The diagnostic utility of nanopore targeted sequencing in suspected endophthalmitis.

PURPOSE: This paper aimed to assess the diagnostic utility of a newly developed gene-based technology-nanopore targeted sequencing (NTS) in suspected endophthalmitis patients. METHODS: This retrospective study included 43 patients (44 eyes) with suspected endophthalmitis. NTS was applied along with microbiological culture to detect unknown pathogens in intraocular fluid samples. The diagnostic utility of NTS was mainly evaluated from three aspects, including the positivity rate of bacterial/fungal presence, diagnostic turnaround time and the frequency of change in treatment based on etiology test results. Non-parametric, two-sided Wilcoxon rank sum test, the McNemar's test and the kappa statistic were used for statistical comparisons. RESULTS: NTS showed significant advantages over traditional culture in positivity rates and diagnostic time (P < 0.001, kappa = 0.082; Z = -5.805, P < 0. 001). As regards antibiotic strategy, 17 patients (39.53%) and 5 patients (11.63%) underwent medication change following NTS and culture results respectively (P < 0.001, kappa = 0.335). With reasonable use of antibiotic and surgical intervention, most patients responded favorably, judged by significantly improved visual acuity (Z = -4.249, P < 0.001). The mean duration of hospitalization was 8.49 ± 2.45 days (range, 1-16 days). CONCLUSION: The high efficiency feature of NTS in pathogen detection renders it a valuable supplementary to traditional culture. Additionally, it has facilitated patients' management for the early and precise diagnosis of endophthalmitis.

IDENTIFICATION OF PATHOGENS IN THE INTRAOCULAR FLUID SAMPLES OF PATIENTS WITH ENDOGENOUS ENDOPHTHALMITIS USING RAPID NANOPORE TARGETED SEQUENCING.

IN BRIEF: Nanopore targeted sequencing showed a higher positivity rate and a shorter turnaround time than did traditional culture in identifying pathogens in the intraocular fluid samples of patients with endogenous endophthalmitis. PURPOSE: To evaluate the feasibility of clinical application of nanopore targeted sequencing (NTS) for the identification of pathogens in patients with endogenous endophthalmitis, especially those with fungus-associated endophthalmitis. METHODS: In this retrospective study, medical records and etiological results of 27 patients (34 eyes) with endogenous endophthalmitis were reviewed. The intraocular fluid samples were examined using both NTS and microbial culture. The results included the differences in detection time, positivity rate of pathogen detection, and positivity rate of fungus identification between two methods. RESULTS: NTS and microbial culture enabled the detection of etiologic agents in 89.28% and 35.71% of the samples, respectively. The difference of positivity rate between these methods was statistically significant ( P < 0.001). NTS also showed high sensitivity in both culture-positive and culture-negative samples (100% and 83.33%, respectively). Regarding culture-positive samples, the NTS results displayed a strong match with culture results. NTS showed a significantly higher positivity rate for fungal infection than did microbial culture (46.43% vs. 7.14%, P = 0.002). The average detection time of NTS was 1.11 ± 0.31 days, which was shorter than that of microbial culture (2.50 ± 0.58 days, Z = -4.686, P < 0.001). NTS technology facilitated an informed switch of intravitreal antimicrobial agents in 13 eyes. CONCLUSION: NTS, as a sensitive, specific, and timely complementary method, can be used along with traditional methods for the identification of pathogenic microorganisms in the intraocular fluid of patients with endogenous endophthalmitis.

Delineation of the bacterial composition in exogenous endophthalmitis using 16S rDNA sequencing.

