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Purpose: Commercially available chlorhexidine gluconate (CHG) has a beyond-use date of 24 h. This study evaluated the stability and sterility of 0.05% CHG for 30 days after opening and compared its cost to povidone iodine (PI) for intravitreal injection antisepsis. Methods: 0.05% CHG was aliquoted into 1-mL syringes and stored at room temperature or refrigerated. Turbidity, pH, high-performance liquid chromatography (HPLC), and sterility testing were performed. A cost analysis was conducted. Results: 0.05% CHG remained stable for at least 30 days. All samples had measured turbidity <0.5 nephelometric turbidity units. The pH of all samples remained between 5.0 and 7.0. HPLC demonstrated CHG concentration at day 30 relative to day 0 of 98.52% ± 4.16% at room temperature and 99.99% ± 3.38% at 2°C –6°C. The cost per week to perform 150 injections using 0.05% CHG was $463.25 when opening a new bottle daily compared with $16.73 for 5% PI. This cost decreased to $23.16 when utilizing a bottle of CHG for 30 days. Conclusion: 0.05% CHG remains stable and sterile for at least 30 days after opening. The ability to use CHG for at least 30 days after its opening significantly decreases its utilization expense. [ABSTRACT FROM AUTHOR]

Background: To evaluate current practice patterns of Immediate Sequential Bilateral Cataract Surgery (ISBCS) by ophthalmologists in Singapore and assess their attitudes towards performing ISBCS in future cataract care. Methods: An anonymised electronic survey, modified to local context from a similar study conducted in the United Kingdom, was distributed to members of the College of Ophthalmologists, Academy of Medicine, Singapore, from 20 June to 1 September 2023. An initial screening question on prior experience with ISBCS directed the rest of the survey. Questions explored ophthalmologists' current ISBCS practice patterns and the importance of factors affecting their willingness to perform ISBCS. Results were descriptively analysed. Results: Results collated 2 months upon survey dissemination saw a total of 58 respondents from 235 eligible members (24.7% response rate). Of these, 16 (27.6%) were currently performing ISBCS, 37 (63.8%) had never performed, and 5 (8.6%) had stopped performing. In considering ISBCS, patient convenience (n = 11, 68.8%) and reduced hospital visits (n = 8, 50.0%) were the most important factors nominated. The most important barriers to performing ISBCS were medico‐legal issues (n = 31, 83.8%) and risk of endophthalmitis (n = 27, 73.0%), followed by perceived lack of evidence for its effectiveness (n = 19, 51.4%). Conclusion: This is one of the first studies evaluating ophthalmologists' sentiments towards performing ISBCS in an Asian country. It highlights some of the most pertinent barriers and concerns that ophthalmologists face in performing and offering ISBCS. This study provides a better understanding of the potential role and prospects of ISBCS in future cataract care in Singapore. [ABSTRACT FROM AUTHOR]

Background: Patients in rural Australia have limited access to intravitreal treatments due to a maldistribution of the ophthalmology workforce. To improve access, a novel outreach service model was implemented whereby junior medical staff administered intravitreal injections under a supervising ophthalmology consultant. This model involves outreach visits in hospitals, mobile clinics and a remote hub with intravitreal injections administered by junior doctors overseen by an ophthalmologist. The article explores the safety of this approach with respect to the rate of post‐injection endophthalmitis. Methods: A retrospective audit was conducted by the Lions Outback Vision outreach ophthalmology service from 2017 to mid‐2023. The number of injections, locations, diagnoses, intravitreal agents used, designation of administering doctor and cases of endophthalmitis were reviewed. Results: A 12 632 intravitreal injections were administered across 32 locations throughout rural Western Australia in the 6.5‐year period. Three cases of endophthalmitis occurred representing a rate of 0.0237%. Conclusion: The rate of endophthalmitis in the outreach service is comparable to other centres. The outreach model with supervising ophthalmology consultant support in person or via telehealth and administration of injections by junior medical staff has improved access for underserved or marginalised populations. [ABSTRACT FROM AUTHOR]

Purpose: To report the first case of acute Abiotrophia defectiva endophthalmitis post-keratoplasty and review the current literature. Methods: A 47-year-old male, post-keratoplasty, presented with vision loss and severe anterior chamber reaction. Diagnostic investigations included vitreous cultures and molecular analysis. Results: Abiotrophia defectiva was identified. Despite aggressive treatment, visual acuity remained low. We reviewed a total of 14 post-procedural cases of A. defectiva endophthalmitis, focusing on antibiotic and steroidal treatment regimens and long-term prognosis. Conclusion: We emphasize aggressive treatment of external disease prior to intraocular surgery. In cases of A. defectiva endophthalmitis, we advocate judicious use of steroids. [ABSTRACT FROM AUTHOR]

Purpose: To demonstrate the non-inferiority of a stand-alone unidirectional airflow system, the SurgiCube (Surgi-Cube International BV), for cataract surgery compared to a conventional operating theater (OT). Methods: This was a retrospective and comparative cross-sectional study conducted at the Rothschild Foundation, Paris, France. All patients who underwent cataract surgery using the SurgiCube between February 2020 and February 2023 were included and compared to a separate group of patients with cataract surgery performed in a conventional OT and under topical anesthesia during the same period. Patients with less than 1 month of follow-up after surgery were excluded. We collected relevant information from the patient's medical records. Main outcome measures, incidence of endophthalmitis, intraoperative and postoperative complication incidence, 1-month logarithm of minimum angle of resolution (logMAR) visual acuity and intraocular pressure, and operating times were analyzed. Results: A total of 1,901 eyes in the SurgiCube group were compared to 5,474 eyes in the OT group. The occurrence of endophthalmitis was 0.05% (n = 1) in the SurgiCube group versus 0.07% (n = 4) in the OT group (P = 1.00; odds ratio = 0.72 [95% CI = 0.01 to 7.28]). The percentage of procedures with at least one perioperative complication was 2.6% in the SurgiCube group and 2.7% in the OT group (P =.87; odds ratio = 0.96 [95% CI = 0.68 to 1.34]). The percentage of procedures with a postoperative complication was 6.31% in the SurgiCube group and 6.6% in the OT group (P =.59; odds ratio = 0.94 [95% CI = 0.75 to 1.17]. Average visual acuity at 30 days was 0.04 logMAR in the SurgiCube group and 0.07 logMAR in the OT group (P =.62). The average operating times were 16.8 and 19.7 minutes for the SurgiCube and OT groups, respectively (P <.001). The average occupation room times were 26.2 and 32.3 minutes for the SurgiCube and OT groups, respectively (P <.001). Conclusions: Cataract surgery in the SurgiCube seems to be non-inferior to cataract surgery in a conventional OT. [J Refract Surg. 2024;40(11):e884–e891.] [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to report a unique case with excellent clinical outcomes after late endophthalmitis following Descemet’s membrane endothelial keratoplasty (DMEK) surgery requiring donor graft removal without replacement. Case Presentation: A 67-year-old female with a prior ocular history of bilateral cataract surgery, Fuchs endothelial dystrophy, and pseudophakic DMEK in the left eye presented with endophthalmitis 2 months after keratoplasty. DMEK graft removal without replacement with an intracameral washout, pars plana vitrectomy, intracameral, and intravitreal antibiotics resulted in an excellent visual outcome (20/25). Conclusion: This is a unique case of late endophthalmitis following DMEK surgery requiring graft removal and pars plana vitrectomy with excellent visual recovery without donor replacement. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionTo investigate the genomic epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) endophthalmitis and correlate it with the presenting clinical features and outcomes.Nine patients presenting with MRSA endophthalmitis from 2014 to 2022 were included. Phenotypic and genomic tests were used for strain characterization. Demographics, clinical presentation, treatment and outcomes were reviewed.The MRSA population was dominated by multidrug-resistant (MDR) strains within the clonal complex 5 (CC5) carrying an SCCmec type II genetic element (USA100-like strains). These strains carried genes that confer resistance to five antibiotic classes, in addition to mutations in topoisomerase genes (gyrA and parC) that resulted in resistance to all fluoroquinolones tested. Patients were mostly male (56%), with a median age of 82.7 years, and most had no recent history of extensive healthcare exposure. All cases were exogenous following ocular surgery (67%) or intravitreal injection (33%). The main exam findings were visual acuity ≤ hand motion, hypopyon (89%), and vitreous opacity (89%). Five patients (56%) showed improvement in visual acuity at 1 month following presentation, three (33%) at 3 months, and two (22%) at 6 months. Complications included evisceration (n = 1) and phthisis (n = 1). Patients who had pars plana vitrectomy within 48 hours of presentation had better clinical outcomes compared to those who did not.Exogenous MRSA endophthalmitis is caused by MDR strains that resemble the hospital-acquired lineage USA100. These strains cause severe endophthalmitis in patients with no recent hospital/healthcare exposure. [ABSTRACT FROM AUTHOR]

