fibrin and Endophthalmitis

Inflammatory reactions following IOL-implantation are being caused by different factors. A recent finding refers to the fact that bacteria of usually low pathogenity (i.e. Probionibacterium acnes, Staph. epidermidis, Staph. aureus haemolyticus) can enter the eye during implantation into the capsular bag and can cause an initially localized endophthalmitis. Previously this clinical appearance had frequently been mistaken as a "Toxic Lens Syndrome". Clinically, a persisting or increasing fibrin reaction with or without hypopyon, a typical whitish appearance of the capsule and a more or less marked vitreous infiltration up to a generalized endophthalmitis may be observed. For diagnostic purposes an isolation of germs from the fibrin network in the pupillary area or from the excised fragments of the capsular bag can be successful. Therapy of choice are locally applied antibiotics (i.e. the combination of Cephalosporin with Tobramycin) or eventually an operative intervention. If this is performed in the early course, the IOL can be saved in the majority of cases, although the visual acuity is usually reduced. Postoperative inflammatory reactions can also be caused by individual disposition (pseudoexfoliation, glaucoma, uveitis). No importance is being attributed furthermore to diagnoses like "Toxic Lens Syndrome" or "Pseudo-phako-anaphylactic Endophthalmitis'. Postoperative inflammatory reactions can be divided into five different clinical courses. In cases of bacterial contamination the prognosis is worsened by mono-steroid therapy.

Topics: Endophthalmitis; Fibrin; Foreign-Body Reaction; Humans; Lenses, Intraocular; Postoperative Complications

Postoperative fibrinoid reactions are regarded as a localized form of endophthalmitis caused by microbial contamination of the capsular bag during intraocular lens implantation. The incidence of early fibrinoid reactions within the first 6 postoperative days following extracapsular cataract extraction was examined after intraocular administration of antibiotics vs placebo. In a double-blind randomized trial, 2 mg cefamandol or a placebo was administered in a 0.4-ml volume at the end of the operation. A group of 28 patients received the antibiotic (mean age 74.6 years; 15 f, 13 m), while 33 patients received the placebo (mean age 72,1 years; 21 f, 12 m). Fibrinoid reactions were observed in 8 out of 61 patients during the first 6 postoperative days. There was no significant difference between the antibiotic group and the placebo group (P = 0.31). We were unable to reduce the incidence of fibrinoid reactions although we had selected a broad-spectrum cephalosporin for antibiotic treatment. The results give rise to the suspicion that most of the early postoperative fibrinoid reactions we observed were not caused by contamination with bacteria of low pathogenicity.

Topics: Cefamandole; Double-Blind Method; Endophthalmitis; Fibrin; Humans; Injections; Lenses, Intraocular; Postoperative Complications

In a controlled prospective trial the peroperative use of sodium hyaluronate and methylcellulose (2%) was compared. Two hundred and fifteen patients received sodium hyaluronate and 189 methylcellulose during extracapsular cataract extraction. We found no significant difference in postoperative anterior chamber inflammation, intraocular pressure, frequency of fibrin in the anterior chamber, nor need for additional medication during the first 5 postoperative days.

Topics: Aged; Anterior Chamber; Cataract Extraction; Endophthalmitis; Female; Fibrin; Humans; Hyaluronic Acid; Intraocular Pressure; Male; Methylcellulose; Prospective Studies

Topics: Administration, Topical; Antifungal Agents; Candida glabrata; Candidiasis; Descemet Stripping Endothelial Keratoplasty; Endophthalmitis; Eye Infections, Fungal; Female; Fibrin; Fuchs' Endothelial Dystrophy; Humans; Middle Aged; Surgical Wound Infection; Vitrectomy

