BACKGROUND Endophthalmitis occurring in silicone oil-filled eyes is a very rare occurrence,with reported incidence rates ranging between 0.07%and 0.039%.Traditional methods of management of infectious endophthalmitis ...BACKGROUND Endophthalmitis occurring in silicone oil-filled eyes is a very rare occurrence,with reported incidence rates ranging between 0.07%and 0.039%.Traditional methods of management of infectious endophthalmitis include the removal of silicone oil,washout of the vitreous cavity,administration of intravitreal antibiotics,and reinjection of silicone oil.CASE SUMMARY Herein,we report the case of a 39-year-old man with unilateral endophthalmitis after pars plana vitrectomy and silicone oil tamponade.Intravitreal injections of full-dose antibiotics and anterior chamber washout were used to treat the patient.No signs of retinal toxicity were observed during the follow-up period.CONCLUSION Intravitreal full-dose antibiotic injections and anterior chamber washout are promising alternatives to traditional therapies for endophthalmitis in silicone oilfilled eyes.展开更多
Dear Editor,We present a case of acute Bacillus cereus(B.cereus)endophthalmitis in a patient with an intraocular perforation injury combined with occult intravitreal cilium implantation.B.cereus endophthalmitis is a s...Dear Editor,We present a case of acute Bacillus cereus(B.cereus)endophthalmitis in a patient with an intraocular perforation injury combined with occult intravitreal cilium implantation.B.cereus endophthalmitis is a severe intraocular infection commonly caused by post-traumatic injuries.It often leads to significant vision loss or even eye loss within 12-48h[1].The presence of an intraocular foreign body(IOFB)increases the risk of infection,while early surgical removal of IOFBs can prevent endophthalmitis,some IOFBs are difficult to detect preoperatively.The Medical Ethics Review Board of West China Hospital of Sichuan University waived application for a clinical study because this was a retrospective report of a single patient based on imaging and because no human experimentation was involved.The patient provided written informed consent to use the imaging data for publication.展开更多
BACKGROUND Micrococcus luteus(M.luteus)-induced endophthalmitis is very rare and and may present as either acute or chronic postoperative endophthalmitis.The aim of this study was to report a case of delayed-onset M.l...BACKGROUND Micrococcus luteus(M.luteus)-induced endophthalmitis is very rare and and may present as either acute or chronic postoperative endophthalmitis.The aim of this study was to report a case of delayed-onset M.luteus-induced endophthalmitis that occurred several months after cataract surgery.CASE SUMMARY A 78-year-old man presented with decreased vision,pain and redness in the right eye that had begun 3 days prior.He had undergone cataract surgery 4 mo prior.Visual acuity was counting fingers;slit-lamp examination revealed conjunctival injection,posterior corneal precipitates,anterior chamber inflammation(cell 4+),and hypopyon.Fundus examination revealed moderate vitreous haze.Urgent vitrectomy was performed for suspected infectious endophthalmitis,followed by vitreous irrigation with injections of antibiotics.On the postoperative day 1,anterior chamber cell decreased to 2+and hypopyon was not observed on slit lamp examination.Six days postoperatively,the patient had recurrent eye pain,and the anterior chamber cell grade increased to 4+;hypopyon recurred in the anterior chamber,and whitish plaque was observed in the lens capsule.Therefore,the patient underwent intraocular lens(IOL)and lens capsule removal,followed by vitreous irrigation,antibiotics injection,and vitrectomy.M.luteus was identified from a lens capsule culture.CONCLUSION In cases of delayed-onset M.luteus-induced endophthalmitis,early vitrectomy and removal of the IOL and lens capsule may be necessary.展开更多
AIM:To analyze the risk factors,ophthalmological features,treatment modalities and their effect on the visual outcome in patients with endogenous fungal endophthalmitis(EFE).METHODS:Data retrieved from the medical fil...AIM:To analyze the risk factors,ophthalmological features,treatment modalities and their effect on the visual outcome in patients with endogenous fungal endophthalmitis(EFE).METHODS:Data retrieved from the medical files included age at presentation to the uveitis clinic,gender,ocular symptoms and their duration before presentation,history of fever,eye affected,anatomical diagnosis and laboratory evidence of fungal infection.Medical therapy recorded included systemic antifungal therapy and its duration,use of intravitreal antifungal agents and use of oral/intravitreal steroids.Surgical procedures and the data of ophthalmologic examination at presentation and at last follow-up were also collected.RESULTS:Included were 13 patients(20 eyes,mean age 58 y).Ten patients presented after gastrointestinal or urological interventions and two presented after organ transplantation.In one patient,there was no history of previous intervention.Diagnostic vitrectomy was performed in 16 eyes(80%)and vitreous cultures were positive in 10 of the vitrectomized eyes(62.5%).In only 4 patients(31%),blood cultures were positive.All patients received systemic antifungal therapy.Sixteen eyes(80%)received intravitreal antifungal agent with voriconazole being the most commonly used.Visual acuity(VA)improved from 0.9±0.9 at initial exam to 0.5±0.8 logMAR at last followup(P=0.03).A trend of greater visual improvement was noted in favor of eyes treated with oral steroids(±intravitreal dexamethasone)than eyes that were not treated with steroids.The most common complication was maculopathy.Twelve eyes(60%)showed no ocular complications.CONCLUSION:High index of suspicion in patients with inciting risk factors is essential because of the low yield of blood cultures and the good general condition of patients at presentation.Visual prognosis is improved with the prompt institution of systemic and intravitreal pharmacotherapy and the immediate surgical intervention.Oral±local steroids could be considered in cases of prolonged or marked inflammatory responses in order to hasten control of inflammation and limit ocular complications.展开更多
BACKGROUND Achromobacter species-associated endophthalmitis is rare and may present as either acute or chronic postoperative endophthalmitis.Delayed-onset Achromobacter species endophthalmitis appearing in acute prese...BACKGROUND Achromobacter species-associated endophthalmitis is rare and may present as either acute or chronic postoperative endophthalmitis.Delayed-onset Achromobacter species endophthalmitis appearing in acute presentation that develops more than several months after cataract surgery is very rare.Intraocular lens(IOL)removal is commonly recommended to treat Achromobacter species endophthalmitis,which is based on previous studies.Here,we report the results of surgery without IOL removal when treating patients with delayed-onset postoperative Achromobacter species endophthalmitis that developed in an acute form.CASE SUMMARY Three patients visited our ophthalmology clinic due to visual impairment that began 2-3 d earlier.They had undergone cataract surgery 5-18 mo prior.Bestcorrected visual acuity of the diseased eye was between counting fingers at 30 cm to non-light perception.They showed conjunctival injection,inflammation in the anterior chamber(cell reaction 4+)and hypopyon formation.The patients were diagnosed with infectious endophthalmitis and immediately underwent pars plana vitrectomy,anterior chamber irrigation and intravitreal injection of ceftazidime and vancomycin.Before fluid infusion,a vitreous specimen was obtained. In all cases, the IOLs were not removed. Achromobacter species was detected on vitreousspecimen culture. After surgery, the vitreous opacity decreased gradually and there was littleretinal damage. At 1 mo after treatment, the best-corrected visual acuity had improved to 20/50and 20/40.CONCLUSIONDelayed onset postoperative endophthalmitis caused by Achromobacter species can appear in anacute form. All patients responded well to early vitrectomy and administration of empiricalantibiotics including ceftazidime. There was no need for IOL removal during surgery.展开更多
