Intravitreal Dexamethasone in the Management of Acute Endophthalmitis: A Comparative Retrospective Study

2016 ◽  
Vol 27 (1) ◽  
pp. 67-73 ◽  
Author(s):  
Elad Moisseiev ◽  
Sam Abbassi ◽  
Susanna S. Park
Keyword(s):  
Intravitreal Injection ◽  
Retrospective Chart Review ◽  
Visual Outcome ◽  
Complication Rates ◽  
Light Perception ◽  
Motion Vision ◽  
Hand Motion ◽  
Bacterial Endophthalmitis ◽  
Intravitreal Dexamethasone

Purpose To compare the clinical outcome of eyes with acute bacterial endophthalmitis treated with intravitreal injection of antibiotics with or without intravitreal dexamethasone. Methods This was a retrospective chart review of 63 eyes diagnosed with acute bacterial endophthalmitis and treated with vitreous tap and intravitreal injection of antibiotics, 19 eyes (30.2%) with and 44 eyes (69.8%) without concurrent intravitreal dexamethasone. Results Visual acuity had significantly improved by 1 week and was maintained long-term (p<0.001). There were no differences in visual outcome or rates of ocular complications between the groups. None of the eyes treated with dexamethasone required repeated intravitreal antibiotic injection while 6 (13.6 %) of the other eyes required repeated intravitreal antibiotic injection (p = 0.09). A subset analysis of 21 eyes that presented with light perception/no light perception vision where vitrectomy was not possible demonstrated that intravitreal antibiotic injection improved vision and achieved similar visual gain as in eyes that presented with hand motion vision or better, with no higher complication rates. Conclusions No adverse effect of intravitreal dexamethasone in the acute management of infectious endophthalmitis was noted. A trend toward less need for repeat intravitreal antibiotic therapy was noted in eyes with acute bacterial endophthalmitis treated with concurrent intravitreal dexamethasone at presentation.

scholarly journals Surgery combined with antibiotics for the treatment of endogenous endophthalmitis caused by liver abscess

2020 ◽  
Author(s):  
Yue Wang ◽  
Xue Wang ◽  
Yu Di
Keyword(s):  
Visual Acuity ◽  
Intravitreal Injection ◽  
Liver Abscess ◽  
Treatment Strategies ◽  
Visual Outcome ◽  
Drug Susceptibility ◽  
Endogenous Endophthalmitis ◽  
Light Perception ◽  
Hand Motion ◽  
Susceptibility Tests

Abstract Backgrounds: Endogenous endophthalmitis is a serious disease caused by intraocular infection that can rapidly progress to cause blindness. This study evaluated the clinical features, surgical and antibiotics treatment strategies, and treatment outcomes in patients with endophthalmitis caused by liver abscess.Methods: Between April 2014 and April 2019, the clinical data of 16 patients (19 eyes) with endophthalmitis associated with liver abscess who underwent surgery at Shengjing Hospital were retrospectively analyzed. Furthermore, we evaluated the final visual outcomes in the patients to determine the efficacy of surgeryResults: Fifteen patients (18 eyes) underwent intravitreal injection followed by vitrectomy after admission. One patient (1 eye) only underwent intravitreal injection. Of the 16 patients, 3 patients (3 eyes) had recurrent intraocular inflammation and eventually underwent evisceration. Systemic antibiotics were administered for all patients based on the results of vitreous humor culture, blood culture, and antibiotic susceptibility tests. Outpatient follow-ups were performed until the patients were stable (6 months). Of the 19 eyes, 1 eye (5%) had visual acuity restored to 20/200, 6 eyes (31%) had visual acuity restored to counting fingers (CF), 2 eyes (11%) had visual acuity restored to hand motion (HM), 4 eyes (22%) showed only light perception (LP), and the remaining 6 eyes (31%) showed no light perception (NLP). Drug susceptibility tests suggested that the carbapenems exhibited significant effects in the inflammatory reaction.Conclusion: Endogenous endophthalmitis caused by liver abscess is a very serious condition, and the final visual outcome is poor. Timely surgical intervention combined with antibiotic treatment is essential, and the primary disease must be treated to control disease progression at the earliest.

