Efficacy of a New Commercial Ocular Spray Containing Oftasecur Citrus Extract for Reducing Microbial Load in the Conjunctiva of Patients Receiving Intravitreal Injections.

INTRODUCTION: The control of conjunctival microbial load is crucial for patients receiving intravitreal injections (IVTs) in order to reduce the risk of endophthalmitis. The purpose of this work was to assess the antimicrobial activity of a new commercial ocular spray containing Biosecur citrus extract (Oftasecur®, Off Health, Florence, Italy). METHODS: This prospective cross-sectional pilot study included patients receiving IVTs who were instructed to apply Oftasecur spray onto the eye to be injected four times daily starting 4 days before surgery. The contralateral eye was considered the control. A conjunctival swab for microbiological analysis was performed in both eyes before starting study treatment and at the time of the injection. The Brief Ocular Discomfort Inventory (BODI) questionnaire was administered to patients based on an 11-point scale (0 for no discomfort and 10 for maximum discomfort). RESULTS: Thirty patients (15 male, 15 female; mean age 64.7 ± 11.6 [standard deviation, SD] years) were included. Before starting treatment, 53.3% of the total eyes tested positive during the microbiological analysis. After the treatment period, only 20% of the eyes tested positive at the time of injection, showing a significant reduction in the microbial load (p < 0.01). Moreover, in the treated arm, the positive swabs before and after the prophylactic treatment with Oftasecur ocular spray showed a significant reduction (from 70.4% to 29.6%; p = 0.003, McNemar's test). Oftasecur ocular spray was well tolerated, with an average BODI score of 1.2 (± 0.70 SD). CONCLUSION: Oftasecur ocular spray showed antimicrobial activity that significantly reduced the microbial load in patients receiving intravitreal injections. Therefore, it may have a role in the prophylaxis of infection in the setting of IVTs.

Screening for multiresistant pathogens before cataract surgery / Multirezisztens kórokozók szurése szürkehályog-mutét elott

Összefoglaló. Bevezetés: A multirezisztens kórokozók által okozott fertozések komoly gondot okoznak. Szemészeti szempontból az ebbe a körbe tartozó meticillinrezisztens Staphylococcus aureus (MRSA) baktérium bír kiemelkedo jelentoséggel. Célkituzés: Multirezisztens kórokozók irányában cataractamutét elott álló betegektol mintavétel és adatelemzés. Módszer: 257, cataractamutét elott álló beteg esetében végeztünk multirezisztens kórokozók szurésére vizsgálatot a conjunctivazsákból. A mikrobiológiai tenyésztés során multirezisztens kórokozóra pozitív eredményt adó betegek esetében a preoperatív kórtörténetet és az általános kíséro betegségeket feltártuk és elemeztük. Eredmények: A minták 17 beteg esetében multirezisztens kórokozóra pozitívak voltak. 11 esetben szisztémás rizikófaktorokat is találtunk. A pozitív betegeknél a mutétet csak a felszabadító mikrobiológiai eredmények birtokában végeztük el. A dekolonizált betegeknél ezt követoen a szakmai protokoll normális antibiotikumprevencióját alkalmaztuk. A 257 beteg 6,6%-ában találtunk multirezisztenskórokozó- és 5%-ában MRSA-pozitivitást. Posztoperatív endophthalmitis nem fordult elo. Következtetés: A cataractamutéteknél alkalmazott antibiotikus endophthalmitisprevenció multirezisztens kórokozóra pozitív betegeknél kevéssé hatékony lehet. Ezért javasolt a veszélyeztetett betegek multirezisztens kórokozókra történo szurése és dekolonizációja. Orv Hetil. 2021; 162(3): 106-111. INTRODUCTION: Infections caused by multiresistant pathogens may have serious consequences. In ophthalmological practice, methicillin-resistant Staphylococcus aureus (MRSA) is the most important multiresistant pathogen. OBJECTIVE: We took samples for multiresistant pathogens from patients assigned for cataract surgery. METHOD: We carried out multiresistant pathogen screening from conjunctival sac in 257 patients, who were assigned for cataract surgery. Preoperative case history and concomitant systemic diseases were evaluated in patients, who turned out to be positive for multiresistant pathogens during the screening procedure. RESULTS: The samples were positive for multiresistant pathogens in 17 patients. In the case history of 11 multiresistant pathogen positive patients, previous systemic risk factors could be explored. Multiresistant pathogen positive patients were operated only after the decolonisation. After the decolonisation, the normal antibiotic prevention was used before the surgery. Multiresistant pathogen positive was 6.6%, MRSA positive was 5% of the 257 patients. There were no cases of endophthalmitis in any of these patients. CONCLUSION: Endophthalmitis prevention with antibiotics, according to the guidelines, may not be efficient in multiresistant pathogen positive patients. Therefore, it is advisable to screen multiresistant pathogens and decolonisation at risk patients before cataract surgery. Orv Hetil. 2021; 162(3): 106-111.