Background: We report two cases of fungal endophthalmitis induced by Candida species identified based on internal transcribed spacer 1 (ITS1) sequencing. Case presentation: In two cases, endophthalmitis was suspected, and the patients underwent pars plana vitrectomy. Case 1 was a 64-year-old woman with a history of cataract surgery 10 days prior. She had a history of anal primary melanoma, which metastasized throughout the body and subsequently relapsed. Vitreous culture and ITS-1 deep sequencing revealed the presence of the rare fungus, Candida dubliniensis. Case 2 was a 54-year-old man with a history of liver cancer and kidney failure. Culture methods and ITS1 deep sequencing both revealed the presence of Candida albicans. Both patients exhibited good visual prognoses after treatment with topical and systemic antibiotics. Conclusions: We present two cases of fungal endophthalmitis caused by two Candida species identified by both the culture method and ITS1 deep sequencing. The fungal pathogen was identified by ITS deep sequencing three days after sample submission; the culture method yielded results after 1 week. These findings support the applicability of ITS1 sequencing for timely pathogen identification for cases of fungal endophthalmitis and provide detailed taxonomic information at the species level. [ABSTRACT FROM AUTHOR]

Introduction: This was a prospective study to investigate the antimicrobial efficacy of a novel ophthalmic solution comprising ozonated sunflower oil in liposomes plus hypromellose in conjunction with liposomal foam (BlefOX), in patients undergoing intravitreal injection, in comparison to povidone iodine 5%. Methods: The study employed a paired-eye design with n = 195 patients and a total of n = 390 eyes divided into two groups. Conjunctival swabs were collected from both eyes of each patient at baseline (T0—3 days before the injection). The study group underwent home therapy, which included instilling two drops of an isotonic ophthalmic solution containing 0.5% ozonated sunflower oil in liposomes plus hypromellose (Ozodrop) four times daily and applying liposomal foam twice daily to the eye undergoing intravitreal injections. In contrast, the control group (contralateral eyes) received treatment with povidone iodine 5%. This treatment regimen was maintained for 3 days. At T1 (10 min before injection), all patients instilled one drop of a topical solution of povidone iodine 5% into the conjunctival sac of both eyes. After 30 seconds had elapsed, a conjunctival swab was obtained for each eye in both study groups. Results: The results, derived from conjunctival swabs, exhibited a significant reduction in the microbial load of the study group on both chocolate agar and blood agar (p ≤ 0.007). The study demonstrated that the combination of povidone iodine 5% + Ozodrop + BlefOX provides a greater reduction in microbial load than povidone iodine 5% alone on both chocolate agar (141 [72.31%] vs. 98 [50.26%], p < 0.0001) and blood agar (130 [66.67%] vs. 97 [49.74%], p = 0.0007). The combination of povidone iodine 5% + Ozodrop + BlefOX resulted in the killing of approximately 41% to 49% of bacteria compared to povidone iodine 5% alone on the chocolate agar and blood agar, respectively. Conclusions: Liposomal ozonated oil treatment, coupled with liposomal foam, in patients undergoing intravitreal injection led to a substantial reduction in conjunctival microbial load compared to eyes treated solely with povidone iodine 5%. [ABSTRACT FROM AUTHOR]

Background/objectives: To compare the prevalence of intra-ocular inflammation (IOI) between brolucizumab and aflibercept in neovascular age-related macular degeneration (nAMD) after intra-vitreal injections (IVI) and to compare the IOI odds ratios (ORs) of both therapies with the prevalence of septic endophthalmitis after IVI that was previously reported in the literature. Methods: A total of 468 IVI of brolucizumab (117 eyes) were compared with 2884 IVI of aflibercept (305 eyes) regarding IOI and occlusive retinal vasculitis (RV) from December 2021 to June 2023 in this retrospective study. The OR was calculated for both anti-VEGF agents and was compared with the relative risk of septic endophthalmitis after IVI. Results: There were four eyes with unilateral IOI related to brolucizumab (3.42%), one presenting uveitis (0.85%), two vitritis (1.71%) and the last one presenting occlusive RV (0.85%), compared with two eyes presenting unilateral IOI (anterior uveitis, 0.66%) and none with RV from the aflibercept cohort. The incidence of IOI per injection with brolucizumab (0.855%) was significantly higher compared with aflibercept (0.069%, p = 0.004). The OR of IOI related to brolucizumab IVI compared with septic endophthalmitis was 20 times greater (1.49 for aflibercept, p = 0.646, versus 20.15 for brolucizumab, p < 0.001). The OR of RV with brolucizumab compared with septic endophthalmitis was 4.6. Conclusion: Data from our department suggest a much higher risk of IOI and occlusive retinal vasculitis after brolucizumab when compared with aflibercept. The risk of IOI and severe sight-threatening complications related to brolucizumab is greater than the risk of septic endophthalmitis after any IVI. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate endogenous endophthalmitis (EE) in Spain and Mexico, focusing on microbial patterns, antibiotic resistance, infection sources, risk factors, and patient outcomes. Methods: Over 20 years, 705 endophthalmitis cases were reviewed, and we identified 78 cases of EE in Santiago de Compostela, Spain, and Mexico City, Mexico. Microbial etiology, infection sources, antibiotic resistance, and treatment outcomes were compared between patients from Spain and Mexico. Results: Among the 78 EE cases, 47 (60.25%) were from Spain and primarily had bacterial infections (57.1%, mainly Staphylococcus and Streptococcus). In contrast, 31 cases (39.74%) were from Mexico and had a higher prevalence of fungal infections, particularly Candida (47.1%). Diabetes mellitus was a significant risk factor, and was more common in Mexico (61.3%) than in Spain (37.0%). The Spanish cohort exhibited notable antibiotic resistance, especially in Staphylococcus. Treatment typically involved systemic and intraocular antibiotics, with vitrectomy performed in 61.5% cases. Post-treatment, bacterial infections had higher success rates (approximately 50%) compared with fungal infections (approximately 30%). Evisceration was necessary in 9% cases, and the overall mortality rate was approximately 4.4%; it was slightly higher in Mexico than in Spain. Conclusions: The study highlights significant regional differences in EE between Spain and Mexico, particularly regarding microbial etiology and antibiotic resistance. The findings emphasize the need to adapt healthcare practices to specific regions to improve EE treatment outcomes, underscoring the importance of ongoing research and interregional collaboration to better understand and manage this complex condition. [ABSTRACT FROM AUTHOR]

