Search

In their recent publication, the authors explored the preventive effect of gentamicin in the irrigating solution on endophthalmitis caused by methicillin-resistant Staphylococcus epidermidis (MRSE) after phacoemulsification with intraocular lens (IOL) implantation in rabbits. This letter commends the authors for their innovative approach and discusses the potential of chitosan-based intraocular lenses as a future solution for reducing the incidence of endophthalmitis. Chitosan's natural antibacterial properties, coupled with its capacity for sustained drug release and surface modification, make it a promising material for IOLs. This letter highlights recent advancements and suggests areas for further research to fully realize the potential of chitosan-based IOLs in ocular surgery.

Objectives: To compare aetiology, microbiological isolates and antibiotic susceptibilities of endophthalmitis between children and adults., Design: Retrospective observational study., Participants: Patients admitted to Zhongshan Ophthalmic Center between January 2013 and December 2019 with clinically diagnosed endophthalmitis were included., Outcome Measures: The aetiology, microbiological isolates and antibiotic susceptibilities of endophthalmitis were analysed., Results: Of 1803 patients, 430 (23.8%) were aged ≤16 years. In both children and adults, the main aetiology was trauma (85.6% vs 64.7%, p<0.05). Streptococcus species (spp.) (28.8%) were most prevalent in paediatric post-traumatic endophthalmitis; whereas, coagulase-negative staphylococci (36.9%) were dominant in adults. In postoperative endophthalmitis, all children had bacterial infections, while fungal infections accounted for 12.5% in adults. In endogenous endophthalmitis caused by fungi, Candida was most prevalent in adults (26.9%); whereas, all causative fungi involved filamentous fungi in children. Isolated bacteria in children presented a higher susceptibility in 7 of 11 antibiotics compared with those in adults. Levofloxacin had the highest susceptibility rate in children (97.9%), and ofloxacin had the highest susceptibility rate in adults (90.6%)., Conclusion: The main aetiology was trauma, with a higher proportion in children than in adults. The microbial profile of paediatric endophthalmitis was different from those of adults. Susceptibilities of causative bacteria to most antibiotics were higher in children than in adults., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

We report a case of a late adolescent female who presented to us with complaints of acute, painful loss of vision in her left eye. Her visual acuity (VA) had reduced to perception of hand movements within a week. Slit lamp examination and ultrasonography revealed that the patient had endophthalmitis. She was treated with intravitreal antibiotics, pars plana vitrectomy, lensectomy and a 5000 centistoke silicone oil injection. The vitreous biopsy showed significant growth of Rothia dentocariosa on blood and chocolate agars. An infected lower mandibular tooth was identified as the infective focus and treated. Systemic evaluation did not reveal any other infections. 1 month after the final procedure, she achieved a VA of 20/60 and IOP of 11 mm Hg. The retina was attached, and the infection had completely resolved. This case of atypical endogenous endophthalmitis was managed with timely surgery and using silicone oil injection and showed a good outcome., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Bacterial endophthalmitis is a severe infection of the aqueous or vitreous humor of the eye that can lead to permanent vision loss. Due to the rapid emergence of antibiotic resistance and dose-limiting toxicities, the standard treatment of bacterial endophthalmitis via the intravitreal injection of broad-spectrum antibiotics remains inadequate. Membrane active cationic antimicrobial peptides (AMPs) have emerged as a promising class of effective and broad-spectrum antimicrobial agents with potential to overcome antibiotic resistance. In this work, we investigate, for the first time, the use of omiganan (IK-12), a 12-amino acid indolicidin derivative for the treatment of bacterial endophthalmitis. Additionally, IK-12 was used as a template to perform amino acid rearrangements, without altering the length or type of amino acids, to yield a series of new derivative AMPs with varying extents of secondary structure formation under membrane mimicking conditions. IK-12 and its derivatives demonstrated strong and broad-spectrum antibacterial activities against a panel of clinically isolated Gram-positive and Gram-negative bacteria, including methicillin-resistant Staphylococcus aureus commonly implicated in bacterial endophthalmitis. Interestingly, two of the new IK-12 derivatives, IP-12 and WP-12, showed lower geometric mean minimum inhibitory concentration and higher 50% hemolysis concentration values, which effectively translated into 2- to 3.4-fold higher bacterial selectivity than the parent IK-12. Furthermore, the intravitreal injection of IK-12, IP-12, and WP-12 in a rabbit model of MRSA -induced endophthalmitis led to considerably improved clinical presentation and reduced recruitment of inflammatory cells. In all, these results demonstrate the potential of IK-12 and its derivatives, IP-12 and WP-12, as promising candidates for the treatment of bacterial endophthalmitis.

Ocular surface inflammatory disorders, such as dry eye, are becoming increasingly prevalent. Developing new treatment strategies targeting harmful bacteria could provide significant therapeutic benefits. The purpose of this study was to characterize the common ocular pathogen Staphylococcus aureus and the rarer endophthalmitis-associated species Enterococcus faecalis isolated from the ocular surface of dry eye disease patients in Norway. Together the 7 isolates (5 S. aureus and 2 E. faecalis) comprise the complete set of members of each species isolated in our previous study of the ocular microbiome of 61 dry eye sufferers. We aimed to investigate the pathogenic potential of these isolates in relation to ocular surface health. To this end, we used whole genome sequencing, multiplex PCR directed at virulence genes and antibiotic susceptibility tests encompassing clinically relevant agents. The E. faecalis isolates showed resistance to only gentamicin. S. aureus isolates displayed susceptibility to most of the tested antibiotics, except for two isolates which showed resistance to trimethoprim/sulfamethoxazole and three isolates which were resistant to ampicillin. Susceptibilities included sensitivity to several first-line antibiotics for treatment of ocular infections by these species. Thus, treatment options would be available if required. However, spontaneous resistance development to gentamicin and rifampicin occurred in some S. aureus which could be a cause for concern. Whole genome sequencing of the isolates showed genome sizes ranging from 2.74 to 2.83 Mbp for S. aureus and 2.86 Mbp for E. faecalis, which is typical for these species. Multilocus sequence typing and phylogenetic comparisons with previously published genomes, did not suggest the presence of eye-specific clusters for either species. Genomic analysis indicated a high probability of pathogenicity among all isolates included in the study. Resistome analysis revealed the presence of the beta-lactamase blaZ gene in all S. aureus isolates and the dfrG gene in two of them; while E. faecalis isolates carried the lsa(A) gene which confers intrinsic resistance to lincosamides and streptogramin A in this species. Screening for virulence factors revealed the presence of various pathogenicity associated genes in both S. aureus and E. faecalis isolates. These included genes coding for toxin production and factors associated with evading the host immune system. Some of the identified genes (tst, hylA & hylB) are suggested to be linked to the pathophysiology of dry eye disease. Lastly, the presence of specific S. aureus virulence genes was confirmed through multiplex PCR analysis., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To report the first case of acute Abiotrophia defectiva endophthalmitis post-keratoplasty and review the current literature., Methods: A 47-year-old male, post-keratoplasty, presented with vision loss and severe anterior chamber reaction. Diagnostic investigations included vitreous cultures and molecular analysis., Results: Abiotrophia defectiva was identified. Despite aggressive treatment, visual acuity remained low. We reviewed a total of 14 post-procedural cases of A. defectiva endophthalmitis, focusing on antibiotic and steroidal treatment regimens and long-term prognosis., Conclusion: We emphasize aggressive treatment of external disease prior to intraocular surgery. In cases of A. defectiva endophthalmitis, we advocate judicious use of steroids.

