Development Of Endophthalmitis Research Articles

Pediatric bacterial keratitis: clinical features, causative organisms, and outcome during a 13-year study period

ObjectiveTo review the clinical features, causative organisms, complications, and outcomes of patients with pediatric bacterial keratitis at a tertiary care eye hospital. MethodsWe conducted a retrospective study at a tertiary care eye centre on clinically diagnosed pediatric patients with bacterial keratitis between 2007 and 2019. Poor outcomes were labelled if any of the following were present: final best-corrected visual acuity worse than 20/200, a drop in best-corrected visual acuity by 1 line or more, perforated corneas, endophthalmitis, and graft failure. ResultsThe study included 43 cases of bacterial keratitis. Female and male patients represented 60.5% and 39.5% of the sample, respectively, with a mean age of 9.3 ± 5.9 years. The rate of culture positivity was 60.5%. The most common causative organisms were coagulase-negative Staphylococcus (23.1%), Pseudomonas (23.1%), and Streptococcus pneumoniae (19.2%). Culture-positive bacterial keratitis was associated with infiltrates ≥2 mm (p = 0.039), as determined by the results of multivariate analysis. Gram-positive and gram-negative bacteria exhibited 100% sensitivity to the tested fluoroquinolones. Complications included visually significant scars (55.8%), cataracts (14.0%), perforations (9.3%), corneal neovascularization (7.0%), nonhealing epithelial defects (7.0%), and endophthalmitis (4.7%). Corneal perforation was associated with the development of endophthalmitis (p < 0.001). On multivariate analysis, the only factor associated with a poor outcome was poor presenting visual acuity (p = 0.020). ConclusionGram-positive bacteria were the most common cause of pediatric microbial keratitis. Positive cultures were associated with larger infiltrates. The only adverse prognostic factor was poor presenting vision.

Disease quiescence in endophthalmitis patients treated with anti-VEGF injections for retinal pathologies

BackgroundThe most feared complication of intravitreal injections is the development of endophthalmitis, which could lead to irreversible visual loss. The aim of this study was to characterize the clinical profiles, causative pathogens, and clinical outcome of patients post-endophthalmitis.MethodsRetrospective, single center case series study. Clinical records, causative pathogens and management of all cases of endophthalmitis post intravitreal anti-vascular endothelial growth factor (VEGF) injections recorded between January 1st, 2006 and May 30th, 2022; were retrieved. The visual and anatomic changes prior to the episode of endophthalmitis and up to 2 years post-treatment were compared.ResultsEleven post-injection endophthalmitis eyes of 10 patients (n = 3 females; 30%) were recruited at mean age of 64.5 ± 20.4 years. The median last recorded BCVA, up to 3 months prior to the episode of endophthalmitis was 60 (Interquartile range (IQR) 55–75) ETDRS letters. Then, it dropped to 30 (IQR 0-57.5), 35 (IQR 0-52.5) and 35 (IQR 0-57.5) ETDRS letters at presentation, 6- and 12-months follow-up; respectively (p = 0.027, p = 0.017 and p = 0.012). However, at 24 months, the median BCVA returned to similar baseline values prior to the episode of endophthalmitis; BCVA 50 (IQR 0–60) ETDRS letters, p = 0.062. Interestingly, two eyes with neovascular age-related macular degeneration (NVAMD), 1 with myopic choroidal neovascularization (CNV) and 1 with retinal vein occlusion (RVO), experienced disease quiescence and did not require additional anti-VEGF injections up to 2 years of follow-up.ConclusionThis study demonstrates long-term recovery of vision loss due to endophthalmitis post anti-VEGF injections, regained up to 2 years later. It also indicates that disease quiescence post endophthalmitis may not only occur in eyes treated for NVAMD, but also with myopic CNV and RVO.

