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Cat scratch disease (CSD) in humans is caused by infection with Bartonella henselae or other Bartonella spp. The name of the disease reflects the fact that patients frequently have a history of contact (often involving bites or scratches) with infected cats. Patients with CSD typically develop lesions at the site where the skin is broken together with regional lymphadenopathy but may go on to exhibit systemic symptoms and with deep-seated infections at a range of sites including the eye. Patients with CSD may present with a range of inflammatory eye conditions, including Parinaud’s oculoglandular syndrome, neuroretinitis, multifocal retinitis, uveitis and retinal artery occlusion. Bartonella spp. are fastidious bacteria that are difficult to culture from clinical specimens so microbiological diagnosis is frequently made on the basis of positive serology for anti-Bartonella antibodies or detection of bacterial DNA by PCR. Due to the lack of clinical trials, the evidence base for optimal management of patients with CSD-associated eye infections (including the role of antibiotics) is weak, being derived from single reports or small, uncontrolled case series.

PurposeThe present study aimed to epidemiologically evaluate patients with infectious keratitis following corneal transplantation.MethodsThis retrospective study analyzed medical records of patients who underwent keratoplasty from March 2014 to March 2022 at a tertiary center. A total of seventy-five patients were evaluated. The data were classified based on culture results, the type of microorganisms involved, treatment requirements, and the type of primary keratoplasty performed.ResultsSeventy-five patients were evaluated in this study, with a mean age of 45.9 years (22–95 years). The mean duration between the first surgery and the incidence of infectious keratitis was 1.43 years, and most cases occurred in the first year (56.2%). Bacterial and fungal keratitis in 2.17%, 1.39%, and 1.26% of cases undergoing penetrating keratoplasty (PK), endothelial keratoplasty (EK), and anterior lamellar keratoplasty (ALK) occurred, respectively. Streptococcus viridans (9.3%) and Staphylococcus aureus (6.6%) had the highest prevalence. Across various smear and culture results (gram-positive, gram-negative, fungal, and negative culture), no significant differences were found in endophthalmitis rates (P = 0.797) and the necessity for tectonic grafts (P = 0.790). Similarly, the choice of surgical method (PK, ALK, EK) showed no significant impact on the need for tectonic grafts (P = 0.45) or the rate of endophthalmitis (P = 0.55).ConclusionsThe incidence of keratitis after a corneal graft was 1.7%, with Streptococcus viridans and Staphylococcus aureus the most common microorganisms. The rate of endophthalmitis associated with post-keratoplasty keratitis was 0.053%. There was no correlation between the necessity for a tectonic graft or the incidence of endophthalmitis and the type of microorganisms involved.

This was a retrospective cross-sectional study evaluating the aetiology and antibiotic susceptibility in patients treated for suspected bacterial keratitis at Skåne University Hospital during 2019. Inclusion criteria: eyes with bacterial keratitis. Exclusion criteria: co-infection with other microbes. Primary outcome parameters: predisposing factors, causative pathogens and antibiotic susceptibility. Secondary outcome parameter: antibiotic treatment. A total of 255 cases met the inclusion criteria. Of these, 149 (58%) occurred in contact lens wearers. Corneal cultures, when performed, were positive in 51% of cases. For eyes which had received antibiotic treatment prior to corneal culture (n = 36), the proportion of positive cultures was 50%. Ulcers < 1 mm were less likely to yield a positive culture than those ≥ 1 mm. The most frequently isolated bacteria were coagulase-negative staphylococci (48%). Antibiotic resistance rates were lowest to levofloxacin (0%), ciprofloxacin (2%) and chloramphenicol (4%), and highest to fusidic acid (47%) and clindamycin (19%). The low proportion of positive cultures from small ulcers suggests that these warrant a different diagnostic approach. Furthermore, corneal cultures from eyes with ongoing antibiotic treatment were positive to the same extent as those from untreated eyes, suggesting that discontinuation of antibiotic treatment before re-culturing might not be necessary.

Purpose To assess whether oculoplastic surgeries can be performed without any topical and systemic antibiotics, in a “100% antibiotic free” fashion. Method We conducted a multicenter retrospective study between November 2017 and December 2022. Patients who underwent an oculoplastic procedure were screened. Patients who received preoperative or postoperative systemic antibiotics were excluded. Intraoperative IV antibiotics were allowed. Patients were divided into two groups: those who were treated with local antibiotics ointments (LATB group) and those who were treated without local antibiotics ointments (LATB free group) postoperatively. The primary outcome was the incidence of surgical site infections (SSI). The relationship between the use of local antibiotics and the occurrence of SSI was assessed using Fisher’s exact test. The alpha risk was set to 5% and two-tailed tests were used. Results Among the 947 procedures included, 617 were included in the LATB group and 330 in the LATB free group. 853 and 80 procedures were classified Altemeier class 1 (clean) and class 2 (clean-contaminated) surgeries, respectively. Overall, 310 (32.73%) procedures were performed without any systemic nor topical antibiotics (100% antibiotic free fashion). SSI occured in four (4/617; 0.65%) and five (5/330; 1.52%) procedures in the LATB and LATB free group respectively, without any statistical difference between the groups ( p  = 0.290). A subgroup analysis was carried out by excluding the procedures performed under prophylactic intraoperative intravenous antibiotics and did not reveal any statistical difference between the two groups ( p  = 0.144). All SSI patients were treated with systemic antibiotics with favorable outcomes. Postoperative wound dehiscence was the only risk factor associated with postoperative SSI ( p  = 0.002). Conclusion This study suggests that performing a “100% antibiotic free” oculoplastic surgery without systemic and topical antibiotics is reasonable in Altemeier class 1 and class 2 procedures.