Introduction: Pediatric infectious endophthalmitis is a rare, severe ocular infection that can have devastating consequences. It may be exogenous or endogenous, with exogenous endophthalmitis being more common. Current data on the etiology, microbiology, antibiotic treatments and outcomes in pediatric cases is limited., Purpose: To summarize the etiology, microbiology, visual outcomes and management of pediatric endophthalmitis., Methods: A literature review was conducted on cases of pediatric endophthalmitis published from 1980 to 2022, identified through searches of PubMed, Medline, Web of Science and Google Scholar databases., Results: A total of 796 patients were included. Ocular trauma was the most common cause with 623 patients (78.3%), followed by posteye surgery with 100 patients (12.6%) and endogenous endophthalmitis with 67 patients (70 eyes) (8.4%). Among culture-positive cases, gram-positive microorganisms predominated. Treatment involved pars plana vitrectomy in 608 patients (76%) and intraocular antibiotics in 590 patients (74%). Favorable visual acuity (≥20/200) was achieved in 30.5% of patients, 20% had no light perception and 12.5% developed poor anatomical outcomes with phthisis bulbi., Conclusion: Our review provides insights into the etiology, epidemiology, microbiology, treatment and visual outcomes of pediatric endophthalmitis based on available literature worldwide., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To describe the clinical and microbiological characteristics of patients with endogenous endophthalmitis (EE), determine factors associated with outcome and propose a management plan for EE., Methods: Retrospective case series in two tertiary referral centers from 2010 to 2022., Results: Sixty-four eyes of 53 patients were included. Bilateral involvement occurred for 11/53 patients (21%). Ocular symptoms were the only first manifestation of the disease in 36/53 (68%) of cases; signs of sepsis were evident in 17/53 (32%). Imaging tests detected at least one extraocular focus of infection in 34/53 patients (64%), with contrast-enhanced thoraco-abdominopelvic computed tomography showing relevant findings in 28/50 (56%) of cases. EE was microbiologically confirmed in 43/53 patients (81%); the organisms involved were: Gram-positive bacteria (19/53, 36%), Gram-negative bacteria (13/53, 25%) and Candida sp. (11/53, 21%). Klebsiella pneumoniae was the most common bacteria (10/32, 31%). Blood cultures were positive in 28/53 patients (53%) and eye samples in 11/41 eyes (27%). All patients were treated with systemic antimicrobial therapy, 39/64 eyes (61%) received anti-infective intravitreal injection(s) and 17/64 eyes (27%) underwent vitrectomy. Four patients (8%) died due to uncontrolled systemic infection. Final visual acuity (VA) was < 20/400 in 28/57 eyes (49%) and ocular structural loss (bulbar phthisis or enucleation/evisceration) was reported in 18/64 eyes (28%). In multivariate analysis, initial VA was the only parameter associated with visual and/or structural loss of the eye (OR = 24.44 (4.33-228.09) and 5.44 (1.33-26.18) respectively)., Conclusions: EE remains a severe infection with a poor ocular outcome. We propose a standard protocol to improve diagnosis and medical management., Competing Interests: Declarations of competing interest The authors have no competing interests to declare that are relevant to the content of this article. The authors declare they have no financial interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: To review the etiology and antibiotic susceptibility patterns of infectious endophthalmitis over 11 years in different age groups., Methods: Microbiology records of culture-positive endophthalmitis cases from January 2011 and December 2021 were reviewed for the age groups 0-30, 31-60, and >60 years. Additionally, data was also analysed for trends in antibiotic susceptibility between different age groups., Results: A total of 5590 patients were clinically diagnosed with endophthalmitis. Of these, 1316 (23.5%) patients were culture positive comprising of 1097 bacteria (83.3%) and 219 fungal (16.6%). Gram-positive bacteria predominated the culture-proven bacterial endophthalmitis group with 709 cases (62.6%). Streptococcus pneumoniae (9.3%) was the most prevalent organism in the age group between 0 and 30 years, while Staphylococcus epidermidis (6%) was the most prevalent organism in the age group of 31-60 years. In comparison, Pseudomonas aeruginosa (4.1%) was the most abundant organism in the age group >60 years. Interestingly, Aspergillus flavus (13.24%) was the predominant fungal pathogen in all age groups. There was an increasing trend in antibiotic resistance from younger to older age groups and this pattern was observed for almost all drugs tested except vancomycin and amikacin., Conclusion: While infection can occur at any age, the etiology also seems to vary. This study helps us understand the demography of endophthalmitis along with choice of empirical antibiotics that would influence treatment outcomes. Although vancomycin currently holds good for the treatment for gram-positive infections, gram-negative infections calls for an immediate need for newer drugs or advanced treatment options.

Purpose: To investigate the clinical features of endogenous Klebsiella pneumoniae endophthalmitis (EKPE) and the molecular characteristics of pathogenic K. pneumoniae ., Methods: A retrospective study was conducted between January 2014 and January 2021. Clinical data were extracted. K. pneumoniae isolates cultured from EKPE patients' specimens were characterized by antimicrobial susceptibility testing, multilocus sequence typing, capsular serotyping, and virulence gene profiles. Virulence phenotypes were confirmed by mouse lethality assay., Results: Thirty-nine patients (47 eyes) were diagnosed with EKPE. Administration of systemic antibiotics and eye treatment within 24 hours of ocular symptom onset was statistically associated with better visual outcomes ( p = .007). Sixteen K. pneumoniae isolates were collected, three of which were carbapenem-resistant and avirulent. Only salmochelin encoding gene was harbored by all isolates., Conclusions: Systemic and eye treatment administered within 24 hours from the onset improves visual prognosis. Besides hypervirulent strains, avirulent carbapenem-resistant K. pneumoniae can cause EKPE.

Objective: To analyze the effect of gentamicin in the irrigating solution on endophthalmitis caused by methicillin-resistant Staphylococcus epidermidis after phacoemulsification with intraocular lens implantation., Methods: Fifteen rabbits were randomly assigned into three groups. During surgery, group A was irrigated with gentamicin-free solution and injected with 100 μL of normal saline postoperatively, group B was irrigated with 80 μg/mL gentamicin and injected with 100 μl of MRSE suspension, group C was irrigated with gentamicin-free solution and injected with 100 μl of MRSE suspension. At different times, corneal endothelial cell count (CEC), inflammation grading，B-scan ultrasonography and histological examination were analyzed., Results: No endophthalmitis occurred in groups A and B. Group C developed severe endophthalmitis, with massive inflammatory exudation in the vitreous cavity., Conclusion: Irrigating solution containing gentamicin is favorable to reduce the incidence of MRSE endophthalmitis after phacoemulsification with IOL in rabbits.

Background: Lactobacillus acidophilus is usually considered nonpathogenic and widely distributed in the human gastrointestinal and vaginal tract. In rare cases, lactobacilli may cause eye infections., Case Presentation: We report a 71-year-old man who experienced unexpected ocular pain and decreased visual acuity for one day after cataract surgery. He presented with obvious conjunctival and circumciliary congestion, corneal haze, anterior chamber cells, anterior chamber empyema, posterior corneal deposits, and pupil light reflection disappearance. This patient underwent the standard three-port 23-gauge pars plana vitrectomy and received the intravitreal perfusion of vancomycin at 1 mg/0.1 mL. The culture of the vitreous fluid produced Lactobacillus acidophilus., Conclusion: Acute Lactobacillus acidophilus endophthalmitis can occur after cataract surgery, which should be taken into consideration.

Purpose: To study the effect of prophylactic intracameral moxifloxacin (ICM) on microbiological profile and antimicrobial sensitivity of culture-proven postoperative endophthalmitis (POE)., Methods: This study evaluated culture-proven POE diagnosed within 6 weeks of cataract surgery over two periods, period-1 (January 2010-March 2015) and period-2 (April 2015-December 2019), before and after introduction of prophylactic ICM, respectively., Results: In period-1, 100 cases of culture-positive POE were reported (1 in 4879, 0.02%), while 20 cases (1 in 24635, 0.004%) were reported in period-2 (5-fold reduction, p < .001). The cumulative culture positivity rate decreased from 27.6% to 17.1% (1.6-fold) . Coagulase-negative Staphylococci (CoNS) were significantly reduced ( p  = .005)., Conclusions: ICM reduced the incidence of culture-proven POE, CoNS in particular. In future, POE caused by rarer pathogens may become more prevalent due to reduction in the rate of commoner and more virulent pathogens with use of intracameral antibiotics. The moxifloxacin sensitivity of CONS did not show change with the use of ICM. Studies with larger population of POE will be more helpful to understand the trend better.

