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Endophthalmitis is one of the most severe ocular emergencies faced by ophthalmologists worldwide. Without prompt treatment significant visual loss is inevitable. With increased understanding of the science of endophthalmitis, recent studies have shown a clear role of early and more definitive surgery to achieve better visual and anatomic outcomes. Surgery in endophthalmitis encompasses a whole gamut of interventions. There are diagnostic procedures like anterior chamber tap and vitreous biopsy or therapeutic procedures like complete pars plana vitrectomy and retinal detachment repair. Current literature is deficient on a detailed description of the spectrum of surgical interventions in endophthalmitis. In the current communication, we summarize the studies based on various surgical interventions in endophthalmitis. We also elaborate in detail on each surgical maneuver, taking the reader through the nuances of each surgery via an exhaustive description and appropriate photos and surgical video clips., (© 2024. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

During outdoor work in April 2022, a 48-year-old man was stabbed by a tree branch and underwent intraocular foreign body extraction and repair of the scleral wound with sutures and amniotic membrane graft at a local hospital. Steroid therapy with prednisone was prescribed after a diagnosis of uveitis. Vitrectomy was performed in June 2023; a fungal culture was positive, and ITS sequencing identified the organism as Paradictyoarthrinium diffractum. Empiric antifungal therapy did not have an effect, and, because of deterioration of the condition, the left eye was enucleated in October 2023. P. diffractum is a mangrove host-specific saprophytic fungus that has not been reported in humans., Competing Interests: Declarations of competing interest The authors have no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The correlation between the change in foveal thickness measured using optical coherence tomography (OCT) following surgery for infectious endophthalmitis and preoperative and postoperative visual acuity is uncertain, and there are few pertinent studies on this topic., Objective: We explored the variations in macular thickness using OCT after emergency vitrectomy for post-cataract infectious endophthalmitis and the relationship between macular thickness with changes in visual function., Methods: We included 10 cases of post-cataract infectious endophthalmitis. Each patient underwent 25-G vitrectomy., Results: The infection in all 10 patients was under control and visual function improved. Postoperative vitreous humor culture was positive in 8 patients, including 7 cases of coagulase-negative Staphylococcus epidermidis and 1 case of Lactobacillus acidophilus. The average age of these 10 patients was 71.60 ± 8.71 years (P< 0.05, two-tailed). There was no significant correlation between time 2 (the time of onset after cataract surgery) and visual prognosis. The average time 1 (the time of the vitrification surgery caused by the onset of the disease) was 1.45 ± 0.76 days (P< 0.05, two-tailed). The postoperative 3dVA ranged from 0.20 to 3.00, with an average visual acuity of 1.87 ± 1.12, which was superior to the preoperative value (P< 0.01, two-tailed). The correlation between the post3dVA and post 1mVA was significant. The post 1mVA ranged from 0.05 to 2.20, with an average visual acuity of 0.94 ± 0.74 (P< 0.05, two-tailed). The correlation between post 1mVA and post3mVA was significant. Also, paired t-tests comparing preoperative and postoperative visual acuity revealed a significant correlation (P< 0.05, two-tailed). The post3mVA was 0-1.00 with an average visual acuity of 0.44 ± 0.41. The postoperative foveal thickness ranged from 176.00 to 514.00 μm, with an average thickness of 281.10 ± 113.12 μm., Conclusion: Emergency 25-G minimally invasive vitrectomy can improve visual acuity and decrease the reoperation rate for patients who have acquired post-cataract infectious endophthalmitis. There were significant correlations between age, disease onset to operation time, preoperative and postoperative visual acuity, and postoperative macular thickness.

Purpose: To assess the feasibility of a novel surgical technique that combines B-scan ultrasound with modern vitrectomy techniques., Methods: Patients with a clinical diagnosis of infectious keratitis endophthalmitis, which were scheduled for pars plana vitrectomy and ruled out as candidates for transient keratoprosthesis, were enrolled. The ultrasound probe was placed over the eye to use the images to witness the vitreous movement around the cutter and to establish its position in relation to the retinal wall. The procedure was performed in at least four ultrasound projections (longitudinal-9,6, 3, and 12). All patients were followed for three months, and in each visit, the visual acuity and the presence of adverse effects were assessed., Results: Overall, 12 patients (mean age: 56.2 ± 18.4 years) were enrolled. Visual acuity at baseline was 2.3 ± 0.25 logarithm of the minimum angle of resolution. Sixty-six percent achieved inactivation of endophthalmitis. Two patients had evisceration caused by uncontrolled infection, and two more had retinal detachment during follow-up. Visual acuity at the end of follow-up was 2.1 ± 0.3 logarithm of the minimum angle of resolution ( P = 0.5)., Conclusion: Ultrasound-guided vitrectomy is a feasible surgical technique. More studies are needed to assess its safety profile and optimize outcomes.

Purpose: To provide an overview of pediatric pars planitis., Methods: Narrative literature review., Results: Pars planitis refers to the idiopathic subset of intermediate uveitis in which there is vitritis along with snowball or snowbank formation occurring in the absence of an associated infection or systemic disease. It is thought to be a T-cell mediated disease with a genetic predisposition. Pars planitis accounts for 5-26.7% of pediatric uveitis cases. Presentation is commonly bilateral but asymmetric, often with insidious onset of floaters and blurred vision. Although pars planitis is known to be a benign form of uveitis in most cases, severe complications secondary to chronic inflammation may arise, with cystoid macular edema being the most common cause of visual morbidity. Mild vitritis in the absence of symptoms, vision loss, or macular edema may be observed. Patients with severe vitritis and/or associated vision-threatening complications require prompt aggressive treatment. A stepladder approach including corticosteroids, immunosuppressive agents, anti‑tumor necrosis factor‑alpha and pars plana vitrectomy and/or laser photocoagulation is the most commonly used method for treatment of pars planitis., Conclusion: Timely diagnosis and adequate treatment of pediatric pars planitis and associated complications are crucial in order to improve visual outcomes.

