ObjectiveTo investigate the clinical settings, antibiotic susceptibilities, management and outcomes of streptococcal endophthalmitis. MethodsA retrospective observational case series study. Fifty six eyes of 56 patients diagnosed with streptococcal endophthalmitis in Eye & ENT Hospital, Fudan University from 2012 to 2022 were collected. The treatment followed the general principles of relevant guidelines, including pars plana vitrectomy (PPV), vitreous injection of antibiotics (IVI), vitreous injection of glucocorticoids and systemic application of antibiotics. The follow-up time was (11.9±17.0) months. Patients' clinical characteristics, pathogenic distribution and antibiotic susceptibilities, treatment and outcomes in their medical records were retrospectively collected and analyzed. ResultsAll 56 patients had monocular onset, including 39 (69.6%, 39/56) males and 17 (30.4%, 17/56) females, 26 (46.4%, 26/56) with left eyes involved and 30 (53.6%, 30/56) with right eyes involved. Their average age was (25.0±24.4) years. Ocular trauma was the leading cause of streptococcal endophthalmitis (73.2%, 41/56), followed by ophthalmic surgery (23.2%, 13/56) and endogenous infection (3.6%, 2/56). The streptococcal species included Streptococcus viridans (50.0%, 28/56), Streptococcus pneumoniae (18/56, 32.1%) and β-hemolytic Streptococcus (17.9%, 10/56). The susceptibility rates of Streptococcus to penicillin, cefatriaxone, vancomycin and levofloxacin were 66.0%, 57.1%, 94.1% and 92.4%, respectively. Patients received PPV+IVI and IVI as initial treatment were 49 eyes (87.5%, 49/56) and 7 eyes (12.5%, 7/56), respectively. Vitreous injection of glucocorticoids were performed in 17 eyes (30.4%, 17/56); and systemic antibiotics were applied in 52 cases (92.9%, 52/56). At the final follow-up, 47 eyes were recorded with visual acuity. Twenty (35.7%, 20/56) had best corrected visual acuity (BCVA)≥0.05 and 27 (48.2%, 27/56) had BCVA ＜0.05, of which 1 (1.8%, 1/56) had an eyeball enucleation. The etiology of endophthalmitis, streptococcal species, initial treatment with PPV, vitreous injection of glucocorticoids, and systemic antibiotics did not significantly affect patients' visual outcomes (P＞0.05). Timely visit to the hospital after the onset of symptoms (≤3 days) was significantly associated with achieving a final BCVA above 0.05 (P=0.025). ConclusionsOcular trauma was the primary cause of streptococcal endophthalmitis. Streptococcus viridans is the most common pathogenic bacterium. Streptococci had high susceptibility to vancomycin, but patients' visual outcomes were poor.
Objective To analyze the etiology trends, etiological characteristics treatment effects of endophthalmitis in 10 years which from 2000 to 2009 in our hospital. Methods 165 patients (172 eyes) of endophthalmitis in hospital from January 2000 to December 2009 were enrolled in this study. The patients included 122 males and 43 females. The median age was (39.0plusmn;23.7) years. The best visual acuity (BCVA) was non light perception in 16 eyes, light perception 0.05 in 135 eyes, ＞0.05 in 12 eyes. Nine children did not have visual acuity records. There were 141 patients (85.45%) with exogenous endophthalmitis which including 89 patients of trauma, 43 patients after intraocular surgery and nine others; 24 patients (14.55%) with endogenous endophthalmitis. 113 eyes were received intravitreal injection with vancomycin 0.1 ml (10 mg/ml). 152 eyes had pathogenic microorganisms culture records of aqueous humor or aqueous humor and vitreous. The positive records were given drug sensitivity test. The types of endophthalmitis, pathogenic microbial culture and drug sensitivity test results and treatment effects were analyzed. Software of SPSS was used for the clinical data statistical analysis in this study. Results Of 152 eyes with a record of aqueous/vitreous samples pathogenic bacteria culture, 42 eyes (27.63%) had a positive result. In which, 28 eyes showed positive in bacteria culture, 12 eyes was positive in fungus culture and two eyes had a positive in culture of fungus and bacteria growing. The culture positive rate was higher in exogenous endophthalmitis than that in endogenous endophthalmitis (chi;2=4.721 9,P=0.029 8).Most of the G+ positive bacteria were resistance to cephalosporin and quinolones except levofloxacin; but sensitive to vancomycin, rifampin and sulfamethoxazole. The intervention effect was more available for postoperative endophthalmitis than that for traumatic endophthalmitis and endogenous endophthalmitis, the difference was statistically significant（chi;2=38.941 3，P=0.000 0).The BCVA of 23 cases was ＞0.05 after the treatment, compared with before the treatment, the difference was statistically significant (chi;2=3.867 3,P=0.049 2).Compared the ratio of past five yearsprime; to that of recent five years, endogenous endophthalmitis was increased from 7.89% to 20.23% (chi;2=5.014 0，P=0.025 1); postoperative endophthalmitis decreased from 27.63% to 24.72%, and traumatic endophthalmitis decreased from 60.53% to 48.31%, other causes linked endophthalmitis raised from 3.95% to 6.74%. Conclusions In recent 10 years (from 2000 to 2009), the patients with endogenous endophthalmitis are growing. The positive rate of pathogenic agent culture is low, but the culture positive rate of the specimens from endogenous endophthalmitis is higher than that from exogenous endophthalmitis.The treatment was more available for postoperative endophthalmitis than that for other two types of endophthalmitis. The general visual prognosis is poor.
