Classification of uveitis
Gwyn Samuel Williams, Mark Westcott, Carlos Pavesio, Bushra Thajudeen in Practical Uveitis, 2017
Just as inflammation can spread from one part of the uveal tract to another it can also spread inwardly and outwardly. To complicate things further the term ‘posterior uveitis’ is imprecisely and confusingly used to describe inflammation anywhere in the back of the eye and can occur with or without involvement of the choroid. For example, inflammation primarily involving the retina, retinitis, can occur either in isolation, without involvement of the choroid, or secondarily to inflammation in the choroid. Similarly, primary inflammation of the choroid can spread to involve the retina secondarily to cause a retinitis. The same is true for posterior spread to involve the outer coat, the sclera. Endophthalmitis is a condition where the entirety of the inside of the eye is inflamed such that the layer most affected cannot be discerned. In this condition the outermost coat, the sclera, is not yet heavily involved. Panophthalmitis is where the inside of the eye and all three coats are inflamed. Although strictly speaking the uveal tract is one distinct layer of the eye, the term ‘uveitis’ rather confusingly is often applied to any intraocular inflammation, in much the same way as ‘America’ can be a term applied to either the country or the continent.
Management of endophthalmitis
A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha in Vitreoretinal Surgical Techniques, 2019
Endophthalmitis is an inflammatory response to bacterial, fungal, parasitic, or viral invasion of the eye. The micro-biology varies, depending on the etiology. Five major categories are: postoperativebleb-associatedtrauma-associatedendogenous (metastatic)post-intravitreal injection-associated (triamcinolone acetonide, pegaptanib, Lucentis (ranibizumab), and recombinant tissue plasminogen activator)1–;4
Endophthalmitis
Glenn J. Jaffe, Paul Ashton, P. Andrew Pearson in Intraocular Drug Delivery, 2006
Endophthalmitis is an uncommon, but perhaps the most feared complication of ocular surgery. Endophthalmitis is defined as a microbial infection involving the vitreous cavity: organisms are often isolated from anterior chamber as well. Retinal, choroidal, and scleral invasion can also occur. Most cases of endophthalmitis occur after elective ocular surgery. In the first six weeks after operation, endophthalmitis is caused by microbes introduced into the eye during the time of the surgery or in the immediate postoperative period before the wound is securely sealed. Delayed onset or chronic endophthalmitis can occur as the result of slow-growing bacteria such as Propionibacterium acnes. Occasionally, bacterial endophthalmitis has a late onset and some delayed cases are caused by fungi. The second most common cause of endophthalmitis is penetrating ocular trauma, while infected filtering blebs constitute a less common but clinically significant presentation. The least common form of endophthalmitis is the endogenous type. These infections may be either bacterial or fungal, originating from an infection elsewhere in the body transmitted to the eye by hematogenous route.
Diagnosis and management of fungal endophthalmitis: India perspective
Published in Expert Review of Ophthalmology, 2020
Taraprasad Das, Manisha Agarwal, Umesh Behera, Harsha Bhattacharjee, Muna Bhende, Anthony V. Das, Vivek P. Dave, Avantika Dogra, Anup K. Ghosh, Sneha Giridhar, Joveeta Joseph, Kaustubh Kandle, Roshni Karoliya, Prajna Lalitha, Avinash Pathengay, Savitri Sharma, Lily Therese
Endophthalmitis is defined as inflammation of the inner layers of the eye and intravitreal colonization by microorganisms. Based on the mode of entry of microorganism it could be ‘exogenous’ (entry of infecting microorganism from outside) or ‘endogenous’ (entry of infecting microorganism from inside). Depending on the incriminating event, exogenous endophthalmitis is labeled ‘postoperative’ (after intraocular surgery) and ‘post traumatic’ (after trauma). Based on the time of onset, postoperative endophthalmitis could be of ‘acute’ onset (infection within 6 weeks of primary event) or ‘delayed’ onset (infection after 6 weeks of primary surgery). Fungal endophthalmitis is less common than bacterial endophthalmitis. It is infrequently reported from Europe and North America [1,2], compared to Asia [3,4] and India has reported more fungal endophthalmitis than other Asian countries [5,6].
Detection and treatment of Candida auris in an outbreak situation: risk factors for developing colonization and candidemia by this new species in critically ill patients
Published in Expert Review of Anti-infective Therapy, 2019
Alba Ruiz-Gaitán, Héctor Martínez, Ana María Moret, Eva Calabuig, María Tasias, Ana Alastruey-Izquierdo, Óscar Zaragoza, Joan Mollar, Juan Frasquet, Miguel Salavert-Lletí, Paula Ramírez, José Luis López-Hontangas, Javier Pemán
Currently, in accordance with several therapeutic guidelines, candidemia management includes not only early antifungal therapy but also a wide bundle of measures: (i) source control such as effective drainage of collections, and CVC or other devices removal, as early as it is possible, when they are the presumed source; (ii) ophthalmologic examination to look for evidence of endophthalmitis; (iii) follow-up blood cultures every other day after initiating therapy in order to determine the date of sterilization; (iv) if blood cultures remain positive, then a search for a metastatic focus, such as an abscess or endocarditis, must be undertaken [43,44]. In all our C. auris candidemia episodes the above-mentioned measures were applied in addition to appropriate antifungal treatment (Table 3). Table 4 summarizes the antifungal agents presently available to treat C. auris candidemia. All patients were initially treated with an echinocandin, but due to its poor outcome in 45% of the cases a second antifungal agent, liposomal amphotericin B (35.4%) or isavuconazole (10.1%) had to be added. However, if C. auris is colonizing a patient and there is no evidence of infection, treatment is generally not indicated [45].
Endophthalmitis: Microbiology and Organism Identification Using Current and Emerging Techniques
Published in Ocular Immunology and Inflammation, 2023
Christine L. Tan, Harsha Sheorey, Penelope J. Allen, Rosie C. H. Dawkins
Currently, endophthalmitis is diagnosed by careful history and examination that is confirmed in the laboratory by conventional microbiological techniques. The processes of microscopy (Gram’s staining), culture and sensitivities (MCS) from aqueous or vitreous samples are well established in clinical laboratories and remain the gold standard for organism identification in endophthalmitis. The difficulty is such that organism identification rates by microbial culture vary remarkably from center to center; these have been documented to vary between 22.5–36.5% for aqueous samples and 42.0–88.2% for vitreous samples.1–5 In the landmark Endophthalmitis Vitrectomy Study (EVS), microbiology results showed that 69% of the cases overall had a positive bacterial culture, whilst 13% had probable contaminants (described as “equivocal” growth) and 18% had no growth.6 Local studies from the Sydney Eye Hospital have produced a culture positivity of 45% and 54% in the context of post-operative and post-injection endophthalmitis, respectively.7 Collectively, these results show that up to half of suspected endophthalmitis can be culture-negative.
Related Knowledge Centers
- Candidiasis
- Cataract Surgery
- Conjunctiva
- Eye
- Pus
- Visual Impairment
- Hypopyon
- Eye Surgery
- Slit Lamp
- Panophthalmitis