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Hui J, Ren Y, Wang Y, Han Q. Lactobacillus acidophilus Endophthalmitis Postcataract Operation: A Case Report with a Literature Review. Ocul Immunol Inflamm 2023:1-5. [PMID: 37186816 DOI: 10.1080/09273948.2023.2202736] [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: 05/17/2023]
Abstract
BACKGROUND Lactobacillus acidophilus is usually considered nonpathogenic and widely distributed in the human gastrointestinal and vaginal tract. In rare cases, lactobacilli may cause eye infections. CASE PRESENTATION We report a 71-year-old man who experienced unexpected ocular pain and decreased visual acuity for one day after cataract surgery. He presented with obvious conjunctival and circumciliary congestion, corneal haze, anterior chamber cells, anterior chamber empyema, posterior corneal deposits, and pupil light reflection disappearance. This patient underwent the standard three-port 23-gauge pars plana vitrectomy and received the intravitreal perfusion of vancomycin at 1 mg/0.1 mL. The culture of the vitreous fluid produced Lactobacillus acidophilus. CONCLUSION Acute Lactobacillus acidophilus endophthalmitis can occur after cataract surgery, which should be taken into consideration.
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Affiliation(s)
- Jingwen Hui
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin, China
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
- Nankai University Eye Hospital, Tianjin, China
- Nankai Eye Institute, Nankai University, Tianjin, China
| | - Yongxia Ren
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin, China
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
- Nankai University Eye Hospital, Tianjin, China
- Nankai Eye Institute, Nankai University, Tianjin, China
| | - Ying Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin, China
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
- Nankai University Eye Hospital, Tianjin, China
- Nankai Eye Institute, Nankai University, Tianjin, China
| | - Quanhong Han
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin, China
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
- Nankai University Eye Hospital, Tianjin, China
- Nankai Eye Institute, Nankai University, Tianjin, China
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Blom K, Jørstad ØK, Faber RT, Stene-Johansen I, Holberg-Petersen M, Hermansen NO, Bragadóttir R. Primary vitrectomy or intravitreal antibiotics followed by early vitrectomy for acute endophthalmitis: A prospective observational study. Acta Ophthalmol 2023; 101:100-108. [PMID: 35751448 PMCID: PMC10084037 DOI: 10.1111/aos.15207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/30/2022] [Accepted: 06/05/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND/AIMS To compare outcomes of acute endophthalmitis (EO) managed with either primary vitrectomy (PV) or primary intravitreal antibiotics (vancomycin and ceftazidime) followed by early vitrectomy (PIAEV) combined with polymerase chain reaction (PCR)-based diagnostics. METHODS This was a prospective, comparative observational study of acute EO cases admitted to a regional vitreoretinal service over 18 months. Depending on whether immediate vitrectomy (within 6 h) was achievable, the EO cases were treated with either (1) PV or (2) PIAEV. Microbiology samples were collected either (A) before or (B) after administration of intravitreal antibiotics. The samples were analysed with broad-range 16S PCR and culture. RESULTS The study included 41 EO cases. There were 19 post-injection EO, 18 post-cataract EO, three post-vitrectomy EO, and one blebitis-related EO. Fifteen of 19 PV cases and 15 of 21 PIAEV had a clinically meaningful improvement in best-corrected visual acuity (BCVA) of at least 15 letters at 3 months (p = 0.58). One patient was lost to follow-up. Twenty-three cases were culture- and PCR-positive, and seven additional cases were culture-negative but PCR-positive (p = 0.02). PCR increased the diagnostic yield for samples collected both before and after administration of intravitreal antibiotics. CONCLUSION Primary vitrectomy or PIAEV allowed for vitrectomy for all cases of acute EO in a large region. Most eyes in both groups achieved a clinically meaningful improvement in BCVA. By combining culture with PCR in connection with the vitrectomy procedure, intravitreal antibiotics could be injected before microbiological sampling, thereby improving the door-to-treatment time without sacrificing microbial identification.
