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Ding J, Zhang Y, Feng H, Sun H. Actinomycotic primary canaliculitis: Predisposing factors, clinical characteristics, and treatment outcomes. Eur J Ophthalmol 2023; 33:2194-2200. [PMID: 36927124 DOI: 10.1177/11206721231163612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Ocular actinomycosis is an uncommon progressive infection. The study aims to investigate the predisposing factors, clinical characteristics and treatment outcomes of culture-proven cases of Actinomycotic primary canaliculitis. METHODS Single-center, retrospective, interventional case series. Culture-proven cases of Actinomyces-associated primary canaliculitis diagnosed and treated between January 2017 and December 2021 at the Beijing Tongren Eye Center, Capital Medical University were identified and reviewed for ocular and systemic risk factors, clinical presentations, microbiological profile, treatment modalities and outcomes. RESULTS Of the 201 patients diagnosed with primary canaliculitis, 22 (10.9%) were caused by Actinomyces. The mean age at onset of 22 patients (21 women and one men) was 54 years. The lower canaliculus was most commonly involved (54.6%). The most frequent symptom was mattering without epiphora (77.3%) and clinical signs were punctal regurgitation of purulent discharge (100%) and expressible concretions (95.5%). Dry eye co-existed in 77.3% of patients, whereas no obvious systemic factors were found. Among 19 cases (86.0%) of identified Actinomyces species, A. odontolyticus (43.5%) was the predominant causative microorganism. There were 50% of patients with polymicrobial infection and the most common additional bacteria isolated were Streptococcus species. Conservative therapy combining repeated canalicular expression and irrigation with susceptible topical antibiotics achieved complete resolution in 86.4% of patients. CONCLUSIONS Dry eye was identified in the vast majority of patients with Actinomycotic canaliculitis. Most cases are odontogenic in origin and the infection occurs in immunocompetent individuals. The conservative method combining canalicular expression and irrigation with topical susceptible antibiotics is recommendable as initial therapy.
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Affiliation(s)
- Jingwen Ding
- Department of Oculoplastic Surgery, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yang Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Hui Feng
- Department of Oculoplastic Surgery, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Hua Sun
- Department of Oculoplastic Surgery, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Tainsh LT, Tieger MG, Wu DM. Propionibacterium acnes-associated Delayed-onset Pseudophakic Endophthalmitis. Int Ophthalmol Clin 2022; 62:145-156. [PMID: 35325916 DOI: 10.1097/iio.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patel TP, Zacks DN, Dedania VS. Antimicrobial guide to posterior segment infections. Graefes Arch Clin Exp Ophthalmol 2020; 259:2473-2501. [PMID: 33156370 DOI: 10.1007/s00417-020-04974-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/08/2020] [Accepted: 10/07/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE This review article is meant to serve as a reference guide and to assist the treating physician in making an appropriate selection and duration of an antimicrobial agent. METHODS Literature review. RESULTS Infections of the posterior segment require prompt medical or surgical therapy to reduce the risk of permanent vision loss. While numerous options exist to treat these infections, doses and alternative therapies, especially with contraindications for first-line therapy, are often elusive. Antimicrobial agents to treat posterior segment infections can be administered via various routes, including topical, intravitreal, intravenous, and oral. CONCLUSIONS Although there are many excellent review articles on the management of endophthalmitis, we take the opportunity in this review to comprehensively summarize the appropriate antimicrobial regimen of both common and rare infectious etiologies of the posterior segment, using evidence from clinical trials and large case series.
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Affiliation(s)
- Tapan P Patel
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Hospital, Baltimore, MD, USA
| | - David N Zacks
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Vaidehi S Dedania
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.
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Mehrotra N, Baidya A, Brijwal M, Aggarwal R, Chaudhry R. Actinomycosis of eye: Forgotten but not uncommon. Anaerobe 2015; 35:1-2. [DOI: 10.1016/j.anaerobe.2015.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/26/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
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A para-canalicular abscess resembling an inflamed chalazion. Case Rep Ophthalmol Med 2013; 2013:618367. [PMID: 23762696 PMCID: PMC3673339 DOI: 10.1155/2013/618367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 05/08/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Lacrimal infections by Actinomyces are rare and commonly misdiagnosed for long periods of time. They account for 2% of all lacrimal diseases. Case Report. We report a case of a 70-year-old female patient suffering from a para-canalicular abscess in the medial canthus of the left eye, beside the lower punctum lacrimale, resembling a chalazion. Purulence exited from the punctum lacrimale due to inflammation of the inferior canaliculus (canaliculitis). When pressure was applied to the mass, a second exit of purulence was also observed under the palpebral conjunctiva below the lacrimal caruncle. A surgical excision was performed followed by administration of local antibiotic therapy. The histopathological examination of the extracted mass revealed the existence of actinomycosis. Conclusion. Persistent or recurrent infections and lumps of the eyelids should be thoroughly investigated. Actinomyces as a causative agent should be considered. Differential diagnosis is broad and should include canaliculitis, chalazion, and multiple types of neoplasias. For this reason, in nonconclusive cases, a histopathological examination should be performed.
