Characteristics Of Endophthalmitis Research Articles

Role Of Ultrasonography In The Diagnosis And Management Of Endophthalmitis In Cats

Endophthalmitis is one of the most devastating diagnoses in veterinary and human ophthalmology. Ocular ultrasound is an effective and non-invasive technique used for evaluating the structures of the eye and the surrounding tissues, especially when the development of ocular opacities in conditions such as corneal disease, uveitis, cataracts or trauma prevent or limit the use of ophthalmoscopy and slit-lamp biomicroscopy. The present study aimed to evaluate the ultrasonographic characteristics of endophthalmitis in cats and to assess the usefulness of ultrasonography in the selection of treatment methods in such cases. Sixty cats (90 eyes) of different breeds were presented with bilateral (30 cats) and unilateral (30 cats; OD=10, OS=20) endophthalmitis. The mean age ± SEM at the initial presentation was 13.46±1.69 months (range, 2 - 72 months). After a thorough ophthalmic examination, the ultrasonographic evaluation using a high frequency (7.5-10 MHz) micro-convex probe was conducted to evaluate the concurrent ocular abnormalities in the anterior and posterior eye segments. After completing the ultrasonographic examination, the treatment protocol was applied. It was concluded that ocular ultrasonographic evaluation was found suitable in the diagnosis of endophthalmitis in cats and for the selection of the treatment protocol

Incidence and Characteristics of Endophthalmitis after Cataract Surgery in Poland, during 2010-2015.

Background: The assessment of the incidence and characteristic of acute and chronic postoperative endophthalmitis (POE) after cataract surgery in Poland during 2010–2015. Patients and methods: All hospitalizations of patients, in the National Database of Hospitalizations, who underwent cataract surgery alone or in combined procedures in Poland between January 2010 and December 2015, with a billing code of endophthalmitis, were selected. Acute endophthalmitis was identified if symptoms occurred within 1–42 days from the cataract surgery and chronic endophthalmitis if symptoms occurred ≥43 days after cataract surgery, respectively. Results: In total, 1331 cases of POE after 1,218,777 cataract extractions were identified. The overall incidence of POE decreased from 0.125% in 2010 to 0.066% in 2015. In multiple logistic regression analyses, increasing age was significantly associated with acute POE, while type II diabetes mellitus, extracapsular cataract extraction, and one-day surgery were significantly associated with chronic POE. The combined cataract surgery and male sex were significant risk factors for both acute and chronic POE. A total of 62.51% of all eyes affected by POE received antibiotic treatment and 37.49% had vitrectomy treatment. Conclusions: During the study period, the total incidence of postoperative endophthalmitis after cataract surgery decreased significantly.

Incidence of Endophthalmitis after Intravitreal Injections: Risk Factors, Microbiology Profile, and Clinical Outcomes

ABSTRACTPurpose: To report the incidence and characteristics of endophthalmitis after intravitreal injections (IVI) of antivascular endothelial growth factor agents and triamcinolone acetonide.Methods: Patients’ medical records were retrospectively reviewed from January 2009 to June 2016, and the incidence, risk factors, clinical and microbiological characteristics of post-IVI endophthalmitis were evaluated.Results: The total number of intravitreal injections given, which included ranibizumab, bevacizumab, and triamcinolone acetonide, was 20,566, of which 27 cases developed endophthalmitis, giving an overall incidence of 0.131%. Significant reduction (p < 0.003) in incidence of endophthalmitis was observed in patients who received prefilled compounded bevacizumab injections (0.050%) compared to multiple bevacizumab injections from a single vial (0.235%). In the triamcinolone acetonide group, the incidence was 0.26%. Staphylococcus species were isolated from 18 cases (67%), and all strains were sensitive to vancomycin.Conclusions: Adherence to strict aseptic protocols and use of prefilled compounded bevacizumab injections reduces the rate of post-IVI endophthalmitis.