Rationale: Endogenous endophthalmitis is a vision-threatening intraocular infection caused by hematogenous spread of infectious organisms from distant sites., Patient Concerns: A 71-year-old man with a history of fever and dysuria 5 days prior to presentation presented with sudden loss of vision in his left eye. The patient had no history of ocular surgery or trauma, and ocular examination revealed a large amount of exudative plaque covering the pupil. Therefore, fundus examination was not feasible. B-scan ultrasonography revealed a dome-shaped subretinal mass with an exudative retinal detachment., Diagnosis: Endogenous endophthalmitis was diagnosed on the basis of these findings., Interventions: The patient underwent pars plana vitrectomy and the early postoperative course was favorable., Outcomes: Vitreous cultures grew gram-negative bacilli, identified as Klebsiella pneumonia. Urinalysis revealed white blood cells (++) and urinary tract infection was the only identifiable risk factor for endogenous endophthalmitis., Lessons: Urinary tract infection is an independent risk factor for endogenous endophthalmitis., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: To explore clinical efficacy of vitrectomy combined with intravitreal antibiotics in treating severe endophthalmitis after open-globe trauma in patients., Methods: The records of all patients who received vitrectomy combined with intravitreal for the severe post-traumatic endophthalmitis with light perception or worse between 2010 and 2022 were retrospectively reviewed. Patients received vitrectomy combined with intravitreal antibiotics, repeated intravitreal antibiotics with or without vitreous aspiration, and retinal repair after the infection was controlled. Efficacy of severe post-traumatic endophthalmitis was analyzed., Results: One hundred and twenty-one patients (121 eyes) were included in this study. The mean BCVA improved from 4.03 ± 0.18 logarithm of the minimum angle of resolution to 1.75 ± 1.41 logarithm of the minimum angle of resolution ( P < 0.001) at the end of the follow-up period, which increased in 106 eyes (87.60%). Infection was successfully controlled in all eyes, 88 eyes within two operations. Pathogens including streptococci (odds ratio [OR] = 6.68, P < 0.001), fungi (OR = 15.23, P < 0.001), and mixed infection (OR = 6.67, P < 0.05) were related to the number of operations. Finally, 60 eyes (49.59%) received silicone oil filling, 25 received gas tamponade, and the remaining 36 received no tamponade; complete vitrectomy was performed in all eyes with intraocular tamponade. All eyes for gas tamponade and no tamponade had been remained stable without retinal detachment and proliferative vitreoretinopathy after 6-month follow-up. The rate of recurrent retinal detachment after silicone oil tamponade was 4.96% (six eyes), including 1.65% (two eyes) of proliferative vitreoretinopathy; these eyes underwent reoperation of retinal detachment repair., Conclusion: Vitrectomy combined with intravitreal antibiotics may be an effective treatment option for severe post-traumatic endophthalmitis.

Purpose: The purpose of this study was to assess the role of combined surgical treatment of therapeutic penetrating keratoplasty and pars plana vitrectomy in the anatomical and functional outcome of infectious keratitis endophthalmitis., Methods: This study reviewed the medical records of 4 participating centers in the United States and Mexico. This study included patients with a clinical diagnosis of infectious keratitis endophthalmitis who had been treated with an early therapeutic penetrating keratoplasty and pars plana vitrectomy as the main treatment for endophthalmitis. From each medical record, the study retrieved demographic data, relevant medical and drug history, baseline clinical manifestation of endophthalmitis, best-corrected visual acuity, and the need for enucleation/evisceration for the control of the infection or any other reason through the follow-up., Results: The study included 48 patients (50.15 ± 20.6 years). The mean follow-up time was 13 ± 0.5 months. The mean best-corrected visual acuity at baseline was 2.1 ± 0.25 logarithm of the minimum angle of resolution. At month 12 was 2.09 ± 0.61 logarithm of the minimum angle of resolution ( P = 0.9). The overall prevalence of enucleation/evisceration was 8.3% (95% confidence interval: 2.32%-19.98%). The prevalence of a vision of no-light perception was 20.8% (95% confidence interval: 2.32%-19.98%)., Conclusions: Combined surgery for severe cases of infectious keratitis endophthalmitis eradicates the infection in most cases, while significantly improving the overall outcomes., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To identify clinical risk factors for enucleation or evisceration in patients with endophthalmitis at an academic institution., Methods: A retrospective review of patients diagnosed with endophthalmitis at Wilmer Eye Institute from 2010 to 2019 was conducted. Clinical characteristics, including demographics, cause for endophthalmitis, microbial culture results, salvaging procedures and surgical intervention were recorded. In patients who underwent enucleation or evisceration, type of surgery and placement of a primary implant were recorded. Chi-squared, Student's t -tests and multivariate analysis were used to identify clinical factors that predicted enucleation or evisceration., Results: Two hundred and fifty three patients treated for endophthalmitis over the study period were identified, of which 25 (9.88%) underwent enucleation or evisceration. Risk factors for enucleation or evisceration included poor presenting visual acuity (OR 7.86, CI: 2.26, 27.3), high presenting intraocular pressure (OR 1.07, CI: 1.03, 1.12), presence of relative afferent pupillary defect (OR 3.69, CI: 1.20, 11.37) and positive vitreous culture for methicillin-resistant staphylococcus aureus (MRSA) (OR 18.3, CI: 1.54, 219.2) on multivariate analysis. Patients undergoing enucleation or evisceration were also more likely to have trauma, corneal ulcer or combined causes for endophthalmitis and underwent fewer salvaging surgical and procedural interventions. There were no significant differences in characteristics of those receiving enucleation versus evisceration in our cohort., Conclusion: Patients with endophthalmitis who underwent enucleation or evisceration had more severe disease on presentation compared to those treated with eye sparing therapy. Presenting clinical characteristics may have a role in triage and management decisions for patients presenting with severe endophthalmitis.

Purpose: We compared the rates of implant exposure and extrusion after evisceration with single and double scleral closure techniques., Methods: This retrospective cohort study included all patients who underwent evisceration with an implant insertion over the past 18 years at Tung Wah Eastern Hospital and Pamela Youde Nethersole Eastern Hospital. Clinical documents and operation records were reviewed., Results: A total of 81 ethnic Chinese patients (44 male) who underwent evisceration with primary implant insertion were reviewed. 39 (48%) patients underwent the double scleral closure technique with an implant placed posterior to the posterior sclera, and 42 (52%) patients underwent the single scleral closure technique with an implant inserted in the intra-scleral cavity. The follow-up interval was 70 months. The surgical indications were endophthalmitis (35%), painful blind eye (23%), traumatic disfigured globe (22%) and phthisis bulbi (20%). Silicone was the most used implant material (69%). The patients who underwent double scleral closure had a larger size of the implant (19.7 vs 17.9 mm, p < 0.05). Both implant exposure (26% vs 3%, p < 0.05) and implant extrusion (26% vs 0%, p < 0.05) were more common in patients who underwent single scleral., Conclusions: Double scleral closure technique allows a larger implant, and it is associated with a lower rate of implant exposure and extrusion. The double scleral closure technique is a superior technique of choice in these patients with primary implant placement., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To assess the long-term (5-year) results and complications of the double-flanged polypropylene technique in patients with capsular tension segment fixation, nonfoldable intraocular lens (IOL) scleral fixation, and foldable IOL scleral fixation., Setting: Santa Casa de Belo Horizonte and Centro Oftalmológico de Minas Gerais., Design: Prospective case series., Methods: Eyes that underwent treatment using the double-flanged polypropylene technique between September 2016 to September 2021 were included. LogMAR visual acuity was recorded, as well as complications such as long-term polypropylene resistance, conjunctival erosion, conjunctival inflammation, flange exposure, internalization, endophthalmitis, retinal detachment, and cystoid macular edema., Results: 71 eyes of 61 patients were evaluated. The mean follow-up period for these eyes was 28.2 ± 14.3 (min: 4; max: 60; median: 26) months. 173 flanges were performed. 13 cases with sub-Tenon flanges (7.5%) were observed. 5 exposed flanges (2.89%), presented after a mean of 1.8 weeks postoperatively, were observed. 1 patient with large flanges presented with conjunctival inflammation and hyperemia. 2 late internalized flanges (1.1%) and 2 recently internalized flanges (1.1%) were observed. 3 eyes (4.22%) had retinal detachment. Moreover, cystoid macular edema was detected in 3 eyes (4.22%). No cases of endophthalmitis were observed., Conclusions: The double-flanged technique was proven to be stable when the correct technical procedure was followed. However, complications can be observed, especially with short scleral tunnels and in eyes where the flanges were not buried inside the sclera., (Copyright © 2023 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: To compare the outcomes of immediate pars plana vitrectomy (PPV) and tap and inject in eyes with postcataract surgery endophthalmitis., Methods: Patients presenting with acute postcataract surgery endophthalmitis and visual acuity between ≥ hand movement and <6/18 were randomized to receive either PPV (Group A) or tap and inject (Group B)., Results: There were 26 and 31 eyes in Group A and Group B, respectively. The final mean visual acuity at 6 weeks [0.14 (Snellen equivalent 6/7.5) versus 0.22 (Snellen equivalent 6/9.5) LogMAR in Groups A and B, respectively; P = 0.2] was similar. However, eyes in Group A had significantly greater mean letter gain in vision compared with Group B (66.36 vs. 43.36, P = 0.02), and more eyes in Group A (88%) than in Group B (65%) attained a visual acuity of ≥ 6/18 ( P = 0.06). Eyes in Group B needed more reinterventions including delayed vitrectomy after tap and inject than those in Group A (39% vs. 8%; P = 0.09). On subgroup analysis, the mean visual acuity at the final follow-up was significantly better in the immediate PPV group compared with the delayed PPV group ( P = 0.04)., Conclusion: PPV resulted in earlier recovery, lesser interventions, and greater change in visual acuity than tap and inject in eyes with postcataract surgery endophthalmitis presenting with visual acuity of ≥HM., Competing Interests: No potential conflict of interest was reported by the authors.

