Rate Of Endophthalmitis Research Articles

Early Endophthalmitis Rates and Risk Factors After Corneal Transplant Surgeries in Medicare Beneficiaries From 2016 to 2019.

The aims of this study were to determine rates of early postkeratoplasty endophthalmitis and identify sociodemographic and medical risk factors in the Medicare population. Using a retrospective cohort design, patients aged 65 years and older undergoing penetrating keratoplasty (PK), endothelial keratoplasty (EK), and anterior lamellar keratoplasty (ALK) from 2016 to 2019 among 100% Medicare Fee-or-Service database were included. Rates of early endophthalmitis within 42 days of keratoplasty were determined using the International Classification of Diseases, 10th Revision-Clinical Modification diagnostic codes. Patient and physician characteristics were compared using x2 tests, and a multivariable logistic regression model was used to evaluate factors associated with endophthalmitis. The overall early endophthalmitis rate after keratoplasty was 0.39% (n = 216/54,822) with a median time to diagnosis of 14 (interquartile range: 5-25) days. Rates by keratoplasty types were 1.31% for cataract surgery combined with PK, 1.13% for PK, and 0.22% for EK. On multivariable analysis, the odds of endophthalmitis were higher for PK [odds ratio (OR): 5.46, 95% confidence interval (CI), 3.98-7.49] and ALK (OR: 5.45, 95% CI, 2.59-11.49) relative to EK. Patients with a Charlson Comorbidity Index (CCI) ≥3 had higher odds of endophthalmitis (OR: 1.82; 95% CI, 1.28-2.58) relative to patients with a CCI of 0. Practices located in the Midwest (OR: 0.59, 95% CI, 0.36-0.96), West (OR 0.57; 95% CI, 0.35-0.93), and Northeast (OR: 0.59 95% CI, 0.35-0.99) had lower odds of reporting endophthalmitis when compared to the South. Patients undergoing PK and ALK and those with a CCI ≥3 had higher odds of endophthalmitis relative to EK and patients without comorbidities, respectively. Practices in the West, Midwest, and Northeast had lower odds of endophthalmitis relative to the South.

LONG-TERM USE OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

Although pivotal trials have demonstrated efficacy of anti-vascular endothelial growth factor therapy in neovascular age-related macular degeneration, there is a paucity of clinical data about the long-term (>5 years) treatment. Retrospective analysis of all patients with neovascular age-related macular degeneration who were actively treated, had received >40 anti-vascular endothelial growth factor injections, and were followed for ≥5 years. Snellen-corrected visual acuity, initial drug choice, and times elapsed between treatments were collected. Rates of endophthalmitis and outcomes of submacular hemorrhage were also evaluated. A total of 88 patients (162 eyes) met the inclusion criteria: the average patient age was 86.3 years with an average follow-up period of 7.6 years. The average total number of injections per eye was 69 (18.0 SD); a total of 11,208 injections were given throughout the study period, and 6 cases (0.05%) of endophthalmitis were observed. Overall, there was a clinical and statistical difference in average Snellen-corrected visual acuity at Injections #2,#3, #4, #5, #6, #10, and #20, as compared with baseline ( P = 0.03, P < 0.01, P = 0.02, P < 0.01, P = 0.01, P = 0.01, P < 0.01, respectively). Patients in the Snellen-corrected visual acuity subgroup 20/20 to 20/40 maintained vision until injection #30. Seven eyes experienced a visually significant submacular hemorrhage. This neovascular age-related macular degeneration cohort received on average eight anti-vascular endothelial growth factor injections per year for approximately 8 years; eyes with good (≥20/40) initial baseline vision maintained their visual acuity, whereas those with worse Snellen-corrected visual acuity (≤20/50) had a robust initial improvement that diminished with time. Most patients were maintained on the same initial drug of choice and the rate of endophthalmitis was low.

The impact of antibiotic prophylaxis with intracameral cefuroxime on postoperative infectious endophthalmitis rates in a high-volume cataract surgery center

Our purpose was to compare postoperative infectious endophthalmitis rates before and after the introduction of antibiotic prophylaxis via intracameral with cefuroxime (ATB-P IC) in a high-volume cataract surgery service. Retrospective cohort study considering patients who underwent cataract surgery at Ophthal Hospital Especializado, São Paulo, Brazil, from January/2011 to December/2019. Patients operated from 2013 to 2019 comprised the ATB-P IC group while those operated from 2011 to 2013 formed the control group without the ATB-P IC protocol. A total of 23,184 cataract surgeries were included, with 6,207 in the Control Group and 16,977 in the ATB-P Group. A significantly higher rate of endophthalmitis was observed in the control group (0.0967%) when compared to the ATB-P group (0.0177%) (p = 0.014). Surgeries performed with ATB-P showed 80% less chance of reported endophthalmitis (OR = 0.20; 95% CI 0.05–0.72; p = 0.014) than those without ATB-P. Of the six cases confirmed by culture in the control group, all tested positive for Pseudomonas aeroginosa and the only case confirmed by culture in the ATB-P group was positive for Staphylococcus epidermidis. Our findings strongly support the use of intracameral antibiotic prophylaxis with cefuroxime to reduce postoperative infectious endophthalmitis rates, and we recommend its incorporation into cataract surgery protocols.

