Mapping prognostic factors for globe survival in panophthalmitis using logistic regression and Cox proportional hazard models: A retrospective study

Purpose: The aim of this study was to report the outcomes of panophthalmitis and to identify factors significantly affecting globe survival in the disease. Methods: This was a retrospective study on patients with panophthalmitis in a tertiary hospital between January 1, 2017, and December 31, 2019. The demographics, treatment details, culture results, and final outcomes were recorded. Logistic regression and Cox proportional hazards (CPH) were calculated to identify variables associated with globe loss. A P < 0.05 was considered significant. Results: Eighty?five eyes of 85 patients (31 culture positive) were eligible for review. The mean age of the participants was 55.21 ± 20.17 years with a male?to?female ratio of 2.04:1. Corneal ulcer (38.82%; n = 33) and open globe injuries (OGIs) (38.82%; n = 33) were the most common etiologies. Pseudomonas aeruginosa (n = 10; 11.76%) was the most common isolate. The mean duration of hospital stay was 7.58 ± 2.32 days. Overall, 44 (51.76%) globes could be salvaged. The need for evisceration (P = 0.901) and hospital stays (P = 0.095) were similar for culture?positive and ?negative cohorts. The unadjusted logistic regression and CPH models showed that culture sterility did not affect globe survival [OR = 1.210 (0.501– 2.950), P = 0.668; HR = 1.176 (0.617–2.243), P = 0.623]. The adjusted logistic regression and the CPH models showed that corneal ulcers [OR = 10.900 (2.460–48.200), P = 0.002; HR = 5.393 (1.603–18.140), P = 0.006] and OGI [OR = 7.360 (1.650–32.700), P = 0.009; HR = 4.548 (1.321–15.660), P = 0.016] were significantly associated with globe loss. Conclusion: Corneal ulcer or OGI as the primary etiology is detrimental to globe survival in panophthalmitis.

Fulminant endogenous panophthalmitis caused by Clostridium septicum infection / Panoftalmite endógena fulminante por infecção por Clostridium septicum

ABSTRACT We report an unusual case of fulminant endogenous Clostridium septicum panophthalmitis. A 74-year-old male patient presented with sudden amaurosis in the right eye, which in a few hours, evolved into an orbital cellulitis, endophthalmitis, anterior segment ischemia, and secondary perforation of the eye. A complete diagnostic study, which included cranial and orbital contrast-enhanced computed tomography scan, contrast-enhanced magnetic resonance imaging, blood cultures, and complete blood work, were performed. No causal agent was identified. Clostridium septicum infection caused fulminant gaseous panophthalmitis. Despite broad-spectrum antibiotic treatment, evisceration of the eyeball was necessary. The extension study showed a colon adenocarcinoma as the origin of the infection. Clostridium septicum panophthalmitis is a rare but aggressive orbital infection. This infection warrants the identification of a neoplastic process in the gastrointestinal tract in many cases not previously described.

RESUMO Este é o relato de um caso incomum de panoftalmite endógena fulminante por Clostridium septicum. Um paciente do sexo masculino, 74 anos, apresentou amaurose súbita no olho direito, que em poucas horas evoluiu para celulite orbitária, endoftalmite, isquemia do segmento anterior e perfuração secundária do olho. Foi realizado um estudo diagnóstico completo, que incluiu uma tomografia computadorizada com contraste cranial e orbital, um exame de ressonância magnética, hemocultura e hemograma completo. Nenhum agente causal foi identificado. A infecção por Clostridium septicum causou uma panoftalmite gasosa fulminante. Apesar do tratamento com antibióticos de amplo espectro, foi necessário eviscerar o globo ocular. O estudo de seguimento mostrou um adenocarcinoma de cólon como a origem da infecção. A panoftalmite por Clostridium septicum é um tipo raro, mas muito agressivo de infecção orbitária. Essa infecção deve sugerir a busca por um processo neoplásico no trato gastrointestinal, em muitos casos não diagnosticado anteriormente.

