Clostridium perfringens Endophthalmitis After Penetrating Keratoplasty With Contaminated Corneal Allografts

Hou, Joshua H.; Tannan, Anjali; Rubenstein, Jonathan B.; Lopez, Osvaldo I.; McCoy, Kristen; Epstein, Randy J.; Grostern, Richard J.; Sugar, Joel

doi:10.1097/ico.0000000000000303

Cited by 6 publications

(2 citation statements)

References 11 publications

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“…In that study, the authors noted that rapid painful visual loss developed within 12 hours; however all subjects had penetrating injuries. Since then, similar findings have been reported in isolated case reports after trauma [5], intravitreal injection [4], penetrating keratoplasty [3], cataract surgery [6], and among IV drug abusers [2]. Although the lateral canthotomy and cantholysis is a potential exogenous source of infection, this is much less likely in our patient, given the endogenous infection resulted in vision loss occurred 6 hours prior to the lateral canthotomy and cantholysis was performed.…”

Section: Discussionsupporting

confidence: 83%

EndogenousClostridium perfringensPanophthalmitis with Potential Entry Port from Diverticulitis Exacerbated by Proliferative Diabetic Retinopathy

Neerukonda

Cheng

Dhanireddy

et al. 2019

Case Reports in Ophthalmological Medicine

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Purpose. To report a rapid endogenous fulminating panophthalmitis from Clostridium perfringens in a patient with diverticulitis and proliferative diabetic retinopathy. Methods. A 61-year-old female with poorly controlled diabetes mellitus, active proliferative diabetic retinopathy, and recent diverticulitis presented with conjunctival injection, ocular discharge, and sudden onset of painful vision loss of the left eye. Patient denied history of ocular trauma, intraocular surgery, or intravenous drug abuse. Examination revealed an erythematous, proptotic eye with restricted extraocular movements, mucopurulent discharge, diffuse corneal edema, and vitreous haze and cell. Orbital computed tomography (CT) confirmed no retained intraocular foreign body. Results. Despite 48 hours of treatment with systemic broad spectrum antimicrobial therapy (vancomycin, meropenem, and amphotericin B), patient underwent enucleation due to declined condition and progressive infection. Patient’s culture revealed gram-positive bacillus microbes (Clostridium perfringens). Patient’s subsequent CT abdomen showed resolved diverticulitis after antimicrobial therapy. Conclusion. Although rare, Clostridium perfringens infection can be a cause of rapid loss of vision from fulminate endogenous panophthalmitis. Urgent extensive systemic work-up to identify potential port of entry from visceral pathology and rapid removal of source of infection are pivotal to avoid high rate of mortality.

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Section: Discussionsupporting

confidence: 83%

EndogenousClostridium perfringensPanophthalmitis with Potential Entry Port from Diverticulitis Exacerbated by Proliferative Diabetic Retinopathy

Neerukonda

Cheng

Dhanireddy

et al. 2019

Case Reports in Ophthalmological Medicine

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“…That could have been an added factor for the final poor outcome. Hou et al 15 described a series of 3 cases that developed endophthalmitis after penetrating keratoplasty. The microbial culture in these cases grew C. perfringens.…”

Section: Discussionmentioning

confidence: 99%

Clostridial Endophthalmitis: Clinical Presentations, Management Outcomes, and Review of Literature

Dave

Joseph

Pathengay

et al. 2022

RETINAL Cases &Amp; Brief Reports

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Purpose: To describe the clinical presentations, diagnosis and management outcomes of clostridial endophthalmitis, and a review of the previous literature.Design: Retrospective, interventional case series from January 2005 to March 2018 and a literature review.Methods: The study included seven eyes of seven patients with culture-proven Clostridium sp. endophthalmitis. Identification of Clostridium sp. was confirmed by the VITEK 2 system using the ANC card. When VITEK failed to identify the organism, MALDI-TOF was used. Data regarding demography, clinical presentations, interventions received, and final visual and anatomical outcomes were noted.Results:The mean age of the patients was 28.28 ± 22.35 years (median 21 years). By the etiology of infection, 5 (75%) eyes were post-open-globe injury, 1 (12.5%) was posttrabeculectomy, and 1 (12.5%) was postintravitreal injection. The mean follow-up was 9.71 ± 12.03 months, median 6 months. Two samples were positive for Clostridium perfringens, one each for C. subterminale, C. difficile, and C. tertium, and two were unidentified clostridial species. Favorable anatomical outcome was seen in 3/7 eyes (42.85%). Favorable functional outcome was seen in 2/7 eyes (28.57%). These were comparable with the outcomes of the pooled pre-existing literature. There was a trend toward better functional and anatomical outcomes and lesser evisceration/enucleation rates with vitrectomy instead of a vitreous tap, although not statistically significant. All cases showed susceptibility to empirically used intravitreal antibiotic vancomycin.Conclusion: Commonest setting of clostridial endophthalmitis is post-open-globe injury. Despite treatment with appropriate antibiotics, the visual and anatomical outcome is unsatisfactory because of high organism virulence. Early vitrectomy may allow for globe salvage and potential vision.

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Obtención de tejido corneal para queratoplastia

Martínez-Cantullera

Pinuaga

2016

Archivos de la Sociedad Española de Oftalmología

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Clostridium perfringens Endophthalmitis After Penetrating Keratoplasty With Contaminated Corneal Allografts

Cited by 6 publications

References 11 publications

EndogenousClostridium perfringensPanophthalmitis with Potential Entry Port from Diverticulitis Exacerbated by Proliferative Diabetic Retinopathy

EndogenousClostridium perfringensPanophthalmitis with Potential Entry Port from Diverticulitis Exacerbated by Proliferative Diabetic Retinopathy

Clostridial Endophthalmitis: Clinical Presentations, Management Outcomes, and Review of Literature

Obtención de tejido corneal para queratoplastia

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