Endophthalmitis after Cataract Surgery: Changes in Management Based on Microbiologic Cultures

Patel, Samir N.; Storey, Philip; Levin, Hannah; Pancholy, Maitri; Obeid, Anthony; Wibbelsman, Turner D.; Kuley, Brandon; Ho, Allen C.; Hsu, Jason; Vander, J.F.; Dunn, James P.

doi:10.1016/j.oret.2020.06.028

Cited by 13 publications

(10 citation statements)

References 22 publications

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“…Recent studies have suggested that culture results have limited impact on clinical management. 31 , 37 Furthermore, another limitation is that a positive gram stain was considered culture-positive even if there was no bacterial growth on culture. However, prior studies have suggested that any bacteria detected on gram stain of a sterile site specimen, such as vitreous or aqueous samples, should be considered significant.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Physician Face Mask Use on Endophthalmitis After Intravitreal Anti–Vascular Endothelial Growth Factor Injections

Patel¹,

Hsu²,

Sivalingam

et al. 2021

American Journal of Ophthalmology

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Purpose To evaluate the effect of physician face mask use on rates and outcomes of post-injection endophthalmitis. Design Retrospective, comparative cohort study Methods . Setting Single-center Study Population Eyes receiving intravitreal anti-vascular endothelial growth factor injections from 7/1/2013 to 9/1/2019. Intervention Cases were divided into “face mask group” if face masks were worn by the physician during intravitreal injections or “no talking group” if no face mask was worn but a no talking policy was observed during intravitreal injections. Main Outcome Measures Rate of endophthalmitis, visual acuity, and microbial spectrum. Results Of 483,622 intravitreal injections administered, 168 out of 453,460 (0.0371%) cases of endophthalmitis occurred in the “no talking” group, and 9 out of 30,162 (0.0298%) cases occurred in the face mask group (odds ratio, 0.81; 95%CI, 0.41–1.57; p=0.527). Sixteen cases of oral flora-associated endophthalmitis were found in the “no talking” group (1 in 28,341 injections) compared to none in the face mask group (p=0.302). Mean logMAR visual acuity at presentation in cases that developed culture-positive endophthalmitis was significantly worse in the “no talking” group compared to the face mask group (17.1 lines lost from baseline acuity vs 13.4 lines lost; p=0.031), though no difference was observed at six months following treatment (p=0.479). Conclusion Physician face mask use did not influence the risk of post-injection endophthalmitis compared to a no talking policy. However, no cases of oral flora-associated endophthalmitis occurred in the face mask group. Future studies are warranted to assess the role of face mask use to reduce endophthalmitis risk, particularly due to oral flora.

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Section: Discussionmentioning

confidence: 99%

The Impact of Physician Face Mask Use on Endophthalmitis After Intravitreal Anti–Vascular Endothelial Growth Factor Injections

Patel¹,

Hsu²,

Sivalingam

et al. 2021

American Journal of Ophthalmology

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“…Patel et al found that in cases of postsurgical endophthalmitis, culture-positive cases had poorer final VA and a higher rate of subsequent RD compared with culture-negative cases, but there were no changes in clinical management based on positive culture results, suggesting that vitreous cultures may have a greater value in determining prognosis than in clinical management. 31 In our cohort, the eye that yielded S viridans on subsequent PPV and mechanical vitreous biopsy underwent a second intravitreal injection of antibiotics and had poor final VA. While further study is needed, culture results may be more helpful in such cases where clinical signs indicate that additional treatment may be necessary and visual outcomes may be poor.…”

Section: Discussionmentioning

confidence: 95%

Management Patterns and Outcomes for Intravitreal Injection–Related Endophthalmitis

