안내염 및 안구로 환자에서 시행한 안구내용제거술 및 일차 보형물 삽입술 결과 비교

정재호,이종헌,전혜신,최희영,Jae Ho Jung,MD,PhD,Jong Heon Lee,MD,Hye Shin Jeon,MD,Hee Young Choi,MD,PhD 대한안과학회 2014 대한안과학회지 Vol.55 No.7

<b>Purpose:</b> To evaluate the efficacy and prognosis of evisceration with primary orbital implant placement in patients with endophthalmitis and compare it to phthisis bulbi patients. <b>Methods:</b> We retrospectively reviewed the medical records of patients who underwent evisceration with primary implant placement by a single surgeon from January 2005 to December 2011 at Pusan National University Hospital. Age, gender, underlying ocular disease, systemic illness, type and size of implant, follow-up period, and the causative organism were evaluated in patients with endophthalmitis. Success rates and prevalence of complications were compared between endophthalmitis and phthisis patients. <b>Results:</b> The present study included 18 patients (18 eyes) with endophthalmitis and 23 patients (23 eyes) with phthisis. Patients in the endophthalmitis group were older than the patients in the phthisis group and no significant differences in gender, size of implant, and underlying diseases between endophthalmitis and phthisis patients were found. Sixteen endophthalmitis and 20 phthisis patients showed successful surgical outcomes with no significant differences (<em>p </em>= 0.31), and implant exchange rates were not significantly different between endophthalmitis and phthisis bulbi patients (<em>p</em> = 0.52). <b>Conclusions:</b> Evisceration with primary orbital implant placement in patients with endophthalmitis is a safe and effective treatment method. Comparison between endophthalmitis and phthisis showed no significant differences in success outcomes and complication rates. J Korean Ophthalmol Soc 2014;55(7):958-962

의인성 진균 안내염 의증 환자에서 성공적 치료 후 발생한 술 후 세균 안내염 1예

권지민,한상엽,방종욱,박강윤,김현웅 한국망막학회 2022 Journal of Retina Vol.7 No.2

Purpose: To report a case of postoperative bacterial endophthalmitis that occurred after successful treatment of suspected iatrogenic fungal endophthalmitis associated with viscoelastics. Case summary: A 60-year-old female was referred with decreased visual acuity 2 months after uneventful cataract surgery. Inflammatory cells in the anterior chamber and fluffy balls in the vitreous were observed. Clinically, postoperative fungal endophthalmitis was suspected. Postoperative fungal endophthalmitis was prevalent in Korea at that time, and the viscoelastic material used during surgery was judged to be unsuitable. Vitrectomy, intraocular lens removal, and intravitreal voriconazole injection were performed. With subsequent intravitreal injections and oral treatment, all signs of endophthalmitis disappeared. Three months later, the patient underwent scleral fixation of intraocular lens at another clinic and visited our emergency room with decreased vision in the right eye 2 days after the surgery. Her visual acuity was hand motion. Fundus was obscured due to corneal edema and anterior chamber inflammation. For suspected bacterial endophthalmitis, vitreous lavage, intravitreal silicone oil injection, and intravitreal antibiotics injection were performed, and the culture showed Staphylococcus epidermidis. Silicone oil was removed 2 months after the surgery, and the best-corrected visual acuity was maintained at 0.9 without recurrence of endophthalmitis. Conclusions: Since patients who have suffered endophthalmitis are vulnerable to infection due to tissue damage caused by previous infection, special attention should be paid during additional procedures or surgeries. 목적: 점탄물질에 의한 의인성 진균 안내염 의증 환자의 성공적 치료 이후 발생한 술 후 세균 안내염을 보고하고자 한다. 증례요약: 여자 60세 환자가 백내장 수술 후 2개월째 발생한 시력저하로 전원되었다. 전방 및 유리체 염증과 유리체 내 털뭉치모양의 혼탁이 관찰되어 임상적으로 진균 안내염이 의심되었다. 당시 백내장 수술 후 진균 안내염이 국내 유행하였고 술 중 사용된 점탄물질의 부적합 판정이 확인되어 유리체절제술, 인공수정체 제거술, 유리체강 내 보리코나졸 주입술을 시행하였다. 추가적 주입술과 경구 치료로안내염이 호전되었다. 3개월 뒤 타 의원에서 인공수정체 공막고정술 시행 후 이틀째 우안 시야 흐림이 발생하여 본원을 내원하였다. 시력은 안전수동이었고, 각막부종, 전방염증으로 안저는 흐리게 관찰되었다. 세균 안내염 의심 하 유리체 세척술, 실리콘기름 주입술, 유리체강 내 항생제 주입술을 시행하였고, 유리체 검체에서 표피포도구균이 동정되었다. 2개월 후 실리콘기름 제거술을 시행하였고, 안내염 재발 없이 최대교정시력 0.9를 유지하고 있다. 결론: 안내염을 겪은 환자는 이전 감염으로 인한 조직 손상으로 감염에 취약하므로, 추가적 시술 및 수술 시 감염에 대한 각별한 주의가 필요하다.