Purpose: We investigated potential risk factors for visual prognosis in Japanese patients with exogenous endophthalmitis. Methods: In this retrospective observational multicenter cohort study, risk factors for legal blindness at 12 weeks after treatment initiation were evaluated based on patient characteristics, initial BCVA, causative events, pathogens, ocular symptoms, duration from symptom onset to initial treatment, and selected treatments. Results: Overall, 23.1% of eyes developed legal blindness. The six risk factors for legal blindness were presence of eye pain, pathogen identification, poor BCVA at the initial visit, longer duration from symptom onset to initial treatment, type of causative event, and type of causative pathogen. Regarding the type of causative pathogen, coagulase-negative staphylococci was associated with a better visual impairment outcome. Conclusion: Exogenous endophthalmitis remains a severe ocular infection; however, it can be managed with rapid treatment, as well as other advances in medical knowledge and technology. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to describe two cases of Cutibacterium acnes endophthalmitis that reinforce the importance of performing both bacterial culture and 16S polymerase chain reaction when the causative pathogen is unclear or difficult to culture, such as C. acnes. A case of C. acnes endophthalmitis complicated by subbuckle scleral perforation is illustrated with intraoperative photography. Methods: This is a two-case series. Results: Case 1 describes a case of C. acnes endophthalmitis in a longstanding pseudophakic patient after multiple vitrectomies for recurrent retinal detachment, complicated by subbuckle scleral perforation. Bacterial culture revealed C. acnes while 16S PCR was negative. Conversely, Case 2 demonstrates a case of chronic endophthalmitis diagnosed one year after cataract surgery. PCR (with repeat tap for confirmation) revealed C. acnes with a negative culture. Conclusion: When the causative pathogen of endophthalmitis is unclear, dual testing of microbial culture and C. acnes 16S PCR improves the diagnostic yield of investigations for fastidious pathogens. C. acnes can present as an indolent or virulent endophthalmitis. [ABSTRACT FROM AUTHOR]

Aysha Aloqab,1,2 Valmore A Semidey,1 Gorka Sesma,3 Abdulmalik AlYahya,1 Khaled Al Malki,1 Abdulrahman Al Yahya,4 Rawa Mosaed Alohali,4 Mozon AlShareef,5 Hassan A Al-Dhibi1 1Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 2Ophthalmology, Bahrain Defence Force Hospital, Riffa, Bahrain; 3Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 4Fellowship and Residency Training Program, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 5Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi ArabiaCorrespondence: Valmore A Semidey, King Khaled Eye Specialist Hospital, Al Urubah Road, Riyadh, 12329, Kingdom of Saudi Arabia, Tel +96614281234 ext. 2665, Fax +966114821234 ext. 3773, Email asemidey@hotmail.comPurpose: This study aimed to describe the functional and anatomical outcomes of post-cataract surgery fungal endophthalmitis at King Khaled Eye Specialist Hospital (KKESH).Patients and Methods: A retrospective analysis of clinical data from a single institution was performed. This study included 29 patients with post-cataract surgery endophthalmitis with suspected or confirmed fungal etiology who presented between January 1, 2017, and December 31, 2022. We evaluated demographics, clinical features, microbiological assessments, and treatment strategies. The effects of various treatments on outcomes were analyzed. The need for additional treatment and functional and anatomical outcomes was also investigated.Results: The mean time from surgery to the onset of ocular symptoms was 52.1 (SD ± 59.9; range, 3– 210) days, and the mean time from surgery to the first visit to KKESH was 81.4 (SD ± 103.5; range, 2– 510) days. Low culture positivity was noted in four samples, with two revealing Aspergillus sp. and two revealing Cladosporium sp. Of the 29 patients, 6 underwent pars plana vitrectomy (PPV) and received intravitreal antimicrobial/antibiotic injections. Two of the six patients also underwent simultaneous intraocular lens removal. The average number of additional treatments, regardless of visual acuity, was lower in the PPV group than in the conservative group (0.5 [SD ± 1.1; range, 0– 3] and 1.48 [SD ± 1.47; range, 0– 6], respectively). In the PPV group, 50% (n=3) of the eyes achieved functional success and 83.3% (n=5) of the eyes achieved anatomical success. In contrast, in the conservative group, 43.5% (n=10) of the eyes achieved functional success and 69.6% (n=16) of the eyes achieved anatomical success.Conclusion: For post-cataract surgery fungal endophthalmitis, a high index of suspicion and prompt PPV with empirical administration of intravitreal antifungal agents are required to achieve a favorable prognosis.Keywords: endophthalmitis, fungal, exogenous, pars plana vitrectomy, intraocular lens removal

Abstract To evaluate diagnostic utility of tear meniscus height (TMH) measurement using anterior segment optical coherence tomography (AS-OCT) for lacrimal passage disorder (LPD) in patients scheduled for cataract surgery. Patients with cataracts were enrolled. Lacrimal irrigation test was used to diagnose LPD. TMH measurement was performed using prior to cataract surgery. A receiver operating characteristic curve analysis was performed to calculate the cutoff value of TMH to detect LPD. Correlation between TMH and age, sex, LPD, use of glaucoma eyedrops, and use of dry eye drops in patients with and without LPD was evaluated. Sixty-six patients (127 eyes) were included, of which 12 (9.4%) eyes had LPD. The mean TMH was significantly higher in the LPD group than in the non-LPD group (P = 0.007). Multiple regression analysis revealed a significant association of TMH with LPD (P = 0.000). With an area under the curve of 0.740, the optimal cut-off TMH value was 401.0 μm. The sensitivity and specificity of this cutoff value were 58.3% and 83.0%, respectively. These findings demonstrate the diagnostic utility of TMH, measured using AS-OCT, for LPD. This suggests that AS-OCT is useful for preoperative exclusion of LPD.

