Incidence Of Endophthalmitis Research Articles

Endophthalmitis Rate in Immediately Sequential versus Delayed Sequential Bilateral Cataract Surgery within the Intelligent Research in Sight (IRIS®) Registry Data

To compare the rate of postoperative endophthalmitis after immediately sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS) using the American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry database. Retrospective cohort study. Patients in the IRIS Registry who underwent cataract surgery from 2013 through2018. Patients who underwent cataract surgery were divided into 2 groups: (1) ISBCS and (2) DSBCS (second-eye surgery ≥1 day after the first-eye surgery) or unilateral surgery. Postoperative endophthalmitis was defined as endophthalmitis occurring within 4 weeks of surgery by International Classification of Diseases (ICD) code and ICD code with additional clinical criteria. Rate of postoperative endophthalmitis. Of 5 573 639 IRIS Registry patients who underwent cataract extraction, 165 609 underwent ISBCS, and 5 408 030 underwent DSBCS or unilateral surgery (3 695 440 DSBCS, 1 712 590 unilateral surgery only). A total of 3102 participants (0.056%) met study criteria of postoperative endophthalmitis with supporting clinical findings. The rates of endophthalmitis in either surgery eye between the 2 surgery groups were similar (0.059% in the ISBCS group vs. 0.056% in the DSBCS or unilateral group; P= 0.53). Although the incidence of endophthalmitis was slightly higher in the ISBCS group compared with the DSBCS or unilateral group, the odds ratio did not reach statistical significance (1.08; 95% confidence interval, 0.87-1.31; P= 0.47) after adjusting for age, sex, race, insurance status, and comorbid eye disease. Seven cases of bilateral endophthalmitis with supporting clinical data in the DSBCS group and no cases in the ISBCS group were identified. Risk of postoperative endophthalmitis was not statistically significantly different between patients who underwent ISBCS and DSBCS or unilateral cataract surgery.

Postoperative Endophthalmitis in Immediate Sequential Bilateral Cataract Surgery: A Nationwide Registry Study

To report the incidence of postoperative endophthalmitis (PE) after immediate sequential bilateral cataract surgery (ISBCS) in Sweden. Retrospective cohort registry study. Patient data from 1 457 172 cataract extractions, including 1 364 934 unilateral surgeries and 92 238 ISBCSs. Endophthalmitis cases reported to the Swedish National Cataract Register (NCR) during a 16-year period (2002-2017) were analyzed in comparison to all control cases with regard to patient characteristics, surgical technique, and capsule complication. Incidence and determinants for PE in ISBCS compared with unilateral surgeries. A total of 422 cases of PE were identified in 1 457 172 cataract extractions, yielding an overall incidence of 0.029% (95% confidence interval [CI], 0.0262-0.0317). For unilateral procedures, the rate was 0.0299% (95% CI, 0.0270-0.0328) or 408 cases in 1 364 934 operations, whereas that for ISBCS was 0.0152% (95% CI, 0.0072-0.0231) or 14 incidents in 92 238 operations (P= 0.01). In a logistic regression model including all cataract procedures, nonuse of intracameral (IC) antibiotics (ABs), capsule complication, age 85 years or more, male gender, and ocular comorbidity were found to be independent risk factors for PE. All these parameters were less frequent in ISBCS. Notwithstanding, in the same multivariate analysis, ISBCS in itself was associated with asignificantly lower risk for PE. At follow-up, 5 of the 14 PE cases in the ISBCS cohort had a visual acuity (VA) of 20/200 or worse. Of these, one 93-year-old ISBCS patient developed bilateral infection. After ISBCS in Sweden, PE occurred once in 6600 surgeries. The risk of sustaining a final VA of 20/200 or less was 1 incident in 18 000 operated eyes. When counseling potential ISBCS patients about the risk of PE, it seems reasonable to state that the reported risk in the literature is lower than that with unilateral surgery but not negligible. Precautions remain necessary.

