Presenting Characteristics, Treatment, and Visual Outcomes in Streptococcal Compared to Non-Streptococcal Endophthalmitis.

PURPOSE: Report the clinical findings, risk factors, treatment, and visual outcomes associated with Streptococcus endophthalmitis in comparison to culture-positive endophthalmitis associated with non-Streptococcus species. METHODS: A retrospective chart review of adults between 18 and 89 years of age diagnosed with exogenous culture-positive endophthalmitis between January 1, 2009, and January 1, 2018, at the Duke Eye Center (Durham, North Carolina) with at least six months of follow-up from time of initial diagnosis was conducted. Clinical data including patient demographics, ocular history, baseline corrected visual acuity (VA) prior to presentation, time to presentation, presenting exam findings, VA at presentation, presumed etiology of endophthalmitis, medical and surgical management, and VA at the six-month follow-up was extracted and statistically analyzed. RESULTS: Fifty-six eyes from 56 patients with culture-positive endophthalmitis were identified. Eyes with Streptococcus (n=18) had elevated intraocular pressure (IOP) at presentation (p=0.002), worse mean VA (Snellen) at presentation (20/14159 vs. 20/3098, p<0.001), and worse mean VA (Snellen) at six months (20/3475 vs. 20/235, p<0.001) compared to non-Streptococcus cases (n=38). Time to presentation (days) (median, IQR) was longer in eyes that underwent glaucoma surgery for both Streptococcus (2241 (836, 3709) vs. 3 (2, 31), p=0.003) and non-Streptococcus endophthalmitis (1236 (125, 3582) vs. 6 (4, 25), p<0.0001). There was no difference in VA at six months between Streptococcus and non-Streptococcus eyes based on treatment.  Conclusions: Streptococci are rare but important causes of exogenous endophthalmitis, and in our study, they were associated with worse visual outcomes than non-Streptococci. A history of any glaucoma surgery, even procedures performed years earlier, should be elicited when evaluating patients with ocular symptoms.

What is normal age-related thigh muscle composition among 45- to 84-year-old adults from the UK Biobank study.

A loss of skeletal muscle mass and an increase in intramuscular fat are known to occur as we enter middle and older age, but the expected changes or normative values have remained unknown. The primary reason for this is that imaging studies are difficult and expensive to conduct, and consequently, the sample sizes have remained small. The development of the UK Biobank which provides access to a large magnetic resonance imaging (MRI) data set of more than 50,000 participants provides an opportunity to finally address this question of normative values for each age group. The study's primary aim was to determine the age-related changes in thigh muscle composition (e.g., thigh fat-free muscle volume and intramuscular fat) between the ages of 45 and 84 years. The second aim was to analyse associations between thigh fat-free muscle volume and intramuscular fat with lifestyle behaviours (smoking, alcohol consumption, and physical activity), leg pain, and bone mineral density. Fifty thousand three hundred thirty-two participants were included in the study. Total fat-free thigh muscle declined between the ages of 45 and 84 years, while intramuscular fat of the thigh continued to increase. The changes were stable between these age groups. The mean volume of fat-free muscle ranged from 11.16 (SD: 1.40) to 13.26 L (SD: 1.85) in adult males and 7.60 (SD: 0.97) to 8.80 L (SD 1.29) in females between the ages of 45 and 84 years. For intramuscular fat, the change among women was from 6.94% (SD: 1.59) in the 45 to 54 years age bracket to 8.83% (SD: 1.92) in the 75 to 84 age bracket, while for men, it was 5.83% (SD: 1.30) in the 45 to 54 age bracket to 7.85% (SD 1.89) in the 75 to 84 age bracket. The total fat-free muscle volume and intramuscular fat percentage provided can be used for the purpose of reference standards or normative values for adults in the age groups provided. Fat-free muscle and intramuscular fat were found to be associated with a range of health, activity, and leg pain outcomes, and these should be investigated in a follow-up longitudinal imaging study.

Telomeres and aging: on and off the planet!

