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PURPOSE: To investigate whether the clinical characteristics, treatment and prognosis of endogenous infectious endophthalmitis (EIE) have changed over the past 5 years. METHODS: Retrospectively analyze all articles about EIE published in the PubMed, Web of Science, and Embase databases from 2017 to 2021. RESULTS: A total of 128 patients and 147 eyes (46 left and 60 right) were included in the study. The mean age at diagnosis was 51 ± 19 years. The most common risk factors were diabetes and intravenous drug use. From 2017 to 2021, Klebsiella was the most common pathogenic microorganism (22%), and vitreous culture had the highest positivity rate. The most common complaint was blurred vision. The mean visual acuity (logMAR) at onset was 2.84, and the clinical symptoms were vitreal inflammation and opacity (63%), ocular pain (37%), and conjunctival congestion (36%). The ocular inflammation could be reduced by intraocular antibiotics or vitrectomy. However, the visual prognosis, with a mean logMAR of 2.73; only 50% of the eyes reached a visual acuity level of finger count and above. Changes in diagnostics over the past 5 years have mainly manifested as more diverse microorganism culture methods. In addition to conventional culture methods, PCR, sputum culture and aqueous humour culture are also commonly used for the diagnosis of pathogenic bacteria, improving the positive culture rate and visual prognosis. CONCLUSION: The prognosis of EIE is poor. It is recommended to pay attention to the pathogenic bacteria culture results and accompanying systemic diseases and to diagnose and treat patients as soon as possible.
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Antibacterianos , Endoftalmitis , Infecciones Bacterianas del Ojo , Agudeza Visual , Endoftalmitis/diagnóstico , Endoftalmitis/microbiología , Endoftalmitis/terapia , Humanos , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/terapia , Pronóstico , Antibacterianos/uso terapéutico , Vitrectomía/métodos , Estudios Retrospectivos , Cuerpo Vítreo/microbiología , Bacterias/aislamiento & purificación , Factores de Riesgo , Masculino , FemeninoRESUMEN
Objective: This case report aimed to describe the unusual clinical presentation and histopathological features of post-injection endophthalmitis. Methods: A 56-year-old male phakic patient with diabetic retinopathy received an intravitreal injection (Bevacizumab as per the patient) for neovascular glaucoma elsewhere and presented to our center one day after the dose with hypopyon. The eye was relatively white without pain or lid oedema. The patient was treated as a case of post-injection endophthalmitis with two doses of intravitreal antibiotics 48 hours apart. During the follow-up, he developed a Covid infection. After one week, when the media cleared, white exudates were seen in the vitreous cavity with a relatively healthy retina. He was taken up for pars plana vitrectomy and vitreous biopsy for histopathological study. Results: The microscopic examination of vitreous aspirate revealed crystalline deposits without any microorganisms. Two control slides, one with a mixture of intravitreal antibiotics, which were previously injected, and the other with fresh Triamcinolone were also examined. Although the findings of the drug mixture did not match the vitreous aspirate, they matched with triamcinolone, which established it as a case of pseudo endophthalmitis due to triamcinolone injected elsewhere. Discussion: Initially, it seemed like a straightforward case of post-injection endophthalmitis, but a further examination of the vitreous aspirate showed that it was pseudoendophthalmitis due to an intravitreal triamcinolone injection. Despite the patient being phakic, neovascularization or elevated intraocular pressure may have led to the disruption of the blood-ocular barrier and the migration of Triamcinolone into the anterior chamber. Conclusion: The case's uniqueness lies in being the first reported case of pseudo endophthalmitis in a phakic patient with an intact lens iris diaphragm. The case also highlighted the judicious use of available resources and out-of-the-box thinking to reach a diagnosis that may not always be obvious. Abbreviations: TA = Triamcinolone acetonide, AC = Anterior chamber, IVB = Intravitreal Bevacizumab, PL = Perception of light.
