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Infectious endophthalmitis (IE) poses a significant threat to vision. This study aimed to explore the impact of microRNA (miR)-27a-3p on inflammation in IE. A rat model was developed through intravitreal injection of lipopolysaccharide. Clinical and demographic data were collected for 54 participants: 31 diagnosed with IE and 23 non-infectious patients with idiopathic macular holes. Expression levels of miR-27a-3p and inflammatory genes were quantified via reverse transcription quantitative polymerase chain reaction. Concentrations of inflammatory cytokines in human vitreous samples were measured using enzyme-linked immunosorbent assay. In vitro studies were conducted to explore the target gene of miR-27a-3p. The final animal experiments further verified the role of miR-27a-3p and tuberous sclerosis complex (TSC)1 in inflammatory responses. Results showed that miR-27a-3p was elevated in LPS-treated rats and IE patients. Thirty-one IE patients were divided into the High (n = 15) and Low (n = 16) groups according to the expression of miR-27a-3p. No significant differences were observed in baseline clinical and demographic characteristics between the control and IE patient groups. Pro-inflammatory cytokine mRNA levels and concentrations were notably increased in both LPS-treated rats and the High group of patients. Besides, results showed that TSC1 is a target gene of miR-27a-3p. Moreover, TSC1 inhibition promoted inflammation in rat vitreous samples. In summary, our findings suggested that miR-27a-3p exacerbated inflammatory responses in IE though targeting TSC1, offering novel insights for potential therapeutic strategies targeting miR-27a-3p in the clinical management of IE.

Purpose To evaluate the efficacy of early pars plana vitrectomy (PPV) and silicone oil (SO) tamponade for treating acute post-phacoemulsification infectious endophthalmitis. Methods This retrospective study included 44 eyes of 44 patients who developed early endophthalmitis after uneventful phacoemulsification. PPV with SO tamponade was performed within 24 h of presentation. Results A significant improvement in logMAR visual acuity (VA) was reported in our patients; (2.595 ± 0.249 at baseline compared to 1.052 ± 0.462 at final visit), with P value 0.0001. SO was removed in all cases after 4–9 months (6 ± 1.3) and all patients continued follow-up for at least 6 months after SO removal (15.4 ± 6.5). Postoperative complications included; three eyes (6.8%) developing severe proliferative vitreoretinopathy (PVR), four eyes (9.1%) developing inferior retinal detachment (RD) under SO, Two eyes (4.5%) developing pupillary block glaucoma and two eyes (4.5%) suffered from recurrent RD after SO removal. Conclusion Early PPV with SO tamponade for the treatment of acute endophthalmitis after phacoemulsification has good visual outcomes and lower complication rates if performed early within 24 h of patient presentation.

Purpose To investigate whether the clinical characteristics, treatment and prognosis of endogenous infectious endophthalmitis (EIE) have changed over the past 5 years. Methods Retrospectively analyze all articles about EIE published in the PubMed, Web of Science, and Embase databases from 2017 to 2021. Results A total of 128 patients and 147 eyes (46 left and 60 right) were included in the study. The mean age at diagnosis was 51 ± 19 years. The most common risk factors were diabetes and intravenous drug use. From 2017 to 2021, Klebsiella was the most common pathogenic microorganism (22%), and vitreous culture had the highest positivity rate. The most common complaint was blurred vision. The mean visual acuity (logMAR) at onset was 2.84, and the clinical symptoms were vitreal inflammation and opacity (63%), ocular pain (37%), and conjunctival congestion (36%). The ocular inflammation could be reduced by intraocular antibiotics or vitrectomy. However, the visual prognosis, with a mean logMAR of 2.73; only 50% of the eyes reached a visual acuity level of finger count and above. Changes in diagnostics over the past 5 years have mainly manifested as more diverse microorganism culture methods. In addition to conventional culture methods, PCR, sputum culture and aqueous humour culture are also commonly used for the diagnosis of pathogenic bacteria, improving the positive culture rate and visual prognosis. Conclusion The prognosis of EIE is poor. It is recommended to pay attention to the pathogenic bacteria culture results and accompanying systemic diseases and to diagnose and treat patients as soon as possible.