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Westermeyer HD, Ward DA, Whittemore JC, Lyons JA. Actinomyces endogenous endophthalmitis in a cat following multiple dental extractions. Vet Ophthalmol 2013; 16:459-63. [PMID: 23281798 DOI: 10.1111/vop.12023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
An 8-year-old, brachycephalic, mixed breed cat underwent full mouth tooth extractions for the treatment of tooth root abscessation. Subsequently, the cat developed anterior uveitis refractory to topical therapy that eventually necessitated enucleation. Actinomyces species were isolated from both the tooth root abscesses and the anterior chamber after enucleation. Histopathology of the enucleated eye revealed panophthalmitis with abundant intralesional bacteria morphologically consistent with Actinomyces. Between the time of tooth root extraction and enucleation (20 weeks), the cat was diagnosed with hyperthyroidism and treated with oral steroids for inflammatory bowel syndrome. We believe this report represents a rare case of endogenous endophthalmitis secondary to dental disease, possibly precipitated by concurrent immunosuppression.
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Affiliation(s)
- Hans D Westermeyer
- Peace Avenue Veterinary Clinic, 7B Liberty Avenue, Mong Kok, Kowloon, Hong Kong
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Lee YH, Kim WJ, Lee SB. Caruncular Abscess Due to Actinomycosis. KOREAN JOURNAL OF OPHTHALMOLOGY 2013; 27:288-90. [PMID: 23908576 PMCID: PMC3730072 DOI: 10.3341/kjo.2013.27.4.288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 10/21/2011] [Indexed: 11/23/2022] Open
Abstract
The authors report a caruncular abscess caused by actinomycosis. A 47-year-old woman was admitted with persistent purulent discharge from the caruncle of the left eye for a duration of six months. Excisional drainage was performed, and 'sulfur granules' were observed, consistent with actinomyces infection. Intraoperative lacrimal probing and irrigation were performed to confirm that the abscess and canaliculus were not connected. Oral and topical antibiotics were administered postoperatively; the lesion resolved with no evidence of recurrence, and the symptom improved.
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Affiliation(s)
- Yeon-Hee Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Woo-Jin Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sung-Bok Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
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Bacterial and Mucopeptide Concretions of the Lacrimal Drainage System. Ophthalmic Plast Reconstr Surg 2012; 28:126-33. [DOI: 10.1097/iop.0b013e31824c88a6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chronic postoperative endophthalmitis: a review of clinical characteristics, microbiology, treatment strategies, and outcomes. Int J Inflam 2012; 2012:313248. [PMID: 22550607 PMCID: PMC3328945 DOI: 10.1155/2012/313248] [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: 10/15/2011] [Revised: 01/10/2012] [Accepted: 01/29/2012] [Indexed: 01/30/2023] Open
Abstract
Chronic postoperative endophthalmitis (CPE) is a delayed infectious intraocular inflammation process that occurs more than six weeks after ocular surgery and frequently masquerades as autoimmune uveitis. These cases are at risk of delayed diagnosis and erroneous long-term treatment with corticosteroids. This paper aims to review the epidemiology, microbiology, clinical characteristics, diagnosis, management strategies, and outcome of chronic postoperative endophthalmitis. The incidence of CPE is still uncommon, and multiple pathogens have been reported with varying frequencies. Review of the literature reveals that CPE cases have a high incidence of visual impairment and recurrence rate might be decreased with aggressive surgical approach.
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Peponis VG, Chalkiadakis SE, Parikakis EA, Mitropoulos PG. Chronic Postoperative Endophthalmitis Caused by Actinomyces meyeri. Case Rep Ophthalmol 2011; 2:95-8. [PMID: 21475608 PMCID: PMC3072179 DOI: 10.1159/000326062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report a female patient who developed chronic endophthalmitis after an uneventful cataract surgery. Cultures of aqueous humor and a vitreous sample showed positivity for Actinomyces meyeri. Intense anterior segment inflammation and a less evident impairment of the patient's posterior segment led us to treat her vigorously with pars plana vitrectomy combined with intraocular and topical antibiotics. The patient achieved a good recovery of vision without the need to remove the intraocular lens and to add systemic drugs. To the best of our knowledge, this is the first reported case of an intraocular infection caused by A. meyeri after small-incision clear corneal phacoemulsification.