Improving human healthspan in our rapidly aging population has never been more imperative. Telomeres, protective "caps" at the ends of linear chromosomes, are essential for maintaining genome stability of eukaryotic genomes. Due to their physical location and the "end-replication problem" first envisioned by Dr. Alexey Olovnikov, telomeres shorten with cell division, the implications of which are remarkably profound. Telomeres are hallmarks and molecular drivers of aging, as well as fundamental integrating components of the cumulative effects of genetic, lifestyle, and environmental factors that erode telomere length over time. Ongoing telomere attrition and the resulting limit to replicative potential imposed by cellular senescence serves a powerful tumor suppressor function, and also underlies aging and a spectrum of age-related degenerative pathologies, including reduced fertility, dementias, cardiovascular disease and cancer. However, very little data exists regarding the extraordinary stressors and exposures associated with long-duration space exploration and eventual habitation of other planets, nor how such missions will influence telomeres, reproduction, health, disease risk, and aging. Here, we briefly review our current understanding, which has advanced significantly in recent years as a result of the NASA Twins Study, the most comprehensive evaluation of human health effects associated with spaceflight ever conducted. Thus, the Twins Study is at the forefront of personalized space medicine approaches for astronauts and sets the stage for subsequent missions. We also extrapolate from current understanding to future missions, highlighting potential biological and biochemical strategies that may enable human survival, and consider the prospect of longevity in the extreme environment of space.

IMPLICATIONS OF COMPLETE POSTERIOR VITREOUS DETACHMENT IN EYES WITH CENTRAL RETINAL VEIN OCCLUSION.

BACKGROUND/PURPOSE: To evaluate the status of the posterior vitreous hyaloid on presenting optical coherence tomography images of the macula and its relationship to clinical characteristics, treatment patterns, and outcomes in eyes with central retinal vein occlusion. METHODS: This is a retrospective longitudinal cohort study of consecutive patients with acute, treatment-naive central retinal vein occlusion diagnosed between 2009 and 2021 who had at least 12 months of follow-up. Clinical characteristics, treatment patterns, and outcomes were analyzed between eyes stratified based on the presence or absence of a complete posterior vitreous detachment (PVD) on optical coherence tomography at presentation. RESULTS: Of 102 acute, treatment-naive central retinal vein occlusions identified, 52 (51%) had complete PVD at presentation and 50 (49%) did not. Central subfield thickness was significantly lower in those with complete PVD (12 months: 284.9 ± 122.9 µ m vs. 426.8 ± 286.4 µ m, P < 0.001; last follow-up: 278 ± 127.9 vs. 372.8 ± 191.0 µ m, P = 0.022). One-year intravitreal injection burden was significantly less for those with a complete PVD than those without (5.1 ± 3.6 injections vs. 6.7 ± 3.3 injections, P = 0.013). CONCLUSION: Central retinal vein occlusion with complete PVD on presentation had significantly lower central subfield thickness and 1-year injection burden. Assessment of the vitreomacular interface in central retinal vein occlusion may serve as a prognostic imaging biomarker.

Reduced Incidence of Intravitreal Injection-Related Endophthalmitis With Prefilled Syringes.

Purpose: To evaluate the incidence and clinical characteristics of intravitreal injection-related endophthalmitis cases with antivascular endothelial growth factor (anti-VEGF) medications manufactured as prefilled syringes or non-prefilled preparations. Methods: This retrospective chart review comprised eyes that received intravitreal anti-VEGF at a single-specialty retina practice from January 1, 2014, to December 31, 2019. Eyes diagnosed with injection-related endophthalmitis were identified. Demographic and clinical data were abstracted from medical records, including the type of anti-VEGF agent, baseline and follow-up corrected visual acuity (VA), and microbiologic findings. Results: The review identified 88 cases of intravitreal anti-VEGF injection-related endophthalmitis and 325 990 total injections. Total injections included 32 045 (9.8%) bevacizumab (BEV), 93 073 (28.6%) ranibizumab (RAN), 122 947 (37.7%) aflibercept (AFL), and 77 925 (23.9%) ranibizumab prefilled syringe (RANPFS). Ten of the endophthalmitis cases were related to BEV, 21 to RAN, 45 to AFL, and 12 to RANPFS. The endophthalmitis rate was lowest for RANPFS (0.0154%) (BEV, 0.0312%; RAN, 0.0226%; AFL, 0.0366%) (P = .030). Thirty-four (41.5%) of 82 samples were culture positive. RANPFS had a significantly lower rate of culture-proven postinjection endophthalmitis than the other agents (P = .003). The mean VA for endophthalmitis cases related to RANPFS vs non-prefilled agents was similar at presentation (Snellen 20/2092 vs 20/2327) and at the 3-month follow-up (Snellen 20/201 vs 20/272) (both P > .05). Conclusions: Anti-VEGF medications in prefilled syringes may reduce the risk for medication contamination during injection preparation. RANPFS was associated with a lower rate of injection-related endophthalmitis than non-prefilled anti-VEGF medications.