Corneal manifestations and treatment among patients with COVID-19-associated rhino-orbito-cerebral mucormycosis

Purpose: TO report the corneal manifestations in patients with COVID?19?associated rhino?orbito?cerebral mucormycosis (ROCM). Methods: This study was a retrospective, observational, and record?based analysis of patients of ROCM with corneal involvement. Results: A total of 220 patients were diagnosed with ROCM over a period of 3 months. Thirty?two patients had developed corneal manifestations. The mean age at diagnosis was 52.84 ± 12.8 years. The associated risk factors were systemic mucormycosis, uncontrolled diabetes, recent COVID?19 infection, and injudicious use of systemic steroids. Twenty?nine patients were known diabetics, 32 had recent COVID?19 infection, and 13 gave a history of injudicious use of steroids. The right eye (RE) was affected in nine patients, the left eye (LE) in 20 patients, and both eyes in three patients. Nine patients had a round?oval corneal ulcer. One patient each had a perforated corneal ulcer with uveal prolapse, sealed perforated corneal ulcer, spontaneously healed limbal perforation, diffuse corneal haze with hyphemia, panophthalmitis, diffuse corneal stromal abscess, limbal ischemia, anterior uveitis with posterior synechiae, inferior corneal facet, and filamentary keratitis. Three patients each had a corneal melt and inferior conjunctival xerosis with chemosis. Orbital exenteration was performed in six patients. Five patients with corneal ulcers healed. Topical eye drops of amphotericin (0.5 mg/ ml) cycloplegic, antiglaucoma medications, and lubricant eye drops were started along with systemic antifungals. Conclusion: Central corneal ulcer was the most common manifestation of mucormycosis. A concentration as low as 0.5 mg/ml of amphotericin eye drops was effective in the treatment.

Evidence of dengue virus in eviscerated specimens of panophthalmitis secondary to dengue fever: A possible cause-effect phenomenon

Purpose: To report a retrospective series of three cases of infectious panophthalmitis post?dengue fever with ex vivo confirmation of dengue virus ribonucleic acid (RNA) in the tissues of the eye. Methods: Four eyes of three patients, who were diagnosed with panophthalmitis following dengue fever and who underwent evisceration, were included. All demographic and clinical data were recorded. The eviscerated samples were subjected to direct microscopy, culture for bacteria, fungi, and parasites, and molecular virology (dengue virus [DENV] NS1?specific reverse transcription loop?mediated isothermal amplification (RT?LAMP) assay). Results: The time from the development of dengue fever to the occurrence of ocular symptoms was 4.33 ± 1.15 (median 5) days. DENV NS1 RNA, suggestive of the presence of the dengue virus, was confirmed in all evisceration specimens (uveal tissue, cornea). All the patients recovered completely from dengue fever and on follow?up had healthy eviscerated sockets. Conclusion: Demonstration of the DENV RNA in the eviscerated specimens of panophthalmitis following dengue fever implicates the DENV in the pathophysiology of the ocular infection.

Panoftalmitis: presentación atípica de un melanoma coroideo

RESUMEN La panoftalmitis es una forma rara y grave ocular de presentación del melanoma coroideo, por lo que, ante la presencia de una masa intraocular e inflamación de todas las estructuras intraoculares, con extensión extraescleral y los tejidos vecinos de la órbita, debe considerarse el diagnóstico diferencial de esta neoplasia maligna. Se presenta el caso de un paciente masculino de 83 años de edad, con diagnóstico de panoftalmitis como presentación atípica de un melanoma coroideo. Acudió a consulta de Cuerpo de Guardia de Oftalmología con dolor ocular intenso en ojo derecho, acompañado de náuseas y vómitos. Se constató, al examen, hipertensión ocular, que evolucionó tórpidamente durante su ingreso, con inflamación intraocular con extensión extraescleral. Se le realizaron ultrasonido ocular y tomografía axial computarizada de órbitas y se diagnosticó una panoftalmitis secundaria a un melanoma coroideo. Los hallazgos clínicos de esta forma atípica de presentación se mostraron, cuyo tratamiento definitivo es la enucleación. El diagnóstico histológico de melanoma maligno coroideo necrótico fue confirmado.