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.

Endophthalmitis rates and risk factors following intraocular surgeries in the medicare population from 2016 to 2019

AimsTo determine endophthalmitis rates and risk factors following intraocular surgeries in the Medicare population.MethodsRetrospective, cross-sectional study from 2016 to 2019 in Medicare fee-for-service and Medicare Advantage beneficiaries. 100% Medicare claims...

Risk and dose-response relationship of diabetes mellitus for endophthalmitis after cataract surgery in a nationwide cohort study in Taiwan.

To investigate the risk of endophthalmitis after cataract surgery in patients with diabetes mellitus (DM) and evaluate the dose-response relationship. This retrospective cohort study enrolled patients who underwent bilateral cataract surgeries from 2000 to 2017 in Taiwan National Health Insurance Research Database. The endophthalmitis rates within 3 months after cataract surgery were compared between DM and non-DM cohorts using a generalised estimating equation. The diabetes complications severity index (DSCI) score was adopted to assess the dose-response effect on the endophthalmitis rate. A total of 883 398 patients (1 766 796 eyes) were included. Patients with DM had an increased risk of endophthalmitis after cataract surgery than patients without DM (0.261% vs. 0.242%, adjusted odds ratio = 1.09, 95% confidence interval = 1.03-1.16). The higher endophthalmitis rate in the DM group than in the non-DM group remains after excluding those with prior vitrectomy or intravitreal injection (IVI), and took IVI between the cataract surgery and endophthalmitis (p = 0.0156, 0.0048, and 0.0139). There was a significant dose-response relationship on the likelihood of endophthalmitis in DM patients when DCSI score >10. The endophthalmitis rate is highest among DM complications in patients with metabolic disorders (0.342%). DM was a risk factor for endophthalmitis after cataract surgery after adjusting for age, sex, common systemic disorders, and excluding those with prior vitrectomy or IVI and having IVI between cataract surgery and endophthalmitis. A dose-response relationship was noted in DM patients with a DCSI score >10.

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

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

Impact of Prefilled Syringes and Masking on Postintravitreal Injection Endophthalmitis.

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

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.].

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

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

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.

National Physician-Level Endophthalmitis Rates for Cataract Surgery among Medicare Beneficiaries in the United States: 2011–2019

National Physician-Level Endophthalmitis Rates for Cataract Surgery among Medicare Beneficiaries in the United States: 2011–2019

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.

Clear corneal incision, an important step in modern cataract surgery: a review.

A clear corneal incision (CCI) is the most commonly used entrance site in modern phacoemulsification cataract surgery. Despite some initial concerns about increased endophthalmitis rates through a self-sealing CCI, recent literature suggests that the risk of infection with proper wound construction and all other necessary precautions is minimal. The technique of creating a clear corneal incision has, with recent developments in corneal imaging, undergone critical appraisal leading to a better understanding of incision architecture. Many surgeons operate through smaller incisions, and they have a wide choice of surgical instruments to create their corneal incisions. The aim of this review is to discuss the history and the current status of clear corneal incision creation, the design and materials of surgical blades, and the current trends in manufacturing and sustainability. Although disposable instruments have some advantages and are very popular, recycling, if possible, and avoiding unnecessary plastic waste are important considerations.In any case, the step of CCI is a small one for the surgeon, but a big one for the eye. That is why it has to be done with the utmost precision and in-depth knowledge is important.

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.

Visual Outcomes and Prognostic Factors of Traumatic Endophthalmitis Treated by Pars Plana Vitrectomy: 11 Years Retrospective Analysis.

To evaluate the visual outcome of traumatic endophthalmitis and describe the risk factors associated with poor visual acuity and retinal detachment (RD) development over an 11-year period. Medical records of 34 patients with traumatic endophthalmitis who underwent PPV over a period of 11 years (1 January 2010-31 December 2020) were reviewed. We extracted details regarding demographic data, initial and final best corrected visual acuity (BCVA) using a standard Snellen chart, wound and IOFB characteristics, ocular associated lesions, and treatment. The outcome was evaluated according to the final BCVA which was defined as poor &lt; 0.1 or good ≥ 0.1 Results: Endophthalmitis rate was 29.8% in open globe injuries. The mean age was 43.6 ± 16.5 years and the majority of patients were males (32 out of 34, 94.1%). All patients received systemic (moxifloxacin) and intravitreal antibiotherapy. We performed pars plana vitrectomy (PPV) in all cases. Poor visual outcome was associated with wound size ≥ 3 mm (p = 0.02), the association of IOFB (p = 0.016), and the development of RD (p = 0.00). The presence of IOFB (p = 0.01) and wound size ≥ 3 mm (p = 0.01) were statistically associated with RD development. After treatment, 47.05% of patients achieved final BCVA ≥ 0.1. Wound size ≥ 3 mm, IOFB and RD were risk factors for poor visual outcomes in traumatic endophthalmitis.

