Use of a subpalpebral lavage system as salvage therapy for Pseudomonas aeruginosa panophthalmitis due to an infected scleral buckle.

PURPOSE: To present a case and surgical technique for management of Pseudomonas aeruginosa panophthalmitis secondary to an infected scleral buckle. METHODS: Surgical technique video for management of an infected scleral buckle resulting in panophthalmitis with scleral buckle and suture explant and insertion of a subpalpebral lavage system. RESULTS: After two months, the visual acuity was restored to hand motion, likely secondary to a fibrotic secondary membrane, and the retina remain attached. This reports the first description of globe salvage for panophthalmitis from a P. aeruginosa-infected scleral buckle. CONCLUSION: This case encourages surgeons to remove all aspects of an exposed scleral buckle, including sutures, and emphasizes the importance of routine culture of all explanted material, even in the absence of clinical infection. In addition, this case encourages the use of a subpalpebral lavage in cases of severe P. aeruginosa ocular infections.

Orbital cellulitis with panophthalmitis and scleral necrosis - a case report.

BACKGROUND: Orbital cellulitis is common in young children and is often secondary to coexisting sinus disease. Coexisting orbital cellulitis and panophthalmitis is a rare clinical event and usually occurs secondary to trauma or from an endogenous source. CASE PRESENTATION: A febrile 2-year-old male presented with periorbital inflammation and exudative retinal detachment. Imaging showed acute sinusitis and extensive orbital cellulitis. Because of progressive scleral thinning, the patient underwent enucleation. CONCLUSION: We present a case of concurrent orbital cellulitis, panophthalmitis, and scleral necrosis in an immunocompetent pediatric patient. Timely intervention is important to prevent life threatening complications with the rare occurrence of coexistent orbital cellulitis and panophthalmitis.

Mapping prognostic factors for globe survival in panophthalmitis using logistic regression and Cox proportional hazard models: A retrospective study.

Purpose: The aim of this study was to report the outcomes of panophthalmitis and to identify factors significantly affecting globe survival in the disease. Methods: This was a retrospective study on patients with panophthalmitis in a tertiary hospital between January 1, 2017, and December 31, 2019. The demographics, treatment details, culture results, and final outcomes were recorded. Logistic regression and Cox proportional hazards (CPH) were calculated to identify variables associated with globe loss. A P < 0.05 was considered significant. Results: Eighty-five eyes of 85 patients (31 culture positive) were eligible for review. The mean age of the participants was 55.21 ± 20.17 years with a male-to-female ratio of 2.04:1. Corneal ulcer (38.82%; n = 33) and open globe injuries (OGIs) (38.82%; n = 33) were the most common etiologies. Pseudomonas aeruginosa (n = 10; 11.76%) was the most common isolate. The mean duration of hospital stay was 7.58 ± 2.32 days. Overall, 44 (51.76%) globes could be salvaged. The need for evisceration (P = 0.901) and hospital stays (P = 0.095) were similar for culture-positive and -negative cohorts. The unadjusted logistic regression and CPH models showed that culture sterility did not affect globe survival [OR = 1.210 (0.501-2.950), P = 0.668; HR = 1.176 (0.617-2.243), P = 0.623]. The adjusted logistic regression and the CPH models showed that corneal ulcers [OR = 10.900 (2.460-48.200), P = 0.002; HR = 5.393 (1.603-18.140), P = 0.006] and OGI [OR = 7.360 (1.650-32.700), P = 0.009; HR = 4.548 (1.321-15.660), P = 0.016] were significantly associated with globe loss. Conclusion: Corneal ulcer or OGI as the primary etiology is detrimental to globe survival in panophthalmitis.

Antimicrobial-eluting cement orbital implant: a case report of staged enucleation for infectious panophthalmitis with extraocular extension.

There are various orbital implant options following enucleation. In cases of severe infection, such as panophthalmitis with extraocular extension, it is reasonable to consider a two-staged approach to decrease the risk of infectious complications. One option, illustrated by this case, is enucleation with insertion of an antimicrobial-eluting cement implant, followed by a secondary procedure to exchange the cement with a permanent orbital implant. We report on a patient with clinical, ultrasound, and radiographical findings consistent with infectious panophthalmitis with extra-scleral extension. Intolerable pain and progressive orbital involvement in a blind eye were the indications for enucleation. To reduce the risk of persistent infection, a gentamycin-eluting cement implant (Palacos® R + G as an intraorbital implant) was utilized in the initial procedure. Two months later, the cement implant was removed, and a scleral-wrapped porous implant was placed into a quiet socket without signs of inflammation or infection. In the setting of severe infection, a two-staged procedure utilizing an antimicrobial-eluting implant can be considered.

