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Ahmad Fauzi N, Rosli AH, Jabbari AJ. A Rare Occurrence of Isolated Endogenous Escherichia coli Panophthalmitis: A Case Report. Cureus 2023; 15:e47059. [PMID: 38021653 PMCID: PMC10644779 DOI: 10.7759/cureus.47059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Panophthalmitis is a severe ocular condition that can lead to devastating outcomes, such as evisceration, if not promptly treated. It typically originates endogenously, with urinary tract infection being a common primary source of infection. This report describes a rare case of a 61-year-old Malay patient with left eye panophthalmitis. Ocular culture revealed Escherichia coli, while systemic septic workup yielded negative results. Due to the severity of the ocular condition at presentation and the disproportionate level of pain the patient had, an immunocompromised state was suspected and later the diagnosis of diabetes mellitus was confirmed via laboratory investigation. Despite the delay in presentation, which hindered early intervention, the patient's eyeball was successfully salvaged through a treatment regimen involving three injections of intravitreal antibiotic administered at 48 to 72-hour intervals and a complete course of intravenous antibiotics. This case report highlights the importance of prompt treatment to salvage an eye from evisceration in the case of panophthalmitis.
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Affiliation(s)
- Nadhirah Ahmad Fauzi
- Ophthalmology, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, MYS
| | - Abdul-Hadi Rosli
- Ophthalmology, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, MYS
| | - Aidila Jesmin Jabbari
- Ophthalmology, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, MYS
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Wang T, Jain S, Glidai Y, Dua P, Dempsey KS, Shakin E, Chu DS, Epstein M, Ha LG. Extensively drug-resistant Pseudomonas aeruginosa panophthalmitis from contaminated artificial tears. IDCases 2023; 33:e01839. [PMID: 37645532 PMCID: PMC10461124 DOI: 10.1016/j.idcr.2023.e01839] [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: 06/23/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 08/31/2023] Open
Abstract
Pseudomonas aeruginosa is one of the common gram-negative organisms that cause severe invasive infections in different organ systems. P. aeruginosa has unique intrinsic mechanisms to develop antimicrobial resistance quickly, making it extremely difficult to treat. We report a case of extensively drug-resistant (XDR) P. aeruginosa panophthalmitis due to contaminated artificial tears. This report investigates the role of systemic and intravitreal antimicrobials, summarizes the resistance mechanisms of P. aeruginosa, and provides an overview on cefiderocol, a novel antimicrobial that targets multidrug-resistant (MDR) and XDR Gram-negative pathogens.
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Affiliation(s)
- Taylor Wang
- Dayton and Karen Brown Division of Infectious Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 400 Community Dr, Manhasset, NY 11030, USA
| | - Sumeet Jain
- Department of Pharmacy, North Shore University Hospital, 300 Community Dr, Manhasset, NY 11030, USA
| | - Yoav Glidai
- Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030, USA
| | - Prachi Dua
- Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030, USA
| | - Katharine S. Dempsey
- Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030, USA
| | - Eric Shakin
- Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030, USA
| | - David S. Chu
- Institute of Ophthalmology and Visual Science, New Jersey Medical School of Rutgers University, 90 Bergen St., Newark, NJ 07103, USA
- Metropolitan Eye Research and Surgery Institute, 540 Bergen Blvd., Palisades Park, NJ 07650, USA
| | - Marcia Epstein
- Dayton and Karen Brown Division of Infectious Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 400 Community Dr, Manhasset, NY 11030, USA
| | - Lawrence G. Ha
- Dayton and Karen Brown Division of Infectious Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 400 Community Dr, Manhasset, NY 11030, USA
