| Patient Education |
|
Click here for patient education.
|
|
You are in: eMedicine Specialties >
Ophthalmology > GLOBE
Endophthalmitis, Bacterial
Article Last Updated: Aug 24, 2006
AUTHOR AND EDITOR INFORMATION
Section 1 of 11  
Author: Robert H Graham, MD, Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
Robert H Graham is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Arizona Ophthalmological Society
Coauthor(s):
David T Wong, MD, FRCS(C), Associate Professor of Ophthalmology, Director of Fellowship Programs, Department of Ophthalmology, St Michael's Hospital, Faculty of Medicine, University of Toronto, Canada;
Hesham Lakosha, MBChB, MS, FRCS, Consulting Surgeon, Department of Ophthalmology, Cape Breton Regional Health Care Centre and Glays Bay Hospitals, Canada
Editors: Andrew W Lawton, MD, Medical Director of Neuro-Ophthalmology Service, Section of Ophthalmology, Baptist Eye Center, Baptist Health Medical Center; Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles; R Christopher Walton, MD, Professor, Director of Uveitis and Ocular Inflammatory Diseases Service, Assistant Department of Ophthalmology, Assistant Dean for Graduate Medical Education and Continuing Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital; Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri; Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Author and Editor Disclosure
Synonyms and related keywords:
bacterial endophthalmitis, bacterial infection in the eye, bacteria in the eye, bacterial eye infection, eye infection, ocular infection
Background
Bacterial endophthalmitis is an inflammatory reaction of the intraocular fluids or tissues caused by microbial organisms.
Pathophysiology
The entry of bacteria into the eye occurs from a breakdown of the ocular barriers. Penetration through the cornea or sclera results in an exogenous insult to the eye. If the entry is through the vascular system, then an endogenous route occurs. After the bacteria gain entry into the eye, rapid proliferation occurs.
The vitreous acts as a superb medium for bacteria growth, and, in the past, animal vitreous was used as a culture medium. Bacteria, as foreign objects, incite an inflammatory response. The cascade of inflammatory products occurs resulting in an increase in blood-ocular barrier breakdown and an increase in inflammatory cell recruitment. The damage to the eye occurs from the breakdown of the inflammatory cells releasing the digestive enzymes as well as the possible toxins produced by the bacteria. Destruction occurs at all tissue levels that are in contact with the inflammatory cells and toxins.
Frequency
United States
Incidence after intraocular surgery is less than 0.1%. Incidence of culture-proven endophthalmitis is similar to that of extracapsular cataract extraction and phacoemulsification.
Mortality/Morbidity
If not properly treated, a risk of complete vision loss and the possibility of persistent ocular pain exist. Infection very rarely spreads beyond the confines of the sclera and tracks into surrounding tissue structures.
History
The clinical presentation is dependent on the route of entry, the infecting organism, and the duration of the disease. In general, patients complain of a decrease in vision, often with a red eye. Most patients also may complain of a deep ocular pain. Classification is based on routes of entry.
- Exogenous
- Acute postoperative ( <6 wk postoperative)
- Usually, infection occurs 2-10 days after surgery.
- Patients present with visual loss greater than expected in the usual postoperative course.
- Ocular pain is seen in 75% of the patients.
- Use of postoperative antibiotic and anti-inflammatory drugs may blunt the severity of the disease and possibly delay medical attention.
- Delayed onset or chronic pseudophakic postoperative (>6 wk postoperative)
- Typically, patients present with mild-to-moderate inflammatory red eye, reduced vision, and photophobia.
- Chronic indolent course is present.
- Patients may be diagnosed with idiopathic uveitis and treated with topical steroids with temporary improvement.
- Rule out fungal species.
- Filtering bleb associated: Clinical features are similar to acute postoperative infection with purulent bleb involvement.
- Posttraumatic: History of trauma is present, and infection usually progresses rapidly.
- Endogenous source
- No recent history of ocular surgery is present.
- Confusion with delayed onset or chronic postoperative is possible if suspicion for endogenous route is not ruled out.