A rare case of Panophthalmitis due to cobra bite.

PURPOSE: Ocular manifestations of snake bite are rare, ranging from direct injury to the eye from snake venom or indirect injury due to antivenom. We report a rare case of cobra bite causing panophthalmitis due to indirect injury as a result of snake venom toxin related tissue necrosis and susceptibility to secondary infections. METHODS: Observational case report. External photographs, slit lamp photos, ultrasonography of the eye and histopathology of the eviscerated eye were used to characterize and describe the clinical findings. Thirty-nine-years-old male farmer presented with history of cobra snake bite on his right index finger and developed right eye sudden onset pain and redness 3 days later. On examination, features were suggestive of panophthalmitis and the eye had to be eviscerated with scleral excision. CONCLUSION: It is important for ophthalmologist to be aware of such grave consequences of snake bite to be prepared for the emergency management of such cases.

Risk factors for globe removal after open-globe injury in agricultural regions.

This study aimed to identify the prevalence and risk factors for globe removal among patients with open-globe injuries (OGIs) in agricultural regions. A retrospective chart review of patients with OGIs was performed between January 2010 and December 2019. Univariable and multivariable logistic regression models were used to identify the factors associated with globe removal in OGI. This study included 422 patients (422 eyes). The highest prevalence of OGI was observed in the middle age group (> 20 to 40 years). The most common cause of OGIs was agriculture-related injury (54.7%), followed by industry or workplace-related injury (20.4%), and assault (5.0%). Intraocular foreign bodies, endophthalmitis, and panophthalmitis were reported in 57.6%, 28.4%, and 5.7% of cases, respectively. Eight eviscerations and 43 enucleations were performed, accounting for 12.1% of OGIs. The most common indication for globe removal was panophthalmitis. Multivariable analysis revealed that the predictive factors significantly associated with globe removal were assault injuries (adjusted odds ratio (aOR) = 5.53; p = 0.026), presenting logarithm of the minimum angle of resolution visual acuity (aOR = 311.79; p < 0.001), and endophthalmitis and panophthalmitis (aOR = 3.58 and 734.94, respectively; p < 0.001). This knowledge would aid in patient counseling and encourage health promotion.

Sterile endogenous panophthalmitis with uncontrolled diabetes.

A female patient with type 2 diabetes in her 50s presented to casualty with a 1-day history of red, painful right eye. Visual acuity (VA) bilaterally was 6/12, but a right anterior uveitis was noted, with hazy fundal view. She was discharged on topical steroid and mydriatic drops with a 2-day follow-up. VA remained unchanged, but she developed right proptosis, restricted eye movements, lid swelling, relative afferent pupillary defect and an intraocular pressure (IOP) of 39 mm Hg. She was admitted and treated with intravenous and intravitreal antibiotics, intravenous antifungals and IOP-lowering drugs. Blood tests showed raised inflammatory markers and an HbA1c of 127 mmol/mol. Over her admission, right eye vision deteriorated to no light perception. A B-scan ultrasound revealed panophthalmitis and a retinal abscess. All investigations looking for a source were negative. Inflammatory markers settled, but despite aggressive treatment, the panophthalmitis did not improve. She was discharged with a follow-up to consider enucleation.

Outcomes of evisceration or enucleation by resident trainees in patients with recalcitrant endophthalmitis or panophthalmitis.

