Cases Of Endophthalmitis Research Articles

Nocardia paucivorans Endophthalmitis and Cerebral Abscesses in an Immunocompetent Patient

Abstract Nocardia spp are an uncommon cause of central nervous system infections and particularly endophthalmitis. In this case report, we present the first documented case of endogenous Nocardia paucivorans endophthalmitis and subretinal abscesses. We also provide a brief summary of the literature regarding ocular and cerebral nocardiosis. Early diagnosis and management improve outcomes; hence, clinicians should be cognizant of Nocardia infection as a differential diagnosis in cases of cerebral abscess or endophthalmitis, including in the immunocompetent.

Comparison of Efficacy and Safety between Immediate Sequential and Delayed Sequential Bilateral Cataract Surgery

Purpose: We compared the efficacy and safety of immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS).Methods: We analyzed the best corrected visual acuity (BCVA), spherical equivalent (SE), and mean absolute error (MAE) in the ISBSC and DSBSC groups. The study population comprised 72 patients (144 eyes) who underwent ISBCS and 92 patients (184 eyes) who underwent DSBCS at Seoul St. Mary's Hospital between January 2019 and December 2021.Results: At 1 month postoperatively, the ISBCS group demonstrated a BCVA, SE, and MAE of 0.11 ± 0.09, -0.33 ± 0.42 diopters (D), and 0.38 ± 0.32 D, respectively; similarly, the DSBCS group exhibited a BCVA, SE, and MAE of 0.11 ± 0.15, -0.29 ± 0.56 D, and 0.41 ± 0.43 D, respectively. Furthermore, no significant differences were observed between the ISBCS and the DSBCS groups regarding SE and MAE at the 1-month follow-up for the first and second operated eyes. No cases of postoperative endophthalmitis and toxic anterior segment syndrome were reported.Conclusions: ISBCS is an effective and cost-effective approach that yields favorable postoperative outcomes when performed by an experienced surgeon supported by appropriate pre- and postoperative care, particularly in patients who demonstrate good cooperation.

Двусторонняя хирургия катаракты в одну госпитализацию

The aim of the work was to analyze the results of bilateral cataract surgery in one hospitalization with an interval of several days. Material and methods. An analysis was made of data from 141 patients operated on in a round-the-clock hospital of the Kirov Clinical Ophthalmological Hospital for bilateral cataracts during one hospitalization for the period 2022–2023. Results. The interval between operations on the eyes of patients ranged from 1 to 7 days, on average 2.7 days. No cases of endophthalmitis were noted. Visual acuity increased from 0.1 to 0.6. In 85.8%, the target refraction was achieved. Conclusion. Bilateral cataract surgery in one hospitalization is possible and often more preferable in terms of a combination of medical, economic, time, quality indicators with a balanced approach from the ophthalmologist-surgeon and strict adherence to the patient safety protocol. Keywords: bilateral surgery, surgery in one hospitalization

Early Endophthalmitis Incidence and Risk Factors after Glaucoma Surgery in the Medicare Population from 2016 to 2019