Anisotropic Properties of Epitaxial Ferroelectric Lead-Free 0.5[Ba(Ti0.8Zr0.2)O3]-0.5(Ba0.7Ca0.3)TiO3 Films.

As the energy demand is expected to double over the next 30 years, there has been a major initiative towards advancing the technology of both energy harvesting and storage for renewable energy. In this work, we explore a subset class of dielectrics for energy storage since ferroelectrics offer a unique combination of characteristics needed for energy storage devices. We investigate ferroelectric lead-free 0.5[Ba(Ti0.8Zr0.2)O3]-0.5(Ba0.7Ca0.3)TiO3 epitaxial thin films with different crystallographic orientations grown by pulsed laser deposition. We focus our attention on the influence of the crystallographic orientation on the microstructure, ferroelectric, and dielectric properties. Our results indicate an enhancement of the polarization and strong anisotropy in the dielectric response for the (001)-oriented film. The enhanced ferroelectric, energy storage, and dielectric properties of the (001)-oriented film is explained by the coexistence of orthorhombic-tetragonal phase, where the disordered local structure is in its free energy minimum.

PSEUDOMONAS ENDOPHTHALMITIS AFTER 0.59 MG FLUOCINOLONE ACETONIDE SURGICAL IMPLANT IN A PATIENT WITH A LONG-STANDING CRAWFORD TUBE.

PURPOSE: The purpose of this study was to report a case of Pseudomonas aeruginosa endophthalmitis after surgical 0.59 mg fluocinolone acetonide implant in a patient with a long-standing Crawford tube. METHODS: This was a retrospective case review. RESULTS: A 52-year-old woman with a history of bilateral sarcoid-associated panuveitis and nasolacrimal duct obstructions treated with dacryocystorhinostomies and long-standing Crawford tubes underwent placement of a surgical fluocinolone acetonide implant. The Crawford tube was visible throughout the surgery and notably exhibited small amounts of rotation and prolapse with manipulation of the eye. On postoperative Day 4, the patient presented urgently with pain and decreased visual acuity. Endophthalmitis was suspected, and a vitreous tap and intravitreal injections of vancomycin and amikacin were performed. Cultures grew P. aeruginosa. Initially she responded to treatment with no evidence of intraocular infection or inflammation by postoperative Week 3. However, at postoperative Week 4, the patient returned with a yellow purulent subconjunctival nodule and surrounding scleral injection. A second nodule appeared 2 weeks later. The patient was treated with topical and systemic antibiotics. The nodules responded well to treatment showing notable consolidation and revealing an area of scleral thinning as they regressed. CONCLUSION: We present a case of P. aeruginosa endophthalmitis and presumed scleritis after the surgical fluocinolone acetonide implant placement in an eye with a Crawford nasolacrimal tube effectively treated with topical, intravitreal, and systemic antibiotics. Long-standing nasolacrimal duct hardware may allow reflux of nasopharyngeal and nasolacrimal bacteria, contaminating the ocular surface during surgery.

NOVEL METHOD FOR VISUALIZING PERIPHERAL RETINAL STRUCTURES WITH MICROSCOPE-INTEGRATED OPTICAL COHERENCE TOMOGRAPHY.

BACKGROUND/PURPOSE: Visualization of peripheral retinal structures with optical coherence tomography (OCT) can be challenging but can offer valuable clinical information. We describe a method for intraoperative OCT of the peripheral retina. METHODS: An investigational microscope-integrated OCT system with real-time 4D volumetric imaging was used in conjunction with a Goldmann style mirrored contact lens intraoperatively to capture peripheral images in three patients. RESULTS: We identified retinoschisis, a retinal break, and areas of focal retinal detachment using our peripheral OCT method. CONCLUSION: Use of a Goldmann lens in conjunction with intraoperative OCT offers surgeons the ability to resolve peripheral pathology that cannot be easily evaluated with OCT otherwise.

Superconducting niobium nitride: a perspective from processing, microstructure, and superconducting property for single photon detectors.