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Tanwar M, Chakrabarty S, Chowdhury G, Kim U. Mapping prognostic factors for globe survival in panophthalmitis using logistic regression and Cox proportional hazard models: A retrospective study. Indian J Ophthalmol 2023; 71:2812-2817. [PMID: 37417126 PMCID: PMC10491044 DOI: 10.4103/ijo.ijo_3034_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/08/2023] [Accepted: 05/26/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose The aim of this study was to report the outcomes of panophthalmitis and to identify factors significantly affecting globe survival in the disease. Methods This was a retrospective study on patients with panophthalmitis in a tertiary hospital between January 1, 2017, and December 31, 2019. The demographics, treatment details, culture results, and final outcomes were recorded. Logistic regression and Cox proportional hazards (CPH) were calculated to identify variables associated with globe loss. A P < 0.05 was considered significant. Results Eighty-five eyes of 85 patients (31 culture positive) were eligible for review. The mean age of the participants was 55.21 ± 20.17 years with a male-to-female ratio of 2.04:1. Corneal ulcer (38.82%; n = 33) and open globe injuries (OGIs) (38.82%; n = 33) were the most common etiologies. Pseudomonas aeruginosa (n = 10; 11.76%) was the most common isolate. The mean duration of hospital stay was 7.58 ± 2.32 days. Overall, 44 (51.76%) globes could be salvaged. The need for evisceration (P = 0.901) and hospital stays (P = 0.095) were similar for culture-positive and -negative cohorts. The unadjusted logistic regression and CPH models showed that culture sterility did not affect globe survival [OR = 1.210 (0.501-2.950), P = 0.668; HR = 1.176 (0.617-2.243), P = 0.623]. The adjusted logistic regression and the CPH models showed that corneal ulcers [OR = 10.900 (2.460-48.200), P = 0.002; HR = 5.393 (1.603-18.140), P = 0.006] and OGI [OR = 7.360 (1.650-32.700), P = 0.009; HR = 4.548 (1.321-15.660), P = 0.016] were significantly associated with globe loss. Conclusion Corneal ulcer or OGI as the primary etiology is detrimental to globe survival in panophthalmitis.
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Affiliation(s)
- Meghana Tanwar
- Department of Orbit and Oculoplasty, Aravind Eye Hospital and PG Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Sabyasachi Chakrabarty
- Department of Paediatric Ophthalmology and Strabismus, Vivekananda Mission Ashram Netra Niramay Niketan, Chaithanyapur, West Bengal, India
| | - Gunja Chowdhury
- Department of Orbit and Oculoplasty, Aravind Eye Hospital and PG Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Usha Kim
- Department of Orbit and Oculoplasty, Aravind Eye Hospital and PG Institute of Ophthalmology, Madurai, Tamil Nadu, India
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Gram-Negative Endogenous Endophthalmitis: A Systematic Review. Microorganisms 2022; 11:microorganisms11010080. [PMID: 36677371 PMCID: PMC9860988 DOI: 10.3390/microorganisms11010080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/20/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Gram-negative bacteria are causative agents of endogenous endophthalmitis (EBE). We aim to systematically review the current literature to assess the aetiologies, risk factors, and early ocular lesions in cases of Gram-negative EBE. Methods: All peer-reviewed articles between January 2002 and August 2022 regarding Gram-negative EBE were included. We conducted a literature search on PubMed and Cochrane Controlled Trials. Results: A total of 115 studies and 591 patients were included, prevalently Asian (98; 81.7%) and male (302; 62.9%). The most common comorbidity was diabetes (231; 55%). The main aetiologies were Klebsiella pneumoniae (510; 66.1%), Pseudomonas aeruginosa (111; 14.4%), and Escherichia coli (60; 7.8%). Liver abscesses (266; 54.5%) were the predominant source of infection. The most frequent ocular lesions were vitreal opacity (134; 49.6%) and hypopyon (95; 35.2%). Ceftriaxone (76; 30.9%), fluoroquinolones (14; 14.4%), and ceftazidime (213; 78.0%) were the most widely used as systemic, topical, and intravitreal anti-Gram-negative agents, respectively. The most reported surgical approaches were vitrectomy (130; 24.1%) and evisceration/exenteration (60; 11.1%). Frequently, visual acuity at discharge was no light perception (301; 55.2%). Conclusions: Gram-negative EBEs are associated with poor outcomes. Our systematic review is mainly based on case reports and case series with significant heterogeneity. The main strength is the large sample spanning over 20 years. Our findings underscore the importance of considering ocular involvement in Gram-negative infections.