Objective Postoperative infectious endophthalmitis is a serious complication of cataract surgery. Understanding its risk factors, pathogen distribution, and related biomarkers is crucial for prevention and treatment. This study aimed to investigate the risk factors for postoperative infectious endophthalmitis following cataract surgery, analyze pathogen types, and evaluate the correlation between changes in peripheral blood levels of IL-17, MMP-2, and IGF-1 and the occurrence of this complication. Methods In this retrospective observational cohort study, 784 patients (1568 eyes) who underwent cataract surgery at Changzhi People’s Hospital Eye Hospital from January 2020 to June 2024. Aqueous humor and vitreous fluid were collected from patients with postoperative infectious endophthalmitis for pathogen culture. Basic clinical data of infected and non-infected groups were compared, and differences in serum concentrations of IL-17, MMP-2, and IGF-1 three days after surgery were analyzed to assess the predictive ability of these biomarkers for infectious endophthalmitis. Results Among the 784 surgical cases, 46 eyes from 42 patients were diagnosed with infectious endophthalmitis, including 38 cases of unilateral infection (38 patients with one infected eye each) and 4 cases of bilateral infection (4 patients with both eyes infected).Pathogen culture results showed that Gram-positive bacteria were the predominant pathogens (accounting for 73.08%). Univariate and multivariate analyses revealed that diabetes mellitus and vitreous spillage were independent risk factors for postoperative infectious endophthalmitis after cataract surgery. Further analysis of serum biomarkers revealed that serum levels of IL-17 and MMP-2 in the infected group were significantly higher, while IGF-1 was significantly lower than those in the non-infected group three days after surgery (all P  < 0.05). Receiver operating characteristic curve analysis indicated that the combined detection of these three biomarkers had a high predictive efficacy for postoperative infectious endophthalmitis after cataract surgery, with an area under the curve of 0.955, a sensitivity of 95.27%, and a specificity of 82.42%. Conclusion Although the incidence of postoperative infectious endophthalmitis after cataract surgery is low, the presence of diabetes mellitus and vitreous spillage significantly increases the risk. Gram-positive bacteria are the main pathogens. Changes in serum levels of IL-17, MMP-2, and IGF-1 are closely related to the occurrence of infectious endophthalmitis, and the combined detection of these three biomarkers has high predictive value, providing an important reference for early clinical identification and intervention.

Background Bacterial endogenous endophthalmitis (BEE) represents a rare but severe ophthalmological emergency which caused by hematogenous spread of bacterial infection. As its characteristics of insidious onset and rapid progression, BEE may lead to vision loss or even enucleation without immediate treatments. In recent years, with increasing numbers of immunosuppression and prevalence of resistant strains, incidence of BEE has risen, and its diagnosis and treatment face new challenges. Case presentation A 15-year-old female patient was admitted to department of ophthalmology due to blurred vision and photophobia and lacrimation in the left eye for two days, and was first diagnosed as endophthalmitis and secondary glaucoma. During the diagnosis and treatment process, after smear culture of left chamber and vitreous aspirates, as well as the metagenomic next-generation sequencing (mNGS), final diagnosis of infectious endophthalmitis secondary to Neisseria meningitidis ( N. meningitidis ) was decided and a targeted treatment plan was developed. After intraocular injection and systemic antibiotic therapy, the patients was discharged after full control of the infection and improved endophthalmitis. Combined with literature review, this study discussed the application value of mNGS in diagnosing endogenous endophthalmitis. Conclusion mNGS shows significant value in the diagnosis of endogenous endophthalmitis in terms of improving positive rate of pathogen detection in intraocular fluid of infectious endophthalmitis and providing strong support for clinical treatments. The successful treatment of this case further confirms the promise of mNGS in ophthalmic infectious diseases. With the continuous progress of technology, mNGS is expected to be popularized and applied in more medical institutions to benefit more patients.