Incidence of acute endophthalmitis after intravitreal bevacizumab injection in a tertiary hospital

Aims: To investigate the incidence of acute endophthalmitis after intravitreal bevacizumab injections. Methods: Patients who received treatment with intravitreal bevacizumab (1.25 mg/0.05 ml) injections for various indications between November 2020 and March 2022 were included in this retrospective study. The patients were followed up for 4 weeks after the injection in terms of acute endophthalmitis symptoms and signs. Results: Acute endophthalmitis developed in 1 patient after 4593 intravitreal bevacizumab injections were administered to 1427 eyes of 1026 patients, and the incidence was found to be 0.0217%. The patient who developed acute endophthalmitis underwent pars plana vitrectomy and after 3 months, a significant improvement in visual acuity was observed. Conclusion: Development of endophthalmitis postoperatively was found to be moderately low after intravitreal bevacizumab injection. It was concluded that following asepsis rules and optimal bevacizumab preparation conditions could further reduce this.

Corneal changes after fulguration and cross-linking in experiment

BACKGROUND: Severe progressive forms of infectious keratitis are often associated with the risk of violation of the structural integrity of the eyeball and the development of endophthalmitis. In the presence of negative dynamics against the background of conservative etiotropic therapy for severe keratitis, it is advisable to use surgical methods of treatment. The combination of two surgical methods of influencing a pharmacoresistant infectious process in the cornea — cross-linking and fulguration — is promising and requires further investigation.&#x0D; AIM: In the experiment, to evaluate the effect on the corneal tissue of various modes of direct current fulguration, as well as in combination with cross-linking as well.&#x0D; MATERIALS AND METHODS: An in vivo experimental study was carried out on 19 rabbits (38 eyes) of the Soviet Chinchilla breed, the average body weight of the animals was 2.5–4.0 kg. Depending on the stage of the study, the type and power of exposure during fulguration, the rabbits were divided into 3 groups.&#x0D; RESULTS: When the cornea was exposed to fulguration in mode 5, the changes covered only 10–15 % of the anterior stroma, about 50 μm, and both clinically and histologically were not sufficient. When exposed to mode 6 and 7 after 3 months, changes in the stromal structure extended by about 150 µm. When using mode 8, there was a slight proliferation of connective tissue between the Descemet’s membrane and the endothelium. The combination of cross-linking with fulguration made it possible to obtain a more compact structure of the anterior layers of the corneal stroma and stability of the epithelium.&#x0D; CONCLUSIONS: Fulguration may be a relatively safe treatment for the cornea in pharmacoresistant progressive keratitis. Fulguration and corneal cross-linking can potentiate each other’s effect. Fulguration mode 7 (1.5 W) is optimal at corneal exposition for the eradication of infectious agents.

Endophthalmitis After Vitreoretinal Surgery

Endophthalmitis after vitreoretinal surgery is uncommon but one of the most serious complications associated with severe visual loss despite appropriate treatment. It can be diagnosed based on symptoms such as ocular pain, conjunctival hyperemia, corneal congestion, corneal edema, anterior chamber inflammation, hypopyon, and vitreous haziness. The most common agents responsible for postoperative endophthalmitis are bacteria from patients' own ocular surface flora. Several factors such as preoperative sterilization, surgical nature of the procedure, intraocular tamponade, and postoperative treatment methods are responsible for the development of endophthalmitis after pars plana vitrectomy. The prognosis of endophthalmitis depends on the virulence of the microorganism, the patients’ immune nature, the time of diagnosis, and the initiation of treatment.

