Intravitreal injections as a leading cause of acute postoperative endophthalmitis—a regional survey in England

Abstract Background To evaluate the characteristics, treatment patterns and outcomes of acute postoperative endophthalmitis. Methods Patients presenting with acute postoperative endophthalmitis between January 2017 to December 2019 were identified from hospital records in this multicentre retrospective cohort study. Clinical records were reviewed for visual acuity (VA) at various timepoints, cause of endophthalmitis, microbiological results, treatments and complications. Results Forty-six eyes of 46 patients were included. Intravitreal injections were the leading cause of acute postoperative endophthalmitis (n = 29; 63%), followed by cataract surgery (n = 8; 17%), vitreoretinal surgery (n = 7; 15%), and secondary intraocular lens insertion (n = 2, 4%). The absolute risk of endophthalmitis was 0.024% (1:4132) for intravitreal injections, 0.016% (1:6096) for cataract surgery, and 0.072% (1:1385) for vitreoretinal surgery. The majority of patients (n = 38; 83%) had better VA at 6 months compared to presentation, although fewer (n = 13; 28%) maintained similar or better VA compared to before the precipitating surgery. Twenty-four cases yielded positive culture results, of which staphylococcus epidermidis was the most commonly isolated organism. Microbiological yield was not associated with better final visual outcomes. Patients who underwent therapeutic vitrectomy (n = 15; 33%) had poorer VA at presentation, but subsequently achieved visual outcomes comparable to those who received medical treatment alone. There was no difference in time to presentation, visual outcome and retinal detachment rates among the different causative procedures. Conclusion Intravitreal injections were the most common cause of endophthalmitis in our region, primarily because of their higher frequency compared to other intraocular procedures. In this cohort, the primary procedure had no effect on presentation, management or visual outcomes.

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Hospital-based community cataract surgery: comparison of visual outcomes between conventional extra-capsular cataract extraction and small incision cataract surgery

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v1i2.3686 ◽

1970 ◽

Vol 1 (2) ◽

pp. 118-122 ◽

Cited By ~ 1

Author(s):

P Karki ◽

JK Shrestha ◽

JB Shrestha

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Visual Outcome ◽

Cataract Extraction ◽

P Value ◽

Small Incision Cataract Surgery ◽

Mean Values ◽

Visual Outcomes ◽

Small Incision ◽

Statistical Program

Introduction: The small-incision cataract surgery is gaining popularity among the ophthalmic surgeons. Objective: To compare the visual outcome of conventional extra-capsular cataract extraction (ECCE) and small-incision cataract surgery (SICS) in a hospital based community cataract program. Materials and methods: A prospective interventional study without randomization was carried out including the patients undergoing cataract surgery by either conventional ECCE or manual SICS. They were followed up for 6 weeks postoperatively. The visual outcomes were compared between the two groups. Statistics: The statistical program Epi-Info version 2000 was used to analyze the data. Mean values with standard deviations, 95% CI and p value were calculated. The p value of <0.05 was considered significant. Results: Of 85 patients, 44 (M: F=10:34) underwent ECCE and 41 (M: F=15:26) SICS (RR= 0.71, 95% CI=0.42-1.2, p value=0.16). Unaided visual acuity on the 1st postoperative day in the ECCE group was e"6/ 18 in 22.7%,<6/18-6/60 in 63.6 %,< 6/60 in 13.7%, whereas in the SICS group, the same was e"6/18 in 70.7%,<6/18-6/60 in 22 %,< 6/60 in 7.3% (95% CI = 0.23 - 0.48, p=0.001). Best corrected visual acuity on the 6th week follow-up in the ECCE group was e"6/18 in 79.5%,<6/18-6/60 in 18.2 %,< 6/60 in 2.3% and in the SICS group the same was 6/18 in 90.5% and <6/18-6/60 in 4.9% (95% CI=0.44 - 0.73; p=0.0012). Conclusion: Both ECCE and SICS are good procedures for hospital based community cataract surgery but within the 6 weeks postoperative period SICS gives better visual outcome. Remarkably higher number of female patients can be provided service in a hospital based community cataract programme as compared to males. Keywords: cataract; small incision; extra-capsular DOI: 10.3126/nepjoph.v1i2.3686 Nep J Oph 2009;1(2):118-122

