Preoperative COVID-19 RT-PCR Testing of Asymptomatic Patients for Ophthalmic Surgery: Experience from Two Tertiary Referral Centers

Purpose: The aim of this study was to evaluate how prevalent asymptomatic SARS-CoV-2 virus infection (COVID-19) is among patients undergoing ophthalmic surgery at two tertiary referral hospitals. Material(s) and Method(s): This retrospective study included patients without COVID-19 symptoms who underwent preoperative screening using reverse transcription-polymerase chain reaction (RT-PCR) before ophthalmic surgery at the Kocaeli University and Gaziantep University departments of ophthalmology [between September 1, 2020, and December 15, 2020 (group 1);between March 1, 2021, and May 30, 2021 (group 2)]. Patients scheduled for surgery and followed up in the retina, glaucoma, pediatric ophthalmology and strabismus, cataract and refractive surgery, and cornea departments were examined. Result(s): RT-PCR was positive for SARS-CoV-2 in 12 (1.4%) of 840 patients in group 1 and 7 (1.1%) out of 600 patients in group 2. None of the patients were symptomatic of COVID-19. The majority of the patients were scheduled for retina or cataract and refractive surgery in both groups (group 1;retina: 29.2%, cataract and refractive: 57.0%, group-2;retina: 31.3%, cataract and refractive: 54.5%). SARS-CoV-2 RT-PCR testing was positive for seven patients in group 1 (7/245, 2.9%) and five patients in group 2 (5/188, 2.6%) who were scheduled for retinal surgery. Conclusion(s): The necessity, availability, and practicality of COVID-19 RT-PCR testing prior to ophthalmic surgeries varies depending on the protocols of each institution. COVID-19 RT-PCR testing is suggested especially before vitreoretinal surgeries and general anesthesia procedures, because of the difficulty in managing postoperative complications.Copyright © 2023 Gazi Eye Foundation. All rights reserved.

Klebsiella Endogenous Endophthalmitis During the COVID-19 Pandemic

Purpose: To describe the characteristics of Klebsiella pneumoniae endogenous endophthalmitis (KEE) encountered during the COVID-19 pandemic. Methods: This retrospective consecutive case series evaluated eyes that presented with KEE between March 2020 and July 2022. Results: Seven eyes of 5 patients developed KEE. Between January 2020 and July 2022, KEE was observed in 42% of consecutive EE cases compared with 7.8% during the preceding 13 years. COVID-19 was positive in 4 of 5 patients before they developed KEE. Only 1 patient presented with a VA better than hand motions (20/400). All eyes were treated with urgent vitrectomy and intravitreal and systemic antibiotics. No improvement in vision occurred in any patient;VA remained light perception to no light perception in 60% of eyes. Conclusions: The visual prognosis in KEE is extremely poor. The presence of a preceding COVID-19 infection in 80% of patients may signal a new risk factor for KEE. Patients with a hypervirulent Klebsiella syndrome should be routinely screened for EE. © The Author(s) 2023.

Endogenous fungal endophthalmitis following COVID-19 infection with microbiological and molecular biological correlation - A report of two cases.

This case report describes three eyes of two patients, who were diagnosed to have endogenous fungal endophthalmitis post coronavirus disease 2019 (COVID-19) infection. Both patients underwent vitrectomy with intravitreal anti-fungal injection. Intra-ocular samples confirmed the fungal etiology by conventional microbiological investigations and polymerase chain reaction in both cases. The patients were treated with multiple intravitreal and oral anti-fungal agents; however, vision could not be salvaged.

Management of presumed candida endophthalmitis during the COVID-19 pandemic: Case report and review of the literature.

