Profilaxis de la endoftalmitis posquirúrgica con cefuroxima intracamerular / Prophylaxis of postoperative endophthalmitis with intracamerular cefuroxime

RESUMEN Fundamento: La cirugía de catarata es la intervención oftalmológica más realizada en el mundo con exitosos resultados visuales posoperatorio, por lo cual una endoftalmitis posquirúrgica es una de las complicaciones más temidas y devastadoras. Objetivo: Caracterizar los pacientes operados de catarata a los cuales se les administró cefuroxima intracameral como método profiláctico para la endoftalmitis posquirúrgica durante los primeros 6 meses de su aplicación. Metodología: Se realizó un estudio retrospectivo en el Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus del 15 de octubre de 2015 al 15 de abril de 2016. El universo estuvo constituido por 575 pacientes operados de cirugía de cataratas y la muestra por 538 pacientes a los cuales se les aplicó cefuroxima intracamerular como método profiláctico. Resultados: Se incluyeron 538 pacientes de ellos 279 mujeres y 259 hombres con edad promedio de 46 a 60 años. Se presentaron complicaciones en 21 ojos. En ningún paciente se diagnosticó síndrome inflamatorio tóxico asociado al uso de medicamentos intraoculares. Se reportó un solo caso de endoftalmitis al cual se le realizó extracción extracapsular. Conclusiones: La inyección de cefuroxima intracameral es una maniobra sencilla, eficaz y segura para la profilaxis de la endoftalmitis posquirúrgica.

ABSTRACT Background: Cataract surgery is the most performed ophthalmologic intervention in the world with successful postoperative visual results, so a postoperative endophthalmitis is one of the most feared and devastating complications. Objective: To characterize cataract surgery patients who were given intracameral cefuroxime as a prophylactic method of postoperative endophthalmitis during the first 6 months of its application. Methodology: A retrospective study was carried out at Camilo Cienfuegos General Provincial Hospital in Sancti Spíritus from October 15, 2015 to April 15, 2016. The universe consisted of 575 patients operated on from cataract surgery with a sample of 538 patients which were applied intracamerular cefuroxime as a prophylactic method. Results: 538 patients were included, 279 women and 259 men with an average age of 46 to 60 years. There were complications in 21 eyes. In no patient was toxic inflammatory syndrome associated with the use of intraocular medications. A single case of endophthalmitis was reported and extracapsular extraction was performed. Conclusions: The injection of intracameral cefuroxime is a simple, effective and safe maneuver for the prophylaxis of postoperative endophthalmitis.

Profilaxis de la endoftalmitis posquirúrgica con cefuroxima intracamerular / Prophylaxis of postoperative endophthalmitis with intracamerular cefuroxime

RESUMEN Fundamento: La cirugía de catarata es la intervención oftalmológica más realizada en el mundo con exitosos resultados visuales posoperatorio, por lo cual una endoftalmitis posquirúrgica es una de las complicaciones más temidas y devastadoras. Objetivo: Caracterizar los pacientes operados de catarata a los cuales se les administró cefuroxima intracameral como método profiláctico para la endoftalmitis posquirúrgica durante los primeros 6 meses de su aplicación. Metodología: Se realizó un estudio retrospectivo en el Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus del 15 de octubre de 2015 al 15 de abril de 2016. El universo estuvo constituido por 575 pacientes operados de cirugía de cataratas y la muestra por 538 pacientes a los cuales se les aplicó cefuroxima intracamerular como método profiláctico. Resultados: Se incluyeron 538 pacientes de ellos 279 mujeres y 259 hombres con edad promedio de 46 a 60 años. Se presentaron complicaciones en 21 ojos. En ningún paciente se diagnosticó síndrome inflamatorio tóxico asociado al uso de medicamentos intraoculares. Se reportó un solo caso de endoftalmitis al cual se le realizó extracción extracapsular. Conclusiones: La inyección de cefuroxima intracameral es una maniobra sencilla, eficaz y segura para la profilaxis de la endoftalmitis posquirúrgica.

ABSTRACT Background: Cataract surgery is the most performed ophthalmologic intervention in the world with successful postoperative visual results, so a postoperative endophthalmitis is one of the most feared and devastating complications. Objective: To characterize cataract surgery patients who were given intracameral cefuroxime as a prophylactic method of postoperative endophthalmitis during the first 6 months of its application. Methodology: A retrospective study was carried out at Camilo Cienfuegos General Provincial Hospital in Sancti Spíritus from October 15, 2015 to April 15, 2016. The universe consisted of 575 patients operated on from cataract surgery with a sample of 538 patients which were applied intracamerular cefuroxime as a prophylactic method. Results: 538 patients were included, 279 women and 259 men with an average age of 46 to 60 years. There were complications in 21 eyes. In no patient was toxic inflammatory syndrome associated with the use of intraocular medications. A single case of endophthalmitis was reported and extracapsular extraction was performed. Conclusions: The injection of intracameral cefuroxime is a simple, effective and safe maneuver for the prophylaxis of postoperative endophthalmitis.

Panophthalmitis with orbital cellulitis following glaucoma drainage implant surgery in a pediatric patient / Panoftalmite com celulite orbitária após implante de drenagem em glaucoma congênito

ABSTRACT Here we report a case of childhood glaucoma refractory to angle and trabeculectomy surgery. The patient was treated with an Ahmed™ drainage implant that was subsequently complicated by rapid-onset panophthalmitis and orbital cellulitis. Intravenous and intravitreal antibiotic therapy was initiated and the drainage tube was removed. The infectious process resolved within 3 weeks; however, phthisis bulbi developed subsequently.

