Postoperative Endophthalmitis Research Articles

Causative organisms and visual prognosis of endophthalmitis in Cairo University Hospitals, Cairo, Egypt

Purpose The aim of this study was to identify the most common causative organisms, treatment modalities, and visual prognosis of cases of endophthalmitis in Cairo University Hospitals, Cairo, Egypt. Patients and methods This was a prospective study that was carried out on consecutive patients presenting with exogenous endophthalmitis to Cairo University Hospital Casualty Unit, Cairo, Egypt, during the period from June 2021 to February 2022. Demographic and clinical characteristics of all patients were collected and analyzed. Vitreous tap was obtained from all patients and cultured. Treatment modalities were tabulated and analyzed. Factors influencing the final visual outcome were studied. Results The study included 31 eyes of 31 patients, with a mean age of 41.8±17.9 years (range=8–69 years). All cases had exogenous endophthalmitis, where 17 were postoperative, 12 posttraumatic, and two postintravitreal injection. Positive vitreous culture was detected in only nine (29%) patients. The most commonly identified organism was Streptococcus pneumoniae (four of nine patients, 44.4%). Cultures were positive for fungi in only two patients. Cultures were positive in 35% of postoperative endophthalmitis and in 25% of posttraumatic endophthalmitis. Treatment modalities included intravitreal antibiotics only (n=15; 48.4%), intravitreal antibiotics and delayed vitrectomy (n=8; 25.8%), immediate vitrectomy (n=7; 22.6%), and evisceration (n=1; 3.2%). The mean follow-up after presentation was 5.1±1.6 months (range=3–9 months). The factors associated with poor visual outcome were older age (P=0.032), history of ocular trauma (P<0.001), early presentation after trauma (P=0.021), and presence of corneal infection (P=0.001). The visual outcome was significantly better in those who had vitrectomy either immediately or after intravitreal injection (P=0.004). Conclusion S. pneumoniae was the most commonly identified organism in exogenous endophthalmitis in Cairo University Hospitals. Early vitrectomy and absence of corneal infection were associated with better visual outcome.

Microbiological Profile and Visual Recovery in Various Clinical Types of Endophthalmitis at a Tertiary Eye Care Hospital of Tamil Nadu, India: A Retrospective Cohort Study

Introduction: Endophthalmitis is a serious, sight-threatening purulent inflammation of the intraocular cavities of the eyeball. It greatly affects vision and can lead to severe complications such as panophthalmitis. The prevalence of endophthalmitis varies from one place to another. Aim: To identify the various aetiological and predisposing factors that contribute to endophthalmitis and to assess the visual outcomes following medical intervention (intravitreal antibiotics only) and surgical intervention (both intravitreal antibiotics and pars plana vitrectomy). Materials and Methods: The present study was conducted in the Department of Ophthalmology at Trichy SRM Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India between January 2023 and February 2023. Demographic and clinical data of patients diagnosed with endophthalmitis over a two year period from October 2020 to September 2022 were collected from the Medical Records Department of the Institution for analysis. A total of 50 case records were selected using convenience sampling. Demographic details such as age, gender, predisposing risk factors, visual acuity, microbiological profiles, treatment modalities, and final visual acuity were collected from the present study. Quantitative data was presented as Mean and Standard Deviation (SD), while qualitative data was presented as frequencies and percentages. Summary statistics were analysed using Microsoft Excel version 2018. Results: In present study, 29 (58%) were males and 21 (42%) were females, with the majority falling within the age group of 50-70 years. The mean age of the sample was 53.8±16.1 years. Postoperative causes accounted for 39 (78%) of the cases, with phacoemulsification surgery with foldable intraocular lens implantation being the leading cause in 23 (58.7%) cases. Culture positivity was observed in only 22 (44%) cases, with Staphylococcus (Staph) epidermidis as the major causative organism. The best visual acuity achieved was 6/12 for two patients. Conclusion: Postoperative endophthalmitis remains the most common cause of endophthalmitis. Additionally, patients who presented with better visual acuity had a better visual outcome after treatment. Therefore, patients should be educated about the early signs of endophthalmitis to ensure prompt medical attention and improve visual recovery

