Endophthalmitis Research Articles

Safety and cost-effectiveness of single-use endolaser probe reprocessing in vitreoretinal surgery

BackgroundEndolaser probes have been designed and sold for single-use only. However, in Brazil, they are not included in the list of single-use medical products that are prohibited from being reprocessed and could potentially be reused if safety requirements are accomplished. Therefore, this study aimed to determine and compare the quality, safety and costs of reprocessed versus original single-use endolaser probes of a specific brand and model.MethodsThe study, conducted at a university hospital in Sao Paulo, Brazil, was divided in two phases. The first one tested the feasibility, sterility and physical integrity of ten reprocessed laser probes. In the second phase, all vitrectomy procedures using endolaser probes (reprocessed and original ones) from August 2017 to October 2019 were evaluated. The operated cases were followed for any signs of infection and number of defective probes for each group were counted. The cost of acquiring a new probe and for all reprocessing stages were evaluated and quantified in US dollars($).ResultsMicrobiologic, residual ethilen oxide and microscopic evaluation of integrity of reprocessed laser probes were all within acceptable range. The second phase of this study included 590 endolaser probes, of which 375 were original and 215 were reprocessed. Functionality rates differed significantly between groups. Among the original probes, 373 (99.47%) were functioning and 2 (0.53%) were non-functioning. Among the reprocessed ones, 201 (93.5%) were functioning and 14 (6.5%) were non-functioning (p < .001). The average cost of one reprocessing was $3.00, and the average cost of an original probe was $150.00. Considering the loss rates, potential savings were $147.60 for each once-reprocessed probe. The frequency of infectious endophthalmitis was null in both groups.ConclusionsOur study showed that a single cycle endolaser probe reprocessing was safe and efficient, not associated with increase in endophthalmitis rate and proved to be significantly cost-effective, even considering a greater malfunction rate when compared to the original devices.

Long-term outcomes of Boston keratoprosthesis type I: the Chinese People’s Liberation Army General Hospital experience

PurposeTo report the long-term outcomes of Boston keratoprosthesis type I (B-KPro type I) implantation in the management of severe ocular surface disorders.MethodsRetrospective case series. Patients who underwent B-KPro type I...

Atypical Microbiological Feature of Infectious Endophthalmitis on Jeju Island: A 10-Year Study at a Single Tertiary Referral Center.

Background To analyze the microbiological causes of infectious endophthalmitis on an isolated island over ten years. Methods A retrospective review of the medical records of 49 eyes clinically diagnosed with infectious endophthalmitis between January 2009 and December 2018 was done. The subjects were recruited from a single tertiary referral center on Jeju Island. The baseline characteristics of all subjects were investigated, and a culture examination was performed. The isolated pathogens were analyzed to determine how their microbiological features differed from those in regions with different geographical conditions. Results Of the 49 eyes, causative microorganisms were identified in 27 eyes (55.1%). Bacteria were found in 24 cases and fungi in 3 cases. Among the exogenous causes, Staphylococcus species (Staphylococcus aureus, S. epidermidis, and S. hominis) were the most common pathogens (7 cases). Achromobacter xylosoxidans was the second most common causative pathogen (4 cases) followed by Moraxella species (3 cases). The most frequent endogenous origin was due to Klebsiella pneumoniae (6 cases). The subjects were divided into two groups according to the treatment results and analyzed for predisposing factors related to visual outcomes. The presence of diabetes mellitus (P = 0.038) and initial visual acuity (P ≤ 0.001) were significant predisposing factors for visual outcomes. Conclusion The causative microorganisms of endogenous endophthalmitis on Jeju Island were not different from those reported previously. However, isolated exogenous microorganisms were different from those reported in other studies from inland areas. A high incidence and atypical clinical features of Achromobacter xylosoxidans and Moraxella in exogenous endophthalmitis were observed, reflective of the distinct climatic features of Jeju Island: high humidity and temperature. Therefore, considering the causative microorganisms of exogenous endophthalmitis, it may be assumed that the causative microorganisms of exogenous endophthalmitis and its clinical manifestations differ according to the region.

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.

