Intravitreal Injection Of Vancomycin Research Articles

A novel case of endophthalmitis secondary to Paenibacillus yonginensis after intravitreal injection of aflibercept.

To report a case of endophthalmitis after intravitreal injection due to Paenibacillus yonginensis. This is a retrospective case report. An 87-year-old man with longstanding neovascular age-related macular degeneration (AMD) in his left eye presented with pain and loss of vision three days after intravitreal injection of aflibercept. Examination revealed a hypopyon and vitreous opacities. A diagnostic anterior chamber paracentesis and intravitreal injections of vancomycin and ceftazidime were performed. One month later, vitrectomy was performed for non-clearing vitreous opacities with a good final visual outcome. The causative bacterium, Paenibacillus yonginensis, was identified with polymerase chain reaction (PCR) sequencing from the aqueous specimen. We encountered a rare presentation of endophthalmitis caused by Paenibacillus yonginensis. Paenibacillus species have been implicated in human infection in recent years. DNA sequencing can allow for the identification of uncommon bacteria.

Endogenous fungal endophthalmitis caused by Cladophialophora devriesii: report of a case and literature review

PurposeTo report a case of endogenous endophthalmitis caused by the dematiaceous fungus Cladophialophora devriesii.MethodsObservational case report and literature review.Case presentationA 73-year-old female with a history of chronic obstructive pulmonary disease presented with a red and painful left eye. Examination revealed anterior segment inflammation and vitritis, indicative of endophthalmitis. She underwent core vitrectomy and intravitreal injection of vancomycin and amphotericin B. The vitreous sample showed inflammatory cells and fungal hyphae, and systemic amphotericin B and itraconazole were commenced for fungal endophthalmitis. Targeted amplification of the sample for bacterial DNA (V2-V3 region of 16 S rDNA) was negative, but fungal DNA targets (ITS1 and ITS2) were present, and their sequences were consistent with Cladophialophora devriesii. Phenotypic characterisation and sequencing of ITS1 and ITS2, carried out on cultured fungus from the sample, also revealed Cladophialophora devriesii. She received repeated intravitreal injections of voriconazole, and based on the antifungal susceptibility results, her systemic medication was changed to posaconazole. After 12 months, the eye showed no signs of inflammation, and posaconazole therapy was discontinued. After 3 months without antifungal medication, the inflammation recurred, and she was restarted on antifungal therapy for an additional 20 months. Another recurrence occurred 3 months after discontinuation of treatment, and a repeat vitreous sample confirmed the presence of Cladophialophora devriesii. She was started on isavuconazole, but developed seclusio pupillae and painful secondary glaucoma. Due to the duration and severity of the infection, the eye was enucleated. Histopathology revealed persistent fungal elements at the ciliary processes and the posterior lens surface.ConclusionsThis second reported case of endogenous endophthalmitis caused by Cladophialophora devriesii illustrates the role of vitreous sampling and molecular methods in diagnosis and treatment of fungal endophthalmitis. Despite early diagnosis and prolonged local and systemic antifungal therapy, it was not possible to achieve long-term control of the fungal infection.

SUBTENON'S VANCOMYCIN INJECTION FOR SUBRETINAL ABSCESS SECONDARY TO METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS ENDOGENOUS ENDOPHTHALMITIS: A CASE REPORT AND LITERATURE REVIEW.

To report the use of a subtenon's vancomycin injection for the treatment of subretinal abscess secondary to methicillin-resistant Staphylococcus aureus endogenous endophthalmitis. A 17-year-old man developed endogenous endophthalmitis with subretinal abscess in his right eye secondary to methicillin-resistant Staphylococcus aureus bacteremia from axillary necrotizing fasciitis. Despite prompt treatment with IV vancomycin and an intravitreal vancomycin injection, the patient displayed minimal improvement. The patient was subsequently treated with a subtenon's vancomycin injection. The injection technique is described in detail, as well as a review of the treatment options available for bacterial subretinal abscesses. On presentation, examination revealed minimal vitritis and a large yellow subretinal abscess superotemporally extending close to the macula with subretinal fluid inferotemporally involving the macula. Four days postintravitreal vancomycin injection, the abscess remained stable and the patient developed an exudative detachment temporally. Vancomycin was injected superotemporally in the subtenon's space with no complications during the procedure or during his postoperative recovery. At seven days postinjection, the subretinal abscess and exudative retinal detachment resolved completely with necrosis at the area of previous abscess. We present the first successful case of subtenon's vancomycin injection for the treatment of bacterial subretinal abscess. Our case demonstrates that subtenon's injection of antibiotics is a safe and effective nonsurgical management option for bacterial subretinal abscesses.

