Endogenous Streptococcus mitis panophthalmitis in a patient visiting the Dominican Republic

2021 ◽  
Vol 14 (7) ◽  
pp. e239187
Author(s):  
Victoria Liu ◽  
Adnan Pirbhai ◽  
Syed Faraz Masood
Keyword(s):  
Dominican Republic ◽  
Vision Loss ◽  
Endogenous Endophthalmitis ◽  
Ocular Surgery ◽  
Global Team ◽  
Best Medical Treatment ◽  
Treatment Measures ◽  
Good Cosmetic ◽  
Ocular Comfort ◽  
Intravitreal Dexamethasone

A 67-year-old woman presented with painful, acute vision loss after 5 days of fever and muscle aches while visiting the Dominican Republic. She had no recent history of ocular surgery, dental work or recent trauma. Anterior chamber aspiration confirmed an initial diagnosis of endogenous endophthalmitis, positive for Streptococcus mitis that progressed to panophthalmitis on return to Canada. Treatment included systemic antibiotics, intravitreal antibiotics and intravitreal dexamethasone. Despite the best medical treatment, the left eye progressed to corneal perforation 5 weeks after presentation. An evisceration with fitted orbital implant was successful in alleviating pain following the surgery. S. mitis is a rare, but possible cause of endogenous endophthalmitis and panophthalmitis. It was important to work with a multidisciplinary and global team to coordinate and offer appropriate treatment measures. Although vision was lost, evisceration of the left eye provided ocular comfort and good cosmetic outcomes for the patient.

Better visual outcome associated with early vitrectomy in the management of endophthalmitis

2021 ◽  
pp. bjophthalmol-2020-316846
Author(s):  
Sarah Welch ◽  
Riyaz Bhikoo ◽  
Nancy Wang ◽  
Martin J Siemerink ◽  
William Shew ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Vision Loss ◽  
Endogenous Endophthalmitis ◽  
Health Board ◽  
Surgical Trauma ◽  
District Health ◽  
Early Vitrectomy ◽  
Younger Age ◽  
Severe Vision Loss ◽  
Culture Positive

AimsTo examine the role of early vitrectomy in the management of endophthalmitis from all causes.MethodsRetrospective study of 290 consecutive subjects diagnosed with endophthalmitis at Auckland District Health Board between 1 January 2006 and 31 July 2019. Main outcome measure was visual acuity at 9-month follow-up and proportion of subjects with severe vision loss (≤20/200).ResultsMedian age at presentation was 70.4 years and 151 subjects (52.1%) were women. Cataract surgery was the most common cause of endophthalmitis in 92 subjects (31.7%) followed by intravitreal injection in 57 (19.7%), endogenous endophthalmitis in 48 subjects (16.6%), non-surgical trauma in 42 subjects (14.5%), glaucoma surgery in 24 subjects (8.3%), vitrectomy in 22 subjects (7.6%) and corneal in 5 subjects (1.7%). Culture was positive in 136 (46.9%) with gram-positive organisms most common (76.5%). Early vitrectomy was performed in 82 subjects (28.3%). Median visual acuity at 9 months was 20/100 (IQR 20/30 to light perception), and severe vision loss occurred in 100 (43.5%). Retinal detachment occurred in 35 eyes (12.1%) and 26 eyes were enucleated. On multivariate analysis, younger age, poor presenting visual acuity and culture-positive endophthalmitis were associated with worse outcomes, and early vitrectomy was associated with better outcomes.ConclusionsEarly vitrectomy (within 24 hours) is associated with better visual outcomes at 9 months, while younger age, poor presenting visual acuity and culture-positive endophthalmitis are associated with poorer visual acuity outcomes.

Intravitreal slow-releasing dexamethasone implant for idiopathic neuroretinitis

2020 ◽  
pp. 112067212095307
Author(s):  
Osman Çekiç ◽  
Samet Gülkaş
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Optic Disc ◽  
Vision Loss ◽  
Dexamethasone Implant ◽  
Optic Disc Edema ◽  
Intravitreal Dexamethasone Implant ◽  
Optic Disc Swelling ◽  
Intravitreal Dexamethasone

Introduction: The purpose of this report is to describe a successful management of idiopathic neuroretinitis with intravitreal dexamethasone implant. Method: Interventional case report. Clinical Case: A 34-year-old man with an acute painless unilateral vision loss, optic disc swelling, and a macular edema was diagnosed as idiopathic neuroretinitis, and he underwent 0.7 mg dexamethasone intravitreous implant injection. Macular edema responded quickly and visual acuity improved from 20/50 to 20/25 within 2 weeks and to 20/20 within a month. One month after the injection, optic disc edema disappeared. No recurrence occurred and visual acuity was stable at 20/20 during 3 years of follow-up. Conclusion: Idiopathic neuroretinitis can be treated with intravitreal dexamethasone implant.

