Vitreous Tap Research Articles

Outcomes of Postcataract Surgery Endophthalmitis Managed Without Microbial Cultures

To evaluate outcomes of eyes with post-cataract surgery endophthalmitis that were managed without microbial cultures. This retrospective, single-center comparative cohort study identified all cases of endophthalmitis after cataract surgery presenting between February 1, 2014, and November 1, 2022. All eyes presenting with presumed endophthalmitis requiring in-office treatment with intravitreal antibiotics and either a vitreous or aqueous tap were included. Endophthalmitis cases were divided into the "culture group" if the vitreous or aqueous specimens were sent for microbiologic sampling or into the "no culture group" if an aqueous or vitreous tap was performed but not sent for microbiologic sampling. Best corrected visual acuity (VA) 12 months following endophthalmitis presentation, incidence of retinal detachment, and need for subsequent procedures. Of the 232 endophthalmitis cases identified, 196 (85%) were in the "culture group" and 36 (15%) were in the "no culture group". At endophthalmitis presentation, eyes in the "culture group" had a mean (SD) logMAR VA [Snellen Equivalent] of 2.14 (0.8) [20/2760] and mean (SD) logMAR VA in the "no culture group" was 1.93 (0.8) [20/1702] (p=0.185). At 12-month follow up, mean (SD) logMAR VA for the "culture group" was 0.80 (1.0) [20/126] and 0.41 (0.5) [20/50] in the "no culture group" (adjusted difference = 0.41, 95% CI = -0.043 - 0.857, p=0.076). Twenty of 196 (10%) eyes in the "culture group" developed secondary retinal detachments within 12 months of presentation compared to 0 in the "no culture group" (p=0.045). Eyes with endophthalmitis following cataract surgery managed without microbiologic cultures have similar visual outcomes to eyes managed with microbiologic cultures and may be less likely to develop secondary retinal detachments. This may be an acceptable strategy to manage endophthalmitis after cataract surgery when prompt access to a microbiologic facility is unavailable.

Do Treatment Patterns for Endophthalmitis after Cataract Surgery Follow the Endophthalmitis Vitrectomy Study Recommendations?: An Academy IRIS® Registry Analysis

ObjectiveEvaluate whether treatment patterns for endophthalmitis after cataract surgery in American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) patients are in line with evidence-based guidelines established by the 1995 Endophthalmitis Vitrectomy Treatment Study (EVS), which showed that patients who present with light perception vision (LP) have better visual outcomes with immediate vitrectomy (VIT) compared with vitreous tap with antibiotic injection (TAP). DesignRetrospective cohort study SubjectsIRIS Registry patients undergoing cataract surgery between 2014 and 2022 (identified by CPT codes), presenting with endophthalmitis (identified by ICD 10 codes) within 42 days post-cataract surgery, and having a record of being treated with VIT or TAP on the same or one day following endophthalmitis diagnosis were identified. MethodsPotential covariates of age, sex, race, ethnicity, geographic region, insurance status, and visual acuity on the day of endophthalmitis diagnosis were evaluated using multivariable logistic regression. Main Outcome MeasureTreatment with VIT or TAP ResultsOf the 2425 patients who met the inclusion criteria, 14% (345) underwent VIT and 86% (2080) underwent TAP. 80% of patients (1946) presented with endophthalmitis within 14 days from cataract surgery (median = 6 days). Notably, 66% (173/263) of the patients presenting with LP vision underwent TAP instead of VIT. In a multivariable logistic regression model, receiving VIT instead of TAP was positively associated with poor vision at endophthalmitis presentation (LP – OR, 5.3 [CI: 2.9-10.5]; Counting Fingers, Hand Motion – OR 1.8 [CI: 1.0-3.6]) vs. [20/20-20/40] vision; Asian vs. White race (OR, 2.6 [CI: 1.2-5.1]); Hispanic vs. Non-Hispanic ethnicity (OR, 1.9 [CI, 1.0-3.2]); living in the West (OR, 1.5 [CI, 1.1-2.2]) and Midwest (OR- 1.4 [CI, 1.0-2.0]) (vs. South), but not with age, sex, and insurance coverage (P>0.05). ConclusionsIn the IRIS Registry, treatment patterns for post-cataract surgery endophthalmitis did not match evidence-based recommendations of the EVS, a randomized controlled clinical trial. More work is needed to evaluate whether the current treatment patterns are optimal for patients with post-cataract surgery endophthalmitis.