Синдром токсического поражения переднего сегмента глаза (tass) после факоэмульсификации катаракты и имплантации иол. (клинический случай)

Purpose.To present a clinical case of TASS at the IRTСEye Microsurgery Ekaterinburg center. Clinical case. Patient C, born in 1955 came to the Center in 2016 with complaints of low vision in the left eye. After a standard ophthalmologic exa mination, she was diagnosed with mature cataract with elements of swelling in the left eye, initial cataract, 1st degree hyperopia in the right eye. Phacoemulsification of cataract with IOL implantation was suggested for the left eye. The patient developed TASS-syndrome the next day after the surgery. Results. We have analyzed possible causes of TASS development in the patient. The peculiarity of the operative treatment was the use of Rhex-ID capsule dye in the volume of 1 ml. We assumed that the use of this dye was the cause of the syndrome. Conclusion. The problem of postoperative inflammatory reaction remains rather urgent despite of rare occurrence of toxic anterior segment syndrome. The syndrome appears suddenly and unpredictably, can take the form of an outbreak in an individual institution. TASS is a condition similar to infectious bacterial postoperative complications in its clinical manifestations and presence of pathognomonic symptoms, which complicates diagnosis and determination of tactic. Key words: TASS; toxic anterior segment syndrome; postoperative endophthalmitis.

Surface modification of commercial intraocular lens by zwitterionic and antibiotic-loaded coating for preventing postoperative endophthalmitis

After cataract surgery, to prevent possible postoperative endophthalmitis (POE) caused by attached pathogenic bacteria onto the surface of implanted intraocular lens (IOL), various antibiotic-loaded IOLs have been proposed and widely studied to inhibit bacterial infection. However, most of these developed antibiotic-loaded IOLs still suffer from shortcomings such as insufficient drug loading, short release time, poor biocompatibility, and risk of secondary infection. Herein, we propose a zwitterionic and high-drug loading coating for surface modification of commercial hydrophobic IOL with both antifouling and antibacterial properties to effectively prevent POE. In this strategy, zwitterionic poly(carboxylbetaine-co-dopamine methacrylamide) copolymers (pCBDA) and dopamine (DA) were first robustly co-deposited onto IOL surface via facile mussel-inspired chemistry, resulting in a hydrophilic coating (defined as PCB) without sacrificing the high light transmittance of the native IOL. Subsequently, amikacin (AMK), an amine-rich antibiotic was reversibly conjugated onto the coating through the acid-sensitive Schiff base bonds formed by the reaction between amino and catechol groups, with high-drug payload over ∼35.5 μg per IOL and 30 days of sustained drug release under weak acid environment. Benefiting from the antifouling property of zwitterionic pCBDA copolymers, the intraocularly implanted PCB/AMK-coated IOL could effectively resist the adhesion and proliferation of residual LECs to inhibit the development of posterior capsule opacification (PCO) without affecting the normal ocular tissues, demonstrating excellent in vivo biocompatibility. Moreover, the synergy of zwitterionic pCBDA and conjugated AMK with acidic-dependent release behavior endowed this PCB/AMK-coated IOL strong antibacterial activity against both in vitro biofilm formation and in vivo postoperative Staphylococcus aureus infection, suggesting its promising application in preventing POE.

Efficacy and safety of intravitreal injection of triamcinolone-moxifloxacin after cataract surgery in a low to middle income country - a one-year audit.

