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Background/aimsTo examine the incidence, causative microorganisms and in vitro antimicrobial susceptibility and resistance profiles of infectious keratitis (IK) in Nottingham, UK.MethodsA retrospective study of all patients who were diagnosed with IK and underwent corneal scraping between July 2007 and October 2019 (a 12-year period) at a UK tertiary referral centre. Relevant data, including demographic factors, microbiological profiles and in vitro antibiotic susceptibility of IK, were analysed.ResultsThe estimated incidence of IK was 34.7 per 100 000 people/year. Of the 1333 corneal scrapes, 502 (37.7%) were culture-positive and 572 causative microorganisms were identified. Sixty (4.5%) cases were of polymicrobial origin (caused by ≥2 different microorganisms). Gram-positive bacteria (308, 53.8%) were most commonly isolated, followed by Gram-negative bacteria (223, 39.0%), acanthamoeba (24, 4.2%) and fungi (17, 3.0%). Pseudomonas aeruginosa (135, 23.6%) was the single most common organism isolated. There was a significant increase in Moraxella spp (p<0.001) and significant decrease in Klebsiella spp (p=0.004) over time. The in vitro susceptibilities of Gram-positive and Gram-negative bacteria to cephalosporin, fluoroquinolone and aminoglycoside were 100.0% and 81.3%, 91.9% and 98.1%, and 95.2% and 98.3%, respectively. An increase in resistance against penicillin was observed in Gram-positive (from 3.5% to 12.7%; p=0.005) and Gram-negative bacteria (from 52.6% to 65.4%; p=0.22).ConclusionIK represents a relatively common and persistent burden in the UK and the reported incidence is likely underestimated. Current broad-spectrum antimicrobial treatment provides a good coverage for IK, although challenged by some level of antimicrobial resistance and polymicrobial infection.

Purpose: To investigate if inflammation score (IS), calculated from the cornea, anterior chamber, iris, and vitreous, indicates endophthalmitis severity. Methods: In a prospective study, consecutive adults with a clinical diagnosis of post-cataract endophthalmitis within 6 weeks of surgery were recruited. Patients were allocated to IS-based primary treatment (IS < 10: intravitreal injection and IS ≥ 10: vitrectomy) and randomized to two intravitreal antibiotics combinations (vancomycin + ceftazidime and vancomycin + imipenem). Undiluted vitreous microbiology work-up included culture susceptibility, polymerase chain reaction, Sanger sequencing, and targeted next-generation sequencing. Results: The average age of 175 people was 63.4 ± 10.7 years and included 52.6% small incision cataract surgery and 47.4% phacoemulsification surgery. Severe endophthalmitis (IS ≥ 20), diagnosed in 27.4% of people, had a shorter time to symptoms (average 5.4 vs 8.7 days; P = 0.018), poorer presenting vision (all ≤ hand motion), higher culture positivity (50% vs 30.7%; P = 0.032), and higher Gram-negative bacterial infection (70.8% vs 46.2%; P = 0.042). For IS ≥ 20 discriminant and Gram-negative infection, Spearman's coefficient was 0.7 [P < 0.0001, 95% confidence interval (CI) 0.59-0.82], with an area under the receiver operating characteristic curve of 0.9 (95% CI 0.85-0.94, P < 0.0001), a Youden index J of 0.74, a sensitivity of 87.2%, and a specificity of 87.5%. The final vision of >20/400 and >20/100 was regained in 50.2% and 29.1% of people, respectively. The susceptibility of common Gram-positive cocci and Gram-negative bacilli was the highest for vancomycin (95.0%) and colistin (88.6%), respectively. NGS detected polymicrobial infection in 88.5% of culture-negative endophthalmitis. Conclusions: Higher inflammation scores indicated severe disease and Gram-negative infection in post-cataract endophthalmitis.

Background/aimsMost post-traumatic acute infectious endophthalmitis occur within a week of open globe trauma, necessitating early antibiotic prophylaxis. There are few randomised studies that demonstrate the benefits of prophylactic antibiotics. This randomised controlled non-inferiority trial was aimed at determining the incidence of post-traumatic endophthalmitis using established intravenous/oral prophylaxis and comparing this to the incidence using oral antibiotics only.MethodsAll adult patients admitted with open globe injury were included. Those with proven endophthalmitis, high-risk features, who underwent primary evisceration and those allergic to the trial antibiotics were excluded. Patients were randomised to receive either intravenous cefazolin and oral ciprofloxacin or oral ciprofloxacin and oral cefuroxime for 3 days from admission. Acute endophthalmitis was the primary outcome. Patients completed the study if they were followed up for 6 weeks post injury.ResultsThree hundred patients were enrolled, with 150 in each arm. There were 99 exclusions. Seven patients developed endophthalmitis despite prophylaxis—2.0% (three cases) in the intravenous and oral arm, compared with 2.7% (four cases) in the oral-only arm—this difference was not statistically significant (p=0.703).ConclusionsThe incidence of endophthalmitis with prophylaxis was 2–3%. Selected patients with open globe injuries (without high-risk features) may receive either intravenous cefazolin and oral ciprofloxacin, or oral cefuroxime and oral ciprofloxacin as prophylaxis against acute endophthalmitis—the latter regimen has the advantage of shortening patients' hospital stays and reducing costs. Non-inferiority study-design limitations should be taken into account, however.