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Inhibidores de la Angiogénesis , Bevacizumab , Endoftalmitis , Glaucoma Neovascular , Inyecciones Intravítreas , Humanos , Masculino , Persona de Mediana Edad , Glaucoma Neovascular/diagnóstico , Glaucoma Neovascular/etiología , Endoftalmitis/diagnóstico , Endoftalmitis/microbiología , Inhibidores de la Angiogénesis/administración & dosificación , Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab/administración & dosificación , Cuerpo Vítreo/patología , Cuerpo Vítreo/microbiología , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , COVID-19/complicaciones , COVID-19/diagnóstico , Vitrectomía/métodos , Glucocorticoides/uso terapéutico , Glucocorticoides/administración & dosificación , SARS-CoV-2 , Retinopatía Diabética/diagnósticoRESUMEN
PURPOSE: This study aimed to investigate the demographics, clinical characteristics, and management outcomes of patients with acute infectious endophthalmitis (AIE). METHODS: This retrospective chart review was conducted on all patients admitted with the clinical diagnosis of infectious endophthalmitis from 2017 to 2022. Demographic data, patients' clinical characteristics, the type of acute infectious endophthalmitis (post-operative, post-traumatic, bleb-associated, and endogenous endophthalmitis), the type of surgical procedure in the post-operative cases, the microbiologic analysis results of vitreous samples, therapeutic measures, and visual outcomes of patients were recorded. RESULTS: In this study, 182 participants, including 122 male (67%) and 60 (33%) female, were involved. The mean age of patients was 54.56 ± 21 years, with a range of 1-88 years old. The most prevalent type of AIE was post-operative (59.9%), followed by endogenous (19.2%), post-traumatic (17%), and bleb-associated (3.8%). The most common type of intraocular surgery in the post-operative subgroups of AIE patients was phacoemulsification (57.8%). The median (interquartile range) of the primary and final BCVA of patients was 1.5 (1.35, 1.85) and 0.65 (0.35, 1.35), respectively. Vitreous haziness grade (OR, 2.89; 95% CI, 1.11-5.74; p = 0.009) and the primary VA (OR, 60.34; 95% CI, 2.87-126.8; p = 0.008) revealed statistical significance for final vision loss. CONCLUSION: AIE is a devastating condition with poor visual outcomes, which presents with acute inflammatory signs and symptoms regardless of its type. However, prompt and appropriate treatment leads to visual recovery to a functional level in many patients.
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Endoftalmitis , Infecciones Bacterianas del Ojo , Agudeza Visual , Humanos , Endoftalmitis/diagnóstico , Endoftalmitis/microbiología , Endoftalmitis/epidemiología , Endoftalmitis/terapia , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Adulto , Anciano de 80 o más Años , Adolescente , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/epidemiología , Infecciones Bacterianas del Ojo/terapia , Adulto Joven , Enfermedad Aguda , Niño , Preescolar , Lactante , Antibacterianos/uso terapéutico , Cuerpo Vítreo/microbiología , Cuerpo Vítreo/patología , Vitrectomía/métodosAsunto(s)
Bacillus cereus , Endoftalmitis , Infecciones Bacterianas del Ojo , Hemofilia A , Humanos , Endoftalmitis/microbiología , Endoftalmitis/diagnóstico , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Bacillus cereus/aislamiento & purificación , Masculino , Hemofilia A/complicaciones , Hemofilia A/diagnóstico , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/microbiología , Antibacterianos/uso terapéutico , Cuerpo Vítreo/microbiología , NiñoRESUMEN
A 78-year-old man with a history of lung cancer, chemotherapy, radiotherapy, and coronavirus disease 2019 infection experienced visual deterioration of two-weeks' duration in his right eye. There was multifocal, yellowish-white retinitis foci, vascular engorgement, and scattered intraretinal hemorrhages extending from posterior pole to retinal periphery in the right eye, whereas the left eye was normal. Intravitreal vancomycin, ceftazidime, clindamycin, and dexamethasone were given for endogenous endophthalmitis initially. Vitreous culture confirmed the presence of Aspergillus lentulus, and he was treated with intravitreal amphotericin-B and voriconazole injections together with systemic amphotericin-B, voriconazole, posaconazole, and micafungin therapy. During follow-up, vitreoretinal surgery was performed because of rhegmatogenous retinal detachment, and he received one additional cycle of chemotherapy due to recurrence of the cancer. Although the retina was attached, enucleation was eventually required due to painful red eye. Atypical squamous cells beneath the neurosensory retina suggesting metastasis were noted on histopathological examination. Timely ocular examination is crucial for any immunocompromised patient having ocular symptoms. High level of suspicion for a fungal etiology is a must in these patients.
