Endophthalmitis

Cunningham, Christy; Widder, Jered; Raiji, Veena

doi:10.1016/j.disamonth.2016.09.005

Cited by 17 publications

(17 citation statements)

References 6 publications

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“…Postoperative endophthalmitis was preceded primarily by cataract surgery (29.3 %), the most common type of eye surgery performed worldwide [4], and IVOM. The incidence of endophthalmitis after the latter procedure is very low (0.06 % in the largest meta-analysis to date with more than 350,000 anti-VEGF injections [17]), but is steadily increasing due to its exponential use, especially in the treatment of age-related macular degeneration [4,7]. With regard to the occurrence of post-injection endophthalmitis, the safety of administration in a clinic setting is comparable to that in the operating room [18].…”

Section: Discussionmentioning

confidence: 99%

“…Da diese Behandlung wiederholt durchgeführt wird, besteht das Risiko, eine Endophthalmitis zu entwickeln, fort. Ein subjektiv verändertes Gefühl des Patienten bei einer solchen Injektion sollte stets ernst genommen werden, da dies der einzige Hinweis auf den Beginn der Infektion sein kann [4].…”

Section: Accepted Manuscriptunclassified

“…Das visuelle Outcome weist eine starke Korrelation zu dem auslösenden Erreger auf. Je nach zugrundeliegender Ätiologie bieten diese ein heterogenes Spektrum [4,6,8]. Posttraumatische Endophthalmitiden sind beispielsweise mit einem besonders schlechten Endvisus assoziiert.…”

Section: Accepted Manuscriptunclassified

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Endophthalmitis: Ursachen, Erreger, Therapie und Visusverlauf mit Fokus auf Glaukompatienten

Vorbeck

Hohberger

Bergua

2022

Klin Monbl Augenheilkd

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Hintergrund Endophthalmitiden stellen einen der schwerwiegendsten Notfälle in der Ophthalmologie dar. Um deren Prävalenz zu minimieren, ist eine möglichst genaue Kenntnis auslösender Faktoren von Bedeutung. Eine chirurgische Therapie mit gezielter, Erreger-spezifischer Medikation und ein intaktes Immunsystem sind die Basis für den Visuserhalt. Ferner stellt sich die Frage, ob anhand zugrundeliegender Erkrankungen am Auge ein ungünstiger Verlauf prognostiziert werden kann, sodass ein Vergleich zwischen Glaukom- (G) und Nicht-Glaukompatienten (NG) im Hinblick auf ursächliche Faktoren, Erreger, Therapie und Visusverlauf gezogen wurde. Da bei Glaukompatienten eine potentielle Alteration des lokalen Immunsystems diskutiert wird, ist von Interesse, ob sich die klinischen Verläufe einer Endophthalmitis von Nicht-Glaukompatienten unterscheiden. Patienten und Methoden Es handelt sich um eine retrospektive Analyse von 75 Augen (13 G, 62 NG), die in einem 5-Jahres-Zeitraum aufgrund einer Endophthalmitis an der Augenklinik des Universitätsklinikums Erlangen-Nürnberg behandelt wurden. Auszuwertende Parameter waren u.a. das klinische Bild, operative und medikamentöse Behandlungen, das mikrobielle Spektrum und der Visusverlauf bei Glaukom- sowie Nicht-Glaukompatienten. Ergebnisse Bei Erstvorstellung dominierte bei allen Patienten eine akute Visusverschlechterung (44%) mit Vorderkammerreiz (62,7%), Hypopyon (52%) und reduziertem (40%) oder fehlendem (26,7%) Funduseinblick. Vorangehende intraokulär-chirurgische Eingriffe wurden bei insgesamt 53,3% beobachtet, insbesondere Kataraktoperationen. In beiden Gruppen konnten gram-positive Kokken als häufigster Erreger identifiziert werden (G: 23,1%; NG: 38,7%), wohingegen seltene Keime nur bei Glaukompatienten vorkamen. Bei 76% aller Patienten wurde eine pars-plana-Vitrektomie durchgeführt, eine Enukleation bei 20%, letzteres signifikant häufiger bei Glaukompatienten (p=0,01). Postoperativ konnte eine signifikante Visusverbesserung bei Nicht-Glaukompatienten erzielt werden (p<0,001); im Direktvergleich stellte sich ein schlechteres visuelles Outcome bei glaukomatös vorerkrankten Augen dar. Schlussfolgerung Stellt die Endophthalmitis eine sehr seltene Erkrankung dar, ist eine frühzeitige Diagnosestellung und Behandlung dennoch für die Prognose entscheidend. In der vorliegenden Kohorte zeigt sich ein schlechterer Endvisus bei Glaukompatienten als bei Nicht-Glaukompatienten. Background Endophthalmitis is one of the most serious emergencies in ophthalmology. In order to lower their prevalence, the most accurate knowledge of potential risk factors is important. Surgical therapy with targeted, pathogen-specific medication and an intact immune system are fundamental to preserve visual acuity. Furthermore, the question arises whether an unfavorable course can be predicted on the basis of underlying diseases of the eye, therefore a comparison between glaucoma patients (G) and non-glaucoma patients (NG) with regard to causative factors, pathogens, therapy and visual acuity course was drawn. Since a potential alteration of the local immune system in glaucoma disease has been described, it is of interest whether the clinical courses of endophthalmitis differ from non-glaucoma patients. Patients and methods A retrospective analysis of 75 eyes (13 G, 62 NG) who underwent treatment and surgery due to the diagnosis of endophthalmitis in the Department of Ophthalmology, University of Erlangen-Nuremberg has been evaluated over a period of 5 years. Clinical characteristics, surgical treatment, microbial spectrum and visual acuity in glaucoma and non-glaucoma eyes were investigated. Results A drastic vision impairment (44%) with inflammation of the anterior chamber (62.7%), hypopyon (52%) and reduced (40%) or complete missing sight (26.7%) of the fundus were predominantly present at first diagnosis in all patients. A previous eye surgery was observed in a total of 53%, especially cataract surgery. Gram-positive cocci were seen as the most common causing agent in both groups, (G: 23.1%; NG: 38.7%), whereas other rare pathogens were present only in glaucoma eyes. Pars-plana-vitrectomy was performed in 76% and enucleations in 20% of all patients, the latter significantly increased in glaucomateous eyes (p=0.01). A significant postoperative improvement of visual acuity was yielded in non-glaucoma patients (p<0.001); visual acuity outcome was worsen in glaucoma eyes. Conclusion Despite its rareness, early diagnosis and treatment of endophthalmitis is crucial for prognosis. In the present cohort, a worse visual acuity outcome was yielded in glaucoma patients in comparison to non-glaucoma patients.