Endophthalmitis incidence and clinical characteristics was reported to change during Covid-19 pandemic, due to multiple influencing factors, such as prolonged lockdown periods, persistent immune suppression following Sars-Cov-2 infection, and mask wearing. We conducted a retrospective eight-year study, during January 2016 and December 2023, that aims to investigates the differences in terms of etiology, clinical characteristics and outcomes in cases with acute endophthalmitis, admitted before (2016-2019) and during Covid-19 pandemic (2020-2023). The two study subgroups were homogenous in term of age, gender distribution, associated comorbidities, and addressability. During Covid-19 pandemic there were significant delays in presentation (p=0.02), more cases of endogenous endophthalmitis (p=0.025), and patients presented a more intense systemic inflammatory reaction (p

Introduction: The aim of the study was to report a unique case with excellent clinical outcomes after late endophthalmitis following Descemet’s membrane endothelial keratoplasty (DMEK) surgery requiring donor graft removal without replacement. Case Presentation: A 67-year-old female with a prior ocular history of bilateral cataract surgery, Fuchs endothelial dystrophy, and pseudophakic DMEK in the left eye presented with endophthalmitis 2 months after keratoplasty. DMEK graft removal without replacement with an intracameral washout, pars plana vitrectomy, intracameral, and intravitreal antibiotics resulted in an excellent visual outcome (20/25). Conclusion: This is a unique case of late endophthalmitis following DMEK surgery requiring graft removal and pars plana vitrectomy with excellent visual recovery without donor replacement.

Abstract Background We report two cases of fungal endophthalmitis induced by Candida species identified based on internal transcribed spacer 1 (ITS1) sequencing. Case presentation In two cases, endophthalmitis was suspected, and the patients underwent pars plana vitrectomy. Case 1 was a 64-year-old woman with a history of cataract surgery 10 days prior. She had a history of anal primary melanoma, which metastasized throughout the body and subsequently relapsed. Vitreous culture and ITS-1 deep sequencing revealed the presence of the rare fungus, Candida dubliniensis. Case 2 was a 54-year-old man with a history of liver cancer and kidney failure. Culture methods and ITS1 deep sequencing both revealed the presence of Candida albicans. Both patients exhibited good visual prognoses after treatment with topical and systemic antibiotics. Conclusions We present two cases of fungal endophthalmitis caused by two Candida species identified by both the culture method and ITS1 deep sequencing. The fungal pathogen was identified by ITS deep sequencing three days after sample submission; the culture method yielded results after 1 week. These findings support the applicability of ITS1 sequencing for timely pathogen identification for cases of fungal endophthalmitis and provide detailed taxonomic information at the species level.

Introduction: The diagnosis of ocular pathology by point-of-care ultrasound (POCUS) has been well established for entities such as retinal detachment, vitreous hemorrhage, posterior vitreous detachment, and lens dislocation.1 However, the use of ultrasound to detect other conditions such as orbital abscess and endophthalmitis in the emergency setting is rarely reported.Case Report: We present a case in which POCUS was used to confirm the suspected diagnosis of endophthalmitis and orbital abscess. This case report will review the ultrasonographic findings of orbital abscess and endophthalmitis, as well as briefly discuss the literature for the use of ultrasound for these applications.Conclusion: Point-of-care ultrasound can be used to rapidly diagnose infectious pathology of the eye and orbit, which could potentially decrease time to diagnosis and time to consultation of these vision-threatening pathologies.

Postoperative endophthalmitis is an uncommon yet devastating complication after cataract surgery. We report a case of acute-onset postoperative endophthalmitis secondary to a rare causative pathogen Chryseobacterium. Elderly male patient with chronic kidney disease on hemodialysis with acute-onset postoperative endophthalmitis was managed with systemic and local higher antibiotics, leading to the resolution of the infection.

To assess and compare the rate of endophthalmitis and visual outcomes in cases of open globe injuries (OGIs) without intraocular foreign bodies repaired within and greater than 24 hours from the time of injury. A retrospective review of 2002 cases of OGIs presenting to a single institution. Patients with OGIs were admitted and managed according to a standardized protocol. The impact of timing of repair was assessed among those undergoing OGI repair within (i) 24 hours, (ii) 25 to 36 hours, and (iii) greater than 36 hours from the time of injury. Rates of endophthalmitis and postoperative visual acuity of logarithm of the minimum angle of resolution (logMAR) 1.3, logMAR 1.0, and logMAR 0.3 at 180 days and 1 year after open globe repair. A total of 1382 patients with OGIs met our inclusion criteria, of whom 75% were male with an average age of 41 years. Maximal zone of injury was zone I for 420 patients, zone II for 488 patients, and zone III for 474 patients. A total of 84% of all OGIs underwent repair within 24 hours from the time of injury, 9% from 25 to 36 hours, and 7% greater than 36 hours. Average preoperative visual acuity was hand motion. Risk factors associated with repair performed greater than 36 hours from the time of injury included female sex (P = 0.042). Endophthalmitis was associated with time to repair greater than 36 hours (P = 0.049) but not with 25 to 36 hours or zone of injury (P = 0.111). Time to repair had no significant impact on visual acuity outcomes. Although repair of OGIs within 24 hours is the current standard of care, this study found no statistically significant difference in rates of endophthalmitis or visual outcomes in eyes undergoing repair within 24 hours of injury compared with repair extending to 25 to 36 hours. Endophthalmitis rates did increase after 36 hours. We recommend urgent repair of OGIs, but in certain circumstances, it may be reasonable to delay repair beyond 24 hours to optimize operating conditions. Proprietary or commercial disclosure may be found after the references. [ABSTRACT FROM AUTHOR]

Abstract Introduction This was a prospective study to investigate the antimicrobial efficacy of a novel ophthalmic solution comprising ozonated sunflower oil in liposomes plus hypromellose in conjunction with liposomal foam (BlefOX), in patients undergoing intravitreal injection, in comparison to povidone iodine 5%. Methods The study employed a paired-eye design with n = 195 patients and a total of n = 390 eyes divided into two groups. Conjunctival swabs were collected from both eyes of each patient at baseline (T0—3 days before the injection). The study group underwent home therapy, which included instilling two drops of an isotonic ophthalmic solution containing 0.5% ozonated sunflower oil in liposomes plus hypromellose (Ozodrop) four times daily and applying liposomal foam twice daily to the eye undergoing intravitreal injections. In contrast, the control group (contralateral eyes) received treatment with povidone iodine 5%. This treatment regimen was maintained for 3 days. At T1 (10 min before injection), all patients instilled one drop of a topical solution of povidone iodine 5% into the conjunctival sac of both eyes. After 30 seconds had elapsed, a conjunctival swab was obtained for each eye in both study groups. Results The results, derived from conjunctival swabs, exhibited a significant reduction in the microbial load of the study group on both chocolate agar and blood agar (p ≤ 0.007). The study demonstrated that the combination of povidone iodine 5% + Ozodrop + BlefOX provides a greater reduction in microbial load than povidone iodine 5% alone on both chocolate agar (141 [72.31%] vs. 98 [50.26%], p

Purpose: To report the clinical profile and donor characteristics of post-optical keratoplasty adverse events notified at an eye bank. Methods: Between January 2013 and December 2022, 37,041 donor corneas were utilized for keratoplasty, of which 16,531 were used for penetrating keratoplasty (PK), 12,171 for endothelial keratoplasty (EK), and 1356 for anterior lamellar keratoplasty (ALK). EK included 10,956 Descemet stripping automated endothelial keratoplasty (DSAEK) and 1215 Descemet membrane endothelial keratoplasty (DMEK). The adverse events reported within the first 6 weeks of optical keratoplasty were analyzed for donor-related parameters. Results: A total of 41 (0.11%) recipients had post-keratoplasty infections. Of these, 33 occurred after EK (29 after DSAEK, and four after DMEK), two after ALK, and six after PK. The clinical presentation was keratitis alone in 16 eyes and associated with endophthalmitis in 25 eyes. The organisms isolated were gram-negative bacteria in 26 eyes, fungus in eight eyes, gram-positive bacteria in four eyes, mixed infection in five eyes, and microbiology inconclusive in seven eyes. The majority (78%) of the gram-negative infections were due to multidrug-resistant organisms. Most (88%) donor corneas were harvested from hospital premises. The most common cause of donor mortality was trauma. The median duration of presentation from surgery was 4.46 (range: 1–30) days. The death to preservation time was 4.18 (1.5–7.65) hours. The death to utilization time was 3 (2–4.7) days. Conclusion: The overall risk of infectious adverse events after keratoplasty was 0.11%, ranging from 0.08% to 0.36%. Most (80.4%) of the adverse events occurred after EK. The majority (78.9%) of the adverse events were of bacterial etiology, of which gram-negative infections (68.4%) were the most common. The trends and microbiological spectrum of organisms associated with infections should be thoroughly documented in eye banks to gain insights and formulate guidelines on the management of adverse events.

