Acute Bacillus cereus endophthalmitis caused by ocular perforation injury and occult intravitreal cilium implantation:a case report

Dear Editor,We present a case of acute Bacillus cereus(B.cereus)endophthalmitis in a patient with an intraocular perforation injury combined with occult intravitreal cilium implantation.B.cereus endophthalmitis is a severe intraocular infection commonly caused by post-traumatic injuries.It often leads to significant vision loss or even eye loss within 12-48h[1].The presence of an intraocular foreign body(IOFB)increases the risk of infection,while early surgical removal of IOFBs can prevent endophthalmitis,some IOFBs are difficult to detect preoperatively.The Medical Ethics Review Board of West China Hospital of Sichuan University waived application for a clinical study because this was a retrospective report of a single patient based on imaging and because no human experimentation was involved.The patient provided written informed consent to use the imaging data for publication.

Endophthalmitis in silicone oil-filled eye: A case report

BACKGROUND Endophthalmitis occurring in silicone oil-filled eyes is a very rare occurrence,with reported incidence rates ranging between 0.07%and 0.039%.Traditional methods of management of infectious endophthalmitis include the removal of silicone oil,washout of the vitreous cavity,administration of intravitreal antibiotics,and reinjection of silicone oil.CASE SUMMARY Herein,we report the case of a 39-year-old man with unilateral endophthalmitis after pars plana vitrectomy and silicone oil tamponade.Intravitreal injections of full-dose antibiotics and anterior chamber washout were used to treat the patient.No signs of retinal toxicity were observed during the follow-up period.CONCLUSION Intravitreal full-dose antibiotic injections and anterior chamber washout are promising alternatives to traditional therapies for endophthalmitis in silicone oilfilled eyes.

Delayed-onset micrococcus luteus-induced postoperative endophthalmitis several months after cataract surgery:A case report

BACKGROUND Micrococcus luteus(M.luteus)-induced endophthalmitis is very rare and and may present as either acute or chronic postoperative endophthalmitis.The aim of this study was to report a case of delayed-onset M.luteus-induced endophthalmitis that occurred several months after cataract surgery.CASE SUMMARY A 78-year-old man presented with decreased vision,pain and redness in the right eye that had begun 3 days prior.He had undergone cataract surgery 4 mo prior.Visual acuity was counting fingers;slit-lamp examination revealed conjunctival injection,posterior corneal precipitates,anterior chamber inflammation(cell 4+),and hypopyon.Fundus examination revealed moderate vitreous haze.Urgent vitrectomy was performed for suspected infectious endophthalmitis,followed by vitreous irrigation with injections of antibiotics.On the postoperative day 1,anterior chamber cell decreased to 2+and hypopyon was not observed on slit lamp examination.Six days postoperatively,the patient had recurrent eye pain,and the anterior chamber cell grade increased to 4+;hypopyon recurred in the anterior chamber,and whitish plaque was observed in the lens capsule.Therefore,the patient underwent intraocular lens(IOL)and lens capsule removal,followed by vitreous irrigation,antibiotics injection,and vitrectomy.M.luteus was identified from a lens capsule culture.CONCLUSION In cases of delayed-onset M.luteus-induced endophthalmitis,early vitrectomy and removal of the IOL and lens capsule may be necessary.

Endogenous fungal endophthalmitis:risk factors,clinical course,and visual outcome in 13 patients