Objective To evaluate the clinical characteristics of end oscopically guided thorough vitrectomy in managing exogenous endophthalmitis with cloudy cornea. Methods The clinical data of 20 patients (20 eyes) suffered from exogenous endophthalmitis with cloudy cornea and underwent endoscopically guided total vitrectomy were retrospectively analyzed. The patients (18 males and 2 females) aged from 5 to 79 years with the average age of 35.9 years. There were 16 post-trauma and 4 post-cataract endophthalmitis. The cornea was cloudy with the visual acuity of not better than counting fingers in all eyes. During the operation, posterior vitreous detachment was induced, vitreous at the base and bands over the ciliary body was removed, and membrane at the anterior or posterior surface of the iris was also removed after lensectomy. The median of the duration of hospita lization to operation was 1.5 days, and the follow-up period was 6～42 months (mean=23 months). Results Positive cultures were obtained in 9 (45%) cases. Seven intraocular foreign bodies were extracted from 6 eyes. Ora serrata was separated at one place in 2 cases, iatrogenic retinal tear at one, two place in 1 case respectively. Vitrectomy and intravitreal injection were underway again in 2 cases respectively after surgery. Ten eyes (50%) retained useful vision (ge;0.05). The visual acuity was decreased, maintained and improved in 1, 3 and 16 eyes, respectively, and 4 cases over than 0.08. Cornea was clear in 11 (55%) eyes after operation; 9 cases with silicon oil in; ocular pressure was slanting low in 2 cases , but more than 5 mm Hg（1 mm Hg=0.133 kPa）; intraocular hypertension in 1 case , controlled by medicine; local and questionable retinal detachment in 1 case respectively, without surgery again. The visual acuity of none of the 9 eyes with silicon oil in was lower than counting fingers, only one eye in 11 eyes without silicon oil in was lower than 0.05 and no eye lost at the end of follow-up. Conclusion Endoscopically guided total vitrectomy is useful, safe and reliable for the management of exogenous endophthalmitis with cloudy cornea in time. （Chin J Ocul Fundus Dis，2008，24：202-205）
Objective To establish rabbit models of mixture-infectious endophthalmitis induced by exogenous Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). Methods A total of 84 eyes of 42 New Zealand white albino rabbits were randomly divided into 4 groups. There were 21 eyes in each group. Rabbit eyes in group 1, 2, 3 and 4 received an intravitreal injection of 0.1 ml of mix bacterium (2times;104 CFU/ ml, including 103 S. aureus and 103 E. coli), S. aureus (104 CFU/ ml), E. coli (104 CFU/ml), and sterilized saline respectively. The eyes were examined by slit-lamp microscopy, ophthalmoscopy, A/B scan, electroretinography (ERG) and bacterial culture of vitreous humors at the timepoints of 6, 12, 24, 48 and 72 hours, and 4, 7, 10, 14 days after intravitreal injection. All eyeballs were then enucleated for histopathological examination. Results Various degrees of inflammatory reactions were presented in the 3 experimental groups after the injection, and the development trend of the disease was nearly the same. In group 1 active intraocular inflammation like anterior chamber exudates, started at 12 hours after injection (which was early than that in group 2 and 3), aggravated between 48 and 72 hours, alleviated slowly from 4 to 7 days, and was obviously better after 10 to 14 days while the corneal neovascularization and vitreous gray opacity begun to form. The bacterial culture was positive in group 1 (100％, 6 hours to 14 days after injection), group 2 (100%, 6 hours to 3 days after injection) and group 3 (100% from 6 hours to 7 days, and 67.67% at 14 days after injection). It was negative for group 2 (7 to 14 days after injection) and group 4 (6 hours to 14 days after injection). The amplitude of ERG b wave dissapeard in group 1 to 3, and decreased less than 30% in group 4 from the 48th hour after injection. Histopathological examination revealed that all intraocular structures infiltrated with inflammatory cells. Conclusion Complicated endophthalmitis rabbit models can be successfully established by intravitreal injection with S. aureus and E. coli.