Superconducting niobium nitride (NbN) continues to be investigated decades on, largely in part to its advantageous superconducting properties and wide use in superconducting electronics. Particularly, NbN-based superconducting nanowire single-photon detectors (SNSPDs) have shown exceptional performance and NbN remains as the material of choice in developing future generation quantum devices. In this perspective, we describe the processing-structure-property relationships governing the superconducting properties of NbN films. We further discuss the complex interplay between the material properties, processing parameters, substrate materials, device architectures, and performance of SNSPDs. We also highlight the latest progress in optimizing SNSPD performance parameters.

Management Patterns and Outcomes for Intravitreal Injection-Related Endophthalmitis.

Purpose: This work describes the clinical management and outcomes in cases of presumed infectious endophthalmitis following intravitreal injection at a tertiary academic medical center. Methods: A retrospective review took place of eyes that presented to the Duke Eye Center over a 9-year period and were diagnosed with intravitreal injection-related endophthalmitis. Clinical presentation, management, microbiologic yield, visual outcomes, and complications were abstracted from medical records. Results: Of 23 eyes diagnosed with postinjection endophthalmitis, 52.2% underwent anterior chamber tap (33.3% of which first underwent dry needle vitreous tap), 47.8% underwent needle vitreous tap, 17.4% underwent neither, and none underwent pars plana vitrectomy (PPV) for initial management. Subsequent PPV was performed in 6 eyes (26.1%). Mean visual acuity (VA) improved by 50 Early Treatment Diabetic Retinopathy Study letters at 6 months. Eyes that underwent initial anterior chamber tap had worse presenting VA than those that did not (P = .01). Eyes undergoing subsequent PPV had worse VA at presentation (P = .02) and at 6 months (P < .001). Eyes presenting with VA of hand motion (20/8000) or worse were more likely to undergo subsequent PPV (P = .02). Conclusions: Eyes with intravitreal injection-related endophthalmitis presenting with VA of hand motion or worse were more likely to undergo subsequent PPV. Future studies with larger cohorts may reveal whether earlier vitrectomy should be considered in these patients.

Mycobacterium chelonae Endogenous Endophthalmitis in a Person Addicted to Intravenous Drugs Presenting as an Intraretinal Peripapillary Granuloma With Tractional Retinal Detachment.

Purpose: To report a case of Mycobacterium chelonae endogenous endophthalmitis in a 28-year-old man with recent intravenous drug use that presented as an intraretinal peripapillary granuloma extending from the optic nerve head with an associated macular tractional retinal detachment. Methods: Case report. Results: Anterior chamber tap yielded aqueous cultures positive for M chelonae. A diagnostic and therapeutic vitrectomy was performed after inpatient hospitalization for 3 weeks to relieve a progressively worsening tractional retinal detachment. Conclusions: Atypical causes of endophthalmitis, including nontuberculous mycobacterium, in the population of individuals addicted to intravenous drugs may present with intraretinal peripapillary granuloma associated with a macular tractional retinal detachment. Surgical debulking to relieve anteroposterior traction is an effective treatment option to improve long-term visual outcomes.

Rhegmatogenous Retinal Detachment in the Setting of Endophthalmitis: Risk Factors and Visual Outcomes.

BACKGROUND AND OBJECTIVE: To investigate risk factors for rhegmatogenous retinal detachment (RRD) and visual acuity (VA) in eyes with RRD after developing endophthalmitis. PATIENTS AND METHODS: Retrospective comparative study of 133 eyes with endophthalmitis at a tertiary center between 2009 and 2018. Demographics, exam findings, interventions, and outcomes were assessed. Cases of RRD within 6 months after onset of endophthalmitis were further analyzed. RESULTS: Seventeen eyes (12.7%) with endophthalmitis developed RRD. Endogenous etiology was associated with higher rate of RRD (P = .038). Eyes that developed RRD had worse VA (20/3271) at 6 months (20/236; P = .001). Excluding the six eyes with macula-off RRD, VA for the remaining 11 eyes that developed RRD (20/1213) was similar to those without RRD (20/236; P = .095). CONCLUSIONS: Endogenous etiology of endophthalmitis was associated with a higher rate of RRD. Eyes with successful RRD repair had outcomes similar to eyes that did not develop RRD. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:257-262.].

Initial Presentation of Cutibacterium (Formerly Propionibacterium) acnes Endophthalmitis Twenty-One Years After Cataract Surgery.