AIM:To analyze the risk factors,ophthalmological features,treatment modalities and their effect on the visual outcome in patients with endogenous fungal endophthalmitis(EFE).METHODS:Data retrieved from the medical files included age at presentation to the uveitis clinic,gender,ocular symptoms and their duration before presentation,history of fever,eye affected,anatomical diagnosis and laboratory evidence of fungal infection.Medical therapy recorded included systemic antifungal therapy and its duration,use of intravitreal antifungal agents and use of oral/intravitreal steroids.Surgical procedures and the data of ophthalmologic examination at presentation and at last follow-up were also collected.RESULTS:Included were 13 patients(20 eyes,mean age 58 y).Ten patients presented after gastrointestinal or urological interventions and two presented after organ transplantation.In one patient,there was no history of previous intervention.Diagnostic vitrectomy was performed in 16 eyes(80%)and vitreous cultures were positive in 10 of the vitrectomized eyes(62.5%).In only 4 patients(31%),blood cultures were positive.All patients received systemic antifungal therapy.Sixteen eyes(80%)received intravitreal antifungal agent with voriconazole being the most commonly used.Visual acuity(VA)improved from 0.9±0.9 at initial exam to 0.5±0.8 logMAR at last followup(P=0.03).A trend of greater visual improvement was noted in favor of eyes treated with oral steroids(±intravitreal dexamethasone)than eyes that were not treated with steroids.The most common complication was maculopathy.Twelve eyes(60%)showed no ocular complications.CONCLUSION:High index of suspicion in patients with inciting risk factors is essential because of the low yield of blood cultures and the good general condition of patients at presentation.Visual prognosis is improved with the prompt institution of systemic and intravitreal pharmacotherapy and the immediate surgical intervention.Oral±local steroids could be considered in cases of prolonged or marked inflammatory responses in order to hasten control of inflammation and limit ocular complications.

Delayed-onset endophthalmitis associated with Achromobacter species developed in acute form several months after cataract surgery:Three case reports

BACKGROUND Achromobacter species-associated endophthalmitis is rare and may present as either acute or chronic postoperative endophthalmitis.Delayed-onset Achromobacter species endophthalmitis appearing in acute presentation that develops more than several months after cataract surgery is very rare.Intraocular lens(IOL)removal is commonly recommended to treat Achromobacter species endophthalmitis,which is based on previous studies.Here,we report the results of surgery without IOL removal when treating patients with delayed-onset postoperative Achromobacter species endophthalmitis that developed in an acute form.CASE SUMMARY Three patients visited our ophthalmology clinic due to visual impairment that began 2-3 d earlier.They had undergone cataract surgery 5-18 mo prior.Bestcorrected visual acuity of the diseased eye was between counting fingers at 30 cm to non-light perception.They showed conjunctival injection,inflammation in the anterior chamber(cell reaction 4+)and hypopyon formation.The patients were diagnosed with infectious endophthalmitis and immediately underwent pars plana vitrectomy,anterior chamber irrigation and intravitreal injection of ceftazidime and vancomycin.Before fluid infusion,a vitreous specimen was obtained. In all cases, the IOLs were not removed. Achromobacter species was detected on vitreousspecimen culture. After surgery, the vitreous opacity decreased gradually and there was littleretinal damage. At 1 mo after treatment, the best-corrected visual acuity had improved to 20/50and 20/40.CONCLUSIONDelayed onset postoperative endophthalmitis caused by Achromobacter species can appear in anacute form. All patients responded well to early vitrectomy and administration of empiricalantibiotics including ceftazidime. There was no need for IOL removal during surgery.

Risk factors for endophthalmitis after cataract surgery in diabetic patients: a case control study

AIM: To identify risk factors associated with post-cataract surgery endophthalmitis(PCE) in type 2 diabetic patients.METHODS: A hospital-based retrospective case-control study was conducted on 194 type 2 diabetic patients undergoing cataract surgery in Rajavithi Hospital from January 2007 to December 2015. Fifteen patients with PCE were included as the case group and 179 patients without PCE were included as the control group. Potential factors associated with PCE among both groups including demographics, pre-operative characteristics, surgical settings and complications, were statistically analyzed using Chi-square testing and a logistic regression model.RESULTS: Within the case group, 53% were females and the median age was 68 y. Univariate analysis of pre-operative characteristics, surgical settings and complications revealed that recent pre-operative fasting plasma glucose, insulin therapy, presence of diabetic retinopathy, and severe non-proliferative or proliferative diabetic retinopathy were significantly associated with PCE. In a multivariate analysis adjusting for blood glucose level, insulin treatment was the only significant factor associated with an increased risk of PCE(OR 3.9, 95%CI 1.0-15.0, P=0.04) compared to patients without insulin treatment. The most common causative organisms were gram-positive bacteria(89%). Staphylococcus species represented the most common group(67%). Median best corrected visual acuity at 1-month and 3-month follow-up was equal at 0.7 logMAR(20/100).CONCLUSION: The authors identify insulin treatment as the only risk factor associated with endophthalmitis after cataract surgery in type 2 diabetic patients. Further studies with serum levels of pre-operative glycated hemoglobin(HbA_(1c)) and post-operative fasting plasma glucose level are essential to truly demonstrate the role of peri-operative glycemic markers as a risk factor for PCE.

