Enterococcal endophthalmitis following cataract extraction, treated with ampicillin intravitreally.

A case of Enterococcal endophthalmitis developed following an extracapsular cataract extraction. The infection was successfully treated with intravenous and intravitreal ampicillin, but a secondary glaucoma led to a later enucleation. We report a case of postoperative endophthalmitis with an unusual etiology, which did not respond to common treatment.     

Capnocytophaga canimorsus endophthalmitis following cataract surgery

An elderly man developed endophthalmitis 1 week after cataract extraction and lens implantation. Intraocular samples were collected and the patient received intravitreal vanco-mycin and ceftazidime, and topical tobramycin. A Gram stain of vitreous humour revealed spindle-shaped Gram-negative bacilli. He was then given systemic clindamycin and topical ofloxacin. Capnocytophaga canimorsus, a member of the oral flora of dogs and cats, was cultured after 3 days. The infection resolved leaving the patient with a visual acuity of 6/60. An attempt was made to culture the organism from the mouth of the patient's pet dog. This was unsuccessful and the source of the infection remains unknown.     

白内障术后急性眼内炎

目的 :探讨白内障术后急性眼内炎的临床特点及治疗方法。方法 :回顾性分析 4例 (5眼 )白内障术后急性眼内炎的治疗经过及病原学特点。结果 :5眼白内障术后急性眼内炎经玻璃体切割术及玻璃体腔注药后 ,并辅以全身及局部抗菌素治疗 ,眼内炎症得到控制 ,5眼最后视力得到不同程度改善 ,细菌培养为表皮萄葡球菌 3眼 ,金黄色萄葡球菌 1眼 ,施氏假单胞菌 1眼 ,这些细菌均对万古霉素、妥布霉素、庆大霉素及头孢他定 (复达欣 )敏感。结论 :白内障术后眼内炎是白内障手术的严重并发症 ,玻璃体切割术联合玻璃体腔内注药是一种有效的治疗方法。     

A case of streptococcus pyogenes endophthalmitis following cataract surgery

A small number of cases of bacterial endophthalmitis due to Streptococcus pyogenes, a Gram positive organism, have previously been reported. In this case, rapidly progressive Streptococcus pyogenes endophthalmitis was developed five years after cataract surgery which had been. The previous cataract surgery was combined with intraocular lens implantation by trans-scleral suspension technique. Treatment included enucleation and intravenous antibiotic injection. In this case of delayed Streptococcus pyogenes endophthalmitis after extracapsular cataract extraction. It seems probable that progressive erosion of the suture material resulted in exogenous endophthalmitis.     

Bilateral Pseudomonas aeruginosa endophthalmitis following bilateral simultaneous cataract surgery

A bilateral simultaneous cataract surgery (BSCS) was performed on a 67-year-old man. The surgeon had not changed the surgical settings in between the two procedures for the two eyes. The patient developed fulminant bilateral endophthalmitis a day following the BSCS. Intravitreal culture grew Pseudomonas aeruginosa . The source of infection was not found. Immediate bilateral vitrectomy and intravitreal, subconjunctival, topical and systemic antibiotic did not save the eyes. Patient ended up with bilateral visual loss.     

Surveillance of endophthalmitis following cataract surgery in the UK

AIMS: To estimate the incidence of acute-onset presumed infectious endophthalmitis (PIE) following cataract surgery in the UK and provide epidemiological data on the presentation, management, microbiology, and outcome of cases of endophthalmitis. METHODS: Cases were identified prospectively by active surveillance through the British Ophthalmological Surveillance Unit reporting card system, for the 12-month period October 1999 to September 2000 inclusive. Questionnaire data were obtained from ophthalmologists throughout the UK at baseline and 6 months after diagnosis. Under-reporting was estimated by independently contacting units with infection databases. RESULTS: Data were available on 213 patients at baseline and 201 patients at follow-up. The minimum estimated incidence of PIE was 0.086 per 100 cataract extractions and the corrected incidence was 0.14 per 100 cataract extractions. For the management of PIE, 96% of patients received intravitreal, 30% subconjunctival, 65% oral, and 17% intravenous antibiotics. In all, 17% of patients received intravitreal steroid. From the intraocular samples taken for microbiological analysis, 56% were culture positive. At follow-up, 48% of patients achieved visual acuity of 6/12 or better and 66% achieved better than 6/60. 13% of patients were unable to perceive light or had evisceration of the globe. CONCLUSIONS: The incidence of PIE after cataract surgery in the UK is comparable to that of other studies. Approximately 50% of patients achieved a visual acuity close to the driving standard.     

Monte-Carlo simulation of random clustering of endophthalmitis following cataract surgery

BACKGROUND: Endophthalmitis remains a serious and potentially blinding complication of cataract surgery with an overall incidence of approximately 0.14% or one in 700 operations. Despite this knowledge of overall frequency, healthcare providers find themselves confronted with clusters of cases where the appropriate level of response to the cluster is uncertain. AIM: To illustrate, by means of Monte-Carlo simulation models, the likelihood of random clustering of cases arising in units within a healthcare setting resembling the NHS and separately within the practices of individual surgeons. METHOD: Simulation models were constructed within a programming language in which individual cataract operations were simulated with a one in 700 likelihood of each operation resulting in a 'case of endophthalmitis'. Random clustering of 'cases of endophthalmitis' was observed in the models and 'outbreaks' were noted and tracked for various outbreak definitions. RESULTS: The model outputs are presented graphically as the proportion of 'simulated units' affected by an 'outbreak' in a year and separately as the proportion of surgeons affected for a range of 'outbreak definitions'. CONCLUSION: These data presentations are easy to use and should facilitate a better understanding of shifts from endemic to epidemic rates of endophthalmitis with appropriate investigation of situations where a remediable common cause may exist.     

