Specialities

Specialities

Artificial Intelligence
Anterior Segment
Cataract Surgery
Corneal and External Disorders
COVID-19
Diabetic Macular Oedema
Diabetic Retinopathy
Glaucoma
Imaging
Macular Degeneration
Neuro-ophthalmology
Ocular Oncology
Ocular Surface Disease
Oculoplastic Surgery
Paediatric Ophthalmology
Refractive Surgery
Retina/Vitreous
Ocular Immunology
Posterior Segment
Search

Trending Topic
23 mins

Trending Topic
Developed by Touch
Mark CompleteCompleted
BookmarkBookmarked

Noninfectious Uveitis: A Review of Ophthalmic Management and Clinical Pearls

Luke G Qin, Michael T Pierce, Rachel C Robbins

The uvea is a vascular stratum that includes the iris, ciliary body and choroid. Uveitis is defined as inflammation of a part of the uvea or its entirety, but it is also used to describe inflammatory processes of any part of the eye, such as the vitreous or peripheral retina. The clinical taxonomy of uveitis […]

touchREVIEWS in Ophthalmology. 2024;19(1):1–8:Online ahead of journal publication

Connect With Us:

Facebook
X (Twitter)
Instagram
Youtube
Linkedin
Anterior Segment
2 mins

Treatment of Post-operative Endophthalmitis

Leopoldo Spadea, Arianna Fiasca
Share
Facebook
X (formerly Twitter)
LinkedIn
Via Email
Mark CompleteCompleted
BookmarkBookmarked
Copy LinkLink Copied
Download as PDF
Published Online: May 22nd 2012 European Ophthalmic Review, 2012;6(3):149-156 DOI: http://doi.org/10.17925/EOR.2012.06.03.149
Select a Section…
1

Abstract

Overview

The rates of post-operative endophthalmitis have been low for many years, but recent reports suggest that this type of ocular infection may be on the rise. Fluctuations in the number of cases appear to correlate with the type of intraocular surgery performed. Post-operative endophthalmitis has been reported as a consequence of nearly every type of ocular surgery, but is most common following cataract surgery. Numerous reports have demonstrated that Gram-positive bacteria cause the vast majority of post-operative endophthalmitis cases. Coagulase-negative staphylococcal isolates are the most common. Most intraocular infections resulting from infection with coagulase-negative staphylococci can be treated with antibiotic and anti-inflammatory agents, resulting in restoration of partial or complete vision. However, the more virulent the bacterial strain, the more devastating the visual outcome. Intraocular infections with Staphyloccus aureus, enterococci, Bacillus or Gram-negative strains are often intractable, and blindness or loss of the eye itself is not uncommon. The therapeutic success of treating post-operative endophthalmitis depends largely on accurate and prompt diagnosis. Antibiotic therapy can be topical, sub-conjunctival, systemic or intravitreal. Vitrectomy must be reserved for patients who present with initial visual acuity of light perception. Only in these cases has vitrectomy been shown to be more advantageous with respect to the intravitreal antibiotic injection.

Keywords

Endophthalmitis, bacteria, cataract, infections, retina, vitreous, therapy

2

Article

Endophthalmitis is a severe inflammation of the interior of the eye caused by the introduction of contaminating micro-organisms following trauma, surgery or haematogenous spread from a distant infection site. Despite appropriate therapeutic intervention, bacterial endophthalmitis frequently results in visual loss, if not loss of the eye itself.

The two types of endophthalmitis are endogenous (metastatic) and exogenous. Endogenous endophthalmitis results from the haematogenous spread of organisms from a distant source of infection (i.e. endocarditis). Endogenous endophthalmitis is rare, occurring in only 2–15 % of all cases of endophthalmitis. Average annual incidence is about five per 10,000 hospitalised patients. In unilateral cases, the right eye is twice as likely to become infected as the left eye, probably because of its more proximal location to direct arterial blood flow from the right innominate artery to the right carotid artery.

