1
|
Rowe LW, McVeigh LG, Hajrasouliha AR. SUBTENON'S VANCOMYCIN INJECTION FOR SUBRETINAL ABSCESS SECONDARY TO METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS ENDOGENOUS ENDOPHTHALMITIS: A CASE REPORT AND LITERATURE REVIEW. Retin Cases Brief Rep 2024; 18:296-300. [PMID: 36728564 DOI: 10.1097/icb.0000000000001398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To report the use of a subtenon's vancomycin injection for the treatment of subretinal abscess secondary to methicillin-resistant Staphylococcus aureus endogenous endophthalmitis. METHODS A 17-year-old man developed endogenous endophthalmitis with subretinal abscess in his right eye secondary to methicillin-resistant Staphylococcus aureus bacteremia from axillary necrotizing fasciitis. Despite prompt treatment with IV vancomycin and an intravitreal vancomycin injection, the patient displayed minimal improvement. The patient was subsequently treated with a subtenon's vancomycin injection. The injection technique is described in detail, as well as a review of the treatment options available for bacterial subretinal abscesses. RESULTS On presentation, examination revealed minimal vitritis and a large yellow subretinal abscess superotemporally extending close to the macula with subretinal fluid inferotemporally involving the macula. Four days postintravitreal vancomycin injection, the abscess remained stable and the patient developed an exudative detachment temporally. Vancomycin was injected superotemporally in the subtenon's space with no complications during the procedure or during his postoperative recovery. At seven days postinjection, the subretinal abscess and exudative retinal detachment resolved completely with necrosis at the area of previous abscess. CONCLUSION We present the first successful case of subtenon's vancomycin injection for the treatment of bacterial subretinal abscess. Our case demonstrates that subtenon's injection of antibiotics is a safe and effective nonsurgical management option for bacterial subretinal abscesses.
Collapse
Affiliation(s)
- Lucas W Rowe
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | | |
Collapse
|
2
|
Carbonaro R, Menean M, Cottone G, Alessandri Bonetti M, Vaienti L, Miserocchi E, Bandello F. Endogenous Endophthalmitis Secondary to Infected Cutaneous Basal Cell Carcinoma: A Case Report. Ocul Immunol Inflamm 2024; 32:355-357. [PMID: 36696367 DOI: 10.1080/09273948.2023.2165951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/07/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Endogenous endophthalmitis (EE) is a severe intraocular infection due to hematogenous spread of bacteria from an extraocular site. Recognition of the primary source of hematogenous spread of bacteria is essential to establish an adequate therapy and avoid other major complications. Infected cutaneous tumor has never been reported as a possible source of EE. PURPOSE To describe the first case of EE due to hematogenous spread of methicillin-sensitive Staphylococcus aureus from an infected cutaneous basal cell carcinoma. Systemic antibiotic therapy and surgical excision of the cutaneous lesion were performed. CONCLUSION Severe and long-standing skin infections should be considered as a rare cause of EE.
Collapse
Affiliation(s)
- Riccardo Carbonaro
- School of Medicine, Università degli Studi di Milano, Milano, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, IRCCS Ospedale Galeazzi, Milan, Italy
| | - Matteo Menean
- School of Medicine, Vita-Salute San Raffaele. University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Cottone
- School of Medicine, Università degli Studi di Milano, Milano, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, IRCCS Ospedale Galeazzi, Milan, Italy
| | - Mario Alessandri Bonetti
- School of Medicine, Università degli Studi di Milano, Milano, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, IRCCS Ospedale Galeazzi, Milan, Italy
| | - Luca Vaienti
- School of Medicine, Università degli Studi di Milano, Milano, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, IRCCS Ospedale Galeazzi, Milan, Italy
| | - Elisabetta Miserocchi
- School of Medicine, Vita-Salute San Raffaele. University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele. University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
3
|
Lin J, Zhong H, Chen Q, Cui L, Xu F, Tang F. Aeromonas veronii-associated endogenous endophthalmitis: a case report. J Med Case Rep 2024; 18:171. [PMID: 38504363 PMCID: PMC10953058 DOI: 10.1186/s13256-024-04412-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 01/25/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Aeromonas veronii is a very rare and highly pathogenic microorganism. We investigate the clinical characteristics and significance of endogenous endophthalmitis caused by Aeromonas veronii in our patient. CASE PRESENTATION A 30-year-old Asian women with systemic lupus erythematosus, uremia, and hypertension developed acute infectious endophthalmitis caused by Aeromonas veronii. After emergency vitrectomy and antibiotic therapy, the clinical condition worsened requiring enucleation. CONCLUSIONS Aeromonas veronii can cause infection in the human eye, which can manifest as acute endophthalmitis. Early diagnosis and targeted therapy are important for successful treatment.
Collapse
Affiliation(s)
- Jiali Lin
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 534000, Guangxi, China
| | - Haibin Zhong
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 534000, Guangxi, China
| | - Qi Chen
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 534000, Guangxi, China
| | - Ling Cui
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 534000, Guangxi, China
| | - Fan Xu
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 534000, Guangxi, China.
| | - Fen Tang
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 534000, Guangxi, China.
| |
Collapse
|
4
|
Yu J, Xu H, Wei J, Niu L, Zhu H, Jiang C. Bacteria-Targeting Nanoparticles with ROS-Responsive Antibiotic Release to Eradicate Biofilms and Drug-Resistant Bacteria in Endophthalmitis. Int J Nanomedicine 2024; 19:2939-2956. [PMID: 38529364 PMCID: PMC10962272 DOI: 10.2147/ijn.s433919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/10/2024] [Indexed: 03/27/2024] Open
Abstract
Background Bacterial endophthalmitis is an acute progressive visual threatening disease and one of the most important causes of blindness worldwide. Current treatments are unsatisfactory due to the emergence of drug-resistant bacteria and the formation of biofilm. Purpose The aim of our research was to construct a novel nano-delivery system with better antimicrobial and antibiofilm effects. Methods This study developed a novel antibiotic nanoparticle delivery system (MXF@UiO-UBI-PEGTK), which is composed of (i) moxifloxacin (MXF)-loaded UiO-66 nanoparticle as the core, (ii) bacteria-targeting peptide ubiquicidin (UBI29-41) immobilized on UiO-66, and (iii) ROS-responsive poly (ethylene glycol)-thioketal (PEG-TK) as the surface shell. Then the important properties of the newly developed delivery system, including biocompatibility, toxicity, release percentage, thermal stability, ability of targeting bacteria, and synergistic antibacterial effects on bacterial biofilms and endophthalmitis, were evaluated. Results In vitro, MXF@UiO-UBI-PEGTK exhibited significant antibiotic effects including the excellent antibiofilm property against Staphylococcus aureus, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus at high levels of ROS. Moreover, MXF@UiO-UBI-PEGTK demonstrated outstanding efficacy in treating bacterial endophthalmitis in vivo. Conclusion This novel nanoparticle delivery system with ROS-responsive and bacteria-targeted properties promotes the precise and effective release of drugs and has significant potential for clinical application of treating bacterial endophthalmitis.
Collapse
Affiliation(s)
- Jian Yu
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People’s Republic of China
- Key Laboratory of Myopia of State Health Ministry and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, People’s Republic of China
| | - Huan Xu
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People’s Republic of China
- Key Laboratory of Myopia of State Health Ministry and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, People’s Republic of China
| | - Jiaojiao Wei
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People’s Republic of China
- Key Laboratory of Myopia of State Health Ministry and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, People’s Republic of China
| | - Liangliang Niu
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People’s Republic of China
- Key Laboratory of Myopia of State Health Ministry and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, People’s Republic of China
| | - Haohao Zhu
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People’s Republic of China
- Department of Ophthalmology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Chunhui Jiang
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People’s Republic of China
- Key Laboratory of Myopia of State Health Ministry and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, People’s Republic of China
| |
Collapse
|
5
|
Chin YYB, Yeo TH, Bakthavatsalu M, Zhou WT, Wagle AM, Gopal L, Lim TH. ACUTE ATYPICAL ENDOPHTHALMITIS FOLLOWING INTRAVITREAL SUSTAINED-RELEASE DEXAMETHASONE IMPLANT: A CASE SERIES. Retin Cases Brief Rep 2024; 18:155-158. [PMID: 36730427 PMCID: PMC10898540 DOI: 10.1097/icb.0000000000001369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/01/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To present three cases of acute endophthalmitis following intravitreal sustained-release dexamethasone (Ozurdex) with atypical presentation and to discuss the management of these patients. METHODS A retrospective case series of three patients with endophthalmitis following intravitreal sustained-release dexamethasone (Ozurdex) implantation who presented between July 2020 and August 2020. RESULTS Two of three patients who were treated with topical steroid and antibiotic therapy alone showed favorable outcomes and were managed without the need for intravitreal antibiotics or implant removal. One patient who showed initial response to topical therapy subsequently required pars plana vitrectomy, implant removal, and a single empirical dose of intravitreal antibiotics and antifungal agent due to persistent inflammation. CONCLUSION Postintravitreal Ozurdex endophthalmitis, although a rare entity, can present with atypical features of a painless white eye and a delayed onset intraocular inflammation. Although all cases of endophthalmitis should be treated as infective until proven otherwise, it is fair to consider a trial of conservative treatment with topical steroids and antibiotics initially with close monitoring. In cases with poor response to topical therapy, pars planar vitrectomy and implant removal should be strongly considered.
Collapse
Affiliation(s)
- Yi Yao Brendan Chin
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
| | - Tun Hang Yeo
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
| | | | - Wen Ting Zhou
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
| | - Ajeet Madhav Wagle
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
- International Eye Cataract Retina Centre, Farrer Park Medical Centre, Singapore; and
| | - Lekha Gopal
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
| | - Tock Han Lim
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
| |
Collapse
|
6
|
Taniguchi Y, Yamamoto H. Endogenous bacterial endophthalmitis associated epidural abscess: Infectious mimics of spondyloarthritis. Int J Rheum Dis 2024; 27:e15135. [PMID: 38519433 DOI: 10.1111/1756-185x.15135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/28/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Affiliation(s)
- Yoshinori Taniguchi
- Department of Endocrinology, Metabolism, Nephrology and Rheumatology, Kochi Medical School Hospital, Nankoku, Japan
| | - Hirotaka Yamamoto
- Department of Endocrinology, Metabolism, Nephrology and Rheumatology, Kochi Medical School Hospital, Nankoku, Japan
| |
Collapse
|
7
|
Bjerager J, Hajari J, Klefter ON, Subhi Y, Schneider M. Endophthalmitis following same-day bilateral anti-VEGF injections: a systematic review. Int Ophthalmol 2024; 44:37. [PMID: 38332399 DOI: 10.1007/s10792-024-02983-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/29/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE To review the risk of endophthalmitis in same-day bilateral anti-VEGF injections. METHODS We searched 12 literature databases for studies on the risk of endophthalmitis after same-day bilateral intravitreal anti-VEGF injections. Data extraction was made independently by two authors and discussed afterward until reaching consensus. RESULTS Seventeen studies were included with a total of 138,478 intravitreal anti-VEGF injections (69,239 bilateral injections sessions) given in at least 7579 patients. In total, 33 cases of endophthalmitis had occurred, and no cases were bilateral. The incidence of endophthalmitis ranged from 0 to 0.53% per intravitreal injection across studies. CONCLUSIONS We suggest that clinicians can consider same-day treatment of both eyes of patients in need of bilateral intravitreal anti-VEGF injection therapy, but larger studies are needed to quantify the exact risk of endophthalmitis.
Collapse
Affiliation(s)
- Jakob Bjerager
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
| | - Javad Hajari
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
| | - Oliver Niels Klefter
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Miklos Schneider
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark.
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
| |
Collapse
|
8
|
Park SW, Kim KH, Kwon HJ, Byon IS, Khan YH, Nguyen QD. Ocular syphilis masquerading as refractory retinal diseases. BMC Infect Dis 2024; 24:165. [PMID: 38326787 PMCID: PMC10848460 DOI: 10.1186/s12879-023-08739-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/23/2023] [Indexed: 02/09/2024] Open
Abstract
PURPOSE To report two cases of syphilis masquerading as chronic refractory macular diseases. CASE DESCRIPTIONS Two patients had been diagnosed with neovascular age-related macular degeneration (neovascular AMD) and diabetic macular edema (DME), respectively. The disease worsened despite repeated intravitreal injections of anti-vascular endothelial growth factor (VEGF) and also surgical treatment (in suspected case of DME). Systemic evaluations were positive for syphilis. Intravenous penicillin was started, and the macular diseases improved. The lesions were well controlled afterward. CONCLUSIONS The current two cases demonstrated that ocular syphilis can masquerade as refractory chronic retinal diseases such as DME and neovascular AMD. Laboratory evaluations for syphilis may be needed, not only for uveitis but also for refractory retinal diseases. Indocyanine green angiography may be helpful to reveal occult syphilis.
