Purulent Endophthalmitis Research Articles

Association between immune checkpoint inhibitor medication and uveitis: a population-based cohort study utilizing TriNetX database.

To explore the associations between the use of immune checkpoint inhibitors (ICIs) and the risk of developing uveitis among cancer patients. Cancer patients who received ICI therapy and a comparison group of cancer patients who did not receive ICI therapy were retrospectively recruited from the TriNetX electronic heath-record registry. The outcome of interest was the development of new-onset uveitis. Propensity score matching based on a 1:1 ratio was conducted in order to reduce bias. Multi-variate cox proportional hazard models and Kaplan Meier method were also utilized to assess for the risk of uveitis among cancer patients who received ICI therapy. 71931 cancer patients (54.7% male; 76.5% white; mean age at index 63.6 ± 12.2 years) who received ICI treatment (ICI group) and 71931 cancer patients (54.7% male; 77% white; mean age at index 63.5 ± 12.4 years) who never received ICI (comparison group) were recruited. Associated Kaplan-Meier curves showed significantly increased uveitis risk among the ICI group for all follow-up years (p<0.001). The risk of uveitis was also higher among the ICI group during the 144-month follow-up period with a hazard ratio (HR) of 2.39 (95% CI: 2.07-2.75). Increased risk for specific uveitis diseases, such as iridocyclitis, chorioretinal inflammation, retinal vasculitis, unspecified purulent endophthalmitis, pan-uveitis and sympathetic uveitis were found. Subgroup analysis demonstrated an elevated hazard ratio for the development of uveitis among ICI recipients, spanning individuals below the age of 65 as well as those aged 65 and older. The elevated hazard ratio for uveitis development among ICI recipients was also observed across all genders, among those of white and Asian ethnicities, those with smoking history, and those with comorbid conditions such as hypertension and dyslipidemia, in comparison to their non-ICI counterparts. An additional subgroup analysis on monotherapy versus combinatory ICI regimens was also conducted. Individuals who received monotherapy from the class of anti-PD-1 (HR:1.98 [CI: 1.65-2.37]) and anti-CTLA-4 (HR:5.86 [CI:1.99-17.24]) exhibited elevated hazard ratios for uveitis development compared to their non-ICI comparators. Those exposed to combinatory ICI regimens, specifically a combination of anti-PD-1 and anti-CTLA4 (HR: 5.04 [CI:3.55-7.16]), showed increased hazard ratios for uveitis development compared to their non-ICI comparators. In contrast, individuals exposed to a combination of anti-PD-1 and anti-PD-L1 (HR: 2.47 [CI:0.81-7.50]) did not demonstrate an increased risk for uveitis compared to their non-ICI comparators. A significantly increased risk for uveitis diseases was found among the ICI group from the first year of follow-up. Increased awareness should be promoted on the occurrence of uveitis among cancer patients receiving ICI therapy.

Bordetella avium-associated endophthalmitis: case report

BackgroundBordetella avium, an aerobic bacterium that rarely causes infection in humans, is a species of Bordetella that generally inhabits the respiratory tracts of turkeys and other birds. It causes a highly contagious bordetellosis. Few reports describe B. avium as a causative agent of eye-related infections.Case presentationWe report a case of acute infectious endophthalmitis associated with infection by B. avium after open trauma. After emergency vitrectomy and subsequent broad-spectrum antibiotic treatment, the infection was controlled successfully, and the patient’s vision improved.ConclusionsB. avium can cause infection in the human eye, which can manifest as acute purulent endophthalmitis. Nanopore targeted sequencing technology can quickly identify this organism. Emergency vitrectomy combined with lens removal and silicone oil tamponade and the early application of broad-spectrum antibiotics are key for successful treatment.

