Endophthalmitis caused by Pseudomonas aeruginosa

OBJECTIVE: To investigate the clinical settings and treatment outcomes for endophthalmitis caused by Pseudomonas aeruginosa. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: The medical records were reviewed of all patients treated for P. aeruginosa endophthalmitis at a single institution between January 1, 1987, and December 31, 2001. MAIN OUTCOME MEASURES: Final visual acuity and rate of enucleation or evisceration. RESULTS: The study included 28 eyes of 28 patients with a median age of 75 years (range, 5-93 years). The clinical setting of endophthalmitis included: cataract surgery (n = 9), corneal ulcer (n = 7), penetrating keratoplasty (n = 5), bleb associated (n = 2), glaucoma drainage implant (n = 2), pars plana vitrectomy (n = 1), iris cyst removal (n = 1), and trauma (n = 1). In acute-onset postoperative cases (n = 10), the median interval between surgery and presentation with endophthalmitis was 4 days (range, 1-26 days). The median duration of symptoms was 1 day, and all patients were treated on the day of diagnosis. Eleven patients (39%) had hand motions or better vision in the infected eye at the time of initial diagnosis. Because of no light perception visual acuity, necrosis of cornea and sclera, and intractable pain, 7 eyes (25%) underwent evisceration or enucleation as initial treatment; of the remaining 21 eyes, intravitreal antibiotics were administered in all cases and intravitreal dexamethasone was administered in 15 cases (71%). Pars plana vitrectomy was performed in 12 patients (43%). The organism was sensitive to the initial antibiotics administered in all but 2 cases. Final visual acuity was 5/200 or better in 2 of 28 eyes (7%). Nineteen patients (68%) had a final visual acuity outcome of no light perception, and no patient achieved a final visual acuity of better than 20/400. Overall, 18 of the 28 eyes (64%) were either eviscerated or enucleated. CONCLUSIONS: Endophthalmitis caused by P. aeruginosa is associated with poor visual outcomes despite prompt treatment with intravitreal antibiotics to which the organisms were sensitive.     

Endophthalmitis caused by Streptococcus pneumoniae

PURPOSE: To investigate clinical settings, management strategies, antibiotic sensitivities, and visual acuity outcomes of endophthalmitis caused by Streptococcus pneumoniae. DESIGN: Retrospective, observational case series. METHODS: Records were reviewed of all patients with culture-positive endophthalmitis caused by Streptococcus pneumoniae treated at the Bascom Palmer Eye Institute between January 1, 1989 and December 31, 2003. MAIN OUTCOME MEASURES: Visual acuity and antibiotic sensitivities. RESULTS: Twenty-seven eyes of 27 patients met study inclusion criteria. The median follow-up was 7 months (range, 3 months to 10 years). Clinical settings included acute postoperative (10 eyes), corneal stitch abscess (5), corneal ulcer (3), bleb-associated (4), post-trauma (3), and endogenous (2). Eighteen cases (67%) were acute-onset (less than 3 weeks from event), with a median interval between event and presentation of endophthalmitis of 5 days (range, 1 day to 16 days). Nine cases (33%) were delayed-onset (median, 27 months; range, 3 to 121 months). Initial visual acuity was hand motions or better in 11 cases (41%). Initial therapeutic procedures included vitreous tap and injection of intravitreal antibiotics in 15 eyes (56%), pars plana vitrectomy and injection of intravitreal antibiotics in 10 eyes (37%), and evisceration in 2 eyes (7%). Seventeen (68%) of 25 eyes received intravitreal dexamethasone. Twelve patients (48%) received additional doses of intraocular antibiotics, and 11 patients (44%) underwent secondary surgical intervention within one week of diagnosis. The Streptococcus pneumoniae isolates showed sensitivity patterns as follows: 27/27 vancomycin, 13/13 clindamycin, 6/6 cefazolin, 11/11 ciprofloxacin, 14/14 moxifloxacin, 24/26 (92%) ofloxacin, 12/14 (86%) levofloxacin, 13/14 (93%) gatifloxacin, and 1/13 (8%) gentamicin. The organism was sensitive to at least one antibiotic administered initially in all cases. Final visual acuity was 20/400 or better in 8/27 (30%) cases, but 10 eyes (37%) had a final vision of no light perception. CONCLUSION: Despite prompt treatment with appropriate antibiotics, endophthalmitis caused by Streptococcus pneumoniae is associated with a poor visual prognosis.     