AIM: To identify risk factors associated with post-cataract surgery endophthalmitis(PCE) in type 2 diabetic patients.METHODS: A hospital-based retrospective case-control study was conducted on 194 type 2 diabetic pati...AIM: To identify risk factors associated with post-cataract surgery endophthalmitis(PCE) in type 2 diabetic patients.METHODS: A hospital-based retrospective case-control study was conducted on 194 type 2 diabetic patients undergoing cataract surgery in Rajavithi Hospital from January 2007 to December 2015. Fifteen patients with PCE were included as the case group and 179 patients without PCE were included as the control group. Potential factors associated with PCE among both groups including demographics, pre-operative characteristics, surgical settings and complications, were statistically analyzed using Chi-square testing and a logistic regression model.RESULTS: Within the case group, 53% were females and the median age was 68 y. Univariate analysis of pre-operative characteristics, surgical settings and complications revealed that recent pre-operative fasting plasma glucose, insulin therapy, presence of diabetic retinopathy, and severe non-proliferative or proliferative diabetic retinopathy were significantly associated with PCE. In a multivariate analysis adjusting for blood glucose level, insulin treatment was the only significant factor associated with an increased risk of PCE(OR 3.9, 95%CI 1.0-15.0, P=0.04) compared to patients without insulin treatment. The most common causative organisms were gram-positive bacteria(89%). Staphylococcus species represented the most common group(67%). Median best corrected visual acuity at 1-month and 3-month follow-up was equal at 0.7 logMAR(20/100).CONCLUSION: The authors identify insulin treatment as the only risk factor associated with endophthalmitis after cataract surgery in type 2 diabetic patients. Further studies with serum levels of pre-operative glycated hemoglobin(HbA_(1c)) and post-operative fasting plasma glucose level are essential to truly demonstrate the role of peri-operative glycemic markers as a risk factor for PCE.展开更多
AIM:To identify the clinical features and treatment outcomes of endogenous Klebsiella pneumoniae endophthalmitis and investigate prognostic factors of poor visual outcome.METHODS:The clinical records of all patients d...AIM:To identify the clinical features and treatment outcomes of endogenous Klebsiella pneumoniae endophthalmitis and investigate prognostic factors of poor visual outcome.METHODS:The clinical records of all patients diagnosed with endogenous Klebsiella endophthalmitis between January 2007 to December 2018 in Prince of Wales Hospital,Hong Kong,China were retrospectively reviewed.Thorough ophthalmological examination findings were recorded in the case note,including visual acuity testing,slit-lamp examination,indirect ophthalmoscopy and B-scan ultrasonography if media opacity precluded fundus viewing.RESULTS:A total of 18 eyes in 14 patients were identified.Bilateral involvement was noted in 4 patients(28.6%).Hepatobiliary sepsis was the source in 9 patients(64.3%).Culture of intraocular fluid was positive in 5 out of 18 eyes(27.8%).Mortality was noted in 2 patients(14.3%).Mean final visual acuity was 20/1500.Six out of 16 eyes had total loss of sight(37.5%)and 3 eyes required evisceration(18.8%).Multivariate linear regression revealed poor presenting visual acuity(P=0.031)and lack of fundus view due to vitritis(P=0.02)as prognostic factors of poor visual outcome.CONCLUSION:Visual outcome of endogenous Klebsiella endophthalmitis is poor.Poor presenting visual acuity and lack of fundus view predict poor visual outcome.High index of suspicion for endophthalmitis is important in Klebsiella sepsis patients with complaints of ocular symptoms.Ophthalmological screening is recommended in noncommunicable patients with Klebsiella sepsis.展开更多
AIM: To report the fungal organisms, clinical features,surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis(EFE) secondary to keratitis, and evaluate the role of...AIM: To report the fungal organisms, clinical features,surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis(EFE) secondary to keratitis, and evaluate the role of surgery in the treatment.METHODS: The clinical records of 27 patients(27 eyes)with culture-proven EFE resulting from fungal keratitis treated at Shandong Eye Institute from January 2007 to January 2015 were retrospectively reviewed. Information about fungal culture results, clinical features, surgical procedures, and final visual acuity was obtained.RESULTS: There were 39 positive culture results from samples of cornea, hypopyon, vitreous and lens capsule,accounting for 56%, 26%, 15% and 2.5%, respectively.Fusarium was identified in 44%(12/27) of the eyes,followed by Aspergillus in 22%(6/27). Posterior segment infection was involved in 78%(21/27) of the patients. The corneal infection was larger than 3 mm×3 mm in 89%(24/27) of the patients, and 22%(6/27) of them had the entire cornea, and even the sclera involved. Three eyes had silicone oil tamponade, and two eyes had retinal detachment. Twenty-two eyes(81.5%) underwent penetrating keratoplasty(PKP), and over half of them(54.5%)were operated within 3d from the onset of antifungal therapy. Fourteen eyes(52%) underwent intracameral antifungal drug injection, and three of them required repeated injections. Fifteen eyes(55.6%) underwent pars plana vitrectomy(PPV). The rate of the eyes undergoing PPV as the initial surgical procedure was 60%(9/15),lower than 77% in PKP. Intravitreal injection was given in 59% of the eyes(16/27), and 75% of them required repeated injections. The final visual acuity was 20/100 or better in 37% of the eyes, and better than counting fingers in 55.6% of the eyes. Five eyes(18.5%) were eviscerated. In the two eyes with concurrent retinal detachment, one achieved retinal reattachment, and the other was eviscerated. In the three eyes with silicone oil tamponade, two eyes received silicone oil removal, and the other one was eviscerated. CONCLUSION: Fusarium and Aspergillus are the dominant pathogens in EFE resulting from keratitis.Aggressive antifungal surgeries including multiple intravitreal injections, PKP and core vitrectomy(especially in the initial surgery) are helpful procedures to improve prognosis of severe EFE secondary to keratitis.展开更多
AIM:To report the incidence,risk factors and visual outcomes for postoperative endophthalmitis(POE)based on 7-year data from the Malaysian Ministry of Health Cataract Surgery Registry(MOH CSR).METHODS:Data was collect...AIM:To report the incidence,risk factors and visual outcomes for postoperative endophthalmitis(POE)based on 7-year data from the Malaysian Ministry of Health Cataract Surgery Registry(MOH CSR).METHODS:Data was collected from the web-based MOH CSR.All consecutive cataract surgery patients from 1st June 2008 to 31st December 2014 were identified.Exclusion criteria were traumatic cataract or previous ocular surgery.Demographic data,ocular co-morbidities,intraoperative details and postoperative visual acuity(VA)at final ophthalmological follow-up were noted.All eyes were taken for analysis.Subjects with POE were compared against subjects with no POE for risk factor assessment using multiple logistic regressions.RESULTS:A total of 163 503 subjects were screened.The incidence of POE was 0.08%(131/163 503).Demographic POE risk factors included male gender(OR:2.121,95%CI:1.464-3.015)and renal disease(OR:2.867,95%CI:1.503-5.467).POE risk increased with secondary causes of cataract(OR:3.562,95%CI:1.740-7.288),uveitis(OR:11.663,95%CI:4.292-31.693)and diabetic retinopathy(OR:1.720,95%CI:1.078-2.744).Intraoperative factors reducing POE were shorter surgical time(OR:2.114,95%CI:1.473-3.032),topical or intracameral anaesthesia(OR:1.823,95%CI:1.278-2.602),posterior chamber intraocular lens(PCIOL;OR:4.992,95%CI:2.689-9.266)and foldable IOL(OR:2.276,95%CI:1.498-3.457).POE risk increased with posterior capsule rupture(OR:3.773,95%CI:1.915-7.432)and vitreous loss(OR:3.907,95%CI:1.720-8.873).Postoperative VA of 6/12 or better was achieved in 15.27%(20/131)subjects with POE.CONCLUSION:This study concurs with other studies regarding POE risk factors.Further strengthening of MOH CSR data collection process will enable deeper analysis and optimization of POE treatment.展开更多
