Top

BMC Ophthalmology

Published in:

01-12-2020 | Cataract | Research article

Long-term visual outcomes of endophthalmitis and the role of systemic steroids in addition to intravitreal dexamethasone

Authors: Christopher D. Conrady, Richard M. Feist Jr, Albert T. Vitale, Akbar Shakoor

Published in: BMC Ophthalmology | Issue 1/2020

Abstract

Background

The purpose of this study was to evaluate the role of systemic steroids in post-procedural endophthalmitis as the role of intravitreal steroids in treatment algorithms of endophthalmitis remain controversial.

Methods

This is a retrospective analysis from a single tertiary referral center of all patients older than 18 years old that developed presumed post-procedure endophthalmitis and were treated at our center from 2009 to 2018.

Results

Eighty-three patients were followed after being treated for post-procedural endophthalmitis that either received systemic steroids or did not around the time of diagnosis. Almost 30 % of all patients regained a final visual acuity of 20/40 or better, while 31.2% had poor visual outcomes of count fingers or worse. Non-clearing debris was the most significant long-term complication. Visual improvement plateaued in 67.7% by 1 month after diagnosis and initial treatment in both groups. There was no difference in visual outcomes when comparing the sixteen patients that received systemic steroids and the sixty-seven that did not; however, no enucleation or evisceration was required in patients receiving systemic steroids. Five patients that did not receive systemic steroids required an enucleation or evisceration due to a blind, painful eye.

Conclusions

The use of systemic steroids does not seem to worsen long-term outcomes of endophthalmitis compared to those patients that did not receive them and they may prove beneficial in the most severe cases by reducing the risk of losing the globe altogether.

Schmier JK, Hulme-Lowe CK, Covert DW, Lau EC. An updated estimate of costs of endophthalmitis following cataract surgery among Medicare patients: 2010-2014. Clin Ophthalmol Auckl NZ. 2016;10:2121–7. https://doi.org/10.2147/OPTH.S117958.CrossRef

Poulsen EJ, Allingham RR. Characteristics and risk factors of infections after glaucoma filtering surgery. J Glaucoma. 2000;9:438–43.CrossRef

Friling E, Lundström M, Stenevi U, Montan P. Six-year incidence of endophthalmitis after cataract surgery: Swedish national study. J Cataract Refract Surg. 2013;39:15–21. https://doi.org/10.1016/j.jcrs.2012.10.037.CrossRefPubMed

Grzybowski A, Turczynowska M, Kuhn F. The treatment of postoperative endophthalmitis: should we still follow the endophthalmitis vitrectomy study more than two decades after its publication? Acta Ophthalmol. 2018;96:e651–4. https://doi.org/10.1111/aos.13623.CrossRefPubMed

Brundrett A, Conrady CD, Shakoor A, Lin A. Current strategies for prevention and treatment of postoperative Endophthalmitis. Curr Ophthalmol Rep. 2018;6:105–14. https://doi.org/10.1007/s40135-018-0171-6.CrossRef

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(12):1479–96.

Ho I-V, Fernandez-Sanz G, Levasseur S, et al. Early pars Plana Vitrectomy for treatment of acute infective Endophthalmitis. Asia-Pac J Ophthalmol Phila Pa. 2019;8:3–7. https://doi.org/10.22608/APO.2018414.CrossRef

Kurniawan ED, Rocke JR, Sandhu SS, Allen PJ. Predictors of visual outcome and the role of early vitrectomy in streptococcal endophthalmitis. Clin Exp Ophthalmol. 2018;46:424–31. https://doi.org/10.1111/ceo.13077.CrossRefPubMed

Shalaby A, Cherubini SDS, Lockwood A, Newsom R. Postoperative Endophthalmitis: incidence, causes and comparison between medical and surgical treatment in a United Kingdom region in the last 10 years. Acta Ophthalmol (Copenh) 93. 2015. https://doi.org/10.1111/j.1755-3768.2015.0673.

10.

Conrady CD, Feistmann JA, Roller AB, et al. Hemorrhagic vasculitis and retinopathy heralding as an early sign of bacterial endophthalmitis after intravitreal injection. Retin Cases Brief Rep. 2017. https://doi.org/10.1097/ICB.0000000000000601.

