Occurrence Of Endophthalmitis Research Articles

Assessment And Comparison of Bacterial Contamination in Anterior Chamber Aspirates in Small Incision Cataract Surgery (SICS) And Phaco-Emulsification

Introduction: The rate of occurrence of endophthalmitis after cataract surgery has been reduced to a greater extent now a day. Even then endophthalmitis related consequences are devastating. Several sources of infection, including contamination by air, solutions, surgical instruments, intraocular lens, and wound leakage have been identified. Aim of the Study: The study aimed to evaluate the influence of two methods of surgical technique of cataract surgery in bacterial as well as comparison of contamination by these two techniques. Methods: This prospective observational study was conducted over 60 patients with age related cataract in the department of Ophthalmology and Microbiology in Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh, from 1st January, 2009 to 30th June, 2009. Patients were selected purposively based on specific selection criteria. Selected patients underwent detail ophthalmic and systemic evaluation as well as relevant investigations. Cataract extraction followed by intraocular lens implantation was planned for all patients. The two techniques of cataract surgery such as SICS and Phacoemulsification were assigned to the patients randomly by 1:1 basis. 1 ml of anterior chamber contents were aspirated through aseptic technique by 26G needle from each patient pre-operatively, after capsulorrhexis (early per-operative) and just before wound closure by stromal hydration (late per-operative). All samples were sent for 10% KOH staining and culture and sensitivity test after proper leveling. Results: Micro-biological examination shows no sample was positive for 10% KOH staining. In SICS group, out of 30 samples 3 were found culture positive, which were positive in 4 and 5 samples in early per-operative and late per-operative sample respectively and in Phacoemulsification group, it was 2, 3, 5 pre-operative, early per-operative and late per-operative sample respectively. The common organisms isolated were Coagulase positive Streptococcus, Corynebacterium species, Streptococcus viridans, and Staphylococcus aureus etc. Almost none of the patients showed clinical activity except few cells and flare in the anterior chamber in early post-operative period. Conclusion: The microbiological examination shows the incidence of microbial contamination of anterior chamber contents is very low after cataract surgery by both form of technique, and there was no statistically significance difference in incidence between these two techniques. J.Natl.Inst.Ophthalmol.2023;6(1): 37-41

Bacterial Contamination Evaluation in Anterior Chamber Aspirates: Contrasting Small Incision Cataract Surgery (SICS) and Phacoemulsification

Introduction: The rate of occurrence of endophthalmitis after cataract surgery has been reduced to a greater extent nowadays. Even then endophthalmitis related consequences are devastating. Several sources of infection, including contamination by air, solutions, surgical instruments, intraocular lenses, and wound leakage have been identified. Aim of the Study: The study aimed to evaluate the influence of two methods of surgical technique of cataract surgery in bacterial as well as comparison of contamination by these two techniques. Methods: This prospective observational study was conducted over 60 patients with age-related cataracts in the Department of Ophthalmology and Microbiology in Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh, from 1st January 2009 to 30 June 2009. Patients were selected purposively based on specific selection criteria. Selected patients underwent detailed ophthalmic and systemic evaluation as well as relevant investigations. Cataract extraction followed by intraocular lens implantation was planned for all patients. The two techniques of cataract surgery such as SICS and Phacoemulsification were assigned to the patients randomly on a 1:1 basis. 1 ml of anterior chamber contents were aspirated through an aseptic technique by 26G needle from each patient pre- operatively, after capsulorhexis (early per-operative), and just before wound closure by stromal hydration (late per- operative). All samples were sent for 10% KOH staining and culture and sensitivity test after proper leveling. Results: Micro-biological examination shows no sample was positive for 10% KOH staining. In the SICS group, out of 30 samples, 3 were found culture positive, which were positive in 4 and 5 samples in early per-operative and late per-operative samples respectively, and in the Phacoemulsification group, it was 2, 3, 5 pre-operative, early per- operative and late per-operative sample respectively. The common organisms isolated were ......

