Objective To observe the effect of emergent vitrectomy combined with lensectomy, silicone oil temponade for endogenous endophthalmitis. Methods The clinical data of 28 patients (30 eyes) with endogenous endophthalmitis were analyzed retrospectively. All patients had no history of ocular trauma and intraocular surgery history. There were 21 patients without systemic symptoms, three patients with fever, two patients with eye pain and headache, and two patients with abdominal pain when presentation. All patients diagnosed by best corrected visual acuity, intraocular pressure, slit-lamp microscopy, direct and indirect ophthalmoscope examination and intraocular B-ultrasound examination. Emergent surgery (vitrectomy, lensectomy, silicone oil temponade) was performed in all 30 patients, those with fever or abdominal pain was also treated by relevant clinical departments. Vitreous purulence was taken in all patients before vitrectomy for bacterial, fungal culture and drug sensitivity test. The follow-up was 18 to 30 months. The preoperative and postoperative visual acuity, intraocular pressure and eye retention situation were observed.Results Endophthalmitis was controlled in 28/30 eyes (93.3%) after surgery, recurrent vitreous empyema occurred in 2/30 eyes (6.7%). Evisceration was performed on those two eyes as uncontrolled intraocular pressure. The visual acuity improved significantly at one month and 18 months after surgery (chi;2=19.87, 32.44; P＜0.01). Postoperative intraocular pressure was normal in 24 eyes (80.0%), transient elevated and controlled in six eyes (chi;2=7.43；P＜0.05). 12/28 (42.9%) vitreous samples were positive for pathogen culture, including 7/12 (58.3%) positive for bacteria, 5/12 (41.7%) positive for fungi. There are 18/28 patients (64.3%) also had hepatobiliary system infections. Conclusion Emergent vitrectomy combined with lensectomy, silicone oil temponade is effective for endogenous endophthalmitis.
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.
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 evaluate the toxic effects of staphylococcus aureus exotoxins and neutrophils on retinal pigment epithelium (RPE) cells (RPEC). Methods An in-vitro model of bacteroidal endophthalmitis was established by co-culturing of human RPE cell line D407 and human peripheral blood neutrophils in the present of staphylococcus aureus exotoxins ATCC29213. The level of lactate dehydrogenase hydroxide（LDH）in the cuture supernant was measured, and the viability of RPE was evlauated by flow cytometry and Hoechst 33342/Propidium Iodide（PI）staining. Results When RPE cells were cultured with the exotoxin ATCC29213, the LDH level and necrotic RPE cells were positive proportional to the dosage of exotoxin, but only 250mu;l or 500mu;l of ATCC29213 had a statistical significant effect. When RPE cells were co-cultured with neutrophils in the present of ATCC29213 for 6 hours, 100mu;l of ATCC29213 already had a statistical significant effect on LDH level and necrotic RPEC, and the effect was proportional to the amount of neutrophils in the culture. Conclusion Both staphylococcus aureus exotoxins and neutrophils can damage the RPEC by inducing necrosis, and their function had synergetic effect.
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.
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.