Chronic,Postoperative Pseudomonas luteola Endophthalmitis

An interventional case report is described of a patient with chronic postoperative endophthalmitis caused by the gram-negative aerobic rod Pseudomonas luteola. A 61-year-old developed slowly progressive blurring of vision, hypopyon, and vitritis following cataract surgery. Diagnostic vitrectomy and intraocular lens explantation were performed. The undiluted vitreous samples and explanted lens were analyzed. Aerobic cultures revealed moderate growth of P. luteola. The patient responded to intravitreal injections of piperacillin/tazobactam and oral trimethoprim/sulfamethoxasole. Best-corrected visual acuity improved from hand motions to 20/40. A repeat anterior chamber tap was negative. P. luteola may be a relatively nonvirulent cause of chronic endophthalmitis. Good visual outcomes may be obtained with appropriate therapy.     

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.     

Culture Proven Endogenous Bacterial Endophthalmitis in Apparently Healthy Individuals

Purpose: To report 7 eyes of 7 patients who were diagnosed as the cases of endogenous endophthalmitis and proved by culture reports. Though in most of the previously published series, one or more predisposing factors were present in the patients of endogenous endophthalmitis, the authors are presenting a case series of culture-proven endogenous endophthalmitis in apparently healthy and immunocompetent individuals.

Design: Retrospective noncomparative case series. All patients were diagnosed as endogenous bacterial endophthalmitis with positive vitreal culture. Variables studied were demographic characteristics, microbiology, therapeutic interventions done, final visual and anatomical outcome.

Results: Streptococcus pneumoniae was the most frequent isolate 43% (3 out of 7 eyes) followed by Staphylococcus aureus and E. coli in equal frequency 29% ( 2 each out of 7 eyes). The median time between the onset of symptoms and presentation with features of endophthalmitis to hospital was 7 days. The presenting visual acuity was less than HM (hand motions) in all cases except one, which had VA of 20/200. No single underlying predisposing condition was identifiable in any of the cases. All the cases were given intravitreal therapeutic agents (one or more doses of antibiotics and steroid) and pars plana vitrectomy was performed in 2 cases. The final visual acuity was not better than presenting VA except in 1 case, which had final VA of 20/40. Intraocular pressure was on the lower side (mean IOP 7?mmHg compared to 12?mmHg in the fellow eye). No eye was enucleated or eviscerated.

Conclusion: Though in most of the previously published literature endogenous endophthalmitis has been a metastatic ocular infection, the present study describes a series of endogenous bacterial endophthalmitis de novo in onset, without any identifiable predisposing factors. The overall age of presentation was in a younger population than in previously published series. The overall visual outcome was poor, probably due to the serious nature of disease itself and the relatively late presentation.     

Endophthalmitis caused by Acinetobacter baumanni: a case series

Purpose

To profile the etiology, clinical outcomes and drug sensitivity patterns in endophthalmitis caused by Acinetobacter baumanni.

Methods

Retrospective analysis of all the cases of Acinetobacter baumanni endophthalmitis presenting to tertiary referral care ophthalmic hospital in Eastern India from January 2009 to December 2011 were done.

Results

A total of four cases were included in the study. Out of the four cases one was post traumatic and the rest were post cataract surgery. All the cases underwent vitreoretinal surgical intervention followed by intravitreal antibiotics. A. Baumanni was isolated from vitreous in all the cases. Among all the drugs tested bacteria were found sensitive to ciprofloxacin (100 %) whereas all tested resistant to ceftazidime. Out of the four cases one had to be eviscerated, another developed retinal detachment post vitrectomy, one was phthisical at final followup, and only one patient achieved a vision of 20/200 with clear media and attached retina at final visit.

Conclusion

A. Baumanni is a very rare cause of endophthalmitis with poor visual and anatomical outcomes. Ciprofloxacin should be considered as first the line intravitreal antibiotic.     