PURPOSE: To report the management of a case of candida endophthalmitis following intubation for SARS-CoV-2 ARDS, during the first lockdown, underlining consequently the limited access to the gold standard of care. METHODS: Case report. RESULTS: We have described the case of a 56-year-old Hispanic man who developed bilateral Candida endophthalmitis after one month of hospitalization in the intensive care unit for severe SARS-CoV-2 pneumonia. Multimodal imaging was obtained. Full serological screening for infection was done resulting negative. A diagnostic vitrectomy was impossible due to the limited access at the surgery room. Diagnosis of presumed candida endophthalmitis was made, according to a highly qualified center, and therapy with intravenous liposomal amphotericin B was administered. At three months, we observed lack of vitreous opacities and atrophic scars with no active lesions. CONCLUSIONS: Diagnosis of candida endophthalmitis was a challenge in this pandemic scenario, given the impossibility of performing a diagnostic vitrectomy. Therefore, it was mainly based on patient's clinical manifestations, multimodal imaging and on unanimity of collegiality between our hospital and the highly specialized center.

Coincidence of Candida Endophthalmitis, and Aspergillus and Pneumocystis jirovecii Pneumonia in a COVID-19 Patient: Case Report.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is associated with immune system dysfunction and makes patients vulnerable to opportunistic infections. This report presents a patient with a history of COVID-19, suffering from opportunistic infections. CASE DESCRIPTION: We reported a 64-year-old man complaining of progressive visual loss in his left eye, who had previously been hospitalized for three weeks due to COVID-19. In the ophthalmologic assessment, large foci of dense subretinal and intraretinal infiltrations involving the macula were observed (compatible with endogenous fungal endophthalmitis). Real-time PCR result of intraocular fluid was positive for Candida spp. During subsequent hospitalization, the patient also suffered from fever and productive coughs (manifestations of pneumonia caused by Aspergillus fumigatus and Pneumocystis jirovecii). In response to antibiotic therapy, the fever and coughs subsided, and the ocular examination revealed a dramatic decrease in the size of retinal infiltrations. CONCLUSIONS: In patients with severe COVID-19, long-term ICU admission and immunosuppressive drugs lead to immune system dysfunction and make the patient more susceptible to opportunistic infections. Consequently, fungal pathogens such as Aspergillus, Pneumocystis jirovecii, and Candida spp. may cause infection in different body organs. Thus, clinicians should be alert and have clinical suspicion to diagnose accurately and manage patients accordingly.

Impact on corneal morphology after cataract surgery with intracameral moxifloxacin in neglected hard cataracts.

AIM: To evaluate corneal morphology after use of 0.5% intracameral moxifloxacin (ICM) in cataract surgery in patients who presented late with hard cataracts. METHODS: Cross-sectional study conducted from June-2021 to December-2021 at a tertiary eye-care center. 90 patients over 60 years with high-risk characteristics for Covid-19, who presented late with higher grades of nuclear-sclerosis (NS), were included. They underwent phacoemulsification and 0.5%moxifloxacin (0.1 ml) was injected intracamerally at the end of surgery. Best-corrected visual acuity (BCVA), intraocular pressures (IOP), endothelial cell density (ECD), coefficient of variation in cell-area (CoV), hexagonality (Hex) and central corneal thickness (CCT) were measured preoperatively and postoperatively on day1, day7 and day30. Statistical analysis was done by Anova test. p-value<0.05 was considered significant. RESULTS: Mean age of presentation was 65.26±8.3 years. Mean preoperative BCVA (1/60-to-6/60), IOP (16.7±2.3 mm of Hg), CCT (523.93±39.6µ), ECD (2547±302.08cells/mm2), Hex (47.04±5.7%) and CoV (37.57±3.9) changed to BCVA (6/9-to-6/6), IOP (17.5±2.1 mm of Hg), CCT (538.42±36.9µ), ECD (2388.40±339.25cells/mm2), Hex (44.44±5.6%) and CoV (39.09±4.5) at day30 postoperative. Average rate of change at day30 was increase in CCT (2.89%), ECD loss (6.4%), decrease in Hex (4.9%) and increase in CoV (4.6%), though clinically insignificant. No case of endophthalmitis or toxic-anterior segment syndrome seen. CONCLUSION: 0.5% moxifloxacin (0.1 ml) is safe as intracameral antibiotic to prevent postoperative infection in high-risk patients. The reported changes in the corneal parameters were within the range of any routine surgeries of hard senile cataracts. No specific effect could be attributed to ICM.