Late-onset postoperative Mycobacterium haemophilum endophthalmitis masquerading as inflammatory uveitis: a case report

BackgroundAlthough atypical mycobacteria had been increasingly found in various ocular infections in the past decades, a slow-growing Mycobacterium haemophilum (M. haemophilum) was scarcely reported. Similar to tuberculous infection, the presentation can masquerade as low-grade granulomatous intraocular inflammation with partial response to corticosteroids. Besides, the special requirements for culture make this pathogen difficult to diagnose. The study aims to report the clinical presentation and notify the awareness of NTM endophthalmitis among clinicians. This is the first case report of late-onset, postoperative M. haemophilum endophthalmitis in the literature.Case presentationA 66-year-old man with non-insulin-dependent diabetes mellitus (NIDDM) manifested chronic granulomatous inflammation in the left eye after multiple glaucoma surgeries. With a diagnosis of noninfectious panuveitis, he was treated with systemic corticosteroids. The inflammation initially responded to therapy although it subsequently worsened and became purulent endophthalmitis. The vitreous cultures grew M. haemophilum. Intraocular and systemic antimicrobial treatments were administered early, but the patient eventually turned blind.ConclusionsM. haemophilum endophthalmitis is a rare but serious intraocular complication leading to loss of vision or eyeball. Awareness of atypical mycobacterial infections is necessary especially in patients with impaired immune function, previous intraocular surgery, and corticosteroid resistance. Proper laboratory investigations and treatments should be performed. However, due to the rarity of the disease, the development of guidelines for its investigation and therapy is still challenging.

Greater Total Dose and Duration of Treatment with Bortezomib Are Associated with Higher Incidence of Chalazion and Other Ocular Side Effects

▪Background: Use of the proteasome inhibitor bortezomib has been anecdotally noted to be associated with a number of ocular side effects, including chalazion, vascular events and conjunctivitis. This type of adverse event has not been characterized in the literature on bortezomib to date. In this retrospective study, we report the incidence of bortezomib-associated eye disease among patients treated at Memorial Sloan Kettering Cancer Center, and identify risk factors for development of ocular side effects.Methods: A retrospective review was conducted to identify all patients treated with bortezomib at Memorial Sloan Kettering Cancer Center between February 1999 and August 2013. Patients with bortezomib-associated eye disease were identified using ICD-9 diagnosis codes as shown in table 1. Patients were included if eye disease occurred after the first date of bortezomib administration and until one week after the last date of administration. Other data collected included dates, total dose and route of bortezomib administration. To identify statistically significant correlations between disease incidence and other variables, FisherÕs exact test was applied to discrete variables, and Wilcoxon rank sum test was applied to continuous variables.Table 1Diagnosis codes used for identification of bortezomib-associated ocular disease.Diagnosis codes identified as “chalazion”Diagnosis codes identified as “other eye disease”Hordeolum Externum Blepharitis Chalazion BlepharoconjunctivitisConjunctival Hemorrhage Conjunctivitis Acute Conjunctivitis Optic Neuritis Conjunctiva Vascular Abnormality Retinal Hemorrhage Eye Swelling or Mass Purulent Endophthalmitis Disorders of Eyelid Keratoconjunctivitis Arterial Branch Occlusion Retinal Vasculitis Vitreous Hemorrhage Mucopurulent Conjunctivitis Retinal Vascular Occlusion Conjunctivitis NEC Inflammation Eyelid NOSResults: 1122 patients were administered bortezomib between February 1999 and August 2013 at Memorial Sloan Kettering Cancer Center. Patients received bortezomib as IV (78.5%) or SC (19.9%) injections (1.6% (18 patients) received both IV and SC injections). Total doses of bortezomib ranged from 5.1mg to 505.2mg (median dose 60.56 mg). 53 patients (4.7%) developed eye disease during the period of bortezomib administration. Of these, 23 (2.0%) developed chalazion, while 30 (2.7%) developed other eye disease. The median dose administered prior to the first episode of eye disease was 34.41mg (range 2.10-147.40mg). The median time from first dose of bortezomib to the first event was 106 days (range 1-2154 days). Incidence of eye disease was positively correlated both with higher cumulative dose of bortezomib (p<0.0001) and with greater total time on bortezomib (p<0.0001). In addition, patients who received bortezomib both intravenously and subcutaneously were statistically more likely to develop eye disease than those who received bortezomib only via one route (p<0.0001). Patients who were documented as having relevant eye disease preceding bortezomib administration were not found to be more likely to develop eye disease during bortezomib therapy than those with no prior history of eye disease. There was also no correlation between the incidence of multiple episodes of eye disease during bortezomib therapy and any of the variables tested.Conclusions: Bortezomib is an important part of treatment regimens for many patients with multiple myeloma and lymphoma. However, its use is associated with side effects, most notably neuropathy, which sometimes necessitates dose reduction or drug discontinuation. In this study we document the incidence of bortezomib-associated eye disease in the total cohort of patients treated with bortezomib over 14.5 years at a large academic medical center. We find that the development of eye disease is associated with higher total dose and greater duration of bortezomib administration. DisclosuresMoskowitz:Seattle Genetics, Inc.: Consultancy, Research Funding; Genentech: Research Funding; Merck: Research Funding. Hamlin:Gilead, Spectrum, Seattle Genetics, Genentech: Consultancy; Spectrum, GSK, Jansen and Jansen/Pharmacyclics, Portola, Seattle Genetics: Research Funding.

