Urgent Vitrectomy with Vancomycin Infusion, Silicone Oil Endotamponade, and General Antibiotic Treatment in Multiple Cases of Endophthalmitis from a Single Day of Intravitreal Injections—Case Series

Abstract

The aim of this study was to report on the anatomical and functional results of surgical management of seven cases of endophthalmitis related to a single day of intravitreal aflibercept injections. Patients with signs of endophthalmitis who underwent aflibercept injections (seven eyes) performed on the same day were retrospectively evaluated. The data of visual acuity and optical coherence tomography (OCT) within nine months of the follow-up and the treatment and results of microbiological cultures are reported. Four of the total seven cases had a positive bacterial culture outcome (Streptococcus mitis). All patients underwent vitrectomy combined with phacoemulsification when the eyes were not pseudophakic, vancomycin infusion, and silicone oil tamponade within 24 h; additionally, systemic antibiotics were administered intravenously. The final best-corrected visual acuity (BCVA) after the treatment was finger counting or light perception in all cases, and all eyes were saved with disruption of the inner retinal layers and stabilization of the retina in regard to changes related to the wet age-related macular degeneration (AMD). Although the retinal anatomy was mostly preserved, most of the patients affected by Streptococcus mitis-induced endophthalmitis did not regain baseline vision after the therapy.

Analysis of retinal detachment resulted from post-operative endophthalmitis treated with 23G pars Plana Vitrectomy

“…post cataract surgery: 0.05-0.68%; post intravitreal injection: 0.02-0.03%). Acute endophthalmitis usually appears within one to 2 weeks after the primary surgical interventions (the median onset of post-operative endophthalmitis after cataract surgeries: 9 days; post intravitreal injection: 24 h) [4,5].…”

Clinical Characteristics and Outcomes in 314 Japanese Patients with Bacterial Endophthalmitis: A Multicenter Cohort Study from J-CREST

“…It is reasonable for any ophthalmologist to treat endophthalmitis. Studies have concluded that vitrectomy is effective for the initial treatment of endophthalmitis; early vitrectomy (i.e., within 24 h) might be helpful in achieving a better visual outcome [2,4,46,51], and a primary vitrectomy demonstrated greater visual improvement [2,18,47]. However, the European Vitreo-Retinal Society Endophthalmitis Study showed similar outcomes after treatment with intravitreal antibiotics alone compared with intravitreal antibiotics and vitrectomy within 1 week of presentation [45].…”

“…The foundation of the treatment for bacterial endophthalmitis is focal and systemic administration of antibiotics; vitrectomy is performed if the endophthalmitis is severe. Unless the patient receives appropriate treatment early in the disease, it causes irreversible damage to the retina, which results in a high probability of vision loss [1][2][3][4][5][6][7][8].…”

“…Exogenous endophthalmitis (ExE) is mainly caused by eye surgery [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] and trauma [24][25][26] due to the direct infection of pathogens into the eye from outside. Acute endophthalmitis appears as a postoperative complication within 1-2 weeks after the surgical intervention, most commonly on the third to fifth postoperative day [1,2]. In endogenous endophthalmitis (EnE), there is an infection focus (or foci) somewhere else in the body, and then the pathogens are transferred to the eye [27][28][29][30][31][32][33][34].…”

Cataract Surgery by Intraoperative Surface Irrigation with 0.25% Povidone–Iodine

“…It is a purulent inflammation of the intraocular fluids comprising the vitreous and the aqueous humor. Although the etiology of this condition can be both endogenous and exogenous, it is mostly secondary to intraocular surgeries, injections or penetrating ocular trauma [16]. The incidence of endophthalmitis after cataract surgery is low with reports of 0.076% [17], 0.02% [18] and 0.048% [19].…”