Incidence Of Endophthalmitis Research Articles

Incidence and Predictive Risk Factors for Post-Cataract Surgery Endophthalmitis in Ministry of Health Hospitals from 2012 to 2020

ABSTRACT Purpose Postoperative endophthalmitis is a devastating complication, leading to poor visual prognosis. The purpose of this study is to determine the incidence, risk factors, and visual outcome of post-cataract surgery endophthalmitis in Malaysia over a 9-year period (2012–2020). Methods Data from National Eye Database (NED), involving all patients who have undergone cataract surgery from January 2012 until December 2020 were analyzed. Results Total number of patients who had undergone cataract surgery between the year 2012 till 2020 were 231,281 patients (267,781 eyes). Incidence of POE in this population was 0.08%. Patient aged 70 and above (p-value 0.047), Malay ethnicity (p-value: 0.009), presence of ischemic heart disease, renal failure, diabetic retinopathy, and poorer preoperative vision were shown to have a higher risk of POE. Cataract surgeries done in KK-KKM, duration more than 45 minutes, use of general anaesthesia, and no IOL or ACIOL implantation were significantly more in POE patients. Multivariate analysis revealed Malay ethnicity, presence of ocular comorbidity, poor preoperative vision, ACIOL, and presence of intra-operative complication were predictive factors for POE. Conclusions Incidence of POE is low in the Malaysian population. Surgeons have to be aware that Malay ethnicity, presence of ocular comorbidity, poor preoperative visual acuity, placement of IOL and complicated cataract operation have higher risk of POE.

Bacterial endophthalmitis following anti-VEGF intravitreal injections: a retrospective case series

BackgroundTo describe the incidence of endophthalmitis and the treatment outcomes of acute bacterial endophthalmitis following intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in a Brazilian hospital. The analysis was based on the timing of infection after intravitreal injection, culture results, visual acuity, and the presence of epiretinal membrane after a 1-year follow-up period, spanning nine years.MethodsThis retrospective case series, conducted over a 9-year period, aimed to evaluate the treatment outcomes of acute endophthalmitis following intravitreal Bevacizumab injections. The inclusion criteria involved a chart review of 25 patients who presented clinical signs of acute endophthalmitis out of a total of 12,441 injections administered between January 2011 and December 2019. Negative culture results of vitreous samples or incomplete data were excluded. Ultimately, 23 patients were enrolled in the study. Eight patients were treated with intravitreal antibiotic injections (IVAI) using vancomycin 1.0 mg/0.05mL and ceftazidime 2.25 mg/0.05mL, while 15 patients underwent pars plana vitrectomy (PPV) followed by intravitreal antibiotic injections at the end of surgery (IVAIES). The main outcome measures were the efficacy of controlling the infection with IVAI as a standalone therapy compared to early PPV followed by IVAIES. Data collected included pre-infection and one-year post-treatment best corrected visual acuity (BCVA), optical coherence tomography (OCT) abnormalities, and enucleation/evisceration rates. To compare groups, Mann-Whitney and ANOVA tests were employed for statistical analysis.ResultsThe incidence rate of bacterial endophthalmitis was 0.185% (1/541 anti-VEGF injections), with the highest infection rates observed in 2014 and 2017. Patients presented clinical symptoms between 2 and 7 days after injection. The most common isolated organisms were coagulase-negative Staphylococci and Streptococci spp. Treatment outcomes showed that both IVAI and PPV + IVAIES effectively controlled the infection and prevented globe atrophy. After one year, the PPV group with BCVA better than Light Perception had a significantly better BCVA compared to the IVAI group (p 0.003). However, PPV group had higher incidence of epiretinal membranes formation compared to the IVAI group. (P 0.035)ConclusionAnti-VEGF injections carry a risk of developing acute bacterial endophthalmitis. Isolated antibiotic therapy could be an effective treatment to control the infection, but performing PPV + IVAIES as a primary treatment showed promising results in terms of improving BCVA after one year, despite a higher rate of epiretinal membrane formation. Further studies are needed to confirm these findings.