Analysis of pathogenic factors and etiological characteristics of 531 patients with suppurative endophthalmitis / 中华眼底病杂志

Objective To analyze pathogenic factors and etiological characteristics of suppurative endophthalmitis.Methods A total of 531 consecutive patients (531 eyes) with suppurative endophthalmitis who were hospitalized in Qingdao Eye Hospital of Shandong Eye Institute from January 2006 to December 2015 were included in the study.Among them,410 patients with 410 eyes were males (77.2％),121 patients with 121 eyes were females (22.8％).The average age of the patients was 38.62± 15.36 years.The relevant medical records were collected to analyze the pathogenic factors.Samples of aqueous humor,vitreous or other intraocular samples were taken under aseptic conditions for bacterial and fungal culture and in vitro drug sensitivity test.Results Ocular trauma was the primary pathogenic factor of suppurative endophthalmitis (60.1％),other factors included postoperative endophthalmitis (19.0％),suppurative keratitis-related endophthalmitis (17.1％) and endogenous endophthalmitis (3.8％).Postoperative endophthalmitis mainly occured after cataract surgery.A total of 224 strains of organisms were isolated,among which the predominant organisms isolated were gram-positive bacteria (54.0％) and staphylococcus epidermidis was the most common (25.0％).The other pathogenic organisms were fungi (29.5％) and gram-negative bacteria (16.5％).Among the fungi,aspergillus (10.7％) was the dominant genus,followed by fusarium (9.8％).For gram-positive organisms,susceptibilities were vancomycin 97.4％,gatifloxacin 91.8％,fusidate acid 77.9％ and levofloxacin 54.6％.For gram-negative organisms,susceptibilities were gatifloxacin 85.7％,levofloxacin 77.8％,tobramycin 71.4％ and ceftazidime 62.5％.For fungal isolates,sensitivities were voriconazole 88.2％ and amphotericin B 84.8％.Conclusions Ocular trauma is the main pathogenic factor of suppurative endophthalmitis,followed by postoperative endophthalmitis and suppurative keratitis-related endophthalmitis.Gram-positive bacteria are the major pathogenic organisms,especially staphylococcus epidermidis followed by fungal species,among which aspergillus and fusarium were the dominating pathogenic genus.

Intracameral cefuroxime in combined pars plana vitrectomy and phacoemulsification: a study of safety.

BACKGROUND: Postoperative endophthalmitis is a severe complication after intraocular surgery. The aim of this pilot study was to investigate the safety of intracameral cefuroxime in combined vitrectomy and phacoemulsification for cataract and various vitreoretinal disease. METHODS: The charts of 152 patients who underwent combined phacoemulsification, intraocular lens implant and pars plana vitrectomy were reviewed. The final tamponade was chosen among fluid, air, gas or silicone oil, based on the requirement of each single case. Patients were operated on by four different surgeons. At the end of surgery, 1 mg/0.1 mL of intracameral cefuroxime (Aprokam) was administered. RESULTS: The mean follow-up was 6.26±7.78 months (range 1-12). No retinal complication, such as retinal infarction or hemorrhages were observed. No acute macular serous detachment and no new intraretinal cysts were noted, in those patients who received optical coherence tomography within the fifth day after surgery. No endophthalmitis was recorded. CONCLUSION: Intracameral cefuroxime, at the end of combined phacoemulsification and pars plana vitrectomy, is safe as it has no toxicity on the retina and maybe could be considered effective in endophthalmitis prevention. Due to the relatively small number of patients, further studies are advisable. SUMMARY STATEMENT: The standard dose of intracameral cefuroxime at the end of combined phacoemulsification and pars plana vitrectomy has no toxic effects on the retina. This paper/The abstract of this paper was presented at the European Vitreo Retinal Society Conference 2017 as a conference talk with interim findings. The poster's abstract was not published.

