Objective To evaluate the rapid diagnosis of bacterial and (or) fungal endophthalmitis by multiplex polymerase chain reaction (MPCR). Methods MPCR was performed to detect the DNA segment of bacteria and (or) fungi from standard strains and 41 samples of intraocular fluid or vitreous from 38 patients (3 with double eyes and 35 with single), and the results were compared with the cultured bacteria and fungi. Results Five hours after detected by MPCR, bacteria and (or) fungi in 34 out of 41 samples (82.9%) from patients were detected，in cluding bacteria in 26，fungi in 6，and both bacteria and fungi in 2. The positive rate of MPCR was obviously higher than the cultured ones（χ2＝9.60, P＜0.05）. Conclusion With the advantages of rapidity, sensibility, and specificity, MPCR can make for the rapid and definitive diagnosis of bacterial and (or) fungal endophthalmitis. (Chin J Ocul Fundus Dis，2004，20：81-83)
ObjectiveTo observe and analyze the clinical features and prognosis of endogenous klebsiella pneumoniae endophthalmitis (EKPE).MethodsThis is a retrospective case series study. Seven patients (8 eyes) with EKPE were enrolled in this study. There were 3 males (4 eyes) and 4 females (4 eyes). The ages were from 39 to 76 years, the mean age was 57.29 years. All these cases had no history of trauma and surgery. Meanwhile, they all had some risk factors, such as infection, diabetes mellitus, systemic lupus erythematosus, liver abscess, renal insufficiency undergoing dialysis treatment, Hodgkin lymphoma and so on. All the eyes were undertaken visual acuity, slit lamp and fundus examination to observe the eye conditions. Seven eyes were undertaken pars plana vitrectomy with intravitreal injection of antibiotics from 2 days to 2 weeks after onset. And only one eye was undertaken intravitreal injection of antibiotics without surgery. Microbial stains and culture were performed for 7 eyes using vitreous and aqueous fluid samples from the procedures of vitrectomy. Meanwhile, culture and drug sensitive tests were performed from blood samples. According to the result of the drug sensitive tests, carbapenems such as imipenem and meropenem were used in each patient through intravenous injection from 1 to 2 weeks. During the follow up period from 3 days to 1 year, prognosis was observed at each office visit.ResultsFrom these eight eyes, presenting visual acuity was light perception (4 eyes), hand motion (3 eyes), 0.1 (1 eye). Hypopyon (6 eyes), aqueous fluid opacity (2 eyes) and diffuse vitreous opacity (8 eyes) were found. Changes in fundus like optic disc, macular edema and retinal vascular occlusion could be observed. Cultures of the vitreous and aqueous fluid samples from vitrectomy were all point out to klebsiella pneumoniae. At last office visit, the visual acuity of patients with hypopyon was no light perception (1 eye), light perception (1 eye), hand motion (1 eye). The visual acuity of patients without hypopyon was 0.05 (1 eye) and 0.5(1 eye). Finally, 1 eye was underwent enucleation and one patient with binocular disease was died of multiple organ failure.ConclusionsEKPE is almost unilateral attacked. Changes in fundus like optic disc, macular edema and retinal vascular occlusion can be observed. EKPE is commonly associated with poor visual outcomes. It is useful to save patients’ visual acuity by performing vitrectomy before hypopyon happened.
Objective To analyze the causes and pathogens of infectious endophthalmitis in our hospital. Methods The clinical data and laboratory findings of 282 inpatients with infectious endophthalmitis were retrospectively reviewed. There were 206 males（73.05%）and 76 females（26.95%）with a mean age of (36.0plusmn;11.2) years (range from 2 to 79 years). Except 14 patients who lost their eyeballs as of serious conditions, pathogen examinations of vitreous specimen had been performed for all remaining 268 cases. The clinical and laboratory data were statistically analyzed by Chi-square and Kappa consistency tests, when P＜0.05 the difference should be considered as statistically significant. Results The 4 major causes of infectious endophthalmitis of those 282 patients included ocular trauma (177 cases, 62.77%), infectious keratitis (61 cases, 21.63%), eye surgery (32 cases, 11.35%), and endogenous endophthalmitis (12 cases, 4.25%). 19.21% of the patients in ocular trauma group was 2-13 years old, 55.74% of the patients in infectious keratitis group was 14 -50 years old, and 60.61% of the patients in eye surgery group was 51-79 years old. The major pathogens were fungus and staphylococci each accounted for 30.63% of all cases. Most of the pathogenic bacteria were sensitive to ciprofloxacin (81.81%) and gentamicin (77.92%). Conclusions The major reason of infectious endophthalmitis was ocular trauma, and the major pathogens were fungus and staphylococci. Those findings may help us to treat infectious endophthalmitis patients appropriately.
