ABSTRACT
PURPOSE: To describe the clinical features, management, and long-term outcome of Infectious crystalline keratopathy (ICK). METHODS: The medical records of clinically diagnosed and microbiologically proven cases of ICK were reviewed from January 2011 to December 2022. Clinical characteristics include the presence of whitish needle-like projections with branching, limited to anterior-mid stroma. Keratoplasty being the most common risk factor, graft-related microbial keratitis during the same period was also studied. The demography, clinical profile, microbiology, treatment, and outcome were analyzed, and compared with secondary graft infiltrate(GI). RESULTS: Medical records of 24 cases with ICK were reviewed. The mean age was 49.3 ± 20.1 years, with 15(62.5%) males. Prior keratoplasty was done in 18 (75%) cases, with a mean graft size of 10.1 ± 1.5 mm, and mean interval between the last graft and presentation was 9.7 ± 6.2 (3-90) months. In comparison to GI (n = 24), ICK patients (n = 18,75%) were less symptomatic, presented late (7.3 ± 6.5 days vs 16.3 ± 19.4, p = 0.003), using frequent topical steroids (> 3 times/day, p = 0.006), smaller infiltrate size < 4 mm (p = 0.008), central (p = 0.02), less associated with epithelial defect (p = 0.0001), hypopyon (p = of 0.0002), corneal perforation (p = 0.0006), and surgical management (p = 0.03). On microbiology, 22 (91.6%) ICK cases were culture positive, 14 (63.6%) gram-positive, 3 (13.6%) gram-negative, 2 (9%) mixed bacteria, and 3 (13.6%) fungus, comparable with GI. CONCLUSION: ICK affects poor ocular surfaces usually following keratoplasty with larger graft size, the use of steroids being the most common association, and it responds to medical management as compared to GI.
Subject(s)
Eye Infections, Bacterial , Visual Acuity , Humans , Male , Middle Aged , Female , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/microbiology , Eye Infections, Bacterial/therapy , Retrospective Studies , Adult , Aged , Bacteria/isolation & purification , Anti-Bacterial Agents/therapeutic use , Cornea/microbiology , Cornea/pathology , Follow-Up Studies , Keratitis/microbiology , Keratitis/diagnosis , Corneal Diseases/diagnosis , Corneal Diseases/microbiology , Corneal Diseases/surgery , Corneal Diseases/therapy , Aged, 80 and over , Young Adult , Corneal Transplantation/methods , Fungi/isolation & purificationABSTRACT
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.
Subject(s)
Endophthalmitis , Eye Infections, Bacterial , Visual Acuity , Humans , Endophthalmitis/diagnosis , Endophthalmitis/microbiology , Endophthalmitis/epidemiology , Endophthalmitis/therapy , Male , Female , Retrospective Studies , Middle Aged , Aged , Adult , Aged, 80 and over , Adolescent , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/microbiology , Eye Infections, Bacterial/epidemiology , Eye Infections, Bacterial/therapy , Young Adult , Acute Disease , Child , Child, Preschool , Infant , Anti-Bacterial Agents/therapeutic use , Vitreous Body/microbiology , Vitreous Body/pathology , Vitrectomy/methodsABSTRACT
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.
Subject(s)
Anti-Bacterial Agents , Endophthalmitis , Eye Infections, Bacterial , Visual Acuity , Endophthalmitis/diagnosis , Endophthalmitis/microbiology , Endophthalmitis/therapy , Humans , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/microbiology , Eye Infections, Bacterial/therapy , Prognosis , Anti-Bacterial Agents/therapeutic use , Vitrectomy/methods , Retrospective Studies , Vitreous Body/microbiology , Bacteria/isolation & purification , Risk Factors , Male , FemaleABSTRACT
This article reviews key concepts in the epidemiology, clinical features, diagnosis and management of ocular syphilis. It is not a systematic review or meta-analysis, but highlights the critical clinical features and investigations in patients with ocular syphilis. It reviews the overlap and interplay between ocular and neuro syphilis and provides practical guidance to diagnose and manage patients with ocular syphilis.