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Chen KJ, Sun MH, Chen YP, Chen YH, Wang NK, Liu L, Chao AN, Wu WC, Hwang YS, Lai CC. Endogenous Fungal Endophthalmitis: Causative Organisms, Treatments, and Visual Outcomes. J Fungi (Basel) 2022; 8:641. [PMID: 35736124 PMCID: PMC9225322 DOI: 10.3390/jof8060641] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/04/2022] Open
Abstract
Endogenous fungal endophthalmitis (EFE) is a vision-threatening intraocular infection and a rare complication of fungemia. Early diagnosis and prompt aggressive treatment are crucial to avoid vision loss. We retrospectively reviewed the data of 37 patients (49 eyes) with EFE who were treated at a tertiary referral hospital from January 2000 to April 2019. The most common risk factor was diabetes (24 patients; 65%), followed by recent hospitalization, urinary tract disease, liver disease, and immunosuppressive therapy. Two or more risk factors were detected in 24 patients (65%), and yeasts (29 patients; 78%) were more commonly detected than mold (8 patients; 22%). The most common fungal isolates were Candida spp. (78%), especially Candida albicans (70%). Moreover, 24 eyes in 21 patients underwent vitrectomy, and 2 eyes underwent evisceration. Retinal detachment (RD) occurred in 17 eyes (35%) in 14 patients, and eyes without RD exhibited significantly superior visual outcomes (p = 0.001). A comparison of the initial VA between the better (20/200 or better) and worse groups (worse than 20/200) revealed that better initial VA was related to a superior visual outcome (p = 0.003). Therefore, to achieve superior visual outcomes, early diagnosis and prompt treatment are necessary for patients with EFE.
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Affiliation(s)
- Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ming-Hui Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yen-Po Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Ophthalmology, Tucheng Municipal Hospital, New Taipei 236, Taiwan
| | - Yi-Hsing Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA;
| | - Laura Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - An-Ning Chao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-H.S.); (Y.-P.C.); (Y.-H.C.); (L.L.); (A.-N.C.); (W.-C.W.); (Y.-S.H.); (C.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
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Risk Factors Leading to Enucleation or Evisceration in Infectious Endophthalmitis. J Clin Med 2022; 11:jcm11113145. [PMID: 35683532 PMCID: PMC9181767 DOI: 10.3390/jcm11113145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 02/01/2023] Open
Abstract
Endophthalmitis treatment consists of intravitreal antibiotics injections and, in selected circumstances, pars plana vitrectomy. However, severe or refractory cases may require an enucleation or evisceration (ENEV). Our study seeks to identify risk factors leading to enucleation or evisceration in patients with infectious endophthalmitis. A retrospective chart review of subjects with a clinical diagnosis of infectious endophthalmitis was undertaken. The affected eyes were stratified into groups: those that underwent ENEV and those in which the eyeball was preserved (EP). The groups were compared using statistical analyses. In total, 69 eyes diagnosed with infectious endophthalmitis were included in the study. There was a higher frequency of exogenous infectious endophthalmitis in the ENEV group versus the EP group. Postsurgical infectious endophthalmitis was lower in the ENEV than in the EP group. A visual acuity of no light perception was more common in the ENEV compared to the EP group. Panophthalmitis was more frequent in the ENEV versus the EP group. Our findings suggest that eyes with endophthalmitis presenting with a visual acuity of no light perception, panophthalmitis, or exogenous etiology have a higher risk of requiring ENEV. In addition, eyes with a postsurgical etiology may be at a lower risk of requiring ENEV.
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Clinical characteristics of endogenous Klebsiella pneumoniae endophthalmitis: a 13-year experience. Int Ophthalmol 2022; 42:2533-2539. [DOI: 10.1007/s10792-022-02301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/10/2022] [Indexed: 11/27/2022]
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Endogenous Endophthalmitis-The Clinical Significance of the Primary Source of Infection. J Clin Med 2022; 11:jcm11051183. [PMID: 35268274 PMCID: PMC8911070 DOI: 10.3390/jcm11051183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/05/2022] [Accepted: 02/21/2022] [Indexed: 02/01/2023] Open
Abstract
Endophthalmitis is a severe form of ocular inflammation. The source of pathogens in endogenous endophthalmitis is located inside the body, and infection spreads hematogenously. Although rare, endogenous endophthalmitis is a very serious condition, as this type of inflammation is very devastating for ocular tissues. Prognosis is very poor, and the patients are often in a serious general condition, so they require special care and an individual approach in the treatment process. Thanks to the knowledge of the risks associated with infections of individual tissues and organs as well as potential pathogens and the clinical picture, it is possible to make a correct diagnosis faster and implement the correct treatment. In the case of endogenous endophthalmitis, reaction time is absolutely crucial for prognosis. In this review, we focus primarily on the importance of the primary source of infection for the course of the disease and prognosis.
