Endophthalmitis : A Guide to Diagnosis and Management

400 Pages·2018·12.629 MB·English

by  Taraprasad Das (eds.)

Taraprasad Das
Editor
Endophthalmitis
A Guide to Diagnosis
and Management
Forewords
Harry W. Flynn Jr.
Narsing A. Rao
123
Endophthalmitis
Taraprasad Das
Editor
Endophthalmitis
A Guide to Diagnosis and Management
Editor
Taraprasad Das
LV Prasad Eye Institute
Hyderabad, India
ISBN 978-981-10-5259-0 ISBN 978-981-10-5260-6 (eBook)
https://doi.org/10.1007/978-981-10-5260-6
Library of Congress Control Number: 2017956571
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Foreword 1
Endophthalmitis is an important sight-threatening complication with multiple eti-
ologies. Early diagnosis and treatment may help in achieving good anatomic and
visual outcomes in these patients. The purpose of this book is to provide clinically
useful information which will help clinicians, fellows, and residents in decision
making and the management of patients with endophthalmitis. All the authors of
this book are well-known in their respective fields and have provided focused dis-
cussion on various endophthalmitis issues.
Part I of this book provides insight into the clinical features, epidemiology, dif-
ferential diagnosis, and management of endophthalmitis with respect to different
geographical areas of the world. Part II has chapters dedicated to specific endo-
phthalmitis scenarios. Part III to V describe pharmacology, microbiology, and
pathology in detail. Discussion of prophylaxis and clinical trials is elaborated in
Parts VI and VII of the book. All the book chapters have been carefully edited by
Dr. Taraprasad Das (vice chairman) of the LV Prasad Eye Institute who is a widely
recognized vitreoretinal expert.
Endophthalmitis: A Guide to Diagnosis and Management will be a valuable
resource for clinicians in the management of endophthalmitis.
Harry W. Flynn Jr., M.D.
Department of Ophthalmology, Bascom Palmer Eye Institute,
University of Miami, Miller School of Medicine,
Miami, FL, USA
v
Foreword 2
It is a great pleasure to write foreword for the book Endophthalmitis: A Guide to
Diagnosis and Management edited by the globally recognized expert on intraocular
infections, Dr. Taraprasad Das. This is a comprehensive book on a dreaded compli-
cation in the ophthalmic field. By virtue of contributions from experts in the field of
diagnosis and treatment of endophthalmitis, it provides state-of-the-art current and
evolving surgical and nonsurgical interventions in preventing visual loss from infec-
tious endophthalmitis.
The book is unique in presenting in depth exogenous endophthalmitis from cata-
ract surgery, pars-plana vitrectomy, intravitreal drug deliveries, glaucoma filtering
procedures, and accidental penetrating injuries. The authors introduce the topics in
an orderly fashion with introduction, incidence/prevalence, microbiology spectrum
for the above surgical interventions, prophylaxis, and treatment followed by perti-
nent conclusions. Importantly, several chapters include global trends in prophylaxis
and specific antimicrobial use in cataract surgery.
The orderly presentation of each chapter allows readers to grasp clinically rele-
vant details, controversies in prophylaxis and treatment, and geographic variations
in current endophthalmitis management. The presence of several tables and graphs
highlighting a spectrum of infectious agents in various surgically related exogenous
endophthalmitis is helpful to both clinicians and microbiologists in establishing a
proper etiologic diagnosis and antimicrobial treatment options. Moreover, the chap-
ters providing critical reviews of various clinical trials, particularly two-decades-old
important endophthalmitis vitrectomy study, help young and established ophthal-
mologists in understanding the evolution of current treatment modalities of endo-
phthalmitis. Interestingly the chapters emphasize the current relevance of decade-old
clinical trials on endophthalmitis and the impact of current improved vitrectomy
procedures and recognition of ever-evolving antibiotic resistances in the manage-
ment of bacterial endophthalmitis.
Congratulations to Dr. Taraprasad Das for assembling the experts who provided
the chapters with recent advances succinctly and including tables, graphs, and illus-
trations. The book will be useful in clinical settings globally for ophthalmologists,
internists, ophthalmology residents, fellows, and laboratory personnel in detecting
vii
viii Foreword 2
infectious agents from ocular fluids. The clinicians faced with endophthalmitis
should find the book very helpful in patient care to prevent visual loss from intra-
ocular infections.
Narsing A. Rao, M.D.
Department of Ophthalmology and Pathology, USC Roski Eye Institute
University of Southern California
Los Angeles, CA, USA
Preface
Endophthalmitis is an intraocular inflammation with exudation in the vitreous cav-