Unaffected retinal function in eyes with toxic anterior segment syndrome evaluated by full-field electroretinography

A 60-year-old woman was suspected of having developed infectious endophthalmitis after cataract surgery. Corrected distance visual acuity (CDVA) was 20/25 in the affected eye with hypopyon and fibrin. Electroretinography (ERG) was normal except for slightly reduced dark-adapted (DA) 0.01 ERG. Anterior chamber irrigation detected no causative organism. Similarly, a 65-year-old woman was suspected of having developed infectious endophthalmitis after cataract surgery. CDVA was 20/100 in the affected eye with hypopyon and vitreous opacity. ERG was normal except for subtly decreased, but not delayed, DA 0.01 and 3 ERGs. Vitrectomy was performed, but no causative organism was detected. Both cases were diagnosed with toxic anterior segment syndrome (TASS) based on the aforementioned findings and because their intraocular lenses were linked to known TASS outbreaks in Japan. Retinal function was not affected in these cases with TASS.

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.

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.

Detecting Streptococcus suis by nanopore sequencing in endophthalmitis: A case report

Endophthalmitis is a rare and infectious disease caused by Streptococcus suis (S suis). Traditionally, S suis is detected by the pathogenic microorganism culture method, which has low positivity and high false negativity. Nanopore sequencing (NS), which is a third-generation sequencing technology, has several advantages over the traditional method; in particular, it is cost and time effective and has a high throughput. In this report, a case of infectious endophthalmitis caused by trauma is examined. The NS results suggest that the pathogen in question is a mixed infection caused by S suis and Clostridium perfringens. This case report provides evidence of the fact that NS can quickly identify pathogens, which is of great significance for clinical diagnosis and treatment.

Predictors for Visual Outcomes in Eye Injuries with Intraocular Foreign Body.

ObjectiveTo study the visual outcomes and identify the predictive factors for visual outcomes in patients with eye injuries and retained intraocular foreign bodies (IOFBs).Patients and MethodsThe medical records of 359 consecutive patients with eye injuries and retained IOFBs were retrospectively reviewed during 2009–2018. Demographic data, clinical findings, treatment and visual outcomes were studied. Univariate and multivariate analyses were used to identify the predictive factors.ResultsMost of the patients were male and the average age was 36.4 years old. The three most common causes of eye injuries were grass trimming (25.07%), chiseling (23.12%) and hammering (13.93%). Most of the patients (79.39%) presented with poor initial best-corrected visual acuity (BCVA) (<3/60). Pars plana vitrectomy with IOFB removal was done in 273 eyes (76.04%). After treatment, eyes with poor BCVA (<3/60) decreased from 79.39% to 62.95% and eyes with good BCVA (≥3/60) increased from 20.61% to 37.05%. Poor initial best-corrected visual acuity (odds ratio 23.39, P<0.001), rhegmatogenous retinal detachment (odds ratio 9.91, P<0.001) and the presence of infectious endophthalmitis (odds ratio 2.06, P=0.02) were statistically significant predictive factors for poor visual outcome.ConclusionMost patients with eye injuries and IOFBs usually have poor final BCVA. Poor presenting BCVA, retinal detachment and endophthalmitis are significant predictive factors for poor visual outcomes. These factors can be used to inform the visual prognosis and plan prompt surgical intervention for the patients. Causes of IOFBs were mostly work-related and could be preventable. Education and activation of using appropriate protective safety glasses during work are necessary to avoid serious eye injuries and blindness.

Bacterial Bacterial Culture and Clinical Characteristics of Infectious Endophthalmitis in Western Gyeongsangnam-do