Outcomes of Management of Glaucoma in Phacomatosis Pigmentovascularis Over the Last Three Decades: A Single-Center Experience

To report the clinical outcomes of glaucoma management in patients with phacomatosis pigmentovascularis (PPV) treated over a period of 3 decades. Retrospective cohort study. Fifty-five eyes of 38 patients (21 unilateral and 17 bilateral) with glaucoma in PPV managed at one institution between January 1990 and December 2019 with a minimum follow-up of 1 year. Medical records of children with glaucoma in PPV were reviewed, and demographic and clinical data were collected. Surgical interventions included primary combined trabeculotomy-trabeculectomy (CTT), trabeculectomy with mitomycin C (MMC), and transscleral cyclophotocoagulation (TSCPC). Complete success was defined as intraocular pressure (IOP) ≥ 6 and ≤ 16 mmHg without medications and qualified success as IOP≤ 16 mmHg with the use of up to 2 medications. Intraocular pressure, best-corrected visual acuity (BCVA), corneal clarity, antiglaucoma medications at preoperative and postoperative visits (last visit), and complications. Median age was 4 months (range, 0.2-252 months) at the time of glaucoma surgery. Thirty-nine eyes (74%) had primary CTT, 10 eyes (19%) had trabeculectomy with MMC, and 4 eyes (7%) with advanced glaucoma had TSCPC. Two eyes (3.6%) received medical treatment. Preoperative IOP reduced from a mean of 25.7 ± 8.4 mmHg on 0.8 ± 0.6 medications to 14.6 ± 5.2 mmHg on 0.4 ± 0.5 medications (P < 0.0001) at last follow-up after surgery (77.7 ± 56.5 months). Thirty-seven eyes (67.3%) required medications preoperatively, and 22 eyes (40%) required medications at the last follow-up. Of 25 patients with available BCVA at last follow-up, 9 (36%) had ≥ 20/60; of these, 6 had > 20/40. Four of 10 eyes that underwent trabeculectomy with MMC developed retinal detachment and were managed surgically; however, all of these eyes had poor visual outcomes. There was no incidence of bleb leakage, bleb-related infection, or endophthalmitis. Combined trabeculotomy-trabeculectomy is safe and effective as a primary procedure for management of glaucoma in PPV. Trabeculectomy augmented with MMC as a second procedure was associated with a higher rate of complications.

Economic burden of age-related macular degeneration in routine clinical practice: the RAMDEBURS study

PurposeTo describe and evaluate the main direct health costs, in routine clinical practice, of age-related macular degeneration (AMD) patients, from hospital perspective, in Spain.MethodsRetrospective, multicenter, and observational study conducted on five third-level Spanish hospitals, between December 2018 and December 2019. The study included patients who were diagnosed of AMD before December 2018. Direct healthcare costs were obtained from a Spanish database. Study variables included demographic and clinical variables, and resources, such as treatment, diagnostic tests, medical examination, and surgery. Among the 1414 screened AMD patients, 1164 patients were included. In the overall study patients, the total cost was €5,386,511.0, with a mean cost per patient of €4627.6 ± 2383.9. The largest cost items were diagnostic examinations (€2.832.902,0) and vascular endothelial growth factor inhibitors (anti-VEGF) treatment (€2.038.257,2). Bevacizumab was administered to 325 (27.9%) patients, ranibizumab to 328 (28.2%), and aflibercept to 626 (53.8%); 115 (10.7%) patients received two anti-VEGF treatments, while 90 (7.7%) did not receive any. Over the course of the study, a total of 6,057 anti-VEGF injections were administered, with a mean (95% confidence interval) of 4.8 (4.4–5.2) injections per patient. Regarding safety, 29 patients experience injection-related adverse events, among them 12 patients had cataract and 11 ones elevated intraocular pressure (IOP). The incidence of endophthalmitis was 0.5% (6/1164).ConclusionsAMD was associated with considerable healthcare costs for regional healthcare systems. Diagnostic examinations, particularly OCT examinations, and anti-VEGF treatment represented the largest cost items.