The purpose of this case report is to present a case of acute-onset postoperative endophthalmitis, caused by multidrug-resistant (MDR) Klebsiella pneumonia, following pars plana vitrectomy for malignant glaucoma. A 52-year-old male patient underwent elective phacoemulsification cataract surgery with intraocular lens implantation in the right eye. Two weeks later, the patient presented with a diminution of vision and clinical features suggestive of malignant glaucoma. With no response to conventional treatment, pars plana vitrectomy was done. Acute-onset postoperative endophthalmitis developed, with severe intraocular inflammation, caused by MDR Klebsiella pneumoniae. The isolates demonstrated sensitivity to polymyxins and tigecycline only. Intravitreal colistin (0.1 mg/0.1 mL) was administered. The response was satisfactory and the vision could be salvaged. At 2 months follow-up a visual acuity of 20/50 was recorded. This is a rare case report of acute-onset postoperative endophthalmitis due to MDR Klebsiella following pars plana vitrectomy. With timely intervention, the patient came out of two difficult situations of malignant glaucoma and MDR endophthalmitis with a reasonably good visual recovery.

Abstract Background Bandage contact lenses are important aids for aftercare following ocular surgery and for a wide variety of ocular surface conditions. However, bandage contact lenses also bear the risk of fostering microbial infections of the cornea. We herein report the safety profile of bandage contact lenses from a comprehensive review of medical records in a tertiary care eye hospital in Germany. Methods We identified 638 consecutive patients who had been prescribed at least one bandage lens during the past 10 years. For these, we performed a computerized search for the following adverse events: (1) endophthalmitis, (2) emergency keratoplasty and (3) vision loss of at least 2 lines according to the Early Treatment Diabetic Retinopathy Study (ETDRS). We manually assessed the relatedness of each event to the bandage lens. Events later than 100 days following the bandage lens prescription were not considered to be related to bandage contact lenses. Results We observed 267 adverse events, with 120 occurring within 100 days after bandage lens prescription. This left a total of 18 endophthalmitis events, 21 penetrating keratoplasties and 81 eyes with vision loss of at least 2 ETDRS lines (for individual review of relatedness). Only two episodes of endophthalmitis could be linked to bandage lens wear. All other adverse events were due to causative conditions that had already been present prior to bandage contact lens insertion. Conclusions Severe adverse events after bandage contact lens wear are not uncommon because lenses are used in patients suffering from preexisting ocular conditions. However, severe adverse events were almost never caused by the bandage contact lenses directly in our hands. We therefore conclude that bandage contact lenses are safe given proper ophthalmological supervision.

Abstract Background Endophthalmitis is a clinical diagnosis but identification of the disease-causing agent or agents allows for a more tailored treatment. This is routinely done through intraocular fluid cultures and staining. However, culture-negative endophthalmitis is a relatively common occurrence, and a causative organism cannot be identified. Thus, further diagnostic testing, such as pan-bacterial and pan-fungal polymerase chain reactions (PCRs), may be required. Body There are now newer, other testing modalities, specifically pan-bacterial and pan-fungal PCRs, that may allow ophthalmologists to isolate a causative agent when quantitative PCRs and cultures remain negative. We present a case report in which pan-fungal PCR was the only test, amongst quantitative PCRs, cultures, and biopsies, that was able to identify a pathogen in endophthalmitis. Pan-PCR has unique advantages over quantitative PCR in that it does not have a propensity for false-positive results due to contamination. Conversely, pan-PCR has drawbacks, including its inability to detect viruses and parasites and its increased turnaround time and cost. Based on two large retrospective studies, pan-PCR was determined not to be recommended in routine cases of systemic infection as it does not typically add value to the diagnostic workup and does not change the treatment course in most cases. However, in cases like the one presented, pan-bacterial and pan-fungal PCRs may be considered if empiric treatment fails or if the infective organism cannot be isolated. If pan-PCR remains negative or endophthalmitis continues to persist, an even newer form of testing, next-generation sequencing, may aid in the diagnostic workup of culture-negative endophthalmitis. Conclusion Pan-bacterial and pan-fungal PCR testing is a relatively new diagnostic tool with unique advantages and drawbacks compared to traditional culturing and PCR methods. Similar to the tests’ use in non-ophthalmic systemic infections, pan-bacterial and pan-fungal PCRs are unlikely to become the initial diagnosis test and completely replace culture methods. However, they can provide useful diagnostic information if an infectious agent is unable to be identified with traditional methods or if empiric treatment of endophthalmitis continues to fail.

James Paauw,1 Michael B Caplan,2 Mark Gallardo,3 Kristi Rushin,4 Jeffrey D Horn5 1Department of Ophthalmology, Piedmont Eye Center, Lynchburg, VA, USA; 2Berkeley Eye Center, Houston, TX, USA; 3El Paso Eye Surgeons, El Paso, TX, USA; 4Alcon Vision LLC, Fort Worth, TX, USA; 5Vision for Life, Nashville, TN, USACorrespondence: James Paauw, Piedmont Eye Center, Lynchburg, VA, USA, Tel +1-437-947-3984, Email paauwer@gmail.comPurpose: This study assessed the incidence of postsurgical intraocular inflammation after cataract extraction by phacoemulsification and implantation with AcrySof IQ ReSTOR intraocular lenses (IOLs) produced using an updated manufacturing process. Incidence rates were compared with historical rates of postsurgical intraocular inflammation.Methods: This was a prospective, multicenter, post-approval study at 34 sites. Patients aged ≥ 22 years received a study lens in at least 1 eye. Postsurgical intraocular inflammation (aqueous cell grade ≥ 3+ within 14 days after surgery, aqueous cell ≥ 2+ at 14 to ≤ 60 days after surgery, or aqueous cell ≥ 1+ at > 60 days) was assessed within a 180-day period after implantation. Rates of toxic anterior segment syndrome (TASS), acute postoperative endophthalmitis, chronic postoperative endophthalmitis, and uncategorized cases of postsurgical intraocular inflammation were assessed. Ocular adverse events (AEs) and ocular adverse device effects (ADEs) were evaluated. Historical rates of postsurgical intraocular inflammation were determined from the 2011– 2013 Medicare Limited Data Set files (a 5% sample of the Medicare data set representative of patients aged ≥ 65 years).Results: Final safety analysis set included 3357 eyes (1792 patients; mean age, 68.6 ± 7.9 years). Postsurgical intraocular inflammation (any type) rate was 5.1 per 1000 attempted IOL implants (95% CI, 2.95, 8.10). TASS, acute postoperative endophthalmitis, and uncategorized inflammation rates were 0.6 (95% CI, 0.07, 2.15), 0.3 (95% CI, 0.01, 1.66), and 4.2 (95% CI, 2.28, 6.99) per 1000 attempted IOL implants, respectively. There were no events of chronic postoperative endophthalmitis. Ocular AEs and ADEs were reported in 17% and 1.5% of eyes, respectively. Most common ADEs were halo (0.63%) and glare (0.51%). The historical postsurgical inflammation rate from 221,519 cataract procedures was 10.3/1000 cataract surgeries, and the endophthalmitis rate was 1.2/1000 surgeries.Conclusion: The updated IOL manufacturing process resulted in postoperative intraocular inflammation rates that were substantially lower than the historic rate.Keywords: endophthalmitis, intraocular lens, postoperative inflammation, toxic anterior segment syndrome