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Aspergilosis , Aspergillus , Endoftalmitis , Infecciones Fúngicas del Ojo , Huésped Inmunocomprometido , Neoplasias Pulmonares , Humanos , Endoftalmitis/diagnóstico , Endoftalmitis/microbiología , Masculino , Anciano , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/microbiología , Neoplasias Pulmonares/diagnóstico , Aspergilosis/diagnóstico , Aspergilosis/microbiología , Aspergillus/aislamiento & purificación , Antifúngicos/uso terapéutico , COVID-19/complicaciones , Cuerpo Vítreo/microbiología , Inyecciones Intravítreas , SARS-CoV-2RESUMEN
Purpose: Extracellular vesicles (EVs) are messenger pigeons of the cells that communicate about cellular microenvironment. In this study, we evaluated the expression of C8α and calpain-2 in EVs from vitreous of patients with bacterial endophthalmitis to assess its utility as a diagnostic marker. Methods: EVs were isolated from vitreous of patients with bacterial endophthalmitis (culture positive and culture negative) and noninfectious control by exosome isolation reagent and characterized, and the levels of C8α and calpain-2 was assessed by enzyme-linked immunosorbent assay in isolated EVs and direct vitreous. The receiver operating characteristic curve was generated to assess the diagnostic performance. Results: Scanning electron microscopy (SEM) and dynamic light scattering (DLS) confirmed the presence of EVs having a diameter (nm) of 275.2 ± 93, 92 ± 22, and 77.28 ± 12 in culture-positive (CP), culture-negative (CN), and control respectively. The expression level (ng/mL) of C8α in the EVs obtained from CP was 144 ± 22 and CN was 31.2 ± 9.8, which was significantly higher (P < 0.01) than control 3.7 ± 2.4. Interestingly, C8α is not expressed directly in the vitreous of CN and controls. Calpain-2 was significantly downregulated (P ≤ 0.0001) in CP (0.94 ± 0.16) and CN (0.70 ± 0.14) than control. The sensitivity and specificity of 1 for C8α and calpain-2 in the EVs implied that its diagnostic accuracy was significant. Conclusions: This study showed that the EV proteins C8α and calpain-2 could be suitable diagnostic markers for endophthalmitis. However, the presence of C8α in the EVs of CN samples but not in direct vitreous promises EVs as the future of diagnostics. Translational Relevance: Expression levels of EV-calpain-2 and EV-C8α could diagnose CN bacterial endophthalmitis.
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Biomarcadores , Calpaína , Endoftalmitis , Vesículas Extracelulares , Cuerpo Vítreo , Calpaína/metabolismo , Humanos , Cuerpo Vítreo/metabolismo , Cuerpo Vítreo/microbiología , Endoftalmitis/diagnóstico , Endoftalmitis/microbiología , Endoftalmitis/metabolismo , Endoftalmitis/patología , Vesículas Extracelulares/metabolismo , Biomarcadores/metabolismo , Masculino , Femenino , Persona de Mediana Edad , Ensayo de Inmunoadsorción Enzimática , Anciano , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/metabolismo , Infecciones Bacterianas del Ojo/patología , Curva ROC , Microscopía Electrónica de Rastreo , AdultoRESUMEN
PURPOSE: To evaluate the utility of galactomannan testing of intraocular fluid in the diagnosis of Aspergillus endophthalmitis (AE). METHODS: This retrospective study enrolled three groups of patients, including those with 17 eyes with AE; 20 eyes with intraocular infection of bacteria, viruses, or other fungi; and 19 eyes with cataract. Intraocular fluid from all these patients was collected for galactomannan testing. In addition, the receiver operating characteristic curves and diagnostic significance were analyzed. RESULTS: The mean optical density index (ODI) of galactomannan was 5.77 ± 1.73 in the AE group, which was significantly higher than that in the non- Aspergillus intraocular infection group (0.19 ± 0.11, P < 0.001) and the negative control group (0.29 ± 0.27, P < 0.001). The area under the receiver operating characteristic curve (area under the curve) was 1.00 (95% confidence interval, 1.00-1.00; P < 0.001) in the AE group and the other two groups. At a cutoff optical density index of 1.88, the sensitivity and specificity were 100.0% and 100.0%, respectively, and the Youden index reached its highest value of 1.00. CONCLUSION: Galactomannan testing of intraocular fluid indicated good sensitivity and specificity for the diagnosis of AE, thereby promising a rapid diagnostic modality for AE.
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Aspergilosis , Endoftalmitis , Infecciones Fúngicas del Ojo , Galactosa , Mananos , Curva ROC , Humanos , Mananos/análisis , Endoftalmitis/diagnóstico , Endoftalmitis/microbiología , Galactosa/análogos & derivados , Estudios Retrospectivos , Masculino , Femenino , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/microbiología , Persona de Mediana Edad , Anciano , Aspergilosis/diagnóstico , Aspergilosis/microbiología , Aspergilosis/metabolismo , Adulto , Aspergillus/aislamiento & purificación , Humor Acuoso/metabolismo , Humor Acuoso/microbiología , Anciano de 80 o más Años , Sensibilidad y Especificidad , Cuerpo Vítreo/microbiología , Cuerpo Vítreo/metabolismo , Biomarcadores/metabolismoAsunto(s)