scholarly journals Surgery combined with antibiotics for the treatment of endogenous endophthalmitis caused by live abscess

2020 ◽  
Author(s):  
Yue Wang ◽  
Xue Wang ◽  
Yu Di
Keyword(s):  
Visual Acuity ◽  
Intravitreal Injection ◽  
Liver Abscess ◽  
Treatment Strategies ◽  
Visual Outcome ◽  
Drug Susceptibility ◽  
Endogenous Endophthalmitis ◽  
Light Perception ◽  
Hand Motion ◽  
Susceptibility Tests

Abstract Backgrounds: Endogenous endophthalmitis is a serious disease caused by intraocular infection that can rapidly progress to cause blindness. This study evaluated the clinical features, surgical and antibiotics treatment strategies, and treatment outcomes in patients with endophthalmitis caused by liver abscess.Methods: Between April 2014 and April 2019, the clinical data of 16 patients (19 eyes) with endophthalmitis associated with liver abscess who underwent surgery at Shengjing Hospital were retrospectively analyzed. Furthermore, we evaluated the final visual outcomes in the patients to determine the efficacy of surgery.Results: Fifteen patients (18 eyes) underwent intravitreal injection followed by vitrectomy after admission. One patient (1 eye) only underwent intravitreal injection. Of the 16 patients, 3 patients (3 eyes) had recurrent intraocular inflammation and eventually underwent evisceration. Systemic antibiotics were administered for all patients based on the results of vitreous humor culture, blood culture, and antibiotic susceptibility tests. Outpatient follow-ups were performed until the patients were stable (6 months). Of the 19 eyes, 1 eye (5%) had visual acuity restored to 20/200, 6 eyes (31%) had visual acuity restored to counting fingers (CF), 2 eyes (11%) had visual acuity restored to hand motion (HM), 4 eyes (22%) showed only light perception (LP), and the remaining 6 eyes (31%) showed no light perception (NLP). Drug susceptibility tests suggested that the carbapenems exhibited significant effects in the inflammatory reaction.Conclusion: Endogenous endophthalmitis caused by liver abscess is a very serious condition, and the final visual outcome is poor. Timely surgical intervention combined with antibiotic treatment is essential, and the primary disease must be treated to control disease progression at the earliest.

scholarly journals Surgery combined with antibiotics for the treatment of endogenous endophthalmitis caused by liver abscess

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yue Wang ◽  
Xue Wang ◽  
Yu Di
Keyword(s):  
Visual Acuity ◽  
Intravitreal Injection ◽  
Liver Abscess ◽  
Treatment Strategies ◽  
Visual Outcome ◽  
Drug Susceptibility ◽  
Endogenous Endophthalmitis ◽  
Light Perception ◽  
Hand Motion ◽  
Susceptibility Tests

Abstract Backgrounds Endogenous endophthalmitis is a serious disease caused by intraocular infection that can rapidly progress to cause blindness. This study evaluated the clinical features, surgical and antibiotics treatment strategies, and treatment outcomes in patients with endophthalmitis caused by liver abscess. Methods Between April 2014 and April 2019, the clinical data of 16 patients (19 eyes) with endophthalmitis associated with liver abscess who underwent surgery at Shengjing Hospital were retrospectively analyzed. Furthermore, we evaluated the final visual outcomes in the patients to determine the efficacy of surgery. Results Fifteen patients (18 eyes) underwent intravitreal injection followed by vitrectomy after admission. One patient (1 eye) only underwent intravitreal injection. Of the 16 patients, 3 patients (3 eyes) had recurrent intraocular inflammation and eventually underwent evisceration. Systemic antibiotics were administered for all patients based on the results of vitreous humor culture, blood culture, and antibiotic susceptibility tests. Outpatient follow-ups were performed until the patients were stable (6 months). Of the 19 eyes, 1 eye (5%) had visual acuity restored to 20/200, 6 eyes (31%) had visual acuity restored to counting fingers (CF), 2 eyes (11%) had visual acuity restored to hand motion (HM), 4 eyes (22%) showed only light perception (LP), and the remaining 6 eyes (31%) showed no light perception (NLP). Drug susceptibility tests suggested that the carbapenems exhibited significant effects in the inflammatory reaction. Conclusion Endogenous endophthalmitis caused by liver abscess is a very serious condition, and the final visual outcome is poor. Timely surgical intervention combined with antibiotic treatment is essential, and the primary disease must be treated to control disease progression at the earliest.