BackgroundTo evaluate the characteristics, treatment patterns and outcomes of acute postoperative endophthalmitis.MethodsPatients presenting with acute postoperative endophthalmitis between January 2017 to December 2019 were identified from hospital records in this multicentre retrospective cohort study. Clinical records were reviewed for visual acuity (VA) at various timepoints, cause of endophthalmitis, microbiological results, treatments and complications.ResultsForty-six eyes of 46 patients were included. Intravitreal injections were the leading cause of acute postoperative endophthalmitis (n = 29; 63%), followed by cataract surgery (n = 8; 17%), vitreoretinal surgery (n = 7; 15%), and secondary intraocular lens insertion (n = 2, 4%). The absolute risk of endophthalmitis was 0.024% (1:4132) for intravitreal injections, 0.016% (1:6096) for cataract surgery, and 0.072% (1:1385) for vitreoretinal surgery. The majority of patients (n = 38; 83%) had better VA at 6 months compared to presentation, although fewer (n = 13; 28%) maintained similar or better VA compared to before the precipitating surgery. Twenty-four cases yielded positive culture results, of which staphylococcus epidermidis was the most commonly isolated organism. Microbiological yield was not associated with better final visual outcomes. Patients who underwent therapeutic vitrectomy (n = 15; 33%) had poorer VA at presentation, but subsequently achieved visual outcomes comparable to those who received medical treatment alone. There was no difference in time to presentation, visual outcome and retinal detachment rates among the different causative procedures.ConclusionIntravitreal injections were the most common cause of endophthalmitis in our region, primarily because of their higher frequency compared to other intraocular procedures. In this cohort, the primary procedure had no effect on presentation, management or visual outcomes.

Gore-Tex sutures are commonly used for scleral-fixated intraocular lenses (SFIOL) due to their high tensile strength and lower risk of breakage. However, complications such as suture erosion and infection remain a concern. This report presents a case of Gore-Tex suture–associated endophthalmitis in a young patient. A 21-year-old man with a history of penetrating eye injury and subsequent aphakia in the left eye underwent SFIOL surgery using Gore-Tex sutures, with a resultant best-corrected visual acuity (BCVA) of 20/30. Eighteen months later, he presented with sudden pain and an exposed suture. He was initially managed with topical antibiotics under observation. However, as signs of endophthalmitis developed, he was managed with an intravitreal antibiotic injection followed by pars plana vitrectomy with intraocular lens explantation. Culture of the vitreous sample identified Haemophilus influenzae. The patient gradually recovered, achieving a final BCVA of 20/125. This case underscores the importance of vigilant postoperative monitoring and timely intervention in managing suture-related complications. [Ophthalmic Surg Lasers Imaging Retina 2025;56:XX–XX.]

PurposeTo report on the clinical characteristics, and outcomes of patients who developed infectious keratitis associated with contact lens (CL) wear following penetrating keratoplasty (PK).MethodsA retrospective chart review was performed to identify all patients who underwent PK between November 2012 and January 2023 at a single tertiary referral practice, and subsequently developed CL related infectious keratitis. 74 patients using CL following PK were identified. Charts were reviewed to obtain data about demographics, ocular history, CL usage, microbial culture reports, visual acuity, treatment, and clinical outcomes.ResultsCL-associated infectious keratitis occurred in 9 patients, more frequently in males (66%), and patients had a mean age of 54.5 ± 11.8 years old. The identified causative organisms included: Stenotrophomonas maltophilia (N = 3), Candida parapsilosis (N = 2), Moraxella nonliquefaciens (N = 1), Pseudomonas aeruginosa (N = 1), Staphylococcus epidermidis (N = 1), Streptococcus mitis (N = 1), Candida albicans (N = 1), and Acanthamoeba (N = 1). Contact lenses were used following PK for an average of 9.1 ± 10.8 months before development of keratitis. Patients were followed for 31.8 ± 30.2 months after infection. The mean best corrected visual acuity without CL prior to infection was 20/150 and decreased to 20/260 post-infection. Complications following the contact-lens-associated infectious keratitis included: central corneal haze (N = 8), chronic corneal epithelial defects (N = 3), perforation (N = 3), endophthalmitis (N = 1), and enucleation (N = 1). Three grafts required repeat PK.ConclusionsCL-associated infectious keratitis following PK have high rates of complication. Patients should be monitored closely for signs of infection.

Background. Since 1986, researchers have noted a syndrome of Klebsiella pneumoniae pyogenic liver abscess that is complicated by endophthalmitis or central nervous system infections. There are limited data regarding the role of bacterial genotype in the pathogenesis of this syndrome. Methods. We conducted a retrospective cohort study involving 177 cases of K. pneumoniae pyogenic liver abscess treated during 1997–2005 at a tertiary university hospital in Taiwan. We performed bacterial cps genotyping by polymerase chain reaction detection of serotype-specific alleles at wzy and wzx loci and used an in vitro serum assay to evaluate the virulence of bacterial strains. Results. Septic ocular or central nervous system complications developed in 23 patients (13%). Logistic regression analysis showed that genotype K1 was the only significant risk factor (adjusted odds ratio, 4.8; 95% confidence interval, 1.5–15.7, P = .009). The serum resistance assay indicated that, on average, K1 strains (n = 100) were significantly more virulent than were strains of K2 (n = 36), K20/K5/K54 (n = 21), or other genotypes (n = 20) (P

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