Subject(s)
Eye Infections, Bacterial , Neurosyphilis , Humans , Neurosyphilis/diagnosis , Neurosyphilis/drug therapy , Neurosyphilis/therapy , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/microbiology , Eye Infections, Bacterial/therapy , Syphilis/diagnosis , Syphilis/drug therapy , Anti-Bacterial Agents/therapeutic use , Treponema pallidum/isolation & purification , Diagnosis, Differential , Syphilis Serodiagnosis , Disease ManagementABSTRACT
PURPOSE: Microbial keratitis is a sight-threatening condition with a higher incidence in agrarian populations. In countries with a high indigent population, due to financial and other constraints, patients prefer to seek therapy locally rather than travel to advanced centres. The aim of this study is to describe the epidemiology, clinical characteristics, and outcomes of 60 consecutive patients with microbial keratitis managed at a rural centre. METHODS: Descriptive case series. All patients clinically diagnosed with infectious keratitis were included. Corneal scrapings were obtained and microbiological identification was done by Gram stain. Anti-microbial therapy was commenced based on smear findings and the patients were followed up till disease resolution. RESULTS: Sixty eyes of 60 patients were diagnosed with microbial keratitis in the study period. The mean age was 47.43 ± 18.69 years. Male:female ratio was 47:53. Risk factors included ocular trauma in the majority of patients (46/60; 76.7%). Microorganisms were identified on 75.6% of smears, with fungal filaments (65.4%) being the most common. Ulcers were central in over half (32/60; 53.3%), and > 3 mm in diameter in over three-fourths (81.6%) of patients. Forty-four patients (73.3%) achieved treatment success whereas 16/60 (26.6%) required referral to our tertiary-eye care facility for management. The median time to resolution was 14 days (IQR 10-26 days). CONCLUSION: Our series demonstrates the feasibility of microbiology-guided therapy in microbial keratitis by ophthalmologists at the secondary rural eye-care level. Two-thirds of the patients could be successfully managed at the rural centre and only severe cases needed a referral to tertiary centres.
Subject(s)
Eye Infections, Bacterial , Rural Population , Humans , Male , Female , Middle Aged , Adult , Eye Infections, Bacterial/epidemiology , Eye Infections, Bacterial/microbiology , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/therapy , Aged , India/epidemiology , Rural Population/statistics & numerical data , Keratitis/epidemiology , Keratitis/microbiology , Keratitis/diagnosis , Young Adult , Anti-Bacterial Agents/therapeutic use , Adolescent , Corneal Ulcer/microbiology , Corneal Ulcer/epidemiology , Corneal Ulcer/diagnosis , Corneal Ulcer/drug therapy , Corneal Ulcer/therapy , Incidence , Eye Infections, Fungal/epidemiology , Eye Infections, Fungal/microbiology , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/therapy , Eye Infections, Fungal/drug therapy , Risk Factors , Bacteria/isolation & purificationABSTRACT
Neglected tropical diseases (NTDs) encompass a group of approximately 20 diseases prevalent in tropical and subtropical regions, closely associated with poverty, affecting over a billion people in low-income countries. This manuscript aims to explore the ocular manifestations and burden of two significant NTDs, namely Hansen's disease and trachoma while addressing gaps in understanding and management. Hansen's disease, caused by Mycobacterium leprae , has a long history and presents with diverse neurological and ocular manifestations. Despite the availability of treatment, ocular complications persist, leading to significant visual impairment in some cases. The manuscript emphasizes the importance of early diagnosis, regular ophthalmic examinations, and follow-ups to prevent and control ocular complications, reducing the burden of visual impairment and blindness. Trachoma, caused by Chlamydia trachomatis , remains the leading infectious cause of blindness in underdeveloped and remote areas. The manuscript highlights the clinical diagnosis and implementation of the World Health Organization's (WHO's) SAFE (surgery, antibiotics, facial hygiene, and environmental sanitation) strategy to prevent transmission and associated blindness. However, challenges in health surveillance tools and underreporting of trachoma cases are addressed, emphasizing the need for improved strategies to combat the disease effectively. Through a comprehensive review of the ocular manifestations and management of Hansen's disease and trachoma, this manuscript contributes to the existing knowledge base and enhances a deeper understanding of these NTDs. Addressing gaps in understanding and management emphasizes the importance of implementing WHO's strategies and collaborative efforts to achieve the global goal of reducing the burden of NTDs and improving community health and well-being. The manuscript underscores the significance of early intervention, preventive measures, and technological advancements, providing valuable insights for policymakers, healthcare professionals, and researchers working in the field of NTDs.