scholarly journals Surgery combined with antibiotics for the treatment of endogenous endophthalmitis caused by live abscess

2020 ◽  
Author(s):  
Yue Wang ◽  
Xue Wang ◽  
Yu Di
Keyword(s):  
Visual Acuity ◽  
Intravitreal Injection ◽  
Liver Abscess ◽  
Treatment Strategies ◽  
Visual Outcome ◽  
Drug Susceptibility ◽  
Endogenous Endophthalmitis ◽  
Light Perception ◽  
Hand Motion ◽  
Susceptibility Tests

Abstract Backgrounds: Endogenous endophthalmitis is a serious disease caused by intraocular infection that can rapidly progress to cause blindness. This study evaluated the clinical features, surgical and antibiotics treatment strategies, and treatment outcomes in patients with endophthalmitis caused by liver abscess.Methods: Between April 2014 and April 2019, the clinical data of 16 patients (19 eyes) with endophthalmitis associated with liver abscess who underwent surgery at Shengjing Hospital were retrospectively analyzed. Furthermore, we evaluated the final visual outcomes in the patients to determine the efficacy of surgery.Results: Fifteen patients (18 eyes) underwent intravitreal injection followed by vitrectomy after admission. One patient (1 eye) only underwent intravitreal injection. Of the 16 patients, 3 patients (3 eyes) had recurrent intraocular inflammation and eventually underwent evisceration. Systemic antibiotics were administered for all patients based on the results of vitreous humor culture, blood culture, and antibiotic susceptibility tests. Outpatient follow-ups were performed until the patients were stable (6 months). Of the 19 eyes, 1 eye (5%) had visual acuity restored to 20/200, 6 eyes (31%) had visual acuity restored to counting fingers (CF), 2 eyes (11%) had visual acuity restored to hand motion (HM), 4 eyes (22%) showed only light perception (LP), and the remaining 6 eyes (31%) showed no light perception (NLP). Drug susceptibility tests suggested that the carbapenems exhibited significant effects in the inflammatory reaction.Conclusion: Endogenous endophthalmitis caused by liver abscess is a very serious condition, and the final visual outcome is poor. Timely surgical intervention combined with antibiotic treatment is essential, and the primary disease must be treated to control disease progression at the earliest.

scholarly journals Visual outcome of endogenous endophthalmitis in Thailand

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Preeyachan Lourthai ◽  
Pitipol Choopong ◽  
Dhanach Dhirachaikulpanich ◽  
Kunravitch Soraprajum ◽  
Warinyupa Pinitpuwadol ◽  
...  
Keyword(s):  
Retrospective Chart Review ◽  
Visual Outcome ◽  
Post Treatment ◽  
Endogenous Endophthalmitis ◽  
Infectious Episode ◽  
Hand Motion ◽  
Phthisis Bulbi ◽  
Causative Agents ◽  
Corneal Decompensation ◽  
The Mean

