Endophthalmitis following combined cataract extraction and placement of an iStent trabecular bypass device

Chaves, Ariel; Grosinger, Alexander; Hulzen, Richard D. Ten; Stewart, Michael W.; Dorairaj, Syril

doi:10.1016/j.ajoc.2020.100830

Cited by 5 publications

(7 citation statements)

References 9 publications

(10 reference statements)

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“…Although postoperative endophthalmitis following MIGS is uncommon, a higher risk of infection has been noted after the implantation of trabecular bypass devices, including the iStent inject (10 reported cases 1,6 excluding the current case), Xen Gel (Allergan Plc, Dublin, Ireland) (6 reported cases 1,7,8 ), and CyPass Microstent (Alcon, Fort Worth, TX) (1 reported case 1 ), compared with nonimplant MIGS procedures. The 10 prior-reported iStent-associated endophthalmitis cases isolated various Staphylococcus and Streptococcus species, none of which resulted in device removal.…”

Section: Discussionmentioning

confidence: 99%

“…The 10 prior-reported iStent-associated endophthalmitis cases isolated various Staphylococcus and Streptococcus species, none of which resulted in device removal. 1,6 R. mucilaginosa-associated infections have been reported with various prosthetic devices in different organ systems, including prosthetic heart valves (most frequently), prosthetic hip implants, cerebral catheters, and peritoneal dialysis catheters. R. mucilaginosa aggressively colonizes implant surfaces with its ability to form biofilms on glass and plastic.…”

Section: Discussionmentioning

confidence: 99%

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Rothia Mucilaginosa Endophthalmitis Associated With iStent Inject Implantation

Lam

Khundkar

Koozekanani

et al. 2022

Journal of Glaucoma

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Postoperative endophthalmitis caused by Rothia mucilaginosa, a gram-positive, coagulase-negative Micrococcaceae of the oropharyngeal flora, is rare and all previously reported intraocular implant-related cases have resulted in evisceration. R. mucilaginosa endophthalmitis has also not been described with any glaucoma implant device. Here, the authors report a case of subacute R. mucilaginosa endophthalmitis after phacoemulsification with implantation of an intraocular lens and the iStent inject (Glaukos). The infection was managed with intravitreal antibiotic injections, pars plana vitrectomy, and intraocular lens and iStent explantations. This was followed by a second pars plana vitrectomy and silicone oil tamponade for a tractional retinal detachment. Nine months after the initial presentation, vision in the affected eye was partially preserved, and the globe remained intact. R. mucilaginosa infections are associated with grave outcomes due to biofilm formation on infected implants, and as such, removal of infected implants is advised.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rothia Mucilaginosa Endophthalmitis Associated With iStent Inject Implantation

Lam

Khundkar

Koozekanani

et al. 2022

Journal of Glaucoma

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“…Chaves et al reported endophthalmitis after a combined cataract extraction and first-generation iStent placement in an elderly patient who struck her eye while instilling drops two days after the surgery. This patient eventually developed no light perception despite a negative culture and two intravitreal injections of antibiotics [ 7 ]. Lam et al reported a case of Rothia mucilaginosa endophthalmitis after phacoemulsification with insertion of two iStent injects, which progressed to retinal detachment requiring pars plana vitrectomy and removal of the IOL as well as iStents [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Endophthalmitis after Combined Cataract Extraction and iStent Inject Implantation

Huang

Nguyen

Tsukikawa

et al. 2023

Case Reports in Ophthalmological Medicine

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Purpose. To report a case of postoperative endophthalmitis after combined cataract extraction and iStent inject implantation. Observation. A 70-year-old male with a nuclear sclerotic cataract and primary open-angle glaucoma underwent an uneventful phacoemulsification cataract extraction with implantation of an intraocular lens and an iStent inject trabecular bypass stent. The patient was prescribed a postoperative regimen of ofloxacin 0.3% and prednisolone acetate 1%, 1 drop four times a day each. On postoperative day five, he presented to the emergency room for eye pain and had 4+ mixed cells in the anterior chamber (AC) without hypopyon or vitritis on exam. Prednisolone 1% eye drops were increased from four times a day to every two hours while awake. Overnight, he developed worsening vision and severe eye pain. The next morning, he was found to have increased AC cells, vitritis, and intraretinal hemorrhages and was diagnosed with endophthalmitis. The patient underwent a vitreous tap and intravitreal injections of vancomycin (1 mg/0.1 mL) and amikacin (0.4 mg/0.1 mL). Cultures grew Staphylococcus epidermidis. Lab work-up revealed underlying neutropenia. Visual acuity eventually recovered to 20/20. Conclusion and Importance. This report highlights a case of endophthalmitis associated with placement of the iStent inject. The infection was well-controlled after administration of intravitreal antibiotics without removal of the iStent inject, and visual acuity eventually recovered to 20/20. Surgeons should be aware of endophthalmitis risk following combined iStent inject placement, and good recovery is possible without removal of the implant.