Objectives: This study reports the surgical outcomes of evisceration with primary orbital implant placement in patients with endophthalmitis and analyses the association with implant exposure and extrusion., Methods: A retrospective, multicentre, Chinese cohort study. Review of medical records and orbital images of patients who underwent evisceration with primary orbital implant placement between January 2005 and January 2021., Results: Out of 79 patients who underwent orbital evisceration with primary orbital implant placement, 26 (26 eyes) of them (male = 13) suffered from endophthalmitis. The duration from endophthalmitis diagnosis (19 = exogenous, 7 = endogenous) to evisceration was 9 standard deviation ± 5 (range: 1-15) days. The follow-up was 70 ± 46 (24-180) months after operation. The orbital implant size was 17 ± 3 (14-20) mm, and silicone was the most used material (69%, 18/26 of patients). The most frequent post-operative complication was orbital implant exposure (42%, 11/26), followed by orbital implant extrusion (12% 3/26) and ptosis (8%, 2/26). Implant exposure or extrusion was more commonly associated with endophthalmitis in comparison to non-endophthalmitis patients that required evisceration and primary orbital implant placement (54% versus 17%, P < 0.05). Univariate analysis showed single scleral closure technique (100% versus 58%, P < 0.05) and endogenous endophthalmitis (50% versus 0%, P < 0.05) were associated with implant exposure or extrusion, and only endogenous endophthalmitis was significant with multivariate analysis (P < 0.05)., Conclusions: Primary implant placement during evisceration should be avoided in eyes with endophthalmitis especially in those with an endogenous source, and double scleral closure technique may be a better alternative for primary orbital implant placement in infected eyes., (© 2022. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: To determine the incidence of and identify risk factors for redetachment in eyes that underwent rhegmatogenous retinal detachment (RRD) repair after infectious endophthalmitis., Methods: Retrospective chart review of patients who had RRD surgery following a diagnosis of endophthalmitis from 2008 to 2021 at a tertiary referral center. Demographic and clinical characteristics as well as operative details were collected. Subjects with prior RRD, trauma, keratoprosthesis, or less than 3 months of postoperative follow-up were excluded. Univariate logistic regression analyses were performed., Results: Thirty-four eyes of 34 patients were included. Most subjects were male with a mean age of 60.1 years. Exogenous (58.8%) was more common than endogenous (41.2%) sources of endophthalmitis. Seventeen of 34 eyes (50.0%) experienced redetachment. Significant risk factors were infection with virulent organisms, hypotony, and postoperative proliferative vitreoretinopathy. Initial management with vitreous tap or vitrectomy, exogenous versus endogenous source, and surgical procedure were not associated with recurrent RRD. At the final follow-up, 32 of 34 eyes (91.2%) were attached, although more than one third of these had silicone oil., Conclusion: Redetachment occurred in half of eyes that underwent surgical repair of RRD after endophthalmitis. Early vitrectomy, with or without prior vitreous tap, was not associated with a higher risk of redetachment and improved the likelihood of a positive culture result. Culture data can aid in risk stratification because organism virulence was a risk factor for recurrent RRD. Although visual outcomes were generally poor, most retinas remained attached at the final visit.

Purpose: Endophthalmitis is a severe inflammation following surgery or endogenous spread of pathogens. Besides clinical signs and symptoms, standardized ultrasound might help to confirm the diagnosis. Thus, we analyzed 172 cases of endophthalmitis for pathogens, visual acuity (VA) and the predictive value of standardized ultrasound., Methods: Retrospective analysis of patients treated with pars-plana-vitrectomy for endophthalmitis at the University Eye Hospital was performed. Sex, age, VA at presentation, first day after surgery, four weeks postoperatively, and at last follow-up, as well as pathogen culture, and presence of standardized ultrasound before vitrectomy were recorded. Mann-Whitney U and Chi-square tests were used for groupwise comparisons., Results: A total of 172 patients (male = 47.7%) with a median age of 76 years (IQR 65-82 years) treated for endophthalmitis (exogenous = 85.5%) were included. Median follow-up time was 65 days (IQR 12-274 days). Visual acuity at presentation was 2.30 logMAR (IQR 2.70-2.30 logMAR); it increased to 1.00 logMAR (1.4-0.40 logMAR) at last follow-up. A total of 79 patients (45.9%) underwent standardized ultrasound before vitrectomy. Patients with positive ultrasound criteria had a significantly decreased VA at presentation (p = 0.034). Positive microbiological cultures for Streptococcus spp. and Enterococcus faecalis were associated with decreased VA (p = 0.028) at last follow-up., Conclusion: Standardized ultrasound is an easy and robust tool in the diagnosis of endophthalmitis. Positive criteria are significantly associated with decreased VA at presentation. The recovery of VA depends on pathogens and is significantly worse for certain species (Streptococcus spp., Enterococcus faecalis)., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

BACKGROUND Endogenous bacterial endophthalmitis is caused by a breach of the blood-ocular barrier by pathogens originating from distant infective foci. Here, we report a case of endogenous endophthalmitis due to cholangitis complicated by common bile duct stones, which is a rare source of infection. CASE REPORT A 73-year-old man with type II diabetes mellitus underwent endoscopic choledocholithotripsy 20 years ago and laparoscopic cholecystectomy 18 years ago. He had choledocholith-related cholangitis 6, 5, and 1 years previously and 4 times in the last year and underwent endoscopic choledocholithotripsy each time. Three days after the last surgery, the patient developed right endogenous endophthalmitis and vitrectomy was performed. Four months later, the patient relapsed with cholangitis and required surgery for recurrent endophthalmitis. Roux-en-Y choledochojejunostomy was performed with curative intent, and the patient was followed up for 5 years without recurrence of choledocholith, cholangitis, or endophthalmitis. CONCLUSIONS The recommended treatment strategy for patients diagnosed with common bile duct stones or choledocholithiasis is stone extraction. Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic intervention is a widely accepted procedure. However, in cases of recurrent choledocholithiasis, the rate of recurrence increases and the interval between ERCP becomes shorter in proportion to the number of recurrences. In such intractable cases requiring numerous sessions of endoscopic stone removal, bypass Roux-en-Y choledochojejunostomy should be performed to prevent possible rare complications such as endogenous bacterial endophthalmitis.

