sterile endophthalmitis after cataract surgery

Interestingly, powder-free gloves are also associated with TASS, as gloves can retain residue from chemicals used during the extraction process in their manufacturing (1,74). There was a poor view of the posterior pole due to the anterior segment inflammation, but no frank evidence of vitritis. A 73-year-old man presented one day after uncomplicated cataract extraction with intraocular lens implant in the right eye. The vision significantly deteriorated over the years to 20/800 due to significant damage to the outer retinal layers, subretinal scar, and cataract. Toxic anterior segment syndrome following deep anterior lamellar keratoplasty. Acute-onset postoperative endophthalmitis. Nanavaty MA, Wearne MJ. Two independent reviewers (J.P. and M.B.) Morioka M, Takamura Y, Miyazaki HT, Gozawa M, Yamada Y, Komori R, Tanaka K, Inatani M. Sci Rep. 2023 Apr 7;13(1):5713. doi: 10.1038/s41598-023-31926-9. Vitreous and aqueous humor cultures revealed Pseudomonas aeruginosa in 5 patients. Most people who develop postoperative endophthalmitis usually notice decreased vision and eye aches within a week or so after the procedure. Recommended practices for cleaning and sterilizing intraocular surgical instruments. A cluster of multiple cases of postoperative endophthalmitis in the same surgical center raises great concern and can often be traced to transmission of pathogens from exogenous sources such as surgical instruments, contaminated fluid solutions, and the surgical environment.1416 At the system-wide level, resource availability and the aseptic protocols defined by national regulatory agencies for ophthalmic surgery impact the routine practices of cataract surgeons.17 There are regional variations, however. For example, the condition may follow a procedure to treat cataracts or glaucoma. Hugonnet S, Dosso A, Dharan S, Martin Y, Herrero ML, Rgnier C, Pittet D. Outbreak of endophthalmitis after cataract surgery: the importance of the quality of the surgical wound. A total of 40 eyes across 5 studies attributed infectious transmission to the PE machine used during cataract surgery. The https:// ensures that you are connecting to the had a final visual acuity of 0.21 0.14 logMAR (Snellen: 20/30).40,41 No patients resulted in either LP or NLP vision. Am J Ophthalmol 1996;122:117, 10. Mycoses 2011;54:e767e774, 26. Baughman DM, Su GL, Tsui I, Lee CS, Lee AY. Montan PG, Koranyi G, Setterquist HE, Stridh A, Philipson BT, Wiklund K. Endophthalmitis after cataract surgery: risk factors relating to technique and events of the operation and patient history: a retrospective case-control study. Gngel H, Eren MH, Pnarc EY, Altan C, Baylaniek DO, Kara N, Grsel T, Yegenolu Y, Susever S. An outbreak of Fusarium solani endophthalmitis after cataract surgery in an eye training and research hospital in Istanbul. The .gov means its official. Delayed-onset (chronic) postoperative endophthalmitis with. Pathogens 2015;4:111136, 51. Cham: Springer, 2018. Lalitha P, Sengupta S, Ravindran RD, Sharma S, Joseph J, Ambiya V, Dast T. A literature review and update on the incidence and microbiology spectrum of postcataract surgery endophthalmitis over past two decades in India. Sterile postoperative endophthalmitis following HOYA IOL insertion. Incidence of postoperative endophthalmitis from 1990 to 2009 using povidone-iodine but no intracameral antibiotics at a single academic institution. In 8 articles, preoperative and/or intraoperative antimicrobials were used to prevent endophthalmitis.2528,32,3537 All but 1 study reported on the use of postoperative antimicrobials to treat endophthalmitis.14,15,2426,2845 Of these studies, 18 (78.3%), 2 (8.7%), and 23 (100%) administered topical, intracameral, and intravitreal antimicrobials, respectively. Toxic anterior segment syndrome: Update on the most common causes. Contacting an intraocular lens with a gloved hand is not a rare event (104), and talc containing surgical glove powders are known to be associated with ocular toxicity (73,74). Unilateral