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.

Incidence, Causes, and Management of Post Vitrectomy Endophthalmitis: A Metaanalysis Study

Background Endophthalmitis is a rare but severe form of ocular inflammation due to infection of the intraocular cavity that can lead to irreversible visual loss if not treated properly and timely. Clinical features of endophthalmitis following PPV (Pars Plana Vitrectomy) are similar to those of endophthalmitis following cataract surgery. Some cases, however, may demonstrate a delayed presentation. Objective To do a meta-analysis of studies to know the incidence, causes, and management of post vitrectomy endophthalmitis. Patients and Methods The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis) statement 2009 PRISMA (Preferred Reporting Itims for Systematic Reviews and Meta analysis). Results Electronic search yielded 306 articles from two databases. After duplicates removal, 102 articles were screened in title/abstract screening, while 33 articles were screened in full text screening for inclusion. Finally, 18 articles were included in qualitative and quantitative meta-analysis. The manual search resulted in no additional studies. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion The overall incidence of post-PPV endophthalmitis across all studies was low. More recent data indicate that using 25 gauge needle during vitrectomy was significantly has the highest endophthalmitis incidence rate than others. While using 20 gauge needle during vitrectomy was significantly has the lowest endophthalmitis incidence rate than others. Vitreoretinal surgeons need to pay close attention especially when performing 25 G PPV, including a meticulous sclerotomy preparation, balancing the potential benefits of nonfluid tamponade, and removing all vitreous wicks, to reduce the risk of endophthalmitis.

Lowering the Incidence of Endophthalmitis Following Intravitreal Anti-VEGF Injection: An Analysis of Aseptic Protocol Adjustment.

The impact of anti-sepsis-anesthesia sequence in intravitreal injection (IVI)-associated endophthalmitis is unknown. We compared outcomes of patients who had 10% topical povidone-iodine before or after 2% topical lidocaine gel during IVIs. A retrospective study of IVIs in nine clinical sites was undertaken. Group 1 had lidocaine gel applied first. This protocol was changed on March 1, 2020, with Group 2 having povidone-iodine applied first. Visual and micro-biological outcomes were compared. Among 72 cases (0.07%) from 102,908 IVIs, Group 1 had 59 cases from 65,307 IVI (0.09%) and Group 2 had 13 cases from 37,601 IVI (0.03%; P = 0.001). There was no significant difference in the best-corrected visual acuity between groups. Highly virulent bacteria were predominantly isolated in Group 1, but proportions of gram-positive bacterial growth were similar. Application of povidone-iodine before lidocaine gel, compared to after, significantly decreased rate of IVI endophthalmitis, with no significant changes in visual and microbiological outcomes. [Ophthalmic Surg Lasers Imaging Retina 2023;54:520-525.].

The Preventive Effect of Gentamicin in the Irrigating Solution on Endophthalmitis Caused by Methicillin-Resistant Staphylococcus epidermidis After Phacoemulsification with Intraocular Lens Implantation in Rabbits

ABSTRACT Objective To analyze the effect of gentamicin in the irrigating solution on endophthalmitis caused by methicillin-resistant Staphylococcus epidermidis after phacoemulsification with intraocular lens implantation. Methods Fifteen rabbits were randomly assigned into three groups. During surgery, group A was irrigated with gentamicin-free solution and injected with 100 μL of normal saline postoperatively, group B was irrigated with 80 μg/mL gentamicin and injected with 100 μl of MRSE suspension, group C was irrigated with gentamicin-free solution and injected with 100 μl of MRSE suspension. At different times, corneal endothelial cell count (CEC), inflammation grading，B-scan ultrasonography and histological examination were analyzed. Results No endophthalmitis occurred in groups A and B. Group C developed severe endophthalmitis, with massive inflammatory exudation in the vitreous cavity. Conclusion Irrigating solution containing gentamicin is favorable to reduce the incidence of MRSE endophthalmitis after phacoemulsification with IOL in rabbits.

