A Prospective Study on the Clinical and Microbiological Spectrum of Endophthalmitis in a Specific Region in Denmark

Purpose: To study the clinical and microbiological spectrum of endophthalmitis with emphasis on clinical features, visual outcomes and risks of surgical complications. Methods: A prospective observational study was conducted between 2012 and 2013 in a specific region in Denmark. Patients were clinically examined before, during and after surgical intervention for endophthalmitis. Results: Fifty eyes with endophthalmitis were included. Endophthalmitis after cataract surgery (post-cataract), anti-VEGF (vascular endothelial growth factor) intravitreal injections (post-injection) and cases of endogenous endophthalmitis were responsible for 40, 28 and 18% of all cases, respectively. There was no difference in the microbiological spectrum in post-cataract patients and post-injection patients, but patients with post-cataract endophthalmitis presented statistically significantly more frequently with hypopyon and fibrin in the anterior chamber. Between 20 and 25% of post-cataract and post-injection endophthalmitis patients developed a surgical complication after primary surgical intervention for endophthalmitis, and this was statistically significantly associated with a poor visual outcome. There was no statistically significant difference in the risk of surgical complications in phakic and pseudophakic eyes with post-injection endophthalmitis. Of the 8 patients with endogenous endophthalmitis, 67% developed a surgical complication, and these patients had a high mortality. The visual outcome in the most common types of endophthalmitis was good, with 60% of post-cataract patients achieving a visual outcome ≥0.5, and 64% of post-injection patients only had a mild vision loss (1-14 ETDRS letters) or even gained vision. Conclusions: The endophthalmitis cases had a broad clinical spectrum. Surprisingly, endogenous endophthalmitis accounted for almost one fifth of all cases. Patients with post-cataract endophthalmitis had a clinically different presentation than patients with post-injection endophthalmitis. In general, the bacteria were low-virulent and the visual outcomes good, but a substantial part of the patients developed a surgical complication which was associated with a poor visual outcome.

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Small-gauge vitrectomy for advanced diabetic eye disease: outcomes and predictive factors for poor postoperative vision

Malaysian Journal of Ophthalmology ◽

10.35119/myjo.v2i3.114 ◽

2020 ◽

Vol 2 (3) ◽

pp. 177-189

Author(s):

Mushawiahti Mustapha ◽

Tan Chim Yoong ◽

Tevanthiran A/L Gobal ◽

Win Inn Chong ◽

Tengku Nadhirah Tengku Zulkeplee ◽

...

Keyword(s):

Predictive Factors ◽

Demographic Data ◽

Visual Outcome ◽

Visual Outcomes ◽

Poor Visual Outcome ◽

Post Surgery ◽

Diabetic Eye Disease ◽

Small Gauge ◽

Anatomical Outcomes

Objective: To evaluate the anatomical and visual outcomes of small-gauge vitrectomy in patients with advance diabetic eye diseases (ADED) and the predictive factors for poor visual outcome. Materials and methods: A retrospective study was conducted from 2009 to 2014. Data at baseline, 6 months, and 12 months post-surgery were collected along with baseline demographic data, indications of surgery, systemic associations, visual and anatomical outcome, and postoperative complications. Poor visual outcomewas defined as visual acuity worse than 6/36. Results: A total of 158 eyes from 133 patients were recruited. Mean age was 54.01 ± 11.57 years and mean follow-up was 9.9 ± 3.7 months. Indications for vitrectomy were vitreous haemorrhage (VH, 77 eyes [48.7%]), tractional retinal detachment (TRD) with macular involvement (75 eyes [47.5%]), and other causes in 6 eyes (3.8%). There was visual improvement in 59.3% of patients, 23.6% worsened, and 17.1% stabilized at 12 months post-surgery. Patients with VH (75.4%) showed significant improvement compared to patients with TRD (48.3%). Successful anatomical outcomes were achieved in VH (98.2%) and TRD (96.7%). However, patients with TRD were found to have a 2.4-fold higher risk of having poor visual outcomes. Conclusion: Small-gauge vitrectomy for ADED resulted in excellent visual and anatomical outcomes. Eyes with TRD were at a higher risk of developing poor visual outcomes.