To determine early endophthalmitis incidence and risk factors after glaucoma surgeries in the Medicare population. Retrospective, longitudinal study. Medicare Fee-for-Service (FFS) and Medicare Advantage beneficiaries in the United States aged 65 years or older undergoing glaucoma surgery. Medicare claims were used to identify all patients who underwent glaucoma, cataract, or combined cataract/glaucoma surgery from 2016 to 2019. Endophthalmitis cases within 42 days of the index surgery were identified using the diagnostic codes. Multivariable logistic regression models were used to evaluate factors associated with postoperative endophthalmitis. The 42-day postoperative endophthalmitis incidence and risk factors associated with endophthalmitis after glaucoma surgery. There were 466 928 glaucoma surgeries, of which 310 823 (66.6%) were combined with cataract surgery. Cataract surgeries alone (n= 8 460 360) served as a reference group. Microinvasive glaucoma surgeries constituted most glaucoma procedures performed (67.8%), followed by trabeculectomy (14.0%), tube shunt (10.9%), and other procedures (7.3%). There were 572 cases of endophthalmitis identified after all glaucoma surgeries. Endophthalmitis incidence after glaucoma, combined cataract/glaucoma, and cataract surgeries alone was 1.5 (95% confidence interval [CI], 1.3-1.7), 1.1 (95% CI, 1.0-1.2), and 0.8 (95% CI, 0.8-0.8) per 1000 procedures, respectively. The median day of diagnosis of endophthalmitis was later for glaucoma surgeries (16.5 days) compared with combined cataract/glaucoma or cataract surgeries alone (8 and 6 days, respectively). Compared with microinvasive glaucoma surgery (MIGS), tube shunts were the only surgery type to be a significant risk factor for endophthalmitis for both stand-alone (adjusted odds ratio [aOR], 1.8, P= 0.002) and combined surgery (aOR 1.8, P= 0.047). The other risk factor for both stand-alone (aOR 1.1, P= 0.001) and combined (aOR 1.06, P= 0.049) surgeries was the Charlson Comorbidity Index (CCI). Age (aOR 1.03, P= 0.004) and male gender (1.46, P= 0.001) were significant risk factors for combined cataract and glaucoma surgeries. Compared with cataract surgery, early endophthalmitis incidence was higher for both glaucoma and combined cataract/glaucoma surgeries, with the highest incidence among tube shunts. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

LATE DIAGNOSIS OF Cutibacterium acnes (FORMERLY Propionibacterium acnes ) ENDOPHTHALMITIS AND THE IMPORTANCE OF DUAL TESTING WITH BACTERIAL CULTURE AND POLYMERASE CHAIN REACTION.

The purpose of this study was to describe two cases of Cutibacterium acnes endophthalmitis that reinforce the importance of performing both bacterial culture and 16S polymerase chain reaction when the causative pathogen is unclear or difficult to culture, such as C. acnes . A case of C. acnes endophthalmitis complicated by subbuckle scleral perforation is illustrated with intraoperative photography. This is a two-case series. Case 1 describes a case of C. acnes endophthalmitis in a longstanding pseudophakic patient after multiple vitrectomies for recurrent retinal detachment, complicated by subbuckle scleral perforation. Bacterial culture revealed C. acnes while 16S PCR was negative. Conversely, Case 2 demonstrates a case of chronic endophthalmitis diagnosed one year after cataract surgery. PCR (with repeat tap for confirmation) revealed C. acnes with a negative culture. When the causative pathogen of endophthalmitis is unclear, dual testing of microbial culture and C. acnes 16S PCR improves the diagnostic yield of investigations for fastidious pathogens. C. acnes can present as an indolent or virulent endophthalmitis.

Comparative evaluation of 16S rRNA metagenomic sequencing in the diagnosis and understanding of bacterial endophthalmitis

ObjectiveTo evaluate the usefulness of metagenomic analysis in the search for causative organisms of bacterial endophthalmitis.Methods and analysisTwenty-one consecutive treatment-naïve patients (13 men and 8 women; mean age, 60.8±19.8 years)...

PSEUDOMONAS AERUGINOSA-INDUCED ACUTE EXOGENOUS ENDOPHTHALMITIS POST-CATARACT SURGERY

Introduction: The Endophthalmitis Vitrectomy Study revealed that only a small percentage of endophthalmitis cases, specifically 4.1%, were caused by Gram-negative organisms, and the most frequent of these was Pseudomonas aeruginosa. Moreover, poor visual outcomes were consistently linked to this bacterium. Objective: To provide knowledge regarding Pseudomonas aeruginosa as a cause of exogenous endophthalmitis and its management. Case Illustration: A 65-year-old male was admitted to the Emergency Department due to pain and blurred vision in his left eye. After cataract surgery, three days prior, these symptoms had been present for four days. The patient had conjunctival redness, corneal edema, posterior synechia of the iris, and very low visual acuity in the affected eye. A B-mode ocular ultrasonography revealed a considerable vitreous opacity and an aberrant echo in the left eye, suggesting endophthalmitis in the patient. The patient underwent emergency surgery immediately, including Pars plana vitrectomy (PPV), Silicon oil, IOL extraction, and intravitreal antibiotics injection. Moreover, Pseudomonas aeruginosa was found in the vitreous by a smear test and culture process. On the first day after the surgery, the patient's vision improved to light perception but with incorrect projection. A Fundus exam showed an attached retina with silicon oil and no macular edema. After one month, the patient's visual acuity improved to 2/60. Conclusions: Identifying the causative organisms in infectious endophthalmitis is critical in determining treatment and visual results. Pars Plana Vitrectomy (PPV) followed by intravitreal injection of antibiotics as the "gold standard" treatment for acute postoperative endophthalmitis.

