Evidence Of Endophthalmitis Research Articles

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

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

Analysis of retinal detachment resulted from post-operative endophthalmitis treated with 23G pars Plana Vitrectomy

BackgroundTo evaluate the rate, risk factors, functional outcome and prognosis in eyes with retinal detachment after post-operative endophthalmitis treated with 23G Pars Plana Vitrectomy.MethodsElectronic patient files from 2009 until 2018 were screened for the presence of an endophthalmitis. Included were 116 eyes of 116 patients. This population was evaluated for the rate of retinal detachment after 23G Pars Plana Vitrectomy for endophthalmitis following cataract surgery or intravitreal injection. The main outcome measures were retinal detachment and visual acuity.ResultsThe reasons for endophthalmitis were previous cataract surgery in 78 patients and following intravitreal injection in 38 patients. The first clinical evidence of endophthalmitis was present in median 5 days after the triggering intervention. Twenty-five eyes (21.55%) developed a retinal detachment an average of 25 days after endophthalmitis. RD is significantly associated with preoperative visual acuity (p = 0.001).ConclusionsWe emphasize the prognostic role of preoperative visual acuity in RD development of the endophthalmitis treated with 23G Pars Plana Vitrectomy.

Utility of wound cultures in the management of open globe injuries: a 5-year retrospective review

BackgroundEndophthalmitis after open globe injury can be devastating to vision recovery. As treatment of endophthalmitis is often empiric, some surgeons may obtain cultures at presentation of trauma in anticipation of later infection. This study examines the usefulness of wound cultures obtained during globe repair.ResultsInstitutional Review Board approval was obtained. Medical records were retrospectively reviewed, with 168 open globes included. Cultures of the wound site had been taken in all cases included in this study. Wound cultures were positive in 63% of cases but were not used for clinical decision-making for any patient in this study. Two patients had evidence of endophthalmitis at presentation, with results of vitreous culture matching those from the wound. No patient later developed endophthalmitis after open globe repair.ConclusionsDespite a high rate of wound contamination, few cases of endophthalmitis (1.2%) were seen in this series. In no case did the results of wound culture impact choice of antibiotic prophylaxis or treatment. Cultures obtained at the time of open globe repair were not cost effective in the subsequent management of the injury.

Culture-Positive Endophthalmitis After Open Globe Injuries With and Without Retained Intraocular Foreign Bodies.

To report the visual and anatomical outcomes and microbiologic spectrum of culture-positive endophthalmitis in open globe injuries (OGIs) with or without intraocular foreign bodies (IOFBs). A retrospective, interventional case series of OGIs (n = 718) treated between 2004 and 2015. Patients underwent a management protocol for OGI, including systemic broad-spectrum antibiotics, on presentation. Culture-positive cases of endophthalmitis after open globe repair occurred in 2.1% of eyes (n = 15 of 718 eyes); two eyes had evidence of endophthalmitis on presentation. The most common organism was Staphylococcus species (five of 17 eyes). An IOFB was present in 6.8% of eyes (n = 49 of 718 eyes). All of these eyes received prophylactic intravitreal antimicrobials. In eyes with IOFB, the rate of culture-positive endophthalmitis after initial globe repair was 8.1% (n = 4 of 49 eyes) versus 1.6% (n = 11 of 669 eyes) in eyes without IOFB (P < .01). Culture-positive endophthalmitis was identified after OGIs more often in eyes with a concurrent IOFB. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:632-637.].

