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Delayed-onset endophthalmitis associated with corneal suture infections.

Henry CR, Flynn HW, Miller D, Schefler AC, Forster RK, Alfonso EC - J Ophthalmic Inflamm Infect (2013)

Bottom Line: Streptoccocus was identified as the causative organism in five of six patients in the current study.Pars plana vitrectomy was performed in two patients.Visual acuity outcomes ranged from 20/150 to no light perception.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136, USA. chenry2@med.miami.edu.

ABSTRACT

Background: The purpose of the current study was to report the microbiology, risk factors, and treatment outcomes in patients with delayed-onset endophthalmitis associated with corneal suture infections. For this retrospective consecutive case series, a search of the ocular microbiology department database was performed to identify all patients with positive corneal and intraocular cultures (anterior chamber and/or vitreous) between 01 January 1995 and 01 January 2010. A subset of patients with a history of corneal suture infections and delayed-onset endophthalmitis was identified.

Results: Over the 15-year period of the study, 68 patients were identified to have both positive corneal and intraocular cultures. Among them, six patients were identified to have a culture-proven, delayed-onset endophthalmitis that developed from a culture-positive corneal suture infection. All of the patients in the current study were using topical corticosteroids at the time of diagnosis. In four of six patients, there was documented manipulation of a suture before the development of endophthalmitis. Streptoccocus was identified as the causative organism in five of six patients in the current study. All of the Streptoccocus isolates were sensitive to vancomycin. The single case of Serratia marcescens endophthalmitis was sensitive to amikacin, ceftazidime, ciprofloxacin, gentamicin, and tobramycin. Treatment modalities varied and were guided by the attending ophthalmologist depending upon clinical presentation. One patient with severe Streptococcus pyogenes keratitis and endophthalmitis underwent a primary enucleation after developing a wound dehiscence. Of the remaining five patients, all received topical and intravitreal antibiotics. Therapeutic penetrating keratoplasty was performed in three patients. Pars plana vitrectomy was performed in two patients. Visual acuity outcomes ranged from 20/150 to no light perception.

Conclusions: In the current study, Streptococcus was isolated in nearly all patients with delayed-onset endophthalmitis associated with corneal suture infections. Topical steroid use and suture manipulation were identified as associated factors for developing endophthalmitis. Visual acuity outcomes were poor despite the prompt recognition of endophthalmitis and appropriate antibiotic therapy.

No MeSH data available.


Related in: MedlinePlus

Representative cases. (A) A 73-year-old woman developed a chronic suture infection and subsequent Streptococcus salivarius endophthalmitis after removal of an exposed suture. (B) A 74-year-old man developed a suture infection and subsequent Serratia marcescens endophthalmitis 2 months following a complicated cataract surgery.
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Figure 1: Representative cases. (A) A 73-year-old woman developed a chronic suture infection and subsequent Streptococcus salivarius endophthalmitis after removal of an exposed suture. (B) A 74-year-old man developed a suture infection and subsequent Serratia marcescens endophthalmitis 2 months following a complicated cataract surgery.

Mentions: The mean age of patients in the current series was 66.0 years (range, 36 to 74). Three patients were men, and three patients were women. A summary of each patient is provided in Table 1, and representative figures are shown in Figure 1. Five patients had a suture infections related to a previous penetrating keratoplasty wound, and one patient has a suture infection related to a corneal wound from a prior complicated cataract surgery that included a pars plana vitrectomy and intraocular lens placement in the ciliary sulcus. At the time of diagnosis, all patients were using topical prednisolone acetate 1%, with the frequency ranging from hourly to twice daily. Three patients had a history of ocular surface disease. No patients were contact lens users, and no patients had a history of being immunocompromised. Potential contributing mechanisms that were temporally related to endophthalmitis included the removal of a loose or exposed suture (two patients), a broken running suture (one patient), and manipulation of a loose running suture (one patient). In each of these four patients, the corneal infiltrate was present at the time of suture removal or manipulation. One of these patients was not immediately started on topical antibiotics despite the presence of a corneal infiltrate and active manipulation of a suture. After presentation with a corneal infiltrate, topical prednisolone acetate 1% was continued at the same frequency in four patients, decreased in one patient, and stopped altogether in a final patient.


