Endophthalmitis in Auckland 1983–1991

Kent, David

doi:10.1111/j.1442-9071.1993.tb00961.x

Cited by 16 publications

(9 citation statements)

References 44 publications

(5 reference statements)

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“…The results of this study are consistent with other reports finding BRE as the second most common form of infectious endophthalmitis, after acute and chronic post-cataract surgery Endophthalmitis 1. BRE usually develop late (>1month) but in our series 15% of the cases had BRE earlier (< 2weeks).…”

Section: Discussionsupporting

confidence: 92%

“…Bleb-related endophthalmitis (BRE) is the second most frequent (16.7%) cause of postoperative endophthalmitis after acute and chronic post-cataract surgery endophthalmitis 1. It's incidence is reported to be between 0.2% to 1.3%,23 and is more common with the use of antiproliferative agent (up to 3%) and even higher when the bleb is placed inferiorly (up to 9.4%) 4–7.…”

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confidence: 99%

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Bleb-related endophthalmitis: Clinical presentation, isolates, treatment and visual outcome of culture-proven cases

Baarah¹,

Smiddy²

2009

Middle East Afr J Ophthalmol

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Purpose:To investigate clinical features, causative organisms and their antibiotic sensitivity, management, and visual acuity outcomes of eyes with bleb-related endophthalmitis (BRE).Design:Retrospective, noncomparative, consecutive eye series.Methods:Clinical and microbiological records of patients with culture positive bleb-related endophthalmitis treated at a single institution between April 1995 and February 2002 were revised retrospectively.Main Outcome Measures:Final visual acuity, loss of eye and complications.Results:There were 34 cases with presenting visual acuities ranging from 20/200 to light perception. Decrease of visual acuity was the most frequent sign (94%) followed by pain (79%) and hypopyon (53%). Associated features included pseudophakia (79%), vitreous wick (29%), and wound leak (12%). The most frequent organisms isolated from vitreous specimens, were streptococcus species (55%) and gram positive coagulase negative staphylococci (20%). Polymicrobial growth was noted in 27% of cases. The cultured organisms were sensitive to antibiotics used in 94% of cases. Treatment modality used was vitreous tap with antibiotic injection without (65%) or with vitrectomy (35%). The most common intravitreal antibiotics combination was vancomycin with ceftazidime, Intravitreal dexamethsone was administered in 56% of cases. Final visual outcome of 20/400 or better was noticed in 50% of cases without and 33% with vitrectomy, but this was not statistically significant (p=0.45). The difference in final visual acuity of cases infected by gram-positive coagulase-negative staphylococci and streptococcus species were not statistically significant (p= 0.18). Overall, final visual outcome of 20/400 or better was noticed in 47% of cases, while no light perception was recorded in 8 (24%) cases. Of no light perception cases 7 underwent evisceration or enucleation. Overall, 32% of the cases experienced other complications like retinal detachment with dislocated intraocular lens, phthisis bulbi, and epiretinal membrane formation.Conclusion:BRE is associated with substantial visual morbidity. Prompt treatment of BRE with intravitreal vancomycin and broad spectrum antibiotics recommended while culture results are pending. Neither tap-injection with vitrectomy nor tap-injection without vitrectomy proved superior in the management of this condition.

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Section: Discussionsupporting

confidence: 92%

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confidence: 99%

Bleb-related endophthalmitis: Clinical presentation, isolates, treatment and visual outcome of culture-proven cases

Baarah¹,

Smiddy²

2009

Middle East Afr J Ophthalmol

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“…is the most common cause of acute-onset postoperative endophthalmitis following cataract surgery [6-8]. Series from Australia [9,10], North America [6], and Europe [11,12] have reported 6% to 12% Gram-negative bacteria and in the EVS reporting Gram-negative bacteria was isolated in 5.9% (19/323) eyes [5]. The Indian studies, at 26% to 42%, have reported higher incidences of Gram-negative bacterial infection [1,2].…”

Section: Resultsmentioning

confidence: 99%

Combined ceftazidime and amikacin resistance among Gram-negative isolates in acute-onset postoperative endophthalmitis: prevalence, antimicrobial susceptibilities, and visual acuity outcome