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Qi M, He L, Zheng P, Shi X. Clinical Features and Mortality of Endogenous Panophthalmitis in China: A Six-Year Study. Semin Ophthalmol 2021; 37:208-214. [PMID: 34280072 DOI: 10.1080/08820538.2021.1954205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To report the clinical features, treatment strategy, and mortality of patients with endogenous panophthalmitis (EP). METHODS Fifteen patients (16 eyes) diagnosed with EP from December 2012 to December 2018 were investigated with a standard protocol at a tertiary medical center of the largest eye center in Northern China. Mortality was followed up. RESULTS All participants were Han Chinese. The mean age was 58.3, 62.5% were male, and 93.3% were unilaterally involved. The average number of predisposing factors was 3.0. The top two predisposing factors were diabetes mellitus (DM, 93.3%) and pyogenic liver abscess (PLA, 66.7%). All patients initially presented at an ophthalmic emergency due to severe ocular symptoms. All patients were co-managed by relevant specialists and were admitted to medical or surgical wards instead of the eye center unless the systemic condition was well controlled. Only four eyes were eligible for vitrectomy. The mean follow-up duration was 12.5 months. The mortality rate was 0%. The predominant causative organism was Klebsiella pneumoniae (80.0%), and there were no positive fungal cases. CONCLUSIONS EP is a rare, life-threatening disease. DM and PLA could predispose its development. The predominant causative organism was Klebsiella pneumoniae. The interdisciplinary cooperation system of the management of EP may reduce the mortality rate.Abbreviations :EP: endogenous panophthalmitis; EE: endogenous endophthalmitis; DM: diabetes mellitus; PLA: pyogenic liver abscess; ACI: acute cerebral infarction; UTI: urinary tract infection; ICU: intensive care unit; VA: visual acuity; LP: light perception; HM: hand motion; NLP: no light perception; K. pneumoniae: Klebsiella pneumoniae; CT: computed tomography; MRI: magnetic resonance imaging; CRP: C-reactive protein; PCT: procalcitonin; FBG: fasting blood glucose; WBC: white blood cell; NEUT: neutrophil proportion; BDG: 1,3-β-D-glucan; GM: galactomannan; IVI: intravitreal injection; PPV: pars plana vitrectomy; ILAS: invasive liver abscess syndrome; cps: capsular polysaccharide; CSF: cerebrospinal fluid; SD: standard deviation.
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Affiliation(s)
- Meng Qi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Lei He
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Pengfei Zheng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Xiangyu Shi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
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Practical Guidance for Clinical Microbiology Laboratories: Diagnosis of Ocular Infections. Clin Microbiol Rev 2021; 34:e0007019. [PMID: 34076493 DOI: 10.1128/cmr.00070-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The variety and complexity of ocular infections have increased significantly in the last decade since the publication of Cumitech 13B, Laboratory Diagnosis of Ocular Infections (L. D. Gray, P. H. Gilligan, and W. C. Fowler, Cumitech 13B, Laboratory Diagnosis of Ocular Infections, 2010). The purpose of this practical guidance document is to review, for individuals working in clinical microbiology laboratories, current tools used in the laboratory diagnosis of ocular infections. This document begins by describing the complex, delicate anatomy of the eye, which often leads to limitations in specimen quantity, requiring a close working bond between laboratorians and ophthalmologists to ensure high-quality diagnostic care. Descriptions are provided of common ocular infections in developed nations and neglected ocular infections seen in developing nations. Subsequently, preanalytic, analytic, and postanalytic aspects of laboratory diagnosis and antimicrobial susceptibility testing are explored in depth.