Carcinoma de Células Renales , Endoftalmitis , Neoplasias Renales , Cuerpo Vítreo , Humanos , Masculino , Persona de Mediana Edad , Carcinoma de Células Renales/secundario , Carcinoma de Células Renales/diagnóstico , Diagnóstico Diferencial , Endoftalmitis/diagnóstico , Endoftalmitis/microbiología , Neoplasias del Ojo/diagnóstico , Neoplasias del Ojo/secundario , Neoplasias Renales/patología , Neoplasias Renales/diagnóstico , Cuerpo Vítreo/patología , Cuerpo Vítreo/microbiología , Cuerpo Vítreo/diagnóstico por imagenRESUMEN
Purpose: Fungal endophthalmitis is characterized by chronic inflammation leading to the partial or complete vision loss. Herein, we analyzed the transcriptomic landscape of Aspergillus flavus (A. flavus) endophthalmitis in C57BL/6 mice to understand the host-pathogen interactions. Methods: Endophthalmitis was induced by intravitreal injection of A. flavus spores in C57BL/6 mice and monitored for disease progression up to 72 hours. The enucleated eyeballs were subjected to histopathological analysis and mRNA sequencing using the Illumina Nextseq 2000. Pathway enrichment analysis was performed to further annotate the functions of differentially expressed genes (DEGs) and validation of cytokines was performed in vitreous of patients with fungal endophthalmitis using multiplex ELISA. Results: Transcriptomic landscape of A. flavus endophthalmitis revealed upregulated T-cell receptor signaling, PI3K-AKT, MAPK, NF-κB, JAK-STAT, and NOD like receptor signaling pathways. We observed significant increase in the T-cells during infection especially at 72 hours infection along with elevated expression levels of IL-6, IL-10, IL-12, IL-18, IL-19, IL-23, CCR3, and CCR7. Furthermore, host-immune response associated genes, such as T-cell interacting activating receptor, TNF receptor-associated factor 1, TLR1, TLR9, and bradykinin receptor beta 1, were enriched. Histopathological assessment validated the significant increase in inflammatory cells, especially T-cells at 72 hours post-infection along with increased disruption in the retinal architecture. Additionally, IL-6, IL-8, IL-17, TNF-α, and IL-1ß were also significantly elevated, whereas IL-10 was downregulated in vitreous of patients with Aspergillus endophthalmitis. Conclusions: Regulating T-cell influx could be a potential strategy to modulate the excessive inflammation in the retina and potentially aid in better vision recovery in fungal endophthalmitis.
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Inmunidad Adaptativa , Aspergilosis , Aspergillus flavus , Citocinas , Modelos Animales de Enfermedad , Endoftalmitis , Infecciones Fúngicas del Ojo , Perfilación de la Expresión Génica , Inmunidad Innata , Ratones Endogámicos C57BL , Animales , Aspergillus flavus/genética , Ratones , Infecciones Fúngicas del Ojo/microbiología , Infecciones Fúngicas del Ojo/genética , Infecciones Fúngicas del Ojo/inmunología , Endoftalmitis/microbiología , Endoftalmitis/inmunología , Endoftalmitis/genética , Aspergilosis/microbiología , Aspergilosis/genética , Aspergilosis/inmunología , Inmunidad Adaptativa/genética , Inmunidad Innata/genética , Citocinas/metabolismo , Citocinas/genética , Transcriptoma , Ensayo de Inmunoadsorción Enzimática , Cuerpo Vítreo/microbiologíaRESUMEN
AIM: Analyze antibiotic susceptibility in the Endophthalmitis Management Study (EMS) and compare it with the current intravitreal antibiotic practice trend of members of the Vitreoretinal Society of India (VRSI) practicing in India. METHODS: The microbiology work-up of undiluted vitreous included microscopy, culture-susceptibility, polymerase chain reaction (PCR), and next-generation sequencing (NGS). VRSI members were invited to the survey. The EMS conventional culture-susceptibility (PCR and NGS excluded) results were compared vis-a-vis gram-positive cocci (GPC), gram-negative bacilli (GNB), and less commonly used antibiotics with the current recommended intravitreal antibiotics. p < 0.05 was considered significant. RESULTS: Culture and positivity (culture + PCR/NGS) positivity was 28.8% and 56.1%, respectively. GPC was most susceptible to cefazolin, linezolid, and vancomycin; GNB was most susceptible to amikacin, ceftazidime, colistin, and imipenem. There was no susceptibility difference between cefazolin and vancomycin (p = 0.999) and between ceftazidime and imipenem (p = 1.0). Colistin was superior to ceftazidime (p = 0.047) against GNB. The GNB resistant to amikacin (n = 14) were equally susceptible to ceftazidime and colistin; resistant to ceftazidime (n = 16) were susceptible to colistin; and resistant to colistin (n = 7) were susceptible to ceftazidime. The preference of VRSI members (n = 231) practicing in India was a vancomycin-ceftazidime combination (82%), vancomycin for GPC (94%), ceftazidime for GNB (61%), and voriconazole for fungi (74%). CONCLUSION: In EMS, GPC had good susceptibility to vancomycin; GNB had good susceptibility to ceftazidime and colistin. Given the lower resistance of colistin, a vancomycin-colistin combination could be an alternative empiric treatment in post-cataract endophthalmitis in India.
