinica Oftalmologica Centro Caracas, Edif. Centro Caracas PH-1, Av. Panteon, Caracas, Venezuela
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71
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Kernt M, Kampik A. Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. Clin Ophthalmol 2010; 4:121-35. [PMID: 20390032 PMCID: PMC2850824 DOI: 10.2147/opth.s6461] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Indexed: 12/07/2022] Open
Abstract
Endophthalmitis is a rare but sight-threatening complication that can occur after ocular surgery or trauma or as a consequence of systemic infection. To optimize visual outcome, early diagnosis and treatment are essential. Over recent decades, advances in hygienic standards, improved microbiologic and surgical techniques, development of powerful antimicrobial drugs, and the introduction of intravitreal antibiotic therapy have led to a decreased incidence and improved management of endophthalmitis. However, endophthalmitis still represents a serious clinical problem. This review focuses on current principles and techniques for evaluation and treatment of endophthalmitis. In addition, it addresses recent developments regarding antimicrobial treatment and prophylaxis of infectious endophthalmitis.
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Affiliation(s)
- M Kernt
- Department of Ophthalmology, Ludwig Maximilian University, Munich, Germany
| | - A Kampik
- Department of Ophthalmology, Ludwig Maximilian University, Munich, Germany
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72
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73
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Kim SY, Choi JY, Cho CH. A Case of Aspergillus Endocarditis Presenting as Endophthalmitis. Korean Circ J 2009. [DOI: 10.4070/kcj.2009.39.2.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- So Yeon Kim
- Department of Cardiology, Catholic University of Daegu, School of Medicine, Daegu, Korea
| | - Ji Yong Choi
- Department of Cardiology, Catholic University of Daegu, School of Medicine, Daegu, Korea
| | - Chang Ho Cho
- Department of Pathology, Catholic University of Daegu, School of Medicine, Daegu, Korea
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74
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Abstract
PURPOSE Endogenous endophthalmitis is a severe and potentially blinding complication caused by haematogenous spreading of microorganisms. We evaluated the causative microorganisms, disposition to and prognosis of the disease. METHODS Thirty-one eyes of 28 patients were treated between 1996 and 2006 as the result of an endogenous endophthalmitis. RESULTS The microorganisms responsible for infection could be identified in 94% of all eyes investigated. Candida isolates were obtained in 15, gram-positive isolates in 11, gram-negative in one and Aspergillus in two of the 29 eyes studied. The majority of patients suffered from severe general disease (immuno-deficiency, severe surgical procedures, diabetes mellitus) and one third were intravenous drug abusers. Only one patient was otherwise healthy. The prognosis depended on the causative microorganisms. Whereas none of the eyes with Candida infection became blind, all except two of the eyes with gram-positive bacteria, Nocardia or Aspergillus infection lost visual function or had to be enucleated. CONCLUSION Compared to postoperative endophthalmitis, patients with endogenous endophthalmitis are more likely to have Candida isolates. Visual prognosis depends mainly on the underlying microorganisms, and is particularly poor in the case of infection with gram-positive bacteria or Aspergillus.
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Affiliation(s)
- Thomas Ness
- Department of Ophthalmology, University of Freiburg, Freiburg, Germany.
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75
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Abstract
PURPOSE To review the current state of evaluation and management of various forms of endophthalmitis. METHODS A review of the literature is included, encompassing endophthalmitis occurring after ocular surgeries, intravitreal injection, trauma, and systemic infection. Based on this review, current principles and techniques for evaluating and treating these forms of endophthalmitis are discussed. RESULTS Postoperative endophthalmitis after cataract surgery is the most common presentation. Conclusions from the Endophthalmitis Vitrectomy Study (EVS) remain a foundation for management of postcataract surgery endophthalmitis, notably prompt intravitreal antibiotic administration after vitreous sampling, with consideration for pars plana vitrectomy in severe cases. The potential impact of advances since the EVS, such as oral fourth generation fluoroquinolones and new vitrectomy techniques, are also discussed. The management of postcataract endophthalmitis is compared and contrasted to endophthalmitis occurring after other ocular surgeries, intravitreal injection, trauma, and systemic infection. Although some principles remain common, treatment rationales differ with other forms of endophthalmitis based on differing clinical circumstances, such as the virulence of organisms that are frequently encountered. CONCLUSIONS Endophthalmitis is a serious, potentially vision threatening condition which can present in various settings. Prompt recognition and treatment are key in maximizing outcomes.