AIM:To demonstrate prognostic factors for poor visual outcome in patients with post-traumatic endophthalmitis(PTE)following open globe injury.METHODS:A retrospective study was conducted on 66 patients(66 eyes)with PTE...AIM:To demonstrate prognostic factors for poor visual outcome in patients with post-traumatic endophthalmitis(PTE)following open globe injury.METHODS:A retrospective study was conducted on 66 patients(66 eyes)with PTE following open globe injury from 2005 to 2015.Potential factors accounting for good and poor visual outcome were statistically analyzed by Chisquare test and Logistic regression model.RESULTS:In 66 cases,39 cases(59%)had a poor visual outcome.Univariate and multivariate Logistic regression analysis identified retained intraocular foreign body(IOFB)as the only factor significantly associated with poor visual outcome[adjusted odds ratio,4.62;95%confidence interval(1.04-20.53);P=0.04].The most common causative agents were gram-positive organisms(83%),of which Bacillus cereus(33%),was the most common pathogen.All cases received intravitreal antibiotic injections.Oral ciprofloxacin was the most used systemic antibiotic(33%).Pars plana vitrectomy was performed in 83%(55/66)of cases.At 6 mo follow-up,mean BCVA was 1.74±0.72 log MAR units.CONCLUSION:In patients with PTE following open globe injury,the only predictor of poor visual outcome is the presence of IOFB.Bacillus cereus is the most isolated microorganism.展开更多
AIM: To determine the risk factors for acute endophthalmitis after cataract extraction in a tertiary care centre in India.·METHODS: We performed a nested case control study within a retrospective cohort. The surg...AIM: To determine the risk factors for acute endophthalmitis after cataract extraction in a tertiary care centre in India.·METHODS: We performed a nested case control study within a retrospective cohort. The surgical records of all patients with clinically diagnosed endophthalmitis within one month after cataract surgery, performed between January 2006 and December 2009, were reviewed. These were compared with randomly selected age and gender-matched controls, from patients having routine cataract surgery within ±1wk of the endophthalmitis case.Univariable and multivariable analysis were performed to identify risk factors for endophthalmitis.· RESULTS: Of the total 33 856 cataract surgeries performed during this period, there were 57 cases of postoperative acute endophthalmitis that met our study criteria. Thus, the overall incidence of endophthalmitis in our cohort was 1.6 per 1000 cataract extractions performed. Mean age of cases was 55.9y(SD: 10.9y) and for controls was 55.6y(SD: 9.8y). Thirty-five cases(61.4%)and 133 controls(59.6%) were males. Median time of onset of endophthalmitis was 4d(IQR 2-9d; range: 1-30d).Thirty-nine cases(68.4%) presented within 7d and 27 cases(47.4%) were culture positive. Two hundred and twenty-three age and gender matched controls were selected. In multivariate analysis, endophthalmitis was associated with posterior capsular rupture(PCR) during surgery(OR 6.98, 95%CI: 2.22-21.98), phacoemulsification via scleral incision with a foldable intraocular lens(IOL)implantation(OR 3.02, 95%CI: 1.13-8.04) and ocular comorbidity(OR 2.32, 95%CI: 1.11-4.87).·CONCLUSION: PCR, presence of ocular co-morbidity,and phacoemulsification via scleral incision with foldable-IOL were found to be independent risk factors for acute endophthalmitis.展开更多
AIM: To study the clinical features, microbial spectrum, associated factors and prognosis of endogenous endophthalmitis(EE) in a group of Chinese patients.METHODS: The medical records from 32 eyes of 29 patients diagn...AIM: To study the clinical features, microbial spectrum, associated factors and prognosis of endogenous endophthalmitis(EE) in a group of Chinese patients.METHODS: The medical records from 32 eyes of 29 patients diagnosed with EE in Peking Union Medical College Hospital from January 2009 to October 2019 were reviewed. RESULTS: The initial visual acuity(VA) of 30 eyes in this study was worse than 20/400. Twenty-three eyes were diagnosed with fungal endophthalmitis and nine with bacterial endophthalmitis. The most common fungal and bacterial isolates were Candida and Klebsiella pneumoniae, respectively. Several rare fungi and bacteria species were also isolated from our patients, including Cryptococcus, Paecilomyces, Brucella, and Bacillus licheniformis. The leading risk factor for EE was diabetes. The most common extraocular infection locus was genitourinary tract. Vitrectomy was performed on twenty-nine eyes. Eight eyes achieved final VA of 20/400 or better. EE caused by Candida had a better prognosis.CONCLUSION: The visual outcome of EE is based on pathogens and prompt intervention. Early vitrectomy and antimicrobial treatment are beneficial for EE.展开更多
At present, the incidence of infectious endophthalmitis after cataract surgery has been significantly reduced, but it is still a serious complication. Removal or not of the intraocular lens(IOL) during vitrectomy in c...At present, the incidence of infectious endophthalmitis after cataract surgery has been significantly reduced, but it is still a serious complication. Removal or not of the intraocular lens(IOL) during vitrectomy in cases with a moderate or severe inflammation is controversial. In order to call upon more discussion, we publish the article entitled “Timely vitrectomy without intraocular lens removal for acute endophthalmitis after cataract surgery” written by Guo et al in this issue. With recent advanced vitrectomy techniques, and critical measures for management of risk factors related to occurrence of infection, IOL remaining during timely vitrectomy for acute endophthalmitis can possibly be safe and effective in selected cases.展开更多
AIM:To analyze the lab diagnosis and etiology of infectious endophthalmitis.· METHODS:The medical and microbial records of 36 patients diagnosed with infectious endophthalmitis and 8 patients diagnosed with intra...AIM:To analyze the lab diagnosis and etiology of infectious endophthalmitis.· METHODS:The medical and microbial records of 36 patients diagnosed with infectious endophthalmitis and 8 patients diagnosed with intraocular lens(IOL)-related inflammation between Nov.1999 and Dec.2009 were retrospectively reviewed for lab diagnosis and etiology.RESULTS:The inflammatory cell counts in all aqueous humor specimens from infectious endophthalmitis patients were more than in all aqueous humor specimens from patients with IOL-related inflammation.Sixteen of the 36 aqueous humor samples(44.4%) and 11 of the 24 vitreous humor samples(45.8%) from infectious endophthalmitis patients showed positive results in smears;while 17 aqueous humor samples(47.2%) and 15 vitreous humor samples(62.5%) from infectious endophthalmitis patients showed positive results in culture.CONCLUSION:The inflammatory cell count may be an important index for infectious endophthalmitis;while,smears can show etiological information earlier.展开更多
AIM:To explore the traumatic endophthalmitis in young children and the outcome of pars plana vitrectomy(PPV).METHODS:Twenty-two eyes of 22 cases of young children consecutive pediatric traumatic endophthalmitis treate...AIM:To explore the traumatic endophthalmitis in young children and the outcome of pars plana vitrectomy(PPV).METHODS:Twenty-two eyes of 22 cases of young children consecutive pediatric traumatic endophthalmitis treated and followed up between September 2014 and May 2018 were included.Aqueous humor or vitreous samples were taken for bacterial culture and sensitivity tests.Intravitreal antibiotics(norvancomycin and ceftazidime)injection,combined with 23-gauge PPV,were administered in 22 eyes.Silicone oil(SO;5000 centistoke)tamponade or perfluoropropane gas(C3F8)was used in all patients.Main outcome measures were best-corrected visual acuity(BCVA)and retinal attachment,the ratio of penetrating injury,and the existence of intraocular foreign body.RESULTS:The mean age of patients was 6.9±2.2(range,3-10)y.All injured eyes suffered from penetrating ocular injury with retained intraocular foreign body in one eye.Bacterial culture was positive in only 2 eyes.The mean follow-up time was 21.1±4.7(range,12-30)mo.In the primary PPV,intravitreal antibiotics was administrated in all eyes,SO in 18 eyes,and C3F8 in 4 eyes.The secondary operation of SO removal and C3F8 endotamponade was performed in 16 eyes and a second SO endotamponade due to emulsification of the oil and retinal detachment(RD)was operated in 7 eyes underwent 3 to 11.5 mo after primary PPV.A third operation was done in 7 eyes.The final intraocular pressure(IOP)was 8.9±1.8(range,6.9-11.4)mm Hg.The final BCVAs were 20/200 or better in 5,counting fingers in 2,and light perception to hand movement in 8 eyes.Whose(66.7%)had retinal injury exhibited worse BCVA(P=0.019,Fisher’s exact test).Eyes underwent SO tamponade exhibited worse final BCVA than that with C3F8 in the primary PPV(P=0.026,Fisher’s exact test).CONCLUSION:Traumatic endophthalmitis in children is generally more severe and associated with more complicated surgical procedures.Most patients have retinal injury need multiple operations and the final BCVA is poor.Prevention of ocular trauma,especially in children,is still critical.展开更多