sterile endophthalmitis developed in 3 (0.11%) eyes of 3 (0.21%) dogs. Development of toxic anterior segment syndrome immediately after uneventful phaco surgery. J Hosp Infect 2012;81:231238, 38. Acute sterile endophthalmitis following intravitreal bevacizumab: case series. Ophthalmology 2009;116:425430, 7. Three patients had hypertension, 1 patient had diabetes, and 1 patient was a hepatitis B carrier. A dose-related response in corneal swelling was observed, and similarly confirmed in human corneas. Bowen RC, Zhou AX, Bondalapati S, Lawyer TW, Snow KB, Evans PR, Bardsley T, McFarland M, Kliethermes M, Shi D, Mamalis CA, Greene T, Rudnisky CJ, Ambati BK. Notably, the identification of contaminated viscoelastic in the study by Roy et al. Acute postoperative endophthalmitis is the most common form of endophthalmitis; Incidence following cataract surgery: 0.08% - 0.68%; Rates increasing since advent of clear corneal incisions; Highest risk after secondary IOL (0.2-0.367%), and traditionally lowest after pars plana vitrectomy (0.03-0.046%). Multistate outbreak of toxic anterior segment syndrome, 2005. doi: 10.1002/14651858.CD006364.pub3. suggested flushing the tubing with sterile water after each procedure and using an ultrasonic bath and compressed air for cleaning prior to autoclave use.14 Dancer et al. Aflibercept-related sterile inflammation. 2022 Jun 18;15(6):855-856. doi: 10.18240/ijo.2022.06.01. 2005 Jun;139(6):983-7. doi: 10.1016/j.ajo.2005.01.025. A total of 44 eyes across 3 studies attributed infectious transmission to the operating room environment.3335 The mean age of the patients was 60.2 years (range: 55.6 to 62.4 years). Authors Saad Althiabi 1 , Abdulaziz J Aljbreen 1 , Asma Alshutily 1 , Faisal A Althwiny 1 Affiliation 1 Ophthalmology, Unaizah College of Medicine, Qassim University, Unaizah, SAU. Hsu CR, Chen JT, Yeh KM, Hsu CK, Tai MC, Chen YJ, Chang YH. Mycopathologia 2014;177:115121, 25. In all nine cases, surgery was performed with refrigerated balanced salt solution (BSS) and 100 mg of cefazolin and/or 20 mg of methylprednisolone sodium succinate, given subconjunctivally, at its completion. Another identified process associated with TASS was ultrasonic bathing, with 63% of facilities utilizing this practice (72). The most commonly performed cataract removal technique was PE, and 1 study highlighted the possible contamination between the aspiration and irrigation fluids due to a connection involving the respective tubes. Toxic endothelial cell destruction of the cornea after routine extracapsular cataract surgery. Eye (Lond) 2007;21:209213, 49. Aflibercept-Related Sterile Intraocular Inflammation Outcomes. Eye (Lond) 2009;23:10281031, 48. The authors recommended obtaining cultures from various IOLs as part of microbiological investigation for endophthalmitis clusters and using molecular biology techniques such as enterobacterial repetitive intergenic consensuspolymerase chain reaction to detect the source of infection more precisely. Miller JJ, Scott IU, Flynn HW Jr, Smiddy WE, Newton J, Miller D. Am J Ophthalmol. Poorly maintained autoclave generators with impurities in steam moisture were suspected to be the cause of eight TASS cases reported by Hellinger et al. Microsoft Excel was used to manage all collected data. Hatch WV, Cernat G, Wong D, Devenyi R, Bell CM. Please try again soon. retrospectively queried data from site visits and questionnaires from surgical centers that reported cases of TASS between 2007 and 2009. Mattos FB, Saraiva FP, Angotti-Neto H, Passos AF. Topical povidone-iodine may cause toxicity to the corneal epithelium. Am J Ophthalmol 2010;150:392398, 6. Methods: All patients were evaluated retrospectively to compare risk factors . The .gov means its official. Endothelium of paired rabbit corneas were perfused with enzymatic detergent as compared to corneas perfused with BSS (109). Endophthalmitis Reduction with Intracameral Moxifloxacin Prophylaxis: Analysis of 600 000 Surgeries. A cluster of nontuberculous mycobacterial endophthalmitis (NTME) cases after cataract surgery: clinical features and treatment outcomes. However, it remains uncertain whether the fluid solution is truly the most common source of endophthalmitis or this is just the most easily proven or reported etiology in the literature. Risk of endophthalmitis after cataract surgery using different protocols for povidone-iodine preoperative disinfection. The https:// ensures that you are connecting to the Cytotoxicity of cannulas for ophthalmic surgery after cleaning and sterilization: evaluation of the use of enzymatic detergent to remove residual ophthalmic viscosurgical device material. Acute-onset postoperative endophthalmitis with sutured corneal wound and hypopyon (arrow), Figure 2. It was unclear exactly how fluid solutions were contaminated, but several studies suggested contamination during the manufacturing process. J Clin Epidemiol 2012;65:934939, 22. Kutty PK, Forster TS, Wood-Koob C, et al. Intraocular transmission of exogenous pathogens in cataract surgery can lead to endophthalmitis. For the ocular surface, lower concentrations of povidone iodine administered as frequent applications during surgery are also shown to be effective in preventing contamination of the anterior chamber. Of the remainder, gram-negative species account for approximately 5% which includes Proteus, Haemophilus influenzae, and Pseudomonas (2,21). The Endophthalmitis Vitrectomy Study (EVS) reported final visual acuity of worse than 20/100 in 36% of patients (2). A review of preoperative manoeuvres for prophylaxis of endophthalmitis in intraocular surgery: topical application of antibiotics, disinfectants, or both? Ophthalmology 1998;105:522526, 36. Endophthalmitis Prophylaxis in Cataract Surgery: Overview of Current Practice Patterns Around the World. 2023 Mar 16;10:1110383. doi: 10.3389/fmed.2023.1110383. The mean age was 71.0 years (range: 66.0 to 74.6 years).15,2432 Across 6 studies that reported preexisting systemic diseases, 15 patients had diabetes and 6 had hypertension.25,26,28,29,31,32 Four of the 10 studies reported preexisting ocular diseases, such as glaucoma in 5 (13.5%) and diabetic retinopathy in 3 (8.1%) patients.25,26,28,31. With respect to the medical treatment of endophthalmitis, all 44 patients received intravitreal antibiotics, whereas only 19 patients (43.2%) from 1 study received intravitreal steroids.34 Vitrectomy was performed in 7 of 44 patients (15.9%), but only 1 patient (2.3%) underwent repeat vitrectomy. Wolters Kluwer Health The site is secure. In Europe there is a commercially available intracameral cefuroxime (Aprokam, Thea Pharmaceuticals), which alleviates some of these concerns. The mean age was 65.5 years (range: 63.4 to 71.4 years).14,3639 Across 4 studies that reported on preexisting systemic diseases, diabetes was the most frequently reported disease with 7 patients, followed by hypertension with 6 patients.14,36,38,39 Only Ji et al. Infection 2009;37:117122, 30. Postoperative infectious endophthalmitis and toxic anterior segment syndrome (TASS) are rare, but potentially sight-threatening complications of cataract and other intraocular surgery. Eleftheriadis H, Cheong M, Sandeman S, et al. Endophthalmitis is a rare eye infection after cataract surgery that can lead to significant vision loss. The damaged blades in the study by Hugonnet et al. Post-operative endophthalmitis is a rare but severe sight-threatening complication of ocular surgery e.g. Severe intraocular inflammation after intravitreal injection of bevacizumab. CAD = coronary artery disease; CHF = congestive heart failure; COAG = chronic open-angle glaucoma; COPD = chronic obstructive pulmonary disease; DM = diabetes mellitus; DME = diabetic macular edema; DR = diabetic retinopathy; ECCE = extracapsular cataract extraction; HBV = hepatitis B; HTN = hypertension; ICCE = intracapsular cataract extraction; N/A = not available; OA = osteoarthritis; OAG = open-angle glaucoma; PDR = proliferative diabetic retinopathy; PE = phacoemulsification; PSX = pseudoexfoliation; RA = rheumatoid