Subretinal Aspergillus Abscess in Post COVID-19 Recovered Patients - An Emerging Problem.

PURPOSE: To describe endogenous endophthalmitis in the setting of Covid-19 pneumonia post recovery. METHODS: Retrospective review of five patients of endogenous endophthalmitis following Covid-19 disease done. RESULTS: All five cases had received systemic corticosteroid for a mean duration of 7 days during severe Covid-19 treatment. Decrease vision was presenting symptom between 1 and 31 days following Covid-19 recovery. All patients had presumed fungal endogenous endophthalmitis based on clinical profile. Four out of five patients subjected to pars plana vitrectomy had microbiologically proven aspergillus species endogenous endophthalmitis on vitreous fluid assessment; two cases each of aspergillus niger and aspergillus fumigates. Four eyes underwent pars plana vitrectomy with silicone oil injection had shown satisfactory anatomical outcome with control of the infection; however, no significant visual gain achieved. CONCLUSION: We reported five cases of aspergillus endogenous endophthalmitis in Covid-19 recovered patients to document the likely presentation of this rising entity and avoid misdiagnosis.

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

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

Legal obligation in the general population: face mask influence on endophthalmitis after intravitreal injection.

PURPOSE: To investigate whether compulsory face masking in public life changes the incidence or pattern of post-injection endophthalmitis (PIE). PATIENTS AND METHODS: All injections of bevacizumab, ranibizumab, aflibercept, dexamethasone or triamcinolone between 01/01/2015 and 12/31/2021 at the University Eye Clinic of Tuebingen were included in this retrospective analysis. The injection procedure itself was unchanged since 2015 and included the use of a sterile drape covering the head up to the shoulders which prevents airflow toward the eye. Furthermore, all staff wore a face mask and gloves at all times. The two study periods were defined by the introduction of a compulsory face masking rule in public life (01/01/2015 until 04/27/2020 vs. 04/28/2020 until 12/31/2021). RESULTS: A total of 83,543 injections were performed in the tertiary eye clinic, associated with a total of 20 PIE (0.024%, 1/4177 injections). Of these, thirteen PIE were documented during the pre-pandemic period (0.021%, 1/4773 injections) and seven PIE during the pandemic period (0.033%, 1/3071 injections). No significant difference in PIE risk was observed (p = 0.49), and there was no case of oral flora associated PIE. CONCLUSION: Although some potential confounders (wearing time, skin flora) could not be considered, there was no clear signal that the introduction of compulsory face masking in public life did alter the risk for PIE in our patient population. Three and six months after PIE, no difference in visual acuity was detectable between the two study periods.

Ocular adnexal lymphoma masquerading as orbital cellulitis in a child: A rare presentation!

Background: Extra-nodal natural killer/T-cell lymphoma (NKTCL) is a rare form of non-Hodgkin lymphoma (NHL). Few cases of Ocular adnexal T-cell lymphoma presenting as pre-septal cellulitis/orbital cellulitis has been reported in the literature. However, Extra Nodal NK/T cell non-Hodgkin lymphoma presenting as orbital cellulitis and also with multisystem involvement in the paediatric age group is a rare presentation and not reported earlier. Method(s): 13 years old male presented to us with weakness of left side with left facial palsy for 2.5 months and right eye severe proptosis and vision loss for 2 months. Initially, He was diagnosed with Orbital cellulitis and treated for the same from elsewhere. PET-CT showed FDG avid metabolic active largest soft tissue mass in left lung upper lobe encasing first rib, large active soft tissue mass in the periorbital area, right nasal cavity, right lobe of the thyroid, right kidney, pancreas head, scrotal area, multiple bony lesions. Further biopsy from rib mass revealed NK- T cell lymphoma. He was diagnosed with a rare case of NK/ T cell Non-Hodgkin Lymphoma with multisystem involvement. Initially, he responded to SMILE regimen of chemotherapy, but he developed white fluffy vitreous opacities in the left eye after 3 cycles, and before vitreous biopsy, he contracted COVID 19 infection. During COVID treatment he has received IV antibiotics and steroids. After recovery from covid illness, his vitreous opacities got disappeared suggestive of possible endophthalmitis rather than intraocular lymphoma. Later within two weeks, he succumbed to the disease. Result(s): Died with disease Conclusion(s): Our case highlights that ocular adnexal lymphoma can be a possible masquerade in cases of refractory lid swelling with erythema and induration and can present as orbital cellulitis with multisystem involvement. Copyright © 2022