Early onset endophthalmitis caused by Aspergillus species following cataract surgery

PURPOSE: To report a series of patients with early onset Aspergillus endophthalmitis following cataract surgery. DESIGN: Retrospective consecutive case series. METHODS: Medical records were reviewed of all cases of endophthalmitis caused by Aspergillus after cataract surgery treated at the authors' practices between 1992 and 2005. RESULTS: Five patients were identified. Two patients were immunocompromised (one on oral corticosteroids and one on chemotherapy for lung cancer). The mean number of days between cataract surgery and diagnosis with endophthalmitis was 29 (range, 10 to 62 days). Three eyes (60%) were enucleated despite a variety of treatments. In addition to vitrectomy and injection of antifungal agents, the other two eyes underwent surgical debridement of a localized necrotic nidus. Final visual acuity was 20/30 in one eye and 20/200 in the remaining eye. CONCLUSIONS: Aspergillus should be considered in the differential diagnosis of early onset endophthalmitis following cataract surgery. Visual outcomes are generally poor and enucleation is common in these patients.     

Delayed-onset endophthalmitis following cataract surgery caused by Acremonium strictum.

This case represents the first report of Acremonium strictum endophthalmitis. Endophthalmitis caused by A. strictum may share clinical features typical of endophthalmitis due to Propionibacterium acnes (such as delayed onset of the infection and white plaque-like material in the capsular bag).     

Epidemic endophthalmitis after cataract surgery

PURPOSE: We analyzed the results of pars plana vitrectomy in group of patients with a view to establishing risk factors, optimal therapy, surgical technique and the best timing of the pars plana vitrectomy. METHODS: Eight patients presented features of bacterial endophthalmitis within two days of cataract extraction. We examined the relations between visual outcome and the identity of infecting species, optimal therapy, surgical technique and vitrectomy timing. RESULTS: Pseudomonas aeruginosa was a pathogenic microbe. Unfortunately the source of infection was not found. The long-term (9-12 months) results are not good. Final visual acuity of all eight patients oscillated between 20/200 and no light perception. Three patients were first treated with intravitreal ATB application and vitrectomy followed with 36 hours lateney. Their final VA was no light perception in two patients and hand motion in one. The outcome was better in five patients operated immediately after the onset of endophthalmitis. Final visual acuity in this group was between hand motion and 20/200. CONCLUSIONS: Visual prognosis in cases of endophthalmitis is closely related to the type of infecting organism, the visual acuity at presentation, and the speed of progression of inflammatory signs. The need for prompt vitrectomy as the only chance of retaining at least basic visual functions is fully demonstrated.     

白内障术后感染性眼内炎的临床观察

目的探讨白内障术后感染性眼内炎的感染途径和治疗措施。方法回顾性分析2005至2006年间入院的8例8眼白内障术后感染性眼内炎病例。结合既往病史和临床检查探讨其感染途径。6例行玻璃体切除联合人工晶体摘除,并结合玻璃体腔内药物注射。结果导致感染的途径主要为白内障手术切口。3例细菌培养结果为表皮葡萄球菌。7例随访期末视力有提高,最高达0.3。结论白内障围手术期规范细致的操作是预防术后感染性眼内炎的重要措施。玻璃体切除联合人工晶体摘除是值得采用的有效治疗步骤。     

前房注射头孢呋辛预防白内障术后眼内炎的临床效果

目的　探讨白内障术末前房注射头孢呋辛对眼内炎发生率的影响,评价该预防措施的临床效果。方法　回顾性研究２００９－２０１５年在我科接受白内障手术的１０５１５眼患者资料,统计各年份白内障患者中接受前房注射头孢呋辛的比例、眼内炎的发生率及逐年累积发生率。对术后眼内炎患者的年龄、性别、视力、病原菌及接受注射的情况进行分析。结果　过去７ａ接受白内障手术者５９９５例（１０５１５眼）,其中９３８２眼（８９．２％）接受了前房注射头孢呋辛１ｍｇ／０．１ｍＬ。随着头孢呋辛前房注射比例的增加,感染性眼内炎发生率由０．１８２％（２００９年）降至０．０７２％（２０１１年）,７ａ总体累积发生率为０．０３８％（９５％ ＣＩ,０．００１－０．０７５）。２００９－２０１１年白内障术后发生眼内炎４例,平均潜伏期３．７５ｄ。２０１２－２０１５年无眼内炎病例发生。所有接受注射的患者未发生药物毒性及过敏反应。结论　白内障术末前房注射１ｍｇ／０．１ｍＬ头孢呋辛安全有效,术后眼内炎的发生率明显降低,有望作为白内障围手术期预防感染的常规措施。