Rahnella Aquatilis Endophthalmitis after Intravitreal Injection in an Immunocompetent Patient.

To present a novel case of exogenous Rahnella aquatilis endophthalmitis following an intravitreal injection. Case report. A 74-year-old male presented with acute progressive vision loss and pain in the left eye, 5 days after an intravitreal injection for diabetic macular edema. The patient was diagnosed with exogenous endophthalmitis and empirically treated with intravitreal injections of vancomycin and ceftazidime as well as topical and oral ciprofloxacin. In follow up two days later, the patient was treated with preoperative povidone-iodine followed by prompt vitrectomy with additional vancomycin and ceftazidime due to pharmacy sterile hood issues that delayed antibiotic availability. Microbiological cultures and two mass spectrometry identification tests confirmed the diagnosis of exogenous Rahnella aquatilis endophthalmitis. Despite the presence of scattered retinal hemorrhagic infarcts involving the macula and subsequent full-thickness atrophic macular holes seen in follow up, the patient achieved a favorable anatomical and functional outcome of BCVA 20/80 at 1 year of follow-up. This case highlights the occurrence of exogenous Rahnella aquatilis endophthalmitis following an intravitreal injection for diabetic macular edema. Prompt diagnosis and treatment produced a favorable outcome relative to other typical Gram-negative Enterobacteriaceae organisms.

A SUCCESSFUL TREATMENT OF INTRAVITREAL MOXIFLOXACIN INJECTION IN ACUTE POST-CATARACT SURGERY ENDOPHTHALMITIS: A CASE REPORT

Introduction : Endophthalmitis is a severe form of ocular inflammation and one of the most dreaded cataract surgery complications which may lead to loss of vision. Post-cataract surgery endophthalmitis is a serious complication that occurs when infecting organisms invade the posterior segment of the eye during the time of surgery. Currently, intravitreal injection of vancomycin along with ceftazidime is the first-line treatment, but another study showed a good result of intravitreal moxifloxacin injection in patients with Postoperative endophthalmitis.
 Case Illustration : We reported a 59-year-old woman presented with blurred vision, redness, and pain in the left eye 4 days after phacoemulsification. Visual acuity of LE was hand movement and anterior segment examination found that there was a conjunctival and pericorneal injection, corneal edema, cells, and anterior chamber fibrin formation. Ultrasonography examination showed severe levels of debris in the vitreous humor. Patient was diagnosed with acute post-cataract surgery endophthalmitis and received an intravitreal moxifloxacin injection. Fortunately, one week after that injection, there wasa good result in the patient’s eye condition. Visual acuity of LE improved to 0,1 and the patient planned to receive the second moxifloxacin injection to get the best possible results.
 Discussion : Moxifloxacin expresses broad-spectrum microbial coverage with a very good diffusion and low adverse effects. Moxifloxacin also has a better penetration ability into inflamed ocular tissue than all other antibiotics. Based on that, other studies said that intravitreal moxifloxacin can replace vancomycin and ceftazidime combinations for the treatment of ocular infections.
 Conclusion : Intravitreal moxifloxacin injections have a good result in acute post-cataract surgery endophthalmitis.

