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1.
BMJ Case Rep ; 15(5)2022 May 11.
Article in English | MEDLINE | ID: covidwho-1840564

ABSTRACT

A man in mid-50s presented with progressive blurred vision in his left eye for over 6 weeks. He was a known diabetic with history of COVID-19 pneumonia treated with steroids and remdesivir. He had pyelonephritis and urinary culture grown Klebsiella He was referred as a case of non-resolving vitreous haemorrhage. Visual acuity (VA) was hand movements with fundus showing dense vitritis. He underwent pars plana vitrectomy, vitreous biopsy with intraocular antibiotics (imipenem) suspecting as a case of endogenous bacterial endophthalmitis. Vitreous biopsy did not yield organisms on the smear/culture. The patient's condition worsened with perception of light and fundus showing dense vitritis with discrete yellowish white deposits on the surface of the retina. A repeat vitreous biopsy done along with intravitreal injection of voriconazole (suspecting fungal aetiology) grown fungal colonies and the organism was identified as Cryptococcus laurentii At 4-month follow-up, the VA improved to 6/24.


Subject(s)
Basidiomycota , COVID-19 , Endophthalmitis , Eye Infections, Bacterial , Anti-Bacterial Agents/therapeutic use , COVID-19/complications , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Endophthalmitis/etiology , Eye Infections, Bacterial/microbiology , Humans , Male , Retrospective Studies , Vitrectomy/adverse effects
2.
Indian J Ophthalmol ; 70(5): 1819-1821, 2022 05.
Article in English | MEDLINE | ID: covidwho-1835147

ABSTRACT

Systemic corticosteroids and immunocompromised state following SARS-CoV-2 infection can predispose individuals to endogenous endophthalmitis. A 66-year-old gentleman presented with complaints of diminution of vision and redness one week post discharge after hospitalization for COVID-19 infection. Clinical examination suggested fulminant endogenous endophthalmitis which responded poorly even after aggressive treatment requiring evisceration. Culture and gene sequenced analysis confirmed Aspergillus fumigatus to be the causative organism. A high degree of suspicion is warranted in the presence of recent onset of floaters in COVID-19-infected individuals to facilitate early diagnosis and outcomes.


Subject(s)
COVID-19 , Endophthalmitis , Eye Infections, Fungal , Aftercare , Aged , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Endophthalmitis/etiology , Eye Infections, Fungal/microbiology , Humans , Male , Patient Discharge , SARS-CoV-2 , Visual Acuity
3.
Turk J Ophthalmol ; 52(2): 139-141, 2022 04 28.
Article in English | MEDLINE | ID: covidwho-1818499

ABSTRACT

A 61-year-old woman presented to our clinic with complaints of decreased visual acuity, pain, and redness in her left eye. Best corrected visual acuity (BCVA) was 20/20 in the right eye and counting fingers at 3 meters in the left eye. On slit-lamp examination, 1+ cells were detected in the anterior chamber. Fundus examination revealed 1+ haze in the vitreous and multiple creamy-whitish lesions in the retina and vitreous. Her history included a diagnosis of coronavirus disease 2019 (COVID-19) one month earlier, for which she was hospitalized in the intensive care unit for 20 days and received systemic corticosteroid treatment. Vitreous culture yielded Candida albicans. The patient's nasopharyngeal swab sample was positive for COVID-19 by reverse transcription polymerase chain reaction test. BCVA was improved to 20/40 after amphotericin therapy (via intravitreal injection and intravenous routes), and the vitritis and chorioretinitis lesion regressed after 2 weeks of treatment. Two weeks later, intravenous amphotericin was discontinued and oral fluconazole treatment was started at a dose of 400 mg/day. At 3-month follow-up, her BCVA was 20/25 and no inflammatory reaction was observed in the anterior chamber and vitreous.


