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Endophthalmitis
Endophthalmitis is inflammation of the interior cavity of the eye, usually caused by infection. It is a possible complication of all intraocular surgeries, particularly cataract surgery, and can result in loss of vision or loss of the eye itself. Infection can be caused by bacteria or fungi, and is classified as exogenous (infection introduced by direct inoculation as in surgery or penetrating trauma), or endogenous (organisms carried by blood vessels to the eye from another site of infection). Other non-infectious causes include toxins, allergic reactions, and retained intraocular foreign bodies. Intravitreal injections are a rare cause, with an incidence rate usually less than .05%. Signs and symptoms There is usually a history of recent eye surgery or penetrating trauma to the eye. Symptoms include severe pain, vision loss, and intense redness of the conjunctiva. Hypopyon can be present and should be looked for on examination by a slit lamp. It can first present with the 'blac ...
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Intravitreal Administration
Intravitreal is a route of administration of a drug, or other substance, in which the substance is delivered into the vitreous humor of the eye. "Intravitreal" literally means "inside an eye". Intravitreal injections were first introduced in 1911 when Ohm gave an injection of air into the vitreous humor to repair a detached retina. In the mid-1940s, intravitreal injections became a standard way to administer drugs to treat endophthalmitis and cytomegalovirus retinitis. Epidemiology Intravitreal injections were proposed over a century ago however the number performed remained relatively low until the mid 2000s. Until 2001, intravitreal injections were mainly used to treat end-ophthalmitis. The number of intravitreal injections stayed fairly constant, around 4,500 injections per year in the US. The number of injections tripled to 15,000 in 2002 when triamcinolone injections were first used to treat diabetic macular oedema. This use continued to drive an increase to 83,000 injections ...
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Chloramphenicol
Chloramphenicol is an antibiotic useful for the treatment of a number of bacterial infections. This includes use as an eye ointment to treat conjunctivitis. By mouth or by injection into a vein, it is used to treat meningitis, plague, cholera, and typhoid fever. Its use by mouth or by injection is only recommended when safer antibiotics cannot be used. Monitoring both blood levels of the medication and blood cell levels every two days is recommended during treatment. Common side effects include bone marrow suppression, nausea, and diarrhea. The bone marrow suppression may result in death. To reduce the risk of side effects treatment duration should be as short as possible. People with liver or kidney problems may need lower doses. In young children a condition known as gray baby syndrome may occur which results in a swollen stomach and low blood pressure. Its use near the end of pregnancy and during breastfeeding is typically not recommended. Chloramphenicol is a broad-spectrum ...
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Cutibacterium Acnes
''Cutibacterium acnes'' (formerly ''Propionibacterium acnes'') is the relatively slow-growing, typically aerotolerant Anaerobic organism, anaerobic, gram-positive bacterium (rod) linked to the skin condition of acne vulgaris, acne; it can also cause chronic blepharitis and endophthalmitis, the latter particularly following intraocular surgery. Its genome has been sequenced and a study has shown several genes can generate enzymes for degrading skin and proteins that may be immunogenic (activating the immune system). The species is largely commensalism, commensal and part of the skin flora present on most healthy adult humans' skin. It is usually just barely detectable on the skin of healthy preadolescents. It lives, among other things, primarily on fatty acids in sebum secreted by sebaceous glands in the Hair follicle, follicles. It may also be found throughout the gastrointestinal tract. Originally identified as ''Bacillus acnes'', it was later named ''Propionibacterium acnes'' ...
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Cataract Surgery
Cataract surgery, also called lens replacement surgery, is the removal of the natural lens of the eye (also called "crystalline lens") that has developed an opacification, which is referred to as a cataract, and its replacement with an intraocular lens. Metabolic changes of the crystalline lens fibers over time lead to the development of the cataract, causing impairment or loss of vision. Some infants are born with congenital cataracts, and certain environmental factors may also lead to cataract formation. Early symptoms may include strong glare from lights and small light sources at night, and reduced acuity at low light levels. During cataract surgery, a patient's cloudy natural cataract lens is removed, either by emulsification in place or by cutting it out. An artificial intraocular lens (IOL) is implanted in its place. Cataract surgery is generally performed by an ophthalmologist in an ambulatory setting at a surgical center or hospital rather than an inpatient setting. Eit ...
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Levofloxacin
Levofloxacin, sold under the brand name Levaquin among others, is an antibiotic medication. It is used to treat a number of bacterial infections including acute bacterial sinusitis, pneumonia, H. pylori (in combination with other medications), urinary tract infections, chronic prostatitis, and some types of gastroenteritis. Along with other antibiotics it may be used to treat tuberculosis, meningitis, or pelvic inflammatory disease. Use is generally recommended only when other options are not available. It is available by mouth, intravenously, and in eye drop form. Common side effects include nausea, diarrhea, and trouble sleeping. Serious side effects may include tendon rupture, tendon inflammation, seizures, psychosis, and potentially permanent peripheral nerve damage. Tendon damage may appear months after treatment is completed. People may also sunburn more easily. In people with myasthenia gravis, muscle weakness and breathing problems may worsen. While use during preg ...