Objective: To report a case of acute postoperative endophthalmitis following cataract surgery due to Pseudomonas stutzeri in a healthy elderly male. Methods: This is a case report. Results: A non-hypertensive, non-diabetic male in his late 60s consulted due to eye pain and blurred vision 5 days after an uncomplicated extracapsular cataract extraction with posterior chamber intraocular lens implantation (PCIOL) on his left eye. On examination, the visual acuity was light perception. Slit-lamp examination showed ciliary injection, conjunctival congestion, mild corneal edema with Descemet membrane folds, hazy anterior chamber with fibrin and a 2-millimeter hypopyon, and a visible PCIOL. IOP was 10 mmHg with no leak on Seidel’s test, and there was poor view of the fundus. B-scan ultrasonography showed findings consistent with endophthalmitis. He was given topical, intravitreal, and systemic antibiotics, and emergency vitrectomy was done. The vitreous sample culture revealed Pseudomonas stutzeri. Despite aggressive medical and surgical management, vision loss was not prevented. Conclusion: Acute postoperative endophthalmitis from Pseudomonas stutzeri is rare; if not recognized and treated promptly, this complication has devastating outcomes. It may present with a fulminant course regardless of the associated risks for infection. Prevention, early recognition, and timely management can prevent unfavorable visual outcomes.

Conditionally pathogenic conjunctival microflora is the most frequent cause of endophthalmitis after cataract phacoemulsification (“PEC”).The purpose. To evaluate the sterility of the surgical field and anterior chamber fluid (ACF) during elective (PEC).Materials and methods. 75 eyes were examined. Patients in the group I underwent standard treatment of the surgical field, in the group IA — the standard technique was supplemented with mechanical delimitation of the upper eyelid margin, in group II additional treatment of the surgical field with povidone iodine after blepharostat installation was performed. Microbiological material was collected preoperatively from three loci (conjunctival cavity, eyelid free margin, lacrimal ducts) and at different stages of surgery from the conjunctival cavity (after standard treatment, after blepharostat placement, after additional treatment). In addition, anterior chamber fluid (ACF) was examined — also during surgery. Microorganisms were identified by the MALDI­-TOF method, sensitivity was determined by the disc­diffusion method.Results. S. epidermidis prevails among all microorganisms. The percentage of the surgical field contamination by S.epidermidis after blepharostat setting was 33,33 %, 26 % and 40 % in the I, IA, II groups respectively; after additional treatment 6,6 % in the II group; in the ACF it was found in 23,33 %, 13 % and 0 % in the I, IA, II groups respectively.Conclusion. The additional treatment of the surgical field is the most effective technique to reduce the contamination of the conjunctival cavity by S.epidermidis after placing a blepharostat and the only one in the study to ensure its absence in the ACF. Standard treatments with and without mechanical delineation are less effective and do not prevent the contamination of the ACF.

Endophthalmitis is a devastating eye complication that requires prompt and effective treatment. A pivotal study in the field of endophthalmitis treatment is the endophthalmitis vitrectomy study (EVS), conducted over a decade ago. The primary objective of this study was to assess the effectiveness of pars plana vitrectomy (PPV) as a treatment option for endophthalmitis following the EVS study. We conducted a comprehensive search across three databases: PubMed, EBSCO host, and ProQuest. Reference lists of published articles were searched. Our study encompassed research conducted between January 2013 and January 2023 to ensure the most up-to-date findings. The best-corrected visual acuity (BCVA) in logMar, causative agents, and predicting factors for visual outcome were evaluated. Nine studies involving 351 eyes were included in the study; however, only eight were included in the meta-analysis. We observed a significant BCVA improvement compared to baseline at 1 month, >1–3 months, >3–6 months, and ≥12-month follow-up, with mean differences of 1.06 (P < 0.001), 1.25 (P < 0.001), 1.41 (P < 0.001), and 1.01 (P < 0.001), respectively. A causative organism was cultured in 61.4% of cases, and the majority of them were Coagulase-negative Streptococcus, Staphylococcus aureus, and Streptococcus sp. Factor associated with better visual acuity includes a younger age, lower intraocular pressure, and culture-negative endophthalmitis. Meanwhile, culture-positive endophthalmitis particularly Streptococcus sp., lower baseline vision, and presence of retinal detachment at initial presentation were identified as a prognostic for poorer visual outcome. PPV demonstrated a significant visual gain in patients with endophthalmitis in the 1st, 3rd, and 6th months. However, caution is warranted in drawing a definitive conclusion.

Abstract Purpose To report a case of Purpureocillium lilacinum endophthalmitis. Methods The case of a fungal endophthalmitis caused by Purpureocillium lilacinum documented in an immunocompetent patient with no apparent trigger. Results A 64-year-old male with a two-month history of panuveitis in his left eye was referred to our hospital. Initially misdiagnosed as sympathetic ophthalmia due to a previous surgery on his right eye 4 months before the onset of the left ocular picture, the patient received corticosteroid treatment, leading to a rapid deterioration of the left eye condition. An urgent exploratory vitrectomy was performed to identify the underlying cause, revealing endophthalmitis. Microbiological investigation yielded Purpureocillium lilacinum as the causative agent. Despite intensive treatment, including intravitreal antibiotics and antifungals, along with another surgical intervention, clinical evolution remained unfavourable, ultimately leading to the evisceration of the affected eye. Conclusions Purpureocillium lilacinum poses a rare yet sever threat as a causative agent of fungal endophthalmitis. Managing such cases is challenging due to the delayed identification, fungus’s resistance to common antifungals, and its association with prior corticosteroid misuse in most patients. This case underscores the crucial importance of heightened clinical suspicion, early diagnosis, and the exploration of alternative treatment strategies in addressing Purpureocillium lilacinum endophthalmitis. The challenges posed by this rare fungal pathogen emphasize the need for a multidisciplinary approach and continued research to improve outcomes in these complex cases.