Surgical management of fungal endophthalmitis resulting from fungal keratitis

AIM： To report the fungal organisms, clinical features, surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis （EFE） secondary to keratitis, and evaluate the role of surgery in the treatment. METHODS： The clinical records of 27 patients （27 eyes） with culture-proven EFE resulting from fungal keratitis treated at Shandong Eye Institute from January 2007 to January 2015 were retrospectively reviewed. Information about fungal culture results, clinical features, surgical procedures, and final visual acuity was obtained. RESULTS： There were 39 positive culture results from samples of cornea, hypopyon, vitreous and lens capsule, accounting for 56%, 26%, 15% and 2.5%, respectively. Fusarium was identified in 44% （12/27） of the eyes, followed by Aspergillus in 22% （6/27）. Posterior segment infection was involved in 78% （21127） of the patients. The corneal infection was larger than 3 mmx3 mm in 89% （24/ 27） of the patients, and 22% （6/27） of them had the entire cornea, and even the sclera involved. Three eyes had silicone oil tamponade, and two eyes had retinal detachment. Twenty-two eyes （81.5%） underwent penetrating keratoplasty （PKP）, and over half of them （545%） were operated within 3d from the onset of antifungal therapy. Fourteen eyes （52%） underwent intracameral antifungal drug injection, and three of them required repeated injections. Fifteen eyes （55.6%） underwent pars plana vitrectomy （PPV）. The rate of the eyes undergoing PPV as the initial surgical procedure was 60% （9/15）, lower than 77% in PKP. Intravitreal injection was given in 59% of the eyes （16/27）, and 75% of them required repeated injections. The final visual acuity was 20/100 or better in 37% of the eyes, and better than counting fingers in 55.6% of the eyes. Five eyes （18.5%） were eviscerated. In the two eyes with concurrent retinal detachment, one achieved retinal reattachment, and the other was eviscerated. In the three eyes with silicone oil tamponade, two eyes received silicone oil removal, and the other one was eviscerated. CONCLUSION： Fusarium and Aspergillus are the dominant pathogens in EFE resulting from keratitis. Aggressive antifungal surgeries including multiple intravitreal injections, PKP and core vitrectomy （especially in the initial surgery） are helpful procedures to improve prognosis of severe EFE secondary to keratitis.

Clinical features and treatment outcomes of endogenous Klebsiella endophthalmitis:a 12-year review

AIM:To identify the clinical features and treatment outcomes of endogenous Klebsiella pneumoniae endophthalmitis and investigate prognostic factors of poor visual outcome.METHODS:The clinical records of all patients diagnosed with endogenous Klebsiella endophthalmitis between January 2007 to December 2018 in Prince of Wales Hospital,Hong Kong,China were retrospectively reviewed.Thorough ophthalmological examination findings were recorded in the case note,including visual acuity testing,slit-lamp examination,indirect ophthalmoscopy and B-scan ultrasonography if media opacity precluded fundus viewing.RESULTS:A total of 18 eyes in 14 patients were identified.Bilateral involvement was noted in 4 patients(28.6%).Hepatobiliary sepsis was the source in 9 patients(64.3%).Culture of intraocular fluid was positive in 5 out of 18 eyes(27.8%).Mortality was noted in 2 patients(14.3%).Mean final visual acuity was 20/1500.Six out of 16 eyes had total loss of sight(37.5%)and 3 eyes required evisceration(18.8%).Multivariate linear regression revealed poor presenting visual acuity(P=0.031)and lack of fundus view due to vitritis(P=0.02)as prognostic factors of poor visual outcome.CONCLUSION:Visual outcome of endogenous Klebsiella endophthalmitis is poor.Poor presenting visual acuity and lack of fundus view predict poor visual outcome.High index of suspicion for endophthalmitis is important in Klebsiella sepsis patients with complaints of ocular symptoms.Ophthalmological screening is recommended in noncommunicable patients with Klebsiella sepsis.