Triple Gram-negative bacterial endophthalmitis following intravitreal injection

PurposeTo describe a puzzling case of endophthalmitis caused by three unusual bacteria after intravitreal injection, its outcome, and underlying questions.FindingsA 70-year-old female patient was diagnosed with acute endophthalmitis following intravitreal aflibercept injection for age-related macular degeneration. A standard tap and inject procedure was performed. Microbiological analyses on the anterior chamber and vitreous samples yielded the presence of three non-fermenting Gram-negative rods: Pseudomonas stutzeri, Stenotrophomonas maltophilia, and Ochrobactrum anthropi. The outcome was favorable after intravitreal injections of vancomycin and ceftazidime, with an almost complete recovery of the visual acuity to its baseline level. No potential source of infection was identified.ConclusionEndophthalmitis following intravitreal injection can be caused by a wide variety of bacteria, including some rare Gram-negative species. They can sometimes co-exist in a single patient, but their virulence may vary greatly. Due to the variable antibiotic susceptibility and frequent multiresistance associated with non-fermenting Gram-negative rods, a prompt microbiological approach is required. Favorable outcome can be achieved with standard management.

Интравитреальное введение моксифлоксацина в комбинации с ванкомицином при субтотальной витрэктомии при послеоперационном эндофтальмите

Acute bacterial postoperative endophthalmitis is inflammation of the internal eye eyeball tunic with the formation of exudate in the vitreous chamber and / or anterior chamber which can quickly lead to an irreversible loss of visual functions, and sometimes loss of the eye as an organ developing most often after surgical treatment of cataracts. The generally accepted standard of the acute bacterial postoperative endophthalmitis treatment (the «gold standard») includes vitrectomy, sampling of contents of the vitreous chamber and anterior chamber for microbial analysis, and determination of its sensitivity to antibiotics. Intravitreal injection of Vancomycin at a dose of 1 mg/0.1 ml and Ceftazidim at a dose of 2.25 mg / 0.1 ml at the final stage of the intervention. To date, the choice of antibacterial substances for intravitreal injections remains open. One of the drugs that meet the requirements is Moxifloxacin; antibacterial drug of fluoroquinolone group with bactericidal effect. It is active against a wide range of Gram-positive bacteria and Gramnegative bacteria, anaerobic, acid-resistant and atypical bacteria. Keywords: acute bacterial postoperative endophthalmitis, intravitreal administration of antibacterial drugs, safety of moxifloxacin and vancomycin, endophthalmitis treatment standards

Fungal blebitis due to Aspergillu ustus. About the first case described in the literature

AbstractPurpose: Blebitis is the infection of the valve created in glaucoma filtering surgery. Only 4 cases have been described that refer to ophthalmic infections caused by A. ustus, the pathogen demonstrated in the cultures in this case.Methods: We present the case of a 73‐year‐old woman with a history of hypertension, dyslipidaemia, hyperuricaemia, hypothyroidism and glaucoma in both eyes under maximum topical treatment, despite which she had elevated intraocular pressure (IOP) and structural progression in the right eye (RE). Trabeculectomy with mitomycin‐C (MMC) was performed in RE. After 36 days, the patient came to the emergency department with a slightly painful red and secretions in RE. Examination revealed a whitish bleb, hyperfiltration, fibrin in the anterior chamber and mild corneal oedema. The vitreous was not found to be involved at any time. A conjunctival swab was taken and treatment was started and the patient was admitted for blebitis 3 days later. Two anterior vitrectomies were necessary, the first with collection of aqueous humour (AH) samples and intravitreal injection of vancomycin, the second, after 3 weeks, with phacoemulsification (leaving the patient in aphakia), collection of AH and vitreous samples and intravitreal injection of voriconazole with the addition of oral fluconazole.Results: Eleven weeks after the first surgery Aspergilus ustus was isolated in vitreous humour samples. After 1 year of follow‐up the patient has visual acuity (VA) of light perception in RE, ptisis bulbi, hypotonia, without pain, discomfort, signs of infection or any other symptoms. Together with her it was decided to perform enucleation.Conclusions: Blebitis is a potentially fatal complication whose risk does not decrease over the years. Being alert to warning signs and symptoms is paramount for early detection and optimal management. To our knowledge this would be the first reported case of A. ustus blebitis.

