Postoperative endophthalmitis resulting from prosthesis contamination in a monocular patient

Complete and early vitrectomy for endophthalmitis

We recently co-authored a report on the ten-year (2007-2017) results achieved at our center (Retina Specialists of Alabama) in the treatment of Acute Post-Cataract Endophthalmitis (APCE). Of all eyes, 77.4% were initially treated with Complete and Early Vitrectomy for Endophthalmitis (CEVE). Visual acuity of ≥ 20/40 was restored in 79% of all eyes versus 53% of eyes reported in the Endophthalmitis Vitrectomy Study. We believe that CEVE is the initial treatment of choice whenever the fundus is obscured by endophthalmitis vitreous opacity.

Conjunctival flora in anophthalmic patients: microbiological spectrum and antibiotic sensitivity

AIM

To identify the spectrum and susceptibility pattern of isolated microorganisms from conjunctival flora of anophthalmic patients.

METHODS

A cross-sectional clinical study including 60 patients with unilateral anophthalmia. Patients with use of antibiotic drops in their socket during the last month were also included. From each patient, three microbiological samples were taken from the lower conjunctival sac (healthy eye, pre-prosthesis, and retro-prosthesis space of socket). The 180 samples obtained were cultured. Isolates were identified and their antibiotic sensitivities were determined.

RESULTS

A total of 251 isolates were recovered (62 isolates from healthy eye, 93 from pre-prosthesis, and 96 from retro-prosthesis space). The most common organism was Staphylococcus epidermidis, in both healthy eyes (64.5%) and sockets (45.5%). Altogether, coagulase-positive Staphylococci, Streptococci, and Gram-negative bacteria accounted for less than 15% of isolates in healthy eyes and more than 35% in sockets. Regarding the antibiotic sensitivities, there were no significant differences between isolates from sockets and healthy eyes. Nine patients recognized the use of self-prescribed antibiotic drops in their socket. In the healthy eyes of these subjects, Gram-positive microorganisms showed significantly greater resistance to aminoglycosides and tetracycline.

CONCLUSION

Sockets of anophthalmic patients show a greater number of pathogens compared to healthy eyes. The use of antibiotic drops in the socket promotes a resistant flora not only in the socket but also in the healthy eye. Quinolones and macrolides may be better therapeutic options than aminoglycosides for treating conjunctivitis of anophthalmic sockets, since these antibiotics are less active against Staphylococcus epidermidis.

Recommendations for post-adaption care of an ocular prosthesis: A review

An ocular prosthesis must be maintained in a suitable state of cleanliness, fit and preservation. Otherwise its functioning may be compromised, leading to a variety of diseases. However, there is a lack of consensus on the care of such prostheses. This review assembles and attempts to update existing knowledge in this area and discusses the most appropriate care regimes.

Outcomes of cataract extraction in seeing eyes of functionally monocular versus completely monocular patients

PURPOSE

To compare outcomes of cataract extraction in seeing eyes of functionally versus completely monocular patients.

SETTING

Jules Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.

METHODS

This study reviewed the records of patients with poor or no vision in 1 eye at the time of cataract surgery in the better-seeing fellow eye. All patients were monocular as defined by corrected distance visual acuity (CDVA) in the blind eye of 20/200 or worse. Group 1 included patients with blind-eye CDVA between light perception and 20/200 and Group 2, patients with no light perception (NLP) in the blind eye. Medical and surgical comorbidities were compared between groups. Outcome measures included CDVA, postoperative procedures, and surgical complications.

RESULTS

The mean number of preoperative comorbidities in operated eyes was similar between groups. The mean number of medical comorbidities in blind eyes was 2.15 +/- 0.97 (SD) in Group 1 and 1.38 +/- 1.10 in Group 2 and the mean surgical comorbidities, 0.21 +/- 0.41 and 1.28 +/- 0.68, respectively; the differences between the groups were statistically significant. At last follow-up, 19.2% of patients in Group 1 and 6.3% in Group 2 had decreased CDVA. The number of additional procedures and surgical complications was similar between groups.

CONCLUSIONS

Blind eyes with limited vision had more medical comorbidity and less surgical comorbidity than eyes with NLP. More patients in the former group ultimately lost CDVA in the good eye. Medical comorbidities were more likely bilateral than surgical comorbidities, predisposing to worse outcomes.

