Risk Factors for Post-Traumatic Endophthalmitis in Patients with Positive Intraocular Cultures

2007 ◽  
Vol 17 (4) ◽  
pp. 642-647 ◽  
Author(s):  
A. Gupta ◽  
R. Srinivasan ◽  
D. Gulnar ◽  
K. Sankar ◽  
T. Mahalakshmi
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Primary Repair ◽  
Final Visual Acuity ◽  
Time Interval ◽  
Fisher Exact Test ◽  
Open Globe ◽  
Post Traumatic ◽  
Group 2 ◽  
Clinically Significant

Purpose To determine the risk factors for post-traumatic endophthalmitis in patients with positive intraocular culture. Methods An institutional-based prospective nonrandomized interventional study of patients older than 15 years who presented for primary repair of open globe injury between June 2003 and April 2005 was undertaken. The main outcomes measured were initial and final visual acuity, type of injury, presence of uveal and vitreous prolapse, time interval between injury and primary repair of the globe, length of wound, location of wound, and virulence of organism. Statistical analysis tests used were Student t-test, Fisher exact test, and chi-square test. Results Fifty patients were included in the study. They were divided into two groups: Group 1 (n=19) patients, who developed clinically significant endophthalmitis; and Group 2 (n=31) patients, who did not develop clinically significant endophthalmitis. Delay in primary repair more than 36 hours (p=0.042), length of wound more than 8 mm (p=0.050), and isolation of organisms like fungus (p=0.006, OR=14), Bacillus cereus (p=0.01, OR=11.25), and Pseudomonas aeruginosa (p=0.05–0.10, OR=11.3) significantly increased the risk of endophthalmitis. Mean initial and final visual acuity was better in Group 2 but was not statistically significant (p=0.21). Conclusions Final visual outcome in the presence of positive intraocular culture is poor. Isolation of virulent organisms, longer length of laceration, and delayed primary repair of open globe injuries have high risk of developing endophthalmitis. Prophylactic intraocular antibiotics should be considered in cases with longer length of wound and delayed primary closure.

scholarly journals An Important Cause of Blindness in Children: Open Globe Injuries

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Meral Yildiz ◽  
Sertaç Argun Kıvanç ◽  
Berna Akova-Budak ◽  
Ahmet Tuncer Ozmen ◽  
Sadık Gorkem Çevik
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Visual Impairment ◽  
Primary Repair ◽  
Final Visual Acuity ◽  
Who Criteria ◽  
Open Globe ◽  
The Mean ◽  
And Gender ◽  
Open Globe Injuries

Objective. Our aim was to present and evaluate the predictive factors of visual impairment and blindness according to WHO criteria in pediatric open globe injuries.Methods. The medical records of 94 patients younger than 18 years who underwent primary repair surgery were reviewed retrospectively. The initial and final visual acuity, anterior and posterior segment findings, and zone of injury were noted. The patients were classified as blindness in one eye or visual impairment in one eye.Results. Of 412 patients who presented with open globe injury, 94 (23%) were under 18 years old. Fifty-four (16 females, 38 males) children were included. The mean age of the children was 7.1 ± 4.1 years. According to WHO criteria, 19 of 54 patients (35%) had unilateral blindness and 8 had unilateral visual impairment (15%). There was no significant relationship between final visual acuity and gender and injured eye. In visually impaired and blind patients, presence of preoperative hyphema, retinal detachment, and zone 2 and zone 3 injuries was significantly higher.Conclusion. Presence of hyphema and zone 2 and zone 3 injuries and retinal detachment may end up with visual impairment and/or blindness in children.

scholarly journals Effect of time to primary repair on final visual outcome after open globe injury

2019 ◽  
Vol 103 (10) ◽  
pp. 1491-1494 ◽  
Author(s):  
Richard J Blanch ◽  
Jonathan Bishop ◽  
Hedayat Javidi ◽  
Philip Ian Murray
Keyword(s):  
Visual Acuity ◽  
Primary Repair ◽  
Demographic Data ◽  
Case Series ◽  
Visual Outcome ◽  
Final Visual Acuity ◽  
Visual Outcomes ◽  
Open Globe ◽  
Final Visual Outcome ◽  
Open Globe Injuries

