Medicine › Ophthalmology

Ocular Infections and Treatments

Works Count: 33461

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Description

This cluster of papers focuses on the epidemiology, risk factors, microbiological spectrum, antibiotic resistance, and management strategies for ocular infections such as endophthalmitis, keratitis, and fungal keratitis. It also explores the impact of cataract surgery and intravitreal injections on the development of these infections, as well as the composition of conjunctival flora.

Keywords

Endophthalmitis; Keratitis; Ocular Infections; Antibiotic Resistance; Fungal Keratitis; Cataract Surgery; Microbial Spectrum; Intravitreal Injection; Conjunctival Flora; Corneal Blindness

ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery

2006-03-01

Peter J. Barry , D.V. Seal , G. Gettinby +3 more

PURPOSE: To report results in the European Society of Cataract & Refractive Surgeons (ESCRS) multicenter study of the prophylaxis of endophthalmitis after cataract surgery. SETTING: Twenty-four ophthalmology units and eye … PURPOSE: To report results in the European Society of Cataract & Refractive Surgeons (ESCRS) multicenter study of the prophylaxis of endophthalmitis after cataract surgery. SETTING: Twenty-four ophthalmology units and eye clinics in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom, with an administrative office in Ireland, coordinating center in England, and data management and statistical unit in Scotland. METHODS: This partially masked randomized placebo-controlled multinational clinical study to evaluate prospectively the prophylactic effect of intracameral cefuroxime injection and/or perioperative levofloxacin eyedrops on the incidence of endophthalmitis after phacoemulsification cataract surgery began in September 2003 and was terminated early in January 2006. The study used random allocation of patients in a 2 × 2 factorial design. RESULTS: By the end of 2005, complete follow-up records had been received for 13 698 study patients. Such a clear beneficial effect from the use of intracameral cefuroxime had been observed that it was agreed it would be unethical to continue the study and to wait for the completion of all follow-up procedures before reporting this important result. If total reported cases of endophthalmitis are considered, the incidence rate observed in those treatment groups not receiving cefuroxime prophylaxis (23 cases in 6862 patients) was almost 5 times as high (odds ratio [OR], 4.59; 95% confidence interval [CI], 1.74-12.08; P = .002) as that in the groups receiving this treatment (5 cases in 6836 patients). If only cases proved to be due to infection are considered, the rate was more than 5 times as high (OR, 5.32; 95% CI, 1.55-18.26; P = .008) in the treatment groups not receiving cefuroxime. Although the use of perioperative levofloxacin eyedrops as prophylaxis was also associated with a reduction in the observed incidence rate of postoperative endophthalmitis, this effect was smaller and was not statistically significant, whether total reported cases or only cases proven to be due to infection are used in calculating the rates. As not all follow-up procedures are complete, it is possible that further cases of endophthalmitis may be reported; however, it is not expected that this will alter the main conclusion. Nevertheless, it is anticipated that successful completion of follow-up procedures in all patients will increase the total number in the study to approximately 16 000. CONCLUSION: Intracameral cefuroxime administered at the time of surgery significantly reduced the risk for developing endophthalmitis after cataract surgery.

Microbial Keratitis

2005-12-22

Lisa Keay , Katie Edwards , Thomas Naduvilath +4 more

Risk Factors for Microbial Keratitis with Contemporary Contact Lenses

2008-07-03

John Dart , Cherry Radford , Angela M. Minassian +2 more

The Epidemiology of Acanthamoeba Keratitis in the United States

1989-04-01

Jeanette K. Stehr‐Green , T M Bailey , Govinda S. Visvesvara

The Changing Spectrum of Fungal Keratitis in South Florida

1994-06-01

Robert H. Rosa , Darlene Miller , Eduardo C. Alfonso

To review the clinical experience with fungal keratitis in south Florida over a 10-year period.One hundred twenty-five cases of fungal keratitis were identified in the microbiology laboratory records between January … To review the clinical experience with fungal keratitis in south Florida over a 10-year period.One hundred twenty-five cases of fungal keratitis were identified in the microbiology laboratory records between January 1982 and January 1992. The medical record of each patient was reviewed.The most commonly associated risk factor was trauma (44%). Fungal keratitis developed in five patients using extended wear contact lenses and one patient wearing a therapeutic bandage contact lens. Clinical features included irregular, feathery margins (62%), a dry, rough texture (47%), and satellite lesions (41%). An initial positive culture was obtained in 90% of patients, with a majority of cultures becoming positive within 48 hours. The Fusarium sp accounted for 62% of the isolates, with Fusarium oxysporum being the most commonly isolated organism. New fungal isolates include Candida parapsilosis, Aspergillus terreus, Candida tropicalis, and Trichosporon beigellii. Natamycin 5% suspension was the initial antifungal agent used for 91% of the patients, with an average duration of treatment of 38 days. Twenty-five patients were treated with oral ketoconazole for a median duration of 2 weeks, in addition to topical antifungal therapy. Thirty-four patients (27%) required a penetrating keratoplasty. Six patients had recurrence of fungal keratitis after penetrating keratoplasty.Trauma, including contact lens wear, is the most commonly associated risk factor. The fungal organisms can be readily identified in culture. F. oxysporum is the most common organism, with new isolates identified. The mainstay of therapy is topical natamycin with the increasing use of imidazoles.

Spectrum and Susceptibilities of Microbiologic Isolates in the Endophthalmitis Vitrectomy Study

1996-07-01

Dennis P. Han , Stephen R. Wisniewski , Louis A. Wilson +4 more

Endogenous bacterial endophthalmitis: A 17-year prospective series and review of 267 reported cases

2003-07-01

Timothy L. Jackson , Susannah Eykyn , E M Graham +1 more

EVOLVING GUIDELINES FOR INTRAVITREOUS INJECTIONS

2004-10-01

Lloyd Paul Aiello , Alexander J. Brucker , Stanley Chang +7 more

Intravitreous (IVT) injection is increasingly being incorporated into the management of ocular diseases. While only fomivirsen sodium (Vitravene™) is currently approved by the Food and Drug Administration as an IVT … Intravitreous (IVT) injection is increasingly being incorporated into the management of ocular diseases. While only fomivirsen sodium (Vitravene™) is currently approved by the Food and Drug Administration as an IVT injection, the number of approved IVT injections indications is anticipated to grow on the basis of promising results from ongoing clinical studies. Despite the potential benefits that may be derived from intraocular injections of different agents, no guidelines have been published previously for IVT injection. The purpose of this document is to identify specific strategies for the delivery of IVT injection that may reduce risks and improve outcomes. Consensus was sought among a panel of investigators, surgeons experienced with this technique, and industry representatives. Objective evidence was sought for all guidelines, but consensus was accepted where evidence remains incomplete. In the absence of either evidence or consensus, the current manuscript identifies outstanding issues in need of further investigation. It is anticipated that more complete guidelines will evolve over time, potentially altering some of the guidelines included here, based on new applications of IVT injection, additional clinical experience, and results of clinical trials.

Endogenous bacterial endophthalmitis. Report of a ten-year retrospective study.

1994-05-01

Annabelle A. Okada , R. Paul Johnson , W. Conrad Liles +2 more

Fungal infections of the cornea

2003-11-01

Philip A. Thomas

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Acanthamoeba Keratitis: Diagnosis and Treatment Update 2009

2009-08-06

John Dart , Valerie Saw , Simon Kilvington

Klebsiella pneumoniae Liver Abscess Associated With Septic Endophthalmitis

1986-10-01

Yung-Ching Liu

Metastatic septic bacterial endophthalmitis is a rare, but devastating disease. We encountered seven cases of pyogenic liver abscess associated with septic endophthalmitis during a recent four-year period. The causative organism … Metastatic septic bacterial endophthalmitis is a rare, but devastating disease. We encountered seven cases of pyogenic liver abscess associated with septic endophthalmitis during a recent four-year period. The causative organism was a pure culture of Klebsiella pneumoniae. The diagnosis was made by results of a blood culture in seven of the cases, liver aspirate culture in four, and eye contents or conjunctival culture in four. Chest roentgenographic examination showed pulmonary embolization in four patients, purulent meningitis in one patient, and suspicious prostatic abscess in one patient. Despite diligent antibiotic therapy, six patients lost their vision and one had impaired vision. This poor outcome for septic endophthalmitis seems to result from delayed diagnosis and lack of scheduled periocular injections of antibiotics. A combination course of treatment by the internist and ophthalmologist acting aggressively, both diagnostically and therapeutically, is needed in the future. To have seven cases of K pneumoniae liver abscess complicated by septic endophthalmitis during a period of four years in one hospital is very unusual. To our knowledge, it has never been reported in the literature.

Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 cases

2003-06-18

Tristan Bourcier

To identify predisposing factors and to define clinical and microbiological characteristics of bacterial keratitis in current practice.A retrospective analysis of the hospital records of patients presenting with bacterial keratitis and … To identify predisposing factors and to define clinical and microbiological characteristics of bacterial keratitis in current practice.A retrospective analysis of the hospital records of patients presenting with bacterial keratitis and treated at the Quinze-Vingts National Center of Ophthalmology, Paris, France, was performed during a 20 month period. A bacterial keratitis was defined as a suppurative corneal infiltrate and overlying epithelial defect associated with presence of bacteria on corneal scraping and/or that was cured with antibiotic therapy. Risk factors, clinical and microbiological data were collected.300 cases (291 patients) of presumed bacterial keratitis were included. Potential predisposing factors, usually multiple, were identified in 90.6% of cases. Contact lens wear was the main risk factor (50.3%). Trauma or a history of keratopathy was found in 15% and 21% of cases, respectively. An organism was identified in 201 eyes (68%). 83% of the infections involved Gram positive bacteria, 17% involved Gram negative bacteria, and 2% were polymicrobial. Gram negative bacteria were associated with severe anterior chamber inflammation (p=0.004), as well as greater surface of infiltrates (p=0.01). 99% of ulcers resolved with treatment, but only 60% of patients had visual acuity better than the level at admission, and 5% had very poor visual outcome.Contact lens wear is the most important risk factor. Most community acquired bacterial ulcers resolve with appropriate treatment.