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PRO score: predictive scoring system for visual outcomes after rhegmatogenous retinal detachment repair

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2021-320440 ◽

2021 ◽

pp. bjophthalmol-2021-320440

Author(s):

Louis Z Cai ◽

Jeffrey Lin ◽

Matthew R Starr ◽

Anthony Obeid ◽

Edwin H Ryan ◽

...

Keyword(s):

Risk Factors ◽

Retinal Detachment ◽

Scoring System ◽

Rhegmatogenous Retinal Detachment ◽

Vision Loss ◽

Visual Outcome ◽

Visual Outcomes ◽

Poor Visual Outcome ◽

History Of ◽

Endothelial Growth Factor

Background/aimsTo compare risk factors for poor visual outcomes in patients undergoing primary rhegmatogenous retinal detachment (RRD) repair and to develop a scoring system.MethodsAnalysis of the Primary Retinal detachment Outcomes (PRO) study, a multicentre interventional cohort of consecutive primary RRD surgeries performed in 2015. The main outcome measure was a poor visual outcome (Snellen VA ≤20/200).ResultsA total of 1178 cases were included. The mean preoperative and postoperative logMARs were 1.1±1.1 (20/250) and 0.5±0.7 (20/63), respectively. Multivariable logistic regression identified preoperative risk factors predictive of poor visual outcomes (≤20/200), including proliferative vitreoretinopathy (PVR) (OR 1.26; 95% CI 1.13 to 1.40), history of antivascular endothelial growth factor (VEGF) injections (1.38; 1.11 to 1.71), >1-week vision loss (1.17; 1.08 to 1.27), ocular comorbidities (1.18; 1.00 to 1.38), poor presenting VA (1.06 per initial logMAR unit; 1.02 to 1.10) and age >70 (1.13; 1.04 to 1.23). The data were split into training (75%) and validation (25%) and a scoring system was developed and validated. The risk for poor visual outcomes was 8% with a total score of 0, 17% with 1, 29% with 2, 47% with 3, and 71% with 4 or higher.ConclusionsIndependent risk factors were compared for poor visual outcomes after RRD surgery, which included PVR, anti-VEGF injections, vision loss >1 week, ocular comorbidities, presenting VA and older age. The PRO score was developed to provide a scoring system that may be useful in clinical practice.

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Long-Term Visual Outcomes in Children with Primary Congenital Glaucoma

European Journal of Ophthalmology ◽

10.5301/ejo.5000976 ◽

2017 ◽

Vol 27 (6) ◽

pp. 705-710 ◽

Cited By ~ 8

Author(s):

Sanaa A. Yassin

Keyword(s):