AbstractTo evaluate a 10-year visual outcome of endogenous endophthalmitis (EE) patients. A 10-year retrospective chart review of EE patients. Thirty-eight patients (40 eyes) were diagnosed with EE at the mean age of 42. Among the identifiable pathogens (71.1% culture positive), the causative agents were predominantly gram-negative bacteria (48.1%). The most common specie was Klebsiella pneumoniae (25.9%). About a quarter of the patients required surgical eye removal, and the remaining 45.7% had visual acuity (VA) worse than hand motion at one month after the infectious episode. The most common complication was ocular hypertension (52.5%). Poor initial VA was significantly associated with a worse visual outcome in the early post-treatment period (p 0.12, adjusted OR 10.20, 95% CI 1.65–62.96). Five patients continued to visit the clinic for at least ten years. One patient had gained his vision from hand motion to 6/7.5. Two patients had visual deterioration, one from corneal decompensation, and the other from chronic retinal re-detachment. Two patients developed phthisis bulbi, with either some VA perception of light or no light perception. Poor initial VA is the only prognostic factor of a poor early post-treatment visual outcome of EE.

scholarly journals Outcome Squares integrating efficacy and safety, as applied to functioning pituitary adenoma surgery

2021 ◽  
Author(s):  
Friso de Vries ◽  
Daniel J Lobatto ◽  
Marco J T Verstegen ◽  
Pieter J Schutte ◽  
Irene C Notting ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Retrospective Chart Review ◽  
Complication Rates ◽  
Efficacy And Safety ◽  
Tertiary Referral Centre ◽  
Patient Level ◽  
Good Outcome ◽  
Poor Outcome

Abstract Purpose Transsphenoidal surgery is standard care in the treatment of hormone-secreting pituitary adenomas. Current clinician-reported surgical outcome measures are one-dimensional, typically focussing primarily on complete or partial resection and secondarily on complication rates. However, outcomes are best reflected by the delicate balance of efficacy and complications at patient level. This study proposes a novel way to classify and report outcomes, integrating efficacy and safety at the patient level. Methods Retrospective chart review of all pure endoscopic transsphenoidal surgical procedures for acromegaly, Cushing’s disease, and prolactinoma between 2010-2018 in a single tertiary referral centre. We present our results in a classic (remission and complications separate) and in a novel Outcome Square integrating both outcomes, focusing on intended and adverse effects (long-term complications). This resulted in four outcome groups, ranging from good to poor. We use this approach to present these outcomes for several subgroups. Results 198 surgical procedures were included (44 reoperations). Remission was achieved in 127 operations (64%). Good outcome was observed after 121 (61%), and poor outcome after 6 (3%) operations. When intended effect of surgery was applied (instead of remission), good outcome as intended was achieved after 148 of 198 surgeries (75%) and poor outcome after 4 (2%). Conclusion Quality of a surgical intervention can be presented in 4 simple categories, integrating both efficacy and safety with flexibility to adapt to the individualized situation at patient, disease, and surgical strategy and to the outcome of interest.

scholarly journals Differences in clinical features between optic neuritis in neuromyelitis optica spectrum disorders and in multiple sclerosis

2018 ◽  
Vol 4 (3) ◽  
pp. 205521731879119 ◽  
Author(s):  
Jindapa Srikajon ◽  
Sasitorn Siritho ◽  
Chanon Ngamsombat ◽  
Naraporn Prayoonwiwat ◽  
Niphon Chirapapaisan ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Visual Acuity ◽  
Optic Neuritis ◽  
Neuromyelitis Optica ◽  
Retrospective Chart Review ◽  
Visual Outcome ◽  
Neuromyelitis Optica Spectrum Disorders ◽  
Fiber Layer ◽  
Spectrum Disorders

Background Optic neuritis (ON) is one of the common manifestations both in neuromyelitis-optica spectrum disorders (NMOSD) and in multiple sclerosis (MS). Objectives The objective of this paper is to compare clinical presentations, laboratories and imaging findings in ON associated with MS and NMOSD. Methods A retrospective chart review was performed in patients presenting with ON in 59 NMOSD patients with 72 eyes’ involvement and 163 ON attacks, and 20 MS patients with 23 eyes’ involvement and 36 ON attacks. Results ON-NMOSD patients had recurrent ON more often and tended to have simultaneous bilateral ON involvement at their first ON attack. Individuals with ON-NMOSD revealed worse visual acuity at first ON attacks and also had poorer long-term visual outcome than those with ON-MS, with nearly half of ON-NMOSD patients still having LogMAR visual acuity ≥1 at their last follow-up ( p = 0.035). Significant thinner average retinal nerve fiber layer thickness was found in the ON-NMOSD group. We found no significant differences in segmentation location of the optic nerve lesions and the length of involvement between the two groups. Conclusions It was difficult to completely differentiate ON-NMOSD from ON-MS. ON-NMOSD patients, however, tended to have simultaneous bilateral ON involvement and poorer long-term visual outcome than individuals with ON-MS.