Mixed infection of rhino-orbito-cerebral mucormycosis and aspergillosis with culture proven aspergillus endophthalmitis in a post covid patient-A case report

Rhino orbito cerebral mucormycosis has become very common in this covid pandemic. Fungal endophthalmitis is also being increasingly reported. All fungal infections may not be just mucor. This is to report a case of rhino orbito cerebral mucormycosis and aspergillosis with aspergillus endophthalmitis, in a post covid patient who had required intensive care during covid illness. A post covid 73 years old female with type 2 diabetes mellitus and hypertension presented with sudden onset painful loss of vision in right eye with right sided headache. Anterior segment examination showed a streak hypopyon with fundus showing severe vitritis. Diagnostic nasal endoscopy and radiological features were suggestive of probable rhino orbital mucor mycosis, Patient was started on systemic amphotericin B with intravitreal and retro orbital amphotericin. The KOH mount and culture of the vitreous aspirate showed aspergillus while the histopathology of the sinus tissue revealed mucor along with aspergillus. Fungal endophthalmitis is making an appearance in a big way in this covid pandemic Early diagnosis and proper treatment is the only way to defend against these life-threatening fungi. Diagnostic nasal endoscopy with biopsy and vitreous tap for culture as well as histopathology taken before initiating treatment will go a long way in making a correct diagnosis. © 2022 Innovative Publication, All rights reserved.

Establishing a new public hospital vitreo-retinal surgical service, during COVID: Our experience

Purpose: To assess the clinical impact and surgical outcomes of a new public vitreo-retinal (VR) service established at Liverpool Hospital, a tertiary trauma referral centre in Sydney, in the context of the COVID-19 pandemic. Method(s): A retrospective surgical audit of all patients who had VR surgery at Liverpool Hospital from January 2020 to January 2021. Result(s): During the inception year of the new service, two surgeons performed 106 operations. Specifically, during the COVID-19 related suspension of elective surgery 22 emergency vitrectomy operations were performed. Of all operations performed, n = 40 (38%) were emergency procedures. The most common pathology was retinal detachment n = 32 (30%), 12 of which had Proliferative vitreoretinopathy at presentation. This was followed by diabetic vitrectomy n = 20 (19%) and nondiabetic vitreous haemorrhage n = 12 (12%). 8 patients had dropped nuclei (5 referred from peripheral hospitals) and 3 patients had endogenous endophthalmitis. Indications for vitrectomy were compared to the UK National Ophthalmology Database Study. Our service performed more operations for diabetic vitrectomy, nondiabetic vitreous haemorrhage and endophthalmitis compared to the UK cohort, while rates of surgery for retinal detachment were similar. At one month postoperatively, uncorrected visual acuity had improved to 6/12 or better in 41 patients (39%). 12 patients (11%) had uncorrected visual acuity worse than 6/60 at the same postoperative period, with limitations identified as PVR re-detachment (5), silicone oil (4), aphakia (2) and corneal scar (1). Conclusion(s): The results of the inaugural year of this VR service demonstrate its viability, despite COVID-19, and clinical results comparable to international standards.

Acute panuveitis after COVID-19 mRNA booster vaccination following cataract surgery.