Collapse
Affiliation(s)
- Sung Who Park
- Department of Ophthalmology, School of Medicine, Pusan National University, Busan, South Korea
- Medical Research Institute, School of Medicine, Pusan National University Hospital, Busan, South Korea
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, 2370 Watson Court, Suite 200, Palo Alto, CA, 94303, USA
| | - Kye-Hyung Kim
- Department of Infection, School of Medicine, Pusan National University, Busan, South Korea
| | - Han Jo Kwon
- Department of Ophthalmology, School of Medicine, Pusan National University, Busan, South Korea
- Medical Research Institute, School of Medicine, Pusan National University Hospital, Busan, South Korea
| | - Ik Soo Byon
- Department of Ophthalmology, School of Medicine, Pusan National University, Busan, South Korea
- Medical Research Institute, School of Medicine, Pusan National University Hospital, Busan, South Korea
| | - Youan Hasan Khan
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, 2370 Watson Court, Suite 200, Palo Alto, CA, 94303, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, 2370 Watson Court, Suite 200, Palo Alto, CA, 94303, USA.
| |
Collapse
|
9
|
Begaj T, Jeong D, Park JG, Runner MM, Capone A, Dass AB, Drenser KA, Faia LJ, Farley ND, Garretson BR, Hassan TS, Mahmoud TH, Margherio A, Raphaelian PV, Randhawa S, Ruby AJ, Sneed S, Rao P, Wolfe JD, Williams GA. LONG-TERM USE OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2024; 44:222-229. [PMID: 37903288 DOI: 10.1097/iae.0000000000003961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
PURPOSE Although pivotal trials have demonstrated efficacy of anti-vascular endothelial growth factor therapy in neovascular age-related macular degeneration, there is a paucity of clinical data about the long-term (>5 years) treatment. METHODS Retrospective analysis of all patients with neovascular age-related macular degeneration who were actively treated, had received >40 anti-vascular endothelial growth factor injections, and were followed for ≥5 years. Snellen-corrected visual acuity, initial drug choice, and times elapsed between treatments were collected. Rates of endophthalmitis and outcomes of submacular hemorrhage were also evaluated. RESULTS A total of 88 patients (162 eyes) met the inclusion criteria: the average patient age was 86.3 years with an average follow-up period of 7.6 years. The average total number of injections per eye was 69 (18.0 SD); a total of 11,208 injections were given throughout the study period, and 6 cases (0.05%) of endophthalmitis were observed. Overall, there was a clinical and statistical difference in average Snellen-corrected visual acuity at Injections #2,#3, #4, #5, #6, #10, and #20, as compared with baseline ( P = 0.03, P < 0.01, P = 0.02, P < 0.01, P = 0.01, P = 0.01, P < 0.01, respectively). Patients in the Snellen-corrected visual acuity subgroup 20/20 to 20/40 maintained vision until injection #30. Seven eyes experienced a visually significant submacular hemorrhage. CONCLUSION This neovascular age-related macular degeneration cohort received on average eight anti-vascular endothelial growth factor injections per year for approximately 8 years; eyes with good (≥20/40) initial baseline vision maintained their visual acuity, whereas those with worse Snellen-corrected visual acuity (≤20/50) had a robust initial improvement that diminished with time. Most patients were maintained on the same initial drug of choice and the rate of endophthalmitis was low.
Collapse
Affiliation(s)
- Tedi Begaj
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Daeun Jeong
- Oakland University William Beaumont, Rochester, Michigan
| | - Jong G Park
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Margaret M Runner
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Antonio Capone
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - A Bawa Dass
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Kimberly A Drenser
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Lisa J Faia
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Nathan D Farley
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
| | - Bruce R Garretson
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Tarek S Hassan
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Tamer H Mahmoud
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Alan Margherio
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
| | | | - Sandeep Randhawa
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Alan J Ruby
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Scott Sneed
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - Prethy Rao
- Retina and Vitreous of Texas, Houston, Texas
| | - Jeremy D Wolfe
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| | - George A Williams
- Associated Retinal Consultants/Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont, Rochester, Michigan
| |
Collapse
|
10
|
Issa M, Balas M, Popovic MM, Lytvyn Y, Kertes PJ, Muni RH. Pars plana vitrectomy versus intravitreal antibiotics for endophthalmitis management following intravitreal anti-VEGF agents: A meta-analysis. Acta Ophthalmol 2024; 102:e11-e21. [PMID: 37340950 DOI: 10.1111/aos.15719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 06/22/2023]
Abstract
In this meta-analysis, we aim to compare the efficacy and safety of pars plana vitrectomy (PPV) versus tap-and-inject (TAI) of intravitreal antibiotics for the management of endophthalmitis secondary to intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents. A systematic literature search was conducted on Ovid MEDLINE, EMBASE, and Cochrane Central (January 2005-October 2022). The primary analysis compared initial PPV versus TAI and the secondary analysis examined the efficacy and safety of TAI alone compared to TAI followed by PPV. The quality of non-randomized observational studies was assessed using the Newcastle-Ottawa Scale. The quality of the evidence was assessed for each outcome. A random effects meta-analysis was performed. Weighted mean differences (WMDs) with 95% confidence intervals were reported. Of the 7474 screened studies, nine studies reporting on 153 eyes were included. The change in mean best corrected visual acuity (BCVA) between endophthalmitis presentation and last follow-up did not significantly differ between the initial TAI versus PPV groups (WMD = 0.05 units; 95% CI -0.12 to 0.22; p = 0.59; heterogeneity p = 0.41). The difference in pre- to post-treatment mean BCVA did not significantly differ between eyes that received TAI alone or TAI followed by PPV (WMD = 0.04 units; 95% CI -0.42 to 0.51; p = 0.85; heterogeneity p = 0.74). While the meta-analysis revealed no significant difference in the change in BCVA between PPV and TAI to treat endophthalmitis secondary to anti-VEGF agents, the quality of evidence was low with potential for confounding and selection bias. Further well-designed studies in this setting are needed.
Collapse
Affiliation(s)
- Mariam Issa
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Yuliya Lytvyn
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Buchan J. Endophthalmitis rates and risk factors following intraocular surgeries: can we turn big-data benchmarks into patient benefit? Br J Ophthalmol 2024; 108:165-166. [PMID: 38164546 DOI: 10.1136/bjo-2023-324593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 01/03/2024]
Affiliation(s)
- John Buchan
- Clinical Research Department, London School of Hygiene and Tropical Medicine International Centre for Eye Health, London, UK
| |
Collapse
|
12
|
Kubicka-Trząska A, Bugara D, Żuber-Łaskawiec K, Pociej-Marciak W, Markiewicz A, Romanowska-Dixon B, Karska-Basta I. Use of Optical Coherence Tomography and Optical Coherence Tomography Angiography in the Diagnosis and Follow-Up of Endogenous Candida Endophthalmitis: A Case Report. Medicina (Kaunas) 2024; 60:207. [PMID: 38399495 PMCID: PMC10890289 DOI: 10.3390/medicina60020207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
Background: Endogenous Candida endophthalmitis (ECE) is a rare but sight-threatening disease. Patients with ECE present with various clinical signs and symptoms, which can complicate the diagnosis. The aim of this report was to demonstrate the outcomes of treatment and to diagnose macular complications caused by intraocular inflammation. Case presentation: A 41-year-old woman with a history of acute intermittent porphyria presented with a progressive vision loss in her left eye. Left-eye OCT revealed findings consistent with a fungal etiology, which was confirmed by the culture of swabs collected from a central vein catheter. The outcomes of intravenous fluconazole treatment were not satisfactory, and the patient developed recurrent attacks of porphyria, suggesting a porphyrogenic effect of systemic antifungal therapy. Repeated intravitreal injections with amphotericin B led to a gradual regression of inflammatory lesions. However, follow-up examinations revealed active macular neovascularization (MNV) on both OCT and OCTA scans. The patient was administered intravitreal bevacizumab. At the 11th month of follow-up, OCT and OCTA scans showed significant inflammatory lesions regression with macula scarring, and no MNV activity was detected. Conclusions: This case highlights the importance of OCT and OCTA as valuable noninvasive imaging techniques for the identification of ECE, the monitoring of its clinical course, and the diagnosis of macular complications.
Collapse
Affiliation(s)
- Agnieszka Kubicka-Trząska
- Department of Ophthalmology, Faculty of Medicine, Medical College, Jagiellonian University, ul. Kopernika 38, 31-501 Krakow, Poland; (D.B.); (K.Ż.-Ł.); (W.P.-M.); (A.M.); (B.R.-D.); (I.K.-B.)
- Clinic of Ophthalmology and Ocular Oncology, University Hospital, ul. Kopernika 38, 31-501 Krakow, Poland
| | - Dawid Bugara
- Department of Ophthalmology, Faculty of Medicine, Medical College, Jagiellonian University, ul. Kopernika 38, 31-501 Krakow, Poland; (D.B.); (K.Ż.-Ł.); (W.P.-M.); (A.M.); (B.R.-D.); (I.K.-B.)
| | - Katarzyna Żuber-Łaskawiec
- Department of Ophthalmology, Faculty of Medicine, Medical College, Jagiellonian University, ul. Kopernika 38, 31-501 Krakow, Poland; (D.B.); (K.Ż.-Ł.); (W.P.-M.); (A.M.); (B.R.-D.); (I.K.-B.)
- Clinic of Ophthalmology and Ocular Oncology, University Hospital, ul. Kopernika 38, 31-501 Krakow, Poland
| | - Weronika Pociej-Marciak
- Department of Ophthalmology, Faculty of Medicine, Medical College, Jagiellonian University, ul. Kopernika 38, 31-501 Krakow, Poland; (D.B.); (K.Ż.-Ł.); (W.P.-M.); (A.M.); (B.R.-D.); (I.K.-B.)
- Clinic of Ophthalmology and Ocular Oncology, University Hospital, ul. Kopernika 38, 31-501 Krakow, Poland
| | - Anna Markiewicz
- Department of Ophthalmology, Faculty of Medicine, Medical College, Jagiellonian University, ul. Kopernika 38, 31-501 Krakow, Poland; (D.B.); (K.Ż.-Ł.); (W.P.-M.); (A.M.); (B.R.-D.); (I.K.-B.)
- Clinic of Ophthalmology and Ocular Oncology, University Hospital, ul. Kopernika 38, 31-501 Krakow, Poland
| | - Bożena Romanowska-Dixon
- Department of Ophthalmology, Faculty of Medicine, Medical College, Jagiellonian University, ul. Kopernika 38, 31-501 Krakow, Poland; (D.B.); (K.Ż.-Ł.); (W.P.-M.); (A.M.); (B.R.-D.); (I.K.-B.)
- Clinic of Ophthalmology and Ocular Oncology, University Hospital, ul. Kopernika 38, 31-501 Krakow, Poland
| | - Izabella Karska-Basta
- Department of Ophthalmology, Faculty of Medicine, Medical College, Jagiellonian University, ul. Kopernika 38, 31-501 Krakow, Poland; (D.B.); (K.Ż.-Ł.); (W.P.-M.); (A.M.); (B.R.-D.); (I.K.-B.)