Poor prognostic factors in post-traumatic endophthalmitis following open globe injury

AIM:To demonstrate prognostic factors for poor visual outcome in patients with post-traumatic endophthalmitis(PTE)following open globe injury.METHODS:A retrospective study was conducted on 66 patients(66 eyes)with PTE following open globe injury from 2005 to 2015.Potential factors accounting for good and poor visual outcome were statistically analyzed by Chisquare test and Logistic regression model.RESULTS:In 66 cases,39 cases(59%)had a poor visual outcome.Univariate and multivariate Logistic regression analysis identified retained intraocular foreign body(IOFB)as the only factor significantly associated with poor visual outcome[adjusted odds ratio,4.62;95%confidence interval(1.04-20.53);P=0.04].The most common causative agents were gram-positive organisms(83%),of which Bacillus cereus(33%),was the most common pathogen.All cases received intravitreal antibiotic injections.Oral ciprofloxacin was the most used systemic antibiotic(33%).Pars plana vitrectomy was performed in 83%(55/66)of cases.At 6 mo follow-up,mean BCVA was 1.74±0.72 log MAR units.CONCLUSION:In patients with PTE following open globe injury,the only predictor of poor visual outcome is the presence of IOFB.Bacillus cereus is the most isolated microorganism.

The Malaysian cataract surgery registry:incidence and risk factors of postoperative infectious endophthalmitis over a 7-year period

AIM：To report the incidence,risk factors and visual outcomes for postoperative endophthalmitis（POE）based on 7-year data from the Malaysian Ministry of Health Cataract Surgery Registry（MOH CSR）.METHODS：Data was collected from the web-based MOH CSR.All consecutive cataract surgery patients from 1st June 2008 to 31st December 2014 were identified.Exclusion criteria were traumatic cataract or previous ocular surgery.Demographic data,ocular co-morbidities,intraoperative details and postoperative visual acuity（VA）at final ophthalmological follow-up were noted.All eyes were taken for analysis.Subjects with POE were compared against subjects with no POE for risk factor assessment using multiple logistic regressions.RESULTS：A total of 163 503 subjects were screened.The incidence of POE was 0.08%（131/163 503）.Demographic POE risk factors included male gender（OR：2.121,95%CI：1.464-3.015）and renal disease（OR：2.867,95%CI：1.503-5.467）.POE risk increased with secondary causes of cataract（OR：3.562,95%CI：1.740-7.288）,uveitis（OR：11.663,95%CI：4.292-31.693）and diabetic retinopathy（OR：1.720,95%CI：1.078-2.744）.Intraoperative factors reducing POE were shorter surgical time（OR：2.114,95%CI：1.473-3.032）,topical or intracameral anaesthesia（OR：1.823,95%CI：1.278-2.602）,posterior chamber intraocular lens（PCIOL;OR：4.992,95%CI：2.689-9.266）and foldable IOL（OR：2.276,95%CI：1.498-3.457）.POE risk increased with posterior capsule rupture（OR：3.773,95%CI：1.915-7.432）and vitreous loss（OR：3.907,95%CI：1.720-8.873）.Postoperative VA of 6/12 or better was achieved in 15.27%（20/131）subjects with POE.CONCLUSION：This study concurs with other studies regarding POE risk factors.Further strengthening of MOH CSR data collection process will enable deeper analysis and optimization of POE treatment.

