Case Of Acute Postoperative Endophthalmitis Research Articles

Acute fulminant post-operative endophthalmitis by Pasteurella caecimuris: A rare case report

The incidence of acute post-operative endophthalmitis (APOE) following cataract surgery in India is comparable to most of the developed world despite performing high-volume cataract surgery. Most infections are caused by bacteria, Streptococcus and Staphylococcus species being the predominant pathogens, which are similar to the findings of most published literatures. However, there is also a significant number of infections seen to be caused by Gram-negative bacteria and fungus. Amid Gram-negative microbes, Pseudomonas aeruginosa is the most common organism followed by Acinetobacter spp., Klebsiella spp., Escherichia coli, Enterobacter spp., and Alkaligenes spp. Another rare newly emerging ocular pathogen is Pasteurella species. Human infections by some species of Pasteurella involving soft tissue, skin, bone, joints, and wounds have been reported following animal exposure. However, there are no documented cases of ocular involvement in humans by Pasteurella caecimuris. We herein report the first case of APOE by this species. P. caecimuris induced endophthalmitis is very fulminant in nature and should be dealt with aggressive intervention.

The outcomes and usefulness of Intraoperative Optical Coherence Tomography in vitreoretinal surgery and its impact on surgical decision making.

Objective. To evaluate the utility of intraoperative OCT and its influence on the surgeon’s decision during vitreoretinal surgery.Methods. This was a pilot, prospective case series conducted at a tertiary care ophthalmology department in Lahore, Pakistan. Sixteen patients undergoing vitreoretinal surgeries were included using the Leica Enfocus microscope integrated intraoperative optical coherence tomography (IOCT). We also investigated the changes in surgical decision making based on the findings revealed by IOCT using a questionnaire. Results. 16 patients with a mean age of 40.6 ± 19.0 (range: 11-66) years, were included in the study; one case of acute postoperative endophthalmitis could not be imaged. The surgeon had to modify surgical decisions in four (26.7%) cases. IOCT clearly delineated various tissue planes for efficient and safe surgical dissection in pathologies such as posterior vitreous detachment, vitreomacular traction and epiretinal membranes. Furthermore, it also helped identifying perfluorocarbon-retina interface.Conclusions. The intraoperative OCT modality is a feasible and useful intraoperative imaging technique for various kinds of vitreoretinal disorders. The decision making of the surgeon was modified in a quarter of the cases after the use of this newer modality.

Acute-onset postoperative endophthalmitis after cataract surgery and transzonular intravitreal triamcinolone–moxifloxacin

To report 4 cases of acute postoperative endophthalmitis (POE) after uneventful temporal clear corneal topical dropless cataract surgery involving intravitreal triamcinolone-moxifloxacin (TriMoxi). Private practice in Peoria, IL, USA. Retrospective noncomparative case series. Charts of patients presenting with POE after an uneventful temporal clear corneal phacoemulsification with in-the-bag implantation of a posterior chamber intraocular lens over a 15-month period were reviewed. Patients presented with typical signs and symptoms of acute POE 3 to 14days after cataract surgery. The POE resolved after 25-gauge pars plana vitrectomy and injection of intravitreal vancomycin, ceftazidime, and dexamethasone. Two of 4 eyes were culture-positive for coagulase-negative Staphylococcus. The corrected distance visual acuity at the last follow-up visit was 20/40 or better in 3 eyes, and 20/400 in 1 eye because of underlying atrophic age-related macular degeneration. Postoperative endophthalmitis can occur after dropless cataract surgery with intravitreal triamcinolone-moxifloxacin.

Outbreak of Multidrug-resistant Acute Postoperative Endophthalmitis due to Enterobacter aerogenes

Purpose: To report the clinical features, management, and outcome of 7 cases of culture-proven multidrug-resistant Enterobacter postoperative endophthalmitis following cataract surgery. Methods: Medical records of 7 cases of acute postoperative endophthalmitis after uneventful cataract surgery were reviewed. Details regarding age, gender, visual acuity and clinical features at presentation, microbiological profile, treatment interventions, and visual acuity and clinical features at 1 week, 1 month, and 3 months follow-up were collected. Results: All patients reported decreased visual acuity and pain as presenting symptoms. All patients were resistant to intravitreal antibiotics such as vancomycin (1 mg/0.1 mL) and ceftazidime (2.25 mg/0.1 mL). Culture of aqueous and vitreous sample was positive for Enterobacter aerogenes and sensitive to co-trimoxazole, cefoperazone–sulbactam, imipenem–meropenem, and piperacillin–tazobactem. Two patients with panophthalmitis and no perception of light underwent evisceration. Three patients had visual acuity of ≥6/24 at the final follow-up. Conclusion: Multidrug-resistant Enterobacter acute postoperative endophthalmitis has a poor prognosis if not intercepted early.