Purpose: To report on the feasibility of 27-gauge (G) vitrectomy for pediatric patients., Methods: This study is an international, multicenter, retrospective, interventional case series. Participants were patients 17 years or younger who underwent 27-G vitrectomy for various indications., Results: The records of 56 eyes from 47 patients were reviewed. Mean age was 5.7 ± 5.2 years. Diagnoses included retinopathy of prematurity (Stages 3 with vitreous hemorrhage, 4A, 4B, and 5), Terson's syndrome, traumatic macular hole, posterior capsular opacification, endophthalmitis, and others. Instruments used were the 27-G infusion, 27-G vitreous cutter, 27-G light pipe, and 27-G internal limiting membrane forceps. Instrument bending was noted in one (1.8%) case. There were no cases with intraoperative complications, infusion issues, or postoperative endophthalmitis. There were 67/145 (46%) sclerotomies that required suturing, of which most (51/145) were sutured out of precaution. There were four cases (7.1%) that required conversion to a larger gauge and three cases (5.3%) that developed postoperative hypotony. Mean visual acuity improved from logarithm of the minimum angle of resolution 1.32 (20/420) to 0.72 (20/105), after a mean follow-up of 125.1 days (P = 0.01). Anatomic success was achieved in 96.4% of eyes after a single surgery., Conclusion: Twenty-seven-gauge vitrectomy was safe and feasible in selected pediatric vitreoretinopathies. Further studies are warranted to examine indications and outcomes.

Background/aims: To compare outcomes of acute endophthalmitis (EO) managed with either primary vitrectomy (PV) or primary intravitreal antibiotics (vancomycin and ceftazidime) followed by early vitrectomy (PIAEV) combined with polymerase chain reaction (PCR)-based diagnostics., Methods: This was a prospective, comparative observational study of acute EO cases admitted to a regional vitreoretinal service over 18 months. Depending on whether immediate vitrectomy (within 6 h) was achievable, the EO cases were treated with either (1) PV or (2) PIAEV. Microbiology samples were collected either (A) before or (B) after administration of intravitreal antibiotics. The samples were analysed with broad-range 16S PCR and culture., Results: The study included 41 EO cases. There were 19 post-injection EO, 18 post-cataract EO, three post-vitrectomy EO, and one blebitis-related EO. Fifteen of 19 PV cases and 15 of 21 PIAEV had a clinically meaningful improvement in best-corrected visual acuity (BCVA) of at least 15 letters at 3 months (p = 0.58). One patient was lost to follow-up. Twenty-three cases were culture- and PCR-positive, and seven additional cases were culture-negative but PCR-positive (p = 0.02). PCR increased the diagnostic yield for samples collected both before and after administration of intravitreal antibiotics., Conclusion: Primary vitrectomy or PIAEV allowed for vitrectomy for all cases of acute EO in a large region. Most eyes in both groups achieved a clinically meaningful improvement in BCVA. By combining culture with PCR in connection with the vitrectomy procedure, intravitreal antibiotics could be injected before microbiological sampling, thereby improving the door-to-treatment time without sacrificing microbial identification., (© 2022 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To describe the anatomical and functional outcomes of patients with infectious keratitis (IK) and secondary endophthalmitis who underwent penetrating keratoplasty (PK) after pars plana vitrectomy (PPV) assisted by temporary keratoprosthesis (TKP)., Methods: An observational retrospective case series was performed. Data were collected from January 2013 to July 2020. Patients over 18 years old with a clinical and microbiological diagnosis of IK, and clinical, ultrasonographic, and or microbiological diagnosis of endophthalmitis were included. Anatomical success was defined as infection resolution with preservation of the ocular globe integrity. No change or improvement of best-corrected visual acuity (VA) at the last follow-up was considered as a functional success., Results: A total of 32 eyes of 32 patients were analyzed. The anatomic success was obtained in 87.5% eyes in which the infection was eradicated. The 63% patients maintained or improved their best-corrected VA, 37.5% ended up with hand motion VA., Conclusions: Our results suggest that PPV assisted by TKP followed by PKP can be a good approach for treating patients with endophthalmitis secondary to IK while allowing further visual improvement after an optical PK. Further prospective studies need to be done to evaluate final visual rehabilitation of these patients.

Purpose: The objective of this study was to evaluate the possibility of analysing quality indicators for uncomplicated primary rhegmatogenous retinal detachment in a hospital department of ophthalmology without the support of a national registry or need to collect data from referring ophthalmological centres., Methods: In 2014, we operated 231 consecutive eyes with uncomplicated retinal detachment. Our quality indicators were primary anatomical success, final anatomical success and postoperative endophthalmitis. We reviewed medical records in our university surgical department retrospectively and compared them with medical records from the regional hospitals that had referred most of the operated patients and done their own postoperative examination. Our hypothesis was that any retinal re-detachment and/or serious postoperative complication would be reported back., Results: The medical records at the surgical department revealed primary anatomic success for 91.3% of eyes and final anatomical success of 99.6%. The data from the regional hospitals confirmed that our hypothesis was correct. All patients with adverse outcomes were referred back for reoperation. Patients who were not referred again had an attached retina and showed no signs of endophthalmitis., Conclusion: Our hypothesis that data in the surgical department's medical records would closely reflect those in referring hospitals was borne out. This supports, under current conditions, an effective strategy for analysing chosen quality indicators without relying on a national registry or reviewing records from regional hospitals., (© 2022 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

