Incidence and outcome of endophthalmitis over a 13-year period

Objective: The aim of the study was to assess the functional results and long-term visual prognosis in patients treated for acute endophthalmitis (AE).Design: Observational clinical series.Participants: Evaluation of 120 eyes of 114 patients with AE treated between 1991 and 2004.Methods: This retrospective institutional analysis included 120 eyes of 114 patients (52 male, 68 female) with AE and a minimum follow-up of half a year. The patients had a mean follow-up of 23 months (6-135 months) and a mean age of 61 years (8 months-94 years) at the time of treatment. Treatment included intraocular injection of antibiotics alone (n = 18, 15%) and vitrectomy combined with intraocular and topical postoperative antibiotics (n = 85, 70%).Results: The most frequent complications were vitreous or retinal hemorrhages (n = 17, 14%), retinal detachment (n = 17, 14%), choroidal detachment (n = 3, 3%), secondary glaucoma (n = 7, 6%), and recurrent endophthalmitis (n = 3, 3%). Four eyes had to be enucleated because of recurrent and uncontrollable infection. Positive microbiological results were achieved in 67 of 88 specimens (76%). The most common isolate was Staphylococcus. At the end of follow-up, visual acuity was reduced (more than 2 lines) in 18 eyes (15%), stable in 22 (18%), and improved (more than 2 lines) in 72 eyes (60%).Conclusions: AE is a rare but severe disease with a potentially deleterious outcome in affected eyes. In our series, 78% of all eyes had stable or improved postoperative visual acuity following various treatment regimens, depending on the severity of each case.     

Incidence and characteristics of acute intraocular inflammation after intravitreal injection of bevacizumab: a retrospective cohort study

Objective: To determine the incidence and characteristics of acute intraocular inflammation after intravitreal bevacizumab injections from a tertiary care retinal practice.Design: Retrospective cohort study.Participants: A consecutive series of patients who had received bevacizumab injections performed by a single surgeon.Methods: We reviewed the records of all patients with severe anterior chamber inflammation and (or) vitritis after bevacizumab injections.Results: A total of 693 bevacizumab injections were performed on 193 eyes of 173 patients between June 2006 and March 2008. There were a total of 9 cases of acute intraocular inflammation for an incidence of 1.30% (95% CI: 0.69%-2.47%). All patients had a worse visual acuity at the end of follow-up than on injection day. The mean loss of vision was 6.1 lines of Snellen visual acuity; one patient developed inflammation-induced glaucoma which required surgical intervention.Conclusions: Intravitreal injection of bevacizumab is associated with a low but significant risk of acute intraocular inflammation and may result in significant visual loss.     

Endogenous mycotic endophthalmitis in an immunocompetent patient

Acute and invasive fungal infections are usually seen in immunocompromised and debilitated patients. We report a young immunocompetent 28-year-old Indian male who presented with unilateral endogenous endophthalmitis in the left eye and was managed with pars plana vitreous surgery. The polymerase chain reaction from the vitrectomy specimen tested positive for the fungal genome while the cytology examination identified aseptate hyphae with wide-angle branching, most likely suggesting Zygomycosis. A detailed systemic evaluation failed to reveal any systemic focus or predisposing factor for fungal infection. The patient had received intravenous dextrose infusions while undergoing a surgical procedure for post-traumatic hydrocele elsewhere a week prior to this episode. The patient was successfully managed with pars plana vitreous surgery along with intravitreal Amphotericin-B and oral Voriconazole.     

兔玻璃体腔注射美罗培南治疗细菌性眼内炎

目的评价兔玻璃体腔注射国产美罗培南对敏感菌引起的眼内炎的疗效。方法选取健康成年日本大耳白兔24只，随机分为Ⅰ、Ⅱ两组，每组12只，分别玻璃体腔内接种金黄色葡萄球菌和绿脓杆菌建立相应的眼内炎模型。待出现典型眼内炎体征时，Ⅰ组和Ⅱ组再随机分为A、B组和C、D组。B、D组玻璃体腔均注射美罗培南1．25mg，A、C组分别注射万古霉素1．0mg和复达欣2．0mg作为对照。通过临床炎症评分、细菌培养阳性率、组织学检查病理评分等指标评估药物疗效。结果在两种眼内炎模型中，美罗培南用药后临床炎症评分均有显著下降，用药前后相比有统计学差异，但与万古霉素、复达欣相比无统计学差异；美罗培南用药后细菌培养阳性率在金黄色葡萄球菌和绿脓杆菌眼内炎模型中分别为0和16．7％，均低于万古霉素和复达欣，与万古霉素相比差异有统计学意义；用药2周后组织学检查显示绝大多数标本视网膜组织结构基本完整，层间有不同程度变性和坏死伴炎症细胞浸润，美罗培南与万古霉素、复达欣相比其视网膜病理评分均无统计学差异。结论兔玻璃体腔注射美罗培南治疗敏感金黄色葡萄球菌和绿脓杆菌引起的眼内炎，疗效分别与万古霉素、复达欣基本相当，但当眼内炎体征已明显时单次眼内用药很难完全控制炎症。     