Delayed-onset endophthalmitis associated with corneal suture infections.

Henry CR, Flynn HW, Miller D, Schefler AC, Forster RK, Alfonso EC - J Ophthalmic Inflamm Infect (2013)

Representative cases. (A) A 73-year-old woman developed a chronic suture infection and subsequent Streptococcus salivarius endophthalmitis after removal of an exposed suture. (B) A 74-year-old man developed a suture infection and subsequent Serratia marcescens endophthalmitis 2 months following a complicated cataract surgery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3717107&req=5

Figure 1: Representative cases. (A) A 73-year-old woman developed a chronic suture infection and subsequent Streptococcus salivarius endophthalmitis after removal of an exposed suture. (B) A 74-year-old man developed a suture infection and subsequent Serratia marcescens endophthalmitis 2 months following a complicated cataract surgery.
Mentions: The mean age of patients in the current series was 66.0 years (range, 36 to 74). Three patients were men, and three patients were women. A summary of each patient is provided in Table 1, and representative figures are shown in Figure 1. Five patients had a suture infections related to a previous penetrating keratoplasty wound, and one patient has a suture infection related to a corneal wound from a prior complicated cataract surgery that included a pars plana vitrectomy and intraocular lens placement in the ciliary sulcus. At the time of diagnosis, all patients were using topical prednisolone acetate 1%, with the frequency ranging from hourly to twice daily. Three patients had a history of ocular surface disease. No patients were contact lens users, and no patients had a history of being immunocompromised. Potential contributing mechanisms that were temporally related to endophthalmitis included the removal of a loose or exposed suture (two patients), a broken running suture (one patient), and manipulation of a loose running suture (one patient). In each of these four patients, the corneal infiltrate was present at the time of suture removal or manipulation. One of these patients was not immediately started on topical antibiotics despite the presence of a corneal infiltrate and active manipulation of a suture. After presentation with a corneal infiltrate, topical prednisolone acetate 1% was continued at the same frequency in four patients, decreased in one patient, and stopped altogether in a final patient.

Bottom Line: Streptoccocus was identified as the causative organism in five of six patients in the current study.Pars plana vitrectomy was performed in two patients.Visual acuity outcomes ranged from 20/150 to no light perception.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136, USA. chenry2@med.miami.edu.

ABSTRACT

Background: The purpose of the current study was to report the microbiology, risk factors, and treatment outcomes in patients with delayed-onset endophthalmitis associated with corneal suture infections. For this retrospective consecutive case series, a search of the ocular microbiology department database was performed to identify all patients with positive corneal and intraocular cultures (anterior chamber and/or vitreous) between 01 January 1995 and 01 January 2010. A subset of patients with a history of corneal suture infections and delayed-onset endophthalmitis was identified.

Results: Over the 15-year period of the study, 68 patients were identified to have both positive corneal and intraocular cultures. Among them, six patients were identified to have a culture-proven, delayed-onset endophthalmitis that developed from a culture-positive corneal suture infection. All of the patients in the current study were using topical corticosteroids at the time of diagnosis. In four of six patients, there was documented manipulation of a suture before the development of endophthalmitis. Streptoccocus was identified as the causative organism in five of six patients in the current study. All of the Streptoccocus isolates were sensitive to vancomycin. The single case of Serratia marcescens endophthalmitis was sensitive to amikacin, ceftazidime, ciprofloxacin, gentamicin, and tobramycin. Treatment modalities varied and were guided by the attending ophthalmologist depending upon clinical presentation. One patient with severe Streptococcus pyogenes keratitis and endophthalmitis underwent a primary enucleation after developing a wound dehiscence. Of the remaining five patients, all received topical and intravitreal antibiotics. Therapeutic penetrating keratoplasty was performed in three patients. Pars plana vitrectomy was performed in two patients. Visual acuity outcomes ranged from 20/150 to no light perception.

Conclusions: In the current study, Streptococcus was isolated in nearly all patients with delayed-onset endophthalmitis associated with corneal suture infections. Topical steroid use and suture manipulation were identified as associated factors for developing endophthalmitis. Visual acuity outcomes were poor despite the prompt recognition of endophthalmitis and appropriate antibiotic therapy.

No MeSH data available.


Related in: MedlinePlus