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.
The etiology of intraocular inflammatory disease and its diagnosis is complicated. Currently available and newly emerging systemic and ocular examinations are of important to determine etiology of intraocular inflammatory disorders. But there also exists multiple misunderstanding, and the strategy of their application is not well defined, or even exaggerated. Unprincipled or randomly selection of auxiliary examination would not help for etiology determination, but bring unnecessary pain and economic burden to patients. Establishment of diagnosis thinking of intraocular inflammatory disease is helpful to standardize the diagnosis process of the disease, improve the diagnostic efficiency, and relief patients from the pain and financial burden that caused by too many useless examinations.
Objective To observe the therapeutic effects of vitrectomy combined with tissue plasminogen activator(r-tPA) and fraxiparine on bacterial endophthalmitis. Methods Forty pigmented rabbits were randomly divided into experimental and control group with 20 rabbits in each. The left eyes underwent intra-vitreous injection with 10 5/ml bacteria of staphylococcus epidermidis 0.1 ml. After 8-4 hours, vitrectomy was performed on all of the animals. Fraxiparine with the final concentration of 6 IU/ml was only added to balanced salt solution in the experimental group during the operation, and the extend of intraocular fibrin exudation was observed by slit lamp and indirect ophthalmoscope after the operation. If the exudation occurred on the 1st, 3rd, 7th, 14th and 21st day postoperatively, 125 mg/ml r-tPA 0.1 ml should be injected into vitreous from the 1st day after operation on. Results Fibrin exudation in the pupil area and vitreous body was much less in experimental group than that in the control group after the surgery. Conclusion vitrectomy combined with r-tPA and fraxiparine may alleviate the extent of fibrosis in bacterial endophthalmitis and improve the prognosis. (Chin J Ocul Fundus Dis, 2005, 21: 391-393)
Objective To review the distribution and shifting trends of cultured bacteria from the aqueous humor and the vitreous body. Methods A retrospective analysis on distribution of Gram′s stain, the distribution and change of isolates was performed in 522 specimens (aqueous humor,261 and vitreous body,261) of patients with suspected endophthalmitis during a 10-year period (1989-1998). Results The positive cultures were 119 (aqueous humor,44 and vitreous body,75) of 522 specimens. The average positive rate was 22.8%. Gram-positive cocci constituting 45.4%(54) of total isolates followed by Gram-negative bacilli,34.5%(41);Gram-positive bacilli, 20.2%(24). In the positive bacterial cultures, enterobacteriaceae was the most common isolate, 18.5%, and the next was micrococcus, 16.0%; coagulase-negative staphylococcus,12.6%; and pseudomonas,10.9%.Comparing the data from 1989 through 1993 with the data from 1994 through 1998, the frequency of Gram-positive cocci had no significant change, while the frequency of Gram-positive bacilli was decreased and the percentage of Gram′s-negative bacilli was increased. Conclusions Gram-positive cocci and Gram-negative bacilli are the predominant pathogens of bacterial endophthalmitis. The percentage of Gram′s-negative bacilli has increased for 5 years. It is very important to comprehend the distribution and shifting trends of these pathogenic bacteria for diagnosis, prevention and treatment of bacterial endophthalmitis. (Chin J Ocul Fundus Dis, 2002, 18: 104-105)