Since 1980, candidal infections reported in intravenous drug users have increased. The number of people at risk may be increasing because of the spread of AIDS, more frequent use of immunosuppressive agents and more invasive procedures (i.e. bone marrow transplantation).1 Exogenous endophthalmitis results from direct inoculation as a complication of ocular surgery, foreign bodies and/or blunt or penetrating ocular trauma. Most cases of exogenous endophthalmitis (about 60 %) occur after intraocular surgery. Under normal circumstances, the blood–ocular barrier provides a natural resistance against invading organisms.2

Destruction of intraocular tissues may be due to direct invasion by the organism and/or inflammatory mediators of the immune response. Endophthalmitis may be as subtle as white nodules on the lens capsule, iris, retina or choroid. It can also be as ubiquitous as inflammation of all the ocular tissues, leading to a globe full of purulent exudates. In addition, inflammation can spread to involve the orbital soft tissue.

To view the full article in PDF or eBook formats, please click on the icons above.

2

References

  1. Romero CF, Rai MK, Lowder CY, Adal KA, Endogenous
    endophthalmitis: case report and brief review, Am Fam Phys,
    1999;60:510–4.

  2. Streilein JW, Ocular immune privilege: therapeutic
    opportunities from an experiment of nature, Nat Rev Immunol,
    2003;3:879–88.

  3. Albert DM, Jakobiec FA, Postoperative endophthalmitis. In:
    Albert DM, Jakobiec FA (eds), Principles and Practice of
    Ophthalmology, Philadelphia: WB Saunders, 2000;2441–62.

  4. Ness T, Pelz K, Hansen LL, Endogenous endophthalmitis:
    microorganisms, disposition and prognosis, Acta Ophthalmol
    Scand, 2007;85:852–6.

  5. Mandelbaum S, Forster RK, Postoperative endophthalmitis,
    Int Ophthalmol Clin, 1987;27:95–106.

  6. Taban M, Behrens A, Newcomb RL, Acute endophthalmitis
    following cataract surgery: a systematic review of the
    literature, Arch Ophthalmol, 2005;123:613–20.

  7. Aaberg TM, Flynn HW, Schiffman J, Newton J, Nosocomial
    acute-onset postoperative endophthalmitis survey: a
    10-year review of incidence and outcomes, Ophthalmology,
    1998;105:1004–10.

  8. Kattan HM, Flynn HW, Pflugfelder SD, et al., Nosocomial
    endophthalmitis survey: current incidence of infection after
    intraocular surgery, Ophthalmology, 1991;98:227–38.

  9. Lundstrom M, Wejde G, Stenevi U, et al., Endophthalmitis
    after cataract surgery: a nationwide prospective study
    evaluating incidence in relation to incision type and location,
    Ophthalmology, 2007;114:866–70.

  10. Behndig A, Montan P, Stenevi U, et al., One million cataract
    surgeries: Swedish National Cataract Register 1992–2009, J Cat Refract Surg, 2011;37:1539–45.

  11. Thompson JT, Parver LM, Enger CL, et al., Infectious
    endophthalmitis after penetrating injuries with retained
    intraocular foreign bodies. National Eye Trauma System,
    Ophthalmology, 1993;100:1468–74.

  12. Taban M, Behrens A, Newcomb RL, et al., Incidence of acute
    endophthalmitis following penetrating keratoplasty: a
    systematic review, Arch Ophthalmol, 2005;123:605–9.

  13. Han DP, Wisniewski SR, Wilson LA, et al., Spectrum and
    susceptibilities of microbiologic isolates in the
    Endophthalmitis Vitrectomy Study, Am J Ophthalmol,
    1996;122:1–17.

  14. Towler H, Aqueous contamination during small incision
    cataract surgery: a lesson in study design, Br J Ophthalmol,
    1995;79:873.

  15. Speaker MG, Milch FA, Shah MK, et al., Role of external
    bacterial flora in the pathogenesis of acute postoperative
    endophthalmitis, Ophthalmology, 1991;98:639–50.

  16. Microbiologic factors and visual outcome in the
    Endophthalmitis Vitrectomy Study, Am J Ophthalmol,
    1996;122:830–46.

  17. Clark WL, Kaiser PK, Flynn HW, et al., Treatment strategies
    and visual acuity outcomes in chronic postoperative
    Propionibacterium acnes endophthalmitis, Ophthalmology,
    1999;106:1665–70.

  18. Scott IU, Flynn HW, Feuer W, et al., Endophthalmitis
    associated with microbial keratitis, Ophthalmology,
    1996;103:1864–70.