AIM To study the clinical profile and outcomes of pediatric endogenous endophthalmitis from a tertiary eye hospital in South India.METHODS A total of 13 eyes of 11 children presented to us with varied symptoms and pre...AIM To study the clinical profile and outcomes of pediatric endogenous endophthalmitis from a tertiary eye hospital in South India.METHODS A total of 13 eyes of 11 children presented to us with varied symptoms and presentations of endogenous endophthalmitis, over a five-year period from January 2010 to December 2015 were studied. Except for two eyes of a patient, vitreous aspirates were cultured from all 11 eyes to isolate the causative organism. These eleven eyes also received intravitreal injections. All patients were treated with systemic antibiotics. RESULTS Two cases had bilateral endophthalmitis. Ages ranged from 4 d to 11 years. Five cases were undiagnosed and treated, before being referred to our center. Ten of the 13 eyes underwent a core vitrectomy. The vitrectomy was done at an average on the second day after presenting(range 0-20 d). Five of the 11 vitreous aspirates showed isolates. The incriminating organisms were bacteria in three and fungus in two. An underlying predisposing factor was found in seven patients. At a mean follow-up 21.5 mo, outcome was good in 7 eyes of 6 cases(54%), five eyes of four cases(38%) ended up with phthisis bulbi while one child died of systemic complications. CONCLUSION Endogenous endophthalmitis is a challenge for ophtha-lmologists. Early diagnosis and intervention is the key for a better outcome.展开更多
AIM:To evaluate the overall endophthalmitis incidence and the effectiveness of potential prophylaxis measures following phacoemulsification cataract surgery(PCS).METHODS:The Pub Med and Web of Science databases were s...AIM:To evaluate the overall endophthalmitis incidence and the effectiveness of potential prophylaxis measures following phacoemulsification cataract surgery(PCS).METHODS:The Pub Med and Web of Science databases were searched from inception to April 30^(th),2021.We included studies that reported on the incidence of endophthalmitis following PCS.The quality of the included studies was critically evaluated with the Newcastle-Ottawa quality assessment scale.The random effect or the fixed-effects model was used to evaluated the pooled incidence based on the heterogeneity.The publication bias was assessed by Egger’s linear regression and Begg’s rank correlation tests.RESULTS:A total of 39 studies containing 5 878 114 eyes were included and critically appraised in the Meta-analysis.For overall incidence of endophthalmitis after PCS,the Meta-analysis yielded a pooled estimate of 0.092%(95%CI:0.083%-0.101%).The incidence appeared to decrease with time(before 2000:0.097%,95%CI:0.060%-0.135%;2000 to 2010:0.089%,95%CI:0.076%-0.101%;after 2010:0.063%,95%CI:0.050%-0.077%).Compared with typical povidone-iodine solution(0.178%,95%CI:0.071%-0.285%) and antibiotics subconjunctival injections(0.047%,95%CI:0.001%-0.095%),the use of intracameral antibiotics significantly reduced the incidence of endophthalmitis after PCS(0.045%,95%CI:0.034%-0.055%,RR:7.942,95%CI:4.510-13.985).CONCLUSION:Due to the advancement of phacoemulsification technology and the widespread use of intracameral antibiotics,the incidence of endophthalmitis following PCS shows a decreasing trend over time.The use of intracameral antibiotics administration will significantly reduce the risk of endophthalmitis.展开更多
Dear Editor, We want to present the first reported Propionobacterium acnes(P. acnes) endophthalmitis case after sutureless fixation of posterior chamber intraocular lens(IOL) to the sclera for the traetment of aphakia...Dear Editor, We want to present the first reported Propionobacterium acnes(P. acnes) endophthalmitis case after sutureless fixation of posterior chamber intraocular lens(IOL) to the sclera for the traetment of aphakia to the best of our knowledge. A 69-year-old man with aphakia due to complicated cataract surgery underwent sutureless intrascleral fixation of threepiece posterior chamber intraocular lens(PCIOL) with Yamane technique.展开更多
Purpose: To determine the role of prophylactic antibiotic use in preventing endophthalmitis following intravitreal injections of Anti-Vascular Endothelial Growth Factor Agents (anti-VEGF).Methods: A meta-analysis was ...Purpose: To determine the role of prophylactic antibiotic use in preventing endophthalmitis following intravitreal injections of Anti-Vascular Endothelial Growth Factor Agents (anti-VEGF).Methods: A meta-analysis was conducted for studies reporting the rates of endophthalmitis following injection of anti-vascular endothelial growth factor agents for a variety of disorders. Inclusion criteria included reporting how many patients were given post-injection antibiotic drops, and how many patients were diagnosed with endophthalmitis (both with and without antibiotic drops). Results: The reported rate of endophthalmitis following intravitreal anti-VEGF agents has varied significantly based on the study, with a range between 0.009% to 0.87%. In our meta-analysis, the rate of endophthalmitis in patients receiving post-injection antibiotics was found to be 0.081%, compared to 0.072% for patients who did not receive antibiotics. This difference was not found to be statistically significant. Conclusion: Although the rate of endophthalmitis is extremely low following intravitreal anti-VEGF injections, the controversy regarding the best prevention of this dreaded complication continues. According to our meta-analysis, the answer does not seem to lie in post-injection antibiotic use.展开更多
Objective:To study risk factors,contributing factors of bacterial and fungal endophthalmitis in Upper Egypt,test the isolated species sensitive to some therapeutic agents,and to investigate the air-borne bacteria and ...Objective:To study risk factors,contributing factors of bacterial and fungal endophthalmitis in Upper Egypt,test the isolated species sensitive to some therapeutic agents,and to investigate the air-borne bacteria and fungi in opthalmology operating rooms.Methods:Thirty one cases of endophthalmitis were clinically diagnosed and microbiologically studied.Indoor air-borne bacteria and fungi inside four air-conditioned operating rooms in the Ophthalmology Department at Assiut University Hospitals were also investigated.The isolated microbes from endophthalmitis cases were tested for their ability to produce some extracellular enzymes including protease,lipase,urease,phosphatase and catalase.Also the ability of 5 fungal isolates from endophthalmitis origin to produce mycotoxins and their sensitivity to some therapeutic agents were studied.Results:Results showed that bacteria and fungi were responsible for infection in 10 and 6 cases of endophthalmitis,respectively and only 2 cases produced a mixture of bacteria and fungi.Trauma was the most prevalent risk factor of endophthalmitis where 58.1%of the 31 cases were due to trauma.In ophthalmology operating rooms,different bacterial and fungal species were isolated.8 bacterial and 5 fungal isolates showed their ability to produce enzymes while only 3 fungal isolates were able to produce mycotoxins.Terbinafine showed the highest effect against most isolates in vitro.Conclusions:The ability of bacterial and fungal isolates to produce extracellular enzymes and mycotoxins may be aid in the invasion and destruction of eye tissues. Microbial contamination of operating rooms with air-borne bacteria and fungi in the present work may be a source of postoperative endophthalmitis.展开更多
基金Supported by National Key R and D Program of China,No.2020YFC2008200.