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Affiliation(s)
- Craig A Lemley
- Medical College of Wisconsin, Department of Ophthalmology, Vitreoretinal Section, Milwaukee, WI 53226-4812, USA
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76
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Seale M, Lee WK, Daffy J, Tan Y, Trost N. Fulminant endogenous Klebsiella pneumoniae endophthalmitis: imaging findings. Emerg Radiol 2006; 13:209-12. [PMID: 17109124 DOI: 10.1007/s10140-006-0550-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Accepted: 09/13/2006] [Indexed: 11/29/2022]
Abstract
Endogenous endophthalmitis is a rare but serious complication of Klebsiella pneumoniae infection that has been predominantly reported to occur in diabetic patients of East Asian origin with K. pneumoniae liver abscesses. The clinical symptoms and signs of endogenous endophthalmitis are nonspecific and may mimic other causes of an acute non-traumatic eye. Permanent visual loss and blindness are common sequelae because of delayed diagnosis and treatment. Computed tomography and magnetic resonance imaging can help to differentiate endophthalmitis from other causes of acute non-traumatic eye when the clinical findings are equivocal. Fluid attenuated inversion recovery and diffusion-weighted imaging with apparent diffusion coefficient map are superior to T2-weighted and gadolinium-enhanced T1-weighted sequences in demonstrating intra-ocular abscesses.
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Affiliation(s)
- Melanie Seale
- Department of Medical Imaging, St. Vincent's Hospital, University of Melbourne, Victoria Parade, Fitzroy, Victoria 3065, Australia.
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77
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Garweg JG, Wanner D, Sarra GM, Altwegg M, Loosli H, Kodjikian L, Halberstadt M. The diagnostic yield of vitrectomy specimen analysis in chronic idiopathic endogenous uveitis. Eur J Ophthalmol 2006; 16:588-94. [PMID: 16952099 DOI: 10.1177/112067210601600414] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The low diagnostic yield of vitrectomy specimen analysis in chronic idiopathic uveitis (CIU) has been related to the complex nature of the underlying disease and to methodologic and tissue immanent factors in older studies. In an attempt to evaluate the impact of recently acquired analytic methods, the authors assessed the current diagnostic yield in CIU. METHODS Retrospective analysis of consecutive vitrectomy specimens from patients with chronic endogenous uveitis (n = 56) in whom extensive systemic workup had not revealed a specific diagnosis (idiopathic) and medical treatment had not resulted in a satisfying clinical situation. Patients with acute postoperative endophthalmitis served a basis for methodologic comparison (Group 2; n = 21). RESULTS In CIU, a specific diagnosis provided in 17.9% and a specific diagnosis excluded in 21.4%. In 60.7% the laboratory investigations were inconclusive. In postoperative endophthalmitis, microbiological culture established the infectious agent in 47.6%. In six of eight randomly selected cases, eubacterial PCR identified bacterial DNA confirming the culture results in three, remaining negative in two with a positive culture and being positive in three no growth specimens. A double negative result never occurred, suggesting a very high detection rate, when both tests were applied. CONCLUSIONS The diagnostic yield of vitrectomy specimen analysis has not been improved by currently routinely applied methods in recent years in contrast to the significantly improved sensitivity of combined standardized culture and PCR analysis in endophthalmitis. Consequently, the low diagnostic yield in CIU has to be attributed to insufficient understanding of the underlying pathophysiologic mechanisms.
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Affiliation(s)
- J G Garweg
- Swiss Eye Institute, Gossetstrasse 43, CH-3084 Wabern, Switzerland.