Clinical features and treatment of endophthalmitis after cataract surgery

The study analyzes the frequency of acute endophthalmitis occurrence after cataract surgery, the risk factors, characteristic symptoms, and the effectiveness of peri-operative prevention measures. The study retrospectively analyzed 59 670 cases of patients operated for cataract in 2017-2021. To prevent infections, patients received four instillations of third generation fluoroquinolone (quinolone antibiotic) in the course of two days prior to cataract phacoemulsification (PE), and two instillations immediately (1 hour and 30 minutes) before the surgery; three-minutes treatment of the cornea, conjunctival sac and periocular skin with 5% povidone iodine before the surgery; and as the last step of surgery, patients received subconjunctival injection of 0.05 g cefazolin with 2 mg dexamethasone. Follow-up after surgery included four injections of 0.5% levofloxacin in the course of 7-10 days, and 0.1% dexamethasone for two weeks, or fixed combination of tobramycin and dexamethasone four times per day for two weeks. The criteria for acute endophthalmitis are: loss of spatial vision, absence of red reflex, pronounced thickening of the choroid, suspended particulates in the retrovitreal space and the vitreous observed with ultrasonography in the early postoperative period (day 4-7 after surgery). There were 32 patients (0.054%) diagnosed with acute endophthalmitis. Posterior capsule rupture was the main complicative risk factor of endophthalmitis development (OR=11.75, p=0.026). Main diagnostic criteria of acute endophthalmitis were hypopyon (OR=22.5, p=0.001) and absence of red reflex (OR=19.59, p<0.001). The use of the fixed combination of tobramycin and dexamethasone was associated with 5.8-times higher risk of acute endophthalmitis than separate application of levofloxacin and dexamethasone (p=0.042). Povidone iodine and third generation fluoroquinolone as a method of acute endophthalmitis prevention after cataract surgery demonstrate comparable efficacy to intracameral antibiotic injections.

Endophthalmitis prophylaxis in cataract surgery and intravitreal injection in the US

AbstractEndophthalmitis is not a “never event” following cataract surgery or intravitreal injection, therefore the occurrence of endophthalmitis does not necessarily imply a break in technique or that the surgeon somehow “did something wrong”. Endophthalmitis cannot be prevented, but its rate can be reduced using evidence‐based measures. Endophthalmitis prophylaxis techniques include more than the use of antibiotics; specifically, prep/drape, speculum use, wound construction, etc.In the US, intracameral antibiotics are not universally used. The decision to use routine intracameral antibiotics appears to depend on many “non‐medical” factors, including internal health system policies, local standards of care, and other concerns. In the US, there is no packaged antibiotic that is specifically approved for intracameral use so all such agents are used “off‐label”; this factor appears to be suppressing the use of intracameral antibiotics at least in some locations.In the US, intravitreal injections are almost always performed in the clinic rather than in an operating room or similar setting. (In fact, it can be difficult to get reimbursed for anti‐VEGF drugs injected in an operating room.) Many practices use a standard examination room rather than a minor procedure room or a room dedicated to performing injections. Eyelid speculums are very widely used, although there is a growing acceptance of the use of bimanual retraction from a skilled assistant, rather than an eyelid speculum. In many practices, topical antibiotics are not used.It is the author's opinion (although there is little or no evidence from randomized clinical trials to support this opinion) that post‐surgical endophthalmitis differs from post‐injection endophthalmitis in how the microorganisms gain access to the intraocular space. Following cataract surgery, it seems most likely that microorganisms enter the eye through the incision in the postoperative period; this would explain the relatively later onset of infection, as well as the apparent benefits of postoperative topical antibiotics, proper wound construction, and suturing the incision when necessary. Following intravitreal injection, it seems most likely that microorganisms enter the eye at the moment of the injection; this would explain the relatively sooner onset of infection, as well as the apparent lack of benefit of postoperative topical antibiotics.