Subject(s)
COVID-19 , Endophthalmitis , Eye Infections, Fungal , Amphotericin B/therapeutic use , Critical Care , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Endophthalmitis/etiology , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/microbiology , Female , Humans , Middle Aged , Steroids
5.
Indian J Ophthalmol ; 70(1): 323-326, 2022 01.
Article in English | MEDLINE | ID: covidwho-1594596

ABSTRACT

A 62-year-old female diabetic recovered from COVID-19 pneumonia after receiving a prolonged course of steroids. She presented with a clinical picture of left-eye panuveitis with white cotton ball chorioretinal lesions and RAPD suggesting an optic neuropathy (VA HM). Diagnostic vitrectomy was performed to take samples for infective screen and to give intravitreal voriconazole empirically. Smear, culture, and PCR for viral DNA confirmed mixed infection of endogenous Candida endophthalmitis and incidental CMV infection. With further treatment, her corrected vision improved to 6/18 with regressing fungal lesions in serial fundus photographs. Prompt diagnosis and intervention preserved her vision and prevented potential life-threatening complications.


Subject(s)
COVID-19 , Cytomegalovirus Infections , Endophthalmitis , Eye Infections, Fungal , Optic Nerve Diseases , Antifungal Agents/therapeutic use , Candida , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Eye Infections, Fungal/complications , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Female , Humans , Middle Aged , Optic Nerve Diseases/diagnosis , Optic Nerve Diseases/drug therapy , Optic Nerve Diseases/etiology , Random Amplified Polymorphic DNA Technique , SARS-CoV-2 , Vitrectomy
6.
Indian J Ophthalmol ; 69(12): 3664-3676, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1538653

ABSTRACT

PURPOSE: Intraocular infection in patients with COVID-19 could be different in the presence of treatment with systemic corticosteroid and immunosuppressive agents. We describe the epidemiology and microbiological profile of intraocular infection in COVID-19 patients after their release from the hospital. METHODS: We analyzed the clinical and microbiological data of laboratory-confirmed COVID-19 patients from April 2020 to January 2021 presenting with features of endogenous endophthalmitis within 12 weeks of their discharge from the hospital in two neighboring states in South India. The data included demography, systemic comorbidities, COVID-19 treatment details, time interval to visual symptoms, the microbiology of systemic and ocular findings, ophthalmic management, and outcomes. RESULTS: The mean age of 24 patients (33 eyes) was 53.6 ± 13.5 (range: 5-72) years; 17 (70.83%) patients were male. Twenty-two (91.6%) patients had systemic comorbidities, and the median period of hospitalization for COVID-19 treatment was 14.5 ± 0.7 (range: 7-63) days. Infection was bilateral in nine patients. COVID-19 treatment included broad-spectrum systemic antibiotics (all), antiviral drugs (22, 91.66% of patients), systemic corticosteroid (21, 87.5% of patients), supplemental oxygen (18, 75% of patients), low molecular weight heparin (17, 70.8% of patients), admission in intensive care units (16, 66.6% of patients), and interleukin-6 inhibitor (tocilizumab) (14, 58.3% of patients). Five (20.8%) patients died of COVID-19-related complications during treatment for endophthalmitis; one eye progressed to pan ophthalmitis and orbital cellulitis; eight eyes regained vision >20/400. Fourteen of 19 (73.7%) vitreous biopsies were microbiologically positive (culture, PCR, and microscopy), and the majority (11 patients, 78.5%) were fungi. CONCLUSION: Intraocular infection in COVID-19 patients is predominantly caused by fungi. We suggest a routine eye examination be included as a standard of care of COVID-19.


Subject(s)
COVID-19 , Endophthalmitis , Eye Infections, Bacterial , Eye Infections, Fungal , Adult , Anti-Bacterial Agents/therapeutic use , COVID-19/drug therapy , Endophthalmitis/diagnosis , Endophthalmitis/epidemiology , Endophthalmitis/etiology , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/epidemiology , Eye Infections, Fungal/drug therapy , Humans , India/epidemiology , Male , Retrospective Studies , SARS-CoV-2 , Visual Acuity , Young Adult
7.
Indian J Ophthalmol ; 69(12): 3759-3761, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1538649

ABSTRACT

We present a case of endogenous fungal endophthalmitis in a nondiabetic, nonhypertensive patient who recovered from COVID-19 infection. Endogenous fungal endophthalmitis in an immunocompetent individual is quite uncommon. The organism in our patient was resistant to amphotericin and voriconazole and was successfully treated with intravitreal caspofungin. The rarity of an opportunistic nosocomial infection in an immunocompetent person with a drug-resistant organism prompted us to write this report.