硅油填充治疗外伤感染性眼内炎伴视网膜脱离

目的 探讨硅油填充治疗外伤性感染性眼内炎伴视网膜脱离的效果和影响因素。方法 回顾性分析1995年1月至2002年12月，我院眼科行硅油填充治疗外伤性感染性眼内炎伴视网膜脱离的16例16眼临床资料。结果 感染性眼内炎均得到控制。视网膜完全复位11眼(68．8％)，限局性视网膜脱离3眼(18．8％)，完全脱离2眼(12．5％)。术后视力光感-0．04者11眼，≥0．05者5眼。结论 应用硅油填充术能够有效地治疗外伤性感染性眼内炎伴视网膜脱离，术后并发症主要是视网膜脱离复发和增生性玻璃体视网膜病变(PVR)。     

外伤性眼内炎手术治疗

目的　探讨外伤性眼内炎玻璃体切除手术治疗效果 ,并分析相关因素。方法　因外伤性眼内炎接受玻璃体切除手术治疗 2 1例 ( 2 1眼 ) ,其中硅油填充 18眼 ,C3 F8填充 2眼 ,无填充物 1眼。术前视力光感至 0 1。眼压平均为 7mmHg( 5～ 2 5mmHg) ( 1mmHg =0 13 3kPa)。平均随访 18月 ( 3～ 43月 )。结果　术后视力无光感至 0 8,视力提高 15眼 ( 71 43 % ) ,不变 4眼( 19 95 % ) ,视力下降 2眼 ( 9 42 % )。眼压平均为 18mmHg( 10～ 2 2mmHg) ,显著高于术前眼压 (P <0 0 5 )。并发症主要包括前房炎性渗出 ( 19眼 ) ,术后短暂高眼压 ( 4眼 ) ,视网膜脱离 ( 3眼 ) ,眼球萎缩 ( 2眼 )。结论　玻璃体切除手术是治疗外伤性眼内炎的安全有效的方法。     

一次性注射针头致儿童眼内炎32例临床疗效分析

目的分析一次性注射针头致儿童眼内炎的临床特点和治疗效果。方法对32例一次性注射针头致儿童眼内炎的就诊时间、临床表现及治疗结果进行回顾性分析。结果农村儿童受伤后就诊迟，虽经积极的手术治疗，但视功能损害严重。结论化脓性眼内炎一经确诊，应积极行玻璃体腔注药，联合玻璃体切割术可提高治疗效果。     

Endogenous endophthalmitis following disseminated fungemia due to Fusarium solani in a patient with acute myeloid leukemia

We report the case of a young man with a resistant acute myeloid leukemia (AML) who developed a disseminated fungemia due to Fusarium solani involving the skin and lungs, during the neutropenic phase following a chemotherapy course. Despite continuous therapy with liposomal amphotericin B, he developed a bilateral endophthalmitis that rapidly evolved to complete blindness. The patient underwent two procedures of vitrectomy, with detection of F. solani in the vitreous fluid, and continued antifungal therapy, without any recovery of visual acuity. When he eventually died due to recurrence of leukemia and hemorrhagic shock, autopsy revealed a diffuse fusarial involvement of the central nervous system.     

Cataract surgery practice and endophthalmitis prevention by Australian and New Zealand ophthalmologists

PURPOSE: Our aim was to examine current cataract surgery practice and the methods of chemoprophylaxis used in Australia and New Zealand, and to determine if these factors were related to self-reported incidence rates of postoperative endophthalmitis. METHODS: All Fellows and trainees of the Royal Australian and New Zealand College of Ophthalmologists were surveyed about their cataract surgery practices and methods of chemoprophylaxis for the prevention of postoperative endophthalmitis. Associations between self-reported incidence rates of endophthalmitis and clinical practice were examined using multivariate Poisson regression modelling. RESULTS: There were 731 respondents (81.6% of 896 surveyed) to the survey. Respondents reported a total of 162,120 cataract operations and 92 cases of endophthalmitis in 2003, a cumulative incidence of 0.057%. The self-reported incidence of endophthalmitis varied from 0.034% in Victoria to 0.56% in the Northern Territory. Topical antibiotics were used preoperatively by 46.7% compared with 97.4% postoperatively; while only 44.1% used subconjunctival antibiotics. The routine use of subconjunctival antibiotic halved the self-reported incidence of postoperative endophthalmitis (incidence rate ratio 0.53, 95% confidence interval 0.30-0.92). CONCLUSIONS: Subconjunctival antibiotics may be beneficial in the prevention of endophthalmitis after cataract surgery.