Endoscopic vitrectomy in endophthalmitis: initial experience of 33 cases at a tertiary eye care center

Vivek Pravin Dave,1 Rajeev R Pappuru,1 Mudit Tyagi,1 Avinash Pathengay,2 Taraprasad Das1 1Smt Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad 500034, Telangana, India; 2Retina and Uveitis Department, GMR Varalaxmi Campus, LV Prasad Eye Institute, Hanumanthawaka Chowk, Visakhapatnam 530040, Andhra Pradesh, India Purpose: To report the presentation and management outcomes of endophthalmitis with endoscopic vitrectomy. Methods: This is a retrospective interventional case series conducted at a tertiary eye care center in south India. Thirty three eyes of 33 patients were included. The medical records of the patients who underwent endoscopic vitrectomy for endophthalmitis from April 2014 to March 2018 were reviewed. Data with regard to age, gender, etiology of endophthalmitis, corneal and retinal examination, type of intervention, final anatomic and visual outcome, and the total follow-up were collected. The main outcome measures were the final visual acuity and evisceration rates. Results: The mean age at presentation was 46.84±19.89 years, with a median age of 50 years. Based on etiology, 13 eyes (39.4%) were post-trauma endophthalmitis, eleven eyes (33.33%) were post-cataract surgery, three eyes (9.09%) were endogenous, three eyes (9.09%) were post-perforated corneal ulcer, two eyes (6.06%) were post-retinal surgery, and one eye (3.03%) was post-combined cataract and corneal surgery. Twenty-four eyes (72.72%) had a favorable anatomic outcome at the last visit, and five eyes (15.15%) had a favorable visual outcome. Of those with unfavorable visual outcome, ten eyes had further visual potential. Sixteen eyes (48.48%) showed a positive culture on microbiologic evaluation. The predominant organism isolated was Pseudomonas aeruginosa. Evisceration was required only in one eye (3.03%). Conclusion: Endoscopic vitrectomy allows early management of endophthalmitis in spite of hazy media. This ensures a reasonable visual outcome, controls the infection, and reduces the incidence of evisceration in these eyes. Keywords: evisceration, trauma, vitrectom

Microbiologic spectrum and susceptibility of isolates in delayed post-cataract surgery endophthalmitis

Animesh Jindal,1 Avinash Pathengay,1 Subhadra Jalali,2 Annie Mathai,2 Rajeev Reddy Pappuru,2 Raja Narayanan,2 Jay Chhablani,2 Savitri Sharma,3,4 Taraprasad Das,2,3 Harry W Flynn Jr51L V Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India; 2Srimati Kannuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, KAR Campus, Hyderabad, India; 3L V Prasad Eye Institute, Bhubaneswar Eye Institute, Bhubaneswar, Odisha, India; 4Jhaveri Microbiology Centre, L V Prasad Eye Institute, KAR Campus, Hyderabad, India; 5Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USAAbstract: The objective of this study was to evaluate the microbiological spectrum and antimicrobial susceptibility of isolates in delayed post-cataract surgery endophthalmitis. A retrospective review of 33 consecutive patients with culture proven delayed post-cataract surgery endophthalmitis was done from January 2006 to March 2013. There were 22 bacterial and eleven fungal cases. Common isolates were Streptococci (seven cases), coagulase-negative staphylococci (five), Gram-negative bacilli (seven), Nocardia (two), Aspergillus (five), Candida (five). Gram-positive cocci were most susceptible to vancomycin and gatifloxacin (91.7%). Gram-negative isolates were most susceptible to ofloxacin (85.7%). Fungi being slow growing organisms are an important cause of delayed post-cataract surgery endophthalmitis.Keywords: delayed endophthalmitis, microbiology, antibiotic sensitivit

The Role of Endoscopy in Uveitic Eyes

In cases where loss of visualization the ability to accomplish surgical goals, hybrid endoscopic vitrectomy is a valid option where an endoscope is combined with a traditional microscopic wide angle viewing system. This may also be done with a three dimensional heads-up display where the endoscopic view is reported on the same monitor as the wide field microscopic view. Endoscopy remains a useful adjunctive technique in several clinical scenarios which may be encountered in uveitic retinal detachment or endophthalmitis. For those interested in pursuing ophthalmic endoscopy, additional information, techniques and animated programs and videos are available on a free educational website, ophthalmicedge.org