Интравитреальное введение Вигамокса (Моксифлоксацин без консервантов) в комбинации с ванкомицином при лечении послеоперационного эндофтальмита

Acute bacterial postoperative endophthalmitis is inflammation of the internal eye eyeball tunic with the formation of exudate in the vitreous chamber and / or anterior chamber which can quickly lead to an irreversible loss of visual functions, and sometimes loss of the eye as an organ developing most often after surgical treatment of cataracts. The generally accepted standard of the acute bacterial postoperative endophthalmitis treatment (the “gold standard”) includes vitrectomy, sampling of contents of the vitreous chamber and anterior chamber for microbial analysis, and determination of its sensitivity to antibiotics. Intravitreal injection of Vancomycin at a dose of 1 mg/0.1 ml and Ceftazidim at a dose of 2.25 mg / 0.1 ml at the final stage of the intervention. To date, the choice of antibacterial substances for intravitreal injections remains open. One of the drugs that meet the requirements is Moxifloxacin; antibacterial drug of fluoroquinolone group with bactericidal effect. It is active against a wide range of Gram-positive bacteria and Gram-negative bacteria, anaerobic, acid-resistant and atypical bacteria. Keywords: bacterial postoperative endophthalmitis, intravitreal injection, Moxifloxacin.

Impact of silicone oil tamponade on intravitreally injected vancomycin pharmacokinetics in cynomolgus monkey eyes

Intravitreal injections of vancomycin (VCM) and ceftazidime (CAZ) are commonly used to treat infectious endophthalmitis. When patient cases require retinal detachment with silicone oil (SO) tamponade, the antibiotic doses are empirically reduced to 25 %. Currently, there is no scientific evidence for these empirical dose reductions. The purpose of the present study is to determine the quantitative impact that SO tamponades have on intraocular VCM pharmacokinetics. Because of high invasiveness of frequent sampling of intraocular VCM concentrations in human, this pharmacokinetic study was performed in cynomolgus monkey’s eyes. Population pharmacokinetic modeling and simulation were performed using 75 different intraocular VCM concentrations obtained from 8 male cynomolgus monkeys. A one-compartment model with a first-order diffusion rate was used as a structural pharmacokinetic model. From the covariate analysis, SO tamponade significantly decreased the volume of distribution while pars plana vitrectomy with lensectomy (PPV) significantly increased the clearance and diffusion rate constants. From the Monte Carlo simulation (n = 1,000), the median time above minimum inhibitory concentration (T>MIC, a therapeutic effect index) durations of SO and normal eyes at clinical doses of 1,000 µg were 2.6 and 11.0 days, respectively. Using intravitreal injections of VCM with SO tamponade or PPV may reduce the therapeutic effect.

Fusarium Endophthalmitis: About a Case of Enucleation

Fungal eye damages are rare but severe diseases that cause corneal opacity and blindness. The most common pathogens of such damages are Fusarium and Aspergillus. Fusarium is ubiquitous mold found commonly in soil and organic debris. The risk factors for fungal eye damages are trauma (plants, soil, metallic or foreign bodies), corneal surgery (keratoplasty), disruption of corneal epithelium, contact lens wear, and immunosuppressed patients. Clinical suspicion of fungal keratitis is helpful because the diagnosis is difficult to reach based on a laboratory verification, with corneal scraping in adequate culture medium and PCR. Fusarium sp are generally resistant to most antifungal drugs. Despite medical therapy with topical natamycin and voriconazole, surgery is often required with antifungal intracorneal injection, corneal transplantation, and enucleation. A 37-year-old patient presented with a trauma of cornea with a metallic piece was examined in this study. Nine months after local treatment, he complained of painful ocular lesion with a hypopyon. He was treated by intravitreal injection of vancomycin. A corneal scrapping showed hyphae of Fusarium proliferatum. He was treated with amphotericin B and voriconazole; however, no convincing efficacy was achieved and the unbearable eye pain persisted and, unfortunately, he was diagnosed with hepatic cytolysis. Due to the treatment failure, therefore, the enucleation was required and the pathological examination of the eye was found negative.