Objective: To identify characteristics and visual outcomes of coagulase-negative staphylococcal (CoNS) endophthalmitis in the era after the Endophthalmitis Vitrectomy Study., Design: Single-centre retrospective analysis., Participants: Forty-two samples from 40 patients with documented CoNS endophthalmitis., Methods: Visual acuity outcomes of CoNS endophthalmitis were assessed in relation to species and type of treatment instituted (i.e., pars plana vitrectomy [PPV] versus vitreous tap and injection of intravitreal antibiotics [T&I]) on 42 samples from 40 patients., Results: Staphylococcus epidermidis was the most prevalent CoNS in our study. Cataract surgery and intravitreal injections were the most common sources for acute CoNS endophthalmitis. Eyes presenting with hand motion or better vision had similar mean final vision after either intravitreal antibiotics or PPV, whereas those with light perception or worse vision at onset had better outcomes after PPV only. Subanalysis showed that patients with S. epidermidis endophthalmitis (n = 39 eyes) had similar visual outcomes with either intravitreal injections or PPV regardless of visual acuity. Hypopyon and vitritis are not always present., Conclusions: Patients with S. epidermidis endophthalmitis may benefit similarly from either early vitrectomy or intravitreal antibiotic injections regardless of visual acuity. This finding may be a supplement to the complements the management standards set forth by the Endophthalmitis Vitrectomy Study., (Copyright © 2023. Published by Elsevier Inc.)

Purpose: To investigate whether the clinical characteristics, treatment and prognosis of endogenous infectious endophthalmitis (EIE) have changed over the past 5 years., Methods: Retrospectively analyze all articles about EIE published in the PubMed, Web of Science, and Embase databases from 2017 to 2021., Results: A total of 128 patients and 147 eyes (46 left and 60 right) were included in the study. The mean age at diagnosis was 51 ± 19 years. The most common risk factors were diabetes and intravenous drug use. From 2017 to 2021, Klebsiella was the most common pathogenic microorganism (22%), and vitreous culture had the highest positivity rate. The most common complaint was blurred vision. The mean visual acuity (logMAR) at onset was 2.84, and the clinical symptoms were vitreal inflammation and opacity (63%), ocular pain (37%), and conjunctival congestion (36%). The ocular inflammation could be reduced by intraocular antibiotics or vitrectomy. However, the visual prognosis, with a mean logMAR of 2.73; only 50% of the eyes reached a visual acuity level of finger count and above. Changes in diagnostics over the past 5 years have mainly manifested as more diverse microorganism culture methods. In addition to conventional culture methods, PCR, sputum culture and aqueous humour culture are also commonly used for the diagnosis of pathogenic bacteria, improving the positive culture rate and visual prognosis., Conclusion: The prognosis of EIE is poor. It is recommended to pay attention to the pathogenic bacteria culture results and accompanying systemic diseases and to diagnose and treat patients as soon as possible., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

The aim of this study was to investigate the efficacy of the ithmid kohl/zinc-oxide nanoparticles (ZnONPs), ithmid kohl/Aloe vera, and ZnONPs/Aloe vera in the treatment of bacterial endophthalmitis. The endophthalmitis model was prepared by contaminating both eyes of 24 healthy adult male albino rabbits with a clinical isolate of Klebsiella pneumoniae. The animals were randomly divided into eight groups (A-H) according to the treatment. Group A received 1 ml of ithmid kohl/ZnONPs ointment, group B received 1 ml of ithmid kohl/Aloe vera gel ointment, group C received 1 ml of ZnONPs/Aloe vera gel ointment, and groups D, E, and F were treated with 1 ml of ithmid kohl solution (0.5 g/ml in distilled water), 1 ml of ZnONPs (0.5 g/ml) colloidal dispersion, and 1 ml of Aloe vera gel, respectively. Group G received 100 μl of a tetracycline antibiotic solution (final concentration: 16 µg/ml), and group H received sterile distilled water (no treatment). In vitro antibacterial activity was evaluated against K. pneumoniae using the agar well diffusion. The combination of ithmid kohl/ZnONPs was the most effective formulation for treating endophthalmitis model in infected rabbits within 2 days. In vitro antibacterial assay confirmed the potential of the ithmid kohl/ZnONPs formulation, which had the largest zone of inhibition (31 mm) among the compounds tested. The preparation of the ithmid kohl/ZnONPs formulation and its in vivo experiment in albino rabbits for the treatment of bacterial endophthalmitis was an innovative approach that has shown promise and may potentially serve as a viable alternative in clinical practice., (© 2024. The Author(s).)

Aim: Analyze antibiotic susceptibility in the Endophthalmitis Management Study (EMS) and compare it with the current intravitreal antibiotic practice trend of members of the Vitreoretinal Society of India (VRSI) practicing in India., Methods: The microbiology work-up of undiluted vitreous included microscopy, culture-susceptibility, polymerase chain reaction (PCR), and next-generation sequencing (NGS). VRSI members were invited to the survey. The EMS conventional culture-susceptibility (PCR and NGS excluded) results were compared vis-a-vis gram-positive cocci (GPC), gram-negative bacilli (GNB), and less commonly used antibiotics with the current recommended intravitreal antibiotics. p < 0.05 was considered significant., Results: Culture and positivity (culture + PCR/NGS) positivity was 28.8% and 56.1%, respectively. GPC was most susceptible to cefazolin, linezolid, and vancomycin; GNB was most susceptible to amikacin, ceftazidime, colistin, and imipenem. There was no susceptibility difference between cefazolin and vancomycin (p = 0.999) and between ceftazidime and imipenem (p = 1.0). Colistin was superior to ceftazidime (p = 0.047) against GNB. The GNB resistant to amikacin (n = 14) were equally susceptible to ceftazidime and colistin; resistant to ceftazidime (n = 16) were susceptible to colistin; and resistant to colistin (n = 7) were susceptible to ceftazidime. The preference of VRSI members (n = 231) practicing in India was a vancomycin-ceftazidime combination (82%), vancomycin for GPC (94%), ceftazidime for GNB (61%), and voriconazole for fungi (74%)., Conclusion: In EMS, GPC had good susceptibility to vancomycin; GNB had good susceptibility to ceftazidime and colistin. Given the lower resistance of colistin, a vancomycin-colistin combination could be an alternative empiric treatment in post-cataract endophthalmitis in India., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Endogenous bacterial endophthalmitis (EE) is an intraocular infection with a poor prognosis. Timely diagnosis and prompt treatment are crucial to prevent vision loss. In this communication, we describe a case of EE caused by Streptococcus pyogenes (Group A Streptococcus [GAS]) in an HIV-positive patient with poorly controlled type 2 diabetes mellitus (DM). A 60-year-old man with a history of HIV and poorly controlled type 2 diabetes, presented with progressive blurry vision, left eye pain, redness, and headache. EE was diagnosed based on the clinical presentation and gram stain analysis of blood culture. Treatment with vitreous tap, intravitreal, topical antibiotics, and systemic antibiotics significantly improved the patient's symptoms. The case highlights the rarity of GAS as a causative agent of EE, particularly in patients with risk factors such as HIV infection and DM., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Infective endophthalmitis is an ophthalmic infection that in severe cases can cause complete loss of vision. In children, the defense against infection is low and eye tissue is not fully developed, leading to increased vulnerability to endophthalmitis. Children may be unable to understand the symptoms; thus, developing a method for prevention and treatment of this disease in children is important. Therefore, we analyzed the clinical and pathogenic characteristics of infectious endophthalmitis in children and provided evidence for clinical treatment. The clinical data of 78 children (78 eyes) with infectious endophthalmitis were retrospectively analyzed. The clinical characteristics, pathogen distribution, drug sensitivity, clinical medication, and treatments were summarized and analyzed. In total, 74 (94.87%) had ocular infections caused by trauma and 75 (96.15%) were from rural townships. A total of 108 sterile specimens were examined, with a positive detection rate of 37.04%. The sensitivity rates of Gram-positive cocci and bacilli to vancomycin were 100%. The sensitivity rates of Gram-negative bacilli to ceftazidime, piperacillin/tazobactam, amikacin, gentamicin, ciprofloxacin, and levofloxacin were 100%. Of the 78 patients, 53 (67.95%) received intravitreal injection and 54 (69.23%) underwent vitrectomy. Trauma is the main factor leading to infectious endophthalmitis in children, wherein Gram-positive bacteria are the most common pathogens. Thus, a timely understanding of the pathogen and drug sensitivity is needed. Intravitreal injection and vitrectomy are effective treatments., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: To report the use of a subtenon's vancomycin injection for the treatment of subretinal abscess secondary to methicillin-resistant Staphylococcus aureus endogenous endophthalmitis., Methods: A 17-year-old man developed endogenous endophthalmitis with subretinal abscess in his right eye secondary to methicillin-resistant Staphylococcus aureus bacteremia from axillary necrotizing fasciitis. Despite prompt treatment with IV vancomycin and an intravitreal vancomycin injection, the patient displayed minimal improvement. The patient was subsequently treated with a subtenon's vancomycin injection. The injection technique is described in detail, as well as a review of the treatment options available for bacterial subretinal abscesses., Results: On presentation, examination revealed minimal vitritis and a large yellow subretinal abscess superotemporally extending close to the macula with subretinal fluid inferotemporally involving the macula. Four days postintravitreal vancomycin injection, the abscess remained stable and the patient developed an exudative detachment temporally. Vancomycin was injected superotemporally in the subtenon's space with no complications during the procedure or during his postoperative recovery. At seven days postinjection, the subretinal abscess and exudative retinal detachment resolved completely with necrosis at the area of previous abscess., Conclusion: We present the first successful case of subtenon's vancomycin injection for the treatment of bacterial subretinal abscess. Our case demonstrates that subtenon's injection of antibiotics is a safe and effective nonsurgical management option for bacterial subretinal abscesses.