Subject(s)
COVID-19 , Endophthalmitis , Eye Infections, Fungal , Antifungal Agents/therapeutic use , Caspofungin/therapeutic use , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Humans , Intravitreal Injections , SARS-CoV-2 , Voriconazole
8.
Retina ; 41(8): 1709-1714, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1503647

ABSTRACT

PURPOSE: To describe endogenous endophthalmitis in the setting of COVID-19 pneumonia. METHODS: Patients recovering from COVID-19 pneumonia who presented to our department with any or all of the following complaints: pain, watering, redness, and decreased vision were identified. All relevant data were collected for analysis. RESULTS: Three patients with endogenous endophthalmitis were identified. All patients had been treated for COVID-19 pneumonia and therefore had received remdesivir and systemic steroids; 2 of the 3 patients received tocilizumab. All patients received vitreous biopsy, vitrectomy, and intraocular antibiotic injection. Patient 1 demonstrated Klebsiella pneumoniae in blood culture, K. pneumoniae and Escherichia coli in urine culture, and K. pneumoniae in vitreous fluid, whereas Patients 2 and 3 demonstrated Stenotrophomonas maltophilia and methicillin-resistant Staphylococcus aureus in the blood and nasopharyngeal culture, respectively. Correspondingly, the same organism was cultured from vitreous in Patients 2 and 3. The visual acuity at the last follow-up in Patients 1 to 3 was 20/100, 20/80, and 20/40, respectively. The probable source of infection was identified in each as renal calculi, dental caries, and the pharynx, respectively. Real-time polymerase chain reaction demonstrated the presence of Severe Acute Respiratory Syndrome Coronavirus 2 in the vitreous fluid of Patient 1. CONCLUSION: We report good outcomes of early intervention for endogenous endophthalmitis in the setting of COVID-19 infection. We also document the presence of SARS-CoV-2 in vitreous.


Subject(s)
COVID-19/complications , Endophthalmitis/microbiology , Eye Infections, Bacterial/microbiology , Klebsiella pneumoniae/isolation & purification , Methicillin-Resistant Staphylococcus aureus/isolation & purification , SARS-CoV-2/isolation & purification , Stenotrophomonas maltophilia/isolation & purification , Adult , Aged , Anti-Bacterial Agents/therapeutic use , COVID-19 Nucleic Acid Testing , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/drug therapy , Female , Glucocorticoids/therapeutic use , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/microbiology , Humans , Klebsiella Infections/diagnosis , Klebsiella Infections/drug therapy , Klebsiella Infections/microbiology , Male , Middle Aged , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Vitrectomy , Vitreous Body/microbiology , Vitreous Body/virology
11.
Indian J Ophthalmol ; 69(10): 2869-2871, 2021 10.
Article in English | MEDLINE | ID: covidwho-1441270

ABSTRACT

Since December 2019, coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has become a global pandemic. There has been a resurgence in complications involving various organs in patients recovered from COVID-19, and endophthalmitis is one of them. Endophthalmitis-an inflammation of intraocular tissues leading to loss of vision or even loss of eye-has been a rare occurrence in the past, but has been on the rise in the post-COVID-19 times. Here we report seven such cases.