Subject(s)
Eye Infections, Bacterial , Leprosy , Trachoma , Humans , Trachoma/diagnosis , Trachoma/epidemiology , Leprosy/diagnosis , Leprosy/epidemiology , Leprosy/complications , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/microbiology , Eye Infections, Bacterial/epidemiology , Eye Infections, Bacterial/therapy , Blindness/etiology , Blindness/diagnosis , Blindness/prevention & control , Blindness/epidemiology , Neglected Diseases/diagnosis , Neglected Diseases/epidemiology , Global Health , Anti-Bacterial Agents/therapeutic useABSTRACT
PURPOSE: This study reports the experience of pediatric preseptal and orbital cellulitis at a London tertiary centre during a 6-year period and highlights the role of orbital surgeons in the management of subperiosteal abscess (SPA). METHODS: A retrospective review was conducted of all pediatric patients hospitalised for preseptal and orbital cellulitis. RESULTS: A total of 201 children including 152 cases of preseptal cellulitis and 49 cases of orbital cellulitis were admitted at a London tertiary centre over the study period. Patients with orbital cellulitis and especially those managed surgically had higher rates of fever, higher presenting white cell count and C-reactive protein level compared to cases of preseptal cellulitis. 77.6% of patients with orbital cellulitis had SPA. 81.6% of SPA had a medial component, while 28.9% had superior component. 61.2% of orbital cellulitis cases were managed surgically. Surgical intervention was carried out by otorhinolaryngologists (ENT) in 76.7% of cases, jointly between ENT and orbital surgeons in 16.7% of cases and by orbital surgeons alone in 6.7% of cases. Of the 11 SPA involving the orbital roof, all were surgically managed and orbital surgeons were involved in 54.5% of cases. When SPA involved the medial wall, orbital surgeons were only involved in 6.5% of cases. CONCLUSIONS: We recommend all patients with superior SPA be treated at a centre with both ENT and orbital surgeons as these may not be amenable to drainage by ENT alone.
Subject(s)
Anti-Bacterial Agents , Orbital Cellulitis , Tertiary Care Centers , Humans , Orbital Cellulitis/diagnosis , Retrospective Studies , Male , Female , Child , London , Child, Preschool , Adolescent , Infant , Anti-Bacterial Agents/therapeutic use , Abscess/therapy , Abscess/surgery , Abscess/microbiology , Eye Infections, Bacterial/microbiology , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/therapy , Ophthalmologic Surgical Procedures , Drainage , Cellulitis/surgery , C-Reactive Protein/metabolismABSTRACT
PURPOSE: Corneal biopsy helps in diagnosing deep-seated or recalcitrant lesions of microbial keratitis (MK). We aim to analyze its role in managing these challenging cases. METHODS: This is a retrospective review of 22 cases of corneal biopsy at our institute from January 2010 to December 2021. Data were retrospectively collected using the electronic medical record (EMR) system. Those cases of indolent, progressive MK or deep-seated lesions where cornea scraping was not possible were considered for corneal biopsy to establish the microbiological diagnosis. The primary aims of our study were to analyze the indications, success rates, and outcomes for biopsy patients in our series. Additional outcomes that were analyzed included the average time from presentation to biopsy, the type of causative organism isolated from the biopsy by either histopathological or microbiological method, and the frequency and outcome of surgical interventions performed. Descriptive statistics using mean (±standard deviation) and median (±range) were used to interpret the demographic data. RESULTS: Overall, 15 of 22 patients (68%) had a positive corneal biopsy after microbiological or histopathological examinations. The most identified organism was microsporidia (n = 4,30.7%), followed by mycobacteria (n = 2,15.4%), gram-negative bacilli (n = 2,15.4%), acid-fast bacilli (n = 1,7.6%), fungus (n = 2,15.4%), gram-positive cocci (n = 1,7.6%), and mixed bacterial infection (n = 1,7.6%). CONCLUSION: Corneal biopsy should be considered a diagnostic modality for patients with deep-seated or unresponsive MK. It can improve the treatment for MK, ensuring targeted therapy.