Purpose: To determine the possible adverse effects and safe dose range of intravitreal colistin, an antibiotic, after its intravitreal application., Methods: Twenty eyes of 20 adult male and female New Zealand white rabbits were selected. Various concentrations of colistin were prepared. In each rabbit, 0.1 mL of colistin solution or saline solution was injected intravitreally into the right eye. Electroretinographic recordings were taken before and 2 weeks after injection. Histopathological examination was made using a light microscope following enucleation and fixation procedures. In histopathologic cross-sections, the differences between drug-injected eyes and control eyes were evaluated., Results: Electroretinographic examination showed a decrease of 30% as a significant value in the a and b wave amplitudes of the rabbits that injected 400 µg/0.1 ml and higher concentrations. Histological examination revealed histiocytic infiltration, histiocytic vacuoles, inflammation, and retinal degeneration in rabbit eyes given 400 µg/0.1 ml, 800 µg/0.1 ml, and 1.6 mg/0.1 ml concentrations of colistin., Conclusion: Based on our findings, the safe concentration of colistin is 0.2 mg/0.1 ml. Administration of 0.4 mg/0.1 ml was associated with cataract development, electrophysiological depression, and pathological changes in retinal layers.

Purpose: To compare the visual outcomes after prompt pars plana vitrectomy (PPV) with tap biopsy and intravitreal antimicrobial injection to treat postinjection and postsurgery endophthalmitis., Methods: The Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Ovid Embase databases were searched for articles published between January 2010 and November 2020. Two independent reviewers selected articles and extracted data. We analyzed data in RevMan 5.3 and assessed methodological quality using the Cochrane ROBINS-I tool. The mean improvement in visual outcome was compared between PPV and intravitreal antimicrobial injection as a relative risk of improving ≥2 lines and a mean logarithm of the minimal angle of resolution difference in improvement., Results: Fifteen retrospective case series (1,355 eyes), of which 739 eyes (55%) received intravitreal antimicrobial injection and 616 (45%) received PPV as initial treatment, were included. The overall relative risk of improving 2 or more lines in PPV in comparison with intravitreal antimicrobial injection was 1.04 (95% CI 0.88-1.23; P = 0.61; I2 = 0%) with a mean difference of 0.04 (95% CI -0.18 to 0.27; P = 0.69; I2 = 0%). The results stayed robust when subgroup analysis based on causative procedure for endophthalmitis was performed., Conclusion: Intravitreal antimicrobial injection is noninferior to PPV for the treatment of postcataract operation, postinjection, and post-PPV endophthalmitis.

Bacterial endophthalmitis is a rare intraocular infection, and prompt administration of intravitreal antibiotics is crucial for preventing severe vision loss. The retrospective study is to investigate the in vitro susceptibility to the antibiotics vancomycin, amikacin, and ceftazidime of bacterial endophthalmitis isolates in specimens at a tertiary referral center from January 1996 to April 2019 in Taiwan. Overall, 450 (49.9%) isolates were Gram positive, 447 (49.6%) were Gram negative, and 4 (0.4%) were Gram variable. In Gram-positive isolates, coagulase-negative staphylococci were the most commonly cultured bacteria (158, 35.1%), followed by Streptococci (100, 22.2%), Enterococci (75, 16.7%), and Staphylococcus aureus (70, 15.6%). In Gram-negative isolates, they were Klebsiella pneumoniae (166, 37.1%) and Pseudomonas aeruginosa (131, 29.3%). All Gram-positive organisms were susceptible to vancomycin, with the exception of one Enterococcus faecium isolate (1/450, 0.2%). Of the Gram-negative isolates, 96.9% and 93.7% were susceptible to ceftazidime and amikacin, respectively. Nine isolates (9/447, 2.0%) were multidrug-resistant Gram-negative bacteria, comprising K. pneumoniae (4/164, 2.4%), Acinetobacter baumannii (2/3, 67%), and Stenotrophomonas maltophilia (3/18, 17%). In conclusion, in vitro susceptibility testing revealed that vancomycin remains the suitable antibiotic treatment for Gram-positive endophthalmitis. Ceftazidime and amikacin provide approximately the same degree of Gram-negative coverage. Multidrug-resistant bacterial endophthalmitis was uncommon., (© 2021. The Author(s).)

Topic : To focus on endogenous endophthalmitis management, particularly etiology-based medical and surgical therapy. Methods : Literature search of published studies from July 1990 to February 2019 on endogenous endophthalmitis available on PubMed was made without any language constraints. Results : A total of 78 articles were retrieved from 728 initially analyzed and 62 studies were included. Although the superiority of vitrectomy over tap and inject techniques is controversial, the most recent publications favor an early surgical approach for endogenous endophthalmitis. Vitrectomy is useful in severe cases complicated by marked vitreous opacity, retinal detachment, poor initial visual acuity, and more virulent pathogens. Oral or intravenous antibiotics are also necessary to treat systemic infection. Vitrectomy is superior to blood cultures in diagnosing the etiology of infection. Conclusions : Endogenous endophthalmitis is an important cause of visual acuity impairment. Prompt treatment with appropriate use of pharmacological or surgical therapy is mandatory to preserve visual function. Abbreviations : IOP: intra-ocular pressure; AIDS: acquired immune deficiency syndrome; EVS: endophthalmitis vitrectomy study; CEVE: complete and early vitrectomy for endophthalmitis.