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Section: Discussionmentioning

confidence: 99%

Section: Accepted Manuscriptunclassified

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Endophthalmitis: Ursachen, Erreger, Therapie und Visusverlauf mit Fokus auf Glaukompatienten

Vorbeck

Hohberger

Bergua

2022

Klin Monbl Augenheilkd

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“…[5] The visual function of BE patient is determined by the timely treatment, toxicity of invaded bacteria, and the severity of intraocular inflammation activated by bacteria and other components. [5][6] At present, BE is commonly treated with empirical intravitreal injection of vancomycin in combination with other antibiotics, and vitrectomy is necessary in some severe cases. [4] Even though the antibiotics could be easily conducted by an intravitreous injection, overuse or misuse of the antibiotics would result in drug resistance of pathogens, even with the emergence of super bacteria.…”

Section: Introductionmentioning

confidence: 99%

Vision Defense: Efficient Antibacterial AIEgens Induced Early Immune Response for Bacterial Endophthalmitis

Cai

et al. 2022

Advanced Science

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Bacterial endophthalmitis (BE) is an acute eye infection and potentially irreversible blinding ocular disease. The empirical intravitreous injection of antibiotic is the primary treatment once diagnosed as BE. However, the overuse of antibiotic contributes to the drug resistance of pathogens and the retinal toxicity of antibiotic limits its application in clinic. Herein, a cationic aggregation-induced emission luminogens named with triphenylamine thiophen pyridinium (TTPy) is reported for photodynamic treatment of BE. TTPy can selectively discriminate and kill bacteria efficiently over normal ocular cells. More importantly, TTPy shows excellent antibacterial ability in BE rat models infected by Staphylococcus aureus. Meanwhile, the bacterial killing behavior triggered by TTPy induces innate immune response at an early stage of infection, limiting subsequent robust inflammation and protecting retina from bacterial toxins and inflammation-induced bystander damage. In addition, TTPy performs better antibacterial ability than commercially used Rose Bengal, suggesting its excellent capability of vision salvage in acute BE. This study exhibits an efficient photodynamic antibacterial treatment to BE, which induces an early intraocular immune response and saves useful vision, endowing TTPy a promising potential for clinical application of ocular infections.

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“…Endogenous endophthalmitis is an infection of the intraocular fluids involving the vitreous and/or aqueous humour due to haematologic spread from a distant site 1 2. Even though the incidence of endogenous endophthalmitis reported in the literature varies, it is less common than exogenous endophthalmitis 3.…”

Section: Introductionmentioning

confidence: 99%

Streptococcus salivariusendogenous endophthalmitis

et al. 2021

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We describe a case of endogenous endophthalmitis in an elderly man caused by Streptococcus salivarius. An 88-year-old male patient with diabetes with iron deficiency anaemia and history of transcatheter aortic valve implantation presented with an insidious clinical picture of atraumatic endophthalmitis. No internal or external source could be identified. Diagnostic and therapeutic vitrectomy revealed papillomacular abscess and vitreous fluids grew S. salivarius. Despite lack of an identifiable source of infection, a high index of suspicion for atypical presentations is required in patients with multiple comorbidities that could weaken their immune system towards opportunistic infections. Early detection, microbiological evaluation and prompt treatment are critical to avoid disastrous outcomes. While S. salivarius has been implicated in cases of exogenous endophthalmitis, this is the first reported case of endogenous endophthalmitis due to S. salivarius.

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Endophthalmitis

Cited by 17 publications

References 6 publications

Endophthalmitis: Ursachen, Erreger, Therapie und Visusverlauf mit Fokus auf Glaukompatienten

Endophthalmitis: Ursachen, Erreger, Therapie und Visusverlauf mit Fokus auf Glaukompatienten

Vision Defense: Efficient Antibacterial AIEgens Induced Early Immune Response for Bacterial Endophthalmitis

Streptococcus salivariusendogenous endophthalmitis

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