Subject(s)
COVID-19 , Endophthalmitis , Endophthalmitis/diagnosis , Endophthalmitis/etiology , Humans , SARS-CoV-2
12.
Indian J Ophthalmol ; 69(10): 2824-2827, 2021 10.
Article in English | MEDLINE | ID: covidwho-1441261

ABSTRACT

Purpose: To compare the post-cataract endophthalmitis (PCE) rates among eyes undergoing syringing or regurgitation on pressure over the lacrimal sac (ROPLAS) test prior to cataract surgery. Methods: We performed a single-center, retrospective, comparative analysis of eyes developing PCE who underwent syringing prior to cataract surgery (group A) in the pre-COVID-19 era between November 1 2019 and January 31, 2020 and the eyes that underwent ROPLAS test prior to cataract surgery (group B) in the COVID-19 era between November 1, 2020 and January 31, 2021. Results: A total of 87,144 eyes underwent cataract surgery during the two time periods of the study. Syringing was performed in 48,071 eyes, whereas ROPLAS was performed in 39,073 eyes. In group A, 19 eyes (0.039%) developed PCE, whereas 20 eyes (0.051%) developed PCE in group B (P = 0.517). Between the two groups, the grade of anterior chamber cellular reaction (P = 0.675), hypopyon (P = 0.738), and vitreous haze (P = 0.664) were comparable. Gram-positive organisms were detected in 4 eyes in group A and 6 eyes in group B; 2 eyes in group A had gram-negative bacilli. The presenting visual acuity (Group A: LogMAR 1.42 and Group B: LogMAR 1.30) and final visual acuity (Group A: LogMAR 0.52 and Group B: LogMAR 0.5) were comparable between the two groups. (P = 0.544 and 0.384, respectively). Conclusion: The rates of PCE were comparable among the eyes undergoing either syringing test or ROPLAS prior to cataract surgery.


Subject(s)
COVID-19 , Cataract Extraction , Cataract , Endophthalmitis , Lacrimal Duct Obstruction , Nasolacrimal Duct , Endophthalmitis/diagnosis , Endophthalmitis/epidemiology , Endophthalmitis/etiology , Humans , Lacrimal Duct Obstruction/diagnosis , Lacrimal Duct Obstruction/epidemiology , Lacrimal Duct Obstruction/etiology , Pandemics , Retrospective Studies , SARS-CoV-2
13.
BMC Infect Dis ; 21(1): 833, 2021 Aug 19.
Article in English | MEDLINE | ID: covidwho-1365329

ABSTRACT

BACKGROUND: Bordetella avium, an aerobic bacterium that rarely causes infection in humans, is a species of Bordetella that generally inhabits the respiratory tracts of turkeys and other birds. It causes a highly contagious bordetellosis. Few reports describe B. avium as a causative agent of eye-related infections. CASE PRESENTATION: We report a case of acute infectious endophthalmitis associated with infection by B. avium after open trauma. After emergency vitrectomy and subsequent broad-spectrum antibiotic treatment, the infection was controlled successfully, and the patient's vision improved. CONCLUSIONS: B. avium can cause infection in the human eye, which can manifest as acute purulent endophthalmitis. Nanopore targeted sequencing technology can quickly identify this organism. Emergency vitrectomy combined with lens removal and silicone oil tamponade and the early application of broad-spectrum antibiotics are key for successful treatment.


Subject(s)
Bordetella avium , Bordetella , Cataract Extraction , Endophthalmitis , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Endophthalmitis/surgery , Humans , Vitrectomy
14.
Ocul Immunol Inflamm ; 29(4): 726-729, 2021 May 19.
Article in English | MEDLINE | ID: covidwho-1307411

ABSTRACT

PURPOSE: To report six patients with endogenous endophthalmitis as a complication of COVID-19 infection. METHODS: A multicentric retrospective database review of patients with a diagnosis of endogenous endophthalmitis and a history of COVID-19 infection. RESULTS: Four of six patients were diabetics. All presented after an average duration of 40 days (Range 17-90 days) of COVID-19 infection. Two of six patients had bilateral involvement. Five of six patients had received intravenous corticosteroid for COVID-19. Two of six vitreous samples showed fungi (Candida and Bipolaris species), two showed bacteria (Staphylococcus species) and two samples were culture negative. Control of infection with good visual outcome in four out of eight eyes. CONCLUSIONS: COVID-19 patients with a history of hospitalization and prolonged use of systemic corticosteroids and comorbidities, for example, diabetes mellitus have a high risk of endogenous endophthalmitis. A high index of clinical suspicion with timely intervention can salvage many eyes.