ëª©ì  서부 경남 지역 3ì°¨ 의료기관에서 진단한 감염안내염 환자들의 ì›ì¸ê· , 임상양상 및 ì‹œë ¥ì˜ˆí›„ë¥¼ ì•Œì•„ë³´ê³ ìž 하였다. 대상과 방법 2010ë „ 1월부터 2019ë „ 6월까지 경상대학교병원에서 감염안내염으로 진단된 93ëª (98안)을 대상으로 í›„í–¥ì ìœ¼ë¡œ 의무기록을 분석하였으며 ëª¨ë“ í™˜ìžì—ì„œ ì „ë°©ê³¼ ìœ ë¦¬ì²´ 검체의 배양검사를 ì‹œí–‰í•˜ì˜€ê³ ë°°ì–‘ëœ ê· ì˜ ì¢ ë¥˜, 치료 방법, ì‹œë ¥ì˜ˆí›„ 등을 분석하였다. ê²°ê³¼ 대상 환자 98안에서 ê· ì´ 배양된 경우는 67안(68.4%)이었으며 가장 흔한 감염안내염의 원인은 ë°±ë‚´ìž¥ìˆ˜ìˆ í›„ 발생한 ì•ˆë‚´ì—¼ì´ì—ˆê³ . 가장 흔한 ì›ì¸ê· ì€ ê·¸ëžŒì–‘ì„±ê· ì¸ Staphylococcus epidermidis (16.3%)이었다. ìµœì¢ ìµœëŒ€êµì •ì‹œë ¥ì„ 1.0 logMAR을 기준으로 분석한 ê²°ê³¼ 초진 ìµœëŒ€êµì •ì‹œë ¥ì´ ì•ˆì „ìˆ˜ì§€ 이상인 경우, ìœ ë¦¬ì²´ì ˆì œìˆ ì„ 시행한 경우가 í†µê³„ì ìœ¼ë¡œ 의미있는 예후를 보였다(p<0.001, p=0.021). ê²°ë¡ ê°ì—¼ì•ˆë‚´ì—¼ 중 외인안내염은 ë°±ë‚´ìž¥ìˆ˜ìˆ í›„ 많은 발생 빈도를 보이며 ê·¸ëžŒì–‘ì„±ê· ì¸ Staphylococcus epidermidis가 가장 흔하며 좋은 ì‹œë ¥ì˜ˆí›„ë¥¼ 보여주었다. 내인안내염은 간농양이 가장 흔한 ê°ì—¼ë³‘ì†Œì´ê³ ê·¸ëžŒìŒì„±ê· ì¸ Klebsiella pneumoniae가 í”í•˜ê³ ë‚˜ìœ ì‹œë ¥ì˜ˆí›„ë¥¼ 보여주었다. Keywords: Culture, Infectious endophthalmitis, Vitrectomy

Outcomes of Infectious Endophthalmitis in Patients with Systemic Antibiotic Allergies to Penicillins, Cephalosporins, or Vancomycin

The mainstay empiric treatments of bacterial endophthalmitis are intravitreal vancomycin and ceftazidime. In the United States, up to 10% of the general population has a reported penicillin (PCN) allergy. Despite low cross-reactivity between PCN and later-generation cephalosporins, some providers alter the intravitreal antibiotic choice for endophthalmitis because of concern for allergic reactions. We evaluated the management strategies of infectious endophthalmitis in the setting of self-reported systemic antibiotic allergies and the association with adverse reactions after standard intravitreal antibiotic administration. Single-center, retrospective cohort study. All patients with endophthalmitis between 2005 and 2019 and documented PCN, PCN-analog, cephalosporin, or vancomycin allergy who received intravitreal antibiotics on the basis of International Classification of Diseases 9th and 10th Revisions, and Current Procedural Terminology codes. Retrospective chart review. Any allergic reaction after intravitreal injection, additional surgical interventions required for treatment, and visual function at last recorded visit. Of the 65 patients included in this cohort, the most common causes of endophthalmitis were postcataract extraction surgery (n = 23, 35.4%) and postintravitreal injection (n = 11, 16.9%). All patients (65/65) received intravitreal vancomycin, and 81.5% (53/65) received intravitreal ceftazidime. Of the 53 patients who received intravitreal ceftazidime, 46 (86.8%) had allergies to PCNs alone, 5 (9.4%) had a cephalosporin allergy alone, and 2 (3.8%) had reported allergies to both PCN and cephalosporin antibiotics. Two patients (3.1%) with a documented vancomycin allergy received intravitreal vancomycin without complication. No patients exhibited any systemic or local allergic reactions or complications after intravitreal injection. There were no documented allergic reactions in this cohort of patients with systemic antibiotic allergies who were treated for infectious endophthalmitis. Our findings are consistent with previous reports of a low allergic cross-reactivity between PCN and later-generation cephalosporins. Ophthalmologists should use evidence-based practices and a careful informed consent process when choosing intravitreal antibiotics for patients with specific antibiotic allergies. In the routine patient with suspected bacterial endophthalmitis, PCN allergy may not be an absolute contraindication to intravitreal cephalosporin use.