Subject(s)
Eye Infections, Bacterial , Keratitis , Humans , Retrospective Studies , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/therapy , Eye Infections, Bacterial/microbiology , Keratitis/microbiology , Cornea/pathology , Biopsy/methodsABSTRACT
Atypical mycobacteria or non-tuberculous mycobacteria (NTM) are a group of acid-fast bacteria that are pathogenic to different parts of the eye. The organisms can cause a spectrum of ocular infections including keratitis, scleritis, uveitis, endophthalmitis and orbital cellulitis. Trauma, whether surgical or nonsurgical, has the highest correlation with development of this infection. Common surgeries after which these infections have been reported include laser in situ keratomileusis (LASIK) and scleral buckle surgery. The organism is noted to form biofilms with sequestration of the microbe at different inaccessible locations leading to high virulence. Collection of infective ocular material (corneal scraping/necrotic scleral tissue/abscess material/vitreous aspirate, etc.) and laboratory identification of the organism through microbiologic testing are vital for confirming presence of the infection and initiating treatment. In cluster infections, tracing the source of infection in the hospital setting via testing of different in-house samples is equally important to prevent further occurrences. Although the incidence of these infections is low, their presence can cause prolonged disease that may often be resistant to medical therapy alone. In this review, we describe the various types of NTM-ocular infections, their clinical presentation, laboratory diagnosis, management, and outcomes.
Subject(s)
Eye Infections, Bacterial , Eye Infections , Keratitis , Mycobacterium Infections, Nontuberculous , Humans , Nontuberculous Mycobacteria , Mycobacterium Infections, Nontuberculous/therapy , Mycobacterium Infections, Nontuberculous/drug therapy , Anti-Bacterial Agents/therapeutic use , Eye Infections, Bacterial/therapy , Eye Infections, Bacterial/drug therapy , Keratitis/diagnosis , Cornea/microbiologyABSTRACT
BACKGROUND: Endophthalmitis, a potentially sight-threatening condition, remains a challenge for ophthalmologists worldwide. The endophthalmitis vitrectomy study (EVS) conducted in 1995 compared vitrectomy and intravitreal antibiotic injections to intravitreal antibiotic injections alone for acute post-cataract surgery and secondary intraocular lens endophthalmitis, setting treatment guidelines. However, the landscape of clinical practice has evolved considerably since then, raising questions about the applicability of EVS recommendations today. SUMMARY: Recent studies have proposed that early and complete vitrectomy (CEVE) could potentially be an effective approach for managing endophthalmitis cases, irrespective of the initial visual acuity. However, it is important to note that the level of rigor in these recent studies may not match that of the EVS study, and as such, this assertion should be considered with caution. Furthermore, the EVS study exclusively focused on post-cataract surgery cases, leaving other endophthalmitis types, like post-intravitreal injection and post-traumatic endophthalmitis, without standardized treatment guidelines. Research exploring the role of early vitrectomy in these contexts yields mixed results, emphasizing the need for further investigation and well-designed prospective trials. Endogenous endophthalmitis, originating from systemic infections, adds complexity to the scenario. While early vitrectomy shows promise in specific cases, conflicting evidence necessitates comprehensive research. KEY MESSAGES: This review underscores the necessity for tailored treatment strategies, supporting early vitrectomy when clinically indicated, and advocating for prospective trials to clarify its role in diverse endophthalmitis scenarios. As surgical techniques and antimicrobial therapies continue to advance, reevaluating treatment paradigms becomes crucial to enhance patient outcomes and protect ocular health.
Subject(s)
Cataract , Endophthalmitis , Eye Infections, Bacterial , Humans , Vitrectomy , Anti-Bacterial Agents/therapeutic use , Prospective Studies , Eye Infections, Bacterial/therapy , Eye Infections, Bacterial/drug therapy , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Retrospective Studies , Postoperative Complications/drug therapyABSTRACT
PURPOSE: To study predisposing factors, clinical presentation and management strategies for Klebsiella keratitis. METHODS: A retrospective case review was performed on clinical records of culture-proven Klebsiella keratitis cases in a tertiary referral center over an 8-year period (from 2012 to 2020). RESULTS: Thirty eight episodes of culture-proven Klebsiella keratitis were identified in 37 patients. The mean age of the patients was 62.9 years (range, 24-101). Multiple predisposing factors were identified in 33 eyes including history of previous keratoplasty (n = 11) history of ocular trauma (n = 7), preexisting ocular surface disease (n = 7) and diabetes (n = 6). Corrected distance visual acuity (CDVA) at presentation was light perception (LP) in 16 patients, hand motion (HM) in 12, counting fingers (CF) at 50 cm in 5, CF at 1 m in 1, CF at 2 m in 2. One patient had a CDVA of 3/10. On initial examination Hypopyon was detected in 21 eyes. Descemet's membrane folds were present in 1 eye. Corneal thinning was identified in 20 eyes and perforation occurred in 4 patients. Corneal ulcer progressed to endophthalmitis in one patient. Microbiologic sensitivity testing showed that 89.5% isolates were sensitive to amikacin (34/38),88.9%sensitive to ceftazidime (32/36),94.4% were sensitive to gentamicin (34/36),97.2% sensitive to ciprofloxacin (35/36), and 100% to levofloxacin (26/26).Ultimately, one or more surgical procedures was needed in 21 patients. CONCLUSION: Previous keratoplasty, history of ocular trauma, ocular surface disease and systemic disease such as diabetes are major risk factors for Klebsiella keratitis. In most of the patients, surgical and tectonic procedures were necessary to control the infection.