Immediately Sequential Bilateral Cataract Surgery: the Opinion of Russian Ophthalmologists

Purpose. A study of the attitude of Russian ophthalmologists to Immediately Sequential Bilateral Cataract Surgery (ISBCS).Methods. The study was carried out with the participation of 184 ophthalmologists actively performing cataract surgery, who were presented (in personal contact or via the Internet) a questionnaire developed by the authors, based on three main sections (“I use ISBCS in practice”; “I do not use ISBCS in practice”; “I don’t use, but I did ISBCS before”), which includes in each of the sections a number of clarifying questions and possible answers (“Doesn’t matter”; “Matters”; “Important”; “Very important”). At the same time, the analysis of possible answers was carried out by summing up two possible options — “Negative” opinion (“Not important” + “Matters”) and “Positive opinion” (“Important” + “Very important”). The age of the interviewed ranged from 26 to 58 years (mean age 36.2 ± 1.9 years), the experience of surgical activity in performing cataract phacoemulsification was predominantly (76 %) more than 5 years.Results. The data obtained indicate that 36 respondents (19.8 %) use ISBCS in their practice, 114 (61.8 %) do not use ISBCS; 34 (18.4 %) — do not use, but previously used ISBCS. At the same time, the volume of ISBCS performed on the same day is (for 84 % of respondents) no more than 20 % of the total number of operations performed. As part of the assessment of the main factors, in accordance with which (according to the ophthalmic surgeon), the patient is offered to perform ISBCS by the leader (in terms of the ratio of “positive” and “negative” opinions) is less clinic visits, and less time spent for the patient. The leading reasons for refusal to perform ISBCS by ophthalmic surgeons who do not use this technology are the possible occurrence of endophthalmitis, the risk of errors in IOL calculation, and medical and legal problems.Conclusion. The conducted questioning of domestic ophthalmologists testifies to the low prevalence of ISBCS technology, which is mainly associated with the possible risks of postoperative infectious complications, the lack of a standard protocol for surgical intervention, as well as medical and legal aspects. For the wider use of ISBCS, especially in a difficult epidemiological situation, it is necessary to carry out a set of measures of medical, educational and medical and economic orientation.

All India Ophthalmological Society (AIOS) Task Force guidelines to prevent intraocular infections and cluster outbreaks after cataract surgery

Infectious endophthalmitis is a serious and vision-threatening complication of commonly performed intraocular surgeries such as cataract surgery. The occurrence of endophthalmitis can result in severe damage to the uveal and other ocular tissues even among patients undergoing an uncomplicated surgical procedure. If the infections result from common factors such as surgical supplies, operative or operation theater-related risks, there can be a cluster outbreak of toxic anterior segment syndrome (TASS) or infectious endophthalmitis, leading to several patients having an undesirable outcome. Since prevention of intraocular infections is of paramount importance to ophthalmic surgeons, the All India Ophthalmological Society (AIOS) has taken the lead in the formation of a National Task Force to help ophthalmic surgeons apply certain universal precautions in their clinical practice. The Task Force has prepared a handy checklist and evidence-based guidelines to minimize the risk of infectious endophthalmitis following cataract surgery.

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.

Endophthalmitis Prophylaxis Failures in Patients Injected With Intracameral Antibiotic During Cataract Surgery

To estimate the association of cefuroxime and moxifloxacin in relation to the occurrence of endophthalmitis following phacoemulsification cataract surgery. Retrospective clinical cohort study. We studied patients with noncomplex phacoemulsification cataract surgery in Kaiser Permanente Northern California during 2014-2019. Data were obtained for acute, postoperative endophthalmitis within 90 days of phacoemulsification, including culture and antibiogram results, intracameral and topical antibiotic agent, and dose. In a post hoc analysis, we also examined preoperative anterior chamber depth (ACD) and postoperative anterior chamber volume (ACV). Of 216,141 surgeries, endophthalmitis occurred in 0.020% of moxifloxacin-injected eyes and 0.013% of cefuroxime eyes (relative risk 1.62 with 95% CI 0.82-3.20, P=.16). Of the 34 (0.016%) cases of endophthalmitis, cefuroxime 1 mg was injected into 13 eyes and moxifloxacin 0.1% into 21 eyes. Organisms with antibiograms were identified in 12 (35%) cases. Of these, bacteria recovered from cefuroxime-injected eyes were resistant to cefuroxime in all cases (4/4), with Enterococcus comprising half of these. In eyes injected with moxifloxacin 0.1%, 6 out of 7 organisms were sensitive to moxifloxacin injected with 0.1 mL and in 1 eye injected with 1 mL. Streptococcus was the most common organism recovered (6/9) in moxifloxacin-injected eyes. Preoperative ACD and postoperative calculated ACV were higher in eyes injected with moxifloxacin. Endophthalmitis cases with positive cultures were generally related to organism resistance in cefuroxime eyes but to sensitive organisms in moxifloxacin eyes. Moxifloxacin doses may have been insufficient in eyes with larger ACV.