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Risk Factors and Causative Organisms in Microbial Keratitis

2008-01-01

Matthew Green , Andrew Apel , Fiona Stapleton

To establish the risk factors, causative organisms, levels of antibiotic resistance, patient demographics, clinical presentations, and clinical outcomes of microbial keratitis at a tertiary hospital in Australia.Patients who had a … To establish the risk factors, causative organisms, levels of antibiotic resistance, patient demographics, clinical presentations, and clinical outcomes of microbial keratitis at a tertiary hospital in Australia.Patients who had a corneal scraping for culture over a 5-year period were identified through the local microbiology database, and a retrospective audit of their medical records was carried out. Clinical information was gathered from medical records, and smear, culture, and antibiotic resistance results were from the microbiology database. An index of disease severity was calculated for each patient from scores for the magnitude of the epithelial defect and anterior-chamber reaction and the location of the lesion. Associations between risk factors for keratitis and variables such as patient demographics, causative organism and antibiotic resistance, disease severity, and outcome were analyzed by using analysis of variance and chi tests with appropriate correction for multiple comparisons.Two hundred fifty-three cases of microbial keratitis in 231 patients were included. Sixty percent of patients were men, and there was a bimodal distribution in the age of presentation. Common risk factors for keratitis were contact lens wear (53; 22%), ocular surface disease (45; 18%), ocular trauma (41; 16%), and prior ocular surgery (28; 11%). Gram stains were positive in 33%, with a sensitivity of 53% and specificity of 89%. Cultures of corneal scrapings were positive in 65% of cases, and Pseudomonas aeruginosa (44; 17%), coagulase-negative staphylococci (22; 9%), Staphylococcus aureus (19; 8%), and fungi (7; 3%) were commonly recovered. P. aeruginosa was more common than other culture results in contact lens-related cases (55% vs. 0%-23%; P < 0.001), and S. aureus was more common than other culture results in ocular surgery-related cases (29% vs. 0%-21%; P < 0.001). Patients with keratitis related to prior ocular surface disease had more severe keratitis at the time of scraping (P = 0.037). Cultures positive for Fusarium, P. aeruginosa, and other Gram-negative organisms had statistically significantly more severe keratitis at the time of scraping, whereas patients with negative cultures had milder keratitis (P = 0.030). Only 2% of all bacterial isolates were resistant to ciprofloxacin, 20% of Gram-positive isolates were resistant to cephalothin, and no Gram-negative isolates were resistant to gentamicin.In this series, the most common risk factor for keratitis was contact lens wear and the most commonly isolated organism was P. aeruginosa.

Spectrum of Microbial Keratitis in South Florida

1980-07-01

Thomas J. Liesegang , Richard K. Forster

The Epidemiological Features and Laboratory Results of Fungal Keratitis

2002-08-01

Usha Gopinathan , Prashant Garg , Merle Fernandes +3 more

Purpose. To report the epidemiological features and laboratory results of 1,352 cases of fungal keratitis diagnosed at the L.V. Prasad Eye Institute (LVPEI) in south India. Methods. The medical and … Purpose. To report the epidemiological features and laboratory results of 1,352 cases of fungal keratitis diagnosed at the L.V. Prasad Eye Institute (LVPEI) in south India. Methods. The medical and microbiology records of 1,352 culture proven cases (1,354 eyes) of fungal keratitis diagnosed at the LVPEI between January 1991 to December 2000 was retrospectively reviewed for demographic features, risk factors, seasonal variation, and laboratory findings. Results. Males (962) were affected significantly more (p < 0.0001) than females (390). Of 1,352 patients, 853 (64.4%) were in the younger age group (16–49 years). Ocular trauma predisposed to infection in 736 (54.4%) of 1,354 eyes. There was a higher incidence of fungal keratitis during the monsoon and winter than summer. A fungal cause was established by smears of corneal scrapings in 1,277 (95.4%) eyes. The potassium hydroxide preparation (KOH), Calcofluor white (CFW), Gram-, and Giemsa-stained smears revealed fungus in 1,219 (91.0%), 1,224 (91.4%), 1,181 (88.2%), and 1,139 (85.1%) eyes, respectively. Fusarium (506, 37.2%) and Aspergillus species (417, 30.7%) predominated the hyaline fungal spectrum (1,133) and Curvularia species (39, 2.8%) were the highest among the dematiaceous isolates (218). Conclusions. To the best of our knowledge, this review presents the epidemiological features and laboratory results of the largest series of fungal keratitis ever reported in the literature. Keratomycosis is predominant in young adults with trauma as the major predisposing factor. With fungal keratitis being a major ophthalmologic problem in the tropical regions of the world, data available on the epidemiological features of a large series would greatly help medical practitioners at primary and secondary health care centers in the management of the disease. A simple KOH preparation of corneal scraping alone is highly beneficial in confirming the diagnosis.

Prophylaxis of Endophthalmitis with Topical Povidone-iodine

1991-12-01

Mark G. Speaker , Jerry Menikoff

Diversity of Bacteria at Healthy Human Conjunctiva

2011-05-13

Qunfeng Dong , Jennifer M. Brulc , Alfonso Iovieno +7 more

Purpose.: Ocular surface (OS) microbiota contributes to infectious and autoimmune diseases of the eye. Comprehensive analysis of microbial diversity at the OS has been impossible because of the limitations of … Purpose.: Ocular surface (OS) microbiota contributes to infectious and autoimmune diseases of the eye. Comprehensive analysis of microbial diversity at the OS has been impossible because of the limitations of conventional cultivation techniques. This pilot study aimed to explore true diversity of human OS microbiota using DNA sequencing-based detection and identification of bacteria. Methods.: Composition of the bacterial community was characterized using deep sequencing of the 16S rRNA gene amplicon libraries generated from total conjunctival swab DNA. The DNA sequences were classified and the diversity parameters measured using bioinformatics software ESPRIT and MOTHUR and tools available through the Ribosomal Database Project-II (RDP-II). Results.: Deep sequencing of conjunctival rDNA from four subjects yielded a total of 115,003 quality DNA reads, corresponding to 221 species-level phylotypes per subject. The combined bacterial community classified into 5 phyla and 59 distinct genera. However, 31% of all DNA reads belonged to unclassified or novel bacteria. The intersubject variability of individual OS microbiomes was very significant. Regardless, 12 genera—Pseudomonas, Propionibacterium, Bradyrhizobium, Corynebacterium, Acinetobacter, Brevundimonas, Staphylococci, Aquabacterium, Sphingomonas, Streptococcus, Streptophyta, and Methylobacterium—were ubiquitous among the analyzed cohort and represented the putative "core" of conjunctival microbiota. The other 47 genera accounted for <4% of the classified portion of this microbiome. Unexpectedly, healthy conjunctiva contained many genera that are commonly identified as ocular surface pathogens. Conclusions.: The first DNA sequencing-based survey of bacterial population at the conjunctiva have revealed an unexpectedly diverse microbial community. All analyzed samples contained ubiquitous (core) genera that included commensal, environmental, and opportunistic pathogenic bacteria.

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Bacterial keratitis: a prospective clinical and microbiological study

2001-07-01

Felicity Schaefer

<h3>AIM</h3> To define the clinical and microbiological profile of bacterial keratitis at the Jules Gonin Eye Hospital and to test the in vitro bacterial resistance. <h3>METHODS</h3> Patients presenting with bacterial … <h3>AIM</h3> To define the clinical and microbiological profile of bacterial keratitis at the Jules Gonin Eye Hospital and to test the in vitro bacterial resistance. <h3>METHODS</h3> Patients presenting with bacterial keratitis were prospectively followed; clinical features (age, risk factors, visual acuity) and response to therapy were analysed. Bacteriological profile was determined and the sensitivity/resistance of isolated strains were tested towards 12 ocular antibiotics (NCCLS disc diffusion test). <h3>RESULTS</h3> 85 consecutive patients (mean age 44.3 (SD 20.7) years) were prospectively enrolled from 1 March 1997 to 30 November 1998. The following risk factors were identified: contact lens wear, 36%; blepharitis, 21%; trauma, 20%; xerophthalmia, 15%; keratopathies, 8%; and eyelid abnormalities, 6%. The most commonly isolated bacteria were<i>Staphylococcus epidermidis</i>, 40%;<i>Staphylococcus aureus</i>, 22%;<i>Streptococcus pneumoniae</i>, 8%; others<i>Streptococcus </i>species, 5%;<i>Pseudomonas</i>, 9%;<i>Moraxella</i> and<i>Serratia marcescens</i>, 5% each;<i>Bacillus</i>,<i>Corynebacterium</i>, <i>Alcaligenes xyloxidans</i>, <i>Morganella morganii</i>, and<i>Haemophilus influenza</i>, 1% each. 1–15% of strains were resistant to fluoroquinolones, 13–22% to aminoglycosides, 37% to cefazolin, 18% to chloramphenicol, 54% to polymyxin B, 51% to fusidic acid, and 45% to bacitracin. Five of the 85 patients (5.8%) had a poor clinical outcome with a visual loss of one or more lines of visual acuity. <h3>CONCLUSION</h3> Fluoroquinolones appear to be the therapy of choice for bacterial keratitis, but, based upon these in vitro studies, some strains may be resistant.

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Nosocomial acute-onset postoperative endophthalmitis survey

1998-06-01

Thomas M. Aaberg , Harry W Flynn , Joyce Schiffman +1 more

ObjectiveThe purpose of the study was to evaluate the incidence of acute-onset (within 6 weeks after surgery) postoperative endophthalmitis and to assess the visual acuity outcomes after treatment over a … ObjectiveThe purpose of the study was to evaluate the incidence of acute-onset (within 6 weeks after surgery) postoperative endophthalmitis and to assess the visual acuity outcomes after treatment over a 10-year period at one institution.Patients and methodsThis retrospective study reviews all surgical cases performed between January 1, 1984 and December 30, 1994 at the Anne Bates Leach Eye Hospital, Bascom Palmer Eye Institute, University of Miami Medical Center, for the occurrence of nosocomial acute-onset postoperative endophthalmitis.ResultsThe overall 10-year incidence of acute-onset postoperative endophthalmitis after intraocular surgery was 0.093% (54/58, 123). The incidences of culture-proven acute-onset postoperative endophthalmitis by surgical category were as follows: cataract surgery with or without intraocular lens (IOL) (0.082%, 34/41, 654), pars plana vitrectomy (PPV) (0.046%, 3/6557), penetrating keratoplasty (0.178%, 5/2805), secondary IOL placement (0.366%, 5/1367), glaucoma surgeries (0.124%, 4/3233), combined trabeculectomy and cataract surgery (0.114%, 2/1743), and combined penetrating keratoplasty and cataract surgery (0.194%, 1/515).The median visual acuity after endophthalmitis treatment was 20/200. The median visual acuities after endophthal- mitis treatment by procedure were as follows: cataract surgery with or without IOL (20/133), PPV (no light perception), penetrating keratoplasty (2/200), secondary IOL implantation (20/40), glaucoma surgery (20/80), and combined trabeculectomy and cataract surgery with or without IOL (20/150).ConclusionsThe overall incidence of endophthalmitis after intraocular surgery was 0.093%. The incidence of endophthalmitis was higher after secondary IOL implantation than after cataract extraction (P = 0.008, Fisher's exact test). After treatment, the visual acuity outcomes were worse in the patients who developed endophthalmitis after PPV than after cataract extraction, glaucoma procedures, or secondary IOL implantation (P < 0.05, analysis of variance, Duncan's multiple range test). Acuity outcomes after treatment of endophthalmitis were better among the patients with secondary IOL implantation than after penetrating keratoplasty or PPV (P < 0.05, analysis of variance, Duncan's multiple range test). The results of this 10-year review from a large teaching center may serve as a source of comparison for other centers and future studies.