Use of an ultra-clean air flow for surgical field asepsis when performing intravitreous injections in an ambulatory surgical environment

BackgroundIntravitreal injection of medications is one of the most common procedures performed in ophthalmology. Intravitreal anti-VEGF agents are currently the chosen treatment for ocular fundus diseases, including age-related macular degeneration and diabetic retinopathy. As an invasive procedure it involves risks. The most serious complication from intravitreal injection of anti-VEGF agents is endophthalmitis (EO). Although rare, EO can result in devastating loss of vision. This article evaluates whether the use of an ultra-clean air flow (UA) can be another useful tool in the prevention of EOs. Accordingly, the maintenance of asepsis of the surgical field of intravitreal injections was verified with and without the use of UA.MethodsThe study was conducted in operating room of an ambulatory surgery center on four different surgical days when just intravitreal injections were scheduled. Two experiments using two Blood Agar and two Chocolate Agar plates (first 2 days; 4 plates by day) were carried out by positioning an UA directed to the surgical table and two other experiments (last 2 days; 4 plates per day) were carried out using similar plates without the use of the UA. All Blood Agar and four Chocolate Agar plates were positioned on the surgical table, close to the surgical filed. At the end of the day, after the conclusion of the intravitreous injections, the plates were sent for a biomolecular study that was carried out after 1 day of incubation at 37 °C.ResultsThe sixteen plates, eight Blood Agar and eight Chocolate Agar, were analyzed qualitatively for the growth or not of microorganism’s colonies and identification of their species. The biomolecular study demonstrated the growth of bacteria of the genus Micrococcus sp. with the use of the UA and without the the UA bacterias of the genera Bacillus sp, Staphylococcus haemolyticus, Staphylococcus aureus and Staphylococcus cohnii ssp urealyticus were found.ConclusionThe use of UA close to the operating table prevented the growth of pathogenic bacteria and should be considered as an alternative tool to avoid the contamination of materials and drugs used for intravitreal injections.

Incidence of Endophthalmitis after Intravitreal Anti-Vascular Endothelial Growth Factor Injections in an Operating Room in China.

Purpose To evaluate the rate of presumed endophthalmitis (EO) after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections performed in an operating room (OR) under sterile conditions in mainland China. Methods Retrospective single-center study between September 2012 and December 2017 at Beijing Tongren Eye Center, Beijing, China. Intravitreal injection database was reviewed. All anti-VEGF injections were performed using a standardized sterile technique in an OR. Injection protocols included antibiotics for 3 days pre-injection, topical 5% povidone-iodine rinsing before the procedure, and post-injection antibiotics for 3 days. Results A total of 37,830 intravitreal injections were performed at Beijing Tongren Eye Center. Three cases were managed as presumed EO (0.0079%). Positive cultures were documented in 2 of 3 cases. EO incidence following ranibizumab and conbercept administration was 0.0088% (3 in 33,930) and 0% (0 in 3,900), respectively. No significant difference was detected between the two drugs (P = 0.745). Conclusions Very low EO rates were seen in mainland China using a standardized sterile technique in an OR. However, EO could not be completely avoided.

Microbiological patterns of endophthalmitis in a tertiary level hospital of Kathmandu, Nepal.