PRIMARY VITREORETINAL LYMPHOMA MASQUERADING AS POSTOPERATIVE ENDOPHTHALMITIS IN A PREGNANT PATIENT WITH LONG-STANDING IDIOPATHIC PANUVEITIS.

To report primary vitreoretinal lymphoma after surgical 0.59 mg fluocinolone acetonide implant (FAi) exchange in a patient treated with adalimumab for idiopathic bilateral panuveitis. Retrospective case review. A 37-year-old woman with bilateral idiopathic panuveitis, who had favorable responses to previous FAi surgical implants, presented with right eye recurrent intraocular inflammation and cystoid macular edema that partially responded to systemic adalimumab. Her FAi was replaced, given her previous favorable response. She developed postoperative ocular inflammation transiently responsive to two serial vitreous taps and injections of intravitreal antimicrobials and then worsening inflammation and new layered flocculant material. Diagnostic vitrectomy showed a few atypical lymphocytes and cultures were negative. At postdiagnostic vitrectomy Month 1, flocculant material recurred. Aqueous cytology and flow cytometry revealed large CD45-positive B cells suspicious for lymphoma. Postoperatively, she revealed that she was pregnant. She was treated with eight monthly intravitreal methotrexate injections and postpartum consolidation radiotherapy. Subsequent repeat cytology, flow cytometry, and corneal pathologic examination revealed large B cells that were CD20 positive, and next-generation sequencing detected a dominant monoclonal B-cell population, diagnostic of PVRL. Nineteen months after FAi exchange, she developed an area of enhancement in the lateral aspect of the right frontal lobe on brain MRI, consistent with central nervous system involvement. The authors present a unique case of PVRL masquerading as postoperative endophthalmitis after FAi exchange in an eye with chronic panuveitis treated with adalimumab immunosuppressive therapy. The authors hypothesize that there may be a causal relationship between adalimumab and PVRL.

Endogenous bacterial endophthalmitis in an HIV patient with uncontrolled diabetes: A case of rare ocular complication

Endogenous bacterial endophthalmitis (EE) is an intraocular infection with a poor prognosis. Timely diagnosis and prompt treatment are crucial to prevent vision loss. In this communication, we describe a case of EE caused by Streptococcus pyogenes (Group A Streptococcus [GAS]) in an HIV-positive patient with poorly controlled type 2 diabetes mellitus (DM). A 60-year-old man with a history of HIV and poorly controlled type 2 diabetes, presented with progressive blurry vision, left eye pain, redness, and headache. EE was diagnosed based on the clinical presentation and gram stain analysis of blood culture. Treatment with vitreous tap, intravitreal, topical antibiotics, and systemic antibiotics significantly improved the patient's symptoms. The case highlights the rarity of GAS as a causative agent of EE, particularly in patients with risk factors such as HIV infection and DM.

Intraocular Pressure Changes after Phacoemulsification with Posterior Vitreous Tap in Cataractous Eyes with Shallow Anterior Chamber

Intraocular Pressure Changes after Phacoemulsification with Posterior Vitreous Tap in Cataractous Eyes with Shallow Anterior Chamber