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Sharma S, Saffra NA, Chinyadza T, Ghitan M, Chapnick EK. Endocapsular cellulomonas as a cause of persistent postoperative endophthalmitis. Ophthalmic Surg Lasers Imaging Retina 2008; 39:328-30. [PMID: 18717441 DOI: 10.3928/15428877-20080701-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sequestration of bacteria within the capsular fornices after cataract extraction with intraocular lens implantation can cause both acute and chronic inflammation. A case of persistent postoperative endophthalmitis caused by capsular sequestration of Cellulomonas is described. The patient underwent uncomplicated cataract extraction with intraocular lens implantation and subsequently developed acute postoperative endophthalmitis. Inflammation persisted despite several vitreous taps and the injection of intravitreal antibiotics. Definitive treatment required pars plana vitrectomy, intraocular lens explantation, capsular bag removal, and intravitreal and parenteral antibiotics. In patients with postoperative endophthalmitis, one must consider atypical organisms as the source and should consider explantation of the intraocular lens with capsular bag removal.
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Affiliation(s)
- Shobha Sharma
- Division of Infectious Diseases, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, USA
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12
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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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Abstract
Actinomycotic conjunctivitis is usually unilateral and secondary to canaliculitis. We report an unusual case of bilateral actinomycotic blepharokeratoconjunctivitis in the absence of canaliculitis. Keratitis occurred without any preceding ocular trauma. Both eyes had remissions and relapses in response to the antibiotic-steroid drops. Diagnosis of A. israelii infection was made on the basis of Gram staining, culture and biochemical characteristics. Complete excision of the conjunctival ulcer along with penicillin therapy resulted in cure. This case highlights that microorganisms of the order Actinomycetales should be considered in the differential diagnosis if conjunctivitis or keratitis shows a waxing and waning course.
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Affiliation(s)
- Ruchi Goel
- Department of Ophthalmology, Safdarjung Hospital, New Delhi, India.
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Pagliani L, Campi L, Cavallini GM. Orbital actinomycosis associated with painful ophthalmoplegia. Actinomycosis of the orbit. Ophthalmologica 2006; 220:201-5. [PMID: 16679798 DOI: 10.1159/000091767] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2004] [Accepted: 06/24/2004] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate a case of orbital actinomycosis presenting as Tolosa-Hunt syndrome in a patient with a history of carcinomas of the kidney and breast. METHODS A woman with ingravescent painful ophthalmoplegia was brought to our observation. Brain and orbital and total body CT scans showed the presence of two orbital neoformations and a miliary pattern of dissemination in the lung. The initial diagnosis, which pointed to secondary localisations of the previous kidney and breast tumours, was changed to orbital and pulmonary actinomycosis following microbiological analysis of lung biopsy samples. RESULTS Prolonged antibiotic therapy with synthetic penicillin completely resolved the case. CONCLUSIONS Actinomycosis is a very rare infection that may also affect the orbit and its association with a pulmonary dissemination is highly unusual. It is important to consider this type of infection among the causes of painful ophthalmoplegia.
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Affiliation(s)
- Livio Pagliani
- Dipartimento Misto di Neuroscienze, Testa, Collo e Riabilitazione, Università degli Studi di Modena e Reggio Emilia, Struttura Complessa di Oftalmologia, Modena, Italia
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15
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Raman VS, Evans N, Shreshta B, Cunningham R. Chronic postoperative endophthalmitis caused by Actinomyces neuii. J Cataract Refract Surg 2005; 30:2641-3. [PMID: 15617941 DOI: 10.1016/j.jcrs.2004.04.070] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2004] [Indexed: 10/26/2022]
Abstract
Uneventful phacoemulsification with implantation of a foldable, acrylic posterior chamber intraocular lens was performed in the right eye of a 73-year-old white man. Postoperatively, the patient developed a chronic, low-grade intraocular inflammation. Cultures from the aqueous specimen grew Actinomyces neuii, an unusual gram-positive bacillus. The low-grade intraocular inflammation persisted with intensive topical steroid-antibiotic medication and systemic antibiotics. A diagnostic, 3-port, pars plana vitrectomy was performed, and aqueous aspirate specimens were sent for culture and sensitivity and to look for abnormal cells. Intracameral antibiotics were not injected. The specimens were sterile to culture, and chronic inflammatory cells were reported on the vitreous specimen. On examination 6 months later, inflammation had not recurred and the best corrected visual acuity was 6/18.