A Genomic Approach to Investigating Ocular Surface Microorganisms: Monitoring Core Microbiota on Eyelid Margin with a Dot hybridization Assay.

A sound ocular surface microbiota has been recognized as a part of ocular surface health following a growing body of evidence from next-generation sequencing technique and metagenomic analysis. However, even from the perspective of contemporary precision medicine, it is difficult to directly apply these new technologies to clinical practice. Therefore, we proposed a model based on dot hybridization assay (DHA) to bridge conventional culture with a metagenomic approach in investigating and monitoring ocular surface microbiota. Endophthalmitis, mostly caused by bacterial infection, is the most severe complication of many intraocular surgeries, such as cataract surgery. Hazardous microorganisms hiding and proliferating in the ocular surface microbiota not only increase the risk of endophthalmitis but also jeopardize the effectiveness of the preoperative aseptic procedure and postoperative topical antibiotics. The DHA model enables the simultaneous assessment of bacterial bioburden, detection of target pathogens and microorganisms, and surveillance of methicillin/oxacillin resistance gene mecA in the ocular surface microbiota. This assay revealed heavier bacterial bioburden in men, compatible with a higher risk of endophthalmitis in male patients who underwent cataract surgery. No occurrence of endophthalmitis for these patients was compatible with non-hazardous microorganisms identified by specific dots for target pathogens. Moreover, the mecA dot detected oxacillin-resistant strains, of which culture failed to isolate. Therefore, the DHA model could provide an alternative genomic approach to investigate and monitor ocular surface microorganisms in clinical practice nowadays.

Intravitreal Injections in Arc Sterile Setting: Safety Profile after More Than 10,000 Treatments.

Purpose To report the occurrence of endophthalmitis and other complications after intravitreal injections (IVIs) in the Arc Sterile setting. Methods A retrospective study that enrolled all patients who underwent IVIs between November 2017 and March 2019, collecting data about the patient's gender and age, type of injected drug, diagnosis, other ocular pathologies, physician and possible occurrence of endophthalmitis, or other complications. Results Ten thousand and eighty-three IVIs were performed during the study period, involving 2014 eyes of 1,670 patients with an average age of 71.37 ± 11.63 years. The injected drugs included ranibizumab (54.6%), aflibercept (38.0%), dexamethasone (6.7%), pegaptanib (0.3%), bevacizumab (0.4%), and ocriplasmin (0.01%). The diagnosis included neovascular age-related macular degeneration (859), myopic choroidal neovascularization (154), diabetic macular edema (576), retinal vein occlusion (203), and miscellaneus diagnosis (222). No cases of endophthalmitis were recorded. One hundred and sixty-nine cases of ocular hypertension were detected, while the most frequent complication was subconjunctival hemorrhage, identified after 1,180 IVIs. The residents performed over 80% of IVIs, but there was no statistically significant difference in incidence of complications between the residents group and consultants group. Conclusions Arc Sterile seems to be a safe setting in which IVIs can be carried out, regarding infective risk, and it is easy to set up compared to operation theatre and useful to improve intravitreal injections governance.