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78
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Fadel HJ, Kumar G, Beckman TJ. 58-year-old man with fever and right eye pain. Mayo Clin Proc 2006; 81:1238-40. [PMID: 16970221 DOI: 10.4065/81.9.1238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hind J Fadel
- Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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79
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Pokharel D, Doan AP, Lee AG. Group B streptococcus endogenous endophthalmitis presenting as septic arthritis and a homonymous hemianopsia due to embolic stroke. Am J Ophthalmol 2004; 138:300-2. [PMID: 15289147 DOI: 10.1016/j.ajo.2004.02.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE To report a case of group B streptococcus (GBS) endogenous endophthalmitis in a patient presenting with septic arthritis and a homonymous hemianopsia due to embolic stroke. DESIGN Observational case report. METHODS A 75-year-old woman with septic arthritis and a homonymous hemianopsia due to embolic stroke was examined and found to have endogenous GBS endophthalmitis due to bacterial endocarditis. RESULTS Magnetic resonance imaging showed many septic emboli to the brain, including the left occipital lobe. Fundus examination showed evidence for endogenous endophthalmitis. Blood and urine cultures were positive for GBS. A mitral valve vegetation was presumed to be the cause of the intracranial septic emboli and was demonstrated on transesophageal echocardiography. CONCLUSIONS Septic arthritis and embolic stroke are suggestive of endocarditis and sepsis. Endogenous endophthalmitis in this case led to transesophageal echocardiography, which was diagnostic for endocarditis.
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MESH Headings
- Aged
- Anti-Bacterial Agents/therapeutic use
- Arthritis, Infectious/diagnosis
- Arthritis, Infectious/drug therapy
- Arthritis, Infectious/microbiology
- Echocardiography, Transesophageal
- Endocarditis, Bacterial/diagnosis
- Endocarditis, Bacterial/drug therapy
- Endocarditis, Bacterial/microbiology
- Endophthalmitis/diagnosis
- Endophthalmitis/drug therapy
- Endophthalmitis/microbiology
- Eye Infections, Bacterial/diagnosis
- Eye Infections, Bacterial/drug therapy
- Eye Infections, Bacterial/microbiology
- Female
- Hemianopsia/diagnosis
- Hemianopsia/drug therapy
- Hemianopsia/microbiology
- Humans
- Intracranial Embolism/diagnosis
- Intracranial Embolism/drug therapy
- Intracranial Embolism/microbiology
- Magnetic Resonance Imaging
- Streptococcal Infections/diagnosis
- Streptococcal Infections/drug therapy
- Streptococcal Infections/microbiology
- Streptococcus agalactiae
- Stroke/diagnosis
- Stroke/drug therapy
- Stroke/microbiology
- Visual Acuity
- Visual Field Tests
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Affiliation(s)
- Dipesh Pokharel
- School of Medicine, University of Oklahoma, Oklahoma City, Oklahoma, USA
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80
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Christensen SR, Hansen ABE, La Cour M, Fledelius HC. Bilateral endogenous bacterial endophthalmitis: a report of four cases. ACTA ACUST UNITED AC 2004; 82:306-10. [PMID: 15115453 DOI: 10.1111/j.1600-0420.2004.00236.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To present and discuss four cases of bilateral endogenous endophthalmitis. METHODS An observational study of four patients aged 55-80 years, seen within a 2-year period. All had diagnostic and therapeutic vitrectomy. The antibiotic therapy was guided by analyses of cultures of blood and vitreous. RESULTS Blood cultures demonstrated Streptococcus pneumoniae in two patients and Staphylococcus aureus and Morganella morganii, each in one patient. The findings corresponded with culture findings from vitreous material in two patients. The primary foci for the metastatic spread of infection were endocarditis, discitis and a subdural abscess of the lumbar spine, urinary tract infection, and infection of a recent hip alloplasty, respectively, in the four patients. Five eyes became blind, whereas three eyes recovered to visual acuity of 0.25-0.67. CONCLUSIONS Endogenous bacterial endophthalmitis usually leads to total loss of vision. The disease is acute and the time span for intervention limited. We believe that an active therapeutic approach including intravitreal antibiotics and vitreoretinal surgery saved three eyes from blindness.
