Acute Bacterial Endophthalmitis Research Articles

Bacterial endophthalmitis following anti-VEGF intravitreal injections: a retrospective case series

BackgroundTo describe the incidence of endophthalmitis and the treatment outcomes of acute bacterial endophthalmitis following intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in a Brazilian hospital. The analysis was based on the timing of infection after intravitreal injection, culture results, visual acuity, and the presence of epiretinal membrane after a 1-year follow-up period, spanning nine years.MethodsThis retrospective case series, conducted over a 9-year period, aimed to evaluate the treatment outcomes of acute endophthalmitis following intravitreal Bevacizumab injections. The inclusion criteria involved a chart review of 25 patients who presented clinical signs of acute endophthalmitis out of a total of 12,441 injections administered between January 2011 and December 2019. Negative culture results of vitreous samples or incomplete data were excluded. Ultimately, 23 patients were enrolled in the study. Eight patients were treated with intravitreal antibiotic injections (IVAI) using vancomycin 1.0 mg/0.05mL and ceftazidime 2.25 mg/0.05mL, while 15 patients underwent pars plana vitrectomy (PPV) followed by intravitreal antibiotic injections at the end of surgery (IVAIES). The main outcome measures were the efficacy of controlling the infection with IVAI as a standalone therapy compared to early PPV followed by IVAIES. Data collected included pre-infection and one-year post-treatment best corrected visual acuity (BCVA), optical coherence tomography (OCT) abnormalities, and enucleation/evisceration rates. To compare groups, Mann-Whitney and ANOVA tests were employed for statistical analysis.ResultsThe incidence rate of bacterial endophthalmitis was 0.185% (1/541 anti-VEGF injections), with the highest infection rates observed in 2014 and 2017. Patients presented clinical symptoms between 2 and 7 days after injection. The most common isolated organisms were coagulase-negative Staphylococci and Streptococci spp. Treatment outcomes showed that both IVAI and PPV + IVAIES effectively controlled the infection and prevented globe atrophy. After one year, the PPV group with BCVA better than Light Perception had a significantly better BCVA compared to the IVAI group (p 0.003). However, PPV group had higher incidence of epiretinal membranes formation compared to the IVAI group. (P 0.035)ConclusionAnti-VEGF injections carry a risk of developing acute bacterial endophthalmitis. Isolated antibiotic therapy could be an effective treatment to control the infection, but performing PPV + IVAIES as a primary treatment showed promising results in terms of improving BCVA after one year, despite a higher rate of epiretinal membrane formation. Further studies are needed to confirm these findings.

Интравитреальное введение моксифлоксацина в комбинации с ванкомицином при субтотальной витрэктомии при послеоперационном эндофтальмите

Acute bacterial postoperative endophthalmitis is inflammation of the internal eye eyeball tunic with the formation of exudate in the vitreous chamber and / or anterior chamber which can quickly lead to an irreversible loss of visual functions, and sometimes loss of the eye as an organ developing most often after surgical treatment of cataracts. The generally accepted standard of the acute bacterial postoperative endophthalmitis treatment (the «gold standard») includes vitrectomy, sampling of contents of the vitreous chamber and anterior chamber for microbial analysis, and determination of its sensitivity to antibiotics. Intravitreal injection of Vancomycin at a dose of 1 mg/0.1 ml and Ceftazidim at a dose of 2.25 mg / 0.1 ml at the final stage of the intervention. To date, the choice of antibacterial substances for intravitreal injections remains open. One of the drugs that meet the requirements is Moxifloxacin; antibacterial drug of fluoroquinolone group with bactericidal effect. It is active against a wide range of Gram-positive bacteria and Gramnegative bacteria, anaerobic, acid-resistant and atypical bacteria. Keywords: acute bacterial postoperative endophthalmitis, intravitreal administration of antibacterial drugs, safety of moxifloxacin and vancomycin, endophthalmitis treatment standards

Tap and inject of intravitreal antibiotics versus pars plana vitrectomy for post-cataract surgery endophthalmitis: a meta-analysis