文摘BACKGROUND Endophthalmitis occurring in silicone oil-filled eyes is a very rare occurrence,with reported incidence rates ranging between 0.07%and 0.039%.Traditional methods of management of infectious endophthalmitis include the removal of silicone oil,washout of the vitreous cavity,administration of intravitreal antibiotics,and reinjection of silicone oil.CASE SUMMARY Herein,we report the case of a 39-year-old man with unilateral endophthalmitis after pars plana vitrectomy and silicone oil tamponade.Intravitreal injections of full-dose antibiotics and anterior chamber washout were used to treat the patient.No signs of retinal toxicity were observed during the follow-up period.CONCLUSION Intravitreal full-dose antibiotic injections and anterior chamber washout are promising alternatives to traditional therapies for endophthalmitis in silicone oilfilled eyes.
文摘Dear Editor,We present a case of acute Bacillus cereus(B.cereus)endophthalmitis in a patient with an intraocular perforation injury combined with occult intravitreal cilium implantation.B.cereus endophthalmitis is a severe intraocular infection commonly caused by post-traumatic injuries.It often leads to significant vision loss or even eye loss within 12-48h[1].The presence of an intraocular foreign body(IOFB)increases the risk of infection,while early surgical removal of IOFBs can prevent endophthalmitis,some IOFBs are difficult to detect preoperatively.The Medical Ethics Review Board of West China Hospital of Sichuan University waived application for a clinical study because this was a retrospective report of a single patient based on imaging and because no human experimentation was involved.The patient provided written informed consent to use the imaging data for publication.
文摘BACKGROUND Micrococcus luteus(M.luteus)-induced endophthalmitis is very rare and and may present as either acute or chronic postoperative endophthalmitis.The aim of this study was to report a case of delayed-onset M.luteus-induced endophthalmitis that occurred several months after cataract surgery.CASE SUMMARY A 78-year-old man presented with decreased vision,pain and redness in the right eye that had begun 3 days prior.He had undergone cataract surgery 4 mo prior.Visual acuity was counting fingers;slit-lamp examination revealed conjunctival injection,posterior corneal precipitates,anterior chamber inflammation(cell 4+),and hypopyon.Fundus examination revealed moderate vitreous haze.Urgent vitrectomy was performed for suspected infectious endophthalmitis,followed by vitreous irrigation with injections of antibiotics.On the postoperative day 1,anterior chamber cell decreased to 2+and hypopyon was not observed on slit lamp examination.Six days postoperatively,the patient had recurrent eye pain,and the anterior chamber cell grade increased to 4+;hypopyon recurred in the anterior chamber,and whitish plaque was observed in the lens capsule.Therefore,the patient underwent intraocular lens(IOL)and lens capsule removal,followed by vitreous irrigation,antibiotics injection,and vitrectomy.M.luteus was identified from a lens capsule culture.CONCLUSION In cases of delayed-onset M.luteus-induced endophthalmitis,early vitrectomy and removal of the IOL and lens capsule may be necessary.
文摘AIM:To analyze the risk factors,ophthalmological features,treatment modalities and their effect on the visual outcome in patients with endogenous fungal endophthalmitis(EFE).METHODS:Data retrieved from the medical files included age at presentation to the uveitis clinic,gender,ocular symptoms and their duration before presentation,history of fever,eye affected,anatomical diagnosis and laboratory evidence of fungal infection.Medical therapy recorded included systemic antifungal therapy and its duration,use of intravitreal antifungal agents and use of oral/intravitreal steroids.Surgical procedures and the data of ophthalmologic examination at presentation and at last follow-up were also collected.RESULTS:Included were 13 patients(20 eyes,mean age 58 y).Ten patients presented after gastrointestinal or urological interventions and two presented after organ transplantation.In one patient,there was no history of previous intervention.Diagnostic vitrectomy was performed in 16 eyes(80%)and vitreous cultures were positive in 10 of the vitrectomized eyes(62.5%).In only 4 patients(31%),blood cultures were positive.All patients received systemic antifungal therapy.Sixteen eyes(80%)received intravitreal antifungal agent with voriconazole being the most commonly used.Visual acuity(VA)improved from 0.9±0.9 at initial exam to 0.5±0.8 logMAR at last followup(P=0.03).A trend of greater visual improvement was noted in favor of eyes treated with oral steroids(±intravitreal dexamethasone)than eyes that were not treated with steroids.The most common complication was maculopathy.Twelve eyes(60%)showed no ocular complications.CONCLUSION:High index of suspicion in patients with inciting risk factors is essential because of the low yield of blood cultures and the good general condition of patients at presentation.Visual prognosis is improved with the prompt institution of systemic and intravitreal pharmacotherapy and the immediate surgical intervention.Oral±local steroids could be considered in cases of prolonged or marked inflammatory responses in order to hasten control of inflammation and limit ocular complications.