A woman presented two weeks after uncomplicated cataract surgery with decreased visual acuity from endophthalmitis. One week after initial management with intravitreal antibiotics, her visual acuity decreased further, undergoing pars plana vitrectomy with intravitreal and intravenous antimicrobial coverage with preliminary improvement. Three days after vitrectomy, her vision decreased with recurrent inflammation. Initial cultures grew Clostridium intestinale She underwent repeat vitrectomy with silicone oil tamponade with no subsequent recurrence. The silicone oil was removed after 4 months and her visual acuity returned to 20/20 after 1 month and through 1 year of follow-up. Postoperative endophthalmitis is rare, with cases due to Clostridium species particularly destructive. In this first reported case of C. intestinale endophthalmitis, conventional management did not achieve lasting quiescence until silicone oil tamponade was employed. Pars plana vitrectomy with silicone oil tamponade should be considered in the management of recurrent endophthalmitis or endophthalmitis secondary to a recalcitrant microbe., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Endophthalmitis is a sight-threatening emergency that requires prompt diagnosis and treatment. The condition is characterised by purulent inflammation of the intraocular fluids caused by an infective agent. In exogenous endophthalmitis, the infective agent is foreign and typically introduced into the eye through intraocular surgery or open globe trauma., Objectives: To assess the potential role of combined pars plana vitrectomy and intravitreal antibiotics in the acute management of exogenous endophthalmitis, versus the standard of care, defined as vitreous tap and intravitreal antibiotics., Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 5); Ovid MEDLINE; Ovid Embase; the International Standard Randomised Controlled Trial Number registry; ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. There were no restrictions to language or year of publication. The date of the search was 5 May 2022., Selection Criteria: We included randomised controlled trials (RCTs) that compared pars plana vitrectomy and intravitreal injection of antibiotics versus intravitreal injection of antibiotics alone, for the immediate management of exogenous endophthalmitis., Data Collection and Analysis: We used standard methods expected by Cochrane. Two review authors independently screened search results and extracted data. We considered the following outcomes: visual acuity improvement and change in visual acuity at three and six months; additional surgical procedures, including vitrectomy and cataract surgery, at any time during follow-up; quality of life and adverse effects. We assessed the certainty of the evidence using the GRADE approach.  MAIN RESULTS: We identified a single RCT that met our inclusion criteria. The included RCT enrolled a total of 420 participants with clinical evidence of endophthalmitis, within six weeks of cataract surgery or secondary intraocular lens implantation. Participants were randomly assigned according to a 2 x 2 factorial design to either treatment with vitrectomy (VIT) or vitreous tap biopsy (TAP) and to treatment with or without systemic antibiotics. Twenty-four participants did not have a final follow-up: 12 died, five withdrew consent to be followed up, and seven were not willing to return for the visit.  The study did not report visual acuity according to the review's predefined outcomes. At three months, 41% of all participants achieved 20/40 or better visual acuity and 69% had 20/100 or better acuity. The study authors reported that there was no statistically significant difference in visual acuity between treatment groups (very low-certainty evidence). There was low-certainty evidence of a similar requirement for additional surgical procedures (risk ratio RR 0.90, 95% confidence interval 0.66 to 1.21). Adverse effects included: VIT group: dislocated intraocular lens (n = 2), macular infarction (n = 1). TAP group: expulsive haemorrhage (n = 1). Quality of life and mean change in visual acuity were not reported.  AUTHORS' CONCLUSIONS: We identified a single RCT (published 27 years ago) for the role of early vitrectomy in exogenous endophthalmitis, which suggests that there may be no difference between groups (VIT vs TAP) for visual acuity at three or nine months' follow-up.   We are of the opinion that there is a clear need for more randomised studies comparing the role of primary vitrectomy in exogenous endophthalmitis. Moreover, since the original RCT study, there have been incremental changes in the surgical techniques with which vitrectomy is performed. Such advances are likely to influence the outcome of early vitrectomy in exogenous endophthalmitis., (Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Donor to host transmission of infectious agents is a well-recognized entity, more commonly related to Endothelial Keratoplasty (EK) than to Penetrating Keratoplasty (PK), that involves complications ranging from interface keratitis to endophthalmitis. A systematic review of the literature was conducted to identify the published articles until December 2020 reporting cases of endophthalmitis secondary to corneal graft contamination in posterior lamellar keratoplasties (DSAEK and DMEK) along with donor characteristics, microbiological profile, treatment and outcomes. Each identified article was assessed to meet donor to host infection criteria, defined as a post-procedural infection in which the same microbiological agent was identified in both the donor corneoscleral rim or preservation medium and receptor ocular tissue. From 23 research articles, eight reports of endophthalmitis in nine patients following DSAEK or DMEK secondary to donor to host infection fulfilled the inclusion criteria. The majority were male and the median age was 72.0 (45.0-81.0) years old. Indications of surgery were primarily pseudophakic bullous keratopathy and Fuchs dystrophy. A fungal pathogen was identified in eight of nine patients. All the cases underwent surgical management with lenticule removal or endothelial plaque aspiration. The final corrected distance visual acuity (CDVA) in all cases was 20/200 or better. Endophthalmitis after an EK procedure is a rare complication whose outcome depends on the aggressive and precocious treatment. Identification of early signs of interface keratitis and lenticule removal seems mandatory in patients undergoing DSAEK or DMEK to prevent further involvement of the globe.

Purpose: To determine the efficacy of immediate pars plana vitrectomy as the primary treatment for acute endophthalmitis in patients with a visual acuity (VA) of hand motion (HM) or better., Methods: A total of 149 patients who were referred to a single center for acute endophthalmitis after cataract surgery over the 13-year study period were retrospectively analyzed. Only patients presenting with a VA of at least HM were included. Patients were initially treated with either primary vitrectomy or intravitreal antibiotic injection alone, and their visual outcomes and reintervention rates after initial treatment were compared., Results: There was no significant difference in the proportion of good (final VA ≥20 / 40) and poor (VA ≤ counting finger) visual outcomes between the groups. However, subgroup analysis of patients with a VA of HM (92 eyes) showed that the incidence of reintervention (14 of 72 eyes [19.4%] vs. 9 of 20 eyes [45.0%]) and poor visual outcomes (10 of 72 eyes [13.9%] vs. 8 of 20 eyes [40.0%]) were lower after prompt vitrectomy than after intravitreal antibiotic injection alone (p = 0.019 and p = 0.022, respectively). For those with a VA of at least counting finger, no significant difference was observed between the groups., Conclusions: For patients with endophthalmitis presenting with a VA of HM, performing a prompt vitrectomy reduced the incidence of reintervention and poor visual outcomes than the administration of intravitreal antibiotics alone. Our results suggest that primary vitrectomy for patients with endophthalmitis presenting with a VA of HM could be more beneficial than intravitreal antibiotic injection alone.

Purpose: To study the clinico-microbiological profile, outcomes and prognostic factors of post penetrating keratoplasty (PKP) infectious keratitis., Methods: Retrospective review of medical records of 78 patients with post PKP infectious keratitis presenting between January 2014 and December 2018. Demographic, clinical and microbiological profile was documented and predictors of treatment and graft success were evaluated using univariate and subsequent multivariate logistic regression analysis., Results: Mean age of patients was 52.17 ± 15.51 years and mean infiltrate size was 19.39 ± 19.68 mm 2 . Mean duration of presentation with infection post PKP was 11.66 ± 10.65 months. Culture positivity was seen in 64 eyes (82.05%). Bacterial growth was observed in 47 eyes (60.25%), fungal growth in 17 (21.79%) and no microbiological growth in 14 eyes (17.94%). At 3 months the visual acuity (VA) improved in 37 eyes (47.44%), did not change in 27 (34.62%) and deteriorated in 14 (17.95%). Graft failure was noted in 53 eyes (73.08%). Surgical intervention was needed in 47 (60.25%) eyes of which most common was therapeutic PKP in 32 eyes (41.02%). Treatment failure was noted with fungal infection ( p  = 0.05), poorer vision at presentation ( p  = 0.02), larger infiltrate area ( p  = 0.002) and graft infection developing before 1 year ( p  = 0.02). Graft failure was noted with associated endophthalmitis ( p  = 0.02), poorer VA at presentation ( p  = 0.01) and larger infiltrate area ( p  = 0.02)., Conclusion: Post PKP infectious keratitis is a sight threatening ocular condition. It is associated with high incidence of graft failure and frequently requires surgical intervention. Fungal etiology, larger infiltrate size, poorer vision at presentation and associated endophthalmitis carries a poorer prognosis.

