Clinical presentations and comparative outcomes of primary versus deferred intraocular lens explantation in delayed-onset endophthalmitis

Dave, Vivek Pravin; Pathengay, Avinash; Sharma, Savitri; Govindhari, Vishal; Karolia, Roshni; Pappuru, Rajeev Reddy; Das, Taraprasad

doi:10.4103/ijo.ijo_1494_18

Cited by 8 publications

(4 citation statements)

References 14 publications

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“…In a recent previously published study of ours, we described the comparative outcomes of primary versus deferred IOL explantation in delayed onset low grade endophthalmitis. 14 In that study, we concluded that primary IOL explantation group required significantly fewer numbers of repeat intravitreal interventions compared to the deferred IOL explantation group. Additionally, the complication rates in terms of corneal decompensation or retinal detachment were comparable in the two groups.…”

Section: Discussionmentioning

confidence: 84%

<p>Clinical Presentations and Comparative Outcomes of Delayed-Onset Low-Grade Endophthalmitis Managed with or Without Intraocular Lens Explantation</p>

Dave¹,

Parmeshwarappa²,

Dogra³

et al. 2020

OPTH

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Purpose: To compare the outcomes of delayed-onset low-grade endophthalmitis managed with and without intraocular lens (IOL) explantation. Setting: Tertiary eye-care research institute in southern India. Design: Retrospective comparative case series. Methods: The study included all cases of post-cataract surgery delayed-onset endophthalmitis from January 1990 to January 2019. Time to endophthalmitis, duration of symptoms, presenting visual acuity, time to IOL explantation when performed, resolution after explantation, number of intravitreal injections, and final visual acuity were compared in the IOL nonexplanted and IOL explanted groups. Results: There were 115 eyes-61 eyes in the IOL non-explant and 54 eyes in the IOL explant group. Between the two groups there was no statistically significant difference in age (58.37 ± 14.05 and 56.04 ± 14.96 years, respectively; p=0.35), vision at presentation (>20/400 in 29.5% and 29.6% eyes, respectively; p=0.98), and the duration of follow-up (14.38 ± 16.05, median 8.5 months and 7.06 ± 3.55, median 6 months respectively; p=0.43). There was a statistically significant difference between the IOL non-explant and IOL-explant groups in the time to resolution of inflammation (92.70 ± 36.28 and 45.33±11.2 days, respectively; p <0.0001) and the number of intravitreal injections (4.57 ± 0.75, median 5 and 2.79 ±2.11, median 2 respectively, p=0.005). Persistent/recurrent inflammation at 6 months was recorded in 18.03% and 5.55% in the IOL non-explant and IOL explant eyes, respectively (p=0.04). Favorable functional outcome was seen in 50.81% vs 68.51% in IOL non-explant and explant eyes, respectively (p=0.05). Conclusion: IOL explantation in delayed-onset endophthalmitis helps in earlier resolution of inflammation, need for lesser number of intravitreal injections and a trend towards better functional outcomes.

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Section: Discussionmentioning

confidence: 84%

<p>Clinical Presentations and Comparative Outcomes of Delayed-Onset Low-Grade Endophthalmitis Managed with or Without Intraocular Lens Explantation</p>

Dave¹,

Parmeshwarappa²,

Dogra³

et al. 2020

OPTH

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“…The reported incidence of infectious endophthalmitis following open globe injuries ranges from 3.1% to 11.9% of open globe injuries in the absence of an intraocular foreign body (IOFB) [47][48][49][50][51][52]. The incidence increases from 3.8% to 48.1%, in the presence of an IOFB, with higher infection rates with retained IOFBs contaminated with organic matter from a rural setting [53][54][55][56][57].…”

Section: Post-traumatic Infectious Endophthalmitismentioning

confidence: 99%

Infectious Endophthalmitis: Ongoing Challenges and New Prospectives

Abri¹,

Al-Hinai²,

Al-Fadhil³

2023

Eye Diseases - Recent Advances, New Perspectives and Therapeutic Options

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Endophthalmitis is a rare but potentially sight and organ-threatening ocular emergency characterized by marked intraocular inflammation. It can be categorized into two broad categories of exogenous and endogenous types. Exogenous endophthalmitis is caused by inoculation of the globe by either bacterial or fungal microorganisms from an external environment and most commonly occurs as a complication of intraocular surgeries or procedures and open globe injuries. Blurred vision and pain are the main symptoms, and gram-positive coagulase-negative organisms are the main etiology of exogenous endophthalmitis. Endogenous endophthalmitis is caused by the hematogenous spread of microorganisms from distant sites of the body into the globe. Both categories lead to subsequent intraocular inflammation and potentially severe visual and anatomical devastating consequences. In addition, they have different risk factors and causative microorganisms, and thus, require somehow different diagnostic and treatment approaches. In this review chapter, further review of infectious endophthalmitis in terms of risk factors, causative pathogens, clinical presentations, prognosis, prevention, and the latest therapeutic recommendations are discussed.

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“…[ 37 ] In recalcitrant cases of post cataract surgery fungal endophthalmitis, the intraocular lens explantation along with the lens capsule could benefit. [ 38 ] The visual outcome of fungal endophthalmitis is poorer than bacterial endophthalmitis.…”

Section: Current Knowledgementioning

confidence: 99%

Understanding the science of fungal endophthalmitis - AIOS 2021 Sengamedu Srinivas Badrinath Endowment Lecture

Das

Joseph²,

Jakati

et al. 2022

Indian Journal of Ophthalmology

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Fungal endophthalmitis is a potentially blinding condition. It is more often reported from Asia, including India. The incidence is lower than bacterial endophthalmitis. But it is relatively more challenging to treat than bacterial endophthalmitis. Many eyes may need therapeutic keratoplasty and/or evisceration. The current mainstays of treatment are vitrectomy irrespective of the presenting vision, intravitreal antifungal agents, and systemic therapy; additionally, the patients could require prolonged treatment with repeat vitreous surgeries and intravitreal injections. Difficulty in clinical diagnosis, delay in microbiological culture, and limited options of antifungal drugs make the treatment more difficult and less rewarding. Three common fungi causing endophthalmitis are Aspergillus , Fusarium , and Candida . The former two are molds, often identified in exogenous endophthalmitis, postoperative and traumatic; the latter is yeast and is more often identified in endogenous endophthalmitis. A faster diagnosis with newer molecular microbiological technologies might help institute treatment earlier than it is currently possible. A target trial using big data from different regions of the world might emulate a randomized clinical trial to design a definite treatment strategy. Given fewer antifungal drugs, one must be mindful of antifungal stewardship to prevent resistance to the existing drugs.

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Clinical presentations and comparative outcomes of primary versus deferred intraocular lens explantation in delayed-onset endophthalmitis

Cited by 8 publications

References 14 publications

<p>Clinical Presentations and Comparative Outcomes of Delayed-Onset Low-Grade Endophthalmitis Managed with or Without Intraocular Lens Explantation</p>

<p>Clinical Presentations and Comparative Outcomes of Delayed-Onset Low-Grade Endophthalmitis Managed with or Without Intraocular Lens Explantation</p>

Infectious Endophthalmitis: Ongoing Challenges and New Prospectives

Understanding the science of fungal endophthalmitis - AIOS 2021 Sengamedu Srinivas Badrinath Endowment Lecture

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