Comparison of Endophthalmitis Rates after Alcohol-Based Chlorhexidine and Povidone-Iodine Antisepsis for Intravitreal Injections

Intravitreal injections (IVIs) are the most frequently performed intraocular procedure in Canada. Povidone-iodine (PI) is the current gold standard for antisepsis for IVI and is widely used; chlorhexidine (CH) is a possible alternative antiseptic agent. This study aims to compare rates of endophthalmitis after IVI with 0.05% chlorhexidine with a 4% alcohol base antisepsis to rates of endophthalmitis after IVI with 10% PI antisepsis. Retrospective cohort study. Eyes that received IVI between May 2019 and October 2022 at a group retina practice in Edmonton, Canada. Eyes at a single center received focal conjunctival application of either 10% PI antisepsis or 0.05% CH in 4% alcohol antisepsis for 30 seconds before each IVI. Rates of endophthalmitis between the PI and CH groups. A total of 170 952 IVIs were performed during the study period. A total of 31 135 were performed using CH prophylaxis compared with 139 817 with PI prophylaxis. Among all IVIs there were 49 total cases of endophthalmitis, 29 in the PI group (0.021%) and 20 in the CH group (0.064%). There was a statistically significant difference in the rates of endophthalmitis between the 2 groups (P < 0.001). The odds ratio for developing endophthalmitis with CH antisepsis was 3.1 (95% confidence interval, 1.9-5.2) compared with PI antisepsis. There were increased odds of developing endophthalmitis with aflibercept injection compared with bevacizumab (odds ratio, 3.48; 95% confidence interval, 2.09-7.24). There is a statistically significant difference in rates of endophthalmitis between alcohol-based CH and PI antisepsis for IVI in our patient population utilizing the methods discussed. In our center, alcohol-based CH is now considered a second-line antiseptic agent. Further studies are warranted to further assess the endophthalmitis rate utilizing these 2 antiseptic agents. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Impact of Prefilled Syringes and Masking on Postintravitreal Injection Endophthalmitis.

Purpose: To compare rates of endophthalmitis (1) following intravitreal injection of antivascular endothelial growth factor therapies with glass-vial preparation (GVP) vs prefilled syringes (PFS) and (2) before and after masking protocols were implemented. Methods: Medical records within a multicenter retina practice in Houston, Texas, from January 2015 to August 2021 were retrospectively reviewed. The primary outcome was rate of endophthalmitis after intravitreal injection. Results: A total of 307 349 injections were performed during the study period and 101 cases of endophthalmitis were identified (0.033%). PFS use was associated with a decreased risk of endophthalmitis (relative risk [RR], 0.320; 95% CI, 0.198-0.518, P < .001); 54 cases of endophthalmitis occurred in the GVP group of aflibercept and ranibizumab (0.052%) compared with 24 in the PFS group (0.017%). There was no difference in the endophthalmitis rates with or without universal masking (RR, 0.953; 95% CI 0.616-1.473, P = .91). Discussion: PFS use was associated with a significant reduction in the rate of endophthalmitis while the use of surgical face masks did not appear to significantly impact the rate of endophthalmitis.

Evaluation of the Clinical Course of Endogenous Endophthalmitis.