Intravitreal Injections and Face Masks: Endophthalmitis Risk Before and During the COVID-19 Pandemic.

To assess the added risk of acute endophthalmitis after intravitreal injections associated with the widespread use of face masks during the COVID-19 pandemic. In this retrospective, single-center study, records of patients with acute endophthalmitis following intravitreal bevacizumab (IVB) injections during the pre-COVID era-that is, March 1, 2013 to October 31, 2019 -and the COVID-19 era-that is, March 1, 2020 to April 1, 2021 -were reviewed and compared. A total of 28,085 IVB injections were performed during the pre-COVID era; nine eyes of nine patients developed acute post-IVB endophthalmitis in this era, giving an overall incidence of 0.032% (3.2 in 10,000 injections). In the COVID era, 10,717 IVB injections were performed; four eyes of four patients developed acute post-IVB endophthalmitis in this era, giving an overall incidence of 0.037% (3.7 in 10,000 injections). The incidences of post-IVB endophthalmitis during these two eras were not statistically significantly different (P = 0.779). Face masking protocols seem unlikely to impose any additional risk of post-IVB endophthalmitis.

Studying the effect of preoperative topical antibiotic drops on anterior chamber contamination after phacoemulsification

Objective Despite the application of aseptic protocols and the technical improvements of intraocular surgery, acute endophthalmitis is still noticed after cataract surgery. Presurgical prophylaxis was suggested to reduce the incidence of postcataract endophthalmitis. However, there is no clear protocol to follow. Aim The current study aimed to investigate the effect of preoperative topical antibiotics on anterior segment contamination in patients with cataract after phacoemulsification or phacotrabeculectomy. Patients, methods, and analysis The study enrolled 55 patients who underwent phacoemulsification or phacotrabeculectomy and intraocular lens implantation; 28 patients have used preoperative antibiotic drops (moxifloxacin 0.3%), and 27 patients did not use antibiotics. Anterior chamber (AC) aspirates were collected to determine the anterior segment microbial profile using microscopic examination and microbial cultures. Results All AC aspirates (100%) of the first group did not show any microbial growth on any culture media. However, bacterial growth was noted in three (11.1%) aspirates of the second group when cultured on blood, chocolate agar, and thioglycolate broth. Microscopic examination revealed Klebsiella pneumoniae, Escherichia coli, and Bacillus subtilis. All aspirates did not show any growth on Sabouraud dextrose agar. All patients were followed up after 1 day, 1 week, 1 month, and 3 months. Their ophthalmologic examinations were free of any abnormities. Conclusion Despite taking all the precautionary measures dictated by best practice guidelines for cataract surgery, there is minimal risk of AC bacterial contamination. Thus, the application of preoperative topical antibiotic drops is recommended for all cases.

Complement inhibitors for age-related macular degeneration.

Complement inhibitors for age-related macular degeneration.

Relationship between surgical field contamination by patient's exhaled air and the state of the drapes during eye surgery

The coronavirus disease (COVID-19) pandemic has led to a dramatic increase in facemask use. Consequently, it has been reported that exhaled airflow toward the eyes can cause the dispersal of bacteria into the eyes, potentially increasing the incidence of postoperative endophthalmitis. In addition to wearing a facemask, gaps between the surgical drape and skin can also direct exhaled airflow toward the eyes. Here, we aimed to examine how the risk of contamination varies depending on the state of the drapes. We used a carbon dioxide imaging camera to visualize changes in exhaled airflow under different drape conditions and a particle counter to evaluate changes in the number of particles around the eye. The results revealed airflow present around the eye and a significant increase in the number of particles when the nasal side of the drape was detached from the skin. However, when a metal rod called “rihika” was used to create space above the body, the airflow and number of particles were significantly reduced. Thus, if drape coverage becomes incomplete during surgery, exhaled airflow toward the eye may contaminate the surgical field. On hanging up the drape, airflow can escape in the direction of the body, potentially preventing contamination.