蜡样芽孢杆菌性眼内炎的临床治疗观察

目的：分析外伤性蜡样芽孢杆菌性眼内炎的临床特征及抗生素敏感性,探讨早期诊治措施。

方法：收集2019-01/2021-12陕西省眼科医院眼外伤中心收治的蜡样芽孢杆菌性眼内炎患者15例15眼的临床资料。记录受伤时间、受伤情况、术前视力、末次随访矫正视力、手术方式、细菌培养及药敏试验检测结果。

结果：纳入患者15例15眼中,5眼单纯角膜穿通伤行伤口清创缝合联合眼内抗生素注射; 10眼眼球穿通伤合并外伤性白内障及眼内异物行清创、白内障切除、眼内异物取出、玻璃体切除联合硅油填充及眼内抗生素注射。末次随访时,11眼(73%)治疗有效,眼球保留; 4眼(27%)治疗无效,行眼内容物剜除。眼球保留的11眼中,视力下降1眼(9%),视力不变1眼(9%),视力提高1级4眼(36%),视力提高2级5眼(45%),治疗后视力较治疗前明显改善。相关性分析显示,病程与最终矫正视力呈负相关(r_s=-0.762,P=0.001)。纳入患者玻璃体液及房水样本培养均为蜡样芽孢杆菌生长,药敏试验检测均对万古霉素敏感。

结论：万古霉素是治疗蜡样芽胞杆菌性眼内炎的有效药物,尽早进行玻璃体切除联合硅油填充、万古霉素玻璃体内注射是治疗蜡样芽孢杆菌眼内炎的有效方法。     

Vitrectomy for endophthalmitis after cataract surgery

PURPOSE: To identify risk factors of poor visual outcome with vitrectomy for early-onset endophthalmitis after cataract surgery. PATIENTS AND METHODS: Clinical records of 29 consecutive eyes with endophthalmitis developing within 6 weeks after cataract surgery and that underwent therapeutic vitrectomy between June 1996 and April 2001 were retrospectively reviewed. Twenty-two of the eyes received intravitreal injections of vancomycin and ceftazidime at the time of vitrectomy, and all patients received intravenous antibiotics. Eyes were divided into two groups; group A consisted of 22 eyes with a final visual acuity of 0.2 or greater, and group B consisted of 7 eyes with a final visual acuity of less than 0.2. RESULTS: Fifteen eyes (52%) in group A achieved a visual acuity of 0.5 or better and 8(28%) achieved a visual acuity of 1.0, while 4 eyes in group B developed phthisis bulbi. For eyes with a preoperative visual acuity of hand motions or worse, there was no correlation between final visual acuity and preoperative visual acuity. The overall culture-positive rate was 57%. In group A, methicillin-resistant Staphylococcus epidermidis was identified in 6 eyes, methicillin-resistant Staphylococcus aureus (MRSA) in 3 eyes and enterococcus in 2 eyes. In group B, alpha-hemolytic streptococcus (AHS) was identified in 4 eyes, aspergillus in 1 eye, and MRSA in 1 eye. All isolates were sensitive to vancomycin with the exception of the aspergillus. AHS infection appeared to be associated with wound failure from the initial cataract surgery and a poor visual outcome. Among 3 of the eyes that developed phthisis bulbi, intravitreal injection of antibiotics was not performed. CONCLUSION: Early vitrectomy and intravitreal injection of vancomycin may improve visual outcomes, but infection with AHS may be associated with cataract surgery wound failure and poor visual outcomes.     

