doi: 10.1097/MD.0000000000029932. Enucleation during Panophthalmitis Suppurativa Trans Am Ophthalmol Soc. Strengths in managing this complicated case can also be noted. Furthermore, there were similar rates of complications and successful prosthesis fittings between experienced staff and resident trainees. All content published within Cureus is intended only for educational, research and reference purposes. Evisceration with primary implant placement in patients with endophthalmitis. The duration of treatment should be three weeks for uncomplicated bacteremia and six to eight weeks for patients with metastatic infection[10]. WebSymptoms With penetrating wounds of the eyeball, panophthalmitis develops rapidly, within 2-3 days. Catheter-related bloodstream infections are among the lethal complications of central venous catheter use. *Correspondence: Orapan Aryasit, Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand (e-mail: Received 2021 Sep 29; Revised 2022 May 23; Accepted 2022 Jun 15. Panophthalmitis Severe inflammation of the anterior and posterior Unable to load your collection due to an error, Unable to load your delegates due to an error. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Multivariate analysis demonstrated that Pseudomonas aeruginosa infection (P = .02, adjusted odd ratio [aOR] = 33.75) and not receiving intravitreal antimicrobial drugs before the eye removal procedure (P = .02, aOR = 30.11) were associated with implant exposure or extrusion. The authors have no conflicts of interest to disclose. The factors related to implant exposure or extrusion were P aeruginosa infection (P=.02, aOR = 33.75) and not receiving intravitreal antimicrobial drugs before the eye removal procedure (P=.02, aOR=30.11). Schellini S, El Dib R, Silva LR, Farat JG, Zhang Y, Jorge EC. Curr Opin Ophthalmol. PMC Diagnosis as endophthalmitis or panophthalmitis was not associated with surgical outcomes in our study, which might be due to a tendency to perform enucleation in patients with panophthalmitis. Endogenous panophthalmitis is a rare sightthreatening condition usually associated with patients with comorbidities such as diabetes mellitus, intravenous drug There were 35 cases of B. cereus eye infection reported in the 20 th century, of which 70% resulted in vision loss due to enucleation. 2008 Dec;27(10):1200-3. doi: 10.1097/ICO.0b013e318180e5a1. This study suggests that evisceration or enucleation with primary implant placement in patients with recalcitrant endophthalmitis or panophthalmitis can be performed by resident trainees with acceptable surgical outcomes and a low rate of serious complications. Microbiological techniques for staining and culture specimens from the eye should be obtained to identify the causative agent; however, it should not delay empiric antibiotic treatment initiation [5]. Evisceration with Primary Orbital Implant in Fulminant Endophthalmitis/Panophthalmitis. Enterococcus faecalis endophthalmitis as a metastatic complication of hemodialysis vascular access-related sepsis: A case report and review of the literature. Rehman R, Schmidt RJ, Moss AH. However, other accesses with foreign material and non-access-related infections should also be considered. Careers, Unable to load your collection due to an error. Both endophthalmitis and panophthalmitis have poor prognoses and can result in complete vision loss[8]. Outcomes of evisceration or enucleation by resident trainees in patients with recalcitrant endophthalmitis or panophthalmitis. All operations were performed, with patients under general anesthesia, by residents under the supervision of at least 1 supervising senior resident and/or ophthalmology consultant. Accessibility Evisceration was the operation of choice for the removal of infectious eyes without the presence of scleral melting or necrosis. Additional topical treatment consisted of dorzolamide-timolol, brimonidine, latanoprost, and atropine. Gajdzis M, Figua K, Kamiska J, Kaczmarek R. J Clin Med. Furthermore, 5 (63%) out of 8 patients were diagnosed with panophthalmitis. The .gov means its official. Disclaimer. sharing sensitive information, make sure youre on a federal Epub 2019 Nov 22. The spectrum of infections in catheter-dependent hemodialysis patients. Please enable it to take advantage of the complete set of features! National Library of Medicine A Case of Escherichia coli Endogenous Panophthalmitis and Orbital Cellulitis With Normal Workup for Primary Focus. Thirty-six (55%) out of 66 patients were diagnosed with panophthalmitis. HHS Vulnerability Disclosure, Help 2005 May;21(3):220-6. doi: 10.1097/01.iop.0000159174.80985.e2. and O.A. Ethics approval was provided by the Ethics Committee, Faculty of Medicine, Prince of Songkla University. All decisions to perform enucleation or evisceration were made by the ophthalmology consultant. Citations Metrics Reprints & Permissions Get access ABSTRACT There are various orbital implant options following enucleation. Diabetic retinopathy could be considered a confounding factor and seeking medical evaluation two months after the beginning of symptoms likely contributed to the worse outcome. Bookshelf Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Inclusion in an NLM database does not imply endorsement of, or agreement with, The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The indications for evisceration and enucleation are still evolving and controversial. 