A Review of the Role of Intravitreal Corticosteroids as an Adjuvant to Antibiotics in Infectious Endophthalmitis

Ho, Dawn; Agarwal, Aniruddha; Lee, Cecilia S.; Chhablani, Jay; Gupta, Vishali; Khatri, M; Nirmal, Jayabalan; Pavésio, Carlos; Agrawal, Rupesh

doi:10.1080/09273948.2016.1245758

Cited by 37 publications

(21 citation statements)

References 42 publications

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“…A major determinant for the prognosis of endophthalmitis is timely diagnosis that facilitates early intervention. 16 However, despite early recognition of the infection and treatment with IVAB, the disease may progress and contribute to the formation of RD.…”

Section: Discussionmentioning

confidence: 99%

Retinal Detachment After Endophthalmitis: Risk Factors and Outcomes

Wang

Moinuddin

Abuzaitoun

et al. 2021

OPTH

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Purpose To analyze the risk factors, clinical course, and visual and anatomic outcomes of retinal detachment (RD) after endophthalmitis. Patients and Methods This retrospective study included 108 patients diagnosed with endophthalmitis between August 2014 and May 2019 at a single tertiary referral center. Sixteen patients developed RD after endophthalmitis. Retrospective analysis was performed to compare the cohort of endophthalmitis alone versus the cohort that developed RD after endophthalmitis, with analysis of potential risk factors for RD after endophthalmitis and treatment outcomes. Results The incidence of RD after endophthalmitis was 14.8% (N=16/108). The median time to develop RD after endophthalmitis was 27 days (range: 1–581 days, IQR: 25.3). Thirteen (81.3%) cases of RD occurred less than 2 months after the diagnosis of endophthalmitis. The incidence of aphakia (p=0.023) and posterior synechia (PS) (p=0.014) were significantly higher in the RD group. The mean initial and final visual acuity (VA) of the endophthalmitis alone group was 1.9±0.8 logMAR and 1.2±1.0 logMAR (p<0.0001), respectively, and 1.9±0.9 logMAR and 1.3±1.2 logMAR (p=0.07) in the RD group, respectively. Enucleation or evisceration occurred in 31.3% of cases with RD after endophthalmitis. The rate of final retinal re-apposition for the RD cohort was 56.3%. Conclusion The anatomic and functional outcomes for RD after endophthalmitis remain poor, with significant risk for permanent vision loss. Aphakia and posterior synechiae were seen more often in cases with RD after endophthalmitis.

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Section: Discussionmentioning

confidence: 99%

Retinal Detachment After Endophthalmitis: Risk Factors and Outcomes

Wang

Moinuddin

Abuzaitoun

et al. 2021

OPTH

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“…Few authors have reported the use of intravitreal corticosteroids. There is likely insufficient support in the current literature to recommend intravitreal corticosteroids as a standard of care [ 51 ].…”

Section: Medical Treatmentmentioning

confidence: 99%

Endogenous Endophthalmitis: A Review of Case Series Published between 2011 and 2020

Danielescu

Anton

Stanca

et al. 2020

Journal of Ophthalmology

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This is a literature review of 31 case series of endogenous endophthalmitis (EE) published in the last ten years, identified from a literature search of several databases (PubMed, EMBASE, and the Cochrane Library). While diabetes mellitus and malignancies remain the most frequently associated medical conditions, intravenous drug use is a significant risk factor (especially in the last years, in studies from Western countries). Ophthalmologic screening is recommended for candidaemia, but not in patients with sepsis of other aetiologies (however, the physician treating patients with sepsis must be well aware of EE). The most frequent Gram-positive microorganisms that cause EE are Staphylococcus and Streptococcus; the most frequent Gram-negative organism is Pseudomonas, and yeasts, probably Candida, usually cause fungal infections. In all-cause EE, prognostic factors of better visual outcomes are initial VA better than counting fingers, performing a pars plana vitrectomy (PPV), performing an intravitreal injection within the first 24 hours after clinical diagnosis, and the presence of a focal type of EE. In endogenous fungal endophthalmitis, more than 1/4 of patients have bilateral involvement. Blood samples have a low rate of positivity. Yeasts remain the most prevalent cause. Many authors report using azoles and echinocandins for systemic therapy (and voriconazole for intravitreal injections). Although PPV was performed in small proportions of eyes, the anatomical success rate is quite high. Klebsiella pneumoniae is an important cause of EE in Southeast Asia (and probably an emergent etiology in other regions), which is frequently associated with diabetes. There is a robust association with pyogenic liver abscess (PLA) (but in up to half of the cases, the diagnosis of EE precedes that of PLA). Blood cultures have a high diagnostic yield, while vitreous samples have a low yield. K. pneumoniae may carry antibiotic resistance. Anatomical and functional success rates are small, but they may be improved with PPV.

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“…pneumoniae endophthalmitis thought to have no underlying risk factors at admission, receiving prompt intravitreal antibiotics and vitrectomy, but who demonstrated the dismal visual outcome that remains associated with this condition. More research is being done to clarify the role of corticosteroids [19]. Patients such as this one, presenting with suspected choroidal abscesses, require a high index of suspicion, and urgent medical assessment to initiate both sepsis screening and immediate empirical treatment.…”

Section: Discussionmentioning

confidence: 99%

Endogenous Klebsiella endophthalmitis as the presentation of both Klebsiella liver abscess and underlying anti-IFN-3 autoimmunity

Castle

Heath

2020

Access Microbiology

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This case study is one of the first ever reported examples of infection in a patient with anti-IFN-3 autoimmunity and demonstrates how overwhelming infection can sometimes present with visual symptoms. We report the case of a previously fit middle-aged patient presenting with painless loss of vision and loss of appetite. Examination showed choroidal abscess and a pan-uveitis, leading to admission for vitreous biopsy. Klebsiella pneumoniae was isolated both in the vitreous and in blood cultures. Subsequent investigation discovered a liver abscess which was treated with percutaneous drainage. Despite the administration of intravitreal antibiotics from the time of presentation, intravenous antibiotics and vitrectomy on the same day, the patient proceeded to need enucleation 19 days later, and now has only light perception in the remaining eye. The strong association between K. pneumoniae endophthalmitis and underlying liver abscess leads to a significant mortality rate. Early diagnosis is essential, with prompt aggressive treatment with antibiotics, but sadly the visual prognosis remains poor. In cases of suspected choroidal abscess, initiation of sepsis screen and immediate empirical treatment is vital to improve this prognosis. This patient had no significant past medical history, no known immunocompromise, was not diabetic and had no recent significant foreign travel. However, further immunological analysis demonstrated the presence of anti-IFN-3 antibodies, a hitherto under-reported potential cause of increased susceptibility to infection, and so cases of sepsis in previously healthy individuals should be considered for further immunology assessment.

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A Review of the Role of Intravitreal Corticosteroids as an Adjuvant to Antibiotics in Infectious Endophthalmitis

Cited by 37 publications

References 42 publications

Retinal Detachment After Endophthalmitis: Risk Factors and Outcomes

Retinal Detachment After Endophthalmitis: Risk Factors and Outcomes

Endogenous Endophthalmitis: A Review of Case Series Published between 2011 and 2020

Endogenous Klebsiella endophthalmitis as the presentation of both Klebsiella liver abscess and underlying anti-IFN-3 autoimmunity

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