玻璃体内注药术后眼内炎的危险因素及预防

近年来玻璃体内药物注射的发展非常迅速,应用范围不断扩大,尤其是玻璃体内注射抗血管内皮生长因子（vascularendothelialgrowthfactor,VEGF）制剂已成为眼科最常用的治疗方法之一。因此更有必要认真审视其并发症,尤其是眼内炎这一玻璃体内注射最严重的并发症。研究显示玻璃体内注射抗VEGF制剂后眼内炎发生率约0．02％～0．09％。危险因素包括注射前危险因素（活动性外眼感染、按压眼睑、较粗注射针头、青光眼、糖尿病等系统性疾病）,注射中危险因素（飞沫传播、无菌操作不严格）和注射后危险因素（多次注射）等。围手术期使用抗生素预防的效果尚无定论。     

外伤性兔眼内炎房水中肿瘤坏死因子-α、白细胞介素-1β及中性粒细胞趋化因子-1的相对含量变化及意义

目的 通过分析兔眼外伤后不同时间点房水中肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-1β(interleukin-1β,IL-1β)、中性粒细胞趋化因子-1(cytokine induced neutrophil chemoattractant-1,CINC-1)含量的动态变化,探讨促炎细胞因子在外伤性眼内炎中的作用机制.方法 将18只兔随机分为3组,每组6只,其中Ⅰ组为正常对照组,Ⅱ组为无菌外伤组,Ⅲ组为有菌(金黄色葡萄球菌)外伤组.Ⅱ组和Ⅲ组兔右眼建立外伤性眼内炎模型,并将金黄色葡萄球菌接种于Ⅲ组兔右眼的玻璃体内.于造模后6h、12 h、1d、2d、4d、5d、7d、14 d用裂隙灯及间接检眼镜观察眼部炎症情况并进行临床炎症评分.ELISA法测定各组造模后6h、12 h、1d、2d、4d、5d房水中TNF-α、IL-1β、CINC-1的含量变化.结果 造模后12 h、1d、2d、4d、5d、7d、14 d,Ⅱ组各时间点临床炎症评分分别为(2.50±0.55)分、(3.67±0.82)分、(4.00±0.63)分、(6.12±0.75)分、(7.00±0.63)分、(7.33±0.52)分、(5.50±0.54)分,Ⅲ组分别为(4.00 ±0.63)分、(6.17±0.75)分、(7.67±0.52)分、(10.60±0.82)分、(11.50±0.55)分、(11.80±0.41)分、(10.33±0.51)分,两组各时间点临床炎症评分间差异均有统计学意义(均为P＜0.05),造模12 h后Ⅲ组炎症反应明显较Ⅱ组重.Ⅱ组和Ⅲ组兔房水中TNF-α在炎症初期就开始升高,1d时达到高峰,与Ⅰ组相比差异均有统计学意义(均为P＜0.05).Ⅱ组和Ⅲ组兔房水中IL-1β含量于造模后1d时达到高峰,与Ⅰ组相比差异均有统计学意义(均为P＜0.05).Ⅱ组和Ⅲ组兔房水中CINC-1含量在造模后12 h时即达到高峰,与Ⅰ组相比差异均有统计学意义(均为P＜0.05).Ⅱ组和Ⅲ组兔房水中TNF-α、IL-1β、CINC-1各时间点相比差异均无统计学意义(均为P＞0.05).结论 外伤后机体的免疫调节机制在外伤性眼内炎发生发展过程中发挥重要作用,房水中TNF-α、IL-1β、CINC-1表达升高与炎症程度相关,调控细胞因子网络可能成为未来眼内炎一个有效的联合治疗措施.     

Endophthalmitis management study. Report #1. Protocol

To date, the Endophthalmitis Vitrectomy Study (EVS) has remained the hallmark of evidence-based management of acute bacterial endophthalmitis after cataract surgery with an intraocular lens. In the last quarter-century since its publication, several studies have reported that the microbiological spectrum of endophthalmitis is not the same across the world; there is emerging antibiotic resistance of gram-negative microorganisms to the EVS recommended antibiotics; there are newer molecules that could cross the blood-retinal barrier; the advances in vitreous surgery have become safer than before, and there are newer methods of microbiological evaluation. One of the often-mentioned drawbacks of the EVS was not recruiting grossly infected eyes with poor visibility of the iris and vitreous. Keeping these factors in mind, a new prospective multi-centered randomized study, the Endophthalmitis Management Study (EMS), is designed. The EMS will recruit all post-cataract surgery endophthalmitis patients irrespective of severity (including suspected fungal infection); the EMS will use quantifiable inflammatory score instead of the presenting vision to allocate for surgery, randomize the eyes to two different combinations of intravitreal antibiotics and use the newer microbiological diagnostic techniques. We believe the EMS findings will complement the EVS recommendations.     

Analysis of post-operative endophthalmitis after pars plana vitrectomy: a 10-year experience at a single center

Background Endophthalmitis can be a devastating complication after pars plana vitrectomy.The incidence of post-vitrectomy endophthalmitis is significantly lower than that of endophthalmitis occurring a...     

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.     

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.