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Hypopyon
Hypopyon is a medical condition involving inflammatory cells in the anterior chamber of the eye. It is an exudate rich in white blood cells, seen in the anterior chamber, usually accompanied by redness of the conjunctiva and the underlying episclera. It is a sign of inflammation of the anterior uvea and iris, i.e. iritis, which is a form of anterior uveitis. The exudate settles at the dependent aspect of the eye due to gravity. It can be sterile (in bacterial corneal ulcer) or not sterile (fungal corneal ulcer). Differential diagnosis Hypopyon can be present in a corneal ulcer. It can occur as a result of Behçet's disease, endophthalmitis, panuveitis/panophthalmitis, or adverse reactions to some drugs (such as rifabutin). Hypopyon is also known as ''sterile pus'' because it occurs due to the release of toxins and not by the actual invasion of pathogens. The toxins secreted by the pathogens mediate the outpouring of leukocytes that settle in the anterior chamber of the eye. A ...
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Cefuroxime
Cefuroxime, sold under the brand name Zinacef among others, is a second-generation cephalosporin antibiotic used to treat and prevent a number of bacterial infections. These include pneumonia, meningitis, otitis media, sepsis, urinary tract infections, and Lyme disease. It is used by mouth or by injection into a vein or muscle. Common side effects include nausea, diarrhea, allergic reactions, and pain at the site of injection. Serious side effects may include ''Clostridium difficile'' infection, anaphylaxis, and Stevens–Johnson syndrome. Use in pregnancy and breastfeeding is believed to be safe. It is a second-generation cephalosporin and works by interfering with a bacteria's ability to make a cell wall resulting in its death. Cefuroxime was patented in 1971, and approved for medical use in 1977. It is on the World Health Organization's List of Essential Medicines. In 2020, it was the 325th most commonly prescribed medication in the United States, with more than 800thousan ...
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Phacoemulsification
Phacoemulsification is a modern cataract surgery method in which the eye's internal lens is emulsified with an ultrasonic handpiece and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution to maintain the anterior chamber. Etymology The term originated from phaco- (Greek ''phako-'', comb. form of ''phakós'', lentil; see lens) + emulsification. Preparation and precautions Proper anesthesia is essential for ocular surgery. Topical anesthesia is most commonly employed, typically by the instillation of a local anesthetic such as tetracaine or lidocaine. Alternatively, lidocaine and/or longer-acting bupivacaine anesthetic may be injected into the area surrounding ( peribulbar block) or behind (retrobulbar block) the eye muscle cone to more fully immobilize the extraocular muscles and minimize pain sensation. A facial nerve block using lidocaine and bupivacaine may occasionally be performed to reduce lid squeezing. General anesthesia is r ...
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Toxocara
The Toxocaridae are a zoonotic family of parasitic nematodes that infect canids and felids and which cause toxocariasis in humans (visceral larva migrans and ocular larva migrans). The worms are unable to reproduce in humans. Notable species include: *''Toxocara canis'', which infects dogs. *''Toxocara cati'', which infects cats and lacks intermediate hosts. *''Toxascaris leonina'', which infects mostly cats, but also dogs. *''Toxocara malayasiensis'', which infects cats. *''Toxocara vitulorum'', which infects buffalo and cattle. Infection Infection by ''T. canis'' or ''T. cati'' can cause various clinical manifestations. One of these is visceral larva migrans, wherein the larvae are unable to develop in humans as they do in cats and dogs, their natural hosts. Arrested development leaves the larvae to wander aimlessly in the body, causing inflammation, most commonly in the liver and lungs. Eggs are introduced into the body through ingestion. This can occur when eggs are depo ...
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Systematic Review
A systematic review is a Literature review, scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from published studies on the topic, then analyzes, describes, and summarizes interpretations into a refined conclusion. For example, a systematic review of randomized controlled trials is a way of summarizing and implementing evidence-based medicine. While a systematic review may be applied in the Biomedical research, biomedical or health care context, it may also be used where an assessment of a precisely defined subject can advance understanding in a field of research. A systematic review may examine clinical tests, public health interventions, environmental interventions, social interventions, adverse effects, qualitative evidence syntheses, methodological reviews, policy reviews, and economic evaluations. An understanding of systematic review ...
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Perioperative
The perioperative period is the time period of a patient's surgical procedure. It commonly includes ward admission, anesthesia, surgery, and recovery. Perioperative may refer to the three phases of surgery: preoperative, intraoperative, and postoperative, though it is a term most often used for the first and third of these only - a term which is often specifically utilized to imply 'around' the time of the surgery. The primary concern of perioperative care is to provide better conditions for patients before operation (sometimes construed as during operation) and after operation. Perioperative care Perioperative care is the care that is given before and after surgery. It takes place in hospitals, in surgical centers attached to hospitals, in freestanding surgical centers, or health care providers' offices. This period is used to prepare the patient both physically and psychologically for the surgical procedure and after surgery. For emergency surgeries this period can be short an ...
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Topical Anesthetic
A topical anesthetic is a local anesthetic that is used to numb the surface of a body part. They can be used to numb any area of the skin as well as the front of the eyeball, the inside of the nose, ear or throat, the anus and the genital area. Topical anesthetics are available in creams, ointments, aerosols, sprays, lotions, and jellies. Examples include benzocaine, butamben, dibucaine, lidocaine, oxybuprocaine, pramoxine, proxymetacaine (proparacaine), and tetracaine (also named amethocaine). Usage Topical anesthetics are used to relieve pain and itching caused by conditions such as sunburn or other minor burns, insect bites or stings, poison ivy, poison oak, poison sumac, and minor cuts and scratches. Topical anesthetics are used in ophthalmology and optometry to numb the surface of the eye (the outermost layers of the cornea and conjunctiva) to: * Perform a contact/applanation tonometry. * Perform a Schirmer's test (The Schirmer's test is sometimes used with a topical ...
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