Trends in Secondary Intraocular Lens Surgery among Vitreoretinal Surgeons

To identify changes in secondary lens techniques over time and to determine common complications of each technique. Retrospective cohort study. All patients in the database from January 2015-December 2021 who underwent secondary lens placement (anterior chamber IOL, scleral fixated IOL, or scleral sutured IOL). Rates of secondary IOL surgery technique were analyzed in 3597 participants in a nationwide aggregated electronic health care database using 2 sample independent T-tests. Rates of post-operative rhegmatogenous retinal detachment (RRD) following secondary IOL surgery were assessed using chi square test of proportion. Post-operative visual acuity was assessed using 2 sample independent T-tests. The primary outcome was change in IOL technique over time. Secondary datapoints examined were the development of post-operative rhegmatogenous retinal detachment (RRD) following secondary IOL surgery, visual acuity changes, the development of endophthalmitis, suture erosion, haptic erosion, or corneal edema following IOL surgery. ACIOL use decreased over the 7-year period from 93% of cases to 36% of cases (p<0.0001), while SFIOL use increased from 3% to 34% (p<0.0001), and SSIOL use increased from 4% to 30% (p<0.0001). Visual acuity increased for each surgical technique (ACIOL: 44.1 vs. 49.2 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, p<0.001; SFIOL: 48.7 vs. 57.6 letters, p<0.001; SSIOL: 51.5 vs. 61.2 letters, p<0.001), with larger visual acuity gains seen in SFIOL and SSIOL use (ACIOL vs. SFIOL, p=0.004; ACIOL vs. SSIOL, p=0.002; SFIOL vs. SSIOL, p=0.64). Average RRD rates did not significantly differ between techniques. Rates of endophthalmitis, haptic erosion, and suture erosion were low and did not significantly differ between techniques. Rates of corneal edema were significantly higher in ACIOL cases (vs. SFIOL, p<0.0001; vs. SSIOL, p<0.0001). Rates of ACIOL implantation performed by vitreoretinal surgeons have decreased over time with more vitreoretinal surgeons electing to place either a SFIOL or SSIOL towards the end of the study period; complication profiles among the three techniques may be similar.

Complement inhibitors for age-related macular degeneration.

Complement inhibitors for age-related macular degeneration.

Endophthalmitis risk factors associates with phacoemulsification (Literature review)

The most frequent sources of microbial flora inside the eye are the ocular surface, foci of para-ocular infection of the patient. In vitreous samples from eyes with endophthalmitis microorganisms are revealed that are the saprophytic flora of the ocular surface. It is mainly represented by staphylococci, from which epidermal staphylococcus prevails quantitatively. Immunodeficiency states, diabetes mellitus, terminal liver and kidney diseases increase the risk of endophthalmitis development. Eradication of opportunistic pathogenic flora in the source loci, sanation of para-ocular infection, correction of somatic pathology by profile specialists is more relevant for endophthalmitis prevention. The problem of growing antibiotic resistance should also be considered. Thus, when selecting patients for surgery, one should be guided by the data on antibiotic resistance of the identified flora, pay attention to the presence of para-ocular infection and the systemic somatic status of the patient. This will provide a better vector for the development of recommendations for optimal prophylaxis.

Clinical features and treatment of endophthalmitis after cataract surgery

The study analyzes the frequency of acute endophthalmitis occurrence after cataract surgery, the risk factors, characteristic symptoms, and the effectiveness of peri-operative prevention measures. The study retrospectively analyzed 59 670 cases of patients operated for cataract in 2017-2021. To prevent infections, patients received four instillations of third generation fluoroquinolone (quinolone antibiotic) in the course of two days prior to cataract phacoemulsification (PE), and two instillations immediately (1 hour and 30 minutes) before the surgery; three-minutes treatment of the cornea, conjunctival sac and periocular skin with 5% povidone iodine before the surgery; and as the last step of surgery, patients received subconjunctival injection of 0.05 g cefazolin with 2 mg dexamethasone. Follow-up after surgery included four injections of 0.5% levofloxacin in the course of 7-10 days, and 0.1% dexamethasone for two weeks, or fixed combination of tobramycin and dexamethasone four times per day for two weeks. The criteria for acute endophthalmitis are: loss of spatial vision, absence of red reflex, pronounced thickening of the choroid, suspended particulates in the retrovitreal space and the vitreous observed with ultrasonography in the early postoperative period (day 4-7 after surgery). There were 32 patients (0.054%) diagnosed with acute endophthalmitis. Posterior capsule rupture was the main complicative risk factor of endophthalmitis development (OR=11.75, p=0.026). Main diagnostic criteria of acute endophthalmitis were hypopyon (OR=22.5, p=0.001) and absence of red reflex (OR=19.59, p<0.001). The use of the fixed combination of tobramycin and dexamethasone was associated with 5.8-times higher risk of acute endophthalmitis than separate application of levofloxacin and dexamethasone (p=0.042). Povidone iodine and third generation fluoroquinolone as a method of acute endophthalmitis prevention after cataract surgery demonstrate comparable efficacy to intracameral antibiotic injections.

