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.     

Endophthalmitis after intravitreal injections

Endophthalmitis following intravitreal injection is an infrequent but serious clinical problem. Infectious endophthalmitis must be differentiated from noninfectious inflammation. Depending on the series, the risk of endophthalmitis is very low. The use of a standardized injection protocol can reduce the risk of infection.     

白内障术后并发症:现状与对策

近年来,由于手术方式、仪器设备和人工晶状体的改进,白内障术后并发症的发生率已明显下降。晶状体上皮细胞间质转化机制学说和人工晶状体材料及设计研究有了新的突破,为后发性白内障的防治提供了新途径。大量临床研究证实,术毕前房注射抗生素（头孢呋辛或莫西沙星）可显著降低术后眼内炎的发生率,包括术中合并晶状体后囊膜破裂的患者,未来有望在临床广泛推广。体外培养人角膜内皮细胞和促角膜内皮细胞增生药物的研发为白内障术后角膜内皮损伤的治疗带来了曙光。利用光学相干断层扫描、光学相干断层扫描血管成像能在早期准确诊断白内障术后黄斑囊样水肿,且非甾体抗炎药或抗血管内皮生长因子药物玻璃体内注射对此疗效明确。随着研究的深入,进一步认识到先天性白内障手术时机、人工晶状体植入否与术后继发性青光眼的相关性。高度近视眼患者晶状体屈光性手术的提前,增加了这类患者晚期人工晶状体-囊袋复合体脱位的发生率,并让相应治疗面临新的挑战。飞秒激光辅助的白内障手术因其精准性和安全性已在临床逐渐应用,但仍需关注其可能带来的干眼、瞳孔缩小、视网膜光损伤等并发症。另外,由于糖尿病的高发病率,对糖尿病患者的白内障手术应全面、综合、系统地治疗,以防止术后各种眼表、眼底并发症的发生。本文就上述各方面的研究现状和相应对策进行综述,以期帮助眼科医生进行临床诊疗。     

盐酸万古霉素综合方案治疗眼内炎

目的：探讨盐酸万古霉素综合方案治疗眼内炎的临床疗效和并发症。 方法：收集我院2009-07/2011-08眼内炎住院患者27例27眼,采用盐酸万古霉素综合治疗方案进行治疗。所有患者取玻璃体做细菌培养和药敏试验。采用玻璃体腔内注射盐酸万古霉素,全身使用盐酸万古霉素联合左旋氧氟沙星。炎症无明显好转者,2~4d后行玻璃体切割术,术中使用含盐酸万古霉素的灌注液。术后观察视力、眼压、前房和玻璃体混浊情况。对术后最佳矫正视力和眼压进行统计学分析。 结果：患者27例眼内炎均治愈,视力均有提高。细菌培养检出率56%。革兰氏阳性菌占67%,对盐酸万古霉素敏感。革兰氏阴性菌对氧氟沙星较敏感。8例患者经过静脉滴注及玻璃体腔内注药后眼内炎症控制,19例行玻璃体切割手术。术后最佳矫正视力提高。临床症状体征好转。 结论：早期细菌培养对眼内炎的治疗有重要意义。盐酸万古霉素综合治疗方案能有效治疗眼内炎。     

白内障术后眼内感染的分析及其防治

白内障术后感染性眼内炎是严重危害患者术后视力恢复的并发症之一。本文就其发病率?危险因素?治疗及预防等做一综述,为临床医生提供参考依据。     

Batch-related sterile endophthalmitis following intravitreal injection of bevacizumab

Background:

To report a series of patients with sterile endophthalmitis after intravitreal bevacizumab (IVB) injection from 2 different batches of bevacizumab.

Materials and Methods:

Records of 11 eyes with severe inflammation after IVB injections from two different batches (7 eyes from one and 4 from the other) on two separate days were evaluated. Fifteen eyes of 15 patients in one day were treated with one batch and 18 eyes of 17 patients were treated another day using another batch injected for different retinal diseases. Each batch was opened on the day of injection. We used commercially available bevacizumab (100 mg/4 ml) kept at 4°C. Severe cases with hypopyon were admitted to the ward and underwent anterior chamber and vitreous tap for direct smear and culture.

