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Graefe's Archive for Clinical and Experimental Ophthalmology

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27.01.2021 | Miscellaneous

Effectiveness of immediate vitrectomy and intravitreal antibiotics for post-injection endophthalmitis

verfasst von: Kai Januschowski, Karl Thomas Boden, Peter Szurman, Peter Stalmans, Rudolf Siegel, Núria Pérez Guerra, Sören Leif Becker, Annekatrin Rickmann, Lukas Bisorca-Gassendorf

Erschienen in: Graefe's Archive for Clinical and Experimental Ophthalmology | Ausgabe 6/2021

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Abstract

Purpose

To show that an immediate vitrectomy with an intravitreal injection of antibiotics can be an effective approach for the treatment of acute endophthalmitis following intravitreal injections.

Methods

We reviewed all cases of clinical endophthalmitis caused by an intravitreal injection that were treated in our department between March 2012 and November 2019. Only patients that underwent a vitrectomy within 6 h after presentation to the clinic and with a documented visual acuity shortly before the causative event were included. Baseline best-corrected visual acuity (BCVA) before the causative event was compared to BCVA measured within a follow-up period of 8 months (up to 14 months).

Results

In total, 30 eyes of 30 patients were included. The BCVA before the intraocular infection was a mean value of 0.55 logMAR, and the BCVA on the day of the endophthalmitis decreased significantly to 1.66 logMAR. Within 2 months following the pars plana vitrectomy (PPV), the mean BCVA improved to 0.83 logMAR. Eight months following PPV (mean value, 8.20 months; SD, 3.59 months), the mean BCVA was 0.63 logMAR. In the last follow-up interval most of the eyes recovered, and the BCVA did not differ significantly from baseline. Two eyes underwent further pars plana surgery during the follow-up period. No enucleation was required.

Conclusion

In this study, we have shown that an immediate vitrectomy with subsequent intravitreal injection of antibiotics is an effective option for treating post-injection endophthalmitis and frequently results in recovery of vision; thus, it should be performed as early as possible, where available.

Forooghian F, Albiani DA, Kirker AW, Merkur AB (2017) Comparison of endophthalmitis rates following intravitreal injection of compounded bevacizumab, ranibizumab, and aflibercept. Can J Ophthalmol 52:616–619. https://doi.org/10.1016/j.jcjo.2017.04.016CrossRefPubMed

Garg P, Roy A, Sharma S (2017) Endophthalmitis after cataract surgery: epidemiology, risk factors, and evidence on protection. Curr Opin Ophthalmol 28:67–72. https://doi.org/10.1097/ICU.0000000000000326CrossRefPubMed

Gower EW, Keay LJ, Stare DE, Arora P, Cassard SD, Behrens A, Tielsch JM, Schein OD (2015) Characteristics of Endophthalmitis after cataract surgery in the United States Medicare population. Ophthalmology 122:1625–1632. https://doi.org/10.1016/j.ophtha.2015.04.036CrossRefPubMed

Czajka MP, Byhr E, Olivestedt G, Olofsson EM (2016) Endophthalmitis after small-gauge vitrectomy: a retrospective case series from Sweden. Acta Ophthalmol 94:829–835. https://doi.org/10.1111/aos.13121CrossRefPubMed

Bhende M, Raman R, Jain M, Shah PK, Sharma T, Gopal L, Bhende PS, Srinivasan S, Jambulingam M, Sankara Nethralaya Vitreoretinal Study G (2018) Incidence, microbiology, and outcomes of endophthalmitis after 111,876 pars plana vitrectomies at a single, tertiary eye care hospital. PLoS One 13:e0191173. https://doi.org/10.1371/journal.pone.0191173CrossRefPubMedPubMedCentral

Cohen SM, Flynn HW Jr, Murray TG, Smiddy WE (1995) Endophthalmitis after pars plana vitrectomy. The Postvitrectomy Endophthalmitis Study Group. Ophthalmology 102:705–712. https://doi.org/10.1016/s0161-6420(95)30965-7CrossRefPubMed

Zheng CX, Moster MR, Khan MA, Chiang A, Garg SJ, Dai Y, Waisbourd M (2017) Infectious endophthalmitis after glaucoma drainage implant surgery: clinical features, microbial spectrum, and outcomes. Retina 37:1160–1167. https://doi.org/10.1097/IAE.0000000000001329CrossRefPubMed

Solborg Bjerrum S, Prause JU, Fuchs J, la Cour M, Kiilgaard JF (2016) Morphological features in eyes with endophthalmitis after cataract surgery - histopathology and optical coherence tomography assessment. Acta Ophthalmol 94:26–30. https://doi.org/10.1111/aos.12858CrossRefPubMed

Damm LJ, Boden KT, Januschowski K (2019) Stellenwert der Vitrektomie bei Endophthalmitis: Wie eine prompte Vitrektomie den Visus wiederherstellen kann. Ophthalmologe 116:569–571. https://doi.org/10.1007/s00347-018-0768-zCrossRefPubMed

10.