Objective To observe the histopathologic features and expression patterns of tumor necrosis factor-alpha; （TNF-alpha;）, interleukin-1beta;（IL-1beta;） and Escherichia coli lipopolysaccharide (LPS) in the rat vitreous with LPS inducedendophthalmitis. Methods Wistar rats were randomly divided into saline control group (SC,136 rats）,endophthalmitis group （EO, 168 rats）and blank control group （BC,12 rats）.EO group received an intravitreal injection of 5 mu;l LPS; SC group received 5 mu;l sterile saline and no intervention for BC group.Six,12,24,48, and 72 hours,5 and 7 days after injection, intraocular inflammation were observed and the eyes and vitreous were collected for histopathological examination and measurement of TNF-alpha;, IL-1beta; and LPS expression. Results Severe inflammatory responses in the eyes were observed in EO group between six and 72 hours after LPS injection，ocular inflammation subsided seven days after LPS injection. In the vitreous, a peak neutrophil count was observed at 24 hours （1224.64plusmn;132.2） cells/eye that rapidly declined at 72 hours （342.25plusmn;47.7） cells/eye. The levels of TNF-alpha; and IL-1beta; in EO group were peaked at 24 hours with （996.18plusmn;89.45） and（5556plusmn;1440）pg/ L, respectively；Persisted at 48 hours and began to decline rapidly thereafter. Seven days after LPS injection, levels of TNF-alpha; and IL-1beta; returned to baseline with （22.16plusmn;5.84）and （73.7plusmn;18.7） pg/L, respectively. LPS concentration in EO group decrease rapidly at 72 hours with （11.03plusmn;3.41） ng and disappear on days 7 with (0.22plusmn;0.08) ng after LPS injection.Conclusions Massive neutrophils infiltration, high levels expression of TNF-alpha; and IL-1beta; and spontaneous elimination of bacterial elements in vitreous cavity were major pathologic characteristics in this experimental model. The expression patterns of TNF-alpha;,IL-1beta; were in accord with LPS clearance process.
Objective To investigate the etiological factors of endophthalmitis and evaluate the outcomes of vitrectomy for endophthalmitis.Methods From January 1999 to December 2001, 53 consecutive patients (54 eyes ), 38 men and 15 women, diagnosed as endophthalmitis were retrospectively evaluated. The patients′ ages ranged from 1 year to 74 years (mean 32 years). Two patients (2 eyes) with mild inflammation received antibiotic medication therapy, 5 patients (5 eyes) with no light perception and severe inflammation underwent evisceration, and the other 46 patients (47 eyes) underwent pars plana vitrectomy. Postoperative follow-up ranged from 2 to 32 months (mean 10.5 months). Results Endophthalmitis was diagnosed as resulting from penetrating injury in 32 eyes (59.26%), endogenous endophthalmitis in 8 eyes (14.81%), cataract surgery in 7 eyes (12.96%), gl au coma surgery in 2 eyes (3.70%), vitrectomy in 3 eyes (5.56%), radial keratotomy in 1 eye (1.85%), and unknown reason in 1 eye (1.85%). The postoperative visual a cuities (VA) of these patients increased significantly (P=0.003). The VA of the patients underwent vitrectomy in 3 days was obviously better than those after 3 days (P=0.014), and the VA of the patients underwent vitrectomy in 7 days was obviously beter than those after 7 days (P=0.021). Thirty-seven eyes (68.52 %) had functional success (VA≥0.02), 47 eyes (87.04%) had anatomical success (VAlt;0.02) , and 27 eyes (50.00%) were out of blindness (VA≥0.05). Conclusions Penetrating ocular injury, especially with retained intraocular foreign bodies, is the most common cause of suppurative endophthalmitis. Vitrectomy is a good method for the treatment of endophthalmitis. (Chin J Ocul Fundus Dis，2003，19：93-95)