ity and an intraocular colonization of microorganisms. It could occur due to any
intraocular surgery, trauma, and occasionally infection at the remote site of the
body. Post-cataract surgery endophthalmitis is by far the commonest because of the
sheer number of cataract surgeries performed in the world. For similar reasons most
prospective studies, either for prevention or treatment, have been done in
post- cataract surgery endophthalmitis. With better understanding of pathogenesis,
availability of superior drugs delivered at site, safer surgical techniques, and tech-
nologies, the incidence of endophthalmitis has reduced significantly from 2% in the
1940s to around 0.05% today. Despite these advances endophthalmitis is a dreaded
condition that results in increased cost to the patients and to care providers and in
loss of vision and/or the eye.
Endophthalmitis. A Guide to Diagnosis and Management is a comprehensive
book on the subject. The book has seven sections: General Features, Specific
Endophthalmitis, Science of Endophthalmitis Treatment, Prophylaxis and
Prevention and Clinical Trials in Endophthalmitis. Each section editor has domain
expertise in the subject.
Part I, General Features, comprises of six chapters that deal with the definition,
general management, and differentiation from toxic anterior segment syndrome
(TASS). Special chapters include the epidemiology and treatment trends in Asia,
Europe, and North America. These chapters have documented the current practice
of endophthalmitis care in the different continents of the world.
Part II, Specific Endophthalmitis, comprises of 14 chapters that deal with spe-
cific endophthalmitis caused by the most common etiology such as intraocular sur-
gery (cataract, glaucoma filtration, penetrating keratoplasty, vitrectomy, intravitreal
injection) and trauma and/or most common microorganisms such as fungus,
Gram-n egative bacteria, methicillin-resistant Staphylococcus aureus (MRSA),
Nocardia, and Bacillus. Special chapters deal with endophthalmitis in children and
cluster infection.
Part III to V, Science of Endophthalmitis Treatment, comprises of eight chapters
that deal with the pharmacology, microbiology, and pathology of endophthalmitis.
ix
x Preface
Pharmacokinetics of drugs used in endophthalmitis and intravitreal antibiotics in
endophthalmitis describe the science and rationality of antibiotic therapy in endo-
phthalmitis. The microbiology section includes the techniques of sample collection
and processing, basic microbiology of common infecting microorganisms and the
global trends in microbial susceptibility.
Part VI, Prophylaxis and Prevention of Endophthalmitis, comprises two chapters
that include the current knowledge and practice of endophthalmitis prophylaxis and
the standard of care guidelines for safe intraocular surgery.
Part VII, Clinical Trials, comprises five chapters. Following the basic facts of
clinical trials, the results of four clinical trials, two on prophylaxis and two on treat-
ment, are analyzed for their value in clinical practice.
This comprehensive book could have not been possible without the help of all
authors and section editors, nationally and internationally. Dr. Naren Aggarwal and
Ms. Sowmya Ramalingam from Springer were exceptionally good in shaping the
book from concept to production. I owe it all to my patients who not only trusted in
my skills but also taught me a lot on the ground. I owe special thanks to Professor
Harry W Flynn Jr from the University of Miami and Professor Narsing A. Rao, from
the University of South California, the world experts in inflammation, infective
endophthalmitis management and eye pathology for writing the forewords. All
authors of this book think that the book will be useful to all in-training and practic-
ing ophthalmologists.
Hyderabad, India Taraprasad Das, M.D.
June 2017
Contents
Part I General Features
1 Definition, Signs, and Symptoms of Endophthalmitis ............. 3
Vivek P. Dave and Taraprasad Das
2 Management of Endophthalmitis ............................. 9
Vivek P. Dave and Taraprasad Das
3 Toxic Anterior Segment Syndrome (TASS)
and Noninfectious Endophthalmitis ........................... 23
Vivek P. Dave
4 Epidemiology and Treatment Trend of Endophthalmitis in Asia .... 29
Jay Siak, May Zun Aung Win, and Soon-Phaik Chee
5 Epidemiology of Endophthalmitis and Treatment
Trend in Europe ........................................... 45
Andrzej Grzybowski and Magdalena Turczynowska
6 Epidemiology and Treatment Trends in North America ........... 57
Robert Raut and Derek Kunimoto
Part II Specific Endophthalmitis
7 Post-cataract Surgery Endophthalmitis ........................ 81
Subhadra Jalali
8 Blebitis and Bleb Related Endophthalmitis ..................... 93
Sirisha Senthil and Prashant Garg
9 Traumatic Endophthalmitis .................................. 101
Tapas R. Padhi
10 Endogenous Endophthalmitis ................................ 109
Soumyava Basu
xi