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.

Postoperative endophthalmitis with and without intracameral moxifloxacin prophylaxis in a high volume surgery setting

ObjectiveThis study was conducted to understand the effects of intracameral moxifloxacin in decreasing the incidence of postoperative endophthalmitis after cataract surgery in an eye hospital with a high volume surgical...

Trends in Endophthalmitis Associated With Intravitreal Injection of Anti-VEGF Agentsat a Tertiary Referral Center.

To report the incidence and clinical features of infectious endophthalmitis after intravitreal (IV) injection of anti-vascular endothelial growth factor inhibitors (VEGF) between 2018 and 2020 and to compare to prior rates. Retrospective analysis of patients with endophthalmitis after anti-VEGF IV injections treated at Bascom Palmer Eye Institute between January 1, 2018, and December 31, 2020. Between 2018 and 2020, the rate of clinically diagnosed endophthalmitis was 0.014% (10/71,858) and of culture-positive was 0.008% (6/71,858). Clinically diagnosed endophthalmitis rates per injection were: aflibercept (0.022%); ranibizumab (0.019%); bevacizumab (0%); and brolucizumab (0%). Clinically diagnosed endophthalmitis rates were similar in the present study compared to those from 2005 to 2017 (P = .84). Fifteen eyes were diagnosed with endophthalmitis (10 in-house, five external referrals). Of culture-positive eyes, the organisms were coagulase-negative Staphylococcus (8/11), Streptococcus species (2/11), and Abiotrophia defectiva (1/11). A universal face-masking policy in 2020 did not lower infection rates (P = .73). Endophthalmitis rates after IV anti-VEGF remain low and are similar to prior reports. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:319-326.].

An effective method to reduce the risk of endophthalmitis after intravitreal injection (IVI): Application of 0.25% povidone-iodine

Background/Aim: The most important complication after intravitreal injection (IVI) is endophthalmitis, which can result in severe vision loss. This study aims to investigate the effect of 0.25% povidone-iodine (PI) application before IVI on the incidence of endophthalmitis in patients who received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection. Methods: A total of 15345 intravitreal anti-VEGF injections and nine endophthalmitis cases after IVI performed at the outpatient injection room of a single university hospital between January 2017 and January 2020 were included in this retrospective cohort study. Before July 2018, after applying 10% PI around the eyes and 5% PI on the eyes, an eyelid speculum was inserted, and the injection was performed. After this date, in addition to these steps, after placing a speculum and determining the injection site with a caliper, 3-4 drops of 0.25% PI were applied just before injection. Topical antibiotics were not used before or after the injection. Results: Nine cases of endophthalmitis were detected in 3 years. The most common symptoms were vision loss (9/9) and pain in the eye (7/9). All cases had conjunctival hyperemia, cells-hypopyon in the anterior chamber, and cells in the vitreous. The time between injection and re-visiting the clinic due to endophthalmitis symptoms ranged between 2-6 days, and visual acuity varied between hand motion and 0.2. While the number of endophthalmitis cases before July 2018 was 8 (8/8330) in 1.5 years, after the addition of 0.25% PI application to the protocol, only 1 case of endophthalmitis (1/7015) was seen in the last 1.5 years. The rate of endophthalmitis had decreased significantly (P=0.037). Conclusion: Since July 2018, the addition of 0.25% PI to the standard IVI protocol just before injection has significantly reduced endophthalmitis rates. With this method, endophthalmitis rates may be decreased despite the increasing number of IVIs.