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Antibacterianos , Bacterias , Endoftalmitis , Infecciones Bacterianas del Ojo , Inyecciones Intravítreas , Pruebas de Sensibilidad Microbiana , Endoftalmitis/microbiología , Endoftalmitis/tratamiento farmacológico , Endoftalmitis/diagnóstico , India/epidemiología , Humanos , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/diagnóstico , Bacterias/aislamiento & purificación , Bacterias/efectos de los fármacos , Cuerpo Vítreo/microbiología , Pautas de la Práctica en MedicinaRESUMEN
PURPOSE: To explore the clinical value of ß-D-glucan (BDG) testing and metagenomic next-generation sequencing (mNGS) for detecting the pathogens of fungal endophthalmitis (FE). METHODS: This study included 32 cases (32 eyes) with FE and 20 cases (20 eyes) with intraocular inflammation caused by other etiologies. All patients underwent extraction of aqueous humor or vitreous fluid samples for BDG testing and mNGS. The diagnostic performance and total clinical concordance rate of BDG testing and mNGS for FE were evaluated and calculated based on the results of the clinical diagnosis. RESULTS: Among the clinically diagnosed FE, the positivity rates of BDG testing and mNGS (90.63%) were both significantly higher ( P < 0.001) than that of microbial cultures (53.13%). There was 100% consistency in pathogen identification using mNGS and culture identification for culture-positive cases. The area under the curve was 0.927 for BDG testing and 0.853 for mNGS. When the two tests were combined, sensitivity (93.75%), specificity (100.00%), and total clinical concordance rate (96.15%) were all improved, compared with the single tests. CONCLUSION: The positive rates of BDG test and mNGS were markedly higher than those of cultures in FE identification. The combination of these two tests showed improved performance when compared with individual tests.
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Humor Acuoso , Endoftalmitis , Infecciones Fúngicas del Ojo , Secuenciación de Nucleótidos de Alto Rendimiento , Metagenómica , Cuerpo Vítreo , beta-Glucanos , Humanos , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/microbiología , Endoftalmitis/diagnóstico , Endoftalmitis/microbiología , Masculino , Persona de Mediana Edad , Femenino , Humor Acuoso/microbiología , beta-Glucanos/análisis , Cuerpo Vítreo/microbiología , Anciano , Metagenómica/métodos , Adulto , Estudios Retrospectivos , Hongos/aislamiento & purificación , Hongos/genética , ADN de Hongos/análisis , Proteoglicanos , Anciano de 80 o más AñosRESUMEN
PURPOSE: To study the epidemiology and microbiological landscape in patients (≤21 yrs) diagnosed with endophthalmitis across a multi-tier ophthalmology network in India. METHODS: This cross-sectional hospital-based study included 1,041 patients (≤21 yrs) diagnosed with endophthalmitis, between April 2012 and May 2022. The data were collected using an electronic medical record system. RESULTS: Bacteria (24%) was the most common etiology followed by fungus (2%). The majority of the patients were male (66%) with a mean age of 8.37 ± 5.99 years. The most common age group was middle childhood (6-11 years) with 365 (35.06%) patients. The patients were more commonly from the lower socio-economic status (60.81%) and urban geography (49%). The common cause of endophthalmitis was trauma (59.33%) and amongst the 279 culture positive eyes, the predominant bacteria isolated was Streptococcus pneumoniae followed by Bacillus species and fungus included predominantly Aspergillus and Candida species. The most common surgical intervention performed was intraocular antibiotics (74%) followed by pars plana vitrectomy (52%). CONCLUSION: The most common etiology of endophthalmitis in children is bacterial and traumatic in nature and presented from the lower socio-economic status. A half of the eyes warranted a vitreo-retinal surgical intervention. .
A cross-sectional study on the microbiological landscape in pediatric endophthalmitis showed that the most common cause of endophthalmitis was trauma and the predominant bacteria isolated was Streptococcus spp. and Bacillus spp. Additionally, majority of the patients were from the lower socio-economic status and urban geography and the most common surgical intervention performed was injection of intraocular antibiotics.