scholarly journals Bleb-Related Endophthalmitis: A 15-Year Review

2018 ◽  
Vol 3 (1) ◽  
pp. 21-27
Author(s):  
Lekha K. Mukkamala ◽  
Tian Xia ◽  
Rana Mady ◽  
Lisa Athwal ◽  
Marco A. Zarbin ◽  
...  
Keyword(s):  
Open Angle Glaucoma ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Glaucoma Surgery ◽  
Patient Characteristics ◽  
Light Perception ◽  
Hand Motion ◽  
Tertiary Care Facility ◽  
Systemic Antibiotics

Purpose: The purpose of this study is to describe the patient characteristics, management, and outcomes of bleb-related endophthalmitis (BRE). Methods: A retrospective chart review was conducted of patients who presented to a tertiary care facility from 2001 to 2016 with BRE. Collected data included demographics, medical and ocular history, visual acuity (VA), intraocular pressure (IOP), presence of hypopyon, treatment, microbiology, visual outcomes particularly of VA and IOP, and complications. Results: Thirty-six eyes (36 patients: 21 females, mean 66.8 years old, 78% with primary open-angle glaucoma) presented an average of 4.5 years (range, 2 days-33 years) after glaucoma surgery (30 trabeculectomies with mitomycin C, 6 tube shunts) with endophthalmitis. Mean VA and IOP at presentation were hand motion (HM; logMAR 2.1) and 19.9 mmHg, respectively, with 82% displaying hypopyon and 87% with purulent blebitis. Eighteen (50%) eyes (mean VA HM) underwent vitreous tap and injection (T/I) of intravitreal antibiotics (vancomycin 1 mg/0.1 cc and ceftazidime 2.25 mg/0.1 cc), and 18 (50%) eyes (mean VA HM) underwent pars plana vitrectomy (PPV) with intravitreal antibiotic injection. Eight (45%) eyes initially treated with T/I required a subsequent PPV, and 5 (28%) eyes treated initially with PPV underwent a second PPV. All patients also received systemic antibiotics (33 intravenous [IV] and 3 oral) and topical medications. Average time to documented resolution was 15 days, with mean VA of HM and IOP of 13.6 mmHg. Thirty-one (86%) eyes had vision worse than 20/200 at resolution, and those presenting with light perception or no light perception (NLP) vision (n = 6) had worse vision final VA (logMAR 2.6) than those with initial vision of HM or better (final VA logMAR 1.7). Three (8.6%) eyes were enucleated, with 4 worsening to NLP during the course of the infection. Conclusions: BRE is a visually devastating infection requiring prompt diagnosis and management. Despite aggressive treatment with antibiotics, visual prognosis is poor.

scholarly journals Surgery combined with antibiotics for the treatment of endogenous endophthalmitis caused by live abscess

2020 ◽  
Author(s):  
Yue Wang ◽  
Xue Wang ◽  
Yu Di
Keyword(s):  
Visual Acuity ◽  
Intravitreal Injection ◽  
Liver Abscess ◽  
Treatment Strategies ◽  
Endogenous Endophthalmitis ◽  
Light Perception ◽  
Hand Motion ◽  
Control Disease ◽  
Serious Disease ◽  
Susceptibility Tests