PURPOSE: To determine the bacterial spectrum of exogenous endophthalmitis of different origins, namely, posttraumatic, postcataract surgery, filtering bleb-associated, and intravitreal treatment-related endophthalmitis, using the 16S rDNA sequencing method. METHODS: Aqueous humor or vitreous humor samples were collected from 24 endophthalmitis patients. Traditional cultivation and 16S rDNA sequencing were conducted with these samples. Three senile cataract controls and one intraocular irrigating solution were used as sequencing control. RESULTS: Eleven of the 24 samples (45.8%) obtained positive bacterial cultivation, and each sample positive for only one species. The 11 culture-positive species could all be identified in their corresponding sequencing results, but only four strains being the top one pathogen in the sequencing. A total of 567 species were isolated using 16S rDNA sequencing, with the top five species being Pseudomonas sp., Staphylococcus epidermidis, Staphylococcus sp., Streptococcus sp., and Enterococcus faecalis. The dominant bacterial strains varied among the different endophthalmitis categories but with no significant difference in the overall bacterial spectrum. Bacterial atlas containing Pseudomonas, Streptococcus, Staphylococcus, Actinomycetales_unclassified, Thermus, and Janibacter was shared by the four categories. Aqueous humor bacterial profile showed a higher overlap with contaminating bacteria from the environment. CONCLUSIONS: 16S rDNA sequencing is more efficient for endophthalmitis pathogen screening than the traditional cultivation method in terms of positive detection rate and the number of bacteria identified. But the risk of environmental contamination exists when using 16S rDNA sequencing method for endophthalmitis diagnosis. Different categories of endophthalmitis displayed diversified bacterial composition.

Detection of Leptospirosis Genome from the Aqueous Humor of a Patient with Bilateral Uveitis.

BACKGROUND: Leptospira species are difficult to culture. Thus, when there is suspicion for an infectious etiology to uveitis, bacterial cultures may fail to identify Leptospira. We describe a case of leptospirosis-associated uveitis that evaded culture and molecular assays. DNA sequencing of the aqueous fluid showed the presence of Leptospira spp. METHODS: Retrospective case review of clinical and laboratory features of a patient with ocular leptospirosis is presented. RESULTS: DNA sequencing identified the genome of Leptospirosis spp. in the aqueous humor. CONCLUSION: Metagenomic sequencing, by virtue of its unbiased nature, can be a helpful adjunctive test when a strong clinical suspicion for intraocular infection persists despite negative routine culture and molecular assays.

CLINICAL PRESENTATIONS, DIAGNOSTIC DILEMMA, AND MANAGEMENT OUTCOMES OF CHRONIC POSTOPERATIVE ENDOPHTHALMITIS CAUSED BY STEPHANOASCUS CIFERRII.

PURPOSE: To report the diagnosis and management of a series of chronic postoperative endophthalmitis caused by Stephanoascus ciferrii. METHODS: This is a retrospective consecutive case series at a tertiary eye care institute. Case records of consecutive cases of chronic postoperative endophthalmitis caused by a novel fungus S. ciferrii were analyzed. The clinical presentations, microbiologic workup including microscopy, culture, antifungal susceptibility and polymerase chain reaction for fungal DNA of clinical samples, and the clinical management were noted. The cases underwent anterior chamber tap, vitreous biopsy, core vitrectomy, and intraocular lens explantation, and the management consisted of a combination of topical and systemic therapy and intravitreal injections of antimicrobial agents. RESULTS: The report includes four eyes of four patients. All patients were diagnosed as chronic postcataract surgery endophthalmitis, and they showed variable levels of persistent low-grade intraocular inflammation till the intraocular lens was explanted. S. ciferrii (identified by the Vitek 2 compact system) was grown in culture from one or more of the clinical samples such as vitreous, anterior chamber fluid, capular bag, and intraocular lens. Fungal DNA was detected from vitreous in one case. One isolate tested for antifungal susceptibility was resistant to amphotericin B; however, the patient responded to treatment with the drug. Good clinical outcome was achieved in all patients. CONCLUSION: We describe successful treatment of endophthalmitis caused by S. ciferrii. A good response is obtained after pars plana vitrectomy and intraocular lens explantation.

Comparative Study of Microbiological Profile and Management Outcomes of Acute Endophthalmitis after Microincision Vitrectomy Surgery versus Intravitreal Injections.