Background/AimHistoric data suggest that open globe injuries should be repaired within 12–24 hours to reduce the risk of endophthalmitis. However, endophthalmitis is uncommon when systemic antibiotic prophylaxis is given. It is not clear whether delayed primary repair impacts visual outcomes in other ways or what is the optimum time to repair. We aimed to examine the effect of time to primary repair on visual outcomes.MethodsThis is a retrospective comparative case series including all open globe injuries presenting to the Birmingham Midland Eye Centre between 1 January 2014 and 15 March 2016. Presenting features, mechanism of injury, visual acuity at 6–12 months and demographic data were examined.Results56 open globe injuries were repaired, of which sufficient data for analysis were available on 52 cases. The mean time to primary repair was 1 day after injury (range 5 hours to 7 days). Final visual acuity at 6–12 months was related to the presenting visual acuity and the Ocular Trauma Score and to the time between injury and primary repair, with a reduction in predicted visual acuity of logarithm of the minimum angle of resolution of 0.37 for every 24 hours of delay (95% CI 0.14 to 0.6).DiscussionOpen globe injuries should be repaired promptly. Presenting visual acuity remains the strongest predictor of outcome; however, delay to primary repair also reduced final visual acuity, and any significant delay from injury to repair is likely to negatively impact final visual outcome.

scholarly journals The Impact of Primary Treatment on Post-Traumatic Endophthalmitis in Children with Open Globe Injuries: A Study in China

2019 ◽  
Vol 16 (16) ◽  
pp. 2956 ◽  
Author(s):  
Lingling Zheng ◽  
Junlian Tan ◽  
Rongjiao Liu ◽  
Xueru Yang ◽  
Huiling He ◽  
...  
Keyword(s):  
Rural Areas ◽  
Primary Repair ◽  
Univariate Analysis ◽  
Primary Treatment ◽  
Delayed Treatment ◽  
Left Behind ◽  
Open Globe ◽  
Post Traumatic ◽  
The Impact ◽  
Open Globe Injuries

Post-traumatic endophthalmitis (PTE) is considered as one of the most serious complications after open globe injuries (OGIs), especially in children. Poor prognosis of this disease can lead to a variety of socioeconomic problems. This study aimed to investigate the clinical characteristics of pediatric OGIs and the factors associated with the development of PTE in China. 131 patients under 14 years old and needed hospitalization for management of OGIs were enrolled. There were 90 males and 41 females. 44 patients were left-behind children, the majority were 3–6 years old (n = 71, 71/131, 54.2%) and living in rural area (n = 106, 106/131, 80.9%). After injury, 82 patients received primary repair within 24 h, with the remaining 49 patients receiving primary repair after 24 h. Eventually, there were 28 (28/131, 21.4%) patients presented with PTE. In those 49 patients, the frequency of PTE achieving 32.7% (16/49). Univariate analysis showed that the timing of primary repair is significantly associated with the development of PTE (p < 0.05). Moreover, left-behind children took higher risks in having delayed treatment that over 24 h after OGIs (OR = 2.466, 95% CI: 1.16–5.26). Reducing the time before primary repair is a useful strategy to prevent the development of PTE. Special supervision is needed for pre-school-aged boys living in rural areas, especially for left-behind children.

scholarly journals Six-year epidemiological analysis of post traumatic endophthalmitis in a Brazilian hospital

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Luis Filipe Nakayama ◽  
Vinicius Campos Bergamo ◽  
Nilva Simeren Bueno de Moraes
Keyword(s):  
Visual Acuity ◽  
Foreign Body ◽  
Penetrating Trauma ◽  
Onset Time ◽  
Intraocular Foreign Body ◽  
Time Interval ◽  
Light Perception ◽  
Initial Visual Acuity ◽  
Open Globe ◽  
Better Than