Microbiological study on foreign body and vitreous samples of patients with intraocular foreign body

To evaluate the relationship between the microbiological results of the vitreous humor and those of foreign body specimens in patients with intraocular foreign body (IOFB). Seventy-one patients with an IOFB were included in this descriptive prospective case series. All patients underwent immediate IOFB removal. Vitreous sampling was performed during vitrectomy. Foreign bodies were placed directly into culture media for microbiological study. Thirteen (18.3%) patients developed endophthalmitis. The results of microbiological analysis of IOFB and vitreous humor specimens were negative in nine patients and positive in four. Fifty-eight (81.6%) patients with an IOFB had no evidence of endophthalmitis. Among them, seven patients showed positive microbiological results of foreign bodies with no manifestations of endophthalmitis. In five patients, a Staphylococcus epidermidis strain was observed in the culture of the IOFB specimen. Two patients had only positive smear test results of their vitreous humor specimen. A correlation appears to be present between the microbiological results of the vitreous humor and IOFB specimens in patients with clinical findings of endophthalmitis but not in patients with a pure IOFB without clinical features of endophthalmitis. This may justify early use of intravitreal and intravenous antibiotics before the development of endophthalmitis.

Novel options in diagnosis and treatment of endophthalmitis

AbstractEndophthalmitis remains the most vision‐threatening condition that in most severe cases can result in a loss of an eye and systemic spreading of the infection. It is defined as an acute inflammation of the inner tissues of the eyeball and is usually caused by intraocular contamination and colonization of infectious agents with exudation within intraocular space. The development of endophthalmitis as well as its clinical presentation and functional and anatomical outcomes is predefined by its type, kind of infection and therapy applied. There is a risk of progression of endophthalmitis to panophthalmitis, which could end up with evisceration or enucleation. The involvement of the general physician and other medical specialists into the treatment of the patients with endophthalmitis shall be always considered and should not be underestimated. As one of the most severe emergencies in ophthalmology, this condition requires urgent therapeutical or/and surgical intervention. Numerous studies compare the efficacy of the first line treatment for different types of endophthalmitis. Since decades the management of endophthalmitis is based on prompt recognition of infectious agents, immediate intraocular antimicrobial therapy and removal of the purulent exudate form the eye. Novel diagnostic options for endophthalmitis shall be considered in order to increase the precision of to treat patients with endophthalmitis. Improvement of the surgical techniques with the development of the new less traumatic instruments and he novel antimicrobial drugs can stablish a new standards of endophthalmitis care.

Treatment of long-term endophthalmitis developing after intraocular lens implantation in children: a retrospective study

BackgroundTo discussed the risk factor and the management of vitrectomy for long-term endophthalmitis developing after intraocular lens (IOL) implantation in children.MethodsWe retrospectively investigated the clinical characteristics and surgical outcomes of long-term endophthalmitis developing after IOL implantation in children.ResultsFour eyes of four children were included in the study. The mean time to endophthalmitis development after IOL implantation was 3.0 ± 0.8 years. The corneal or scleral sutures may have been caused the infection. All 4 patients underwent vitrectomy and received intravitreal antibiotics with or without IOL removal. At the last follow-up, the outcomes were satisfactory; the fundus was clear, the retina remained attached, the visual acuity improved, and there were no severe complications.ConclusionsThe use of scleral sutures and the exposure of conceal sutures may induce the onset of long-term endophthalmitis after IOL implantation. Complete vitrectomy and appropriate use of antibiotics are effective in the treatment of long-term endophthalmitis developing after IOL implantation in children.

Endophthalmitis, Visual Outcomes, and Management Strategies in Eyes with Intraocular Foreign Bodies.