- Rarely are the symptoms bilateral.
Physical
- General findings
- Visual acuity decreased below the level expected
- Lid edema
- Conjunctival hyperemia
- Corneal edema
- Anterior chamber cells and flare
- Keratic precipitates
- Hypopyon
- Fibrin membrane formation
- Vitritis
- Loss of red reflex
- Retinal periphlebitis if view of fundus possible
- Specific findings
- Delayed onset or chronic: Occasionally, findings display a white plaque within the equator of the remaining lens capsule.
- Filtering bleb associated: A purulent bleb is seen occasionally with areas of necrosis in the sclera from the use of antimetabolites.
- Posttraumatic: Evidence of penetrating trauma is seen with the possibility of an intraocular foreign body.
- Endogenous: Patient may appear systemically ill.
Causes
Causes are related to classification of exogenous and endogenous.
- Exogenous
- Ocular surgical procedure - Increased risk when complications arise
- Trauma
- Ocular surface infection (eg, corneal ulcer)
- Filtering bleb associated - Use of antimetabolites or contaminated contact lenses
- Endogenous
- Septicemia
- Patients who are debilitated
- Indwelling catheters
- Intravenous drug use
- Bacteria involved include the following:
- Acute pseudophakic postoperative - Coagulase-negative staphylococci, Staphylococcus aureus, and Streptococcus, Enterococcus, and gram-negative species
- Delayed onset or chronic pseudophakic postoperative - Propionibacterium acnes, and coagulase-negative and Corynebacterium species
- Filtering bleb associated - Streptococcus and Staphylococcus species and Haemophilus influenzae
- Posttraumatic - Bacillus and Staphylococcus species
- Endogenous - S aureus, Escherichia coli, and Streptococcus species
Acute Retinal Necrosis
Ankylosing Spondylitis
Cataract, Traumatic
Endophthalmitis, Fungal
Foreign Body, Intraocular
HLA-B27 Syndromes
Ocular Manifestations of Syphilis
Sarcoidosis
Uveitis, Anterior, Granulomatous
Uveitis, Anterior, Nongranulomatous
Uveitis, Intermediate
Vitreous Wick Syndrome
Other Problems to be Considered
Retained lens material following cataract surgery
Long-standing hyphema or vitreous hemorrhage
Lab Studies
- Perform culture and sensitivity studies on aqueous and vitreous samples to determine type of organism and antibiotic sensitivity.
- If endogenous bacterial endophthalmitis is suspected, a systemic workup for the source is required. This workup includes the following:
- Blood culture
- Sputum culture
- Urine culture
Imaging Studies
- B-scan ultrasound
- Perform ultrasound of the posterior pole if view of fundus is poor.
- Typically, choroidal thickening and ultrasound echoes in the anterior and posterior vitreous support diagnosis.
- Occasionally, another source of inflammation other than or in addition to bacterial such as retained lens material may be seen.
- The ultrasound is also important to provide a baseline prior to intraocular intervention and to assess the posterior vitreous face and areas of possible traction.
- Rarely, a retinal detachment is seen concurrently with endophthalmitis.
- A CT scan rarely is performed unless trauma is involved. Thickening of the sclera and uveal tissues associated with various degree of increased density in the vitreous and periocular soft tissue structures may be seen.
- If an endogenous route is considered, perform other imaging modalities to rule out potential sources.
- Two-dimensional echocardiogram
- Chest x-ray
Procedures
- Anterior chamber tap: A 30-gauge needle on a tuberculin syringe is used to obtain a 0.1 cc sample under topical anesthesia through the limbus.
- Vitreous tap
- A retrobulbar block or a sub-Tenon block with lidocaine with epinephrine is given.
- A sub-Tenon block has the advantage over a retrobulbar block because it does not create increased intraocular pressure that may cause recent surgical wounds to open.
- A 21-gauge needle on a tuberculin syringe is used to obtain an adequate vitreous sample of 0.1-0.2 cc. Smaller gauge needles may be used but with increasing difficulty to create the aspiration vacuum necessary to obtain a sample.