Purpose: To report a case of presumed COVID-19 Pfizer third dose (booster) vaccination leading to severe panuveitis mimicking acute endophthalmitis in the early postoperative period following routine cataract extraction and intraocular lens implantation. Observations: A 68-year-old female with mild refractive error who previously received 2 doses of the BNT162b2 vaccine underwent routine cataract extraction and intraocular lens implantation in the right eye. On postoperative day (POD) 2 the patient received her BNT162b2 booster vaccination. On POD 3 the patient's vision was hand motion at face with photophobia. Anterior segment examination was significant for 2+ conjunctival injection, mild stromal edema, 4+ cell and flare with trace hypopyon, and 4+ anterior vitreous cell without any wound leak. Subsequent Gram staining, culture for aerobic and anaerobic bacteria, KOH preparation, and PCR testing for infectious organisms were also obtained, all of which were found to be negative. ESR and CRP values were also negative. The patient was started on intravitreal injections of vancomycin and ceftazidime, as well as oral moxifloxacin, fortified vancomycin and tobramycin drops, prednisolone acetate 1%, and atropine 1%. On POD 5 the patient reported significant improvement of her vision and was found to have 20/80 vision. On POD 12 her vision improved to 20/25, and improved further on POD 19 to 20/20 vision with a completely normal examination. Cultures remained negative throughout the entire course. Conclusions and importance: This is the first report to suggest a possible association between the BNT162b2 booster vaccination and development of acute panuveitis in the postoperative period after routine cataract extraction and intraocular lens implantation. This condition may mimic acute bacterial postoperative endophthalmitis and may portend a more favorable prognosis, but the authors believe such cases should nonetheless be treated aggressively as presumed infection.

Eye signs in anaesthesia and intensive care

Ophthalmology can be unfamiliar territory for the anaesthetist and intensivist. This updated article describes the clinical signs that may indicate injury to the eye, relevant to the operating theatre and intensive care environments. Patients are at risk of corneal abrasions, exposure keratopathy and chemosis. Prone positioning of patients, a task all too familiar to medical and nursing staff throughout the coronavirus disease (COVID-19) pandemic, is associated with additional risks of ischaemic optic neuropathy and acute glaucoma. The intensivist should also be alert to signs of ocular infection, for example, conjunctivitis, microbial keratitis and endophthalmitis. Ocular injury in the trauma patient requires prompt evaluation and management of sight-threatening conditions.

Clinical profile and visual outcome predictors in exogenous endophthalmitis in a referral center in Mexico City

Purpose : Exogenous endophthalmitis (EE) is the most serious complication of penetrating eye surgeries and open globe trauma (OGT). It is crucial to know the associated factors that will determine the final visual prognosis. The aim of the present study was to describe the epidemiological, clinical profile and visual outcomes (VO) predictors in patients with EE in a referral ophthalmology center. Methods : Retrospective, observational clinical study. Patients diagnosed with EE between January 2018 to September 2021 were included. Data collected included demographic characteristics, endophthalmitis origin, culture samples, microbiological diagnosis, initial and final best corrected visual acuity (BCVA), and treatment received. Major outcome was change in BCVA after endophthalmitis treatment and associated factors. T-test and Fisher's exact test for statistical analysis were used. Results : Seventy-three patients with EE were included. Surgery associated (SA) was the most common cause responsible for 39 cases (53.4%), followed by keratitis associated 18 cases (24.6%) and trauma associated (TA) 16 cases (21.9%). Gram-positive bacteria predominated in positive cultures (n= 35 [54.3%]). There was a statistically significant difference at mean age between TA group 41.1 ±18.7 years and SA group 59.9 ±20.9 years (p= 0.002). Final logMAR BCVA in the TA group was 4 ±0.9 (Snellen, light perception [LP]) and in the SA group was 2.7 ±1.7 (Snellen, Hand Motion [HM]). Fourteen (35.8%) patients in the SA group had a final BCVA ≥ 20/400;whereas in the TA group all patients had a final BCVA ≤ CF. Risk factors for non-improving BCVA after EE included OGT (p= 0.007) and initial BCVA of LP or worse (p <0.0001) in the SA group. There was no statistical difference in the final VO in patients that were treated with intravitreal injection (II) and those treated with vitrectomy (VTM) (p =0.40). Although 6 patients (75%) treated with VTM had an improvement in final BCVA compared with 12 (57.1%) of the patients just treated with II, this could be due to the sample number. We observed a tendency of diminishing cases of TA endophthalmitis after covid era, this could be associated with the isolation measures recommended. Conclusions : Surgery associated EE had a better visual prognosis than those with trauma associated EE. The initial BCVA is a meaningful indicator for final VO, being favorable when is better than HM.