Subject(s)
COVID-19/complications , Endophthalmitis/etiology , Eye Infections, Bacterial/etiology , Eye Infections, Fungal/etiology , Pandemics , Visual Acuity , Vitreous Body/microbiology , Adult , Bacteria/isolation & purification , COVID-19/epidemiology , Endophthalmitis/diagnosis , Endophthalmitis/microbiology , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/microbiology , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/microbiology , Follow-Up Studies , Fungi/isolation & purification , Humans , India/epidemiology , Male , Middle Aged , Retrospective Studies
15.
Indian J Ophthalmol ; 69(7): 1909-1914, 2021 07.
Article in English | MEDLINE | ID: covidwho-1278602

ABSTRACT

Purpose: To report endogenous fungal endophthalmitis, postrecovery from severe COVID-19 infection in otherwise immunocompetent individuals, treated with prolonged systemic steroids. Methods: Retrospective chart review of cases with confirmed and presumed fungal endogenous endophthalmitis, following severe COVID-19 disease, treated at two tertiary care referral eye institutes in North India. Results: Seven eyes of five cases of endogenous fungal endophthalmitis were studied. All cases had been hospitalized for severe COVID-19 pneumonia and had received systemic steroid therapy for an average duration of 42 ± 25.1 days (range 18-80 days). All the cases initially complained of floaters with blurred vision after an average of 6 days (range 1-14 days) following discharge from hospital. They had all been misdiagnosed as noninfectious uveitis by their primary ophthalmologists. All eyes underwent pars plana vitrectomy (PPV) with intravitreal antifungal therapy. Five of the seven eyes grew fungus as the causative organism (Candida sp. in four eyes, Aspergillus sp. in one eye). Postoperatively, all eyes showed control of the infection with a marked reduction in vitreous exudates and improvement in vision. Conclusion: Floaters and blurred vision developed in patients after they recovered from severe COVID-19 infection. They had received prolonged corticosteroid treatment for COVID-19 as well as for suspected noninfectious uveitis. We diagnosed and treated them for endogenous fungal endophthalmitis. All eyes showed anatomical and functional improvement after PPV with antifungal therapy. It is important for ophthalmologists and physicians to be aware of this as prompt treatment could control the infection and salvage vision.


Subject(s)
COVID-19 , Endophthalmitis , Eye Infections, Fungal , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Endophthalmitis/etiology , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/surgery , Fungi , Humans , India/epidemiology , Retrospective Studies , SARS-CoV-2 , Visual Acuity , Vitrectomy
16.
Jpn J Ophthalmol ; 65(4): 515-525, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1245663

ABSTRACT

PURPOSE: To present the different clinical manifestations of rhino-orbital mucormycosis (ROM) co-infection in severe COVID-19 patients. STUDY DESIGN: Prospective observational clinical study METHODS: Among 32,814 patients hospitalized with the diagnosis of COVID-19 between March 2020 and December 2020 in our center, eleven microbiologically confirmed ROM co-infection cases in severe COVID-19 patients were evaluated. RESULTS: There were nine men and two women with a mean age of 73.1 ± 7.7 years. Eight patients had uncontrolled type 2 diabetes with a mean diagnosis duration of 12.1 ± 4.4 years. All patients had COVID-19-associated acute respiratory distress syndrome and received corticosteroids. The mean time interval between COVID-19 diagnosis and ROM diagnosis was 14.4 ± 4.3 days. Seven patients (63.6%) had orbital apex syndrome, and four patients (36.4%) presented with orbital cellulitis. Endophthalmitis was detected in 54.5% of patients, and two of these patients developed retinoschisis. CT scan/MRI revealed sino-orbital involvement in all patients, and three of these had cerebral involvement at initial presentation. All patients received intravenous and retrobulbar liposomal amphotericin B and had undergone radical debridement of involved sinuses. Intravitreal liposomal amphotericin B injected in patients with endophthalmitis. Despite all measures, 63.6% of patients expired. CONCLUSIONS: Severe COVID-19 is associated with a significant incidence of ROM with higher mortality rates due to immune dysregulation and the widespread use of steroids. Physicians should be aware of the possibility of this infection in patients with COVID-19. An aggressive multidisciplinary approach can help to reduce mortality.