Intravitreal injection of povidone-iodine for the treatment of vancomycin-resistant Enterococcus faecalis endophthalmitis in rabbit eyes

The aim of this study was to investigate the efficacy of intravitreal povidone-iodine (PI) in the treatment of vancomycin-resistant Enterococcus faecalis (VRE) endophthalmitis. Fifty New Zealand white rabbits were divided into 5 groups (n = 10 in each group). After the induction of endophthalmitis using VRE (minimum inhibitory concentration [MIC] ≥ 40 μg/mL) in the right eye, Group A, B, C, and D received intravitreal injections of 0.1% PI, 0.3% PI, 0.05% vancomycin, and 0.5% vancomycin, respectively. Eyes in Group E were used as controls. Fundus photography, vitreous culture, electroretinography (ERG), and histologic examinations of the retina were conducted on day 14. A marked improvement in endophthalmitis was observed in Group A, B, C and D, compared to Group E. Fundus photographs showed mild vitreous opacities in Group A and B, and moderate vitreous opacity in Group C. All eyes in Group D had a clear vitreous. In vitreous culture, bacterial growth was found in 6 eyes (100, 200, 200, 400, 500, and 500 colony-forming units) in Group C, but not in Groups A, B, or D. ERG and histological examination also indicated intraocular damage in Group C. Our results show that intravitreal injection of PI, even at low concentrations, was effective for treatment of VRE endophthalmitis, although some vitreous opacity remained. Intravitreal vancomycin injection was also useful to treat resistant strains, if used at a higher concentration within the safety threshold.

Traumatic endophthalmitis with intraocular metallic foreign body

Background: Post-traumatic endophthalmitis with retained intraocular foreign body is a severe complication of open globe injuries. It is generally associated with poor visual outcome and requires prompt and adapted management. Case report: A 39-year-old male patient presented with open globe injury of the right eye due to a metallic foreign body projection. He was a victim of a neglected work accident 10 days ago when hammering a metallic bar. Visual acuity on admission was LP (+) in the right eye. The Slit-lamp examination revealed perikeratic injection, edematous cornea and severe inflammation of the anterior chamber with hypopyon. Ocular ultrasound showed a heterogeneous vitreous organization compatible with a vitreous abscess. Orbito-cerebral CT scan revealed a retained intraocular metallic foreign body located in the posterior segment, within the vitreous humor. The patient received local and general antibiotherapy associated with intravitreal injections of vancomycin and ceftazidime followed by a vitrectomy to remove the intraocular foreign body. The visual outcome was poor with an evolution towards phtysis bulbi. The aim of this case report is to study the risk factors of post-traumatic endophthalmitis with retained intraocular foreign body and to examine treatment principles and visual outcome of this severe complication.

Acute endophthalmitis caused by Enterococcus faecalis following intravitreal ranibizumab injection

A 58-year-old immunocompetent male developed acute endophthalmitis after intravitreal ranibizumab injection for choroidal neovascular membrane. The preinjection vision in the left eye (LE) was 6/24. One-day postinjection, he presented with pain, redness, and defective vision. The vision in the LE was hand movements at presentation. On examination, the presence of circumcorneal congestion, hypopyon (2 mm), and anterior-chamber reaction was noted. Core vitrectomy was done along with intravitreal injections of vancomycin and ceftazidime. Vitreous biopsy grew Enterococcus faecalis. The isolate was sensitive to vancomycin and moxifloxacin. There was an improvement in vision (6/36) at the final follow-up. We present the case of acute endophthalmitis caused by E. faecalis after intravitreal ranibizumab injection with better visual outcome.

Postoperative Hemorrhagic Occlusive Retinal Vasculitis Associated with Intravitreal Injection of Vancomycin

PURPOSE: To present a case of hemorrhagic occlusive retinal vasculitis (HORV) associated with intravitreal injection of vancomycin after pars plana vitrectomy (PPV).METHODS: Single case report.RESULTS: A 67-year-old woman presented with best corrected visual acuity (BCVA) of 20/400 in left eye. For clinical suspicion of chronic endophthalmitis, empirical treatment was initiated with vancomycin and ceftazidime without clinical improvement. The patient was submitted to pars plana vitrectomy. During surgery rhegmatogenous retinal detachment was observed and treated. At the end of surgery, intravitreal vancomycin was injected. After 18 days BCVA was counting fingers and fundus examination showed diffuse retinal vascular sheathing, intraretinal hemorrhages and ischemic macular whitening. The clinical diagnosis was compatible with HORV secondary to retinal toxicity due to intraocular vancomycin.CONCLUSIONS: This case illustrates the importance of including intravitreal vancomycin during PPV surgery on the list of potential causes when investigating a case of suspected hemorrhagic occlusive retinal vasculitis.