ACUTE INTERSTITIAL NEPHRITIS AS A PRIMARY PRESENTATION OF CANDIDA INFECTIVE ENDOCARDITIS

Introduction: Acute Interstitial Nephritis (AIN) is an important cause of Acute Kidney Injury (AKI), and infections are the second most common etiology, after the drugs. However, AIN following fungal infections is rare. We describe two cases of AIN, which on the investigation turn out to be candidemia following fungal infective endocarditis. Methods: CASE 1: A 65-year-old man with hypertension and diabetes without diabetic or hypertensive retinopathy and prior normal renal function, presented to us with vague abdominal pain with steadily creeping creatinine to 2mg/dl within 2 weeks, and urine showed no albuminuria and sediments. There was no history of any specific drug intake. His hematological and other parameters were normal. Blood and urine cultures were sterile. He underwent a renal biopsy which revealed acute interstitial nephritis (Figure 1). He was started on prednisolone at 1mg/kg/day for 1-week following which he had a rapidly worsening azotemia requiring hemodialysis. Steroids were stopped. Repeat blood cultures were sent which grew candida albicans resistant to flucytosine. Re-evaluation of the fundus revealed macular infarct in the right eye with vitreoretinitis in the left eye suggestive of endophthalmitis. PET CT showed increased FDG uptake in both kidneys suggestive of pyelonephritis. Trans-esophageal echocardiography (TEE) showed aortic valve vegetations. He was treated with antifungals for 3 months. He was dialysis-dependent for 2 weeks. He gradually regained normal renal function 3 weeks after starting anti-fungal agents. CASE 2: A 57-years-old man with diabetic, hypertensive, and no diabetic retinopathy had severe covid pneumonia in June 2021 requiring oxygen and tocilizumab 80 mg for 4 days, recovered with normal renal function. He presented to us 1 month later with unexplained non-oliguric severe AKI requiring dialysis, with bland urine sediments. Renal biopsy showed lymphocytic infiltrates in the interstitium suggestive of AIN (Figure 2). Blood cultures were sterile, but serum beta-D-glucan was elevated at 333 pg/ml. He was Initiated on 1mg/kg of prednisolone, on the presumption of drug-induced AIN. Simultaneously workup for systemic infection revealed mitral anterior leaflet endocarditis. He was initiated on anti-fungal therapy on the advice of an infectious disease specialist and the steroid was stopped. He continued to be dialysis-dependent after 6 weeks, despite anti-fungal agents. Results: [Formula presented] Conclusions: AIN contributes a significant proportion of cases in unexplained AKI. Prompt evaluation with a renal biopsy is warranted. Acute interstitial nephritis particularly due to candidemia can be oligosymptomatic as seen in our two cases. Since steroids have a significant role in treating early AIN, a dedicated search for underlying silent endocarditis and candidemia is advisable before initiating steroid therapy. Ophthalmic fundus evaluation, TEE, and repeat blood culture may be necessary to identify hidden candidemia. We recommend an evaluation to exclude fungal endocarditis in patients with AIN who present with minimal or no symptoms and no definitive cause for AIN is present. No conflict of interest

Endogenous panophthalmitis in a patient with COVID-19 during hospitalization in an intensive care unit: A case report.