PurposeOcular trauma with intraocular foreign body (IOFB) can have devastating visual consequences. Management and antimicrobial strategies remain variable due to the infrequency and heterogeneity of presentation. Our goal was to identify risk factors for endophthalmitis and poor visual outcomes in cases of IOFB and investigate management strategies.Patients and MethodsA retrospective chart review was conducted in 88 eyes of 88 patients suffering traumatic injury with IOFB at the University of Michigan between January 2000 and December 2019. Medical records were reviewed to characterize the injuries and IOFBs as well as how clinical presentation and treatment modalities were associated with outcomes.ResultsDelayed presentation (P=0.016) and organic IOFB (P=0.044) were associated with development of endophthalmitis. Retinal detachment (P=0.012), wound length greater than 5 mm (P=0.041), and poor presenting visual acuity (P=0.003) correlated with poor final visual outcome. Antibiotic prophylaxis was given to all patients, though agents and routes of delivery varied. Endophthalmitis developed in 4.9% of the eyes after initial management, with primary and secondary removal of posterior segment IOFBs associated with similar rates of endophthalmitis (P=1.000).ConclusionPoor presenting visual acuity and severity of injury, as measured by large wound and retinal detachment, correlate with poor visual outcome. Prompt globe closure and antimicrobial prophylaxis are critical for infection prevention. In cases where IOFB removal and globe closure cannot be performed concurrently, primary globe closure with aggressive antibiotic prophylaxis offers a reasonable alternative to prevent endophthalmitis.

LAWN TRIMMER-RELATED OPEN-GLOBE INJURIES IN TAIWAN.

Work-related ocular trauma remains the leading cause of unilateral visual impairment worldwide. Many preventable work-related ocular injuries continue to occur, even at home. This study describes the characteristics, surgical techniques, and prognostic factors of lawn trimmer-related open-globe injuries in eastern Taiwan. This was a retrospective, consecutive case series study. Slit-lamp biomicroscopy, dilated fundoscopy, and orbital computed tomography (CT) images were collected. Twenty-six eyes of 26 patients were enrolled in the study. Fifteen patients (57.7%) had an intraocular foreign body (IOFB). The IOFB was metallic in 13 cases and glass and stone in the other 2 cases. Seven IOFBs (46.7%) were retained in the anterior chamber, 7 (46.7%) in the posterior segment, and 1 (6.7%) in the intraconal space. Univariate analysis showed that the presence of IOFB trended toward the development of endophthalmitis; however, this was not statistically significant (hazard ratio, 2.25; 95% confidence interval 0.35-14.61; P = 0.658). Eleven patients had metallic IOFBs noted on CT scans with metal artifacts, whereas two patients had small metallic IOFBs without metal artifacts. One patient had a glass IOFB mimicking metal artifacts on the CT scan. In one case, CT failed to reveal the IOFB, and an intralenticular metallic foreign body was incidentally found intraoperatively. Our study provides a broad characterization of lawn trimmer-related open-globe injuries. The informative and diverse findings of IOFBs on CT scans will help clinicians detect and recognize IOFBs more precisely and perform the surgery without causing further damage.

Inadvertent ocular perforation with hypodermic needle during saline irrigation

<br>We present a case of globe perforation with hypodermic needle during saline irrigation. A 24-year-old presented with sudden onset defective vision during saline wash in his left eye. Patient on examination had hypotony and mild lid edema. Scleral wound was only apparent after staining; rest of the anterior segment was within normal limits. Posterior segment showed vitreous hemorrhage with retinal tear nasal to disc and adjacent commotio retinae. Patient was given tapering topical antibiotic steroid eye drops and kept under close observation. On his final follow-up 6 weeks after the initial injury, vitreous hemorrhage was resolving; the retinal tear had scarred with a choroidal rupture. Hypodermic-needle injuries are often complicated by the development of endophthalmitis. Our patient did not develop endophthalmitis, possibly due to the needle being sterile. He regained good vision and was saved from devastating consequences as the needle had missed the disc by a few millimeters.<br>

Cost effectiveness of intracameral cefuroxime prophylaxis and its efficacy in preventing endophthalmitis after cataract surgery in a referral hospital.

To present the results of a retrospective study regarding the clinical and economic impact of intracameral cefuroxime administration to prevent endophthalmitis during cataract surgery in a referral hospital. This study included 16,902 eyes from patients who had undergone cataract surgery between 2013 and 2017. From May 2014 onwards, all patients received routine intracameral injections of 1 mg cefuroxime (10 mg/1 mL) after phacoemulsification. The prophylactic efficacy was evaluated using the relative risk ratio, whereas the economic impact was evaluated using number needed to treat to avoid endophthalmitis. Before introducing cefuroxime, 3,407 cataract surgeries were performed using the phacoemulsification technique, and 7 post-operatory cases of endophthalmitis occurred (0.2% incidence). After introducing the cefuroxime protocol, 13,495 surgeries were performed, and 4 endophthalmitis cases were registered (0.03% incidence). Cefuroxime was identified as a protective factor against the development of endophthalmitis [risk ratio = 14%, p=0.002, 95% confidence interval (CI) 95%, 4%-49%], with an economic impact of number needed to treat = 568. The potential savings with cefuroxime was approximately US $2,334.36 for every 568 patients treated. The incidence of endophthalmitis decreased by 86% (risk ratio = 14%, p=0.002, 95% CI, 4%-49%) after introducing intracameral cefuroxime prophylaxis at the study hospital. The results presented herein provide strong evidence for the use of cefuroxime in endophthalmitis prophylaxis after phacoemulsification surgeries, outperforming the alter-native by providing both economic and clinical benefits.