ContexteOn ignore toujours si l'efficacité et l'innocuité du T/I (tap and inject, soit le prélèvement et l'injection intravitréenne) initial sont supérieures à celles de la vitrectomie par la pars plana (VPP) initiale devant une endophtalmie bactérienne aiguë apparue après une chirurgie de la cataracte. Or, bien cerner l'efficacité et l'innocuité comparatives du T/I initial et de la VPP initiale peut aider à la prise de décision thérapeutique dans ces circonstances. MéthodesOn a procédé à un examen systématique de la littérature publiée entre janvier 1990 et janvier 2021 dans 3 bases de données (Ovid MEDLINE, EMBASE et Cochrane Library). Ont été incluses les études comparatives qui présentaient les résultats de la meilleure acuité visuelle corrigée (MAVC) finale après un T/I initial ou une VPP initiale en présence d'endophtalmie infectieuse survenue après une chirurgie de la cataracte. L'outil ROBINS-I (Risk Of Bias In Non-randomised Studies of Interventions) de Cochrane a permis d’évaluer le risque de biais, tandis que le système GRADE (Grading of Recommendations Assessment, Development and Evaluation) a servi à évaluer le niveau de preuve des données probantes. La méta-analyse a été réalisée à l'aide d'un modèle à effets aléatoires. RésultatsAinsi, 7 études non randomisées portant sur 188 yeux au départ ont été incluses dans cette méta-analyse. Le T/I initial a donné une MAVC significativement supérieure lors de la dernière visite de l’étude, comparativement à la VPP initiale (différence moyenne pondérée = –0,61 logMAR; intervalle de confiance [IC] à 95 % : –1,19 à –0,03; p = 0,04; I2 = 89 %; n = 7 études; niveau de preuve GRADE = très faible). L'incidence d’énucléation était semblable, que les patients aient subi un T/I initial ou une VPP initiale (risque relatif [RR] = 0,73; IC à 95 % : 0,09–6,25; p = 0,78; I2 = 4 %; n = 2 études; niveau de preuve GRADE = très faible). Le risque de décollement de la rétine était semblable avec les 2 formes de traitement (RR = 0,29; IC à 95 % : 0,01–5,94; p = 0,42; I2 = 52 %; n = 2 études; niveau de preuve GRADE = très faible). ConclusionsLa qualité des données probantes dans le présent contexte est limitée. Le recours au T/I initial a donné une MAVC significativement supérieure lors de la dernière visite de l’étude, comparativement à la VPP initiale. Les profils d'innocuité du T/I et de la VPP étaient semblables.

Bacterial and sterile endophthalmitis after intravitreal injections, treatment options and outputs: literature review

Ieva Kunickaitė1 1Vilnius University, Faculty of Medicine, Vilnius, Lietuva Abstract Introduction. In the last 2 decades, vitreous injections have become increasingly used in treatment of intraocular diseases, especially posterior segment disorders. It is estimated that 5.9 million of these injections were performed in the United States alone in 2016, and that number is growing at least 10% annually. Acute bacterial or sterile endophthalmitis can occure after intravitreal injections. Aim. Based on the latest scientific literature, summarize and present information on the occurrence of bacterial and sterile endophthalmitis after vitreous injections, treatment options and outcomes. Methods. The literature review was performed using PubMed and ScienceDirect databases. Scientific articles were analyzed by keywords and their combinations: bacterial endophthalmitis, sterile endophthalmitis, intravitreal injections. Exclution criteria were applied to articles related to fungal endophthalmitis. 23 publications were examined. Only articles written in English were selected. Results. ​​The incidence of endophthalmitis of vascular endothelial growth factor inhibitors (anti-VEGF) is 0,131%. The incidence of sterile endophthalmitis after intravitreal injections is uncommon, ranging from 0.09% to 1.1%. The primary treatment for endophthalmitis is vitreous injection of antibiotics and / or pars plana vitrectomy (PPV). Conclusions. The main clinical differences between bacterial and sterile endophthalmitis are the onset of endophthalmitis (bacterial usually occurs more than 3 days after intervention and sterile within the first 3 days) and the absence of eye pain in sterile endophthalmitis. It has been reported in the literature that sterile endophthalmitis usually resolves spontaneously, but antimicrobial therapy with PPV is used as the disease progresses. Keywords. Bacterial endophthalmitis, sterile endophthalmitis, intravitreal injections.

Visual outcomes of acute bacterial endophthalmitis treated with adjuvant intravitreal dexamethasone: A meta-analysis and systematic review.