Purpose: To estimate the association of cefuroxime and moxifloxacin in relation to the occurrence of endophthalmitis following phacoemulsification cataract surgery., Design: Retrospective clinical cohort study., Methods: We studied patients with noncomplex phacoemulsification cataract surgery in Kaiser Permanente Northern California during 2014-2019. Data were obtained for acute, postoperative endophthalmitis within 90 days of phacoemulsification, including culture and antibiogram results, intracameral and topical antibiotic agent, and dose. In a post hoc analysis, we also examined preoperative anterior chamber depth (ACD) and postoperative anterior chamber volume (ACV)., Results: Of 216,141 surgeries, endophthalmitis occurred in 0.020% of moxifloxacin-injected eyes and 0.013% of cefuroxime eyes (relative risk 1.62 with 95% CI 0.82-3.20, P = .16). Of the 34 (0.016%) cases of endophthalmitis, cefuroxime 1 mg was injected into 13 eyes and moxifloxacin 0.1% into 21 eyes. Organisms with antibiograms were identified in 12 (35%) cases. Of these, bacteria recovered from cefuroxime-injected eyes were resistant to cefuroxime in all cases (4/4), with Enterococcus comprising half of these. In eyes injected with moxifloxacin 0.1%, 6 out of 7 organisms were sensitive to moxifloxacin injected with 0.1 mL and in 1 eye injected with 1 mL. Streptococcus was the most common organism recovered (6/9) in moxifloxacin-injected eyes. Preoperative ACD and postoperative calculated ACV were higher in eyes injected with moxifloxacin., Conclusions: Endophthalmitis cases with positive cultures were generally related to organism resistance in cefuroxime eyes but to sensitive organisms in moxifloxacin eyes. Moxifloxacin doses may have been insufficient in eyes with larger ACV., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the clinical characteristics and investigate the role of surgical antibiotic prophylaxis (SAP) in acute endophthalmitis cases after cataract surgery., Design: Retrospective, consecutive case series., Participants: A total of 126 patients referred to a tertiary center from 2007 to 2015 for acute endophthalmitis after unilateral cataract surgery., Methods: All patients who underwent a vitreous biopsy were included. Clinical and microbiology data were reviewed, and associations with visual outcome were analyzed using multivariate logistic regression. Data regarding SAP via intracameral injection were also retrieved., Main Outcome Measures: Bacterial culture results and visual acuity outcome., Results: Bacterial growth was observed in 92 of 126 cases (73%). Among these positive cultures, 49 (53.3%), 29 (31.5%), and 13 (14.1%) were coagulase-negative staphylococci, other gram-positive, and gram-negative bacteria, respectively. Among the 77 gram-positive strains tested, 76 (98.7%) were vancomycin-sensitive; among the 12 gram-negative strains tested, all 12 (100%) were ceftazidime-sensitive. Best achieved visual acuity outcome was ≥20/40 Snellen in 77 of 114 cases (67.5%). On multivariate analysis, we found an association between visual outcome of worse than 20/40 Snellen and a positive culture of more virulent bacteria (gram-negative and other gram-positive groups) and presentation with light perception or worse, with an odds ratio of 3.3 and 3.0, respectively. A subgroup of 25 cases (19.8%) developed endophthalmitis despite receiving a SAP by cefuroxime at the end of cataract surgery., Conclusions: Two-thirds of the patients in this endophthalmitis cohort experienced a visual outcome of ≥20/40 Snellen. Efficacy of primary treatment with vancomycin combined with ceftazidime is supported by this study. A subgroup treated prophylactically with cefuroxime demonstrated that SAP alone does not prevent endophthalmitis. This highlights the importance of surgical factors in the prevention of postoperative endophthalmitis., (Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

We present a case of a patient that experienced severe hemorrhagic occlusive retinal vasculitis secondary to injection of 1.0 mg/0.1 ml of intracameral vancomycin for endophthalmitis prophylaxis after an uneventful cataract surgery. The case is especially unique in that our patient ended up maintaining 20/25 vision with an ocular disease that is typically visually threatening. This may be due to the aggressive administration of periocular and oral steroids combined with scheduled anti-VEGF injections that were later transitioned into a treat and extend regimen.

Purpose: To investigate the impact of time from symptom onset to presentation on the clinical course and outcomes of eyes with endophthalmitis., Design: Retrospective, longitudinal cohort study., Participants: One hundred thirty-three eyes of 130 patients with endophthalmitis., Methods: Adults diagnosed with endophthalmitis at the Duke Eye Center from January 1, 2009, through January 1, 2018, were identified using the Duke Enterprise Data Unified Content Explorer. Patient demographics, time of symptom onset, presenting clinical features, management, and outcomes were recorded by retrospective review. Patients were divided into those seeking medical care either early (within 2 days) or later (delayed, i.e., 3 days or longer) with regard to symptom onset. Clinical features, management, and visual outcomes of eyes with early or delayed presentation were compared., Main Outcome Measures: Mean corrected visual acuity (VA) at presentation and at 6 months., Results: In eyes with delayed presentation, VA was significantly worse on initial examination (delayed, 20/2941 vs. early, 20/1124; P = 0.009) and at 6 months (delayed, 20/547 vs. early, 20/173; P = 0.01). When controlling for time to presentation, VA before endophthalmitis was correlated significantly with VA at 6 months (Pearson r = 0.55; R 2  = 29%; P < 0.0001). Eyes with glaucoma drainage device-related endophthalmitis were more likely to have a delayed presentation (P = 0.03). Eyes with delayed presentation were more likely to have conjunctival injection on initial examination (delayed, 73% vs. early, 52%; P = 0.01). Visual acuity before endophthalmitis, pain, and patient-reported blurred vision were not associated with early or delayed presentation (P > 0.05)., Conclusions: Delayed presentation was associated with worse VA on initial examination and at 6 months in eyes with endophthalmitis. Presence of pain did not prompt earlier presentation. Visual acuity before endophthalmitis was associated with VA at 6 months, regardless of time to presentation. Further investigation may help to improve anticipatory guidelines for at-risk patients., (Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Streptococcus pneumoniae endophthalmitis is clinically more severe, more difficult to treat, and carry a higher risk of vision loss, evisceration, or enucleation. This study is to investigate the clinical settings, antibiotic susceptibility, and visual outcomes of S. pneumoniae endophthalmitis at a tertiary referral center in Taiwan. S. pneumoniae endophthalmitis was diagnosed in 38 eyes of 38 patients. The main clinical features were postcataract endophthalmitis (n = 13, 34%) and endophthalmitis associated with corneal ulcer (n = 12, 32%), trauma (n = 6, 16%), endogenous etiology (n = 4, 11%), trabeculectomy (n = 2, 5%), and pterygium excision-related scleral ulcer (n = 1, 3%). Presenting visual acuity ranged from counting fingers to no light perception. Pars plana vitrectomy with intravitreal antibiotics was performed in 17 eyes (39%) in primary or secondary treatments. S. pneumoniae isolates were susceptible to vancomycin (38/38, 100%), penicillin (37/38, 97%), ceftriaxone (37/38, 97%), cefuroxime (12/15, 80%), levofloxacin (13/15 ,87%), and moxifloxacin (15/17, 88%). Final visual acuity was better than 20/400 in 3 of 38 eyes (8%), 5/200 to hand motions in 3 eyes (8%), and light perception to no light perception in 32 eyes (84%). Ten eyes (26%) underwent evisceration or enucleation. Although S. pneumoniae isolates were susceptible to vancomycin, S. pneumoniae endophthalmitis had a very poor visual prognosis.