- Vitreous biopsy: A 23-gauge vitrectomy cutter may be used if available.
Medical Care
Bacterial endophthalmitis is an ocular emergency and urgent treatment is required to reduce the potential of significant visual loss.
- All patients should have therapy consisting of intravitreal and topical antibiotics, topical steroids, and cycloplegics.
- The Endophthalmitis Vitrectomy Study (EVS) identified that the use of periocular and intravenous antibiotics are not required in endophthalmitis following cataract surgery. Medical therapy was found to be statistically as effective as surgical intervention when the presenting vision was hand motion or better. Use caution in interpreting the data from the EVS; apply it cautiously to non–cataract-related endophthalmitis.
- When the inflammation is severe, systemic and periocular therapy may be used in non–cataract-induced, delayed onset, filtering bleb–associated, and posttraumatic endophthalmitis.
- In endogenous endophthalmitis, systemic, topical, and possibly periocular therapy usually is required.
Surgical Care
Surgical intervention usually is performed urgently except in the delayed onset category where elective surgery may suffice.
- Indications for surgical therapy
- Acute pseudophakic postoperative - When the presenting vision is light perception or worse
- Delayed onset or chronic postoperative - If marked inflammation or a subcapsular plaque is identified, surgical removal is required.
- Filtering bleb associated - If marked inflammation is present. Take care not to disturb the bleb if some function still exists. To allow the possibility of a shunt valve to be placed at a later time, make an attempt to minimize the disturbance to the superior conjunctiva. If the patient is aphakic, performing the pars plana vitrectomy from the temporal side using a limbal approach may be required.
- Posttraumatic - If marked inflammation or rapid onset occurs
- Technique
- A 3-port core pars plana vitrectomy with intravitreal antibiotic injections is performed. If visualization is poor from anterior segment pathology, then a 2-port limited pars plana vitrectomy or endoscopic guided 3-port pars plana vitrectomy may be performed.
- An increased risk for retinal tears and detachments occur when the vitreous close to the retina is removed aggressively due to the higher probability of retinal necrosis.
- Intravitreal antibiotics usually are given after the completion of the vitrectomy; however, if an air-fluid exchange is to be performed, the antibiotics may be mixed into the vitrectomy solution. Dilute the antibiotics in the vitrectomy solution carefully to prevent possible toxic retinopathy from incorrect dosages.
Consultations
- In most exogenous cases of endophthalmitis, the ophthalmologist may manage the case sufficiently; however, in cases of less common or extremely virulent bacteria, consulting an infectious disease specialist may aid in the selection of antibiotics.
- When endogenous cases are suspected, an internist should be consulted to look for a source.
The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications. Various routes for drug administration are available. Intravitreous is the most effective.
Drug Category: Antibiotics
Therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.
| Drug Name | Vancomycin (Vancocin, Vancoled, Lyphocin) |
|---|
| Description | Potent antibiotic directed against gram-positive organisms and active against Enterococcus species. Indicated for patients who cannot receive or have failed to respond to penicillins and cephalosporins or have infections with resistant staphylococci.
To avoid toxicity, current recommendation is to assay vancomycin trough levels after third dose drawn 0.5 h prior to next dosing. Use creatinine clearance to adjust dose in patients diagnosed with renal impairment. DOC for gram-positive organisms. |
|---|
| Adult Dose | Topical: 50 mg/mL q1h
Intravitreal: 1 mg/0.1 mL
Periocular: 25 mg
Systemic: 1 g IV q12h |
|---|
| Pediatric Dose | Topical: Administer as in adults
Intravitreal: Administer as in adults
Systemic: 10 mg/kg/dose IV q6h |
|---|
| Contraindications | Documented hypersensitivity |
|---|
| Interactions | Erythema, histaminelike flushing, and anaphylactic reactions may occur when administered with anesthetic agents; taken concurrently with aminoglycosides, risk of nephrotoxicity may increase above that with aminoglycoside monotherapy; effects in neuromuscular blockade may be enhanced when coadministered with nondepolarizing muscle relaxants |
|---|
| Pregnancy | B - Usually safe but benefits must outweigh the risks.