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Garelick JM, Khodabakhsh AJ, Josephberg RG. Acute postoperative endophthalmitis caused by Actinomyces neuii. Am J Ophthalmol 2002; 133:145-7. [PMID: 11755855 DOI: 10.1016/s0002-9394(01)01206-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To describe a case of acute postoperative endophthalmitis caused by Actinomyces neuii after uncomplicated phacoemulsification with posterior chamber intraocular lens implant. METHODS Interventional case report. A 58-year-old male underwent phacoemulsification, right eye, with posterior chamber intraocular lens implant. On postoperative day 6, he presented with pain, redness, and decreased visual acuity, right eye, and was found to have endophthalmitis. RESULTS Vitreous cultures revealed the gram-positive, anaerobe Actinomyces neuii. After appropriate intraocular, periocular, topical, and systemic therapy, the infection cleared, but the vision of the patient never improved as a result of a central vein occlusion. CONCLUSION Actinomyces species can rarely cause postoperative endophthalmitis, and it should be considered in cases of severe postoperative intraocular inflammation.
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Affiliation(s)
- Jordan M Garelick
- New York Medical College, Department of Ophthalmology, Westchester Medical Center, Valhalla, New York, USA
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19
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Abstract
Endophthalmitis, attributable to Actinomyces viscosus, developed in a 78-year-old man after cataract surgery. Postoperative endophthalmitis with this organism is a rare occurrence. This report emphasizes the importance of the Actinomyces species as potential eye pathogens and presents antimicrobial susceptibility data for the isolate.
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Affiliation(s)
- F J Scarano
- Department of Pathology and Laboratory Medicine, Hartford Hospital, CT, USA
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20
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Therese KL, Anand AR, Madhavan HN. Polymerase chain reaction in the diagnosis of bacterial endophthalmitis. Br J Ophthalmol 1998; 82:1078-82. [PMID: 9893601 PMCID: PMC1722759 DOI: 10.1136/bjo.82.9.1078] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Microbiological investigations of vitreous fluid (VF) and aqueous humour (AH) specimens have often failed to detect the infecting agent in infectious endophthalmitis, resulting in a clinical dilemma regarding therapy. In this study, the polymerase chain reaction (PCR) was evaluated in the diagnosis of bacterial and Propionibacterium acnes endophthalmitis. METHODS 58 intraocular specimens (30 VF and 28 AH) from 55 cases of endophthalmitis and 20 specimens (14 VF and 6 AH) as controls from non-infective disorders were processed for microbiological investigations. Nested PCR directed at the 16S rDNA using universal primers for eubacterial genome was done. PCR for P acnes was performed on specimens microbiologically negative by conventional techniques but eubacterial genome positive. RESULTS Of the 20 controls from non-infective cases, one (5%) was positive using eubacterial primers and none with P acnes primers. PCR for eubacterial genome showed 100% correlation with 20 (34.5%) bacteriologically positive specimens. Eubacterial genome, was detected in 17 (44.7%) of 38 bacteriologically negative specimens and nine (52.9%) out of the 17 were positive for P acnes genome. Among the 21 eubacterial PCR negative specimens, seven were fungus positive. By inclusion of PCR, microbiologically positive specimens increased from 46.5% to 75.8%. PCR on AH was as sensitive as that on VF for the detection of both eubacterial and the P acnes genome. CONCLUSION PCR performed on AH and VF is a reliable tool for the diagnosis of bacterial and P acnes endophthalmitis particularly in smear and culture negative specimens.
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Abstract
Chronic, low-grade endophthalmitis after cataract surgery with intraocular lens (IOL) implantation is often unresponsive to antibiotic therapy, probably because of low drug penetration into the capsular bag. To increase the drug concentration at the infection site, we irrigated the capsular bag with antibiotics. Within 6 weeks, endophthalmitis resolved in three consecutive patients with positive aqueous cultures. Visual acuity improved from finger counting or less to 20/40 or better in all cases. No recurrence was seen in the 12 to 19 month follow-up. Antibiotic irrigation of the capsular bag can resolve chronic, low-grade endophthalmitis in culture-positive patients unresponsive to the same drugs administered by other routes, including conventional intraocular injection. With this approach there is minimal surgical trauma and the IOL is retained.
