Diagnosis and management of fungal endophthalmitis: India perspective

Das, Taraprasad; Agarwal, Manisha; Behera, Umesh Chandra; Bhattacharjee, Harsha; Bhende, Muna; Das, Anthony Vipin; Dave, Vivek Pravin; Dogra, Avantika; Ghosh, Anup; Giridhar, Sneha; Joseph, Joveeta; Kandle, Kaustubh; Karoliya, Roshni; Lalitha, Prajna; Pathengay, Avinash; Sharma, Savitri; Therese, Lily

doi:10.1080/17469899.2020.1820322

Cited by 18 publications

(4 citation statements)

References 58 publications

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“…The series of 15 microbiology-positive fungal infections did not allow us to make a definite conclusion though the current results suggested that primary vitrectomy is a required intervention. These patients should receive an intravitreal antifungal agent injection and vitrectomy when a microbiology confirmation is available 26,27 …”

Section: Discussionmentioning

confidence: 99%

“…These patients should receive an intravitreal antifungal agent injection and vitrectomy when a microbiology confirmation is available. 26,27 Interim Analysis Interim analysis, a standard practice in large and longduration clinical trials, evaluates the current data in an ongoing trial, in which the primary research question is addressed and which has the potential to modify the conduct of the study. 28,29 The interim analysis in the current study showed that colistin could be a better alternative to imipenem and ceftazidime.…”

Section: Fungal Endophthalmitismentioning

confidence: 99%

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Endophthalmitis Management Study—A Prospective Randomized Clinical Trial on Postoperative Endophthalmitis Management in India: An Interim Analysis. Endophthalmitis Management Study Report #3

Das,

Belenje,

Pandey

et al. 2023

Asia-Pacific Journal of Ophthalmology

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Purpose: An interim analysis of the Endophthalmitis Management Study to examine the outcome of inflammation score (IS)–based treatment and antibiotic susceptibility. Design: A prospective randomized study. Patients and Methods: IS was measured on a 0–4 scale from presenting signs in 4 cardinal ocular tissues. The eyes with IS <10 received vitreous tap and intravitreal antibiotics, whereas eyes with IS ≥10 received vitrectomy and intravitreal antibiotics. These eyes were randomized to 2 intravitreal antibiotic combinations: (1) vancomycin and ceftazidime and (2) vancomycin and imipenem. Microbiology workup of undiluted vitreous included microscopy, culture-susceptibility, Sanger, and targeted next-generation sequencing. The clinical and microbiology outcomes were analyzed for advanced (IS = ≥20) and less advanced (IS = <10) endophthalmitis. Results: Interim analysis was performed after the Endophthalmitis Management Study recruited 56.85% (248/436) of patients and completed 54.6% (238/436) of microbiology workup. A 90-day follow-up was completed in 90.8% (168/185) of eligible people. In eyes with IS ≥20, the time to symptoms was shorter (5.8 ± 6.7 vs 8.5 ± 9.1 d; P = 0.015), and the need for additional treatment was higher (95.8% vs 53.1%; P = 0.0267). Good final vision was associated with good presenting vision (r = 0.30) and IS-based treatment decisions (r = 0.170). Microbiology positivity was 55.9%. Eyes with IS <10 had a higher Gram-positive cocci (33.9% vs 4.8%; P = 0.013) infection. Gram-positive cocci were most susceptible to vancomycin (95.7%), and Gram-negative bacilli to colistin (95.7%). Conclusions: Considering both IS and presenting vision, rather than only one of them, helps in making appropriate management decisions for acute postoperative endophthalmitis.

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Section: Discussionmentioning

confidence: 99%

Section: Fungal Endophthalmitismentioning

confidence: 99%

Endophthalmitis Management Study—A Prospective Randomized Clinical Trial on Postoperative Endophthalmitis Management in India: An Interim Analysis. Endophthalmitis Management Study Report #3

Das,

Belenje,

Pandey

et al. 2023

Asia-Pacific Journal of Ophthalmology

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“…[ 20 21 ] Additionally, concurrent systemic therapy is always recommended in fungal endophthalmitis. [ 22 ]…”

Section: Discussionmentioning

confidence: 99%

Evaluating the utility of inflammation score in post-cataract surgery endophthalmitis. Results from a prospective study in India. EMS Report #4