To evaluate the surgical outcomes and complications of evisceration or enucleation with primary implantation, performed by ophthalmology resident trainees, in regards to patients with recalcitrant endophthalmitis or panophthalmitis. We also compared the surgical outcomes and complications between resident trainees and experienced staff. In this retrospective analysis, the clinical records of all patients diagnosed with endophthalmitis or panophthalmitis who underwent enucleation or evisceration with primary implantation over a 13-year period were reviewed. The factors predicting implant exposure or extrusion in regards to patients who underwent eye removal by trainees were identified using multivariate analysis. The percentages of successful prosthesis fittings and complications were also reported. Sixty-six patient records, median age of 46.8 years, who underwent eye removal by resident trainees were reviewed. Thirty-six (55%) out of 66 patients were diagnosed with panophthalmitis. Four patients (6%) had implant exposure, and 4 patients (6%) had implant extrusion. Multivariate analysis demonstrated that Pseudomonas aeruginosa infection (P = .02, adjusted odd ratio [aOR] = 33.75) and not receiving intravitreal antimicrobial drugs before the eye removal procedure (P = .02, aOR = 30.11) were associated with implant exposure or extrusion. Patients with panophthalmitis who underwent evisceration had a higher rate of implant exposure or extrusion than those who underwent enucleation (P = .03, aOR 38.38). At the last visit, 65 patients had a successful prosthesis fitting. Furthermore, there were similar rates of complications and successful prosthesis fittings between experienced staff and resident trainees. This study suggests that evisceration or enucleation with primary implant placement in patients with recalcitrant endophthalmitis or panophthalmitis can be performed by resident trainees with acceptable surgical outcomes and a low rate of serious complications.

Clostridial panophthalmitis - An unusual case of localised malignant oedema in Merino lambs associated with Clostridium chauvoei.

The authors report an unusual case of Clostridium chauvoei causing severe panophthalmitis in Merino lambs. More than half of the lambs affected survived, which is unusual for clostridial disease; however, there have been reports in humans that the mortality risk for ocular gas gangrene is lower than when other body parts are affected. A combination of factors in this case included environmental contamination (specific to a particular paddock), genetics predisposing to entropion (lambs born of maiden 2-year-old ewes with some inbreeding), the practice of manually everting eyelids for the entropion and vaccination strategies. C. chauvoei was cultured in pure growth from the eye of a lamb affected by severe panophthalmitis. Histopathology was consistent with severe acute infection, and microscopic sections showed Gram-positive organisms associated with the inflammatory response in the eye. In the acutely affected animal examined there were no signs that the lesions were long-standing. Animals that recovered had one or both eyes destroyed. This report describes that malignant oedema in sheep due to C. chauvoei can manifest as acute and severe panophthalmitis. The case fatality rate of lambs with panophthalmitis was less than 50%, lower than normally occurs for clostridial diseases. Clostridial vaccination of the ewes may have provided a low level of protection in reducing the case fatality rate in the affected lambs as well localisation of the infection from the blood-ocular barrier.

Evidence of dengue virus in eviscerated specimens of panophthalmitis secondary to dengue fever: A possible cause-effect phenomenon.

PURPOSE: To report a retrospective series of three cases of infectious panophthalmitis post-dengue fever with ex vivo confirmation of dengue virusribonucleic acid (RNA) in the tissues of the eye. METHODS: Four eyes of three patients, who were diagnosed with panophthalmitis following dengue fever and who underwent evisceration, were included. All demographic and clinical data were recorded. The eviscerated samples were subjected to direct microscopy, culture for bacteria, fungi, and parasites, and molecular virology (dengue virus [DENV] NS1-specific reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay). RESULTS: The time from the development of dengue fever to the occurrence of ocular symptoms was 4.33 ± 1.15 (median 5) days. DENV NS1 RNA, suggestive of the presence of the dengue virus, was confirmed in all evisceration specimens (uveal tissue, cornea). All the patients recovered completely from dengue fever and on follow-up had healthy eviscerated sockets. CONCLUSION: Demonstration of the DENV RNA in the eviscerated specimens of panophthalmitis following dengue fever implicates the DENV in the pathophysiology of the ocular infection.

Parvimonas micra Necrotizing Panophthalmitis Involving the Sclera, Cornea, Uvea, Retina, and Orbit.

We present an unusual case of a patient who acquired a pansinusitis and orbital cellulitis with necrotizing features, subsequently developing scleritis, keratitis, and anterior uveitis. To date, there are no reported cases of the simultaneous involvement of these ocular structures from a pansinusitis. Our patient was urgently taken to the operating room for drainage of the abscesses within his sinuses and the orbit. Intraoperative cultures were positive for Parvimonas micra, an odontogenic anaerobic bacteria. He was additionally found to have a central retinal artery occlusion. He was treated with systemic and topical antibiotics as well as topical dilute hypochlorous acid. The mechanisms of virulence of P. micra, including its synergistic relationship with other bacteria, ability to bind plasminogen, and its expression of proteases, contributed to this diffuse infection.

