Acute endophthalmitis after penetrating and endothelial keratoplasty at a tertiary eye care center over a 13-year period

Purpose:To evaluate the clinico-microbiological profile, donor cornea risk factors, and outcomes of postkeratoplasty endophthalmitis at a tertiary care center.Methods:Retrospective analysis of charts of 28 consecutive patients (28 eyes) of acute endophthalmitis following either an endothelial keratoplasty (EK) or an optical penetrating keratoplasty (PK) surgery, performed between 2006 and 2018 (13-year period). Positive microbiology, identification and classification of predisposing factors, surveillance of utilized paired donors, treatment outcomes, and differences in the rate and severity of the event between optical penetrating and endothelial keratoplasty.Results:The estimated incidence of endophthalmitis was 0.23% in the entire cohort; it was 0.34% and 0.15%, after EK and PK, respectively (P = 0.049). The median time of endophthalmitis was 4.5 days postsurgery. Donor-related endophthalmitis was recognized in 7/28 (25%) eyes. Culture positivity was 68% (n = 19 of 28). Bacteria was isolated in 84% (n = 16 of 19) instances; Gram-negative bacilli were more common (87.5%; 14 of 16), and Pseudomonas species (50%; 7 of 14) was the most common Gram-negative bacterium. Majority (>75%) of the Gram-negative bacteria were resistant to all fluoroquinolones, aminoglycosides, 3^rd generation cephalosporins, and meropenam; 1/3^rd were resistant to imipenem; and 90% were sensitive to colistin. Treatment included intraocular antibiotic injections (96.4%), vitrectomy (42.9%), and therapeutic keratoplasty (50%). In 85.7% (24 of 28), globe was salvaged. The final vision was 20/200 or better in 39.1% (9 of 23) eyes.Conclusion:EK carried a higher risk of endophthalmitis than PK in this cohort. Bacterial infection was more common in this series, with Gram negative bacilli being the commonest organisms. Multidrug resistance was common (~75%) in Gram negative isolates.     

Antimicrobial, analgesic, DPPH scavenging activities and molecular docking study of some 1,3,5-triaryl-2-pyrazolines

A series of 1,3,5-triaryl-2-pyrazolines 2a–g were synthesized by the reaction of 4,4′-disubstituted chalcone with phenyl hydrazine. All these compounds were characterized by NMR, IR and mass spectral and single crystal XRD data. All the synthesized products were screened for their in vitro antimicrobial, analgesic and antioxidant properties. The docking studies were carried out for these compounds against the active site of methionyl-tRNA synthetase (metRS). Some of the tested compounds exhibited significant antimicrobial, analgesic, DPPH scavenging activities and molecular binding.     

Studies on radioprotective and antiviral activities of some bischalcone derivatives

This work reports the cyclic voltammetric, modulatory effect on oxidative stress markers against radiation induced oxidative stress in E. coli bacteria and antiviral activities of two bischalcone derivatives (2E,5E)-2,5-bis(3-methoxy-4-hydroxy-benzylidene)-cyclopentanone (B1) and (2E,5E)-2,5-bis(4-fluorobenzylidene)-cyclopentanone (B2). The reducing ability of B1 and B2 was determined by cyclic voltammetry. The anodic peak current i _pa and anodic peak potential Epa of B1 and B2 were ?154.7, ?99?μA, and ?0.15?V, 0.0125?V, respectively. The low anodic current and low anodic peak potential imply the good reducing ability of the molecules. The radioprotective effect of bischalcones was studied by gamma radiation induced oxidative stress in E. coli K12 at 0.2 and 0.4?Gy. The bacteria samples treated with B1 and irradiated showed diminished level of TBARS, an oxidative stress marker. The levels of SOD and CAT antioxidant enzymes were brought to near basal level for B1 treated and irradiated bacteria with respect to the control. The protective effect of the bischalcone derivatives against radiation was further supported by determining colony forming units (CFU) of bacteria in pre- and post-irradiated samples. Further, B2 showed 73.69% of inhibition of buffalopox virus and camelpox virus.     

Direct exchange endoprosthetic reconstruction with tumour prosthesis for periprosthetic knee infection associated with segmental bone defects

Revision knee arthroplasty for infection poses a treatment challenge. The presence of massive osteolysis limits the treatment options in this cohort. Controversy exists in the management of these patients. Direct exchange arthroplasty has provided good results in the presence of infection, but whether this is appropriate in the presence of massive bone defects associated with the infection is undetermined. We present our experience in revision knee arthroplasty for infection associated with massive bone defects. The aim of the study is to present the preliminary results of a direct exchange endoprosthetic reconstruction with tumour prosthesis for periprosthetic infection associated with segmental bone defects. This is a retrospective study of prospectively collected data, involving six patients with periprosthetic infection and massive bone defects treated by direct exchange tumour prostheses between 2003 and 2007 (four distal femoral replacements and two total femoral replacements). The mean age and follow-up were 74.2 (±5.2) years and 32.5 (±8.2) months respectively. Each patient had an infected revised knee arthroplasty at the time of referral to our institution. Staphylococcus aureus was the most common causal organism. The mean duration of antibiotics was 6 weeks intravenous therapy followed by 3.5 months oral. The recurrences of infection, pain or immobility were outcome criteria considered failures. Our success rate was 80%. Salvage of infected revised knee arthroplasty by direct exchange endoprosthetic reconstruction has provided an effective means of pain relief, joint stability and improved mobility in our cohort. It reduces morbidity through earlier mobilisation and avoids a second major operation.     

Clinical outcomes of non-Descemet stripping automated endothelial keratoplasty

To describe the results of non-Descemet stripping automated endothelial keratoplasty (non-DSAEK). Retrospective, interventional, consecutive clinical case series. Twenty-three patients underwent non-DSAEK from January 2010 to February 2011. The various indications were pseudophakic corneal edema, aphakic corneal edema, failed graft, iridocorneal endothelial syndrome and congenital glaucoma. Corneal edema cleared in all patients within 1–4?weeks. Mean follow-up duration was 7.6?months. Post-operative best corrected visual acuity ranged from 20/400 to 20/40. Fourteen patients had co-morbid factors affecting the vision. No patient had interface haze. Immediate post-operative complications were partial graft detachment (1 patient) and secondary angle closure (1 patient). Corneal clarity was restored following secondary interventions. One late post-operative complication was graft rejection at 6?months, leading to graft failure. Non-DSAEK is a safe and viable option in cases of corneal decompensation when the Descemet membrane is non-pathological.