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Affiliation(s)
- A Girish Rao
- Vitreo Retina Service, Shri Ganapati Netralaya, Jalna, India
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82
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Schiedler V, Scott IU, Flynn HW, Davis JL, Benz MS, Miller D. Culture-proven endogenous endophthalmitis: clinical features and visual acuity outcomes. Am J Ophthalmol 2004; 137:725-31. [PMID: 15059712 DOI: 10.1016/j.ajo.2003.11.013] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2003] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate clinical features and visual acuity outcomes associated with endogenous endophthalmitis. DESIGN Retrospective, observational case series. METHODS Twenty-one eyes of 21 patients treated at Bascom Palmer Eye Institute for culture-proven endogenous endophthalmitis between 1996 and 2002 were reviewed. RESULTS Patients were followed a mean of 3 months (range, 1 to 12 months). Fungal isolates occurred in 13 eyes (62%), gram-positive isolates in 7 (33%), and gram-negative isolates in 1 (5%). Twelve patients (57%) were hospitalized at the time of diagnosis and 6 patients (29%) died within 2 months of diagnosis. Initial treatment included tap and injection of intravitreal medication in 10 eyes (48%) and pars plana vitrectomy with injection of intravitreal medication in 11 eyes (52%). Final visual outcomes were obtainable for 18 eyes (two patients died within 10 days of diagnosis, and one patient was lost to follow-up). Eight (44%) of these 18 eyes achieved a visual acuity of 20/400 or better and 10 (56%) of 18 eyes achieved a visual acuity worse than 20/400, including 3 that were either enucleated or eviscerated. Three eyes with Aspergillus endophthalmitis had worse visual outcomes than eyes with either Candida (P =.036) or bacterial endophthalmitis (P =.024). CONCLUSIONS Compared with published series of postoperative or post-traumatic endophthalmitis, patients with endogenous endophthalmitis are more likely to have fungal isolates with a predominance of Candida albicans. Endogenous endophthalmitis is generally associated with high mortality and poor visual acuity outcomes, particularly when caused by more virulent species such as Aspergillus.
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Affiliation(s)
- Vivian Schiedler
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine, Miami, Florida 33101, USA
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83
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Voros GM, Pandit R, Griffiths PG. Metastatic endogenous endophthalmitis secondary to Staphylococcus aureus iliopsoas abscess. Eye (Lond) 2004; 18:97-8. [PMID: 14707984 DOI: 10.1038/sj.eye.6700518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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84
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Siegersma JE, Klont RR, Tilanus MAD, Verbeek AM, Schülin T, Cruysberg JRM, Deutman AF. Endogenous endophthalmitis after otitis media. Am J Ophthalmol 2004; 137:202-4. [PMID: 14700678 DOI: 10.1016/s0002-9394(03)00836-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE To report a case of bacterial endophthalmitis after otitis media in a healthy adult. DESIGN Interventional case report. METHODS A healthy 49-year-old Caucasian woman developed acute otitis media of the right ear. Three weeks after the first onset there was a recurrence of the otitis media, with perforation of the tympanic membrane. Two days after this, the woman presented at our clinic with endophthalmitis of the right eye. RESULTS A culture of vitreous material grew Streptococcus pyogenes (Streptococcus Lancefield group A). The same strain was found in a smear from the perforated ear. Despite aggressive treatment, the affected eye had to be eviscerated. CONCLUSIONS Otitis media can result in a bacteremia. This may, even in a healthy adult, lead to a devastating endogenous bacterial endophthalmitis.
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Affiliation(s)
- Jan Eize Siegersma
- Department of Ophthalmology, University Medical Centre Nijmegen, The Netherlands.
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