Reduced Incidence of Intravitreal Injection-Related Endophthalmitis With Prefilled Syringes.

Purpose: To evaluate the incidence and clinical characteristics of intravitreal injection-related endophthalmitis cases with antivascular endothelial growth factor (anti-VEGF) medications manufactured as prefilled syringes or non-prefilled preparations. Methods: This retrospective chart review comprised eyes that received intravitreal anti-VEGF at a single-specialty retina practice from January 1, 2014, to December 31, 2019. Eyes diagnosed with injection-related endophthalmitis were identified. Demographic and clinical data were abstracted from medical records, including the type of anti-VEGF agent, baseline and follow-up corrected visual acuity (VA), and microbiologic findings. Results: The review identified 88 cases of intravitreal anti-VEGF injection-related endophthalmitis and 325 990 total injections. Total injections included 32 045 (9.8%) bevacizumab (BEV), 93 073 (28.6%) ranibizumab (RAN), 122 947 (37.7%) aflibercept (AFL), and 77 925 (23.9%) ranibizumab prefilled syringe (RANPFS). Ten of the endophthalmitis cases were related to BEV, 21 to RAN, 45 to AFL, and 12 to RANPFS. The endophthalmitis rate was lowest for RANPFS (0.0154%) (BEV, 0.0312%; RAN, 0.0226%; AFL, 0.0366%) (P = .030). Thirty-four (41.5%) of 82 samples were culture positive. RANPFS had a significantly lower rate of culture-proven postinjection endophthalmitis than the other agents (P = .003). The mean VA for endophthalmitis cases related to RANPFS vs non-prefilled agents was similar at presentation (Snellen 20/2092 vs 20/2327) and at the 3-month follow-up (Snellen 20/201 vs 20/272) (both P > .05). Conclusions: Anti-VEGF medications in prefilled syringes may reduce the risk for medication contamination during injection preparation. RANPFS was associated with a lower rate of injection-related endophthalmitis than non-prefilled anti-VEGF medications.

Endogenous Endophthalmitis From a Klebsiella pneumoniae Liver Abscess: The Incidence, Risk Factors, and Utility of Imaging

We investigated the rate of ophthalmologic examinations to detect endogenous endophthalmitis in patients with pyogenic liver abscesses (PLAs) and the incidence and risk factors of endophthalmitis from a PLA caused by Klebsiella pneumoniae (PLA-K). A retrospective case series METHODS: A total of 536 patients admitted to a university hospital in Korea, to treat PLAs during 2012-2022 were primarily included. The proportion of patients who were referred for ophthalmologic examinations was investigated and the incidence of endophthalmitis in 248 patients with PLA-K was calculated. Univariate and multivariate logistic regression analyses were performed to define risk factors including demographic characteristics, underlying diseases, radiological findings, and systemic conditions. A comprehensive ophthalmologic examination was performed in 73.7% of all patients with PLAs, and the incidence of endophthalmitis from a PLA-K was 7.3%. A liver abscess larger than 5 cm in size increased the incidence of endogenous endophthalmitis 4-fold compared to smaller abscesses (OR=4.01, 95% CI=1.02 - 15.78, P=.047), and portal or hepatic vein thrombophlebitis increased the incidence approximately 4-fold (OR=4.04, 95% CI=1.10 - 14.83, P=.036). Acute cholangitis was approximately 8-fold (OR=8.33, 95% CI=1.25 - 55.71, P=.029), and disseminated intravascular coagulation (DIC) was approximately 6-fold (OR=5.76, 95% CI=1.22 - 27.21, P=.027) more related to prevalence of endophthalmitis. Other extrahepatic infections increased the incidence approximately 43-fold (OR=43.06, 95% CI=10.14 - 182.90, P < .001). . Clinicians should consider the risk of endogenous endophthalmitis when PLA-K patients have large liver abscesses (> 5 cm), acute cholangitis, portal or hepatic vein thrombophlebitis, DIC, or other extrahepatic infections.