Bacterial corneal ulcers in pediatric patients. Algorithms of pharmacotherapy. Part II

Part I of the article presents a review of publications highlighting current exogenous and endogenous risk factors contributing to the occurrence of bacterial corneal ulcers, laboratory diagnostic methods, clinical differential diagnostic features of bacterial corneal ulcers.&#x0D; A wide variety of objective symptoms characterizes the clinical picture of bacterial corneal ulcers. Still, objective differential diagnostic signs make it possible with a high degree of probability to assume the etiology of the disease during the first biomicroscopy and immediately begin etiotropic therapy, on the timing of which the outcome of the disease depends.&#x0D; Standard laboratory examination of patients with bacterial corneal ulcers includes the bacterioscopic and cultural examination of the contents of the conjunctival sac. However, the absence of etiotropic therapy while waiting for the results of microbiological research methods, which takes from 3 to 7 days, contributes to the rapid progression of the disease, the development of endophthalmitis, and corneal perforation, up to the loss of an eye in children. In this regard, treatment must be started immediately. Therefore, the choice of a drug is determined not only by the causative agent, proven laboratory but, first of all, based on clinical differential diagnostic signs of the disease.&#x0D; The traditional, undeniable approach to the conservative treatment of bacterial corneal ulcers is conventional etiotropic therapy using local and systemic antibacterial drugs. In addition, timely intensive specific drug therapy prevents the destruction of all layers of the cornea, and the use of metabolic drugs that improve regeneration and trophism promotes epithelialization of corneal ulcers.&#x0D; Attention should be given to the necessity and validity of the choice of antibacterial drugs for various etiological forms of bacterial corneal ulcers in children. An individual approach is a basis for effective antibiotic therapy in pediatric ophthalmology.&#x0D; The article presents an up-to-date review of publications and modern algorithms for treating bacterial corneal ulcers in children, the main causative agents of which are: Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Neisseria gonorrhoeae.

Intraocular Foreign Bodies: Clinical Characteristics and Factors Affecting Visual Outcome.

Objective To investigate the clinical characteristics and factors affecting visual outcome in patients with intraocular foreign bodies (IOFBs) and determine the risk factors for the development of endophthalmitis. Study Design. A retrospective case-series study design was adopted. Subjects In total, 242 patients (242 eyes) who were hospitalized and underwent surgical treatment for IOFB at the Second Hospital of Hebei Medical University between January 1, 2008, and December 31, 2019, were included. Methods The demographic data, cause of injury, characteristics of IOFBs, postinjury ocular manifestations, and surgical details of the subjects were collected, and the factors affecting visual outcome and endophthalmitis development were analyzed. Results The most common cause of IOFBs was the propulsion of foreign bodies into the eye due to hammering (149 cases, 61.57%), followed by foreign body penetration (57 cases, 23.55%). Most of the subjects were young adult men who sustained injuries in the work environment. Poorer visual outcomes were found in subjects with initial presenting symptoms visual acuity (PVA) < 0.1, largest IOFB diameter ≥ 3 mm, IOFBs located in the posterior segment, wound length > 5 mm, entrance wound length larger than the largest IOFB diameter, concomitant retinal detachment, concomitant vitreous hemorrhage, concomitant endophthalmitis, and concomitant proliferative vitreoretinopathy (PVR). Factors related to the development of endophthalmitis included lens capsule rupture, time of stage 1 repair surgery ≥ 24 h after trauma, removal of IOFBs ≥ 24 h after trauma, and nonadministration of intravitreal antibiotic injection. Conclusion Among patients with IOFBs, initial PVA < 0.1, entrance wound length larger than the largest IOFB diameter, concomitant endophthalmitis, and concomitant PVR were risk factors for poor visual outcomes. Lens capsule rupture was a risk factor for endophthalmitis development, and the administration of intravitreal antibiotic injection was a protective factor against endophthalmitis development.