11.

Manning S, Ugahary LC, Lindstedt EW, et al. A prospective multicentre randomized placebo-controlled superiority trial in patients with suspected bacterial endophthalmitis after cataract surgery on the adjuvant use of intravitreal dexamethasone to intravitreal antibiotics. Acta Ophthalmol. 2018;96:348–55. https://doi.org/10.1111/aos.13610.CrossRefPubMed

12.

Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap) - a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81. https://doi.org/10.1016/j.jbi.2008.08.010.CrossRef

13.

Doan T, Acharya NR, Pinsky BA, et al. Metagenomic DNA sequencing for the diagnosis of intraocular infections. Ophthalmology. 2017;124:1247–8. https://doi.org/10.1016/j.ophtha.2017.03.045.CrossRefPubMedPubMedCentral

14.

Gan IM, Ugahary LC, van Dissel JT, van Meurs JC. Effect of intravitreal dexamethasone on vitreous vancomycin concentrations in patients with suspected postoperative bacterial endophthalmitis. Graefes Arch Clin Exp Ophthalmol Albrecht Von Graefes Arch Klin Exp Ophthalmol. 2005;243:1186–9. https://doi.org/10.1007/s00417-005-1182-1.CrossRef

15.

Albrecht E, Richards JC, Pollock T, et al. Adjunctive use of intravitreal dexamethasone in presumed bacterial endophthalmitis: a randomised trial. Br J Ophthalmol. 2011;95:1385–8. https://doi.org/10.1136/bjo.2010.187963.CrossRefPubMed

16.

Bucher RS, Hall E, Reed DM, et al. (2005) effect of intravitreal triamcinolone acetonide on susceptibility to experimental bacterial endophthalmitis and subsequent response to treatment. Arch Ophthalmol Chic Ill. 1960;123:649–53. https://doi.org/10.1001/archopht.123.5.649.CrossRef

17.

Rasmussen MLR. The eye amputated – consequences of eye amputation with emphasis on clinical aspects, phantom eye syndrome and quality of life. Acta Ophthalmol. 2010;88:1–26. https://doi.org/10.1111/j.1755-3768.2010.02039.x.CrossRefPubMed

18.

Ye J, Lou L, Jin K, et al. Vision-Related Quality of Life and Appearance Concerns Are Associated with Anxiety and Depression after Eye Enucleation: A Cross-Sectional Study. PLoS ONE. 2015:10. https://doi.org/10.1371/journal.pone.0136460.

19.

Brandberg Y, Kock E, Oskar K, et al. Psychological reactions and quality of life in patients with posterior uveal melanoma treated with ruthenium plaque therapy or enucleation: a one year follow-up study. Eye. 2000;14:839–46. https://doi.org/10.1038/eye.2000.233.CrossRefPubMed

20.

Sauer A, Ermanno C, Gaucher D, et al. Intraocular cytokine levels in post-cataract Endophthalmitis and their association with visual outcome. Ocul Immunol Inflamm. 2017;26:1–7. https://doi.org/10.1080/09273948.2017.1310253.CrossRef

21.

Novosad BD, Astley RA, Callegan MC. Role of toll-like receptor (TLR) 2 in experimental Bacillus cereus endophthalmitis. PLoS One. 2011;6:e28619. https://doi.org/10.1371/journal.pone.0028619.CrossRefPubMedPubMedCentral

22.

Gan IM, Ugahary LC, van Dissel JT, et al. Intravitreal dexamethasone as adjuvant in the treatment of postoperative endophthalmitis: a prospective randomized trial. Graefes Arch Clin Exp Ophthalmol Albrecht Von Graefes Arch Klin Exp Ophthalmol. 2005;243:1200–5. https://doi.org/10.1007/s00417-005-0133-1.CrossRef

23.

Petropoulos IK, Vantzou CV, Lamari FN, et al. Expression of TNF-α, IL-1β, and IFN-γ in Staphylococcus epidermidis slime-positive experimental endophthalmitis is closely related to clinical inflammatory scores. Graefes Arch Clin Exp Ophthalmol. 2006;244:1322–8. https://doi.org/10.1007/s00417-006-0261-2.CrossRefPubMed

24.

