Fulminant endogenous <Emphasis Type="Italic">Klebsiella pneumoniae</Emphasis> endophthalmitis: imaging findings

Endogenous endophthalmitis is a rare but serious complication of Klebsiella pneumoniae infection that has been predominantly reported to occur in diabetic patients of East Asian origin with K. pneumoniae liver abscesses. The clinical symptoms and signs of endogenous endophthalmitis are nonspecific and may mimic other causes of an acute non-traumatic eye. Permanent visual loss and blindness are common sequelae because of delayed diagnosis and treatment. Computed tomography and magnetic resonance imaging can help to differentiate endophthalmitis from other causes of acute non-traumatic eye when the clinical findings are equivocal. Fluid attenuated inversion recovery and diffusion-weighted imaging with apparent diffusion coefficient map are superior to T2-weighted and gadolinium-enhanced T1-weighted sequences in demonstrating intra-ocular abscesses.     

Endogenous filamentous fungal endophthalmitis--single-centre survey in patients with acute leukaemia or postallogeneic stem cell transplantation and review of the literature

Endogenous endophthalmitis caused by filamentous fungi has been infrequently described and its prognosis in immunocompromised patients is largely unknown. Patients were identified through a single-centre database containing patients with endophthalmitis. Cases published since 2002 were reviewed. Clinical and treatment features as well as outcomes were analysed. Six patients were identified from the database. Underlying conditions were haematological malignancies (HM) and/or allogeneic haematopoietic stem cell transplantation (HSCT). Three patients underwent vitrectomy. None of the patients survived and the median time from first evidence of endophthalmitis until death was 33 days. The median time from first evidence of an invasive fungal infection to endophthalmitis was only 5 days. Fifty-six patients were identified from the literature. The majority of these patients underwent vitrectomy (27) or enucleation (10) and received intraocular antifungal therapy (28). Only 13 (23%) of 56 patients experienced an improved vision. The survival rate was 52% in all 56 patients but was significantly less in patients with HM or post-HSCT when compared with all others (26% vs. 70%, respectively; P = 0.003). Endogenous endophthalmitis caused by filamentous fungi is frequently associated with a permanent decrease or loss of vision. This type of fungal infection carries a particular poor prognosis in patients with profound immunosuppression, requiring improved treatment strategies.     

Risk and dose–response relationship of diabetes mellitus for endophthalmitis after cataract surgery in a nationwide cohort study in Taiwan

Background

To investigate the risk of endophthalmitis after cataract surgery in patients with diabetes mellitus (DM) and evaluate the dose–response relationship.

Methods

This retrospective cohort study enrolled patients who underwent bilateral cataract surgeries from 2000 to 2017 in Taiwan National Health Insurance Research Database. The endophthalmitis rates within 3 months after cataract surgery were compared between DM and non-DM cohorts using a generalised estimating equation. The diabetes complications severity index (DSCI) score was adopted to assess the dose–response effect on the endophthalmitis rate.

Results

A total of 883 398 patients (1 766 796 eyes) were included. Patients with DM had an increased risk of endophthalmitis after cataract surgery than patients without DM (0.261% vs. 0.242%, adjusted odds ratio = 1.09, 95% confidence interval = 1.03–1.16). The higher endophthalmitis rate in the DM group than in the non-DM group remains after excluding those with prior vitrectomy or intravitreal injection (IVI), and took IVI between the cataract surgery and endophthalmitis (p = 0.0156, 0.0048, and 0.0139). There was a significant dose–response relationship on the likelihood of endophthalmitis in DM patients when DCSI score >10. The endophthalmitis rate is highest among DM complications in patients with metabolic disorders (0.342%).

Conclusion

DM was a risk factor for endophthalmitis after cataract surgery after adjusting for age, sex, common systemic disorders, and excluding those with prior vitrectomy or IVI and having IVI between cataract surgery and endophthalmitis. A dose–response relationship was noted in DM patients with a DCSI score >10.     