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Bacterias , Registros Electrónicos de Salud , Endoftalmitis , Infecciones Bacterianas del Ojo , Infecciones Fúngicas del Ojo , Humanos , Endoftalmitis/epidemiología , Endoftalmitis/microbiología , Niño , India/epidemiología , Masculino , Adolescente , Femenino , Estudios Transversales , Infecciones Bacterianas del Ojo/epidemiología , Infecciones Bacterianas del Ojo/microbiología , Preescolar , Infecciones Fúngicas del Ojo/epidemiología , Infecciones Fúngicas del Ojo/microbiología , Bacterias/aislamiento & purificación , Hongos/aislamiento & purificación , Lactante , Oftalmología , Adulto Joven , Estudios Retrospectivos , Cuerpo Vítreo/microbiología , Distribución por Edad , Antibacterianos/uso terapéutico , Incidencia , VitrectomíaRESUMEN
BACKGROUND: Endogenous Candida endophthalmitis is an emergency that can threaten vision and the eye as a whole organ but also the life of the patient due to its systemic cause. MATERIAL AND METHOD: Retrospective case evaluation of the University Hospital for Ophthalmology Halle (Saale) and the Eye Clinic of the Ernst von Bergmann Hospital Potsdam from 2017-2022. (Age, gender, side involvement, underlying diseases, symptoms, preoperative and postoperative visual acuity, diagnostics, treatment and complications). The standardized procedures for endogenous Candida endophthalmitis are explained, the data are compared with the literature and treatment suggestions are presented. RESULTS: 8 patients with 14 eyes were treated for endogenous Candida endophthalmitis. Of the patients 2 were women and 6 were men. The overall average age was 70.25 years (53-82 years), 6 patients had bilateral eye involvement and 2 patients were affected on one side. All patients had several serious immunocompromising underlying diseases that were the cause of the candidemia. All patients underwent a pars plana vitrectomy (ppV) on the affected eyes except for one male patient who did not obtain permission for anesthesia. In addition to systemic treatment with antimycotics, voriconazole was routinely administered intravitreally during ppV. The patients received further intravitreal doses of voriconazole based on the findings. Vitreous body samples were taken from all patients during the ppV and detection of Candida albicans was possible in all cases. As part of the local perioperative treatment 1 patient received parabulbar administration of a triamcinolone depot in both eyes, 7 patients received a dexamethasone depot in 11 eyes and all 8 patients received findings-oriented local treatment with prednisolone acetate eye drops. visual acuity increased from preoperatively 1.2 logMar to 1.0 logMar. Postoperative retinal detachment did not occur and there were no serious perioperative complications. 2 patients died from one of the underlying diseases after 3 and 25 months, respectively. CONCLUSION: Despite an increasing number of case series, there are still no uniform guidelines for ophthalmologists in Germany. There is agreement regarding systemic treatment and the intravitreal administration of antifungal agents. The role of ppV has not yet been clearly defined and the question of the adjuvant use of steroids (systemic and/or local) has also not been conclusively clarified.
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Endoftalmitis , Humanos , Masculino , Femenino , Anciano , Endoftalmitis/diagnóstico , Voriconazol/uso terapéutico , Estudios Retrospectivos , Cuerpo Vítreo/microbiología , Candida albicansRESUMEN
PURPOSE: To investigate if inflammation score (IS), calculated from the cornea, anterior chamber, iris, and vitreous, indicates endophthalmitis severity. METHODS: In a prospective study, consecutive adults with a clinical diagnosis of post-cataract endophthalmitis within 6 weeks of surgery were recruited. Patients were allocated to IS-based primary treatment (IS < 10: intravitreal injection and IS ≥ 10: vitrectomy) and randomized to two intravitreal antibiotics combinations (vancomycin + ceftazidime and vancomycin + imipenem). Undiluted vitreous microbiology work-up included culture susceptibility, polymerase chain reaction, Sanger sequencing, and targeted next-generation sequencing. RESULTS: The average age of 175 people was 63.4 ± 10.7 years and included 52.6% small incision cataract surgery and 47.4% phacoemulsification surgery. Severe endophthalmitis (IS ≥ 20), diagnosed in 27.4% of people, had a shorter time to symptoms (average 5.4 vs 8.7 days; P = 0.018), poorer presenting vision (all ≤ hand motion), higher culture positivity (50% vs 30.7%; P = 0.032), and higher Gram-negative bacterial infection (70.8% vs 46.2%; P = 0.042). For IS ≥ 20 discriminant and Gram-negative infection, Spearman's coefficient was 0.7 [P < 0.0001, 95% confidence interval (CI) 0.59-0.82], with an area under the receiver operating characteristic curve of 0.9 (95% CI 0.85-0.94, P < 0.0001), a Youden index J of 0.74, a sensitivity of 87.2%, and a specificity of 87.5%. The final vision of >20/400 and >20/100 was regained in 50.2% and 29.1% of people, respectively. The susceptibility of common Gram-positive cocci and Gram-negative bacilli was the highest for vancomycin (95.0%) and colistin (88.6%), respectively. NGS detected polymicrobial infection in 88.5% of culture-negative endophthalmitis. CONCLUSIONS: Higher inflammation scores indicated severe disease and Gram-negative infection in post-cataract endophthalmitis.