ABSTRACT Panophthalmitis is a rare and severe ocular form of presentation of choroid melanoma, therefore, in the presence of intraocular mass and inflammation of all intraocular structures, with extra-scleral extension and to the tissues neighboring the orbit, the differential diagnosis of this malignant neoplasia should be considered. The case presented deals with a male patient, aged 83 years, with diagnosis of panophthalmitis as atypical presentation of choroid melanoma. He assisted to the consultation of Ophthalmology Emergency with intense ocular pain in the right eye, accompanied by nausea and vomits. On examination, ocular hypertension was observed, that torpidly evolved during admission, with intraocular inflammation with extra-scleral extension. He had ocular ultrasound and computed axial tomography of orbits and was diagnosed with panophthalmitis secondary to choroid melanoma. The clinical findings of this atypical presentation form showed, whose definite treatment is enucleation. Histological diagnosis of necrotic choroid malignant melanoma was confirmed.

Bilateral panophthalmitis following toxic epidermal necrolysis: A case report

A 70 year old man presented with systemic signs of toxic epidermal necrolysis (TEN) following consumption of diclofenac tablets for a prodromal illness a week back. Ophthalmic evaluation showed no perception of light in both eyes along with lid edema, total corneal sloughing, and pus-filled anterior chamber. An amniotic membrane transplant was planned but within a few hours, both eyes developed panophthalmitis with restricted extraocular movements and mild proptosis and had to be eviscerated. This is perhaps the first case showing such devastating sequelae of TEN.

Panophthalmitis associated with scleral necrosis in dengue hemorrhagic fever

Dengue is a mosquito-borne flavivirus disease affecting humans. The Aedes aegypti mosquito spreads it. Ophthalmic manifestations of dengue range from subconjunctival hemorrhage to optic neuropathy. Panophthalmitis in dengue fever is a rare finding. We report a case of a 22-year-old male having dengue fever, who presented with pain, redness, swelling and loss of vision in his right eye. He was diagnosed as panophthalmitis with subretinal hemorrhage and required right eye evisceration.

Two Cases of Unusual Presentation of Postoperative Endophthalmitis Caused by Streptococcus dysgalactiae Subspecies Equisimilis

PURPOSE: To report two cases of postoperative endophthalmitis caused by Streptococcus dysgalactiae subspecies equisimilis (SDSE), which appeared as hyperacute presentation and panophthalmitis. CASE SUMMARY: A 68-year-old male was treated with cataract surgery and was evaluated the next day (less than 24 hours after surgery) because of acute loss of vision. There was severe inflammation and the visual acuity was light perception. The patient underwent pars plana vitrectomy (PPV) with intravitreal antibiotic injection. The vitreous culture revealed SDSE. After PPV, regression of inflammation was observed, although the corneal edema had progressed. The cornea evolved to decompensate due to bullous keratopathy and visual acuity of the eye decreased to no light perception after 3 months. A 87-year-old male who underwent phacoemulsification and intraocular lens implantation 2 days previously was hospitalized due to severe ocular pain and visual loss. There was severe inflammation, and the visual acuity was no light perception. The patient received only intravitreal injections of antibiotics due to severe corneal necrosis. The aqueous humor revealed SDSE. Four days after intravitreal injection, erythema and swelling of the eyelid of the affected eye was observed, and diagnosed as panophthalmitis. After treatment with intravenous antibiotics, cellulitis of the eyelid was resolved. The eye progressed as phthisis after 3 months without recurrence. CONCLUSIONS: Postoperative SDSE endophthalmitis showed aggressive and hyperacute presentation, resulting in blindness despite prompt treatment. SDSE is an emerging organism and should be considered a potential cause of postoperative endophthalmitis.

Fungal keratitis caused by Podospora austroamericana: A first case report

We report a case of keratitis caused by a rare fungus Podospora austroamericana. Clinical and microbiological evaluation of the corneal ulcer was done and the treatment outcome was studied. The fungus was grown from the corneal scraping, and it was identified as P. austroamericana based on DNA sequence and analysis of the internal transcribed spacer region. The patient was treated with topical azithromycin, natamycin and voriconazole. Despite maximum medical therapy, the ulcer progressed very rapidly and the patient developed panophthalmitis and evisceration of the eye had to be done. This is the first reported case of keratitis caused by P. Austroamericana.