To analyze the cause of fibrinous inflammation in eyes with capsular tension rings (CTRs) after cataract surgery.. Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.. Retrospective case series.. High-performance liquid chromatography was implemented to eliminate impurities. One CTR was explanted for microbiologic examination. The pH values of the CTR and the storage solution were analyzed, Seldi and Maldi tests were performed, as well as toxicity tests with immortal cell lines. Material batches were analyzed. The organic carbon content of CTRs, detergents, and storage solutions was checked. The presence of endotoxins was excluded with the limulus amoebocyte lysate test. Gas chromatography with mass selective detector excluded the presence of extractable organic substances. An inductively coupled plasma analysis scanned for inorganic substances. The microbial count in operating rooms, smear tests, and microbiologic examinations of technical devices were initiated.. Analyses found no pathological findings. After intensive systemic and topical treatment with antibiotics and steroids, clinical findings improved. The implantation of CTRs was stopped immediately. No further cases occurred.. Fibrinous inflammations after implantation of CTRs were unknown until now. Contamination and/or irritation by detergents or the material CTR itself were excluded, indicating mechanical or toxic irritation by the CTR.. No author has a financial or proprietary interest in any material or method mentioned.

Topics: Aged; Aged, 80 and over; Device Removal; Endophthalmitis; Female; Fibrin; Humans; Lens Implantation, Intraocular; Male; Methacrylates; Methylmethacrylate; Middle Aged; Phacoemulsification; Postoperative Complications; Prostheses and Implants; Prosthesis Implantation; Retrospective Studies

Topics: Diabetic Retinopathy; Endophthalmitis; Female; Fibrin; Humans; Male; Postoperative Complications; Vitrectomy; Vitreous Body

Topics: Diabetic Retinopathy; Endophthalmitis; Female; Fibrin; Humans; Male; Postoperative Complications; Vitrectomy; Vitreous Body

The purpose of this study was to determine to what extent blood-retinal barrier (BRB) permeability occurred during experimental Bacillus cereus endophthalmitis and whether tight junction alterations were involved in permeability.. Mice were intravitreally injected with 100 colony-forming units of B. cereus, and eyes were analyzed at specific times after infection for permeability to fibrin and albumin, quantitation of intraocular plasma constituent leakage, production of inflammatory cytokines, and alterations in tight junction protein localization and expression at the level of the retinal pigment epithelium.. B. cereus induced the leakage of albumin and fibrin into the aqueous and vitreous humor by 8 hours after infection. BRB permeability occurred as early as 4 hours and increased 13.30-fold compared with uninfected controls by 8 hours. Production of proinflammatory cytokines IL-6, MIP-1alpha, IL-1beta, and KC increased over the course of infection. In the retina, ZO-1 disruption began by 4 hours and was followed by decreasing occludin and ZO-1 expression at 4 and 8 hours, respectively. Tubulin condensation and RPE65 degradation occurred by 12 hours. A quorum-sensing mutant B. cereus strain caused BRB permeability comparable to that of wild-type B. cereus. Wild-type and mutant B. cereus sterile supernatants induced blood-ocular barrier permeability similarly to that of wild-type infection.. These results indicate that BRB permeability occurs during the early stages of experimental B. cereus endophthalmitis, beginning as early as 4 hours after infection. Disruption of tight junctions at the level of the retinal pigment epithelium may contribute to barrier breakdown. Quorum-sensing dependent factors may not significantly contribute to BRB permeability.

Topics: Animals; Aqueous Humor; Bacillus cereus; Blood-Retinal Barrier; Blotting, Western; Capillary Permeability; Cytokines; Endophthalmitis; Fibrin; Fluorescent Antibody Technique, Indirect; Gram-Positive Bacterial Infections; Male; Membrane Proteins; Mice; Mice, Inbred C57BL; Occludin; Phosphoproteins; Serum Albumin; Tight Junctions; Vitreous Body; Zonula Occludens-1 Protein

The aim of this paper was to describe the use of r-TPA for fibrin clot dissolution following endophthalmitis.. A 74-year-old man presented with painful loss of vision following routine uncomplicated cataract surgery.. He underwent standard treatment for postoperative endophthalmitis but despite this, developed a dense fibrin clot. He underwent further intracameral injection of r-TPA.. Following the injection, he had complete clot dissolution within 2 hours without any complications.. R-TPA may be used effectively in the treatment of fibrin clots secondary to endophthalmitis following cataract surgery.

