بسم الله الرحمن الرحیم

اند وفتالمیت =یوئیت وحشتناک ENDOPHTHALMITIS اند وفتالمیت =یوئیت وحشتناک

د کتر علی صالحی

اندوفتالمیت The term refers to intraocular inflammation predominantly involving the vitreous cavity and A/C, as a result of intraocular colonization by micro organisms.

اندوفتالمیت Is a serious condition that can result in permanent and dramatic loss of vision. Early diagnosis and treatment are 2 of the most important factors related to good visual outcomes.

Diagnosis   Endophthalmitis is a clinical diagnosis that is confirmed by positive aqueous or vitreous culture. However, a negative culture does not exclude the diagnosis

Signs and symptoms Decrease VA. pain. A/C reaction +/- hypopyon . Vitritis . lid swelling , discharge , C. edema, chemosis .

Classification 1) Endogenous : bacterial / fungal / parasite. 2) Exogenous : a) postoperative. b) post traumatic . c) Bleb associated . d) miscellaneous ; e.g. microbial keratitis , scleritis (infectious)

Endogenous endophthalmitis results from the hematogenous spread of organisms from a distant source of infection ( eg , endocarditis ). Exogenous endophthalmitis results from direct inoculation of an organism from the outside as a complication of ocular surgery, foreign bodies, and/or blunt or penetrating ocular trauma

In unilateral cases, the right eye is twice as likely to become infected as the left eye, probably because of its more proximal location to direct arterial blood flow from the right innominate artery to the right carotid artery.

اندوفتالمیت اندوژن Endogenous endophthalmitis is rare, occurring in only 2-15% of all cases of endophthalmitis . Average annual incidence is about 5 per 10,000 hospitalized patients.

اند وفتالمیت اندو ژنوس

هتل عباسی

پاتو فیزیو لوژی In 29 – 43% of cataract surgery , intraocular contamination occurs with facultative bacteria from ocular surface without development of endophthalmitis Immune privilege mechanisms are particularly effective in the anterior part of the eye.

incidence *Post cataract 0.07 – 0.5 %.. *post PPV 0.05 %. *Bleb related 0.2 – 9.6 %. *traumatic 2.4 – 8.0 % , up to 40% in rural areas with IOFB.

Microbial spectrum Post cataract : CNS 33-77% Staph. Aurous 10-21% Streptococci 9-19% fungi 6-22% Delayed onset (chronic) post cataract: Prop. Acne , corynebacteria, fungi. Post glaucoma Sx : coagulas – staph 67% early .

Cont. Post traumatic : Coagulase negative staph 16 – 44 % Bacillus 17 – 32% Strept. 8 – 21% Fungi 4 – 14 %

Organisms isolated in the confirmed culture-positive group included Coagulase -negative staphylococci — 70 percent Staphylococcus aureus — 10 percent Streptococci —9 percent Other Gram positive organisms — 5 percent Gram negative organisms — 6 percent

Source of infection *Mainly Eye lids and conjunctiva. *Other sources : - lacrimal drainage syst. Infections. - Blephritis. - infected socket in contralateral prosthetic eye.

Bleb associated end.

اند وفتالمیت باکتریال

Postoperative E. POE a complication resulting from bacterial or fungal infection following cataract surgery. 2 form of POE Acute presenting up to 6 weeks post surgery .(80-90%) Chronic occurring months or even years after initial surgery. (10-20%)

In the United States, post cataract endophthalmitis is the most common form, with approximately 0.1-0.3% of operations having this complication, which has increased .over the last 3 years

Vitrous loss Associated with CME, glaucoma, retinal detachment, 10-14 folds endophthalmitis, vitreous hemorrhage, retinal vascular oclusions , IOL dislocation,

Risk factors for Post cataract surgery * post. Caps. tear, zonular dialysis, vitreous loss 14 fold). *clear corneal incision > scleral tunnel. *wound leakage in the first day post op. *Silicon IOL > PMMA.

Differential diagnosis *TASS. *Complicated , prolong surgery . *Preexisting uveitis . *Retained lens material. *Associated ocular injury . presence of significant vitritis = infectious Endoph. Till proven otherwise .

هتل عباسی عباسی

NO difference *No difference of incidence between sutureless and suture technique if no leak. *No diff. between inpatients and outpatients. *No diff. Between DM and non DM. *No diff. between disposable and reusable instruments.

هتل عباسی

Prophylaxis *Antiseptics: 5% povidone – iodine for at least 3 minutes is the most important prophylaxis in many studies; decreasing conj +periorbital.skin flora . *Single use instruments is always preferable esp. tubes.

Lid lashes *there has been no randomised controlled studies of preoperative cutting of eye lashes, available data in the literature showed no association with the reduction of the risk of Endoph. *But taping back of the lashes with adhesive tape is recommended. * Treat any underlying predisposing cause e.g. blephritis.

Antibiotics Topical antibiotics esp. 4th generation fluoroquinolones appears to be very effective in reducing conj. Flora load , achieving high concentrations in the in the A/C. But no controlled clinical trial prove their effect in reducing incidence of Endoph.

انتی بیوتیک ها Systemic antibiotics preopertive or post op has not proven to be of benefit against post op Endoph. In penetrating ocular trauma systemic +/- intravitreal Abx shown to have some protective effects ; two recent studies.

انتی بیوتیک ها Adding antibiotics to irrigation solution , there was a debate about there use but there is no study based evidence showing reduction of Endoph. Also , risk of endoth. Toxicity not studied .

انتی بیوتیک ها Injection of intracameral 1mg/0.1ml of cefuroxime (3000ug/ml @ a/c ) at the end of surgery: It has bee shown the risk of Endoph. with this regimen reduced by almost 5 .folds (ESCRS ) study .

انتی بیوتیک ها Subconjunctival antibiotics: It is very common practice to inject Abx subconj. At conclusion of surgery. *Gentamycin is not effective against Strept. Species ,prop.acne. *Subconj. cefuroxime --- 20ug/ml. *till now no proven evidence of it’s help.

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