|
|---|
| Precautions | Corneal toxicity; in systemic administration ototoxicity, nephrotoxicity reversible neutropenia may occur; adjust dose in renal insufficiency; caution in renal failure, neutropenia; red man syndrome is caused by too rapid IV infusion (dose given over a few minutes) but rarely happens when dose given IV over 2 h administration or as PO or IP administration; red man syndrome is not an allergic reaction |
|---|
| Drug Name | Ceftazidime (Ceptaz, Fortaz, Tazicef, Tazidime) |
|---|
| Description | First-line choice for intravitreal gram-negative coverage. Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins. |
|---|
| Adult Dose | Topical: 50 mg/mL q1h
Intravitreal: 2.25 mg/0.1 mL
Periocular: 100 mg
Systemic: 1 g IV q12h |
|---|
| Pediatric Dose | Not established |
|---|
| Contraindications | Documented hypersensitivity |
|---|
| Interactions | Can cause false-positive results in glucose-urine testing with copper reduction test (Benedict or Fehling solution); false-negative results in ferricyanide test; positive Coombs test; nephrotoxicity may increase with aminoglycosides, furosemide, and ethacrynic acid; probenecid may increase ceftazidime levels |
|---|
| Pregnancy | B - Usually safe but benefits must outweigh the risks.
|
|---|
| Precautions | Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections, and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy |
|---|
| Drug Name | Amikacin (Amikin) |
|---|
| Description | Second-line choice for intravitreal injection for gram-negative coverage. For gram-negative bacterial coverage of infections resistant to gentamicin and tobramycin. Effective against Pseudomonas aeruginosa.
Irreversibly binds to 30S subunit of bacterial ribosomes; blocks recognition step in protein synthesis; causes growth inhibition. Use the patient's IBW for dosage calculation. |
|---|
| Adult Dose | Topical: 13.6 mg/mL
Intravitreal: 0.4 mg/0.1 mL
Systemic: 75 mg/kg IV q12h |
|---|
| Pediatric Dose | Administer as in adults |
|---|
| Contraindications | Documented hypersensitivity |
|---|
| Interactions | Coadministration with other aminoglycosides, penicillins, cephalosporins, and amphotericin B increases nephrotoxicity; enhances effects of neuromuscular blocking agents; causes respiratory depression; irreversible hearing loss may occur with coadministration of loop diuretics |
|---|
| Pregnancy | C - Safety for use during pregnancy has not been established.
|
|---|
| Precautions | Not intended for long-term therapy; caution in patients with renal failure (not on dialysis), hypocalcemia, myasthenia gravis, and conditions that depress neuromuscular transmission |
|---|
| Drug Name | Ciprofloxacin (Cipro, Ciloxan) |
|---|
| Description | Fluoroquinolone with activity against pseudomonas, streptococci, MRSA, S epidermidis, and most gram-negative organisms, but no activity against anaerobes. Inhibits bacterial DNA synthesis, and consequently growth. Provides gram-positive coverage. Uncertain benefit in noncataract causes. |
|---|
| Adult Dose | Topical: 1 gtt qid to q1h
Systemic: 750 mg PO q12h |
|---|
| Pediatric Dose | Not established |
|---|
| Contraindications | Documented hypersensitivity |
|---|
| Interactions | Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; ciprofloxacin reduces therapeutic effects of phenytoin; probenecid may increase ciprofloxacin serum concentrations
May increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT) |
|---|
| Pregnancy | C - Safety for use during pregnancy has not been established.
|
|---|
| Precautions | In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy |
|---|
Drug Category: Corticosteroids
Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.
| Drug Name | Prednisolone acetate (Pred Forte) |
|---|
| Description | Treats acute inflammations following eye surgery or other types of insults to eye.
Decreases inflammation and corneal neovascularization. Suppresses migration of polymorphonuclear leukocytes and reverses increased capillary permeability.