scholarly journals Intravitreal Dexamethasone Implants versus Intravitreal Anti-VEGF Treatment in Treating Patients with Retinal Vein Occlusion: A Meta-analysis

2018 ◽  
Author(s):  
Qian Shi ◽  
Lixiong Gao ◽  
Lijun Zhou ◽  
Chunyu Tian ◽  
Na Li ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Retinal Vein Occlusion ◽  
Macular Oedema ◽  
Vision Loss ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
First Choice ◽  
Intravitreal Dexamethasone

Abstract Background: Retinal vein occlusion (RVO) is a common retinal venous disorder that causes vision loss. No specific therapy has been developed. Controversy exists regarding two treatments: intravitreal dexamethasone implants and anti-vascular endothelial growth factor (VEGF). The goal of this study is to compare the effectiveness and safety of dexamethasone implants and anti-VEGF treatment for RVO. Methods: The PubMed, Embase, and Cochrane Library databases were searched for studies comparing dexamethasone implants with anti-VEGF in patients with RVO. Best-corrected visual acuity (BCVA), central subfield thickness (CST), intraocular pressure changes, conjunctival haemorrhage, reduced VA, and macular oedema were extracted from the final included studies. RevMan 5.3 was used to conduct the quantitative analysis and bias assessment. Results: Four articles assessing 969 eyes were included. The anti-VEGF treatment showed better BCVA improvement (mean difference [MD] = -10.59, P < 0.00001) and more CST decrease (MD = -86.71 μm, P = 0.02) than the dexamethasone implants. However, the dexamethasone implants required fewer injections. As for adverse effects, the dexamethasone implants showed significantly higher intraocular pressure (IOP) and more cataracts than the anti-VEGF treatment. No significant differences were found in conjunctival haemorrhage, reduced VA, and macular oedema. Conclusions: Anti-VEGF treatment showed better functional and anatomical improvement with less risk of IOP elevation and cataract formation compared to dexamethasone implants. Thus, anti-VEGF treatment is the first choice for treating RVO patients. Keywords: dexamethasone intravitreal implant, anti-VEGF treatment, retinal vein occlusion, meta-analysis

A painful red eye in an intravenous drug abuser: When not everything is what it seems

2021 ◽  
pp. 112067212110601
Author(s):  
Mariana Leuzinger-Dias ◽  
Gonçalo Godinho ◽  
Mário Lima-Fontes ◽  
Cláudia Oliveira-Ferreira ◽  
Elisa Camisa ◽  
...  
Keyword(s):  
Vision Loss ◽  
Clinical Signs ◽  
Significant Risk ◽  
Human Leukocyte ◽  
Intravenous Drug ◽  
Endogenous Endophthalmitis ◽  
Ocular Infection ◽  
Injectable Drug ◽  
Red Eye ◽  
History Of

Introduction Endogenous endophthalmitis is a rare but devastating ocular infection, resulting from microbial seeding of the eye during bacteremia or fungemia. Among other sources of septicemia, intravenous drug abuse is a significant risk factor, and endogenous endophthalmitis should always be thought of in any patient with a history of injectable drug use, presenting with a painful vision loss and a red inflamed eye. Case Description We report the case of a 47-year-old male, with a history of injectable drug consumption, who presented to our emergency department complaining of a painful red eye and recent deterioration of visual acuity. After the first clinical hypothesis of endogenous endophthalmitis being considered, the final diagnosis of Human Leukocyte Antigen (HLA) B27-associated acute anterior uveitis was established. Conclusion Ocular inflammation is one of the most challenging fields in all ophthalmology. Several inflammatory disorders, ranging from a wide variety of infectious and non-infectious conditions, can present themselves with the same clinical signs and symptoms, making their diagnosis extremely defiant.