CLINICAL OUTCOMES AND TREATMENT COURSE OF EYES WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION FOLLOWING THE DEVELOPMENT OF ENDOPHTHALMITIS.

To evaluate the clinical course of patients with neovascular age-related macular degeneration (nAMD) after developing endophthalmitis during their treatment with intravitreal injections. Multicenter, retrospective series. From April 2013 to October 2018, 196,598 intravitreal anti-vascular endothelial growth factor (VEGF) injections were performed, with 75 cases of endophthalmitis (incidence 0.0381%). There was no association between intravitreal anti-VEGF drug (P = 0.29), anesthetic method (P = 0.26), povidone concentration (P = 0.22), or any intraprocedure variable and endophthalmitis incidence. Seventy-two patients (96%) were treated with intravitreal tap and inject , while 3 underwent immediate pars plana vitrectomy. After endophthalmitis resolution, 17 patients (22.7%) were not re-treated for nAMD (in 10 cases due to inactive disease; follow-up, 115 ± 8.4 weeks). Patients required less frequent anti-VEGF injections after infection (7.4 ± 0.61 weeks vs. 11.5 ± 1.8 weeks; P = 0.004). Preinfection logarithm of the minimum angle of resolution visual acuity was 0.585 ± 0.053 (∼20/77). It worsened with endophthalmitis (1.67 ± 0.08, ∼20/935; P < 0.001) and again on postendophthalmitis treatment day 1 (1.94 ± 0.064; count fingers; P < 0.001), but improved after reinitiating nAMD therapy (1.02 ± 0.11; ∼20/209; P < 0.001). Better visual acuity on postendophthalmitis week 1 (P = 0.002) and reinitiation of nAMD treatment (P = 0.008) were associated with better final visual acuity, and streptococcal culture with worse visual acuity (P = 0.028). The postendophthalmitis treatment interval was associated with the anti-VEGF drug used (aflibercept = ranibizumab > bevacizumab; P < 0.001). Patients with nAMD required fewer injections after endophthalmitis, suggesting a biological change in disease activity. Neovascular age-related macular degeneration became quiescent in 13.3% of eyes. Most achieved better outcomes with anti-VEGF reinitiation.

Risk Factors for Endophthalmitis Following Open Globe Injuries: A 17-Year Analysis.

Background/AimsTo determine the rate of endophthalmitis and assess risk factors for development of endophthalmitis following open globe injury (OGI).MethodsA retrospective chart review of all patients treated for OGI at the University of Michigan from January 2000 to July 2017 was conducted. Exclusion criteria included intravitreal injection or intraocular surgery in the 30 days prior to injury or less than 30 days of follow-up. A total of 586 out of 993 open globe injuries were included in the study. The main outcome measure was the rate of endophthalmitis.ResultsIn this study, 25/586 eyes (4.3%) had endophthalmitis. Of these, 12/25 eyes (48.0%) presented with endophthalmitis and 13/25 eyes (52.0%) developed endophthalmitis after globe closure. Multivariate analysis identified time to globe repair (OR 4.5, CI 1.9–10.7, p = 0.0008), zone I injury (OR 3.6, CI 1.1–11.0, p = 0.0282), and need for additional surgery (OR 5.5, CI 1.5–19.7, p = 0.0092) as factors associated with increased risk of developing endophthalmitis. Subconjunctival antibiotic injection at the time of globe closure (OR 0.3, CI 0.1–0.7, p = 0.0036) was associated with decreased risk of developing endophthalmitis.ConclusionPrompt globe closure and subconjunctival antibiotics may reduce the risk of endophthalmitis in OGI. Furthermore, our practice of a one-time dose of systemic prophylactic antibiotics, and intravitreal antibiotics if intraocular foreign body (IOFB) removal is delayed, was not found to increase the rate of endophthalmitis.