Endophthalmitis caused by Bacillus species

PURPOSE: To investigate clinical settings, management, and visual outcomes of endophthalmitis caused by Bacillus species and to review in vitro effectiveness of antibiotics commonly used against Bacillus species. DESIGN: Retrospective, consecutive case series. METHODS: Record review of all patients with endophthalmitis caused by Bacillus species treated at Bascom Palmer Eye Institute between January 1, 1990 and July 1, 2007. Antibiotic sensitivities were conducted on 21 of 22 isolates. RESULTS: Twenty-two eyes of 22 patients met study inclusion criteria. Median follow-up was 18 months. Clinical settings included open globe injury (18 eyes), endogenous (two eyes), delayed-onset bleb-associated (one eye), and acute-onset postoperative (one eye). Twelve (67%) of 18 patients with open globe injuries had intraocular foreign bodies. Presenting visual acuity (VA) was hand movements or better in 13 (59%) patients. Initial treatment included pars plana vitrectomy and injection of antibiotics in 14 eyes (64%), vitreous tap and injection of antibiotics in seven eyes (32%), and evisceration in one eye (5%). Four (18%) patients received additional doses of intravitreal antibiotics; 16 (73%) underwent secondary surgical procedures. Eight (36%) patients achieved a final VA of 20/400 or better and four (18%) achieved a final VA of 20/60 or better. All patients received intraocular vancomycin and a cephalosporin or aminoglycoside. Systemic antibiotics were used in 18 (82%) patients. Fifteen (68%) isolates were Bacillus cereus. All isolates tested were sensitive to vancomycin, gentamicin, and five fluoroquinolones. Only three of 21 isolates were susceptible to penicillin and cephalosporins. CONCLUSIONS: Endophthalmitis caused by Bacillus species often results in poor visual outcomes. In vitro antibiotic sensitivities indicate that vancomycin, aminoglycosides, and fluoroquinolones were effective against Bacillus isolates, whereas cephalosporins were relatively ineffective.     

Hypodermic needles: a new source of penetrating ocular trauma in Indian children.

PURPOSE: To study the clinico-microbiologic profile and visual prognosis of ocular injuries caused by disposable hypodermic needles used by children to squirt water. METHODS: We analyzed 19 consecutive cases of hypodermic needle injury seen at our institute. RESULTS: The average age of the patients was 10.3 years (range, 4-20 years). A small self-sealed corneal or scleral laceration was seen in 11 eyes; in 8 eyes, the site of injury was occult. Initial visual acuity was no light perception (3 eyes) or hand motion or light perception (16 eyes). Surgery in 18/19 eyes included vitrectomy with intraocular antibiotic injections for endophthalmitis (14 eyes), evisceration for panophthalmitis (2 eyes), and cataract extraction for traumatic cataract (2 eyes). Final visual acuity was no light perception or light perception only in 10 eyes, 20/400-20/60 in three eyes, and 20/40 or better in six eyes. CONCLUSIONS: Severe ocular morbidity may result from improper disposal of hypodermic needles.     

眼内炎16例临床分析

目的:探讨眼内炎的病因以及玻璃体切割术治疗眼内炎的临床疗效。方法:对我院2010-01/2012-12收治的眼内炎患者共16例16眼进行回顾性分析,其中男13例,女3例,年龄42～82(平均60)岁。其中5例患者行眼球内容物剜除术,11例患者行玻璃体切割术。结果:因眼外伤所致眼内炎8例,内源性眼内炎2例,白内障术后2例,抗青光眼术后2例,感染性角膜炎1例,白内障过熟期晶状体过敏性眼内炎1例。经玻璃体切割术后8例视力有不同程度提高,脱盲(视力>0.05)6例(55%)。结论:眼外伤是眼内炎的最常见原因,玻璃体切割手术治疗能不同程度恢复患者视功能。     