  19. Song A, Scott IU, Flynn HW Jr, Budenz DL, Delayed-onset
    bleb-associated endophthalmitis: clinical features and visual
    acuity outcomes, Ophthalmology, 2002;109:985–91.

  20. Okhravi N, Adamson P, Carroll N, et al., PCR-based evidence
    of bacterial involvement in eyes with suspected intraocular
    infection, Invest Ophthalmol Vis Sci, 2000;41:3474.

  21. Wilson FM 2nd, Causes and prevention of endophthalmitis,
    Int Ophthalmol Clin, 1987;27:67–73.

  22. Lundstrom M, Wejde G, Stenevi U, et al., Endophthalmitis
    after cataract surgery: a nationwide prospective study
    evaluating incidence in relation to incision type and location,
    Ophthalmology, 2007;114:866–70.

  23. Ng JQ, Morlet N, Pearman JW, et al., Management and
    outcomes of postoperative endophthalmitis since the
    endophthalmitis vitrectomy study: the Endophthalmitis
    Population Study of Western Australia (EPSWA)’s fifth report,
    Ophthalmology, 2005;112:1199–206.

  24. Donahue SP, Kowalski RP, Jewart BH, Friberg TR, Vitreous
    cultures in suspected endophthalmitis. Biopsy or
    vitrectomy? Ophthalmology, 1993;100:452–5.

  25. Jager RD, Aiello LP, Patel SC, Cunningham ET Jr, Risks of
    intravitreal injection: a comprehensive review, Retina,
    2004;24:676–98.

  26. Results of the Endophthalmitis Vitrectomy Study. A
    randomized trial of immediate vitrectomy and of intravenous
    antibiotics for the treatment of postoperative bacterial
    endophthalmitis. Endophthalmitis Vitrectomy Study Group,
    Arch Ophthalmol, 1995;113:1479–96.

  27. Streilein JW, Regulation of ocular immune responses, Eye,
    1997;11:171–5.

  28. Bohigian GM, Olk RJ, Factors associated with a poor visual
    result in endophthalmitis, Am J Ophthalmol, 1986;101:332–41.

  29. Rowsey JJ, Stonecipher KG, Jensen H, et al., Culture and
    sensitivities of infectious endophthalmitis: a microbiological
    analysis of 302 intravitreal biopsies, Invest Ophthalmol Vis Sci,
    1992;33(Suppl.):745.

  30. Johnson MW, Doft BH, Kelsey SF, et al., The Endophthalmitis
    Vitrectomy Study. Relationship between clinical presentation
    and microbiologic spectrum, Ophthalmology, 1997;104:261–72.

  31. Okhravi N, Towler HMA, Hykin P, et al., Assessment of a
    standard treatment protocol on visual outcome following
    presumed bacterial endophthalmitis, Br J Ophthalmol,
    1997;81:719–22.

  32. Kresloff MS, Castellarin AA, Zarbin MA, Endophthalmitis, Surv
    Ophthalmol, 1998;43:193–224.

  33. Lam SR, Devenyi RG, Berger AR, Dunn W, Visual outcome
    following penetrating globe injuries with retained intraocular
    foreign bodies, Can J Ophthalmol, 1999;34:389–93.

  34. Baum J, Peyman GA, Barza M, Intravitreal administration of
    antibiotic in the treatment of bacterial endophthalmitis. III
    Consensus, Surv Ophthalmol, 1982;26:204–6.

  35. Brod RD, Flynn HW, Endophthalmitis: current approaches to
    diagnosis and therapy, Curr Opin Infect Dis, 1993;6:628–37.

  36. Ferencz JR, Assia EI, Diamantstein L, Rubinstein E,
    Vancomycin concentration in the vitreous after intravenous
    and intravitreal administration for postoperative
    endophthalmitis, Arch Ophthalmol, 1999;117:1023–7.

  37. Fleisher LN, Ferrell JB, McGahan MC, Synergistic uveitic
    effects of tumor necrosis factor-alpha and interleukin-1
    beta, Investig Ophthalmol Vis Sci, 1992;33:2120–7.

  38. Morlet N, Graham GG, Gatus B, et al., Pharmacokinetics of
    ciprofloxacin in the human eye: a clinical study and
    population pharmacokinetic analysis, Antimicrob Agents
    Chemother, 2000;44:1674–9.