Intravitreal cidofovir injection for the management of chronic glaucoma in dogs

The objective of this retrospective study was to determine whether an intravitreal injection of 562.5 ug of cidofovir was effective in lowering the intraocular pressure (IOP) in chronically glaucomatous avisual canine eyes. This study reviews the medical records of 167 canine patients diagnosed with chronic glaucoma between 2006 and 2011. The criteria for study inclusion were patients with irreversibly avisual eyes that were refractory to medical management, without evidence of endophthalmitis or intraocular neoplasia as determined by historical, clinical, and/or ultrasonographic examination, who were treated with an intravitreal injection of cidofovir. Using only topical anesthesia for most patients, aqueouscentesis was followed by an intravitreal injection of 562.5 ug of cidofovir and 1 mg of subconjunctival triamcinolone. An initial recheck was performed 14 days following the injection. The mean IOP immediately prior to injection was 46 ± 13 mm Hg with a median of 47 mm Hg. At the initial recheck, the mean IOP was 10 ± 11 mm Hg with a median of 6 mm Hg. A common postinjection finding was mild intraocular inflammation, which was controlled in all cases with topical neopolydex solution. Post injection complications included corneal ulceration (2.4%) and endophthalmitis (2.4%). Phthisis bulbi was a common sequalae (70%). One injection of cidofovir was successful in lowering the IOP in 85% of cases (P < 0.0001); multiple injections raised the success rate to 97%. An intravitreal injection of cidofovir was found to be an effective method of lowering intraocular pressure to <20 mm Hg. While the common side effect of phthisis bulbi resulted in a less than optimal cosmetic result, patients subjectively benefited from enhanced comfort warranting consideration of this approach in the management of chronically glaucomatous avisual canine eyes.

Management of recurrent Paecilomyces lilacinus keratitis

A 72‐year‐old man presented with Paecilomyces keratitis subsequent to immunosuppressive treatment. Despite medical therapy with voriconazole, perforation occurred requiring a tectonic keratoplasty of 10-mm. Despite oral, topical and intracameral voriconazole, there was recurrent stromal infiltration. A corneoscleral graft of 15-mm was undertaken. Two weeks later, hyphae were seen on the anterior lens capsule with hypopyon requiring phacoemulsification and anterior chamber washout. Six weeks later, there was evidence of endophthalmitis. Pars plana vitrectomy, capsulectomy and intravitreal injection of voriconazole were performed. Voriconazole treatment was continued for a further 10-months and then ceased. At 16-months following the last recurrence of Paecilomyces, there was no evidence of infection. After 20-months, the patient had a sutured intraocular lens with an artificial iris. Vision is 6/36 unaided and 6/24 pinhole.

Endogenous filamentous fungal endophthalmitis - single-centre survey in patients with acute leukaemia or postallogeneic stem cell transplantation and review of the literature

Endogenous endophthalmitis caused by filamentous fungi has been infrequently described and its prognosis in immunocompromised patients is largely unknown. Patients were identified through a single-centre database containing patients with endophthalmitis. Cases published since 2002 were reviewed. Clinical and treatment features as well as outcomes were analysed. Six patients were identified from the database. Underlying conditions were haematological malignancies (HM) and/or allogeneic haematopoietic stem cell transplantation (HSCT). Three patients underwent vitrectomy. None of the patients survived and the median time from first evidence of endophthalmitis until death was 33 days. The median time from first evidence of an invasive fungal infection to endophthalmitis was only 5 days. Fifty-six patients were identified from the literature. The majority of these patients underwent vitrectomy (27) or enucleation (10) and received intraocular antifungal therapy (28). Only 13 (23%) of 56 patients experienced an improved vision. The survival rate was 52% in all 56 patients but was significantly less in patients with HM or post-HSCT when compared with all others (26% vs. 70%, respectively; P = 0.003). Endogenous endophthalmitis caused by filamentous fungi is frequently associated with a permanent decrease or loss of vision. This type of fungal infection carries a particular poor prognosis in patients with profound immunosuppression, requiring improved treatment strategies.

Clinical Manifestations of Presumed Sterile Endophthalmitis After Intravitreal Triamcinolone Injection

Purpose: To evaluate the distinguishing characteristics that may assist in the clinical diagnosis of sterile endophthalmitis from intravitreal triamcinolone injection. Methods: From January 2005 to June 2006, the medical records of 163 eyes that received intravitreal triamcinolone injection were reviewed. In 5 eyes of 5 patients who complained of decreasing vision and mild ocular pain within three days after injection, slit lamp bimicroscopy revealed hypopyon, anterior chamber reaction, and vitritis. We analyzed clinical pictures retrospectively. Results: Intravitreal triamcinolone injections were performed for diabetic macular edema in 4 patients and for panuveitis in 1 patient with Behcet’s disease. Pseudophakia was found in all five eyes. Inflammations in three eyes resolved with topical and oral antibiotics within 13 days, and the other two patients were treated with a vitreous culture and intravitreal antibiotic injection. However, vitreous tap showed no evidence of endophthalmitis, and inflammation resolved within the same period. Conclusions: Presumed sterile endophthalmitis presents within 3 days after intravitreal triamcinolone injection and may be accompanied by decreased vision and ocular discomfort, although it is characterized by no distinct ocular pain. The symptoms and ocular inflammation resolved quickly within 13 days with a favorable visual outcome. Inflammations in three eyes resolved without surgical intervention, so it may be necessary to closely observe clinical manifestations before assuming that the eye is suffering from infectious endophthalmitis.