To evaluate the safety and efficacy of intravitreal injection of triamcinolone and moxifloxacin regime administered immediately following cataract surgery. The retrospective study was conducted from January to June 2021 at a tertiary care referral centre in Karachi and comprised record of all patients who underwent dropless cataract surgery from April 2018 to June 2019. Data included slit lamp examination, dilated fundal exam, uncorrected visual acuity, best corrected visual acuity, and intraocular pressure. Cataract assessment and anterior chamber reaction were graded according to the World Health Organisation cataract grouping system. Efficacy of the regime was defined as the ability to prevent postoperative endophthalmitis. Stratification analysis was done to note if gender has any role in terms of effectiveness. Data was analysed using Microsoft Excel version 16.0 and IBM SPSS version 27. Of 240 eyes of 161 patients analysed, 114(47.5%) were of men who had a mean age of 57.89±14.32 years, and 126(52.5%) were of females with a mean age of 58.02±10.85 years. Overall, 2(1.75%) male subjects and 1(0.8%) female subject developed breakthrough inflammation within one week of the procedure. They were treated with anti-inflammatory drops and in 1(33%) of the cases antibiotic drop for 1 week. At day 90, no patient had residual inflammation or new onset inflammation. Also, 15(6.25%) patients developed raised intraocular pressure from day 7 to day 30. Most cases 10(66.7%) resolved within 1 week of using intraocular pressure-lowering drops. No patient developed endophthalmitis postoperatively. Dropless cataract regime was found to be an effective and safe alternative that was easy to administer.

Acute postoperative endophthalmitis after cataract operation: result of early vitrectomy within 24 hours of presentation.

To evaluate result of early pars plana vitrectomy (PPV) within 24 hours of presentation for acute postoperative endophthalmitis after cataract operation, and to determine factors that predict visual outcome. Consecutive patients who developed acute postoperative endophthalmitis within 6 weeks after cataract operation were reviewed. Patients were divided into two groups for analysis: (1) those receiving PPV within 24 hours of presentation (early PPV group), and (2) those receiving initial intravitreal antibiotics only without PPV within 24 hours of presentation (IVA group). Out of 41,411 cataract operations, 22 eyes developed acute postoperative endophthalmitis. Presenting VA was hand-movement or worse in 72.7%. The most common organisms were Staphylococcus (40.9%), Streptococcus (13.6%) and Enterococcus (13.6%). 22.7% of eyes had good final VA ≥ 20/30 and 27.3% had poor final VA < 20/400. Early PPV group had significantly lower rate of requiring additional treatments to control infection (25% versus 80%, P = 0.030), higher rate of retinal detachment (25% versus 0%, P = 0.221) and similar final logMAR VA (1.08 ± 1.08 versus 0.80 ± 0.80, P = 0.489) compared to IVA. Multivariate linear regression analysis showed that worse final VA was significantly associated with Streptococcus (ß = 1.92, P = 0.007) and retinal detachment (ß = 1.72, P = 0.005) but not with early PPV (P = 0.225). Early PPV was superior to initial intravitreal antibiotics alone as it required fewer additional treatments to control infection. Visual outcome was similar between early PPV and initial intravitreal antibiotics alone despite high number of poor presenting VA of light-perception in early PPV group. Streptococcal infection and retinal detachment were major poor prognostic factors for vision.

Is the endophthalmitis vitrectomy study still relevant in 2022?

AbstractEndophthalmitis is a severe intraocular inflammatory response secondary to an infectious intraocular load. Postoperative endophthalmitis (POE) is the most common type. It is most often seen after cataract surgery and intravitreal injections (IVI) but can be seen after any intraocular procedures (e.g. glaucoma surgery or pars plana vitrectomy (PPV)). A definitive approach to treatment of endophthalmitis is not uniformly agreed upon by many vitreoretinal surgeons. The current standard treatment for acute POE remains the injection of intravitreal antibiotics with the addition of PPV for severe cases.In the 1990 s, a clinical trial (Endophthalmitis Vitrectomy Study, EVS) was conducted, comparing vitrectomy (VIT) versus intravitreal antibiotics in one arm and intravenous (IV) antibiotics yes or no in the other arm for the treatment of postoperative bacterial endophthalmitis. The suggestions regarding VIT was that it is of substantial benefit for patients with an initial VA of light perception (LP) while offering VIT should not be considered in patients with hand motion or better VA (Endophthalmitis Vitrectomy Study Group 1995).While the EVS has been widely used as the guideline for management of POE, even for indications other than after cataract surgery or placement of secondary intraocular lenses (IOL), the study has come under scrutiny. Some physicians recommend early PPV, or management based on clinical assessment other than visual acuity.But so many years after the results of EVS were published, remarkable progress in vitrectomy techniques have been achieved, including the introduction of transconjunctival surgery (23‐,25‐ and 27‐gauge instrumentation), higher cutting rates, wide‐angle visualization. Preoperative povidone‐iodine antisepsis, intravitreal antimicrobial injections, improved vitrectomy instrumentation, availability of silicone oil as adjunctive treatment and newer alternative antimicrobials contribute to better outcome for patients with endophthalmitis. Further advances in the microbiology diagnosis including polymerase chain reaction (PCR) and newer molecular application of peptide nucleic acid–fluorescence in situ hybridization (PNA‐FISH) are promising diagnostic tools.All those remarkable advances that took place in the decades after the EVS was published, leads us to the conclusion, that the results of the EVS are extremely important but some of the recommendations could be reconsidered. A new randomized prospective multicenter study should be organized to address management of endophthalmitis.