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Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, south India

1997-11-01

Muthiah Srinivasan , Calle A. Gonzales , C. George +6 more

<h3>AIMS/BACKGROUND</h3> To determine the epidemiological characteristics and risk factors predisposing to corneal ulceration in Madurai, south India, and to identify the specific pathogenic organisms responsible for infection. <h3>METHODS</h3> All patients … <h3>AIMS/BACKGROUND</h3> To determine the epidemiological characteristics and risk factors predisposing to corneal ulceration in Madurai, south India, and to identify the specific pathogenic organisms responsible for infection. <h3>METHODS</h3> All patients with suspected infectious central corneal ulceration presenting to the ocular microbiology and cornea service at Aravind Eye Hospital, Madurai, from 1 January to 31 March 1994 were evaluated. Sociodemographic data and information pertaining to risk factors were recorded, all patients were examined, and corneal cultures and scrapings were performed. <h3>RESULTS</h3> In the 3 month period 434 patients with central corneal ulceration were evaluated. A history of previous corneal injury was present in 284 patients (65.4%). Cornea cultures were positive in 297 patients (68.4%). Of those individuals with positive cultures 140 (47.1%) had pure bacterial infections, 139 (46.8%) had pure fungal infections, 15 (5.1%) had mixed bacteria and fungi, and three (1.0%) grew pure cultures of<i>Acanthamoeba</i>. The most common bacterial pathogen isolated was <i>Streptococcus pneumoniae</i>, representing 44.3% of all positive bacterial cultures, followed by <i>Pseudomonas </i>spp (14.4%). The most common fungal pathogen isolated was <i>Fusarium</i>spp, representing 47.1% of all positive fungal cultures, followed by <i>Aspergillus </i>spp (16.1%). <h3>CONCLUSIONS</h3> Central corneal ulceration is a common problem in south India and most often occurs after a superficial corneal injury with organic material. Bacterial and fungal infections occur in equal numbers with <i>Streptococcus pneumoniae</i>accounting for the majority of bacterial ulcers and <i>Fusarium</i>spp responsible for most of the fungal infections. These findings have important public health implications for the treatment and prevention of corneal ulceration in the developing world.

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Choroidal and scleral mechanisms of compensation for spectacle lenses in chicks

1995-05-01

Christine F. Wildsoet , Josh Wallman

Endophthalmitis isolates and antibiotic sensitivities: a 6-year review of culture-proven cases

2003-12-30

Matthew S. Benz , Ingrid U. Scott , Harry W. Flynn +2 more

The Incidence of Ulcerative Keratitis among Users of Daily-Wear and Extended-Wear Soft Contact Lenses

1989-09-21

Eugene C. Poggio , Robert J. Glynn , Oliver D. Schein +4 more

The wearing of contact lenses has increased dramatically in the past decade; over 4 million people in the United States now use extended-wear soft contact lenses, and 9 million use … The wearing of contact lenses has increased dramatically in the past decade; over 4 million people in the United States now use extended-wear soft contact lenses, and 9 million use daily-wear soft contact lenses. Numerous reports have caused concern that the use of soft contact lenses, especially extended-wear lenses, may result in a substantial risk of ulcerative keratitis. To examine this issue, we conducted a prospective study in five New England states to estimate the incidence of ulcerative keratitis among those who use cosmetic extended-wear and daily-wear soft contact lenses. To obtain the numerator for each estimate of incidence, we surveyed all practicing ophthalmologists in the study area to identify all new cases diagnosed over a four-month period. To provide the denominator, we conducted a survey of 4178 households to estimate the number of persons who wore each type of soft contact lens. The annualized incidence of ulcerative keratitis was estimated to be 20.9 per 10,000 persons using extended-wear soft contact lenses for cosmetic purposes and 4.1 per 10,000 persons using daily-wear soft contact lenses for cosmetic purposes (P less than 0.00001).

Role of External Bacterial Flora in the Pathogenesis of Acute Postoperative Endophthalmitis

1991-05-01

Mark G. Speaker , Florence A. Milch , Mahendra Shah +2 more

Coagulase-Negative Staphylococci: Role as Pathogens

1999-02-01

Johannes Hüebner , Donald A. Goldmann

Coagulase-negative staphylococci have long been regarded as apathogenic but their important role as pathogens and their increasing incidence have been recognized and studied in recent years. Although specific virulence factors … Coagulase-negative staphylococci have long been regarded as apathogenic but their important role as pathogens and their increasing incidence have been recognized and studied in recent years. Although specific virulence factors are not as clearly established as they are in Staphylococcus aureus, it seems clear that factors such as bacterial polysaccharide components are involved in attachment and/or persistence of bacteria on foreign materials. Coagulase-negative staphylococci are by far the most common cause of bacteremia related to indwelling devices. Most of these infections are hospital-acquired, and studies over the past several years suggest that they are often caused by strains that are transmitted among hospitalized patients. Other important infections due to coagulase-negative staphylococci include central nervous system shunt infections, native or prosthetic valve endocarditis, urinary tract infections, and endophthalmitis. Intravenous treatment of systemic infections is usually required because coagulase-negative staphylococci have become increasingly resistant to multiple antibiotics.

Acute endophthalmitis following intravitreal triamcinolone acetonide injection

2003-10-28

Darius M. Moshfeghi , Peter K. Kaiser , Ingrid U. Scott +7 more

International Conference for the Development of a Consensus on the Management and Prevention of Severe Candidal Infections

1997-07-01

John E. Edwards , Gerald P. Bodey , Raleigh A. Bowden +7 more

Because of the rapidly increasing incidence of serious candidal infections, a consensus conference of 22 investigators from the United States, Europe, and Japan was held to discuss strategies for the … Because of the rapidly increasing incidence of serious candidal infections, a consensus conference of 22 investigators from the United States, Europe, and Japan was held to discuss strategies for the prevention and treatment of deep-organ infections caused by Candida species. Commonly asked questions concerning the management of candidal infections were selected for discussion by the participating investigators. Possible answers to the questions were developed by the investigators, who then voted anonymously for their preferences. In certain instances, unanimity or a strong consensus was the result. In all cases, the full spectrum of responses was recorded and is presented in this report. The forms of candidal infection addressed included candidemia, candiduria, hepatosplenic candidiasis (chronic systemic candidiasis), candidal endophthalmitis, and candidal peritonitis. Prevention and treatment strategies were considered for patients who have undergone surgery, for neutropenic and nonneutropenic patients, and for patients who have undergone bone marrow and solid organ transplantation. The therapeutic roles of amphotericin B (standard and lipid formulations) and the azoles were considered.

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Emerging fluoroquinolone resistance in bacterial keratitis

1999-07-01

Michael H. Goldstein , Regis P. Kowalski , Y. Jerold Gordon

Incidence of contact-lens-associated microbial keratitis and its related morbidity

1999-07-01

Kam H. Cheng , Siu Lan Leung , Hans W Hoekman +4 more

Multistate Outbreak of Fusarium Keratitis Associated With Use of a Contact Lens Solution

2006-08-22

Douglas C. Chang , Gavin B. Grant , Kerry O’Donnell +7 more

Fusarium keratitis is a serious corneal infection, most commonly associated with corneal injury. Beginning in March 2006, the Centers for Disease Control and Prevention received multiple reports of Fusarium keratitis … Fusarium keratitis is a serious corneal infection, most commonly associated with corneal injury. Beginning in March 2006, the Centers for Disease Control and Prevention received multiple reports of Fusarium keratitis among contact lens wearers.To define the specific activities, contact lens hygiene practices, or products associated with this outbreak.Epidemiological investigation of Fusarium keratitis occurring in the United States. A confirmed case was defined as keratitis with illness onset after June 1, 2005, with no history of recent ocular trauma and a corneal culture growing Fusarium species. Data were obtained by patient and ophthalmologist interviews for case patients and neighborhood-matched controls by trained personnel. Available Fusarium isolates from patients' clinical and environmental specimens were genotyped by multilocus sequence typing. Environmental sampling for Fusarium was conducted at a contact lens solution manufacturing plant.Keratitis infection with Fusarium species.As of June 30, 2006, we identified 164 confirmed case patients in 33 states and 1 US territory. Median age was 41 years (range, 12-83 years). Corneal transplantation was required or planned in 55 (34%). One hundred fifty-four (94%) of the confirmed case patients wore soft contact lenses. Forty-five case patients and 78 controls were included in the case-control study. Case patients were significantly more likely than controls to report using a specific contact lens solution, ReNu with MoistureLoc (69% vs 15%; odds ratio, 13.3; 95% confidence interval, 3.1-119.5). The prevalence of reported use of ReNu MultiPlus solution was similar between case patients and controls (18% vs 20%; odds ratio, 0.7; 95% confidence interval, 0.2-2.8). Fusarium was not recovered from the factory, warehouse, solution filtrate, or unopened solution bottles; production of implicated lots was not clustered in time. Among 39 isolates tested, at least 10 different Fusarium species were identified, comprising 19 unique multilocus genotypes.The findings from this investigation indicate that this outbreak of Fusarium keratitis was associated with use of ReNu with MoistureLoc contact lens solution. Contact lens users should not use ReNu with MoistureLoc.

Bacterial endophthalmitis prophylaxis for cataract surgery

2002-01-01

Thomas A. Ciulla , Michael B. Starr , Samuel Masket

Shifting trends in bacterial keratitis in South Florida and emerging resistance to fluoroquinolones

2000-08-01

George Alexandrakis

Corneal blindness: a global perspective.

2001-01-01

John P. Whitcher , Muthiah Srinivasan , Madan Prasad Upadhyay

Diseases affecting the cornea are a major cause of blindness worldwide, second only to cataract in overall importance. The epidemiology of corneal blindness is complicated and encompasses a wide variety … Diseases affecting the cornea are a major cause of blindness worldwide, second only to cataract in overall importance. The epidemiology of corneal blindness is complicated and encompasses a wide variety of infectious and inflammatory eye diseses that cause corneal scarring, which ultimately leads to functional blindness. In addition, the prevalence of corneal disease varies from country to country and even from one population to another. While cataract is responsible for nearly 20 million of the 45 million blind people in the world, the next major cause is trachoma which blinds 4.9 million individuals, mainly as a result of corneal scarring and vascularization. Ocular trauma and corneal ulceration are significant causes of corneal blindness that are often underreported but may be responsible for 1.5-2.0 million new cases of monocular blindness every year. Causes of childhood blindness (about 1.5 million worldwide with 5 million visually disabled) include xerophthalmia (350,000 cases annually), ophthalmia neonatorum, and less frequently seen ocular diseases such as herpes simplex virus infections and vernal keratoconjunctivitis. Even though the control of onchocerciasis and leprosy are public health success stories, these diseases are still significant causes of blindness--affecting a quarter of a million individuals each. Traditional eye medicines have also been implicated as a major risk factor in the current epidemic of corneal ulceration in developing countries. Because of the difficulty of treating corneal blindness once it has occurred, public health prevention programmes are the most cost-effective means of decreasing the global burden of corneal blindness.