Povidone-iodine concentration and dosing in cataract surgery.

Iodine has been recognized as an effective bactericide since the 1800s, and povidone-iodine (PI) solution has been applied to the ocular surface and periocular skin since the 1980s to prevent endophthalmitis in cataract surgery. In vitro, PI solution kills bacteria quickly at dilute concentrations (0.05%-1.0%). In many instances, PI kills bacteria more quickly at these dilute concentrations than more conventional (5%-10%) concentrations. This is due to greater availability of diatomic free iodine in dilute solution, the bactericidal component of PI. The toxicity of PI, both in vitro and clinically, has been shown to be related to concentration. Current American Academy of Ophthalmology and the European Society of Cataract and Refractive Surgeons recommendations regarding PI use suggest using 5% PI before surgery. An alternative dosing strategy uses dilute PI repetitively throughout cataract surgery (0.25% every 30 seconds). We review the povidone-iodine literature with attention to basic science and use of dilute PI.

Prophylactic intracameral levofloxacin in cataract surgery - an evaluation of safety.

PURPOSE: To evaluate posterior and anterior segment safety of an intracameral injection of levofloxacin 0.5% ophthalmic solution as prophylaxis for patients undergoing cataract extraction and intraocular lens implantation. SETTING: This study was conducted at Manila Doctors Hospital, Ermita, Manila, Philippines. DESIGN: This was a prospective interventional study. METHODS: Eyes undergoing standard phacoemulsification cataract surgery with intraocular lens implantation were treated with intracameral levofloxacin 0.5% at the conclusion of surgery. Safety parameters, including best-corrected visual acuity (BCVA), endothelial cell counts, anterior chamber cells and flare, and central foveal thickness, were evaluated preoperatively and at 1 day and 1 week postoperatively. RESULTS: A total of 50 eyes of 50 patients were included in the analysis. At 1 week postoperatively, all eyes demonstrated BCVA of 20/30 or better and 19 eyes (38%) achieved BCVA of 20/20 or better. On the first postoperative day, no corneal edema was observed, and trace to +2 cells and flare in the anterior chamber were noted in all eyes. After 1 week, all eyes had a quiet anterior chamber and endothelial cell counts decreased by an average of 225 cells/mm2, which was marginally significant (p=0.0525) when compared to other time points. Optical coherence tomography results showed no statistically significant differences between central foveal thickness measurements before and after surgery. There were also no statistically significant differences in preoperative and postoperative pachymetry. No study-related adverse events occurred. CONCLUSION: There were no safety concerns associated with intracameral injection of levofloxacin 0.5%, prophylactically, following cataract surgery. Further study is required to demonstrate effectiveness in endophthalmitis prevention.

Mobile ultra-clean unidirectional airflow screen reduces air contamination in a simulated setting for intra-vitreal injection.

The aim of this study is to determine whether the use of a mobile ultra-clean laminar airflow screen reduces the air-borne particle counts in the setting of a simulated procedure of an intra-vitreal injection. A mobile ultra-clean unidirectional airflow (UDF) screen was tested in a simulated procedure for intra-vitreal injections in a treatment room without mechanical ventilation. One UDF was passed over the instrument tray and the surgical area. The concentration of particles was measured in the background, over the instrument table, and next to the ocular area. The degree of protection was calculated at the instrument table and at the surgical site. Use of the UDF mobile screen reduced the mean particle concentration (particles > 0.3 microns) on the instrument table by a factor of at least 100.000 (p < 0.05), and over the patient's eye by at least a factor of 436 (p < 0.05), which in clinical practice translates into significantly reduced air contamination. Mobile UDF screen reduces the mean particle concentration substantially. The mobile UDF screen may therefore allow for a safer procedural environment for ambulatory care procedures such as intra-vitreal injections in treatment rooms.