Adjunctive treatment of bacterial endophthalmitis with intravitreal steroids is a topic of controversy among many ophthalmologists. The objective of this study is to evaluate the effects of intravitreal dexamethasone on the visual outcomes of patients with acute bacterial endophthalmitis through a systematic review and meta-analysis. A literature search of PubMed, Scopus, and Cochrane Library databases was performed to include studies on the visual outcomes of adjuvant intravitreal dexamethasone in patients with acute bacterial endophthalmitis. The review is based on the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) protocol. A total of 1545 articles met our search criteria and after further review, two randomized controlled trials and three retrospective case series were included in the final analysis. A total of 126 eyes were treated with intravitreal dexamethasone combined with antibiotics, and another 139 eyes were treated with antibiotics alone. All cases of endophthalmitis were post-operative or post-intravitreal injection, with pooled results demonstrating no visual benefit with supplementation of intravitreal dexamethasone. Our meta-analysis does not show any visual benefit from steroid supplementation and yet, considering a relatively small number of patients included in each study, larger randomized controlled trials are required to further clarify the role of steroids in the treatment of acute bacterial endophthalmitis.

Интравитреальное введение Вигамокса (Моксифлоксацин без консервантов) в комбинации с ванкомицином при лечении послеоперационного эндофтальмита

Acute bacterial postoperative endophthalmitis is inflammation of the internal eye eyeball tunic with the formation of exudate in the vitreous chamber and / or anterior chamber which can quickly lead to an irreversible loss of visual functions, and sometimes loss of the eye as an organ developing most often after surgical treatment of cataracts. The generally accepted standard of the acute bacterial postoperative endophthalmitis treatment (the “gold standard”) includes vitrectomy, sampling of contents of the vitreous chamber and anterior chamber for microbial analysis, and determination of its sensitivity to antibiotics. Intravitreal injection of Vancomycin at a dose of 1 mg/0.1 ml and Ceftazidim at a dose of 2.25 mg / 0.1 ml at the final stage of the intervention. To date, the choice of antibacterial substances for intravitreal injections remains open. One of the drugs that meet the requirements is Moxifloxacin; antibacterial drug of fluoroquinolone group with bactericidal effect. It is active against a wide range of Gram-positive bacteria and Gram-negative bacteria, anaerobic, acid-resistant and atypical bacteria. Keywords: bacterial postoperative endophthalmitis, intravitreal injection, Moxifloxacin.

Evaluation of intraocular penetration of levofloxacin by high performance liquid chromatography

AIM: To evaluate the levofloxacin eye drop into human eye penetration, levofloxacin eye drop concentrations in human ocular aqueous of 33 patients undergoing cataract surgery were measured by high performance liquid chromatography (HPLC). METHODS: Totally 33 volunteer patients who scheduled for phacoemulsification surgery received one drop of levofloxacin every 6h for 3d before and on the day of surgery, administration of drug was stopped 1h before surgery. Levofloxacin concentration in aqueous humor was measured by HPLC method with fluorescence detector. RESULTS: A simple, effective and sensitive HPLC method for determination of levofloxacin in human ocular aqueous was validated. Linearity was shown for levofloxacin concentration over a wide range of 1.95×10-3-1.50 µg/mL. The mean aqueous level of levofloxacin was 0.3399±0.03405 µg/mL. CONCLUSION: Results from the present study demonstrate that topical administration of levofloxacin 0.5% before cataract surgery with routine dose (one drop every 6h) unable to reach MIC90 for most common microorganism causing acute bacterial endophthalmitis.