Purpose: To report a case of endogenous panophthalmitis in a patient with COVID-19 during treatment in an Intensive Care Unit. Observation: A 64-year-old woman with COVID-19 and Salmonella septicemia presented with decreased visual acuity, ocular pain, and proptosis in her right eye after treatment with favipiravir, intravenous dexamethasone, and ceftriaxone. An ocular examination of her right eye revealed periorbital tenderness, exophthalmos, and corneal haze. The ultrasonography showed a subretinal abscess. Her right eye lost light perception vision and underwent enucleation. Microbiologic evaluation of the enucleated right eye was negative for organisms. Conclusions and importance: Patents with COVID-19 may develop severe ocular involvement after COVID-19 due to a generalized reduction in immunity. Comorbidities and intensive care unit treatments can predispose COVID-19 patients to endogenous panophthalmitis.

Fundus findings in patients admitted with post COVID-19 sepsis in an intensive care unit.

Purpose: COVID-19 infection is being increasingly identified as a risk factor for the development of ocular infections, especially endogenous endophthalmitis. Current studies primarily report cases among survivors, and the overall prevalence, especially amongst patients admitted with active sepsis is unknown. We report on the fundus and systemic findings of inpatients who were being treated for post-COVID-19 systemic secondary infections in a tertiary intensive care unit. Methods: Retrospective observational study based on chart review. Results: A total of 24 patients were identified. These included 21 (87.5%) males and 3 (12.5%) females with ages ranging from 33 to 72 years (mean 54.1 years). Pre-existing risk factors included type 2 diabetes mellitus, systemic hypertension, chronic kidney disease, multiple myeloma, and patients on long-term corticosteroid/immunosuppressive treatment. Nine patients (37.5%) died and 15 (62.5%) survived. Of a total of 48 eyes, observed fundus lesions included endogenous endophthalmitis (4 eyes of 2 patients, 8.3%), preretinal hemorrhages (4 eyes of 2 patients, 8.3%), optic disc pallor (2 eyes of 1 patient, 4.1%), moderate non-proliferative diabetic retinopathy (4 eyes of 2 patients, 8.3%), Roth spots (2 eyes of 1 patient, 4.1%), and 2 eyes of 1 patient (4.1%) with evidence of previous pan-retinal photocoagulation. Conclusion: Two patients had evidence of endogenous endophthalmitis. These findings suggest that the actual incidence of ocular lesions, especially infections is higher than that reported. Fundus examination should form a part of the management protocol for patients being treated for post-COVID-19 systemic infections.

A Rare Case of Endophthalmitis with Rhizobium radiobacter, Soon after a Resolved Keratitis: Case Report.

BACKGROUND: Rhizobium (Agrobacterium) species are plant aerobic bacteria, which in some cases can produce endophthalmitis in humans after corneal trauma. CASE PRESENTATION: A 42-year-old female patient presented in the Emergency Department of the Emergency County Hospital of Craiova, Romania, reporting pain, epiphora, and blurry vision in her right eye for about five days. This initial infectious keratitis episode was successfully resolved, but after 20 days she presented again after trauma with a leaf with corneal abscess. In the conjunctival secretion, R. radiobacter was identified. Despite antibiotherapy, the patient's state did not improve, and ultimately the eye was eviscerated. METHODS: A search was performed in the ProQuest, PubMed, and ScienceDirect databases for the terms Agrobacterium, Rhizobium, radiobacter, and eye. We eliminated non-human studies, editorials and commentaries, and non-relevant content, and excluded the duplicates. RESULTS: In total, 138 studies were initially obtained, and then we selected 26 studies for retrieval. After the selection process, we ended up including 17 studies in our analysis. Most studies reported R. radiobacter endophthalmitis after ocular surgical procedures or outdoor activities that involve exposure to soil. CONCLUSION: R. radiobacter is a rare cause of endophthalmitis after eye trauma that generally responds well to usual antibiotherapy, but occasionally can evolve to severe, leading to the loss of the eye.