Asunto(s)
Catarata , Endoftalmitis , Infecciones Bacterianas del Ojo , Adulto , Humanos , Antibacterianos/uso terapéutico , Catarata/tratamiento farmacológico , Endoftalmitis/diagnóstico , Endoftalmitis/tratamiento farmacológico , Endoftalmitis/epidemiología , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/epidemiología , Inflamación , Complicaciones Posoperatorias/cirugía , Estudios Prospectivos , Vancomicina/uso terapéutico , Vitrectomía , Cuerpo Vítreo/microbiologíaRESUMEN
PURPOSE: Increasing rates of antibiotic resistance in endophthalmitis have been reported. This study examines outcomes of triple therapy with intravitreal vancomycin, ceftazidime, and moxifloxacin for endophthalmitis. METHODS: Retrospective, consecutive series of all patients treated with abovementioned intravitreal antibiotics from January 2009 to June 2021. Percentages of eyes attaining greater than or equal to 20/200 and 20/50 Snellen visual acuities and adverse events were evaluated. RESULTS: 112 eyes met inclusion criteria. 63 of 112 eyes (56%) achieved a visual acuity of 20/200 during follow-up, with 39 (35%) returning to at least 20/50. In subgroup analysis, 23 of 24 (96%) eyes with post-cataract endophthalmitis obtained ≥ 20/200 acuity and 21 of 24 (88%) obtained ≥ 20/50 acuity during follow-up. There were no cases of macular infarction. CONCLUSIONS: Intravitreal moxifloxacin (160 µg/0.1 mL) was well tolerated as an adjunct to vancomycin and ceftazidime for bacterial endophthalmitis. Use of this novel combination offers several theoretical advantages compared to standard therapy with two antibiotics, including expanded gram-negative coverage and potential synergy, and may be particularly valuable in geographies where the local antibiogram supports empiric use. Further study is merited to verify the safety and efficacy profile.
Asunto(s)
Endoftalmitis , Infecciones Bacterianas del Ojo , Humanos , Vancomicina/uso terapéutico , Ceftazidima/uso terapéutico , Moxifloxacino , Estudios Retrospectivos , Cuerpo Vítreo/microbiología , Antibacterianos , Endoftalmitis/diagnóstico , Endoftalmitis/tratamiento farmacológico , Endoftalmitis/microbiología , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/microbiologíaRESUMEN
A 17-year-old male was taken to the emergency department for decreased left visual acuity and floaters beginning that same day. There was a history of exposure to pulmonary tuberculosis five years before (mother as index case) followed by a four-month period of isoniazid prophylaxis. The ophthalmic examination showed posterior and intermediate uveitis in the left eye. Laboratory tests were normal; IgG for herpes simplex 1 was positive and both the varicella-zoster virus and remaining serologic tests were negative. Chest radiography was normal. Two weeks later, an epiretinal membrane with risk of tractional retinal detachment was observed. The Mantoux tuberculin skin test showed an induration of 15 mm and the IGRA test was positive. Sputum and vitreous humor samples were collected. Quadruple therapy and prednisolone were started. Ten days later, a posterior vitreous detachment with underlying vitreous hematoma was observed. Posterior vitrectomy and peripheral endolaser were performed without complications. One month later, the microbiological results became available, with the identification of Mycobacterium tuberculosis. Corticosteroids were weaned progressively. Antituberculous drugs were maintained for six months. The patient made a full recovery.
Asunto(s)
Oftalmopatías , Mycobacterium tuberculosis , Tuberculosis Ocular , Masculino , Humanos , Niño , Adolescente , Tuberculosis Ocular/diagnóstico , Tuberculosis Ocular/tratamiento farmacológico , Tuberculosis Ocular/cirugía , Cuerpo Vítreo/microbiología , Cuerpo Vítreo/cirugía , Vitrectomía , Oftalmopatías/cirugíaRESUMEN
PURPOSE: The aim of this study is to report the clinical characteristics, causative organisms, and treatment outcomes in patients presenting with endophthalmitis related to XEN stent implants. DESIGN: Retrospective, noncomparative consecutive case series. METHODS: Clinical and microbiologic review was performed for 8 patients presenting to the Bascom Palmer Eye Institute Emergency Room between 2021 and 2022 with XEN stent-related endophthalmitis. Data collected included clinical characteristics of patients at presentation, organisms identified in ocular cultures, treatments received, and visual acuity at last follow-up. RESULTS: The current study included 8 eyes from 8 patients. All cases of endophthalmitis occurred >30 days after implantation of the XEN stent. At the time of presentation, there were external exposures of the XEN stent in 4 of 8 patients. Five of the 8 patients had positive intraocular cultures, all of which were variants of staphylococcus and streptococcus species. Management included intravitreal antibiotics in all patients, explantation of the XEN stent in 5 patients (62.5%), and pars plana vitrectomy in 6 patients (75%). At last follow-up, 6 of the 8 patients (75%) had a visual acuity of hand motion or worse. CONCLUSIONS: Endophthalmitis in the setting of XEN stents results in poor visual outcomes. The most common causative organisms are staphylococcus or streptococcus species. At time of diagnosis, prompt treatment with broad-spectrum intravitreal antibiotics is recommended. Consideration can be made to explant the XEN stent and perform early pars plana vitrectomy.