文摘BACKGROUND Achromobacter species-associated endophthalmitis is rare and may present as either acute or chronic postoperative endophthalmitis.Delayed-onset Achromobacter species endophthalmitis appearing in acute presentation that develops more than several months after cataract surgery is very rare.Intraocular lens(IOL)removal is commonly recommended to treat Achromobacter species endophthalmitis,which is based on previous studies.Here,we report the results of surgery without IOL removal when treating patients with delayed-onset postoperative Achromobacter species endophthalmitis that developed in an acute form.CASE SUMMARY Three patients visited our ophthalmology clinic due to visual impairment that began 2-3 d earlier.They had undergone cataract surgery 5-18 mo prior.Bestcorrected visual acuity of the diseased eye was between counting fingers at 30 cm to non-light perception.They showed conjunctival injection,inflammation in the anterior chamber(cell reaction 4+)and hypopyon formation.The patients were diagnosed with infectious endophthalmitis and immediately underwent pars plana vitrectomy,anterior chamber irrigation and intravitreal injection of ceftazidime and vancomycin.Before fluid infusion,a vitreous specimen was obtained. In all cases, the IOLs were not removed. Achromobacter species was detected on vitreousspecimen culture. After surgery, the vitreous opacity decreased gradually and there was littleretinal damage. At 1 mo after treatment, the best-corrected visual acuity had improved to 20/50and 20/40.CONCLUSIONDelayed onset postoperative endophthalmitis caused by Achromobacter species can appear in anacute form. All patients responded well to early vitrectomy and administration of empiricalantibiotics including ceftazidime. There was no need for IOL removal during surgery.
文摘AIM: To identify risk factors associated with post-cataract surgery endophthalmitis(PCE) in type 2 diabetic patients.METHODS: A hospital-based retrospective case-control study was conducted on 194 type 2 diabetic patients undergoing cataract surgery in Rajavithi Hospital from January 2007 to December 2015. Fifteen patients with PCE were included as the case group and 179 patients without PCE were included as the control group. Potential factors associated with PCE among both groups including demographics, pre-operative characteristics, surgical settings and complications, were statistically analyzed using Chi-square testing and a logistic regression model.RESULTS: Within the case group, 53% were females and the median age was 68 y. Univariate analysis of pre-operative characteristics, surgical settings and complications revealed that recent pre-operative fasting plasma glucose, insulin therapy, presence of diabetic retinopathy, and severe non-proliferative or proliferative diabetic retinopathy were significantly associated with PCE. In a multivariate analysis adjusting for blood glucose level, insulin treatment was the only significant factor associated with an increased risk of PCE(OR 3.9, 95%CI 1.0-15.0, P=0.04) compared to patients without insulin treatment. The most common causative organisms were gram-positive bacteria(89%). Staphylococcus species represented the most common group(67%). Median best corrected visual acuity at 1-month and 3-month follow-up was equal at 0.7 logMAR(20/100).CONCLUSION: The authors identify insulin treatment as the only risk factor associated with endophthalmitis after cataract surgery in type 2 diabetic patients. Further studies with serum levels of pre-operative glycated hemoglobin(HbA_(1c)) and post-operative fasting plasma glucose level are essential to truly demonstrate the role of peri-operative glycemic markers as a risk factor for PCE.
文摘AIM:To identify the clinical features and treatment outcomes of endogenous Klebsiella pneumoniae endophthalmitis and investigate prognostic factors of poor visual outcome.METHODS:The clinical records of all patients diagnosed with endogenous Klebsiella endophthalmitis between January 2007 to December 2018 in Prince of Wales Hospital,Hong Kong,China were retrospectively reviewed.Thorough ophthalmological examination findings were recorded in the case note,including visual acuity testing,slit-lamp examination,indirect ophthalmoscopy and B-scan ultrasonography if media opacity precluded fundus viewing.RESULTS:A total of 18 eyes in 14 patients were identified.Bilateral involvement was noted in 4 patients(28.6%).Hepatobiliary sepsis was the source in 9 patients(64.3%).Culture of intraocular fluid was positive in 5 out of 18 eyes(27.8%).Mortality was noted in 2 patients(14.3%).Mean final visual acuity was 20/1500.Six out of 16 eyes had total loss of sight(37.5%)and 3 eyes required evisceration(18.8%).Multivariate linear regression revealed poor presenting visual acuity(P=0.031)and lack of fundus view due to vitritis(P=0.02)as prognostic factors of poor visual outcome.CONCLUSION:Visual outcome of endogenous Klebsiella endophthalmitis is poor.Poor presenting visual acuity and lack of fundus view predict poor visual outcome.High index of suspicion for endophthalmitis is important in Klebsiella sepsis patients with complaints of ocular symptoms.Ophthalmological screening is recommended in noncommunicable patients with Klebsiella sepsis.
文摘AIM: To report the fungal organisms, clinical features,surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis(EFE) secondary to keratitis, and evaluate the role of surgery in the treatment.METHODS: The clinical records of 27 patients(27 eyes)with culture-proven EFE resulting from fungal keratitis treated at Shandong Eye Institute from January 2007 to January 2015 were retrospectively reviewed. Information about fungal culture results, clinical features, surgical procedures, and final visual acuity was obtained.RESULTS: There were 39 positive culture results from samples of cornea, hypopyon, vitreous and lens capsule,accounting for 56%, 26%, 15% and 2.5%, respectively.Fusarium was identified in 44%(12/27) of the eyes,followed by Aspergillus in 22%(6/27). Posterior segment infection was involved in 78%(21/27) of the patients. The corneal infection was larger than 3 mm×3 mm in 89%(24/27) of the patients, and 22%(6/27) of them had the entire cornea, and even the sclera involved. Three eyes had silicone oil tamponade, and two eyes had retinal detachment. Twenty-two eyes(81.5%) underwent penetrating keratoplasty(PKP), and over half of them(54.5%)were operated within 3d from the onset of antifungal therapy. Fourteen eyes(52%) underwent intracameral antifungal drug injection, and three of them required repeated injections. Fifteen eyes(55.6%) underwent pars plana vitrectomy(PPV). The rate of the eyes undergoing PPV as the initial surgical procedure was 60%(9/15),lower than 77% in PKP. Intravitreal injection was given in 59% of the eyes(16/27), and 75% of them required repeated injections. The final visual acuity was 20/100 or better in 37% of the eyes, and better than counting fingers in 55.6% of the eyes. Five eyes(18.5%) were eviscerated. In the two eyes with concurrent retinal detachment, one achieved retinal reattachment, and the other was eviscerated. In the three eyes with silicone oil tamponade, two eyes received silicone oil removal, and the other one was eviscerated. CONCLUSION: Fusarium and Aspergillus are the dominant pathogens in EFE resulting from keratitis.Aggressive antifungal surgeries including multiple intravitreal injections, PKP and core vitrectomy(especially in the initial surgery) are helpful procedures to improve prognosis of severe EFE secondary to keratitis.
文摘AIM:To report the incidence,risk factors and visual outcomes for postoperative endophthalmitis(POE)based on 7-year data from the Malaysian Ministry of Health Cataract Surgery Registry(MOH CSR).METHODS:Data was collected from the web-based MOH CSR.All consecutive cataract surgery patients from 1st June 2008 to 31st December 2014 were identified.Exclusion criteria were traumatic cataract or previous ocular surgery.Demographic data,ocular co-morbidities,intraoperative details and postoperative visual acuity(VA)at final ophthalmological follow-up were noted.All eyes were taken for analysis.Subjects with POE were compared against subjects with no POE for risk factor assessment using multiple logistic regressions.RESULTS:A total of 163 503 subjects were screened.The incidence of POE was 0.08%(131/163 503).Demographic POE risk factors included male gender(OR:2.121,95%CI:1.464-3.015)and renal disease(OR:2.867,95%CI:1.503-5.467).POE risk increased with secondary causes of cataract(OR:3.562,95%CI:1.740-7.288),uveitis(OR:11.663,95%CI:4.292-31.693)and diabetic retinopathy(OR:1.720,95%CI:1.078-2.744).Intraoperative factors reducing POE were shorter surgical time(OR:2.114,95%CI:1.473-3.032),topical or intracameral anaesthesia(OR:1.823,95%CI:1.278-2.602),posterior chamber intraocular lens(PCIOL;OR:4.992,95%CI:2.689-9.266)and foldable IOL(OR:2.276,95%CI:1.498-3.457).POE risk increased with posterior capsule rupture(OR:3.773,95%CI:1.915-7.432)and vitreous loss(OR:3.907,95%CI:1.720-8.873).Postoperative VA of 6/12 or better was achieved in 15.27%(20/131)subjects with POE.CONCLUSION:This study concurs with other studies regarding POE risk factors.Further strengthening of MOH CSR data collection process will enable deeper analysis and optimization of POE treatment.