Prophylaxis of postoperative endophthalmitis following cataract surgery: Results of the ESCRS multicenter study and identification of risk factors

2007-05-25

ESCRS Endophthalmitis Study Group

To identify risk factors and describe the effects of antibiotic prophylaxis on the incidence of postoperative endophthalmitis after cataract surgery based on analysis of the findings of the European Society … To identify risk factors and describe the effects of antibiotic prophylaxis on the incidence of postoperative endophthalmitis after cataract surgery based on analysis of the findings of the European Society of Cataract & Refractive Surgeons (ESCRS) multicenter study.Twenty-four ophthalmology units in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom.A prospective randomized partially masked multicenter cataract surgery study recruited 16 603 patients. The study was based on a 2 x 2 factorial design, with intracameral cefuroxime and topical perioperative levofloxacin factors resulting in 4 treatment groups. The comparison of case and non-case data was performed using multivariable logistic regression analyses. Odds ratios (ORs) associated with treatment effects and other risk factors were estimated.Twenty-nine patients presented with endophthalmitis, of whom 20 were classified as having proven infective endophthalmitis. The absence of an intracameral cefuroxime prophylactic regimen at 1 mg in 0.1 mL normal saline was associated with a 4.92-fold increase (95% confidence interval [CI], 1.87-12.9) in the risk for total postoperative endophthalmitis. In addition, the use of clear corneal incisions (CCIs) compared to scleral tunnels was associated with a 5.88-fold increase (95% CI, 1.34-25.9) in risk and the use of silicone intraocular lens (IOL) optic material compared to acrylic with a 3.13-fold increase (95% CI, 1.47-6.67). The presence of surgical complications increased the risk for total endophthalmitis 4.95-fold (95% CI, 1.68-14.6), and more experienced surgeons were more likely to be associated with endophthalmitis cases. When considering only proven infective endophthalmitis cases, the absence of cefuroxime and the use of silicone IOL optic material were significantly associated with an increased risk, and there was evidence that men were more predisposed to infection (OR, 2.70; 95% CI, 1.07-6.8).Use of intracameral cefuroxime at the end of surgery reduced the occurrence of postoperative endophthalmitis. Additional risk factors associated with endophthalmitis after cataract surgery included CCIs and the use of silicone IOLs.

Review of epidemiological features, microbiological diagnosis and treatment outcome of microbial keratitis: Experience of over a decade

2009-01-01

Savitri Sharma , Usha Gopinathan , Prashant Garg +1 more

Purpose: To review the epidemiological characteristics, microbiological profile, and treatment outcome of patients with suspected microbial keratitis. Materials and Methods: Retrospective analysis of a non-comparative series from the database was … Purpose: To review the epidemiological characteristics, microbiological profile, and treatment outcome of patients with suspected microbial keratitis. Materials and Methods: Retrospective analysis of a non-comparative series from the database was done. All the patients presenting with corneal stromal infiltrate underwent standard microbiologic evaluation of their corneal scrapings, and smear and culture-guided antimicrobial therapy. Results: Out of 5897 suspected cases of microbial keratitis 3563 (60.4%) were culture-proven (bacterial – 1849, 51.9%; fungal – 1360, 38.2%; Acanthamoeba – 86, 2.4%; mixed – 268, 7.5%). Patients with agriculture-based activities were at 1.33 times (CI 1.16–1.51) greater risk of developing microbial keratitis and patients with ocular trauma were 5.33 times (CI 6.41–6.44) more likely to develop microbial keratitis. Potassium hydroxide with calcofluor white was most sensitive for detecting fungi (90.6%) and Acanthamoeba (84.0%) in corneal scrapings, however, Gram stain had a low sensitivity of 56.6% in detection of bacteria. Majority of the bacterial infections were caused by Staphylococcus epidermidis (42.3%) and Fusarium species (36.6%) was the leading cause of fungal infections. A significantly larger number of patients (691/1360, 50.8%) with fungal keratitis required surgical intervention compared to bacterial (799/1849, 43.2%) and Acanthamoeba (15/86, 17.4%) keratitis. Corneal healed scar was achieved in 75.5%, 64.8%, and 90.0% of patients with bacterial, fungal, and Acanthamoeba keratitis respectively. Conclusions: While diagnostic and treatment modalities are well in place the final outcome is suboptimal in fungal keratitis. With more effective treatment available for bacterial and Acanthamoeba keratitis, the treatment of fungal keratitis is truly a challenge.

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Current Perspectives on Ophthalmic Mycoses

2003-10-01

Philip A. Thomas

SUMMARY Fungi may infect the cornea, orbit and other ocular structures. Species of Fusarium , Aspergillus , Candida , dematiaceous fungi, and Scedosporium predominate. Diagnosis is aided by recognition of … SUMMARY Fungi may infect the cornea, orbit and other ocular structures. Species of Fusarium , Aspergillus , Candida , dematiaceous fungi, and Scedosporium predominate. Diagnosis is aided by recognition of typical clinical features and by direct microscopic detection of fungi in scrapes, biopsy specimens, and other samples. Culture confirms the diagnosis. Histopathological, immunohistochemical, or DNA-based tests may also be needed. Pathogenesis involves agent (invasiveness, toxigenicity) and host factors. Specific antifungal therapy is instituted as soon as the diagnosis is made. Amphotericin B by various routes is the mainstay of treatment for life-threatening and severe ophthalmic mycoses. Topical natamycin is usually the first choice for filamentous fungal keratitis, and topical amphotericin B is the first choice for yeast keratitis. Increasingly, the triazoles itraconazole and fluconazole are being evaluated as therapeutic options in ophthalmic mycoses. Medical therapy alone does not usually suffice for invasive fungal orbital infections, scleritis, and keratitis due to Fusarium spp., Lasiodiplodia theobromae , and Pythium insidiosum . Surgical debridement is essential in orbital infections, while various surgical procedures may be required for other infections not responding to medical therapy. Corticosteroids are contraindicated in most ophthalmic mycoses; therefore, other methods are being sought to control inflammatory tissue damage. Fungal infections following ophthalmic surgical procedures, in patients with AIDS, and due to use of various ocular biomaterials are unique subsets of ophthalmic mycoses. Future research needs to focus on the development of rapid, species-specific diagnostic aids, broad-spectrum fungicidal compounds that are active by various routes, and therapeutic modalities which curtail the harmful effects of fungus- and host tissue-derived factors.

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Mycotic keratitis: epidemiology, diagnosis and management

2013-01-12

Philip A. Thomas , J Kaliamurthy

Aetiology of suppurative corneal ulcers in Ghana and south India, and epidemiology of fungal keratitis

2002-10-18

Astrid Leck , Philip A. Thomas , M Hagan +7 more

<b>Background:</b> A multicentre study was carried out in Ghana and southern India to determine the aetiology of suppurative keratitis in two regions located at similar tropical latitudes. Studies of fungal … <b>Background:</b> A multicentre study was carried out in Ghana and southern India to determine the aetiology of suppurative keratitis in two regions located at similar tropical latitudes. Studies of fungal keratitis from the literature were reviewed. <b>Methods:</b> Patients presenting at rural and urban eye units with suspected microbial keratitis were recruited to the study. Corneal ulceration was defined as loss of corneal epithelium with clinical evidence of infection with or without hypopyon. Microscopy and culture were performed on all corneal specimens obtained. <b>Results:</b> 1090 patients were recruited with suspected microbial keratitis between June 1999 and May 2001. Overall the principal causative micro-organisms in both regions were filamentous fungi (42%): <i>Fusarium</i> species and <i>Aspergillus</i> species were the commonest fungal isolates. <i>Pseudomonas</i> species were most frequently isolated from cases of bacterial keratitis in Ghana but in India the commonest bacterial isolates were streptococci. <b>Conclusion:</b> Infections of the cornea due to filamentous fungi are a frequent cause of corneal damage in developing countries in the tropics and are difficult to treat. Microscopy is an essential tool in the diagnosis of these infections. A knowledge of the "local" aetiology within a region is of value in the management of suppurative keratitis in the event that microscopy cannot be performed.

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Bacterial Endophthalmitis: Epidemiology, Therapeutics, and Bacterium-Host Interactions

2002-01-01

Michelle C. Callegan , Michael Engelbert , David W. Parke +2 more

Endophthalmitis is a severe inflammation of the interior of the eye caused by the introduction of contaminating microorganisms following trauma, surgery, or hematogenous spread from a distant infection site. Despite … Endophthalmitis is a severe inflammation of the interior of the eye caused by the introduction of contaminating microorganisms following trauma, surgery, or hematogenous spread from a distant infection site. Despite appropriate therapeutic intervention, bacterial endophthalmitis frequently results in visual loss, if not loss of the eye itself. Although the pathogenicity of bacterial endophthalmitis has historically been linked with toxin production during infection, a paucity of information exists as to the exact mechanisms of retinal toxicity and the triggers for induction of the intraocular immune response. Recently, research has begun to examine the bacterial and host molecular and cellular events that contribute to ocular damage during endophthalmitis. This review focuses on the causative agents and therapeutic challenges of bacterial endophthalmitis and provides current data from the analysis of the role of bacterial virulence factors and host inflammatory interactions in the pathogenesis of eye infections. Based on these and related studies, a hypothetical model for the molecular pathogenesis of bacterial endophthalmitis is proposed. Identifying and understanding the basic mechanisms of these bacterium-host interactions will provide the foundation for which novel, information-based therapeutic agents are developed in order to prevent vision loss during endophthalmitis.

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Contact lenses and other risk factors in microbial keratitis

1991-09-01

John Dart , Fiona Stapleton , Angela M. Minassian

META-ANALYSIS OF ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTION OF ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR AGENTS

2011-02-17

Colin A. McCannel

To report the rates of endophthalmitis and the spectrum of causative organisms after intravitreal injection of anti-vascular endothelial growth factor agents and possible prevention strategies.Meta-analysis of the U.S. literature from … To report the rates of endophthalmitis and the spectrum of causative organisms after intravitreal injection of anti-vascular endothelial growth factor agents and possible prevention strategies.Meta-analysis of the U.S. literature from 2005 to 2009 reporting endophthalmitis bacterial isolates after intravitreal injection of anti-vascular endothelial growth factor agents and comparison with reports of endophthalmitis bacterial isolates after intraocular surgery in the United States.Endophthalmitis after intravitreal injection occurred in 52 of 105,536 injections (0.049%) (95% confidence interval [CI], 0.038-0.065%). Among 50 cases of endophthalmitis with bacterial culture isolates, 24 (48.0% [95% CI, 34.8-61.5%]) were culture negative and 26 (52% [95% CI, 38.5-65.2%]) were culture positive. Among the 26 culture-positive isolates, causative organisms were coagulase-negative Staphylococcus in 17 cases (65.4% [95% CI, 46.0-80.6%]), Streptococcus species in 8 cases (30.8% [95% CI, 16.5-50.2%]), and Bacillus cereus in 1 case (3.8% [95% CI, 0.9-19.0%]). Streptococcus species were significantly more frequent after intravitreal injection than after intraocular surgery in the Endophthalmitis Vitrectomy Study (29 of 226 isolates, 9.0% [95% CI, 6.3-12.6%], P = 0.005), a report on clear corneal cataract surgery endophthalmitis (6 of 73 isolates, 8.2% [95% CI, 3.9-16.8%], P = 0.022), and a report on postvitrectomy endophthalmitis with no cases of Streptococcus species.Streptococcal isolates are approximately three times more frequent after intravitreal anti-vascular endothelial growth factor injection than after intraocular surgery. Strategies to consider minimizing oropharyngeal droplet transmission may include avoiding talking, coughing, and sneezing or wearing surgical masks.

