Delayed-Onset Streptococcus Pyogenes Endophthalmitis Following Ahmed Glaucoma Valve Implantation (original) (raw)
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American Journal of Ophthalmology, 2014
PURPOSE: To report the clinical settings, antibiotic susceptibilities, and outcomes of endophthalmitis caused by Streptococcus species. DESIGN: Retrospective, observational case series. METHODS: Single-center study evaluating all patients with culture-positive endophthalmitis caused by Streptococcus species between January 1, 2000, and December 31, 2011.
Endophthalmitis caused by streptococcus pneumoniae
American Journal of Ophthalmology, 2004
PURPOSE: To investigate clinical settings, management strategies, antibiotic sensitivities, and visual acuity outcomes of endophthalmitis caused by Streptococcus pneumoniae. • DESIGN: Retrospective, observational case series. • METHODS: Records were reviewed of all patients with culture-positive endophthalmitis caused by Streptococcus pneumoniae treated at the Bascom Palmer Eye Institute between January 1, 1989 and December 31, 2003. MAIN OUTCOME MEASURES: Visual acuity and antibiotic sensitivities. • RESULTS: Twenty-seven eyes of 27 patients met study inclusion criteria. The median follow-up was 7 months (range, 3 months to 10 years). Clinical settings included acute postoperative (10 eyes), corneal stitch abscess (5), corneal ulcer (3), bleb-associated (4), post-trauma (3), and endogenous . Eighteen cases (67%) were acuteonset (less than 3 weeks from event), with a median interval between event and presentation of endophthalmitis of 5 days (range, 1 day to 16 days). Nine cases (33%) were delayed-onset (median, 27 months; range, 3 to 121 months). Initial visual acuity was hand motions or better in 11 cases (41%). Initial therapeutic procedures included vitreous tap and injection of intravitreal antibiotics in 15 eyes (56%), pars plana vitrectomy and injection of intravitreal antibiotics in 10 eyes (37%), and evisceration in 2 eyes (7%). Seventeen (68%) of 25 eyes received intravitreal dexamethasone. Twelve patients (48%) received additional doses of intraocular antibiotics, and 11patients (44%) underwent secondary surgical intervention within one week of diagnosis. The Streptococcus pneumoniae isolates showed sensitivity patterns as follows: 27/27 vancomycin, 13/13 clindamycin, 6/6 cefazolin, 11/11 ciprofloxacin, 14/14 moxifloxacin,
Streptococcus salivarius endogenous endophthalmitis
BMJ Case Reports, 2021
We describe a case of endogenous endophthalmitis in an elderly man caused by Streptococcus salivarius. An 88-year-old male patient with diabetes with iron deficiency anaemia and history of transcatheter aortic valve implantation presented with an insidious clinical picture of atraumatic endophthalmitis. No internal or external source could be identified. Diagnostic and therapeutic vitrectomy revealed papillomacular abscess and vitreous fluids grew S. salivarius. Despite lack of an identifiable source of infection, a high index of suspicion for atypical presentations is required in patients with multiple comorbidities that could weaken their immune system towards opportunistic infections. Early detection, microbiological evaluation and prompt treatment are critical to avoid disastrous outcomes. While S. salivarius has been implicated in cases of exogenous endophthalmitis, this is the first reported case of endogenous endophthalmitis due to S. salivarius.
Staphylococcus epidermidis endophthalmitis following intraocular lens implantation
British Journal of Ophthalmology, 1980
A 90-year-old man developed a hypopyon following cataract extraction with intraocular lens implantation. The hypopyon cleared with topical corticosteroid therapy but recurred whenever the corticosteroid therapy was reduced. At surgery for the removal of the intraocular lens an opaque anterior vitreous membrane was excised. Cultures of the anterior vitreous grew Staphylococcus epidermidis. The diagnosis was further confirmed by the histology of the anterior vitreous membrane, which showed Gram-positive cocci in the macrophages and polymorphonuclear leucocytes. This case shows that corticosteroids may completely mask an endophthalmitis from an organism of low virulence such as Staphylococcus epidermidis. Endophthalmitis from an organism of low virulence should be considered in any case of persistent postoperative inflammation.