Factors influencing treatment results in pseudophakic endophthalmitis

PURPOSE: To evaluate risk factors, therapeutic approaches and factors associated with the poor visual outcome in pseudophakic endophthalmitis. METHODS: Data related to 28 cases with the diagnosis of endophthalmitis after cataract surgery and IOL implantation were gathered retrospectively. RESULTS: Preceding surgery was extracapsular cataract extraction (ECCE) in 18, phacoemulsification in 8 and scleral fixated intraocular lens implantation in two cases. Posterior capsule rupture and diabetes mellitus were considered to contribute to the development of endophthalmitis because of their high incidences (50% and 25%) in the study group. Microbiological studies from aqueous and vitreous humour were done in 85% of the cases and 58% were positive. S. Epidermidis was the most common organism, accounting for 50% of the isolates. All cases were given topical and systemic antibiotics. Inflammation was controlled by addition of subconjunctival antibiotics to this regimen in two, intravitreal antibiotic injection in 14, pars plana vitrectomy, total capsular and lens extraction and intravitreal antibiotic injection in three, lens exchange, intracapsular and intravitreal antibiotic injection in three cases. Six (21%) cases eventually needed evisceration. Visual acuity of 20/40 or better was achieved in 25%, and 20/100 or better in 64%. CONCLUSIONS: Treatment delay (p=0.039), capsular rupture complicating cataract surgery, especially with extracapsular cataract extraction (p=0.015), and initial visual acuity worse than hand motion (p=0.003) were strong predictors of poor visual outcome. The risk of endophthalmitis was not different forplanned ECCCE (0.26%) andphacoemulsification (0.27%) but the prognosis was better with the latter.     

Early intravitreal treatment of endogenous bacterial endophthalmitis

Background: There are currently no standardized treatment guidelines for endogenous bacterial endophthalmitis. We report the long‐term outcomes of early intravitreal treatment of endogenous bacterial endophthalmitis, defined as intravitreal and systemic antibiotics administered within 24 h of diagnosis, with conservative use of pars plana vitrectomy. Design: Interventional retrospective case series. Participants: Consecutive patients treated for culture‐proven endogenous bacterial endophthalmitis between 2001 and 2008 at the Weill Cornell Medical Center. Methods: The clinical records of 18 eyes from 13 patients were reviewed. Main Outcome Measures: Visual acuity. Results: Mean age at presentation was 61 (25–85) years. All patients had underlying medical conditions. Extraocular infectious foci were identified in nine (69%) patients, with endocarditis being the most common. Gram‐positive organisms were identified in 12 (92%) patients, including five with methicillin‐resistant Staphylococcus aureus. No cases were misdiagnosed. Final visual acuities of better than 6/120 and counting fingers were achieved in 6 (55%) and 7 (64%) of 11 eyes, respectively. Longer time between onset of ocular symptoms and intravitreal antibiotic injection correlated with worse visual outcomes (P < 0.05) and was associated with mortality (P < 0.05). Mortality was also associated with methicillin‐resistant S. aureus infection (P < 0.05). Of those with follow up longer than 1 year, retinal detachment developed in 3 of 10 eyes (30%) after the acute infection, and cataract developed in 6 of 9 (67%) phakic eyes. Mean follow up was 146 (4–313) weeks. Conclusions: Intravitreal antibiotics for endogenous bacterial endophthalmitis administered within 24 h to supplement immediate systemic antibiotics may provide a relatively favourable visual prognosis.     

Endophthalmitis after cataract surgery in China, 1995-2009

A systematic search of the China National Knowledge Infrastructure database for articles on endophthalmitis after cataract surgery between 1995 and 2009 identified 57 articles that included 403 eyes. The incidence of endophthalmitis after cataract surgery was 0.06% (140/233,115). Treatments included intraocular antibiotic injection in 54.1% of eyes and immediate vitrectomy in 40.2%. Of 356 intraocular samples, 214 (60.1%) were culture positive; 187 (87.3%) bacterial and 27 (12.7%) fungal. The presenting visual acuity was <5/200 in 195 (75.3%) of 259 eyes and the final visual acuity, ≥20/40 in 63 eyes (16.8%). During these 15 years, the use of vitrectomy increased significantly (P<.05). The proportion of eyes with a final visual acuity of ≥20/400 also increased significantly (P<.05) during each 5-year period. Although these represent favorable changes in the treatment and prognosis of endophthalmitis, there are differences between these outcomes and those in developed countries. A more unified therapeutic standard is needed to further improve the prognosis of postoperative endophthalmitis in China.     