Inpatient costs of endophthalmitis evaluated for the whole of France

Endophthalmitis is a severe condition that requires hospitalization with at least day care. Information on the incidence rate, costs and consequences of endophthalmitis is scarce. To estimate the number of patients with endophthalmitis hospitalized in France, as well as the average costs and hospital budget consequences. French Programme de Médicalisation des Systèmes d'Information (PMSI) data for 2006, derived from the official DRG classification, were analysed. Data were extracted concerning the following primary diagnoses: 'purulent endophthalmitis', 'other endophthalmitis' and 'endophthalmitis associated with another disease'. Two durations of hospitalization were compared: the actual duration and a weighted DRG duration. The cost of hospitalization was weighted by the average DRG cost + daily hospital costs x the difference between the actual and weighted DRG days in hospital. All costs are presented in euro, year 2007 values. A total of 1518 patients (mean age 68.7 years; 47.1% male) experienced 1725 hospitalizations for endophthalmitis, including 1416 cases (82.1%) admitted to public hospitals. The majority of patients (79.1%) were classified by DRG codes that did not specify endophthalmitis (DRG 02M03Z). Most patients (1342) were given a drug injection and 510 underwent vitrectomy. Four patients died in hospital and 75 were transferred to other hospitals. The actual duration of hospitalization for endophthalmitis in public hospitals was 8.1 days (mean), whereas the average weighted DRG duration was 5.1 days, which underestimated the actual duration by 3 days. The average hospital cost was 3688 euro per patient, totalling 6,361,119 euro per annum for all public and private hospitalizations in France, including 223,723 euro as day care. If hospital funding was wholly based on DRG tariffs, the budget for endophthalmitis would be severely underestimated. The DRG inclusion of 'severe acute ocular infections' as a proxy for endophthalmitis dramatically underestimated its true cost by approximately 30%. For health economic evaluations, it is inappropriate to use DRG classifications as proxies for endophthalmitis. Expressed more generally, hospitalization cost analyses should not be based on any specific DRG, but always on the clinically relevant primary diagnosis. The PMSI clustering algorithm underestimates the hospital budgets required for endophthalmitis. Lastly, the PMSI (exhaustively reporting all hospitalizations) is best suited to capturing yearly endophthalmitis incidence rates, average costs and national health expenditure.

Clinical observation of purulent endophthalmitis treated by vitrectomy

目的 探讨玻璃体切除术治疗化脓性眼内炎的临床价值.方法 对35例(35眼)化脓性眼内炎行玻璃体切除、巩膜环扎及联合晶状体切除、人工晶状体摘出、眼内异物摘出、眼内充填术,并配合全身及局部应用抗生素、皮质类固醇治疗.术后随访12～24月.结果 35例中的32例(91.43%)感染得到控制.28例(80.00%)术后视力有不同程度提高,4例术后视力无变化,3例(8.57%)眼内炎未能控制而行眼内容摘除术.结论 玻璃体切除联合抗生素应用是治疗化脓性眼内炎的有效方法。

Five‐year retrospective review of guideline‐based management of fungal endophthalmitis

Guidelines were introduced in 2000 at the Bristol Eye Hospital (BEH) for the management of fungal endophthalmitis. A 5-year retrospective audit re-evaluated the guidelines and monitored the management of this rare condition. Clinical effectiveness and management costs were considered in light of visual outcome. Cases were identified through a 5-year retrospective review of theatre logbooks, Patient Administration System coded admissions with primary diagnosis of purulent endophthalmitis and pharmacy logbooks of patients receiving antifungal therapy. Data correlation and review of patient management were carried out in light of the findings. Twenty-three cases were included, based on clinical disease and/or positive smears or cultures. Age range was 13-74 years, with a male : female ratio of 16 : 7 and right eye : left eye ratio of 14 : 9. Risk factors for fungal endophthalmitis included septicaemia caused by intravenous drug use (78%), presence of indwelling lines (9%), postocular surgery (9%) and post-trauma (4%). Guidelines were rigidly followed in 56% of cases, with improved visual acuity in 9/13 patients compared to 4/10 where management deviated from guidelines. Deviation from guidelines occurred with incomplete use of the recommended drug regimen for the disease severity or use of drugs that were alternative to the suggested guidelines. Treatment was initiated on clinical judgement in 91% of cases and laboratory diagnosis in 9%. The BEH guidelines provided a useful reference when managing this uncommon condition. Voriconazole, a newer broad-spectrum agent with good ocular penetration (used in 9%), has been added to the revised guidelines. Monitoring rare conditions over prolonged time frames supports evidence-based medicine