10.1097/ICU.0b013e32833b7a56 Typical disadvantages of dialysis catheters when compared to AVFs/grafts include decreased blood flow rate leading to decreased dialysis efficiency and increased risk of complications, including thrombosis, catheter dysfunction, and CRBIs[14]. -, Fu R, Childs J, Nunery W, et al. -, Shore JW, Dieckert JP, Levine MR. Analysis was performed using STATA version 14 (StataCorp LP, College Station, TX). Panophthalmitis shown by involvement of the vitreous cavity and all coats of the eye including the sclera. Enucleation PLoS One. Empirical intravitreal antibiotics should cover gram-positive and gram-negative organisms when the etiology remains unknown, including vancomycin and ceftazidime[5]. This study suggests that evisceration or enucleation with primary implant placement in patients with recalcitrant endophthalmitis or panophthalmitis can be performed by resident trainees with acceptable surgical outcomes and a low rate of serious complications. Painful blind eye is a major therapeutic dilemma for an ophthalmologist. Endophthalmitis treatment consists of intravitreal antibiotics injections and, in selected circumstances, pars plana vitrectomy. Endogenous Endophthalmitis-The Clinical Significance of the Primary Source of Infection. [4] Primary orbital implantation has been performed recently in cases of endophthalmitis or panophthalmitis, with satisfactory outcomes and an acceptable rate of complications. We also compared the surgical outcomes and complications between resident trainees and experienced staff. The https:// ensures that you are connecting to the Thus, physicians should be aware of and consider endogenous endophthalmitis/panophthalmitis among the differential diagnosis in symptomatic patients with risk factors. Acanthamoeba panophthalmitis Right eye ophthalmitis was treated with intravitreal moxifloxacin. 2022 Jun 16;8(6):641. doi: 10.3390/jof8060641. The purpose of this study was to evaluate the rate of implant exposure or extrusion and the predictive factors related to implant exposure or extrusion in connection to eviscerations or enucleations with primary implants, performed by resident trainees on patients with recalcitrant endophthalmitis or panophthalmitis. Two patients with silicone orbital implants had extrusions; one was successfully managed with a secondary dermis-fat graft, and another patient who refused additional treatment was allowed to heal by secondary intention after the implant was removed. Proc (Bayl Univ Med Cent). [2], The management of fulminant endophthalmitis or panophthalmitis, which is refractory to other medical treatments, is evisceration or enucleation, in order to eradicate the infection. Saleem MR, Mustafa S, Drew PJ, Lewis A, Shah Y, Shankar J, Ahmed W. Ultrasonographic characteristics of eyes with endophthalmitis. Panophthalmitis is the most extensive ocular involvement in endophthalmitis with inflammation in periocular tissues. Bethesda, MD 20894, Web Policies An official website of the United States government. Ophthalmology recommended left eye intervention with enucleation and debridement. Risk Factors Leading to Enucleation or Evisceration in Infectious Endophthalmitis. Orbit. Overall, these findings were concerning for infectious panophthalmitis. His symptoms progressively worsened, which resulted in his hospitalization at the beginning of 2022. Frequently, nonspecific symptoms might delay the conditions diagnosis, resulting in worse outcomes. Ethical and legal obligation to avoid long-term tunneled catheter access. The temporary catheter was intact and in place, with no infectious signs. Bloodstream dissemination of the causative agent(s) can result in metastatic complications, with endocarditis, vertebral osteomyelitis, and spinal epidural abscess among the most common complications [1]. If nonviable sclera was present, then the operation was shifted to enucleation. Panophthalmitis The average number of intraviteal injections was 1.6 (range: 14). A new CT maxillofacial without contrast (Figure1) revealed an enlarged and proptotic left globe with scleral irregularity and swelling extending into the post-septal and intraconal space. 2010 Sep;21(5):375-9. doi: 10.1097/ICU.0b013e32833b7a56. The one report that did not result in eye evisceration also had a poor outcome, with significant impairment of the patients vision[4]. 