The authors report a case of an 81-year-old female who presented with sudden onset of light perception vision and intraocular inflammation. After several months of continuing symptoms despite antibiotics, an aqueous tap culture grew Cutibacterium acnes. The patient had cataract surgery 21 years prior, and had no intervening trauma, intraocular procedure, or endogenous source. The presumed diagnosis was C. acnes endophthalmitis with significantly delayed onset. Capsulectomy and intraocular lens removal resolved the patient's symptoms. In rare cases, C. acnes endophthalmitis may present as recurrent inflammation despite an extremely remote history of cataract surgery, mimicking a virulent, acute-onset endophthalmitis despite antibiotic administration. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:44-46.].

Ocular Toxocariasis Presenting as Endophthalmitis in a Young Adult Intravenous Drug User.

Purpose: This report describes the diagnosis of ocular toxocariasis presenting as endophthalmitis in an adult intravenous drug user. Methods: A case is reported. Results: Fundus imaging showed numerous white opacities obscuring the macula. Toxocara canis serology was reactive with an enzyme immunoassay titer of 1:2 (positive ≥ 1:32). Findings from bacterial and fungal cultures were negative, and vitrectomy cytology revealed no organisms. Postoperatively, serial optical coherence tomography imaging demonstrated a slight decrease in size of an intraretinal hyperreflective lesion in the macula. Conclusions: Owing to a variety of presentations, ocular toxocariasis can be challenging to diagnose. In a patient with a history of intravenous drug use where fungal and bacterial organisms are more common causes of endophthalmitis, it is important to have a wide differential of causative organisms, particularly in the context of negative culture results and a worsening clinical examination.

Treatment Patterns and Outcomes in Bleb-Related Endophthalmitis: A 9-Year Analysis at a Tertiary Eye Center.

Purpose: Clinical presentation, treatment choices, and outcomes in cases of bleb-related endophthalmitis (BRE) at a tertiary care center over a 9-year period are described. Methods: A retrospective review was conducted of patients diagnosed with BRE at Duke Eye Center (Durham, North Carolina) from January 1, 2009 to January 1, 2018, with at least 6 months of follow-up, assessing demographic data, initial management, and visual acuity (VA). Results: Twenty eyes of 20 patients with BRE were identified. Median time from surgery to presentation was 6.53 years. Presenting VA of light perception only was significantly associated with the decision to pursue pars plana vitrectomy (PPV) as initial treatment (odds ratio 59.4, 95% CI, 2.1-1670.8, P = .016). Twelve eyes (60%) had culture-proven infectious endophthalmitis. Eleven eyes (55%) underwent PPV during treatment; 5 eyes underwent PPV on presentation, and 6 eyes underwent PPV after initial presentation. Compared with pre-endophthalmitis VA, 6 eyes that underwent subsequent PPV had greater VA loss at 6 months than cases not undergoing subsequent PPV (Early Treatment Diabetic Retinopathy Study line loss of 14 vs 4 lines, respectively; P = .044). Conclusions: BRE eyes presenting with light-perception VA were more likely to undergo initial PPV; yet many eyes in this study required PPV during treatment. Visual outcomes are often poor in BRE despite intensive management. There was greater VA loss from pre-endophthalmitis VA levels at 6 months in eyes undergoing PPV after initial treatment. Prospective studies are needed to assess the optimal role of PPV in patients with BRE.

Time to Presentation after Symptom Onset in Endophthalmitis: Clinical Features and Visual Outcomes.

PURPOSE: To investigate the impact of time from symptom onset to presentation on the clinical course and outcomes of eyes with endophthalmitis. DESIGN: Retrospective, longitudinal cohort study. PARTICIPANTS: One hundred thirty-three eyes of 130 patients with endophthalmitis. METHODS: Adults diagnosed with endophthalmitis at the Duke Eye Center from January 1, 2009, through January 1, 2018, were identified using the Duke Enterprise Data Unified Content Explorer. Patient demographics, time of symptom onset, presenting clinical features, management, and outcomes were recorded by retrospective review. Patients were divided into those seeking medical care either early (within 2 days) or later (delayed, i.e., 3 days or longer) with regard to symptom onset. Clinical features, management, and visual outcomes of eyes with early or delayed presentation were compared. MAIN OUTCOME MEASURES: Mean corrected visual acuity (VA) at presentation and at 6 months. RESULTS: In eyes with delayed presentation, VA was significantly worse on initial examination (delayed, 20/2941 vs. early, 20/1124; P = 0.009) and at 6 months (delayed, 20/547 vs. early, 20/173; P = 0.01). When controlling for time to presentation, VA before endophthalmitis was correlated significantly with VA at 6 months (Pearson r = 0.55; R2 = 29%; P < 0.0001). Eyes with glaucoma drainage device-related endophthalmitis were more likely to have a delayed presentation (P = 0.03). Eyes with delayed presentation were more likely to have conjunctival injection on initial examination (delayed, 73% vs. early, 52%; P = 0.01). Visual acuity before endophthalmitis, pain, and patient-reported blurred vision were not associated with early or delayed presentation (P > 0.05). CONCLUSIONS: Delayed presentation was associated with worse VA on initial examination and at 6 months in eyes with endophthalmitis. Presence of pain did not prompt earlier presentation. Visual acuity before endophthalmitis was associated with VA at 6 months, regardless of time to presentation. Further investigation may help to improve anticipatory guidelines for at-risk patients.