Bacterial and Fungal Endophthalmitis

2017-03-30

Marlene L. Durand

Endophthalmitis is a severe eye infection that may result in permanent loss of useful vision in the affected eye. Most cases are exogenous and occur as a complication of cataract … Endophthalmitis is a severe eye infection that may result in permanent loss of useful vision in the affected eye. Most cases are exogenous and occur as a complication of cataract surgery, an intravitreal injection, or penetrating ocular trauma. Endogenous endophthalmitis results from hematogenous seeding of the eye by bacteria or fungi, but bacteremia or fungemia may be transient and patients may present without symptoms of systemic infection. Nearly all endophthalmitis patients present with decreased vision, and some also have eye pain. Eye examination usually reveals a hypopyon and intraocular inflammation. Diagnosis is clinical, supported by cultures of the vitreous and/or aqueous or by blood cultures in some endogenous cases. Molecular diagnostic techniques have been used in research laboratories for pathogen identification in endophthalmitis and offer the possibility of rapid diagnosis, including in culture-negative cases. Intravitreal injection of antibiotics is the most important component of treatment; some cases also benefit from surgical debridement of the vitreous by a vitrectomy. The visual outcome depends partly on the pathogen: coagulase-negative staphylococcal endophthalmitis has a better prognosis than does streptococcal endophthalmitis, for example. Endophthalmitis is a medical emergency, and prompt diagnosis and treatment are essential for saving vision.

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Update on the Management of Infectious Keratitis

2017-09-21

Ariana Austin , Tom Lietman , Jennifer Rose‐Nussbaumer

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The persistent dilemma of microbial keratitis: Global burden, diagnosis, and antimicrobial resistance

2018-12-24

Lawson Ung , Paulo J. M. Bispo , Swapna S. Shanbhag +2 more

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Endophthalmitis

2013-02-25

Marlene L. Durand

Endophthalmitis means bacterial or fungal infection inside the eye involving the vitreous and/or aqueous humors. Most cases are exogenous and occur after eye surgery, after penetrating ocular trauma, or as … Endophthalmitis means bacterial or fungal infection inside the eye involving the vitreous and/or aqueous humors. Most cases are exogenous and occur after eye surgery, after penetrating ocular trauma, or as an extension of corneal infection. An increasing number of cases are occurring after intravitreal injections of anti-vascular endothelial growth factor (VEGF) medications. Endophthalmitis may also be endogenous, arising from bacteraemic or fungaemic seeding of the eye. The infected eye never serves as a source of bacteraemia or fungaemia, however. The most common pathogens in endophthalmitis vary by category. Coagulase-negative staphylococci are the most common causes of post-cataract endophthalmitis, and these bacteria and viridans streptococci cause most cases of post-intravitreal anti-VEGF injection endophthalmitis, Bacillus cereus is a major cause of post-traumatic endophthalmitis, and Staphylococcus aureus and streptococci are important causes of endogenous endophthalmitis associated with endocarditis. In Taiwan and other East Asian nations, Klebsiella pneumoniae causes most cases of endogenous endophthalmitis, in association with liver abscess. Endogenous fungal endophthalmitis in hospitalized patients is usually caused by Candida species, particularly Candida albicans. Acute endophthalmitis is a medical emergency. The most important component of treatment is the intravitreal injection of antibiotics, along with vitrectomy in severe cases. Systemic antibiotics should be used in cases of endogenous endophthalmitis and exogenous fungal endophthalmitis, but their role in exogenous bacterial endophthalmitis is uncertain. Repeated intravitreal injections of antibiotics may be necessary if there is no response to the initial therapy. Many eyes that receive prompt and appropriate treatment will recover useful vision.

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Results of the Endophthalmitis Vitrectomy Study

1995-12-01

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Ophthalmology HomeNew OnlineCurrent … Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Ophthalmology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Ophthalmology journal

Endogenous Bacterial Endophthalmitis

1994-05-01

Annabelle A. Okada , R. Paul Johnson , W. Conrad Liles +2 more

Facets of Vision

1989-01-01

Doekele G. Stavenga , Roger Hardie

Nosocomial Endophthalmitis Survey

1991-02-01

Hasan M. Kattan , Harry W. Flynn , Stephen C. Pflugfelder +2 more

Shifting trends in bacterial keratitis in a referral center

2025-06-24

Zülfiye Köktaş , Eray Atalay , Gül Durmaz +1 more | International Ophthalmology

A Rare Case of Subretinal Abscess Secondary to Methicillin-Sensitive <i>Staphylococcus aureus</i> Bacteremia

2025-06-23

Esther S. Gan , Jun Fai Yap , Sylves Patrick +2 more | Ocular Immunology and Inflammation

Subretinal abscess is a rare but vision-threatening manifestation of endogenous endophthalmitis, accounting for approximately 5% of cases. It typically occurs in immunocompromised individuals and may be caused by a variety … Subretinal abscess is a rare but vision-threatening manifestation of endogenous endophthalmitis, accounting for approximately 5% of cases. It typically occurs in immunocompromised individuals and may be caused by a variety of microbial pathogens. We aim to highlight the importance of early recognition of subretinal abscess in a patient with preserved vision and minimal ocular symptoms. We report a case of acute subretinal abscess secondary to Methicillin-Sensitive Staphylococcus aureus bacteremia in a 55-year-old man with previously undiagnosed diabetes mellitus. The patient presented with floaters in the left eye one day after undergoing incision and drainage of a lip abscess. Visual acuity remained 6/6 in both eyes. Fundus examination of the left eye revealed a superotemporal subretinal abscess with surrounding hemorrhage and Roth spots. Blood and pus cultures confirmed methicillin-sensitive Staphylococcus aureus. The patient was treated with a single dose of intravitreal vancomycin and ceftazidime, along with systemic antibiotics including intravenous cloxacillin, cefazolin, and oral ciprofloxacin. Pars plana vitrectomy was deemed unnecessary due to the lesion's favorable location, size, and good presenting visual acuity. The lesion resolved with choroidoretinal scarring, and vision was preserved. Subretinal abscess is an uncommon ocular complication of systemic infections that may be overlooked due to its subtle presentation. This case highlights the need for thorough ocular evaluation in patients with bacteremia, even in the presence of minimal visual symptoms. Early diagnosis and targeted antimicrobial therapy are crucial in preventing serious ocular morbidity and preserving vision.

Outcomes of Endogenous <i>Klebsiella pneumoniae</i> Endophthalmitis With and Without Vitrectomy: A Meta‐Analysis of Individual Participant Data

2025-06-22

Chieh‐Yu Lin , Wen‐Yi Shau , Chia‐Ying Tsai +1 more | Clinical and Experimental Ophthalmology

ABSTRACT Background The use of vitrectomy in treating endogenous Klebsiella pneumoniae endophthalmitis (EKPE) remains controversial. This study aims to compare visual and anatomical outcomes of EKPE with and without vitrectomy. … ABSTRACT Background The use of vitrectomy in treating endogenous Klebsiella pneumoniae endophthalmitis (EKPE) remains controversial. This study aims to compare visual and anatomical outcomes of EKPE with and without vitrectomy. Methods A meta‐analysis of individual participant data with relevant studies identified from PubMed, Embase and Web of Science. Patients were classified into the vitrectomy and non‐vitrectomy groups (patients who received IVI antibiotics alone). Poor visual acuity (VA) was defined as hand motion (HM) or worse. A generalised linear mixed model (for within‐study comparisons) and generalised estimating equations (for single‐arm studies) were used in the first stage of data synthesis, followed by a secondary meta‐analysis to integrate the effect estimates through a fixed‐effect model. The primary outcomes included differences in VA improvements, risks of poor final VA and risks of globe preservation failure between the vitrectomy and non‐vitrectomy groups. Results Of 68 retrospective studies, 324 patients (383 eyes) were included. Overall, VA improvement was significantly better in the vitrectomy group (mean differences [MD] = −0.27; p < 0.01). When stratified by initial VA, the result remained robust in eyes with poor initial VA (MD = −0.35; p < 0.01). There were no significant differences in risks of poor final VA (odds ratio [OR] = 0.84; p = 0.64) and risks of globe preservation failure (OR = 0.42; p = 0.09) between the two groups. Conclusions Vitrectomy results in greater VA improvement than IVI antibiotics alone in the management of EKPE, especially in eyes with an initial VA of HM or worse.

Aetiology and antibiotic susceptibility of bacterial keratitis at a referral centre in southern Sweden

2025-06-20

Elin Österhed , Karl Oldberg , Ingemar Gustafsson | Scientific Reports

Abstract This was a retrospective cross-sectional study evaluating the aetiology and antibiotic susceptibility in patients treated for suspected bacterial keratitis at Skåne University Hospital during 2019. Inclusion criteria: eyes with … Abstract This was a retrospective cross-sectional study evaluating the aetiology and antibiotic susceptibility in patients treated for suspected bacterial keratitis at Skåne University Hospital during 2019. Inclusion criteria: eyes with bacterial keratitis. Exclusion criteria: co-infection with other microbes. Primary outcome parameters: predisposing factors, causative pathogens and antibiotic susceptibility. Secondary outcome parameter: antibiotic treatment. A total of 255 cases met the inclusion criteria. Of these, 149 (58%) occurred in contact lens wearers. Corneal cultures, when performed, were positive in 51% of cases. For eyes which had received antibiotic treatment prior to corneal culture (n = 36), the proportion of positive cultures was 50%. Ulcers < 1 mm were less likely to yield a positive culture than those ≥ 1 mm. The most frequently isolated bacteria were coagulase-negative staphylococci (48%). Antibiotic resistance rates were lowest to levofloxacin (0%), ciprofloxacin (2%) and chloramphenicol (4%), and highest to fusidic acid (47%) and clindamycin (19%). The low proportion of positive cultures from small ulcers suggests that these warrant a different diagnostic approach. Furthermore, corneal cultures from eyes with ongoing antibiotic treatment were positive to the same extent as those from untreated eyes, suggesting that discontinuation of antibiotic treatment before re-culturing might not be necessary.

Acanthamoeba Keratitis Secondary Glaucoma Associated With Mature Cataract and a Fixed Dilated Pupil in a 40-Eye Series

2025-06-19

Rohan Hussain , John Dart , Sana Hamid | Cornea

Purpose This case series describes the incidence, clinical associations, and treatment outcomes of Acanthamoeba keratitis (AK) secondary glaucoma to identify potential prophylactic measures and optimal treatment. Methods AK-affected eyes developing … Purpose This case series describes the incidence, clinical associations, and treatment outcomes of Acanthamoeba keratitis (AK) secondary glaucoma to identify potential prophylactic measures and optimal treatment. Methods AK-affected eyes developing secondary glaucoma from 1992 to 2020 were identified from Moorfields databases. The annualized incidence was established from those patients with AK registered between 2000 and 2015. Results The 2000–2015 incidence of AK secondary glaucoma was 26 of 417 (6.2%). Forty eyes (39 patients) developed glaucoma or ocular hypertension; 16 of 28 (57%) had been treated for AK for ≥12 months from onset. Thirty-four of 40 eyes (85%) had an associated keratoplasty; 26 of 40 (65%) had a fixed dilated pupil and/or mature cataract. Sixteen of 40 (40%) underwent antiglaucoma drug treatment alone. Twenty-four of 40 (60%) eyes had surgical treatments including cyclodiode laser (2 eyes) leading to phthisis or evisceration, trabeculectomy (2 eyes) failed, glaucoma drainage devices in 20 of 40 (50%) eyes resulted in glaucoma control in 18/20 (90%) but required additional surgery in 9 of 20 (45%) eyes. Conclusions Mature cataract or a fixed dilated pupil has not been previously identified as a cause of secondary glaucoma in AK. The implications are that both result in angle closure and that early surgery for maturing cataract, despite its complexity, might prevent the development of angle closure. However, the potential for better medical treatment to reduce the time to cure to less than 12 months is likely the most effective way to reduce AK glaucoma incidence. Successful management of AK glaucoma once developed probably requires use of a glaucoma drainage device.