Objective To analyze the etiology trends, etiological characteristics treatment effects of endophthalmitis in 10 years which from 2000 to 2009 in our hospital. Methods 165 patients (172 eyes) of endophthalmitis in hospital from January 2000 to December 2009 were enrolled in this study. The patients included 122 males and 43 females. The median age was (39.0plusmn;23.7) years. The best visual acuity (BCVA) was non light perception in 16 eyes, light perception 0.05 in 135 eyes, ＞0.05 in 12 eyes. Nine children did not have visual acuity records. There were 141 patients (85.45%) with exogenous endophthalmitis which including 89 patients of trauma, 43 patients after intraocular surgery and nine others; 24 patients (14.55%) with endogenous endophthalmitis. 113 eyes were received intravitreal injection with vancomycin 0.1 ml (10 mg/ml). 152 eyes had pathogenic microorganisms culture records of aqueous humor or aqueous humor and vitreous. The positive records were given drug sensitivity test. The types of endophthalmitis, pathogenic microbial culture and drug sensitivity test results and treatment effects were analyzed. Software of SPSS was used for the clinical data statistical analysis in this study. Results Of 152 eyes with a record of aqueous/vitreous samples pathogenic bacteria culture, 42 eyes (27.63%) had a positive result. In which, 28 eyes showed positive in bacteria culture, 12 eyes was positive in fungus culture and two eyes had a positive in culture of fungus and bacteria growing. The culture positive rate was higher in exogenous endophthalmitis than that in endogenous endophthalmitis (chi;2=4.721 9,P=0.029 8).Most of the G+ positive bacteria were resistance to cephalosporin and quinolones except levofloxacin; but sensitive to vancomycin, rifampin and sulfamethoxazole. The intervention effect was more available for postoperative endophthalmitis than that for traumatic endophthalmitis and endogenous endophthalmitis, the difference was statistically significant（chi;2=38.941 3，P=0.000 0).The BCVA of 23 cases was ＞0.05 after the treatment, compared with before the treatment, the difference was statistically significant (chi;2=3.867 3,P=0.049 2).Compared the ratio of past five yearsprime; to that of recent five years, endogenous endophthalmitis was increased from 7.89% to 20.23% (chi;2=5.014 0，P=0.025 1); postoperative endophthalmitis decreased from 27.63% to 24.72%, and traumatic endophthalmitis decreased from 60.53% to 48.31%, other causes linked endophthalmitis raised from 3.95% to 6.74%. Conclusions In recent 10 years (from 2000 to 2009), the patients with endogenous endophthalmitis are growing. The positive rate of pathogenic agent culture is low, but the culture positive rate of the specimens from endogenous endophthalmitis is higher than that from exogenous endophthalmitis.The treatment was more available for postoperative endophthalmitis than that for other two types of endophthalmitis. The general visual prognosis is poor.