Postcataract surgery endophthalmitis in Port Harcourt, Nigeria

Background: Endophthalmitis is a rare but dreaded complication of cataract surgery. It is, therefore, imperative for cataract surgeons to know about its prevalence and how to prevent it in their institutions. Aim: The aim of this study was to determine the prevalence of postcataract surgery endophthalmitis in a private health facility in Port Harcourt. Methods: A retrospective analysis of the case files and theater records of 92 eyes of all 83 patients who had cataract surgery at the DDS Eye Centre and Surgery, Port Harcourt, Nigeria, between August 2006 and November 2012 was done. This included pre-, intra-, and post-operative care and features of endophthalmitis. Statistical software package SPSS version 17 was used to analyze the data (P Results: A total of 2484 (1490 males and 994 females) patients were seen in the private eye hospital in the period under review and 92 eyes of 83 (3.34%) patients (59 males and 24 females) were included in the study. Sixty-seven (73%) eyes had extracapsular cataract extraction with intra-ocular lens (ECCE + IOL) whereas twenty-five (27%) had small incision cataract surgery with intra-ocular lens (SICS + IOL). Among those who had ECCE, one (1.49%) developed endophthalmitis while two (8%) developed endophthalmitis following SICS, and they were all males which was statistically significant for surgery type. The prevalence of endophthalmitis in this study was 3.23%. Conclusion: The high prevalence of endophthalmitis in this study may be due to inadequate management of comorbid conditions such as corneal ulcer and diabetes. The incisions were temporally placed and sutures were not used which may have compromised the integrity of the wound in SICS, causing a higher prevalence of endophthalmitis with this method.

Characteristics of Endophthalmitis after Cataract Surgery in the United States Medicare Population

Endophthalmitis is a rare but sight-threatening infection after cataract surgery. Roughly one third of eyes remain blind after treatment. We report United States population-based data on microbiological investigations and treatment patterns plus risk factors for poor outcomes. Retrospective cohort study. Medicare beneficiaries from 5 states in whom endophthalmitis developed within 6 weeks after cataract surgery in 2003 and 2004. We identified endophthalmitis cases occurring after cataract surgery using Medicare billing claims. We contacted treating physicians and requested they complete a questionnaire on clinical and microbiological data and submit relevant medical records. Two independent observers reviewed materials to confirm that cases met a standardized definition. Positive culture results, vitrectomy status, microbiology spectrum, and final visual acuity. In total, 615 cases met our case definition. Initial visual acuity was counting fingers or worse for 72%. Among 502 cases with known culture results, 291 (58%) had culture positive results. Twelve percent had positive results for streptococci. More than 99% of cases were treated with intravitreal vancomycin. Vitrectomy was performed in 279 cases (45%), including 201 cases with initial acuity better than light perception. Rates of vitrectomy varied across states, with California having the highest rate and Michigan having the lowest (56% and 19% of cases, respectively). Overall, 43% of individuals achieved visual acuity of 20/40 or better. Poor initial acuity (adjusted odds ratio [OR], 1.08; 95% confidence interval [CI], 1.04-1.12 per 0.10 logarithm of the minimum angle of resolution units), older age at diagnosis (OR, 1.22; 95% CI, 1.03-1.45 per 5-year increase), and more virulent organisms were important predictors of poor final visual acuity. Cases with streptococci infection were 10 times more likely to have poor final acuity than coagulase-negative staphylococci cases (adjusted OR, 11.28; 95% CI, 3.63-35.03). Vitrectomy was not predictive of final visual acuity (adjusted OR, 1.26; 95% CI, 0.78-2.04). Population-based data on the microbiology of acute postoperative endophthalmitis in the United States after cataract surgery are consistent with prior reports. Vitrectomy usage is higher than that recommended from the Endophthalmitis Vitrectomy Study, with no evidence of increased benefit.