文摘AIM:To demonstrate prognostic factors for poor visual outcome in patients with post-traumatic endophthalmitis(PTE)following open globe injury.METHODS:A retrospective study was conducted on 66 patients(66 eyes)with PTE following open globe injury from 2005 to 2015.Potential factors accounting for good and poor visual outcome were statistically analyzed by Chisquare test and Logistic regression model.RESULTS:In 66 cases,39 cases(59%)had a poor visual outcome.Univariate and multivariate Logistic regression analysis identified retained intraocular foreign body(IOFB)as the only factor significantly associated with poor visual outcome[adjusted odds ratio,4.62;95%confidence interval(1.04-20.53);P=0.04].The most common causative agents were gram-positive organisms(83%),of which Bacillus cereus(33%),was the most common pathogen.All cases received intravitreal antibiotic injections.Oral ciprofloxacin was the most used systemic antibiotic(33%).Pars plana vitrectomy was performed in 83%(55/66)of cases.At 6 mo follow-up,mean BCVA was 1.74±0.72 log MAR units.CONCLUSION:In patients with PTE following open globe injury,the only predictor of poor visual outcome is the presence of IOFB.Bacillus cereus is the most isolated microorganism.
文摘AIM: To determine the risk factors for acute endophthalmitis after cataract extraction in a tertiary care centre in India.·METHODS: We performed a nested case control study within a retrospective cohort. The surgical records of all patients with clinically diagnosed endophthalmitis within one month after cataract surgery, performed between January 2006 and December 2009, were reviewed. These were compared with randomly selected age and gender-matched controls, from patients having routine cataract surgery within ±1wk of the endophthalmitis case.Univariable and multivariable analysis were performed to identify risk factors for endophthalmitis.· RESULTS: Of the total 33 856 cataract surgeries performed during this period, there were 57 cases of postoperative acute endophthalmitis that met our study criteria. Thus, the overall incidence of endophthalmitis in our cohort was 1.6 per 1000 cataract extractions performed. Mean age of cases was 55.9y(SD: 10.9y) and for controls was 55.6y(SD: 9.8y). Thirty-five cases(61.4%)and 133 controls(59.6%) were males. Median time of onset of endophthalmitis was 4d(IQR 2-9d; range: 1-30d).Thirty-nine cases(68.4%) presented within 7d and 27 cases(47.4%) were culture positive. Two hundred and twenty-three age and gender matched controls were selected. In multivariate analysis, endophthalmitis was associated with posterior capsular rupture(PCR) during surgery(OR 6.98, 95%CI: 2.22-21.98), phacoemulsification via scleral incision with a foldable intraocular lens(IOL)implantation(OR 3.02, 95%CI: 1.13-8.04) and ocular comorbidity(OR 2.32, 95%CI: 1.11-4.87).·CONCLUSION: PCR, presence of ocular co-morbidity,and phacoemulsification via scleral incision with foldable-IOL were found to be independent risk factors for acute endophthalmitis.
文摘AIM: To study the clinical features, microbial spectrum, associated factors and prognosis of endogenous endophthalmitis(EE) in a group of Chinese patients.METHODS: The medical records from 32 eyes of 29 patients diagnosed with EE in Peking Union Medical College Hospital from January 2009 to October 2019 were reviewed. RESULTS: The initial visual acuity(VA) of 30 eyes in this study was worse than 20/400. Twenty-three eyes were diagnosed with fungal endophthalmitis and nine with bacterial endophthalmitis. The most common fungal and bacterial isolates were Candida and Klebsiella pneumoniae, respectively. Several rare fungi and bacteria species were also isolated from our patients, including Cryptococcus, Paecilomyces, Brucella, and Bacillus licheniformis. The leading risk factor for EE was diabetes. The most common extraocular infection locus was genitourinary tract. Vitrectomy was performed on twenty-nine eyes. Eight eyes achieved final VA of 20/400 or better. EE caused by Candida had a better prognosis.CONCLUSION: The visual outcome of EE is based on pathogens and prompt intervention. Early vitrectomy and antimicrobial treatment are beneficial for EE.
文摘At present, the incidence of infectious endophthalmitis after cataract surgery has been significantly reduced, but it is still a serious complication. Removal or not of the intraocular lens(IOL) during vitrectomy in cases with a moderate or severe inflammation is controversial. In order to call upon more discussion, we publish the article entitled “Timely vitrectomy without intraocular lens removal for acute endophthalmitis after cataract surgery” written by Guo et al in this issue. With recent advanced vitrectomy techniques, and critical measures for management of risk factors related to occurrence of infection, IOL remaining during timely vitrectomy for acute endophthalmitis can possibly be safe and effective in selected cases.
文摘AIM:To analyze the lab diagnosis and etiology of infectious endophthalmitis.· METHODS:The medical and microbial records of 36 patients diagnosed with infectious endophthalmitis and 8 patients diagnosed with intraocular lens(IOL)-related inflammation between Nov.1999 and Dec.2009 were retrospectively reviewed for lab diagnosis and etiology.RESULTS:The inflammatory cell counts in all aqueous humor specimens from infectious endophthalmitis patients were more than in all aqueous humor specimens from patients with IOL-related inflammation.Sixteen of the 36 aqueous humor samples(44.4%) and 11 of the 24 vitreous humor samples(45.8%) from infectious endophthalmitis patients showed positive results in smears;while 17 aqueous humor samples(47.2%) and 15 vitreous humor samples(62.5%) from infectious endophthalmitis patients showed positive results in culture.CONCLUSION:The inflammatory cell count may be an important index for infectious endophthalmitis;while,smears can show etiological information earlier.
基金Supported by the National Natural Science Foundation of China(No.81770934)Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support(No.20181810).