Subject(s)
Eye Infections, Bacterial , Keratitis , Humans , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Retrospective Studies , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/epidemiology , Eye Infections, Bacterial/therapy , Keratitis/drug therapy , Cornea/microbiology , Risk Factors , Anti-Bacterial Agents/therapeutic useABSTRACT
Bacterial corneal infections, or bacterial keratitis (BK), are ophthalmic emergencies that frequently lead to irreversible visual impairment. Though increasingly recognized as a major cause of global blindness, modern paradigms of evidence-based care in BK have remained at a diagnostic and therapeutic impasse for over half a century. Current standards of management - based on the collection of corneal cultures and the application of broad-spectrum topical antibiotics - are beset by important yet widely underrecognized limitations, including approximately 30% of all patients who will develop moderate to severe vision loss in the affected eye. Though recent advances have involved a more clearly defined role for adjunctive topical corticosteroids, and novel therapies such as corneal crosslinking, overall progress to improve patient and population-based outcomes remains incommensurate to the chronic morbidity caused by this disease. Recognizing that the care of BK is guided by the clinical axiom, "time equals vision", this chapter offers an evidence-based synthesis for the clinical management of these infections, underscoring critical unmet needs in disease prevention, diagnosis, and treatment.
Subject(s)
Eye Infections, Bacterial , Keratitis , Humans , Keratitis/therapy , Keratitis/drug therapy , Eye Infections, Bacterial/therapy , Eye Infections, Bacterial/drug therapy , Glucocorticoids/therapeutic use , Anti-Bacterial Agents/therapeutic use , CorneaABSTRACT
PURPOSE: Describe presumed microbial keratitis cases resulting in evisceration/enucleation from 2012 to 2016 in Sydney, Australia. METHODS: A retrospective case review included 33 patients. Cases were identified from pathology and hospital coding data. Sociodemographic and clinical details were collated. RESULTS: Mean age was 79 years (range: 38-100 years), and 64% female. There were 30 eviscerations and 3 enucleations, at a median time of 8 days (range: 1-270 days) due to endophthalmitis (n = 15, 45%). Major ocular associated factors included topical corticosteroid use in 12 patients (36%), exposure keratopathy in 4 (12%), ectropion in 3 (9%), degenerative corneal disease in 3 (9%), and corneal graft in 2 (6%). Pseudomonas aeruginosa was the most common isolate with no reports of antimicrobial resistance. CONCLUSIONS: Educating elderly patients with a history of topical corticosteroid use, corneal or ocular surface disease about prompt hospital presentation and treatment of microbial keratitis may decrease the probability of losing the eye.
Subject(s)
Corneal Diseases , Eye Infections, Bacterial , Keratitis , Humans , Female , Aged , Male , Retrospective Studies , Keratitis/diagnosis , Keratitis/etiology , Keratitis/drug therapy , Cornea , Eye Enucleation , Adrenal Cortex Hormones/therapeutic use , Glucocorticoids/therapeutic use , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/therapyABSTRACT
PURPOSE: To investigate the incidence, characteristics, risk factors, and treatment outcomes for infectious keratitis in patients with ocular Sjögren's syndrome (SS). METHODS: We performed a retrospective chart review of patients who had been followed up for ocular SS in Seoul National University Hospital from 2010 to 2020 and identified cases where infectious keratitis developed. The incidence, demographical and clinical characteristics, risk factors, microbiological profiles, and treatment outcome were investigated, some of which were compared with infectious keratitis cases in the non-SS group. RESULTS: Out of 929 patients with ocular SS, infectious keratitis occurred in 18 eyes (1.94%). All 18 patients were female in the ocular SS group, while 48 out of 100 infectious keratitis patients (48%) were female in the non-SS group (p < 0.01). The mean age at diagnosis of infectious keratitis was 66.1 years in the ocular SS group, which was not different from the non-SS group (57.2 years, p = 0.12). Of risk factors analyzed, the use of therapeutic contact lens was more frequently used in the ocular SS patients, compared to the non-SS patients (67% vs. 11%, p < 0.01). Culture-positivity rate was 50% in the ocular SS group. All culture-proven cases were bacterial infection, one of which was bacterial-fungal coinfection. Infection resolved in all eyes after the mean 29 days of medical treatment, except one that additionally required penetrating keratoplasty with vitrectomy. The visual acuity improved in 15 eyes (83%) after resolution. Infectious keratitis recurred in three patients (17%) during the mean 55.7 months of follow-up. CONCLUSIONS: The incidence of infectious keratitis was 1.94% in patients with ocular SS. Most were bacterial infections and resolved by medical treatment. Therapeutic and visual outcomes were favorable, but recurrence occurred in 17%.