Neuroretinitis connotes a descriptive clinical entity of optic disc oedema in association with macular exudates in a star configuration. Accordingly, it does not indicate a specific aetiology, although cat scratch disease caused by Bartonella henselae is the most common cause. Historically, the recognition of neuroretinitis dates to the early 20 th century with the eventual understanding that the optic disc is the primary target of disease with secondary macular involvement. Neuroretinitis can be broadly divided into four categories: infectious, inflammatory, autoimmune and mimickers. The intention of this article is to review the various aetiologies of neuroretinitis with a focus on the etiopathogenesis, clinical manifestations, and management of B. henselae associated neuroretinitis and recurrent idiopathic neuroretinitis.

Intravitreal injections (IVIs) are the most common outpatient procedure worldwide, yet no consensus exists regarding their optimal setting. This study analysed 101 976 IVIs performed between 2017 and 2023, comparing endophthalmitis rates before and after introducing a mobile laminar air flow (LAF) device in a clean room. The incidence of endophthalmitis decreased from 0.033% to 0.013%, a 63.2% risk reduction (Odds Ratio=0.368, p=0.04). These findings suggest that mobile LAF enhances air quality and reduces infection risk, offering a cost-effective, efficient alternative to operating theatres for IVIs.

Purpose: To present five cases of infectious keratitis following femtosecond laser–assisted cataract surgery combined with laser arcuate keratotomies (FLACS-AK). Methods: This was a retrospective review of the medical records of five patients who developed infectious keratitis after FLACS-AK, including medical history, clinical findings, surgical details, microbiological culture results, and imaging. Review of the literature revealed only two other published cases describing infectious keratitis following FLACS-AK. Results: All patients underwent uneventful FLACS-AK in both eyes and later developed unilateral infectious keratitis at the arcuate keratotomy incision. One patient developed an early-onset, fulminant infection with cultures positive for Pseudomonas aeruginosa. Two patients presented with late-onset, milder infections, with negative culture results. Two patients developed a very late-onset infection due to P. aeruginosa, with one of them requiring surgical intervention. All patients were also treated with fortified antibiotics. Four of five patients had good clinical and visual outcomes, whereas one patient suffered from devastating results. Conclusions: Infectious keratitis following FLACS-AK is a rare but potentially sight-threatening complication with variable onset and severity. Penetrating arcuate keratotomies may pose a higher risk of infection compared to intrastromal incisions, underscoring the need for careful surgical planning and long-term postoperative surveillance. Surgeons should therefore consider performing an intrastromal incision or, when applicable, a different method for arcuate correction.

Background Bacterial eye infections are major global health issue in developing countries like Ethiopia, poor hygiene, limited healthcare infrastructure, and inadequate treatment options contribute to the increased burden of these infections, leading to significant ocular morbidity and potential blindness. Major bacterial pathogens, including Staphylococcus aureus , Haemophilus influenzae , Streptococcus pneumoniae , and Pseudomonas aeruginosa , are responsible for these infections. The objective of this systematic review and meta-analysis is to synthesize existing literature on the prevalence of bacterial eye infections in Ethiopia, identify common bacterial pathogens, and analyze antibiotic resistance patterns. Methods Comprehensive search were performed across electronic databases and grey literature using specific search terms. Eligible studies were organized in MS Excel and imported into STATA version 14 for statistical analysis. The pooled prevalence of bacterial eye infections and multidrug resistance patterns was calculated using a random-effects model, with heterogeneity assessed via the I² statistic. Publication bias was evaluated through funnel plots and Egger’s test. A sensitivity analysis was conducted to assess the influence of individual studies on the overall effect size. Result The systematic review and meta-analysis of 19 studies conducted in Ethiopia revealed significant regional variations in the prevalence of bacterial eye infections and multidrug resistance (MDR). The overall pooled prevalence of bacterial eye infections was 54.07%, with substantial heterogeneity (I² = 99.2%). Prevalence rates varied across regions, with the highest in Oromia (62.98%) and the lowest in SNNPR (34.3%). Staphylococcus aureus was the most common pathogen (45.47%), followed by coagulase-negative Staphylococci (36.14%). The pooled prevalence of MDR was 66.06%, with the highest rates in Somali (87.7%) and the lowest in Tigray (37.9%). Subgroup analysis showed higher prevalence in studies before 2020 and with smaller sample sizes. Conclusion In conclusion, the study highlights a high prevalence of bacterial eye infections and multidrug resistance in Ethiopia, with significant regional variation. These findings highlight the urgent need for targeted interventions and antimicrobial stewardship programs to address the growing challenge of antibiotic resistance in Ethiopia.