We describe a case of endogenous endophthalmitis in an elderly man caused by Streptococcus salivarius An 88-year-old male patient with diabetes with iron deficiency anaemia and history of transcatheter aortic valve implantation presented with an insidious clinical picture of atraumatic endophthalmitis. No internal or external source could be identified. Diagnostic and therapeutic vitrectomy revealed papillomacular abscess and vitreous fluids grew S. salivarius Despite lack of an identifiable source of infection, a high index of suspicion for atypical presentations is required in patients with multiple comorbidities that could weaken their immune system towards opportunistic infections. Early detection, microbiological evaluation and prompt treatment are critical to avoid disastrous outcomes. While S. salivarius has been implicated in cases of exogenous endophthalmitis, this is the first reported case of endogenous endophthalmitis due to S. salivarius ., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To assess the utility of microbiologic culture data for the management of endophthalmitis after cataract surgery., Design: Retrospective, single-center, cohort study., Participants: All patients treated for endophthalmitis after cataract surgery between January 1, 2014, and December 31, 2017, at a single institution., Methods: Endophthalmitis cases were determined from billing records and confirmed with chart review. A change in clinical management was defined as additional intravitreal antibiotic injections or pars plana vitrectomy., Main Outcome Measures: A change in clinical management within 2 weeks of initial endophthalmitis culture and treatment; visual acuity (VA)., Results: A total of 111 eyes of 111 patients were treated for endophthalmitis after cataract surgery, of which 57 (51%) were culture-positive. After initial treatment of endophthalmitis, a change in clinical management after vitreous culture occurred in 9 of 111 eyes (8%), including 6 of 57 (11%) culture-positive eyes compared with 3 of 54 (6%) culture-negative eyes (P = 0.49). Change in clinical management for culture-positive eyes was based on declining vision (3 eyes), worsening clinical examination results (2 eyes), and retinal detachment (1 case). Change in clinical management for culture-negative endophthalmitis eyes was based on worsening clinical examination results (2 eyes) and declining vision (1 eye). No additional interventions were initiated on the basis of positive culture results. At final follow-up, mean logarithm of the minimum angle of resolution (logMAR) VA was 1.09 (∼20/250) for the culture-positive eyes compared with 0.59 (∼20/80) for culture-negative eyes (adjusted difference, 0.394; 95% confidence interval, 0.02-0.77, P = 0.03). Rhegmatogenous retinal detachments (RRDs) or retinal tears occurred in 19 of 111 eyes (17%) after developing endophthalmitis, and culture-positive eyes developed a secondary RRD in 11 of 57 eyes (19%) compared with 3 of 54 (6%) culture-negative eyes (P = 0.03)., Conclusions: After endophthalmitis related to cataract surgery, vitreous cultures may have prognostic value for final visual outcomes but have a limited effect on clinical management., (Copyright © 2020. Published by Elsevier Inc.)

Objective: To investigate the recent pieces of evidence regarding the bacterial ocular surface contamination and its treatment in the prophylaxis of post-cataract surgery endophthalmitis. Methods: We conducted a literature research on the topic of interest and selected the most relevant data. Results: The studies reported a relatively high rate of positive conjunctival culture and the most frequently isolated organism was Coagulase negative Staphylococcus, which is also the most common etiological agent of the postoperative endophthalmitis. The bacterial ocular surface load is influenced by age, climate, associated diseases, topical and systemic medication. The use of povidone-iodine alone or in association with levofloxacin eyedrops as prophylactic method is effective in reducing the conjunctival bacterial contamination and consequently decreases the incidence of postoperative endophthalmitis. Conclusions: Based on the current pieces of evidence, adequate treatment of the bacterial ocular surface contamination prior to cataract surgery seems to be effective in preventing endophthalmitis after cataract surgery. Abbreviations: EU = European Union, Spp. = Species, HIV = Human Immunodeficiency Virus., (©Romanian Society of Ophthalmology.)

Background: To report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature in order to study the clinical profile, treatment modalities, and visual outcomes among patients with NTM endophthalmitis., Methods: Clinical manifestation and management of patients with NTM endophthalmitis in the Department of Ophthalmology, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand were described. In addition, a review of previously reported cases and case series from MEDLINE, EMBASE, and CENTRAL was performed. The clinical information and type of NTM from the previous studies and our cases were summarized., Results: We reported three cases of NTM endophthalmitis caused by M. haemophilum, M. fortuitum and M. abscessus and a summarized review of 112 additional cases previously published. Of 115 patients, there were 101 exogenous endophthalmitis (87.8%) and 14 endogenous endophthalmitis (12.2%). The patients' age ranged from 13 to 89 years with mean of 60.5 ± 17.7 years with no gender predominance. Exogenous endophthalmitis occurred in both healthy and immunocompromised hosts, mainly caused by cataract surgery (67.3%). In contrast, almost all endogenous endophthalmitis patients were immunocompromised. Among all patients, previous history of tuberculosis infection was identified in 4 cases (3.5%). Rapid growing NTMs were responsible for exogenous endophthalmitis, while endogenous endophthalmitis were commonly caused by slow growers. Treatment regimens consisted of macrolides, fluoroquinolones or aminoglycosides, which were continued for up to 12 months. Initial and final vision were generally worse than 6/60., Conclusions: NTM endophthalmitis is a serious intraocular infection that leads to irreversible loss of vision. The presentation can mimic a chronic recurrent or persistent intraocular inflammation. History of multiple intraocular surgeries or immune-deficiency in patient with chronic panuveitis should raise the practioner's suspicion of NTM endophthalmitis. Appropriate diagnosis and treatment are important to optimize visual outcome.

Purpose: Postoperative endophthalmitis caused by nontuberculous mycobacterium is a rare but devastating complication after intraocular surgery. However, optimal treatment strategies remain undetermined in view of its rarity., Methods: We investigated the cases of culture-proven postoperative Mycobacteroides abscessus subsp. abscessus endophthalmitis in southern Taiwan, focusing on clinical manifestations and microbiological study, and aimed to describe clinical staging and to propose a therapeutic modality for this disease., Results: Twelve cases, including two published cases, were treated in two medical centers in southern Taiwan between Aug. 2011 and Dec. 2016, and all ever received cataract surgery at one clinic. Their disease courses could be categorized into four distinct stages, i.e., the initial, quiescent, recurrent, and end stage, and some cases experienced 1-4 cycles of quiescent-recurrent stages. Although all eyes ended up with phthisis or were eviscerated, the affected eyes receiving pars plana vitrectomy (PPV) tended to become quiescent and survived longer than those without PPV (adjusted hazard ratio: 13.9, p < 0.05). Eight isolates of eight patients were available for microbiological study. All isolates were susceptible to amikacin, and inducible clarithromycin resistance was observed in 100% of isolates., Conclusion: Despite the preservation of vision in postoperative M.abscessus endophthalmitis remained a challenge, a stage-based approach is proposed, which may facilitate decision-makings for the future study., (Copyright © 2019. Published by Elsevier B.V.)

Purpose : The main purpose of this study was to increase the concentration and bioavailability of Ciprofloxacin (CPX) in the rabbit eye by liposomal formulation. Methods : CPX- loaded liposomes with and without Carbomer 934 (carbomer) were prepared by a thin-layer hydration method. Liposomal formulations after evaluation for characters such as particle size and entrapment efficiency were used in in-vivo experimental for installation into the rabbit's eyes. This experimental study consisted of 10 rabbits divided into two groups. Group 1 (liposomes without coating) and group 2 (carbomer coated liposomes) received one drop per h of liposomes consists of 0.3% CPX in the right eye and commercial CPX eye drop in the left eye until 6 h. Aqueous humor and vitreous samples were collected from all rabbits at the baseline, 1, 3 and 6 h and the drug concentration determined by high pressure liquid chromatography (HPLC). On the other hand, minimum inhibitor concentration (MIC) and minimum bactericidal concentration (MBC) of CPX-loaded in liposomes were determined. Results : liposomal formulations increased ocular bioavailability of CPX around four-folds compared with a commercial CPX eye drop. The increase in the ocular bioavailability may be effective and help to treat bacterial endophthalmitis as well as can be used in prophylaxis of post-operative endophthalmitis. Conclusion : The concentrations of CPX on the aqueous humor and vitreous after liposomes application were more than MIC of CPX against pseudomonas auroginosa and staphylococcus aurous but for commercial eye drop was less than MIC. Therefore liposomes modified the pharmacokinetics of CPX and improved pharmacodynamics property.