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Affiliation(s)
- M Busin
- University Eye Hospital, Bonn, Germany
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22
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Busin M, Cusumano A, Spitznas M. Intraocular lens removal from eyes with chronic low-grade endophthalmitis. J Cataract Refract Surg 1995; 21:679-84. [PMID: 8551447 DOI: 10.1016/s0886-3350(13)80566-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Intraocular lenses (IOLs) were removed from 11 eyes with chronic low-grade endophthalmitis after cataract extraction to restore useful vision and prevent recurrence. One anterior chamber lens, one iris-supported lens, and nine posterior chamber lenses were removed. In the eyes with posterior chamber lenses, the posterior capsule was intact; total (n = 7) or partial (n = 2) capsulectomy was performed in these eyes. Aqueous humor specimens obtained at surgery were positive for bacteria in five eyes, but scanning electron microscopy showed bacteria on all removed IOLs and capsular bags. Final best corrected visual acuity was 20/40 or better in seven eyes. Reduced visual acuity, between 20/50 and 20/400 in three eyes and counting fingers in one eye, was related to retinal detachment (n = 2) and age-related macular degeneration (n = 2). Transient hyphema was seen in one eye. With a mean follow-up of 21 months (range 10 to 31 months), no recurrence of inflammation was observed. The results show that negative cultures do not preclude a bacterial cause for infection and that primary IOL removal with partial or total capsulectomy provides a surgical approach to the treatment of chronic low-grade endophthalmitis not responsive to medical therapy.
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Affiliation(s)
- M Busin
- University Eye Hospital, Bonn, Germany
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23
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Kinnear FB, Kirkness CM. Advances in rapid laboratory diagnosis of infectious endophthalmitis. J Hosp Infect 1995; 30 Suppl:253-61. [PMID: 7560958 DOI: 10.1016/0195-6701(95)90027-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Infectious endophthalmitis is a serious ocular condition which always requires rapid medical or surgical intervention. At present this, in a number of situations, remains empirical as a consequence of problems inherent in unequivocal identification of the causative organism, should one be present. Aqueous humor smears and culture have limited value in diagnosis. Vitreous samples can often reveal the presence of microbes, but these may not necessarily be detected in all cases, principally due to suboptimal sampling or pretreatment with antimicrobials which render microbes non-culturable on routine media. Use of electron microscopy and/or immunocytochemistry offers an alternative means of identification, but these approaches have drawbacks principally associated with interpretation. Molecular methods which identify conserved sequences from common causative microbes of endophthalmitis, or which can specify whether the organism is a bacterium or a fungus may become especially important as diagnostic tools in this clinical scenario.
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Affiliation(s)
- F B Kinnear
- Tennent Institute of Ophthalmology, Western Infirmary, Glasgow, Scotland
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Campos MS, Campos e Silva LDQ, Rehder JR, Lee MB, O'Brien T, McDonnell PJ. Anaerobic flora of the conjunctival sac in patients with AIDS and with anophthalmia compared with normal eyes. Acta Ophthalmol 1994; 72:241-5. [PMID: 8079632 DOI: 10.1111/j.1755-3768.1994.tb05023.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Relatively few investigations of anaerobic bacteria as ocular flora have been conducted, and their results have been contradictory. The conjunctival sacs of 22 normal subjects and of 14 patients with acquired immunodeficiency syndrome, and 22 anophthalmic sockets were cultured for anaerobic bacteria Thirty-four (77.3%) of the 44 eyes of normal subjects harbored anaerobic bacteria; Propionibacterium acnes was present in 28 eyes (63.6%), Lactobacillus species in 6 eyes (13.6%), and Veillonella species in 7 eyes (15.9%). The finding were very similar for anophthalmic sockets (p = 0.01), with 17 (77.3%) of the 22 sockets harboring anaerobes; Propionibacterium acnes was the organism identified in 16 (72.7%) of these sockets; Veillonella was identified in 4 (18.1%), Peptococcus niger in 3 (13.6%) and P. granulosum in 2 (9.0%) of these sockets. Acquired immunodeficiency syndrome patients had the highest incidence of anaerobic organisms, with positive cultures obtained from 24 (85.7%) of the 28 eyes. Propionibacterium species were isolated from 16 (57.1%) of these eyes. Clostridium species from 10 (35.7%) eyes and Actinomyces species from 8 (28.6%) eyes. It thus appears that anaerobic organisms are common flora in normal conjunctival sacs and in anophthalmic sockets, as well as in the sacs of acquired immunodeficiency syndrome patients, but the latter group had a higher incidence (x2 = 0.87) and a spectrum of organisms that was different from that of the other two groups.