Subject(s)
COVID-19/diagnosis , Endophthalmitis/diagnosis , Eye Infections, Fungal/diagnosis , Mucormycosis/diagnosis , Orbital Cellulitis/diagnosis , Aged , Aged, 80 and over , Antifungal Agents/administration & dosage , Antifungal Agents/therapeutic use , COVID-19 Testing , Diabetes Mellitus, Type 2 , Endophthalmitis/drug therapy , Endophthalmitis/epidemiology , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/epidemiology , Female , Humans , Male , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Orbital Cellulitis/drug therapy , Orbital Cellulitis/epidemiology , Orbital Diseases/diagnosis , Orbital Diseases/drug therapy , SARS-CoV-2
17.
Indian J Ophthalmol ; 69(5): 1322-1325, 2021 May.
Article in English | MEDLINE | ID: covidwho-1207865

ABSTRACT

The novel coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, has challenged the medical community. Several ocular manifestations secondary to COVID-19 have been documented. Prolonged hospitalization exposes the patient to various multiresistant bacteria making them prone to various secondary infections. This case series describes four cases of presumed fungal endogenous endophthalmitis in patients who recovered from COVID-19.


Subject(s)
COVID-19 , Coinfection , Endophthalmitis , Eye Infections, Fungal , Endophthalmitis/diagnosis , Endophthalmitis/etiology , Eye Infections, Fungal/diagnosis , Humans , SARS-CoV-2
18.
BMJ Case Rep ; 14(4)2021 Apr 21.
Article in English | MEDLINE | ID: covidwho-1197249

ABSTRACT

A 35-year-old Hispanic man presented with fever, chills, dysuria, diarrhoea, scleral icterus, tachycardia and tachypnea. He was found to be COVID-19 positive, CT of the pelvis revealed prostatic abscess, and urine culture grew Klebsiella pneumoniae Additionally, he was found to have diabetes and cirrhosis. During treatment, the patient developed vision loss, and was diagnosed with endogenous Klebsiella endophthalmitis. The patient was treated with intravenous antibiotics, pars plana vitrectomy, intravitreal antibiotics and cystoscopy/suprapubic catheter placement. On follow-up, the patient has had the suprapubic catheter removed, and successfully passed a voiding trial, but suffers permanent vision loss in both eyes.


Subject(s)
COVID-19 , Diabetes Mellitus , Endophthalmitis , Klebsiella Infections , Prostatitis , Adult , Anti-Bacterial Agents/therapeutic use , Blindness , COVID-19/complications , Diabetes Mellitus/virology , Endophthalmitis/complications , Endophthalmitis/diagnosis , Endophthalmitis/therapy , Humans , Klebsiella Infections/complications , Klebsiella Infections/diagnosis , Klebsiella Infections/drug therapy , Klebsiella pneumoniae , Liver Cirrhosis/complications , Liver Cirrhosis/virology , Male , Prostatitis/complications , Prostatitis/microbiology , SARS-CoV-2 , Vitrectomy
19.
Ocul Immunol Inflamm ; 29(4): 662-665, 2021 May 19.
Article in English | MEDLINE | ID: covidwho-1165117