Culture-positive unilateral panophthalmitis in a serology-positive case of dengue hemorrhagic fever

Dengue fever, a mosquito-borne disease commonly found in the tropics, is one of the most prevalent forms of Flavivirus infection in humans. Symptomatically, it is characterized by fever, arthralgia, headache, and rash. Ophthalmic manifestations can involve both the anterior and posterior segment. Panophthalmitis is rare in dengue hemorrhagic fever, and there is no report of culture-positive panophthalmitis in this setting. Here, we report a case of a serology-positive 33-year-old male patient of dengue hemorrhagic fever who developed sudden onset pain, redness, and proptosis in the right eye. The patient subsequently developed panophthalmitis in his right eye, and Bacillus cereus was isolated from eviscerated sample. This case provides unique insights into pathogenesis of panophthalmitis in dengue and highlights the management options.

Panophthalmitis with orbital cellulitis following glaucoma drainage implant surgery in a pediatric patient / Panoftalmite com celulite orbitária após implante de drenagem em glaucoma congênito

ABSTRACT Here we report a case of childhood glaucoma refractory to angle and trabeculectomy surgery. The patient was treated with an Ahmed™ drainage implant that was subsequently complicated by rapid-onset panophthalmitis and orbital cellulitis. Intravenous and intravitreal antibiotic therapy was initiated and the drainage tube was removed. The infectious process resolved within 3 weeks; however, phthisis bulbi developed subsequently.

RESUMO Relato de um caso de uma criança portadora de glaucoma congênito primário, refratário a cirurgias angulares e trabeculectomias prévias, submetido à implante de drenagem do tipo Ahmed®. O paciente evoluiu com panoftalmite e celulite orbitária de aparecimento súbito, sendo submetido à remoção do tubo e antibioticoterapia endovenosa e intravítrea. O processo infeccioso foi resolvido em três semanas, porém o olho evoluiu para phthisis bulbi.

Panoftalmite tardia após trabeculectomia com mitomicina C / Late panophthalmitis after trabeculectomy with mitomycin C

Infecção intraocular é a mais dramática e temível complicação após uma trabeculectomia, com sequelas anatômicas significativas e grave comprometimento funcional, por vezes irreversíveis. Trata-se no presente caso de um paciente do sexo masculino, portador de glaucoma congênito, submetido à trabeculectomia bilateral aos 13 anos de idade, e uma segunda trabeculectomia com mitomicina C aos 32 anos no olho direito (OD), que se apresentou 8 anos após o procedimento com endoftalmite neste olho. Após tratamento anti-inflamatório e antibioticoterápico, tópico e intravítreo, intensivos, o processo foi controlado, restando um olho hipotrófico e amaurótico com catarata e descolamento de retina totais.

An intraocular infection is the most terrible complication after a trabeculectomy, usually with significant anatomical consequences and irreversible functional impairment. The case of a 40-year-old male patient with congenital glaucoma, submitted to a trabeculectomy on both eyes at the age of 13, is presented. At the age of 32 a second trabeculectomy with mitomycin C was performed on the right eye. Eight years later he presented with an endophthalmitis in the same eye. Despite intensive local treatment and intravitreous injection, a hypotrophic amaurotic eye resulted with total cataract and retinal detachment.

A Case of Non-Clostridial Gangrenous Panophthalmitis

PURPOSE: To report a case of non-clostridial gangrenous panophthalmitis extended directly from adjacent gangrenous skin infection METHODS: A 62-year-old woman, with diabetes mellitus, was admitted to ICU after explorative laparotomy for panperitonitis, retroperitoneal hemorrhage, and disseminated intravascular coagulation caused by traffic accident. She was referred to the ophthalmologic department because of necrotizing skin infection and panophthalmitis extended directly from an adjacent skin infection, which had developed after superficial abrasion on the left forehead. RESULTS: Necrotizing gangrenous skin infection with subcutaneous emphysema had rapidly progressed to her left face and there was panophthalmitis with subconjunctival gas bubbles. Proteus mirabilis, Serratia marcescens, Enterobacter aerogenes, and Enterococcus faecalis were cultured from the skin wound and aqueous humor, Acinetobacter baumannii, and Serratia marcescens were cultured from sump drainage. She died after 3 days because of sepsis, acute renal failure, and multiple organ failure. CONCLUSIONS: Physicians should always keep in mind that a serious infectious disease like non-clostridial gas gangrene can develop even from a superficial skin wound in immunocompromised patients like diabetics.