Endophthalmitis After Intravitreal Injections: Incidence, Presentation, Management, and Visual Outcome

To report the incidence and characteristics of endophthalmitis after intravitreal injections of anti-vascular endothelial growth factor agents or corticosteroids and to describe the clinical and bacteriologic characteristics, management, and outcome of these eyes with acute endophthalmitis in France. Retrospective, nationwide multicenter case series. From January 2, 2008 to June 30, 2013, a total of 316,576 intravitreal injections from 25 French ophthalmic centers were included. For each center, the number of intravitreal injections was determined using billing codes and the injection protocol was recorded. A registry and hospital records were reviewed to identify patients treated for endophthalmitis after injection during the same time period. The main outcome measures were the incidence of clinical endophthalmitis and visual acuity of endophthalmitis cases. During the study period, 65 cases of presumed endophthalmitis were found, giving an overall incidence of 0.021% (2.1 in 10,000 injections) (95% confidence interval [CI], 0.016%-0.026%). The median number of days from injection to presentation was 4 [1-26] days. The most common symptom was vision loss. Bacterial identification was achieved in 43.4%. The most frequent pathogens were gram-positive bacteria (91.3%), including coagulase-negative Staphylococcus in 78.3%. Neither the interval between injection and presentation for endophthalmitis nor the clinical signs differentiated culture-positive from culture-negative cases. In multivariate analysis, the use of a disposable conjunctival mould assist device and the use of prophylaxis with an antibiotic or antiseptic were significantly associated with an increased incidence of endophthalmitis (P = .001). The majority of patients had worse visual acuity after 3 months of follow-up when compared with acuity before endophthalmitis. The incidence of presumed endophthalmitis after intravitreal injections of anti-vascular endothelial growth factors or corticosteroids was low and the prognosis poor. Prevention and management remain challenging. It remains to be determined whether the findings of this study are relevant for other countries using different techniques for intravitreal injections.

Culture Proven Endogenous Bacterial Endophthalmitis in Apparently Healthy Individuals

Purpose: To report 7 eyes of 7 patients who were diagnosed as the cases of endogenous endophthalmitis and proved by culture reports. Though in most of the previously published series, one or more predisposing factors were present in the patients of endogenous endophthalmitis, the authors are presenting a case series of culture-proven endogenous endophthalmitis in apparently healthy and immunocompetent individuals.Design: Retrospective noncomparative case series. All patients were diagnosed as endogenous bacterial endophthalmitis with positive vitreal culture. Variables studied were demographic characteristics, microbiology, therapeutic interventions done, final visual and anatomical outcome.Results: Streptococcus pneumoniae was the most frequent isolate 43% (3 out of 7 eyes) followed by Staphylococcus aureus and E. coli in equal frequency 29% ( 2 each out of 7 eyes). The median time between the onset of symptoms and presentation with features of endophthalmitis to hospital was 7 days. The presenting visual acuity was less than HM (hand motions) in all cases except one, which had VA of 20/200. No single underlying predisposing condition was identifiable in any of the cases. All the cases were given intravitreal therapeutic agents (one or more doses of antibiotics and steroid) and pars plana vitrectomy was performed in 2 cases. The final visual acuity was not better than presenting VA except in 1 case, which had final VA of 20/40. Intraocular pressure was on the lower side (mean IOP 7 mmHg compared to 12 mmHg in the fellow eye). No eye was enucleated or eviscerated.Conclusion: Though in most of the previously published literature endogenous endophthalmitis has been a metastatic ocular infection, the present study describes a series of endogenous bacterial endophthalmitis de novo in onset, without any identifiable predisposing factors. The overall age of presentation was in a younger population than in previously published series. The overall visual outcome was poor, probably due to the serious nature of disease itself and the relatively late presentation.

Metastatic endophthalmitis

Endophthalmitis carries a poor visual prognosis for patients and can be a potentially blinding condition that may result in loss of the eye. Early diagnosis and prompt treatment are imperative to save the eye. Delay in diagnosis affects visual prognosis and therefore doctors should be aware of the presenting features of endophthalmitis. Urgent ophthalmic referral is advised as soon as a diagnosis is suspected.

Endophthalmitis after lens extraction.

This article describes most features of endophthalmitis after lens extraction: symptomatology, differential diagnosis, prognosis, treatment and prevention. Literature findings are compared to the author's proper extensive experience with endophthalmitis. Cultures have been positive in 153 cases. A hundred and fifteen of them were seen after previous ocular surgery. Amongst these cases 104 were seen after cataract surgery.