Asunto(s)
Endoftalmitis , Infecciones Bacterianas del Ojo , Humanos , Estudios Retrospectivos , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/etiología , Endoftalmitis/diagnóstico , Endoftalmitis/tratamiento farmacológico , Endoftalmitis/etiología , Cuerpo Vítreo/microbiología , Vitrectomía/efectos adversos , Antibacterianos/uso terapéutico , Stents/efectos adversosRESUMEN
PURPOSE: To report an atypical case of exogeneous endophthalmitis presenting with Roth spots. CASE: A 67-year-old man presented with decreased vision, mild pain, and discomfort in his left eye 12 days after an intravitreal aflibercept injection. Best-corrected visual acuity was 20/200, and there were +3 anterior chamber cells. On fundus examination, multiple intraretinal hemorrhages with a central white core resembling a Roth spot were observed. Intravitreal antibiotic injections were performed, and a vitreous sample was taken. Although post-intravitreal injection history was available, full systemic screening was planned to rule out endogenous endophthalmitis because of the presence of these Roth spots. Vitrectomy was performed and methicillin-sensitive coagulase-negative Staphylococcus was detected on culture. CONCLUSION: Although the presence of Roth spots is an unexpected finding in post-injection endophthalmitis, it was nevertheless demonstrated in our case. For this reason, it should be kept in mind that Roth spots can be encountered in bacterial endophthalmitis.
Asunto(s)
Endoftalmitis , Infecciones Bacterianas del Ojo , Masculino , Humanos , Anciano , Inyecciones Intravítreas , Endoftalmitis/diagnóstico , Endoftalmitis/tratamiento farmacológico , Endoftalmitis/etiología , Cuerpo Vítreo/microbiología , Vitrectomía/efectos adversos , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/etiología , Antibacterianos/uso terapéuticoRESUMEN
PURPOSE: We report a case of delayed onset Cutibacterium acnes ( C. acnes , formerly Propionibacterium acnes or P. acnes ) endophthalmitis with the onset triggered by intravitreal steroid injection (triamcinolone acetonide) in a pseudophakic patient, 7 years after cataract surgery. METHODS/PATIENTS: A 67-year-old man presented with gradual worsening of vision, eye redness, and photosensitivity that started a month after intravitreal triamcinolone acetonide injection (Triescience, 4 mg/0.1 mL, Alcon Labs, Fort Worth, TX) for cystoid macular edema secondary to branch retinal vein occlusion in the right eye. The patient had undergone cataract surgery with intraocular lens in that eye 7 years prior. Examination showed the visual acuity of counting fingers at 3 feet and conjunctival injection, with 2+ anterior chamber cell and 2+ vitreous haze. Uveitis work up including angiotensin-converting enzyme, QuantiFERON Gold, and syphilis IgG screen was negative. Diagnostic pars plana vitrectomy with intravitreal injection of antibiotics was performed, and vitreous sample was sent for detailed laboratory analysis. RESULTS: Vitreous fluid analysis was positive for C. acnes and negative for viral, fungal, and malignant cells. Although the patient received intravitreal antibiotics injection twice, the intraocular infection and inflammation persisted which eventually required an intraocular lens and capsular bag removal, followed by insertion of a secondary intraocular lens later. CONCLUSION: Delayed onset C. acnes endophthalmitis may be triggered by an intravitreal steroid injection in pseudophakic patients.
Asunto(s)
Catarata , Endoftalmitis , Infecciones Bacterianas del Ojo , Uveítis , Masculino , Humanos , Anciano , Triamcinolona Acetonida/efectos adversos , Cuerpo Vítreo/microbiología , Endoftalmitis/microbiología , Glucocorticoides/efectos adversos , Infecciones Bacterianas del Ojo/etiología , Infecciones Bacterianas del Ojo/microbiología , Antibacterianos , PropionibacteriumRESUMEN
PURPOSE: To report a rare case of Abiotrophia defectiva bleb-associated endophthalmitis. METHODS: In this case report of a patient with bleb-associated endophthalmitis, the authors describe the features of severe and rapid onset, associated retinitis, and a favorable outcome after aggressive early intervention. RESULTS: A 75-year-old woman presented decreased visual acuity of hand motions with an elevated intraocular pressure of 39 mmHg in the left eye. Her ocular history was notable for severe primary open-angle glaucoma with uneventful trabeculectomy and cataract surgery in both eyes 7 years before. Examination revealed conjunctival injection and an opaque avascular cystic bleb along with anterior chamber cellular reaction with a B-scan ultrasound concerning for vitritis. A. 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 pars plana vitrectomy, her best-corrected visual acuity had improved to 20/500 at postoperative week one and then improved to 20/40 at postoperative month 2. Her examination was notable for resolved corneal edema, a deep and quiet anterior chamber, and resolved intraretinal hemorrhages. CONCLUSION: This is one of the first bleb-associated endophthalmitis cases with rapid identification of A. defectiva . A. 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 A. defectiva may be indicative of a greater bacterial load and should prompt aggressive intervention and that the visual prognosis can be favorable.