无滴眼液的白内障手术发展现状

随着白内障手术步入了微创精准的屈光时代,对于围手术期感染控制提出了更高的要求。近年来,无滴眼液的白内障手术被提出并逐步应用于临床,其是基于白内障手术中联合不同局部注药形式,将抗生素及类固醇等药物通过即时或缓释等方式应用于术眼,使患者在整个围手术期均不需使用滴眼液。在达到术后抗炎、抗感染目的的同时,也能减少患者、患者家属及医生的负担。本文对无滴眼液的白内障手术的概念、联合用药方式、包括联合前房注射抗生素、曲安奈德与莫西沙星的混合注射剂(triamcinolone acetonide and moxifloxacin hydrochloride, TriMoxi)和曲安奈德、莫西沙星与万古霉素的混合注射剂(triamcinolone -moxifloxacin and vancomycin,TriMoxiVanc)玻璃体腔注射、联合地塞米松泪小点塞植入、持续或缓释药物传递机制等、以及其有效性及安全性等内容进行综述,以期为白内障术后感染预防提供新的思路与方向。     

Neisseria meningitidis Endogenous Endophthalmitis with Meningitis in an Immunocompetent Child

Abstract

Neisseria meningitidis is a major cause of childhood morbidity and mortality worldwide. We describe an exceptional case of an immunocompetent 15-month-old child presenting with a unilateral anterior uveitis, hypopyon, and sepsis. Anterior chamber aspirate demonstrated gram-negative cocci before Neisseria meningitidis was identified in blood and cerebrospinal fluid. Meningococcal endophthalmitis presents variably with sepsis, meningitis, or isolated ocular symptoms. Diagnosis is a clinical challenge, requiring diagnostic sampling and treatment from both pediatricians and ophthalmologists. Delayed or incorrect treatment risks blindness, disability, or death. Simultaneous invasion of meningococcus across intact blood–brain and blood–ocular barriers in this child suggests antigenic correlates between meningeal and ocular endothelial interfaces. Meningococcus is an exclusively human pathogen; research is hampered by the lack of animal models. This clinical observation suggests the potential of a novel in vitro experimental approach of using ocular tissue from eye banks to further elucidate the meningococcal–endothelial interaction that underpins meningococcal disease.     

Neonatal candidiasis associated with meningitis and endophthalmitis

From January 1991 to March 1993, a total of 11 infants with positive blood, urine, cerebrospinal fluid (CSF) or stool cultures of Candida albicans were found in the nursery or neonatal intensive care unit of the Chung Shan Medical and Dental College Hospital. Clinical features including respiratory deterioration, poor activity, abdominal distension and/or apnea were noted. Indwelling peripheral venous catheters had been used in all patients to provide parenteral nutrition and broad spectrum antibiotic therapy and six infants had received intravenous fat emulsions. Prolonged endotracheal intubation with mechanical ventilation had been used in eight infants. Six infants (54.5%) had meningitis, five infants (45.5%) had endophthalmitis, and two infants (18.2%) had arthritis. All 11 infants received intravenous amphotericin B therapy, and the concurrent oral administration of 5-fluorocytosine was used in the six infants with meningitis. Three infants died later. Since meningitis was recognized in 54.5% patients and endophthalmitis was recognized in 45.5% patients with systemic candidiasis, the author recommends that culture and analysis of CSF along with indirect ophthalmoscopy should be performed on all infants suspected of having systemic candidiasis.     

内源性眼内炎的临床特征及治疗

目的：探讨内源性眼内炎的临床特征及治疗。方法：对2005/2011年所收治的内源性眼内炎患者8例进行常规眼科检查,取前房水及玻璃体标本涂片和培养,血培养。给予局部及全身抗菌药物治疗,行玻璃体注药或（和）玻璃体切割术。观察病变特点及治疗效果。结果：患者8例9眼中男6例7眼,女2例2眼,年龄45～78岁。患者可有前葡萄膜炎症表现,玻璃体炎性改变,5例患者病原菌培养阳性,3眼行玻璃体腔注射,6眼行玻璃体切割手术。经治疗,患者病情控制,6眼视力提高。结论：内源性眼内炎根据病史、危险因素、临床表现以及实验室检查等综合进行诊断。局部＋全身治疗可有效控制感染。     

做好围手术期准备降低内眼手术后感染的风险

目的 讨论眼内手术和玻璃体腔注射术后发生细菌性眼内炎的危险因素和围手术期规范化管理.方法 针对易引起眼内手术和玻璃体腔注射术后感染的因素进行分析,规范了眼内手术和玻璃体腔注射标准、建立健全严格的消毒、器械清洗制度,严格管理无菌植入物品使用,强化医护人员的无菌观念.结果 通过完善围手术期感染控制流程,提高医护人员预防手术感染意识,确保手术的安全,降低了眼内手术感染率.本组眼内手术和玻璃体腔注射4096例,细菌性眼内炎3例,眼内炎的发病率为0.07％.结论 做好围手术期准备,规范眼内手术和玻璃体腔注射标准和严格的无菌操作是减少术后细菌性眼内炎的重要措施.