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An experience of management of cluster endophthalmitis in western hilly rural region of Nepal: A descriptive, interventional study

Journal of Chitwan Medical College ◽

10.3126/jcmc.v5i4.16545 ◽

2017 ◽

Vol 5 (4) ◽

pp. 10-19

Author(s):

P Bastola

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Treatment Protocol ◽

Visual Outcome ◽

High Volume ◽

World Health Organisation ◽

Intravitreal Injections ◽

World Health ◽

Interventional Study ◽

Small Incision Cataract Surgery

Infectious endophthalmitis is among the most serious complications of cataract surgery. Cluster endophthalmitis is defined as five or more cases of endophthalmitis occurring on a particular day in a single operating room in one centre. The study aimed to find out causative organisms, ocular status and visual outcome after an outbreak of cluster endophthalmitis in a high volume cataract surgery in a camp. A descriptive, interventional study was carried out in 18 suspected cases of acute endophthalmitis after manual small incision cataract surgery in a single day. All clinically suspected cases underwent vitreous tap and received intravitreal injections. Vitreous samples were sent for staining and KOH mount, culture, sub-culture and sensitivity test was carried out in all vitreous specimens. Standard treatment protocol was followed. Patients were followed up till six weeks. Of the 89 eyes operated, 18 (20.2%) eyes underwent vitreous tap and intravitreal injections. Mean duration of presentation was 36 hours (24 – 48 hours). Commonest presenting symptom was redness 18 (100%), pain 83.3% (15) followed by decreased vision 77.8% (14). 10 (55.6%) eyes were culture negatives while, 8 (44.4%) were culture positive for pseudomonas aeruginosa. Six (33.3%) eyes needed core vitrectomy and repeat intravitreal injections, whereas 2 (11.1%) eyes needed repeat intravitreal injections only. Eight eyes (44.4%) got a normal visual acuity; two eyes (11.1%) fair and 8 eyes (44.4%) had poor visual acuity according to World Health Organisation (WHO) guidelines. Four eyes (22.2%) needed evisceration, while three (16.7%) eyes progressed to phthisis bulbi. Acute post operative endophthalmitis is a serious complication following cataract surgery. Prognosis of cluster endophthalmitis with proven culture positivity to pseudomonas infection is poor even with prompt standard management.

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Treatment of Bilateral Endogenous Aspergillus Endophthalmitis with Multiple Intravitreal Voriconazole Injections with Good Visual Outcome

Case Reports in Ophthalmology ◽

10.1159/000520819 ◽

2021 ◽

pp. 1002-1007

Author(s):

Inas F. Aboobakar ◽

Sally S. Ong ◽

Akosua Nti ◽

Kim Jiramongkolchai ◽

J. Fernando Arevalo

Keyword(s):

Visual Outcome ◽

Intravitreal Injections ◽

Endogenous Endophthalmitis ◽

Visual Outcomes ◽

Good Visual Outcome ◽

The Right ◽

Final Visual Outcome

Endogenous endophthalmitis caused by <i>Aspergillus</i> species tends to be very aggressive, often leading to devastating visual outcomes. Historically, intravitreal amphotericin injections have played a central role in management, but with variable visual outcomes and a risk of toxicity. Limited reports suggest that use of intravitreal voriconazole is a safe and efficacious alternative, though these cases were treated with only few intravitreal injections. Here, we report a case of bilateral endogenous <i>Aspergillus</i> endophthalmitis treated with 8 intravitreal voriconazole injections in the right eye and 11 in the left eye with good best-corrected final visual outcome (20/50 right eye and 20/40 left eye).