Endophthalmitis After Cataract Extraction: Incidence,Treatment, and Outcome in Crete,Greece, During Period 2000–2008

Purpose: To report the incidence, microbial spectrum, and outcome of cataract operation related endophthalmitis cases from 2000 to 2008 in the Department of Ophthalmology, University Hospital of Heraklion, Crete.

Methods: Retrospective, observational case series collected from the files of the University Eye Clinic of Heraklion.

Results: From 2000 to 2008, 23 eyes of 23 patients with endophthalmitis after cataract surgery were reported. Vitreous specimens were obtained in all cases. Twelve were cultured positive, 8 with gram-positive bacteria, and 4 with gram-negative bacteria. Ten patients were treated medically, 13 surgically, and 2 finally underwent enucleation of the affected globe. Fourteen (60.8%) eyes of the total 23 managed in our hospital, achieved a final visual acuity of 1/10 or better and 9 lower than 1/10. Five eyes ended up with no light perception.

Conclusions: We provide an overview of cataract operation related endophthalmitis cases managed in our clinic during the past 9 years.     

16例白内障术后眼内炎的治疗分析

目的探讨白内障术后眼内炎的治疗方法。方法回顾性分析16例（16只眼）经临床和/或微生物检查证实为白内障术后眼内炎患者的临床资料。结果 16只眼中10只眼（62.5%）行前段玻璃体切割联合玻璃体注药术,3只眼（18.75%）行前房冲洗和玻璃体注药术,3只眼（18.75%）单行玻璃体注药术。16只眼均保住眼球,最终视力〉0.05者9只眼（56.25%）。结论前段玻璃体切割联合玻璃体腔注药可控制白内障术后眼内炎,保留部分有用视力。     

Pseudomonas aeruginosa Endophthalmitis: Clinical Outcomes and Antibiotic Susceptibilities

Purpose: To report the clinical characteristics, antibiotic susceptibilities, and visual outcomes for eyes with endophthalmitis caused by Pseudomonas aeruginosa.

Methods: In this retrospective, non-comparative case series, medical records of eyes with culture-proven Pseudomonas aeruginosa endophthalmitis, who were treated from April 2005 to April 2015 at a referral center in Tehran were reviewed. Clinical features, antibiotic susceptibilities, and visual outcomes were assessed.

Results: In total, 20 eyes of 19 patients were identified. The clinical settings included cataract surgery (85%), pars plana vitrectomy (5%), endogenous source (5%), and intravitreal bevacizumab injection (5%). Presenting visual acuity ranged from 20/120 to no light perception. Pars plana vitrectomy with intravitreal antibiotic injection was performed as the initial treatment in 16 eyes (80%). The organisms were sensitive to ciprofloxacin and imipenem in 100%; amikacin in 88.3%; ceftazidime in 83.4%; and tobramycin in 83.4% of isolates tested. Final visual acuity was hand motions or worse in 18 eyes (90%). Evisceration was performed in five eyes (20%).

Conclusions: Susceptibility to ciprofloxacin and imipenem was found in all isolates tested. Despite appropriate treatment, visual and anatomic outcomes were generally poor.     

Safety of undiluted intracameral moxifloxacin without postoperative topical antibiotics in cataract surgery

The objective of this study is to evaluate the safety of undiluted 0.5 % intracameral moxifloxacin for postoperative endophthalmitis prophylaxis in cataract surgery patients without the use of additional postoperative topical antibiotics. All phacoemulsification cataract surgeries performed by a single surgeon (B.A.) at the John A. Moran Eye Center from June 2012 to May 2015 were reviewed retrospectively. From June 2012 to April 2014, patients were given topical 0.5 % moxifloxacin postoperatively. From May 2014 to May 2015, all patients were given moxifloxacin intracamerally with no antibiotics postoperatively. The follow-up period was 1 month after surgery. Preoperative visual acuity and postoperative visual acuity, corneal edema, and anterior chamber reaction were recorded and compared between the two groups. 384 cataract surgeries were performed during the study period. None of the 384 eyes in the study developed endophthalmitis. Of those 384 eyes, 222 were included in the study for analysis based on the inclusion and exclusion criteria. 131 were part of the topical antibiotic group and 91 were part of the intracameral group. The differences in uncorrected visual acuity at 1 day postoperatively (p = 0.595) and best corrected visual acuity at 1 month postoperatively (p = 0.099) were not statistically significant. Differences in corneal edema (p = 0.370) and anterior chamber reaction (p = 0.069) at 1 day postoperatively and corneal edema (p = 0.512) and anterior chamber reaction (p = 0.512) at 1 month postoperatively were also not statistically significant. Undiluted 0.5 % moxifloxacin can be safely injected intracamerally following cataract surgery without additional postoperative antibiotic prophylaxis to prevent endophthalmitis without adverse effects on patient outcomes.     

