Endophthalmitis: Difference between revisions
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*[[Vitrectomy]] may or may not performed. | *[[Vitrectomy]] may or may not performed. | ||
*Removal of the lens may be required.<ref name="pmid14765348">{{cite journal| author=Hanscom TA| title=Postoperative endophthalmitis. | journal=Clin Infect Dis | year= 2004 | volume= 38 | issue= 4 | pages= 542-6 | pmid=14765348 | doi=10.1086/381262 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14765348 }} </ref> | *Removal of the lens may be required.<ref name="pmid14765348">{{cite journal| author=Hanscom TA| title=Postoperative endophthalmitis. | journal=Clin Infect Dis | year= 2004 | volume= 38 | issue= 4 | pages= 542-6 | pmid=14765348 | doi=10.1086/381262 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14765348 }} </ref> | ||
===Fungal Endophthalmitis=== | |||
==References== | ==References== | ||
Revision as of 03:56, 6 February 2014
| Endophthalmitis | |
| ICD-10 | H44.0-H44.1 |
|---|---|
| ICD-9 | 360.0-360.1 |
| DiseasesDB | 30828 |
| MedlinePlus | 001626 |
| eMedicine | emerg/880 oph/393 oph/394 oph/706 |
| MeSH | D009877 |
Endophthalmitis is an inflammation of the internal coats of the eye. It is a dreaded complication of all intraocular surgeries, particularly cataract surgery, with possible loss of vision and the eye itself. Infectious etiology is the most common and various bacteria and fungi have been isolated as the cause of the endophthalmitis. Other causes include penetrating trauma and retained intraocular foreign bodies.
Signs and symptoms
A history of recent intraocular surgery or penetrating ocular trauma is usually elicited. In some cases of metastatic endophthalmitis, the spread of infection may be hematogenous (via the blood-stream). That is more commonly seen in patients with immunocompromised states like AIDS and also in diabetes. The condition is usually accompanied by severe pain, loss of vision and redness of the conjunctiva and the underlying episclera. Alongside are present signs of inflammation of the various coats of the eye. Hypopyon can also be present in endophthalmitis and should be looked for on examination by a slit lamp. Progression to involve all the coats of the eye is called as panuveitis or panophthalmitis.
Treatment
Overview
The patient needs urgent examination by an expert ophthalmologist and/or vitreo-retina specialist who will usually decide for urgent intervention to provide intravitreal injection of potent antibiotics and also prepare for an urgent pars plana vitrectomy as needed. Enucleation may be required to remove a blind and painful eye.
Bacterial Endophthalmitis
| Bacterial Endophthalmitis |
|---|
| Preferred Regimen |
| ▸ Vancomycin 1 mg intravitreal PLUS ▸ Ceftazidime 2.25 mg intravitreal |
| PLUS |
| ▸ Vancomycin 1 gm IV q12h PLUS ▸Cefotaxime 1 gm IV q4h OR ▸Ceftriaxone 1 gm IV q4h OR ▸Ceftazidime 1 gm IV q8h |
- Vitrectomy is very important in sever cases for better visual outcomes.[1]
- Systemic antibiotics may shows a benefit as an adjunctive therapy to intravitreal antibiotics.[2]
- Antibiotics are adjusted after sensitivity results.
- Clindamycin is added, in cases of intravenous drug users until Bacillus infection is ruled out.
Post-traumatic Endophthalmitis
| Post-traumatic Endophthalmitis |
|---|
| Preferred Regimen |
| ▸ Vancomycin 1 mg intravitreal PLUS ▸ Ceftazidime 2.25 mg intravitreal |
| PLUS |
| ▸ Vancomycin 1 gm IV q12h PLUS ▸Ciprofloxacin 400 mg IV/po q12h OR ▸Ceftazidime 1 gm IV q8h |
- Topical antibiotics, or subconjunctival antibiotics often used in conjunction with intravitreal antibiotics post-operatively.[3]
Post-Cataract Endophthalmitis
In early acute cases
- Immediate vitrectomy may be needed, and intravitreal injection of Vancomycin 1 mg, and Ceftazidime 2.25 mg.
- Intravitreal antibiotics may be repeated in 2–3 days.
- Lens can be left without removal.
In chronic cases:
- Intravitreal injection of Vancomycin 1 mg, and Ceftazidime 2.25 mg.
- Vitrectomy may or may not performed.
- Removal of the lens may be required.[4]
Fungal Endophthalmitis
References
- ↑ "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. 113 (12): 1479–96. 1995. PMID 7487614.
- ↑ Hooper CY, Lightman SL, Pacheco P, Tam PM, Khan A, Taylor SR (2012). "Adjunctive antibiotics in the treatment of acute bacterial endophthalmitis following cataract surgery". Acta Ophthalmol. 90 (7): e572–3. doi:10.1111/j.1755-3768.2011.02365.x. PMID 22429465.
- ↑ Durand ML (2013). "Endophthalmitis". Clin Microbiol Infect. 19 (3): 227–34. doi:10.1111/1469-0691.12118. PMC 3638360. PMID 23438028.
- ↑ Hanscom TA (2004). "Postoperative endophthalmitis". Clin Infect Dis. 38 (4): 542–6. doi:10.1086/381262. PMID 14765348.
External links
- Peters JR. "Endophthalmitis." eMedicine.com. Accessed September 28, 2006.
- Wu L. "Endophthalmitis, Fungal." eMedicine.com. Accessed September 28, 2006.