Purpose: The aim of this study was to evaluate and compare incidence and outcomes of management of acute endophthalmitis after microincision vitrectomy surgery (MIVS) and intravitreal injections (IVIs).Methods: Medical records were retrospectively reviewed from January 2012 to December 2017, and the incidence, clinical and microbiological profiles of acute endophthalmitis were documented.Results: Of 26,332 MIVS and 24,143 IVI performed, incidence of acute endophthalmitis in MIVS group was 0.027% (1 in 3761 cases) against 0.054% (1 in 1857 cases) in IVI. Gram-positive organisms were causative in post IVI group as against gram-negative organisms in MIVS group.Conclusion: Incidence of endophthalmitis after IVI is almost twice that after MIVS. A trend toward poorer outcomes in MIVS eyes was observed. Both MIVS and IVI being pars plana procedures warrant similar kind of aseptic precautions.

Endogenous Endophthalmitis Caused by Isolated Listeria Monocytogenes Infection.

Purpose: The purpose of this report is to present an extremely rare case of endogenous Listeria monocytogenes endophthalmitis.Methods: A 72-year-old woman was diagnosed with endogenous endophthalmitis. Listeria monocytogenes was identified by culture of aqueous humor. Multiple investigations could not reveal any source of infection. An overview of other published cases is presented and a standardized treatment protocol is suggested.Results: Treatment consisted of topical therapy with antibiotics, corticosteroids, cycloplegics, and intraocular pressure-lowering agents, four intravitreal injections of vancomycin, an anterior chamber washout, intravenous amoxicillin, and eventually a pars plana vitrectomy. The inflammation subsided and the patient was discharged with a best-corrected visual acuity of 20/40.Conclusion: Our study emphasizes the importance of adequate microbiological testing and initiating appropriate treatment early in the management of endogenous endophthalmitis.

Cladosporium Endogenous Endophthalmitis Mimicking Toxoplasma Retinochoroiditis.

Background: Endogenous fungal endophthalmitis is a sight-threatening condition with potentially devastating outcome. Hematogenous spread of the infective seedings is the route of infection. Infected individuals have usually a compromised immune status. The clinical picture of mycotic endogenous endophthalmitis is commonly seen as chorioretinitis. Candida is the most common fungus. Cladosporium causing endogenous endophthalmitis is a rare occurrence, with only a few cases published.Methods: The report includes study and management of a diabetic patient with endogenous cladosporium endophthalmitis mimicking toxoplasma retinochoroiditis.Results: Diagnosis was confirmed as Cladosporium Cladosporioides in vitreous and aqueous aspirate by polymerase chain reaction-based DNA sequencing. Patient was successfully managed with intravitreal and systemic voriconazole.Conclusion: Cladosporium can cause endogenous endophthalmitis and mimic toxoplasma retinochoroiditis. Vitreous biopsy can help in diagnosis in the absence of positive blood culture. Intravitreal voriconazole along with systemic voriconazole shows a good response.

Clinical utility of aqueous humor polymerase chain reaction and serologic testing for suspected infectious uveitis: a single-center retrospective study in South Korea.

BACKGROUND: This study aimed to assess and compare the clinical value of aqueous humor polymerase chain reaction (PCR) and serologic tests in patients diagnosed with suspected infectious uveitis. METHODS: In this retrospective observational study, data of 358 patients who were diagnosed with suspected infectious uveitis and who underwent aqueous humor PCR testing were analyzed. PCR and serologic test results were compared with the clinical features. RESULTS: The rates of initial diagnoses for infectious uveitis were higher with PCR (99 patients, 28%) compared to those with serologic tests (38 pateints, 11%). The diagnostic positivity of PCR was 29% for anterior uveitis, 0% for intermediate uveitis, 5% for posterior uveitis, and 30% for panuveitis. In particular, PCR was useful in confirming the diagnosis of cytomegalovirus and varicella-zoster virus infections and Toxoplasma gondii-associated uveitis. For PCR test, the sensitivity was 0.431, specificity was 0.985, and the negative and positive predictive values were 0.506 and 0.980, respectively. For IgM test, the sensitivity was 0.151, specificity was 0.970, and the negative and positive predictive values were 0.403 and 0.895, respectively. CONCLUSION: Aqueous humor PCR can be a valuable diagnostic tool for confirming the infectious etiology in patients clinically diagnosed with uveitis. PCR had good predictive and diagnostic value for anterior uveitis and panuveitis compared with that for intermediate and posterior uveitis.