Endophthalmitis prophylaxis in cataract surgery and intravitreal injection in Europe

AbstractEndophthalmitis is a significant complication of cataract surgery and intravitreal injections (IVI), leading in severe cases to blindness. The improvements of surgical technology, techniques and procedures have significantly reduced the incidence of postoperative infections in recent years; however, it is impossible to eliminate this problem completely. The incidence of post‐cataract endophthalmitis varies among several countries from 0.03% to 0.7%. The recommendations of the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO), have set the maximum acceptable level of postoperative endophthalmitis (POE) after cataract extractions at 0.05%. Awareness about risk factors and prevention measures is necessary for ophthalmic surgeons. Surgical complications (wound leak, posterior capsule rupture, vitreous loss or zonular complications) are related with higher incidence of postoperative endophthalmitis. Elderly patients (&gt;85 years), those with clear corneal incisions versus scleral tunnel incisions, and those without intracameral injection of cefuroxime have also a higher risk of infection.The available evidence suggests that intracameral antibiotic lowers the POE. Of the two most commonly used IC antibiotics, moxifloxacin and cefuroxime, there is no clear evidence that one is better than the other. Vancomycin is not recommended for routine ICAP because of both the risk of HORV (extremely low) and concerns regarding the use of an indispensable agent to treat multi‐drug‐resistant endophthalmitis as routine prophylaxis. Topical antibiotics may not provide an additional benefit, as has been suggested by several studies.In IVI, perioperative antibiotics cannot be considered the standard of care, as there is no evidence of prophylactic effects with regard to POE when using perioperative antibiotics. Topical administrations of 5% povidone‐iodine over at least 30 s into the conjunctival sac is recommended. Current clinical practices include minimized physician/patient talking during IVI, wearing of surgical face masks, and using face masks for nurses, technicians and physicians.

The silent beast – a case of late‐onset postoperative endophalmitis

AbstractLate‐onset postoperative cataract surgery endophthalmitis remains a rare but sight‐threatening complication usually caused by slow‐growing pathogenic agents: bacterial or fungus. The delayed diagnosis and the potential irreversible ocular damage make this condition a challenging case for ophthalmologists.Herein, we present a 71‐year‐old woman with late‐onset fungal endophthalmitis after cataract surgery caused by candida parapsilopsis, a rare etiologic agent. This diagnosis should be taken into consideration in every late‐onset postoperative persistent panuveitis with no response to antibiotics and partial response to topical steroids, even after negative vitreous or tap culture. White deposits on the surface of the intraocular lens or the capsule are a crucial sign. Systemic and intraocular antifungal therapy along with vitrectomy and intraocular lens removal—if necessary—are the main therapy to ensure the best visual prognosis.

A Case of Postoperative Bacterial Endophthalmitis after Successful Treatment of Suspected Iatrogenic Fungal Endophthalmitis

A Case of Postoperative Bacterial Endophthalmitis after Successful Treatment of Suspected Iatrogenic Fungal Endophthalmitis

The Effect of Antibiotic Use in Surgery on the Incidence of Postsurgical Cataract Endophthalmitis

Endophthalmitis is a rare complication that can occur either endogenous or exogenous. Postsurgical endophthalmitis remains the primary exogenous etiology. Its complications remain formidable and involve the functional prognosis see anatomical eye. All interest of the question resides in preoperative prevention by incising on the measures of asepsis and antisepsis and per operatory by administering the antibiotic. Intracameral cefuroxime reduces the incidence of postoperative endophthalmitis of similar or slightly increased efficacy compared to the intravenous tract.