Abstract Background To evaluate the epidemiology of endophthalmitis cases related to ocular trauma, including visual acuity during and 1 year after trauma, source of trauma and method of treatment. Methods A retrospective study analyzed the epidemiological data of patients with a clinical presentation of endophthalmitis after ocular penetrating trauma between January 2012 and January 2017 at Escola Paulista de Medicina/UNIFESP, a hospital in São Paulo, SP, Brazil. Results A total of 453 patients with antecedent open globe trauma were evaluated, among these, 30 patients with suspected endophthalmitis. All patients were male. The time interval between trauma and ophthalmological evaluation and collection of vitreous and aqueous material was 1 day in 36.66%, 2–7 days in 43.44%, 7–14 days in 10% and more than 15 days in 10% of patients; 66.66% had positive cultures. 11 patients had intraocular foreign body. One year after trauma, visual acuity was classified as no light perception (NLP) in 33.33%, light perception in 6.66%, hand motion in 13.33%, counting fingers in 13.33%, and better than 20/400 in 20% of patients. Considering presence of intraocular foreign body, initial visual acuity and symptoms onset time, only initial visual acuity showed as better prognostic factor in final visual acuity. Conclusion Endophthalmitis is a severe ocular inflammatory condition that may lead to irreversible vision loss. Initially only one patient had visual acuity of NLP, but after 1 year, 33% showed visual acuity of NLP, and only 20% had visual acuity better than 20/400, what is consistent with a severe infection with a guarded prognosis. The high incidence of endophthalmitis after ocular penetrant trauma justifies distinct treatment and greater attention.

scholarly journals A Possible Regression Equation for Predicting Visual Outcomes after Surgical Repair of Open Globe Injuries

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Huseyin Gursoy ◽  
Mustafa Deger Bilgec ◽  
Afsun Sahin ◽  
Ertugrul Colak
Keyword(s):  
Primary Repair ◽  
Linear Regression Analysis ◽  
Anterior Segment ◽  
Penetrating Injury ◽  
Time Interval ◽  
Visual Outcomes ◽  
Primary Surgery ◽  
Open Globe ◽  
Trauma Score ◽  
Open Globe Injuries

Background. To analyze the effects of factors other than the ocular trauma score parameters on visual outcomes in open globe injuries.Methods. Open globe injuries primarily repaired in our hospital were reviewed. The number of surgeries, performance of pars plana vitrectomy (PPV), lens status, affected tissues (corneal, scleral, or corneoscleral), intravitreal hemorrhage, intraocular foreign body, glaucoma, anterior segment inflammation, loss of iris tissue, cutting of any prolapsed vitreous in the primary surgery, penetrating injury, and the time interval between the trauma and repair were the thirteen variables evaluated using linear regression analysis.Results. In total, 131 eyes with a mean follow-up of16.1±4.7(12–36) months and a mean age of33.8±22.2(4–88) years were included. The regression coefficients were 0.502, 0.960, 0.831, −0.385, and −0.506 for the performance of PPV, aphakia after the initial trauma, loss of iris tissue, penetrating injury, and cutting of any prolapsed vitreous in the primary surgery, respectively (P<0.05for these variables).Conclusions. The performance of PPV, aphakia after the initial trauma, and loss of iris tissue were associated with poor visual outcomes, whereas cutting any prolapsed vitreous in the primary repair and penetrating-type injury were associated with better visual outcomes.

scholarly journals Prognostic Factors and Epidemiology of Open Globe Injuries from Western Sydney: A Twelve-Year Review

2021 ◽  
Author(s):  
Haochi Ho ◽  
Jane Foo ◽  
Yi-Chiao Li ◽  
Samantha Bobba ◽  
Christopher Go ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Prognostic Factors ◽  
Retinal Detachment ◽  
Case Series ◽  
Final Visual Acuity ◽  
Ocular Injury ◽  
Visual Outcomes ◽  
Globe Rupture ◽  
Open Globe ◽  
Open Globe Injuries

Abstract BackgroundTo identify prognostic factors determining final visual outcome following open globe injuries.MethodsRetrospective case series of patients presenting to Westmead Hospital, Sydney, Australia with open globe injuries from 1st January 2005 to 31st December 2017. Data collected included demographic information, ocular injury details, management and initial and final visual acuities.ResultsA total of 104 cases were identified. Predictors of poor final visual outcomes included poor presenting visual acuity (p < 0.001), globe rupture (p < 0.001), retinal detachment (p < 0.001), Zone III wounds (p < 0.001), hyphema (p=0.003), lens expulsion (p = 0.003) and vitreous hemorrhage (p < 0.001). Multivariate analysis demonstrated presenting visual acuity (p < 0.001), globe rupture (p = 0.013) and retinal detachment (p = 0.011) as being statistically significant for predicting poor visual outcomes. The presence of lid laceration (p = 0.197) and uveal prolapse (p = 0.667) were not significantly associated with the final visual acuity. ConclusionsPoor presenting visual acuity, globe rupture and retinal detachment are the most important prognostic factors determining final visual acuity following open globe injury.

