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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Purpose. To describe the clinical characteristics, diagnosis, and treatment with intravitreal ampicillin sodium of a postoperative endophthalmitis case due to Streptococcus uberis; an environmental pathogen commonly seen in mastitis cases of lactating cows. Methods. Case Report. A 52-year-old, Hispanic diabetic patient who suddenly developed severe pain and severe loss of vision, following vitrectomy. Results. The patient was diagnosed with postoperative endophthalmitis secondary to a highly resistant strain of Streptococcus uberis that did not respond to intravitreal antibiotics. He was treated with an air-fluid interchange, anterior chamber washout, intravitreal ampicillin sodium (5 mg/0.1 mL), and silicon oil tamponade (5000 ck). The eye was anatomically stabilized, though there was no functional recovery. Conclusion. Streptococcus uberis is an uncommon pathogen to the human eye, which has unique features that help the strain in developing resistance to antibiotics. While treatment with intravitreal ampicillin is feasible, there are still concerns about its possible toxicity.
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PMID:Intravitreal Ampicillin Sodium for Antibiotic-Resistant Endophthalmitis: Streptococcus uberis First Human Intraocular Infection Report. 2070 79

BACKGROUND: Endogenous endophthalmitis is a rare disease and its visual prognosis is poor. CASE REPORTS: We present two patients, a 60-year-old man and a 53-year-old man, who developed endogenous endophthalmitis caused by Gram-positive organisms but recovered good vision after antibiotics and vitrectomy. RESULTS: The first patient complained of ocular pain and visual decrease in his right eye. Ophthalmoscopy showed inflammation in the anterior chamber and vitreous opacities. Antibiotic was administrated systemically, and blood culture detected Streptococcus anginosus. He underwent successful heart surgery for endocarditis and total dental extraction for severe gingivitis. Vitrectomy was performed 36 days after the onset and vision improved from 0.02 to 0.7. The second patient was referred for acute visual decrease in his left eye. Severe iritis and vitreous opacities were observed, and systemic examination showed acute pyelitis and prostatic abscesses. Blood cultures detected Staphylococcus sp., and systemic antibiotics were given. Vitrectomy was performed 12 days after the onset, and vision improved from 0.06 to 1.2. CONCLUSIONS: We conclude that the rapid treatment with systemic antibiotics for the organisms at the primary site, and the vitrectomy, even though delayed, can lead to a good recovery of vision.
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PMID:Two Cases of Endogenous Endophthalmitis Caused by Gram-Positive Bacteria with Good Visual Outcome. 2110 97

Endogenous bacterial endophthalmitis, also called metastatic bacterial endophthalmitis, remains a diagnostic and therapeutic challenge. It is a rare and potentially sight-threatening ocular infection that occurs when bacteria reach the eye via the bloodstream, cross the blood-ocular barrier, and multiply within the eye. It usually affects immunocompromised patients and those suffering from diabetes mellitus, malignancy, or cardiac disease, but has also been reported after invasive procedures or in previously healthy people. In most cases, the ocular symptoms occur after the diagnosis of septicemia or systemic infection. Ocular symptoms include decreased vision, redness, discharge, pain, and floaters. The ocular inflammatory signs may be anterior and/or posterior. Bilateral involvement occurs in nearly 25% of cases. A wide range of microorganisms are involved, with differences in their frequency according to geography as well as the patient's age and past medical history, because of variations in the predisposing conditions and the source of the sepsis. The majority of patients are initially misdiagnosed, and ophthalmologists should be aware of this because prompt local and general management is required to save the eye and/or the patient's life.
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PMID:[Endogenous bacterial endophthalmitis]. 2114 28

A 3-year-old child underwent bilateral medial rectus recession for partially accommodative esotropia. No recognized complications occurred at the time of surgery. Six days following surgery, she presented with increasing ocular redness, pain, and discharge. The clinical picture was consistent with endophthalmitis. The patient underwent trans pars plana vitrectomy and lensectomy, combined with a course of intravitreal, periocular, and systemic antibiotics. Four years following surgery, after aggressive occlusion therapy for amblyopia, her visual acuity improved to 20/30 with aphakic correction.
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PMID:Endophthalmitis following pediatric strabismus surgery with good visual result. 2114 1

Small gauge vitrectomy utilizing 23- and 25-gauge instrumentation has definite advantages, but also limitations, due to the physics of smaller instruments and sutureless surgery. Higher infusion and aspiration pressures are needed to remove the vitreous using 23- and 25-gauge probes. The advantages include decreased surgical times, less tissue manipulation, reduced inflammation and pain postoperatively with more rapid visual recovery. A disadvantage is greater instrument flexion than 20-gauge probes, making small gauge vitrectomy more appropriate for indications such as vitreous opacities, epiretinal membranes, macular holes, and simple retinal detachments. There are also some increased complications related to small gauge vitrectomy, including dislocation of cannulas intraoperatively, early postoperative hypotony, choroidal detachment, and possibly an increased risk of infectious endophthalmitis.
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PMID:Advantages and limitations of small gauge vitrectomy. 2123 59