Incidence and Clinical Characteristics of Postoperative Endophthalmitis After Ab-Interno Canaloplasty.

Postoperative endophthalmitis (POE) is a rare but devastating complication of ophthalmic surgeries. Microinvasive glaucoma surgery (MIGS) procedures have become increasingly utilized for the surgical reduction of intraocular pressure (IOP). Ab-interno canaloplasty (ABiC) is a popular MIGS procedure, but POE rates and clinical effects following ABiC have not been studied. This study conducted a retrospective review of all consecutive cases of either standalone ABiC or combined ABiC with phacoemulsification performed at a tertiary care academic referral center from 2015 to 2021. Exclusion criteria included a history of incisional glaucoma surgery, retinal surgery, or additional concurrent microinvasive glaucoma surgery (MIGS) at the time of ABiC. The ratesof POE afterABiC were calculated with 95% confidence intervals (CI) based on the Clopper-Pearson exact method. Of 3256 cases of ABiC, one case (0.03%, 1/3256, 95% CI: 0.00-0.17%) of post-ABiC endophthalmitis was identified. The rate of POE in standalone ABiC was 0.00% (0/1332 cases, 95% CI: 0.00-0.28%), whereas the rate in combined ABiC with phacoemulsification was 0.05% (1/1924 cases, 95% CI: 0.00-0.29%). Additionally, the rate of POE following stand-alone cataract surgery, 0.10%, 11/11,470 cases, 95% CI: 0.05-0.17%), total cataract surgeries, 0.06% (17/28,013 cases, 95% CI: 0.04-0.10%), total MIGs, excluding ABiC, surgeries, 0.08%, (3/3845 cases, 95% CI: 0.02-0.23%) portray non-inferiority of ABiC in the risk of POE. The case of ABiC-POE presented four days after surgery and required a vitreous tap with intraocular injection of antibiotics and pars plana vitrectomy. No causative organism was identified. A final 1-year follow-up revealed a corrected distance visual acuity of 20/40 and stable glaucoma. The rate ofPOE after ABiC (1 per 3256 cases) is statistically non-inferior to the reported incidence of POE after otherMIGS and incisional glaucoma surgeries.

Commentary: Rule out lacrimal duct obstruction before every intraocular procedure.

