Mycobacterium chelonae keratitis

A case of Mycobacterium chelonae keratitis is described. As with any infective keratitis, appropriate treatment depends upon rapid and accurate microbiological assessment of corneal scraping. Acid-fast stains such as Ziehl-Nielson should be performed, particularly in chronic corneal ulcers, as only these stains will distinguish mycobacteria from the more common diphtheroid organisms. The mycobacterium chelonae organism was sensitive only to tetracyclines.     

Stenotrophomonas maltophilia and Mycobacterium chelonae Coinfection of the Extraocular Scleral Buckle Explant

Purpose: To report a very unusual form of coinfection of the extraocular scleral buckle explant by Stenotrophomonas maltophilia and Mycobacterium chelonae. Design: Interventional case report. Methods and results: A 61-year-old man had infected buckle after uneventful retinal reattachment surgery. Culture showed coinfection by Stenotrophomonas maltophilia and Mycobacterium chelonae. This concomitance is not random but rather fortified virulence of these otherwise facultative pathogens. Organisms responded to broad-spectrum antibiotics. Conclusions: The co-inhabitation of these two low-virulence organisms seems to represent an interesting symbiosis with boosting virulence and resistance to host defense, especially in those immunocompromised.     

超声乳化白内障吸出术后感染性眼内炎的治疗

目的:讨论超声乳化白内障吸出术后感染性眼内炎的原因和处理。方法:对3850例超声乳化白内障吸出术中5例感染性眼内炎患者进行前房冲洗及注药术,术后全身和局部应用抗菌素、激素及散瞳药。结果:5例感染性眼内炎均得到控制,1例需进行玻璃体切割术,4例进行前房冲洗术。除1例患者外,4例均获得满意的视功能恢复。结论:超声乳化白内障吸出术后眼内炎的发生,术中前房污染是最常见的致病菌来源,及时、彻底的前房冲洗注药术是有效的处理方法之一。眼科学报1999;15:124—126。     

Sympathetic Ophthalmia Following Vitrectomy for Endophthalmitis After Intravitreal Bevacizumab

Purpose: To describe a case of sympathetic ophthalmia following vitrectomy for endophthalmitis after an intravitreal injection of bevacizumab. Design: Retrospective case report. Methods: An 84-year-old male developed sympathetic ophthalmia 4 months after vitrectomy for endophthalmitis following an intravitreal injection. The inciting blind eye was enucleated. Results: Histopathology demonstrated sympathetic ophthalmia and phacoanaphylactic endophthalmitis. Visual acuity improved from 20/200 to 20/30 in the sympathizing eye with a combination of oral prednisone and azathioprine. Conclusions: Sympathetic ophthalmia can develop following exogenous endophthalmitis but has a good visual prognosis with appropriate treatment.     

Visual recovery following Mycobacterium chelonae endophthalmitis

Following uncomplicated cataract surgery, a patient receiving etanercept for psoriatic arthritis developed Mycobacterium chelonae endophthalmitis. Vitrectomy, capsulectomy, and intraocular lens removal was followed by intravitreal amikacin, topical gatifloxacin, intravenous imipenem, and oral clarithromycin for six months. The patient achieved a final corrected visual acuity of 20/20. Etanercept has been implicated in the development of numerous, severe granulomatous infections, though not previously with M. chelonae. This represents the first reported case of visual recovery following M. chelonae endophthalmitis.     

Delayed-Onset Streptococcus Pyogenes Endophthalmitis Following Ahmed Glaucoma Valve Implantation

Background To report a case of delayed-onset Streptococcus pyogenes endophthalmitis following implantation of an Ahmed glaucoma valve.Case A 10-year-old patient presented with acute endophthalmitis 1 year after Ahmed glaucoma valve implantation.Observations The conjunctiva and Tenon’s capsule over the valve plate had been penetrated by one of the polypropylene fixation sutures. The valve was removed, and pars plana vitrectomy was performed. Vitreous specimens and removal of the discharge over the plate revealed Streptococcus pyogenes.Conclusions This is the first documented case of Streptococcus pyogenes endophthalmitis following Ahmed glaucoma valve implantation. We think the conjunctival buttonhole caused by the polypropylene suture provided an entry site for the infection. Jpn J Ophthalmol 2005;49:315–317 © Japanese Ophthalmological Society 2005     

Endophthalmitis

Australia and New Zealand continue to be at the forefront of endophthalmitis research. In this Clinical Controversy, an ophthalmologist from each country presents different approaches to the management of a 72-year-old patient with routine endophthalmitis following cataract surgery. Mark Elder concludes that this case needs aqueous and vitreous aspirates for culture and the initial treatment of choice is intracameral vancomycin and amikacin. The evidence for intravitreal steroids is equivocal. Systemic antibiotics are indicated if there is a possibility of a bacterial biofilm present on the intraocular lens. Nigel Morlet concludes that timely intervention with appropriate antibiotics delivered in the right concentration to the vitreous cavity is the crux of successful management of endophthalmitis. Aggressive treatment of the inflammatory response is also required to further reduce the damage to the intraocular structures. Both ophthalmologists agree that vitrectomy is not necessarily the most appropriate treatment option.     