Purpose: We sought to determine changes in the conjunctival bacterial flora and antibiotic resistance after topical antibiotic drops for infection prophylaxis were administered following intravitreal injections in patients with type 2 diabetes., Methods: This prospective and nonrandomized cohort study included 116 eyes of 116 treatment-naive patients with type 2 diabetes who received six serial intravitreal anti-vascular endothelial growth factor injections for macular edema. Three conjunctival cultures were obtained from each eye over the course of the study (Culture 1, baseline; Culture 2, 1 month after the third injection; and Culture 3, 1 month after the sixth injection). The study subjects were given topical moxifloxacin hydrochloride for 4 days after each monthly intravitreal injection. The growth patterns of conjunctival bacterial flora and the antibiotic resistance to several commonly used antibiotics were examined., Results: The rate of culture positivity increased significantly during the observation period (Culture 1, n = 47, 40.5%; Culture 2, n = 58, 50%; Culture 3, n = 76, 65.5%, p < 0.001). The bacterium with the highest baseline culture positivity was Staphylococcus epidermidis (n = 45, 38.8%), which increased significantly during the observation period ( p < 0.001). No significant increase was noted in the culture positivity of the other bacteria with baseline culture positivity ( p > 0.05). Regarding antibiotic susceptibility, significant increases in resistance to the fluoroquinolone group of drugs were noted ( p < 0.001). No significant changes in sensitivity were detected in the other 11 investigated antibiotics that are commonly used in clinical practice ( p > 0.05)., Conclusions: The use of topical moxifloxacin after each intravitreal injection significantly increases the fluoroquinolone resistance of the ocular surface flora and the culture-positivity rate of S. epidermidis in patients with type 2 diabetes., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2020 The Korean Ophthalmological Society.)

Rationale: Endophthalmitis, which is one of the severest complications of cataract surgeries, can seriously threaten vision and even lead to irreversible blindness owing to its complicated microenvironment, including both local bacterial infection and severe inflammation. It is urgent to develop a comprehensive treatment for both anti-bacterial and anti-inflammatory effects. Methods: Herein, we developed AuAgCu 2 O-bromfenac sodium nanoparticles (AuAgCu 2 O-BS NPs), which was designed to combine anti-bacterial and anti-inflammatory effects for integrated therapy of endophthalmitis after cataract surgery. The AuAgCu 2 O-BS NPs could eradicate methicillin-resistant Staphylococcus aureus (MRSA) bacterial strain relied on their photodynamic effects and the release of metal ions (Ag + and Cu + ) by the hollow AuAgCu 2 O nanostructures mediated mild photothermal effects. The anti-inflammatory drug, bromfenac sodium, released from the nanoparticles were able to significantly reduce the local inflammation of the endophthalmitis and promote tissue rehabilitation. In vivo bacterial elimination and anti-inflammation were confirmed by a postcataract endophthalmitis rabbit model. Results: Excellent antibacterial ability of AuAgCu 2 O-BS NPs was verified both in vitro and in vivo . Ophthalmological clinical observation and pathologic histology analysis showed prominent treatment of inflammatory reaction. Importantly, the mild temperature photothermal effect not only promoted the release of metal ions and bromfenac sodium but also avoided the thermal damage of the surrounding tissues, which was more suitable for the practical application of ophthalmology due to the complex structure of the eyeball. Moreover, superior biocompatibility was approved by the preliminary toxicity investigations, including low cytotoxicity, negligible damage to major organs, and stable intraocular pressure. Conclusions: Our studies of nanosystem provide a promising synergic therapeutic strategy for postcataract endophthalmitis treatment with favorable prognosis and promise in clinical translations., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Objective: To determine bacteria obtained from eye infections, both resistance and minimal inhibitory concentration (MIC) to gatifloxacin, moxifloxacin, tigecycline, linezolid and imipenem, in vitro. Methods: A cross-sectional descriptive study was undergone with 50 samples from 50 eyes of patients diagnosed with keratitis or endophthalmitis, who came to a consultation at the Fundación Oftalmológica de Santander (Floridablanca, Colombia) from August to November 2014. The MICs of the isolated microorganisms were established through Etest® strips (BioMérieux SA, Marcy-l'Etoile - France). Results: Of the 50 samples in total, 17 different bacteria species or groups were isolated. The main isolate for gram-positives was Methicillin Resistant Coagulase-Negative Staphylococcus (17 samples), and for gram-negatives was Pseudomonas aeruginosa (6 samples). The susceptibility percentages sorted from highest to lowest for gram-positive isolates (n=38) were: imipenem 90.3%, linezolid 87.9%, tigecycline 78.1%, gatifloxacin 68.8% and moxifloxacin 68.8%. For gram-negative isolates (n=12), they were: imipenem 72.7%, gatifloxacin 70%, moxifloxacin 66.7% (no reference cut-off points were found for Pseudomonas aeruginosa ), tigecycline 22.2%, and linezolid 0% (as expected according to its inhibition spectrum). Conclusions: Although fourth generation fluoroquinolones are currently the preferred initial empirical monotherapy in our practice, given the increasing bacterial resistance, in cases in which gram-positive bacteria were isolated in the initial staining imipenem, linezolid or tigecycline could be used as an alternative. On the other hand, for cases of gram-negative bacteria, no antimicrobial susceptibility exceeded 80%, so using two antimicrobials looking for a synergy between them could be a better option. Abbreviations: S = Susceptibility, IS = Intermediate susceptibility, R = Resistance., (©Romanian Society of Ophthalmology.)

Purpose: To analyze practice patterns, microbiologic yield, and clinical outcomes in cases of presumed infectious endophthalmitis at a single tertiary academic referral center., Design: Retrospective chart review., Participants: Eyes diagnosed with endophthalmitis at the Duke Eye Center between January 1, 2009, and January 1, 2018, that underwent aqueous tap, needle vitreous tap, or mechanical vitreous biopsy with pars plana vitrectomy (PPV) in conjunction with intravitreal antimicrobials., Methods: Charts of 133 eyes of 130 consecutive patients were identified and reviewed for etiology of endophthalmitis, ocular history, interventions, visual outcomes, complication rates, and microbiologic culture results., Main Outcome Measures: Microbiologic yield and corrected visual acuity (VA) at initial presentation and last follow-up (up to 1 year) were the primary outcome measures. Secondary outcome measures included need for subsequent intervention, retinal detachment (RD) rate, and antimicrobial sensitivities., Results: Of the 133 cases of presumed infectious endophthalmitis, 74% were unrelated to cataract surgery. Initial management included intravitreal antimicrobials with aqueous tap in 46% of eyes, needle vitreous tap in 59% of eyes, and mechanical vitreous biopsy with PPV in 14% of eyes. Twenty-seven percent of cases that underwent initial aqueous or needle vitreous tap required subsequent intervention with PPV. Overall, 45% of endophthalmitis cases were culture proven. Needle vitreous tap and mechanical vitreous biopsy with PPV were more likely to yield culture growth compared with aqueous tap (P = 0.042, P = 0.004, respectively). All isolated bacteria were sensitive to the combination of intravitreal vancomycin and ceftazidime. Eyes that underwent initial mechanical vitreous biopsy with PPV had worse VA at presentation (P = 0.024) and at last follow up (P = 0.011) compared with eyes that underwent initial aqueous tap or needle vitreous tap. An RD occurred within 3-12 months in 13% (17/133) of cases, and of these, 41% had an endogenous etiology., Conclusions: Needle vitreous tap and mechanical vitreous biopsy were more effective in yielding positive cultures compared with aqueous tap; however, culture results may not influence initial intravitreal antimicrobial choice. Eyes with presenting VA between counting fingers and hand motion at 1 foot were more likely to undergo initial PPV., (Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

To report long-term outcomes of intravitreal ceftazidime injection in patients with endogenous Klebsiella pneumoniae endophthalmitis (EKPE).This was a retrospective observational case study, including 7 eyes from 6 patients with EKPE. The medical records from January 2010 to December 2018 were reviewed.Diagnosis of EKPE was made based on the finding of endophthalmitis with concurrent systemic infection and positive blood culture result. All patients received tap and intravitreal ceftazidime injection base on the results of antibiotics sensitivity test. Visual acuity ranged from no light perception to 20/60 at initial visit, and the final visual acuity was 20/20. Two eyes underwent evisceration after intravitreal injection.Intravitreal ceftazidime injection showed favorable results in patients with EKPE.