Microbiota conjuntival en el preoperatorio de pacientes que se someterán a cirugía de cataratas / Microbial flora isolated from patient's conjunctiva previous to cataract surgery

Background. Endophtalmitis post cataract surgery is one of most feared and devastating complications resulting in serious consequences and an uncertain visual prognosis. Antimicrobial prophylaxis against endophtalmitis must be based on the best knowledge of conjuntival microbiota. Objective: To establish microbiological basis for the best antibiotic prophylaxis to prevent endophthalmitis in cataract surgery. Materials and Methods: A descriptive, cross-sectional, prospective study. A preoperative conjunctival sample was taken from the lower fornix of 118 pacients, sowing it immediately in culture media. Identification of growing colonies and susceptibility testing were performed by manual or automated methods. Results: 106 (89.8%) of 118 preoperative cultures were positive. 159 bacteria were isolated in single or mixed flora, with 95% of Gram positive organisms. Staphylococci represented 76.1% of isolated bacteria, with 82.6% of coagulase-negative staphylococci (SCN) and 17.4% of Staphylococcus aureus. Forty two percent of SCN and 38% of S. aureus were methicillin resistan; both groups showed high susceptibility to tobramycin and fourth-generation fluoroquinolones. Conclusions: we recommend the use of topical tobramycin as pre-operative antimicrobial prophylaxis associated with povidone-iodine antisepsis. A fourth-generation quinolone is recommended when there is risk of infection.

Introducción: La endoftalmitis post-cirugía de cataratas es una de las complicaciones post-operatorias más temidas y devastadoras, pudiendo ocasionar secuelas graves, con un pronóstico visual incierto. La profilaxis antimicrobiana de esta complicación debe basarse en el conocimiento acabado de la microbiota presente en el territorio conjuntival. Objetivo: Establecer bases microbiológicas para una mejor profilaxis antimicrobiana de la endoftalmitis en cirugía de cataratas. Materiales y Métodos: Estudio descriptivo, de corte transversal, prospectivo. A 118 pacientes se les tomó muestra conjuntival pre-operatoria del fondo de saco inferior, sembrándola de inmediato en medios de cultivo. Las colonias desarrolladas se identificaron por métodos manuales y método de microdilución y difusión en disco. Resultados: De 118 cultivos pre-operatorios, 106 (89,8%) desarrollaron colonias bacterianas. Se aislaron 159 bacterias conjuntivales como especie única o cultivo mixta, siendo 95% grampositivas. El género Staphylococcus representó 76,1% del total de bacterias aisladas, siendo 82,6% Staphylococcus coagulasa negativa (SCN) y 17,4% Staphylococcus aureus. El 42% de los SCN y 38% de S. aureus presentaron resistencia a meticilina, presentando ambos buena susceptibilidad a tobramicina y fluoroquinolonas de cuarta generación. Conclusiones: Considerando nuestros resultados, recomendaríamos a nuestros pacientes tobramicina tópica como antibioprofilaxis, asociada a povidona yodada como antiséptico. Una quinolona de cuarta generación podría usarse cuando existan factores de riesgo de infección.

Clinical analysis of 282 patients with infectious endophthalmitis / 中华眼底病杂志

Objective To analyze the causes and pathogens of infectious endophthalmitis in ourhospital.Methods The clinical data and laboratory findings of 282 inpatients with infectiousendophthalmitis were retrospectively reviewed.There were 206 males(73.05%)and 76 females(26.95%)with a mean age of(36.0±11.2)years(range from 2 to 79 years).Except 14 patients who lost theireyeballs as of serious conditions.pathogen examinations of vitreous specimen had been performed for allremaining 268 cases.The clinieal and laboratory data were statistically analyzed by Chi-square and Kappaconsistency tests,when P<0.05 the difference should be considered as statistically significant.ResultsThe 4 major causes of infectious endophthalmitis of those 282 patients included ocular trauma(177cases,62.77%),infectious keratitis(61 cases,21.63%),eye surgery(32 cases,11.35%),andendogenous endophthalmitis(12 cases,4.25%).19.21% of the patients in ocular trauma group was 2-13years old,55.74% of the patients in infectious keratitis group was 14-50 years old,and 60.61% of thepatients in eye surgery group was 51-79 years old.The major pathogens were fungus and staphylococcieach accounted for 30.63% of all cases.Most of the pathogenic bacteria were sensitive to ciprofloxaein(81.81%)and gentamicin(77.92%).Conclusions The major reason of infectious endophthalmitis wasocular trauma,and the major pathogens were fungus and staphylococci.Those findings may help us totreat infectious endophthalmitis patients appropriately.