Objective: To report the incidence of acute postinjection endophthalmitis following intravitreal injection of triamcinolone acetonide (IVTA) as an office procedure. Methods: Retrospective, noncomparative, consecutive,...Objective: To report the incidence of acute postinjection endophthalmitis following intravitreal injection of triamcinolone acetonide (IVTA) as an office procedure. Methods: Retrospective, noncomparative, consecutive, interventional case series of all patients who had received IVTA at 2 clinical centers between January 1, 2000, and January 30, 2004. Results: A total of 1006 eyes received IVTA. None of the eyes developed acute, culture-positive, postoperative endophthalmitis in the 6 weeks following the procedure. One patient developed acute, culture-negative, postoperative endophthalmitis 4 days after receiving IVTA, resulting in an incidence of 0.10% . In this case, the presenting symptoms were decreased vision and acute conjunctival erythema. The case was notable for the absence of pain or hypopyon. Conclusion: Although acute postoperative endophthalmitismay follow IVTA, our experience suggests that this is a relatively uncommon event.展开更多
Purpose To analyze the clinical characteristics and treatment outcomes of pati ents with bleb-associated endophthalmitis (BAE). Design Retrospective, non comp arative, interventional case series. Participants Consecut...Purpose To analyze the clinical characteristics and treatment outcomes of pati ents with bleb-associated endophthalmitis (BAE). Design Retrospective, non comp arative, interventional case series. Participants Consecutive patients treated a t one institution for BAE. Interventions Prompt pars plana vitrectomy (PPV) with intravitreal injection of antibiotics, or prompt vitreous biopsy and intravitre al injection of antibiotics (tap and inject). Methods Retrospective analysis of 68 consecutive cases of BAE between July 1, 1989 and June 30, 2001. Clinical pre sentation, treatment modality, microbiologic data, and clinical course were anal yzed. Visual outcomes were compared between vitrectomy and tap-and-inject grou ps, culture-positive and culture-negative groups, and early and late times. Ma in outcome measures Snellen visual acuities (VAs) at 3 months and 12 months afte r treatment and at most recent follow-up. Results The incidence of no light per ception (NLP) at 12 months after treatment for BAE was 35%. Vitreous isolates i ncluded streptococcal species (32%of positive cultures), Staphylococcus epiderm idis (26%), Enterococcus, and Serratia (12%each). Patients with a positive vit reous culture had significantly worse VA (median, hand movements HM at 3 and 1 2 months after treatment) and a higher rate of NLP vision. Patients treated with tap-and-inject had a significantly worse final VA (medians, HM at 3 months an d LP at 12 months) and a significantly higher rate of NLP vision than patients t reated with PPV. One third of patients who underwent PPV achieved a final VA of 20/100 or better 12 months after treatment (P=0.09). Conclusions Bleb associated endophthalmitis causes significant visual morbidity. Patients with culture-neg ative BAE and patients treated with prompt PPV may achieve better visual outcome .展开更多
Background: To determine whether local complications at the site of pacemaker implantation indicate infection of the intravascular part of the lead as well as of the pacemaker pocket. Methods: 105 patients admitted fo...Background: To determine whether local complications at the site of pacemaker implantation indicate infection of the intravascular part of the lead as well as of the pacemaker pocket. Methods: 105 patients admitted for local inflammatory findings, impending pacemaker or lead exteriorisation, frank pacemaker or lead e xteriorisation, or overt infection were studied prospectively. After systematic lead extraction, the initial clinical presentation was related to the results of lead cultures. Results: Regardless of the initial presentation, the intravascul ar parts of the leads gave positive cultures in 79.3%of patients. Additionally, 91.6%of the cultures of the extravascular lead segments were positive, in cont rast to 38.1%positivity for wound swab cultures. No clinical observations or la boratory investigations permitted identification of patients with negative lead cultures. In a subgroup of 50 patients with manifestations strictly limited to t he pacemaker implantation site, cultures of intravascular lead segments were pos itive in 72%. Infection recurred in 4/8 patients without complete lead body extraction(50%) v 1/97 pat ients (1.0%)whose leads were totally extracted (p< 0.001). Conclusions: Local c omplications at the site of pacemaker implantation are usually associated with i nfection of the intravascular part of the leads, with a risk of progressing to s ystemic infection. Such local symptoms should prompt the extraction of leads eve n in the absence of other infectious manifestations.展开更多
文摘Objective: To report the incidence of acute postinjection endophthalmitis following intravitreal injection of triamcinolone acetonide (IVTA) as an office procedure. Methods: Retrospective, noncomparative, consecutive, interventional case series of all patients who had received IVTA at 2 clinical centers between January 1, 2000, and January 30, 2004. Results: A total of 1006 eyes received IVTA. None of the eyes developed acute, culture-positive, postoperative endophthalmitis in the 6 weeks following the procedure. One patient developed acute, culture-negative, postoperative endophthalmitis 4 days after receiving IVTA, resulting in an incidence of 0.10% . In this case, the presenting symptoms were decreased vision and acute conjunctival erythema. The case was notable for the absence of pain or hypopyon. Conclusion: Although acute postoperative endophthalmitismay follow IVTA, our experience suggests that this is a relatively uncommon event.
