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Published in: Graefe's Archive for Clinical and Experimental Ophthalmology 4/2018

01-04-2018 | Medical Ophthalmology

Trends in treatment strategies for suspected bacterial endophthalmitis

Authors: Greg D. Fliney, Paula E. Pecen, Jennifer N. Cathcart, Alan G. Palestine

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 4/2018

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Abstract

Purpose

To describe how vitreoretinal specialists have incorporated the Endophthalmitis Vitrectomy Study (EVS) findings into current practice, to highlight divergences from the EVS recommendations, and address the role of microbial culture in guiding additional treatments.

Methods

This is a cross-sectional survey of vitreoretinal specialists regarding indications used for performing a pars plana vitrectomy (PPV), selection of antibiotics for treatment, utilization of cultures, and treatment strategies for treatment-refractory patients with bacterial endophthalmitis.

Results

Of 681 physicians contacted, 149 (21.9%) responded. For patients with visual acuity of light perception or less, 75% of respondents utilized PPV. Intravitreal vancomycin and ceftazidime were used by 100% and 96% of participants respectively. Vitreal cultures were obtained more than 50% of the time by 86.5% of participants, and were used to influence retreatment less than 50% of the time by 77.8% of respondents. For patients with worsening clinical signs 48 hours after initial treatment, 69.8% of participants performed PPV with intravitreal antibiotics.

Conclusions

Although most respondents followed the EVS guidelines, a minority deviated, and the majority generalized their strategy to other forms of endophthalmitis. There is significant variation in retreatment strategies, and while cultures are frequently obtained to help guide these treatments, they are utilized infrequently.
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Literature
4.
go back to reference Nagaki Y, Hayasaka S, Kadoi C, Matsumoto M, Yanagisawa S et al (2003) Bacterial endophthalmitis after small-incision cataract surgery. Effect of incision placement and intraocular lens type. J Cataract Refract Surg 29:20–26CrossRefPubMed Nagaki Y, Hayasaka S, Kadoi C, Matsumoto M, Yanagisawa S et al (2003) Bacterial endophthalmitis after small-incision cataract surgery. Effect of incision placement and intraocular lens type. J Cataract Refract Surg 29:20–26CrossRefPubMed
6.
go back to reference Endophthalmitis Vitrectomy Study Group (1995) Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol 113:1479–1496CrossRef Endophthalmitis Vitrectomy Study Group (1995) Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol 113:1479–1496CrossRef
8.
go back to reference Hilton GF, Josephberg RG, Halperin LS, Madreperla SA, Brinton DA et al (2002) Office-based sutureless transconjunctival pars plana vitrectomy. Retina 22:725–732CrossRefPubMed Hilton GF, Josephberg RG, Halperin LS, Madreperla SA, Brinton DA et al (2002) Office-based sutureless transconjunctival pars plana vitrectomy. Retina 22:725–732CrossRefPubMed
9.
go back to reference Zhang YQ, Wang WJ (2005) Treatment outcomes after pars plana vitrectomy for endogenous endophthalmitis. Retina 25:746–750CrossRefPubMed Zhang YQ, Wang WJ (2005) Treatment outcomes after pars plana vitrectomy for endogenous endophthalmitis. Retina 25:746–750CrossRefPubMed
10.
go back to reference Modjtahedi BS, Finn AV, Papakostas TD, Durand M, Husain D et al (2017) Intravenous drug use-associated endophthalmitis. Ophthalmol Retina 1:192–199CrossRef Modjtahedi BS, Finn AV, Papakostas TD, Durand M, Husain D et al (2017) Intravenous drug use-associated endophthalmitis. Ophthalmol Retina 1:192–199CrossRef
13.
go back to reference Galloway G, Ramsay A, Jordan K, Vivian A (2002) Macular infarction after intravitreal amikacin: mounting evidence against amikacin. Br J Ophthalmol 86:359–360CrossRefPubMedPubMedCentral Galloway G, Ramsay A, Jordan K, Vivian A (2002) Macular infarction after intravitreal amikacin: mounting evidence against amikacin. Br J Ophthalmol 86:359–360CrossRefPubMedPubMedCentral
16.
go back to reference Barza M, Pavan PR, Doft BH, Wisniewski SR, Wilson LA et al (1997) Evaluation of microbiological diagnostic techniques in postoperative endophthalmitis in the Endophthalmitis Vitrectomy Study. Arch Ophthalmol 115:1142–1150CrossRefPubMed Barza M, Pavan PR, Doft BH, Wisniewski SR, Wilson LA et al (1997) Evaluation of microbiological diagnostic techniques in postoperative endophthalmitis in the Endophthalmitis Vitrectomy Study. Arch Ophthalmol 115:1142–1150CrossRefPubMed
24.
go back to reference Shrader SK, Band JD, Lauter CB, Murphy P (1990) The clinical spectrum of endophthalmitis: incidence, predisposing factors, and features influencing outcome. J Infect Dis 162:115–120CrossRefPubMed Shrader SK, Band JD, Lauter CB, Murphy P (1990) The clinical spectrum of endophthalmitis: incidence, predisposing factors, and features influencing outcome. J Infect Dis 162:115–120CrossRefPubMed
25.
go back to reference Okada AA, Johnson RP, Liles WC, D’Amico DJ, Baker AS (1994) Endogenous bacterial endophthalmitis. Report of a ten-year retrospective study. Ophthalmology 101:832–838CrossRefPubMed Okada AA, Johnson RP, Liles WC, D’Amico DJ, Baker AS (1994) Endogenous bacterial endophthalmitis. Report of a ten-year retrospective study. Ophthalmology 101:832–838CrossRefPubMed
26.
go back to reference Greenwald MJ, Wohl LG, Sell CH (1986) Metastatic bacterial endophthalmitis: a contemporary reappraisal. Surv Ophthalmol 31:81–101CrossRefPubMed Greenwald MJ, Wohl LG, Sell CH (1986) Metastatic bacterial endophthalmitis: a contemporary reappraisal. Surv Ophthalmol 31:81–101CrossRefPubMed
27.
go back to reference Jackson TL, Eykyn SJ, Graham EM, Stanford MR (2003) Endogenous bacterial endophthalmitis: a 17-year prospective series and review of 267 reported cases. Surv Ophthalmol 48:403–423CrossRefPubMed Jackson TL, Eykyn SJ, Graham EM, Stanford MR (2003) Endogenous bacterial endophthalmitis: a 17-year prospective series and review of 267 reported cases. Surv Ophthalmol 48:403–423CrossRefPubMed
Metadata
Title
Trends in treatment strategies for suspected bacterial endophthalmitis
Authors
Greg D. Fliney
Paula E. Pecen
Jennifer N. Cathcart
Alan G. Palestine
Publication date
01-04-2018
Publisher
Springer Berlin Heidelberg
Published in
Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 4/2018
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-018-3910-3

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