Severe Intraocular Inflammation Following Intravitreal Faricimab

Monitoring for and reporting potential cases of intraocular inflammation (IOI) in clinical practice despite limited occurrences in clinical trials, including experiences with relatively new intravitreal agents, such as brolucizumab, pegcetacoplan, or faricimab, helps balance potential benefits and risks of these agents. To provide descriptions of 3 initially culture-negative cases of acute, severe, posterior-segment IOI events occurring within the same month following intravitreal faricimab injections at a single institution. In this case series, 3 patients manifesting acute, severe IOI following intravitreal injection of faricimab were identified between September 20, 2023, and October 20, 2023. Faricimab, 6 mg (0.05 mL of 120 mg/mL solution), for neovascular age-related macular degeneration among patients previously treated with aflibercept; 1 patient also had prior exposure to bevacizumab. Visual acuity, vitreous taps for bacterial or fungal cultures, and retinal imaging. All 3 patients received intravitreal faricimab injections between September 20 and October 20, 2023, from 2 different lot numbers (expiration dates, July 2025) at 3 locations of 1 institution among 3 of 19 retina physicians. Visual acuities with correction were 20/63 OS for patient 1, 20/40 OD for patient 2, and 20/20 OS for patient 3 prior to injection. All 3 patients developed acute, severe inflammation involving the anterior and posterior segment within 3 to 4 days after injection, with visual acuities of hand motion OS, counting fingers OD, and hand motion OS, respectively. Two patients were continuing faricimab treatment while 1 patient was initiating faricimab treatment. All received intravitreal ceftazidime, 2.2 mg/0.1 mL, and vancomycin, 1 mg/0.1 mL, immediately following vitreous taps. All vitreous tap culture results were negative. One patient underwent vitrectomy 1 day following presentation. Intraoperative vitreous culture grew 1 colony of Staphylococcus epidermidis, judged a likely contaminant by infectious disease specialists. All symptoms resolved within 1 month; visual acuities with correction were 20/100 OS for patient 1, 20/50 OD for patient 2, and 20/30 OS for patient 3. In this case series, 3 patients with acute, severe IOI within 1 month at 3 different locations among 3 ophthalmologists of 1 institution following intravitreal faricimab could represent some unknown storage or handling problem. However, this cluster suggests such inflammatory events may be more common than anticipated from faricimab trial reports, emphasizing the continued need for vigilance to detect and report such cases following regulatory approval.

A RARE CASE OF STERILE ENDOPHTHALMITIS FOLLOWING INTRAVITREAL TRIAMCINOLONE ACETONIDE INJECTION IN VITRECTOMIZED EYE

Introduction : Intravitreal Triamcinolone Acetonide (IVTA) has been widely used to treat Diabetic Macular Edema (DME). Sterile endophthalmitis is one of the major related complications after IVTA which occurs between 0.20% and 6.73% of the injections. We present a case of sterile endophthalmitis following IVTA injection in a patient with a vitrectomized eye and DME.
 Case Illustration : A 53?year?old female patient with a history of vitrectomy due to high-risk characteristic proliferative diabetic retinopathy on her right eye underwent IVTA for DME. One day after the injection, the visual acuity (VA) improved from 6/45 to 6/12 without any complication. Three days later, she complained of ocular discomfort and sudden diminution of vision. The VA had dropped to hand movement, with conjunctival injection, hypopyon, anterior chamber reaction, and an inaccessible fundus. The patient was treated with topical antibiotics, corticosteroids, and cycloplegic, followed by intravitreal antibiotics injection. Furthermore, vitrectomy and vitreous tap were performed. On one- week follow-up, the VA was improved to 6/60 with normal IOP. The anterior chamber and the vitreous cavity remained clear.
 Discussion : The etiology of sterile endophthalmitis following IVTA injection remains unclear. Compared to infectious endophthalmitis, the patient is usually in less pain, and the eye is less injected. Although it generally has a benign course, some studies have shown serious complications such as vitreous hemorrhage and retinal detachment. Therefore, caution should be taken to prevent such complications from developing.
 Conclusion : In presumed sterile endophthalmitis, a careful diagnosis and intervention must be reconsidered to avoid potential long-term visual loss due to its related complications.

Successful antibiotic management of Staphylococcus epidermidis endophthalmitis after implantable collamer lens implantation