Disseminated Nocardiosis with subretinal abscess in a patient with nephrotic syndrome-a case report

BackgroundNocardia infection is uncommon in clinical practice, with most cases occuring as the result of opportunistic infection in immunocompromsed patients. Here, we report a case of disseminated nocardiosis with subretinal abscess in a patient with nephrotic syndrome, and whom is receiving immunosuppressive therapy.Case presentationA 58-year-old male presented with decreased vision in his left eye, without redness or floaters, which had persisted for three days. The patient had previously been diagnosed with membranous nephropathy, and as such, had received systemic corticosteroid therapy for four months. Further, the patient had developed pneumonia three weeks prior to this presentation. The ocular lesion appeared as a creamy-white subretinal abscess, with overlying retinal hemorrhages. Subsequent administration of three intravitreal injections of vancomycin and ceftazidime ultimately led to eradication of the intraocular infection, however, two months later, the patient developed a brain abcess. Pathogens isolated from the blood were subsequently identified as Nocardia. The patient was successfully treated via systemic administration of imipenem and trimethoprim-sulfamethoxazole.ConclusionsClinicians should be aware of the possibility of Nocardia infections within all immunocompromised patients, as well as the tendency of this infection to disseminate--particularly in the brain. The early detection of Nocardia infections and prolonged treatment of the proper antibiotics may significantly improve the prognosis of this life-threatening infection.

Treatment of endophthalmitis by 25-gauge+ vitrectomy combined with intraocular injection of vancomycin

Objective To observe the clinical effect of 25 G+ vitrectomy under retinoscope combined with intravitreal injection of vancomycin in the treatment of endophthalmitis. Methods Sixteen eyes of 16 case with infectious endophthalmitis after cataract surgery were observed. After diagnosis, the 25 G+ vitrectomy under the pan-retinoscope combined with intravitreal injection of vancomycin was performed. The aqueous humor, vitreous bacteria culture results, the postoperative best corrected visual acuity and eye conditions were observed. The postoperative follow-up was 6-12 months. Results Postoperative visual acuity increased by more than 2 rows in 14 eyes accounting for 87.5% and remained unchanged in 2 eyes accounting for 12.5%. The intraocular lens was not removed and the silicone oil was not filled during the surgery. No postoperative complication such as retinal detachment occurred. Vitreous humor culture showed G+ cocci in 6 cases, G-bacillus in 1 case and the pathogen detection rate was 43.75%.At the end of follow-up, the viteous of 16 eyes were clear. Conclusion The pan-retinoscopic 25 G+ vitrectomy combined with intravitreal injection of vancomycin for endophthalmitis after cataract surgery is an effective method. Key words: Endophthalmitis; Cataract surgery; Vitrectomy, 25 G+; Pan-retinoscope; Vancomycin

Clinical and bacteriological outcome of combined intravitreal injection of vancomycin and ceftazidime in experimentally induced endophthalmitis

