The comparison of clinical outcomes of endophthalmitis from fluoroquinolone-resistant and susceptible bacteria

To identify patients who developed acute-onset endophthalmitis after clear corneal cataract surgery, and to compare treatment outcomes between cases caused by fluoroquinolone susceptible organisms versus fluoroquinolone resistant organisms. Retrospective case series. Patients who developed endophthalmitis within six weeks of cataract surgery, and were treated between January 1996 and December 2008 at Bascom Palmer Eye Institute in Miami, Florida, were identified retrospectively. Clinical features, organisms cultured, and visual acuity outcomes were evaluated. A total of 97 patients met study criteria, and 37 (38%) demonstrated in vitro fluoroquinolone resistance. All fluoroquinolone resistant endophthalmitis in the study was caused by either Staphylococcus epidermidis (n = 32) or Staphylococcus aureus (n = 5). Presenting clinical features were similar between fluoroquinolone resistant and fluoroquinolone susceptible groups. Final visual acuity was >/=20/40 in 49% of fluoroquinolone-resistant cases and 42% of fluoroquinolone-susceptible cases. All fluoroquinolone-resistant isolates were susceptible to vancomycin. In the current study, approximately one-third of isolates were resistant to fluoroquinolones. There was no significant difference in clinical outcomes in this study, regardless of fluoroquinolone susceptibility

Toxic Anterior Segment Syndrome after Foldable Artiflex Iris-Fixated Phakic Intraocular Lens Implantation

Toxic anterior segment syndrome (TASS) developed in four cases after uneventful implantation of a foldable iris-fixated phakic intraocular lens (pIOL). Two cases occurred sequentially in one patient. The TASS subsided without complications in all cases after intensive topical steroid treatment. A multitude of possible causes is considered for the occurrence of these TASS cases. From the sterilization and cleaning of surgical instruments to the possibility of endotoxines in ophthalmic viscosurgical devices (OVD). These rare cases should alert the surgeon to the possibility of TASS after pIOL implantation

Intraocular pressure after implantation of the Vsian Implantable Collamer Lens with CentraFLOW without iridotomy

PURPOSE: To compare the intraocular pressure (IOP) values during a 3-month period after implantation of the new Visian Implantable Collamer Lens (ICL; STAAR Surgical Company, Nidau, Switzerland) V4c design with CentraFLOW technology without iridotomy using a standard procedure followed by implantation of the conventional ICL V4b model.ALL AUTHORS HAVE COMPLETED AND SUBMITTED THE ICMJE FORM FOR DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST and none were reported. Supported in part by a grant from the Spanish Ministry of Health, Instituto Carlos III, Red Temitica de Investigacion Cooperativa en Salud Patologia Ocular del Envejecimiento, Calidad Visual y Calidad de Vida, Subproyecto de Calidad Visual, Madrid, Spain (RD07/0062). Involved in Design and conduct of study (A.H.-E., C.V.-C., R.G.-O., P.F., J.G.-M.); Collection, management, analysis, and interpretation of data (A.H.-E., J.G.-M., P.F.); and Preparation, review, or approval of manuscript (A.H.-E., A.O.-G., C.V.-C., R.G.-O., J.-A., P.F., J.G.-M.)

Development of Retinal Infarct Due to Intracameral Cefuroxime Injection Following Complicated Cataract Surgery

We present the case of a 60-year-old patient who underwent a complicated cataract surgery with cefuroxime injection (1 mg/0.1 mL) into the anterior chamber at the end of surgery. The patient presented to our hospital due to decrease in visual acuity (VA) after surgery. VA was counting fingers (CF) from 4 meters. There was extensive retinal hemorrhages and edema in addition to retinal vascular leakage detected with fluorescein angiography (FA). After negative microbiologic tests, the patient was treated with intravenous pulse and oral corticosteroids. Rheumatologic investigation was also negative. At month 5, VA was CF from 1 meter in addition to disseminated capillary loss in FA and optic nerve atrophy despite corticosteroid treatment. The patient developed retinal infarction due to cefuroxime injection following a complicated cataract surgery. Surgeons and surgical staff should be aware of the possibility of retinal toxicity while using cefuroxime, particularly in complicated cases

Incidence of postoperative acute endophthalmitis after phacoemulsification, effect of intracameral moxifloxacin: 2007-2011 cohort study