- Clinic of Ophthalmology and Ocular Oncology, University Hospital, ul. Kopernika 38, 31-501 Krakow, Poland
| |
Collapse
|
13
|
Das T, Belenje A, Joseph J, Pandey S, Behera U, Dave VP. Evaluating the utility of inflammation score in post-cataract surgery endophthalmitis. Results from a prospective study in India. EMS Report #4. Indian J Ophthalmol 2024; 72:81-86. [PMID: 38131575 PMCID: PMC10841797 DOI: 10.4103/ijo.ijo_997_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/07/2023] [Accepted: 08/01/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To investigate if inflammation score (IS), calculated from the cornea, anterior chamber, iris, and vitreous, indicates endophthalmitis severity. METHODS In a prospective study, consecutive adults with a clinical diagnosis of post-cataract endophthalmitis within 6 weeks of surgery were recruited. Patients were allocated to IS-based primary treatment (IS < 10: intravitreal injection and IS ≥ 10: vitrectomy) and randomized to two intravitreal antibiotics combinations (vancomycin + ceftazidime and vancomycin + imipenem). Undiluted vitreous microbiology work-up included culture susceptibility, polymerase chain reaction, Sanger sequencing, and targeted next-generation sequencing. RESULTS The average age of 175 people was 63.4 ± 10.7 years and included 52.6% small incision cataract surgery and 47.4% phacoemulsification surgery. Severe endophthalmitis (IS ≥ 20), diagnosed in 27.4% of people, had a shorter time to symptoms (average 5.4 vs 8.7 days; P = 0.018), poorer presenting vision (all ≤ hand motion), higher culture positivity (50% vs 30.7%; P = 0.032), and higher Gram-negative bacterial infection (70.8% vs 46.2%; P = 0.042). For IS ≥ 20 discriminant and Gram-negative infection, Spearman's coefficient was 0.7 [P < 0.0001, 95% confidence interval (CI) 0.59-0.82], with an area under the receiver operating characteristic curve of 0.9 (95% CI 0.85-0.94, P < 0.0001), a Youden index J of 0.74, a sensitivity of 87.2%, and a specificity of 87.5%. The final vision of >20/400 and >20/100 was regained in 50.2% and 29.1% of people, respectively. The susceptibility of common Gram-positive cocci and Gram-negative bacilli was the highest for vancomycin (95.0%) and colistin (88.6%), respectively. NGS detected polymicrobial infection in 88.5% of culture-negative endophthalmitis. CONCLUSIONS Higher inflammation scores indicated severe disease and Gram-negative infection in post-cataract endophthalmitis.
Collapse
Affiliation(s)
- Taraprasad Das
- Anant Bajaj Retina Institute, Srimati Kanuri Santhama Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Akash Belenje
- Anant Bajaj Retina Institute, Srimati Kanuri Santhama Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Suchita Pandey
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Umesh Behera
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Retina Service, Bhubaneswar, Odisha, India
| | - Vivek Pravin Dave
- Anant Bajaj Retina Institute, Srimati Kanuri Santhama Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - on behalf of the EMS working group
- Anant Bajaj Retina Institute, Srimati Kanuri Santhama Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| |
Collapse
|
14
|
Zaslavsky K, Grewal PS, Cruz-Pimentel M, Qian J, Derzko-Dzulynsky L, Yan P. ENDOGENOUS FUNGAL ENDOPHTHALMITIS AFTER COVID-19 INFECTION: CASE REPORT AND REVIEW OF LITERATURE. Retin Cases Brief Rep 2024; 18:71-76. [PMID: 35921634 DOI: 10.1097/icb.0000000000001306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to describe a case of endogenous endophthalmitis (EE) after severe COVID-19 disease, review patient outcomes with EE after COVID-19 infection, and review evidence regarding risk factors for developing EE. METHODS This is a review of health records, imaging, intravitreal injection, and pars plana vitrectomy for bilateral fungal EE after severe COVID-19 disease, and is a literature review on outcomes in EE after COVID-19 disease. RESULTS Sixty-three year-old man with diabetes and hypertension was admitted to hospital for severe COVID-19 disease for 3 months. His stay required intensive care unit admission, intubation, high-dose corticosteroids, tocilizumab, and was complicated by bacteremia, empyema, and fungal esophagitis. He developed floaters and bilateral vision loss (visual acuity 20/40 in the right eye, counting fingers in the left eye) with vitritis 2.5 months into his stay that did not respond to intravitreal voriconazole. Pars plana vitrectomy was performed for both eyes, resulting in visual acuity of 20/40 in the right eye, 20/30 in the left eye. Vitreous cultures were positive for Candida albicans . Endogenous endophthalmitis after COVID-19 disease has been reported in 22 patients to date, and outcomes are poor, with 40%+ of eyes legally blind (20/200 or worse). Although influenced by availability of imaging modalities and degree of training of the evaluating physician, misdiagnosis can affect ¼ of cases, delaying treatment. Age, male sex, and diabetes increase the risk of severe COVID-19, which requires prolonged hospitalization, invasive catheterization, and immunosuppression, which in turn increases the risk of nosocomial infection. CONCLUSION Low threshold for suspecting EE in patients presenting with floaters and decreased vision after severe COVID-19 disease is necessary to ensure prompt recognition and treatment.
Collapse
Affiliation(s)
- Kirill Zaslavsky
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
15
|
Kuzman T, Gabric I, Meter A, Skegro I, Masnec S, Kalauz M, Pupic-Bakrac A. Clinical Experience of Using a Combination of Dexamethasone and Levofloxacin After Cataract Surgery. Med Arch 2024; 78:127-130. [PMID: 38566870 PMCID: PMC10983092 DOI: 10.5455/medarh.2024.78.127-130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
Background Where routine prophylactic antibiotics have been adopted following cataract surgery, rates of endophthalmitis have been decreasing. Intracameral and topical antibiotics are currently used to prevent endophthalmitis after cataract surgery. When applying topical antibiotics, there are different recommendations on the frequency and duration of therapy. The development of bacterial resistance to the excessive and long-term use of antibiotics is a growing problem worldwide. The goal is to achieve a good antibiotic effect with the shortest possible use of antibiotics. Objective The aim of this study was to compare the effectiveness of a new combination therapy of dexamethasone and levofloxacin for seven days after cataract surgery with the previous regimen of dexamethasone, neomycin sulfate, and polymyxin B, which was given for 21 days. Methods A retrospective analysis of medical records and administered a questionnaire was conducted to assess the effectiveness of postoperative therapy in our cataract surgery patients. The study involved 52 patients who underwent surgery within the last year, performed by a single surgeon at our institution. The findings can help us improve the quality of care we provide and optimize our patients' overall quality of life. Results We conducted an in-depth study on 52 individuals who underwent cataract surgery at our institution. The prescribed therapeutic regimen for the participants included administering Ducressa solution four times daily for the first seven days and Maxidex solution three times daily for the subsequent 14 days. The study found that none of the participants experienced complications after surgery, and all found it easy to instill the medication. The prescribed regimen effectively managed the postoperative recovery of the participants, and the medication was well-tolerated. Conclusion Our research found that a new combination of levofloxacin and dexamethasone, when used topically, may require a shorter treatment period, reducing the risk of antibiotic resistance and providing a safe alternative for endophthalmitis prevention.
Collapse
Affiliation(s)
- Tomislav Kuzman
- Department of Ophthalmology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivana Gabric
- Department of Ophthalmology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Meter
- Department of Ophthalmology, Dubrava University Hospital, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivan Skegro
- Department of Ophthalmology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sanja Masnec
- Department of Ophthalmology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Miro Kalauz
- Department of Ophthalmology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Pupic-Bakrac
- Department of Ophthalmology, Dubrava University Hospital, School of Medicine, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
16
|
Zhang Y. Endophthalmitis associated with Staphylococcus cohnii after vitrectomy and silicone oil insertion: A case report. Medicine (Baltimore) 2023; 102:e36574. [PMID: 38115335 PMCID: PMC10727602 DOI: 10.1097/md.0000000000036574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND To report a case of endophthalmitis in a silicone oil (SO)-filled eye associated with Staphylococcus cohnii. After vitrectomy, the environment for bacterial growth in the eye is removed, and SO has antibacterial effect on a variety of microorganisms. Endophthalmitis is seen in about 0.040% cases after pars plana vitrectomy and is even more uncommon in cases where SO is used. METHODS The patient was diagnosed as endophthalmitis and admitted to our hospital for emergency. The main concern is if intraocular infection can be controlled and the visual prognosis. In this case, multiple intravitreal antibiotics injection and anterior chamber washout were performed. Not only that, phacoemulsification was performed. RESULTS Hypopyon became less after 3 operations were performed. The infection was under control finally. CONCLUSION To the best of our knowledge, it is the first report of S. cohnii endophthalmitis in an SO-filled globe of an middle-aged patient. It is important to treat infective endophthalmitis with antibiotics promptly. Delayed therapy may affect the visual prognosis.
Collapse
Affiliation(s)
- Yuqiu Zhang
- Department of Ophthalmology, The Second Hospital of Lanzhou University, Lanzhou, China
| |
Collapse
|
17
|
Chen Y, Zeng F, Wang ZY. Comment on: Incidence of post vitrectomy endophthalmitis in India-a multicentric study by VRSI study Group. Eye (Lond) 2023; 37:3696. [PMID: 37130948 PMCID: PMC10686378 DOI: 10.1038/s41433-023-02550-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/04/2023] Open
Affiliation(s)
- Yao Chen
- Department Of Central Sterile Supply Department, The Third Affiliated Hospital of Chongqing Medical University, Chong Qing, 401120, China
| | - Fang Zeng
- Department Of Central Sterile Supply Department, The Third Affiliated Hospital of Chongqing Medical University, Chong Qing, 401120, China
| | - Zi Yu Wang
- Nursing Department of China-Singapore Maylook Eye Hospital, Chong Qing, 401147, China.
| |
Collapse
|
18
|
Hamon A, Benaboud S, Anjou M, Thoreau B, Dedieu D, Brezin A, Froelicher Bournaud L, Tazi A, Charlier C, Canouï E. Dalbavancin: a new option for systemic treatment of Gram-positive endogenous endophthalmitis? J Antimicrob Chemother 2023; 78:3005-3006. [PMID: 37812460 DOI: 10.1093/jac/dkad308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Affiliation(s)
- Antoine Hamon
- Faculté de Médecine, Université Paris Cité, F-75006 Paris, France
- Équipe Mobile d'Infectiologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
| | - Sihem Benaboud
- Faculté de Médecine, Université Paris Cité, F-75006 Paris, France
- Service de Pharmacologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
| | - Mickael Anjou
- Faculté de Médecine, Université Paris Cité, F-75006 Paris, France
- Service d'Ophtalmologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
| | - Benjamin Thoreau
- Faculté de Médecine, Université Paris Cité, F-75006 Paris, France
- Service de Médecine Interne, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
| | - Daphné Dedieu
- Faculté de Médecine, Université Paris Cité, F-75006 Paris, France
- Service d'Ophtalmologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
| | - Antoine Brezin
- Faculté de Médecine, Université Paris Cité, F-75006 Paris, France
- Service d'Ophtalmologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
| | | | - Asmaa Tazi
- Faculté de Médecine, Université Paris Cité, F-75006 Paris, France
- Service de Bactériologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
| | - Caroline Charlier
- Faculté de Médecine, Université Paris Cité, F-75006 Paris, France
- Équipe Mobile d'Infectiologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
- CNR Listeria, CC OMS, Unité biologie des infections Inserm U1117, Institut Pasteur, F-75015 Paris France
| | - Etienne Canouï
- Équipe Mobile d'Infectiologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
| |
Collapse
|
19
|
Samanta R, Jayaraj S, Mittal SK, Kumari J, Naharwal A, Agrawal A. Post-COVID-19 endogenous endophthalmitis case series and review of literature. Indian J Ophthalmol 2023; 71:3677-3683. [PMID: 37991303 PMCID: PMC10788740 DOI: 10.4103/ijo.ijo_3079_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE To describe a series of post-coronavirus disease 2019 (COVID-19) endogenous endophthalmitis (EE) patients from a multispecialty tertiary hospital in North India. METHODS A retrospective chart review including all consecutive cases with EE following confirmed COVID-19 disease from July 2020 to June 2021. RESULTS Seven eyes of four patients (three female and one male) were included. Two patients had confirmed bilateral fungal (Aspergillus sp.) EE and two patients had presumed fungal EE (one bilateral and one unilateral). Three of these four patients received systemic steroids as part of COVID-19 treatment previously. Five eyes were managed with initial intravitreal injection (IVI), followed by pars plana vitrectomy (PPV), and two eyes were managed with only IVI. All patients received systemic antifungal agents. Intraocular inflammation resolved in all eyes with treatment. One patient of EE also developed voriconazole-induced transient visual hallucination, which resolved on discontinuing the medication. CONCLUSION This case series represents a series of EE cases following COVID-19 disease or its sequelae or as a result of prior treatment for COVID-19. Ophthalmologists and physicians must be vigilant about these complications and initiate prompt management at the earliest.