scholarly journals Bungee cord related ocular trauma: An avoidable cause of ocular morbidity

2021 ◽  
Vol 11 (2) ◽  
pp. 297-300
Author(s):  
Nazia Imam ◽  
Mobashir Sarfraz Ali ◽  
Bibhuti Prassan Sinha ◽  
Gyan Bhaskar ◽  
Rakhi Kusumesh
Keyword(s):  
Visual Acuity ◽  
Clinical Features ◽  
Medical Records ◽  
Tertiary Care ◽  
Final Visual Acuity ◽  
Ocular Injury ◽  
Age Group ◽  
Mechanism Of Injury ◽  
Open Globe Injury ◽  
Open Globe

To study the mechanism and clinical features of ocular injury and its outcome associated with bungee cord related eye trauma. A retrospective review of medical records was performed at our tertiary care centre to identify patients presented with bungee cord related eye injury between March 2016 to February 2017. Data collected from medical records were age, sex, mechanism of injury, clinical features, therapeutic intervention, presenting visual acuity, final visual acuity and length of follow up. Total of thirteen patients with bungee cord related trauma were identified. Ten (77%) patients presented with closed globe injury and 3(23%) presented with open globe injury. All patients were male with mean age group of 30.15±7.38 years. Presenting visual acuity ranges from 6/12 to NPL. Only seven (54%) of patients were having final visual acuity of better than or equal to 6/18 in injured eye. Three patients (23.1%) with open globe injury had final visual acuity of counting fingers or worse. Main mechanism of injury being combination of blunt and high speed projectile injury due to slippage of metal or plastic hook while the cord is stretched. Trauma with bungee cord is usually affecting working age group male with injury resulting in loss of workable vision to loss of eye hence there is need of appropriate intervention like use of printed warning on package and modification of hook design to decrease the incidence of bungee cord related trauma.

Reductions in final visual acuity occur even within the first 3 days after a macula-off retinal detachment

2018 ◽  
Vol 103 (10) ◽  
pp. 1503-1506 ◽  
Author(s):  
Margaret A Greven ◽  
Theodore Leng ◽  
Ruwan Amila Silva ◽  
Loh-Shan Bryan Leung ◽  
Peter A Karth ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Outcome Measure ◽  
University Hospital ◽  
Final Visual Acuity ◽  
Minimum Angle ◽  
Group 2 ◽  
Post Hoc ◽  
Group 1

PurposeTo determine if final visual acuity (VA) is affected by duration of macular detachment (DMD) within the first week of macula-off retinal detachment (RD).MethodsThis is a retrospective study of eyes that underwent repair within 7 days with vitrectomy or vitrectomy with scleral buckle for macula-off RD at Stanford University Hospital between 1 May 2007 and 1 May 2017. A generalised linear model was constructed using DMD, postoperative lens status, preoperative VA, patient age and surgeon as the independent variables and the final VA as the dependent variable. The main outcome measure was the final VA.ResultsSeventy-nine eyes met the entry criteria. Group 1 included 52 eyes with RD repaired within 3 days of DMD, and group 2 included 27 eyes repaired between 4 and 7 days of DMD. The average final VA in group 1 eyes was logarithm of the minimum angle of resolution (logMAR) 0.21 (Snellen 20/33) and in group 2 eyes was logMAR 0.54 (Snellen 20/69). In group 1 and group 2 eyes, preoperative VA (p=0.017and p=0.007), DMD (p=0.004 and p=0.041) and final lens status (p<0.0001 and p<0.001) predicted postoperative VA. Post-hoc analysis showed significant differences in final VA between detachments of 1day vs 3 days (p=0.0009).ConclusionDMD affects the final VA even among patients whose DMD is <3 days. Based on these results, interventions that shorten DMD, including those occurring within the first 3days, may result in improved long-term VA outcomes.