Non-smoker with pulmonary nodules

A 57-year-old man was admitted to the hospital in May because of fever, night sweats, cough, dyspnea, and multiple pulmonary nodules. He had non-insulin dependent diabetes and had been in his usual state of health until three months before admission, when he was successfully treated with a six-week course of antibiotics for right foot osteomyelitis. One month before admission, he was treated for a dry cough and dyspnea, attributed to worsening congestive heart failure. Five days before admission, he developed fever, night sweats, dry cough, pleuritic chest pain, but no hemoptysis. Over the past six months, he had lost 30 pounds. He was admitted for workup. Antibiotics were not started. The patient was a married, black, retired handyman/ doorman with a past history of diabetic retinopathy, CHF, mitral regurgitation, remote CVA with residual left facial droop. There was no history of recurrent sinusitis. His medications included furosemide, captopril, digoxin, glyburide, lovastatin, ranitidine, and oxycodone. He was born in New York City and had spent most of his life in New York, except 20 years ago, when he lived in Western Texas for three to four months. He had not traveled outside of North America.There was no history of tobacco use, drug use, alcohol abuse, HIV risk factors, asbestos exposure, or undercooked seafood ingestion. He did not have pets or unusual bird exposure. On examination, the temperature was 100.6”F, blood pressure 150/80 mmHg, pulse 92/min, and respiratory rate 20/min. Fundoscopic examination revealed diabetic retinopathy, but no evidence of endophthalmitis. No adenopathy was found. Jugular venous distention was elevated at 10 cm. There were bibasilar crackles and pedal edema. Oxygen saturation was 96% on room air. No clubbing was noted. There were no murmurs, Osler nodes, Janeway lesions, splinter hemorrhages, subconjunctival hemorrhages, or Roth spots. There was

Serum and Vitreous Toxocara Antibody in Nematode Endophthalmitis

Five patients had a clinical diagnosis of nematode endophthalmitis and had both a serum and vitreous titer for Toxocara antibody. All five patients had a vitreous titer that was equal to or greater than the serum titer. Serum and vitreous obtained from ten other patients who had no evidence of endophthalmitis did not show this correlation. This study provides the clinician with a further understanding of the meaning of a positive enzyme-linked immunosorbent assay titer as well as an additional area for analysis in selected patients with ocular inflammation.

Hospital-acquired fungemia: Its natural course and clinical significance

Eighty-five episodes of hospital-acquired fungemia in 77 adult patients were reviewed. The predominant risk factors associated with fungemia were prior antibiotic therapy (100 per cent), indwelling intravenous (100 per cent) and Foley catheters (97 per cent), concomitant bacterial infections (88 per cent), recent surgery (69 per cent) and parenteral hyperalimentation (66 per cent). The clinical picture was indistinguishable from sepsis of a bacterial origin. Laboratory data were nonspecific. Hence, diagnosis could only be made by blood culture. Patients followed one of four clinical courses: (1) spontaneous resolution of fungemia (42.8 per cent), (2) endophthalmitis after apparent spontaneous resolution of fungemia (5.1 per cent), (3) illness of a severity or duration requiring antifungal therapy (including the five patients in category 2) (36.3 per cent), or (4) no antifungal therapy and death from fungemia (20.7 per cent). Endophthalmitis was documented in 14 per cent of the patients with fungemia. The over-all mortality was 56 per cent whereas 29 per cent died as a result of fungemia. The data suggested that fungemia of a duration of greater than 72 hours, evidence of endophthalmitis or critically ill clinical status were all reasons for instituting amphotericin B therapy. Speciation of Candida organisms may be important, as patients with nonalbicans Candida fungemia were less likely to require antifungal therapy than patients with Candida albicans fungemia. All patients with fungemia require routine periodic ophthalmologic examinations.