Endophthalmitis is a serious ocular infection that can result in blindness and therefore is a major ophthalmic concern. The study was conducted to find out the microbial etiology in clinically diagnosed cases of endophthalmitis and to determine the antibacterial susceptibilities of bacterial isolates in vitro. A retrospective analysis was carried out of all patients presenting between 15th January 2012 to 15th January 2013 with clinically diagnosed Endophthalmitis at Tilganga Institute of Ophthalmology (TIO). Intraocular specimens (aqueous or vitreous fluids) were collected from 102 patients. Along with intraocular aspirates, blood and urine specimens, chest X-ray from endogenous endophthalmitis and corneal scrapes from corneal ulcer leading to endophthalmitis were also collected. The intraocular specimens were then subjected to microbiological evaluation. Antibiotic susceptibility of isolates were determined for different ocular antibiotics using the Kirby-Bauer disk-diffusion test. Samples from 102 patients diagnosed with endophthalmitis underwent microbiological analysis, of which culture positive 34(33.33%). Out of 34, 29 (85.29%) had bacterial growth and the remaining 5 (14.70%) had fungal growth. Most of them (40.8%) were secondary to cataract surgery(postoperative). A total of 29 bacterial culture reports, 72.41% were gram-positive and 27.58% were gram-negative. Streptococcus pneumoniae (37.93%) was the most frequently isolated organism. The antimicrobial sensitivity for isolates was as follows: Ofloxacin - 86.2%, Chloramphenicol - 82.75%,Cefazolin- 82.7%, Gentamicin - 75.8%, Ceftazidime - 58.6%, Amikacin - 55.17% and Vancomycin - 51.7%. The data highlights low culture positivity and a predominance of gram positive bacteria as the major causes of infectious endophthalmitis, usually following cataract surgery. The most common isolate was Streptococcus pneumoniae. Ofloxacin and Chloramphenicol demonstrated greatest efficacy against these bacterial isolates.

Postintravitreal Injection Endophthalmitis: An Infection Control Investigation and Case–Control Analysis of Risk Factors

Background: Intravitreal injection of vascular endothelial growth factor inhibitors with or without steroids is a well-established, effective therapy for several ocular disorders. The expected rate of complications from these injections is low, with meta-analyses reporting 5–6 occurrences of infectious endophthalmitis per 10,000 injections. Through October 2019, our health system observed 8 cases of endophthalmitis among 7,693 injections (10.4 per 10,000 injections), compared to 1 case in 2018. This unusually high rate prompted an infection control investigation and a case control study to examine risk factors for the development of postintravitreal injection endophthalmitis. Methods: Infection control providers performed direct observation of several ophthalmologists performing intravitreal injections on 3 separate occasions to determine points of intervention to prevent infection. To define risk factors for postintravitreal injection endophthalmitis, we conducted a retrospective case-control study of the 8 affected patients. Four control patients were selected per case, matched by clinic location, drug injected, and date of injection (total subjects, N = 40). We extracted patient-level risk factors from medical records; documentation was not sufficient to compare procedure-level factors. We conducted unadjusted univariate Poisson regression and Mantel–Cox method rate ratios to identify significant risk predictors of endophthalmitis. Results: Direct observation yielded variable practice in use of masks, gloves, sterile lid speculum, and the duration of povidone-iodine contact on the ocular surface prior to injection. The location of alcohol hand gel relative to the procedure field was suboptimal. Due to patient volume, there were significant delays between procedure and patient prep and injection time. The mean age was 76 years among cases and 74.1 years among controls; 35% of patients were men. Age-related macular degeneration was the most common indication for injection (55%). Only 10% of injections were bilateral. Although not statistically significant, patients with coronary artery disease had a higher rate of infection than those without coronary artery disease (165.3 vs 16.3 per 10,000 person years; IRR = 3.0; 95% CI, 0.60–14.8; P = .18); current smokers were also at higher risk (86.9 per 10,000; IRR, 3.2; 95% CI, 0.33–30.4; P = .32). Conclusions: Coronary artery disease and smoking were risk factors for the development of postintravitreal injection endophthalmitis in a 2019 cluster of cases in our organization. We are continuing to work with our ophthalmologists to optimize infection prevention in the injection environment, including strict use of gloves, appropriate use of povidone-iodine, and routinely wearing a mask and encouraging a no-talking policy during injections.Funding: NoneDisclosures: None

Management Patterns and Visual Outcomes of Endophthalmitis After Glaucoma Drainage Device Placement: A Case Series.

To describe clinical presentation, management, and outcomes of eyes with endophthalmitis related to glaucoma drainage device (GDD) placement. Retrospective chart review of patients diagnosed with GDD-related endophthalmitis at Duke Eye Center from 2009 to 2018. Six eyes of 6 patients had endophthalmitis related to a GDD (2 Ahmed, 4 Baerveldt). The mean time from surgery to presentation was 22.7 months. Five of 6 cases (83%) had culture-proven infectious endophthalmitis. Eyes undergoing GDD explantation (n=2) had better visual acuity at 6 months compared with those without hardware removal (20/11,314 vs. 20/358). Visual acuity at 6 months was hand motion (20/8000) or worse in 3 of 6 cases (50%). GDD-related endophthalmitis often leads to poor visual outcomes. Hardware removal may lead to improved visual outcomes; a multicenter prospective study assessing the benefit of hardware removal may be warranted.