Collapse
Affiliation(s)
- Ramanuj Samanta
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Sreeram Jayaraj
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Sanjeev K Mittal
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Jyoti Kumari
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Aarshi Naharwal
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Ajai Agrawal
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| |
Collapse
|
20
|
Lim SY, Kwon HJ, Lee YW, Sung H, Kim MN, Chang E, Bae S, Jung J, Kim MJ, Kim SH, Choi SH, Lee SO, Kim YS, Lee JY, Chong YP. Routine ophthalmologic examination in Klebsiella pneumoniae bacteremia is not necessary: incidence of and risk factors for ocular involvement. Antimicrob Agents Chemother 2023; 67:e0082223. [PMID: 37874294 PMCID: PMC10648850 DOI: 10.1128/aac.00822-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/12/2023] [Indexed: 10/25/2023] Open
Abstract
Klebsiella pneumoniae bacteremia is known to present a virulent clinical course, including multiple metastatic infections, which is not uncommon in Asia. However, there are limited data on the incidence and risk factors for ocular involvement in K. pneumoniae bacteremia. We retrospectively reviewed the medical records of all patients with K. pneumoniae bacteremia who underwent ophthalmologic examination in a tertiary center in Seoul, Korea, from February 2012 to December 2020. Two retinal specialists reviewed the findings of the ophthalmologic examinations and classified them as endophthalmitis, chorioretinitis, and no ocular involvement. Of 689 patients, 56 [8.1%; 95% confidence interval (CI) 6.2-10.4] had ocular involvement, and 9 (1.3%; 95% CI 0.6-2.5) were diagnosed with endophthalmitis. Of 47 patients with chorioretinitis, 45 (95.7%) improved with systemic antibiotic therapy alone. Community-onset bacteremia (100% vs 62.1% vs 57.4%, P = 0.04), cryptogenic liver abscess (55.6% vs 11.8% vs 8.5%, P = 0.003), and metastatic infection (66.7% vs 5.8% vs 10.6%, P < 0.001) were more common in endophthalmitis than in no ocular involvement or chorioretinitis. In the multivariable analysis, cryptogenic liver abscess [adjusted odds ratio (aOR), 6.63; 95% CI 1.44-35.20] and metastatic infection (aOR, 17.52; 95% CI 3.69-96.93) were independent risk factors for endophthalmitis. Endophthalmitis was not associated with 30-day mortality. Endophthalmitis is rare in Asian patients with K. pneumoniae bacteremia. Targeted ophthalmologic examination in those with cryptogenic liver abscess, metastatic infection, or ocular symptoms may be more appropriate than routine examination of all patients.
Collapse
Affiliation(s)
- So Yun Lim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hye Ji Kwon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yun Woo Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mi-Na Kim
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Euijin Chang
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seongman Bae
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joo Yong Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
21
|
Kvopka M, Chan W, Baranage D, Sia D. Morganella morganii and Enterococcus faecalis endophthalmitis following intravitreal injection. BMC Ophthalmol 2023; 23:450. [PMID: 37950172 PMCID: PMC10638747 DOI: 10.1186/s12886-023-03198-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Endophthalmitis following intravitreal injection is a potentially devastating complication of anti-VEGF injections. Post-injection endophthalmitis due to Enterococcus faecalis is rare, and no previous case of Morganella morganii endophthalmitis after intravitreal injection has been reported. CASE PRESENTATION We present the first reported case of Morganella morganii and Enterococcus faecalis endophthalmitis after intravitreal injection in an immunocompetent patient in the absence of recent ocular surgery. Our patient presented with hand movement visual acuity one day after anti-VEGF injection and demonstrated no clinical improvement despite repeated intravitreal ceftazidime and vancomycin injections. A decision was made to proceed with early vitrectomy given failure of intravitreal antibiotics. Visual acuity improved to 6/90 at 12 weeks after vitrectomy without any evidence of disease recurrence. CONCLUSIONS Post-injection endophthalmitis due to concurrent Morganella morganii and Enterococcus faecalis infections can have visually devastating consequences despite repeated empirical and targeted intravitreal antibiotics. Lack of clinical improvement following intravitreal antibiotics should warrant consideration of early vitrectomy. Our experience is a pertinent reminder of the ever-growing threat of uncommon and multi-resistant bacteria that must be considered when treating infections such as post-injection endophthalmitis.
Collapse
Affiliation(s)
- Michael Kvopka
- Department of Ophthalmology, The Royal Adelaide Hospital, Port Road, 5000, Adelaide, SA, Australia.
| | - WengOnn Chan
- Department of Ophthalmology, The Royal Adelaide Hospital, Port Road, 5000, Adelaide, SA, Australia
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia
| | - Duleepa Baranage
- Department of Ophthalmology, The Royal Adelaide Hospital, Port Road, 5000, Adelaide, SA, Australia
| | - David Sia
- Department of Ophthalmology, The Royal Adelaide Hospital, Port Road, 5000, Adelaide, SA, Australia
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia
| |
Collapse
|
22
|
Sano T, Sasaki H, Maki Y, Nagaoka R, Hamamoto T, Sugaoka S, Kanda T, Takeuchi M, Kawana A, Kimizuka Y. Ocular candidiasis in a tertiary hospital in Japan: A 10-year single-center retrospective study. J Infect Chemother 2023; 29:1081-1087. [PMID: 37392844 DOI: 10.1016/j.jiac.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/15/2023] [Accepted: 06/28/2023] [Indexed: 07/03/2023]
Abstract
Ocular candidiasis is a major complication of candidemia that is sometimes sight-threatening. Although prompt ophthalmologic consultation and antifungal medication have been emphasized, recent changes in the causative species and drug susceptibilities make the picture unclear. This study aimed to determine whether there are trends among patients with ocular candidiasis and included 80 patients with candidemia who underwent ophthalmological screening at our hospital between 2010 and 2020. Data on the clinical characteristics, comorbidities, biochemical test results, causative Candida species, treatment, outcomes, visual acuity, and antifungal susceptibility were collected and analyzed. Statistical analyses were performed by comparing two groups, namely, the ocular candidiasis (n = 29) and non-ocular candidiasis (n = 51) groups. In the ocular candidiasis group, there were significantly more cases of central venous catheter insertion (82.8%, p = 0.026) and Candida albicans candidemia (72.4%, p < 0.001). Regarding ocular involvement, the majority of patients were asymptomatic. Most cases improved with antifungal therapy, but one case underwent vitrectomy. Between 2016 and 2020, there was a diversification of species, with a decrease in Candida parapsilosis and the emergence of Candida glabrata and Candida tropicalis. Regarding drug susceptibility, the minimum inhibitory concentrations of echinocandin and 5-fluorocytosine against Candida albicans, Candida parapsilosis, and Candida glabrata were slightly increased. In conclusion, in addition to appropriately performing ophthalmologic examinations, it is beneficial to select antifungal agents according to the diversity of species and drug susceptibilities.
Collapse
Affiliation(s)
- Tomoya Sano
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, 359-8513, Japan.
| | - Hisashi Sasaki
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, 359-8513, Japan.
| | - Yohei Maki
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, 359-8513, Japan.
| | - Ryosuke Nagaoka
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, 359-8513, Japan.
| | - Takaaki Hamamoto
- Department of Laboratory Medicine, National Defense Medical College, Saitama, 359-8513, Japan.
| | - Shimpei Sugaoka
- Department of Ophthalmology, National Defense Medical College, Saitama, 359-8513, Japan.
| | - Takayuki Kanda
- Department of Ophthalmology, National Defense Medical College, Saitama, 359-8513, Japan.
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Saitama, 359-8513, Japan.
| | - Akihiko Kawana
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, 359-8513, Japan.
| | - Yoshifumi Kimizuka
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, 359-8513, Japan.
| |
Collapse
|
23
|
Ciociola EC, Powell JC, Barnwell E, Zehden JA, Robbins CB, Soundararajan S, Singh P, Zhang AY, Fekrat S, Greven MA. ENDOGENOUS ENDOPHTHALMITIS ASSOCIATED WITH INJECTION DRUG USE COMPARED WITH OTHER ETIOLOGIES. Retina 2023; 43:1996-2002. [PMID: 37490751 DOI: 10.1097/iae.0000000000003898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
PURPOSE To compare features of endogenous endophthalmitis associated with injection drug use (IDU) to endogenous endophthalmitis from other etiologies. METHODS The authors retrospectively collected data on patients with endogenous endophthalmitis due to IDU or other causes from three academic tertiary care centers over a six-year period. Differences in presenting characteristics, culture results, treatment, and visual acuity were compared between groups. RESULTS Thirty-eight patients (34%) had IDU-associated endogenous endophthalmitis while 75 patients (67%) had endogenous endophthalmitis from other causes. Compared with patients in the non-IDU group, IDU patients were significantly younger, more frequently male, had longer duration of symptoms at diagnosis, and were less likely to have bilateral disease ( P < 0.05 for all). Injection drug use patients were less likely to have a systemic infection source identified (29% vs. 71%, P < 0.001) or have positive cultures (47% vs. 80%, P < 0.001). The IDU group was less likely to be admitted to the hospital (71% vs. 92%, P = 0.005) and less likely to receive treatment with intravenous antimicrobials (55% vs. 83%, P = 0.003). Visual acuity did not significantly differ between groups. CONCLUSION Endophthalmitis related to IDU presents in younger patients with less comorbidities and frequently without positive cultures or an identifiable systemic source; therefore, a high index of suspicion is needed to identify this disease.
Collapse
Affiliation(s)
- Elizabeth C Ciociola
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jeffrey C Powell
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Eliza Barnwell
- Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina; and
| | - Jason A Zehden
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Cason B Robbins
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Srinath Soundararajan
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Pali Singh
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Alice Yang Zhang
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Margaret A Greven
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
24
|
Das T, Joseph J, Simunovic MP, Grzybowski A, Chen KJ, Dave VP, Sharma S, Staropoli P, Flynn H. Consensus and controversies in the science of endophthalmitis management: Basic research and clinical perspectives. Prog Retin Eye Res 2023; 97:101218. [PMID: 37838286 DOI: 10.1016/j.preteyeres.2023.101218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 10/16/2023]
Abstract
Infectious endophthalmitis is a severe intraocular infection caused by bacteria, or less commonly by fungi. It can occur after penetrating eye procedures, trauma, or the spread of infection from contiguous structures or via emboli from distant organs. Because of the time-critical nature of the treatment, endophthalmitis is treated with the clinical diagnosis and modified by the microbiological report of the intraocular contents. The current strategy for managing endophthalmitis relies on pre-clinical literature, case series, and one large multi-center randomized clinical trial on post-cataract surgery endophthalmitis. Culture-susceptibility of the microorganisms from undiluted vitreous guides the definitive treatment in non-responsive cases. Strategies to reduce the incidence of endophthalmitis after penetrating eye procedures have been developed concurrently with refined means of treatment. Despite these advances, outcomes remain poor for many patients. Although consensus articles have been published on managing endophthalmitis, treatment patterns vary, and controversies remain. These include (1) the use of newer methods for early and precise microbiological diagnosis; (2) the choice of intravitreal antibiotics; (3) the need for systemic therapy; (4) early and complete vitrectomy. Here, we review the current consensus and address controversies in diagnosing and managing endophthalmitis. This review is intended to familiarize physicians and ophthalmologists with different aspects of endophthalmitis management to make informed decisions.
Collapse
Affiliation(s)
- Taraprasad Das
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V, Prasad Eye Institute, Hyderabad, India.
| | - Joveeta Joseph
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India.
| | - Matthew P Simunovic
- Save Sight Institute, University of Sydney, NSW, 2006, Australia; Sydney Eye Hospital, 8 Macquarie St., Sydney, NSW, 2000, Australia.
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland.