Purpose: To evaluate the presentations, clinical course, treatments, and outcomes of endogenous endophthalmitis cases. Methods: Consecutive medical records from 2016 to 2021 of a county hospital and an academic, private hospital in Dallas, Texas were retrospectively reviewed. This study comprised 37 eyes of 31 patients with endogenous endophthalmitis. Collected data included demographic factors, identifiable risk factors, medical history, presenting symptoms, infectious data, complications, and best-corrected visual acuity (VA) throughout the clinical course. Results: Twenty-two eyes had bacterial endophthalmitis, 7 had fungal endophthalmitis, and 8 had infections that could not be classified. Of the bacterial cases, 5 eyes had panophthalmitis with associated cellulitis. The most common organisms were Staphylococcus aureus, Candida albicans, and Pseudomonas aeruginosa. The most common presenting symptoms were decreased vision (70%), eye redness (41%), and eye pain (38%). Among all cases, there was no significant difference in the presenting logMAR VA (1.86) before treatment and the most recent logMAR VA (1.75; P = .70) after treatment. However, fungal infections demonstrated better logMAR VA than bacterial infections 6 months after diagnosis (mean logMAR VA, 0.93 vs 2.54, respectively; P = .016) and at most recent follow-up (mean logMAR VA, 0.76 vs 2.3, respectively; P = .004). There was also a strong correlation between presenting VA and most recent VA (r2 = 0.81; P < .01). Conclusions: Visual outcomes of endogenous endophthalmitis cases were poor. Our study found 2 components to be predictive of final VA: (1) whether the infecting organism was bacterial or fungal and (2) a patient's presenting VA.

Fungal endophthalmitis following transscleral cyclophotocoagulation

Most cases of refractory glaucoma not amenable to filtration surgery or glaucoma drainage device are managed by cyclodestructive procedures. An 84-year-old female had undergone oculus sinister (OS) transscleral cyclophotocoagulation (TSCPC) after a diagnosis of OS closed angle stage of neovascular glaucoma was made. On the 1st week post-TSCPC, discharge on the conjunctival surface was noted along with a 6 mm hypopyon in the anterior chamber and associated vitritis. Treatment on the lines of fungal endophthalmitis was initiated. At 1 month review, the reaction had reduced significantly. Cases with significant reaction and vitritis post-TSCPC must be treated aggressively on the lines of endophthalmitis to salvage the globe. A rather safe approach to the management of such cases, TSCPC does have rare complications such as inadvertent sclerostomy or panophthalmitis, being reported as isolated case reports. To the best of our knowledge, this is the first case of fungal endophthalmitis being reported post-TSCPC.

Pars Plana Vitrectomy in Tuberculous Endophthalmitis: A Case Report

Introduction: Ocular tuberculosis (TB) is an extrapulmonary mycobacterial disease with varied manifestations. Endophthalmitis is a severe manifestation with a rapid progression that may lead to intraocular tissue destruction and panophthalmitis. This study aimed to report a case of tuberculous endophthalmitis treated with pars plana vitrectomy (PPV).&#x0D; Case presentation: A 57-year-old male patient with TB endophthalmitis. The follow-up period was 6 months. The diagnosis was made on a clinical basis, and the specific etiology was confirmed by TST and IGRA tests. The diagnosis of ocular TB was delayed by one year. He had bilateral endophthalmitis with severe inflammation. The right eye (OD) was blind, and the left (OS) had best-corrected visual acuity (BCVA) of hand motion. Intraocular pressure (IOP) was elevated in both eyes. B-scan disclosed hyperreflective exudate, filling 1/3 of the vitreous cavity in OD, and vitritis and intravitreal hemorrhage in OS. We commenced triple antitubercular therapy. 23G PPV with silicone oil and phacoemulsification with IOL implantation were done. The intraocular inflammation in OS decreased postsurgically, and in one month, BCVA was 20/200 and IOP was within normal limits.&#x0D; Conclusion: Eendophthalmitis is an indication for therapeutic vitrectomy. The risks of surgery seem to be lower than the benefits, including a decent chance for visual improvement and avoidance of enucleation. In our case, 23G PPV with phacoemulsification seemed to be beneficial in decreasing the level of inflammation, improvement of visual acuity, reduction of IOP, and preservation of the eye.

Efficacy and safety of 'dropless vitrectomy surgery' and comparison of outcomes to standard of care topical therapy.