Perioperative Vision Loss after Non-Ocular Surgery

2017 ◽  
Vol 33 (1) ◽  
pp. 17-22 ◽  
Author(s):  
Bart Chwalisz ◽  
Aubrey L. Gilbert ◽  
John W. Gittinger
Keyword(s):  
Vision Loss ◽  
Ocular Surgery

Differences in clinical ocular outcomes between exogenous and endogenous endophthalmitis caused by Sporothrix: a systematic review of published literature

2017 ◽  
Vol 102 (7) ◽  
pp. 977-982 ◽  
Author(s):  
Max Carlos Ramírez Soto
Keyword(s):  
Anterior Uveitis ◽  
Vision Loss ◽  
Case Reports ◽  
Posterior Uveitis ◽  
Endogenous Endophthalmitis ◽  
Data Set ◽  
Patient Groups ◽  
Exogenous Endophthalmitis ◽  
Analyse Data ◽  
Poor Outcomes

BackgroundSporotrichosis is an implantation mycosis caused by Sporothrix species prevalent worldwide, which occasionally can also result in intraocular infection presenting as an exogenous or endogenous infection (disseminated sporotrichosis). Knowledge in its clinical recognition and management is limited.AimsTo systematically review and analyse data from published literature with a view to comparing clinical outcomes between exogenous and endogenous endophthalmitis caused by Sporothrix.MethodsCase reports of intraocular sporotrichosis, published from 1960 to 2016, were retrieved from MEDLINE, Embase, Cochrane, LILACS and SciELO databases. The entire data set was divided into two patient groups: (1) exogenous endophthalmitis and (2) endogenous endophthalmitis. Primary outcomes were differences in ocular findings and clinical ocular outcomes between the two groups.ResultsFrom 16 publications retrieved, a total of 8 eyes of 8 patients with exogenous endophthalmitis and 13 eyes of 10 patients with endogenous endophthalmitis were identified. Compared with exogenous endophthalmitis, endogenous endophthalmitis was more common in patients infected with HIV (p=0.001) and those from hyperendemic areas (p=0.036). Anterior uveitis (p=0.015) and posterior uveitis (p=0.04) were more common in the exogenous and endogenous endophthalmitis groups, respectively. The majority of patients with endogenous endophthalmitis had partial or full clinical resolution of ocular lesions with systemic amphotericin B alone or in combination with an oral antifungal, whereas patients with exogenous endophthalmitis had poor outcomes with irreversible vision loss, enucleation and evisceration.ConclusionsAnterior uveitis is more common in exogenous endophthalmitis with worse overall outcomes and complications, compared with endogenous endophthalmitis where posterior uveitis is the most common clinical manifestation, especially in patients infected with HIV and those from hyperendemic areas. Sporothrix infection should be included in the differential diagnosis for ocular inflammation, regardless of the presence or absence of autoimmune comorbidities and whether the patient resides in an endemic area or not. Ophthalmologists should consider intravitreal and systemic antifungal therapy for exogenous and endogenous endophthalmitis caused by Sporothrix.

The first case of fungal endogenous endophthalmitis caused by Aspergillus nidulans: Diagnostic and therapeutic challenge

2020 ◽  
pp. 112067212093208
Author(s):  
Lucia Mata-Moret ◽  
Clara Monferrer-Adsuara ◽  
Laura Hernández-Bel ◽  
Marisa Hernández-Garfella ◽  
Miriam Torrecillas-Muelas ◽  
...  
Keyword(s):  
Vision Loss ◽  
Visual Outcome ◽  
Endogenous Endophthalmitis ◽  
Pcr Analysis ◽  
Causative Organism ◽  
Systemic Corticosteroids ◽  
First Case ◽  
Dismal Prognosis ◽  
History Of ◽  
High Index Of Suspicion

Significance: Fungal endogenous endophthalmitis is an uncommon and potentially blinding infection. Aspergillus is a causative organism in immunocompromized although is virulent enough to afflict immunocompetents. Their propensity to affect macula usually results in a dismal prognosis; thus, improving visual outcome has always been challenging to clinicians. A. nidulans has only rarely been implicated in exogenous endophthalmitis. Purpose: To report the first case of A. nidulans endogenous endophthalmitis. Case report: An asthmatic 42-year-old female presented with sudden unilateral vision loss due to a submacular abscess that progressively worsened in a matter of days. Vitreous PCR analysis after an urgent vitrectomy was positive for A. nidulans with no active systemic foci found. Oral and intravitreal Voriconazole was prescribed but multiple reactivations led to three vitrectomies in total alongside with subretinal Voriconazole, abscess aspiration, and endolaser. There was complete resolution of the infection and, although visual acuity was poor due to macular scar, enucleation was avoided. Conclusion: Although uncommon, we must consider Aspergillus as the causative organism in apparently immunocompetent patients with history of recent systemic corticosteroids treatment, especially if they suffer a broncopulmonary disorder. Aspergillus is an aggressive organism so a high index of suspicion along with early diagnosis and prompt treatment is the key for better outcomes. We highlight A. nidulans as the causative agent as there are no other reported cases.