文摘Purpose To analyze the clinical characteristics and treatment outcomes of pati ents with bleb-associated endophthalmitis (BAE). Design Retrospective, non comp arative, interventional case series. Participants Consecutive patients treated a t one institution for BAE. Interventions Prompt pars plana vitrectomy (PPV) with intravitreal injection of antibiotics, or prompt vitreous biopsy and intravitre al injection of antibiotics (tap and inject). Methods Retrospective analysis of 68 consecutive cases of BAE between July 1, 1989 and June 30, 2001. Clinical pre sentation, treatment modality, microbiologic data, and clinical course were anal yzed. Visual outcomes were compared between vitrectomy and tap-and-inject grou ps, culture-positive and culture-negative groups, and early and late times. Ma in outcome measures Snellen visual acuities (VAs) at 3 months and 12 months afte r treatment and at most recent follow-up. Results The incidence of no light per ception (NLP) at 12 months after treatment for BAE was 35%. Vitreous isolates i ncluded streptococcal species (32%of positive cultures), Staphylococcus epiderm idis (26%), Enterococcus, and Serratia (12%each). Patients with a positive vit reous culture had significantly worse VA (median, hand movements HM at 3 and 1 2 months after treatment) and a higher rate of NLP vision. Patients treated with tap-and-inject had a significantly worse final VA (medians, HM at 3 months an d LP at 12 months) and a significantly higher rate of NLP vision than patients t reated with PPV. One third of patients who underwent PPV achieved a final VA of 20/100 or better 12 months after treatment (P=0.09). Conclusions Bleb associated endophthalmitis causes significant visual morbidity. Patients with culture-neg ative BAE and patients treated with prompt PPV may achieve better visual outcome .
文摘Background: To determine whether local complications at the site of pacemaker implantation indicate infection of the intravascular part of the lead as well as of the pacemaker pocket. Methods: 105 patients admitted for local inflammatory findings, impending pacemaker or lead exteriorisation, frank pacemaker or lead e xteriorisation, or overt infection were studied prospectively. After systematic lead extraction, the initial clinical presentation was related to the results of lead cultures. Results: Regardless of the initial presentation, the intravascul ar parts of the leads gave positive cultures in 79.3%of patients. Additionally, 91.6%of the cultures of the extravascular lead segments were positive, in cont rast to 38.1%positivity for wound swab cultures. No clinical observations or la boratory investigations permitted identification of patients with negative lead cultures. In a subgroup of 50 patients with manifestations strictly limited to t he pacemaker implantation site, cultures of intravascular lead segments were pos itive in 72%. Infection recurred in 4/8 patients without complete lead body extraction(50%) v 1/97 pat ients (1.0%)whose leads were totally extracted (p< 0.001). Conclusions: Local c omplications at the site of pacemaker implantation are usually associated with i nfection of the intravascular part of the leads, with a risk of progressing to s ystemic infection. Such local symptoms should prompt the extraction of leads eve n in the absence of other infectious manifestations.