Abstract BackgroundEndogenous endophthalmitis is a serious disease caused by intraocular infection, that can rapidly progress to cause blindness. This study evaluated the clinical features, surgical and antibiotics treatment strategies, and treatment outcomes in patients with endophthalmitis caused by liver abscess.MethodsBetween April 2014 and April 2019, the clinical data of patients (19 eyes) with endophthalmitis associated with liver abscess who underwent surgery at Shengjing Hospital were retrospectively analyzed. Furthermore, we also evaluated the degree of visual acuity correction in patients after surgery to determine the efficacy of vitrectomy.ResultsFifteen patients (18 eyes) underwent intravitreal injection followed by vitrectomy after admission. One patient (1 eye) was only underwent intravitreal injection. Three patients (3 eyes) had recurrent intraocular inflammation and eventually underwent evisceration. Systemic antibiotics were administered for all patients based on the results of vitreous humor culture, blood culture, and antibiotic susceptibility tests. Outpatient follow-ups were performed until the patients were stable (6 months). Of the 19 eyes, 1 eye (5.26%) had visual acuity restored to 20/200, 6 eyes (31.58%) had visual acuity restored to counting fingers (CF), 2 eyes (10.53%) had visual acuity restored to hand motion (HM), 4 eyes (21.58%) showed only light perception (LP), and the remaining 6 eyes showed no light perception (NLP),3 patients showed carbapenems resistance.ConclusionEndogenous endophthalmitis caused by liver abscess is occult, and prognosis is poor. Timely surgical intervention combined with antibiotic treatment is essential, and the primary disease must be treated to control disease progression at the earliest.

scholarly journals Long-Term Outcomes of Behçet’s Syndrome-Related Uveitis: A Monocentric Italian Experience

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Jurgen Sota ◽  
Luca Cantarini ◽  
Antonio Vitale ◽  
Arianna Sgheri ◽  
Stefano Gentileschi ◽  
...  
Keyword(s):  
Retinal Vasculitis ◽  
Human Leukocyte ◽  
Retrospective Chart Review ◽  
Treatment Decision ◽  
Visual Outcome ◽  
Posterior Uveitis ◽  
Epiretinal Membranes ◽  
Visual Prognosis

Objectives. To examine demographic and clinical characteristics and long-term visual outcome in a cohort of Italian patients affected by Behçet’s uveitis (BU). Materials and Methods. Retrospective chart review of 47 patients with BU attending our unit between January 2018 and December 2019. Ophthalmologic manifestations, best-corrected visual acuity (BCVA), fluoroangiography and optical coherence tomography findings, and ocular complications were recorded. Predictive factors of a poor visual outcome and long-term complications were also investigated. Results. Forty-seven patients (23 males and 24 females) for a total of 84 eyes were enrolled. Uveitis was bilateral in 37 (78.7%) patients with panuveitis being the most frequent anatomical pattern (40 out of 84 eyes), whereas 27 eyes presented a posterior uveitis. Isolated anterior uveitis was detected in 16 eyes. A significant improvement of median BCVA between baseline and last follow-up values was detected (p=0.042). A higher risk of poor visual prognosis was observed in patients with uveitis duration greater than 15 years (p=0.019). A significant resolution of retinal vasculitis was detected between baseline and last follow-up evaluation (p<0.0001) whereas the mean±SD macular thickness did not decrease significantly between baseline (376.00±97.45 μm) and last follow-up evaluation (338.08±55.81 μm). Forty-two eyes developed 57 complications during the disease course. Cataract was the most frequent (n=12), followed by epiretinal membranes (n=11) and cystoid macular edema (n=6). The following variables were identified as predictors of long-term complications: human leukocyte antigen- (HLA-) B51 (p=0.006), panuveitis (p=0.037), and a uveitis duration of more than 15 years (p=0.049). Conclusions. In Italian patients, BU typically arises in the third decade and predominantly manifests as a bilateral posterior uveitis or panuveitis. Its duration is associated with a poor visual prognosis. Uveitis duration, the presence of HLA-B51, and panuveitis are predictors of long-term structural complications, thus representing main drivers in the treatment decision-making.

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