The age of presentation often overlaps for a person with acquired cataracts and acquired nasolacrimal duct obstruction (NLDO). Hence, there is more probability of having an asymptomatic NLDO and a cataract in the same person. Ipsilateral NLDO is considered an important risk factor for postoperative endophthalmitis in an intraocular procedure. Therefore, it becomes mandatory to rule out ipsilateral NLDO in all patients planned for cataract surgery.[1] Overall, the reported incidence of NLDO is 3–6.6%, with a mean age range of 48–59.5 years.[12] The ophthalmic evaluation of cataract surgery focuses on the factors affecting the visual acuity outcomes, like the health of tear-film, cornea, and anterior and posterior segments. Similarly, the ocular investigations are also targeted mainly at calculating and computing the refractive indices directly involved in the outcome of cataract surgery. Regurgitation on pressing lacrimal sac (ROPLaS) and lacrimal irrigation are generally not included in the routine examination of most ophthalmic cases. Hence, an asymptomatic lacrimal patient with a cataract tends to get his/her NLDO missed. ROPLaS and/or lacrimal irrigation must be included in the preoperative workup of a cataract patient to avoid the chance of postoperative endophthalmitis.[3] Lacrimal irrigation is an invasive diagnostic procedure requiring the desired skill-set to avoid any iatrogenic injury to the delicate lacrimal drainage system and interpret the results. Moreover, the patient and examiner must be in specific positions for lacrimal irrigation rather than sitting on an examination chair and slit lamp. Each step requires patient co-operation, like topical anesthesia, gaze positioning of the patient, punctum dilatation (preferably superior), lacrimal cannula insertion in horizontal canaliculus, and perception of gently forced injection of fluid in nose or throat. A significant part of lacrimal irrigation is dependent on the patient’s co-operation and systemic condition. ROPLaS, on the other hand, is a simple test that can be easily performed in the sitting position (any position) of the patient without consuming much time in the workup period. All those beneficial parameters are vital in high-volume centers and screening camps in remote areas. The examiner desires no special instrumentation or patient co-operation. In a survey involving members of the Oculoplastics Association of India, ROPLaS (59.6%) was opted as the preferred modality compared to lacrimal irrigation/syringing (32.6%), for checking NLDO before cataract surgery.[3] The sensitivity and specificity of ROPLaS have been reported to be 93.2% and 99.3%, respectively.[1] They recommended preoperative lacrimal irrigation to be unnecessary in case of a negative ROPLaS test. A recent retrospective, single-center study from India, including a large sample size (87,144 eyes), compared postcataract surgery endophthalmitis rates among eyes undergoing syringing (48,071 eyes) or ROPLAS (39,073 eyes) test before cataract surgery.[4] They found that the rates of post-cataract endophthalmitis (PCE) were comparable among the eyes undergoing either syringing test or ROPLAS before cataract surgery. This study was performed to avoid lacrimal irrigation, an aerosol-generating procedure, during COVID-19 times. However, when the safety of a vision-restoring surgical procedure (elective cataract surgery) is in question, more details in the ophthalmic examination will add to the safety value. As per the current study by Kim et al.,[5] the ROPLaS and lacrimal irrigation are both recommended to be performed in the preoperative workup of a cataract patient.[5] In their study, the ROPLaS was performed by an ophthalmologist, while a trained ophthalmic technician performed the lacrimal irrigation. We want to emphasize that ophthalmologists should first train the technician adequately before performing an invasive procedure (lacrimal irrigation) on a patient. This would ensure the desired outcomes from the lacrimal irrigation procedure without iatrogenic trauma to the lacrimal punctum and canaliculus. Additionally, a history of significant epiphora ± discharge goes a long way in suspecting lacrimal obstructions. Slit-lamp examination of the tear film and inferior conjunctival fornix is a must to rule out any debris/discharge. The fluorescein dye staining provides basic information about the health of corneal epithelium, and the simultaneous observation of the fluorescein dye disappearance test can provide an additional dimension in ruling out lacrimal duct obstruction. We believe that if a patient has a positive ROPLaS test, lacrimal irrigation is not necessary. However, in a patient with negative ROPLaS, lacrimal irrigation should be performed before any intraocular procedure to avoid the most-dreaded complication of endophthalmitis due to a treatable cause - NLDO.

Spectrum of signs, symptoms, and treatment in amphotericin B-resistant Trichosporon endophthalmitis: A series of ten cases of post-cataract surgery cluster endophthalmitis.

The aim of this study was to present the signs, symptoms, management, and outcome of a series of cases of cluster endophthalmitis caused by a multi-drug resistant fungus, Trichosporon. This was a retrospective, non-randomized, consecutive interventional case series. Ten cases of postoperative endophthalmitis operated by a surgeon on three consecutive operation theater (OT) days presented 3-5 months after their surgery. All cases were microbiologically confirmed. The pathogen was found to be resistant to most antifungals, including amphotericin B. The cases had a latent period of around 45 days. Management of endophthalmitis included intravitreal injections, anterior chamber (AC) lavage, Pars Plana vitrectomy (PPV), posterior capsulotomy, IOL, and capsular bag removal. Multiple intravitreal injections were required due to recurrence of infections after initial improvement with voriconazole injections. Structural integrity was maintained and infection-free status was achieved in all the eyes. The presenting vision ranged from 6/60 to PL (perception of light). Seven out of 10 had improvement in their final vision over the presenting vision. Final outcome of four patients had vision of 6/24 or better, 4 patients had vision in the range of 2/60 to 6/36 and 2 patients had PL. Trichosporon can cause devasting infections even in the immunocompetent, especially in association with implants and catheters. Triazoles form the mainstay of treatment of Trichosporon infection due to the high susceptibility of the organism in vitro. A regimen including voriconazole and amphotericin B may prove to be the most effective. This is the first report of an outbreak of cluster endophthalmitis caused by Trichosporon.