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Hassanin FF, Elkhamary S, Al Thaqib R, Strianese D. A Case of Escherichia coli Endogenous Panophthalmitis and Orbital Cellulitis With Normal Workup for Primary Focus. Cureus 2021; 13:e15103. [PMID: 34159011 PMCID: PMC8212906 DOI: 10.7759/cureus.15103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We describe a case of a poorly controlled diabetic patient with left endogenous panophthalmitis with orbital cellulitis and positive ocular culture of Escherichia coli with negative systemic workup and rare clinical presentation. Was misdiagnosed and mismanaged as acute angle-closure glaucoma. Despite medical treatment with intravenous antibiotics, the patient required evisceration of the left eye as a result of the delay in diagnosis and treatment. A high index of suspicion for endogenous endophthalmitis and awareness of the proper workup and different clinical presentations is needed to avoid vision and life-threatening consequences.
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Affiliation(s)
- Fadi F Hassanin
- Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, SAU.,College of Medicine, Jeddah University, Jeddah, SAU
| | | | - Rawan Al Thaqib
- Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, SAU
| | - Diego Strianese
- Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, SAU
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Streptococcus pneumoniae endophthalmitis: clinical settings, antibiotic susceptibility, and visual outcomes. Sci Rep 2021; 11:6195. [PMID: 33737573 PMCID: PMC7973428 DOI: 10.1038/s41598-021-85456-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/28/2021] [Indexed: 11/17/2022] Open
Abstract
Streptococcus pneumoniae endophthalmitis is clinically more severe, more difficult to treat, and carry a higher risk of vision loss, evisceration, or enucleation. This study is to investigate the clinical settings, antibiotic susceptibility, and visual outcomes of S. pneumoniae endophthalmitis at a tertiary referral center in Taiwan. S. pneumoniae endophthalmitis was diagnosed in 38 eyes of 38 patients. The main clinical features were postcataract endophthalmitis (n = 13, 34%) and endophthalmitis associated with corneal ulcer (n = 12, 32%), trauma (n = 6, 16%), endogenous etiology (n = 4, 11%), trabeculectomy (n = 2, 5%), and pterygium excision-related scleral ulcer (n = 1, 3%). Presenting visual acuity ranged from counting fingers to no light perception. Pars plana vitrectomy with intravitreal antibiotics was performed in 17 eyes (39%) in primary or secondary treatments. S. pneumoniae isolates were susceptible to vancomycin (38/38, 100%), penicillin (37/38, 97%), ceftriaxone (37/38, 97%), cefuroxime (12/15, 80%), levofloxacin (13/15 ,87%), and moxifloxacin (15/17, 88%). Final visual acuity was better than 20/400 in 3 of 38 eyes (8%), 5/200 to hand motions in 3 eyes (8%), and light perception to no light perception in 32 eyes (84%). Ten eyes (26%) underwent evisceration or enucleation. Although S. pneumoniae isolates were susceptible to vancomycin, S. pneumoniae endophthalmitis had a very poor visual prognosis.
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Marinos E, McCall D, Tumuluri K, Rowe N, Do H. Panophthalmitis and Orbital Inflammation with Cavernous Sinus Thrombosis Following Cataract Surgery. Int Med Case Rep J 2020; 13:569-572. [PMID: 33173353 PMCID: PMC7648554 DOI: 10.2147/imcrj.s274140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/15/2020] [Indexed: 11/29/2022] Open
Abstract
Background Panophthalmitis is a severe inflammation of the globe that can result as a rare complication of ophthalmic surgery. In severe cases, it may also be associated with orbital inflammation and cavernous sinus thrombosis. Purpose This case demonstrates a rare and life-threatening post-operative complication of cataract surgery. We also hope to highlight the importance of considering the relevant risk factors associated with developing potential infections after cataract surgery, including the use of corneal sutures, high-risk behaviours such as excessive eye-rubbing, and non-compliance with appointments and post-operative medications. Case Report We report the case of a 35-year-old female with severe autism and developmental delay who developed panophthalmitis, orbital inflammation and cavernous sinus thrombosis 6 weeks post cataract surgery. The likely cause was corneal suture-related microbial keratitis, and the patient required enucleation due to sepsis. Conclusion Post-surgical panophalmitis is a rapidly progressive disease that is not only sight- but life-threatening and demands urgent and intensive treatment. Consideration of early enucleation may be required to prevent deterioration in such patients.