Soundararajan

Robbins

Feng

et al. 2021

Journal of VitreoRetinal Diseases

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Purpose: This work describes the clinical management and outcomes in cases of presumed infectious endophthalmitis following intravitreal injection at a tertiary academic medical center. Methods: A retrospective review took place of eyes that presented to the Duke Eye Center over a 9-year period and were diagnosed with intravitreal injection–related endophthalmitis. Clinical presentation, management, microbiologic yield, visual outcomes, and complications were abstracted from medical records. Results: Of 23 eyes diagnosed with postinjection endophthalmitis, 52.2% underwent anterior chamber tap (33.3% of which first underwent dry needle vitreous tap), 47.8% underwent needle vitreous tap, 17.4% underwent neither, and none underwent pars plana vitrectomy (PPV) for initial management. Subsequent PPV was performed in 6 eyes (26.1%). Mean visual acuity (VA) improved by 50 Early Treatment Diabetic Retinopathy Study letters at 6 months. Eyes that underwent initial anterior chamber tap had worse presenting VA than those that did not ( P = .01). Eyes undergoing subsequent PPV had worse VA at presentation ( P = .02) and at 6 months ( P < .001). Eyes presenting with VA of hand motion (20/8000) or worse were more likely to undergo subsequent PPV ( P = .02). Conclusions: Eyes with intravitreal injection–related endophthalmitis presenting with VA of hand motion or worse were more likely to undergo subsequent PPV. Future studies with larger cohorts may reveal whether earlier vitrectomy should be considered in these patients.

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“…17 In all 9 of these patients, a change in clinical management was prompted by worsening of the clinical appearance, not by the culture results. 17 To our knowledge, this is the first report of unilateral acute-onset postoperative endophthalmitis in a cognitively impaired patient after IBSCS. This patient responded well to empiric intravitreal vancomycin without cultures.…”

Section: Discussionmentioning

confidence: 99%

“…17 In all 9 of these patients, a change in clinical management was prompted by worsening of the clinical appearance, not by the culture results. 17…”

Section: Discussionmentioning

confidence: 99%

Unilateral endophthalmitis after immediate sequential bilateral cataract surgery in a cognitively impaired patient: diagnosis and treatment

Martínez¹,

Levine²,

Flynn³

et al. 2023

JCRS Online Case Rep

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Introduction:Immediate sequential bilateral cataract surgery (ISBCS) is a reasonable approach for cataract surgery in patients needing general anesthesia, such as those with cognitive impairment. To our knowledge, this is the first reported case of unilateral acute-onset postoperative endophthalmitis in a patient with cognitive impairment after ISBCS, with emphasis on diagnostic and treatment challenges.Patient and Clinical Findings:A 64-year-old woman with a history of cognitive impairment, seizure disorder, and no prior ocular surgery presented with dense visually significant cataracts and visual acuity of fix and follows in both eyes.Diagnosis, Intervention, and Outcomes:Patient underwent ISBCS under general anesthesia and without intracameral antibiotics or corneal sutures. The patient returned with unilateral acute-onset endophthalmitis 2 weeks postoperatively. Because of the patient's limited ability to comply with treatment, and lack of emergency general anesthesia needed for vitreous cultures, intravitreal vancomycin injection (1 mg/0.1 mL) was empirically given, with clinical resolution of the infection and visual acuity of fix and follows.Conclusions:Acute-onset postoperative endophthalmitis in the setting of cognitive impairment is challenging because emergency general anesthesia may not be available, and the patient can tolerate only limited interventions. In this patient, empiric intravitreal vancomycin injection without cultures led to a satisfactory clinical outcome.

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Endophthalmitis after Cataract Surgery: Changes in Management Based on Microbiologic Cultures

Cited by 13 publications

References 22 publications

The Impact of Physician Face Mask Use on Endophthalmitis After Intravitreal Anti–Vascular Endothelial Growth Factor Injections

The Impact of Physician Face Mask Use on Endophthalmitis After Intravitreal Anti–Vascular Endothelial Growth Factor Injections

Management Patterns and Outcomes for Intravitreal Injection–Related Endophthalmitis

Unilateral endophthalmitis after immediate sequential bilateral cataract surgery in a cognitively impaired patient: diagnosis and treatment

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