Influence of discontinuation of prophylactic antimicrobial agent for trabeculectomy

BackgroundThere is no unified view of the necessity of prophylactic antimicrobial agents in trabeculectomy. Preoperative prophylactic antimicrobial agent injection and cefazolin sodium (CEZ) for trabeculectomy were discontinued at the Hiroshima University Hospital. In this study, we evaluated whether discontinuation of preoperative administration of CEZ in ophthalmology affects the incidence of postoperative infections.MethodsWe retrospectively investigated patient background, concomitant medications, subconjunctival dexamethasone sodium phosphate (DEX) injection at the end of the surgery, and the incidence of infective endophthalmitis within 6 weeks after surgery in the CEZ and non-CEZ groups. We also performed propensity score matching for background matching. Statistical analysis was performed using the Mann-Whitney U-test and Fisher’s exact test.ResultsThe incidence of postoperative endophthalmitis was not significantly different between 629 and 751 patients in the CEZ and no-CEZ groups, respectively (0 in the CEZ group and 2 in the no-CEZ group, P = 0.504). More patients in the CEZ group were taking diabetes drugs preoperatively (P = 0.028) and fewer patients were receiving subconjunctival DEX at the end of surgery (P < 0.001) than those in the non-CEZ group. Propensity scores were calculated using the risk factors for postoperative infection as covariates, and matching (580 patients in the CEZ group and 580 patients in the non-CEZ group) showed no significant difference in the incidence of postoperative endophthalmitis (P = 0.500).ConclusionsThere was no significant difference in the incidence of endophthalmitis after trabeculectomy between the CEZ and non-CEZ groups, suggesting a decreased need for CEZ injections before trabeculectomy.

Incidence and Clinical Course of Acute Endophthalmitis after Idiopathic Epiretinal Membrane Surgery with Microincision Vitrectomy

Purpose: To investigate the incidence and clinical course of acute endophthalmitis after idiopathic epiretinal membrane (iERM) surgery employing microincision vitrectomy (MIVS).Methods: We retrospectively reviewed the medical records of eyes with acute endophthalmitis developing after iERM surgery via 23- or 25-gauge MIVS from 2011 to 2021. The incidence, culture-positive rate (and responsible bacteria), final visual acuity (VA), and factors affecting poor visual outcomes were assessed.Results: Acute endophthalmitis developed in 20 of the 12,921 eyes (0.15%) after MIVS. Of these, 14 of 3,180 eyes treated via iERM (0.44%, one per 227 procedures) developed endophthalmitis; the incidence ratio (iERM versus non-iERM) was 7.1 (p &lt; 0.001, 95% confidence interval [CI] = 2.6-22.7). At least one sclerotomy remained unsutured in all eyes after iERM surgery. Thirteen eyes (92.9%) were given intravitreal antibiotic injections after emergency vitrectomy, and one eye was treated with intravitreal antibiotic injection alone. Staphylococcus epidermidis was cultured from four eyes (28.6%); three strains were methicillin-resistant. All final VAs were not better than the initial VAs; the average VA decreased from 20/42 to 20/259 (p &lt; 0.001). Six eyes (42.9%) attained legal blindness status (final VA &lt; 20/200); Macular invasion was a unique risk factor for such blindness (p = 0.020, odds ratio = 35.0, 95% CI = 1.7-703.0).Conclusions: Acute endophthalmitis developing after iERM surgery with MIVS was more common than such endophthalmitis after other retinal surgery. Approximately 40% of the former patients became legally blind, and the risk was higher in eyes with macular involvement of endophthalmitis.