Background: There are no data available regarding the complications associated with using antibiotic ointment at the end of intraocular surgery. This study aimed to explore the necessity of using ocular tobramycin-dexamethasone prophylactically at the end of intraocular surgery., Methods: This was a retrospective cohort study of patients who received intraocular surgery at Tianjin Medical University General Hospital from January 2015 to December 2017. The patients were grouped according to whether they received tobramycin-dexamethasone eye ointment or not after surgery. The Tobramycin dexamethasone eye ointment was sampled to observe bacterial contamination pathogens at 0.5, 1, 1.5, 2, 2.5, 3, 6, 8, 24, 36, 48, 72, and 168 h after being opened., Results: A total of 3811 eyes in 3811 patients (mean age of 63 ± 12 years) were included: 2397 eyes that received prophylactic tobramycin-dexamethasone eye ointment and 1414 eyes that did not. The overall rate of endophthalmitis was 0.08% (3/3811) in our study, all in the eye ointment group (0.12%, 3/2397); no patients developed endophthalmitis in the non-ointment group (0%, 0/1414)(P = 0.184). The anterior chamber reactions 1 day after surgery were more serious in the eye ointment group compared with the non-ointment group (all P < 0.05), but there were no statistically significant differences at 1 month postoperatively (all P > 0.05). The contamination rate was 0% at all time points over 7 days., Conclusion: We did not observe a statistically significant difference in the incidence of endophthalmitis in patients with or without prophylactic tobramycin-dexamethasone eye ointment. And tobramycin-dexamethasone eye ointment seemed to increase some side effects such as eye secretions increasing and foreign body feeling.

Background and Objective: To evaluate antibiotic resistance patterns in Staphylococcus epidermis endophthalmitis isolates, identify antibiotic resistance genes, and compare this to their phenotypic resistance., Materials and Methods: Retrospective case series of S. epidermidis isolates from January 2012 to December 2017. Phenotypic resistance was determined from minimum inhibitory concentration values. Genotypic resistance was determined from DNA microarray. The relationship between these was analyzed using Cohen's kappa and predictive value., Results: Seventy-five isolates were included. More than 60% were resistant to methicillin and erythromycin. Approximately 60% possessed the resistance genes for methicillin and erythromycin, and 25% for clindamycin. There was near perfect agreement between genotype and phenotype for erythromycin and methicillin (kappa = 0.88 and 0.89, respectively). Approximately 98% (P < 0.0001) of isolates with erythromycin and methicillin resistance genes and 90% (P = 0.0006) with clindamycin resistance genes were phenotypically resistant to those antibiotics. None were resistant to vancomycin., Conclusion: The relationship between genotypic and phenotypic antibiotic resistance highlights that resistance may be polygenic, and genes may be silent. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:S13-S16.]., (Copyright 2020, SLACK Incorporated.)

Endogenous endophthalmitis, EE, a less common form of endophthalmitis, occurs when the microorganisms spread to the eye through the bloodstream, from a septic focus elsewhere in the body, that breaches into the integrity of the eyeball itself. The etiopathogenesis of endogenous endophthalmitis has changed over the past two decades, the aim of this review being to study the changing trends in causative organism in the era of modern antibiotics., (©Romanian Society of Ophthalmology.)

Bacillus cereus (B. cereus) endophthalmitis is a devastating intraocular infection primarily associated with post-traumatic injuries. The majority of these infections result in substantial vision loss, if not loss of the eye itself, within 12-48 h. Multifactorial mechanisms that lead to the innate intraocular inflammatory response during this disease include the combination of robust bacterial replication, migration of the organism throughout the eye, and toxin production by the organism. Therefore, the window of therapeutic intervention in B. cereus endophthalmitis is quite narrow compared to that of other pathogens which cause this disease. Understanding the interaction of bacterial and host factors is critical in understanding the disease and formulating more rational therapeutics for salvaging vision. In this review, we will discuss clinical and research findings related to B. cereus endophthalmitis in terms of the organism's virulence and inflammogenic potential, and strategies for improving of current therapeutic regimens for this blinding disease., Competing Interests: Declaration of competing interest The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To describe the clinical presentation and management of Enterobacter endophthalmitis and compare with previous in-house published literature., Methods: This was a retrospective interventional comparative case series involving 44 cases with culture proven Enterobacter endophthalmitis from April 2006 to August 2018 who underwent vitrectomy/vitreous biopsy, intravitreal antibiotics with or without additional procedures as appropriate. The current outcomes were compared to the outcomes previously reported a decade back from our center. The mean age at presentation, predisposing factor, number of interventions, interval between inciting event and presentation, type of intravitreal antibiotic used, anatomic, and the functional outcomes were analyzed and compared to the previous series., Results: There were 30 males. Mean age was 22.73 ± 21.35 years (median 14 years). Inciting event was open globe injury in 34 (77.27%) eyes, 4 (9.09%) eyes following cataract surgery, 3 (6.81%) eyes with endogenous endophthalmitis, 2 (4.54%) eyes following keratoplasty, and 1 eye (2.27%) following trabeculectomy. Presenting visual acuity was favorable (≥20/400) in 2 eyes (4.54%), at the final visit it was in 11 eyes (25%). The organisms were most sensitive to ciprofloxacin (95.12%), amikacin (90.47%), and ceftazidime (85.36%). A comparison of the current study with previous in-house study showed that number of eyes with presenting vision ≥20/400 as well as final vision ≥20/400 were comparable. Susceptibility was highest to ciprofloxacin 39 (95.12%) (previous series) and 33 (92%) (current series)., Conclusion: Enterobacter organisms show susceptibility to ciprofloxacin, amikacin, and ceftazidime. Susceptibility profile, clinical presentations, and management remain largely similar over many years. Final outcome is unfavorable., Competing Interests: None

Objectives: The aim of this study was to analyse the clinical features, microbiology results, management and outcomes of patients with endogenous endophthalmitis caused by Klebsiella pneumoniae in western China., Methods: A retrospective review of medical records of 10 eyes in 10 subjects diagnosed with endogenous K. pneumoniae endophthalmitis from January 2008 to December 2018 was undertaken., Results: The top 3 predisposing medical conditions included diabetes mellitus (50%), malignancy (20%) and cardiac stent implantation (10%). Extraocular infective foci were mainly found in the liver (40%), lungs (20%) and kidneys (10%). The positive culture rate was 85.71% (6/7) in vitreous samples, 83.33% (5/6) in blood samples and 100% (4/4) in body fluid samples. Only 20% of the patients, who had good initial visual acuity (VA) better than hand movement (HM), achieved a final VA better than 1.0 (log MAR). The mortality rate was 10%., Conclusions: Though the prognosis of endogenous K. pneumoniae endophthalmitis is often poor, patients with an initial VA better than HM may have a good prognosis under comprehensive treatments, including vitrectomy, systemic sensitive antibiotic injection and drainage of the primary infection loci., (© 2020 S. Karger AG, Basel.)