Corneal blindness affects over 8 million adults and 1.5 million children worldwide, making it one of the top 5 causes of blindness. Depending on the recipient's corneal condition corneal transplantation may not be a viable treatment option. In such seemingly no-alternative situations, keratoprosthesis implantation can be an option in some patients. In terms of numbers, two types of keratoprostheses are currently used: 1. Keratoprostheses with biological haptics made of tooth or tibia bone. 2. The Boston type I-keratoprosthesis. Both types have optics made of PMMA. The most common complication is the formation of an optically disturbing retroprosthetic membrane behind the optic, which can usually be removed with YAG laser. Causes of blindness after keratoprosthesis implantation are glaucoma, endophthalmitis and retinal detachment. The extrusion rate of the Boston type I-keratoprosthesis seems to be higher than after keratoprosthesis implantation with biological haptic. Autoimmunological corneal diseases have increased extrusion rates and higher rates of endophthalmitis when compared to non-autoimmunological diseases. Visual outcomes after keratoprosthesis implantation are potentially very good and usually limited by extracorneal concomitant diseases. Advances in glaucoma diagnostic (OCT, implantation of intraocular pressure sensors), standard glaucoma prophylaxis by medication or surgery, modern retinal surgery and better treatment options in case of extrusion improve the prognosis of keratoprosthesis surgery. Still, the ideal technique for permanent anchoring of artifical optics in biological tissue has yet to be developed., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: ja, von einer anderen Institution (Pharma- oder Medizintechnikfirma usw.); Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: nein. Erklärung zu nichtfinanziellen Interessen Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background/purpose: The aim of this report was to present the details of a case of culture-positive endophthalmitis in a silicone oil-filled eye., Methods: This report includes the description of the preoperative, intraoperative, and postoperative findings of the case., Patient: A 73-year-old male patient presented to our emergency department with complaints and symptoms indicative of acute postvitrectomy endophthalmitis., Results: Aqueous, silicone oil, and vitreous washout samples tested positive for Streptococcus pneumoniae after a culture test., Conclusion: Culture-positive endophthalmitis in a silicone oil-filled eye has rarely been described in literature. The reported cases were culture-negative cases, possibly because they were cases of acute inflammatory reactions to silicone oil. In the present case, an otherwise healthy patient developed acute endophthalmitis after pars plana vitrectomy plus silicone oil tamponade. The case was successfully managed with conventional silicone oil removal, antibiotic injection, and silicone oil reinjection.

Aims: To examine the role of early vitrectomy in the management of endophthalmitis from all causes., Methods: Retrospective study of 290 consecutive subjects diagnosed with endophthalmitis at Auckland District Health Board between 1 January 2006 and 31 July 2019. Main outcome measure was visual acuity at 9-month follow-up and proportion of subjects with severe vision loss (≤20/200)., Results: Median age at presentation was 70.4 years and 151 subjects (52.1%) were women. Cataract surgery was the most common cause of endophthalmitis in 92 subjects (31.7%) followed by intravitreal injection in 57 (19.7%), endogenous endophthalmitis in 48 subjects (16.6%), non-surgical trauma in 42 subjects (14.5%), glaucoma surgery in 24 subjects (8.3%), vitrectomy in 22 subjects (7.6%) and corneal in 5 subjects (1.7%). Culture was positive in 136 (46.9%) with gram-positive organisms most common (76.5%). Early vitrectomy was performed in 82 subjects (28.3%). Median visual acuity at 9 months was 20/100 (IQR 20/30 to light perception), and severe vision loss occurred in 100 (43.5%). Retinal detachment occurred in 35 eyes (12.1%) and 26 eyes were enucleated. On multivariate analysis, younger age, poor presenting visual acuity and culture-positive endophthalmitis were associated with worse outcomes, and early vitrectomy was associated with better outcomes., Conclusions: Early vitrectomy (within 24 hours) is associated with better visual outcomes at 9 months, while younger age, poor presenting visual acuity and culture-positive endophthalmitis are associated with poorer visual acuity outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: This study aimed to investigate the clinical features and risk factors for poor visual outcomes in patients with endogenous Klebsiella pneumoniae endophthalmitis (EKE)., Methods: This retrospective interventional case series reviewed the medical records of 17 patients (21 eyes) with EKE from January 2007 to December 2019. Clinical findings, treatments, visual outcomes, and potential prognostic factors were evaluated., Results: The mean age of the patients was 55.9 years and 13 patients (76.5%) were males. Diabetes (23.5%) was the most commonly associated systemic disease and liver abscess (70.6%) was the major infection source. Poor initial visual acuity worse than counting fingers was significantly associated with poor final visual outcome (p = 0.003). In this study, adjunctive intravitreal dexamethasone injection and primary vitrectomy were not associated with final visual outcome. Secondary enucleation/evisceration was performed in 14.3%., Conclusions: EKE usually has a poor visual prognosis, and early diagnosis with fair initial visual acuity would be crucial in saving vision., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective: To evaluate the safety of performing cataract surgery prior to eyelid (entropion/ectropion) surgery in patients with concurrent cataract and lower eyelid malposition., Design: Retrospective case series., Participants and Methods: Patients with concurrent lower eyelid malposition and cataract undergoing cataract surgery before lower eyelid repair from 2013 to 2020 were identified from two ophthalmologists (M.L.W., G.R.). Both surgeries were performed by the same ophthalmologist, with eyelid repair completed at least 1 month following cataract extraction. Data analysis was performed with two-parameter estimations. The primary outcome was the postoperative endophthalmitis rate in this cohort., Results: 129 cases in 90 patients were found (86 involutional entropion and 43 involutional ectropion). No cases of endophthalmitis were encountered. Statistical analysis using the 95% Jeffreys interval for one-sample binomial proportion revealed an upper limit of 1.9%. The Agresti-Caffo interval of the proportional difference between the study procedure and historical incidence data of postoperative endophthalmitis following cataract surgery alone yielded an estimate of 0.8% with an upper confidence limit of 2.2%., Conclusion: We present preliminary evidence on the endophthalmitis risk in patients with concurrent lower eyelid malposition and cataract who undergo cataract surgery prior to eyelid repair. We propose that this strategy may be a viable option to expedite vision restoration and reduce the risk of recurrent lower eyelid malposition in select patients. More data are required to reach statistically significant noninferiority and show that a malpositioned lower eyelid is not a risk factor for postoperative endophthalmitis following cataract surgery., (Copyright © 2021 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

To evaluate the surgical outcomes and complications of evisceration or enucleation with primary implantation, performed by ophthalmology resident trainees, in regards to patients with recalcitrant endophthalmitis or panophthalmitis. We also compared the surgical outcomes and complications between resident trainees and experienced staff. In this retrospective analysis, the clinical records of all patients diagnosed with endophthalmitis or panophthalmitis who underwent enucleation or evisceration with primary implantation over a 13-year period were reviewed. The factors predicting implant exposure or extrusion in regards to patients who underwent eye removal by trainees were identified using multivariate analysis. The percentages of successful prosthesis fittings and complications were also reported. Sixty-six patient records, median age of 46.8 years, who underwent eye removal by resident trainees were reviewed. Thirty-six (55%) out of 66 patients were diagnosed with panophthalmitis. Four patients (6%) had implant exposure, and 4 patients (6%) had implant extrusion. Multivariate analysis demonstrated that Pseudomonas aeruginosa infection (P = .02, adjusted odd ratio [aOR] = 33.75) and not receiving intravitreal antimicrobial drugs before the eye removal procedure (P = .02, aOR = 30.11) were associated with implant exposure or extrusion. Patients with panophthalmitis who underwent evisceration had a higher rate of implant exposure or extrusion than those who underwent enucleation (P = .03, aOR 38.38). At the last visit, 65 patients had a successful prosthesis fitting. Furthermore, there were similar rates of complications and successful prosthesis fittings between experienced staff and resident trainees. This study suggests that evisceration or enucleation with primary implant placement in patients with recalcitrant endophthalmitis or panophthalmitis can be performed by resident trainees with acceptable surgical outcomes and a low rate of serious complications., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Postoperative endophthalmitis after cataract surgery often requires emergency surgery if caused by an infection. However, early reoperation after the surgery put a heavy mental burden on the patient. Here we report a relatively mild case of postoperative endophthalmitis in which emergency surgery was avoided through careful observation including gram stain and culture test., Case: 87-year-old male. The patient had a sudden decrease in visual acuity on the 4th day after cataract surgery of the left eye performed at another hospital and visited his previous doctor on the following day. Postoperative endophthalmitis was suspected, so he was referred to our department on the same day. The inflammation was observed in the anterior segment of the left eye. The gram staining results for collected anterior aqueous humor were negative. The patient was followed up with continued medication and careful observation without undergoing emergency surgery. The inflammation of the anterior segment subsequently improved. The patient underwent a left vitrectomy three months later to remove residual vitreous opacity., Conclusion: Postoperative endophthalmitis after cataract surgery is often indicated for emergency surgery, but there can be cases in which conservative therapy with thorough observation succeeds in retaining visual function.