Comparison of the Effectiveness of Levofloxacin Eye Drop 0.5% and Povidone-Iodine 2.5% Against Conjunctival Normal Flora Bacterial Colonies in Intraocular Preoperative Procedures

Introduction: Endophthalmitis is the most severe ocular complication and often causes blindness. The incidence of endophthalmitis varies depending on the type of surgery performed, from 0.082% to 0.32%. The use of povidone-iodine and topical antibiotics on the conjunctiva has been reported to reduce the likelihood of postoperative infection. This study aimed to compare the effectiveness of levofloxacin ED 0.5% with povidone-iodine 2.5% in reducing the normal bacterial flora of the conjunctiva in intraocular preoperative procedures.&#x0D; Methods: Clinical trial experimental studies. A total of 34 research subjects participated in this study. The research subjects were grouped into treatment groups of 0.5% levofloxacin and 2.5% povidone-iodine. Analysis of differences in the number of bacterial colonies was carried out with the help of bivariate SPSS software.&#x0D; Results: Treatment with levofloxacin 0.5% eye drop was able to reduce the number of colonies by 78.11%, while treatment with povidone-iodine 2.5% was able to reduce the number of colonies by 68.57%.&#x0D; Conclusion: Levofloxacin 0.5% eye drop is superior in reducing the number of conjunctival bacterial colonies in intraocular preoperative procedures compared to 2.5% povidone-iodine.

Association between Aphakia and Endophthalmitis after Pediatric Cataract Surgery

Endophthalmitis is a rare but devastating complication of cataract surgery. The IRIS® Registry (Intelligent Research in Sight) reported a significantly higher incidence of endophthalmitis in children compared with adults (0.37% vs. 0.04%). Other studies have reported rates of 0.45% and 0.51%, 1 Pershing S. Lum F. Hsu S. et al. Endophthalmitis after cataract surgery in the United States: a report from the Intelligent Research in Sight Registry, 2013-2017. Ophthalmology. 2020; 127: 151-158 Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar , 2 Nguyen A.M. Roberts T.L. Ryu W.Y. Lambert S.R. Endophthalmitis after pediatric cataract surgery in the United States: report using an insurance claims database. J Cataract Refract Surg. 2021; 47: 1161-1166 Crossref PubMed Scopus (3) Google Scholar , 3 Good W.V. Hing S. Irvine A.R. et al. Postoperative endophthalmitis in children following cataract surgery. J Pediatr Ophthalmol Strabismus. 1990; 27: 283-285 Crossref PubMed Google Scholar , 4 Lacy M. Hung T.P.H. Own J.P. et al. Endophthalmitis rate in immediately sequential versus delayed sequential bilateral cataract surgery within the Intelligent Research in Sight (IRIS) Registry Data. Ophthalmology. 2022; 129: 129-138 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar but associated factors remain largely unknown. The purpose of this study was to assess factors associated with endophthalmitis after pediatric cataract surgery using a large claims database.

The effect of topical antibiotic use on the incidence of endophthalmitis after intravitreal injection

The effect of topical antibiotic use on the incidence of endophthalmitis after intravitreal injection

Incidence rate and clinical characteristics of acute endophthalmitis following 23-gauge pars plana vitrectomy

PurposeIn this study, we evaluated the incidence and clinical characteristics of post-vitrectomy acute endophthalmitis in a tertiary eye center.MethodsData were obtained by reviewing the patients’ medical records who underwent primary pars plana vitrectomy (PPvitx) from September 2011 to March 2017. We excluded patients who had any ocular surgery in the past 6 months, immunocompromised patients, and patients with a pre-operative diagnosis of endophthalmitis. The primary outcome was the incidence of acute post-pars plana vitrectomy endophthalmitis.ResultsOut of 6474 cases who underwent PPvitx, 12 cases of endophthalmitis (incidence rate of 0.18%) were identified. We found two positive cultures for staphylococcus epidermidis and one positive culture for staphylococcus aureus. Underlying causes of primary vitrectomy in patients who got endophthalmitis were diabetic retinopathy (8 cases), rhegmatogenous retinal detachment (2 cases), and the epiretinal membrane (1 case), and non-clearing vitreous hemorrhage secondary to central retinal vein occlusion (1 case).ConclusionIn the present study, the rate of post-vitrectomy acute endophthalmitis was higher than in other reported studies.