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The visual outcomes after cataract surgery in urban slums of Raipur, Chhattisgarh, India: a cross sectional study

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20190183 ◽

2019 ◽

Vol 6 (2) ◽

pp. 638

Author(s):

Anjana Tiwari ◽

Indu Padmey

Keyword(s):

Cataract Surgery ◽

Visual Outcome ◽

Cross Sectional Study ◽

Urban Slums ◽

Sectional Study ◽

Chi Square ◽

Cross Sectional ◽

Visual Outcomes ◽

Chi Square Test ◽

Poor Outcomes

Background: Poor outcomes of cataract surgery are a major problem in developing countries, including India which affects the demand and uptake of cataract surgical services. The present study was aimed to assess the visual outcomes after cataract surgery and identify factors associated with it, among persons aged 50 year and above in urban slums of Raipur.Methods: A community-based, cross-sectional study was conducted in15 randomly selected clusters (urban slums) of Raipur from June 2012 to March 2013. Interviews, Visual Acuity measurements and ocular examinations were performed on all persons aged 50 year and above through house to house visits. Details about surgical intervention i.e. date, setting, type of cataract surgery were obtained from cataract operated persons, for each eye that had cataract surgery. Collected data were analyzed by using both descriptive and inferential statistics. The chi- square test was used to determine the associations of different cataract related parameters with visual outcomes in cataract operated eyes.Results: Of the 870 participants, 203 persons (329 eyes) had undergone cataract surgery. Among all operated eyes, visual outcome was good (VA ≥6/18) in 84.5%, borderline (VA <6/18 and ≥6/60) in 12.5%, and poor (VA <6/60) in 3% of eyes with available correction. Visual outcome of cataract surgery was significantly associated with age at time of surgery, literacy, type of surgery, place of surgery and time since surgery.Conclusions: The visual outcomes of cataract surgery were excellent in study area; it can be further improved by appropriate refractive correction, provision of glasses and adequate follow up after cataract surgery.

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Surgical and visual outcomes of posterior dislocated lens fragments after cataract surgery during 5-years at a tertiary eye hospital of North India

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v11i2.27824 ◽

2019 ◽

Vol 11 (2) ◽

pp. 172-180

Author(s):

Lagan Paul ◽

Manisha Agarwal ◽

Shalini Singh ◽

Rahul Mayor ◽

Chanda Gupta ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Cataract Surgery ◽

Visual Outcome ◽

Vitreous Cavity ◽

Age Related Macular Degeneration ◽

Visual Outcomes ◽

Poor Visual Outcome ◽

Age Related

Objective: To determine the surgical and visual outcomes of posteriorly dislocated lens fragments in the vitreous cavity in patients undergoing cataract surgery. Methods: A total of 149 eyes of 149 patients from 2013 to 2018 were included in the study. The primary cataract surgery was performed either at the base hospital and its peripheral centres or referred from elsewhere. Pars plana vasectomy and nucleus removal was performed along with implantation of intraocular lens, wherever possible. Success was defined as best corrected visual acuity (BCVA) ≥ 6/12 at 3 months follow up. Poor visual outcome was defined as per WHO guidelines as BCVA ≤ 3/60. Results: Posterior capsular rupture and dislocation into vitreous cavity most frequently occurred during phaco-fragmentation in cases of phacoemulsification and during nucleus delivery in cases of small incision cataract surgery. Early vitrectomy was performed within 3 days in 36.2% of cases and within 14 days in 63.8% of cases. Successful visual outcome was achieved in 85.2% of patients at 3 months follow up after vitrectomy. Iatrogenic retinal break occurred in five patients during vitrectomyand five patients had retinal detachment. Poor visual outcome was observed in 12eyes, out of which glaucomatous optic neuropathy seen in 5 cases, cystoid or diabeticmacular edema in 4 cases and age related macular degeneration in 3 cases. Conclusion: Posterior dislocation of lens can be successfully managed in majority of cases with vitreoretinal surgical intervention. The timing of vitrectomy whether performed early or late did not affect the visual outcome. The most important predictorof final visual acuity after PPV for retained lens fragments is a less complicated clinical course without any associated complications such as retinal detachment, cystoidmacula edema and glaucoma. Expertise of the primary cataract surgeon could not be assessed in this study, though surgeon grade with more experience is an important factor in the assessment of complications during the cataract surgery.