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Affiliation(s)
- Emmanuel Marinos
- Ophthalmology Department, Westmead Hospital, Sydney, NSW, Australia
| | - Dominic McCall
- Ophthalmology Department, Westmead Hospital, Sydney, NSW, Australia
| | - Krishna Tumuluri
- Ophthalmology Department, Westmead Hospital, Sydney, NSW, Australia
| | - Neil Rowe
- Ophthalmology Department, Westmead Hospital, Sydney, NSW, Australia
| | - Helen Do
- Ophthalmology Department, Westmead Hospital, Sydney, NSW, Australia
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Wang Y, Wang X, Di Y. Surgery combined with antibiotics for the treatment of endogenous endophthalmitis caused by liver abscess. BMC Infect Dis 2020; 20:661. [PMID: 32894069 PMCID: PMC7487656 DOI: 10.1186/s12879-020-05390-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/02/2020] [Indexed: 01/01/2023] Open
Abstract
Backgrounds Endogenous endophthalmitis is a serious disease caused by intraocular infection that can rapidly progress to cause blindness. This study evaluated the clinical features, surgical and antibiotics treatment strategies, and treatment outcomes in patients with endophthalmitis caused by liver abscess. Methods Between April 2014 and April 2019, the clinical data of 16 patients (19 eyes) with endophthalmitis associated with liver abscess who underwent surgery at Shengjing Hospital were retrospectively analyzed. Furthermore, we evaluated the final visual outcomes in the patients to determine the efficacy of surgery. Results Fifteen patients (18 eyes) underwent intravitreal injection followed by vitrectomy after admission. One patient (1 eye) only underwent intravitreal injection. Of the 16 patients, 3 patients (3 eyes) had recurrent intraocular inflammation and eventually underwent evisceration. Systemic antibiotics were administered for all patients based on the results of vitreous humor culture, blood culture, and antibiotic susceptibility tests. Outpatient follow-ups were performed until the patients were stable (6 months). Of the 19 eyes, 1 eye (5%) had visual acuity restored to 20/200, 6 eyes (31%) had visual acuity restored to counting fingers (CF), 2 eyes (11%) had visual acuity restored to hand motion (HM), 4 eyes (22%) showed only light perception (LP), and the remaining 6 eyes (31%) showed no light perception (NLP). Drug susceptibility tests suggested that the carbapenems exhibited significant effects in the inflammatory reaction. Conclusion Endogenous endophthalmitis caused by liver abscess is a very serious condition, and the final visual outcome is poor. Timely surgical intervention combined with antibiotic treatment is essential, and the primary disease must be treated to control disease progression at the earliest.
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Affiliation(s)
- Yue Wang
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Heping district, Sanhao Road 36, Shenyang, 110004, People's Republic of China
| | - Xue Wang
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Heping district, Sanhao Road 36, Shenyang, 110004, People's Republic of China
| | - Yu Di
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Heping district, Sanhao Road 36, Shenyang, 110004, People's Republic of China.
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Chaparro Tapias TA, Rangel Gualdron CM, Rodriguez HA, Rodriguez LM, Flores de Los Reyes L, Sánchez España JC. Bilateral enucleation due to multi-bacterial fulminant endogenous panophthalmitis. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:34-37. [PMID: 31767407 DOI: 10.1016/j.oftal.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/01/2019] [Accepted: 10/10/2019] [Indexed: 06/10/2023]
Abstract
The case is presented of a 62 year-old woman with a rapid, progressive bilateral decrease in visual acuity and panuveitis with orbital cellulitis. She was also in poor general condition, with emesis and fever. Septicaemia due to Klebsiella pneumoniae and bilateral endogenous panophthalmitis were diagnosed. The ocular infection quickly progressed to sclerokeratitis and bilateral perforation despite broad spectrum systemic antibiotic management, and eventually the patient required bilateral enucleation. Microbiological cultures of the surgical pieces identified Klebsiella pneumoniae and Candida magnoliae. To our knowledge, this is the third published case that required bilateral enucleation or evisceration due to endogenous panophthalmitis, and the first case of endogenous ocular infection caused by Candida magnoliae.