Intravitreal Bevacizumab: Safety of multiple doses preparation from single vial in minor theater in tertiary care center

PURPOSE:&#x0D; To determine the safety of multiple doses preparation of bevacizumab from single vial in minor theatre in reducing the frequency of endophthalmitis.&#x0D; STUDY DESIGN:&#x0D; Retrospective exposure study&#x0D; PLACE AND DURATION OF STUDY:&#x0D; Department of Ophthalmology, Fauji Foundation Hospital (FFH), Rawalpindi from June 2016 to March 2018.&#x0D; MATERIAL AND METHODS:&#x0D; 1690 eyes belonging to 1001 patients was included using computer logs of patients receiving intravitreal bevacizumab (IVB). In FFH, we allocate three consecutive days every month in order to administer IVB. Approximately 50 patients were typically given IVB over three-days period.1-2 ml (depending upon the number of patients) of bevacizumab was withdrawn in a 3 cc syringe.1 cc insulin syringe with 29 G needle was taken and, 0.05 ml (1.25 mg) bevacizumab was injected from behind using the 3 cc syringe, resulting in preparation of 10-20 injections of IVB. The bevacizumab vial was then stored at 4 degrees Celsius.&#x0D; RESULTS:&#x0D; Total 1690 eyes belonging to 1001 patients were analyzed. The occurrence of endophthalmitis was 2/1690 (0.12%) corresponding to a 95% CI of 0.03%-0.43%, which does not represent an increase in cases as compared to endophthalmitis resulting from using a compounding pharmacy.&#x0D; CONCLUSION:&#x0D; Whereas, a priori, it seems reasonable to assume that aliquot preparation and storage of bevacizumab for intravitreal use particularly by a compounding pharmacy is safer. We, however, show that our preparation of IVB from single vial technique using proper sterilization is equally safe. Due to the reduced cost of our technique, we recommend it, particularly in the developing world.

Endophthalmitis Prophylaxis Study, Report 2: Intracameral antibiotic prophylaxis with or without postoperative topical antibiotic in cataract surgery

Purpose:Intracameral antibiotic in cataract surgery has shown level I evidence as prophylaxis for postoperative endophthalmitis. Not much is known if one should also use topical antibiotics after intracameral injection. The purpose of the study was to determine efficacy of intracameral antibiotic with and without postoperative topical antibiotic in reducing the incidence of acute endophthalmitis after cataract surgery in rural India.Methods:A prospective comparative, non-randomized interventional study was designed in 15 rural centres in India. The study recruited 40,006 patients (n = 42,466 eyes), who underwent cataract surgery (phacoemulsification/small incision cataract surgery), and received intracameral antibiotic (cefuroxime/moxifloxacin). Postoperative topical antibiotic prescription was left to the choice of the treating physician, but they were encouraged not to use it in uneventful surgeries. Primary outcome measure was occurrence of acute clinical endophthalmitis within 6 weeks of surgery. Statistical analysis was done using STATA software v13.1 (StataCorp, Texas); P value of <0.05 was considered statistically significant.Results:In the study, 17,932 (42%) eyes received intracameral cefuroxime (ICC) and 24,534 (58%) eyes received intracameral moxifloxacin (ICM). Topical antibiotic was not prescribed to 17,855 (42%) eyes - 5723 (32%) eyes in ICC group and 12,132 (68%) eyes in ICM group. Acute clinical endophthalmitis occurred in 15 (0.035%) eyes - 1 / 3515 (0.028%) eyes and 1 / 2231 (0.045%) eyes that received and did not receive topical antibiotic, respectively. The difference in occurrence of endophthalmitis with/without topical antibiotics in each group (ICC: 0.016% and 0.017%; P = 0.958; ICM: 0.040% and 0.058%; P = 0.538) was not significant (P = 0.376).Conclusion:Supplementing intracameral antibiotic with topical antibiotic postoperatively did not impact the occurrence of acute post cataract surgery endophthalmitis in rural India

