No abstract

Endophthalmitis is a severe form of intraocular inflammation which is caused by bacteria or fungi. It is a medical emergency with an imminent threat to vision and permanent structural and functional complications. The condition affects the anterior and posterior segments of the eye. It may be either exogenous – following penetrating trauma or intraocular surgery, or endogenous, in which the pathogens enter the eye hematogenous. The diagnosis is based on the clinical picture and on specialized testing – aqueous and/or vitreous cultures, with or without additional PCR for panbacterial and panfungal primers. If endogenous endophthalmitis is suspected, blood and urine cultures may also be performed. The most common bacterial pathogens in acute postoperative endophthalmitis belong to the Staphylococcus and Streptococcus groups. Endogenous endophthalmitis is most frequently fungal and caused by Candida. The incidence of post-traumatic endophthalmitis ranges from 0.9 to 17% and of postoperative - from 0.016 to 5.7%, depending on the surgical procedure and the geographic location. Endogenous endophthalmitis has been observed in up to 8% of all cases. Therapy is urgent and may include intravitreal medications or pars plana vitrectomy (PPV), according to the Endophthalmitis Vitrectomy Study criteria. The combination of COVID-19-associated severe pneumonia, systemic corticosteroid therapy, and diabetes appear to be risk factors for endogenous endophthalmitis. The ethology has mostly been linked to fungal infections, especially Candida, as in the pre-COVID-19 era. There has been a tendency to perform PPV with intravitreal medications as the primary procedure, but the results have been mixed.

Introduction: The human Herpesviridae have been described as a leading cause of infectious uveitis. The most common manifestations are keratouveitis and iridocyclitis. The diagnosis is usually made on clinical grounds. The present therapy is based upon the inhibition of viral replication and the use of anti-inflammatory medications. Methods: A descriptive study was conducted on the records of 206 patients with uveitis from the Clinic of Ophthalmology at University Hospital Alexandrovska, Sofia, Bulgaria. The study period was from January 2012 until August 2019. The diagnosis was based on the clinical exam and, when necessary, on specialized testing – PCR on aqueous humor or vitreous material. We used descriptive statistical methods. Results: Out of 206 patients with intraocular inflammation, 46 (22.3%) were diagnosed with herpetic uveitis. Of them, 35 (76.1%) had anterior uveitis, 7 patients (15.2%) had panuveitis, and 4 patients (8.7%) had posterior uveitis. The mean age was 45.3 years. The leading complications were ocular hypertension, corneal leucoma, retinal detachment, and cataract. Antiviral therapy with acyclovir or valaciclovir, alone or with corticosteroids, was used in all groups. Conclusion: The herpesviruses are important causative agents of infectious uveitis. In our study, non-granulomatous, hypertensive anterior uveitis was the most common clinical entity. There were also a few patients with posterior and panuveitis. VZV was the most common etiologic agent. The panuveitis cohort had the worse prognosis for visual acuity, mostly as a result of retinal detachment. The posterior uveitis presented most frequently as focal retinochoroiditis with a good prognosis.