Visual Impairment ◽

Visual Outcome ◽

Glaucoma Surgery ◽

Congenital Glaucoma ◽

Primary Congenital Glaucoma ◽

Visual Outcomes ◽

Antiglaucoma Medication ◽

Poor Visual Outcome ◽

The Mean

Purpose To determine the long-term visual outcomes and risk factors for visual loss in children with primary congenital glaucoma (PCG) who underwent angle surgery over a 21-year period. Methods This was a retrospective study of patients who underwent trabeculotomy, trabeculectomy, or combined trabeculotomy-trabeculectomy for PCG. Visual acuity (VA), surgeries, and underlying cause of visual impairment were recorded and compared. Main outcome measures were final best-corrected good VA (20/20 to 20/50), moderate VA (<20/50 to 20/200), or poor VA (<20/200); age at surgery, sex, laterality, type of initial glaucoma surgery, and number of surgeries were recorded. Results Fifty-three eyes were eligible to be included in the study. The mean logMAR VA was 0.61 ± 0.57. A good VA was attained in 51%, moderate VA in 30%, and poor VA in 19%. The main cause of visual impairment with VA <20/50 was deprivation amblyopia (64%). There was no association between VA level and status of success (controlled with or without medications) (p = 0.202). The mean spherical equivalent of refraction was -4.47 ± 5.66; myopia was the predominant refractive error (74%) and astigmatism >2 D (40%). A statistically significant high myopic shift was more frequent in the visually impaired group. None of the studied factors was statistically associated with moderate to poor visual outcome (all p>0.05). Conclusions A favorable VA outcome was achieved. Topical antiglaucoma medication has an adjuvant role in maintaining the success rate of surgery without risking the visual outcome. Corneal opacification and anisometropia were the cause of amblyopia.

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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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Optical Coherence Tomographic Features and Prognostic Values of Macular Edema in Vogt-Koyanagi-Harada Disease

Frontiers in Medicine ◽

10.3389/fmed.2021.772439 ◽

2022 ◽

Vol 8 ◽

Author(s):

Peng Qin ◽

Zi Ye ◽

Guannan Su ◽

Aize Kijlstra ◽

Peizeng Yang

Keyword(s):

Macular Edema ◽

Case Series ◽

Visual Outcome ◽

Intraocular Inflammation ◽

Optical Coherence ◽

Retrospective Case ◽

Visual Outcomes ◽

Treatment Regimens ◽

Poor Visual Outcome

Purpose: To determine optical coherence tomographic (OCT) features of macular edema (ME) and identify potential prognostic values for ME and visual outcomes in Vogt-Koyanagi-Harada disease (VKH).Methods: In the retrospective case series, a total of 1,377 VKH patients who were seen in a tertiary uveitis center between September 2011 and January 2018 were reviewed on their demographics, visual acuity, ocular and extraocular manifestations, modes of treatment, and OCT examinations. Of these patients, 79 (5.7%) having ME were included for analysis of OCT features. Four patients were missed without ME resolution, and the remaining 75 patients who either had ME resolved or were followed up for 2 years were included for analysis of disease outcomes.Results: Of the 115 affected eyes in these 79 patients, 100 (87.0%) had cystoid ME (CME), accounting for the most common OCT feature of VKH-related ME. Disruption of the inner-segment/outer-segment junction (IS/OS) band seen in 33 (28.7%) affected eyes of 24 (30.4%) patients was found as a risk factor for the development of persistent ME [10 of 62 (16.1%) vs. 13 of 13 (100%); P < 0.001] and a poor visual outcome (1.16 ± 0.42 vs. 1.17 ± 0.46 in logMAR unit; P = 0.89). CME patients with a concurrent choroidal neovascular membrane often had a disrupted IS/OS band, thus becoming refractory cases. A 6-month well-controlled intraocular inflammation following standard treatment regimens was found to associate with complete resolution of the refractory edema [4 of 5 (80%) vs. 2 of 13 (15%); P = 0.02].Conclusions: Intraretinal cystoid changes are most commonly seen in the edematous macula of VKH patients. Disruption of the IS/OS band is a useful risk sign for poor ME and visual outcomes in VKH-related ME, and a long-term well-controlled intraocular inflammation may be critical for the resolution of refractory cases.

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Microsurgical Transcranial Approach of 112 Paraoptic Meningiomas: A Single-Center Case Series

Operative Neurosurgery ◽

10.1093/ons/opaa207 ◽

2020 ◽

Cited By ~ 1

Author(s):

Etienne Lefevre ◽

Louis-Marie Terrier ◽

Olivier Bekaert ◽

Adrien Simonneau ◽

Alister Rogers ◽

...

