TAP and inject versus pars plana vitrectomy for postprocedural endophthalmitis: A meta-analysis. On slit lamp examination, his tube shunt was clogged by fibrin and corneal edema was present. Taban M., Behrens A., Newcomb R.L., et al. The leading causes of postoperative endophthalmitis include staphylococci, streptococci, Enterococcus faecalis, and Propionibacterium acnes. We use cookies to help provide and enhance our service and tailor content and ads. Intravenous administration of Penicillin results in therapeutic intravitreal levels in chronic postoperative endophthalmitis - PMC Journal List J Ophthalmic Inflamm Infect v.11; 2021 PMC7820044 As a library, NLM provides access to scientific literature. Copyright 2010 Elsevier Masson SAS. The EVS is still the only large, multicenter, randomized clinical trial that investigated the visual outcomes of immediate pars plana vitrectomy versus tap and injection, both with and without systemic antibiotics.7 For eyes that had hand-motion vision or better there was no advantage to prompt vitrectomy over tap and inject alone. Careers. Whitish condensations in plaques on the posterior capsule suggest the diagnosis and over several months the vitreous becomes inflamed. Johnson MW, Doft BH, Kelsey SF, et al. Huang D., Schallhorn S.C., Sugar A., et al. Intravitreal dexamethasone in exogenous bacterial endophthalmitis: Results of a prospective randomised study. Filtering operations for glaucoma (which produce a fistulous connection for aqueous flow through the corneoscleral limbus between the anterior chamber and a conjunctival bleb) lower the physical resistance of the globe to invasion by microorganisms, creating a higher risk for intraocular infections. Ophthalmology 2015;122:7:1438-1451. The https:// ensures that you are connecting to the Endophthalmitis: Treatment, Symptoms, Causes, and The endophthalmitis vitrectomy study: relationship between clinical presentation and microbiologic spectrum. Seminars in Ophthalmology 2018;33:1:95-101. JCRS Online Case Reports 2019;7:1:3-5. Subsequently, however, his symptoms worsened. Spectrum of signs, symptoms, and treatment in amphotericin B-resistant. Treatment of Post-operative Endophthalmitis 33. 10. This condition usually resolves with topical steroid treatment. 1A). Sjoholm-Gomez de Liano C, Soberon-Ventura VF, Salcedo-Villanueva G, et al. Safety of intracameral moxifloxacin for prophylaxis of endophthalmitis after cataract surgery. Treatment generally involves pars plana vitrectomy with intravitreal antibiotics, systemic antibiotics, and often removal of the lens implant and capsular bag. Furthermore, the efficacy of tap and injection was reported to be non-inferior to vitrectomy by a meta-analysis of 15 retrospective case series published between January 2010 and November 2020.29 In a sample of 1,355 eyes, 55 percent received an intravitreal antimicrobial injection and 45 percent received pars plana vitrectomy. Unauthorized use of these marks is strictly prohibited. The most common types of intraocular surgeries performed worldwide are cataract extraction, glaucoma drainage implants/trabeculectomy, and pars plana vitrectomy. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Europe PMC Chronic postoperative endophthalmitis: a review of clinical characteristics, microbiology, treatment strategies, (2) He was noted to have prolonged anterior chamber (AC) cell despite topical steroids. He had no social history/exposure except for exposure to a pet turtle. Endophthalmitis found the rate of endophthalmitis in post-ICL patients to be approximately 1 in 6000 (0.017%).10. estoring vision through cataract surgery remains a gift ophthalmologists provide patients, and the outcomes continue to improve. The visual outcomes are poor, with final vision reported as 20/100 or worse.25, 26 Due to the rare occurrence of HORV, theres no absolute contraindication to the use of intracameral vancomycin, but its risks and benefits must be carefully considered. FOIA Durand M.L. His vitreous biopsy was negative. 2020 Dec 1;36(12):856-859. doi: 10.3928/1081597X-20201015-01. Br J Ophthalmol 1999;83:9:1050-1055. In cases of traumatic endophthalmitis, the authors typically recommend vitrectomy if a safe view of the posterior segment is at all possible, as most patients with traumatic endophthalmitis will eventually require vitrectomy for visual rehabilitation. Mr. Im is a medical student at the Sidney Kimmel Medical College at Thomas Jefferson University. J Refract Surg. Several patient characteristics and intraoperative factors have been identified as potential risks for PCE. Dr. Garg is a professor of ophthalmology at Thomas Jefferson University, and co-director of the Retina Research Unit at Wills Eye Hospital, where he also practices with Mid Atlantic Retina. 