Case Of Acute Endophthalmitis Research Articles

Incidence and outcomes of endophthalmitis with in-house compounded intravitreal bevacizumab injections: A multicentric study

ABSTRACT Purpose To evaluate the incidence rate and outcomes of endophthalmitis after intravitreal injection of in-house compounded bevacizumab. Methods In this multicentric study performed from 2014 to 2018, patients who were injected with in-house compounded and sterilized bevacizumab were observed for endophthalmitis. In-house compounded syringes were prepared in compounding pharmacy using sterile standard operating guidelines. All cases of acute endophthalmitis following intravitreal injection were recorded and followed up for final anatomical and visual outcome after management. Results A total of 50,361 bevacizumab injections were administered. Incidence of post-injection endophthalmitis was 0.0377%. Incidence of culture-positive endophthalmitis was 0.0178%, with 55.5% culture positivity for Staphylococcus species. A significant improvement in the final visual outcome was noted (p<0.05), and overall five patients (26.3%) achieved visual acuity of 6/18 or more. Conclusions In-house compounded injections of bevacizumab can reduce post-injection endophthalmitis to a minimum, with maintenance of proper asepsis and strict protocols by the compounding pharmacy.

Acute Endophthalmitis after Cataract Surgery: Clinical Characteristics and the Role of Intracameral Antibiotic Prophylaxis

To evaluate the clinical characteristics and investigate the role of surgical antibiotic prophylaxis (SAP) in acute endophthalmitis cases after cataract surgery. Retrospective, consecutive case series. A total of 126 patients referred to a tertiary center from 2007 to 2015 for acute endophthalmitis after unilateral cataract surgery. All patients who underwent a vitreous biopsy were included. Clinical and microbiology data were reviewed, and associations with visual outcome were analyzed using multivariate logistic regression. Data regarding SAP via intracameral injection were also retrieved. Bacterial culture results and visual acuity outcome. Bacterial growth was observed in 92 of 126 cases (73%). Among these positive cultures, 49 (53.3%), 29 (31.5%), and 13 (14.1%) were coagulase-negative staphylococci, other gram-positive, and gram-negative bacteria, respectively. Among the 77 gram-positive strains tested, 76 (98.7%) were vancomycin-sensitive; among the 12 gram-negative strains tested, all 12 (100%) were ceftazidime-sensitive. Best achieved visual acuity outcome was ≥20/40 Snellen in 77 of 114 cases (67.5%). On multivariate analysis, we found an association between visual outcome of worse than 20/40 Snellen and a positive culture of more virulent bacteria (gram-negative and other gram-positive groups) and presentation with light perception or worse, with an odds ratio of 3.3 and 3.0, respectively. A subgroup of 25 cases (19.8%) developed endophthalmitis despite receiving a SAP by cefuroxime at the end of cataract surgery. Two-thirds of the patients in this endophthalmitis cohort experienced a visual outcome of ≥20/40 Snellen. Efficacy of primary treatment with vancomycin combined with ceftazidime is supported by this study. A subgroup treated prophylactically with cefuroxime demonstrated that SAP alone does not prevent endophthalmitis. This highlights the importance of surgical factors in the prevention of postoperative endophthalmitis.

Experimental and clinical studies of transconjunctival vitrectomy 20G, 23G and 25G

Abstract Purpose Microincision transconjunctival vitrectomy has gained popularity in the recent years. This surgical innovation needs to be evaluated in prospective and controlled studies. Methods A prospective study concerning 23‐Gauge vitrectomy (with cryoapplication and gas tamponade) in 20 patients with retinal detachment and 4 patients with acute endophthalmitis was performed and litterature data (Pubmed database research) was analyzed. Results Performance of microincision transconjunctival vitrectomy may be maximized with use of high duty cycle, largest internal diameter (23G), a sharp guillotine and a high cut rate. Sclerotomy construction is a key point of this technique. In retinal detachment surgery on a selected population, the rate of anatomic reattachment and visual recovery were similar between 23G PPV and 20G PPV. In one patient 23G PPV was complicated by a choroidal detachment secondary to a displacement of the infusion cannula. The redetachment in one 23G case was secondary to a sclerotomy related retinal tear. Microincision transconjunctival vitrectomy for acute endophthalmitis is feasible but has limited capacities as compared with 20G technique. Conclusion The main advantage of sutureless vitrectomy remains the confort of patient after complicated surgeries, but this point should be analyzed with quality of life. This trend toward smaller incisions will lead to improvement of instrumentations, better understanding of the surgical techniques (wound construction, performance of vitreous cutters). 23G PPV is suitable for patients with retinal detachment treated with PPV‐cryo‐gas technique. Sutureless vitrectomy is usefull only in selected cases of acute endophthalmitis .

Acute endophthalmitis following intravitreal bevacizumab (Avastin) injection

To report two cases of acute endophthalmitis following intravitreal bevacizumab injection. Two patients with exudative age-related macular degeneration were treated sequentially with an intravitreal injection of bevacizumab and developed signs of severe but painless infectious endophthalmitis 2 days later. Vitreous samples were obtained, followed by the injection of vancomycin 1 mg/0.1 ml and ceftazidime 2.25 mg/0.1 ml. Pulsed-field gel electrophoresis (PFGE) was used to determine whether the isolated microorganisms were the same. Coagulase-negative staphylococci were identified and isolated from the vitreous specimen of both patients. PFGE revealed different patterns of banding, excluding that interpatient contamination occured. Infectious endophthalmitis is a potential complication of intravitreal bevacizumab injection.

Endogenous endophthalmitis as the leading sign of endocarditis

Endogenous bacterial endophthalmitis is an uncommon intraocular infection caused by hematogeneous spread of bacteria from else-where in the body. The ocular infection usually is manifested in patients with already diagnosed systemic disease. We report 2 cases of acute endophthalmitis caused by undiagnosed infectious endocarditis. Multiple preretinal white dots, resembling bacterial colonies, were seen in 1 eye. Severe infectious endophthalmitis without ocular trauma or surgery may be the first sign of a life-threatening systemic infection.

An Epidemiologic and Pathologic Study of Globes Enucleated Following Trauma

This retrospective study examined demographic, clinical, and histopathologic factors in 24 traumatically ruptured globes that were enucleated at Wills Eye Hospital during a 2-year period. The majority of these injuries occurred in a violent assault setting with a blunt mechanism, during the evening and early morning hours, and in the fall and winter months. Most patients were black males, and 67% were substance abusers. Clinically, the initial visual acuity in 96% of the eyes was light perception or worse. Five of the eyes were enucleated primarily. Gross examination of the globes revealed that 92% of the wounds involved the sclera, 83% of the eyes had hyphema, and 71% of the lacerations were longer than 10 mm. Histopathologic examination demonstrated that the majority of eyes had fragmented or missing lenses, disrupted ciliary bodies, and detached choroids. Ninety-six percent of the retinas were detached. There was one case of acute endophthalmitis.