Subject(s)
Eye Infections, Bacterial , Keratitis , Sjogren's Syndrome , Aged , Cornea , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/epidemiology , Eye Infections, Bacterial/therapy , Female , Humans , Keratitis/diagnosis , Keratitis/epidemiology , Keratitis/therapy , Male , Retrospective Studies , Sjogren's Syndrome/complications , Sjogren's Syndrome/diagnosis , Sjogren's Syndrome/epidemiologyABSTRACT
PURPOSE: To describe the clinical presentations, microbiology, and factors affecting management outcomes in lens abscess with concurrent endophthalmitis. MATERIALS: A retrospective, consecutive, noncomparative series including cases of endophthalmitis with concurrent lens abscess from January 2017 to May 2021. RESULTS: This study included 102 eyes, predominantly male (71.6%). All cases were posttrauma. The mean age noted was 30.47 ± 19.51 years. Presenting vision was logMAR 3.02 ± 0.74 (median 3.5, Snellen 20/63245). A favorable anatomical outcome was seen in 63 eyes (61.8%), while a final favorable functional outcome was seen in 51 eyes (50%). The mean follow-up duration was 10.04 ± 10.87 months (median 4.5). Final vision was logMAR 2.13 ± 1.32 (median 2.7, Snellen 20/10023) (P < 0.0001). The mean follow-up duration was 10.04 ± 10.87 months (median 4.5). Increasing age (OR 1.04, P = 0.02), female sex (OR 7.91, P = 0.007), initial intervention of vitrectomy instead of limited vitreous biopsy (OR 11.72, P = 0.009), and a negative vitreous culture (OR 14.28, P = 0.0004) predicted a favorable anatomical outcome. Absence of a corneal infiltrate (OR 11.11, P = 0.003) and initial intervention of vitrectomy instead of a limited vitreous biopsy (OR 21.96, P < 0.0001) predicted a favorable functional outcome. Culture positivity was seen in 56.9% of the cases. Gram-positive organisms were predominant (n = 41) followed by Gram-negative organisms (n = 12) and fungi (n = 10). CONCLUSION: Lens abscess can present concurrently with traumatic endophthalmitis. Management should involve the complete removal of the crystalline lens along with a pars plana vitrectomy for optimal outcomes.
Subject(s)
Endophthalmitis , Eye Infections, Bacterial , Lens, Crystalline , Abscess/complications , Abscess/diagnosis , Abscess/therapy , Anti-Bacterial Agents/therapeutic use , Endophthalmitis/drug therapy , Endophthalmitis/therapy , Eye Infections, Bacterial/complications , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/therapy , Female , Humans , Male , Retrospective Studies , Treatment Outcome , VitrectomyABSTRACT
Bacterial keratitis continues to be one of the leading causes of corneal blindness in the developed as well as the developing world, despite swift progress since the dawn of the "anti-biotic era". Although, we have expeditiously developed our understanding about the different causative organisms and associated pathology leading to keratitis, extensive gaps in knowledge continue to dampen the efforts required for early and accurate diagnosis, and management in these patients, resulting in poor clinical outcomes. The ability of the causative bacteria to subdue the therapeutic challenge stems from their large genome encoding complex regulatory networks, variety of unique virulence factors, and rapid secretion of tissue damaging proteases and toxins. In this review article, we provide an overview of the established diagnostic techniques and therapeutics for keratitis caused by various bacteria. We extensively report the recent in-roads through novel tools for accurately diagnosing mono- and poly-bacterial corneal infections. Furthermore, we outline the recent progress by our groups and others in understanding the sub-cellular genomic changes that lead to antibiotic resistance in these organisms. Finally, we discuss in detail, the novel therapies and drug delivery systems in development for the efficacious management of bacterial keratitis.