Patient's Knowledge after Informed Consent for Intravitreal Injections

Intravitreal treatment (IVT) is one of the most common ophthalmological procedures. Therapeutic effectiveness is however dependent on patient compliance. Unwanted treatment cessation rates are high though. The authors therefore decided to analyse the patient's knowledge and treatment expectations, as discrepancies are known to negatively affect compliance and thus treatment outcomes. The study was designed as an exploratory survey. In total, 100 patients presenting to an outpatient clinic of a tertiary care centre from October to December 2016 were included. A structured, anonymised questionnaire was handed out, consisting mainly of question items with closed code lists as response domains. Solely descriptive analysis of results was performed. The median age of patients was 73 years. 70% had received more than 3 IVTs in at least one eye. Age-related macula degeneration was the most common underlying cause (52%). 64% expected improvement of visual acuity after IVT. 42% could not name one medication used in their IVT. 55% felt that the information provided during informed consent had been adequate. 69% did not know the post-surgical occurrence of endophthalmitis. Three patients were confident of being able to drive a car directly after IVT. Patient's knowledge of their underlying disease, treatment goals and complications rates exhibited some deficiencies. Standardised patient information sheets could be of significant use and were actively suggested by patients to improve the informed consent process.

Endophthalmitis rates among patients receiving intravitreal anti-VEGF injections: a USA claims analysis.

PurposeIntravitreal (IVT) injections of the anti-vascular endothelial growth factor (VEGF) agents aflibercept, bevacizumab, and ranibizumab are commonly prescribed to treat neovascular age-related macular degeneration (nAMD). Studies comparing inflammation rates in large populations of patients receiving these agents and the treatment of ocular inflammation post-IVT anti-VEGF injections are scarce. In this study, we compared rates of endophthalmitis claims (sterile and infectious) following IVT anti-VEGF injections to determine the risk factors associated with developing endophthalmitis, and examined the claims for subsequent treatment.Patients and methodsThis retrospective cohort study of USA claims data examined the risk of developing endophthalmitis following IVT injection of aflibercept, bevacizumab, or ranibizumab in patients with nAMD between 11/18/2011 and 5/31/2013. The primary study outcome was occurrence of endophthalmitis within 30 days of a claim for an IVT anti-VEGF injection. Endophthalmitis rates were calculated separately for aflibercept, bevacizumab, and ranibizumab, followed by pairwise comparisons of endophthalmitis frequencies among the 3 treatments.ResultsThis analysis included 818,558 injections from 156,594 patients with nAMD. The rates (% [n/N]) of endophthalmitis following aflibercept, bevacizumab, and ranibizumab IVT injections were 0.100% (136/135,973), 0.056% (268/481,572), and 0.047% (94/201,013), respectively. In a multivariate analysis, aflibercept was associated with a significantly higher risk of endophthalmitis vs ranibizumab (adjusted odds ratio, 2.19; 95% CI: 1.68–2.85; P<0.0001). The risk of endophthalmitis was similar for bevacizumab and ranibizumab. Within 14 days after endophthalmitis, 38.6% of cases received injectable antibiotics, 15.3% received injectable steroids, and 30.3% underwent vitrectomy.ConclusionThe rate of endophthalmitis was very low, but higher following IVT injection with aflibercept compared with both bevacizumab and ranibizumab in patients with nAMD.

Endophthalmitis Rates after Bilateral Same-Day Intravitreal Anti–Vascular Endothelial Growth Factor Injections

To evaluate practice patterns for bilateral same-day intravitreal anti-vascular endothelial growth factor (VEGF) injections and determine the rate of unilateral and bilateral postinjection endophthalmitis after bilateral same-day intravitreal anti-VEGF injections. Retrospective cohort study. The records of a large academic private practice were electronically queried for all office visits, during which bilateral intravitreal anti-VEGF injections were performed between April 1, 2012 and August 21, 2017 for patients with a diagnosis of neovascular age-related macular degeneration, diabetic macular edema, or retinal vein occlusion. Demographic information and indication for injection were recorded for each patient and office visit. Charts of patients with endophthalmitis were reviewed, and information was collected on presentation examination, culture data, and visual outcomes. During the study period, 101 932 bilateral same-day intravitreal anti-VEGF injections were performed over 50 966 office visits for 5890 patients. The mean (standard deviation) age of patients in this cohort was 74.2 (14.1) years and 60.6% of patients were female. The 2 most common indications for injection were neovascular age-related macular degeneration (54.3% of patients) and diabetic macular edema (35.4% of patients). Twenty-eight cases of endophthalmitis (0.027% of total injections) occurred during the study period. There were no cases of bilateral endophthalmitis, and no patients had more than 1 occurrence of endophthalmitis. In this large cohort of patients undergoing bilateral same-day intravitreal anti-VEGF injections, there were no cases of bilateral endophthalmitis. Additionally, the overall rate of unilateral endophthalmitis was low and comparable to prior studies of unilateral injections. These results support the safety of bilateral same-day intravitreal anti-VEGF treatment.