Acute-onset postoperative endophthalmitis after cataract surgery performed by resident and attending physicians at a university teaching hospital.

To evaluate acute-onset postoperative endophthalmitis following cataract surgery and to compare rates between resident and attending physician-performed cohorts. Bascom Palmer Eye Institute, Miami, Florida. Retrospective chart review. Records of patients diagnosed with endophthalmitis within 6 weeks of surgery performed by attending and resident physicians between January 1, 2015, and December 31, 2020, were reviewed. Total cataract volume was obtained from institutional records, and resident case totals were obtained from case logs. Endophthalmitis cases were obtained from billing records and confirmed with chart review. There were 22 cases of endophthalmitis among 32 505 cases (0.068%). Endophthalmitis occurred in 6 of 6447 (0.093%) resident cases and 16 of 26 058 (0.061%) attending cases ( P = .55). The most common bacterial isolates were coagulase-negative Staphylococcus (8/22, 36.3%) and Streptococcus species (3/22, 13.6%), with negative cultures in 10 (10/22, 45.5%). Initial treatment with vitreous tap and injection of intravitreal antibiotics was performed in 21 eyes (21/22, 95.4%) and vitrectomy with intravitreal antibiotic injection in one (1/22, 4.5%). Vitrectomy was performed secondarily in 9 patients (9/22, 40.9%). Corrected distance visual acuity (CDVA) at last follow-up was ≥20/40 in 13 eyes (13/22, 59%) and ≤hand motions in 3 eyes (3/22, 13.6%). CDVA (logMAR mean ± SD) was 1.22 ± 1.16 in resident and 0.49 ± 0.79 in attending cases ( P = .11). In the current study, acute-onset postoperative endophthalmitis developed infrequently following cataract surgery. The rates and visual outcomes of endophthalmitis were similar in resident and attending cases.

Comparison of different endophthalmitis prophylactic measures in cataract surgery - An analysis of 2.4 lakh cases.

To compare different endophthalmitis prophylaxis methods adopted in cataract surgery (manual small-incision cataract surgery and phacoemulsification) between the years 2013 and 2021 in the community eye care section of a tertiary eye care hospital in South India and report their outcomes. All cataract surgeries performed from January 2013 to December 2021 (2,46,874 surgeries) at a single center were included in this retrospective study. The different endophthalmitis rates with each regimen were analyzed and evaluated. 70,081 surgeries were performed from January 2013 to February 2015, where Tobramycin was added to Balanced Salt Solution (BSS) (Group A). From March 2015 to January 2017, 63,245 surgeries were performed when intracameral Moxifloxacin was given (Group B). From February 2017 to December 2021, 1,13,548 surgeries were performed were Amikacin was added to BSS (Group C). In total, 42 cases of postoperative endophthalmitis were reported during the study period (0.02%). There was no significant difference in the endophthalmitis rates between groups A and B (P = 0.4152); however, there was a significant decrease in endophthalmitis rates in group C when compared with group A (P = 0.04) and group B (P = 0.006). There was a significant reduction in the rates of endophthalmitis following the addition of amikacin in irrigating BSS. Nocardia was one of the predominant organisms isolated from these endophthalmitis patients. This is the first single-center study to report a comparative analysis of different endophthalmitis prophylactic measures in a community eye care set up with a high incidence of Nocardia endophthalmitis prevented with amikacin in BSS irrigating solution.

Outcomes of very delayed onset chronic postoperative endophthalmitis caused by Cutibacterium acnes including treatment with endolaser photocoagulation

Introduction: To the authors' knowledge, these are 2 of the longest reported time periods between cataract surgery and diagnosis of chronic postoperative endophthalmitis. The clinical course and outcomes are discussed. Patient and Clinical Findings: 2 patients underwent uneventful cataract surgery and presented with recurrent anterior segment inflammation years after the surgery. In the first case, an 88-year-old man presented with granulomatous uveitis in the left eye 4 years after intracapsular cataract extraction and posterior chamber intraocular lens (CE/PC IOL) placement. In the second case, a 79-year-old woman presented with iritis 7 years after CE/PC IOL. Diagnosis, Intervention, and Outcomes: Both patients were treated for presumed idiopathic uveitis for years before the diagnosis of chronic endophthalmitis caused by Cutibacterium acnes. 1 case required endolaser photocoagulation to an infectious nidus. Conclusions: Chronic postoperative endophthalmitis can present many years after uneventful cataract surgery.