ABSTRACT

Purpose: To firstly present management of toxic anterior segment syndrome (TASS) and possible postoperative endophthalmitis (POE) after implantation of a new hydrophilic-acrylic posterior chamber (PC) phakic intraocular lens (pIOL) in a case with undeclared history of COVID-19.Methods: A 21-year-old male without known disease represented severe anterior chamber inflammation (hypopyon), poor vision and corneal edema without vitreous involvement (TASS) at 24-hours after PC-pIOL implantation for unilateral high myopia (amblyopic).Results: Preoperative best-corrected visual acuity (BCVA) was 0.2 OS (-13 diopters). At 56-hours, vitreous was involved with visual loss indicating POE. The patient confessed that he had COVID-19 1-month ago. COVID-19 immunoglobulin M/G tests were positive, while other markers were negative. Intracameral/intravitreal antibiotics were applied. BCVA was 0.15 without hypopyon at 24-hours. Cultures were negative. Final BCVA was 0.6 with normal examination.Conclusion: TASS/POE etiology could not be demonstrated in this case, whereas COVID-19-related proinflammatory systemic background could have effect on triggering/aggravating this scenario.].


Subject(s)
COVID-19/epidemiology , Endophthalmitis/etiology , Eye Infections, Viral/etiology , Myopia/surgery , Phakic Intraocular Lenses/adverse effects , SARS-CoV-2/genetics , Surgical Wound Infection/etiology , Anterior Eye Segment/diagnostic imaging , Anterior Eye Segment/virology , Comorbidity , Endophthalmitis/diagnosis , Endophthalmitis/virology , Eye Infections, Viral/diagnosis , Eye Infections, Viral/virology , Humans , Lens Implantation, Intraocular , Male , Myopia/epidemiology , RNA, Viral/analysis , Surgical Wound Infection/diagnosis , Surgical Wound Infection/virology , Young Adult
20.
Retina ; 41(8): 1709-1714, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1140026

ABSTRACT

PURPOSE: To describe endogenous endophthalmitis in the setting of COVID-19 pneumonia. METHODS: Patients recovering from COVID-19 pneumonia who presented to our department with any or all of the following complaints: pain, watering, redness, and decreased vision were identified. All relevant data were collected for analysis. RESULTS: Three patients with endogenous endophthalmitis were identified. All patients had been treated for COVID-19 pneumonia and therefore had received remdesivir and systemic steroids; 2 of the 3 patients received tocilizumab. All patients received vitreous biopsy, vitrectomy, and intraocular antibiotic injection. Patient 1 demonstrated Klebsiella pneumoniae in blood culture, K. pneumoniae and Escherichia coli in urine culture, and K. pneumoniae in vitreous fluid, whereas Patients 2 and 3 demonstrated Stenotrophomonas maltophilia and methicillin-resistant Staphylococcus aureus in the blood and nasopharyngeal culture, respectively. Correspondingly, the same organism was cultured from vitreous in Patients 2 and 3. The visual acuity at the last follow-up in Patients 1 to 3 was 20/100, 20/80, and 20/40, respectively. The probable source of infection was identified in each as renal calculi, dental caries, and the pharynx, respectively. Real-time polymerase chain reaction demonstrated the presence of Severe Acute Respiratory Syndrome Coronavirus 2 in the vitreous fluid of Patient 1. CONCLUSION: We report good outcomes of early intervention for endogenous endophthalmitis in the setting of COVID-19 infection. We also document the presence of SARS-CoV-2 in vitreous.


Subject(s)
COVID-19/complications , Endophthalmitis/microbiology , Eye Infections, Bacterial/microbiology , Klebsiella pneumoniae/isolation & purification , Methicillin-Resistant Staphylococcus aureus/isolation & purification , SARS-CoV-2/isolation & purification , Stenotrophomonas maltophilia/isolation & purification , Adult , Aged , Anti-Bacterial Agents/therapeutic use , COVID-19 Nucleic Acid Testing , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/drug therapy , Female , Glucocorticoids/therapeutic use , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/microbiology , Humans , Klebsiella Infections/diagnosis , Klebsiella Infections/drug therapy , Klebsiella Infections/microbiology , Male , Middle Aged , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Vitrectomy , Vitreous Body/microbiology , Vitreous Body/virology
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