Management Patterns and Visual Outcomes of Endophthalmitis After Glaucoma Drainage Device Placement: A Case Series.

PURPOSE: To describe clinical presentation, management, and outcomes of eyes with endophthalmitis related to glaucoma drainage device (GDD) placement. PATIENTS AND METHODS: Retrospective chart review of patients diagnosed with GDD-related endophthalmitis at Duke Eye Center from 2009 to 2018. RESULTS: Six eyes of 6 patients had endophthalmitis related to a GDD (2 Ahmed, 4 Baerveldt). The mean time from surgery to presentation was 22.7 months. Five of 6 cases (83%) had culture-proven infectious endophthalmitis. Eyes undergoing GDD explantation (n=2) had better visual acuity at 6 months compared with those without hardware removal (20/11,314 vs. 20/358). Visual acuity at 6 months was hand motion (20/8000) or worse in 3 of 6 cases (50%). CONCLUSIONS: GDD-related endophthalmitis often leads to poor visual outcomes. Hardware removal may lead to improved visual outcomes; a multicenter prospective study assessing the benefit of hardware removal may be warranted.

Endophthalmitis After Descemet Stripping Endothelial Keratoplasty: Microbiological Yield and Visual Outcomes.

PURPOSE: To describe the clinical presentation, management, and visual outcomes of 6 eyes with endophthalmitis after Descemet stripping endothelial keratoplasty (DSEK). DESIGN: Retrospective case series. METHODS: Setting: Tertiary, academic eye center. StudyPopulation: Individuals developing endophthalmitis after DSEK at the Duke Eye Center from January 1, 2009, to January 1, 2018, with at least 6 months of follow-up. ObservationProcedure: Retrospective chart review. OutcomeMeasures: Diagnostic procedures, microbiological yield, and visual outcomes. RESULTS: Six eyes of 6 patients were identified. Mean time from surgery to presentation was 51 days (range, 4-137 days). Dense vitreous opacities were present in all cases. Five of 6 cases (83%) had culture-proven infectious endophthalmitis (2 Candida glabrata, 2 coagulase-negative Staphylococcus, 1 Streptococcus pneumoniae). Aqueous tap yielded positive culture in 2 of 2 cases with adequate sample (100%); needle vitreous tap yielded positive culture in 0 of 3 cases. One eye underwent vitrectomy on presentation, and 3 eyes (50%) underwent subsequent vitrectomy for persistent endophthalmitis after a mean of 37 days. Mean pre-endophthalmitis visual acuity (VA) was 20/64; mean VA at 6 months was 20/2069 (average 15 ETDRS lines lost). VA at 6 months was light perception or no light perception in 3 of 6 cases (50%). One eye underwent enucleation at 6 months, and 1 eye became phthisical 1 year after endophthalmitis. CONCLUSIONS: DSEK-related endophthalmitis may lead to severe vision loss, even with prompt and appropriate treatment. Aqueous tap had a higher culture yield than needle vitreous tap in our series.

A Nine-Year Analysis of Practice Patterns, Microbiologic Yield, and Clinical Outcomes in Cases of Presumed Infectious Endophthalmitis.