Endophthalmitis: A review of recent trends

Endophthalmitis is a feared complication of trauma, surgical procedures and septicemia. Although uncommon, its potential for significant visual loss is well recognized. Especially over the past decade, complicated surgeries and medical techniques have increased and seriously ill patients are being sustained in ever increasing numbers. New pathogens are being recognized and known ones reclassified thanks to advances in molecular analysis. Continuously evolving PCR methodologies also add a new dimension to the diagnosis of infectious endophthalmitis. As well, medical literature is now truly international, encompassing studies from around the world that expand our understanding of ocular infectious disease. This report reviews some of these changes as they relate to endophthalmitis and particularly to the spectrum of organisms involved.     

Complications of Surgery in Glaucoma: Early and Late Bacterial Endophthalmitis Following Glaucoma Filtering Surgery

One case of “early” post-trabeculectomy endophthalmitis and five eyes with “late” endophthalmitis three to nine years after glaucoma filtration surgery are presented. Differentiation of early versus late endophthalmitis is based on the time of onset and pathogenesis. Retrospective analysis of 1100 consecutive trabeculectomies revealed an incidence of less than 0.1% for early and 0.2% for late endophthalmitis. Medical and surgical approaches are discussed. The presumed importance of identifying posterior extension into the vitreous and performing a therapeutic vitrectomy is emphasized.     

Review of Endogenous Endophthalmitis Caused by Salmonella Species Including Delayed Onset Salmonella Typhi Endophthalmitis

Endogenous endophthalmitis is a rare but serious condition that occurs when bacteria cross the blood–ocular barrier and multiply within the eye. We provide a literature review of Salmonella endogenous endophthalmitis by reviewing eight reported cases and integrating this with our experience of one case in which a four-year-old child presented with acute endophthalmitis of four days duration. He had suffered typhoid fever two months back. Vitreous biopsy revealed Salmonella typhi. Despite aggressive surgical and medical treatment, the eye developed retinal necrosis, detachment, and phthisis. Blood, aqueous, and vitreous cultures were the most frequent means of establishing the diagnosis in the reported cases. The visual outcome in most cases of endogenous Salmonella endophthalmitis is blindness in the affected eye, which has not improved since its first report in 1979. Endogenous endophthalmitis due to Salmonella typhi should be incorporated into standard literature on complications of acute and relapse phases of typhoid fever.     

Prevention and Management of Traumatic Endophthalmitis

Twelve cases of traumatic culture-proven endophthalmitis were treated with intraocular antibiotics or in combination with vitrectomy. In 11 cases, the eyes were saved and in 10 the visual acuity was equal to or better than 20/200.     

Intraocular Cytokine Levels in Post-Cataract Endophthalmitis and their Association with Visual Outcome

Purpose: The host immune reaction during endophthalmitis, studied in particular through the intraocular cytokine network, is essential for the comprehension of the disease and the development of new therapies. Therefore, the purpose of this study was to elucidate the cytokine composition of aqueous humor during endophthalmitis.

Methods: In a multicenter case-control study, forty-nine patients with postoperative endophthalmitis and 60 controls (cataract surgery) were included. Visual acuity, local inflammatory grading, medical history and intraocular levels of 27 cytokines and chemokines (measured by multiplex immunoassay) were recorded.

Results: During endophtalmitis, an increase in total cytokines was observed. The raise of Th1 cytokines was particularly noticeable. Chemokines, such as IL-8, MIP-1 β, MCP-1, G-CSF and IP-10, also increased. Pearson’s correlation analyses showed a poor visual prognosis with high levels of IL-8, MCP-1 and VEGF and a low level of IL-10 at admission.

Conclusion: An increase in inflammatory cytokines is noticeable during endophthalmitis, with a particular emphasis on IL-8, MCP-1 and VEGF. Targeted anti-inflammatory and anti-VEGF treatments may be of interest in the future.     

白内障术后眼内炎诊治

目的:探讨白内障术后眼内炎的临床表现及诊治方法。方法:回顾性分析2005-05/2008-03我院诊治的4例白内障术后眼内炎病例,总结临床表现及治疗方法。结果:药物治疗2例,玻璃体切除手术治疗2例,全部患者感染控制,视力提高3例。结论:白内障围手术期应制定规范预防方案,严格执行,减少眼内炎发生可能。尽早发现、根据病情选择合理方式是治疗眼内炎的关键。     

Endogenous Endophthalmitis Among Patients with Candidemia

Thirty-eight patients with fungemia were examined prospectively for development of endophthalmitis. Endophthalmitis was present in 10 of 27 (37%) patients with Candida albicans fungemia. Only one patient with nonalbicans fungemia developed endophthalmitis. Of the preselected factors studied, only hemodialysis and parenteral hyperalimentation correlated with an increased incidence of endophthalmitis. Antibody titers by latex agglutination were of little predictive value for endophthalmitis. Antigen titers by latex agglutination were performed in four cases with endophthalmitis. Antigenemia was demonstrated in three of the four patients, all of whom had negative antibody serologies. Although inconclusive, the preliminary data indicate the test may prove to be of clinical value. Periodic ophthalmoscopic examinations should be considered mandatory in the evaluation of patients with fungemia.