arthritis; SICS = small-incision cataract surgery, ABX = antibiotics; AMB = amphotericin B; AMK = amikacin; CAZ = ceftazidime; CFZ = cefazolin; CHL = chloramphenicol; CIP = ciprofloxacin; CLR = clarithromycin; CRO = ceftriaxone; CXM = cefuroxime; GAT = gatifloxacin; GEN = gentamycin; IPM = imipenem; ITC = itraconazole; LVX = levofloxacin; MEM = meropenem; MEZ = mezlocillin; MIZ = miconazole; MXF = moxifloxacin; N/A = not available; NEO/PMB = neomycin/polymyxin B; NVCM = norvancomycin; OFX = ofloxacin; OR = operating room; OXA = oxacillin; phaco = phacoemulsification; TET = tetracycline; TGC = tigecycline; TMP/SMX = trimethoprim/sulfamethoxazole; TOB = tobramycin; TZP = piperacillin-tazobactam; U/K = unknown; VAN = vancomycin; VRC = voriconazole, CF = counting finger; HM = hand motion; LP = light perception; N/A = not available; NLP = no light perception; VA = visual acuity, BSS = a balanced salt solution; ERIC = enterobacterial repetitive intergenic consensus; FAFLP = fluorescent amplified fragment length polymorphism; N/A = not available; PCR = polymerase chain reaction, 1. Treatment with topical methylprednisolone every hour and polymyxin B sulfate/trimethoprim every four hours to the affected eye was initiated. Surv Ophthalmol. Study protocols were significantly different between articles, leading to variability in treatment protocols, sterilization standard, policy on instrument reuse, and resource allocation among other factors. The mean time to presentation with infectious features was 16.7 days (range: 8 to 20 days), and the baseline visual acuity at presentation was 1.46 0.85 logMAR (Snellen: 20/600). The personnel had failed to remove the used indicator tape, and thus, the drum containing the unsterile contents was returned to the operating room without being autoclaved. Intracameral vancomycin is associated with hemorrhagic occlusive retinal vasculitis (HORV) (48), and retinal toxicity is also associated with cefuroxime at high (49,50) and standard intracameral doses (51). All rights reserved, JRS_2021_07_19_PARK_1_SDC1.docx; [Word] (30 KB), Clinical features of endophthalmitis clusters after cataract surgery and practical recommendations to mitigate risk: systematic review, Articles in PubMed by Jeff Park, BHSc, MD(C), Articles in Google Scholar by Jeff Park, BHSc, MD(C), Other articles in this journal by Jeff Park, BHSc, MD(C), Privacy Policy (Updated December 15, 2022), Acne rosacea (1), chronic blepharitis (1), dry eye (1), glaucoma (1), PSX (1), sequels of trachoma (1), Glaucoma (3), corneal dystrophy (1), PDR (1), pterygium (1), COAG (1), DR (1), retinitis pigmentosa (1), High myopia (5), ocular trauma (1), PDR (1), HTN (3), dementia (1), DM (1), HBV carrier (1), OFX (15, 75); TOB (11, 55); GAT (4, 20); CHL & CIP (3, 15), NEO/PMB (3, 60); GEN (1, 20); U/K (1, 20), AMB (5, 100); MIZ (2, 40); AMK, CFZ & VAN (1, 20), Use molecular techniques such as PCR and sequencing analysis to reliably detect, identify and type fungal source of pathogen transmission, Use separately prepared fluid solutions and antibiotics for each surgery; intraocular cefuroxime may not be required as it may do more harm than good, Do not assume that commercially available solutions or medications are sterile and ensure proper sterilization before use, Consider compounded medications as potential source of an outbreak; use manufactured medications whenever possible, Use solutions prepared individually for each patient and obey rules of the sterilization process strictly, Obtain official statistical data on epidemic hospital infections to help implement preventive measures against large outbreaks, Critically evaluate the surgical procedures to prevent direct contamination of fluids and instruments, Be cautious of contamination in presterilized products; active involvement of governmental agencies and individual hospitals to ensure product sterility, Do not assume that solutions or medications are sterile and do not use the same solution for multiple surgeries.

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