Das,

Belenje,

Joseph

et al. 2023

Indian Journal of Ophthalmology

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Purpose: To investigate if inflammation score (IS), calculated from the cornea, anterior chamber, iris, and vitreous, indicates endophthalmitis severity. Methods: In a prospective study, consecutive adults with a clinical diagnosis of post-cataract endophthalmitis within 6 weeks of surgery were recruited. Patients were allocated to IS-based primary treatment (IS < 10: intravitreal injection and IS ≥ 10: vitrectomy) and randomized to two intravitreal antibiotics combinations (vancomycin + ceftazidime and vancomycin + imipenem). Undiluted vitreous microbiology work-up included culture susceptibility, polymerase chain reaction, Sanger sequencing, and targeted next-generation sequencing. Results: The average age of 175 people was 63.4 ± 10.7 years and included 52.6% small incision cataract surgery and 47.4% phacoemulsification surgery. Severe endophthalmitis (IS ≥ 20), diagnosed in 27.4% of people, had a shorter time to symptoms (average 5.4 vs 8.7 days; P = 0.018), poorer presenting vision (all ≤ hand motion), higher culture positivity (50% vs 30.7%; P = 0.032), and higher Gram-negative bacterial infection (70.8% vs 46.2%; P = 0.042). For IS ≥ 20 discriminant and Gram-negative infection, Spearman’s coefficient was 0.7 [P < 0.0001, 95% confidence interval (CI) 0.59–0.82], with an area under the receiver operating characteristic curve of 0.9 (95% CI 0.85–0.94, P < 0.0001), a Youden index J of 0.74, a sensitivity of 87.2%, and a specificity of 87.5%. The final vision of >20/400 and >20/100 was regained in 50.2% and 29.1% of people, respectively. The susceptibility of common Gram-positive cocci and Gram-negative bacilli was the highest for vancomycin (95.0%) and colistin (88.6%), respectively. NGS detected polymicrobial infection in 88.5% of culture-negative endophthalmitis. Conclusions: Higher inflammation scores indicated severe disease and Gram-negative infection in post-cataract endophthalmitis.

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“…These patients should receive an intravitreal antifungal agent injection and vitrectomy as soon as a microbiology con rmation is available. [25,26] Interim analysis Interim analysis, a standard practice in large and long duration clinical trials, evaluates the current data in an ongoing trial, in which the primary research question is addressed and which has the potential to modify the conduct of the study. [27,28] The interim analysis in the current study showed that colistin could be a better alternative to imipenem and ceftazidime.…”

Section: Fungal Endophthalmitismentioning

confidence: 99%

Endophthalmitis Management Study- a prospective randomized clinical trial on postoperative endophthalmitis management in India: An interim analysis. EMS Report # 3

Das

Belenje²,

Pandey³

et al. 2023

Preprint

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Purpose An interim analysis of Endophthalmitis Management Study - a multi-center study of acute postoperative endophthalmitis to examine the outcome of inflammation score (IS)- based treatment and identify an antibiotic alternate to ceftazidime with higher susceptibility to gram-negative bacilli. Methods Inflammation Score was measured on a 0 to 4 scale from presenting signs in four cardinal ocular tissues. The eyes with IS < 10 received vitreous biopsy + intravitreal antibiotics; eyes with IS ≥ 10 received vitrectomy + intravitreal antibiotics. These eyes were randomized to two intravitreal antibiotics combinations: vancomycin + ceftazidime and vancomycin + imipenem. Microbiology workup of undiluted vitreous included microscopy, culture-susceptibility, Sangers, and targeted next-generation sequencing. Results In three years, the EMS recruited 56.85% (248 of 436) patients, microbiology work-up was completed in 54.6% (238 of 436) people, and 94.4% (n = 234 of 248) had received cataract surgery. A 90-day follow-up was completed in 90.8% (168 of 185) of eligible people. In eyes with IS ≥ 20, the time to symptoms was shorter (5.8 ± 6.7 vs. 8.5 ± 9.1 days; p = 0.015), the need for additional treatment was higher (95.8% vs. 53.1%; p = 0.0267) and more often included vitreous procedures (44% vs. 6%; p = 0.012). Microbiology positivity was 55.9%; eyes with IS < 10 had a higher yield of gram-positive cocci (33.9% vs. 4.8%; p = 0.013). Vancomycin had good susceptibility to gram-positive cocci (95.7%); colistin had a better susceptibility to gram-negative bacilli (89.2%) than ceftazidime or imipenem (62.2% each). Conclusion Inflammation score could be a better guide to acute postoperative endophthalmitis treatment. Clinical Trial Registration. Clinical Trial Registry of India (CTRI/2019/02/017876)

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Diagnosis and management of fungal endophthalmitis: India perspective

Cited by 18 publications

References 58 publications

Endophthalmitis Management Study—A Prospective Randomized Clinical Trial on Postoperative Endophthalmitis Management in India: An Interim Analysis. Endophthalmitis Management Study Report #3

Endophthalmitis Management Study—A Prospective Randomized Clinical Trial on Postoperative Endophthalmitis Management in India: An Interim Analysis. Endophthalmitis Management Study Report #3

Evaluating the utility of inflammation score in post-cataract surgery endophthalmitis. Results from a prospective study in India. EMS Report #4

Endophthalmitis Management Study- a prospective randomized clinical trial on postoperative endophthalmitis management in India: An interim analysis. EMS Report # 3

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