Recent Clinical Manifestation and Prognosis of Fungal Endophthalmitis: A 7-Year Experience at a Tertiary Referral Center in Korea

김동윤,문해인,조수근,김중곤,윤영희,이주용 대한의학회 2015 Journal of Korean medical science Vol.30 No.7

This study analyzed the recent causes, prognosis, and treatment strategies for fungal endophthalmitis. A retrospective review of patients who were diagnosed with fungal endophthalmitis at our center was conducted. The fungal organisms isolated from each patient and the visual prognosis according to the route of infection and treatment method were analyzed. A total of 40 eyes from 30 patients with fungal endophthalmitis were included in this study. Candida species were the most common causative organisms in 35 of 40 eyes. Endogenous and exogenous endophthalmitis were observed in 33 and 7 eyes, respectively. Pre- and post-treatment best-corrected visual acuity (BCVA) was not significantly different between endogenous endophthalmitis and exogenous endophthalmitis. The 40 eyes were treated using the following modalities: intravitreal antifungal agent injection with intravenous antifungal agent (16 eyes), vitrectomy with intravenous antifungal agent (14 eyes), intravenous antifungal agent alone (9 eyes), and evisceration (1 eye). Post-treatment BCVA only significantly improved after treatment in the vitrectomy group. Candida species were the most common cause of fungal endophthalmitis, irrespective of the route of infection. The visual prognosis of fungal endophthalmitis was generally poor. In conclusion, if the general condition of the patient tolerates a surgical procedure, prompt vitrectomy and intravitreal injection of antifungal agents can improve visual acuity

감염성 안구내염의 초음파 소견

김재형,최재완,윤영희,김중곤.Jae-Hyung Kim. M.D.. Jae-Wan Choi. M.D.. Young-Hee Yoon. M.D.. June-Gone Kim. M.D. 대한안과학회 2005 대한안과학회지 Vol.46 No.4

Purpose: To investigate the correlation between ultrasonographic findings and clinical features of infectious endophthalmitis. Methods: We analyzed ultrasonographic findings of 38 eyes of 36 patients who had been diagnosed as having infectious endophthalmitis with various etiologies. The correlation between ultrasonographic findings and clinical features such as initial and final visual acuities were studied. Results: Fourteen eyes were diagnosed with endogenous endophthalmitis and 11 eyes with postoperative endophthalmitis. Posterior vitreous opacity in the endophthalmitis secondary to keratitis was more severe and subhyaloid opacity in the traumatic endophthalmitis was less severe. Coagulase negative staphylococcus was the most common causative agents. Subhyaloid opacity in the eyes where cultures were not performed, was more severe than in those where coagulase negative staphylococcus was identified. Among the various ultrasonographic findings only the degree of the posterior vitreous opacity was correlated with the initial visual acuity, and none of the findings was significantly related with the final visual acuity. Treatment modalities included intravitreal antibiotics injections in 13 eyes, immediate vitrectomies and antibiotics injection in 6 eyes, conversion to vitrectomy after antibiotics injection in 17 eyes, and eviscerations in 2 eyes. The grades of posterior vitreous opacity of the patients with conversion to vitrectomy after antibiotics injection were lower than those of the other groups. Conclusions: Ultrasonographic findings might be a useful factors in the diagnosis and the determination of treatment modality and may therefore be helpful in the prognosis of patients with suspected infectious endophthalmitis.