In cases of bacterial infections, concomitant use of anti-infective agents is mandatory; if signs and symptoms do not improve after 2 days, reevaluate patient. Dosing may be reduced, but advise patients not to discontinue therapy prematurely. Dosage dependent on severity of inflammation. |
|---|
| Adult Dose | 1 gtt qid to q1h |
|---|
| Pediatric Dose | Administer as in adults |
|---|
| Contraindications | Documented hypersensitivity; viral, fungal, or tubercular infections |
|---|
| Interactions | None reported |
|---|
| Pregnancy | C - Safety for use during pregnancy has not been established.
|
|---|
| Precautions | Caution in hypertension; known to cause cataract formation with long-term use; suspect fungal invasion in any persistent corneal ulceration where a corticosteroid has been used or is in use (obtain fungal cultures when appropriate) |
|---|
| Drug Name | Dexamethasone (Ocu-Dex) |
|---|
| Description | For various allergic and inflammatory diseases. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability. Optional; clinical data are controversial on benefit. |
|---|
| Adult Dose | Intravitreal: 0.4 mg/0.1 mL |
|---|
| Pediatric Dose | Not established |
|---|
| Contraindications | Documented hypersensitivity; active bacterial, viral, or fungal infection |
|---|
| Interactions | None reported |
|---|
| Pregnancy | C - Safety for use during pregnancy has not been established.
|
|---|
| Precautions | Prolonged use may increase hazard of secondary ocular infection; suspect fungal invasion in any persistent corneal ulceration where a corticosteroid has been used or is in use (obtain fungal cultures when appropriate) |
|---|
| Drug Name | Triamcinolone (Aristocort) |
|---|
| Description | Treats inflammatory dermatosis responsive to steroids. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. |
|---|
| Adult Dose | Periocular: 40 mg |
|---|
| Pediatric Dose | Not established |
|---|
| Contraindications | Documented hypersensitivity; fungal, viral, and bacterial skin infections |
|---|
| Interactions | None reported |
|---|
| Pregnancy | C - Safety for use during pregnancy has not been established.
|
|---|
| Precautions | Do not use in decreased skin circulation; prolonged use, applications over large areas, and use of potent steroids and occlusive dressings may result in systemic absorption; systemic absorption may cause Cushing syndrome, reversible HPA axis suppression, hyperglycemia, and glycosuria |
|---|
Drug Category: Cycloplegics
Reduces ciliary spasm that may cause pain. Cycloplegic agents are also mydriatics, and the practitioner should make sure that the patient does not have glaucoma. This medication could provoke an acute angle-closure attack.
| Drug Name | Atropine (Isopto, Atropair, Atropisol) |
|---|
| Description | DOC; acts at parasympathetic sites in smooth muscle to block response of sphincter muscle of iris and muscle of ciliary body to acetylcholine, causing mydriasis and cycloplegia. |
|---|
| Adult Dose | Topical: 1 gtt bid |
|---|
| Pediatric Dose | Not established |
|---|
| Contraindications | Documented hypersensitivity, thyrotoxicosis, narrow-angle glaucoma, and tachycardia |
|---|
| Interactions | Coadministration with other anticholinergics have additive effects; pharmacologic effects of atenolol and digoxin may increase with atropine; antipsychotic effects of phenothiazines may decrease with this medication; tricyclic antidepressants with anticholinergic activity may increase effects of atropine |
|---|
| Pregnancy | C - Safety for use during pregnancy has not been established.