Symptoms as an Indicator of Microbial Keratitis Severity and Its Association With Visual Acuity

2025-06-19

Dena Ballouz , Leslie M. Niziol , N. Venkatesh Prajna +7 more | Eye & Contact Lens Science & Clinical Practice

Microbial keratitis (MK) is a vision-threatening and often painful corneal infection. This study aims to quantify severity of symptoms of MK at presentation and investigate their association with visual acuity … Microbial keratitis (MK) is a vision-threatening and often painful corneal infection. This study aims to quantify severity of symptoms of MK at presentation and investigate their association with visual acuity (VA). The Automated Quantitative Ulcer Analysis (AQUA) study recruited MK patients from two sites (University of Michigan and Aravind Eye Care System). At presentation, best-corrected VA was recorded. Patients were surveyed on severity of symptoms on a five-point scale for pain or a four-point scale for redness, light sensitivity/glare, and blurry vision. The association between symptom severity and VA was tested with Spearman correlations (r) and Kruskal-Wallis tests. Seven hundred three patients with MK were enrolled in the AQUA study from July 2020 to November 2022. Presenting logMAR VA had a median value of 1.3 (Snellen equivalent, 20/400). Most patients reported pain (98.7%), redness (99.1%), light sensitivity/glare (98.4%), and blurry vision (99.2%). Visual acuity showed a significant correlation with cumulative symptom severity (spearman r=0.15, P<0.0001). For those who reported pain and blurry vision, VA worsened with increasing symptom severity (P<0.0001). Presenting VA showed a significant positive correlation with cumulative symptom severity and the individual symptoms of pain and blurry vision. Patient-reported symptoms at MK presentation may indicate disease severity.

Photodynamic Therapy for the Management of Lipid Keratopathy Secondary to Herpetic Keratitis

2025-06-18

Margarita Zamorano , Carlos Solera de Andres , Natalia Pastora-Salvador +4 more | Ocular Immunology and Inflammation

To report the quantitative effectiveness of photodynamic therapy (PDT) with verteporfin in reducing corneal neovascularization (CNV) and lipid keratopathy (LK) in patients with herpetic interstitial keratitis. We retrospectively evaluated patients … To report the quantitative effectiveness of photodynamic therapy (PDT) with verteporfin in reducing corneal neovascularization (CNV) and lipid keratopathy (LK) in patients with herpetic interstitial keratitis. We retrospectively evaluated patients with secondary LK due to herpetic keratitis who underwent PDT with Verteporfin. We analyzed before and after PDT, visual acuity (VA) and the percentage of CNV, LK, and total pathological corneal areas. The number of stromal neo-vessels and its activity, and the severity of the corneal opacity were also analyzed. We studied nine consecutive patients. The CNV area, LK extent, pathological area, vessel count, vessel activity and corneal opacity all exhibited a statistically significant decrease (p < 0.05) in all patients following PDT. A second PDT was required in 3 patients. Complete vascular occlusion was observed in 5 eyes (55.5%), and partial occlusion in 3 eyes (33.5%). The mean post-treatment VA was 0.76 ± 0.32. VA improved by more than 1 line in 5 eyes (55.5%), with more than 2 line-improvement observed in 4 eyes (44.4%). It remain unchanged in 3 eyes (33.3%), while one patient (11%) worsened. No adverse effects were detected after a mean of 14.9 ± 3.9 years follow-up. There was no relapse of herpetic keratitis after discharging 88,8% patients (follow-up after discharged 8.1 ± 4.6 years). PDT with verteporfin is a safe and effective treatment of herpetic CNV and LK, with long lasting efficacy. Additionally, after the treatment, our cases had a lower incidence of herpetic recurrences than expected.

Nanoformulations of Antifungal Agents for the Management of Ocular Fungal Infections

2025-06-18

Eman Mohamed , Amna M. A. Makky , Islam A. Khalil +1 more | BioNanoScience

Targeting fungal keratitis: In vivo efficacy of corneal-targeting and non-targeting peptides againstFusarium dimerum

2025-06-17

Aditi Arora , Prasanjeet Kaur , Shikha Yadav +4 more | European Journal of Pharmaceutics and Biopharmaceutics

Efficacy and safety of ciprofloxacin, eye ointment and eye drops, 0.3 %, in modern therapy of infectious and inflammatory eye diseases. A review

2025-06-14

А. V. Trubilin , Е. Г. Полунина , Serebriannikova E.A. +2 more | Russian Ophthalmological Journal

Bacterial conjunctivitis is the main reason for patients to visit ophthalmologists, and the incidence is high among both children and adults. In the current version of the Clinical Guidelines for … Bacterial conjunctivitis is the main reason for patients to visit ophthalmologists, and the incidence is high among both children and adults. In the current version of the Clinical Guidelines for the section “Conjunctivitis”, approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation, antibacterial and antiseptic agents are recommended as etiotropic therapy for the treatment of infectious conjunctivitis (bacterial, chlamydial) or in case of suspicion/prevention of secondary bacterial infection in conjunctivitis of other etiologies with antibacterial purposes. Antibacterial agents in the dosage form of eye drops are represented by the following International Nonproprietary Names (INN): ofloxacin, ciprofloxacin, levofloxacin, moxifloxacin, netilmicin, tobramycin, chloramphenicol, in the dosage form of eye ointments: INN tetracycline, erythromycin, tetracycline + chloramphenicol. Of the antiseptic agents, eye drops are presented with the INN picloxidine and benzyldimethyl-myristoylamino-propylammonium. Thе review presents the comparative efficacy and safety of ciprofloxacin eye drops and ointment, as well as on the assessment of their clinical significance in the treatment of bacterial eye infections.

Staphylococcal exotoxins in ocular infection with focus on enterotoxins

2025-06-14

Jiawei Shen , Muhammad Yasir , Mark Willcox | Microbiological Research

Staphylococcus aureus (S. aureus) is one of principal etiological agents of bacterial keratitis, a blinding corneal infection. Traditional treatment strategies rely heavily on antibiotics. However, the overuse and injudicious use … Staphylococcus aureus (S. aureus) is one of principal etiological agents of bacterial keratitis, a blinding corneal infection. Traditional treatment strategies rely heavily on antibiotics. However, the overuse and injudicious use of these agents have significantly contributed to the emergence of multidrug-resistant bacterial strains. Therefore, understanding the role of virulence factors in the disease is important for the design of new therapeutics. This review aims to explore and summarize current research on the role of Staphylococcal toxins, especially enterotoxins (SEs), in ocular infections. The relationship between SEs and ocular infections is reviewed, as are their genomic location and regulatory mechanisms. Current research suggests that SE genes are detected in ocular isolates, with a higher frequency of specific SE genes observed in ocular isolates compared to non-ocular isolates. Additionally, several SE genes have been confirmed to confer cytotoxicity and invasion ability to S. aureus in animal keratitis models. Despite the progress in this area, significant knowledge gaps remain, particularly regarding the specific functions of SEs and the host response pathways. Addressing these questions may contribute to the development of effective preventive and therapeutic measures for eye damage caused by SEs.

Assessment of the Microbial Contamination Rate of Multi-puncture Vials of Bevacizumab and the Risk of Endophthalmitis

2025-06-12

Maytham Hashim Neamah , Hasan Abdulameer Al-Mu’mar | Deleted Journal

Atypical Endophthalmitis Following Artificial Corneal Endothelial Implantation

2025-06-12

Beatrice Cesaro , Mariantonia Ferrara , Francesco Morescalchi +4 more | Cornea

Purpose: EndoArt is an artificial endothelial layer device for the management of chronic corneal edema in cases with multiple corneal failed transplants, aiming to restore corneal deturgescence and optical clarity. … Purpose: EndoArt is an artificial endothelial layer device for the management of chronic corneal edema in cases with multiple corneal failed transplants, aiming to restore corneal deturgescence and optical clarity. However, postoperative complications, such as endophthalmitis, remain a significant risk. We report the first case of EndoArt-associated endophthalmitis, although a direct causual link remains uncertain. Case description: A 75-year-old woman presented with increasing floaters in the left eye 7 months after EndoArt implantation for corneal endothelial dysfunction following multiple graft failures. At presentation, the best-corrected visual acuity (BCVA) was counting fingers, without ocular pain. Slitlamp examination showed noninjected conjunctiva and well-positioned corneal implant with mild corneal edema. B-scan ultrasonography revealed mild vitreous haze, flat retina. Six weeks before, a corneal transfixing single suture was removed. Right eye was unremarkable. The following day, BCVA in the left eye worsened with the appearance of stromal infiltrate, anterior chamber fibrin, and hypopyon, increased vitreous opacification and vitreous strands, leading to diagnosis of endophthalmitis. The patient underwent prompt vitrectomy, revealing purulent vitreous infiltration and hemorrhagic chorioretinitis. The EndoArt was not removed, as not directly involved in the infection. Staphylococcus epidermidis was identified in the aqueous and vitreous humors. Postoperative local and systemic antibiotics led to a gradual resolution of inflammation. At 2-month follow-up, the BCVA improved to 20/400. Discussion: This case describes the atypical clinical appearance and the rapid progression of endophthalmitis in a patient with EndoArt. Prompt vitrectomy and a conservative approach, with EndoArt retention, led to infection resolution and preserved corneal clarity. Conclusions: Vigilance, early diagnosis, and a tailored surgical approach are crucial to improving outcomes after artificial corneal endothelial implantation. Here the artifcial corneal endothelium implantation may have helped preserve cornea clarity during endophthalmitis, enably timely vitrectomy and contribuiting to a favorable outcome.