미세절개유리체절제술을 통한 특발 망막앞막 수술 후 발병한 급성 안내염의 발생률 및 임상 경과

박보현,김재현,박수환,강민승,이재정,이승민,박성후,변익수,박현준,이지은,권한조 대한안과학회 2023 대한안과학회지 Vol.64 No.2

Purpose: To investigate the incidence and clinical course of acute endophthalmitis after idiopathic epiretinal membrane (iERM) surgery employing microincision vitrectomy (MIVS). Methods: We retrospectively reviewed the medical records of eyes with acute endophthalmitis developing after iERM surgery via 23- or 25-gauge MIVS from 2011 to 2021. The incidence, culture-positive rate (and responsible bacteria), final visual acuity (VA), and factors affecting poor visual outcomes were assessed. Results: Acute endophthalmitis developed in 20 of the 12,921 eyes (0.15%) after MIVS. Of these, 14 of 3,180 eyes treated via iERM (0.44%, one per 227 procedures) developed endophthalmitis; the incidence ratio (iERM versus non-iERM) was 7.1 (p < 0.001, 95% confidence interval [CI] = 2.6-22.7). At least one sclerotomy remained unsutured in all eyes after iERM surgery. Thirteen eyes (92.9%) were given intravitreal antibiotic injections after emergency vitrectomy, and one eye was treated with intravitreal antibiotic injection alone. Staphylococcus epidermidis was cultured from four eyes (28.6%); three strains were methicillin- resistant. All final VAs were not better than the initial VAs; the average VA decreased from 20/42 to 20/259 (p < 0.001). Six eyes (42.9%) attained legal blindness status (final VA < 20/200); Macular invasion was a unique risk factor for such blindness (p = 0.020, odds ratio = 35.0, 95% CI = 1.7-703.0). Conclusions: Acute endophthalmitis developing after iERM surgery with MIVS was more common than such endophthalmitis after other retinal surgery. Approximately 40% of the former patients became legally blind, and the risk was higher in eyes with macular involvement of endophthalmitis. 목적: 미세절개유리체절제술로 특발 망막앞막 수술 후 발생한 급성 안내염의 발생률과 임상 경과를 알아보고자 하였다. 대상과 방법: 2011년부터 2021년까지 미세절개유리체절제술로 특발 망막앞막 수술 후 급성 안내염이 발병한 증례들의 의무기록을 분석하였다. 안내염의 발생률, 배양 양성 비율 및 균주, 최종 시력에 대해 조사 후 불량한 시력 예후에 영향을 주는 인자들을 조사하였다. 결과: 총 12,921안에서 미세절개유리체절제술 후 20안(0.15%)에서 급성 안내염이 발생하였다. 그중 3,180안의 특발 망막앞막 증례들에서 14안의 안내염이 발생하여 발생률과 발생률비는 각각 0.44% 및 7.1이었다(p<0.001, 95% confidence interval [CI]=2.6-22.7). 14안모두 특발 망막앞막 수술 시 하나 이상의 공막창을 봉합하지 않았다. 안내염 진단 후 13안은 응급 유리체절제술 후 유리체내 항생제주사를 시행하였고 1안은 유리체내 항생제 주사만으로 치료되었다. 배양 결과 4안(28.6%)에서 모두 표피포도구균이 배양되었고 3안은 메티실린 내성이었다. 최종 시력은 모든 증례들에서 첫 수술 전 시력보다 호전되지 않았고, 그 평균은 20/42에서 20/259로 감소하였다(p<0.001). 법적 실명에 해당하는 20/200 이하의 최종 시력은 6안(42.9%)으로 안내염의 황반 침범은 실명 위험이 높은 단일 소견이었다(p=0.020, odds ratio=35.0, 95% CI=1.7-703.0). 결론: 미세절개유리체절제술을 통한 특발 망막앞막 수술 후 급성 안내염은 다른 망막질환의 수술 후 급성 안내염보다 높은 빈도로발생한다. 해당 안내염이 발병하면 약 40%에서 법적 실명을 할 수 있고 안내염의 황반 침범 시 그 위험이 증가한다.