  39. Johnson MW, Doft BH, Kelsey SF, et al. The Endophthalmitis
    Vitrectomy Study Group. The Endophthalmitis Vitrectomy
    Study: relationship between clinical presentation and
    microbiologic spectrum, Ophthalmology, 1997;104:261–72.

  40. Campochiaro PA, Lim JI, Aminoglycoside toxicity in the
    treatment of endophthalmitis, Arch Ophthalmol,
    1994;112:48–53.

  41. D’Amico DJ, Caspers-Velers L, Libert L, et al., Comparative
    toxicity of intravitreal aminoglycoside antibiotics, Am J
    Ophthalmol, 1985;100:264–75.

  42. Stevens SX, Fouraker BD, Jensen HG, Intraocular safety of
    ciprofloxacin, Arch Ophthalmol, 1991;109:1737–43.

  43. Wiechens B, Neumann D, Grammer JB, et al., Retinal toxicity
    of liposome-incorporated and free ofloxacin after intravitreal
    injection in rabbit eyes, Int Ophthalmol,
    1998;22:133–43.

  44. Merino G, Fujino Y, Hanashiro RK, Lipoteichoic acid as an
    inducer of acute uveitis in the rat, Investig Ophthalmol Vis Sci,
    1998;39:1251–6.

  45. Callegan MC, Booth MC, Jett BD, Gilmore MS, Pathogenesis
    of Gram-positive bacterial endophthalmitis, Infect Immun,
    1999;67:3348–56.

  46. Mo JS, Matsukawa A, Ohkawara S, Yoshinaga M, Role and
    regulation of IL-8 and MCP-1 in LPS-induced uveitis in
    rabbits, Exp Eye Res, 1999;68:333–40.

  47. Ozturk F, Kurt E, Inan UU, et al., Effect of propolis on
    endotoxin-induced uveitis in rabbits, Jpn J Ophthalmol,
    1999;43:285–9.

  48. Rooney P, Bilbe G, Zak O, O’Reilly T, Dexamethasone
    treatment of lipopolysaccharide-induced meningitis in
    rabbits that mimics magnification of inflammation following
    antibiotic therapy, J Med Microbiol, 1995;43:37–44.

  49. Smith MA, Sorenson JA, D’Aversa G, et al., Treatment
    of experimental methicillin-resistant Staphylococcus
    epidermidis endophthalmitis with intravitreal
    vancomycin and intravitreal dexamethasone,
    J Infect Dis, 1997;175:462–6.

  50. Yoshizumi MO, Lee GC, Equi RA, et al., Timing of
    dexamethasone treatment in experimental Staphylococcus
    aureus endophthalmitis, Retina, 1998;18:130–5.

  51. Shah GK, Stein JD, Sharma S, et al., Visual outcomes following
    the use of intravitreal steroids in the treatment of
    postoperative endophthalmitis, Ophthalmology, 2000;107:486–9.

  52. Kim IT, Chung KH, Koo BS, Efficacy of ciprofloxacin and
    dexamethasone in experimental Pseudomonas
    endophthalmitis, Korean J Ophthalmol, 1996;10:8–17.

  53. Meredith TA, Aguilar HE, Drews C, et al., Intraocular
    dexamethasone produces a harmful effect on treatment of
    experimental Staphylococcus aureus endophthalmitis, Trans
    Am Ophthalmol Soc, 1996;94:241–52.

  54. Adenis JP, Robert PY, Mounier M, Denis F, Anterior
    chamber concentrations of vancomycin in the irrigating
    solution at the end of cataract surgery, J Cataract Refract
    Surg, 1997;23:111–14.

  55. Gan IM, van Dissel JT, Beekhuis WH, et al., Intravitreal
    vancomycin and gentamicin concentrations in patients
    with postoperative endophthalmitis, Br J Ophthalmol,
    2001;85:1289–93.

  56. Haider SA, Hassett P, Bron AJ, Intraocular vancomycin levels
    after intravitreal injection in post-cataract extraction
    endophthalmitis, Retina, 2001;21:210–13.

  57. Gentamicin, Drug information provided by Lexi-Comp, The
    Merck Manual Professional. Available at:
    www.merckmanuals.com/professional/lexicomp/gentamicin.
    html (accessed 26 July 2012).