Endophthalmitis caused by enterococcus faecalis: antibiotic selection and treatment outcomes

PURPOSE: To investigate clinical settings, treatment strategies, and visual acuity outcomes of endophthalmitis caused by Enterococcus faecalis and to determine antibiotic sensitivity and resistance patterns. DESIGN: Retrospective, noncomparative, consecutive case series. PARTICIPANTS AND METHODS: Records were reviewed of all patients with culture-positive endophthalmitis caused by E. faecalis evaluated at the Bascom Palmer Eye Institute between January 1, 1990, and December 31, 2001. MAIN OUTCOME MEASURES: Associated prior surgical procedures, clinical features, treatments administered, antibiotic sensitivity and resistance patterns, and final visual outcomes. RESULTS: Endophthalmitis caused by E. faecalis was identified in 29 eyes of 29 patients. The mean follow-up was 17.8 months (range, 0.1-86.7 months). Endophthalmitis caused by E. faecalis was associated with, in order of decreasing frequency, cataract surgery in 12 of 29 eyes (41.4%), trabeculectomy in 8 of 29 eyes (27.6%), penetrating keratoplasty in 4 of 29 eyes (13.8%), combined cataract and trabeculectomy in 3 of 29 eyes (10.3%), seton implantation in 1 of 29 eyes (3.5%), and pupilloplasty in 1 of 29 eyes (3.5%). Resistance patterns among the isolates were the following: vancomycin in 0 of 23 eyes (0.0%), linezolid in 0 of 29 eyes (0.0%), ciprofloxacin in 1 of 14 eyes (7.1%), gentamicin (minimum inhibitory concentration >8 mg/l) in 8 of 16 eyes (50.0%), high-level gentamicin (minimum inhibitory concentration >500 mg/l) in 5 of 29 eyes (17.2%), cefazolin in 7 of 8 eyes (87.5%), and quinupristin and dalfopristin in 29 of 29 eyes (100.0%). Preinfection baseline visual acuities ranged from 20/30 to hand motions. Visual acuities on presentation with endophthalmitis ranged from 2/200 to no light perception. Final visual acuity was better than or equal to 20/50 in two cases (6.9%), 20/60 to 20/400 in three cases (10.3%), 5/200 to hand motions in 10 cases (34.5%), and light perception to no light perception in 14 cases (48.3%). CONCLUSIONS: E. faecalis often is resistant to gentamicin and cephalosporins but was sensitive to vancomycin in all isolates tested. Endophthalmitis caused by E. faecalis usually is associated with poor visual outcomes.     

Management of endophthalmitis related to glaucoma drainage devices: review of the literature and our experience

Glaucoma drainage device (GDD)-related endophthalmitis is a devastating complication of device implantation. There are no guidelines in the literature to assist clinicians in deciding if the GDD should be explanted or if patients require pars plana vitrectomy (PPV). This study compares the outcomes of GDD explantation with device retention and also independently compares the outcomes of PPV versus intravitreal antibiotics alone in patients with GDD-related endophthalmitis. A literature search for studies discussing GDD-related endophthalmitis from 2005 to 2019 was performed; 30 articles were included. The visual acuity/anatomical outcomes were compared between GDD explantation and retention, and between patients that received a PPV and those that did not. These outcomes were combined with a medical records review of 13 patients with GDD-related endophthalmitis from an academic institution. A total of 88 eyes were included. 70.5% underwent GDD explantation, while 37.8% received a PPV. GDD explantation was associated with a lower rate of evisceration/enucleation when compared to GDD retention (4.8% versus 19.2%, OR 0.22, 95% CI 0.05–1.01, p = 0.05), but visual acuity outcomes were similar. No eyes that received an immediate vitrectomy became phthisic or required evisceration/enucleation, compared an evisceration/enucleation rate of 15.2% in eyes treated solely with intravitreal antibiotics (OR 1.18, 95% CI 1.04–1.33, p = 0.04). Explantation of the GDD and immediate vitrectomy are both associated with better anatomical outcomes in GDD-related endophthalmitis. Further research is needed to provide more definitive guidelines in the ideal management of these patients.Subject terms: Retinal diseases, Glaucoma     