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Vivek Pravin Dave
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V Prasad Eye Institute, Hyderabad, India.
| | - Savitri Sharma
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India.
| | - Patrick Staropoli
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V Prasad Eye Institute, Hyderabad, India.
| | - Harry Flynn
- Bascom Palmer Eye Institute, Miami, FL, USA.
| |
Collapse
|
25
|
Bjerager J, Leegaard Holm DM, Holm L, Faber C, Bate A, Christakopoulos C, Solborg Bjerrum S. Outbreak of Bilateral Endophthalmitis After Immediate Sequential Bilateral Cataract Surgery. JAMA Ophthalmol 2023; 141:1075-1078. [PMID: 37856103 PMCID: PMC10587825 DOI: 10.1001/jamaophthalmol.2023.4637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/26/2023] [Indexed: 10/20/2023]
Abstract
Importance Since bilateral simultaneous postoperative endophthalmitis (BSPOE) after immediate sequential bilateral cataract surgery (ISBCS) can be devastating for the patient, evaluating such cases in depth is important to maintaining patient safety. Objective To evaluate whether a systemic breach of sterility was associated with an outbreak of BSPOE after ISBCSs performed on the same day at a single community-based eye clinic. Design, Setting, and Participants This retrospective case series included all patients diagnosed with BSPOE at ophthalmology departments in Denmark following an infectious outbreak after ISBCSs performed at a single community-based eye clinic in December 2022. Exposure Bilateral simultaneous postoperative endophthalmitis acquired after ISBCS. Main Outcome and Measures Patient recovery from BSPOE after ISBCS was evaluated based on clinical and microbiological reports. Results A woman aged 71 years, a man aged 84 years, and a woman aged 79 years consecutively presented with symptoms of endophthalmitis at regional eye departments 4 to 8 days after ISBCS performed on the same date at the same eye clinic. Five of 6 infected eyes underwent vitrectomy, and all eyes received an intravitreous injection of antibiotics. The same strain of Staphylococcus epidermidis was isolated in 4 of 5 eyes that underwent vitrectomy. Contamination of viscoelastics was ruled out with repeated cultures. One eye was eviscerated due to phthisis. In another patient, the final visual acuity of the eye most severely affected was 20/63 Snellen equivalents. Visual acuity of the remaining eyes recovered to 20/25 (3 eyes in 2 patients) and 20/20 (1 eye) Snellen equivalents. Conclusions and Relevance The finding of the same strain of S epidermidis in all patient cultures suggests a systemic breach of sterility at the clinic on the day of ISBCS. The outcome of these cases emphasizes the need to adhere to a strict surgical methodology and sterile principles during ISBCS.
Collapse
Affiliation(s)
- Jakob Bjerager
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | | | - Lars Holm
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Carsten Faber
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Anja Bate
- Department of Ophthalmology, Zealand University Hospital, Næstved, Denmark
| | | | | |
Collapse
|
26
|
Panahi P, Mirzakouchaki-Borujeni N, Pourdakan O, Arévalo JF. Early Vitrectomy for Endophthalmitis: Are EVS Guidelines Still Valid? Ophthalmic Res 2023; 66:1318-1326. [PMID: 37857260 PMCID: PMC10634277 DOI: 10.1159/000534650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Endophthalmitis, a potentially sight-threatening condition, remains a challenge for ophthalmologists worldwide. The endophthalmitis vitrectomy study (EVS) conducted in 1995 compared vitrectomy and intravitreal antibiotic injections to intravitreal antibiotic injections alone for acute post-cataract surgery and secondary intraocular lens endophthalmitis, setting treatment guidelines. However, the landscape of clinical practice has evolved considerably since then, raising questions about the applicability of EVS recommendations today. SUMMARY Recent studies have proposed that early and complete vitrectomy (CEVE) could potentially be an effective approach for managing endophthalmitis cases, irrespective of the initial visual acuity. However, it is important to note that the level of rigor in these recent studies may not match that of the EVS study, and as such, this assertion should be considered with caution. Furthermore, the EVS study exclusively focused on post-cataract surgery cases, leaving other endophthalmitis types, like post-intravitreal injection and post-traumatic endophthalmitis, without standardized treatment guidelines. Research exploring the role of early vitrectomy in these contexts yields mixed results, emphasizing the need for further investigation and well-designed prospective trials. Endogenous endophthalmitis, originating from systemic infections, adds complexity to the scenario. While early vitrectomy shows promise in specific cases, conflicting evidence necessitates comprehensive research. KEY MESSAGES This review underscores the necessity for tailored treatment strategies, supporting early vitrectomy when clinically indicated, and advocating for prospective trials to clarify its role in diverse endophthalmitis scenarios. As surgical techniques and antimicrobial therapies continue to advance, reevaluating treatment paradigms becomes crucial to enhance patient outcomes and protect ocular health.
Collapse
Affiliation(s)
- Parsa Panahi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
- Finetech in Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Omid Pourdakan
- Department of Molecular Imaging, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - J Fernando Arévalo
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
27
|
Zheng K, Zheng X, Gan D, Zhou X. Successful antibiotic management of Staphylococcus epidermidis endophthalmitis after implantable collamer lens implantation. BMC Ophthalmol 2023; 23:410. [PMID: 37828437 PMCID: PMC10568818 DOI: 10.1186/s12886-023-03127-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023] Open
Abstract
PURPOSE We report a case of successful medical management of endophthalmitis post implantable collamer lens (ICL) culture-positive of Staphylococcus epidermidis. OBSERVATIONS A 18-year-old female presented with decreased visual acuity in the left eye 20 days after ICL implantation. A diagnosis of postoperative endophthalmitis was made based on examination and ultrasonography. A vitreous tap was taken, and intravitreal antibiotics (vancomycin 1 mg/0.1ml and ceftazidime 2 mg/0.1ml) were administered twice (every 72 h), and peribulbar injection of triamcinolone acetonide after four days of the second intravitreal injection. The vitreous culture was confirmed for Staphylococcus epidermidis. The endophthalmitis was resolved, and visual acuity improved from 6/20 to 12/20 on day 7 and 22/20 on day 38. This is the first successful medical resolution of Staphylococcus epidermidis endophthalmitis post ICL surgery without ICL explantation and vitrectomy in the V4c model. CONCLUSIONS AND IMPORTANCE In antibiotic therapy, the excellent compliance and close follow-up of this endophthalmitis patient enabled careful postoperative surveillance on the effect of antibiotic therapy, avoiding the removal of the ICL or the loss of the integrity of the eye. The risk of potential infectious endophthalmitis post-ICL surgery should be fully emphasized during preoperative counseling.
Collapse
Affiliation(s)
- Ke Zheng
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, 200031, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiaohong Zheng
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, 200031, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Dekang Gan
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, 200031, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, 200031, Shanghai, China.
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
| |
Collapse
|
28
|
Taubenslag KJ, Cherney EF, Patel SN, Law JC, Daniels AB, Kim SJ. Intravitreal triple therapy with vancomycin, ceftazidime, and moxifloxacin for bacterial endophthalmitis: A Twelve-year experience. Graefes Arch Clin Exp Ophthalmol 2023; 261:2813-2819. [PMID: 37227476 DOI: 10.1007/s00417-023-06112-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023] Open
Abstract
PURPOSE Increasing rates of antibiotic resistance in endophthalmitis have been reported. This study examines outcomes of triple therapy with intravitreal vancomycin, ceftazidime, and moxifloxacin for endophthalmitis. METHODS Retrospective, consecutive series of all patients treated with abovementioned intravitreal antibiotics from January 2009 to June 2021. Percentages of eyes attaining greater than or equal to 20/200 and 20/50 Snellen visual acuities and adverse events were evaluated. RESULTS 112 eyes met inclusion criteria. 63 of 112 eyes (56%) achieved a visual acuity of 20/200 during follow-up, with 39 (35%) returning to at least 20/50. In subgroup analysis, 23 of 24 (96%) eyes with post-cataract endophthalmitis obtained ≥ 20/200 acuity and 21 of 24 (88%) obtained ≥ 20/50 acuity during follow-up. There were no cases of macular infarction. CONCLUSIONS Intravitreal moxifloxacin (160 µg/0.1 mL) was well tolerated as an adjunct to vancomycin and ceftazidime for bacterial endophthalmitis. Use of this novel combination offers several theoretical advantages compared to standard therapy with two antibiotics, including expanded gram-negative coverage and potential synergy, and may be particularly valuable in geographies where the local antibiogram supports empiric use. Further study is merited to verify the safety and efficacy profile.
Collapse
Affiliation(s)
- Kenneth J Taubenslag
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edward F Cherney
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shriji N Patel
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Janice C Law
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anthony B Daniels
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, TN, USA.
- 2 Vanderbilt Eye Institute, 2311 Pierce Avenue, Nashville, TN, 37232, USA.
| |
Collapse
|
29
|
Kiraly P, De Silva SR, Stone N. Retinal vasculitis as the presenting sign of post-injection endophthalmitis. J Fr Ophtalmol 2023; 46:972-973. [PMID: 37442692 DOI: 10.1016/j.jfo.2022.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 07/15/2023]
Affiliation(s)
- P Kiraly
- Oxford University Hospitals NHS Foundation Trust, Oxford Eye Hospital, Level Lg1 John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom; Department of Clinical Neurosciences, University of Oxford Nuffield, Oxford, United Kingdom
| | - S R De Silva
- Oxford University Hospitals NHS Foundation Trust, Oxford Eye Hospital, Level Lg1 John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom; Department of Clinical Neurosciences, University of Oxford Nuffield, Oxford, United Kingdom
| | - N Stone
- Oxford University Hospitals NHS Foundation Trust, Oxford Eye Hospital, Level Lg1 John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom.
| |
Collapse
|
30
|
Arshinoff SA, Shi RB. Reply: Relative efficacy of intracameral moxifloxacin injection methods. J Cataract Refract Surg 2023; 49:1080-1081. [PMID: 37769177 DOI: 10.1097/j.jcrs.0000000000001263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Affiliation(s)
- Steve A Arshinoff
- From the York Finch Eye Associates, Toronto, Ontario, Canada (Arshinoff); Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (Arshinoff); Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada (Shi); Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Shi)
| | | |
Collapse
|
31
|
Jung S, Kim MS. Fungal Endophthalmitis in a Case of Rhino-Orbital-Cerebral Mucormycosis Treated with 0.02% Intravitreal Liposomal Amphotericin B Injection: A Case Report. Korean J Ophthalmol 2023; 37:434-436. [PMID: 37699555 PMCID: PMC10587451 DOI: 10.3341/kjo.2023.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/15/2023] [Accepted: 09/07/2023] [Indexed: 09/14/2023] Open
Affiliation(s)
- Sangwon Jung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Min Seok Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| |
Collapse
|
32
|
Sakamoto T, Terasaki H, Yamashita T, Shiihara H, Funatsu R, Uemura A. Increased incidence of endophthalmitis after vitrectomy relative to face mask wearing during COVID-19 pandemic. Br J Ophthalmol 2023; 107:1472-1477. [PMID: 35728937 DOI: 10.1136/bjophthalmol-2022-321357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/22/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND/AIMS To determine the incidence and causative pathogens of endophthalmitis after vitrectomy during strict face mask wearing in the COVID-19 period. METHODS This was a retrospective multicentre study including 31 ophthalmological institutions of the Japanese Retina and Vitreous Society or Japan-Clinical Retina Study group. Patients who had undergone vitrectomy during 2019, the pre-COVID-19 period, and from July 2020 to June 2021, the COVID-mask period, were studied. The results of cataract surgery were used as a control. The total number of vitrectomies and the total number of postoperative endophthalmitis were determined. Then, the differences in the incidence of postoperative endophthalmitis between the pre-COVID-19 period and the COVID-mask period, and the type of pathogens causing the endophthalmitis were studied. RESULTS The incidence of postvitrectomy endophthalmitis was significantly lower in the pre-COVID-19 period with 16 568 surgeries and 18 endophthalmitis cases (0.11%) than in the COVID-mask period of 14 929 surgeries and 31 endophthalmitis cases (0.21%; p=0.031, OR=1.913, 95% CI 1.078 to 3.394). In the pre-COVID-19 period, 4 of the 18 eyes were culture positive, and all were of the Staphylococcus family. In the COVID-mask period, 9 of the 31 eyes were culture positive, and 4 cases were related to oral commensals including Streptococcus spp, which are reportedly very rare in endophthalmitis after vitrectomy. CONCLUSIONS It is necessary for physicians to be aware of the higher incidence of postvitrectomy endophthalmitis during the COVID-mask period, and to treat their patients appropriately.
