Result of Early Vitrectomy for Endogenous Klebsiella Pneumoniae Endophthalmitis

Yoon, Young Hee; Lee, Sang U.; Sohn, Joon Hong; Lee, Song Eun

doi:10.1097/00006982-200306000-00013

Cited by 107 publications

(96 citation statements)

References 8 publications

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“…However, overall, irrespective of causative organism, and similar to previous reports on EE, there were poor visual outcomes in this series. 5,8,10,24 Certainly, final VA is often dependent on the vascular inflammatory response, which may be severe and result in long-term sequelae, even in those successfully managed with tap and injection alone. Klebsiella species identification, or demonstration of a liver abscess, in particular, in association with diabetes mellitus, may necessitate early vitrectomy, as demonstrated in this series and previous studies because of the aggressive nature of this microbe and poor outcomes, 10,12,13 however, it remains unclear whether early vitrectomy would salvage these eyes.…”

Section: Discussionmentioning

confidence: 99%

“…The role of vitrectomy in EE is controversial, with published studies often referring to the Endophthalmitis Vitrectomy Study visual acuity (VA) thresholds, which may not be applicable to EE, a disease with a very different pathogenesis and natural history to postsurgical endophthalmitis. [8][9][10][11] Historically, the visual outcomes following EE have been poor, particularly when the causative organism is identified as one of the Klebsiella species. 12,13 Few large case series have documented the incidence, clinical features, and outcomes of EE.…”

Section: Introductionmentioning

confidence: 99%

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Endogenous endophthalmitis: 10-year experience at a tertiary referral centre

Connell

O'Neill

Fabinyi

et al. 2010

Eye

209

153

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Purpose Endogenous endophthalmitis (EE) is a sight-threatening emergency and the aetiology is often multifactorial. Delayed diagnosis may exacerbate the poor visual prognosis. We describe the management and visual outcomes of EE presenting to a tertiary referral centre. Patients and methods A prospective consecutive case series of 64 patients presenting with presumed EE from 1997 to 2007 to the Royal Victorian Eye and Ear Hospital were included. All data were collected in a standardized manner. Outcome measures included: visual acuity, microbial profiles, and vitrectomy rate. Results In total, 64 cases of EE were identified over the study period with a mean age of 57.5 years, and 53.5% were male. Presenting acuities ranged from Snellen 6/6 to no perception of light (NPL). Identifiable risk factors were present in 78.1%, with the majority related to intravenous drug abuse. A 64.1% culture positivity rate was recorded. A vitrectomy rate of 57, 56, and 21% was recorded in documented bacterial, fungal, and no growth cases, respectively. Final Snellen acuities ranged from 6/6 to NPL. A total of 5 out of 64 eyes were enucleated, of which 3 identified Klebsiella species. Better visual outcome was documented in fungal cases. Conclusion EE is a serious ocular condition and has a varied aetiology. Visual outcomes are often poor, irrespective of the method of management. Fungal aetiology often confers a better prognosis, and vitrectomy is advocated for bacterial proven cases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endogenous endophthalmitis: 10-year experience at a tertiary referral centre

Connell

O'Neill

Fabinyi

et al. 2010

Eye

209

153

View full text Add to dashboard Cite

show abstract

“…In cases of posttraumatic endophthalmitis where the eye contains retained IOFBs, immediate vitrectomy and intravitreal antibiotic injection has been recommended (Abu El-Asrar, et al, 1999). For endogenous endophthalmitis, adjunct vitrectomy conferred significant improvements in vision, but any delay in vitrectomy resulted in a comparative loss of visual acuity (Yoon, et al, 2003). Most reports agree that vitrectomy should be performed without delay in severe cases of endophthalmitis, especially those involving IOFBs.…”

Section: Therapeutic Challengesmentioning

confidence: 99%

Bacterial endophthalmitis: Therapeutic challenges and host–pathogen interactions

Callegan

Gilmore

Gregory

et al. 2007

Progress in Retinal and Eye Research

156

153

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Endophthalmitis is an infection of the posterior segment of the eye that frequently results in loss of vision. This devastating result occurs despite prompt and often aggressive therapeutic and surgical intervention. Over the past decade, research has centered on determining the bacterial and host factors involved in this potentially blinding disease. The initial focus on the bacterial factors responsible for intraocular virulence has recently expanded into analysis the inflammatory response to infection, including the molecular and cellular interactions between the pathogen and host. This review discusses the epidemiology and therapeutic challenges posed by endophthalmitis, as well as recent findings from the analysis of interactions between the host and pathogen. Based on these findings, a model for the pathogenesis of endophthalmitis is presented. A more comprehensive understanding of the molecular and cellular interactions taking place between pathogen and host during endophthalmitis will expose possible therapeutic targets designed to arrest the infection and prevent vision loss.

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“…Okada et al 25 , Wong et al 29 and Jackson et al 30 stressed the main risk of diabetes contributing to the infection. Chen et al 31 and Yoon et al 10 reported liver abscess as the most frequent source of endogenous endophthalmitis, with Klebsiella pneumoniae as the most common pathogen.…”

Section: Discussionmentioning

confidence: 99%

“…It may be indicated too, in patients with proliferative diabetic retinopathy for conditions connected to repeated intravitreal hemorrhage, tractional retinal detachment, traction-rhegmatogenous retinal detachment and tractional retinal detachment with neovascular glaucoma 6,7 . The literature also mentions the antimicrobial activity of silicone oil which may improve the surgical treatment of endophthalmitis [8][9][10] . At present, a large number of silicone oil variants which differ in viscosity and specific gravity, are available for use in vitreoretinal surgery.…”

Section: Introductionmentioning

confidence: 99%