Risk factors, microbial profiles and prognosis of microbial keratitis-associated endophthalmitis in high-risk eyes

O'Neill, Evelyn C; Yeoh, Jonathan; Fabinyi, David; Cassidy, Dermot; Vajpayee, Rasik B; Allen, Penelope J; Connell, Paul

doi:10.1007/s00417-014-2732-1

Cited by 50 publications

(68 citation statements)

References 28 publications

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“…Previous large series of P. aeruginosa endophthalmitis have demonstrated a no light perception outcome in 68% to 82% of cases. 11,12,18 Anatomical outcomes were also poor; the enucleation rate in this study was 42%, slightly better than the previously reported rate of 50% to 82% observed in those other large series. 11,12,18 P. aeruginosa may cause devastating functional and anatomical outcomes secondary to the nature of its intrinsic enzymes.…”

Section: Discussioncontrasting

confidence: 79%

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Endophthalmitis Caused by Pseudomonas Aeruginosa

Sridhar

Kuriyan

Flynn

et al. 2015

Retina

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Section: Discussioncontrasting

confidence: 79%

“…11 Recently, there have been reports of multidrugresistant P. aeruginosa endophthalmitis. [15][16][17][18] Previous studies have not demonstrated the antibiotic minimal inhibitory concentrations for 90% (MIC 90) of P. aeruginosa isolates in endophthalmitis cases.…”

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confidence: 99%

Endophthalmitis Caused by Pseudomonas Aeruginosa

Sridhar

Kuriyan

Flynn

et al. 2015

Retina

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“…O’Neill et al . found that among 37 patients with microbial keratitis-associated endophthalmitis, 16 (43.3%) were eviscerated or enucleated as primary treatment, and 23 (62.2%) subsequently required evisceration or enucleation7. Scott IU et al .…”

Section: Discussionmentioning

confidence: 99%

“…found that 3 (21.4%) out of 14 patients with corneal ulcer underwent evisceration or enucleation8. The risk factors for the progression from keratitis to endophthalmitis included: delayed diagnosis and treatment of microbial keratitis, the use of topical steroid, trauma, contact lens use and previous ocular surgical history78910111213141516171819. In our study, 65.2% of corneal ulcer-related endophthalmitis required enucleation or evisceration which was higher than most previous reports.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for endophthalmitis requiring evisceration or enucleation

Zheng

et al. 2016

Sci Rep

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Endophthalmitis has devastating sequelae resulting in blindness and even loss of eyeball. Although the prognosis of endophthalmitis has much improved with the advances of antibiotics and vitreoretinal surgery, of the number of patients that required evisceration or enucleation is still significant. We retrospectively reviewed the charts of 210 eyes of 210 patients with endophthalmitis andcompared the group that required evisceration or enucleation with those that received salvaging therapies. Regression analysis was used to identify the risk factors for evisceration or enucleation. Thirty eyes (14.3%) underwent enucleation or evisceration. The group of eviscerated or enucleated eyes were older (58.7 vs. 42.2 years, p < 0.001), had more women (56.7% vs. 22.2%, p = 0.003), had poorer initial visual acuity (2.79 vs. 2.10 LogMAR, p < 0.001), and had longer duration before intervention (18.03 vs. 5.74 days, p = 0.031). The most common primary indications for endophthalmitis were infections from corneal ulcer (50.0% vs. 4.4%, p < 0.001) andfrom endogenous source (23.3% vs. 5.6%, p < 0.001). Less common indications were trauma (26.7% vs. 67.8%, p < 0.001) and postoperative (6.7% vs. 22.2%, p = 0.049) endophthalmitis. After adjusting for confounding factors, corneal ulcer-related endophthalmitis, endogenous endophthalmitis and initial visual acuity were the independent risk factors for evisceration or enucleation.

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“…Microbial keratitis is a sight threatening disorder associated with multiple risk factors, including use of extended wear soft contact lenses, 1 ocular surface disease, 2 ocular surgery, 3 immunosuppression, 4,5 and traumatic ocular surface accidents, particularly prevalent in developing countries. 6,7 Among pathogens, the Gram-negative bacterium, Pseudomonas aeruginosa , remains a leading cause of contact lens–induced microbial keratitis, 8 and infections result in ocular pain, stromal destruction, corneal thinning, and/or perforation, leading to vision loss, if untreated.…”

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confidence: 99%

Glycyrrhizin Reduces HMGB1 and Bacterial Load in Pseudomonas aeruginosa Keratitis

Ekanayaka

McClellan

Barrett

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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PurposeHigh mobility group box 1 (HMGB1) contributes to poor disease outcome in Pseudomonas aeruginosa keratitis. This study tests the prophylactic effect of treatment with HMGB1 inhibitors, glycyrrhizin (GLY) and its derivative, carbenoxolone (CBX), for Pseudomonas keratitis.MethodsWe treated C57BL/6 (B6) mice subconjunctivally with GLY or CBX, infected with a noncytotoxic clinical isolate (KEI 1025) or a cytotoxic strain (ATCC 19660) of P. aeruginosa, and injected intraperitoneally with either agent. Clinical score, photography with a slit lamp, real-time RT-PCR, ELISA, myeloperoxidase (MPO) assay, bacterial plate count, histopathology, and absorbance assays were used to assess treatment efficacy and bacteriostatic activity.ResultsAfter KEI 1025 infection, GLY treatment reduced HMGB1 (mRNA and protein levels) and improved disease outcome with significant reduction in mRNA levels of IL-1β, TLR4, CXCL2, and IL-12; protein expression (IL-1β, CXCL2); neutrophil infiltrate; and bacterial load. Treatment with GLY enhanced antimicrobial proteins, including CRAMP and mBD2, but not mBD3. Glycyrrhizin also reduced clinical scores and improved disease outcome in corneas infected with strain 19660. However, neither HMGB1 mRNA or protein levels were reduced, but rather, CXCL2 expression (mRNA and protein), neutrophil infiltrate, and bacterial load were reduced statistically. Treatment with GLY initiated 6 hours after infection reduced plate count; GLY also was bacteriostatic for KEI 1025 and ATCC 19660.ConclusionsGlycyrrhizin reduces HMGB1 and is protective against P. aeruginosa–induced keratitis with a clinical isolate that is noncytotoxic. It was similar, but less effective when used after infection with a cytotoxic strain, which did not reduce HMGB1.

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Risk factors, microbial profiles and prognosis of microbial keratitis-associated endophthalmitis in high-risk eyes

Abstract: MK-associated endophthalmitis is a serious ocular condition occurring more frequently in elderly populations, and those with long standing severe pre-existing ocular disease. Visual outcomes are poor, often requiring evisceration/enucleation.

Cited by 50 publications

References 28 publications

Endophthalmitis Caused by Pseudomonas Aeruginosa

Endophthalmitis Caused by Pseudomonas Aeruginosa

Risk factors for endophthalmitis requiring evisceration or enucleation

Glycyrrhizin Reduces HMGB1 and Bacterial Load in Pseudomonas aeruginosa Keratitis

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