|
|---|
| Precautions | Caution in patients with Down syndrome and/or children with brain damage to prevent hyperreactive response; caution also in coronary heart disease, tachycardia, congestive heart failure, cardiac arrhythmias, hypertension, peritonitis, ulcerative colitis, hepatic disease, and hiatal hernia with reflux esophagitis; in prostatic hypertrophy, prostatism can have dysuria and may require catheterization |
|---|
Further Inpatient Care
- Patients may be admitted or may be treated as outpatients depending on the following:
- Severity of endophthalmitis and treatment modalities
- Underlying systemic diseases
- Patient reliability and compliance
Further Outpatient Care
- Patients should receive follow-up care on a daily basis. Clinical features indicating improvement include the following:
- Reduced pain
- Decreased inflammation and hypopyon
- Increased red reflex
- Retraction of any fibrin
- Improved visual acuity
- If no improvement occurs in 48-72 hours consider the following:
- Repeat tap/biopsy and antibiotic injections
- Vitrectomy and injection of antibiotics, if no previous vitrectomy exists
- If view is poor, B-scan ultrasound is useful to rule out retinal detachment.
In/Out Patient Meds
- Topical antibiotic coverage with dosage dependent on severity
- Vancomycin 50 mg/mL 1 gtt qid to q1h
- Ceftazidime 50 mg/mL 1 gtt qid to q1h
- Prednisolone 1 gtt qid to q1h
- Atropine 1 gtt bid
Deterrence/Prevention
- Identify high-risk patients before elective surgery
- Blepharitis
- Abnormal lacrimal drainage
- Active infection elsewhere
- Preparation of operative field
- Prep with 5-10% povidone-iodine solution in preoperative area
- Prep with 5-10% povidone-iodine immediately before draping and allow solution to dry
- Drape to cover lashes and lid margins
- Prophylactic topical and/or periocular antibiotics
- Prophylactic intravitreal antibiotics in trauma cases
Complications
- Retinal necrosis
- Retinal detachment
- Retinal necrosis
- Vitreous tap
- Vitrectomy
- Increased intraocular pressure
- Retinal vascular occlusion
- Optic neuropathy
- Panophthalmitis
- Hypotony
- Ciliary body shut down
- Leaking wound
- Retinal detachment
- Cyclodialysis cleft
- Medication
Prognosis
- Depends on the following:
- Duration of endophthalmitis
- Time to treatment
- Virulence of bacteria
- Etiology of entry
- Existing ocular diseases
- From the EVS, percentage of patients achieving a final visual acuity of 20/100 or better were as follows:
- Gram-positive, coagulase-negative micrococci - 84%
- S aureus - 50%
- Streptococci - 30%
- Enterococci - 14%
- Gram-negative organisms - 56%
- A statistically significant number (P <.001) of poorer visual outcomes occurred with a positive Gram stain or when bacteria other than gram-positive, coagulase-negative cocci were found.
Patient Education
- Direct patients to maintain hygienic practice after surgery.
Medical/Legal Pitfalls
- Medical legal problems usually occur when the expectations of the patient are not met. If the potential for infection and the risk of loss of vision are explained clearly to the patient, the risk for legal action may be avoided. The problem most often occurs in elective surgery (eg, cataract extraction) when patients expect improved vision but end with significant loss of vision and morbidity. Document the discussions in all cases.
| Media file 1:
Bacterial endophthalmitis. Hypopyon, 3 days after phacoemulsification. |
 |  View Full Size Image | |
Media type: Photo
|
| Media file 2:
Bacterial endophthalmitis. Retinopathy induced by Enterococcus faecalis endotoxin. |
 | View Full Size Image | |
Media type: Photo
|
- Aaberg TM Jr, Flynn HW Jr, Schiffman J, Newton J. Nosocomial acute-onset postoperative endophthalmitis survey. A 10-year review of incidence and outcomes. Ophthalmology. Jun 1998;105(6):1004-10. [Medline].
- Alfonso E, Crider J. Ophthalmic infections and their anti-infective challenges. Surv Ophthalmol. Nov 2005;50 Suppl 1:S1-6. [Medline].
- Barza M, Pavan PR, Doft BH, et al. Evaluation of microbiological diagnostic techniques in postoperative endophthalmitis in the Endophthalmitis Vitrectomy Study. Arch Ophthalmol. Sep 1997;115(9):1142-50. [Medline].
- Bouza E, Grant S, Jordan C, Yook RH, Sulit HL. Bacillus cereus endogenous panophthalmitis. Arch Ophthalmol. Mar 1979;97(3):498-9. [Medline].