8. Cultures are helpful for guiding prognosis but may not be critical to management.11. Lee CS, Hong B, Kasi S, et al. While this method is currently limited by access, labor and costs, WGS may help detect pathogens that can impact patient prognosis. Prophylaxis of postoperative endophthalmitis following cataract surgery: Results of the ESCRS multicenter study and identification of risk factors. Dense vitritis, and a hazy posterior view were noted(figure 3). Pars plana vitrectomy is also used as an initial treatment in certain cases as outlined by the Endophthalmitis Vitrectomy Study. Federal government websites often end in .gov or .mil. 22. COP 2021;12:1:1-10. The site is secure. There was ongoing discussion about the need for ICL removal; however, the patient was resistant to additional surgical intervention. The site is secure. Incidence, clinical features, causative organisms, and visual outcomes of delayed-onset pseudophakic endophthalmitis. Interestingly, this study also found Torque Teno Virus (TTV) was present in 8/14 (57.1 percent) of the culture-positive samples and 7/7 (100 percent) of the culture-negative samples. the contents by NLM or the National Institutes of Health. Federal government websites often end in .gov or .mil. If you have any questions, you can email OnLine@Ingrams.com, or call 816.268.6402. Multiple intravitreal and intracameral injections with topical steroids were required to maintain a stable VA at 20/30; however, inflammation persisted and removal of the ICL and his native lens was ultimately required. HHS Vulnerability Disclosure, Help However, variations inthe management of post-operative infectious endophthalmitis still existamongst ophthalmologists in Malaysia. Shorstein NH, Winthrop KL, Herrinton LJ. Patients with a diagnosis of chronic post-surgical endophthalmitis of bacterial etiology were included. 175 As over 2 million cataract surgeries are performed each Slit lamp exam was notable for 0.5+ AC cell with more consolidation of whitish opacities and debris on the anterior lens capsule (Fig. 2012;2012 doi: 10.1155/2012/313248. Halachmi-Eyal O, Halachimi-Eyal O, Lang Y, Keness Y, Miron D. Preoperative topical moxifloxacin 0.5% and povidone-iodine 5.0% versus povidone-iodine 5.0% alone to reduce bacterial colonization in the conjunctival sac. Gram-positive, coagulase-negative staphylococci are the most common, making up about 70 percent of culture-positive cases.7,8 Other common organisms include other Gram-positive cocci such as Staphylococcus aureus (6.8 to 10.2 percent), as well as Streptococcus (8.2 to 11.5 percent) and Enterococcus species (2.5 to 6.8 percent).7,8 Cutibacterium acnes, the organism formerly known as Propionibacterium acnes, is a slow-growing, facultative anaerobic, Gram-positive bacteria that can cause chronic postoperative endophthalmitis.9 Gram-negative bacteria make up about 5 percent of cases, with some notable species being Klebsiella pneumonia, Pseudomonas aeruginosa and Enterobacter species.3,7,8 Klebsiella pneumonia is especially prevalent in older populations and in Southeast Asia.3 Rarely, endophthalmitis can be caused by fungal organisms such as Candida albicans and Aspergillus species. Endophthalmitis (which means inflammation inside the eye) can also occasionally be caused by retained surgical material (e.g. cotton fibres). It is called acute if it occurs within the first week after surgery and chronic if it occurs up to a month after surgery. Reducing the severe inflammation typically present in acute endophthalmitis may help prevent collateral damage and could mean better visual outcomes.On the other hand, intraocular steroids could suppress the immune systems clearance of the causative pathogen. Anaerobic vitreous culture grew C. acnes and an intravitreal and intracameral injection of vancomycin 1 mg/0.1 mL (dose divided) and intravitreal dexamethasone 0.4 mg/0.1 mL OD were performed. J Cataract Refract Surg 2008;34:9:1439-1450. Du DT, Wagoner A, Barone SB, et al. With observation, the inflammation resolves within one week. Curr Opin Ophthalmol. On the other hand, there was no statistical difference in the rates of endophthalmitis with or without the application of levofloxacin. J Cataract Refract Surg 2013;39:1:15-21. 