PURPOSE: To analyze practice patterns, microbiologic yield, and clinical outcomes in cases of presumed infectious endophthalmitis at a single tertiary academic referral center. DESIGN: Retrospective chart review. PARTICIPANTS: Eyes diagnosed with endophthalmitis at the Duke Eye Center between January 1, 2009, and January 1, 2018, that underwent aqueous tap, needle vitreous tap, or mechanical vitreous biopsy with pars plana vitrectomy (PPV) in conjunction with intravitreal antimicrobials. METHODS: Charts of 133 eyes of 130 consecutive patients were identified and reviewed for etiology of endophthalmitis, ocular history, interventions, visual outcomes, complication rates, and microbiologic culture results. MAIN OUTCOME MEASURES: Microbiologic yield and corrected visual acuity (VA) at initial presentation and last follow-up (up to 1 year) were the primary outcome measures. Secondary outcome measures included need for subsequent intervention, retinal detachment (RD) rate, and antimicrobial sensitivities. RESULTS: Of the 133 cases of presumed infectious endophthalmitis, 74% were unrelated to cataract surgery. Initial management included intravitreal antimicrobials with aqueous tap in 46% of eyes, needle vitreous tap in 59% of eyes, and mechanical vitreous biopsy with PPV in 14% of eyes. Twenty-seven percent of cases that underwent initial aqueous or needle vitreous tap required subsequent intervention with PPV. Overall, 45% of endophthalmitis cases were culture proven. Needle vitreous tap and mechanical vitreous biopsy with PPV were more likely to yield culture growth compared with aqueous tap (P = 0.042, P = 0.004, respectively). All isolated bacteria were sensitive to the combination of intravitreal vancomycin and ceftazidime. Eyes that underwent initial mechanical vitreous biopsy with PPV had worse VA at presentation (P = 0.024) and at last follow up (P = 0.011) compared with eyes that underwent initial aqueous tap or needle vitreous tap. An RD occurred within 3-12 months in 13% (17/133) of cases, and of these, 41% had an endogenous etiology. CONCLUSIONS: Needle vitreous tap and mechanical vitreous biopsy were more effective in yielding positive cultures compared with aqueous tap; however, culture results may not influence initial intravitreal antimicrobial choice. Eyes with presenting VA between counting fingers and hand motion at 1 foot were more likely to undergo initial PPV.

Clinical Decision Making and Visual Outcomes in Endophthalmitis Treated with Systemic Corticosteroids.

PURPOSE: To characterize practice patterns and compare visual outcomes in patients with endophthalmitis who did or did not receive systemic corticosteroid therapy. DESIGN: Retrospective, nonrandomized comparative trial. PARTICIPANTS: Eyes diagnosed with endophthalmitis at the Duke Eye Center between January 1, 2009, and January 1, 2018, with at least 6 months of follow-up from the time of initial diagnosis. METHODS: Retrospective chart review identified 133 eyes of 130 consecutive patients meeting inclusion criteria. Clinical presentation, initial management decisions, and subsequent outcomes and complications were assessed. Visual acuity (VA) at presentation with endophthalmitis and at 6 months were assessed for each patient. Eyes treated with systemic corticosteroid therapy were identified for further analysis. MAIN OUTCOME MEASURES: Factors associated with oral steroid use on binary logistic regression analysis and improvement in VA 6 months after endophthalmitis. RESULTS: Of 133 eyes with endophthalmitis, 33 (25%) received oral steroids. Oral steroid use was associated with culture-positive endophthalmitis (odds ratio [OR] 2.7; 95% confidence interval [CI], 1.2-6.2), hypotony (OR, 4.2; 95% CI, 1.3-13.6), conjunctival hyperemia (OR, 2.6; 95% CI, 1.02-6.5), and anterior chamber fibrin on examination (OR, 2.7; 95% CI, 1.1-6.3). Eyes with endogenous endophthalmitis were less likely to receive oral steroids (OR, 0.2; 95% CI, 0.05-0.92). Eyes treated with oral steroids were more likely to show VA improvement of 3 lines or more after endophthalmitis (OR, 2.8; 95% CI, 1.1-6.7) and to exhibit greater improvement from presentation to month 6 (-1.102 logarithm of the minimum angle of resolution [logMAR] vs. -0.655 logMAR; P = 0.024). CONCLUSIONS: Systemic corticosteroid therapy was associated with improved visual outcomes in endophthalmitis. The decision to administer oral steroids was significantly associated with hypotony, conjunctival hyperemia, and fibrinous reaction on presentation. Culture-positive cases were more likely to receive oral steroids, whereas patients with endogenous endophthalmitis were less likely to receive oral steroids. A prospective, randomized trial of systemic corticosteroid use in endophthalmitis may be warranted.