  58. Solomon R, Farbowitz M, Ciardella A, et al., Investigation of
    the safety of intravitreal ceftriaxone in an experimental
    rabbit model, Cutaneous Ocular Toxicol, 2000;19:131–6.

  59. Aguilar HE, Meredith TA, Shaarawy A, et al., Vitreous cavity
    penetration of ceftazidime after intravenous administration,
    Retina, 1995;15:154–9.

  60. Martin DF, Ficker LA, Aguilar HA, et al., Vitreous cefazolin
    levels after intravenous injection. Effects of inflammation,
    repeated antibiotic doses, and surgery, Arch Ophthalmol,
    1990;108:411–4.

  61. Christmas NJ, Smiddy WE, Vitrectomy and systemic
    fluconazole for treatment of endogenous fungal
    endophthalmitis, Ophthalmic Surg Lasers, 1996;27:1012–18.

  62. Hariprasad SM, Mieler WF, Lin TK, et al., Voriconazole in the
    treatment of fungal eye infections: a review of current
    literature, Br J Ophthalmol, 2008;92:871–8

  63. Beigi B, Westlake W, Chang B, et al., The effect of
    intracameral, per-operative antibiotics on microbial
    contamination of anterior chamber aspirates during
    phacoemulsification, Eye, 1998;12:390–4.

  64. Romero P, Mendez I, Salvat M, Fernandez J, Almena M,
    Intracameral cefazolin as prophylaxis against
    endophthalmitis in cataract surgery, J Cataract Refract Surg,
    2006;32:438–41.

  65. Mayer E, Cadman D, Ewings P, et al., A 10 year
    retrospective survey of cataract surgery and
    endophthalmitis in a single eye unit: injectable lenses lower
    the incidence of endophthalmitis, Br J Ophthalmol,
    2003;87:867–9

  66. Montan PG, Koranyi G, Setterquist HE, et al.,
    Endophthalmitis after cataract surgery: risk factors relating
    to technique and events of the operation and patient
    history: a retrospective case–control study, Ophthalmology,
    1998;105:2171–7.

  67. Kodjikian L, Burillon C, Roques C, et al., Bacterial adherence
    of Staphylococcus epidermidis to intraocular lenses: a
    bioluminescence and scanning electron microscopy study,
    Invest Ophthalmol Vis Sci, 2003;44:4388–94.

  68. Colleaux KM, Hamilton WK, Effect of prophylactic antibiotics
    and Incision type on the incidence of endophthalmitis after
    cataract surgery, Can J Ophthalmol, 2000;35:373–8.

  69. Wallin T, Parker J, Jin Y, et al., Cohort study of 27 cases of
    endophthalmitis at a single institution, J Cataract Refract Surg,
    2005;31:735–41.

3

Article Information

Disclosure

The authors have no conflicts of interest to declare.

Correspondence

Leopoldo Spadea, Via Benozzo Gozzoli 34, 00142 Rome, Italy. E: lspadea@cc.univaq.it

Support

Financial support received from the Department of Surgical Sciences, University of L’Aquila, Italy.

Received

2011-09-16T00:00:00

4

Further Resources

Share
Facebook
X (formerly Twitter)
LinkedIn
Via Email
Mark CompleteCompleted
BookmarkBookmarked
Copy LinkLink Copied
Download as PDF
15 mins

Trending Topic
Developed by Touch
Mark CompleteCompleted
BookmarkBookmarked

Pilocarpine Hydrochloride Ophthalmic Solution 1.25%: An Innovative Prescription Eye Drop for the Treatment of Presbyopia

Selina McGee, George O Waring IV

Presbyopia is a progressive, age-related condition that reduces the eye’s ability to focus on near objects, due to gradual lens thickening and decline in its elasticity and accommodative capacity, and represents the first stage of the dysfunctional lens syndrome.1–3 Presbyopia typically affects individuals aged >40 years and is highly prevalent, affecting nearly 2 billion people worldwide […]

European Ophthalmic Review, 2012;6(3):149-156 DOI: http://doi.org/10.17925/EOR.2012.06.03.149
Advertisement
    • 5

    Related Content in Anterior Segment

    Latest articles videos and clinical updates - straight to your inbox

    Close Popup