Endophthalmitis following intravitreal injection versus endophthalmitis following cataract surgery: clinical features, causative organisms and post-treatment outcomes

Simunovic, Matthew P.; Rush, Ryan B; Hunyor, Alex P.; Chang, Andrew

doi:10.1136/bjophthalmol-2011-301439

Cited by 102 publications

(88 citation statements)

References 28 publications

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“…Our results confirm previous reports, showing that cases of streptococcus-induced endophthalmitis are characterized by a worse functional outcome [10, 12, 16]. Our study revealed a higher rate of office-based procedures in the streptococcus-associated group.…”

Section: Discussionsupporting

confidence: 82%

“…Nonstaphylococcal and nonstreptococcal pathogens accounted for 12% of all endophthalmitis cases in our study. This proportion is in agreement with previous reports of nation-wide studies [9, 11-13, 16, 17]. In contrast to other studies, the present one included 17 international retina referral centers in Europe, Australia, Asia, and South America.…”

Section: Discussioncontrasting

confidence: 52%

“…Streptococcus-induced endophthalmitis has previously been shown to be associated with worse outcome compared to nonstreptococcal cases [10, 12, 16]. Therefore, the second objective of this study was to describe the streptococcus-induced endophthalmitis cohort and compare baseline characteristics and injection procedure to nonstreptococcal endophthalmitis cases.…”

Section: Discussionmentioning

confidence: 99%

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Causative Pathogens of Endophthalmitis after Intravitreal Anti-VEGF Injection: An International Multicenter Study

et al. 2019

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Purpose: The main objective of this study was to investigate the microbiological spectrum of endophthalmitis after anti-VEGF injections and to compare streptococcal with non-streptococcus-associated cases with regard to baseline characteristics and injection procedure. Methods: Retrospective, international multicenter study of patients with culture-positive endophthalmitis after intravitreal anti-VEGF injection at 17 different retina referral centers. Results: Eighty-three cases with 87 identified pathogens were included. Coagulase-negative staphylococci (59%) and viridans streptococci (15%) were the most frequent pathogens found. The use of postoperative antibiotics and performance of injections in an operating room setting significantly reduced the rate of streptococcus-induced endophthalmitis cases (p = 0.01 for both). Conclusion: We found a statistically significant lower rate of postinjectional local antibiotic therapy and operating room-based procedures among the streptococcus-induced cases compared to cases caused by other organisms.

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Section: Discussionsupporting

confidence: 82%

Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

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Causative Pathogens of Endophthalmitis after Intravitreal Anti-VEGF Injection: An International Multicenter Study

et al. 2019

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“…Unlike many previous studies [10,12,13,14], we did not find an increased frequency of streptococcus species when we compared patients with post-injection and post-cataract endophthalmitis. We recognize that the numbers are small, but we cannot concur with the idea that the oral flora is a relatively greater risk factor for post-injection endophthalmitis compared to post-cataract endophthalmitis [15].…”

Section: Discussioncontrasting

confidence: 54%

“…VAs were converted to logMAR values as applied by Simunovic et al [10]. If patients were lost to follow-up (post-cataract: n = 3, post-injection: n = 2, endogenous: n = 1, vitreoretinal surgery: n = 1 and other causes: n = 1), the last recorded chart VA was used.…”

Section: Methodsmentioning

confidence: 99%

A Prospective Study on the Clinical and Microbiological Spectrum of Endophthalmitis in a Specific Region in Denmark

Bjerrum

Hamoudi²,

Friis-Møller³

et al. 2015

Ophthalmologica

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Purpose: To study the clinical and microbiological spectrum of endophthalmitis with emphasis on clinical features, visual outcomes and risks of surgical complications. Methods: A prospective observational study was conducted between 2012 and 2013 in a specific region in Denmark. Patients were clinically examined before, during and after surgical intervention for endophthalmitis. Results: Fifty eyes with endophthalmitis were included. Endophthalmitis after cataract surgery (post-cataract), anti-VEGF (vascular endothelial growth factor) intravitreal injections (post-injection) and cases of endogenous endophthalmitis were responsible for 40, 28 and 18% of all cases, respectively. There was no difference in the microbiological spectrum in post-cataract patients and post-injection patients, but patients with post-cataract endophthalmitis presented statistically significantly more frequently with hypopyon and fibrin in the anterior chamber. Between 20 and 25% of post-cataract and post-injection endophthalmitis patients developed a surgical complication after primary surgical intervention for endophthalmitis, and this was statistically significantly associated with a poor visual outcome. There was no statistically significant difference in the risk of surgical complications in phakic and pseudophakic eyes with post-injection endophthalmitis. Of the 8 patients with endogenous endophthalmitis, 67% developed a surgical complication, and these patients had a high mortality. The visual outcome in the most common types of endophthalmitis was good, with 60% of post-cataract patients achieving a visual outcome ≥0.5, and 64% of post-injection patients only had a mild vision loss (1-14 ETDRS letters) or even gained vision. Conclusions: The endophthalmitis cases had a broad clinical spectrum. Surprisingly, endogenous endophthalmitis accounted for almost one fifth of all cases. Patients with post-cataract endophthalmitis had a clinically different presentation than patients with post-injection endophthalmitis. In general, the bacteria were low-virulent and the visual outcomes good, but a substantial part of the patients developed a surgical complication which was associated with a poor visual outcome.

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Antibiotic Resistance of Ocular Surface Flora With Repeated Use of a Topical Antibiotic After Intravitreal Injection

Yin¹,

Weisbrod²,

Eng³

et al. 2013

JAMA Ophthalmol

100

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Endophthalmitis following intravitreal injection versus endophthalmitis following cataract surgery: clinical features, causative organisms and post-treatment outcomes

Abstract: Endophthalmitis following IVI is associated with an increased incidence of Streptococcus spp. infection, earlier presentation and poorer visual outcomes when compared with endophthalmitis following cataract surgery.

Cited by 102 publications

References 28 publications

Causative Pathogens of Endophthalmitis after Intravitreal Anti-VEGF Injection: An International Multicenter Study

Causative Pathogens of Endophthalmitis after Intravitreal Anti-VEGF Injection: An International Multicenter Study

A Prospective Study on the Clinical and Microbiological Spectrum of Endophthalmitis in a Specific Region in Denmark

Antibiotic Resistance of Ocular Surface Flora With Repeated Use of a Topical Antibiotic After Intravitreal Injection

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