PurposeWe report a case of successful medical management of endophthalmitis post implantable collamer lens (ICL) culture-positive of Staphylococcus epidermidis.Observations: A 18-year-old female presented with decreased visual acuity in the left eye 20 days after ICL implantation. A diagnosis of postoperative endophthalmitis was made based on examination and ultrasonography. A vitreous tap was taken, and intravitreal antibiotics (vancomycin 1 mg/0.1ml and ceftazidime 2 mg/0.1ml) were administered twice (every 72 h), and peribulbar injection of triamcinolone acetonide after four days of the second intravitreal injection. The vitreous culture was confirmed for Staphylococcus epidermidis. The endophthalmitis was resolved, and visual acuity improved from 6/20 to 12/20 on day 7 and 22/20 on day 38. This is the first successful medical resolution of Staphylococcus epidermidis endophthalmitis post ICL surgery without ICL explantation and vitrectomy in the V4c model.Conclusions and importance: In antibiotic therapy, the excellent compliance and close follow-up of this endophthalmitis patient enabled careful postoperative surveillance on the effect of antibiotic therapy, avoiding the removal of the ICL or the loss of the integrity of the eye. The risk of potential infectious endophthalmitis post-ICL surgery should be fully emphasized during preoperative counseling.

Endogenous endophthalmitis in post-COVID-19 patients: a case report.

Two patients who were hospitalized and received treatment for COVID-19 pneumonia with remdesivir and systemic steroids presented with decreased vision. The first case had a severe anterior chamber reaction with a hypopyon and dense exudates in the vitreous. The second case had cells and flare in the anterior chamber and exudates in the vitreous. They were diagnosed with EE and underwent a diagnostic vitreous tap followed by pars plana vitrectomy and intravitreal antibiotic and steroid. The culture of vitreous fluid was negative for any bacteria and fungus in both cases. However, the first case demonstrated Escherichia coli in urine culture. The follow-up visual acuity was no perception of light and only perception of light in the first and second case, respectively. Severe COVID-19 patients who are hospitalized, receive systemic steroid and have associated comorbidities like diabetes mellitus are at high risk of EE. Delay in diagnosis and appropriate treatment in these patients leads to poor visual outcome.

Coagulase-negative staphylococcal endophthalmitis: clinical severity and outcomes based on speciation

ObjectifIdentifier les caractéristiques de l'endophtalmie causée par un staphylocoque à coagulase négative (SCN) et en décrire les résultats visuels près de 30 ans après l’étude sur la vitrectomie dans la prise en charge de l'endophtalmie (EVS, pour Endophthalmitis Vitrectomy Study). NatureAnalyse rétrospective dans un établissement unique. ParticipantsAu total, 42 échantillons provenant de 40 patients qui présentaient une endophtalmie à SCN documentée. MéthodesOn a mesuré, sur 42 échantillons provenant de 40 patients, l'acuité visuelle après une endophtalmie à SCN en fonction de l'agent pathogène responsable et du type de traitement choisi, soit la vitrectomie par la pars plana (VPP) ou la ponction de vitré suivie de l'injection intravitréenne d'antibiotiques. RésultatsStaphylococcus epidermidis était l'agent pathogène le plus souvent responsable d'une endophtalmie à SCN dans notre étude. La chirurgie de la cataracte et les injections intravitréennes étaient les sources les plus fréquentes d'endophtalmie à SCN aiguë. L'acuité visuelle finale moyenne des patients dont la vision permettait de voir un mouvement de la main ou mieux lors de l'examen initial était semblable après l'administration intravitréenne d'antibiotiques et après la VPP. Cependant, les patients dont la vision se limitait au mieux à la perception de la lumière lors de l'examen initial ont bénéficié de meilleurs résultats visuels après la VPP seulement. Une sous-analyse a révélé que les patients qui présentaient une endophtalmie à S. epidermidis (n = 39 yeux) ont eu les mêmes résultats visuels après les injections intravitréennes ou la VPP, sans égard à leur acuité visuelle initiale. On ne note pas systématiquement la présence d'un hypopyon et d'une hyalite. ConclusionsLes patients qui présentent une endophtalmie à S. epidermidis peuvent bénéficier de l'un ou l'autre traitement, soit la vitrectomie hâtive ou les injections intravitréennes d'antibiotiques, sans égard à leur acuité visuelle initiale. Cette observation peut venir s'ajouter aux normes thérapeutiques issues de l’étude EVS.

Outcomes of Rhegmatogenous Retinal Detachment Repair Following Infectious Endophthalmitis.