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Affiliation(s)
- T A Chaparro Tapias
- Departamento de Cirugía Plástica Ocular, Oncológica y Órbita, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia
| | - C M Rangel Gualdron
- Departamento de Cirugía Plástica Ocular, Oncológica y Órbita, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia
| | - H A Rodriguez
- Departamento de Cirugía Plástica Ocular, Oncológica y Órbita, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia; Departamento de Oftalmología, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | - L M Rodriguez
- Departamento de Cirugía Plástica Ocular, Oncológica y Órbita, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia
| | - L Flores de Los Reyes
- Departamento de Oftalmología, Hospital General de Granollers, Granollers, Barcelona, España.
| | - J C Sánchez España
- Departamento de Oftalmología, Hospital General de Granollers, Granollers, Barcelona, España
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Chen YH, Li YH, Lin YJ, Chen YP, Wang NK, Chao AN, Liu L, Wu WC, Lai CC, Chen TL, Chen KJ. Prognostic Factors and Visual Outcomes of Pyogenic Liver Abscess-Related Endogenous Klebsiella pneumoniae Endophthalmitis: A 20-year retrospective review. Sci Rep 2019; 9:1071. [PMID: 30705320 PMCID: PMC6355790 DOI: 10.1038/s41598-018-37643-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/11/2018] [Indexed: 02/07/2023] Open
Abstract
Endogenous K. pneumoniae endophthalmitis (EKE) has a higher incidence among East Asians, and the most common infectious source of EKE is pyogenic liver abscess (PLA). We investigate the risk factors for poor visual outcomes in patients with PLA-related EKE. The retrospective medical records of 104 patients (120 eyes) diagnosed with PLA-related EKE between 1996 and 2015. In univariate logistic regression analysis, the risk factors for poor visual outcomes were initial visual acuity (VA) worse than counting fingers (CF) (p < 0.001), eye pain (p = 0.013), hypopyon (p = 0.003), ocular hypertension (p = 0.003), positive intraocular fluids cultures (p < 0.001), subretinal abscess (p = 0.025), unilateral involvement (p = 0.017), delayed ophthalmologic visit (p = 0.022), initially presented with ocular symptoms ahead of systemic symptoms (p < 0.001), and corneal edema (p < 0.001). Intravitreal dexamethasone reduced the requirement of enucleation or evisceration (p = 0.01). The multivariate logistic regression revealed that poor initial VA worse than CF (p = 0.004) and initially presented with ocular symptoms ahead of systemic symptoms (p = 0.007) were the significant independent factors for poor visual outcomes. Early diagnosis and prompt treatment may salvage useful vision in some eyes.
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Affiliation(s)
- Yi-Hua Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ya-Han Li
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Ophthalmology, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Yu-Jr Lin
- Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Po Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY, 10032, United States
| | - An-Ning Chao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Laura Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tun-Lu Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Diagnosis of Vitreoretinal Aspergillosis with Transvitreal Retinochoroidal Biopsy. Case Rep Ophthalmol Med 2018; 2018:8306163. [PMID: 30627469 PMCID: PMC6304639 DOI: 10.1155/2018/8306163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/06/2018] [Accepted: 11/15/2018] [Indexed: 11/17/2022] Open
Abstract
Diagnosing culture-proven endophthalmitis is complicated by the insufficient yield of intraocular samples and the variety of etiologies which mimic true endophthalmitis. In cases of impending vision loss where vitreous biopsy cannot provide a definitive diagnosis, transvitreal retinochoroidal biopsy can be an effective next step. Our case is a 48-year-old male with B-cell acute lymphoblastic leukemia that presented with counting fingers vision, redness, and tearing of the left eye. Exam showed cell and flare with hypopyon as well as dense vitritis. The patient underwent diagnostic pars plana vitrectomy and vitreous culture was negative at the time. Flow cytometry demonstrated no malignant cells. However, the patient's vision and mental status continued to clinically decline despite being started on intravitreal and systemic antibiotic and antifungal therapy. Neuroimaging revealed rim-enhancing brain lesions. Transvitreal retinochoroidal biopsy was performed in an elevated area of the retina. The biopsy helped rule out malignancy and showed acute-angle, septate, branching hyphae characteristic of Aspergillus fumigatus. Ultimately, the vitreous biopsy, cultures, and a biopsy from the left frontal lobe brain abscess all confirmed this diagnosis as well. Transvitreal retinochoroidal biopsy can play a role in the diagnosis of a case of posterior uveitis and can be particularly effective in diagnosing a fungal endophthalmitis.