The rate of endophthalmitis after pars plana vitrectomy and its risk factors.

To study the incidence of endophthalmitis after pars plana vitrectomy, its causative organisms, and visual acuity outcomes. In this retrospective, comparative study, the medical records of patients with acute-onset postoperative endophthalmitis after pars plana vitrectomy at Farabi Eye Hospital, Tehran, Iran, during a 12-year period between January 2004 and November 2015 were reviewed. To compare the endophthalmitis patients with other cases who underwent pars plana vitrectomy at the same day and also the same operating room, a control group was developed by gathering the data from surgical records. In the present study, the incidence rate of pos- vitrectomy endophthalmitis was 0.04% (16/39783). The organisms identified in aqueous or vitreous cultures (culture positive 44%) included Streptococcus pneumoniae (two patients, 12.5%), Pseudomonas aeruginosa (two patients, 12.5%), fungi (two patients, 12.5%), and Streptococcus viridans (one patient, 6.25%). Visual acuity after treatment for endophthalmitis ranged from light perception (7 eyes) to hand motion (1 eye), and evisceration was performed in 8 eyes (50%). When comparing the cases (patients developing endophthalmitis) and controls (patients with no complications operated in the same day and place of operation with the case group), only not using tamponade showed a statistically significant relation with the occurrence of endophthalmitis (p = 0.034). Our results indicated low incidence of endophthalmitis after pars plana vitrectomy comparable to previous studies which resulted in poor visual acuity. It seems that not using tamponade might increase the risk of endophthalmitis among these patients.

When to treat with vitrectomy and the outcomes of open-globe injured eyes

Open-globe injuries (OGI) result in complicated and diverse conditions with different mechanisms and anatomical locations, which lead to completely different outcomes based on when to perform pars plana vitrectomy (PPV) after trauma. The PPV operation time points are generally divided into early (0 - 3 days), delayed (4 - 14 days), and late (> 2 weeks). There are still some controversies about the PPV time points after OGI. Injuries with intraocular foreign bodies or high risk of infection usually need early surgery to reduce the occurrence of endophthalmitis. However corneal edema and vitreous hemorrhage can increase the difficulties for early diagnosis and surgery. If there is choroidal hemorrhage or severe trauma in the back part of the eye, delayed intervention can allow the blood clots to be liquefied and removed easily. But there is higher incidence of postoperative complications. Late surgery can reduce the difficulty of PPV, but the increased incidence of proliferative vitreoretinopathy may lead to severe retinal traction, tears and postoperative scar formation. Key words: Eye injuries/surgery; Vitrectomy; Review

Intravitreal Infliximab Injection to Treat Experimental Endophthalmitis.