Incidence and outcomes of endophthalmitis with in-house compounded intravitreal bevacizumab injections: A multicentric study

ABSTRACT Purpose To evaluate the incidence rate and outcomes of endophthalmitis after intravitreal injection of in-house compounded bevacizumab. Methods In this multicentric study performed from 2014 to 2018, patients who were injected with in-house compounded and sterilized bevacizumab were observed for endophthalmitis. In-house compounded syringes were prepared in compounding pharmacy using sterile standard operating guidelines. All cases of acute endophthalmitis following intravitreal injection were recorded and followed up for final anatomical and visual outcome after management. Results A total of 50,361 bevacizumab injections were administered. Incidence of post-injection endophthalmitis was 0.0377%. Incidence of culture-positive endophthalmitis was 0.0178%, with 55.5% culture positivity for Staphylococcus species. A significant improvement in the final visual outcome was noted (p<0.05), and overall five patients (26.3%) achieved visual acuity of 6/18 or more. Conclusions In-house compounded injections of bevacizumab can reduce post-injection endophthalmitis to a minimum, with maintenance of proper asepsis and strict protocols by the compounding pharmacy.

The ocular surface bacterial contamination and its management in the prophylaxis of post cataract surgery endophthalmitis.

Objective: To investigate the recent pieces of evidence regarding the bacterial ocular surface contamination and its treatment in the prophylaxis of post-cataract surgery endophthalmitis.Methods: We conducted a literature research on the topic of interest and selected the most relevant data.Results: The studies reported a relatively high rate of positive conjunctival culture and the most frequently isolated organism was Coagulase negative Staphylococcus, which is also the most common etiological agent of the postoperative endophthalmitis. The bacterial ocular surface load is influenced by age, climate, associated diseases, topical and systemic medication. The use of povidone-iodine alone or in association with levofloxacin eyedrops as prophylactic method is effective in reducing the conjunctival bacterial contamination and consequently decreases the incidence of postoperative endophthalmitis.Conclusions: Based on the current pieces of evidence, adequate treatment of the bacterial ocular surface contamination prior to cataract surgery seems to be effective in preventing endophthalmitis after cataract surgery.Abbreviations: EU = European Union, Spp. = Species, HIV = Human Immunodeficiency Virus

Incidence of chorioretinitis and endophthalmitis in hospitalized patients with fungemia.

Bloodstream candida infections can seed the eye via hematogenous spread and result in chorioretinitis or endophthalmitis. If undetected and untreated, this can result in permanent vision loss. Past studies evaluating incidence of ocular candidiasis among hospitalized patients with positive fungal blood cultures have demonstrated variable rates of occurrence, but recent studies have generally shown a lower incidence than was reported several decades ago. Given low rates of occurrence, the utility of screening patients with dilated fundus exams has been called into question. The primary aim of this investigation is to identify the rate of chorioretinitis and endophthalmitis based on dilated fundoscopy for patients with fungemia at a tertiary care hospital. This study was a retrospective chart review of adult patients admitted to the medical centre of the University of Arkansas for Medical Sciences (UAMS) between May 1, 2014 and December 31, 2017, who had positive fungal blood cultures during their hospitalization. There were 324 positive fungal cultures in 290 patients. Of this initial group, there were 161 eye exams. Ocular examination identified 7 of 161 patients (4.3%) with chorioretinitis or endophthalmitis. These outcomes along with previous studies support the current guidelines that screening with dilated fundus examination for these patients is appropriate and necessary.

Acute Infectious Endophthalmitis After Cataract Surgery: Epidemiological Characteristics, Risk Factors and Incidence Trends, 2008-2019.