Ho IV, Fernandez-Sanz G, Levasseur S, Ting E, Liew G, Playfair J, Downie J, Gorbatov M, Hunyor AP, Chang AA (2019) Early pars plana vitrectomy for treatment of acute infective Endophthalmitis. Asia Pac J Ophthalmol (Phila) 8:3–7. https://doi.org/10.22608/APO.2018414CrossRef

11.

Group EVS (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 113:1479–1496. https://doi.org/10.1001/archopht.1995.01100120009001CrossRef

12.

Al Mahmood AM, Al-Swailem SA, Behrens A (2014) Clear corneal incision in cataract surgery. Middle East Afr J Ophthalmol 21:25–31. https://doi.org/10.4103/0974-9233.124084CrossRefPubMedPubMedCentral

13.

Kasi SK, Hariprasad SM, Hsu J (2017) Making the jump to 27-gauge vitrectomy: perspectives. Ophthalmic Surg Lasers Imaging Retin 48:450–456. https://doi.org/10.3928/23258160-20170601-02CrossRef

14.

Wong TY, Chee SP (2004) Risk factors of acute endophthalmitis after cataract extraction: a case-control study in Asian eyes. Br J Ophthalmol 88:29–31. https://doi.org/10.1136/bjo.88.1.29CrossRefPubMedPubMedCentral

15.

Boisgontier MP, Cheval B (2016) The ANOVA to mixed model transition. Neurosci Biobehav Rev 68:1004–1005. https://doi.org/10.1016/j.neubiorev.2016.05.034CrossRefPubMed

16.

Casals M, Girabent-Farres M, Carrasco JL (2014) Methodological quality and reporting of generalized linear mixed models in clinical medicine (2000-2012): a systematic review. PLoS One 9:e112653. https://doi.org/10.1371/journal.pone.0112653CrossRefPubMedPubMedCentral

17.

Detry MA, Ma Y (2016) Analyzing repeated measurements using mixed models. JAMA 315:407–408. https://doi.org/10.1001/jama.2015.19394CrossRefPubMed

18.

McGlothlin AE, Viele K (2018) Bayesian hierarchical models. JAMA 320:2365–2366. https://doi.org/10.1001/jama.2018.17977CrossRefPubMed

19.

Inoue M, Kobayakawa S, Sotozono C, Komori H, Tanaka K, Suda Y, Matsushima H, Kinoshita S, Senoo T, Tochikubo T, Kadonosono K (2011) Evaluation of the incidence of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor. Ophthalmologica 226:145–150. https://doi.org/10.1159/000329863CrossRefPubMed

20.

Garg SJ, Dollin M, Hsu J, Storey P, Vander JF (2015) Effect of a strict ‘no-talking’ policy during intravitreal injection on post-injection endophthalmitis. Ophthalmic Surg Lasers Imaging Retin 46:1028–1034. https://doi.org/10.3928/23258160-20151027-07CrossRef

21.

McCannel CA (2011) Meta-analysis of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents: causative organisms and possible prevention strategies. Retina 31:654–661. https://doi.org/10.1097/IAE.0b013e31820a67e4CrossRefPubMed

22.

Levinson JD, Garfinkel RA, Berinstein DM, Flory M, Spellman FA (2018) Timing of povidone-iodine application to reduce the risk of endophthalmitis after intravitreal injections. Ophthalmol Retin 2:654–658. https://doi.org/10.1016/j.oret.2017.06.004CrossRef

23.

Moshfeghi AA, Rosenfeld PJ, Flynn HW Jr, Schwartz SG, Davis JL, Murray TG, Smiddy WE, Berrocal AM, Dubovy SR, Lee WH, Albini TA, Lalwani GA, Kovach JL, Puliafito CA (2011) Endophthalmitis after intravitreal vascular [corrected] endothelial growth factor antagonists: a six-year experience at a university referral center. Retina 31:662–668. https://doi.org/10.1097/IAE.0b013e31821067c4CrossRefPubMed

24.

Lyall DA, Tey A, Foot B, Roxburgh ST, Virdi M, Robertson C, MacEwen CJ (2012) Post-intravitreal anti-VEGF endophthalmitis in the United Kingdom: incidence, features, risk factors, and outcomes. Eye (Lond) 26:1517–1526. https://doi.org/10.1038/eye.2012.199CrossRef

25.

Chaudhary KM, Romero JM, Ezon I, Fastenberg DM, Deramo VA (2013) Pars plana vitrectomy in the management of patients diagnosed with endophthalmitis following intravitreal anti-vascular endothelial growth factor injection. Retina 33:1407–1416. https://doi.org/10.1097/IAE.0b013e3182807659CrossRefPubMed

26.