- Chan IM, Jalkh AE, Trempe CL, Tolentino FI. Ultrasonographic findings in endophthalmitis. Ann Ophthalmol. Aug 1984;16(8):778-84. [Medline].
- Cohen SM, Flynn HW Jr, Murray TG, Smiddy WE. Endophthalmitis after pars plana vitrectomy. The Postvitrectomy Endophthalmitis Study Group. Ophthalmology. May 1995;102(5):705-12. [Medline].
- Costello P, Bakri SJ, Beer PM. Vitreous penetration of topical moxifloxacin and gatifloxacin in humans. Retina. Feb 2006;26(2):191-5. [Medline].
- Donahue SP, Kowalski RP, Jewart BH, Friberg TR. Vitreous cultures in suspected endophthalmitis. Biopsy or vitrectomy?. Ophthalmology. Apr 1993;100(4):452-5. [Medline].
- Endophthalmitis Vitrectomy Study Group. 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. Dec 1995;113(12):1479-96. [Medline].
- Flynn HW Jr, Pulido JS, Pflugfelder SC, et al. Endophthalmitis therapy: changing antibiotic sensitivity patterns and current therapeutic recommendations. Arch Ophthalmol. Feb 1991;109(2):175-6. [Medline].
- Forster RK. Etiology and diagnosis of bacterial postoperative endophthalmitis. Ophthalmology. Apr 1978;85(4):320-6. [Medline].
- Gan IM, Ugahary LC, van Dissel JT. Intravitreal dexamethasone as adjuvant in the treatment of postoperative endophthalmitis: a prospective randomized trial. Graefes Arch Clin Exp Ophthalmol. Dec 2005;243(12):1200-5. [Medline].
- Garat M, Moser CL, Alonso-Tarres C. Intracameral cefazolin to prevent endophthalmitis in cataract surgery: 3-year retrospective study. J Cataract Refract Surg. Nov 2005;31(11):2230-4. [Medline].
- Greenfield DS, Suner IJ, Miller MP, et al. Endophthalmitis after filtering surgery with mitomycin. Arch Ophthalmol. Aug 1996;114(8):943-9. [Medline].
- Han DP, Wisniewski SR, Wilson LA, et al. Spectrum and susceptibilities of microbiologic isolates in the Endophthalmitis Vitrectomy Study. Am J Ophthalmol. Jul 1996;122(1):1-17. [Medline].
- Hariprasad SM, Shah GK, Chi J. Determination of aqueous and vitreous concentration of moxifloxacin 0.5% after delivery via a dissolvable corneal collagen shield device. J Cataract Refract Surg. Nov 2005;31(11):2142-6. [Medline].
- Hariprasad SM, Shah GK, Mieler WF, et al. Vitreous and aqueous penetration of orally administered moxifloxacin in humans. Arch Ophthalmol. Feb 2006;124(2):178-82. [Medline].
- Irvine WD, Flynn HW Jr, Murray TG, Rubsamen PE. Retained lens fragments after phacoemulsification manifesting as marked intraocular inflammation with hypopyon. Am J Ophthalmol. Nov 15 1992;114(5):610-4. [Medline].
- Iyer MN, He F, Wensel TG. Clearance of intravitreal moxifloxacin. Invest Ophthalmol Vis Sci. Jan 2006;47(1):317-9. [Medline].
- Katz HR, Masket S, Lane SS. Absorption of topical moxifloxacin ophthalmic solution into human aqueous humor. Cornea. Nov 2005;24(8):955-8. [Medline].
- Kowalski RP, Romanowski EG, Mah FS. Intracameral Vigamox (moxifloxacin 0.5%) is non-toxic and effective in preventing endophthalmitis in a rabbit model. Am J Ophthalmol. Sep 2005;140(3):497-504. [Medline].
- Kunimoto DY, Das T, Sharma S, et al. Microbiologic spectrum and susceptibility of isolates: part I. Postoperative endophthalmitis. Endophthalmitis Research Group. Am J Ophthalmol. Aug 1999;128(2):240-2. [Medline].