Incidence of endophthalmitis after phacoemulsification cataract surgery:a Meta-analysis

AIM:To evaluate the overall endophthalmitis incidence and the effectiveness of potential prophylaxis measures following phacoemulsification cataract surgery(PCS).METHODS:The Pub Med and Web of Science databases were searched from inception to April 30^(th),2021.We included studies that reported on the incidence of endophthalmitis following PCS.The quality of the included studies was critically evaluated with the Newcastle-Ottawa quality assessment scale.The random effect or the fixed-effects model was used to evaluated the pooled incidence based on the heterogeneity.The publication bias was assessed by Egger’s linear regression and Begg’s rank correlation tests.RESULTS:A total of 39 studies containing 5 878 114 eyes were included and critically appraised in the Meta-analysis.For overall incidence of endophthalmitis after PCS,the Meta-analysis yielded a pooled estimate of 0.092%(95%CI:0.083%-0.101%).The incidence appeared to decrease with time(before 2000:0.097%,95%CI:0.060%-0.135%;2000 to 2010:0.089%,95%CI:0.076%-0.101%;after 2010:0.063%,95%CI:0.050%-0.077%).Compared with typical povidone-iodine solution(0.178%,95%CI:0.071%-0.285%) and antibiotics subconjunctival injections(0.047%,95%CI:0.001%-0.095%),the use of intracameral antibiotics significantly reduced the incidence of endophthalmitis after PCS(0.045%,95%CI:0.034%-0.055%,RR:7.942,95%CI:4.510-13.985).CONCLUSION:Due to the advancement of phacoemulsification technology and the widespread use of intracameral antibiotics,the incidence of endophthalmitis following PCS shows a decreasing trend over time.The use of intracameral antibiotics administration will significantly reduce the risk of endophthalmitis.

Intraocular lens removal or not during vitrectomy for acute infectious endophthalmitis after cataract surgery

At present, the incidence of infectious endophthalmitis after cataract surgery has been significantly reduced, but it is still a serious complication. Removal or not of the intraocular lens(IOL) during vitrectomy in cases with a moderate or severe inflammation is controversial. In order to call upon more discussion, we publish the article entitled “Timely vitrectomy without intraocular lens removal for acute endophthalmitis after cataract surgery” written by Guo et al in this issue. With recent advanced vitrectomy techniques, and critical measures for management of risk factors related to occurrence of infection, IOL remaining during timely vitrectomy for acute endophthalmitis can possibly be safe and effective in selected cases.

Traumatic endophthalmitis and the outcome after vitrectomy in young children

AIM:To explore the traumatic endophthalmitis in young children and the outcome of pars plana vitrectomy(PPV).METHODS:Twenty-two eyes of 22 cases of young children consecutive pediatric traumatic endophthalmitis treated and followed up between September 2014 and May 2018 were included.Aqueous humor or vitreous samples were taken for bacterial culture and sensitivity tests.Intravitreal antibiotics(norvancomycin and ceftazidime)injection,combined with 23-gauge PPV,were administered in 22 eyes.Silicone oil(SO;5000 centistoke)tamponade or perfluoropropane gas(C3F8)was used in all patients.Main outcome measures were best-corrected visual acuity(BCVA)and retinal attachment,the ratio of penetrating injury,and the existence of intraocular foreign body.RESULTS:The mean age of patients was 6.9±2.2(range,3-10)y.All injured eyes suffered from penetrating ocular injury with retained intraocular foreign body in one eye.Bacterial culture was positive in only 2 eyes.The mean follow-up time was 21.1±4.7(range,12-30)mo.In the primary PPV,intravitreal antibiotics was administrated in all eyes,SO in 18 eyes,and C3F8 in 4 eyes.The secondary operation of SO removal and C3F8 endotamponade was performed in 16 eyes and a second SO endotamponade due to emulsification of the oil and retinal detachment(RD)was operated in 7 eyes underwent 3 to 11.5 mo after primary PPV.A third operation was done in 7 eyes.The final intraocular pressure(IOP)was 8.9±1.8(range,6.9-11.4)mm Hg.The final BCVAs were 20/200 or better in 5,counting fingers in 2,and light perception to hand movement in 8 eyes.Whose(66.7%)had retinal injury exhibited worse BCVA(P=0.019,Fisher’s exact test).Eyes underwent SO tamponade exhibited worse final BCVA than that with C3F8 in the primary PPV(P=0.026,Fisher’s exact test).CONCLUSION:Traumatic endophthalmitis in children is generally more severe and associated with more complicated surgical procedures.Most patients have retinal injury need multiple operations and the final BCVA is poor.Prevention of ocular trauma,especially in children,is still critical.