The purpose of this study was to compare the use of an intravitreal injection of infliximab and of dexamethasone combined with vancomycin to treat experimental endophthalmitis induced by Staphylococcus epidermidis. The study was conducted between March 25 and April 13, 2012. Twenty-five six-month-old healthy rabbits were used, each weighing 2.5-3 kg. The rabbits were randomized into five groups with five animals per group. Endophthalmitis was induced by 0.1 mL (103 colony-forming units) S. epidermidis in all groups. In group 1, injection was not implemented after the occurrence of endophthalmitis. In groups 2, 3, and 4, the following intravitreal injections were given 24 h after the occurrence of endophthalmitis: group 2, 0.1 mg/0.1 mL vancomycin; group 3, 1 mg/0.1 mL vancomycin and 1 mg/0.1 mL dexamethasone; and group 4, 1 mg/0.1 mL vancomycin and 2 mg/0.1 mL infliximab. Group 5 was the control/uninfected group. The rabbits were clinically assessed each day for seven days. On day 9, a histopathologic evaluation was performed after enucleation. After a clinical evaluation, no statistically significant difference was found between the vancomycin+infliximab and vancomycin+dexamethasone groups (p>0.05). The difference was significant when both groups were compared with the vancomycin group (p<0.001). After the histopathologic evaluation, no statistically significant difference was found among the three groups (p>0.05). An intravitreal injection of infliximab and of dexamethasone combined with vancomycin have similar clinical and histopathologic effects. To supplement the antibiotic treatment of endophthalmitis, infliximab in a safe dose range can be used as an alternative to dexamethasone to suppress inflammation and prevent ocular damage.

Role of intravitreal/intracameral antibiotics to prevent traumatic endophthalmitis - Meta-analysis.

Traumatic endophthalmitis is a devastating condition that can occur following an open globe injury and result in loss of vision. The use of prophylactic antibiotics is empirical as most surgeons fear complications associated with the same. No systematic review has been performed in English on the role of intravitreal/intracameral antibiotics in preventing traumatic endophthalmitis. We searched for randomized controlled trials and controlled clinical trials comparing intracameral/intravitreal antibiotics with placebos on PubMed, Google Scholar, Science Direct, and Cochrane Library using keywords open globe/trauma/penetrating/perforating injuries endophthalmitis. The last search was on 5 May 2017. We included patients of all ages with open globe injuries who received intracameral/intravitreal antibiotics, regardless of the dose. Quality of the trials was assessed using Cochrane collaboration tools to assess the risk of bias. The main outcome measures were endophthalmitis and visual acuity. We included three trials. Overall, intravitreal/intracameral antibiotics were noted to significantly reduce the occurrence of endophthalmitis in open globe injuries (relative risk [RR] 0.19, 95% confidence interval [CI] 0.06–0.57). The use of intravitreal/intracameral antibiotics did not have an effect in improving visual acuity (RR 1.17, 95% CI 0.61–2.23). Two trials (Narang 2003; Soheilan 2001) were observed to have no significant effect on visual acuity while another trial (Soheilan 2007) did not list visual acuity as part of its objectives. Intracameral/intravitreal antibiotics reduce the risk of endophthalmitis in open globe injuries; although, there was no improvement in the visual acuity. We, therefore, recommend the use of intravitreal/intracameral injections in open globe injuries to prevent this devastating complication.

Effect of the time of the intraocular foreign body extraction on the occurrence of endophthalmitis

Objective To investigate the effect of the time of the intraocular foreign body(IOFB) extraction on the occurrence of endophthalmitis. Methods The medical records of 370 eyes of 370 patients with IOFB treated in the Second Hospital of Jilin University from Jan.2009 to Aug. 2014 were reviewed. The incidence rate of endophthalmitis was calculated on the time of the IOFB extraction, using the χ2 test to identify the relationship between each group. Results The endophthalmitis incidence was 14.75%. The incidence of endophthalmitis in the group IOFB extraction less than 24 hours was 10.45%, and the incidence in the group IOFB extraction more than 24 hours was 19.77%.The incidence in ≤24 hours group had significant difference compared with that in more than 24 hours group (χ2=6.404, P=0.011). The incidence of endophthalmitis in the group IOFB extraction in 2 days-2 weeks was significantly lower than that in the group IOFB extraction in 3 weeks-3 months (χ2=4.446, P=0.035). Conclusion The incidence of endophthalmitis in the group IOFB extraction≤24 hours is lower than that in the group IOFB extraction>24 hours. When the IOFB can’t be extracted in less than 24 hours, the extraction in 2 days-2 weeks can also reduce the risk of endophthalmitis after the repair of the wound and use of antibiotics. Key words: Extraction of intraocular foreign body; Time of extraction; Endophthalmitis