ObjectiveIntended to investigate the epidemiological characteristics, risk factors and incidence trend of endophthalmitis after cataract surgery in recent 12 years.MethodsA retrospective study was conducted on the patients who underwent cataract surgery in Qingdao Eye Hospital from January 1, 2008, to December 31, 2019, including age, sex, history of diabetes, intraoperative operation and complications. In addition, the related risk factors and incidence trend of acute infective endophthalmitis were analyzed. The incidence of endophthalmitis and its related factors were analyzed by univariate and multivariate logistic regression analysis.ResultsA total of 55,612 cases of cataract surgery were performed in our hospital in 12 years, and 42 cases of acute infective endophthalmitis occurred (the incidence rate was 0.076%). The average occurrence time was 10.57 days ± 11.17, with eye pain as the main complaint and anterior chamber fibrin exudation as the main clinical manifestation. In addition, there were eight cases of anterior chamber hypopyon and 18 cases of vitreous reaction, the results of anterior aqueous humor or vitreous fluid culture in 10 patients were positive. Univariate analysis showed that intraoperative rupture of posterior capsule, non-use of antibiotics and non-use of behind-the-lens washout were the risk factors of infectious endophthalmitis after cataract surgery (P=0.032, P=0.000, P=0.000). Besides, multivariate logistic regression analysis showed that intraoperative rupture of posterior capsule was the main risk factor.ConclusionThe occurrence of endophthalmitis after cataract surgery is mainly related to intraoperative rupture of posterior capsule, absence of antibiotics and behind-the-lens washout. In addition, the incidence of endophthalmitis after cataract surgery decreased during the past 12 years.

Toxicidad ocular tras sobredosificación accidental de cefuroxima intracameral en cirugía de catarata

PurposeTo describe intracameral toxic effects of cefuroxime at a higher dose than recommended in cataract surgery. MethodsRetrospective study of 8 eyes of 8 patients who inadvertently received 12.5mg/0.1ml of intracameral cefuroxime due to a dilution error, at the end of the cataract surgery. All patients underwent a strict ophthalmology follow-up for 6 months. ResultsAll patients presented with a marked anterior segment inflammation with corneal oedema that resolved completely in all cases (between 5 days and 3 months). At 6 months of follow-up a statistically significant difference was found in the corneal endothelial cell density when compared with the fellow eye (P=.038), being<1000 cells/mm2 in 3 cases. Three patients (37.5%) showed early macular oedema, with subfoveal ellipsoid layer disruption in one case as a permanent sequel. One patient developed an optic neuropathy with associated afferent pupillary defect. ConclusionsAlthough 1mg/0.1ml of intracameral cefuroxime has been shown to reduce the incidence of endophthalmitis, its overdose can have potentially toxic eye effects in both anterior and posterior segments.

Incidence of Acute Endophthalmitis After Intravitreal Bevacizumab Injection at a Tertiary Care Hospital in Lahore.

Objective: We aimed to assess the incidence, management, and visual outcome of acute endophthalmitis in patients following intravitreal bevacizumab injection in a tertiary care setup. It was a prospective and single-center database study.Patients and methods: Patients receiving intravitreal bevacizumab injections for various retinal vascular diseases from January 2019 to September 2020. The study was carried out at the Institute of Ophthalmology, Mayo Hospital, Lahore over a period of 21 months. Preformed bevacizumab injections were administered intravitreally on patients of various retinal vascular diseases under strict aseptic measures and by following the standard guidelines. The patients were put on follow-ups for a duration of four weeks to see any signs of acute endophthalmitis.Results: A total of 3051 injections were administered in 1104 eyes of 743 patients during the above-mentioned study period. The incidence of endophthalmitis was found to be 0.0328% (1/3051). The patient, who developed endophthalmitis, was treated with topical and intravitreal antibiotics followed by vitrectomy that resulted in clinically significant improvement in vision.Conclusion: Incidence of acute endophthalmitis following intravitreal bevacizumab injection was low and could be prevented by taking strict aseptic measures during administration.

Endophthalmitis following Intravitreal Anti-Vascular Endothelial Growth Factor Therapy: Changes in Incidence and Outcomes over a 9-Year Period