To determine the incidence of and identify risk factors for redetachment in eyes that underwent rhegmatogenous retinal detachment (RRD) repair after infectious endophthalmitis. Retrospective chart review of patients who had RRD surgery following a diagnosis of endophthalmitis from 2008-2021 at a tertiary referral center. Demographic and clinical characteristics as well as operative details were collected. Subjects with prior RRD, trauma, keratoprosthesis, or less than 3 months of postoperative follow-up were excluded. Univariate logistic regression analyses were performed. Thirty-four eyes of 34 patients were included. Most subjects were male with a mean age of 60.1 years. Exogenous (58.8%) was more common than endogenous (41.2%) sources of endophthalmitis. Seventeen of 34 eyes (50.0%) experienced redetachment. Significant risk factors were infection with virulent organisms, hypotony, and postoperative proliferative vitreoretinopathy. Initial management with vitreous tap and/or vitrectomy, exogenous versus endogenous source, and surgical procedure were not associated with recurrent RRD. At final follow-up, 32 of 34 eyes (91.2%) were attached, though over one-third of these had silicone oil. Redetachment occurred in half of eyes that underwent surgical repair of RRD after endophthalmitis. Early vitrectomy, with or without prior vitreous tap, was not associated with a higher risk of redetachment and improved the likelihood of a positive culture result. Culture data can aid in risk stratification, as organism virulence was a risk factor for recurrent RRD. While visual outcomes were generally poor, the majority of retinas remained attached at the last visit.

Endophthalmitis After Intravitreal Bevacizumab (Avastin) Injections: An Outbreak Investigated.

Purpose To investigate an endophthalmitis outbreak in different eye hospitals after intravitreal (IVT) bevacizumab (Avastin) injections over two days. Place and duration of the study Mughal Eye Hospital, Nov 2022 to Jan 2023. Materials and methods All cases reported with endophthalmitis in Mughal Eye Hospital after administration of anti-vascular endothelial growth factor IVT injections in different hospitals on November 8-9, 2022, were studied. In all endophthalmitis cases, one to five IVT injections of antibiotics (vancomycin, ceftazidime, and dexamethasone) were given depending on the clinical picture. Results Thirty-six eyes of 34 patients who developed endophthalmitis were included in the study. Age (mean 53 years) ranged from 44 years to 70 years. There were 18 males and 16 females. Two patients had bilateral endophthalmitis. Thirty-three patients were given two to four IVT injections of antibiotics depending on the clinical response. Five cases of vitreous tap done before injecting antibiotics were found to have Pseudomonas. Anterior chamber wash was done in 15 cases to improve visualization for doing pars plana vitrectomy (PPV). In 24 patients PPV with silicon oil was done. Eighteen patients showed improvement as their hypopyon disappeared after IVT antibiotic injections. One patient developed corneal sloughing (she refused IVT antibiotic injections). One patient developed malignant/pupil block glaucoma. In two eyes, early PPV was done. Four eyes developed no perception of light. In our series, endophthalmitis patients started reporting one day after the injection. One patient who developed bilateral endophthalmitisdeveloped bilateral cataracts with subluxations. One patient developed retinal detachment. One eye developed choroidal detachment. Conclusion IVT bevacizumab (Avastin) may be associated with an outbreak of endophthalmitis. Pseudomonas endophthalmitis is a very grave condition associated with severe morbidity.

LATE-ONSET, BLEB-ASSOCIATED ENDOPHTHALMITIS CAUSED BY STAPHYLOCOCCUS AUREUS

Introduction: Bleb-associated endophthalmitis (BAE) is a potentially sight-threatening complications of trabeculectomy and is associated with poor visual outcome. BAE denotes an ocular infection with involvement of the vitreous, which usually develops months or years after glaucoma filtering surgery. The purpose of this case report was to present a case about late onset BAE caused by Staphylococcus aureus. Methods: A 55-year-old male presented with a 3-days history of left eye pain, redness, hypopion decreased visual acuity and hypotony with Seidel test positive. He had a history of primary open angle glaucoma that was treated with a combined procedure of cataract surgery and trabeculectomy in the left eye ten years earlier. His visual acuity had decreased from 6/20 to light perception. This patient showed signs of hypotony, endophthalmitis, leak, and pain but no previous history of using anti-fibrotic agents. BAE causative organisms cultures grew the S.aureus, that frequent cause of acute-onset endophthalmitis. The patient underwent treatment with pars plana vitrectomy, vitreous taps, administered intravitreal antibiotic, and prescribed hourly topical antibiotic. Six months after his last treatment, his left eye shows no residual infection, and visual acuity increase to 1/60. Results: One case of late onset BAE with visual improvement after early vitrectomy, intravitreal, oral and topical antibiotic treatment. Conclusion: Despite the poor prognosis of BAE caused by S.aureus infection, after proper treatment can yield an adequate result, as demonstrated in this case.