Topics: Aged; Cataract Extraction; Endophthalmitis; Fibrin; Fibrinolytic Agents; Humans; Male; Postoperative Period; Recombinant Proteins; Tissue Plasminogen Activator

Topics: Aged; Anterior Chamber; Anti-Bacterial Agents; Cataract Extraction; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Female; Fibrin; Fibrinolysis; Fibrinolytic Agents; Humans; Injections; Lens Implantation, Intraocular; Male; Postoperative Complications; Staphylococcal Infections; Staphylococcus; Tissue Plasminogen Activator; Vitreous Body

Having changed our cataract operation technique from ECCE to phacoemulsification (PE) we had the impression of less fibrinous membranes postoperatively.. To ascertain whether our impression was correct, we examined the last 2056 IOL implanted cataract patients retrospectively.. In the 2056 cataract cases we found 152 fibrinous reactions (7.4%). We observed after ECCE (n = 586) a 12.8% rate of fibrinous membranes, after phacoemulsification (PE) with sutured 6.5-mm corneoscleral incision (n = 546) 7.0%, and after PE with clear corneal self-sealing 4.1-mm incision (n = 924) only 3.9%. In 56% of these patients we found diabetes, in 13% former uveitis with posterior synechiae, in 11% glaucoma with rigid pupil, and in 10% pseudoexfoliation syndrome. In those cases with no diabetic retinopathy but known diabetes (n = 198), we found a 27% rate of fibrin reactions following ECCE (12 mm), 12% following PE (6.5 mm) and 8% following PE (4.1 mm). In non-proliferative diabetic retinopathy (n = 80) a 32% rate of fibrinous changes was observed after ECCE, 18% after PE (6.5 mm), and 9% after PE (4.1 mm). In cases of uncomplicated ECCE (n = 341) the rate of fibrinous reactions amounted to 22.4% following prolonged procedures (> 50 min) by residents, while it was as low as 9.5% following operations of short duration (< 30 min) by experienced surgeons. Intraocular injection of tPA (25 micrograms) was the most effective treatment.. The self-sealing corneal small incision cataract technique guarantees a short duration of the surgical procedure and the last fibrinous reactions.

Topics: Cataract Extraction; Endophthalmitis; Fibrin; Humans; Lenses, Intraocular; Phacoemulsification; Postoperative Complications; Retrospective Studies

To assess whether annexin V-coated poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) prevent postoperative inflammation in rabbit eyes.. Department of Ophthalmology, Hôpital Purpan, Toulouse, France.. Thirteen IOLs coated with annexin V were implanted in 13 rabbit eyes; the contralateral eyes received uncoated IOLs. Postoperative fibrin was quantitated by daily slitlamp examination until the anterior chamber was completely clear. Results were analyzed using a Wilcoxon test. Ocular toxicity was evaluated by light and electron microscopy.. Eyes with the annexin V-coated IOLs had less severe inflammation on the first postoperative day, and the inflammation resolved more quickly than in eyes with uncoated IOLs (P < .05). No annexin V was released postoperatively, nor were there signs of ocular toxicity.. Annexin V-coated lenses effectively reduced postoperative inflammation in rabbit eyes.

Topics: Animals; Annexin A5; Cataract Extraction; Endophthalmitis; Enzyme-Linked Immunosorbent Assay; Fibrin; Follow-Up Studies; Foreign-Body Reaction; Lenses, Intraocular; Methylmethacrylates; Postoperative Complications; Rabbits

We investigated the anti-inflammatory effects of 0.1% diclofenac sodium on anterior inflammation after cataract surgery. Fibrin precipitation after surgery in patients without systemic or ocular disease was markedly less when diclofenac sodium ophthalmic solution was used in combination with topical corticosteroids. There was also a reduction in fibrin precipitation in other patients, especially in those with diabetes mellitus, primary angle-closure glaucoma, and exfoliation syndrome. In conclusion, diclofenac sodium was shown to be clinically useful as a topical preparation to suppress inflammation after cataract surgery.