Treatment Patterns and Outcomes in Bleb-Related Endophthalmitis: A 9-Year Analysis at a Tertiary Eye Center.

Clinical presentation, treatment choices, and outcomes in cases of bleb-related endophthalmitis (BRE) at a tertiary care center over a 9-year period are described. A retrospective review was conducted of patients diagnosed with BRE at Duke Eye Center (Durham, North Carolina) from January 1, 2009 to January 1, 2018, with at least 6 months of follow-up, assessing demographic data, initial management, and visual acuity (VA). Twenty eyes of 20 patients with BRE were identified. Median time from surgery to presentation was 6.53 years. Presenting VA of light perception only was significantly associated with the decision to pursue pars plana vitrectomy (PPV) as initial treatment (odds ratio 59.4, 95% CI, 2.1-1670.8, P = .016). Twelve eyes (60%) had culture-proven infectious endophthalmitis. Eleven eyes (55%) underwent PPV during treatment; 5 eyes underwent PPV on presentation, and 6 eyes underwent PPV after initial presentation. Compared with pre-endophthalmitis VA, 6 eyes that underwent subsequent PPV had greater VA loss at 6 months than cases not undergoing subsequent PPV (Early Treatment Diabetic Retinopathy Study line loss of 14 vs 4 lines, respectively; P = .044). BRE eyes presenting with light-perception VA were more likely to undergo initial PPV; yet many eyes in this study required PPV during treatment. Visual outcomes are often poor in BRE despite intensive management. There was greater VA loss from pre-endophthalmitis VA levels at 6 months in eyes undergoing PPV after initial treatment. Prospective studies are needed to assess the optimal role of PPV in patients with BRE.

Endophthalmitis After Descemet Stripping Endothelial Keratoplasty: Microbiological Yield and Visual Outcomes

To describe the clinical presentation, management, and visual outcomes of 6 eyes with endophthalmitis after Descemet stripping endothelial keratoplasty (DSEK). Retrospective case series. Setting: Tertiary, academic eye center. StudyPopulation: Individuals developing endophthalmitis after DSEK at the Duke Eye Center from January 1, 2009, to January 1, 2018, with at least 6months of follow-up. ObservationProcedure: Retrospective chart review. OutcomeMeasures: Diagnostic procedures, microbiological yield, and visual outcomes. Six eyes of 6 patients were identified. Mean time from surgery to presentation was 51days (range, 4-137days). Dense vitreous opacities were present in all cases. Five of 6 cases (83%) had culture-proven infectious endophthalmitis (2 Candida glabrata, 2 coagulase-negative Staphylococcus, 1 Streptococcus pneumoniae). Aqueous tap yielded positive culture in 2 of 2 cases with adequate sample (100%); needle vitreous tap yielded positive culture in 0 of 3 cases. One eye underwent vitrectomy on presentation, and 3 eyes (50%) underwent subsequent vitrectomy for persistent endophthalmitis after a mean of 37days. Mean pre-endophthalmitis visual acuity (VA) was 20/64; mean VA at 6months was 20/2069 (average 15 ETDRS lines lost). VA at 6months was light perception or no light perception in 3 of 6 cases (50%). One eye underwent enucleation at 6months, and 1 eye became phthisical 1 year after endophthalmitis. DSEK-related endophthalmitis may lead to severe vision loss, even with prompt and appropriate treatment. Aqueous tap had a higher culture yield than needle vitreous tap in our series.