Endophthalmitis Caused by Curtobacterium pusillum Following Open Globe Injury

Purpose: To report the first case of <i>Curtobacterium</i> endophthalmitis within 6 hours after open globe injury, with extensive phlebitis and secondary subretinal neovascularization. Case summary: A 53-year-old man with hypersensitivity to beta-lactam antibiotics was admitted due to visual disturbance in the left eye experienced while working in a rural area. Fundus examination was impossible due to a full-layer corneal laceration and traumatic cataract in the left eye. B-scan ultrasonography and orbital computed tomography showed no shadowing of retained intraocular foreign bodies. After a corneal scraping smear, primary closure, lensectomy, and vitrectomy were performed. Organic material was observed in a focal area of pale macula, accompanied by extensive retinal phlebitis in the mid-periphery. After diagnosing acute bacterial endophthalmitis, intravitreal vancomycin and dexamethasone were injected. <i>Curtobacterium pusillum</i> was cultured on an automated microbial identification system. Intravenous vancomycin and oral clarithromycin were administered for 2 weeks. After 3 months, endophthalmitis had not recurred, and the visual acuity reached 20/100. However, subretinal neovascularization was newly detected under the damaged macula. No complications of neovascularization were observed until 6 months after primary closure. Conclusions: <i>Curtobacterium pusillum</i> can induce acute endophthalmitis through direct penetration in cases of ocular trauma, and may be accompanied by extensive phlebitis and secondary subretinal neovascularization. In cases of open globe injury sustained in rural areas, acute endophthalmitis caused by a rare Gram-positive bacillus, such as <i>Curtobacterium</i> species, should be considered.

Management and Visual Outcomes of Acute Bacterial Endophthalmitis Following Intravitreal Injection of Contaminated Bevacizumab in a Single Day

Bevacizumab requires compounding for off-label intravitreal injection, thus creating a risk of possible contamination during preparation. This retrospective, consecutive case series from a single site included patients who developed culture-proven acute endophthalmitis after intravitreal injection with contaminated bevacizumab. All patients suspected of endophthalmitis had vitreous biopsy and microbial cultures prior to initiation of treatment and were managed with immediate tap and injection of antibiotics followed early by pars plana vitrectomy. Main outcome measures included best-corrected visual acuity (BCVA) at 3-month follow-up after treatment. Twenty-four patients developed acute bacterial endophthalmitis following intravitreal injection of contaminated bevacizumab single-dose syringes in a single day. Twenty-three cases (95.8%) grew Streptococcus species and one (4.2%) grew Enterococcus species. Six cases (25.0%) had optic nerve atrophy, three (12.5%) developed retinal detachment, one (4.2%) had vitreous hemorrhage, and one (4.2%) had band keratopathy. At 3-month follow-up, compared to BCVA at the time of initial presentation, 11 patients (45.8%) had improved vision, eight (33.3%) had unchanged BCVA, and five (20.8%) had worse BCVA. However, when compared to BCVA prior to endophthalmitis (baseline), 22 cases (91.7%) had significantly worse BCVA at 3-month follow-up. Contamination of off-label bevacizumab poses devastating risk of endophthalmitis following intravitreal injection. Vigilance is needed to ensure all possible safeguards are in place to prevent contamination. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:346-352.].

Study of the Effectiveness of Precision Doses of Antibiotics in the Treatment of Induced Acute Bacterial Postoperative Endophthalmitis in an Experiment

Objective: to conduct a clinical and histomorphological study of the efficacy and safety of individually calculated doses of antibiotic in an experimental model of acute endophthalmitis in laboratory animals. Materials and methods. The study group included 15 adult laboratory white rabbits of the Chinchilla breed, male, aged from 2 to 3 months (2.6 ± 0.44 months). Determination of the anatomical parameters of the eyeball was performed on an ultrasound biometer — Compact Touch Quantel Medical (France). The obtained data were exported to the original program of an electronic computing machine of its own design, for automatic calculation of the dose of antibacterial drug for intravitreal injection. In the course of the experiment, the native lens was removed from animals with intraoperative administration of a culture of epidermal staphylococcus in a volume of 0.1 ml (10,000 colony forming units). After surgery, the animals were divided into 4 treatment groups: group 1 — without treatment, group 2 — standard dose of vancomycin for intravitreal administration (1 mg / 0.1 ml), group 3 — double dose (2 mg / 0.1 ml), group 4 — individual a dose of 0.25 mg / 0.1 ml (according to the calculation of the computer program). After a period of clinical observation, the enucleation of the eyeball was performed with a histomorphological study. Results . Group 1 — increase of the inflammation signs, deep irreversible structural damage to all intraocular structures according to histomorphology. Group 2 — regression of clinical manifestations by the first week of observation, the processes of alteration and initial regeneration of intraocular structures according to histomorphology. Group 3 — diffuse opacification of the cornea with the impossibility of further analysis, signs of toxic damage to intraocular structures according to histomorphology. Group 4 — complete regression of clinical symptoms, residual signs of aseptic inflammation according to histomorphology. Conclusions . Clinical and histomorphological studies of enucleated eyeballs in experimental animals demonstrate clinical efficacy and safety of vancomycin concentration in the vitreal cavity equal to or close to 128 μg/ml. Individual (personalized) calculation of the antibacterial drug dose eliminates the risk of toxic damage to the retina when the antibiotic concentration is excessive in the vitreal cavity. The toxic effects of excessive doses of antibiotics increase with increasing concentration of the active substance.