Evaluation of the effect of gentamicin in surgical perfusion solution on cataract postoperative endophthalmitis

ObjectiveTo evaluate the effect of gentamicin in surgical perfusion solution on endophthalmitis incidence after cataract surgery.MethodsA retrospective analysis of endophthalmitis incidence was conducted in two groups of patients who underwent cataract surgery, with (Group B) or without gentamicin (Group A) in the surgical perfusion solution. Endophthalmitis incidence, the isolated pathogenic bacteria strains and their antibiotic sensitivity, and the drug-resistant genotype of the pathogens were examined.ResultsThe incidence of endophthalmitis in patients of group A was 0.8‰. Thirteen pathogenic bacterial strains were isolated from the patient samples in group A, including 8 strains of Staphylococcus epidermidis, 1 Staphylococcus aureus, 1 Streptococcus pneumoniae, 1 Streptococcus bovis, 1 Enterococcus faecium and 1 Morganella sp. The incidence of endophthalmitis in group B patients was 0.2‰, which was significantly lower than that in group A (P<0.05). Five strains of pathogenic bacteria were successfully isolated, including 2 strains of Enterococcus faecium, 1 Enterococcus faecalis, 1 Staphylococcus epidermidis and 1 Staphylococcus aureus. There was no significant difference in the proportion of Staphylococcus strains in all isolated bacteria between the two groups (P > 0.05). However, the proportion of Enterococci isolated in group B samples was higher than that in group A (P < 0.05). There were more gentamicin-sensitive strains than levofloxacin-sensitive strains identified (P < 0.05). Interestingly, aminoglycoside-inactivating enzyme resistance gene was detected in Enterococcus strains.ConclusionOur data suggest that gentamicin-containing perfusion solution can reduce the incidence of postoperative endophthalmitis in cataract patients. However, the selective pressure imposed by gentamicin may facilitate the development of aminoglycoside-resistant Enterococcos strains.

Prophylactic antibiotics for postcataract surgery endophthalmitis: a systematic review and network meta-analysis of 6.8 million eyes

To reveal optimal antibiotic prophylactic regimen for postoperative endophthalmitis (POE), we conducted systematic review and network meta-analysis. A total of 51 eligible original articles, including two randomized controlled trials, were identified. In total, 4502 POE cases occurred in 6,809,732 eyes (0.066%). Intracameral injection of vancomycin had the best preventive effect (odds ratio [OR] 0.03, 99.6% confidence interval [CI] 0.00–0.53, corrected P-value = 0.006, P-score = 0.945) followed by intracameral injection of cefazoline (OR 0.09, 99.6% CI 0.02–0.42, corrected P-value < 0.001, P-score = 0.821), cefuroxime (OR 0.18, 99.6% CI 0.09–0.35, corrected P-value < 0.001, P-score = 0.660), and moxifloxacin (OR 0.36, 99.6% CI 0.16–0.79, corrected P-value = 0.003, P-score = 0.455). While one randomized controlled trial supported each of intracameral cefuroxime and moxifloxacin, no randomized controlled trial evaluated vancomycin and cefazoline. Sensitivity analysis focusing on the administration route revealed that only intracameral injection (OR 0.19, 99.4% CI 0.12–0.30, corrected P-value < 0.001, P-score = 0.726) significantly decreased the risk of postoperative endophthalmitis. In conclusion, intracameral injection of either vancomycin, cefazoline, cefuroxime, or moxifloxacin prevented POE.

Immediate sequential bilateral cataract surgery: a 13-year real-life report of 56 700 cataract operations

Background/aimsTo assess the frequency of immediate sequential bilateral cataract surgery (ISBCS) and endophthalmitis during 13-year period in Tays Eye Centre, Tampere University Hospital, Tampere, Finland.MethodsAll cataract surgeries performed between 1...