Harrell M, Carvounis PE (2014) Current treatment of toxoplasma Retinochoroiditis: an evidence-based review. In : J. Ophtalmol. https://www.hindawi.com/journals/joph/2014/273506/. Accessed 7 Apr 2019.

25.

Shantha JG, Weissman HM, Debiec MR, et al. Advances in the Management of Acute Retinal Necrosis. Int Ophthalmol Clin. 2015;55:1–13. https://doi.org/10.1097/IIO.0000000000000077.CrossRefPubMedPubMedCentral

26.

Combey de Lambert A, Campolmi N, Cornut P-L, et al. Baseline factors predictive of visual prognosis in acute postoperative bacterial endophthalmitis in patients undergoing cataract surgery. JAMA Ophthalmol. 2013;131:1159–66. https://doi.org/10.1001/jamaophthalmol.2013.4242.CrossRefPubMed

27.

Yospaiboon Y, Intarapanich A, Laovirojjanakul W, et al. Factors affecting visual outcomes after treatment of infectious endophthalmitis in northeastern Thailand. Clin Ophthalmol Auckl NZ. 2018;12:765–72. https://doi.org/10.2147/OPTH.S160758.CrossRef

28.

Moshirfar M, Feiz V, Vitale AT, et al. Endophthalmitis after uncomplicated cataract surgery with the use of fourth-generation fluoroquinolones: a retrospective observational case series. Ophthalmology. 2007;114:686–91. https://doi.org/10.1016/j.ophtha.2006.08.038.CrossRefPubMed

29.

Ravindran RD, Venkatesh R, Chang DF, et al. Incidence of post-cataract endophthalmitis at Aravind eye hospital: outcomes of more than 42,000 consecutive cases using standardized sterilization and prophylaxis protocols. J Cataract Refract Surg. 2009;35:629–36. https://doi.org/10.1016/j.jcrs.2009.01.002.CrossRefPubMed

30.

Stem MS, Rao P, Lee IJ, et al. Predictors of Endophthalmitis after Intravitreal injection: a multivariable analysis based on injection protocol and Povidone iodine strength. Ophthalmol Retina. 2019;3:3–7. https://doi.org/10.1016/j.oret.2018.09.013.CrossRefPubMed

31.

Dossarps D, Bron AM, Koehrer P, et al. Endophthalmitis after Intravitreal injections: incidence, presentation, management, and visual outcome. Am J Ophthalmol. 2015;160:17–25.e1. https://doi.org/10.1016/j.ajo.2015.04.013.CrossRefPubMed

32.

Al-Rashaed S, Alsulaiman SM, Alrushood AA, et al. Incidence of Endophthalmitis after Intravitreal anti-vascular endothelial growth factor: experience in Saudi Arabia. Middle East Afr J Ophthalmol. 2016;23:60–3. https://doi.org/10.4103/0974-9233.171756.CrossRefPubMedPubMedCentral

Title: Long-term visual outcomes of endophthalmitis and the role of systemic steroids in addition to intravitreal dexamethasone
Authors: Christopher D. Conrady
Richard M. Feist Jr
Albert T. Vitale
Akbar Shakoor
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Cataract
Vitrectomy
Dexamethasone
Published in: BMC Ophthalmology / Issue 1/2020
Electronic ISSN: 1471-2415
DOI: https://doi.org/10.1186/s12886-020-01449-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Long-term visual outcomes of endophthalmitis and the role of systemic steroids in addition to intravitreal dexamethasone

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2020

Central retinal artery and vein occlusion as a complication of persistent hyaloid artery – a case report

Malignant acanthosis nigricans: a case report

Peripheral anterior chamber depth and screening techniques for primary angle closure disease in community elderly Chinese

Efficacy and safety of atropine to control myopia progression: a systematic review and meta-analysis

The effect of adjunctive intravitreal conbercept at the end of diabetic vitrectomy for the prevention of post-vitrectomy hemorrhage in patients with severe proliferative diabetic retinopathy: a prospective, randomized pilot study

Evaluation of retinal and choroidal variations in thyroid-associated ophthalmopathy using optical coherence tomography angiography