2005;123(5):613620. The site is secure. Cases of C. acnes endophthalmitis have been reported in post-cataract patients; however, to the authors knowledge, only one other case of post-ICL C. acnes endophthalmitis has been reported, which required removal of the ICL and lensectomy.11 Chronic inflammation in the post-operative period of ICL implantation should raise high suspicion for C. acnes endophthalmitis. A benefit of vitreous tap with intraocular antibiotic injection is that it can be performed immediately in the clinic. Chronic Postoperative Endophthalmitis (CPE) is an indolent complication presenting months to years after intraocular surgery that is most often caused by Cutibacterium acnes. Vision remained 20/30 or better, but AC inflammation recurred and the IOL deposits persisted, necessitating removal of the ICL with AC washout, approximately 6 months after the original ICL surgery. Dr. Light is a vitreoretinal fellow with MidAtlantic Retina, the Retina Service of Wills Eye Hospital. 2017;30(3):597613. C. acnes endophthalmitis commonly presents as delayed or chronic ocular inflammation occurring more than six weeks post-operation. In a child with posttraumatic endophthalmitis, the possibility of an intraocular foreign body (which needs to be removed surgically) must be considered and should be excluded, if necessary, with ultrasonographic or radiographic imaging. We report a case of chronic post-operative endophthalmitis secondary to Cutibacterium acnes (C. acnes) in a patient with an implantable collamer lens (ICL). The routine use of intracameral antibiotics to prevent endophthalmitis after cataract surgery: How good is the evidence? Friling E, Lundstrm M, Stenevi U, Montan P. Six-year incidence of endophthalmitis after cataract surgery: Swedish national study. Treatment strategies and visual acuity outcomes in chronic postoperative Propionibacterium acnes endophthalmitis. The ICL was in good position with white round deposits between the ICL and the native lens (Fig. J Vitreoretin Dis. 29. government site. Chronic postoperative endophthalmitis (CPE) is a delayed infectious With WGS, its possible to screen for all non-human DNA in the sample, making it a powerful tool for identifying causative organisms in PCE. All rights reserved. B scan showed a lens capsule without deposits, fluffy material attached to the temporal ciliary body suspicious for vegetation, and anterior vitreous hemorrhage (figure 2). Because both Gram-positive and Gram-negative organisms were encountered, antibiotic coverage for both types of organisms is recommended. Postoperative endophthalmitis is a severe complication of ocular surgeries, such as cataract surgery, glaucoma surgery, or vitrectomy. Only 6% is due to Gram-negative bacteria. eCollection 2021 Jan-Apr. Future studies may help to better highlight whether some eyes benefit from an earlier surgery, particularly when guided by prompt identification of the various organisms that are present in eyes with endophthalmitis. 2001 Jun;12(3):225-9. doi: 10.1097/00055735-200106000-00015. In post-traumatic endophthalmitis, the rationale for vitrectomy over vitreous tap and injection is the mechanical removal of toxins, debris, and infectious organisms. Vancomycin-associated hemorrhagic occlusive retinal vasculitis: Clinical characteristics of 36 Eyes. Both intraoperative intracameral antibiotic injection and perioperative topical povidone-iodine have been shown to be effective prophylactic interventions that reduce the risk of PCE. Sensitivity testing of the intraocular isolate is recommended. This condition is seen in the immediate post-injection period, typically within two days. On examination, visual acuity was 20/200 in the right eye, the intraocular pressure was 31. Chronic post-operative inflammation and white plaque after ICL implantation should raise high suspicion for endophthalmitis secondary to C. acnes. Decreased postoperative endophthalmitis rate after institution of intracameral antibiotics in a Northern California eye department. and transmitted securely. Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons. Application of 10% povidone iodine reduces conjunctival bacterial contamination rate in patients undergoing cataract surgery. Am J Ophthalmol 2020;217:325-334. The ESCRS study and another study have shown that there doesnt seem to be a significant difference in infection rates when postoperative topical antibiotics such as gatifloxacin, ofloxacin and levofloxacin are used along with intraoperative intracameral antibiotics.18,21. Ophthalmology 2020;127:2:151-158. Associated features may include marked conjunctival, lid and corneal edema, but systemic features are virtually never seen. Dilated fundus exam (DFE) showed 0.5+ vitreous cell. She was known to be a steroid responder and complained of intermittent pain in the right eye. Chronic postoperative endophthalmitis designates delayed-onset postoperative Fowler BJ, Miller D, Yan X, Yannuzzi NA, Flynn Jr HW. Treatment is prolonged because of the slow replication of the microorganisms involved. Chronic Section 12.14: Chronic Postoperative Uveitis. Significant media opacity often requires ultrasonography to grossly examine the posterior segment (Figure 2). Both a positive Gram stain and infection with species other than Gram-positive coagulase-negative micrococci were associated with a significantly worse outcome.3,47. government site. Preoperative risks include age below 44 years old, male sex, living in a rural area and immunosuppressive conditions such as diabetes mellitus.2,3 Acute or chronic eyelid inflammatory disease can also be a risk factor.6 Intraoperative risk factors include vitreous loss, posterior capsular rupture, the need for an anterior vitrectomy, poor corneal wound construction and potentially the use of silicone or polymethyl methacrylate intraocular lenses rather than acrylic.3,6, Acute PCE can be caused by a diverse group of organisms. His vitreous cultures from surgery were positive for 4+ PMNs, 2+ Propionibacterium acnes. Pain and progressive vision loss are not characteristic. -, Johnson M.W., Doft B.H., Kelsey S.F., et al. P. acnes often produces a granulomatous inflammation, usually beginning 48 weeks after surgery. Chronic Postoperative Endophthalmitis: A Review of In any case, the currently available data dont show definitive benefits. Intraoperative: preservative-free antibiotics in irrigating solution (ie, vancomycin) or injected intracamerally at conclusion of surgery (ie, cefuroxime, vancomycin, or Vigamox). TTV was present in 23/47 (49 percent) samples. Shirodkar AR, Pathengay A, Flynn HW Jr, et al. Seal D, Reischl U, Behr A, et al. Before While a rare occurrence, post-cataract endophthalmitis occurs in a few thousand people each year in the United States and is a significant source of visual morbidity. An official website of the United States government. Nonetheless, the current standard practice is to culture the vitreous from a vitreous tap procedure. 1997;104(2):261272. Endophthalmitis is a rare vision-threatening intraocular inflammation, most commonly due to exogenous organisms introduced via ocular surgery, intravitreal injections, or trauma. Arch Soc Esp Oftalmol 2013;88:9:345-351. Acute and chronic Staphylococcus epidermidis post-operati ve.pdf Content uploaded by Francesco Pichi Author content Content may be subject to copyright. Most series report a mixture of case etiologies, including postoperative, traumatic, and endogenous. FOIA The visual prognosis depends on the kind of pathogen, and Staphylococcus aureus, streptococci, and Enterococcus faecalis infections often lead to significant vision loss. Multiple intravitreal and intracameral injections with topical steroids were required to maintain a stable VA at 20/30; however, inflammation persisted and removal of the ICL and his native lens was ultimately required. C. acnes in particular, often takes up to 14 days to grow on culture, and vitreous and aqueous can be culture negative due to sequestration of the organism in the capsular bag4. We report a case of chronic post-operative endophthalmitis secondary to Cutibacterium acnes (C. acnes) in a patient with an implantable collamer lens (ICL). Int J Inflamm. It occurs between 0.01% and 0.367% of post-operative patients.4 A meta-analysis of international rates of endophthalmitis after cataract surgery between 1964 and 2003 revealed an increase in incidence of endophthalmitis from the 1990s (0.087%) to the 2000s (0.265%). Author: Mark R Johnson, University of Alabama, Heersink School of Medicine, MS4 Primary treatment of PCE is still guided by the recommendations of the Endophthalmitis Vitrectomy Study, with vitreous