ABSTRACT Aims: To evaluate whether the incidence, microbial spectrum, and visual outcomes of endophthalmitis following intravitreal injections have changed over time. Methods: Retrospective cohort study of endophthalmitis in eyes receiving intravitreal injection of anti-vascular endothelial growth factor between 2009–2012 and 2016–2017 at a single, large retina practice. Results: A total of 283,315 injections resulted in 96 suspected infectious endophthalmitis cases. Comparing 2009–2012 and 2016–2017, the rate of suspected endophthalmitis changed from 1 in 2,663 injections to 1 in 3,195 injections (p = .37). Visual outcomes 6 months after endophthalmitis were significantly better during the latter period (p = .04), with an average loss of 6.3 lines of VA in 2009–2012 compared to a loss of 3.6 lines in 2016–2017. In multivariate analysis, a “no-talking” policy during injections resulted in a trend towards a decrease in endophthalmitis incidence (p = .08). Cessation of post-injection topical antibiotic use did not independently decrease endophthalmitis incidence (p = .24) when the effect of a “no-talking” policy was taken into account. A lower rate of endophthalmitis was seen after prefilled vs. conventionally prepared ranibizumab syringe use for injection (0.014% vs. 0.035%, respectively), though this difference did not meet statistical significance (p = .16). Conclusion: The incidence of endophthalmitis after intravitreal injection decreased and visual outcomes improved between the periods of 2009–2012 and 2016–2017. A “no-talking” policy during injections was associated with a trend toward a decrease in endophthalmitis rate.

Ten-year trends in the incidence, clinical profile and outcomes of acute-onset endophthalmitis following combined pars plana vitrectomy and sutureless, glueless and flapless scleral fixation of intraocular lenses.

To evaluate the frequency and outcomes of acute-onset endophthalmitis following combined pars plana vitrectomy and scleral fixation of intraocular lens. We evaluated patients undergoing a sutureless, glueless, flapless technique of scleral fixation of intraocular lenses (SFIOL) implantation for various causes of aphakia and documented the clinico-demographic data, microbiological profile and final outcome after acute endophthalmitis in this cohort of eyes. The frequency of suspected acute endophthalmitis diagnosed post-surgery was 0.112% (4/3541 eyes), with culture-positive endophthalmitis frequency being 0.028% (1 eye), showing growth of Pseudomonas aeruginosa. Mean age of patients with endophthalmitis was 51.75 ± 9.28years, and mean interval between surgery and acute endophthalmitis presentation was 10.25 ± 9.6days. Patients were managed with intravitreal antibiotics with or without core vitrectomy. Visual acuity of patients increased from baseline 1.43 ± 0.32 logMAR (Snellen equivalent = 6/150) to 0.79 ± 0.16 logMAR (Snellen equivalent = 6/36) after an average follow-up of 11 ± 2weeks. Endophthalmitis is a rare complication following SFIOL surgery, and all ophthalmic surgeons must be aware of this inadvertent possibility, since SFIOLs are gaining wider acceptability recently. Moreover, these cases of endophthalmitis may show a different pattern of microorganisms than post-cataract surgery endophthalmitis; however, with prompt diagnosis and effective timely management, favorable outcomes can be achieved.

Incidence of endophthalmitis following intravitreal anti VEGF injections at a tertiary care hospital in Pakistan.

To assess the rate of infectious endophthalmitis with anti-vascular endothelial growth factor injection, and to evaluate institutional procedure protocol in this regard. The retrospective consecutive case series was conducted at Shifa International Hospital, Islamabad, Pakistan, from August 2018 to January 2019, and comprised 5-year data from August 2014 to July 2019 related to patients who underwent intravitreal anti-vascular endothelial growth factor injections. Data was analysed using SPSS 21. Of the 7,542 injections administered to 2,734 patients, 5,976(79.2%) were bevacizumab, 1,081(14.3%) ranibizumab and 485(6.4%) aflibercept. There was 1(0.01%) case of infectious endophthalmitis which was treated with 25 gauge pars plana vitrectomy. The institutional procedure protocol was found to be effective as the rate of infectious endophthalmitis was lower than what is reported in literature.