Collapse
Affiliation(s)
- Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
- Japan-Clinical Retina Study Group (J-CREST), Kagoshima, Japan
| | - Hiroto Terasaki
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
- Japan-Clinical Retina Study Group (J-CREST), Kagoshima, Japan
| | - Toshifumi Yamashita
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
- Japan-Clinical Retina Study Group (J-CREST), Kagoshima, Japan
| | - Hideki Shiihara
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
- Japan-Clinical Retina Study Group (J-CREST), Kagoshima, Japan
| | - Ryoh Funatsu
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
- Japan-Clinical Retina Study Group (J-CREST), Kagoshima, Japan
| | - Akinori Uemura
- Department of Ophthalmology, Kagoshima City Hospital, Kagoshima, Japan
| |
Collapse
|
33
|
Myers WG, Chang DF, Shorstein NH, Mah FS, Mamalis N, Miller KM. ASCRS clinical advisory on intracameral moxifloxacin injection for infection prophylaxis. J Cataract Refract Surg 2023; 49:1068-1070. [PMID: 37290753 DOI: 10.1097/j.jcrs.0000000000001237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/05/2023] [Indexed: 06/10/2023]
Abstract
Moxifloxacin solution is frequently injected at the conclusion of cataract surgery for endophthalmitis prophylaxis. 2 different concentrations are most commonly available in the United States for intracameral (IC) use: 0.5% (5 mg/mL) and 0.1% (1 mg/mL). The recommended volume to be injected is different for the 2 concentrations, and incorrect dosing can increase the risk of toxic anterior segment syndrome or endophthalmitis. In addition, the U.S. Food and Drug Administration recently published an alert regarding potential adverse events associated with intraocular compounded moxifloxacin. This clinical advisory reviews the optimal dosing of IC moxifloxacin based on current evidence.
Collapse
Affiliation(s)
- William G Myers
- From the Northwestern University, Chicago, Illinois (Myers); University of California, San Francisco, San Francisco, California (Chang); Kaiser Permanente, Walnut Creek, California (Shorstein); Scripps Clinic Medical Group, La Jolla, California (Mah); Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah (Mamalis); Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California (Miller)
| | | | | | | | | | | |
Collapse
|
34
|
Das S, Ahmad Z, Singh S, Singh S, Wright RE, Giri S, Kumar A. Oral administration of S-nitroso-L-glutathione (GSNO) provides anti-inflammatory and cytoprotective effects during ocular bacterial infections. Cell Mol Life Sci 2023; 80:309. [PMID: 37770649 DOI: 10.1007/s00018-023-04963-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/20/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023]
Abstract
Bacterial endophthalmitis is a severe complication of eye surgeries that can lead to vision loss. Current treatment involves intravitreal antibiotic injections that control bacterial growth but not inflammation. To identify newer therapeutic targets to promote inflammation resolution in endophthalmitis, we recently employed an untargeted metabolomics approach. This led to the discovery that the levels of S-nitroso-L-glutathione (GSNO) were significantly reduced in an experimental murine Staphylococcus aureus (SA) endophthalmitis model. In this study, we tested the hypothesis whether GSNO supplementation via different routes (oral, intravitreal) provides protection during bacterial endophthalmitis. Our results show that prophylactic administration of GSNO via intravitreal injections ameliorated SA endophthalmitis. Therapeutically, oral administration of GSNO was found to be most effective in reducing intraocular inflammation and bacterial burden. Moreover, oral GSNO treatment synergized with intravitreal antibiotic injections in reducing the severity of endophthalmitis. Furthermore, in vitro experiments using cultured human retinal Muller glia and retinal pigment epithelial (RPE) cells showed that GSNO treatment reduced SA-induced inflammatory mediators and cell death. Notably, both in-vivo and ex-vivo data showed that GSNO strengthened the outer blood-retinal barrier during endophthalmitis. Collectively, our study demonstrates GSNO as a potential therapeutic agent for the treatment of intraocular infections due to its dual anti-inflammatory and cytoprotective properties.
Collapse
Affiliation(s)
- Susmita Das
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, 4717 St. Antoine, Detroit, MI, 48201, USA
| | - Zeeshan Ahmad
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, 4717 St. Antoine, Detroit, MI, 48201, USA
| | - Sneha Singh
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, 4717 St. Antoine, Detroit, MI, 48201, USA
| | - Sukhvinder Singh
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, 4717 St. Antoine, Detroit, MI, 48201, USA
| | - Robert Emery Wright
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, 4717 St. Antoine, Detroit, MI, 48201, USA
| | - Shailendra Giri
- Department of Neurology, Henry Ford Health System, Detroit, MI, USA
| | - Ashok Kumar
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, 4717 St. Antoine, Detroit, MI, 48201, USA.
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MI, USA.
| |
Collapse
|
35
|
Lin BR, Al-Khersan H, Bitrian E, Flynn HW. Endophthalmitis Associated With XEN Stent Implantation. Am J Ophthalmol 2023; 253:37-43. [PMID: 37059319 PMCID: PMC10524262 DOI: 10.1016/j.ajo.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE The aim of this study is to report the clinical characteristics, causative organisms, and treatment outcomes in patients presenting with endophthalmitis related to XEN stent implants. DESIGN Retrospective, noncomparative consecutive case series. METHODS Clinical and microbiologic review was performed for 8 patients presenting to the Bascom Palmer Eye Institute Emergency Room between 2021 and 2022 with XEN stent-related endophthalmitis. Data collected included clinical characteristics of patients at presentation, organisms identified in ocular cultures, treatments received, and visual acuity at last follow-up. RESULTS The current study included 8 eyes from 8 patients. All cases of endophthalmitis occurred >30 days after implantation of the XEN stent. At the time of presentation, there were external exposures of the XEN stent in 4 of 8 patients. Five of the 8 patients had positive intraocular cultures, all of which were variants of staphylococcus and streptococcus species. Management included intravitreal antibiotics in all patients, explantation of the XEN stent in 5 patients (62.5%), and pars plana vitrectomy in 6 patients (75%). At last follow-up, 6 of the 8 patients (75%) had a visual acuity of hand motion or worse. CONCLUSIONS Endophthalmitis in the setting of XEN stents results in poor visual outcomes. The most common causative organisms are staphylococcus or streptococcus species. At time of diagnosis, prompt treatment with broad-spectrum intravitreal antibiotics is recommended. Consideration can be made to explant the XEN stent and perform early pars plana vitrectomy.
Collapse
Affiliation(s)
- Benjamin R Lin
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Hasenin Al-Khersan
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Elena Bitrian
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Harry W Flynn
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA..
| |
Collapse
|
36
|
Bilgic A, Kodjikian L, Gonzalez-Cortes JH, Heuvels A, Heuvels P, Sudhalkar A, Mathis T. Postoperative Aspergillus Infection: A Case Series. Ocul Immunol Inflamm 2023; 31:1486-1489. [PMID: 35914298 DOI: 10.1080/09273948.2022.2103714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/18/2022] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To report the clinical findings, therapy and outcomes of pauci-symptomatic Aspergillus infection in 11 eyes of 11 patients who had recently undergone uneventful cataract surgery and IOL implantation in a single operating room on the same day. METHODS Retrospective, observational study that looks at 11 patients who demonstrated Aspergillus infection after cataract surgery. All data were collected and intracameral samples sent for microscopic evaluation and culture. Additional swabs were sent from the operating room and operative consumables. RESULTS A total of 11 eyes of 11 patients were included in the analysis and were followed for at least 12 months. All patients responded completely to local and systemic voriconazole therapy. The source of infection was noted to be air-conditioning vents. Eyes with manual small incision cataract surgery (11/17) had a higher propensity for infection. CONCLUSION Pauci-symptomatic aspergillosis infection has been reported here following cataract surgery.
Collapse
Affiliation(s)
- Alper Bilgic
- Alphavision Augenarztpraxis, Bremerhaven, Germany
| | - Laurent Kodjikian
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Matéis, UMR-CNRS 5510, Lyon, France
| | | | - Alexandra Heuvels
- Department of Ophthalmology, Augenärzte Niederelbe, Stade & Cuxhaven, Germany
| | - Per Heuvels
- Department of Ophthalmology, Augenärzte Niederelbe, Stade & Cuxhaven, Germany
| | - Aditya Sudhalkar
- Alphavision Augenarztpraxis, Bremerhaven, Germany
- MS Sudhalkar Medical Research Foundation, Baroda, India
| | - Thibaud Mathis
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Matéis, UMR-CNRS 5510, Lyon, France
| |
Collapse
|
37
|
Ramamurthy SR, Joseph J, Dave VP. Clinical settings, management and factors affecting outcomes in multi and extensively-drug resistant Pseudomonas endophthalmitis. Eur J Ophthalmol 2023; 33:1997-2005. [PMID: 36908204 DOI: 10.1177/11206721231163353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE To report the clinical settings, management and factors affecting outcomes in multi-drug resistant (MDR) and extensively-drug resistant (XDR) Pseudomonas endophthalmitis. SETTINGS Retrospective, consecutive, non-comparative interventional case series. Cases of MDR and XDR Pseudomonas endophthalmitis from January 2012 to December 2020 treated at our tertiary eye care center were included. Data collected included clinical data, anatomic and functional outcome, isolated micro-organisms, and culture sensitivity. RESULTS This study included 29 eyes of 29 patients with MDR/XDR Pseudomonas endophthalmitis. Mean age at presentation was 60.27 ± 14.9 years (median 63). Commonest clinical setting was acute post-operative endophthalmitis in 27 cases (93.1%). Concurrent corneal infiltrate was present in 11 eyes (37.9%). Initial intervention in 19 eyes (65.5%) was vitrectomy, 2 of which underwent endoscopic pars plana vitrectomy. Mean number of interventions was 3.34 ± 1.44 (median 4). Mean follow up was 3.25 ± 3.07 months (median 2). Sensitivity to ceftazidime was 48.28%. All isolates were sensitive to colistin. Mean visual acuity at last follow up in logMAR was 2.64 ± 1.48 (median 3.5). Seven eyes (24.13%) were NPL (nil perception of light) at the last follow up. Two eyes (6.9%) underwent evisceration. Nine eyes (31.03%) had a favourable anatomic and functional outcome. Eyes without a corneal infiltrate at presentation were found to have a favourable anatomic and favourable functional outcome (OR 11.91, P < 0.04, CI 1.08 to 130.93). CONCLUSION Corneal involvement at presentation is associated with poorer outcomes in MDR and XDR Pseudomonas endophthalmitis. There is a potential role of higher newer antibiotics especially colistin in the management of these cases.
Collapse
Affiliation(s)
- Srishti Raksheeth Ramamurthy
- Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
- Standard Chartered Academy for Eye Care Education, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Vivek Pravin Dave
- Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
38
|
Velez-Montoya R, Monroy-Esquivel L, Ortiz-Guevara R, Quiroz-Mercado H, Fromow-Guerra J. ALTERNATIVE INTRAVITREAL ANTIBIOTICS: A Systematic Review for Consideration in Recalcitrant or Resistant Endophthalmitis. Retina 2023; 43:1433-1447. [PMID: 36893433 DOI: 10.1097/iae.0000000000003773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
PURPOSE To organize, categorize, and create a quick reference guide for the use of intravitreal antibiotic alternatives to the standard combination of vancomycin and ceftazidime for the treatment of endophthalmitis. METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. The authors searched for all available information regarding intravitreal antibiotics in the last 21 years. Manuscripts were selected according to relevance, level of information, and the available data regarding intravitreal dose, potential adverse effects, bacterial coverage, and relevant pharmacokinetic information. RESULTS The authors included 164 of 1810 manuscripts. The antibiotics were classified according to their class into fluoroquinolones, cephalosporins, glycopeptide and lipopeptide, penicillins and beta-lactams, tetracyclines, and miscellaneous. The authors also included information regarding intravitreal adjuvants for the treatment of endophthalmitis and one ocular antiseptic. CONCLUSION The treatment of infectious endophthalmitis is a therapeutic challenge. The current review summarizes the properties of possible intravitreal antibiotic alternatives that should be considered in cases of suboptimal response to initial treatment.