Endophthalmitis prophylaxis in cataract surgery and intravitreal injection in Europe

AbstractEndophthalmitis is a significant complication of cataract surgery and intravitreal injections (IVI), leading in severe cases to blindness. The improvements of surgical technology, techniques and procedures have significantly reduced the incidence of postoperative infections in recent years; however, it is impossible to eliminate this problem completely. The incidence of post‐cataract endophthalmitis varies among several countries from 0.03% to 0.7%. The recommendations of the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO), have set the maximum acceptable level of postoperative endophthalmitis (POE) after cataract extractions at 0.05%. Awareness about risk factors and prevention measures is necessary for ophthalmic surgeons. Surgical complications (wound leak, posterior capsule rupture, vitreous loss or zonular complications) are related with higher incidence of postoperative endophthalmitis. Elderly patients (&gt;85 years), those with clear corneal incisions versus scleral tunnel incisions, and those without intracameral injection of cefuroxime have also a higher risk of infection.The available evidence suggests that intracameral antibiotic lowers the POE. Of the two most commonly used IC antibiotics, moxifloxacin and cefuroxime, there is no clear evidence that one is better than the other. Vancomycin is not recommended for routine ICAP because of both the risk of HORV (extremely low) and concerns regarding the use of an indispensable agent to treat multi‐drug‐resistant endophthalmitis as routine prophylaxis. Topical antibiotics may not provide an additional benefit, as has been suggested by several studies.In IVI, perioperative antibiotics cannot be considered the standard of care, as there is no evidence of prophylactic effects with regard to POE when using perioperative antibiotics. Topical administrations of 5% povidone‐iodine over at least 30 s into the conjunctival sac is recommended. Current clinical practices include minimized physician/patient talking during IVI, wearing of surgical face masks, and using face masks for nurses, technicians and physicians.

Bacterial and sterile endophthalmitis after intravitreal injections, treatment options and outputs: literature review

Ieva Kunickaitė1 1Vilnius University, Faculty of Medicine, Vilnius, Lietuva Abstract Introduction. In the last 2 decades, vitreous injections have become increasingly used in treatment of intraocular diseases, especially posterior segment disorders. It is estimated that 5.9 million of these injections were performed in the United States alone in 2016, and that number is growing at least 10% annually. Acute bacterial or sterile endophthalmitis can occure after intravitreal injections. Aim. Based on the latest scientific literature, summarize and present information on the occurrence of bacterial and sterile endophthalmitis after vitreous injections, treatment options and outcomes. Methods. The literature review was performed using PubMed and ScienceDirect databases. Scientific articles were analyzed by keywords and their combinations: bacterial endophthalmitis, sterile endophthalmitis, intravitreal injections. Exclution criteria were applied to articles related to fungal endophthalmitis. 23 publications were examined. Only articles written in English were selected. Results. ​​The incidence of endophthalmitis of vascular endothelial growth factor inhibitors (anti-VEGF) is 0,131%. The incidence of sterile endophthalmitis after intravitreal injections is uncommon, ranging from 0.09% to 1.1%. The primary treatment for endophthalmitis is vitreous injection of antibiotics and / or pars plana vitrectomy (PPV). Conclusions. The main clinical differences between bacterial and sterile endophthalmitis are the onset of endophthalmitis (bacterial usually occurs more than 3 days after intervention and sterile within the first 3 days) and the absence of eye pain in sterile endophthalmitis. It has been reported in the literature that sterile endophthalmitis usually resolves spontaneously, but antimicrobial therapy with PPV is used as the disease progresses. Keywords. Bacterial endophthalmitis, sterile endophthalmitis, intravitreal injections.