<i>Leuconostoc</i>as a Cause of Endophthalmitis Post-intravitreal Injection of Ranibizumab

Damasceno, Nadyr P; Horowitz, Soraya; Damasceno, Eduardo de França

doi:10.3109/09273948.2014.898073

Cited by 13 publications

(15 citation statements)

References 5 publications

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“…While coagulase-negative Staphylococcus species have been isolated in the majority of culture-positive cases, endophthalmitis due to Streptococcus species has been associated with poorer visual outcomes [ 6 – 8 ]. Moreover, prophylactic topical antibiotic use may promote the emergence of unusual pathogens resistant to standard antimicrobial therapies; indeed, cases of atypical microbes isolated from intraocular fluid in patients with post-injection endophthalmitis have been increasingly reported [ 9 – 11 ]. Regarding the management of post-injection endophthalmitis, in the absence of evidence-based guidelines, many ophthalmologists use the severity of visual acuity on presentation to inform their decision to treat initially with either “tap and inject” (withdrawal of a vitreous sample for microbiologic analysis and intravitreal injection of antibiotics) versus primary vitrectomy based on the results and recommendations of the Endophthalmitis Vitrectomy Study (EVS) [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Endophthalmitis following intravitreal injection of anti-VEGF agents: long-term outcomes and the identification of unusual micro-organisms

Sachdeva

Moshiri

Leder

et al. 2016

J Ophthal Inflamm Infect

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BackgroundWhile the development of targeted molecular therapy to inhibit vascular endothelial growth factor (VEGF) has revolutionized the treatment and visual prognosis of highly prevalent retinal diseases such as diabetic retinopathy and age-related macular degeneration, each intravitreal injection of these agents carries a small risk of endophthalmitis which can be visually devastating. In the absence of specific guidelines, current management of post-injection endophthalmitis is typically extrapolated from data regarding endophthalmitis occurring after cataract surgery despite potential differences in pathogenic organisms and clinical course. Here, we assess the contribution of intravitreal injections of anti-VEGF agents to all cases of endophthalmitis at our tertiary care referral center and characterize the clinical outcomes and microbial pathogens associated with post-injection endophthalmitis in order to inform management of this serious iatrogenic condition.ResultsDuring the 7-year study period analyzed, 199 cases of endophthalmitis were identified using billing records. Of these, the most common etiology was post-surgical, accounting for 62 cases (31.2 %), with bleb-associated, endogenous, and corneal ulcer-related infections representing the next most frequent causes, comprising 15.6 % (31/199), 13.1 % (26/199), and 13.6 % (27/199) of all cases, respectively. Intravitreal injections of anti-VEGF agents represented 8.5 % of endophthalmitis (17/199 cases). Intraocular cultures yielded positive results in 75 % of post-injection cases, with the majority associated with coagulase-negative Staphylococcus. Consistent with prior literature, a case of Strep viridans displayed more rapid onset and progression. We also report the first association of Enterobacter cloacae and Lactococcus garvieae with post-injection endophthalmitis. While all but one patient were treated with initial vitreous tap and intravitreal injection of antibiotics, both patients with these rare organisms exhibited persistent vitritis requiring subsequent vitrectomy. Long-term outcomes of post-injection endophthalmitis indicated visual recovery to baseline levels, even with resumption of anti-VEGF agents following resolution of the acute infection.ConclusionsAcute endophthalmitis following intravitreal injections of anti-VEGF agents is an uncommon but potentially devastating complication which may be managed effectively with vitreous tap and injection of intravitreal antibiotics. However, persistent vitritis requiring subsequent vitrectomy should raise suspicion for unusual pathogens.