A Rare Case of Abiotrophia defectiva Bleb Associated Endophthalmitis.

To report a rare case of Abiotrophia defectiva bleb associated endophthalmitis (BAE). In this case report of a patient with BAE, the authors describe the features of severe and rapid onset, associated retinitis, and a favorable outcome after aggressive early intervention. A 75-year old female presented that decreased visual acuity of hand motions with elevated intraocular pressure of 39 mm Hg in the left eye. Her past ocular history was notable for severe primary open angle glaucoma with uneventful trabeculectomy and cataract surgery in both eyes 7 years prior. Examination revealed conjunctival injection and an opaque avascular cystic bleb along with anterior chamber cellular reaction with a B-scan ultrasound concerning for vitritis. Abiotrophia defectiva was isolated from the vitreous tap within 48 hours and confirmed later with 16S ribosomal RNA sequencing. After initial vitreous tap and inject and subsequent PPV, her BCVA had improved to 20/500 at post operative week 1 and then improved to 20/40 at post-operative month 2. Her exam was notable for resolved corneal edema, a deep and quiet anterior chamber, and resolved intraretinal hemorrhages. This is one of the first BAE cases with rapid identification of Abiotrophia defectiva. Abiotrophia defectiva was isolated from the initial vitreous tap within 48 hours and confirmed with 16S ribosomal RNA sequencing. This case highlights that rapid identification of Abiotrophia defectiva may be indicative of a greater bacterial load and should prompt aggressive intervention and that the visual prognosis can be favorable.

Endogenous Fungal Endophthalmitis following COVID-19 Hospitalization: Evidence from a Year-Long Observational Study

To describe cases of endogenous fungal endophthalmitis (EFE) post-recovery from or hospitalization for coronavirus disease 2019 (COVID-19). This prospective audit involved patients with suspected endophthalmitis referred to a tertiary eye care center over a one-year period. Comprehensive ocular examinations, laboratory studies, and imaging were performed. Confirmed cases of EFE with a recent history of COVID-19 hospitalization±intensive care unit admission were identified, documented, managed, followed up, and described. Seven eyes of six patients were reported; 5/6 were male, and the mean age was 55. The mean duration of hospitalization for COVID-19 was approximately 28days (14-45); the mean time from discharge to onset of visual symptoms was 22days (0-35). All patients had underlying conditions (5/6 hypertension; 3/6 diabetes mellitus; 2/6 asthma) and had received dexamethasone and remdesivir during their COVID-related hospitalization. All presented with decreased vision, and 4/6 complained of floaters. Baseline visual acuity ranged from light perception (LP) to counting fingers (CF). The fundus was not visible in 3 out of 7 eyes; the other 4 had "creamy-white fluffy lesions" at the posterior pole as well as significant vitritis. Vitreous taps were positive for Candida species in six and Aspergillus species in one eye. Anti-fungal treatment included intravenous amphotericin B followed by oral voriconazole and intravitreal amphotericin B. Three eyes underwent vitrectomy; the systemic health of two patients precluded surgery. One patient (with aspergillosis) died; the others were followed for 7-10months - the final visual outcome improved from CF to 20/200-20/50 in 4 eyes and worsened (hand motion to LP) or did not change (LP), in two others. Ophthalmologists should maintain a high index of clinical suspicion for EFE in cases with visual symptoms and a history of recent COVID-19 hospitalization and/or systemic corticosteroid use - even without other well-known risk factors.