Adjuvant use of laser in eyes with macular retinoblastoma treated with primary intravenous chemotherapy

2020 ◽  
pp. bjophthalmol-2020-316862
Author(s):  
Andrew W Stacey ◽  
Mai Tsukikawa ◽  
Ido Didi Fabian ◽  
Sarah Turner ◽  
Helen Jenkinson ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Systemic Chemotherapy ◽  
Final Visual Acuity ◽  
Recurrence Rates ◽  
Similar Time ◽  
Chemotherapy Group ◽  
The United Kingdom ◽  
First Relapse ◽  
Laser Group ◽  
Group 2

BackgroundAdjuvant use of laser with systemic chemotherapy for treatment of retinoblastoma may reduce recurrence rates while also causing local side effects. Information is lacking on the effect of laser on visual outcomes.MethodsA retrospective review of two retinoblastoma centres in the United Kingdom was conducted. Patients were included if there was a macular tumour in at least one eye. Eyes that received chemotherapy alone were compared with eyes that received chemotherapy plus adjuvant laser.ResultsA total of 76 patients and 91 eyes were included in the study. Systemic chemotherapy alone was used in 71 eyes while chemotherapy plus laser was used in 20 eyes. Demographic characteristics of both groups were similar. Macular relapse rates were similar between groups: 22/71 (31%) eyes in chemotherapy group and 9/20 (45%) eyes in laser group (p=0.29). There was no increase in vitreous relapses in the laser group (2/20 eyes), compared with the chemotherapy group 10/71 eyes (p=0.99). Survival analysis demonstrated similar time to first relapse between groups. Final visual acuity was equal between groups with 6/15 or better present in 31.1% of eyes in the chemotherapy group and 37.5% of eyes in the laser group (p=0.76). Presence of tumour at the fovea was predictive of final visual acuity, regardless of treatment group.ConclusionAdjuvant laser in the treatment of retinoblastoma is safe and does not lead to increased rate of vitreous recurrence. Final visual acuity is determined by the presence of tumour at the fovea and not the use of laser.

Idiopathic polypoidal choroidal vasculopathy in Caucasians: The POLYON real-life study in 50 naive patients

2019 ◽  
Vol 30 (5) ◽  
pp. 948-955 ◽  
Author(s):  
Hussam El Chehab ◽  
Laurent Kodjikian ◽  
Constance Lagenaite-Desmaizère ◽  
Emilie Agard ◽  
Flore De Bats ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Photodynamic Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Real Life ◽  
Caucasian Population ◽  
Intravitreal Injections ◽  
Final Visual Acuity ◽  
Group 2 ◽  
Choroidal Vasculopathy ◽  
Group 1

Objectives: Polypoidal choroidal vasculopathy is a common disease in Asia, but it has been less described in the Caucasian population. The aim of this real-life observational study was to describe the diagnostic and therapeutic practices as well as the prognosis in this population. Method: Fifty Caucasian patients with polypoidal choroidal vasculopathy were included in this study. All patients underwent angiography to confirm the diagnosis. Patients were divided into two treatment groups: patients of group 1 only received anti–vascular endothelial growth factor injections and those of group 2 required photodynamic therapy rescue in addition to intravitreal injections in case of suboptimal (anatomically or functionally) response. Clinical (visual acuity, fundus examination), paraclinical (retinal pigment epithelium detachment height and central retinal thickness on optical coherence tomography), and therapeutic (number of intravitreal injections) criteria were analyzed after 24 months. Results: Patient mean age was 73.9 ± 9.1 years, and half of the patients had age-related macular degeneration. In the whole cohort, the initial visual acuity was equivalent to the final visual acuity (59.9 ± 24.0 letters vs 62.5 ± 21.1 letters, p = 0.259). In group 1, the final visual acuity was significantly increased (from 56.9 ± 24.7 letters to 63.4 ± 21.6 letters, p = 0.016), while in group 2, it remained stable (from 61.7 ± 23.4 letters to 61.0 ± 21.4 letters, p = 0.249). The number of intravitreal injections was similar between both groups. Conclusion: In a Caucasian population, polypoidal choroidal vasculopathy seems to have a later onset. A non-standardized management allows stabilizing the functional prognosis. Patients requiring photodynamic therapy rescue have a poorer prognosis.

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