Evaluation of ocular prosthesis biofilm and anophthalmic cavity contamination after use of three cleansing solutions

In addition to an initial socket discomfort, ocular prosthesis (OP) installation may allow the adherence of fungi and/or bacteria due to the superficial characteristics of the prosthesis' material, use of inadequate cleansing solutions and methods, or because the void located between the internal portion of the prosthesis and the anophthalmic cavity (AC) mucosa.

OBJECTIVE

The aim of this study was to evaluate OP biofilm formation and the level of contamination of the internal portion of the OP and the AC in 24 patients.

MATERIAL AND METHODS

Material was collected from the AC at the beginning of the study and 15 days after cleansing of the OP with 3 cleansing solutions: a neutral liquid soap, a multiuse solution for contact lens (Complete) and 0.12% chlorhexidine (Periogard). The collected materials were sowed in Petri dishes containing selective media for aerobic and facultative microorganisms, specifically staphylococci (Hipersalt agar with egg yolk), aerobic microorganisms (Brain Heart Infusion Blood Agar), streptococci (Mitis salivarius Agar), gram-negative bacilli (MacConkey Agar) and yeasts (Chromagar Candida), incubated at 35 degrees C or 37 degrees C and the number of colony forming units were counted. Data were analyzed statistically by ANOVA, Friedman's test and Spearman's correlation.

RESULTS

Aerobic microorganisms, gram-negative bacilli and S. aureus were found in the OP biofilm and in the AC. There was statistically significant difference (p<0.05) between the number of microorganisms before and after the use of the cleansing solutions.

CONCLUSION

There was positive correlation with respect to the microorganisms present in the OP biofilm and AC for the 4 proposed treatments, indicating that the decrease of OP contamination leads to AC contamination as well.

Bacterial endophthalmitis after small-incision cataract surgery. effect of incision placement and intraocular lens type

PURPOSE

To determine whether endophthalmitis after small-incision cataract surgery is affected by the incision site (superior sclerocorneal versus temporal cornea) or the foldable intraocular lens (IOL) material (silicone versus acrylic).

SETTING

Multicenter study.

METHODS

Patients who had small-incision cataract surgery at Toyama Medical and Pharmaceutical University Hospital and affiliated hospitals from March 1998 to March 2001 were examined prospectively. The patients were randomized into 3 groups. In Group A, an acrylic IOL (MA60BM, Alcon) was implanted through a temporal corneal incision. In Group B, an acrylic IOL (MA60BM) was implanted via a superior sclerocorneal incision. In Group C, a silicone poly(methyl methacrylate) IOL (SI-40NB, Allergan) was implanted via a superior sclerocorneal incision. Each patient was followed for more than 6 months.

RESULTS

Initially, 7622 patients (12 317 eyes) agreed to participate in the study. The final study included 3831 eyes in Group A, 3901 eyes in Group B, and 3863 eyes in Group C. Postoperative endophthalmitis was diagnosed clinically in 11 eyes (0.29%) in Group A, 2 (0.05%) in Group B, and 2 (0.05%) in Group C. Endophthalmitis proven by culture was found in 9 eyes in Group A, 2 in Group B, and 2 in Group C. The incidence of endophthalmitis in Group A was higher than in the other groups. The incidence of endophthalmitis in Group B was similar to that in Group C. The relative risk of postoperative endophthalmitis proven by culture in Groups B and C was 4.6 times (P =.037) lower than in Group A.

CONCLUSION

The findings suggest that a temporal corneal incision may lead to an increased risk of postoperative endophthalmitis and that the IOL material does not affect the incidence of this complication.

Endophthalmitis

Endophthalmitis is an inflammatory reaction of intraocular fluids or tissues. Infectious endophthalmitis is one of the most serious complications of ophthalmic surgery. Occasionally, infectious endophthalmitis is the presenting feature of an underlying systemic infection. Successful management of infectious endophthalmitis depends on timely diagnosis and institution of appropriate therapy. Recognition of the different clinical settings in which endophthalmitis occurs and awareness of the highly variable presentation it may have facilitate timely diagnosis. Biopsy of intraocular fluid/tissue is the only method that permits reliable diagnosis and treatment. The different presenting clinical settings, a rational approach to diagnosis (i.e., when, what, and how to biopsy), and the treatment of infectious endophthalmitis are reviewed.