Background/aimsTo describe an alternative technique for avoiding contact with the lids and lashes, without the use of a lid speculum, during intravitreal anti-vascular endothelial growth factor injections.MethodsRetrospective case series of all patients undergoing intravitreal injections of bevacizumab and ranibizumab, with the lid splinting retraction technique from January 2010 to December 2015. Injections performed by six vitreoretinal specialists were included. The key preinjection ocular surface preparation includes topical anaesthetic, 5% povidone-iodine and a subconjunctival injection of 2% lidocaine with epinephrine. A second instillation of 5% povidone-iodine is given and the intravitreal injection is then performed. No lid speculum is used. A search of the electronic medical records identified patients diagnosed with postinjection endophthalmitis and charts were reviewed to ensure inclusion criteria were met. The main outcome measure was incidence of postinjection endophthalmitis.ResultsA total of 78 009 consecutive intravitreal injections were performed, of which 22 207 were bevacizumab and 55 802 were ranibizumab. In this cohort of patients (n=6320), 12 cases of endophthalmitis developed, corresponding to a rate of 0.015%.ConclusionsThe technique of eyelid retraction for intravitreal injection has a low rate of endophthalmitis, similar to the reported rates using a metal lid speculum. This is beneficial for both the physician and the patient as it minimises patient discomfort as well as the duration of the procedure. To our knowledge, this is one of the largest studies performed to date evaluating intravitreal injection-related endophthalmitis.

To compare the surgical outcomes and assess the effectiveness of a three-dimensional digital visualization system (3DVS) versus traditional microscope-assisted pars plana vitrectomy in the management of infectious endophthalmitis. A retrospective case series study was conducted on 29 patients diagnosed with infectious endophthalmitis who underwent 23-gauge transconjunctival vitrectomy between 1 Jan. 2020 and 31 Aug. 2023. Of all these patients, 16 cases underwent vitrectomy-assisted by the 3DVS (3D group), and the other 13 cases by traditional microscope (eyepiece group). The main comparison focuses on the differences between the two systems in terms of operation time, the brightness of the endoillumination, complications, and preoperative and final best-corrected visual acuity (BCVA, logMAR). There were no significant differences in baseline characteristics between the two groups, with trauma being the most prevalent cause of infection (10 vs 8). The positive detection rate of pathogenic bacteria exceeded 40% in both groups (43.75% vs. 46.15%). The results showed that the incidence of complications, including high intraocular pressure (3 vs. 4) and retinal detachment (4 vs. 3), did not differ significantly between the groups (chi-square = 0.2857, = 0.5930). The mean operation time was slightly shorter in the 3D group (75.94 ± 25.70 min) compared to the eyepiece group (82.31 ± 25.38 min, = 0.5102). However, the 3D group exhibited significantly lower endoillumination (25%-35%) than the eyepiece group (40%-50%, < 0.0001). Both groups demonstrated significant improvement in BCVA at the end of follow-up ( = 0.0006,  = 4.321). The mean final BCVA for the 3D group was 1.373 ± 0.9824 logMAR, which was modestly superior to the eyepiece group's mean of 1.805 ± 0.9549 logMAR. The 3DVS provides comparable surgical outcomes to the traditional microscope, with the advantages of clearer intraoperative visualization, lower required illumination, and optimized ergonomic design. It is suitable for complex and prolonged endophthalmitis surgery, offering excellent safety and efficacy.