Endophthalmitis after pars plana vitrectomy with reused single-use devices: a 13-year retrospective study

BackgroundTo describe the incidence, clinical characteristics, and treatment outcomes of endophthalmitis after pars plana vitrectomy (PPV) with recycled single-use devices. The recommended sterilization process as well as safety measures are discussed.MethodsMedical charts of patients who developed endophthalmitis after PPV were retrospectively reviewed and reported in a descriptive manner. Cases undergoing PPV for preexisting endophthalmitis or open globe injury were excluded. Data collection included patient demographics, operative details, ocular findings, microbiological profiles, treatment modalities, and visual outcomes.ResultsOver the past thirteen years, a total of 12,989 pars plana vitrectomy operations were included. In total, 13 eyes of 13 cases (0.10%) experienced endophthalmitis after vitrectomy. These occurred in 3 cases (0.11%) using 20-gauge vitrectomy compared to 8 cases (0.09%) using 23-gauge vitrectomy and 2 cases (0.18%) using 25-gauge vitrectomy. There were no statistically significant differences between the 20-gauge and microincisional vitrectomy surgery (MIVS) group (P = 0.64), and the 23- and 25-gauge approach (P = 0.34). Causative pathogens were positive by culture in 5 cases (45%): 3 g-positive cases, 1 g-negative case, and 1 fungus case.ConclusionsThe rate of endophthalmitis in patients who underwent 23-gauge PPV was comparable to those who underwent 25-gauge PPV. With our standardized protocol for instrument sterilization, endophthalmitis rates in those undergoing PPV using recycled single-use instruments were within the range of previously published results in which vitrectomy tools were disposed of after one use.

Endophthalmitis Post Pars Plana Vitrectomy Surgery: Incidence, Organisms' Profile, and Management Outcome in a Tertiary Eye Hospital in Saudi Arabia.

PURPOSE:To determine the incidence of endophthalmitis after pars plana vitrectomy (PPV), organisms' profile, and management outcomes at a tertiary eye hospital in a Middle East country.METHODS:In this single-arm cohort study conducted in 2020, medical records of patients who underwent PPV not accompanied by any other intraocular surgery were reviewed; those with a diagnosis of acute endophthalmitis in the immediate postoperative period (within 6 weeks) during the past 6 years were analyzed.RESULTS:A total of 8153 records of PPV surgeries were reviewed. Five cases had endophthalmitis post-PPV with an incidence of 0.061%. Three (0.037%) had positive cultures, all of them for Staphylococcus epidermidis. The interval between PPV and diagnosis of endophthalmitis ranged from 3 to 25 days (mean, 15.8 days). Final vision after treatment ranged from 20/400 to no light perception, and one eye was eviscerated.CONCLUSION:The incidence of endophthalmitis post PPV is low. Despite prompt diagnosis and standard management, visual prognosis seems to be poor. The infective agents for endophthalmitis were commensals from the ocular surface.

Incidence of Endophthalmitis, Then and Now

Purpose: Report the frequency of differing etiologies of endophthalmitis at the Upstate Medical University, and compare these results to previously reported data. Methods: A retrospective study was conducted based on the medical records of all patients diagnosed with endophthalmitis at the Upstate Medical University in Syracuse, New York between January 2014 to December 2019. Variables recorded included source of infection, microbial profiles, comorbidities, visual acuity and survival. Results: The study identified 62 patients who were diagnosed with endophthalmitis at the Upstate Medical University from January 2014 to December 2019. The most common etiology was endogenous endophthalmitis with 40 cases (64.5%), of these patients, 13 (32.5%) were culture positive. The remaining 22 cases (35.5%) were due to exogenous endophthalmitis. The mean age of patients with endogenous endophthalmitis was 51.4 years with 65.0% as male. The mean age of patients with exogenous endophthalmitis was 59.5 years with 59.1% as male. The most common identifiable risk factor associated with endogenous endophthalmitis was a history of intravenous drug use seen in 47.5%. Conclusion: Endogenous source was established as the most common etiology in patients diagnosed with endophthalmitis. These results, however, do not parallel with any of the previously reported data where endogenous etiology was identified as one of least common causes. The significance of demonstrating this increase in incidence of endogenous endophthalmitis is to illustrate a shift in paradigm and create awareness among ophthalmologists to avoid overlooking a possible life-threatening condition.