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Affiliation(s)
- M S Campos
- Department of Ophthalmology, Paulista School of Medicine, São Paulo, Brazil
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Hussain I, Bonshek RE, Loudon K, Armstrong M, Tullo AB. Canalicular infection caused by Actinomyces. Eye (Lond) 1993; 7 ( Pt 4):542-4. [PMID: 8253235 DOI: 10.1038/eye.1993.118] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We present 7 cases of canalicular involvement with Actinomyces collected over a 5-year period. All patients had involvement of one canaliculus, upper or lower, with lacrimal drainage patent to syringing. Curettings obtained by incising the involved canaliculi yielded Actinomyces species (5 cases) and Arachnia propionica (2 cases), typically in association with a mixed bacterial growth. Our results show that these patients often remain undiagnosed for months or even years, and are treated inappropriately for their recurrent symptoms. Despite sensitivity of Actinomyces to a broad spectrum of antibiotics, medical therapy alone does not eradicate the disease, and surgical evacuation of all concretions is essential to achieve a cure.
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Ormerod LD, Ho DD, Becker LE, Cruise RJ, Grohar HI, Paton BG, Frederick AR, Topping TM, Weiter JJ, Buzney SM. Endophthalmitis caused by the coagulase-negative staphylococci. 1. Disease spectrum and outcome. Ophthalmology 1993; 100:715-23. [PMID: 8493015 DOI: 10.1016/s0161-6420(93)31584-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE The coagulase-negative staphylococci are the most common causes of postoperative endophthalmitis. This study investigates the variability in the disease spectrum and visual outcome of coagulase-negative staphylococcal endophthalmitis in a large, single-center series. METHODS Ninety consecutive cases of coagulase-negative staphylococcal endophthalmitis were investigated retrospectively from two time periods, 1978 to 1982 and 1985 to 1987, separated by a transitional period in cataract surgery technique. Using a detailed protocol, inpatient, outpatient, and microbiologic records were analyzed. Six-month visual acuity results were obtained. RESULTS Diagnosis frequently was delayed, often suspected only after hypopyon development. Thirty-seven percent of patients presented more than 1 week after the inoculating event, and 13% presented after more than 1 month. Variable asymptomatic intervals and gradually worsening inflammatory prodromes are noted. Painless endophthalmitis occurred in 16%. Non-epidermidis infections comprised 28%. With vitrectomy/intraocular antibiotic management, 38% and 68% achieved visual acuities of 20/50 and 20/400, respectively. Overall, 10% of patients developed late retinal detachments. This occurred in only 4% of patients, with endophthalmitis occurring after cataract surgery. CONCLUSION Ophthalmologists should become familiar with the emerging concepts of delayed-onset, chronic, and often painless endophthalmitis in which the coagulase-negative staphylococci play a prominent role.
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Affiliation(s)
- L D Ormerod
- Schepens Eye Research Institute, Harvard University Medical School, Boston, MA
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Apple DJ, Solomon KD, Tetz MR, Assia EI, Holland EY, Legler UF, Tsai JC, Castaneda VE, Hoggatt JP, Kostick AM. Posterior capsule opacification. Surv Ophthalmol 1992; 37:73-116. [PMID: 1455302 DOI: 10.1016/0039-6257(92)90073-3] [Citation(s) in RCA: 629] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A complication of extracapsular cataract extraction with or without posterior chamber intraocular lens (PC-IOL) implantation is posterior capsule opacification. This condition is usually secondary to a proliferation and migration of residual lens epithelial cells. Opacification may be reduced by atraumatic surgery and thorough cortical clean-up. Clinical, pathological and experimental studies have shown that use of hydrodissection, the continuous curvilinear capsulorhexis and specific IOL designs may help reduce the incidence of this complication. Capsular-fixated, one-piece all-polymethylmethacrylate PC-IOLs with a C-shaped loop configuration and a posterior convexity of the optic are effective. Polymethylmethacrylate loops that retain "memory" create a symmetric, radial stretch on the posterior capsule after in-the-bag placement, leading to a more complete contact between the posterior surface of the IOL optic and the taut capsule. This may help form a barrier against central migration of epithelial cells into the visual axis. Various pharmacological and immunological methods are being investigated but conclusive data on these modalities are not yet available.
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Affiliation(s)
- D J Apple
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston
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