Vancomycin-resistant Staphylococcus hominis endophthalmitis following cataract surgery

We report a case of acute postoperative endophthalmitis caused by vancomycin-resistant Staphylococcus hominis, treated at our hospital. An 80-year-old male presented 2 days after uncomplicated phacoemulsification and posterior chamber intraocular lens implantation, with a 24-hour history of progressive visual loss and redness in the operated (right) eye. On examination, best corrected visual acuity was counting fingers. Anterior segment examination revealed conjunctival injection, chemosis, corneal edema, and hypopyon. B-scan ultrasonography showed vitreous opacification, but no retinal detachment. Acute postoperative endophthalmitis was diagnosed. We performed vitrectomy with vancomycin in the irrigating solution, intraocular lens removal, and silicone oil tamponade. Culture of the vitreous grew Staphylococcus hominis. Antibiotic susceptibility testing showed the isolate was sensitive to trimethoprim/sulfamethoxazole and teicoplanin but resistant to ciprofloxacin, moxifloxacin, levofloxacin, cefazolin, and vancomycin. At 3 months, the visual acuity of the silicone oil-treated eye was 20/400.

Acute postoperative endophthalmitis by Gemella haemolysans

Endophthalmitis is a rare and serious post-surgical complication. We report a case of acute postoperative endophthalmitis after an uneventful cataract surgery caused by a commensal organism, Gemella haemolysans. The patient was successfully treated with vitrectomy and intravitreal antibiotics like vancomycin, along with topical cefazolin.

Acute postoperative endophthalmitis caused by Actinomyces neuii

PURPOSE: To describe a case of acute postoperative endophthalmitis caused by Actinomyces neuii after uncomplicated phacoemulsification with posterior chamber intraocular lens implant. METHODS: Interventional case report. A 58-year-old male underwent phacoemulsification, right eye, with posterior chamber intraocular lens implant. On postoperative day 6, he presented with pain, redness, and decreased visual acuity, right eye, and was found to have endophthalmitis. RESULTS: Vitreous cultures revealed the gram-positive, anaerobe Actinomyces neuii. After appropriate intraocular, periocular, topical, and systemic therapy, the infection cleared, but the vision of the patient never improved as a result of a central vein occlusion. CONCLUSION: Actinomyces species can rarely cause postoperative endophthalmitis, and it should be considered in cases of severe postoperative intraocular inflammation.

Visual outcomes following the use of intravitreal steroids in the treatment of postoperative endophthalmitis

ObjectiveTo compare visual outcomes between cases of acute postoperative endophthalmitis that did or did not receive intravitreal steroids. DesignRetrospective nonrandomized comparative trial. ParticipantsFifty-seven patients with postoperative endophthalmitis. InterventionThirty-one patients with postoperative endophthalmitis resulting from cataract extraction received both intravitreal antibiotics and steroids, whereas the remaining 26 received only intravitreal antibiotics. Main outcome measuresImprovement in visual acuity. ResultsMultivariate logistic regression was used to analyze the variables that potentially influence a three-line visual acuity improvement. The mean baseline visual acuities of both groups were comparable. The use of intravitreal steroids reduced the probability of developing a three-line improvement in visual acuity (odds ratio [OR] = 0.287; 95% confidence interval [CI] [0.072–0.852]). On the basis of logistic regression analysis using our multivariate model, gender, baseline visual acuity, and pars plana vitrectomy were not significantly associated with visual outcome differences between the two groups. ConclusionsPatients who received intravitreal steroids had a significantly reduced likelihood of obtaining a three-line improvement in visual acuity. At a minimum our study provides no support for their use and, therefore, steroids may not be efficacious for acute endophthalmitis related to cataract extraction.