8600 Rockville Pike The causes of endophthalmitis consist of endogenous and exogenous causes, such as direct trauma, intraocular surgery, and adjacent infection. Eleven patients received hydroxyapatite implants; 11 patients received silicone implants. The right globe revealed no evidence of malignancy. Positive methicillin-resistant Staphylococcus aureus (MRSA) blood cultures were thought to be secondary to a catheter-related bloodstream infection originating from his TDC. the contents by NLM or the National Institutes of Health. The MRSA bloodstream infection was diagnosed by the first blood cultures obtained at his external hospitalization and the right eye infection were successfully treated with antibiotic therapy. Semin Ophthalmol. the contents by NLM or the National Institutes of Health. enucleation Endophthalmitis progressing to panophthalmitis: clinical features, demographic profile, and factors predicting outcome. A few cases of endophthalmitis as a complication of bacteremia related to a TDC have been reported[4,15-17]. His uncontrolled diabetes can weaken the immune response, allowing for an aggressive bacterial infection spread. See this image and copyright information in PMC. Eighteen patients were diagnosed with EBP, with liver abscesses in eight patients, retroperitoneal infection in four, pneumonia in two, infective endocarditis in one, cellulitis in one, drug abuse in one, and mycotic pseudoaneurysm in one. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Common Practices Among Oculofacial Surgeons The decision to proceed with left eye enucleation and left orbit debridement was necessary, given the failure of antibiotic treatment after three weeks. Would you like email updates of new search results? Multivariate analysis demonstrated that Pseudomonas aeruginosa infection (P = .02, adjusted odd ratio [aOR] = 33.75) and not receiving intravitreal antimicrobial drugs before the eye removal procedure (P = .02, aOR = 30.11) were associated with implant exposure or extrusion. [9] This might be due to the higher proportion of panophthalmitis patients, which consisted of 55% with panophthalmitis in our study versus 22% with panophthalmitis in a previous study. 2015;34(5):279-83. doi: 10.3109/01676830.2015.1078366. Categorical variables were compared by Pearson chi-square test and Fisher exact test. Four days later, when blood cultures did not result in any organism, piperacillin-tazobactam was replaced by daptomycin targeting MRSA specifically since his initial blood cultures were positive for the organism. In regards to the sample size calculation, we aimed to detect an implant retention rate of 97%. Sixty-six patient records, median age of 46.8 years, who underwent eye removal by resident trainees were reviewed. He was discharged to a skilled nursing facility, with a follow-up appointment scheduled with the ophthalmologist, and he continued HD via a TDC. By joining Cureus, you agree to our Clinical characteristics of endogenous Klebsiella pneumoniae endophthalmitis: a 13-year experience. Disclaimer. Br J Ophthalmol. Unable to load your collection due to an error, Unable to load your delegates due to an error. Daptomycin was discontinued a few days later in favor of starting vancomycin, given that it would be easier to dose with HD. 2005;33:59. Allon M, Brouwer-Maier DJ, Abreo K, et al. Copyright 2022 the Author(s). a Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand. The most common pathogens were P aeruginosa and Escherichia coli. Allon M. Tunnelled haemodialysis catheter bacteraemia: risk factors for bacteraemia recurrence, infectious complications and mortality. JCM | Free Full-Text | Risk Factors Leading to Enucleation or - MDPI Enucleation or evisceration was the only remaining viable treatment option when all options to salvage the eye had been exhausted. Published by Wolters Kluwer Health, Inc. The predictive factors affecting implant exposure or extrusion were Pseudomonas aeruginosa infection and not receiving intravitreal antimicrobial drugs before the eye removal procedure. Re: "Enucleation with primary implant for treatment of recalcitrant endophthalmitis and panophthalmitis". There is no evidence of thrombosis or superior ophthalmic veins or cavernous sinus thrombosis in this study. He used a tunneled dialysis catheter (TDC) for hemodialysis for approximately 12 months. Culture results were positive for Klebsiella pneumoniae in 12 patients, Streptococcus spp. Four patients (6%) had implant exposure, and 4 patients (6%) had implant extrusion. The TDC was replaced by a non-tunneled temporary catheter in his right internal jugular (RIJ) vein. The potential of porous implants in reducing implant extrusion due to vascular ingrowth has been previously discussed. Treatment of panophthalmitis can be divided into systemic or topical antibiotic therapy that crosses the blood-eye barrier. In 1988, Shore et al[14] performed delayed wound closure in 3 patients who had successful outcomes, but 1 patient underwent primary closure, which developed wound dehiscence and implant extrusion at 6 weeks postoperatively. His physical examination revealed bilateral eyelid swelling, worse on the left side, with drainage of purulent secretion. Among the most frequent and lethal complications from central venous catheters (CVCs) include catheter-related bloodstream infections (CRBIs).
Pioneers Hockey Camp Cost,
Cornell Law My Information,
Nyu Cas Valedictorian,
Articles P