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Section: Introductionmentioning

confidence: 99%

Endophthalmitis following intravitreal injection of anti-VEGF agents: long-term outcomes and the identification of unusual micro-organisms

Sachdeva

Moshiri

Leder

et al. 2016

J Ophthal Inflamm Infect

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“…However, in the current review, 4/27 cases of endophthalmitis with reported reduced vancomycin susceptibility were caused by Bacillus species. Leuconostoc species, well-known to be opportunistic infectious agents with intrinsic resistance to vancomycin,10 11 22 were reported in three of 27 cases in the current review. Leuconostoc species are microaerophilic, catalase-negative, Gram-positive cocci with high intrinsic resistance to vancomycin, and are often mistaken for Streptococcus species because of similar biochemical characteristics.…”

Section: Discussionmentioning

confidence: 75%

Endophthalmitis caused by Gram-positive organisms with reduced vancomycin susceptibility: literature review and options for treatment

et al. 2015

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Background Endophthalmitis caused by Gram-positive organisms with reduced vancomycin susceptibility and/or resistance is an important clinical issue worldwide. Purpose To review the published literature on endophthalmitis caused by Gram-positive organisms with reduced vancomycin susceptibility and/or vancomycin resistance. Methods The data were analysed from a PubMed search of endophthalmitis cases caused by Gram-positive organisms with reported reduced vancomycin susceptibility and/or vancomycin resistance from 1990 to 2015. Results From 18 publications identified, a total of 27 endophthalmitis cases caused by Gram-positive organisms with reduced vancomycin susceptibility and/or vancomycin resistance were identified. The aetiologies of endophthalmitis were exogenous in 19/27 cases (11 post-cataract surgery, 2 post-penetrating keratoplasty, 1 post-glaucoma surgery, 4 post-open globe injury, 1 post-intravitreal injection of ranibizumab), and endogenous in 4/24 cases; no details were available about the four remaining patients. The causative organisms included Enterococcus species (7/27), coagulase-negative staphylococci (4/27), Staphylococcus aureus (4/27), Bacillus species (4/27), Streptococcus species (3/27), Leuconostoc species (3/27), Staphylococcus hominis (1/27), and unidentified Gram-positive cocci (1/27). Visual acuity of 20/400 or better at the final follow-up was recorded in 10/26 patients (38.5%; data were not available for one patient). Treatment options include fluoroquinolones, penicillin, cephalosporins, tetracyclines, and oxazolidinones. Conclusions In the current study, visual acuity outcomes were generally poor. Enterococcus and Staphylococcus species were the most common organisms reported and postoperative endophthalmitis after cataract surgery was the most common clinical setting.

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“…[10][11][12] The macular edema treatments with anti-VEGF (Ranibizumab) is promising, and the results depends on continuity what can increase the side effects. [13][14][15][16][17] The mechanisms of radiation protection are still the most effective in preventing radiation retinopathy, which do not have curative treatment. published pages including figures, diagrams and references.…”

Section: Resultsmentioning

confidence: 99%

<p>Treatment of Radiation Retinopathy with Intravitreal Injection of Ranibizumab (Lucentis®)</p>

Horowitz¹,

Damasceno²,

Damasceno³

2020

IMCRJ

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To report a treatment of radiation retinopathy in a patient exposed to ionizing radiation for a period of 2 years. A 26-year-old female patient with no comorbidities diagnosed with myelodysplasia confirmed by bone marrow biopsy. She presented a complaint of bilateral progressive visual acuity reduction. At the ophthalmologic examination, she presented alterations suggestive of radiation retinopathy as well as macular thickness to optical coherence tomography (OCT) of over 500 µm. The patient underwent intravitreal injection (0.05 mL) of ranibizumab (Lucentis ®) monthly in both eyes and follow-up through visual acuity and OCT examination. She presented reduction of macular edema as well as a slight improvement of visual acuity. In this case, the treatment of radiation retinopathy with intravitreal injection of ranibizumab (Lucentis) was relatively useful, with a slight improvement of visual acuity, due to the regression of macular edema, not being curative.

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Leuconostocas a Cause of Endophthalmitis Post-intravitreal Injection of Ranibizumab

Abstract: Considerations regarding this bacterium were done by calling attention to its rarity, difficulty of isolation, and action on secondary comorbidities as opportunistic pathogen.

Cited by 13 publications

References 5 publications

Endophthalmitis following intravitreal injection of anti-VEGF agents: long-term outcomes and the identification of unusual micro-organisms

Endophthalmitis following intravitreal injection of anti-VEGF agents: long-term outcomes and the identification of unusual micro-organisms

Endophthalmitis caused by Gram-positive organisms with reduced vancomycin susceptibility: literature review and options for treatment

<p>Treatment of Radiation Retinopathy with Intravitreal Injection of Ranibizumab (Lucentis®)</p>

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