Subject(s)
Eye Infections, Bacterial , Keratitis , Bacteria , Cornea , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/therapy , Humans , Keratitis/diagnosis , Keratitis/etiology , Keratitis/therapyABSTRACT
OBJECTIVE: To report the clinical features and management outcomes of mixed fungal and bacterial endophthalmitis. METHODS: Retrospective, consecutive non-comparative case series. Fifteen eyes of 15 patients were included from January 2009 to December 2019 with culture proven mixed fungal and bacterial endophthalmitis. Demography, clinical presentations, interventions received, and final visual and anatomical outcomes were noted. A favorable anatomic outcome was defined as preservation of the globe, absence of hypotony, attached retina, and absence of active inflammation at the last visit. RESULTS: The mean age of patients in this series was 34.2 ± 19.6 years (range: 5-61 years). Male preponderance was found in 14 (93.3%). Eight (53.3%) eyes had open globe injury, 5(33.3%) had postoperative endophthalmitis and one (6.6%) each with endogenous endophthalmitis and post-keratitis. Pars plana vitrectomy was done in eight (53.3%) eyes whereas vitreous tap alone was done in seven (46.7%) eyes. Gram positive cocci (n = 11, 73.3%) were the commonest bacterial isolates (n = 7, 46.6%). Staphylococcus aureus (n = 3, 20%) was the most common bacterial isolate. The commonest fungi were filamentous hyaline fungi (n = 5, 33.3%). An unfavorable visual outcome (VA<20/400) was seen in all the eyes. The mean duration of follow-up was 13 ± 18.3 months. Globe salvage was possible only in five (33.3%) eyes. The bacterial isolates were highly sensitive to all of the tested antibiotics. CONCLUSION: Mixed fungal and bacterial endophthalmitis occur commonly in a setting of open-globe trauma. The presence of fungus concurrently leads to a very poor management outcome even if the bacterial isolate sensitivity is good.
Subject(s)
Endophthalmitis , Eye Infections, Bacterial , Eye Infections, Fungal , Adolescent , Adult , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Endophthalmitis/diagnosis , Endophthalmitis/epidemiology , Endophthalmitis/therapy , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/epidemiology , Eye Infections, Bacterial/therapy , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/epidemiology , Eye Infections, Fungal/therapy , Humans , Male , Middle Aged , Retrospective Studies , Visual Acuity , Vitrectomy , Young AdultABSTRACT
PURPOSE: To describe the presentation, microbiology, management, and prognosis of eyes with endophthalmitis after Boston keratoprosthesis implantation. METHODS: Retrospective case series with history, diagnostics, management, and outcomes data in endophthalmitis after keratoprosthesis implantation presenting to a tertiary center between 2009 and 2020. RESULTS: Of 137 keratoprosthesis-implanted eyes, 7 eyes of 7 patients (5%) developed endophthalmitis. On presentation, 6 (86%) reported decreased visual acuity, and only 1 (14%) reported pain. Peripheral corneal ulcers were present in 2 eyes (29%). Seidel testing was negative in all cases. Six eyes (86%) had retroprosthetic membranes. One (14%) underwent initial pars plana vitrectomy with mechanical vitreous biopsy, whereas 6 (86%) received a needle vitreous tap-half of which were dry. Organisms were isolated after vitreous tap in two eyes: Streptococcus intermedius and Mycobacterium abscessus. The mean visual acuity preendophthalmitis, at presentation, and at 6 months were 20/267, 20/5,944, and 20/734, respectively. The visual acuity improved 9.08 ± 11.78 Early Treatment Diabetic Retinopathy Study lines from presentation to 6 months. Six-month visual acuity was correlated with preendophthalmitis visual acuity (r = 0.92, P = 0.003) but not presenting visual acuity (P = 0.838). CONCLUSION: Visual acuity at 6 months is correlated with preendophthalmitis visual acuity, not presenting visual acuity. Endophthalmitis should be considered in the differential diagnosis of painless intraocular inflammation any time after keratoprosthesis implantation, even if Seidel negative.