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

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

Post-intravitreal injection endophthalmitis secondary to Turicella otitidis: a case report.

BACKGROUND: Endophthalmitis is a rare but potentially devastating complication of intravitreal injection. The causative organism plays an important role in prognosis following endophthalmitis. Here we present the first reported case of Turicella otitidis endophthalmitis, which is notable for a delayed presentation. CASE PRESENTATION: A 71 year old male who was receiving intravitreal aflibercept injections for neovascular age-related macular degeneration presented 4 weeks after his most recent intravitreal injection and was found to have endophthalmitis. Polymerase chain reaction (PCR) testing of aqueous fluid was positive for Turicella otitidis. The endophthalmitis responded well to treatment with intravitreal antibiotics. CONCLUSIONS: Coryneform bacteria are a rare cause of endophthalmitis, and this is the first reported case of endophthalmitis caused by the corynebacterium species Turicella otitidis. As in this case, post-intravitreal injection endophthalmitis may have a bacterial etiology even with delayed presentation. The relatively indolent disease course and excellent response to intravitreal antibiotics is consistent with previous ophthalmic reports regarding other corynebacteria, as well as with otolaryngology and hematology oncology reports addressing Turicella otitidis specifically. This case supports the growing body of evidence for pathogenicity of Turicella otitidis and demonstrates the utility of PCR for diagnosis in small volume aqueous specimens.

Immunoblot and Polymerase Chain Reaction to Diagnose Ocular Syphilis and Neurosyphilis in HIV-positive and HIV-negative Patients.

Purpose: To evaluate immunoblot (IB) and polymerase chain reaction (PCR) to diagnose ocular- and neurosyphilis. Methods: Prospective cross-sectional study. Aqueous humor (AH) and cerebrospinal fluid (CSF) samples were tested for treponemal DNA or antibodies to treponemal antigens. Results: Thirteen of 106 cases had positive syphilis serology of which 69.2% were HIV+ (median CD4+ = 181 cells/µL). Four cases met CDC criteria for neurosyphilis (3 confirmed, 1 probable) and 2 additional cases required neurosyphilis treatment according to UpToDate algorithms. All AH and CSF samples tested PCR negative. Five cases were CSF IB+ and 3 cases AH IB+. Using our classification, eight patients had confirmed neurosyphilis, one had probable neurosyphilis, three had confirmed ocular syphilis and nine had probable ocular syphilis. Conclusion: Our findings suggest that IB of AH and CSF provides additional evidence to diagnose ocular and neurosyphilis and allows us to classify them as probable or confirmed.

Usefulness of aqueous and vitreous humor analysis in infectious uveitis.

OBJECTIVE: To evaluate the role of intraocular fluid analysis as a diagnostic aid for uveitis. METHODS: Twenty-eight samples (27 patients including 3 HIV-infected patients) with active (n=24) or non-active (n=4) uveitis were submitted to aqueous (AH; n=12) or vitreous humor (VH) analysis (n=16). All samples were analyzed by quantitative PCR for herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV) and Toxoplasma gondii. RESULTS: The positivity of the PCR in AH was 41.7% (5/12), with 50% (2/4) in immunocompetent and 67% (2/3) in HIV+ patients. The positivity of the PCR in VH was 31.2% (5/16), with 13% (1/8) in immunocompetent and 50% (4/8) in immunosuppressed HIV negative patients. The analysis was a determinant in the diagnostic definition in 58% of HA and 50% of VH. CONCLUSION: Even in posterior uveitis, initial AH analysis may be helpful. A careful formulation of possible clinical diagnosis seems to increase the chance of intraocular sample analysis being meaningful.

Factors Associated With Positive Microbial Culture in Patients With Endophthalmitis Based on Clinical Presentation and Multimodal Intraocular Sampling.

