Manav Khera

Warrington and Halton Teaching Hospitals NHS Foundation Trust

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Avinash Pathengay

L V Prasad Eye Institute

Taraprasad Das

L V Prasad Eye Institute

Harry W. Flynn

University of Miami

Savitri Sharma

L V Prasad Eye Institute

Animesh Jindal

Post Graduate Institute of Medical Education and Research

Annie Mathai

L V Prasad Eye Institute

Subhadra Jalali

L V Prasad Eye Institute

Rajeev Reddy Pappuru

L V Prasad Eye Institute

Mayur Moreker

Bombay Hospital

Manmath Kumar Das

All India Institute of Medical Sciences Bhubaneswar

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L V Prasad Eye Institute

Creative Commons

Advanced Centre for Treatment, Research and Education in Cancer

University of Miami

Sankara Nethralaya

The California Eye Institute

Dr. Shroff’s Charity Eye Hospital

Aravind Eye Hospital

Sriram Chandra Bhanja Medical College Hospital

Maharaja Krishna Chandra Gajapati Medical College and Hospital

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Combined ceftazidime and amikacin resistance among Gram-negative isolates in acute-onset postoperative endophthalmitis: prevalence, antimicrobial susceptibilities, and visual acuity outcome

Journal of Ophthalmic Inflammation and Infection (2013)

Animesh Jindal Avinash Pathengay Manav Khera Subhadra Jalali Annie Mathai

The purpose of this study is to evaluate the prevalence, antimicrobial susceptibilities, and visual acuity outcome of acute-onset postoperative Gram-negative bacterial endophthalmitis cases resistant to both ceftazidime and amikacin seen between 2005 and 2010 at L. V. Prasad Eye Institute, a tertiary care ophthalmic Centre in South India. Medical records of all patients with Gram-negative bacterial endophthalmitis resistant to both amikacin and ceftazidime between 1 January 2005 and 31 December 2010 were reviewed in this non-comparative, consecutive, retrospective case series. Favorable outcome was defined as a best-corrected visual acuity of ≥20/200.Sixty five (39.6%) of 164 culture-positive postoperative endophthalmitis were caused by Gram-negative organisms. Among these 65 isolates, 32 (49%; 95% confidence interval (CI) 37% to 61%) were resistant to ceftazidime, 17 (26%; 95% CI 15% to 37%) to amikacin, and 12 (18.5%; 95% CI 9% to 27%) to both ceftazidime and amikacin. Eight Pseudomonas isolates, three Enterobacter isolates, and one Haemophilus isolate were resistant to both ceftazidime and amikacin. The isolates were sensitive to fluoroquinolones (42%) and imipenem (50%). Presenting visual acuity was light perception in 10 (83.3%) cases. A final visual acuity ≥20/200 was achieved in 5/12 (41.7%) of these patients.In the current study, Pseudomonas was the most common Gram-negative bacteria resistant to both amikacin and ceftazidime. The emergence of multidrug-resistant bacteria causing endophthalmitis is a matter of concern in India. Alternative antibiotics like imipenem or fluoroquinolones may be considered for the management of these resistant organisms.

Amikacin

10.1186/1869-5760-3-62

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Bilateral Sequential Non-arteritic Anterior Ischaemic Optic Neuropathy (NA-AION) Presumed Secondary to 5-Fluorouracil (5-FU): A Case Report and Literature Review

Cureus (2024)

Paras Agarwal Manav Khera

Bilateral successive anterior ischaemic optic neuropathy (AION) episodes are uncommon occurrences with a short list of differential diagnoses. We present the case of a 75-year-old male who developed bilateral consecutive non-arteritic AION after commencing 5-fluorouracil (5-FU) chemotherapy. The case report describes a temporal sequence of events with a halt in the progression of signs and symptoms upon cessation of treatment with this agent. Our patient demonstrated preexisting cardiovascular risk factors that were medically well controlled, as evidenced by laboratory results and blood pressure measurements. We reaffirm the current evidence that postulates an association between 5-FU use and arterial vasospasm in blood vessels predisposed to narrowing resulting in prolonged ischaemia to the optic nerve head.

10.7759/cureus.72754

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Polymicrobial endophthalmitis: prevalence, causative organisms, and visual outcomes

Journal of Ophthalmic Inflammation and Infection (2013)