Early Pars Plana Vitrectomy for Treatment of Acute Infective Endophthalmitis.

To evaluate the efficacy and safety of early pars plana vitrectomy (PPV) for the treatment of acute infective endophthalmitis, and identify prognostic factors for better visual outcome. Retrospective cohort study. Consecutive patients who underwent early PPV within 72 hours of presentation for the treatment of acute infective bacterial endophthalmitis and presented to a large tertiary referral center in New South Wales, Australia, between January 2009 and December 2013 were included. Changes in best-corrected visual acuity (VA) from baseline to 1 year were examined. A total of 64 patients were included. The inciting events were cataract surgery (53%), intravitreal injection (36%), trabeculectomy (3%), and endogenous (3%). The mean VA improved from 3.1 logMAR (hand motion) at baseline to 1.02 (approximately 20/200) at 1 year, with 42% achieving final VA equal to or better than 0.477 logMAR (20/60) following early PPV. Positive prognostic factors were negative microbial cultures (P < 0.01) and etiology of post-cataract surgery (P < 0.01). In multivariable analyses adjusting for age and prognostic factors, patients with baseline VA of light perception and hand motion achieved greater visual gains than those with counting fingers, with gains of logMAR of -2.68, -2.09, and -0.85, respectively (P < 0.0001). Most patients who undergo early PPV experience substantial VA improvement. Negative microbial cultures and endophthalmitis after cataract surgery were associated with better final visual outcome. Patients with presenting VA of light perception or hand motion achieved higher visual gains than those with counting fingers, suggesting the possibility that early PPV may be beneficial in both groups.

Comparison of methods for identifying causative bacterial microorganisms in presumed acute endophthalmitis: conventional culture, blood culture, and PCR

BackgroundIdentification of bacterial pathogens in endophthalmitis is important to inform antibiotic selection and treatment decisions. Hemoculture bottles and polymerase chain reaction (PCR) analysis have been proposed to offer good detection sensitivity. This study compared the sensitivity and accuracy of a blood culture system, a PCR approach, and conventional culture methods for identification of causative bacteria in cases of acute endophthalmitis.MethodsTwenty-nine patients with a diagnosis of presumed acute bacterial endophthalmitis who underwent vitreous specimen collection at King Chulalongkorn Memorial Hospital were enrolled in this study. Forty-one specimens were collected. Each specimen was divided into three parts, and each part was analyzed using one of three microbial identification techniques: conventional plate culture, blood culture, and polymerase chain reaction and sequencing. The results of the three methods were then compared.ResultsBacteria were identified in 15 of the 41 specimens (36.5%). Five (12.2%) specimens were positive by conventional culture methods, 11 (26.8%) were positive by hemoculture, and 11 (26.8%) were positive by PCR. Cohen’s kappa analysis revealed p-values for conventional methods vs. hemoculture, conventional methods vs. PCR, and hemoculture vs. PCR of 0.057, 0.33, and 0.009, respectively. Higher detection rates of Enterococcus faecalis were observed for hemoculture and PCR than for conventional methods.ConclusionsBlood culture bottles and PCR detection may facilitate bacterial identification in cases of presumed acute endophthalmitis. These techniques should be used in addition to conventional plate culture methods because they provide a greater degree of sensitivity than conventional plate culture alone for the detection of specific microorganisms such as E. faecalis.Trial registrationThai Clinical Trial Register No. TCTR20110000024.