scholarly journals Intravitreal Dexamethasone Implants versus Intravitreal Anti-VEGF Treatment in Treating Patients with Retinal Vein Occlusion: A Meta-analysis

2018 ◽  
Author(s):  
Qian Shi ◽  
Lixiong Gao ◽  
Lijun Zhou ◽  
Chunyu Tian ◽  
Na Li ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Retinal Vein Occlusion ◽  
Macular Oedema ◽  
Vision Loss ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
First Choice ◽  
Intravitreal Dexamethasone

Abstract Background: Retinal vein occlusion (RVO) is a common retinal venous disorder that causes vision loss. No specific therapy has been developed. Controversy exists regarding two treatments: intravitreal dexamethasone implants and anti-vascular endothelial growth factor (VEGF). The goal of this study is to compare the effectiveness and safety of dexamethasone implants and anti-VEGF treatment for RVO. Methods: The PubMed, Embase, and Cochrane Library databases were searched for studies comparing dexamethasone implants with anti-VEGF in patients with RVO. Best-corrected visual acuity (BCVA), central subfield thickness (CST), intraocular pressure changes, conjunctival haemorrhage, reduced VA, and macular oedema were extracted from the final included studies. RevMan 5.3 was used to conduct the quantitative analysis and bias assessment. Results: Four articles assessing 969 eyes were included. The anti-VEGF treatment showed better BCVA improvement (mean difference [MD] = -10.59, P < 0.00001) and more CST decrease (MD = -86.71 μm, P = 0.02) than the dexamethasone implants. However, the dexamethasone implants required fewer injections. As for adverse effects, the dexamethasone implants showed significantly higher intraocular pressure (IOP) and more cataracts than the anti-VEGF treatment. No significant differences were found in conjunctival haemorrhage, reduced VA, and macular oedema. Conclusions: Anti-VEGF treatment showed better functional and anatomical improvement with less risk of IOP elevation and cataract formation compared to dexamethasone implants. Thus, anti-VEGF treatment is the first choice for treating RVO patients. Keywords: dexamethasone intravitreal implant, anti-VEGF treatment, retinal vein occlusion, meta-analysis

Multimodal imaging of two cases of retinal vein occlusion secondary to Waldenstrom macroglobulinemia

2021 ◽  
pp. 112067212199138
Author(s):  
Lidia Remolí Sargues ◽  
Javier Montero Hernández ◽  
Catalina Navarro Palop ◽  
Clara Monferrer Adsuara ◽  
Verónica Castro Navarro ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Retinal Vein Occlusion ◽  
Multimodal Imaging ◽  
Vision Loss ◽  
Optical Coherence ◽  
Waldenström Macroglobulinemia ◽  
Vein Occlusion ◽  
Waldenstrom Macroglobulinemia ◽  
Intravitreal Dexamethasone ◽  
Intraretinal Hemorrhages

Purpose: To report multimodal imaging characteristics of two cases of retinal vein occlusion (RVO) secondary to Waldenstrom macroglobulinemia (WM). Case report: Case 1: An 82-year-old woman presented with vision loss. She had a history of WM. Best-corrected visual acuity (BCVA) was 20/100 Snellen equivalent in the right eye (OD) and 20/63 in the left eye (OS). Fundoscopy showed bilateral hemorrhages in posterior pole and along superotemporal arcade. Fluorescein angiography illustrated no macular leakage. Optical coherence tomography (OCT) revealed macular edema (ME). Optical coherence tomography angiography (OCTA) demonstrated abnormalities in choriocapillaris. A diagnosis of bilateral branch RVO was made and ME was treated with intravitreal dexamethasone, achieving stability. Case 2: A 65-year-old man presented with venous dilation, tortuosity, and intraretinal hemorrhages. BCVA was 20/20 in both eyes (OU). OCT showed ME and hyperreflective dots in choroid. A diagnosis of bilateral central RVO was made. Laboratory evaluation and bone narrow biopsy confirmed a diagnosis of WM. After that, our patient consulted because of vision loss. BCVA was 20/400 in OU. Fundoscopy and OCT demonstrated a worsening of the intraretinal hemorrhages and the ME. OCTA showed damage of choriocapillaris. Thus, intravitreal dexamethasone and plasmapheresis was advised. Two months after, BCVA was 20/40 in the OD and 20/32 in the OS. Also, fundoscopy and OCT improved. Conclusion: Early treatment of WM is truly important, with the aim of achieving a decrease in IgM levels in order to avoid toxic effect over the RPE that results in refractory ME.

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