Introduction Endophthalmitis, despite being rare, is the most serious complication of ocular surgery. Aminoglycosides, used in combination with vancomycin (VAN), were found to cause macular toxicity. Ceftazidime has been suggested as an alternative antibiotic because of its lower risk of retinal toxicity. Purpose of the study The purpose is to evaluate outcome of intravitreal injection (IVI) of VAN and ceftazidime combination versus ciprofloxacin on experimentally induced endophthalmitis. Materials and methods Twenty-one albino rabbits were divided into three groups as follows: group I received IVI of 0.1 ml saline, group II received IVI of VAN (1 mg/0.1 ml) and ceftazidime (2.25 mg/0.1 ml), and group III received IVI of ciprofloxacin (1 mg/0.1 ml). Right eyes were inoculated with 10 5 colony forming units (CFU)/0.l ml of Staphylococcus epidermidis . After 24 h, inoculated eyes were examined by indirect ophthalmoscopy for signs and severity of endophthalmitis according to the modified scheme of Peyman and Bassili, and IVI was provided. On day 3 of the study, inoculated eyes were re-examined clinically, vitreous samples were obtained for bacteriological examination, and if culture was positive, antibiotics were reinjected. On day 6, animals were killed, right eyes were enucleated, and contents of the posterior segment were inoculated on blood agar for evaluation of bacterial growth and counting the CFU. Results On day 3, frequency of animals having severe grades of conjunctival injection and corneal edema was significantly higher in groups I and III compared with group II, and not significantly higher in group I compared with group III. Frequency of animals showing good red reflex was significantly higher in group II compared with groups I and III, and not significant different in group III compared with group I. On day 3, the mean number of CFU was significantly lower in group II compared with groups I and III with significantly lower number in group III compared with group I. On day 6, all samples of group II were sterile, while mean number of CFU was significantly lower in group III compared with group III. Conclusion Combined therapy using VAN and ceftazidime provided proper clinical and bacteriological control of experimentally induced endophthalmitis, with significant difference from single-drug therapy.

An outbreak of Ralstonia pickettii endophthalmitis following intravitreal methotrexate injection.

PurposeTo report an outbreak of endophthalmitis in three eyes of two patients following intravitreal methotrexate, caused by Ralstonia pickettii.DesignRetrospective, noncomparative, consecutive case series.MethodsMedical records and microbiology results of two patients who presented with acute endophthalmitis following intravitreal methotrexate injection in November 2013 were reviewed.ResultsFollowing intravitreal injections, the patients experienced pain and decrease in vision in the affected eye within 24 hours of receiving intravitreal methotrexate injection. The presenting visual acuity in case 1 was 20/50 in the left eye. The presenting visual acuity in case 2 was hand motions in the right eye and counting fingers at 1 m in the left eye. Both the patients received methotrexate prepared in the same manufacturing facility. Both the patients underwent vitreous biopsy and intravitreal injection of vancomycin 1 mg/0.1 mL, amikacin 400 µg/0.1 mL, and dexamethasone 400 µg/0.1 mL. Microbiology cultures from vitreous, and used and unused vials of methotrexate from the same batch grew R. pickettii. After 8 months of follow-up, both the patients had visual acuity 20/60 or better.ConclusionR. pickettii can be rarely associated with outbreak of endophthalmitis. Timely intervention can be associated with good visual outcome in such patients.

The prevention of infectious endophthalmitis after intraocular foreign body injury in Tibet high altitude district

Objective To evaluate the efficacy of early intravitreal Vancomycin injection for prevention of infectious endophthalmitis after intraocular foreign body injury. Methods One hundred and five eyes of 105 cases with intraocular foreign body injury were divided into two groups. Fifty-five cases were recruited in research group, before suturing the eyeball wound, the foreign body was attracted with magnet firstly, then intravitreal Vancomycin(1 mg) injection was performed and the broad spectrum antibiotics was used after the operation. Some cases failed to attract the foreign body were transferred to another hospital for vitrectomy. In control group, a similar treatment except for intravitreal Vancomycin injection was carried out in 50 cases. The incidences of infectious endophthalmitis between the two groups were compared. Results After operation, infectious endophthalmitis occurred in 3 cases(5.45%) in research group (55 cases). infectious endophthalmitis occurred in 9 cases(18.00%) in control group (50 cases). The difference in incidence of infectious endophthalmitis between the two groups was statistically significant (χ2=4.072, P<0.05). Conclusion Early intravitreal Vancomycin injection can reduce the incidence of incidence of infectious endophthalmitis after intraocular foreign body injury. Key words: Foreign body, intraocular; Endophthalmitis; Injection, intravitreal; Vancomycin; Prevention