Endophthalmitis associated with the Ahmed glaucoma valve implant
British Journal of Ophthalmology, 2005
To investigate the rate, risk factors, clinical course, and treatment outcomes of endophthalmitis following glaucoma drainage implant (GDI) surgery. Methods: A computerised relational database search was conducted to identify all patients who were implanted with Ahmed glaucoma valve (AGV) and developed endophthalmitis following surgery at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, between 1 January 1994 and 30 November 2003. Only medical records of the patients who developed endophthalmitis were retrospectively reviewed. Results: 542 eyes of 505 patients who were on active follow up were included in the study. Endophthalmitis developed in nine (1.7%) eyes; the rate was five times higher in children than in adults. Delayed endophthalmitis (developed 6 weeks after surgery) occurred in eight of nine eyes. Conjunctival erosion overlying the AGV tube was present in six of nine eyes. Common organisms isolated in the vitreous included Haemophilus influenzae and Streptococcus species. Multiple regression analysis revealed that younger age and conjunctival erosion over the tube were significant risk factors associated with endophthalmitis. Conclusion: Endophthalmitis is a rare complication of GDI surgery that appears to be more common in children. Conjunctival dehiscence over the GDI tube seems to represent a major risk factor for endophthalmitis. Prompt surgical revision of an exposed GDI tube is highly recommended.
Post-operative ocular infection due to Streptococcus dysgalactiae subspecies equisimilis
The Journal of Infection in Developing Countries, 2011
Ocular infections due to Streptococcus dysgalactiae subsp. equisimilis are rare. In the present report, three patients with a history of uncomplicated small incision cataract surgery with intraocular lens implantation developed exogenous endophthalmitis due to Streptococcus dysgalactiae subsp. equisimilis. The identification of the organisms was confirmed by PCR for a 16S rRNA sequence specific to the species S. dysgalactiae. Intravitreal treatment of cefazolin and amikacin, in addition to topical ofloxacin and tobramycin, resulted in resolution of infection in all three patients. Our reports indicate the importance of bacterial culture and molecular identification in the diagnosis of S. dysgalactiae subsp. equisimilis infection in the eye.
Pyogenic Granuloma Formation Following Ahmed Valve Glaucoma Implant
Journal of Glaucoma, 2019
Ocular pyogenic granuloma is a benign tumor seen after ocular insult secondary to ocular surgeries, trauma or infection. Although benign, intervention is sometimes necessary. Previous authors have reported pyogenic granuloma formation following oculoplastic surgeries. We report a pyogenic granuloma after an Ahmed glaucoma valve implantation. A 65-year-old gentleman presented with right eye redness associated with pain and swelling~2 months after Ahmed glaucoma valve implantation. Examination found a sessile growth on the tube extruding puss with signs of endophthalmitis. The glaucoma drainage device was explanted and culture results grew Staphylococcus aureus. This article discusses the formation of pyogenic granuloma on a glaucoma drainage device and its management.
Clinical features of Streptococcus pyogenes keratitis: Case series
Contact Lens and Anterior Eye, 2019
To characterize the risk factors, clinical presentations, management, outcomes, and microbiological properties of Streptococcus pyogenes keratitis. Methods: Eight culture-proven cases (eight eyes) of S. pyogenes keratitis were diagnosed and treated between 2008 and 2018 at the University of Pittsburgh Medical Center (UPMC). Medical records were available for six patients, and these were reviewed to identify demographic information, systemic and ocular history, clinical presentations, antibiotic sensitivity, treatments, and outcomes of S. pyogenes isolates. Results: Of the six charts reviewed, the median patient age was 67 years and all patients were female. Four patients had a history of cataract extraction more than one year prior to presentation, one had a history of improper contact lens use, and one had basement membrane dystrophy. Two patients, who also happened to have the most serious medical comorbidities, presented with corneal perforation on initial examination. The median follow-up length was 90.5 days. Visual outcomes varied greatly between patients. Three patients had visual acuity ranging from 20/30 to 20/70, while the two patients with corneal perforation had a final visual acuity of light perception, and one patient was lost to follow-up. Five of six isolates were susceptible to fluoroquinolones and all isolates were susceptible to cefazolin. Conclusions: S. pyogenes represented an uncommon ocular pathogen at UPMC eye clinic. However, if left untreated, this infection resulted in severe ocular morbidity. The majority of patients had a benign ocular history, suggesting that S. pyogenes can infect healthy corneas in immunocompetent patients. The majority of isolates were susceptible to cefazolin and fluoroquinolones.