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ENDOPHTHALMITIS
Drugs 1996, 52(4), 526-540 ENDOPHTHALMITIS   : It is an inflamation of the inner structure of the eyeball i.e., uveal tissue & retina associated with pouring of exudates in the vitreous cavity, anterior chamber & posterior chamber.
Classification  ,[object Object],Ind J Med Micro 1999, 17(3), 108-115 ,[object Object],[object Object],[object Object]
According to mode of entry Ind J Med Micro 1999; 17(3): 108-115 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Endogenous Exogenous
Acc to aetiological agents ,[object Object],Bacterial Fungal viral Fungal Parasitic Endophthalmitis  Ind J Med Micro 1999; 17 (3): 108-115
[object Object],[object Object],                                                                                       
[object Object],[object Object],Ind J ophthalmol 2000, 48: 123-128
[object Object],[object Object]
Postoperative endophthalmitis ,[object Object],[object Object],Ophthalmology 1998; 105(6): 1004-1010
[object Object],[object Object],CMR 2002, 15(1), 111-124
POE: A potentially blinding condition ,[object Object],[object Object],Surv Ophthalmol 2004, 49(2), S53-S54)
Post-op endophthalmitis: causes ,[object Object],[object Object],[object Object],[object Object]
Risk factors  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Symptoms  ,[object Object],[object Object],[object Object],[object Object],[object Object],Patient presents with symptoms most commonly on the second day after surgery
signs Left eye (OS) status post phacoemulsification and IOL placement 6 days prior. The eye now has profound injection, corneal edema, hypopyon, and fibrin strands in the anterior chamber.
 
 
appearance and pain.   A patient presented to the eye casualty three days after cataract extraction with the following
This eye is suffering from serious infection, also called endophthalmitis.  
 
POE: Clinical aspects  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Day of presentation of infection In most cases, infection occurs in immediate post-op period,  Suppl. Ophthal Times 2003; 28(5), 1-15
POE: Aetiological agents ,[object Object],[object Object],[object Object],[object Object],[object Object]
Most common organisms responsible for endophthalmitis Br J Oph 1997, 81:1006-15 Cephalosporium spp. Aspergillus Candida parapsilosis Fungi (rare) Coliform spp 0-1% Bacillus cereus  1% Klebsiella 0-1% Propionibacterium acnes  30 reports Haemophilus influenzae  0-1%  Staphylococcus aureus  15% Proteus  5% Streptococcus spp  20%  Pseudomonas  8% Staphylococcus epidemidis  43% Gram negative bacteria 10%-15% Gram positive bacteria 75%-85%
Aetiological Agents: Indian Data N=170 Ind J Ophth 2000, 48: 123-128
Spectrum of bacteria from cases of post-operative endophthalmitis: Indian Data 5 Miscellaneous 5 Enterobacteriaceae 15 Other Pseudomonas 18 Non-fermenters 29 P. Aeruginosa 72 Organisms Gram negative
Spectrum of bacteria  from cases of  post-operative endophthalmitis: Indian Data 2 Bacillus spp 2 Coryne bacterium spp 4 Micrococc spp 4 E.faecalis 7 Streptococc spp 10 P. Acnes 13 S. Aureus 22 S. Epidermidis 64 Organisms Gram positive
Spectrum of fungi from cases of post-operative endophthalmitis: Indian Data Ind J Ophthalmol 2000; 123-28 1 Paecilomyus spp 1 Fusarium spp 2 Candida spp. 2 Acremonium falciforme 12 Unidentified fungi 19 Aspergillus spp 37 Fungi Fungi
Diagnosis  ,[object Object],[object Object],[object Object],[object Object]
Obtaining aqueous samples ,[object Object],[object Object],[object Object],[object Object]
Obtaining vitreous samples ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management  Findings of the Endophthalmitis Vitrectomy Study (EVS) provide guidelines for management of POE.
Management  ,[object Object],[object Object],[object Object],Br J ophthalmol 1997, 81:1006-1015
For gram positive organisms   ,[object Object],[object Object],[object Object],[object Object]
[object Object],Arch Oph 1999, 117: 1023-27
For gram negative organisms ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],Intravitreal injection of dexamethsone 0.4 mg in 0.1 ml Subconjunctival injection dexamethsone of 4 mg OD for 5-7 days Systemic steroids : prednisolone
[object Object],[object Object],[object Object],[object Object]
Pre-operative scrub ,[object Object],[object Object],[object Object]
Role of prophylactic antibiotics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
THANK YOU

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Endopthalmitis

  • 2. Drugs 1996, 52(4), 526-540 ENDOPHTHALMITIS : It is an inflamation of the inner structure of the eyeball i.e., uveal tissue & retina associated with pouring of exudates in the vitreous cavity, anterior chamber & posterior chamber.
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  • 13.
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  • 15. signs Left eye (OS) status post phacoemulsification and IOL placement 6 days prior. The eye now has profound injection, corneal edema, hypopyon, and fibrin strands in the anterior chamber.
  • 16.  
  • 17.  
  • 18. appearance and pain. A patient presented to the eye casualty three days after cataract extraction with the following
  • 19. This eye is suffering from serious infection, also called endophthalmitis.  
  • 20.  
  • 21.
  • 22. Day of presentation of infection In most cases, infection occurs in immediate post-op period, Suppl. Ophthal Times 2003; 28(5), 1-15
  • 23.
  • 24. Most common organisms responsible for endophthalmitis Br J Oph 1997, 81:1006-15 Cephalosporium spp. Aspergillus Candida parapsilosis Fungi (rare) Coliform spp 0-1% Bacillus cereus 1% Klebsiella 0-1% Propionibacterium acnes 30 reports Haemophilus influenzae 0-1% Staphylococcus aureus 15% Proteus 5% Streptococcus spp 20% Pseudomonas 8% Staphylococcus epidemidis 43% Gram negative bacteria 10%-15% Gram positive bacteria 75%-85%
  • 25. Aetiological Agents: Indian Data N=170 Ind J Ophth 2000, 48: 123-128
  • 26. Spectrum of bacteria from cases of post-operative endophthalmitis: Indian Data 5 Miscellaneous 5 Enterobacteriaceae 15 Other Pseudomonas 18 Non-fermenters 29 P. Aeruginosa 72 Organisms Gram negative
  • 27. Spectrum of bacteria from cases of post-operative endophthalmitis: Indian Data 2 Bacillus spp 2 Coryne bacterium spp 4 Micrococc spp 4 E.faecalis 7 Streptococc spp 10 P. Acnes 13 S. Aureus 22 S. Epidermidis 64 Organisms Gram positive
  • 28. Spectrum of fungi from cases of post-operative endophthalmitis: Indian Data Ind J Ophthalmol 2000; 123-28 1 Paecilomyus spp 1 Fusarium spp 2 Candida spp. 2 Acremonium falciforme 12 Unidentified fungi 19 Aspergillus spp 37 Fungi Fungi
  • 29.
  • 30.
  • 31.
  • 32. Management Findings of the Endophthalmitis Vitrectomy Study (EVS) provide guidelines for management of POE.
  • 33.
  • 34.
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  • 36.
  • 37.
  • 38.
  • 39.
  • 40.
  • 41.
  • 42.
  • 43.