약제 내성을 지닌 페니실리움 안내염에서 유리체강내 보리코나졸 주입술을 이용한 치료 1예

이성복,박창준,김정열,Sung Bok Lee,Chang Jun Park,Jung Yeul Kim 대한안과학회 2007 대한안과학회지 Vol.48 No.11

Purpose: To report a case of a drug-resistant Penicillium endophthalmitis that was treated with intravitreal voriconazole injection. Case summary: A 73-year-old male who developed endophthalmitis after cataract surgery was treated with intravitreal vancomycin and ceftazidime injection after aqueous and vitreous cultures were done. The condition were not improve after intravitreal injection, and the culture showed Penicillium species. Fungal endophthalmitis was diagnosed and pars plana vitrectomy, intraocular lens removal, and intravitreal amphotericin B injection were performed. However, a progressive worsening of the ocular condition was observed, and the patient was transferred to our hospital. At initial visit, the best corrected visual activity was hand movement. The hypopyon and thick exudative membrane filled the anterior chamber. Pars plana vitrectomy and intravitreal voriconazole injection were performed under the diagnosis of drug-resistant Penicillium endophthalmitis. The condition improved after the operation, and there was no recurrence of endophthalmitis until four months after vitrectomy. Conclusions: Voriconazole is useful in the treatment of drug-resistant fungal endophthalmitis.

Results of Extensive Surgical Treatment of Seven Consecutive Cases of Postoperative Fungal Endophthalmitis

Yun Sik Yang 대한안과학회 2009 Korean Journal of Ophthalmology Vol.23 No.3

Purpose: Postoperative endophthalmitis is a dreaded outcome of any intraocular surgery. Fungal endophthalmitis is a particularly severe complication that poses a significant threat of blindness. We experienced seven consecutive cases of postoperative fungal endophthalmitis stemming from a single local clinic in which extensive early intervention resulted in favorable final visual acuity. Methods: The present study is retrospective observational case series of fungal endophthalmitis. The initial case, as diagnosed by fungal culture, resulted in blindness. In the ensuing eight months, seven consecutive cases were referred to our institution. All were presumed to be fungal endophthalmitis as the cases possessed similar inflammatory findings to the preceding case and occurred in the same environment. Extensive surgical and antifungal treatment was immediately administered, including complete vitrectomy with removal of the intraocular lens and lens capsule and Amphotericin B injections. Results: Retinal infiltration was identified in three cases and the lesion site was photocoagulated with an endolaser. All cases were confirmed fungal endophthalmitis by culture (4 cases: Candida parapsilosis, one case each: Fusarium, Acremonium, Candida tropicalis) and five cases required secondary intraocular lens implantation. Final corrected visual acuity ranged from 20/20 to 40/200 by the Snellen chart. Conclusions: Early extensive surgical intervention and antifungal agent administration may result in favorable visual outcomes in patients with fungal endophthalmitis following cataract surgery. Korean J Ophthalmol 2009;23:159-163

Results of Extensive Surgical Treatment of Seven Consecutive Cases of Postoperative Fungal Endophthalmitis

양연식 대한안과학회 2009 Korean Journal of Ophthalmology Vol.23 No.3

Purpose: Postoperative endophthalmitis is a dreaded outcome of any intraocular surgery. Fungal endophthalmitis is a particularly severe complication that poses a significant threat of blindness. We experienced seven consecutive cases of postoperative fungal endophthalmitis stemming from a single local clinic in which extensive early intervention resulted in favorable final visual acuity. Methods: The present study is retrospective observational case series of fungal endophthalmitis. The initial case, as diagnosed by fungal culture, resulted in blindness. In the ensuing eight months, seven consecutive cases were referred to our institution. All were presumed to be fungal endophthalmitis as the cases possessed similar inflammatory findings to the preceding case and occurred in the same environment. Extensive surgical and antifungal treatment was immediately administered, including complete vitrectomy with removal of the intraocular lens and lens capsule and Amphotericin B injections. Results: Retinal infiltration was identified in three cases and the lesion site was photocoagulated with an endolaser. All cases were confirmed fungal endophthalmitis by culture (4 cases: Candida parapsilosis, one case each: Fusarium, Acremonium, Candida tropicalis) and five cases required secondary intraocular lens implantation. Final corrected visual acuity ranged from 20/20 to 40/200 by the Snellen chart. Conclusions: Early extensive surgical intervention and antifungal agent administration may result in favorable visual outcomes in patients with fungal endophthalmitis following cataract surgery.