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Endophthalmitis following Intravitreal Injection, Cataract Surgery, and Vitrectomy: Clinical Features and Visual Outcomes

Journal of Ophthalmology ◽

10.1155/2021/9985821 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Ana Maria Cunha ◽

Maria Manuel Iglésias ◽

Amândio Rocha-Sousa ◽

Fernando Falcão-Reis ◽

Manuel Falcão

Keyword(s):

Cataract Surgery ◽

Clinical Features ◽

Primary Outcome ◽

Visual Outcome ◽

Single Centre ◽

Visual Outcomes ◽

Poor Visual Outcome ◽

Number Of Patients ◽

Pars Plana ◽

Better Than

Purpose. To describe and compare the clinical features and visual outcomes of endophthalmitis following intravitreal injections (IVI), cataract surgery, and pars plana vitrectomy (PPV). Methods. This is a single-centre, retrospective study. All included patients had acute postoperative endophthalmitis secondary to one of these three procedures. Visual acuity (VA), comorbidities, time to presentation, and treatment were assessed. The primary outcome was visual outcome. A poor outcome was considered if final VA was worse than or equal to counting fingers (CF) and a good outcome was classified as VA better than CF. Results. Over 12 years, a total of 61 patients were included. Twenty-seven cases were post-cataract endophthalmitis; twenty-five were post-IVI and nine post-PPV. Endophthalmitis post-PPV had a worse visual outcome (88.9% of patients with VA worse than or equal to CF 95% CI 51.3 to 100.0%) than endophthalmitis following cataract surgery (25.9% of patients with VA worse than or equal to CF 95% CI 11.0 to 39.9%) and the IVI subgroup (44.0% of VA worse than or equal to CF 95% CI 24.0 to 67.0%) ( p = 0.001 and p = 0.047 ). There were no significant differences in the proportion of patients with a poor visual outcome between endophthalmitis following cataract surgery and IVI ( p = 0.171 ). Conclusions. The number of patients with poor visual outcomes following acute endophthalmitis was similar in endophthalmitis following IVI and cataract surgery, but better than endophthalmitis following vitrectomy.

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Cataract surgery in camp patients: a study on visual outcomes

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v3i2.5270 ◽

1970 ◽

Vol 3 (2) ◽

pp. 159-164

Author(s):

SG Pai ◽

SJ Kamath ◽

V Kedia ◽

K Shruthi ◽

A Pai

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Visual Outcome ◽

Posterior Chamber ◽

Small Incision Cataract Surgery ◽

Evaluation Team ◽

Visual Outcomes ◽

Corrected Visual Acuity ◽

Operative Complications ◽

Best Corrected Visual Acuity

Aim: To assess the complications and visual outcomes associated with cataract surgery in camp patients operated at a tertiary centre. Materials and methods: In a retrospective study, 206 outreach camp patients had undergone cataract surgeries with posterior chamber intraocular lens implantation under peribulbar anesthesia over a period of 6 months. Post-operative complications on Day 1 were graded as per Oxford Cataract Treatment and Evaluation Team (OCTET) definitions. One month postoperative complications, best corrected visual acuity and refractive errors were assessed. Results: 206 eyes underwent cataract extraction with PCIOL implantation. Small incision cataract surgery (SICS) was the commonest method (78.6%) used. The most common first post-operative day complication was mild iridocyclitis (26.2%). The complications were based on OCTET definitions, and showed that 33 % had Grade I and 3.4 % had Grade II complications. The major post-operative complication after 4 weeks of surgery was posterior capsular opacity. 89.8 % of the eyes had a 4 week-post-operative best corrected visual acuity of e” 6/24. The commonest refractive error was myopia with against the rule astigmatism, seen in 86 out of 150 cases. Conclusion: High quality cataract surgery with a low rate of intra-operative complications and good visual outcome can be attained in camp patients operated in the base hospitals, thus justifying more similar screening camps to clear the vast cataract backlog. Key words: cataract surgery, eye camp, visual outcomes DOI: http://dx.doi.org/10.3126/nepjoph.v3i2.5270 Nepal J Ophthalmol 2011; 3(2): 159-164

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Visual Outcome in Pars Plana Vitrectomy for Acute Postoperative Endophthalmitis after Cataract Surgery

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i3.991 ◽

2020 ◽

Vol 36 (3) ◽

Author(s):

Abdul Rafio Soomro ◽

Fayaz Ahmed Soomro ◽

Munawar Hussain ◽

Abdul Qadeem Soomro ◽

Nazia Qidwai ◽

...