Collapse
Affiliation(s)
- Raul Velez-Montoya
- Retina department, Asociación para Evitar le Ceguera en México IAP, México City, México
| | | | | | | | | |
Collapse
|
39
|
Green MB, Agranat JS, Davoudi S, Sanayei N, Ness S. Penicillin Responsive Presumed Seronegative Ocular Syphilis in a Patient with Human Immunodeficiency Virus: A Case Report and Review of the Literature. Ocul Immunol Inflamm 2023; 31:1320-1327. [PMID: 36897959 DOI: 10.1080/09273948.2023.2183413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/12/2023]
Abstract
Ocular and systemic syphilis are well known to mimic other clinical entities making them challenging to diagnose in many cases. Syphilis testing plays an important role in diagnosis and timely treatment. Here we describe a patient with untreated human immunodeficiency virus (HIV) infection who presented with bilateral panuveitis with repeatedly negative syphilis serologies. In light of worsening retinitis while on aggressive anti-viral treatment and in consideration of the clinical suspicion for syphilitic uveitis, intravenous penicillin was initiated empirically. The patient demonstrated significant improvement subjectively and objectively after treatment. We also review and discuss syphilis testing reliability generally and in HIV co-infected patients in particular. Empiric intravenous penicillin should be considered in patients with clinical features of ocular syphilis despite negative serologic testing, especially in those with HIV co-infection.
Collapse
Affiliation(s)
- Michael B Green
- Boston Medical Center, Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Joshua S Agranat
- Boston Medical Center, Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Samaneh Davoudi
- Boston Medical Center, Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nedda Sanayei
- Boston Medical Center, Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Steven Ness
- Boston Medical Center, Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
40
|
Fabiani C, Agarwal M, Dogra M, Tosi GM, Davis JL. Exogenous Endophthalmitis. Ocul Immunol Inflamm 2023; 31:1386-1395. [PMID: 36534597 DOI: 10.1080/09273948.2022.2152699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Exogenous endophthalmitis (ExE) results from microbial infection as a complication of ocular surgery, penetrating ocular trauma, and intraocular foreign bodies. We herein review the classification of ExE, etiological agents, differential diagnosis and therapeutic challenges. METHODS Narrative Literature Review. RESULTS Identification of the causative agent through ocular fluid analysis is central in the diagnostic work-up of ExE. Prompt intravitreal antimicrobial therapy is key to successful management of ExE and vitrectomy is essential in severe cases. In culture-negative cases, and in the presence of specific features, a diagnosis of sterile intraocular inflammation or toxic syndrome should be suspected. CONCLUSION Strict adherence to treatment guidelines may improve outcomes of ExE, however the ultimate prognosis, especially in severe cases, may depend more on the virulence of the causative organism and associated ocular complications. Accurate differential diagnosis and effective treatment are crucial elements in the management and prognosis of non-infectious masquerades of ExE.
Collapse
Affiliation(s)
- Claudia Fabiani
- Department of Medical Sciences, Surgery and Neurosciences, Unit of Ophthalmology, University of Siena, Siena, Italy
| | - Manisha Agarwal
- Department of Vitreoretina and Uvea, Dr Shroff's Charity Eye Hospital New Delhi, Daryaganj, India
| | - Mohit Dogra
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gian Marco Tosi
- Department of Medical Sciences, Surgery and Neurosciences, Unit of Ophthalmology, University of Siena, Siena, Italy
| | - Janet L Davis
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA
| |
Collapse
|
41
|
Das T, Belenje A, Pandey S, Behera UC, Joseph J, Dave VP. Endophthalmitis Management Study-A Prospective Randomized Clinical Trial on Postoperative Endophthalmitis Management in India: An Interim Analysis. Endophthalmitis Management Study Report #3. Asia Pac J Ophthalmol (Phila) 2023; 12:437-443. [PMID: 37851560 DOI: 10.1097/apo.0000000000000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/06/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE An interim analysis of the Endophthalmitis Management Study to examine the outcome of inflammation score (IS)-based treatment and antibiotic susceptibility. DESIGN A prospective randomized study. PATIENTS AND METHODS IS was measured on a 0-4 scale from presenting signs in 4 cardinal ocular tissues. The eyes with IS <10 received vitreous tap and intravitreal antibiotics, whereas eyes with IS ≥10 received vitrectomy and intravitreal antibiotics. These eyes were randomized to 2 intravitreal antibiotic combinations: (1) vancomycin and ceftazidime and (2) vancomycin and imipenem. Microbiology workup of undiluted vitreous included microscopy, culture-susceptibility, Sanger, and targeted next-generation sequencing. The clinical and microbiology outcomes were analyzed for advanced (IS = ≥20) and less advanced (IS = <10) endophthalmitis. RESULTS Interim analysis was performed after the Endophthalmitis Management Study recruited 56.85% (248/436) of patients and completed 54.6% (238/436) of microbiology workup. A 90-day follow-up was completed in 90.8% (168/185) of eligible people. In eyes with IS ≥20, the time to symptoms was shorter (5.8 ± 6.7 vs 8.5 ± 9.1 d; P = 0.015), and the need for additional treatment was higher (95.8% vs 53.1%; P = 0.0267). Good final vision was associated with good presenting vision (r = 0.30) and IS-based treatment decisions (r = 0.170). Microbiology positivity was 55.9%. Eyes with IS <10 had a higher Gram-positive cocci (33.9% vs 4.8%; P = 0.013) infection. Gram-positive cocci were most susceptible to vancomycin (95.7%), and Gram-negative bacilli to colistin (95.7%). CONCLUSIONS Considering both IS and presenting vision, rather than only one of them, helps in making appropriate management decisions for acute postoperative endophthalmitis.
Collapse
Affiliation(s)
- Taraprasad Das
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, LV Prasad Eye Institute, Hyderabad, TS, India
| | - Akash Belenje
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, LV Prasad Eye Institute, Hyderabad, TS, India
| | - Suchita Pandey
- Jhaveri Microbiology Center, LV Prasad Eye Institute, Hyderabad, TS, India
| | - Umesh C Behera
- Anant Bajaj Retina Institute, Centre for Vitreoretinal Disease, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, LV Prasad Eye Institute, Hyderabad, TS, India
| | - Vivek Pravin Dave
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, LV Prasad Eye Institute, Hyderabad, TS, India
| |
Collapse
|
42
|
Mursalin MH, Astley R, Coburn PS, Bagaruka E, Hunt JJ, Fischetti VA, Callegan MC. Therapeutic potential of Bacillus phage lysin PlyB in ocular infections. mSphere 2023; 8:e0004423. [PMID: 37273201 PMCID: PMC10449515 DOI: 10.1128/msphere.00044-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/19/2023] [Indexed: 06/06/2023] Open
Abstract
Bacteriophage lytic enzymes (i.e., phage lysins) are a trending alternative for general antibiotics to combat growing antimicrobial resistance. Gram-positive Bacillus cereus causes one of the most severe forms of intraocular infection, often resulting in complete vision loss. It is an inherently β-lactamase-resistant organism that is highly inflammogenic in the eye, and antibiotics are not often beneficial as the sole therapeutic option for these blinding infections. The use of phage lysins as a treatment for B. cereus ocular infection has never been tested or reported. In this study, the phage lysin PlyB was tested in vitro, demonstrating rapid killing of vegetative B. cereus but not its spores. PlyB was also highly group specific and effectively killed the bacteria in various bacterial growth conditions, including ex vivo rabbit vitreous (Vit). Furthermore, PlyB demonstrated no cytotoxic or hemolytic activity toward human retinal cells or erythrocytes and did not trigger innate activation. In in vivo therapeutic experiments, PlyB was effective in killing B. cereus when administered intravitreally in an experimental endophthalmitis model and topically in an experimental keratitis model. In both models of ocular infection, the effective bactericidal property of PlyB prevented pathological damage to ocular tissues. Thus, PlyB was found to be safe and effective in killing B. cereus in the eye, greatly improving an otherwise devastating outcome. Overall, this study demonstrates that PlyB is a promising therapeutic option for B. cereus eye infections.IMPORTANCEEye infections from antibiotic-resistant Bacillus cereus are devastating and can result in blindness with few available treatment options. Bacteriophage lysins are an alternative to conventional antibiotics with the potential to control antibiotic-resistant bacteria. This study demonstrates that a lysin called PlyB can effectively kill B. cereus in two models of B. cereus eye infections, thus treating and preventing the blinding effects of these infections.
Collapse
Affiliation(s)
- Md Huzzatul Mursalin
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Roger Astley
- Dean McGee Eye Institute, Oklahoma City, Oklahoma, USA
| | - Phillip S. Coburn
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Dean McGee Eye Institute, Oklahoma City, Oklahoma, USA
| | - Eddy Bagaruka
- Oklahoma Christian University, Edmond, Oklahoma, USA
| | | | - Vincent A. Fischetti
- Laboratory of Bacterial Pathogenesis and Immunology, The Rockefeller University, New York, New York, USA
| | - Michelle C. Callegan
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Dean McGee Eye Institute, Oklahoma City, Oklahoma, USA
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| |
Collapse
|
43
|
Wong BM, Bonnet C, Ghaffari R, Houser K, DeMatteo J, Lau N, Aldave AJ. Fungal Infection After Descemet Membrane Endothelial Keratoplasty: Incidence and Outcomes. Cornea 2023; 42:687-698. [PMID: 36731080 DOI: 10.1097/ico.0000000000003102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of the study was to describe the incidence, presentation, management, and outcomes of fungal infection after Descemet membrane endothelial keratoplasty (DMEK). METHODS Retrospective case series of culture-proven fungal infections after DMEK reported in the literature, directly by surgeons, and to the Eye Bank Association of America from January 1, 2011, to December 31, 2020. RESULTS The domestic incidence of fungal infections, fungal keratitis, and fungal endophthalmitis after DMEK from 2011 to 2020 was 3.5, 1.3, and 2.2 per 10,000 cases, respectively, with no significant increasing trend. Thirty-four cases were identified, 14 (41.2%) published and 20 (58.8%) unpublished. Donor tissue fungal cultures were performed in 20 of the 34 (58.8%) cases and were positive in 19 of the 20 (95.0%), all but one Candida species. Recipient fungal cultures were performed in 29 of the 34 (85.3%) cases and were positive in 26 of the 29 (89.7%), all but one Candida species. Infection presented a mean of 33 ± 38 days (median 23, range 2-200, outlier 949) after transplantation: 25 (73.5%) with endophthalmitis and 9 (26.5%) with keratitis. Topical, intrastromal, intracameral, intravitreal, or systemic antifungal therapy was used in all 27 eyes with treatment data. Surgical intervention (DMEK explantation or partial removal, repeat endothelial keratoplasty, penetrating keratoplasty, and/or pars plana vitrectomy) was required in 21 of the 27 (77.8%) eyes. The corrected distance visual acuity at the last follow-up was ≥20/40 in 13 of the 27 (48.1%) eyes and counting fingers or worse in 6 of the 27 (22.2%) eyes. CONCLUSIONS Fungal infection is a rare but serious complication of DMEK that results in counting fingers or worse corrected distance visual acuity in nearly a quarter of eyes.
Collapse
Affiliation(s)
- Brittany M Wong
- Stein Eye Institute, University of California Los Angeles, Los Angeles, CA
| | - Clémence Bonnet
- Stein Eye Institute, University of California Los Angeles, Los Angeles, CA
- Department of Ophthalmology, Cochin Hospital, Paris Cité University, Paris, France
| | - Reza Ghaffari
- Stein Eye Institute, University of California Los Angeles, Los Angeles, CA
| | - Kourtney Houser
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC
| | | | - Nicola Lau
- Corneal Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Anthony J Aldave
- Stein Eye Institute, University of California Los Angeles, Los Angeles, CA
| |
Collapse
|
44
|
Bathula S, Bhate M, Joseph J, Tyagi M, Bagga B. Pediatric Pasteurella canis endophthalmitis. J AAPOS 2023; 27:172-174. [PMID: 37196917 DOI: 10.1016/j.jaapos.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/11/2023] [Accepted: 03/19/2023] [Indexed: 05/19/2023]
Abstract
We report an atypical presentation of endophthalmitis in a 2-month-old infant due to a rare infection by Pasteurella canis, small Gram-negative coccobacilli that inhabit the oral cavity and the gastrointestinal tracts of animals, including domesticated cats and dogs. Ocular infections are mainly associated with animal bites and scratches.
Collapse
Affiliation(s)
- Shruthi Bathula
- Pediatric Ophthalmology, Strabismsus and Neuro-ophthalmology, LV Prasad Eye Institute, Hyderabad, India
| | - Manjushree Bhate
- Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Jasti V Ramanamma Children's Eye Care Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Microbiology, LV Prasad Eye Institute, Jhaveri Microbiology Centre & Saroja A Rao Immunology Laboratory, Hyderabad, India
| | - Mudit Tyagi
- Vitreo-Retina, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Bhupesh Bagga
- The Ramoji Foundation Centre for Ocular Infections Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, India.
| |
Collapse
|
45
|
Chen X, Pan X, Zhu J, Liu T. Endophthalmitis Secondary to Fish Tank Granuloma. JAMA Ophthalmol 2023; 141:605-607. [PMID: 37079323 DOI: 10.1001/jamaophthalmol.2023.0955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
This case report describes an uncommon case of endophthalmitis secondary to fish tank granuloma.