Brote de Endoftalmitis Postquirúrgica Secundaria a Colirio Contaminado por “Grupo Burkholderia Cepacia”. Reporte de Casos

2025-06-11

María J. Rivas F. , Juan I. Verdaguer Díaz , Patricio S. Anuch J. +3 more | Highlights of Vitreoretina

Brote de Endoftalmitis Postquirúrgica Secundaria a Colirio Contaminado por “Grupo Burkholderia Cepacia”. Reporte de Casos

2025-06-11

María J. Rivas F. , Juan I. Verdaguer Díaz , Patricio S. Anuch J. +3 more | Highlights of Vitreoretina

Resistance trend in bacteria isolated from corneal ulcers: A retrospective analysis from Pakistan

2025-06-05

Naila Obaid , Ayesha Saeed , Sidra Abbas +2 more | PLoS ONE

Objective The purpose of this study is to isolate and characterize bacteria from corneal ulcers and screen them for multiple antibiotic resistance, contributing to understanding patterns of resistance and identifying … Objective The purpose of this study is to isolate and characterize bacteria from corneal ulcers and screen them for multiple antibiotic resistance, contributing to understanding patterns of resistance and identifying effective treatment strategies. Design A retrospective study was conducted between January 2024 to August 2024 Subjects, participants and/or controls The study involved the isolation of pathogenic bacterial strains from 15 corneal ulcer samples. Methods, intervention, or testing We isolated and characterized bacterial strains from corneal ulcer samples, which were routinely collected at an ophthalmology clinic for suspected infectious corneal ulcers and examined their resistance to twenty-six routinely prescribed antibiotics. The bacterial species included methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and E. coli among others. Antibiotic resistance patterns were assessed, with a focus on commonly used antibiotics such as ciprofloxacin, gentamycin, and vancomycin. Main outcome measures The study measured the healing rates of corneal ulcer patients, antibiotic resistance levels across bacterial strains, and specific treatment responses to various antibiotics. Results Thirteen out of fifteen corneal ulcer patients healed completely, while two patients developed full corneal opacity due to infection with P. aeruginosa . Significant differences in resistance were observed among the bacterial strains. MRSA exhibited the highest resistance levels, particularly to multiple antibiotics. Ciprofloxacin and gentamycin were less effective against the isolated strains, while vancomycin showed reduced resistance, against Gram-positive bacteria. Both ciprofloxacin and co-trimoxazole exhibited strong connections with multiple bacterial strains, indicating high resistance. Conclusion This study underscores the need for ongoing surveillance of antibiotic resistance patterns to guide treatment approaches and slow the spread of resistant bacteria. It also highlights the importance of developing new antibiotics and alternative therapies, with an emphasis on understanding the molecular mechanisms behind resistance to combat the global health posed by antibiotic-resistant infections.

Clinical retrospective analysis of 218 cases of infectious endophthalmitis

2025-06-02

Chunhui Li , Zheng Yan , Guohong Zhou +2 more | BMC Ophthalmology

Endophthalmitis is a serious medical condition that needs immediate antibiotic therapy. There are few studies analyzing the pathogenic bacteria of endophthalmitis in China recently. This study was conducted to analyze … Endophthalmitis is a serious medical condition that needs immediate antibiotic therapy. There are few studies analyzing the pathogenic bacteria of endophthalmitis in China recently. This study was conducted to analyze the pathogenic factors, pathogenic bacteria and prognosis of infectious endophthalmitis. A cross-sectional study was conducted from January 2016 to December 2020 in Shanxi Eye Hospital. Statistical analysis by using Logistic regression analysis were performed to evaluate of independent risk factor for prognostic factors for poor visual acuity. Positive case of specimen culture was detected in 96 cases, accounting for 44.04%. Staphylococcus epidermidis, the most common bacteria, accounted for 32.98% (31/94), mainly in traumatic endophthalmitis and postoperative endophthalmitis, and was extremely sensitive to vancomycin (96.77%). The Gram-positive bacteria were highly sensitive to vancomycin (87.01%) and relatively sensitive to levofloxacin (68.83%). Gram-negative bacteria were highly sensitive to levofloxacin (88.24%). 12.39% of patients with visual acuity > 0.02 at admission and 27.98% at discharge, the difference was statistically significant (χ2 = 17.449, P < 0.001). Logistic regression analysis of traumatic endophthalmitis group showed that intraocular foreign body was an independent risk factor for poor visual acuity after post-operation (OR = 2.215. P = 0.016). As society progresses and hygiene concepts increase in China, the bacteria that cause infection are changing, and factors that influence prognosis may also be changing. Clarifying the different causative factors and etiological characteristics of infectious endophthalmitis are important to provide appropriate clinical treatment.

Eye Health in Post-Conflict and Climate-Vulnerable Settings: Iraq as a Case Study for Equitable, Integrated Primary Eye Care

2025-06-01

Fatma Shakarchi | Deleted Journal

Poly-(L-homoarginine) for the non-invasive treatment of endophthalmitis

2025-06-01

Tingting Hua , Tianzi Zhang , Yi Tang +5 more | Materials Today Bio

Moxifloxacin-Resistant and Moxifloxacin-Susceptible Staphylococcus aureus Keratitis: Outcomes from A 10-year Retrospective Study

2025-06-01

Raven Diacou , Rohan Bir Singh , Eric G. Romanowski +4 more | The Ocular Surface

Antimykotikum und Dexpanthenol: im Duo gegen Kopfhautschuppen

2025-06-01

Redaktion Facharztmagazine | ästhetische dermatologie & kosmetologie

Delayed-Onset Endophthalmitis After Intravitreal Dexamethasone Implantation

2025-05-31

April D Enger , James Dossett , Christine Clavell +4 more | Journal of VitreoRetinal Diseases

Purpose: To present a series of cases of acute endophthalmitis after intravitreal (IVT) sustained-release dexamethasone implantation (Ozurdex) with an unusually delayed onset. Methods: A retrospective review was performed of 3 … Purpose: To present a series of cases of acute endophthalmitis after intravitreal (IVT) sustained-release dexamethasone implantation (Ozurdex) with an unusually delayed onset. Methods: A retrospective review was performed of 3 patients presenting to West Virginia University Eye Institute and diagnosed with acute endophthalmitis 16 days, 18 days, and 35 days after dexamethasone implantation. The presenting visual acuities (VAs) were counting fingers at face to hand motions (HM) only. Each patient had an aqueous or vitreous tap with injection of IVT antibiotics followed by pars plana vitrectomy. The dexamethasone implants were not removed. Results: All cultures returned positive, including Staphylococcus aureus, Staphylococcus epidermidis , and Granulicatella adiacens . The 3 patients’ final VAs were 20/60, 20/100, and HM only, respectively. Conclusions: Delayed-onset acute endophthalmitis after dexamethasone implantation represents a clinical challenge, potentially occurring up to weeks after the injection. Sustained suspicion for endophthalmitis is warranted given that cases may present beyond what is typical for postinjection endophthalmitis.

Case Report - Curvularia lunata Fungal Keratitis Following Trauma

2025-05-30

Devika Krishnadas , Smitha Mohan , Sneha John +5 more | Journal of Evolution of Medical and Dental Sciences

A 51-year-old, non-diabetic male with a history of trauma to his right eye with a coconut leaf 10 days ago presented with pain, watering, redness, and intolerance to light for … A 51-year-old, non-diabetic male with a history of trauma to his right eye with a coconut leaf 10 days ago presented with pain, watering, redness, and intolerance to light for the past 5 days. Examination Findings: Visual acuity, hand movements (HM+) in the right eye. Corneal infiltrate of size 4x4 mm observed in the inferotemporal quadrant. Pigmentation was noted at the site of the infiltrate; the surrounding cornea demonstrated edema. The anterior chamber showed 2+ flare and 2+ cells. No hypopyon. The pupil was sluggishly reacting to light. The patient was using Moxifloxacin eye drops 6 times, prescribed from the peripheral center.

Endophthalmitis After Retinal Surgery: A 8-Year Medicare Analysis

2025-05-30

Sidra Zafar , Chen Dun , Cindy X. Cai +3 more | Retina

Purpose: Determine endophthalmitis incidence among Medicare beneficiaries undergoing retina surgery and assess patient and surgeon-related risk factors for developing postoperative endophthalmitis. Methods: Retrospective, cross-sectional of Medicare beneficiaries who underwent retina … Purpose: Determine endophthalmitis incidence among Medicare beneficiaries undergoing retina surgery and assess patient and surgeon-related risk factors for developing postoperative endophthalmitis. Methods: Retrospective, cross-sectional of Medicare beneficiaries who underwent retina surgery between 2016 and 2022. Individuals who underwent surgery during the 2-year look-back period, those with an endophthalmitis diagnosis 12 months prior to index procedure, those with any intraocular procedure or intravitreal injection 3 months prior to PPV and missing laterality information were excluded. A multivariable logistic regression model was used to evaluate factors associated with occurrence of postoperative endophthalmitis 42 days following retina surgery. Results: 369,471 PPVs were performed among Medicare beneficiaries between 2016-2022. Endophthalmitis occurred in 1,019 cases for an overall incidence of 0.28%. Endophthalmitis rates following standard retinal detachment (RD) repair, complex RD repair, macular surgery and other PPV cases were: 0.09%, 0.18%, 0.20% and 0.61%, respectively. Excluding other PPV cases, endophthalmitis occurred in 480 cases for an overall incidence of 0.17%. On multivariable analysis, patient aged ≥85 years, Charlson comorbidity index (CCI) ≥3, macular surgery and complex RD cases had an increased endophthalmitis risk. Concurrent cataract surgery was associated with decreased postoperative endophthalmitis risk. We found no association between surgeon factors and endophthalmitis risk. Conclusion: The overall endophthalmitis rate following retina surgery was 0.28%. Patient age, CCI and PPV indication (complex RD and macular surgery vs. standard RD) were associated with increased endophthalmitis risk. No associations were identified between any surgeon characteristics and postoperative endophthalmitis risk.

Endogenous Endophthalmitis Caused by Group B Streptococcus Following Urinary Tract Infection

2025-05-30

Yohei Yamahista , Koji Kitazawa , Hiroshi Tanaka +1 more | Ramathibodi Medical Journal

Background: Endogenous endophthalmitis is a condition where infection spreads hematogenously to the eye. Group B Streptococcus (GBS) is a rare causative microorganism of endogenous endophthalmitis. A case of endogenous endophthalmitis … Background: Endogenous endophthalmitis is a condition where infection spreads hematogenously to the eye. Group B Streptococcus (GBS) is a rare causative microorganism of endogenous endophthalmitis. A case of endogenous endophthalmitis caused by GBS secondary to urinary tract infection (UTI) is reported. Case Presentation: An 83-year-old male presented with decreased visual acuity, ocular pain, and headache in his right eye three days after experiencing lower back pain. Initial examination revealed light perception in visual acuity, intraocular pressure of 30 mmHg, hypopyon in the anterior chamber, and severe vitreous opacity in the right eye. There was no history of trauma or ophthalmic surgery. The patient had been self-catheterizing due to chronic ureteral obstruction. Aqueous and vitreous samples were collected and blood tests and a urine culture were performed for microbiological examination. On the same day as the initial visit, vitrectomy was performed. Intraoperatively, extensive retinal necrosis and total retinal detachment were observed. Gram-positive cocci were detected in the aqueous humor, and GBS was isolated from both vitreous and urine cultures. Blood tests showed elevated levels of inflammatory markers, with a C-reactive protein of 5.4 mg/dL, and undiagnosed diabetes mellitus was found. Intensive antibiotic therapy resolved the inflammation, although, visual acuity did not improve. Conclusions: Endogenous endophthalmitis was caused by GBS occurred secondary to UTI. Systemic assessment is crucial for diagnosing endogenous endophthalmitis, and early and appropriate treatment is essential.