Ng JQ, Morlet N, Pearman JW, Constable IJ, McAllister IL, Kennedy CJ, Isaacs T, Semmens JB, Team E (2005) Management and outcomes of postoperative endophthalmitis since the endophthalmitis vitrectomy study: the Endophthalmitis Population Study of Western Australia (EPSWA)’s fifth report. Ophthalmology 112:1199–1206. https://doi.org/10.1016/j.ophtha.2005.01.050CrossRefPubMed

27.

Kuhn FGG (2007) Complete and early vitrectomy for endophthalmitis vitreo-retinal surgery (part of the essentials in ophthalmology book series (ESSENTIALS)), p 16

28.

Yospaiboon Y, Meethongkam K, Sinawat S, Laovirojjanakul W, Ratanapakorn T, Sanguansak T, Bhoomibunchoo C (2018) Predictive factors in the treatment of streptococcal endophthalmitis. Clin Ophthalmol 12:859–864. https://doi.org/10.2147/OPTH.S161217CrossRefPubMedPubMedCentral

29.

Durand ML (2013) Endophthalmitis. Clin Microbiol Infect 19:227–234. https://doi.org/10.1111/1469-0691.12118CrossRefPubMedPubMedCentral

30.

Barry P, Cordovés L; Gardner, S (2013) ESCRS guidelines for prevention and treatment of endophthalmitis following cataract surgery data, Dilemmas and Conclusions. ESCRS

31.

Pflugfelder SC, Hernandez E, Fliesler SJ, Alvarez J, Pflugfelder ME, Forster RK (1987) Intravitreal vancomycin. Retinal toxicity, clearance, and interaction with gentamicin. Arch Ophthalmol 105:831–837. https://doi.org/10.1001/archopht.1987.01060060117045CrossRefPubMed

32.

Grzybowski A, Turczynowska M, Kuhn F (2018) The treatment of postoperative endophthalmitis: should we still follow the endophthalmitis vitrectomy study more than two decades after its publication? Acta Ophthalmol 96:e651–e654. https://doi.org/10.1111/aos.13623CrossRefPubMed

33.

Ching Wen Ho D, Agarwal A, Lee CS, Chhablani J, Gupta V, Khatri M, Nirmal J, Pavesio C, Agrawal R (2018) A review of the role of intravitreal corticosteroids as an adjuvant to antibiotics in infectious endophthalmitis. Ocul Immunol Inflamm 26:461–468. https://doi.org/10.1080/09273948.2016.1245758CrossRefPubMed

34.

Manning S, Ugahary LC, Lindstedt EW, Wubbels RJ, van Dissel JT, Jansen JTG, Gan I, van Goor AT, Bennebroek CA, van der Werf DJ, Ossewaarde-van Norel A, Mayland Nielsen CC, Tilanus M, van den Biesen PR, Schellekens PA, La Heij E, Faridpooya K, van Overdam K, Veckeneer M, van Meurs JC (2018) 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 96:348–355. https://doi.org/10.1111/aos.13610CrossRefPubMed

35.

Albrecht E, Richards JC, Pollock T, Cook C, Myers L (2011) Adjunctive use of intravitreal dexamethasone in presumed bacterial endophthalmitis: a randomised trial. Br J Ophthalmol 95:1385–1388. https://doi.org/10.1136/bjo.2010.187963CrossRefPubMed

36.

Moisseiev E, Abbassi S, Park SS (2017) Intravitreal dexamethasone in the management of acute endophthalmitis: a comparative retrospective study. Eur J Ophthalmol 27:67–73. https://doi.org/10.5301/ejo.5000866CrossRefPubMed

37.

Witkin AJ, Chang DF, Jumper JM, Charles S, Eliott D, Hoffman RS, Mamalis N, Miller KM, Wykoff CC (2017) Vancomycin-associated hemorrhagic occlusive retinal vasculitis: clinical characteristics of 36 eyes. Ophthalmology 124:583–595. https://doi.org/10.1016/j.ophtha.2016.11.042CrossRefPubMed

Titel: Effectiveness of immediate vitrectomy and intravitreal antibiotics for post-injection endophthalmitis
verfasst von: Kai Januschowski
Karl Thomas Boden
Peter Szurman
Peter Stalmans
Rudolf Siegel
Núria Pérez Guerra
Sören Leif Becker
Annekatrin Rickmann
Lukas Bisorca-Gassendorf
Publikationsdatum: 27.01.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Graefe's Archive for Clinical and Experimental Ophthalmology / Ausgabe 6/2021
Print ISSN: 0721-832X
Elektronische ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-021-05071-w

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Effectiveness of immediate vitrectomy and intravitreal antibiotics for post-injection endophthalmitis

Abstract

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Conclusion

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