Results:

Pain, redness and decreased vision began after 11-17 days. All had anterior chamber and vitreous reactions and 5 had hypopyon. Antibiotics and corticosteroids were initiated immediately, but the antibiotics were discontinued after negative culture results. Visual acuity returned to pre-injection levels in 10 eyes after 1 month and only in one eye pars plana vitrectomy was performed. Mean VA at the time of presentation with inflammation (1.76 ± 0.78 logMAR) decreased significantly (P =0.008) compared to the initial mean corrected VA (1.18 ± 0.55 logMAR); however, final mean corrected VA (1.02 ± 0.48 logMAR) improved in comparison with the baseline but not to a significant level (P =0.159).

Conclusions:

We report a cluster of sterile endophthalmitis following intravitreal injection of bevacizumab from the same batch of bevacizumab that has a favorable prognosis.     

Comparison of the antimicrobial effect of heavy silicone oil and conventional silicone oil against endophthalmitis-causing agents

Purpose:

To conduct an in vitro experimental study comparing the effectiveness of conventional silicone oil and heavy silicone oil against endophthalmitis-causing agents.

Materials and Methods:

The antimicrobial activity of conventional silicone oil (RS OIL 5000) and heavy silicone oil (heavySil 1500) was tested. The antimicrobial effects of both silicone oils were determined by the growing capability of the microorganism.

Results:

The number of Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans decreased to zero levels at the second day of inoculation in heavy silicone oil. In conventional silicone oil, the microorganisms survived longer than in heavy silicone oil.

Conclusion:

Heavy silicone oil seems to be more effective than conventional silicone oil against endophthalmitis-causing agents.     

感染性眼内炎的致病菌培养结果分析

目的：探讨引起感染性眼内炎的致病菌对广谱抗生素的耐药性及敏感性。

方法：对我院15例白内障术后眼内炎术中抽取玻璃体做病原学检查并对治疗结果进行回顾性分析。

结果：此15例在术中采集前房水及玻璃体做细菌培养与药物敏感试验,7例培养出致病菌,细菌培养阳性率47%(其中真菌1例,表皮葡萄球菌3例,缓慢葡萄球菌1例,凝固酶阴性葡萄球菌1例,浅绿气球菌1例),8例示无菌生长。培养阳性病例中3例表皮葡萄球菌和1例缓慢葡萄球菌的药敏试验均显示对左氧氟沙星是耐药的,MIC均>4; 另外1例凝固酶阴性葡萄球菌和1例浅绿气球菌药敏试验显示对左氧氟沙星是敏感的,MIC均<2,万古霉素与利福平均为敏感抗生素,MIC均<1。

结论：大多数医疗机构常规使用左氧氟沙星作为内眼手术预防性用药,但本文章总结后对此现象提出质疑。临床医生对致病菌经验性用药经常出现,但当未做细菌培养和药物敏感性试验同时致病菌出现耐药时经验性用药往往导致治疗效果降低或更严重的后果。因此应该及时根据细菌培养和药物敏感性试验结果合理选择抗生素,适时调整用药方案是规范治疗的首选。     

Red eyes as the initial presentation of systemic meningococcal infection

The present paper is a report of a 14-month-old boy who presented with fever, coryzal symptoms and red eyes. The patient developed a generalized tonic clonic convulsion on day 2 of his illness. Ophthalmological assessment demonstrated bilateral hypopyon and vitreous opacity resulting from endophthalmitis. Cerebrospinal fluid was positive for Neisseria meningitidis (A, C, Y, W 135) by latex agglutination. He was treated with high dose intravenous cefotaxime and intravitreal ceftazidime. He made good recovery and his vision was preserved. In view of the potential morbidity and mortality associated with systemic meningococcal infection, the presence of red eye and hypopyon provides important diagnostic clues indicating the need to investigate beyond superficial conjunctivitis. It should prompt the clinician to recognize endopthalmitis early and accurately diagnose this serious disease.