tap and injection of intravitreal antibiotics without vitrectomy as the initial treatment in all but the most severe cases. Br J Ophthalmol 2011;95:10:1385-1388. Management of post-traumatic (as well as postoperative) endophthalmitis remains contro-versial despite a prospective, randomized, multicenter study. Causative organisms of these cases include Propionibacterium acnes,15,1720,134 fungal cases (particularly Candida parapsilosis),16,65 and nonvirulent forms of Staphylococcus epidermidis.16,54 The onset is usually days to weeks after surgery, and the clinical manifestation is one of chronic, indolent inflammation, often initially responding to suppression by topical corticosteroid therapy. 6 months ago he was seen by a local retina specialist and injected with dexamethasone intravitreal implant (Ozurdex) which improved his symptoms initially. -, Maalouf F., Abdulaal M., Hamam R.N. One-month post-operatively the patient complained of floaters with associated blurry vision, redness, and ocular pain OD. In conclusion, given the high number of cataract surgeries performed in the United States each year, its important to remain vigilant for post-cataract surgery endophthalmitis. Endophthalmitis ABOUT US| The use of intravitreal steroid injections as an adjunct treatment remains controversial. Laboratory diagnosis of endophthalmitis: Comparison of microbiology and molecular methods in the European Society of Cataract & Refractive Surgeons multicenter study and susceptibility testing. An official website of the United States government. Visual acuity (VA) was 20/30-1 OD and 20/20-1 OS with intraocular pressure (IOP) of 16 and 17mm Hg, respectively. 2. George NK, Stewart MW. It characteristically manifests as a white plaque on the lens capsule. Chronic post-cataract government site. During surgery, the ICL is placed anterior to the natural lens, without disturbing the natural lens. and transmitted securely. In a recent retrospective review of 111 cases of post-cataract endophthalmitis, nine cases had a change in management based on clinical findings, but none changed based on microbiology. Results of the Endophthalmitis Vitrectomy Study. Careers, Unable to load your collection due to an error. Chronic postoperative endophthalmitis: a review of clinical characteristics, microbiology, treatment strategies, and outcomes. sharing sensitive information, make sure youre on a federal Chronic post-operative iris prosthesis endophthalmitis in 27. Fowler BJ, Miller D, Yan X, Yannuzzi NA, Flynn HW Jr. Case Rep Ophthalmol. Robbins C.C., Sobrin L., Ma K.K., Brouillette K.M., Moore J.K. Culture-negative C acnes endophthalmitis following implantation of a phakic implantable collamer lens. Given concern for chronic post-operative endophthalmitis OD, a vitreous tap and injection of vancomycin 1 mg/0.1 mL and ceftazidime 2 mg/0.1 mL was performed. LP vision or worse: same as above but also perform pars plana vitrectomy. When Pseudomonas aeruginosa or Bacillus organisms are the infecting microbes, salvage of useful vision is almost never reported.12,13,21,88 Delay of therapy for more than 36 h after onset of symptoms has been reported to be associated with poor visual outcome in one series, whereas delay of greater than 24 h after onset of symptoms in eyes in which vitrectomy was performed was associated with a worse outcome in others.96,188 In animal experiments, administration of antibiotics in a model of Pseudomonas endophthalmitis 24 h after bacterial injection produced sterilization of the vitreous cavity, whereas later injection did not.171, Visual acuity at initial manifestation has also been correlated with outcome. WebBACKGROUND: Post-operative endophthalmitis is a serious complication of intraocular surgery which may present acutely or chronically. The relative risk of improvement of visual outcomes between the two groups was shown to be 1.04, indicating the viability of both treatments.29 However, surgeons in the included studies may have performed PPV on more severe cases, biasing the results. To our knowledge, this is the first reported case of chronic, post-operative Anaerobic cultures from a vitreous tap grew C. acnes. These infections can persist for decades if the drainage tract remains patent. 16. C. acnes is a gram-positive anaerobic bacillus that is associated with chronic infections of the skin and prosthetic devices due to its ability to evade the immunological response.