- Mamalis N, Edelhauser HF, Dawson DG. Toxic anterior segment syndrome. J Cataract Refract Surg. Feb 2006;32(2):324-33. [Medline].
- Mandelbaum S, Forster RK, Gelender H, Culbertson W. Late onset endophthalmitis associated with filtering blebs. Ophthalmology. Jul 1985;92(7):964-72. [Medline].
- Mieler WF, Ellis MK, Williams DF, Han DP. Retained intraocular foreign bodies and endophthalmitis. Ophthalmology. Nov 1990;97(11):1532-8. [Medline].
- Miller JJ, Scott IU, Flynn HW. Acute-onset endophthalmitis after cataract surgery (2000-2004): incidence, clinical settings, and visual acuity outcomes after treatment. Am J Ophthalmol. Jun 2005;139(6):983-7. [Medline].
- Ng JQ, Morlet N, Pearman JW. Management and outcomes of postoperative endophthalmitis since the endophthalmitis vitrectomy study: the Endophthalmitis Population Study of Western Australia (EPSWA)'s fifth report. Ophthalmology. Jul 2005;112(7):1199-206. [Medline].
- Okada AA, Johnson RP, Liles WC, et al. Endogenous bacterial endophthalmitis. Report of a ten-year retrospective study. Ophthalmology. May 1994;101(5):832-8. [Medline].
- Packer AJ, Weingeist TA, Abrams GW. Retinal periphlebitis as an early sign of bacterial endophthalmitis. Am J Ophthalmol. Jul 1983;96(1):66-71. [Medline].
- Prydal JI, Jenkins DR, Lovering A. The pharmacokinetics of linezolid in the non-inflamed human eye. Br J Ophthalmol. Nov 2005;89(11):1418-9. [Medline].
- Rathinam SR, Rao NA. Sympathetic ophthalmia following postoperative bacterial endophthalmitis: a clinicopathologic study. Am J Ophthalmol. Mar 2006;141(3):498-507. [Medline].
- Smiddy WE, Smiddy RJ, Ba'Arath B. Subconjunctival antibiotics in the treatment of endophthalmitis managed without vitrectomy. Retina. Sep 2005;25(6):751-8. [Medline].
- Somani S, Grinbaum A, Slomovic AR. Postoperative endophthalmitis: incidence, predisposing surgery, clinical course and outcome. Can J Ophthalmol. Aug 1997;32(5):303-10. [Medline].
- Suzuki T, Uno T, Kawamura Y. Postoperative low-grade endophthalmitis caused by biofilm-producing coccus bacteria attached to posterior surface of intraocular lens. J Cataract Refract Surg. Oct 2005;31(10):2019-20. [Medline].
- Thompson JT, Parver LM, Enger CL, et al. Infectious endophthalmitis after penetrating injuries with retained intraocular foreign bodies. National Eye Trauma System. Ophthalmology. Oct 1993;100(10):1468-74. [Medline].
- van Kooij B, Rothova A, de Vries P. The pros and cons of intravitreal triamcinolone injections for uveitis and inflammatory cystoid macular edema. Ocul Immunol Inflamm. Apr 2006;14(2):73-85. [Medline].
- Winward KE, Pflugfelder SC, Flynn HW Jr. Postoperative Propionibacterium endophthalmitis. Treatment strategies and long-term results. Ophthalmology. Apr 1993;100(4):447-51. [Medline].
- Wolner B, Liebmann JM, Sassani JW, et al. Late bleb-related endophthalmitis after trabeculectomy with adjunctive 5-fluorouracil. Ophthalmology. Jul 1991;98(7):1053-60. [Medline].
- Zhang YQ, Wang WJ. Treatment outcomes after pars plana vitrectomy for endogenous endophthalmitis. Retina. Sep 2005;25(6):746-50. [Medline].
Endophthalmitis, Bacterial excerpt Article Last Updated: Aug 24, 2006
|