Collapse
Affiliation(s)
- Xiaofei Chen
- Senior Department of Ophthalmology, Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaoying Pan
- Senior Department of Ophthalmology, Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jian Zhu
- Department of Rheumatism and Immunology Department, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Tiecheng Liu
- Senior Department of Ophthalmology, Third Medical Center of Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
46
|
Almulhim A, Alkhalifah MI, Kalantan H, Alsarhani WK. Bacterial Keratitis: Clinical Features, Causative Organisms, and Outcome During a 13-year Study Period. Cornea 2023; 42:702-707. [PMID: 36730384 DOI: 10.1097/ico.0000000000003179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 09/05/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to review clinical features, causative organisms, complications, and outcome of bacterial keratitis cases at a tertiary eye hospital. METHODS A retrospective study was conducted on clinically diagnosed bacterial keratitis cases from 2007 to 2019. Poor outcome was flagged if any of the following was identified: final visual acuity (VA) worse than 20/200, decrease in VA (1 line or worse compared with presenting VA), corneal perforation, endophthalmitis, failed graft, or cases requiring enucleation or evisceration. RESULTS The study included 263 cases of bacterial keratitis with 169 cases (64.3%) of culture-positive bacterial keratitis. Gram-positive bacteria were found to be the causative organism in 106 cases (62.8%). The most common types were coagulase-negative staphylococci (23.1%) and Pseudomonas (23.1%). Culture-positive bacterial keratitis was associated with the development of anterior chamber reaction (≥1+) on multivariate analysis [adjusted odds ratio (OR): 3.03, confidence interval (CI): 1.23-7.45, P = 0.016]. The complications that occurred in the current cohort included visually significant scar (64.7%), perforation (10.8%), cataract (8.8%), nonhealing epithelial defects (8.0%), corneal neovascularization (4.9%), endophthalmitis (4.6%), and hypotony (1.5%). On multivariate analysis, diabetes mellitus (adjusted OR: 3.51, CI: 1.59-7.76, P = 0.002), poor presenting best-corrected VA (adjusted OR: 3.95, CI 1.96-7.96, P < 0.001), and positive cultures (adjusted OR: 2.36, CI: 1.11-5.00, P = 0.025) were associated with poor outcome. CONCLUSIONS Culture-negative keratitis had less severe infection and better outcomes when compared to culture-positive bacterial keratitis. Factors associated with poor outcome included diabetes, poor presenting VA, and positive cultures.
Collapse
Affiliation(s)
- Abdulmohsen Almulhim
- Department of Ophthalmology, College of Medicine, Jouf University, Sakakah, Al-Jouf, Saudi Arabia
| | - Muhannad I Alkhalifah
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hatem Kalantan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Waleed K Alsarhani
- Department of Ophthalmology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; and
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
47
|
Zhang Y, Fang L, Zhou Y, Zhang Y, Liang B, Yan C, Li L. A case report of long-delayed diagnosis of pseudorabies virus encephalitis with endophthalmitis: lessons from metagenomic next generation sequencing. BMC Neurol 2023; 23:192. [PMID: 37194001 PMCID: PMC10186779 DOI: 10.1186/s12883-023-03227-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/26/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Pseudorabies virus (PRV) was thought to only infect animals. Recent studies have shown that it can also infect human. CASE PRESENTATION We report a case of pseudorabies virus encephalitis and endophthalmitis, diagnosed 89 days after onset, confirmed with intraocular fluid metagenomic next generation sequencing (mNGS) after the result of two cerebrospinal fluid (CSF) mNGS tests were negative. Although treatment with intravenous acyclovir, foscarnet sodium, and methylprednisolone improved the symptoms of encephalitis, significant diagnostic delay resulted in permanent visual loss. CONCLUSIONS This case suggests that pseudorabies virus (PRV) DNA in the intraocular fluid may have a higher positivity than that in the CSF. PRV may persist in the intraocular fluid for an extended period and may thus require extended antiviral therapy. Patients with severe encephalitis and PRV should be examined with the focus on pupil reactivity and light reflex. A fundus examination should be performed in patients with a central nervous system infection, specifically, those in a comatose state, to help reduce eye disability.
Collapse
Affiliation(s)
- Yi Zhang
- Department of Neurology, Qilu Hospital(Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035, Shandong, China
- Department of Neurology, Rizhao Central Hospital, 66 Wanghai Road, Rizhao, 276800, Shandong, China
| | - Lei Fang
- Department of Neurology, Qingdao Central Hospital, No.127, Siliu South Road, Qingdao, Shandong, China
| | - Yi Zhou
- Department of Neurology, Qilu Hospital(Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035, Shandong, China
- Department of Ultrasonic, Rizhao Hospital of Traditional Chinese Medicine, 35 Wanghai Road, Rizhao, 276800, Shandong, China
| | - Yongqing Zhang
- Department of Neurology, Qilu Hospital(Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035, Shandong, China
| | - Bing Liang
- Department of Neurology, Qilu Hospital(Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035, Shandong, China
| | - Chuanzhu Yan
- Department of Neurology, Qilu Hospital(Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035, Shandong, China
| | - Ling Li
- Department of Neurology, Qilu Hospital(Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035, Shandong, China.
| |
Collapse
|
48
|
Arshinoff SA, Shi RB. Relative efficacy of intracameral moxifloxacin injection methods. J Cataract Refract Surg 2023; 49:538-542. [PMID: 36745844 DOI: 10.1097/j.jcrs.0000000000001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE To determine the amount of moxifloxacin remaining in the anterior chamber (AC), immediately after its injection using 3 current injection methods, assuming mixing and fluid exchange with the AC contents during injection of the drug, and to determine the most desirable injection method. SETTING Department of Ophthalmology and Vision Sciences and Institute of Biomedical Engineering, University of Toronto, Toronto, Canada. DESIGN Mathematical modeling. METHODS Mathematical modeling using first-order mixing methods were used to assess mixing. RESULTS The Kaiser method of injecting 0.5 mL × 100 μg/0.1 mL does not achieve the desired 500 μg level of moxifloxacin in the AC. The "straight from the bottle" method of injecting 0.1 mL × 500 μg/0.1 mL is fraught with potential error, yielding a relatively unreliable final amount in the AC. Injecting 0.5 to 0.6 mL × 150 μg/0.1 mL yields a result closest to the desired goal. CONCLUSIONS Based on the calculation, the most accurate of current methods to deliver 500 μg moxifloxacin intracamerally is the method of 150 μg/0.1 mL × 0.5 to 0.6 mL.
Collapse
Affiliation(s)
- Steve A Arshinoff
- From the York Finch Eye Associates, Toronto, Ontario, Canada (Arshinoff); Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (Arshinoff); Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada (Shi); Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Shi)
| | | |
Collapse
|
49
|
Wang H, Chang Y, Zhang Y, Yang R, Shi H, Zhang M. Bilateral endogenous fungal endophthalmitis: A case report. Medicine (Baltimore) 2023; 102:e33585. [PMID: 37083776 PMCID: PMC10118318 DOI: 10.1097/md.0000000000033585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023] Open
Abstract
RATIONALE Endogenous fungal endophthalmitis is a challenging condition. There are no universally accepted diagnostic or management protocols. We share a case of endogenous fungal endophthalmitis who was successfully treated, focusing on the diagnostic and treatment procedures. PATIENT CONCERNS A 31-year-old female with a history of fungal vaginitis and tinea corporis presented with progressive visual decrease in both eyes after having an induced abortion. Her best corrected visual acuity at presentation was 20/1000 in her right eye and 20/250 in her left eye. Upon slit lamp examination, mild inflammatory reaction in the anterior chamber was found. Dilated fundus examination revealed a hazy view of the optic disc and posterior retina, and there was a whitish mass with "string and pearls" just in front of the macular region in each eye. DIAGNOSES Bilateral fungal endogenous endophthalmitis was diagnosed empirically, which was confirmed later by deoxyribonucleic acid sequencing and culture of intraocular fluid. INTERVENTIONS Oral itraconazole and intravitreal voriconazole were administered to the patient at first. The intraocular inflammation was partially responsive to the medication, yet the visual acuity persisted to deteriorate and the vitreous whitish masses became more prominent. Then vitrectomy procedures were carried out and oral itraconazle was switched to intravenous fluconazole. The antifungal treatment lasted for 8 weeks. OUTCOMES The intraocular inflammation alleviated and visual acuity improved after vitrectomy. At the 9-month follow-up visit, the patient's best corrected visual acuity was 20/40 in the right eye and 20/30 in the left eye. There was no intraocular inflammatary reaction, and retinal scar was noticed in each eye. LESSON Early and correct diagnosis, coupled with prompt and aggressive treatment, is crucial for cases of fungal endogenous endophthalmitis. Deoxyribonucleic acid sequencing techniques can contribute to early diagnosis, while vitrectomy may be necessary when antifungal medication is insufficient in controlling the condition.
Collapse
Affiliation(s)
- Hao Wang
- Department of TCM Ophthalmology, Hebei Eye Hospital, Hebei province, China
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei province, China
- Hebei Provincial Clinical Research Center for Eye Diseases, Hebei province, China
| | - Yongye Chang
- Department of TCM Ophthalmology, Hebei Eye Hospital, Hebei province, China
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei province, China
- Hebei Provincial Clinical Research Center for Eye Diseases, Hebei province, China
| | - Yifan Zhang
- School of Life Sciences and Food Engineering, Hebei University of Engineering, Hebei province, China
| | - Rong Yang
- Department of TCM Ophthalmology, Hebei Eye Hospital, Hebei province, China
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei province, China
- Hebei Provincial Clinical Research Center for Eye Diseases, Hebei province, China
| | - Huijun Shi
- Department of TCM Ophthalmology, Hebei Eye Hospital, Hebei province, China
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei province, China
- Hebei Provincial Clinical Research Center for Eye Diseases, Hebei province, China
| | - Minglian Zhang
- Department of TCM Ophthalmology, Hebei Eye Hospital, Hebei province, China
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei province, China
- Hebei Provincial Clinical Research Center for Eye Diseases, Hebei province, China
| |
Collapse
|
50
|
Gautam M, Gupta R, Singh P, Verma V, Verma S, Mittal P, Karkhur S, Sampath A, Mohan RR, Sharma B. Intracameral Drug Delivery: A Review of Agents, Indications, and Outcomes. J Ocul Pharmacol Ther 2023; 39:102-116. [PMID: 36757304 DOI: 10.1089/jop.2022.0144] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
An intracameral (IC) injection directly delivers the drug into the anterior chamber of the eye. This targeted drug delivery technique overcomes the ocular barriers and offers a high therapeutic concentration of medication at the desired site and consequently better clinical outcomes. IC drug delivery is a safe and effective modality with many advantages over topical delivery. These include excellent bioavailability, reduced systemic risk, and minimal ocular toxicity. Agents delivered via IC injection have shown promising results against infection, inflammation, ocular hypertension, and neovascularization. Current literature shows that IC antibiotics, including cefuroxime, vancomycin, and moxifloxacin, are routinely used for prophylaxis of endophthalmitis. Other drugs available for IC use are steroids, anesthetics, mydriatics, miotics, antivascular endothelial growth factor, antiglaucoma, and alkylating agents. Introduction of sustained-release devices containing dexamethasone or Bimatoprost in anterior chamber via IC route has the potential in treating ocular inflammation and raised intraocular pressure. The complications such as hemorrhagic occlusive retinal vasculitis and toxic anterior segment syndrome have been documented with IC prophylaxis but are rare. In this review, we provide an overview of available IC drugs, their pharmacokinetics, the spectrum of activity, dosage and preparation, prophylactic and therapeutic usage, clinical efficacy, and safety profiles.
Collapse
Affiliation(s)
- Megha Gautam
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Rituka Gupta
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Priti Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Vidhya Verma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Sunil Verma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Parul Mittal
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Samendra Karkhur
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Ananyan Sampath
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Rajiv R Mohan
- Department of Ophthalmology and Molecular Medicine, University of Missouri, Columbia, Missouri, USA
| | - Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| |
Collapse
|