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Affiliation(s)
- Kathrine Blom
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | - Ragnheiður Bragadóttir
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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3
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Elhusseiny AM, Shamim MM, Sanders RN, Sallam AB. Endogenous endophthalmitis caused by Staphylococcus capitis. Am J Ophthalmol Case Rep 2022; 25:101415. [PMID: 35198828 PMCID: PMC8850336 DOI: 10.1016/j.ajoc.2022.101415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose To report a rare case of endogenous endophthalmitis caused by Staphylococcus capitis. Observation A 34-year-old male patient with a history of gonococcal urethritis and arthritis presented with right endogenous endophthalmitis. Vitreous biopsy culture confirmed Staphylococcus capitis involvement. The patient was treated with pars plana vitrectomy, intravitreal vancomycin, and ceftazidime injections and systemic antibiotics. Conclusion and importance Staphylococcus capitis-related endogenous endophthalmitis has rarely been reported in the literature. None of the published reports specifically describe its clinical course and management.
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Affiliation(s)
- Abdelrahman M Elhusseiny
- Department of Ophthalmology, Bernice and Harvey Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Muhammad M Shamim
- Department of Ophthalmology, Bernice and Harvey Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Riley N Sanders
- Department of Ophthalmology, Bernice and Harvey Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ahmed B Sallam
- Department of Ophthalmology, Bernice and Harvey Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Sivertsen MS, Lode HE, Gjølberg TT, Petrovski G, Andersen JT, Jørstad ØK, Moe MC. Cluster of symptomatic silicone oil droplets following intravitreal injections: a 1-year observational study. BMJ Open Ophthalmol 2021; 6:e000764. [PMID: 34485702 PMCID: PMC8378358 DOI: 10.1136/bmjophth-2021-000764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/09/2021] [Indexed: 11/03/2022] Open
Abstract
Objective To describe a cluster of symptomatic intravitreal silicone oil (SiO) droplets following intravitreal injections (IVIs) and assess the effect of switching to a SiO-free syringe. Methods and analysis Observational quality registry study of patients receiving IVI at a large Norwegian ophthalmology centre between April 2018 (start of cluster) and November 2019 (1 year after switching to SiO-free syringes). At onset, anti-vascular endothelial growth factor drugs were administered using SiO-containing insulin syringes. From November 2018, SiO-free syringes were implemented. Spontaneously reported symptomatic SiO cases were confirmed by slit-lamp examination. A follow-up interview was performed after 1 year, assessing visual complaints. The prevalence of non-symptomatic cases was assessed in a sample of 50 eyes from 50 consecutive IVI patients. Results Among 13 429 IVIs, 50 eyes of 46 patients (29 women) with symptomatic intravitreal SiO droplets were identified. Forty-one patients reported floaters at regular appointments, whereas five patients contacted the department regarding symptoms between scheduled appointments. After 1 year, 34 patients (79%) still experienced floaters, 21 (49%) reported reduced symptoms and 3 (7%) reported worsened symptoms. Eighteen patients (42%) reported being bothered, and eight (18.6%) reported that their lives were negatively affected by the floaters. Among 50 non-symptomatic eyes that had received IVI during the same period, intravitreal SiO was found in 34 (68%). No cases of symptomatic intravitreal SiO droplets were identified after switching to SiO-free syringes. Conclusion Symptomatic intravitreal SiO following IVI can cause significant and prolonged distress for affected patients. It can be avoided by using SiO-free syringes.
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Affiliation(s)
| | - Heidrun Elisabeth Lode
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Department of Immunology, Oslo University Hospital, Oslo, Norway.,Department of Pharmacology, University of Oslo, Oslo, Norway
| | - Torleif Tollefsrud Gjølberg
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Department of Immunology, Oslo University Hospital, Oslo, Norway.,Department of Pharmacology, University of Oslo, Oslo, Norway
| | - Goran Petrovski
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Jan Terje Andersen
- Department of Immunology, Oslo University Hospital, Oslo, Norway.,Department of Pharmacology, University of Oslo, Oslo, Norway
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Sun J, Guo Z, Li H, Yang B, Wu X. Acute Infectious Endophthalmitis After Cataract Surgery: Epidemiological Characteristics, Risk Factors and Incidence Trends, 2008-2019. Infect Drug Resist 2021; 14:1231-1238. [PMID: 33790593 PMCID: PMC8007477 DOI: 10.2147/idr.s304675] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/05/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Intended to investigate the epidemiological characteristics, risk factors and incidence trend of endophthalmitis after cataract surgery in recent 12 years. Methods A retrospective study was conducted on the patients who underwent cataract surgery in Qingdao Eye Hospital from January 1, 2008, to December 31, 2019, including age, sex, history of diabetes, intraoperative operation and complications. In addition, the related risk factors and incidence trend of acute infective endophthalmitis were analyzed. The incidence of endophthalmitis and its related factors were analyzed by univariate and multivariate logistic regression analysis. Results A total of 55,612 cases of cataract surgery were performed in our hospital in 12 years, and 42 cases of acute infective endophthalmitis occurred (the incidence rate was 0.076%). The average occurrence time was 10.57 days ± 11.17, with eye pain as the main complaint and anterior chamber fibrin exudation as the main clinical manifestation. In addition, there were eight cases of anterior chamber hypopyon and 18 cases of vitreous reaction, the results of anterior aqueous humor or vitreous fluid culture in 10 patients were positive. Univariate analysis showed that intraoperative rupture of posterior capsule, non-use of antibiotics and non-use of behind-the-lens washout were the risk factors of infectious endophthalmitis after cataract surgery (P=0.032, P=0.000, P=0.000). Besides, multivariate logistic regression analysis showed that intraoperative rupture of posterior capsule was the main risk factor. Conclusion The occurrence of endophthalmitis after cataract surgery is mainly related to intraoperative rupture of posterior capsule, absence of antibiotics and behind-the-lens washout. In addition, the incidence of endophthalmitis after cataract surgery decreased during the past 12 years.