This case report presents a case of infected corneal laceration with traumatic endophthalmitis in a pediatric patient. A boy in his middle childhood sustained an ocular injury with scissors, resulting in a full-thickness corneal laceration and infection. Despite the delay in seeking treatment, the patient underwent successful surgical interventions, including corneal scraping, pars plana lensectomy, vitrectomy, and secondary intraocular lens implantation (IOL). The infection was managed with targeted antibiotics, and Staphylococcus aureus was confirmed as the causative organism. Remarkably, these efforts led to a satisfactory improvement in the patient’s vision to 20/50. This case underscores the importance of early intervention and a multidisciplinary approach in the management of pediatric ocular trauma to optimize outcomes.

Background: Bandage contact lenses are important aids for aftercare following ocular surgery and for a wide variety of ocular surface conditions. However, bandage contact lenses also bear the risk of fostering microbial infections of the cornea. We herein report the safety profile of bandage contact lenses from a comprehensive review of medical records in a tertiary care eye hospital in Germany. Methods: We identified 638 consecutive patients who had been prescribed at least one bandage lens during the past 10 years. For these, we performed a computerized search for the following adverse events: (1) endophthalmitis, (2) emergency keratoplasty and (3) vision loss of at least 2 lines according to the Early Treatment Diabetic Retinopathy Study (ETDRS). We manually assessed the relatedness of each event to the bandage lens. Events later than 100 days following the bandage lens prescription were not considered to be related to bandage contact lenses. Results: We observed 267 adverse events, with 120 occurring within 100 days after bandage lens prescription. This left a total of 18 endophthalmitis events, 21 penetrating keratoplasties and 81 eyes with vision loss of at least 2 ETDRS lines (for individual review of relatedness). Only two episodes of endophthalmitis could be linked to bandage lens wear. All other adverse events were due to causative conditions that had already been present prior to bandage contact lens insertion. Conclusions: Severe adverse events after bandage contact lens wear are not uncommon because lenses are used in patients suffering from preexisting ocular conditions. However, severe adverse events were almost never caused by the bandage contact lenses directly in our hands. We therefore conclude that bandage contact lenses are safe given proper ophthalmological supervision. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article is to report a case of Lemierre's Syndrome producing unilateral endogenous endophthalmitis in a healthy, young woman with a history of tonsillitis. Case report/observations: A 17-year-old healthy woman developed fever after a few days of sore throat. She later developed pneumonia with septic signs, leading to admission to the Intensive Care Unit. Lemierre Syndrome was diagnosed due to multiple septic pulmonary emboli and signs of sepsis following a recent episode of tonsillitis. During hospitalization, the patient complained of decreased visual acuity and floaters in her left eye. Ophthalmological examination revealed papillary edema, vitritis, foci of chorioretinitis in the macula and Roth's spots, confirming the diagnosis of endogenous endophthalmitis. Subsequently, she underwent appropriate treatment, progressing satisfactorily. Conclusion and importance: Although ophthalmological manifestations are rare, due to the pathophysiological characteristics of Lemierre's Syndrome, all patients should underwent standard ophthalmologic assessment, even in the absence of ophthalmic symptoms or visible findings, as part of a multidisciplinary management approach. [ABSTRACT FROM AUTHOR]

Purpose: To study the incidence, predictive factors, etiology, and visual consequences of postoperative endophthalmitis (PE) in relation to 3 intracameral (IC) antibiotic regimes. Setting: Swedish National Cataract Register entries from 2011 through 2017. Design: Observational retrospective study. Methods: PE incidence, influencing factors, bacteriology, and visual outcome were analyzed regarding the 3 major prophylactic IC protocols. Results: The overall incidence of PE was 0.023% or 177 cases in 764 513 cataract procedures. Analyzed per IC regime, the rates of PE were 0.024% (126 cases in 514 916 surgeries) for cefuroxime, 0.020% (25 cases in 122 340 surgeries) for moxifloxacin, and 0.017%(20 cases in 121 045 surgeries) for combined cefuroxime-ampicillin. Incidences were not statistically significantly different from one another. Grampositive bacteria caused 89.0% of culture positive cases. Enterococci as pathogens were significantly more frequent with IC cefuroxime than with moxifloxacin, P = .006, or cefuroxime-ampicillin, P < .001, while streptococci other than enterococci were more common with moxifloxacin than with cefuroxime, P < .001. Bacterial susceptibility to the given antibiotics was demonstrated in 21.3% of PE cases treated with cefuroxime, which was statistically significantly lower than proportions found with cefuroxime-ampicillin, 60.0%, P = .015, or with moxifloxacin, 88.2%, P < .001. Visual outcome worse than 20/200 was similar in the groups ranging from 42.0% to 53.7%. Conclusions: No statistically significant differences in PE incidence or visual outcome results between treatment groups were demonstrated. However, differences in etiology and bacterial sensitivity were found between the prophylactic IC treatments. [ABSTRACT FROM AUTHOR]

Background: Endophthalmitis is a clinical diagnosis but identification of the disease-causing agent or agents allows for a more tailored treatment. This is routinely done through intraocular fluid cultures and staining. However, culture-negative endophthalmitis is a relatively common occurrence, and a causative organism cannot be identified. Thus, further diagnostic testing, such as pan-bacterial and pan-fungal polymerase chain reactions (PCRs), may be required. Body: There are now newer, other testing modalities, specifically pan-bacterial and pan-fungal PCRs, that may allow ophthalmologists to isolate a causative agent when quantitative PCRs and cultures remain negative. We present a case report in which pan-fungal PCR was the only test, amongst quantitative PCRs, cultures, and biopsies, that was able to identify a pathogen in endophthalmitis. Pan-PCR has unique advantages over quantitative PCR in that it does not have a propensity for false-positive results due to contamination. Conversely, pan-PCR has drawbacks, including its inability to detect viruses and parasites and its increased turnaround time and cost. Based on two large retrospective studies, pan-PCR was determined not to be recommended in routine cases of systemic infection as it does not typically add value to the diagnostic workup and does not change the treatment course in most cases. However, in cases like the one presented, pan-bacterial and pan-fungal PCRs may be considered if empiric treatment fails or if the infective organism cannot be isolated. If pan-PCR remains negative or endophthalmitis continues to persist, an even newer form of testing, next-generation sequencing, may aid in the diagnostic workup of culture-negative endophthalmitis. Conclusion: Pan-bacterial and pan-fungal PCR testing is a relatively new diagnostic tool with unique advantages and drawbacks compared to traditional culturing and PCR methods. Similar to the tests' use in non-ophthalmic systemic infections, pan-bacterial and pan-fungal PCRs are unlikely to become the initial diagnosis test and completely replace culture methods. However, they can provide useful diagnostic information if an infectious agent is unable to be identified with traditional methods or if empiric treatment of endophthalmitis continues to fail. [ABSTRACT FROM AUTHOR]

Postoperative endophthalmitis is a devastating complication, leading to poor visual prognosis. The purpose of this study is to determine the incidence, risk factors, and visual outcome of post-cataract surgery endophthalmitis in Malaysia over a 9-year period (2012–2020). Data from National Eye Database (NED), involving all patients who have undergone cataract surgery from January 2012 until December 2020 were analyzed. Total number of patients who had undergone cataract surgery between the year 2012 till 2020 were 231,281 patients (267,781 eyes). Incidence of POE in this population was 0.08%. Patient aged 70 and above (p-value 0.047), Malay ethnicity (p-value: 0.009), presence of ischemic heart disease, renal failure, diabetic retinopathy, and poorer preoperative vision were shown to have a higher risk of POE. Cataract surgeries done in KK-KKM, duration more than 45 minutes, use of general anaesthesia, and no IOL or ACIOL implantation were significantly more in POE patients. Multivariate analysis revealed Malay ethnicity, presence of ocular comorbidity, poor preoperative vision, ACIOL, and presence of intra-operative complication were predictive factors for POE. Incidence of POE is low in the Malaysian population. Surgeons have to be aware that Malay ethnicity, presence of ocular comorbidity, poor preoperative visual acuity, placement of IOL and complicated cataract operation have higher risk of POE. [ABSTRACT FROM AUTHOR]