Fusarium spp. and Aspergillus flavus infection induces pathogen-specific and pathogen-independent host immune response in patients with fungal keratitis

2025-05-30

S. Dinesh , Prajna Lalitha , Prajna Namperumalsamy Venkatesh +2 more | Frontiers in Cellular and Infection Microbiology

Fungal keratitis, caused primarily by Fusarium spp. and Aspergillus flavus, is a significant cause of corneal blindness, particularly in tropical regions. Current antifungal agents like natamycin and voriconazole have limited … Fungal keratitis, caused primarily by Fusarium spp. and Aspergillus flavus, is a significant cause of corneal blindness, particularly in tropical regions. Current antifungal agents like natamycin and voriconazole have limited efficacy, underscoring the need for a deeper understanding of host immune responses. This study employed high-throughput RNA sequencing to investigate differential gene expression in human corneal tissues from patients with Fusarium spp. and A. flavus keratitis and compared them to control cadaver corneal samples. RNA was extracted from infected and control samples, followed by sequencing and differential expression analysis. Further confirmation of differential expression of selected genes were carried out by Real-Time quantitative PCR (RT-qPCR). Data analysis identified common and Fusarium spp. and A. flavus-specific differentially expressed genes (DEGs). Pathway enrichment analysis using common genes identified pathways enriched in both infections, such as interleukin 17 (IL-17), tumor necrosis factor (TNF), and chemokine signalling. Expression of hub genes, including S100 calcium binding protein A7 (S100A7), S100 calcium binding protein A8 (S100A8), S100 calcium binding protein A9 (S100A9) and C-X-C motif chemokine ligand 8 (CXCL8), identified in interleukin 17 (IL-17) signalling, was confirmed by RT-qPCR analysis. Fusarium spp.-specific DEGs, including complement C3 (C3), interleukin 6 (IL-6), interleukin 19 (IL-19) and leucine rich alpha-2-glycoprotein 1 (LRG1), are enriched in pathways such as positive regulation of immune responses, acute inflammatory responses, leukocyte cell-cell adhesion, and the regulation of cell-cell adhesion. A. flavus-specific DEGs, such as triggering receptor expressed on myeloid cells 2 (TREM2) and apolipoprotein E (APOE), are predominantly enriched in adaptive immune response, negative regulation of immune system process, negative regulation of immune response, cell migration and motility pathways. RT-qPCR confirmed the key pathogen-specific DEGs, highlighting their potential as biomarkers for pathogen-specific immune responses. These findings provide insights into the distinct immune pathways triggered by Fusarium spp. and A. flavus, offering new therapeutic targets for improving fungal keratitis treatment.

Lacrifill Injection into Punctum for Dry Eyes

2025-05-30

Alexander Martin | Journal of Medical Insight

Impact of Ultraviolet C Light for the Management of Infectious Keratitis

2025-05-29

Bhumi Chandarana | International Journal of Science and Research (IJSR)

Rose Bengal-Assisted Photodynamic Antimicrobial Therapy for Keratitis

2025-05-29

Aravind Roy , Uday B. Kompella | Journal of Ocular Pharmacology and Therapeutics

Rose bengal-assisted green light photodynamic antimicrobial therapy (RB-PDAT) is a new approach being evaluated for treating infectious keratitis. Preliminary clinical evidence suggests the broad-spectrum antimicrobial activity of RB-PDAT. The therapy … Rose bengal-assisted green light photodynamic antimicrobial therapy (RB-PDAT) is a new approach being evaluated for treating infectious keratitis. Preliminary clinical evidence suggests the broad-spectrum antimicrobial activity of RB-PDAT. The therapy potentially exerts its activity by generating reactive oxygen species that inhibit microbial growth. Large clinical trials are underway to further establish a role for RB-PDAT in clinical medicine, especially recalcitrant fungal keratitis that is less responsive to conventional photodynamic therapy with riboflavin. A potential limitation of the therapy includes poor penetration of rose bengal dye into the cornea. This limitation is being addressed by several approaches, including lipophilic prodrugs, nanoparticles, and physical approaches for enhanced delivery, including iontophoresis and ultrasound.

Kératites fongiques

2025-05-28

Tristan Bourcier , Nacim Bouheraoua , Emilia Koestel +3 more | Encyclopédie médico-chirurgicale. Ophtalmologie

Infections oculaires complexes : impact de la biologie moléculaire dans leurs diagnostics, premiers résultats de l'étude prospective ICODIA

2025-05-28

Etienne Canouï , D. Dedieu , Nicolas Veyrenche +7 more | Médecine et Maladies Infectieuses Formation

Exploring the use of millipore filters to prevent post-injection endophthalmitis: A proof-of-concept in-vitro study

2025-05-28

Devesh Kumawat , Nishat Hussain Ahmed , Pradeep Venkatesh | Indian Journal of Ophthalmology

Purpose: Millipore filters are routinely used in vitreous surgeries for loading intraocular gas. This study purports to establish feasibility of in-line Millipore filter as a filtration barrier and rationalize their … Purpose: Millipore filters are routinely used in vitreous surgeries for loading intraocular gas. This study purports to establish feasibility of in-line Millipore filter as a filtration barrier and rationalize their use during intravitreal antivascular endothelial growth factor (antiVEGF) injection to reduce the risk of endophthalmitis. Design: Proof-of-concept in-vitro study. Methods: At the Ocular Microbiology section of a tertiary care eye center in North India, bacterial broths of various microorganisms ( Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa , Escherichia coli , Corynebacterium species, Streptococcus species , and a mixture of Staphylococcus aureus and Pseudomonas aeruginosa ) of different concentrations (McFarland 0.5 and McFarland 1) were inoculated onto blood, chocolate, and/or MacConkey agar with (Group 1) or without (Group 2) in-line sterile Millipore filter of 0.22-micron pore size (Set GS Mini filter, ARCEOLE, France). The filter was attached to a one-ml syringe with bacterial broth solution at one end and a 30-gauge needle at the other. Culture plates were incubated and observed daily for colony formation with photographic documentation for up to 5 days. Results: Bacterial broths could be injected across the filter with little resistance. None of the culture media showed growth when filters were used, compared with growth in all culture plates when inoculation of broth was done without the filter. The fluid loss in the filter (dead space volume) ranged from 0.12 to 0.17 ml. Conclusions: Millipore filter act as an effective filtration barrier and could enhance the safety of intravitreal antiVEGF injection by reducing the risk of endophthalmitis. Further microbiological and toxicology studies are essential before their integration into clinical practice.

Preferred practice patterns of endophthalmitis management and prevention: A survey among the members of Vitreoretinal Society of India – Study by the VRSI study group

2025-05-28

Deepanshu Agrawal , Anil Gangwe , Koushik Tripathy +5 more | Indian Journal of Ophthalmology

Purpose: To assess the preferred practice patterns of endophthalmitis management and prophylaxis among the members of Vitreo Retina Society of India (VRSI). Methods: An online questionnaire was circulated among the … Purpose: To assess the preferred practice patterns of endophthalmitis management and prophylaxis among the members of Vitreo Retina Society of India (VRSI). Methods: An online questionnaire was circulated among the VRSI members, enquiring details on clinical presentation of endophthalmitis, initial management protocols of acute and chronic endophthalmitis, usage of antibiotics, steroids, and silicone oil (SO) in endophthalmitis, and prophylaxis followed for prevention of endophthalmitis. Results: A total of 313 (20.2%) responses were obtained. The mean age of the respondents was 43.2 ± 0.5 years, and there was a male predominance ( n = 231, 73.8%). Post-cataract surgery endophthalmitis (PCSE) was the most common ( n = 273, 87.2%) reported variant, followed by post-traumatic endophthalmitis (PTE) (n=37,11.8%). Over 50% ( n = 181, 57.8%) of respondents followed Endophthalmitis Vitrectomy Study (EVS) guidelines for acute PCSE and about 60% ( n = 194, 61.9%) would not extrapolate EVS guidelines to other forms of endophthalmitis. A total of 159 (50.8%) respondents preferred using a vitreous/anterior chamber tap with needle, and vitreous biopsy with vitrector was preferred by 117 (37.3%) respondents. Vancomycin–ceftazidime remains the preferred combination of empirical intravitreal antibiotics (IVAs), and 169 (54%) preferred injecting intravitreal steroids along with IVA. About one-fourth ( n = 90, 28.8%) of the respondents preferred pars plana vitrectomy as the initial management for PCSE. SO was used mostly in cases with PTE ( n = 176, 56.2%). Prophylactic measures to prevent endophthalmitis varied among the respondents. Conclusion: Majority of the Indian vitreoretinal surgeons felt the need for amendment in the EVS guidelines, but would prefer to follow the EVS guidelines for managing endophthalmitis at present.

Prospective comparison of conventional microbiological diagnostic methods and direct polymerase chain reaction genotyping in diagnosis of suspected bacterial keratitis in Ilrorin

2025-05-27

olawale Job oladejo , Janet Mosunmola Oladejo , Promise Adedayo Oladejo +4 more | Microbes and Infectious Diseases /Microbes and Infectious Diseases

Alterations in ocular fungal microbiota in patients with fungal keratitis: a comparative study from coastal regions of Eastern China

2025-05-27

Xudong Zhao , Zhichao Ren , Wenfeng Li +3 more

The understanding of the ocular microbiota, particularly in fungal keratitis (FK), is evolving with advancements in high-throughput sequencing technologies. Traditional culture-based methods may not fully capture the microbial diversity present … The understanding of the ocular microbiota, particularly in fungal keratitis (FK), is evolving with advancements in high-throughput sequencing technologies. Traditional culture-based methods may not fully capture the microbial diversity present in keratitis, highlighting the need for more comprehensive approaches to explore microbial dysbiosis in corneal infections. This study aimed to reveal the dysbacteriosis of the ocular fungal microbiome associated with FK. We analysed 105 samples, including conjunctival swabs from healthy eyes (HE) and conjunctival swabs (SW), as well as corneal scrapings (SC), from FK eyes. Positive results were observed in 58 samples, and detailed taxonomic categorization was carried out across multiple levels-phylum, class, order, family, and genus-using high-throughput ITS sequencing. Alpha and beta diversity indices were computed, and interaction networks at the genus level were predicted to elucidate changes in microbial communities. The analyses also included assessments of functional groups within the fungal microbiome. Among the samples, the HE, SW, and SC groups presented differences in positivity rates and diversity indices. Compared with HE eyes, infected eyes (SW and SC) presented significantly greater Good's coverage estimator and lower Chao1, Shannon, and Simpson diversity indices, indicating reduced species richness and evenness. At multiple taxonomic levels, various taxa were significantly downregulated in the FK eyes. Functional analyses revealed differences, notably, an increase in the number of litter saprotrophs in FK eyes. Ascomycota and Basidiomycota were identified as core phyla in the ocular microbiota interaction network. Fungal keratitis significantly alters the ocular surface microbiome, which is characterized by decreased microbial richness and evenness. High-throughput sequencing revealed a complex interaction network with significant variability between healthy and infected eyes. Additionally, these findings suggest potential benefits from early and aggressive debridement in managing FK due to its impact on functional microbial groups.