人工晶状体植入术后急性眼内炎

目的 探讨白内障摘出联合人工晶状体植入术后急性眼内炎的临床特点、治疗方法及效果.方法 回顾性分析5848例白内障摘出人工晶状体植入术后发生急性眼内炎4例(4眼),眼内炎发生于术后2～6d,视力为光感～数指/10 cm.治疗方法:2例行玻璃体腔内注药术,其中1例效果欠佳,于次日行玻璃体切除联合玻璃体内注药;另2例行玻璃体切除术联合玻璃体腔内注药,均配合全身及局部应用抗生素及皮质类固醇类药物.结果 随访8～26个月,4例眼内炎均得到控制,最后视力分别为0.15、0.25、0.6、0.8.结论 白内障摘出人工晶状体植入术后急性眼内炎是白内障手术的严重并发症,玻璃体切除联合玻璃体腔注药是一种安全、有效的治疗方法.     

Nosocomial postoperative endophthalmitis: a 14-year review

Background The objective of this study was to evaluate the incidence, predisposing surgery, management and final visual outcome of postoperative endophthalmitis over a 14-year period at one institute.Methods This retrospective study reviewed all intraocular operations performed between 1 January 1991 and 31 August 2004 at Chang Gung Memorial Hospital, Kaohsiung Medical Center, to determine the incidence of nosocomial postoperative endophthalmitis and the characteristics of patients who developed this condition.Results The overall incidence of postoperative endophthalmitis after intraocular surgery was 0.19% (56 out of 30,219). Postoperative endophthalmitis developed in 56 eyes in 56 patients during the study period. The condition developed after cataract surgery in 46 eyes, after penetrating keratoplasty in 6 eyes, after filtering surgery in 2 eyes, after secondary intraocular lens implant in 1 eye, and after vitrectomy in 1 eye. Postoperative endophthalmitis was culture-positive in 31 cases (55%). The most frequent organism isolated was coagulase-negative Staphylococcus. Factors associated with better visual acuity outcomes included low virulence of isolated pathogen, initial visual acuity of counting fingers or better, and history of cataract surgery compared with other intraocular surgery.Conclusion The overall incidence of endophthalmitis after intraocular surgery was 0.19%. The results of this 14-year review from a local medical center may serve as a source of comparison for other centers and future studies.No proprietary interests     

Postcataract Endophthalmitis Caused by Enterococcus faecalis

Purpose: To investigate the management strategies, susceptibility patterns, and visual outcomes of postcataract Enterococcus faecalis endophthalmitis.

Methods: Retrospective chart review study of 26 eyes of 26 patients with culture-proven E. faecalis endophthalmitis.

Results: In initial treatments, pars plana vitrectomy with intravitreal antibiotics in 15 eyes (58%). Resistance patterns among the isolates were the following: vancomycin in 0 of 26 eyes (0%), ampicillin in 0 of 26 eyes (0%), teicoplanin in 0 of 18 eyes (0%), and high-level gentamicin (minimum inhibitory concentration >?500?mg/L) in 8 of 12 eyes (67%). Presenting visual acuity ranged from counting fingers to no light perception. Final visual acuity was better than 5/200 in 4 of 26 eyes (15%), 5/200 to hand motions in 4 of 26 eyes (15%), and light perception to no light perception in 18 of 26 eyes (69%).

Conclusions: Although all E. faecalis isolates were susceptible to vancomycin, endophthalmitis caused by E. faecalis was usually associated with poor visual prognosis.