Modern Aspects of the Treatment of Acute Bacterial Postoperative Endophthalmitis

Acute bacterial postoperative endophthalmitis (AE) is a destructive intraocular infection with a tendency to an increase of morbidity and prevalence. This phenomenon is contributed by worldwide increase of surgical activity together with an increase of life expectancy. Nowadays AE prevalence in the best ophthalmic clinics of the world varies from 0.039% to 0.59%. Modern approaches to complex treatment of acute bacterial postoperative endophthalmitis are described in details in EVS 1995 and ESCRS 2013 investigations where the two main standards — “gold” and “silver” — are reflected. “Gold standard” includes 3-port vitrectomy with bacterial seeding of anterior chamber and vitreous cavity content and intravitreal antibiotics injection at the final step of operation within 1 hour after diagnosing acute endophthalmitis. Use of “silver standard” is acceptable in absence of vitreoretinal operation room and trained surgeon, that is, in case if full vitreoretinal surgery is impossible. In such cases surgical intervention is limited by taking vitreous cavity and anterior chamber content for bacterial seeding with intravitreal antibiotics injection at the final step of operation. Nowadays surgeons have the task not only to suppress infection and preserve the eye as an organ, but also to preserve maximal possible visual functions. The review deals with the questions of antibiotics choice with sufficient antibacterial spectrum and minimal toxicity. Questions of modern antibiotics pharmacokinetics and influencing factors such as molecular mass of the antibiotic, the extent of vitreous liquefaction, solubility coefficient of the antibiotic, the extent of eyeball inflammation, status of iris-lens diaphragm and vitreous cavity (phakic, aphakic, pseudophakic, avitreal eye, silicone tamponade), density of antibiotic solution are being discussed. Features and advantages of vitreal surgery are considered. Choice of vitreous body substitutes which are capable to improve anatomic results of treatment is analyzed. Thus, search for most effective treatment algorithm for acute bacterial endophthalmitis is still going on.

Acute bacterial endophthalmitis following intravitreal dexamethasone implant: A case report and review of literature

Endophthalmitis following intravitreal dexamethasone (DEX) implant has been rarely reported. This report describes the case of a 70-year-old male who underwent intravitreal DEX implant injection under aseptic conditions, for diabetic macular edema. He developed a clinical picture suggestive of endophthalmitis within 2weeks of the injection, and vitreous culture grew coagulase negative Staphylococcus. He was treated with intravitreal antibiotics followed by pars plana vitrectomy and removal of the implant. This was followed by resolution of the infection with a favorable final visual outcome. The challenges faced during surgical management of this case are discussed.

A Large Outbreak of Fulminant Bacterial Endophthalmitis after Intravitreal Injection of Counterfeit Bevacizumab.

This study reports the findings in a large series of patients with acute bacterial endophthalmitis after intravitreal injection of bevacizumab (IVB) in two eye hospitals. Medical records were reviewed for patients who presented with acute fulminant endophthalmitis in one or two eyes following intravitreal injection of bevacizumab from two separate batches in two eye hospitals. Twenty-eight eyes of 21 patients presented with acute endophthalmitis 12-48 hours after IVB injection. Cultures from the eyes and the vials were positive for E. coli and Citrobacter, each in one of the hospitals. All patients were initially treated with topical, intravitreal, and systemic antibiotics. Twenty-four eyes underwent pars plana vitrectomy. Best corrected visual acuity (BCVA) was 1.27 ± 0.89 logMAR before IVB injecti,on which decreased to 2.80 ± 0.45 LogMAR after presentation of endophthalmitis and 2.12 ± 0.97 logMAR three months after IVB injection. Final visual acuity was found to be no light perception in four eyes. This large outbreak of E.coli and Citrobacter endophthalmitis occurred after intravitreal injection of counterfeit bevacizumab. Visual outcomes were very poor.

Occurrence and risk factors for retinal detachment after pars plana vitrectomy in acute postcataract bacterial endophthalmitis

Background/aimsTo report the incidence, risk factors and prognosis of retinal detachment (RD) in patients who had vitrectomy for acute bacterial endophthalmitis after cataract surgery.Methods123 patients with acute postcataract endophthalmitis, consecutively...