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Affiliation(s)
- Jiajun Sun
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, 266071, People's Republic of China
| | - Zhen Guo
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, 266071, People's Republic of China
| | - Honglei Li
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, 266071, People's Republic of China
| | - Baoxia Yang
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, 266071, People's Republic of China
| | - Xiaoming Wu
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, 266071, People's Republic of China
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Malmin A, Syre H, Ushakova A, Utheim TP, Forsaa VA. Twenty years of endophthalmitis: Incidence, aetiology and clinical outcome. Acta Ophthalmol 2021; 99:e62-e69. [PMID: 32567150 DOI: 10.1111/aos.14511] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To review the incidence, aetiology and outcomes of endophthalmitis during a 20-year period in a Norwegian university hospital. METHODS Single-centre retrospective review. Medical records of all patients admitted to Stavanger University Hospital with suspected endophthalmitis between January 1999 and December 2018 were reviewed. RESULTS We identified 84 eyes of 81 patients. Postoperative endophthalmitis (PE) was seen in 64 eyes (76%), endogenous endophthalmitis in thirteen eyes (15%), trauma in four eyes (5%) and three eyes (4%) had keratitis-associated endophthalmitis. Administration of intravitreal injections (IVI) was the most common cause (30%), followed by cataract surgery (CS) (21%). Of 40238 IVI, 23 PE cases were identified (incidence, 0.057%; 95% confidence interval [CI] 0.036-0.086%). Of 39697 CS, 12 PE cases were identified (incidence, 0.030%; 95%CI 0.016-0.053%). After introduction of intracameral cefuroxime PE incidence after CS decreased from 0.10% in 1999-2003 to 0.015% in 2004-2018 (p = 0.003). Eighty-four per cent of organisms were Gram-positive. Coagulase-negative staphylococci accounted for 54% of culture-proven cases, and 89% of post-IVI culture-proven cases. Thirty eyes (36%) either regained their previous vision or lost ≤1 Early Treatment Diabetic Retinopathy Study line. One third of endophthalmitis cases had a favourable visual outcome of logMAR 0.2 or better. CONCLUSION PE after IVI occurred in 1 in 1750 procedures, and was the most common cause of PE. The incidence of PE after CS has decreased >sixfold since 2003, to 1 in 6700 surgeries. A high proportion of low-virulence bacterial species may have contributed to the favourable visual outcome.
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Affiliation(s)
- Agni Malmin
- Department of Ophthalmology Stavanger University Hospital Stavanger Norway
| | - Heidi Syre
- Department of Medical Microbiology Stavanger University Hospital Stavanger Norway
| | - Anastasia Ushakova
- Department of Research Section of Biostatistics Stavanger University Hospital Stavanger Norway
| | - Tor Paaske Utheim
- Department of Ophthalmology Stavanger University Hospital Stavanger Norway
- Department of Clinical Medicine Section of Ophthalmology University of Bergen Norway
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Blom K, Bragadóttir R, Sivertsen MS, Moe MC, Jørstad ØK. Does Pharmaceutical Compounding of Vascular Endothelial Growth Factor Inhibitors for Intravitreal Use Alter the Risk of Post-injection Endophthalmitis? Ocul Immunol Inflamm 2020; 30:713-716. [DOI: 10.1080/09273948.2020.1820530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Kathrine Blom
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Ragnheiður Bragadóttir
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Morten Carstens Moe
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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