Risk factors for endophthalmitis following cataract surgery-our experience at a tertiary eye care centre in India

AIMTo determine the risk factors for acute endophthalmitis after cataract extraction in a tertiary care centre in India.METHODSWe performed a nested case control study within a retrospective cohort. The surgical records of all patients with clinically diagnosed endophthalmitis within one month after cataract surgery, performed between January 2006 and December 2009, were reviewed. These were compared with randomly selected age and gender-matched controls, from patients having routine cataract surgery within ±1wk of the endophthalmitis case. Univariable and multivariable analysis were performed to identify risk factors for endophthalmitis.RESULTSOf the total 33 856 cataract surgeries performed during this period, there were 57 cases of postoperative acute endophthalmitis that met our study criteria. Thus, the overall incidence of endophthalmitis in our cohort was 1.6 per 1000 cataract extractions performed. Mean age of cases was 55.9y (SD: 10.9y) and for controls was 55.6y (SD: 9.8y). Thirty-five cases (61.4%) and 133 controls (59.6%) were males. Median time of onset of endophthalmitis was 4d (IQR 2-9d; range: 1-30d). Thirty-nine cases (68.4%) presented within 7d and 27 cases (47.4%) were culture positive. Two hundred and twenty-three age and gender matched controls were selected. In multivariate analysis, endophthalmitis was associated with posterior capsular rupture (PCR) during surgery (OR 6.98, 95%CI: 2.22-21.98), phacoemulsification via scleral incision with a foldable intraocular lens (IOL) implantation (OR 3.02, 95%CI: 1.13-8.04) and ocular co-morbidity (OR 2.32, 95%CI: 1.11-4.87).CONCLUSIONPCR, presence of ocular co-morbidity, and phacoemulsification via scleral incision with foldable-IOL were found to be independent risk factors for acute endophthalmitis.

Microbial spectrum and risk factors of endogenous endophthalmitis in a tertiary center of Northern China

AIM: To study the clinical features, microbial spectrum, associated factors and prognosis of endogenous endophthalmitis(EE) in a group of Chinese patients.METHODS: The medical records from 32 eyes of 29 patients diagnosed with EE in Peking Union Medical College Hospital from January 2009 to October 2019 were reviewed. RESULTS: The initial visual acuity(VA) of 30 eyes in this study was worse than 20/400. Twenty-three eyes were diagnosed with fungal endophthalmitis and nine with bacterial endophthalmitis. The most common fungal and bacterial isolates were Candida and Klebsiella pneumoniae, respectively. Several rare fungi and bacteria species were also isolated from our patients, including Cryptococcus, Paecilomyces, Brucella, and Bacillus licheniformis. The leading risk factor for EE was diabetes. The most common extraocular infection locus was genitourinary tract. Vitrectomy was performed on twenty-nine eyes. Eight eyes achieved final VA of 20/400 or better. EE caused by Candida had a better prognosis.CONCLUSION: The visual outcome of EE is based on pathogens and prompt intervention. Early vitrectomy and antimicrobial treatment are beneficial for EE.

Nanopore techniques as a potent tool in the diagnosis and treatment of endophthalmitis:a literature review

Endophthalmitis is a serious ophthalmic disease characterized by changes in the eye's posterior segment,such as hypopyon and intraocular inflammation,vitritis being a hallmark.Infection-caused endophthalmitis can lead to irreversible vision loss,accompanied by eye pain or eye distention,and in the most severe cases the removal of the eyeball.Microorganisms such as bacteria,fungi,viruses,and parasites typically account for the disease and the entry pathways of the microbial can be divided into either endogenous or exogenous approaches,according to the origin of the etiological agents.Exogenous endophthalmitis can be derived from various occasions(such as postoperative complications or trauma)while endogenous endophthalmitis results from the bloodstream which carries pathogens to the eye.This review aims to summarize the application of new technology in pathogen identification of endophthalmitis so as to prevent the disease and better guide clinical diagnosis and treatment.