The authors report a rare presentation of bilateral Klebsiella pneumoniae endophthalmitis in an ambulatory patient without other known medical conditions. A 51-year-old Chinese woman presented with severe bilateral reduction in vision, photophobia, pain, and eyelid swelling. Hospital admission and evaluation revealed vitreous, blood, and urine cultures positive for K. pneumoniae (K1 serotype). Additional work-up revealed endocarditis, multiple liver abscesses, brain abscesses, and left lobar pneumonia. The patient underwent multiple bilateral intravitreal antibiotic injections. Ultimate visual acuity was no light perception in both eyes. K. pneumoniae endogenous endophthalmitis is a severe but potentially subclinical disease. Early diagnosis requires a high index of suspicion and recognition of risk factors including Asian ancestry and other sources of systemic infection including, most commonly, liver abscess.
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PMID:Bilateral Klebsiella pneumoniae (K1 serotype) endogenous endophthalmitis as the presenting sign of disseminated infection. 2132 88

We describe the case of a healthy, pregnant female who developed endogenous endophthalmitis at the time of delivery, and discuss the possible mechanism of infection and the management of this case. A 26-year-old Asian woman presented with a 3-week history of visual deterioration and pain in the right eye. There was no history of ocular trauma or surgery. The ocular symptoms developed one day after vaginal delivery of a healthy baby. The pregnancy had been uncomplicated until premature rupture of membranes one week prior to delivery. Right visual acuity was light perception. There was marked right anterior chamber activity with a hypopyon and fibrin. A B-scan ultrasound showed dense vitritis. Examination of the left eye was normal. Blood tests and a chest X-ray were normal. A vitreous tap was performed and bacterial culture grew Sphingomonas paucimobilis. Intravitreal antibiotics were injected (amikacin 0.4 mg/0.1 ml and vancomycin 2.0 mg/0.1 ml) and the patient was treated with oral moxifloxacin and corticosteroids. Right visual acuity improved to 6/9. This case highlights the need for clinicians to have a high level of awareness of endogenous bacterial endophthalmitis (a rare, potentially sight-threatening condition) in any patient with a painful eye or visual deterioration in the peripartum period, particularly if associated with complications such as premature rupture of membranes or perineal laceration.
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PMID:A rare case of peripartum endogenous bacterial endophthalmitis. 2132 78

Endophthalmitis following intravitreal injections of therapeutic medications is a rare but potentially vision-threatening problem. Infectious agents associated with endophthalmitis following injection of vascular endothelial growth factor (VEGF) inhibitors are typically Gram positive organisms with a predominance of Streptococcal and Staphylococcal microbiologic isolates. Patients with infectious endophthalmitis generally present within the first 72 hours following an intravitreal anti-VEGF injection with complaints of pain, redness, and decreased vision. Prompt treatment with a conventional endophthalmitis management approach may mitigate irreversible vision loss; however, poorer outcomes have been reported with more virulent organisms such as those associated with Streptococcal species. As the number of intravitreal injections performed each year continues to increase, ophthalmologists must maintain a rigorous approach to their injection technique and remain vigilant for the signs and symptoms of endophthalmitis.
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PMID:Endophthalmitis following intravitreal anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration. 2160 27

Endophthalmitis is one of the most serious and most dreaded complications in ophthalmology. It is most often seen as a complication to intraocular surgery and especially after cataract surgery. Approximately 90% of the cases of endophthalmitis are caused by bacteria. Symptoms and signs may include pain, blurred vision, and hypopyon. Intravitreal injection of antibiotics in combination with vitrectomy or vitreous tap is the mainstay in the treatment of endophthalmitis. Prompt recognition and intervention are essential in preserving the vision of the affected eye in the case of endophthalmitis.
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PMID:[Endophthalmitis is an acute disease which threatens the vision]. 2162 11

A 54-year-old male patient was seen in clinic for ocular pain and decreased vision in the right eye with duration of two days. He underwent a cataract operation for his right eye 12 years ago, then a sclera-fixated secondary intraocular implantation and pars plana vitrectomy three years ago due to intraocular lens dislocation. At the initial visit, his visual acuity was restricted to the perception of hand motion. An edematous cornea, cells, flare with hypopyon, and exposed suture material at were observed at the six o'clock direction by slit lamp. Vitreous opacity was noted from B-scan ultrasonography. The patient was diagnosed with late-onset endophthalmitis and an intravitreal cocktail injection was done. On the next day, the hypopyon was aggravated, and therefore a pars plana vitrectomy was performed. A vitreous culture tested positive for Citrobacter koseri. After 12 weeks, the best corrected visual acuity of the right eye improved to 0.7 and a fundus examination revealed a relatively normal optic disc and retinal vasculature. We herein report the first case of endophthalmitis caused by Citrobacter koseri in Korea. Exposed suture material was suspected as the source of infection in this case and prompt surgical intervention resulted in a relatively good visual outcome.
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PMID:Late-onset Citrobacter koseri endophthalmitis with suture exposure after secondary intraocular lens implantation. 2186 May 79


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