CLOSTRIDIAL ENDOPHTHALMITIS: CLINICAL PRESENTATIONS, MANAGEMENT OUTCOMES, AND REVIEW OF LITERATURE

Clostridial panophthalmitis - An unusual case of localised malignant oedema in Merino lambs associated with Clostridium chauvoei

The authors report an unusual case of Clostridium chauvoei causing severe panophthalmitis in Merino lambs. More than half of the lambs affected survived, which is unusual for clostridial disease; however, there have been reports in humans that the mortality risk for ocular gas gangrene is lower than when other body parts are affected. A combination of factors in this case included environmental contamination (specific to a particular paddock), genetics predisposing to entropion (lambs born of maiden 2-year-old ewes with some inbreeding), the practice of manually everting eyelids for the entropion and vaccination strategies. C. chauvoei was cultured in pure growth from the eye of a lamb affected by severe panophthalmitis. Histopathology was consistent with severe acute infection, and microscopic sections showed Gram-positive organisms associated with the inflammatory response in the eye. In the acutely affected animal examined there were no signs that the lesions were long-standing. Animals that recovered had one or both eyes destroyed. This report describes that malignant oedema in sheep due to C. chauvoei can manifest as acute and severe panophthalmitis. The case fatality rate of lambs with panophthalmitis was less than 50%, lower than normally occurs for clostridial diseases. Clostridial vaccination of the ewes may have provided a low level of protection in reducing the case fatality rate in the affected lambs as well localisation of the infection from the blood-ocular barrier.

Detecting Streptococcus suis by nanopore sequencing in endophthalmitis: A case report

Endophthalmitis is a rare and infectious disease caused by Streptococcus suis (S suis). Traditionally, S suis is detected by the pathogenic microorganism culture method, which has low positivity and high false negativity. Nanopore sequencing (NS), which is a third-generation sequencing technology, has several advantages over the traditional method; in particular, it is cost and time effective and has a high throughput. In this report, a case of infectious endophthalmitis caused by trauma is examined. The NS results suggest that the pathogen in question is a mixed infection caused by S suis and Clostridium perfringens. This case report provides evidence of the fact that NS can quickly identify pathogens, which is of great significance for clinical diagnosis and treatment.

Endophthalmitis with opaque cornea managed with primary endoscopic vitrectomy and secondary keratoplasty: Presentations and outcomes

Purpose:

To describe the outcomes of endophthalmitis with opaque cornea managed with primary endoscopic vitrectomy and secondary keratoplasty.

Methods:

Retrospective consecutive interventional case series. All cases of endophthalmitis with opaque cornea which underwent endoscopic vitrectomy followed by secondary keratoplasty were analyzed. The study period was from Jan 2015 to March 2019. The outcome measures were resolution of infection, the magnitude of unnecessary keratoplasties avoided and corneal graft survival. The final anatomic and functional outcomes were reported and compared with relevant literature.

Results:

Seventy-eight eyes of 78 patients underwent endoscopic pars plana vitrectomy for endophthalmitis with the opaque cornea, of these 14 eyes of 14 patients were deemed eligible for further corneal intervention and were included in the study. The mean age at presentation was 42.27 ± 21.6 years (median 36 years). Etiology-wise, eight cases (57.14%) were post-trauma, three cases (21.42%) post-keratoplasty, two cases (14.28%) were endogenous, and one case (7.14%) following corneal dermoid excision and wound melt. Culture positivity was in 5/14 (35.71%). The mean interval between endoscopic vitrectomy and keratoplasty was 5.42 ± 2.69 months (median 3.5 months). The mean follow-up noted was 20.42 ± 11.45 months (median 17.5 months). The infection resolved in 100% of cases. Unnecessary keratoplasties were avoided in 64/78 (82%) cases due to the primary endoscopic intervention. The favorable anatomic outcome was seen in 11/14 (78.57%) of cases and favorable functional outcome in 8/14 (57.14%) cases.

Conclusion:

Endoscopic vitrectomy allows for early intervention in endophthalmitis with the opaque cornea. This facilitates early settlement of infection, globe preservation, greater graft survival, and lesser repeat posterior segment procedures.

<p>Can Prompt Endoscopic Vitrectomy in Post-Trauma Endophthalmitis with Corneal Edema Avoid Unnecessary Keratoplasties?</p>

Objective

To describe a series of prompt endoscopic vitrectomy in eyes with post-trauma endophthalmitis and hazy cornea.

Methods

Retrospective consecutive interventional case series. Cases of endophthalmitis with hazy cornea which underwent prompt endoscopic vitrectomy were analyzed. The study period was from August 2018 to April 2019. The final anatomic and functional outcomes are reported here.

Results

Four eyes of four patients were included. Mean age at presentation was 24.50±21.29 years (median 24 years). All cases were post-open globe injury. Microbiology showed smear positivity in 3/4 (75%) and culture positivity in 2/4 (50%). The antibiotic susceptibility was 100% for vancomycin and ceftazidime. Mean follow-up was 7.75±1.7 months (median 7.5 months). Favorable anatomic outcome was seen in 100% of cases and favorable functional outcome in 75% cases.

Conclusion

Endoscopic vitrectomy allows for early intervention in endophthalmitis post open-globe injuries. This enables early resolution of infection and avoids a need for unnecessary corneal interventions.