To compare the effectiveness of intravitreal injection of triamcinolone acetonide/moxifloxacin (Tri-Moxi) with the standard eye drop regimen for controlling postoperative inflammation, intraocular pressure, infections, macular thickness, and visual acuity (VA) in patients undergoing pars plana vitrectomy for various retinal disorders. In this retrospective longitudinal study, patients who underwent vitrectomy using intravitreal Tri-Moxi at the end of surgery (Group 1) were compared with those who received standard topical steroid antibiotics (Group 2) in terms of intraocular inflammation, intraocular pressure, macular thickness based on optical coherence tomography, and visual acuity. In total, 162 consecutive eyes (group 1 [81 eyes]; group 2 [82 eyes]) were included. VA improved by two lines in both groups at 90 days. In Group 1, preoperative VA (logMAR) was 0.92 (0.66) compared to 0.92 (0.75) in Group 2 (p = 1), while at 3 months, it was 0.61 (0.3) and 0.57 (0.3), respectively (p = 0.46). Group 1 showed superior outcomes concerning central foveal thickness. The average central foveal thickness CFT (µm) in group 2 preoperatively was 423 (95) and 348 (63) at 3 months compared to group 1 526 (109) and 306 (108) preoperatively and 3 months, respectively (p = 0.042). There was no statistically significant difference in the rate of elevated intraocular pressure between the two groups or anterior chamber cell reaction severity, and no cases of endophthalmitis were observed in either group. Tri-Moxi is effective after vitrectomy and is not inferior to standard postoperative topical therapy.

Role of Antimicrobial Resistance in Outcomes of Acute Endophthalmitis.

This study explores local trends in antimicrobial resistance and its influence on long-term visual outcomes following treatment with broad-spectrum empiric intravitreal antibiotics. All patients undergoing intraocular sampling for endophthalmitis from Auckland between January 2006-May 2023 were included. The impact of antimicrobial resistance on the final visual outcome was analysed using logistic regression models. 389 cases of endophthalmitis were included, and 207 eyes (53.2%) were culture positive. When tested, all Gram-positive microorganisms were fully susceptible to Vancomycin, and all Gram-negative microorganisms demonstrated full or intermediate susceptibility to Ceftazidime. Resistance to at least one antimicrobial agent was present in 89 culture results (43.0%), and multidrug resistance (resistant to ≥3 antimicrobials) in 23 results (11.1%). No increase in resistance was observed over time. The primary procedure was a tap and inject in 251 eyes (64.5%), and early vitrectomy was performed in 196 eyes (50.3%). Severe vision loss (≤20/200) occurred in 167 eyes (42.9%). Antimicrobial resistance was associated with an increased risk of retinal detachment (OR 2.455 p = 0.048) but not vision loss (p = 0.288). High sensitivity to Vancomycin and Ceftazidime was present in our population, reinforcing their role as first-line empiric treatments. Resistant microorganisms were associated with an increased risk of retinal detachment but no alteration in final visual outcome.

Scleral flaps, pars plana vitrectomy and gore-tex sutured posterior chamber intraocular lens placement: a case series and review of literature.

Cataract surgery is one of the most common surgical procedures performed worldwide. Intraocular lens (IOL) implants are placed routinely in the capsular bag after successful cataract extraction. However, in the absence of adequate capsular support, IOL may be placed in the anterior chamber, fixated to the iris or fixated to the sclera. The purpose of this study is to report the clinical outcomes and safety profile of a trans-scleral sutured intraocular lens (IOL) technique using scleral flaps, vitrectomy, and Gore-Tex suture to place posterior chamber IOL. Retrospective, interventional case series of eyes undergoing scleral fixation of an IOL using Gore-Tex suture with concurrent vitrectomy. Ocular examination with the logarithm of the minimum angle of resolution visual acuity (logMAR BCVA), tonometry, and slit-lamp biomicroscopy was performed on all patients at 1, 3, 6, and 12 months after the operation. All post-operative complications were recorded. Twenty-five eyes of 25 patients were included. Mean logMAR BCVA improved from 0.43 ± 0.36 (20\40 Snellen equivalent) preoperatively to 0.13 ± 0.18 (20\25 Snellen equivalent) postoperatively at 12 months (p<0.01). Indications included surgical aphakia (16) and dislocated lens implant (9). No cases of IOL opacification, suprachoroidal haemorrhage, post-operative endophthalmitis, IOL dislocation, Gore-Tex exposure, or retinal detachment were observed during the follow-up period. Ab externo scleral fixation of IOLs with Gore-Tex suture plus scleral flap is well tolerated and associated with a very low rate of suture exposition. Moreover, our study confirms excellent refractive outcomes after surgery.