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Klebsiella pneumoniae Orbital Cellulitis: Clinical Manifestations and Outcomes in a Tertiary Medical Center in Taiwan. J Ophthalmol 2018; 2018:4237573. [PMID: 30370149 PMCID: PMC6189659 DOI: 10.1155/2018/4237573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/09/2018] [Accepted: 07/15/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose To report six cases of Klebsiella pneumoniae orbital cellulitis without preceding endophthalmitis. Method Retrospective chart review. Results We reported four females and two males admitted to our hospital for Klebsiella pneumoniae orbital cellulitis proven by computed tomographies and bacterial cultures from May 1995 to March 2017. Proptosis, conjunctival congestion, and chemosis and limitation of ocular motility were present in all six patients. Four patients had decreased visual acuities, and three of them recovered completely after treatment. The origin of the infection was sinus in four patients, skin wound in one patient, and sepsis presumably caused by a dental procedure in one patient. Three of all six patients had underlying diabetes mellitus. Two patients had orbital cellulitis before they were diagnosed of diabetes during hospital stay. Conclusion Diabetes may be a risk factor of Klebsiella pneumoniae orbital cellulitis, especially for those of nonsinus origin.
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Li YH, Chen YH, Chen KJ, Wang NK, Sun MH, Chao AN, Liu L, Lin YJ, Wu WC, Hwang YS, Lai CC, Chen TL. Infectious Sources, Prognostic Factors, and Visual Outcomes of Endogenous Klebsiella pneumoniae Endophthalmitis. Ophthalmol Retina 2018; 2:771-778. [PMID: 31047528 DOI: 10.1016/j.oret.2017.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/16/2017] [Accepted: 11/20/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the infectious sources and prognostic factors for poor visual outcome, including subjective symptoms, presenting clinical features, laboratory data, and treatments, in patients diagnosed with endogenous Klebsiella pneumoniae endophthalmitis (EKE) at a tertiary referral center in Northern Taiwan. DESIGN Retrospective, single-institution, consecutive case series. PARTICIPANTS One hundred ten consecutive patients (124 eyes) diagnosed with EKE. METHODS One hundred ten patients (124 eyes) were reviewed retrospectively between January 1996 and April 2013. MAIN OUTCOME MEASURES Visual acuity (VA), subjective symptoms, presenting clinical features, laboratory data, treatments, and requirement of evisceration or enucleation. RESULTS Of the 110 patients with EKE, 74 (67.3%) were men. Diabetes was the most commonly associated systemic disease (75/110 [68.2%]), and liver abscess was the major infection source (85/110 [77.3%]). In addition, 91 of 124 eyes (73.4%) had final VA worse than counting fingers (CF; poor visual outcome), and 20 eyes required evisceration or enucleation. The binary multivariate logistic regression (forward-Wald) model revealed that poor initial VA worse than CF (odds ratio [OR], 8.8; 95% confidence interval [CI], 2.2-36; P = 0.002), positive vitreous culture results (OR, 9.8; 95% CI, 1.7-56.1; P = 0.010), posterior focal EKE (OR, 0.15; 95% CI, 0.03-0.8; P = 0.027), and the presence of intravitreal dexamethasone administration (OR, 0.19; 95% CI, 0.04-0.9; P = 0.030) were the significant independent factors for visual outcomes. CONCLUSIONS Liver abscess was the major infection source, and EKE typically has poor visual prognosis. Early diagnosis and prompt treatment may salvage useful vision in some eyes. Early diagnosis with fair initial VA and intravitreal antibiotic and dexamethasone combination therapy may have beneficial effects on visual outcomes.
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Affiliation(s)
- Ya-Han Li
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Ophthalmology, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Yi-Hua Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Nan-Kai Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Hui Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - An-Ning Chao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Laura Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Jr Lin
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tun-Lu Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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