Topics: Administration, Topical; Aged; Aged, 80 and over; Anterior Eye Segment; Betamethasone; Cataract Extraction; Diclofenac; Drug Therapy, Combination; Endophthalmitis; Female; Fibrin; Fibrinolysis; Humans; Lenses, Intraocular; Male; Middle Aged; Ophthalmic Solutions; Postoperative Complications; Retrospective Studies

The authors injected 25 micrograms of recombinant tissue plasminogen activator (tPA) into the anterior chamber or vitreous cavity of 23 eyes of 22 patients with severe intraocular fibrin formation that developed after vitrectomy surgery for complicated cases of proliferative vitreoretinopathy (PVR) (13 eyes), diabetic traction retinal detachment (TRD) (7 eyes), or endophthalmitis (3 eyes). Tissue plasminogen activator injected an average (+/- standard deviation) of 73 +/- 63 hours after vitrectomy surgery resulted in complete fibrinolysis in 21 of 23 eyes and partial fibrinolysis in one eye. The mean time to fibrin resolution was 3.0 +/- 1.0 hours. Four eyes required repeat tPA injection for recurrent fibrin formation; repeat injection resulted in complete fibrinolysis in each case. The mean follow-up duration after tPA administration was 6 months. At the final follow-up examination, the retina was totally attached in 18 of 23 eyes and was partially attached in 2. Visual acuity improved in 12 eyes (52%); it was at least 20/400 in 8. Complications of tPA injection included hyphema (2 patients) and corneal stromal thickening (2 patients). Mild, transient, periocular pain that was easily managed with non-narcotic analgesia developed in three patients.

Topics: Adolescent; Adult; Aged; Anterior Chamber; Child; Endophthalmitis; Female; Fibrin; Follow-Up Studies; Humans; Male; Middle Aged; Pilot Projects; Recombinant Proteins; Retinal Detachment; Retinal Diseases; Tissue Plasminogen Activator; Visual Acuity; Vitrectomy; Vitreous Body

In a retrospective review of 30 cases of complex retinal detachment, which had been managed by pars plana vitrectomy techniques together with silicone oil injection, we found that two patients developed marked postoperative anterior chamber fibrin and hypopyon. In all 30 cases, the same silicone oil was used: purified and heat-sterilized trimethylsiloxy-terminated, polydimethylsiloxane of 1000-centistoke viscosity. Although the silicone oil itself remained clear and without emulsification, the differential diagnosis of this postoperative inflammation included microbial endophthalmitis. These two cases were treated with frequent topical steroids and antibiotics while we closely monitored the retraction of the anterior chamber fibrin. In both cases, clinical improvement and long-term retinal reattachment with satisfactory visual function were achieved. The use of intense scatter laser endophotocoagulation and the presence of impurities in the silicone oil may have contributed to the excessive postoperative inflammation in these cases.

Topics: Anterior Chamber; Endophthalmitis; Fibrin; Humans; Injections; Middle Aged; Postoperative Complications; Retrospective Studies; Silicone Oils; Suppuration; Time Factors; Vitrectomy

We examined the role that fibrin deposition and fibrin-associated factors (FAF) play in acute anterior segment inflammatory responses in the rabbit eye. It was demonstrated by immunofluorescence that fibrin represented a major component of the exudative meshwork deposited within the anterior chamber and on leukocyte surfaces therein. Using our in vivo model of endocular inflammation we next demonstrated that fibrin and fibrinogen-derived peptides, but not thrombin, induced inflammatory responses characterized by both leukocyte influx and endothelial cell injury. Fibrin formation within the anterior chamber induced a leukocyte influx consisting primarily of PMN's. Fibrinogen-derived peptides induced primarily a monocyte influx. This dichotomy suggests that multiple inflammatory mediators are elaborated or released during endocular fibrinogenesis and fibrinolysis. To investigate direct effects of fibrin deposition on the corneal endothelial cells (CEC) an in vitro "corneal cup" organ culture model was next developed. Studies comparing various types of mediators demonstrated that only fibrin- derived preparations directly induced CEC injury. Fibrin deposition may thus play multiple roles in endocular inflammation, including the modulation of leukocyte influx, and the direct mediation of corneal endothelial cell injury.

Topics: Animals; Anterior Eye Segment; Cornea; Endophthalmitis; Endothelium; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinogen; In Vitro Techniques; Microscopy, Electron; Rats