MYCOBACTERIUM HAEMOPHILUM

Nontuberculous mycobacterial (NTM) infections are becoming an increasingly important complication in ophthalmology, particularly among immunocompromised patients. We report a case of NTM in a 66-year-old male immunosuppressed after cardiac transplantation. Chronic granulomatous iridocyclitis progressed to purulent endophthalmitis despite intraocular and systemic antimicrobial therapy. Direct immunoflourescent staining of the vitrectomy specimen revealed acid-fast bacilli. Biopsies of nodular skin lesions revealed non-caseating granulomas with acid-fast bacilli. Cultures of skin and eye biopsies yielded Mycobacterium haemophilum. Despite aggressive combination antimicrobial therapy, the eye was eventually enucleated. Resolution of systemic infection occurred with the addition of granulocyte macrophage-colony stimulating factor. This is the first reported case of M. haemophilum endophthalmitis.

Pathological findings in eyes enucleated because of perforating injury

Forty-eight eyes enucleated after a perforating eye injury (PEI) in 1980-86 (15% of all PEIs) were examined. The time between injury and enucleation varied from 0 to 1145 days. The lens had been damaged or lost in all eyes and 94% had an uveal tract injury. In 83% the retina was detached, in 15% it was totally prolapsed in injury. The inflammatory signs were most marked in eyes with a corneoscleral or double perforation. Proliferation of the retinal pigment epithelial cells or fibrous proliferation from the wound or ciliary body was found 9-10 days after trauma and epiretinal membranes from the optic nerve head or from the surface of the retina after 1 month. Massive fibrous proliferation was seen in 94% of eyes enucleated 1 month or later after injury. One case of post-traumatic purulent endophthalmitis was detected, but signs of sympathetic ophthalmia were not observed.

Staphylokokken-Endophthalmitis nach Schieloperation

A 10-year-old boy was referred to the authors three days after bimedial faden operation (posterior fixation), with a purulent endophthalmitis in his right eye and visual acuity of LP. Systemic combined antibiotics "ad hoc", including cephalosporins and amikacin, were administered in combination with immunosuppressive doses of methylprednisolone after swabs had been taken for bacteriologic workup. Nine days after admission a pars plana vitrectomy was performed. Both the conjunctival swabs and the vitreous aspirate grew coagulase-negative, gram-positive cocci with high colony counts. Traction retinal detachment developed, and 30 days after the squint surgery lensectomy and silicone oil instillation had to be performed. Visual acuity 3 months after squint surgery was RE cc 0.2.

Early vitrectomy in the treatment of post-operative purulent endophthalmitis.

In 1979-85, 12 cases of purulent postoperative endophthalmitis (PPE) were treated with broad-spectrum antibiotics, corticosteroids and vitreous surgery. In 11 eyes endophthalmitis developed after cataract surgery, in 6 of them after an intraocular lens (IOL) implantation, in one eye after trabeculectomy. Signs related to an intraocular infection appeared 2 to 32 days after surgery, earlier in eyes with an IOL or post-operative complications than in those without. All 5 eyes where vitrectomy was performed within 24 h from the beginning of symptoms retained useful vision (0.1-0.6), whereas 2 of the 7 eyes where vitrectomy was performed later were lost. In the latter two the causative agent was streptococcus. No IOL implants were removed.

化膿性内眼球炎および化膿性鼻炎を伴う&lt;I&gt;Streptococcus suis&lt;/I&gt; (T群) による子豚の化膿性髄膜炎の1例

化膿性内眼球炎および化膿性鼻炎を伴う&lt;I&gt;Streptococcus suis&lt;/I&gt; (T群) による子豚の化膿性髄膜炎の1例

Management of purulent postoperative endophthalmitis.