PURPOSE: The aim of this study was to identify the factors associated with positive culture sample in patients with endophthalmitis based on clinical presentation and multimodal intraocular sampling. DESIGN: Retrospective review. METHODS: A total of 259 subjects with a diagnosis of endophthalmitis presented to a tertiary ophthalmic referral center between 2006 and 2018. Patient demographics, presenting clinical findings and the results of aqueous and vitreous sampling were analyzed. RESULTS: Mean age was 64.2 (± 22.6) years with 52.9% female. Endophthalmitis followed cataract surgery in 84 eyes (32.4%) and was the most common precipitant; intravitreal injections were the next common cause involving 60 eyes (23.2%). Mean visual acuity on presentation was hand movements with a hypopyon present 134 eyes (52%). In total, 135 cases (52.1%) were culture positive. Aqueous sampling was performed in 112 eyes [culture positive 36 (32.1%)]; vitreous sample in 122 eyes [positive in 56 (45.3%)]. Vitrectomy was performed in 169 eyes with 149 sent for culture [70 (47.0%) positive]. A positive vitrectomy culture was observed in 14 eyes (36.9%) of 38, despite initial treatment with intravitreal antibiotics. Factors associated with positive culture were aqueous tap [odds ratio (OR) 2.06, P = 0.02], vitrectomy (OR 2.86, P = 0.001), and absent red reflex (OR 2.73, P = 0.001). CONCLUSIONS: A multimodal approach to intraocular sampling should be considered in those presenting with endophthalmitis, with both aqueous tap and vitrectomy associated with an increased probability of achieving a positive culture.

Specific PCR and Quantitative Real-Time PCR in Ocular Samples from Acute and Delayed-Onset Postoperative Endophthalmitis.

PURPOSE: Rapid identification of virulent pathogens is essential to strengthen the therapeutic strategy of acute endophthalmitis. OBJECTIVES: This study sought to compare the contribution of a combination of polymerase chain reaction (PCR)-based tests to culture methods, in patients with postoperative endophthalmitis. DESIGN: Prospective multicenter study diagnostic evaluation. METHODS: Setting: university referral centers. PARTICIPANTS: 153 consecutive patients presenting with acute or delayed-onset postoperative endophthalmitis, between 2008 and 2015. There were a total of 284 aqueous humor (AH) and/or vitreous fluid (VF) samples. Outcomes and measurements: microbiological tests of intraocular samples included bacterial culturing of pediatric blood culture bottles; 16SrDNA amplification and sequencing (panbacterial PCR) for detection and identification of all bacterial species; real-time PCR (qPCR) assays targeting the femA or lytA gene for detection of Staphylococcus aureus (S. aureus) or Streptococcus pneumoniae (S. pneumoniae), respectively; and a qPCR assay targeting the tuf gene for detection and quantification of Staphylococcus epidermidis (S. epidermidis). RESULTS: At the time of admission, the rate of detection of microorganisms by PCR-based tests was not significantly different than that by culturing (38% versus 30% in AH samples [n = 69]; 66% versus 63% in VF samples [n = 82], respectively). In contrast, after 1 intravitreal injection (IVI) of antibiotics, the identification rate by PCR-based tests was higher than that in VF by culturing (62% vs 48%, respectively; n = 94; P = 0.05). Bacteria were identified in 70% of patients, with a predominance of Gram-positive bacteria (93%). Specific qPCR tests targeting S. aureus and S. pneumoniae did not provide additional diagnoses but provided earlier results. The S. epidermidis load in vitreous at the time of patients' admission was higher in cases of final visual acuity (VA) of <20/40 (127,118 ± 125,848 DNA copies/mL) in patients with a VA of ≥20/40 (40350,000 ± 46,912 DNA copies/mL; P = 0.09). No significant changes in S. epidermidis load was found after one IVI. CONCLUSIONS: Patients with acute or delayed-onset endophthalmitis should benefit from microbiological identification in vitreous samples by combined analysis using bacterial cultures in pediatric blood culture bottles and panbacterial PCR. The last test was more effective than cultures in vitreous samples collected after an IVI of antibiotics. The qPCR tests targeting S. aureus and S. pneumoniae gave earlier results than culture and panbacterial PCR but did not provide additional diagnoses. As for S. epidermidis infections, determination of bacterial load using the qPCR test targeting the tuf gene could help evaluation of the visual prognosis of patients. Its role in the follow-up of patients after antibiotic treatment needs further investigation.