Clinical and Pathologic Features ofBipolarisEndophthalmitis After Intravitreal Triamcinolone

This is a notice to ophthalmologists performing intravitreal injections of triamcinolone or other medications of the risk for endophthalmitis caused by Bipolaris hawaiiensis-contaminated medications. Histopathologic review of 5 eyes from a series of 17 treated with intravitreal triamcinolone for retinal vascular disease and diabetes mellitus over 1 year from 1 lot prepared by a compounding pharmacy. Endophthalmitis occurred in 14 of 17 eyes, the first presenting a mild vitritis 5 days following injection. The onset of signs and symptoms of endophthalmitis (eg, decreased vision, anterior chamber, or vitreous cells) in the 5 cases presented here varied from 5 to 174 days. Vitreous biopsy with cytospin and periodic acid–Schiff stain for hyphae was the most sensitive method for proving that fungus was present (positive in 3 of 5 of our cases). Five of 5 sample results from the whole series of 14 clinical cases were confirmed as positive for Bipolaris hawaiiensis by genotyping at the Centers for Disease Control and Prevention. Three of the removed eyes received fresh were culture negative; however, all 5 demonstrated organisms with fungal stains. Symptoms of fungal endophthalmitis can be minimal and delayed long beyond the 5 to 7 days expected for acute bacterial endophthalmitis. Also, apparently viable organisms persist in ocular tissues despite prolonged exposure to antifungal agents. This series reminds us that cytological or histological examination of tissue specimens may be necessary to exclude fungal infections that fail to grow in culture.

Baseline Factors Predictive of Visual Prognosis in Acute Postoperative Bacterial Endophthalmitis in Patients Undergoing Cataract Surgery

Although rare, postoperative endophthalmitis in patients undergoing cataract surgery can lead to anatomical or functional loss of the eye. Therapeutic strategies such as antibiotic prophylaxis and microbiological diagnosis are more effective with a target patient population. New prospective data are needed to identify prognostic factors. To identify baseline factors of visual prognosis in patients with acute bacterial endophthalmitis after cataract surgery. Prospective study of consecutive patients undergoing cataract surgery, enrolled from March 1, 2004, through December 31, 2005. We analyzed outcomes to determine the effect on the final visual outcome, defined as poor (visual acuity [VA] worse than 20/100) or good (VA 20/40 or better) using univariate and multivariate analysis. Four academic hospitals. Ninety-nine consecutive patients with cataract. Corneal phacoemulsification. Factors related to the cataract surgery (complications), initial clinical presentation, and microbiological diagnosis and the final VA. The significant baseline factors (at presentation) for good visual outcome (45% of the series) were the winter season, absence of complications during cataract surgery, initial VA, microbiological investigations revealing no microorganism or a coagulase-negative Staphylococcus species (CNSP), and fundus visibility. Quantitative factors associated with a good clinical prognosis were shorter duration of cataract surgery, younger age, and a hypopyon no greater than 1.5 mm. Significant factors associated with poor visual outcome were infection of the right eye, initial VA, corneal edema, a hypopyon larger than 1.5 mm, detection of bacterial species other than a CNSP, and the absence of fundus visibility. Multiple logistic regression analysis showed that high bacterial virulence was the only independent factor (odds ratio, 14.0 [95% CI, 2.7-71.0]; P = .001) for poor visual outcome. On the other hand, low bacterial virulence (odds ratio, 0.2 [95% CI, 0.03-0.6]; P = .01) and the absence of complications during cataract surgery (0.1 [0.01-0.4]; P = .003) were independent factors for good VA. Most clinical outcome factors in acute postoperative endophthalmitis can be identified at presentation. The bacterial virulence level is the main factor predictive of the final visual prognosis.

Acute bacterial endophthalmitis after intravitreal bevacizumab injection: Case report and literature review

A case report of a 52year old male who received intravitreal bevacizumab and developed culture positive endophthalmitis. Vitreous culture indicated that endophthalmitis was caused by Staphylococcus epidermidis. The patient was initially managed with intravitreal injection of ceftazidime and vancomycin, followed by pars plana lensectomy, pars plana vitrectomy with intravitreal injection of 1mg/0.1ml vancomycin, 2.25mg/0.1ml ceftazidime, 5mg/0.1ml fortified amphotericin-B and 4mg/0.1ml dexamethasone. Postoperatively the patient improved significantly. However, vision improved from hand motion to counting fingers secondary to severe retinal ischemia. Acute endophthalmitis can develop after intravitreal bevacizumab injections and cause profound visual loss. A review of literature was also performed for similar cases.

Adjunctive antibiotics in the treatment of acute bacterial endophthalmitis following cataract surgery

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