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Pars Plana Vitrectomy ◽

Visual Outcome ◽

Final Visit ◽

P Value ◽

Postoperative Endophthalmitis ◽

Chi Square ◽

Finger Counting ◽

Pars Plana

Purpose: To determine the visual outcomes in patients undergoing pars plana-vitrectomy (PPV) for acute postoperative endophthalmitis after cataract surgery.Study Design: Quasi experimental study.Place and Duration of Study: Al- Ibrahim Eye Hospital, Malir, Karachi for a period of 2 years.Material and Methods: Thirty-three patients were selected using non-probability convenient sampling technique.Patients with acute postoperative endophthalmitis after cataract surgery diagnosed clinically and on B-scan, withvisual acuity of only perception of light were included while patients with better visual acuity and any other typesof endophthalmitis were excluded. PPV was performed in all cases and the patients were examined postoperativelyon 1st day, 3rd day, 1, 2 and 3 weeks after surgery. During these follow ups, visual acuity wasrecorded, detailed slit lamp and fundus examination was performed. Using SPSS version 20.0, chi-square testwas applied to test for significance keeping p-value of < 0.05 as significant.Results: Out of 33 patients 19 (57.6%) were males and 14 (42.4%) were females. Mean age of the patients was54.50 ± 14.14 years. On 1st post-operative day 8 patients (24.2%) showed improvement of visual acuity fromperception of light to finger counting while 02 (6.1%) patients reported visual acuity of 6/60. On final visit at 3rdweek postoperatively, 19 patients (57.6%) had visual acuity of finger counting, 08 patients (24.2%) had handmovement and 06 (18.2%) patients reported a visual acuity of 6/60.Conclusion: PPV for acute post-cataract endophthalmitis results in favourable outcomes in terms of visual acuity.

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Visual outcomes of cataract surgery: An observational study of ten years from a tertiary eye care hospital in Pakistan

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.7.4428 ◽

2021 ◽

Vol 37 (7) ◽

Author(s):

Shahid Ahsan ◽

Muhammad Saleh Memon ◽

Sadia Bukhari ◽

Tauseef Mahmood ◽

Muhammad Faisal Fahim ◽

...

Keyword(s):

Observational Study ◽

Cataract Surgery ◽

Visual Impairment ◽

Visual Outcome ◽

Care Hospital ◽

Eye Care ◽

Visual Outcomes ◽

Creative Commons ◽

Good Visual Outcome ◽

Visual Assessments

Objectives: To observe and analyze the visual outcomes of cataract surgery of ten years at a tertiary eye care hospital, Karachi. Methods: An observational study with retrospective data search was conducted in Al Ibrahim Eye Hospital (AIEH), Karachi. Data of all adults (above 16 years) who underwent cataract surgery from 2010-2019 was retrieved from HIMS. Presence of opacity in the lens was labelled as cataract. Surgery was advised when patient’s BCVA was found to be 6/18. Visual assessments of the patients were done on day 01, one week and six weeks postoperatively. Postoperatively, 6/6 – 6/12 was considered as good, 6/18 as mild visual impairment, < 6/18 to 6/60 as moderate visual impairment and < 6/60 as severe visual impairment. Results: A total of 1,027,840 patients visited AIEH with different eye diseases. Among 1027840 individuals, cataract was identified in 88443 (8.6%). Surgery was advised to 58371 and performed in 38616. Records of operated cases (38616) were retrieved. Mean age of patients was 54.96±14.22 years. There were 20578 (53.29%) males and 18038 (46.71%) females who underwent surgery . At the end of sixth week, 3561 (18.4%), patients were found to have “good vision”, 12242 (63.43%) had mild visual impairment, 2676 (13.86%) had moderate visual impairment and 822 (4.26%) had severe visual impairment. Corneal Complications was the commonest cause (33.56%) at sixth week. Conclusions: The institution achieved WHO recommended criteria of “good visual outcome” (6/6 to 6/18) of 81.83% which is near to recommended ≥ 90% and severe visual impairment of 4.26%. doi: https://doi.org/10.12669/pjms.37.7.4428 How to cite this:Ahsan S, Memon MS, Bukhari S, Mahmood T, Fahim MF, Haseeb U, et al. Visual outcomes of cataract surgery: An observational study of ten years from a tertiary eye care hospital in Pakistan. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4428 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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