Infectious and Sterile Endophthalmitis in Eyes with Glaucoma Drainage Device from Two Large Ophthalmic Institutions

To describe the predisposing factors, presentation, management, and outcome of glaucoma drainage implant (GDI)-associated endophthalmitis. Retrospective chart review. Eyes that developed GDI-associated endophthalmitis between December 1, 2011, and December 23, 2019, at the Duke Eye Center and Cole Eye Institute. Patient data search was performed on the basis of diagnostic codes for GDI and endophthalmitis. Endophthalmitis was defined clinically according to each physician's discretion. Eyes with infection source other than GDI were excluded. Worse vision was defined as a decrease of more than 2 Snellen lines. Data were collected on baseline demographics, systemic and ocular comorbidities, ocular surgical history, best-corrected visual acuity (BCVA), intraocular pressure (IOP), clinical presentation, eye culture results, and treatments performed. Statistical analysis included the paired t test and odds radio calculations. Visual acuity and IOP at final follow-up. Thirty cases (0.7%) of GDI endophthalmitis were identified among 4073 GDIs performed at the 2 institutions with active follow-up. Device exposure was identified in 20 eyes (67%) on presentation. The average follow-up after presentation was 22.4 ± 25 months. The most frequently identified organism on culture was Streptococcus pneumoniae. Same-day injection of intravitreal antibiotics was the universal first-line therapy. From baseline to final follow-up, the mean BCVA decreased from-0.84 ± 0.77 to-1.30 ± 0.93 (logarithm of the minimum angle of resolution, P= 0.02). Mean IOP did not change from baseline to final visit in the overall cohort (16.2 ± 8.2 mmHg to 14.6 ± 9.4 mmHg, P= 0.30) and in the subgroup that underwent tube explant (15.9 ± 5.5 mmHg to 15.2 ± 10.4 mmHg, P= 0.97). Eighteen of 20 tube exposure cases (90%) underwent tube explant, 1 underwent tube revision, and 1 re-epithelialized. Glaucoma drainage implant-associated endophthalmitis was correlated with poor visual outcome. Immediate intravitreal antibiotic delivery was a universal first-line therapy. Tube exposure was a necessary risk factor for late-onset endophthalmitis and required surgical removal or repair.

Infectious endophthalmitis at a Philippine tertiary hospital: a ten-year retrospective study

BackgroundEndophthalmitis is a sight-threatening disease characterized by marked progressive inflammation of the vitreous and/or aqueous humors. Limited information is currently available regarding endophthalmitis in the Philippines. This study aimed to provide long-term summary data on endophthalmitis cases seen at the largest tertiary referral hospital in the Philippines.MethodsAll endophthalmitis cases diagnosed at the Philippine General Hospital from January 1, 2007 to December 31, 2016 were retrieved and classified by etiology. Data pertaining to history, associated risk factors, isolated microorganisms, management, and final visual outcomes for each patient were reviewed.ResultsA total of 202 cases diagnosed within the audit period were included in the study. These were classified as post-traumatic (55.94%), endogenous (14.36%), acute post-operative (10.40%), keratitis-induced (6.93%), chronic post-operative (5.44%), bleb-associated (3.96%), and suture-associated (2.97%) endophthalmitis. Males comprised 71.29% of the population, while the largest age group affected was 0–10 years (24.75%). The culture-positive rate was 57.89%. The predominant etiology was Gram-positive bacteria (38.18%), followed by Gram-negative bacteria and mixed pathogens (21.82% each), and fungi (18.18%). The most common organisms were Streptococcus, Staphylococcus, Pseudomonas, Aspergillus, and Candida, accounting for 56.45% of isolates. Pars plana vitrectomy was done for 62.87% of patients, intravitreal and other antibiotic therapy in 23.27%, and primary enucleation/evisceration in 10.89%. The final outcomes and best corrected visual acuities were: anophthalmia 11.86%, no light perception/no dazzle 27.84%, light perception 8.76%, hand motions 24.23%, counting fingers 5.15%, 3/200 to 20/50 12.89%, and 20/40 to 20/20 9.28%.ConclusionsThere was a higher proportion of post-traumatic endophthalmitis cases compared to traditional estimates but consistent with studies from China and Thailand. The majority of these cases involved younger children as well as young to middle-aged males engaged in carpentry and construction work, implying a need for increased public health awareness and strengthening of childcare and workplace safety policies. Our microbiologic profile showed a lower proportion of Gram-positive infections and a higher proportion of mixed pathogen infections compared to other studies. There was also a higher proportion of fungi associated with post-operative and keratitis-induced endophthalmitis. The best outcomes were seen in acute post-operative and bleb-associated endophthalmitis, and the worst outcomes in endogenous and keratitis-induced endophthalmitis. Visual outcomes were poorer compared to other Western and Asian countries, with only 21.7% of patients improving from presentation.