Consensus and controversies in the science of endophthalmitis management: Basic research and clinical perspectives

IF 18.6 1区 医学 Q1 OPHTHALMOLOGY Progress in Retinal and Eye Research Pub Date : 2023-11-01 DOI:10.1016/j.preteyeres.2023.101218
Taraprasad Das , Joveeta Joseph , Matthew P. Simunovic , Andrzej Grzybowski , Kuan-Jen Chen , Vivek Pravin Dave , Savitri Sharma , Patrick Staropoli , Harry Flynn Jr.
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Abstract

Infectious endophthalmitis is a severe intraocular infection caused by bacteria, or less commonly by fungi. It can occur after penetrating eye procedures, trauma, or the spread of infection from contiguous structures or via emboli from distant organs. Because of the time-critical nature of the treatment, endophthalmitis is treated with the clinical diagnosis and modified by the microbiological report of the intraocular contents. The current strategy for managing endophthalmitis relies on pre-clinical literature, case series, and one large multi-center randomized clinical trial on post-cataract surgery endophthalmitis. Culture-susceptibility of the microorganisms from undiluted vitreous guides the definitive treatment in non-responsive cases. Strategies to reduce the incidence of endophthalmitis after penetrating eye procedures have been developed concurrently with refined means of treatment.

Despite these advances, outcomes remain poor for many patients. Although consensus articles have been published on managing endophthalmitis, treatment patterns vary, and controversies remain. These include (1) the use of newer methods for early and precise microbiological diagnosis; (2) the choice of intravitreal antibiotics; (3) the need for systemic therapy; (4) early and complete vitrectomy. Here, we review the current consensus and address controversies in diagnosing and managing endophthalmitis. This review is intended to familiarize physicians and ophthalmologists with different aspects of endophthalmitis management to make informed decisions.

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眼内炎治疗科学的共识与争议:基础研究与临床展望。
感染性眼内炎是一种由细菌引起的严重眼内感染,较不常见的是由真菌引起的。它可能发生在穿透眼部手术、创伤或感染从相邻结构或通过远处器官的栓塞传播之后。由于治疗的时间紧迫性,眼内炎的治疗采用临床诊断,并通过眼内内容物的微生物学报告进行修改。目前治疗眼内炎的策略依赖于临床前文献、病例系列和一项关于白内障手术后眼内炎大型多中心随机临床试验。未稀释玻璃体中微生物的培养敏感性指导无反应病例的最终治疗。降低穿透性眼科手术后眼内炎发生率的策略已与精细的治疗方法同时制定。尽管取得了这些进展,但许多患者的预后仍然很差。尽管已经发表了关于治疗眼内炎的共识文章,但治疗模式各不相同,争议仍然存在。这些措施包括(1)使用较新的方法进行早期和精确的微生物诊断;(2) 玻璃体内抗生素的选择;(3) 需要系统治疗;(4) 早期和完整的玻璃体切除术。在这里,我们回顾目前的共识,并解决诊断和治疗眼内炎的争议。这篇综述旨在让医生和眼科医生熟悉眼内炎管理的不同方面,以便做出明智的决定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
34.10
自引率
5.10%
发文量
78
期刊介绍: Progress in Retinal and Eye Research is a Reviews-only journal. By invitation, leading experts write on basic and clinical aspects of the eye in a style appealing to molecular biologists, neuroscientists and physiologists, as well as to vision researchers and ophthalmologists. The journal covers all aspects of eye research, including topics pertaining to the retina and pigment epithelial layer, cornea, tears, lacrimal glands, aqueous humour, iris, ciliary body, trabeculum, lens, vitreous humour and diseases such as dry-eye, inflammation, keratoconus, corneal dystrophy, glaucoma and cataract.
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