Animesh Jindal Mayur Moreker Avinash Pathengay Manav Khera Subhadra Jalali

Abstract Background The purpose of the present study is to evaluate the prevalence, causative organisms, and visual acuity outcome in patients with culture-proven polymicrobial endophthalmitis. The method used in this study is the non-comparative, consecutive case series using a retrospective analysis of patients diagnosed with polymicrobial endophthalmitis for the period 2000 to 2010. Results Polymicrobial endophthalmitis was identified in 43/1,107 (3.88%) patients. Forty-two patients had two isolates, and one patient had grown three isolates, yielding a total of 87 isolates. Gram-positive cocci were the most common isolate ( n = 53; 60.9%) including Staphylococcus epidermidis ( n = 14/53; 16.1%) and Streptococcus pneumoniae ( n = 13/53; 13.8%). The etiologies included posttraumatic ( n = 31/43; 72.1%) and postoperative ( n = 9/43; 20.9%) endophthalmitis. Antibiotic susceptibilities among Gram-positive bacteria were vancomycin (100%) and chloramphenicol (96%). Susceptibilities among Gram-negative bacteria were ciprofloxacin (86.4%) and ofloxacin (81.2%). A maximum number of secondary interventions were done in traumatic cases (38.7%) and cases having coinfection with Gram-negative bacteria and fungus (66.7%). Visual acuity (VA) < 20/200 was more frequently observed in posttraumatic cases ( n = 27/31; 87.1%) as compared with postoperative cases ( n = 4/9; 44.4%). Of the 43 patients, only 9 patients (20.9%) achieved a VA ≥ 20/200 on final follow-up. Four out of twelve patients (33.3%), with fungus as one of the isolates, had a VA ≥ 20/200. Conclusions Although polymicrobial infection in endophthalmitis is uncommon, it is generally associated with poor visual acuity outcomes especially in eyes with open-globe injuries. Coinfection with Gram-negative bacteria or fungi was associated with most unfavorable visual outcome.

Etiology

10.1186/1869-5760-3-6

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ROLE OF FAMCICLOVIR IN THE MANAGEMENT OF ACUTE RETINAL NECROSIS IN DEVELOPING COUNTRIES

Retinal Cases & Brief Reports (2012)

Avinash Pathengay Gaurav Y. Shah Manmath Kumar Das Manav Khera

In Brief Purpose: To evaluate clinical presentations, management strategies, and results in patients with acute retinal necrosis (ARN) who received famciclovir. Methods: In a retrospective, noncomparative, interventional case series, we reviewed case records of patients with ARN from the computerized database between January 2007 and December 2009. Data collected included demographic details of the patient, relevant history, examination findings, drugs administered, clinical response, and final visual acuity. The main outcome measures were visual acuity and clinical response. Results: Famciclovir was administered in three cases of ARN. In these three immunocompetent patients, there was complete resolution of ARN with improvement in visual acuity and absence of other eye involvement or recurrence in the primary eye. Conclusion: One may consider treating ARN with oral famciclovir in immunocompetent patients in developing countries when intravenous acyclovir treatment is not affordable to the patient or when there is clinical resistance to acyclovir. As oral famciclovir achieves resolution of ARN, one may consider treating acute retinal necrosis with oral famciclovir in immunocompetent patients who cannot afford acyclovir therapy especially in developing countries or who have shown clinical resistance to acyclovir.

Famciclovir

Acute retinal necrosis

10.1097/icb.0b013e31824f7118

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Acute Postoperative Endophthalmitis Following Cataract Surgery

Asia-Pacific Journal of Ophthalmology (2012)

Avinash Pathengay Manav Khera Taraprasad Das Savitri Sharma Darlene Miller

Endophthalmitis following cataract surgery is rare but continues to be a serious complication following cataract surgery. Over the years, the incidence of endophthalmitis has declined because of various preoperative and perioperative measures. They include use of antiseptic and appropriate surgical draping techniques. In this review, we have focused on the incidence, existing risk factors, various clinical features, management strategies, and prophylaxis pertaining to postoperative endophthalmitis following cataract surgery. Outcomes and pitfalls of 2 landmark studies, namely, the Endophthalmitis Vitrectomy Study and the European Society of Cataract and Refractive Surgeons Endophthalmitis Study, are briefly mentioned.Infectious endophthalmitis following cataract surgery is a dreaded complication. Preoperative identification of risk factors and effective prophylaxis could help in reducing its incidence. Early diagnosis followed by management of these patients either with vitreous tap or vitrectomy coupled with intravitreal antibiotics holds the key.

10.1097/apo.0b013e31823e574b

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Vancomycin-resistant Gram-positive bacterial endophthalmitis: epidemiology, treatment options, and outcomes

Journal of Ophthalmic Inflammation and Infection (2013)

Manav Khera Avinash Pathengay Animesh Jindal Subhadra Jalali Annie Mathai

The purpose of this study is to evaluate the microbiological profile and treatment outcomes of vancomycin-resistant Gram-positive bacterial endophthalmitis. Medical records of all patients with Gram-positive bacterial endophthalmitis resistant to vancomycin presenting between 1 January 2005 and 31 December 2010 were reviewed in this noncomparative, consecutive, retrospective case series. Favorable outcome was defined as a best-corrected visual acuity of ≥20/200.Out of 682 culture-positive endophthalmitis isolates, 448/682 (65.6%) were associated with Gram-positive bacteria. In vitro resistance to vancomycin was noted in 7/448 (1.56%). Three cases were posttraumatic, three were postoperative, and one was endogenous in origin. Four Bacillus isolates, two Staphylococcus isolates, and an Enterococcus isolate were resistant. Isolates resistant to vancomycin were sensitive in vitro to ciprofloxacin in 6/7 (86%) patients. Presenting visual acuity was light perception in all seven cases. Favorable outcome was achieved in only 1/7 (14.3%) cases.Vancomycin-resistant endophthalmitis is uncommon and usually associated with poor visual outcome. Bacillus sp. is the most frequent Gram-positive bacteria resistant to vancomycin. Fluoroquinolones like ciprofloxacin may be considered as a useful alternative in vancomycin-resistant endophthalmitis.

Gram

Gram-positive bacterial infections

Gram-negative bacterial infections

10.1186/1869-5760-3-46

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Citations (44)