Reported Rates of Intraocular Inflammation with Intravitreal Aflibercept Administered via Pre-Filled Syringe or from Vials in Clinical Practice Between 2012 and 2022.

To determine the reported rates of intraocular inflammation (IOI) in patients treated with intravitreal aflibercept (IVT-AFL) 2 mg in routine clinical practice (ie, outside interventional studies), across all indications and within all countries (excluding the United States), with access to either the vial presentation or pre-filled syringe (PFS). A search was conducted using the Bayer EYLEA® Global Safety Pharmacovigilance Database for reported cases of IOI and IVT-AFL use between October 2012 and March 31, 2022. With more than 10 years of post-marketing experience with the IVT-AFL vial presentation (>25 million sold units), and over 2 years of experience with the PFS of IVT-AFL (>6.7 million sold units) the rate of any IOI, including endophthalmitis, outside the United States was 0.3 events per 10,000 units for the PFS and 1.2 events per 10,000 units for the vial presentation. The event rates specifically for endophthalmitis were 0.1 per 10,000 units for the IVT-AFL PFS and 0.6 per10,000 units for the IVT-AFL vial presentation. In patients with retinal diseases treated in routine clinical practice with IVT-AFL either from a vial or the PFS, medically important adverse events of IOI, and in particular, endophthalmitis, are infrequently reported events. Numerically, reported rates of IOI and endophthalmitis are low for the vial presentation and even lower for the PFS.

The Prevalence of Positive Donor Corneoscleral Rim Culture and its Association with Ocular Infection After Transplantation.

The aim of the study was to determine the prevalence of positive corneoscleral donor rim cultures and to report keratitis and endophthalmitis after keratoplasty. Eye bank records and medical records of patients who underwent keratoplasty between September 1, 2015, and December 31, 2019, were retrospectively reviewed. Patients who had routine donor-rim culture taken during surgery and followed up for at least 1 year in the post-operative period were included in the study. A total of 826 keratoplasty procedures were performed. A total of 120 (14.5%) cases had a positive donor corneoscleral rim culture. Positive bacterial cultures were obtained from 108 (13.7%) of the donors. Bacterial keratitis was observed in one patient (0.83% of recipients) who had a positive bacterial culture. Positive fungal cultures were obtained from 12 (1.45%) donors, of whom one (8.33% of recipients) developed fungal keratitis. Endophthalmitis was observed in one patient whose culture result was negative. Both bacterial and fungal culture results were similar in penetrating and lamellar surgical procedures. Although the donor corneoscleral rims have a high positive culture result, the rate of bacterial keratitis and endophthalmitis is low, the risk of infection is high in patients with a fungal positive donor rim. Closer follow-up of patients with fungal positive donor corneo-scleral rim result and initiation of aggressive antifungal treatment when infection occurs will be beneficial.

Antibiotic Protocols for Endophthalmitis Prophylaxis Following Open-Globe Repair: A Survey of U.S. Residency Programs.

Purpose To assess the various approaches to endophthalmitis prevention following traumatic open-globe injury (OGI) repair. Methods A research electronic data capture (REDCap) questionnaire evaluating the usage of antibiotics and steroids in patients with OGI was distributed to program directors of all U.S. ophthalmology residency programs using the Association of University Professors of Ophthalmology program directors' listserv. Completed questionnaires were analyzed for treatment patterns. Results The REDCap questionnaire was distributed to 111 programs, with 32 residency programs responding. Two responses were excluded. Ninety percent (27/30) of included programs used perioperative intravenous (IV) antibiotics, with 78% (21/27) of those giving one dose only. At the time of surgery, 27% (8/30) of programs gave intravitreal antibiotics and 60% (18/30) gave subconjunctival antibiotics. Postoperatively, 100% (30/30) gave topical antibiotics and 97% (29/30) gave topical steroids. Only 53% of responders discharged patients on oral antibiotics. Of the three programs who did not use IV antibiotics, all three gave intravitreal therapy and one also discharged patients on oral antibiotics. Conclusion There is a large variation in practice patterns for endophthalmitis prophylaxis among residency programs. Further investigation is needed to compare rates of endophthalmitis between these protocols and establish a safe and minimally burdensome standard of care.

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.