Jindal

Pathengay

Khera

et al. 2013

J Ophthal Inflamm Infect

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BackgroundThe purpose of this study is to evaluate the prevalence, antimicrobial susceptibilities, and visual acuity outcome of acute-onset postoperative Gram-negative bacterial endophthalmitis cases resistant to both ceftazidime and amikacin seen between 2005 and 2010 at L. V. Prasad Eye Institute, a tertiary care ophthalmic Centre in South India. Medical records of all patients with Gram-negative bacterial endophthalmitis resistant to both amikacin and ceftazidime between 1 January 2005 and 31 December 2010 were reviewed in this non-comparative, consecutive, retrospective case series. Favorable outcome was defined as a best-corrected visual acuity of ≥20/200.ResultsSixty five (39.6%) of 164 culture-positive postoperative endophthalmitis were caused by Gram-negative organisms. Among these 65 isolates, 32 (49%; 95% confidence interval (CI) 37% to 61%) were resistant to ceftazidime, 17 (26%; 95% CI 15% to 37%) to amikacin, and 12 (18.5%; 95% CI 9% to 27%) to both ceftazidime and amikacin. Eight Pseudomonas isolates, three Enterobacter isolates, and one Haemophilus isolate were resistant to both ceftazidime and amikacin. The isolates were sensitive to fluoroquinolones (42%) and imipenem (50%). Presenting visual acuity was light perception in 10 (83.3%) cases. A final visual acuity ≥20/200 was achieved in 5/12 (41.7%) of these patients.ConclusionIn the current study, Pseudomonas was the most common Gram-negative bacteria resistant to both amikacin and ceftazidime. The emergence of multidrug-resistant bacteria causing endophthalmitis is a matter of concern in India. Alternative antibiotics like imipenem or fluoroquinolones may be considered for the management of these resistant organisms.

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“…Although vitreous samples are of greater benefit the value of aqueous and capsule/IOL culture should not be underestimated. Kent et al found aqueous samples to be positive by culture in eight cases when culture of vitreous proved unhelpful24 and Busin et al used scanning electron microscopy and detected bacteria on all removed lenses in 11 patients in whom cultures were negative before IOL removal, five of which were culture positive from samples taken at the time of IOL removal 25…”

Section: Discussionmentioning

confidence: 99%

Assessment of a standard treatment protocol on visual outcome following presumed bacterial endophthalmitis

Okhravi

Towler

Hykin

et al. 1997

British Journal of Ophthalmology

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Aims-The aim of this prospective study was, firstly, to judge the eVect of early aggressive treatment with a standardised regimen of high dose broad spectrum intraocular and systemic antibiotics on visual outcome and, secondly, to assess the sensitivity of isolated organisms to the treatment regimen utilised. Methods-Thirty two consecutive patients presenting with presumed bacterial endophthalmitis were treated and completed follow up. In every case, intraocular sampling was undertaken and treatment with intraocular vancomycin, amikacin, and systemic ciprofloxacin was commenced immediately, followed by systemic steroids 1 day later. Results-In 69% of patients vision improved with 47% achieving a final visual acuity of 6/36 or better and 31% achieving 6/12 or better. Of the intraocular samples taken from post-surgical and posttraumatic cases, 10/27 (37%) and 3/5 (60%) were culture positive, respectively. All the bacteria isolated were sensitive to at least one of the three antibiotics used. Conclusions-The study demonstrated that the combination of vancomycin, amikacin, and ciprofloxacin is adequate as a standard regimen for the treatment of most patients with suspected bacterial endophthalmitis. The prognosis for a good visual outcome, however, remains poor with 15/27 (55%) post-surgical and 2/5 (40%) post-traumatic cases achieving a final acuity of 6/60 or less.

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Endophthalmitis in Auckland 1983–1991

Cited by 16 publications

References 44 publications

Bleb-related endophthalmitis: Clinical presentation, isolates, treatment and visual outcome of culture-proven cases

Bleb-related endophthalmitis: Clinical presentation, isolates, treatment and visual outcome of culture-proven cases

Combined ceftazidime and amikacin resistance among Gram-negative isolates in acute-onset postoperative endophthalmitis: prevalence, antimicrobial susceptibilities, and visual acuity outcome

Assessment of a standard treatment protocol on visual outcome following presumed bacterial endophthalmitis

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