ABSTRACT
PURPOSE: The goal of this study is to determine if certain aspects of endophthalmitis prophylaxis strategies are superior to others. DESIGN: This investigation is a systematic review and meta-analysis. METHODS: All studies specifying a type of prophylaxis strategy and resulting rates of endophthalmitis were included. Time course, method of administration, and antibiotic regimen, and confounding factors were collected and included for meta-regression. RESULTS: Time courses greater than 24 h did not significantly improve outcomes. Likewise, intraocular and/or intravenous antibiotic administration methods did not significantly outperform oral administration. No antibiotic regimens performed differently from vancomycin/ ≥ 3rd generation cephalosporin except for ciprofloxacin monotherapy which yielded significantly worse outcomes. CONCLUSIONS: Future antibiotic strategies should strongly consider the risks of antibiotic treatment > 24 h and administration methods other than the oral antibiotic forms. In addition, providers should be wary of using ciprofloxacin monotherapy for endophthalmitis prophylaxis when treating open globe injuries.
Subject(s)
Cryptococcosis/diagnosis , Cryptococcus gattii/isolation & purification , Eye Infections, Fungal/diagnosis , Retinitis/diagnosis , Administration, Oral , Adult , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Choroiditis/diagnosis , Choroiditis/microbiology , Cryptococcosis/drug therapy , Cryptococcosis/microbiology , Drug Therapy, Combination , Eye Diseases/diagnosis , Eye Diseases/microbiology , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/microbiology , Fluconazole/therapeutic use , Flucytosine/therapeutic use , HIV Infections/diagnosis , Humans , Infusions, Intravenous , Male , Meningitis, Cryptococcal/diagnosis , Meningitis, Cryptococcal/drug therapy , Meningitis, Cryptococcal/microbiology , Retinitis/drug therapy , Retinitis/microbiology , Tomography, Optical Coherence , Vitreous Body/microbiology , Vitreous Body/pathologyABSTRACT
PURPOSE: To describe an unusual case of frosted branch angiitis that developed in a patient with acute onset systemic vasculitis possibly triggered by the antithyroid medication methimazole. METHODS: We conducted a thorough review of the medical records of a 16-year-old female patient who presented with frosted branch angiitis. During the initial hospital admission, the patient underwent an extensive systemic workup to determine the etiology of her disease and ophthalmologic testing including fundus photographs and fluorescein angiography. RESULTS: Our patient presented with a unilateral acute onset loss of vision, whose fundus examination revealed the pathognomonic features of frosted branch angiitis. Extensive systemic workup revealed an antineutrophilic cytoplasmic antibody-positive vasculitis, possibly triggered by methimazole. CONCLUSION: This case is the first reported frosted branch angiitis associated with a drug-induced antineutrophilic cytoplasmic antibody-positive vasculitis triggered by methimazole.
Subject(s)
Antibodies, Antineutrophil Cytoplasmic/immunology , Behcet Syndrome/chemically induced , Methimazole/adverse effects , Retinal Artery/pathology , Retinal Vasculitis/etiology , Visual Acuity , Adolescent , Antithyroid Agents/adverse effects , Behcet Syndrome/complications , Behcet Syndrome/immunology , Female , Fluorescein Angiography , Fundus Oculi , Humans , Retinal Vasculitis/diagnosis , Retinal Vasculitis/physiopathologySubject(s)
Eye Injuries/diagnosis , Maxillofacial Injuries/diagnosis , Triage , Conjunctiva/injuries , Corneal Injuries , Eye Hemorrhage/diagnosis , Eye Injuries/etiology , Eye Injuries/surgery , Eyeglasses , Eyelids/injuries , Humans , Hyphema/diagnosis , Iris/injuries , Maxillofacial Injuries/etiology , Maxillofacial Injuries/surgery , Ocular Motility Disorders/diagnosis , Physical Examination , Rupture , Tomography, X-Ray Computed/methods , Vision Disorders/diagnosis , Vision, Ocular/physiology , Visual Acuity/physiology , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/etiology , Wounds, Nonpenetrating/surgery , Wounds, Penetrating/diagnosis , Wounds, Penetrating/etiology , Wounds, Penetrating/surgeryABSTRACT
Management of combat-related trauma is derived from skills and data collected in past conflicts and civilian trauma, and from information and experience obtained during ongoing conflicts. The best methods to prevent infections associated with injuries observed in military combat are not fully established. Current methods to prevent infections in these types of injuries are derived primarily from controlled trials of elective surgery and civilian trauma as well as retrospective studies of civilian and military trauma interventions. The following guidelines integrate available evidence and expert opinion, from within and outside of the US military medical community, to provide guidance to US military health care providers (deployed and in permanent medical treatment facilities) in the diagnosis, treatment, and prevention of infections in those individuals wounded in combat. These guidelines may be applicable to noncombat traumatic injuries under certain circumstances. Early wound cleansing and surgical debridement, antibiotics, bony stabilization, and maintenance of infection control measures are the essential components to diminish or prevent these infections. Future research should be directed at ideal treatment strategies for prevention of combat-related injury infections, including investigation of unique infection control techniques, more rapid diagnostic strategies for infection, and better defining the role of antimicrobial agents, including the appropriate spectrum of activity and duration.
Subject(s)
Military Medicine , Warfare , Wound Infection/prevention & control , Wounds and Injuries/therapy , HumansABSTRACT
Maxillofacial injuries constitute 16% of all war-related injuries. This review focuses on data available from military and civilian studies to provide evidence-based recommendations for the modification of infections associated with combat-related injuries to the head and neck. The major emphasis of this review is on the study of subsequent infection, perioperative antimicrobial prophylaxis, debridement of devitalized tissue, optimal time to wound closure to achieve a water tight seal, wound irrigation with removal of debris and gross contaminants, fracture fixation, and removal of ocular foreign bodies with intravitreal antibiotics. Further studies are needed in combat-related injuries to the head and neck in military personnel to provide the highest evidence-based medicine recommendations.
