Objective To observe the clinical features and prognosis of endogenous bacterial endophthalmitis (EBE). Methods Ten eyes of 10 patients diagnosed with unilateral EBE were retrospectively reviewed, including 7 males and 3 females. The mean age was 57.6±10.8 years old. Eight patients were with diabetes and 7 of them were diagnosed over 5 years. There were 3 patients with hepatocirrhosis, 1 patient with hypertension, and 1 patient with coronary disease. Nine cases had infectious diseases, including liver abscess (7 cases), pulmonary infection (3 cases), erysipelas (1 case) and perianal abscess (1 case). Seven cases had fever history. Culture and drug sensitive tests for aerobic bacteria, anaerobic bacteria and fungal were performed for 9 eyes using vitreous samples from the procedures of vitrectomy and/or intravitreal injection. All patients were treated with broad-spectrum antibiotics and adjusted for drug use according to microbiological culture and drug sensitivity test results. After the diagnosis was established, vitrectomy combined with lens removal was performed in 5 hours (3 eyes) and 24 hours (5 eyes); Vitreous tamponade of C3F8 (1 eye) and silicone oil (7 eyes) was used; At the end of the operation, 0.1 ml vancomycin (1 mg) and 0.1 ml ceftazidime (1 mg) were injected into the vitreous cavity. One eye received intravitreal injection of 0.1 ml vancomycin (1 mg) and 0.1 ml ceftazidime (mg), one eye received evisceration. During the follow up period from 6 to 24 months, visual function, slit lamp and fundus examinations were performed at each office visit. Results All patients complained of blurred vision and 5 patients had ocular pain. The visual acuity was no light perception (3 eyes), light perception (5 eyes); hand motion (1 eye) and 0.1 (1 eye). Corneal edema was found in all 10 eyes; hypopyon in 8 eyes; diffuse vitreous opacity in 10 eyes, including 3 eyes with retinal detachment. For 8 eyes treated by vitrectomy and intravitreal injection, 1 eye was eviscerated due to uncontrolled inflammation. The eye treated with intravitreal injection was enucleated for its uncontrolled inflammation. For 9 eyes received vitreous culture and drug testing, 8 eyes (88.9％) had positive results, including 5 eyes with Klebsiellar pneumonia, and 1 eye with Staphylococcus aureus, or Streptococcus agalactiae or Enterococcus faecalis respectively. At last office visit, 2 eyes were with no light perception; 4 eyes were with hand motion; and 1 eye with visual acuity of 0.1. Conclusions Most of the patients with endogenous bacterial endophthalmitis have systemic predisposing factors. Klebsiella pneumoniae is the leading cause of ocular EBE. Vitrectomy combined with intravitreal injection of antibiotics showed efficacy in treating EBE.
Objective To observe and analyze the risk factors of positive conjunctival capsule microbial culture in patients with intravitreal injection treatment (IVT) before treatment. MethodsA prospective study. A total of 1 092 patients who received IVT at the Vitreous Injection Center of Tianjin Medical University Eye Hospital from February 2021 to February 2024 were included in the study. Among them, 539 were males and 553 were females. The age was (62.29±13.61) years. Hypertension and diabetes were 661 and 576 cases, respectively. There were 742 cases of urban residence and 350 cases of rural residence. Three and one days before IVT, 364 patients received antibiotics and 364 patients did not receive antibiotics. Patients' gender, age, history of hypertension and diabetes, pre-IVT antibiotic eye drops use history, and differences in residence (town/country) were collected in detail. Samples were collected after the conjunctival sac was rinsed, and microbial culture was performed. The differences in conjunctival microbial culture positivity rates was compared between those who did not use antibiotic eye drops before IVT, those who used them 1 day before IVT, and those who used them 3 days before IVT. The positive rate of conjunctival sac microbial culture were compared among individuals of different ages, genders, with/without hypertension, with/without diabetes, with different IVT times, and from different living areas (urban/rural). The clinical baseline of positive conjunctival capsule bacterial culture was compared and observed. χ2 test was used to compare the positive rate of conjunctival capsule microbial culture among different clinical baselines. Logistic binary regression analysis was used to analyze the influencing factors. ResultsAmong the 1 092 patients, 54 cases (4.95%, 54/1 092) were positive for microbial culture of conjunctival sac. There was no significant difference (P＞0.05) in the positive rate of conjunctival sac microbial culture among patients of different ages (χ2=5.599), gender (χ2=0.549), residence (χ2=0.153), with or without hypertension and diabetes (χ2=3.545, 0.044), and with or without diabetic macular edema (χ2=0.180). There was no significant difference (P＞0.05) in the positive rate of conjunctival sac microbial culture between patients with different numbers of IVT (χ2=0.961) or between those who received antibiotic eye drops before IVT and those who did not (χ2=5.600). Logistic binary regression analysis showed that none of the above factors were risk factors for positive conjunctival capsule microbial culture (P＞0.05). No infective endophthalmitis occurred in all patients during the observation period. ConclusionThe use of antibiotics before IVT is not the decisive factor for positive microbial culture in conjunctival sac.