Objective: To assess the patterns of patient generated aerosol in the context of ophthalmic surgery and ophthalmic examinations. To inform medical teams regarding potential hazards and suggest mitigating measures., Methods: Qualitatively, real-time time videography assessed exhalation patterns from simulated patients under different clinical scenarios using propylene glycol from an e-cigarette. Quantitatively, high-speed Schlieren imaging was performed to enable high resolution recordings analysable by MATLAB technical computing software., Results: Without a face mask, the standard prior to COVID 19, vapour was observed exiting through the opening in the drape over the surgical field. The amount of vapour increased when a surgical mask was worn. With a taped face mask, the amount of vapour decreased and with inclusion of a continuous suction device, the least amount of vapour was seen. These results were equivocal when the patient was supine or sitting upright. High-speed Schlieren imaging corroborated these findings and in addition showed substantial increase in airflow egress during coughing and with ill-fitting face masks., Conclusion: Advising patients to wear a surgical mask at the time of ophthalmic interventions potentially contaminants the ocular field with patient generated aerosol risking endophthalmitis. Surgeon safety can be maintained with personal protective equipment to mitigate the increased egress of vapour from the surgical drape and taping, with or without suction is advisable, whilst meticulous hygiene around lenses is required at the time of slit lamp examination.

Objective: To compare the rate of long-term complications in Boston keratoprosthesis type 1 (KPro) patients with and without soft contact lens wear (SCL)., Methods: A chart review was performed on patients who underwent KPro type 1 surgery from January 2008 to June 2018 performed by a single surgeon at the University of Montreal Hospital Centre. Ninety-nine KPro patients (114 eyes) were separated into group 1 (patients with SCL) and group 2 (patients without SCL) at 1 and 5 years. Survival at 1- and 5-year follow-ups is defined as the absence of complications: corneal melts, leaks, retroprosthetic membrane, infectious keratitis, sterile vitritis, endophthalmitis, and KPro extrusion., Results: The mean SCL retention duration was 3.17 years. Overall, the survival distribution of both groups was not significantly different. At 1 year, group 1 achieved a higher KPro survival rate (75.11%) than group 2 (61.39%; p = 0.248). At 5 years, group 1 had a lower survival rate (49.11%) than group 2 (65.22%; p = 0.127). Although not statistically significant, the percentage of individual complications was higher in group 2 at 1 year (p = 0.3040) and lower in group 2 at 5 years (p = 0.6089) compared with group 1., Conclusion: The mean SCL retention duration in our study was longer than previously reported. Long-term SCL does not significantly decrease the rate of complications. A prospective study is warranted to further examine the outcomes of long-term SCL wear., (Copyright © 2021 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Purpose: To analyze the incidence and risk factors of postoperative endophthalmitis after primary surgical repair and intraocular foreign body (IOFB) removal within 24 hours of injury., Methods: The records of all patients treated surgically for open globe injury and IOFB removal at the Eye Hospital of Shandong First Medical University between January 1, 2015, and June 30, 2020, were retrospectively reviewed. Variables included time from injury to operation, cause of injury, details of surgical repair, and follow-up. The incidence and risk factors of endophthalmitis after IOFB removal were studied., Results: During 5 years, 99 patients with IOFB were reviewed. Of these, 19 patients were diagnosed with endophthalmitis on admission, and 5 were suspected of having endophthalmitis during operation. Fifty-four cases had no clinical signs of endophthalmitis on admission and during operation and were treated with operation within 24 hours after the injury. Two patients (2 of 54; 3.70%) developed endophthalmitis after IOFB removal, and the causative agent in both cases was Bacillus cereus., Conclusion: The incidence of infectious endophthalmitis after primary surgical repair combined with IOFB removal (≤24 hours) was 3.70% in patients who received a series of standard treatments, and B. cereus infection might be a risk factor., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)

An 86-year-old man with diabetes and a history of prostate cancer, indwelling urinary catheter and Pseudomonas aeruginosa bacteriuria presented on day 4 post left phacoemulsification cataract extraction and intraocular lens implant with signs and symptoms of postoperative endophthalmitis. Vitreous sample was positive for P. aeruginosa Prompt treatment with intravitreal antibiotics was initiated followed by anterior chamber washout with pars plana vitrectomy; however, the visual outcome was poor., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To analyze the epidemiological profiles of evisceration and enucleation cases in the ophthalmologic emergency department of a Brazilian tertiary hospital., Methods: Patients treated in the ophthalmologic emergency department of Hospital São Paulo (Universidade Federal de São Paulo) during the period 2013 to 2018 were retrospectively evaluated. Urgent cases of evisceration or enucleation surgery were included, and elective cases were excluded. The following information was extracted from the patients' medical records: demographic data, immediate and associated reasons for the surgical procedure, informed visual acuity, symptom duration until ophthalmologic care, complications, distance from the residence to the tertiary hospital, and time of hospitalization., Results: In total, 61 enucleations and 121 eviscerations were included in this study. The patients had a mean age of 63.27 ± 18.68 years. Of the patients, 99 were male (54.40%), and 83 were female (45.60%). The indications for evisceration or enucleation were corneal perforation with (44.50%) and without (23.63%) signs of infection, endophthalmitis (15.38%), ocular trauma (14.29%), neoplasia (0.55%), burn accident (1.10%), and phthisis bulbi (0.55%). The self-reported visual acuity was no light perception (87.36%) or light perception (1.10%). However, 3.30% of the patients did not cooperate with the examination, and no information on visual acuity was available for the remaining 8.24%. The mean symptom duration before ophthalmologic care was sought was 18.32 days. Two patients had sympathetic ophthalmia after evisceration., Conclusions: More eviscerations than enucleations were performed throughout the study period. The most common demographic characteristics were age >60 years and male sex. The main indications for urgent evisceration and enucleation procedures were corneal perforation with and without infection, endophthalmitis, and ocular trauma. The findings from this study could guide clinicians in performing preventive measures to avoid destructive eye procedures.