Usefulness of aqueous and vitreous humor analysis in infectious uveitis

OBJECTIVE: To evaluate the role of intraocular fluid analysis as a diagnostic aid for uveitis. METHODS: Twenty-eight samples (27 patients including 3 HIV-infected patients) with active (n=24) or non-active (n=4) uveitis were submitted to aqueous (AH; n=12) or vitreous humor (VH) analysis (n=16). All samples were analyzed by quantitative PCR for herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV) and Toxoplasma gondii. RESULTS: The positivity of the PCR in AH was 41.7% (5/12), with 50% (2/4) in immunocompetent and 67% (2/3) in HIV+ patients. The positivity of the PCR in VH was 31.2% (5/16), with 13% (1/8) in immunocompetent and 50% (4/8) in immunosuppressed HIV negative patients. The analysis was a determinant in the diagnostic definition in 58% of HA and 50% of VH. CONCLUSION: Even in posterior uveitis, initial AH analysis may be helpful. A careful formulation of possible clinical diagnosis seems to increase the chance of intraocular sample analysis being meaningful.

Impact of antibiotic resistance of pathogens and early vitrectomy on the prognosis of infectious endophthalmitis: a 10-year retrospective study.

PURPOSE: Infectious endophthalmitis (IE) is a severe complication that can lead to blindness even with treatment. However, the impact of antibiotic resistance and early vitrectomy on its prognosis has scarcely been documented. This study investigated the impact of antibiotic resistance of pathogen and early vitrectomy on the prognosis of IE. METHODS: The medical records of 171 patients treated for IE at a tertiary referral center between 2007 and 2016 were retrospectively reviewed and analyzed for etiology, pathogen, drug resistance to vancomycin or third-generation cephalosporins, treatment types and timing, and visual outcomes. Multivariate logistic regression analysis was used to determine significant prognostic factors. RESULTS: Among 171 eyes, 121 (70.8%) eyes developed IE after intraocular surgery (cataract surgery, 46.3%; intraocular injection, 13.2%), 37 (21.6%) eyes developed IE endogenously, and 9 (5.3%) eyes developed IE after trauma. The major causative pathogens were Staphylococcus aureus (9.4%) and Klebsiella pneumoniae (7.0%). In total, 72.6% of the identified pathogens demonstrated antibiotic resistance. Antibiotic resistance was associated with a worse final vision (P = .027). Visual prognosis was better for eyes treated with early vitrectomy combined with intravitreal antimicrobial injections within 24 h of onset than for eyes that received only intravitreal antimicrobial injections before undergoing delayed vitrectomy (P = .003). CONCLUSION: Antibiotic resistance of organisms causing IE is one of the most important prognostic factors. Early vitrectomy (i.e., within 24 h) may be helpful for achieving a better visual outcome. Immediate vitrectomy can be recommended, especially in IE cases caused by organisms with resistance to empirically used antibiotics.

The Collaborative Ocular Tuberculosis Study (COTS)-1 Report 3: Polymerase Chain Reaction in the Diagnosis and Management of Tubercular Uveitis: Global Trends.

Purpose: To analyze the role of polymerase chain reaction (PCR) of ocular fluids in management of tubercular (TB) anterior, intermediate, posterior, and panuveitis. Methods: In Collaborative Ocular Tuberculosis Study (COTS)-1 (25 centers, n = 962), patients with TB-related uveitis were included. 59 patients undergoing PCR of intraocular fluids (18 females; 53 Asian Indians) were included. Results: 59 (6.13%) of COTS-1 underwent PCR analysis. PCR was positive for Mycobacterium TB in 33 patients (23 males; all Asian Indians). 26 patients were PCR negative (18 males). Eight patients with negative PCR had systemic TB. Anti-TB therapy was given in 18 negative and 31 PCR cases. At 1-year follow-up, five patients with positive PCR (15.15%) and three with negative PCR (11.54%) had persistence/worsening of inflammation. Conclusions: Data from COTS-1 suggest that PCR is not commonly done for diagnosing intraocular TB and positive/negative results may not influence management or treatment outcomes in the real world scenario.