La endoftalmitis es una complicación muy poco frecuente de la cirugía de catarata. La incidencia publicada tiene un rango gigantesco, de casi 60 veces menos en unos grupos que en otros (entre el 0,01% y 0,59%)(1-9). Puede llevar a una pérdida visual severa con agudezas visuales de 20/200 o peores en el 15-30% de los casos (10). Se han adoptado diversas medidas profilácticas para disminuir la incidencia de endoftalmitis después de cirugía de catarata. Algunas como la aplicación de iodopovidona al 0.5 % en la superficie ocular ya han demostrado su eficacia (7,8). Por otra parte el empleo de antibióticos tópicos profilácticos al igual que antibióticos en la solución de irrigación todavía es motivo de controversia, por lo que no existe un criterio unificado. En cuanto a antibióticos intraoculares, en 2007 the European Society of Cataract and Refractive Surgeons ( ESCRS) publicó un gran ensayo clínico multicéntrico incluyendo 13.698 casos, mostrando una incidencia de endoftalmitis post-operatoria en los pacientes que recibieron cefuroxima intracameral de 0.07%, comparados con el grupo control (aquellos a quienes no se les aplicó) de 0.34%, lo cual apoyaría el uso profiláctico de antibiótico en cámara anterior (11). Esto ha despertado de nuevo una vieja discusión acerca de la inyección intraocular profiláctica de antibióticos. Esta vía es muy llamativa por las altas concentraciones que se pueden alcanzar intraocularmente, pero se debe tener muy en cuenta que por efectos de toxicidad se pueden lesionar tejidos muy vulnerables como el endotelio corneal o la retina. En 2010 Garcia- Saenz y colaboradores realizaron un estudio prospectivo de la incidencia de endoftalmitis a 10 años (1999- 2008) en pacientes operados de catarata incluyendo13.652 pacientes divididos en dos grupos dependiendo de si habían recibido o no el antibiótico intracameral: la incidencia de endoftalmitis dentro de los pacientes que no recibieron cefuroxima intracameral fue del 0.590% y en quienes recibieron cefuroxima intracameral fue mucho menor (0.043%) (5).EspecializaciónEndophthalmitis is a very rare complication of cataract surgery. The published incidence has a gigantic range, almost 60 times less in some groups than in others (between 0.01% and 0.59%) (1-9). It can lead to severe visual loss with visual acuities of 20/200 or worse in 15-30% of cases (10). Various prophylactic measures have been taken to decrease the incidence of endophthalmitis after cataract surgery. Some, such as the application of 0.5% povidone iodine on the ocular surface, have already demonstrated its efficacy (7,8). On the other hand, the use of prophylactic topical antibiotics as well as antibiotics in the irrigation solution is still controversial, so there is no unified criterion. Regarding intraocular antibiotics, in 2007 the European Society of Cataract and Refractive Surgeons (ESCRS) published a large multicenter clinical trial including 13,698 cases, showing an incidence of postoperative endophthalmitis in patients who received intracameral cefuroxime of 0.07%, compared to the control group (those to whom it was not applied) of 0.34%, which would support the prophylactic use of antibiotics in the anterior chamber (11). This has once again sparked an old discussion about prophylactic intraocular injection of antibiotics. This pathway is very striking due to the high concentrations that can be reached intraocularly, but it must be taken into account that due to toxicity effects, very vulnerable tissues such as the corneal endothelium or the retina can be injured. In 2010, Garcia-Saenz et al. Carried out a prospective study of the incidence of endophthalmitis at 10 years (1999-2008) in patients operated on for cataract, including 13,652 patients divided into two groups depending on whether or not they had received the intracameral antibiotic: the incidence Endophthalmitis among patients who did not receive intracameral cefuroxime was 0.590% and in those who received intracameral cefuroxime it was much lower (0.043%) (5)

Endophthalmitis

Endophthalmitis means bacterial or fungal infection inside the eye involving the vitreous and/or aqueous humors. Most cases are exogenous and occur after eye surgery, after penetrating ocular trauma, or as an extension of corneal infection. An increasing number of cases are occurring after intravitreal injections of anti-vascular endothelial growth factor (VEGF) medications. Endophthalmitis may also be endogenous, arising from bacteraemic or fungaemic seeding of the eye. The infected eye never serves as a source of bacteraemia or fungaemia, however. The most common pathogens in endophthalmitis vary by category. Coagulase-negative staphylococci are the most common causes of post-cataract endophthalmitis, and these bacteria and viridans streptococci cause most cases of post-intravitreal anti-VEGF injection endophthalmitis, Bacillus cereus is a major cause of post-traumatic endophthalmitis, and Staphylococcus aureus and streptococci are important causes of endogenous endophthalmitis associated with endocarditis. In Taiwan and other East Asian nations, Klebsiella pneumoniae causes most cases of endogenous endophthalmitis, in association with liver abscess. Endogenous fungal endophthalmitis in hospitalized patients is usually caused by Candida species, particularly Candida albicans. Acute endophthalmitis is a medical emergency. The most important component of treatment is the intravitreal injection of antibiotics, along with vitrectomy in severe cases. Systemic antibiotics should be used in cases of endogenous endophthalmitis and exogenous fungal endophthalmitis, but their role in exogenous bacterial endophthalmitis is uncertain. Repeated intravitreal injections of antibiotics may be necessary if there is no response to the initial therapy. Many eyes that receive prompt and appropriate treatment will recover useful vision

One week of levofloxacin plus dexamethasone eye drops for cataract surgery: an innovative and rational therapeutic strategy

Background: Cataract surgery is the most common operation performed worldwide. A fixed topical corticosteroid-antibiotic combination is usually prescribed in clinical practice for 2 or more weeks to treat post surgical inflammation and prevent infection. However, this protracted schedule may increase the incidence of corticosteroid-related adverse events and notably promote antibiotic resistance. Methods: This International, multicentre, randomized, blinded-assessor, parallel-group clinical study evaluated the non-inferiority of 1-week levofloxacin/dexamethasone eye drops, followed by 1-week dexamethasone alone, vs. 2-week gold-standard tobramycin/dexamethasone (one drop QID for all schedules) to prevent and treat ocular inflammation and prevent infection after uncomplicated cataract surgery. Non-inferiority was defined as the lower limit of the 95% confidence interval (CI) around a treatment difference >\u201310%. The study randomized 808 patients enrolled in 53 centres (Italy, Germany, Spain and Russia). The primary endpoint was the proportion of patients without anterior chamber inflammation on day 15 defined as the end of treatment. Endophthalmitis was the key secondary endpoint. This study is registered with EudraCT code: 2018-000286-36. Results: After the end of treatment, 95.2% of the patients in the test arm vs. 94.9% of the control arm had no signs of inflammation in the anterior chamber (difference between proportions of patients = 0.028; 95% CI: 120.0275/0.0331). No case of endophthalmitis was reported. No statistically significant difference was evident in any of the other secondary endpoints. Both treatments were well tolerated. Conclusions: Non-inferiority of the new short pharmacological strategy was proven. One week of levofloxacin/dexamethasone prevents infection, ensures complete control of inflammation in almost all patients and may contain antibiotic resistance