Keyword(s):

Strong Predictor ◽

Case Series ◽

Visual Outcome ◽

Compressive Optic Neuropathy ◽

Visual Outcomes ◽

Poor Visual Outcome ◽

Visual Deficit ◽

Transcranial Approach ◽

Tuberculum Sellae ◽

A Prospective Study

Abstract BACKGROUND Predictors of visual outcomes after optic nerve decompression are controversial. OBJECTIVE To identify the predictors of poor visual outcomes after surgery of meningiomas responsible of a compressive optic neuropathy. METHODS We focused on paraoptic meningiomas (POMs), which gathered tuberculum sellae meningiomas (TSMs) and anterior clinoid meningiomas (ACMs) responsible for visual impairment or threatening visual function, that underwent surgery at our institution between January 2009 and December 2015 and analyzed the clinical and radiological findings of our patients. RESULTS Among 112 patients who underwent surgery for a POM, a preoperative visual deficit was present in 108 patients (96.4%). Six months after surgery, 79 patients (70.5%) had a visual improvement, 15 patients (13.4%) had an unchanged vision, and 18 patients (16.1%) had deteriorated vision. A preoperative visual deficit of 6 mo or more was a strong predictor of poor visual outcome after surgery (P = .034). Poor visual outcome after surgery was not significantly related to the size of the tumor (P = .057), the age of the patient (P = .94), or the tumor extension into the optic canal (P = .47). CONCLUSION The duration of preoperative visual deficit was found to be a strong predictor of poor visual outcomes after surgery in POMs Other predictors of poor visual outcomes are still needed and are currently under evaluation in a prospective study at our institution.

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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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Clinical and microbiological characteristics of Moraxella keratitis

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313557 ◽

2019 ◽

pp. bjophthalmol-2018-313557 ◽

Cited By ~ 1

Author(s):

Terence Joseph McSwiney ◽

Susan J Knowles ◽

Conor C Murphy

Keyword(s):

Risk Factors ◽

Clinical Features ◽

Surgical Intervention ◽

Visual Outcome ◽

Single Centre ◽

Ocular Surgery ◽

Maldi Tof ◽

Poor Visual Outcome ◽

Microbiological Characteristics ◽

Mean Time

Background/aimsTo describe the risk factors, clinical features, bacterial subspecies characteristics and treatment outcomes of Moraxella keratitis in a single centre.MethodsA retrospective review of all patients diagnosed with Moraxella keratitis between November 2012 and December 2017 at the Royal Victoria Eye and Ear Hospital, Dublin, Ireland was performed. Matrix-assisted laser desorption ionisation time-of-flight (MALDI-TOF) mass spectrometry was used to identify Moraxella subspecies.ResultsForty-one cases of Moraxella keratitis were identified. Previous ocular surgery and diabetes were the most common local and systemic risk factors. The most common appearance on presentation was an oval-shaped paracentral infiltrate with a mean diameter of 4.2 mm. Mean presenting and final logarithm of minimal angle of resolution visual acuity were 1.307±0.74 and 0.99±1.01, respectively. Surgical procedures, including penetrating keratoplasty, corneal glueing or evisceration, were required to manage nine (22%) patients. Mean time to complete corneal epithelialisation was 32 (range, 7–109) days and mean duration of topical antibiotic therapy was 54 (range, 9–124) days. MALDI-TOF analysis revealed the following Moraxella subspecies: nonliquifaciens (16; 39%), lacunata (15; 36%), osloensis (4; 10%) and catarrhalis (2; 5%). In four cases (10%), subspecies analysis was inconclusive. M.nonliquifaciens and M. lacunata were associated with larger infiltrates on presentation (p<0.05), required more surgical intervention and longer treatment duration (p<0.001).ConclusionIn this large series of patients from Ireland, Moraxella keratitis was notable for its severity on presentation, slow response to antimicrobial therapy, high risk of surgical intervention and poor visual outcome. We have demonstrated the value of subspecies identification using MALDI-TOF by reporting significant differences in the clinical features and prognosis of M. nonliquifaciens and M. lacunata compared with other subspecies.

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