Clinical Characteristics and Outcomes of Endophthalmitis Before and During the COVID-19 Pandemic.

To evaluate the clinical characteristics and visual acuity outcomes of patients who presented with endophthalmitis prior to and during the coronavirus disease 2019 (COVID-19) pandemic. This multicenter retrospective case series with historical controls included consecutive patients presenting with any form of endophthalmitis from March 1, 2019 to September 1, 2019 (pre-COVID-19) and from March 1, 2020 to September 1, 2020 (COVID-19) at Mayo Clinic Rochester (MCR), Health System (MCHS), Arizona (MCA), and Florida (MCF) sites. Cases were divided into "pre-COVID-19" versus "COVID-19" groups depending on when they first presented with endophthalmitis. Twenty-eight cases of endophthalmitis presented to all Mayo Clinic sites during the study period. Of these, 10 patients presented during the first six months of the COVID-19 pandemic. During the same six-month period the year prior, 18 patients presented with endophthalmitis. Endophthalmitis etiology (post-injection, post-cataract extraction, post-glaucoma filtering surgery, post-pars plana vitrectomy, endogenous, and others) was similar between both groups (P = 0.34), as was post-injection endophthalmitis rate (P = 0.69), days to presentation (P = 0.07), initial management (P = 0.11), culture-positivity rate (P = 0.70), and need for subsequent pars plana vitrectomy (P = 1). Visual acuity outcomes were similar between both groups at six months, however, the mean LogMAR visual acuity at presentation was worse in the COVID-19 group compared to the pre-COVID-19 group (2.44 vs 1.82; P = 0.026). Clinical characteristics and the post-injection endophthalmitis rate were similar during both periods, however, patients presented with worse vision during the pandemic suggesting that the pandemic may have contributed to delayed presentation, regardless, outcomes are still poor.

A case of postoperative Sphingomonas paucimobilis endophthalmitis after parsplana vitrectomy

We report a case of acute onset of postoperative endophthalmitis following pars plana vitrectomy, in a healthy middle-aged male person, caused by Sphingomonas paucimobilis, a gram-negative bacillus widely distributed in the environment and reported to cause opportunistic infection in immunocompromised. The case showed complete resolution on vitrectomy and intravitreal antibiotics. The bacillus was multi-drug resistant, showing resistance to all known commonly used antibiotics except intermediate sensitivity to meropenem. There have been two reported cases of postoperative endophthalmitis caused by Sphingomonas paucimobilis following cataract surgery, but this is the first reported case following pars plana vitrectomy.

Was it Leuconostoc species? A case of delayed-onset endophthalmitis presenting 14 years after cataract surgery.

To report a case of delayed-onset endophthalmitis presenting 14 years after uncomplicated cataract surgery. Case report. An 89 year-old pseudophakic man complained of redness and reduced visual acuity in his right eye. He had no history of trauma or systemic infection, and his only surgery on the right eye was an uncomplicated cataract surgery 14 years prior. On physical exam, he was found to have keratic precipitates and a white posterior capsular plaque in the right eye. He was treated with a right pars plana vitrectomy and intraocular lens removal. Microbiological classification of the samples revealed the presence of a Leuconostoc species within the vitreous humor and coagulase negative Staphylococci on the lens. Two months following placement of the intraocular lens, he achieved a best corrected visual acuity of 20/200 in his right eye. To our knowledge, this is the first reported case of delayed-onset endophthalmitis occurring more then 10 years following an uncomplicated cataract surgery. This case highlights a highly unusual presentation of delayed-onset endophthalmitis, and reports a potential novel microbiological cause of plaque formation.

Endogenous listeria monocytogenes endophthalmitis in a cirrhotic patient

AbstractEndogenous endophthalmitis caused by listeria monocytogenes is rare and serious, which is easily misdiagnosed initially. We present one case of endogenous endophthalmitis due to listeria monocytogenes in a cirrhotic patient, whose diagnosis was delayed 17 days after admission.

Complement inhibitors for age-related macular degeneration.

Complement inhibitors for age-related macular degeneration.