Purpose To evaluate and compare the results of bipedicle conjunctival flap (CF) and cryopreserved amniotic membrane graft (AMG) in the treatment of non-viral infectious keratitis resistant to medical treatment. Methods This prospective randomised interventional study included 40 eyes of 40 patients with resistant non-viral infectious keratitis. Twenty eyes received CF and 20 eyes received AMG. In the CF group, there were 12 eyes with fungal keratitis, 7 eyes with bacterial keratitis and 1 eye with Acanthamoeba keratitis. In the AMG group there were 13 eyes with fungal keratitis, 5 eyes with bacterial keratitis and 2 eyes with Acanthamoeba keratitis. In the CF group, three ulcers had descemetocele and four ulcers were perforated. In the AMG group, four ulcers had descemetocele and two ulcers were perforated. In CF, 360° peritomy was done and a bipedicle CF from the upper conjunctiva was dissected from Tenon's capsule, mobilised to cover the cornea and sutured to episclera. In AMG, one or two layers of AM were trimmed to fit the ulcer and sutured to the cornea. The follow-up period was 6 months. Results Successful results were observed in 18/20 eyes (90%) in each group. Postoperatively, no significant differences between the two groups were found regarding success rate (p=1.0), epithelialisation time (p=0.75) or visual acuity improvement (p=0.84). Conclusions CF and AMG are effective in treatment-resistant infectious keratitis. They could restore ocular surface integrity and provide metabolic and mechanical support for corneal healing. For large corneal perforation, it may be better to use another procedure such as penetrating keratoplasty to restore ocular integrity.

Introduction Antimicrobial resistance in microbial keratitis has not been previously explored in Alexandria. We aim to recommend effective therapies through identification of etiological agents, determination of antimicrobial susceptibilities, and comparing outcomes of empiric topical antimicrobials. Methods In this 2022 prospective cohort conducted in Alexandria Main University Hospital cornea clinic, antimicrobial susceptibilities of isolated microorganisms from corneal scrapings were detected and antibiograms were developed. Bacterial (BK), fungal (FK), or mixed fungal/bacterial keratitis (MFBK) patients on empiric regimens were compared for ulcer healing, time-to-epithelialization, best-corrected visual acuity, interventions, and complications. Results The prevalent microorganisms in 93 positive-cultures were coagulase-negative staphylococci (CoNS, 30.1%), Pseudomonas aeruginosa (14%), and Aspergillus spp. (12.9%). CoNS were susceptible to vancomycin (VAN, 100%) and moxifloxacin (MOX, 90.9%). Gram-negative bacteria showed more susceptibility to gatifloxacin (90.9%) than MOX (57.1%), and to gentamicin (GEN, 44.4%) than ceftazidime (CAZ, 11.8%). Methicillin-resistance reached 23.9% among Gram-positive bacteria. Fungi exhibited 10% resistance to voriconazole (VRC). Percentages of healed ulcers in 49 BK patients using GEN + VAN, CAZ + VAN and MOX were 85.7%, 44.4%, and 64.5%, respectively ( p  = 0.259). Their median time-to-epithelialization reached 21, 30, and 30 days, respectively (log-rank p  = 0.020). In 51 FK patients, more ulcers (88.9%) healed with natamycin (NT) + VRC combination compared to VRC (39.1%) or NT (52.6%) ( p  = 0.036). Their median time-to-epithelialization was 65, 60, and 22 days, respectively (log-rank p  < 0.001). The VRC group required more interventions (60.9%) than NT + VRC-treated group (11.1%) ( p  = 0.018). In 23 MFBK patients, none healed using NT + CAZ + VAN, while 50% healed using VRC + CAZ + VAN ( p  = 0.052). Regimens had comparable visual outcomes and complications. Conclusion Based on the higher detected susceptibility, we recommend empiric MOX in suspected Gram-positive BK, gatifloxacin in Gram-negative BK, and GEN + VAN in severe BK. Due to better outcomes, we recommend NT + VRC in severe FK. Trial registration ClinicalTrials.gov identifier, NCT05655689. Registered December 19, 2022– Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05655689?cond=NCT05655689.&draw=2&rank=1