文摘AIM:To explore the traumatic endophthalmitis in young children and the outcome of pars plana vitrectomy(PPV).METHODS:Twenty-two eyes of 22 cases of young children consecutive pediatric traumatic endophthalmitis treated and followed up between September 2014 and May 2018 were included.Aqueous humor or vitreous samples were taken for bacterial culture and sensitivity tests.Intravitreal antibiotics(norvancomycin and ceftazidime)injection,combined with 23-gauge PPV,were administered in 22 eyes.Silicone oil(SO;5000 centistoke)tamponade or perfluoropropane gas(C3F8)was used in all patients.Main outcome measures were best-corrected visual acuity(BCVA)and retinal attachment,the ratio of penetrating injury,and the existence of intraocular foreign body.RESULTS:The mean age of patients was 6.9±2.2(range,3-10)y.All injured eyes suffered from penetrating ocular injury with retained intraocular foreign body in one eye.Bacterial culture was positive in only 2 eyes.The mean follow-up time was 21.1±4.7(range,12-30)mo.In the primary PPV,intravitreal antibiotics was administrated in all eyes,SO in 18 eyes,and C3F8 in 4 eyes.The secondary operation of SO removal and C3F8 endotamponade was performed in 16 eyes and a second SO endotamponade due to emulsification of the oil and retinal detachment(RD)was operated in 7 eyes underwent 3 to 11.5 mo after primary PPV.A third operation was done in 7 eyes.The final intraocular pressure(IOP)was 8.9±1.8(range,6.9-11.4)mm Hg.The final BCVAs were 20/200 or better in 5,counting fingers in 2,and light perception to hand movement in 8 eyes.Whose(66.7%)had retinal injury exhibited worse BCVA(P=0.019,Fisher’s exact test).Eyes underwent SO tamponade exhibited worse final BCVA than that with C3F8 in the primary PPV(P=0.026,Fisher’s exact test).CONCLUSION:Traumatic endophthalmitis in children is generally more severe and associated with more complicated surgical procedures.Most patients have retinal injury need multiple operations and the final BCVA is poor.Prevention of ocular trauma,especially in children,is still critical.
文摘AIM To study the clinical profile and outcomes of pediatric endogenous endophthalmitis from a tertiary eye hospital in South India.METHODS A total of 13 eyes of 11 children presented to us with varied symptoms and presentations of endogenous endophthalmitis, over a five-year period from January 2010 to December 2015 were studied. Except for two eyes of a patient, vitreous aspirates were cultured from all 11 eyes to isolate the causative organism. These eleven eyes also received intravitreal injections. All patients were treated with systemic antibiotics. RESULTS Two cases had bilateral endophthalmitis. Ages ranged from 4 d to 11 years. Five cases were undiagnosed and treated, before being referred to our center. Ten of the 13 eyes underwent a core vitrectomy. The vitrectomy was done at an average on the second day after presenting(range 0-20 d). Five of the 11 vitreous aspirates showed isolates. The incriminating organisms were bacteria in three and fungus in two. An underlying predisposing factor was found in seven patients. At a mean follow-up 21.5 mo, outcome was good in 7 eyes of 6 cases(54%), five eyes of four cases(38%) ended up with phthisis bulbi while one child died of systemic complications. CONCLUSION Endogenous endophthalmitis is a challenge for ophtha-lmologists. Early diagnosis and intervention is the key for a better outcome.
基金Supported by the National Natural Science Foundation of China (No.81800869,No.81970781,No.81800807)the Natural Science Foundation of Zhejiang Province (No.LD21H120001)。
文摘AIM:To evaluate the overall endophthalmitis incidence and the effectiveness of potential prophylaxis measures following phacoemulsification cataract surgery(PCS).METHODS:The Pub Med and Web of Science databases were searched from inception to April 30^(th),2021.We included studies that reported on the incidence of endophthalmitis following PCS.The quality of the included studies was critically evaluated with the Newcastle-Ottawa quality assessment scale.The random effect or the fixed-effects model was used to evaluated the pooled incidence based on the heterogeneity.The publication bias was assessed by Egger’s linear regression and Begg’s rank correlation tests.RESULTS:A total of 39 studies containing 5 878 114 eyes were included and critically appraised in the Meta-analysis.For overall incidence of endophthalmitis after PCS,the Meta-analysis yielded a pooled estimate of 0.092%(95%CI:0.083%-0.101%).The incidence appeared to decrease with time(before 2000:0.097%,95%CI:0.060%-0.135%;2000 to 2010:0.089%,95%CI:0.076%-0.101%;after 2010:0.063%,95%CI:0.050%-0.077%).Compared with typical povidone-iodine solution(0.178%,95%CI:0.071%-0.285%) and antibiotics subconjunctival injections(0.047%,95%CI:0.001%-0.095%),the use of intracameral antibiotics significantly reduced the incidence of endophthalmitis after PCS(0.045%,95%CI:0.034%-0.055%,RR:7.942,95%CI:4.510-13.985).CONCLUSION:Due to the advancement of phacoemulsification technology and the widespread use of intracameral antibiotics,the incidence of endophthalmitis following PCS shows a decreasing trend over time.The use of intracameral antibiotics administration will significantly reduce the risk of endophthalmitis.
文摘Dear Editor, We want to present the first reported Propionobacterium acnes(P. acnes) endophthalmitis case after sutureless fixation of posterior chamber intraocular lens(IOL) to the sclera for the traetment of aphakia to the best of our knowledge. A 69-year-old man with aphakia due to complicated cataract surgery underwent sutureless intrascleral fixation of threepiece posterior chamber intraocular lens(PCIOL) with Yamane technique.
文摘Purpose: To determine the role of prophylactic antibiotic use in preventing endophthalmitis following intravitreal injections of Anti-Vascular Endothelial Growth Factor Agents (anti-VEGF).Methods: A meta-analysis was conducted for studies reporting the rates of endophthalmitis following injection of anti-vascular endothelial growth factor agents for a variety of disorders. Inclusion criteria included reporting how many patients were given post-injection antibiotic drops, and how many patients were diagnosed with endophthalmitis (both with and without antibiotic drops). Results: The reported rate of endophthalmitis following intravitreal anti-VEGF agents has varied significantly based on the study, with a range between 0.009% to 0.87%. In our meta-analysis, the rate of endophthalmitis in patients receiving post-injection antibiotics was found to be 0.081%, compared to 0.072% for patients who did not receive antibiotics. This difference was not found to be statistically significant. Conclusion: Although the rate of endophthalmitis is extremely low following intravitreal anti-VEGF injections, the controversy regarding the best prevention of this dreaded complication continues. According to our meta-analysis, the answer does not seem to lie in post-injection antibiotic use.
文摘Objective:To study risk factors,contributing factors of bacterial and fungal endophthalmitis in Upper Egypt,test the isolated species sensitive to some therapeutic agents,and to investigate the air-borne bacteria and fungi in opthalmology operating rooms.Methods:Thirty one cases of endophthalmitis were clinically diagnosed and microbiologically studied.Indoor air-borne bacteria and fungi inside four air-conditioned operating rooms in the Ophthalmology Department at Assiut University Hospitals were also investigated.The isolated microbes from endophthalmitis cases were tested for their ability to produce some extracellular enzymes including protease,lipase,urease,phosphatase and catalase.Also the ability of 5 fungal isolates from endophthalmitis origin to produce mycotoxins and their sensitivity to some therapeutic agents were studied.Results:Results showed that bacteria and fungi were responsible for infection in 10 and 6 cases of endophthalmitis,respectively and only 2 cases produced a mixture of bacteria and fungi.Trauma was the most prevalent risk factor of endophthalmitis where 58.1%of the 31 cases were due to trauma.In ophthalmology operating rooms,different bacterial and fungal species were isolated.8 bacterial and 5 fungal isolates showed their ability to produce enzymes while only 3 fungal isolates were able to produce mycotoxins.Terbinafine showed the highest effect against most isolates in vitro.Conclusions:The ability of bacterial and fungal isolates to produce extracellular enzymes and mycotoxins may be aid in the invasion and destruction of eye tissues. Microbial contamination of operating rooms with air-borne bacteria and fungi in the present work may be a source of postoperative endophthalmitis.