Background and Objective: Current literature lacks good-quality evidence regarding the outcomes of early pars plana vitrectomy (PPV) for acute exogenous endophthalmitis. The aim for this study was to analyze and discuss the outcomes of PPV for endophthalmitis in a UK tertiary hospital., Patients and Methods: This study was a retrospective case series. The clinical records of consecutive patients who had PPV for acute exogenous endophthalmitis were reviewed. Demographic data, etiology, timing of onset, timing of PPV, intraand postoperative complications, baseline and final best-corrected visual acuity (BCVA), therapeutic regimens, and microbiology details were collected. Primary efficacy and safety outcome measures were BCVA improvement of two or more logMAR lines and intra- or postoperative complications, respectively., Results: Forty-one patients with a median age of 76 (interquartile range, 64 to 82) years were studied. The most common etiology was intravitreal injection (41%), followed by phacoemulsification (34%). Median interval to PPV was 1.0 (interquartile range, 1.0 to 3.0) days. In a multivariate model controlling for age, baseline BCVA, microbiology positivity, and etiology (post-intravitreal injection), PPV after 24 hours was seven times more likely to achieve significant BCVA improvement (odds ratio, 7.47; 95% confidence interval, 1.12 to 49.66; P = .038). PPV within 24 hours of presentation was associated with more intraoperative complications., Conclusions: Favorable outcomes may be achieved with current antibiotic regimens and PPV for endophthalmitis. The series suggests that an early surgical intervention may be associated with poorer functional outcomes. Tap and inject at presentation, followed by a semi-urgent PPV as required, seems to be a sensible approach. [ Ophthalmic Surg Lasers Imaging Retina. 2022;53:96-102.] .

Aim : To analyze the incidence, microbiological profile, risk factors, and outcomes in eyes with osteo-odonto keratoprosthesis (OOKP) developing endophthalmitis. Methods & material : Retrospective review of medical records of patients presenting between 2003 and 2013 with OOKP and endophthalmitis was undertaken after obtaining IRB approval. Patient demographics, clinical features, microbiological evaluation, treatment details, and outcomes were analyzed. Results : Of 92 eyes with OOKP, 8 (9%) had endophthalmitis. Indications for OOKP included Steven-Johnson syndrome (SJS; n = 6; 75%) and chemical injuries (n = 2; 25%). The mean duration from OOKP surgery to endophthalmitis was 49.4 ± 32.3 months. Seven of eight eyes had associated laminar resorption. Endophthalmitis resolved with conservative management in three eyes. Lamina removal was required in three eyes; one eye underwent evisceration. At presentation, mean BCVA was 2.76 ± 0.24 logMAR that improved to 2.48 ± 1.0 logMAR after intervention. Mean follow-up was 12.6 ± 13.2 months. Conclusion : Endophthalmitis portends a grave prognosis for eyes with OOKP. The most important risk factors are SJS (75%) and lamina resorption (88%).

Purpose: To evaluate endogenous endophthalmitis clinical features following minimally invasive removal of upper urinary tract calculi., Methods: Medical records of twelve patients (17 eyes) with endogenous endophthalmitis secondary to minimally invasive upper urinary tract calculus removal were retrospectively reviewed., Results: Diabetes mellitus was found in 7 patients (58%). 10 patients (83%) suffered from fever. The stone extraction and ocular symptom onset interval ranged from 2 to 22 days. All eyes presented as vitritis and fluffy yellow-white retinal exudates. Hypopyon was only found in 3 eyes (18%). 5 patients (42%) were misdiagnosed as uveitis which led to mismanagement. Ocular fluids were culture positive for only C. albicans in 12 eyes (71%). 10 of 12 eyes (83%) with silicon oil tamponade obtained a final BCVA≥0.05., Conclusions: C. albicans was the most common endogenous endophthalmitis pathogen after urinary calculus removal by minimally invasive surgery. Pars plana vitrectomy with silicon oil tamponade may be helpful to achieve a favorable visual outcome. Routine ophthalmologic evaluation by the uveitis or vitreoretinal specialist may be necessary within 2 weeks after the urological procedures.

Purpose: To report four cases of endogenous endophthalmitis (EE) secondary to Klebsiella pneumoniae liver abscess, and discuss their clinic features and outcomes., Methods: Clinical data were collected by reviewing the medical records of four patients diagnosed with endogenous Klebsiella Pneumoniae endophthalmitis (EKPE) secondary to liver abscess., Results: Four patients were diagnosed with EE. Two males and two females, with ages ranging from 33 to 63 years old. All patients presented with ocular symptoms initially. Liver abscesses were diagnosed during hospitalization. All cases were caused by Klebsiella Pneumoniae confirmed by blood or tissue cultures. All patients were treated with intravitreal antibiotic injection, and two of the patients had vitrectomy. At the end, all affected eyes underwent evisceration. One patient died of septic shock with multiple organ failures., Conclusion: EE secondary to liver abscess with metastatic spread is a severe sight-threatening condition. The delayed discovery of liver abscess may hinder the diagnosis and treatment of the disease, which may be related to poor prognosis.

With modern technology and peri-op antibiotic use, postoperative endophthalmitis is uncommon to modern cataract surgery, and its recurrence even more unusual. Enterococcal faecalis endophthalmitis is an acute type of endophthalmitis that is not only rare, but can be recurrent, and has a poor functional prognosis [1]. Since the disease is refractory to conventional therapy, this paper details our experience with treating the disease given the current lack of standard care both medically and surgically.

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.

Background and Objective: To describe the experience and clinical outcomes of povidone iodine (PI) infusion in the setting of pars plana vitrectomy for the treatment of endophthalmitis., Materials and Methods: This was a retrospective case series of 12 patients with clinical and/or culture evidence of endophthalmitis requiring pars plana vitrectomy with 0.025% PI used in vitreous irrigation solution during vitrectomy. The primary endpoint was clinical resolution of the infection. Secondary endpoints included visual recovery, need for repeat surgery, and ocular toxicity RESULTS: There were 11 eyes that showed clinical or culture evidence of resolution of infection postoperatively (91.7%); 10 eyes had improvement in vision postoperatively (83.3%). Overall uncorrected visual acuity improved from 20/5321 (2.43 ± 0.58 logMAR) to 20/375 (1.27 ± 1.05 logMAR) ( P = .0003). No clinical evidence of ocular toxicity or unexplained vision loss due to PI was observed., Conclusions: PI infusion during pars plana vitrectomy for endophthalmitis appears safe and led to excellent post-surgical results in a traditionally high-risk cohort. [ Ophthalmic Surg Lasers Imaging Retina. 2021;52:485-490.] .

Background: Bordetella avium, an aerobic bacterium that rarely causes infection in humans, is a species of Bordetella that generally inhabits the respiratory tracts of turkeys and other birds. It causes a highly contagious bordetellosis. Few reports describe B. avium as a causative agent of eye-related infections., Case Presentation: We report a case of acute infectious endophthalmitis associated with infection by B. avium after open trauma. After emergency vitrectomy and subsequent broad-spectrum antibiotic treatment, the infection was controlled successfully, and the patient's vision improved., Conclusions: B. avium can cause infection in the human eye, which can manifest as acute purulent endophthalmitis. Nanopore targeted sequencing technology can quickly identify this organism. Emergency vitrectomy combined with lens removal and silicone oil tamponade and the early application of broad-spectrum antibiotics are key for successful treatment., (© 2021. The Author(s).)