Objective To observe the clinical features and prognosis of endogenous bacterial endophthalmitis (EBE). Methods Ten eyes of 10 patients diagnosed with unilateral EBE were retrospectively reviewed, including 7 males and 3 females. The mean age was 57.6±10.8 years old. Eight patients were with diabetes and 7 of them were diagnosed over 5 years. There were 3 patients with hepatocirrhosis, 1 patient with hypertension, and 1 patient with coronary disease. Nine cases had infectious diseases, including liver abscess (7 cases), pulmonary infection (3 cases), erysipelas (1 case) and perianal abscess (1 case). Seven cases had fever history. Culture and drug sensitive tests for aerobic bacteria, anaerobic bacteria and fungal were performed for 9 eyes using vitreous samples from the procedures of vitrectomy and/or intravitreal injection. All patients were treated with broad-spectrum antibiotics and adjusted for drug use according to microbiological culture and drug sensitivity test results. After the diagnosis was established, vitrectomy combined with lens removal was performed in 5 hours (3 eyes) and 24 hours (5 eyes); Vitreous tamponade of C3F8 (1 eye) and silicone oil (7 eyes) was used; At the end of the operation, 0.1 ml vancomycin (1 mg) and 0.1 ml ceftazidime (1 mg) were injected into the vitreous cavity. One eye received intravitreal injection of 0.1 ml vancomycin (1 mg) and 0.1 ml ceftazidime (mg), one eye received evisceration. During the follow up period from 6 to 24 months, visual function, slit lamp and fundus examinations were performed at each office visit. Results All patients complained of blurred vision and 5 patients had ocular pain. The visual acuity was no light perception (3 eyes), light perception (5 eyes); hand motion (1 eye) and 0.1 (1 eye). Corneal edema was found in all 10 eyes; hypopyon in 8 eyes; diffuse vitreous opacity in 10 eyes, including 3 eyes with retinal detachment. For 8 eyes treated by vitrectomy and intravitreal injection, 1 eye was eviscerated due to uncontrolled inflammation. The eye treated with intravitreal injection was enucleated for its uncontrolled inflammation. For 9 eyes received vitreous culture and drug testing, 8 eyes (88.9％) had positive results, including 5 eyes with Klebsiellar pneumonia, and 1 eye with Staphylococcus aureus, or Streptococcus agalactiae or Enterococcus faecalis respectively. At last office visit, 2 eyes were with no light perception; 4 eyes were with hand motion; and 1 eye with visual acuity of 0.1. Conclusions Most of the patients with endogenous bacterial endophthalmitis have systemic predisposing factors. Klebsiella pneumoniae is the leading cause of ocular EBE. Vitrectomy combined with intravitreal injection of antibiotics showed efficacy in treating EBE.
Objective To investigate the etiological factors of endophthalmitis and evaluate the outcomes of vitrectomy for endophthalmitis.Methods From January 1999 to December 2001, 53 consecutive patients (54 eyes ), 38 men and 15 women, diagnosed as endophthalmitis were retrospectively evaluated. The patients′ ages ranged from 1 year to 74 years (mean 32 years). Two patients (2 eyes) with mild inflammation received antibiotic medication therapy, 5 patients (5 eyes) with no light perception and severe inflammation underwent evisceration, and the other 46 patients (47 eyes) underwent pars plana vitrectomy. Postoperative follow-up ranged from 2 to 32 months (mean 10.5 months). Results Endophthalmitis was diagnosed as resulting from penetrating injury in 32 eyes (59.26%), endogenous endophthalmitis in 8 eyes (14.81%), cataract surgery in 7 eyes (12.96%), gl au coma surgery in 2 eyes (3.70%), vitrectomy in 3 eyes (5.56%), radial keratotomy in 1 eye (1.85%), and unknown reason in 1 eye (1.85%). The postoperative visual a cuities (VA) of these patients increased significantly (P=0.003). The VA of the patients underwent vitrectomy in 3 days was obviously better than those after 3 days (P=0.014), and the VA of the patients underwent vitrectomy in 7 days was obviously beter than those after 7 days (P=0.021). Thirty-seven eyes (68.52 %) had functional success (VA≥0.02), 47 eyes (87.04%) had anatomical success (VAlt;0.02) , and 27 eyes (50.00%) were out of blindness (VA≥0.05). Conclusions Penetrating ocular injury, especially with retained intraocular foreign bodies, is the most common cause of suppurative endophthalmitis. Vitrectomy is a good method for the treatment of endophthalmitis. (Chin J Ocul Fundus Dis，2003，19：93-95)
Endophthalmitis caused by intravitreal injection is a rare disease which impair patients’s vision. In recent years, with the increase of the diseases and frequency of intravitreal injections, the incidence of endophthalmitis has increased. Standardizing each step of intravitreal injections is an important method to reduce postoperative endophthalmitis. Despite the current availability of prevention strategies providing by a lot of clinical trials, there are considerable variations and a lack of consensus and inconsistencies in clinical practice. Understanding the existing key measures, standardizing the operation of intravitreal injection in my country, and minimizing the incidence of infective endophthalmitis are of positive significance for improving the treatment of ophthalmology, especially fundus diseases.