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“…Also, in 2020, the first report of endophthalmitis after iStent was published in the United States. This occurred 4 days following combined cataract surgery and iStent placement, and it resulted in no light perception vision 58. However, in a 2017 review and meta-analysis of MIGS outcomes, there were no cases of postoperative infection in the 30 studies that were examined 59.…”

Section: Infection In Glaucoma Surgeriesmentioning

confidence: 99%

“…This occurred 4 days following combined cataract surgery and iStent placement, and it resulted in no light perception vision. 58 However, in a 2017 review and meta-analysis of MIGS outcomes, there were no cases of postoperative infection in the 30 studies that were examined. 59 It is important to note that most of the individual studies were small and underpowered to identify a case of endophthalmitis assuming the rate of endophthalmitis more closely resembles that of cataract surgery alone.…”

Section: Rates Of Infection After Migsmentioning

confidence: 99%

Intracameral Antibiotics and Glaucoma Surgery

Marando¹,

Neeson²,

Valle³

2022

International Ophthalmology Clinics

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surgery. 21 Despite these statistics, there is no consensus in the glaucoma community regarding IC antibiotic prophylaxis. ' Infection in Glaucoma Surgeries Timing of Infection IC antibiotics only have utility in preventing acute postoperative endophthalmitis. Under ideal conditions, IC antibiotics maintain a minimum inhibitory concentration for up to ∼30 hours in the anterior chamber (AC). 22 In the literature, acute infections are defined as occurring <4 to 6 weeks following surgery, whereas late infections occur > 6 weeks postoperatively. Late infections are more common than acute infections following trabeculectomy 23 and are often associated with bleb leaks. 24,25 In one study, only 15% (10/68) of cases of bleb-associated endophthalmitis (BAE) occurred within 1 month of surgery. 26 Late infections are also more common than acute infections following GDI surgery and are often associated with late tube exposures. 27,28 Since MIGS are relatively new, and the devices vary, it is unclear whether endophthalmitis will more often be acute (like after traditional cataract surgery) or late (like after traditional glaucoma surgery). This will probably vary based on whether a conjunctival bleb is formed, like in the case of the XEN Gel Stent (XGS) (Allergan, Abbvie Company, Irvine, CA, USA), and whether corneal incisions are made, which can act as a gateway for periocular bacteria in the immediate postoperative period. Even though late infections tend to be common, acute infections still confer significant morbidity for glaucoma patients.In fact, acute postoperative endophthalmitis occurs 3 times as often following glaucoma surgery than cataract surgery according to data from the Intelligent Research in Sight (IRIS) registry from 2013 to 2017. Before the widespread adoption of IC antibiotics for cataract surgery, the rate of acute endophthalmitis was 0.08% for cataract surgery and 0.12% for glaucoma filtering surgeries. 29 After evidence supporting IC antibiotics in cataract surgery emerged, the rate of acute endophthalmitis halved to 0.04% following cataract surgery alone, but remained at 0.12% following cataract surgery combined with glaucoma surgery. This may be because IC antibiotics have not been studied in the setting of glaucoma surgery, though this has yet to be determined. 21 Since, theoretically, only acute infections are prevented by the use of IC antibiotics, Table 1 summarizes the estimated incidence of overall and acute infection for each of the major glaucoma surgeries. Rate of Infection After TrabeculectomyTrabeculectomy is the second most common glaucoma surgery following MIGS. 1,2 The exact rate of infection after trabeculectomy is 126 ' Marando et al

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Endophthalmitis following combined cataract extraction and placement of an iStent trabecular bypass device

Cited by 5 publications

References 9 publications

Rothia Mucilaginosa Endophthalmitis Associated With iStent Inject Implantation

Rothia Mucilaginosa Endophthalmitis Associated With iStent Inject Implantation

Postoperative Endophthalmitis after Combined Cataract Extraction and iStent Inject Implantation

Intracameral Antibiotics and Glaucoma Surgery

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