Occult Colon Adenocarcinoma and Multiple Myeloma Associated With Clostridium septicum Panophthalmitis With Orbital and Chiasmal Extension: A Case Report.

A previously healthy 62-year-old African American female presented with a fulminant orbital cellulitis of the right eye with diffuse scleritis and orbital inflammation extending to the optic chiasm on neuroimaging. She was taken for an emergent orbitotomy with an orbital fat biopsy and started on broad-spectrum intravenous (IV) and topical antibiotics. Within 36 hours of presentation, scleral thinning and a corneal melt ensued, ending in enucleation. Intraoperative cultures were positive for Clostridium septicum, leading to a systemic work-up exposing a previously undiagnosed colon adenocarcinoma and metastatic multiple myeloma.

Clinical Features and Mortality of Endogenous Panophthalmitis in China: A Six-Year Study.

PURPOSE: To report the clinical features, treatment strategy, and mortality of patients with endogenous panophthalmitis (EP). METHODS: Fifteen patients (16 eyes) diagnosed with EP from December 2012 to December 2018 were investigated with a standard protocol at a tertiary medical center of the largest eye center in Northern China. Mortality was followed up. RESULTS: All participants were Han Chinese. The mean age was 58.3, 62.5% were male, and 93.3% were unilaterally involved. The average number of predisposing factors was 3.0. The top two predisposing factors were diabetes mellitus (DM, 93.3%) and pyogenic liver abscess (PLA, 66.7%). All patients initially presented at an ophthalmic emergency due to severe ocular symptoms. All patients were co-managed by relevant specialists and were admitted to medical or surgical wards instead of the eye center unless the systemic condition was well controlled. Only four eyes were eligible for vitrectomy. The mean follow-up duration was 12.5 months. The mortality rate was 0%. The predominant causative organism was Klebsiella pneumoniae (80.0%), and there were no positive fungal cases. CONCLUSIONS: EP is a rare, life-threatening disease. DM and PLA could predispose its development. The predominant causative organism was Klebsiella pneumoniae. The interdisciplinary cooperation system of the management of EP may reduce the mortality rate.Abbreviations :EP: endogenous panophthalmitis; EE: endogenous endophthalmitis; DM: diabetes mellitus; PLA: pyogenic liver abscess; ACI: acute cerebral infarction; UTI: urinary tract infection; ICU: intensive care unit; VA: visual acuity; LP: light perception; HM: hand motion; NLP: no light perception; K. pneumoniae: Klebsiella pneumoniae; CT: computed tomography; MRI: magnetic resonance imaging; CRP: C-reactive protein; PCT: procalcitonin; FBG: fasting blood glucose; WBC: white blood cell; NEUT: neutrophil proportion; BDG: 1,3-ß-D-glucan; GM: galactomannan; IVI: intravitreal injection; PPV: pars plana vitrectomy; ILAS: invasive liver abscess syndrome; cps: capsular polysaccharide; CSF: cerebrospinal fluid; SD: standard deviation.

Blowout fracture-associated orbital cellulitis progressing to panophthalmitis: a case report.

BACKGROUND: Parvimonas micra is known as a causative agent of chronic periodontal disease. This Gram-positive obligate anaerobic coccus was cultured from the ocular surface of blowout fracture-related orbital cellulitis progressing to panophthalmitis. CASE PRESENTATION: The patient was a woman in her fifties who had panic disorder and subsequently was a victim of domestic violence. These factors led to delayed consultation. At the initial visit to an ophthalmologist, the ocular surface of the right eye was covered with pus. Swelling of the upper and lower eyelids prevented the eyelid from closing and exophthalmos, severe corneal ulcer, panophthalmitis, and no light perception were observed. Head computed tomography revealed an old blowout fracture and chronic sinusitis with orbital cellulitis. P. micra were isolated from culture of pus samples from the sinus and from the ocular surface. CONCLUSIONS: There is a possibility that P. micra invaded the orbit via the fragile bony site and caused orbital cellulitis, severe corneal ulcer, and panophthalmitis that required enucleation. In cases of coexisting old blowout fracture and chronic sinusitis, the chronic sinusitis should be treated as quickly as possible.