Conjunctival Epithelial Down growth Following Trabeculectomy Simulating Chronic Postoperative Endophthalmitis

Epithelial down growth is a rare and sight-threatening eye condition which can occur after penetrating trauma or any intraocular surgery. Epithelial cells invade the intraocular structures through an incompetent wound and proliferate wildly causing inflammation and multiple damages .We report a case of a 6-year-old patient who presented to the emergency room for a decreased visual acuity, pain over a week in his right eye. Trabeculectomy surgery for congenital glaucoma was performed three years prior and revised with mitomycin C 6 months ago. Slit lamp examination of the affected eye showed conjunctival hyperemia, anterior chamber inflammation, a drawn upwars pupil, in this upper parts we can clearly see a membrane originating from the superior trabeculectomy site with neovascularization on the membrane, a yellow reflect light in pupil area interfering with the fundus examination and highly suggestive of chronic endophthalmitis. Vitreous tap was performed which allowed us to eliminate an infectious origin and revealed the presence of squamous epithelial cells that are not found inside the eye. The diagnose of epithelial down growth resulting to inflammation and vitreous hemorrhage following trabeculectomy was made. Local and general corticotherapy was started. Epithelial down growth treatment is variable, studies showed that patients treated surgically underwent fewer enucleations than those treated medically or not treated.

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.

Early vitrectomy for exogenous endophthalmitis following surgery.

Endophthalmitis is a sight-threatening emergency that requires prompt diagnosis and treatment. The condition is characterised by purulent inflammation of the intraocular fluids caused by an infective agent. In exogenous endophthalmitis, the infective agent is foreign and typically introduced into the eye through intraocular surgery or open globe trauma. To assess the potential role of combined pars plana vitrectomy and intravitreal antibiotics in the acute management of exogenous endophthalmitis, versus the standard of care, defined as vitreous tap and intravitreal antibiotics. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 5); Ovid MEDLINE; Ovid Embase; the International Standard Randomised Controlled Trial Number registry; ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. There were no restrictions to language or year of publication. The date of the search was 5 May 2022. We included randomised controlled trials (RCTs) that compared pars plana vitrectomy and intravitreal injection of antibiotics versus intravitreal injection of antibiotics alone, for the immediate management of exogenous endophthalmitis. We used standard methods expected by Cochrane. Two review authors independently screened search results and extracted data. We considered the following outcomes: visual acuity improvement and change in visual acuity at three and six months; additional surgical procedures, including vitrectomy and cataract surgery, at any time during follow-up; quality of life and adverse effects. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We identified a single RCT that met our inclusion criteria. The included RCT enrolled a total of 420 participants with clinical evidence of endophthalmitis, within six weeks of cataract surgery or secondary intraocular lens implantation. Participants were randomly assigned according to a 2 x 2 factorial design to either treatment with vitrectomy (VIT) or vitreous tap biopsy (TAP) and to treatment with or without systemic antibiotics. Twenty-four participants did not have a final follow-up: 12 died, five withdrew consent to be followed up, and seven were not willing to return for the visit. The study did not report visual acuity according to the review's predefined outcomes. At three months, 41% of all participants achieved 20/40 or better visual acuity and 69% had 20/100 or better acuity. The study authors reported that there was no statistically significant difference in visual acuity between treatment groups (very low-certainty evidence). There was low-certainty evidence of a similar requirement for additional surgical procedures (risk ratio RR 0.90, 95% confidence interval 0.66 to 1.21). Adverse effects included: VIT group: dislocated intraocular lens (n = 2), macular infarction (n = 1). TAP group: expulsive haemorrhage (n = 1). Quality of life and mean change in visual acuity were not reported. AUTHORS' CONCLUSIONS: We identified a single RCT (published 27 years ago) for the role of early vitrectomy in exogenous endophthalmitis, which suggests that there may be no difference between groups (VIT vs TAP) for visual acuity at three or nine months' follow-up. We are of the opinion that there is a clear need for more randomised studies comparing the role of primary vitrectomy in exogenous endophthalmitis. Moreover, since the original RCT study, there have been incremental changes in the surgical techniques with which vitrectomy is performed. Such advances are likely to influence the outcome of early vitrectomy in exogenous endophthalmitis.

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.

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.