To analyze the effect of gentamicin in the irrigating solution on endophthalmitis caused by methicillin-resistant Staphylococcus epidermidis after phacoemulsification with intraocular lens implantation. Fifteen rabbits were randomly assigned into three groups. During surgery, group A was irrigated with gentamicin-free solution and injected with 100 μL of normal saline postoperatively, group B was irrigated with 80 μg/mL gentamicin and injected with 100 μl of MRSE suspension, group C was irrigated with gentamicin-free solution and injected with 100 μl of MRSE suspension. At different times, corneal endothelial cell count (CEC), inflammation grading，B-scan ultrasonography and histological examination were analyzed. No endophthalmitis occurred in groups A and B. Group C developed severe endophthalmitis, with massive inflammatory exudation in the vitreous cavity. Irrigating solution containing gentamicin is favorable to reduce the incidence of MRSE endophthalmitis after phacoemulsification with IOL in rabbits. [ABSTRACT FROM AUTHOR]

To understand retina specialists' attitudes and practice patterns for screening for and managing Candida endophthalmitis and any impact of the COVID-19 pandemic on these practice patterns. A survey was developed on Survey Monkey and distributed to ASRS regular members via email in April 2021. The survey had 231 respondents, of whom 169 (73%) performed inpatient consultations. Ninety percent responded that they do not recommend routinely screening asymptomatic patients with candidemia. For unresponsive patients with candidemia that lack visible signs of endophthalmitis, 65% did not recommend routine screening. However, 85% reported their affiliated hospitals did not have a policy to defer such screening consultations; this proportion did not significantly change when asked if a policy was implemented in response to the COVID-19 pandemic. For patients with a dilated examination without signs of endophthalmitis, 89% surveyed recommended continuing systemic antifungals and reconsult PRN, while the remainder recommended repeat examinations until off antifungals. For initial management of Candida endophthalmitis, 55% indicated systemic antifungals only; 43% indicated systemic antifungals with tap & inject, and 2% indicated systemic antifungals with vitrectomy and intravitreal antifungals. A discordance exists between the prevailing opinion among retina specialists against routine Candida endophthalmitis screening and hospital consultation policies, which were not significantly impacted by the COVID-19 pandemic. In cases of diagnosed endogenous endophthalmitis, slightly more than half of surveyed retina specialists would not initiate additional treatment beyond systemic antifungals while just under half surveyed recommended initial tap and inject in addition to systemic antifungals. [ABSTRACT FROM AUTHOR]

We aimed to compare the visual outcomes after pars plana vitrectomy (PPV) versus tap and inject (T&I) in fungal endophthalmitis (FE) reported in the literature and to compare the findings from the literature with data from a reference centre. We performed a systematic review and meta-analysis of studies reporting the use of PPV versus T&I in FE. We also performed a retrospective review of the clinical records of patients with endophthalmitis from a reference centre in Colombia. We included 13 studies with 334 eyes; 53.59% received PPV and 46.4% received T&I. The overall relative risk of improving ≥ 2 lines in PPV versus T&I was 0.98 (95% confidence interval [CI] 0.80–1.22; p = 0.88) with a mean difference of final visual acuity of 0.26 (95% CI 0.12–0.63; p = 0.18). There were no significant differences in subgroup analysis. Data from the reference centre included 32 endophthalmitis cases, 15.6% of which had a fungal aetiology (80% received PPV and 20% T&I). There were no significant differences in the subgroup analysis. Based on the findings from the literature and the reference centre, T&I is noninferior to PPV. This is the first meta-analysis in the literature evaluating these effects in FE. It is necessary to execute new prospective randomised controlled studies in patients with endophthalmitis. [ABSTRACT FROM AUTHOR]

To study the epidemiology and microbiological landscape in patients (≤21 yrs) diagnosed with endophthalmitis across a multi-tier ophthalmology network in India. This cross-sectional hospital-based study included 1,041 patients (≤21 yrs) diagnosed with endophthalmitis, between April 2012 and May 2022. The data were collected using an electronic medical record system. Bacteria (24%) was the most common etiology followed by fungus (2%). The majority of the patients were male (66%) with a mean age of 8.37 ± 5.99 years. The most common age group was middle childhood (6-11 years) with 365 (35.06%) patients. The patients were more commonly from the lower socio-economic status (60.81%) and urban geography (49%). The common cause of endophthalmitis was trauma (59.33%) and amongst the 279 culture positive eyes, the predominant bacteria isolated was Streptococcus pneumoniae followed by Bacillus species and fungus included predominantly Aspergillus and Candida species. The most common surgical intervention performed was intraocular antibiotics (74%) followed by pars plana vitrectomy (52%). The most common etiology of endophthalmitis in children is bacterial and traumatic in nature and presented from the lower socio-economic status. A half of the eyes warranted a vitreo-retinal surgical intervention. A cross-sectional study on the microbiological landscape in pediatric endophthalmitis showed that the most common cause of endophthalmitis was trauma and the predominant bacteria isolated was Streptococcus spp. and Bacillus spp. Additionally, majority of the patients were from the lower socio-economic status and urban geography and the most common surgical intervention performed was injection of intraocular antibiotics. [ABSTRACT FROM AUTHOR]

To review the etiology and antibiotic susceptibility patterns of infectious endophthalmitis over 11 years in different age groups Microbiology records of culture-positive endophthalmitis cases from January 2011 and December 2021 were reviewed for the age groups 0–30, 31–60, and >60 years. Additionally, data was also analysed for trends in antibiotic susceptibility between different age groups. A total of 5590 patients were clinically diagnosed with endophthalmitis. Of these, 1316 (23.5%) patients were culture positive comprising of 1097 bacteria (83.3%) and 219 fungal (16.6%). Gram-positive bacteria predominated the culture-proven bacterial endophthalmitis group with 709 cases (62.6%). Streptococcus pneumoniae (9.3%) was the most prevalent organism in the age group between 0 and 30 years, while Staphylococcus epidermidis (6%) was the most prevalent organism in the age group of 31–60 years. In comparison, Pseudomonas aeruginosa (4.1%) was the most abundant organism in the age group >60 years. Interestingly, Aspergillus flavus (13.24%) was the predominant fungal pathogen in all age groups. There was an increasing trend in antibiotic resistance from younger to older age groups and this pattern was observed for almost all drugs tested except vancomycin and amikacin. While infection can occur at any age, the etiology also seems to vary. This study helps us understand the demography of endophthalmitis along with choice of empirical antibiotics that would influence treatment outcomes. Although vancomycin currently holds good for the treatment for gram-positive infections, gram-negative infections calls for an immediate need for newer drugs or advanced treatment options. [ABSTRACT FROM AUTHOR]