Objective To observe the therapeutic effects of vitrectomy combined with tissue plasminogen activator(r-tPA) and fraxiparine on bacterial endophthalmitis. Methods Forty pigmented rabbits were randomly divided into experimental and control group with 20 rabbits in each. The left eyes underwent intra-vitreous injection with 10 5/ml bacteria of staphylococcus epidermidis 0.1 ml. After 8-4 hours, vitrectomy was performed on all of the animals. Fraxiparine with the final concentration of 6 IU/ml was only added to balanced salt solution in the experimental group during the operation, and the extend of intraocular fibrin exudation was observed by slit lamp and indirect ophthalmoscope after the operation. If the exudation occurred on the 1st, 3rd, 7th, 14th and 21st day postoperatively, 125 mg/ml r-tPA 0.1 ml should be injected into vitreous from the 1st day after operation on. Results Fibrin exudation in the pupil area and vitreous body was much less in experimental group than that in the control group after the surgery. Conclusion vitrectomy combined with r-tPA and fraxiparine may alleviate the extent of fibrosis in bacterial endophthalmitis and improve the prognosis. (Chin J Ocul Fundus Dis, 2005, 21: 391-393)
ObjectiveTo analyze pathogenic factors and etiological characteristics of suppurative endophthalmitis.MethodsA total of 531 consecutive patients (531 eyes) with suppurative endophthalmitis who were hospitalized in Qingdao Eye Hospital of Shandong Eye Institute from January 2006 to December 2015 were included in the study. Among them, 410 patients with 410 eyes were males (77.2%), 121 patients with 121 eyes were females (22.8%). The average age of the patients was 38.62±15.36 years. The relevant medical records were collected to analyze the pathogenic factors. Samples of aqueous humor, vitreous or other intraocular samples were taken under aseptic conditions for bacterial and fungal culture and in vitro drug sensitivity test.ResultsOcular trauma was the primary pathogenic factor of suppurative endophthalmitis (60.1%), other factors included postoperative endophthalmitis (19.0%), suppurative keratitis-related endophthalmitis (17.1%) and endogenous endophthalmitis (3.8%). Postoperative endophthalmitis mainly occured after cataract surgery. A total of 224 strains of organisms were isolated, among which the predominant organisms isolated were gram-positive bacteria (54.0%) and staphylococcus epidermidis was the most common (25.0%). The other pathogenic organisms were fungi (29.5%) and gram-negative bacteria (16.5%). Among the fungi, aspergillus (10.7%) was the dominant genus, followed by fusarium (9.8%). For gram-positive organisms, susceptibilities were vancomycin 97.4%, gatifloxacin 91.8%, fusidate acid 77.9% and levofloxacin 54.6%. For gram-negative organisms, susceptibilities were gatifloxacin 85.7%, levofloxacin 77.8%, tobramycin 71.4% and ceftazidime 62.5%. For fungal isolates, sensitivities were voriconazole 88.2% and amphotericin B 84.8%.ConclusionsOcular trauma is the main pathogenic factor of suppurative endophthalmitis, followed by postoperative endophthalmitis and suppurative keratitis-related endophthalmitis. Gram-positive bacteria are the major pathogenic organisms, especially staphylococcus epidermidis followed by fungal species, among which aspergillus and fusarium were the dominating pathogenic genus.
Objective To observe the effects of vitrectomy combined with endotamponade on severe endophthalmitis. Methods The clinical data of 44 patients (44 eyes) of posttraumatic and 22 patients (22 eyes) of postoperative severe endophthalmitis were retrospectively analyzed. All patients were treated by vitrectomy and endotamponade. Intraocular foreign body removal (19 eyes), lens extraction (25 eyes), intraocular lens removal (six eyes) and scleral buckling (16 eyes) were performed. Tamponade with silicone oil (52 eyes) or C3F8 gas (14 eyes) was also performed. Postoperative follow-up ranged from two to 25 months, with the mean of 7-9 months. The visual acuity（VA）and intraocular pressure before and after surgery were comparatively analyzed. Results Inflammation of all the patients were controlled，the effective rate was 5.10%. There was no recurrence and retinal detachment. Among the 66 eyes, postoperative VA of 58 eyes (87.90%) increased,five eyes（7.60%）didn't change and three eyes（4.55%）decreased, the difference was statistically significant（chi;2=45.27，P＜0.05）. The postoperative intraocular pressure was higher than that before surgery，the difference was statistically significant（t=-3.23，P＜0.05）. Conclusions Vitrectomy combined with endotamponade is an effective way to cure severe endophthalmitis. It can improve the visual acuity and intraocular pressure.