Povidone-iodine, an indispensable broad-spectrum and low-resistance antimicrobial agent in ophthalmology, holds dual therapeutic value: it serves as a preoperative conjunctival sac disinfectant to effectively prevent postoperative endophthalmitis, and as adjuvant therapy for refractory infectious eye diseases that respond poorly to conventional treatments. This article systematically summarizes the progress of clinical research on povidone-iodine, focusing on in-depth discussions of core issues such as the mechanism by which it achieves sterilization through free iodine, the controversy over concentration and exposure time in practical applications, and ocular surface safety. The aim is to provide a solid scientific basis for the standardized clinical application and future research of povidone-iodine.
ObjectiveTo analyze the incidence of infectious endophthalmitis after intravitreal injection of three anti-vascular endothelial growth factor (VEGF) drugs. MethodsA single-center retrospective study. From January 1, 2020 to June 30, 2025, a total of 7 534 patients who received intravitreal anti-VEGF injections at Department of Pharmacy of Zhengzhou Second Hospital were included in the study. The administered drugs included ranibizumab, aflibercept, and conbercept. By reviewing the hospital information system to determine whether patients developed endophthalmitis after injection and collecting clinical data, the Charlson Comorbidity Index (CCI) was calculated. Among the 7 534 cases, there were 4 008 males and 3 526 females, with a mean age of (60.22±13.33) years. The diagnoses included neovascular age-related macular degeneration (1 980 cases), diabetic macular edema (2 974 cases), retinal vein occlusion (1 866 cases), choroidal neovascularization (556 cases), and neovascular glaucoma (158 cases). Intravitreal injections comprised ranibizumab (2 813 cases), aflibercept (1 716 cases), and conbercept (3 005 cases), which served as the basis for grouping. A total of 17 109 anti-VEGF injections were administered, including 6 230 ranibizumab, 4 213 aflibercept, and 6 666 conbercept injections, with a median injections of 2 (1, 3) per eye. Intergroup comparisons were performed using the χ2 test, and Cox proportional hazards regression models were employed to analyze risk factors for infectious endophthalmitis. ResultsAmong 7 534 cases, 7 cases (0.092%, 7/7 534) developed endophthalmitis after intravitreal injection of anti-VEGF drugs, including 1 case (0.04%, 1/2 813) in the ranibizumab group, 2 cases (0.12%, 2/1 716) in the aflibercept group, and 4 cases (0.13%, 4/3 005) in the conbercept group. The incidence of endophthalmitis in the conbercept group was higher than that in the ranibizumab and aflibercept groups, but the difference was not statistically significant (P=0.494). Univariate Cox analysis showed that age, gender, fundus diseases, CCI, diabetes comorbidity, and anti-VEGF drugs were not correlated with the occurrence of endophthalmitis (P＞0.05). The median time to endophthalmitis onset after injection was 4 days in the 7 cases. Intravitreal injections of vancomycin and ceftazidime were administered. ConclusionsThe incidence of infectious endophthalmitis following intravitreal anti-VEGF injections was 0.092%, with no significant difference observed among the three drugs. No correlation was found with age, fundus disease, or number of injections.