Clinical profile and outcomes of pediatric endogenous endophthalmitis: A report of 11 cases from South India

AIM To study the clinical profile and outcomes of pediatric endogenous endophthalmitis from a tertiary eye hospital in South India.METHODS A total of 13 eyes of 11 children presented to us with varied symptoms and presentations of endogenous endophthalmitis, over a five-year period from January 2010 to December 2015 were studied. Except for two eyes of a patient, vitreous aspirates were cultured from all 11 eyes to isolate the causative organism. These eleven eyes also received intravitreal injections. All patients were treated with systemic antibiotics. RESULTS Two cases had bilateral endophthalmitis. Ages ranged from 4 d to 11 years. Five cases were undiagnosed and treated, before being referred to our center. Ten of the 13 eyes underwent a core vitrectomy. The vitrectomy was done at an average on the second day after presenting(range 0-20 d). Five of the 11 vitreous aspirates showed isolates. The incriminating organisms were bacteria in three and fungus in two. An underlying predisposing factor was found in seven patients. At a mean follow-up 21.5 mo, outcome was good in 7 eyes of 6 cases(54%), five eyes of four cases(38%) ended up with phthisis bulbi while one child died of systemic complications. CONCLUSION Endogenous endophthalmitis is a challenge for ophtha-lmologists. Early diagnosis and intervention is the key for a better outcome.

Timely vitrectomy without intraocular lens removal for acute endophthalmitis after cataract surgery

AIM:To investigate the clinical features,causative organisms and effects of timely vitrectomy and silicone oil tamponade without intraocular lens(IOL)removal in the treatment of acute-onset endophthalmitis after cataract surgery(APCE).METHODS:We retrospectively analyzed the clinical features and microbiological factors in 10 eyes of 10 patients with APCE at Tianjin Medical University General Hospital from January 2010 to December 2018.Data on the clinical features,causative organisms,visual acuity,intraocular pressure(IOP)and complications were collected.The mean follow-up period was 25.5 mo.RESULTS:The mean age of the patients was 71.4 y.The mean time between cataract surgery and the onset of endophthalmitis was 2.0 d.Preoperative visual acuity ranged from no light perception to hand motion.After vitrectomy,the visual acuity increased in nine eyes(90%),and was unchanged in one eye(10%).A significant difference was observed between the mean preoperative(36.3±7.1 mm Hg)and postoperative IOP(14.9±4.3 mm Hg,P<0.05).Staphylococcus epidermidis was isolated in 5 eyes,S.aureus in 2 eyes,and Enterococcus in 1 eye.Postoperative complications mainly included fibrin exudates in the anterior chamber at the early stages in all eyes and temporary IOP elevation in one eye.No retinal detachment or ocular atrophy was observed during the follow-up period.CONCLUSION:Under systemic antibiotic treatment and timely diagnosis,vitrectomy and silicone oil tamponade without IOL removal is a safe and effective method for APCE.

Laboratory diagnosis of infectious endophthalmitis

AIM:To analyze the lab diagnosis and etiology of infectious endophthalmitis.METHODS:The medical and microbial records of 36 patients diagnosed with infectious endophthalmitis and 8 patients diagnosed with intraocular lens(IOL)-related inflammation between Nov.1999 and Dec.2009 were retrospectively reviewed for lab diagnosis and etiology.RESULTS:The inflammatory cell counts in all aqueous humor specimens from infectious endophthalmitis patients were more than in all aqueous humor specimens from patients with IOL-related inflammation.Sixteen of the 36 aqueous humor samples(44.4%) and 11 of the 24 vitreous humor samples(45.8%) from infectious endophthalmitis patients showed positive results in smears;while 17 aqueous humor samples(47.2%) and 15 vitreous humor samples(62.5%) from infectious endophthalmitis patients showed positive results in culture.CONCLUSION:The inflammatory cell count may be an important index for infectious endophthalmitis;while,smears can show etiological information earlier.

Late onset endophthalmitis after sutureless intrascleral IOL implantation with Yamane Technique

Dear Editor, We want to present the first reported Propionobacterium acnes(P. acnes) endophthalmitis case after sutureless fixation of posterior chamber intraocular lens(IOL) to the sclera for the traetment of aphakia to the best of our knowledge. A 69-year-old man with aphakia due to complicated cataract surgery underwent sutureless intrascleral fixation of threepiece posterior chamber intraocular lens(PCIOL) with Yamane technique.