PurposeInfectious endophthalmitis (IE) is a severe complication that can lead to blindness even with treatment. However, the impact of antibiotic resistance and early vitrectomy on its prognosis has scarcely been documented. This study investigated the impact of antibiotic resistance of pathogen and early vitrectomy on the prognosis of IE.MethodsThe medical records of 171 patients treated for IE at a tertiary referral center between 2007 and 2016 were retrospectively reviewed and analyzed for etiology, pathogen, drug resistance to vancomycin or third-generation cephalosporins, treatment types and timing, and visual outcomes. Multivariate logistic regression analysis was used to determine significant prognostic factors.ResultsAmong 171 eyes, 121 (70.8%) eyes developed IE after intraocular surgery (cataract surgery, 46.3%; intraocular injection, 13.2%), 37 (21.6%) eyes developed IE endogenously, and 9 (5.3%) eyes developed IE after trauma. The major causative pathogens were Staphylococcus aureus (9.4%) and Klebsiella pneumoniae (7.0%). In total, 72.6% of the identified pathogens demonstrated antibiotic resistance. Antibiotic resistance was associated with a worse final vision (P = .027). Visual prognosis was better for eyes treated with early vitrectomy combined with intravitreal antimicrobial injections within 24 h of onset than for eyes that received only intravitreal antimicrobial injections before undergoing delayed vitrectomy (P = .003).ConclusionAntibiotic resistance of organisms causing IE is one of the most important prognostic factors. Early vitrectomy (i.e., within 24 h) may be helpful for achieving a better visual outcome. Immediate vitrectomy can be recommended, especially in IE cases caused by organisms with resistance to empirically used antibiotics.

Background: Uniplex polymerase chain reaction (PCR) for detection of bacterial and panfungal genome has been applied onto a large number of intraocular fluids facilitating management of infective endophthalmitis. Aim: To develop and apply a novel, rapid multiplex polymerase chain reaction (mPCR) to detect the presence of eubacterial, Propionibacterium acnes and panfungal genomes in intraocular fluids from patients clinically diagnosed to have infective endophthalmitis. Settings and Design: Prospective study. Materials and Methods: Conventional methods of direct microscopy by KOH/calcofluor mount, Gram′s staining and culture were done on 30 (19 Aqueous humor-AH and 11 Vitreous fluid-VF) intraocular specimens and mPCR done for simultaneous detection of eubacterial, P. acnes and panfungal genomes. Results: mPCR detected an infectious etiology in 18 (60%) of 30 intraocular specimens. Eubacterial genome was detected in 12 (40%) specimens, P. acnes genome in 4 (13.3%) specimens and panfungal genome in 2 (6.6%) specimens. mPCR results correlated with those of uniplex PCR. mPCR results were available within 5-6 hours after receipt of specimen, as against 8 hours required for each uniplex PCR with three separate thermalcyclers for their completion. Consumption of Taq polymerase was reduced considerably for mPCR. Conclusion: mPCR is a cost effective, single tube method for the simultaneous detection of eubacterial, P. acnes and panfungal genomes in intraocular specimens from patients with infective endophthalmitis. It is a more rapid procedure than uniplex PCRs and requires only a single thermalcycler.

Purpose In this study, we evaluated the incidence and clinical characteristics of post-vitrectomy acute endophthalmitis in a tertiary eye center. Methods Data were obtained by reviewing the patients’ medical records who underwent primary pars plana vitrectomy (PPvitx) from September 2011 to March 2017. We excluded patients who had any ocular surgery in the past 6 months, immunocompromised patients, and patients with a pre-operative diagnosis of endophthalmitis. The primary outcome was the incidence of acute post-pars plana vitrectomy endophthalmitis. Results Out of 6474 cases who underwent PPvitx, 12 cases of endophthalmitis (incidence rate of 0.18%) were identified. We found two positive cultures for staphylococcus epidermidis and one positive culture for staphylococcus aureus. Underlying causes of primary vitrectomy in patients who got endophthalmitis were diabetic retinopathy (8 cases), rhegmatogenous retinal detachment (2 cases), and the epiretinal membrane (1 case), and non-clearing vitreous hemorrhage secondary to central retinal vein occlusion (1 case). Conclusion In the present study, the rate of post-vitrectomy acute endophthalmitis was higher than in other reported studies.