RESUMO Relato de um caso de uma criança portadora de glaucoma congênito primário, refratário a cirurgias angulares e trabeculectomias prévias, submetido à implante de drenagem do tipo Ahmed®. O paciente evoluiu com panoftalmite e celulite orbitária de aparecimento súbito, sendo submetido à remoção do tubo e antibioticoterapia endovenosa e intravítrea. O processo infeccioso foi resolvido em três semanas, porém o olho evoluiu para phthisis bulbi.

Comparison of 23G and 20G vitrectomy for treatment of infectious endophthalmitis / 中华眼底病杂志

ObjectiveTo compare the outcomes and safety of 23G and 20G vitrectomy for treatment of infectious endophthalmitis.MethodsThis was a retrospective case study.Sixty-seven eyes of 67 eyes suffering from infectious endophthalmitis with a history of trauma or intraocular operation history were enrolled in this study.They were diagnosed by the examinations of best corrected visual acuity,intraocular pressures,slit lamp microscope,indirect ophthalmoscopy,B-scan ultrasound and CT.There were 49 males (49 eyes) and 18 females (18 eyes).The patients aged from 18 to 72 years with a mean age of (43±13)years.There were 60 patients (60 eyes) with a history of trauma,7 patients (7 eyes) with intraocular operation history.The patients were enrolled into 20G vitrectomy group (35 patients,35 eyes) before December,2009 and 23G vitrectomy group (32 patients,32 eyes) after January,2010 when 23G vitrectomy system was imported in this hospital.Vitreous purulence was taken in all patients at the beginning of the surgery for bacteria and fungal culture and drug sensitivity test. A standard vitrectomy with artificial posterior vitreous detachment followed by internal limiting membrane peeling,and (or) intraocular laser photocoagulation,cryocoagulation,fluid-air exchange with intraocular silicone oil or gas tamponade were performed in all eases.Broad-spectrum antibiotics and glucocorticoids were used systematically for one week after surgery,but glucocorticoids were not used for fungal infections.The follow-up was ranged from two to nine months with a mean of (7 ± 1) months.The surgical time,inflammation situation,visual acuity,intraocular pressure, retinal reattachment rare,iatrogenic retinal hole rate, bulbar conjunctiva scar formation rate,reoperation rate and eye retention situation before and after surgery were comparatively analyzed.ResultsThe mean surgical times were (126 ± 12) and (89 ± 12) minutes in 20G and 23G group,which was significantly different (t=3.125,P＜0.05).The major surgery complications were ora serrata dialysis and other iatrogenic retinal breaks,and were occurred in 34 eyes,including 30 eyes (85.71％) in 20G group and 4 eyes (12.50％) in 23G group (x2 =35.85,P＜0.05).These 4 eyes in 23G group received foreign body removal surgery previously.The inflammation was controlled in 65 eyes (97.01％) including 34 eyes (97.14％) and 31 eyes (96.88％) in 20G and 23G group respectively,which was not significantly different (x2=0.004,P＞0.05).At last follow-up,There was no statistical difference of visual acuity between the two groups (t=3.12,P＞0.05).Fourteen eyes underwent silicone oil tamponade including 13eyes (37.14％) and 1 eye (3.13％) in 20G and 23G group respectively,which was significantly different (x2=11.703,P＜0.05).Nine eyes underwent reoperation (13.43％),including 8 eyes (22.86％) and 1eye (3.13％) in 20G and 23G group respectively,which was significantly different (x2=5.597,P＜0.05).The 8 re-operated eyes in 20G group included 1 eye of recurrent endophthalmitis and 7 eyes with retinal detachment,the 1 re-operated eye in 23G group was of recurrent endophthalmitis.There was significantly different (x2=7.147,P＜0.05) for the rate of retinal detachment between the 2 groups.There were 40eyes with bulbar conjunctiva scar including 35 eyes (100.00％) and five eyes (15.63％) in 20G and 23G group.Conclusion 23G vitrectomy is an effective treatment for infectious endophthalmitis with shorter surgery time,lower reoperation rate,lower retinal reattachment rate and fewer bulbar conjunctiva scar.

Surgical timing of severe infectious endophthalmitis / 中华眼底病杂志

Objective To investigate the clinical efficacy and surgical timing of vitrectomy combined with silicone oil tamponade for severe infectious endophthalmitis. Methods Sixty-two patients (62 eyes)with endophthalmitis, diagnosed by the examinations of the best corrected visual acuity (BCVA),intraocular pressure, slit-lamp microscopy, direct and (or) indirect ophthalmoscopy and ocular B-ultrasound. There are 44, 17 and 1 eyes with posttraumatic, postoperative and endogenous infectious endophthalmitis, respectively. The patients were randomly divided into the group A (32 eyes) and B (30eyes). The former was treated immediately by vitrectomy combined with silicone oil tamponade after diagnosis, while the latter was treated by the same surgery after drug treatment depended on patients'choice. Vitreous purulence was taken in all patients before vitrectomy for bacterial, fungal culture and drug sensitivity test. 19/62 (30.65%) vitreous samples were positive for culture. The follow-up was ranged from 6 to 26 months. The visual acuity, intraocular pressure and eye retention situation before and after surgery were comparatively analyzed. Results In group A, endophthalmitis was controlled in all eyes after surgery;the visual acuity and intraocular pressure improved significantly after surgery (χ2=43.72, 6.83; P＜0.05). In group B, endophthalmitis was controlled in 19/30 eyes (63.33%) after surgery; evisceration was performed on 11 eyes (36.67%) because of the atrophy of the eyeball. There was no significant difference of visual acuity before and after surgery. Conclusions Vitrectomy combined with silicone oil tamponade is an effective way to cure severe infected endophthalmitis. Performing the surgery immediately after the diagnosis is the key to achieve good effect.