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Endophthalmitis : a threat to the eye
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Endoftalmite é uma doença potencialmente devastadora que envolve as estruturas internas do olho. É classificada em exógena, o subtipo mais comum, e em endógena, com base na origem da infeção. A endoftalmite exógena é causada por inoculação direta do olho por microorganismos do meio externo, e surge mais frequentemente como uma complicação de uma cirurgia oftalmológica, injeções intravítreas ou de trauma penetrante, enquanto a endoftalmite endogena é causada pela propagação hematogénica de microorganismos de outras localizações no organismo. Tem um diagnóstico clínico e quando suspeitada, amostras devem ser obtidas de forma a isolar o microorganismo causador em coloração gram, culturas e por polymerase chain reaction (PCR). O passo mais importante do tratamento é a administração direta intraocular de antibióticos. Antibióticos de largo espectro com cobertura de microorganismos gram-positivos e gram-negativos devem ser iniciados após a obtenção das amostras, e subsequentemente ajustados de acordo com o antibiograma. Apesar do tratamento adequado, o prognóstico a nível da acuidade visual é reservado e por isso medidas asséticas de prevenção são importantes. A iodopovidona é a única intervenção pré-operatória que permite a redução do risco da taxa de endoftalmites. No que diz respeito à cirurgia de catarata, a profilaxia com administração de 1mg de cefuroxime no final do procedimento parece ter benefício na redução da incidência de endoftalmites.
Endophthalmitis is a potentially devastating condition involving the internal structures of the eye. It is classified based on the source of infection, as exogenous, the most common subtype, or endogenous. Exogenous endophthalmitis is caused by direct inoculation of the eye by microorganisms from the external environment, most frequently as a complication of ocular surgery, intravitreal injections or penetrating trauma, whereas endogenous endophthalmitis is caused by hematogenous spread of microorganisms from distant sites of the body. It has a clinical diagnosis and when suspected samples should be obtained for isolating the causative microorganism in gram staining, culture, and polymerase chain reaction (PCR) test. The most important step of treatment is the direct injection of antibiotics into the eye. Empiric gram-positive and gram-negative antibiotic coverage should be initiated, after obtaining cultures, and subsequentialy adjust to the antibiotic susceptibility. In spite of appropriate treatment, visual outcomes tend to be poor and preventing antiseptic measures are key. Povidone-iodine (PI) is the only preoperative technique with evidence of risk reduction in the rates of endophthalmitis. Regarding cataract surgery, the administration of 1mg of cefuroxime seems beneficial in reducing the incidence of endophthalmitis.
Endophthalmitis is a potentially devastating condition involving the internal structures of the eye. It is classified based on the source of infection, as exogenous, the most common subtype, or endogenous. Exogenous endophthalmitis is caused by direct inoculation of the eye by microorganisms from the external environment, most frequently as a complication of ocular surgery, intravitreal injections or penetrating trauma, whereas endogenous endophthalmitis is caused by hematogenous spread of microorganisms from distant sites of the body. It has a clinical diagnosis and when suspected samples should be obtained for isolating the causative microorganism in gram staining, culture, and polymerase chain reaction (PCR) test. The most important step of treatment is the direct injection of antibiotics into the eye. Empiric gram-positive and gram-negative antibiotic coverage should be initiated, after obtaining cultures, and subsequentialy adjust to the antibiotic susceptibility. In spite of appropriate treatment, visual outcomes tend to be poor and preventing antiseptic measures are key. Povidone-iodine (PI) is the only preoperative technique with evidence of risk reduction in the rates of endophthalmitis. Regarding cataract surgery, the administration of 1mg of cefuroxime seems beneficial in reducing the incidence of endophthalmitis.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Endoftalmite Acuidade visual Técnicas de assepsia Lodopovidona Rara Oftalmologia