In 1985, postoperative purulent endophthalmitis (PPE) was diagnosed in 8 eyes (severe in 5 and presumed in 3 eyes). All were treated with paraocular injections of cefotaxime, gentamicin and triamcinolone with or without the same antibiotics by intraocular and/or systemic route with or without systemic corticosteroids. The suspect causative organisms were Staphylococcus epidermidis in 2 cases, Staphylococcus aureus in 3 cases, streptococcus in 1 case, in 2 cases the cause remained unknown. Pars plana vitrectomy and anterior chamber lavage were performed on 5 eyes, and anterior chamber and vitreous tap on 1 eye. The intraocular lens implants were not removed at vitrectomy. A useful vision ranging from 0.15 to 0.6 was obtained in all cases. Our present regime for the management of purulent postoperative or posttraumatic endophthalmitis is given.

Subperiosteal Hematomas of the Orbit in Young Males: A Serious Complication of Trauma or Surgery in the Eye Region

Three documented cases of subperiosteal hematomas in the region of the orbital roof of young males are used to demonstrate the unpredictable appearance, the obscure nature, the complications and the treatment of this process. One case occurred in a 14-year-old boy following blunt head trauma and was cured by aspiration. The second case, in a 16-year-old boy, also resulted from blunt head trauma; it was associated with a large subgaleal hematoma and caused permanent blindness of the involved eye. The third case developed in an 18-year-old male as a complication of acute purulent endophthalmitis following an intraocular foreign body. The aim of this study is to separate subperiosteal hematomas and to show that it is a concise clinical entity with its own typical history, appearance and treatment.

CAUSES OF ENUCLEATION FOLLOWING CATARACT SURGERY

Between the years 1962 and 1976 85 eyes which had undergone cataract surgery were accessioned to the Ophthalmic Pathology Laboratory of the Helsinki University Eye Hospital. The specimens were submitted from the various eye departments of the country. Of these 8k eyes nine had been enucleated within 2 months after surgery while in 64 cases the enucleation had been performed more than 12 months after surgery. 40 eyes had had an attempted operation for senile cataract, 30 eyes for traumatic cataract while the remaining cases were congenital cataract cases or cataracts in pre-existing glaucomatous or chronic uveitis eyes. Most frequent causes for the loss of the eyes were related to incomplete or abnormal healing of the operative wound such as epithelial down-growth and closure of the chamber angle with extensive anterior synechiae leading to absolute glaucoma. It is noteworthy that all cases of epithelial downgrowth were derived from the beginning of the observation period. No new cases were obtained after 1969. Other important causes were purulent endophthalmitis and retinal detachment. Haemosiderosis was a prominent cause in the group with traumatic cataract. A careful histopathological analysis of eyes enucleated after cataract surgery is mandatory as it is from the complications we learn most in cataract surgery.

PENICILLIN AND SULFADIAZINE IN THE TREATMENT OF EXPERIMENTAL INTRAOCULAR INFECTIONS WITH STAPHYLOCOCCUS AUREUS AND CLOSTRIDIUM WELCHII

The study of the chemotherapy of intraocular infections of the anterior segment with Diplococcus pneumoniae¹was extended in these experiments to similar infections with Staphylococcus aureus, which stands second to D. pneumoniae in frequency as the cause of post-traumatic and postoperative purulent endophthalmitis, and Clostridium welchii was selected as a representative of the anaerobe group. The effect of the oral administration of sulfadiazine in combination with the topical use of its sodium salt was again compared with that of the local treatment with penicillin.² <h3>INFECTIONS WITH STAPHYLOCOCCUS AUREUS</h3><h3>Preliminary Experiments.</h3> —Eight strains of Staph. aureus, obtained in cultures of material from human conjunctivas and corneas,³were tested in vitro for their sensitivity to penicillin. The determinations were made in accordance with the modified method of Fleming⁴except for the use of a 10^-2dilution of the broth culture in place of a loopful of the

Experimental Arthritis in the Albino Rat Produced by a Group A Hemolytic Streptococcus.

SummaryAn acute multiple arthritis has been produced in 45 of 51 albino rats by the intravenous injection of a Group A hemolytic streptococcus. In the eyes of 5 rats, an acute monocular purulent endophthalmitis was present.The author wishes to thank Dr. D. M. Angevine for his assistance in this work.