Subject(s)
Artificial Organs , Cornea , Endophthalmitis/physiopathology , Eye Infections, Bacterial/physiopathology , Postoperative Complications , Visual Acuity/physiology , Aged , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Drug Combinations , Endophthalmitis/microbiology , Endophthalmitis/therapy , Eye Infections, Bacterial/microbiology , Eye Infections, Bacterial/therapy , Female , Humans , Male , Middle Aged , Mycobacterium Infections, Nontuberculous/microbiology , Mycobacterium Infections, Nontuberculous/physiopathology , Mycobacterium Infections, Nontuberculous/therapy , Mycobacterium abscessus/isolation & purification , Prostheses and Implants , Prosthesis Implantation , Retrospective Studies , Streptococcal Infections/microbiology , Streptococcal Infections/physiopathology , Streptococcal Infections/therapy , Streptococcus intermedius/isolation & purification , Vitrectomy , Vitreous Body/microbiologyABSTRACT
AIM: This study aimed to profile the clinical features and demographics of patients with endophthalmitis in a tertiary care center, Western region, Saudi Arabia. We used a retrospective cross-sectional case series at King Abdulaziz University Hospital. MATERIALS AND METHODS: Endophthalmitis was diagnosed in a total of 14 eyes of 14 patients treated in our hospital between 2002 and 2018. The patients' medical records were reviewed to gather demographic and clinical data. RESULTS: The mean age of patients was 52.8 ± 19.2 years, and 50% of patients were male. The majority of endophthalmitis cases were post-ophthalmic surgery (50%), 35.7% were of endogenous origin, 7.2% were associated with corneal ulcer with perforation, and 7.2% were post open globe injury. Patients' admission to the hospital ranged from 2 to 10 days from symptoms occurrence with a median of 5 days. Half of the patients presented with no light perception vision, counting fingers in 14.2%, hand motion in 14.2%, light perception in 7.2%, and 20/300 in 7.2%. The final visual outcome improved in four cases (28.5%) with best corrected visual acuity of 20/40 reached in one patient. CONCLUSION: Post- ophthalmic surgery and endogenous endophthalmitis were the most common causes of endophthalmitis among our patients, with late presentation to the hospital and poor vision at presentation also being common findings. These findings highlight the necessity of proper patient education, after care and adherence to sterile techniques in ensuring that patients recover successfully from ophthalmic surgery.
Subject(s)
Endophthalmitis , Eye Infections, Bacterial , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Cross-Sectional Studies , Endophthalmitis/drug therapy , Endophthalmitis/epidemiology , Endophthalmitis/etiology , Eye Infections, Bacterial/epidemiology , Eye Infections, Bacterial/therapy , Humans , Male , Middle Aged , Retrospective Studies , Saudi Arabia/epidemiology , Tertiary Care Centers , Visual AcuityABSTRACT
OBJECTIVE: To describe common bacterial organisms cultured from retrobulbar cellulitis and abscess lesions, in vitro susceptibility patterns, common diagnostic techniques utilized, etiologies encountered, and prevalence of blindness. ANIMALS STUDIED: Thirty-eight dogs diagnosed with retrobulbar cellulitis or abscessation from 2007 to 2017. PROCEDURE: For cases of orbital cellulitis or abscess, signalment, orbital imaging, cytology, histopathology, bacterial culture and susceptibility testing, presence of vision at the initial examination and resolution, and presumed cellulitis/abscess etiology were recorded. RESULTS: Most cases were medically (78.9%) versus surgically managed (18.4%). Most common form of orbital imaging was computed tomography (48.5%) followed by ocular ultrasound (18.2%). Fifteen of eighteen cultures (83.3%) showed growth of aerobic bacterial organisms, anaerobic bacterial organisms, or both. Most common aerobic bacteria were gram-negative bacilli (40.0%) followed by Corynebacterium sp. (26.7%) and α-hemolytic Streptococci sp. (26.7%) but Micrococcus and Bacillus spp. were also identified. Most common anaerobic bacteria were gram-negative bacilli (40.0%). Antibiotics with highest susceptibility patterns included gentamicin, followed equally by amoxicillin/clavulanic acid, cephalothin, chloramphenicol, and imipenem. No bacteria were susceptible to cefovecin. Six cases presented with vision loss due to retrobulbar disease (15.8%). Idiopathic (50%) disease and tooth root abscessation (23.7%) were most commonly diagnosed cause of orbital disease. CONCLUSION: Retrobulbar cellulitis/abscess is a serious and vision-threatening process, which can be effectively managed by broad-spectrum antibiotics such as gentamicin or amoxicillin/clavulanic acid, but not cefovecin. This study identified three organisms that have not been previously reported to be associated with orbital cellulitis (Corynebacterium sp., Bacillus sp. and Micrococcus sp.).