Real-world incidence of endopthalmitis after intravitreal anti-VEGF injections in Korea: findings from the Common Data Model in ophthalmology

Yongseok Mun,Seng Chan You,Da Yun Lee,Seok Kim,Yoo-Ri Chung,Kihwang Lee,Ji Hun Song,Young Gun Park,Young Hoon Park,Young-Jung Roh,Se Joon Woo,Kyu Hyung Park,Rae Woong Park,Sooyoung Yoo,Dong-Jin Chang 한국역학회 2021 Epidemiology and Health Vol.43 No.-

OBJECTIVES: The aim of this study was to evaluate the real-world incidence of endophthalmitis after intravitreal anti-vascular endothelial growth factor (VEGF) injections using data from the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). METHODS: Patients with endophthalmitis that developed within 6 weeks after intravitreal anti-VEGF injections were identified in 3 large OMOP CDM databases. RESULTS: We identified 23,490 patients who received 128,123 intravitreal anti-VEGF injections. The incidence rates of endophthalmitis were 15.75 per 10,000 patients and 2.97 per 10,000 injections. The incidence rates of endophthalmitis for bevacizumab, ranibizumab, and aflibercept (per 10,000 injections) were 3.64, 1.39, and 0.76, respectively. The annual incidence has remained below 5.00 per 10,000 injections since 2011 despite the increasing number of intravitreal anti-VEGF injections. Bevacizumab presented a higher incidence rate for endophthalmitis than ranibizumab and aflibercept (incidence rate ratio, 3.17; p=0.021). CONCLUSIONS: The incidence of endophthalmitis after intravitreal anti-VEGF injections has stabilized since 2011 despite the explosive increase in anti-VEGF injections. The off-label use of bevacizumab accounted for its disproportionately high incidence of endophthalmitis. The OMOP CDM, which includes off-label uses, laboratory data, and a scalable standardized database, could provide a novel strategy to reveal real-world evidence, especially in ophthalmology.

아메드방수유출장치삽입술 후 발생한 감염성 안내염의 임상 양상 및 예후

홍채민,김규남,조용운,김성재,정인영,유웅선 대한안과학회 2023 대한안과학회지 Vol.64 No.11

목적: 아메드방수유출장치삽입술 후 발생한 감염성 안내염의 임상 양상과 치료 결과를 보고하고자 한다대상 및 방법: 2010년 1월 1일부터 2022년 5월 31일까지 아메드방수유출장치삽입술을 받은 환자의 기록을 후향적으로 검토하였고, 감염성 안내염이 발생한 환자의 임상 경과, 미생물학적 실험실 결과 및 치료에 대한 데이터를 분석하였다. 결과: 아메드방수유출장치삽입술을 받은 310안 중 9안(2.90%)에서 안내염이 발생하였다. 아메드방수유출장치삽입술과 안내염 진단사이의 평균 발생 시간 간격은 3.59년이었다. 초기 치료를 위해 모든 눈에 유리체강 내 항생제 주사를 시행하였고 4안에서 유리체절제술을 시행하였다. 삽입된 장치는 7예에서 제거되었다. 4안에서 원인균이 배양되었다. 2명의 환자는 최대교정시력이 20/200 이상이었으나 5안은 최대교정시력이 안전수동 이하였다. 결론: 아메드방수유출장치삽입술과 관련된 안내염은 드물긴 하나, 시각적 예후가 불량한 경우가 많으며 발병을 예측하기 어렵다. 따라서 아메드방수유출장치삽입술을 받는 환자는 정기적인 추적 관찰 시 교육을 받아야 하며, 수술 후 증상이 나타난 환자에 대해서는신속한 평가와 치료가 필요하다. Purpose: We studied the clinical features and assessed the treatment outcomes of infectious endophthalmitis subsequent to Ahmed glaucoma valve (AGV) implant surgery. Methods: We performed a retrospective review of the medical records of patients who underwent AGV implant surgery between January 1, 2010 and May 31, 2022. Clinical course, microbiological lab results, and the treatment data of patients who developed infectious endophthalmitis were analyzed. Results: Of 310 eyes that underwent AGV implant surgery, 9 (2.90%) developed endophthalmitis. The average time interval between AGV implant surgery and the diagnosis of endophthalmitis was 3.59 years. As initial treatment, all affected eyes received injections of intravitreal antibiotics, while four underwent primary pars plana vitrectomy. The implanted valve was removed in seven instances. Microorganisms were found in cultures from four cases. Two patients achieved a final best-corrected visual acuity (BCVA) above 20/200, while the other five had a final BCVA of hand motion or worse. Conclusions: AGV implant-related endophthalmitis is uncommon and often results in poor visual outcomes, with unpredictable onset. Consequently, it is crucial to educate patients undergoing AGV implant surgery during regular follow-ups. Immediate evaluation and treatment are necessary for patients exhibiting symptoms after surgery.