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2019 OMIG Abstract

Cysticidal Activity of Povidone Iodine and Natamycin for Acanthamoeba

Cecilia Lee, MD, MS1, Sundeep Kasi MD2, Bryan Hong, MD2, Lakshmi Akileswaran, PhD1,
Kenjie Nakamichi BS1, Aaron Y. Lee MD, MSCI1, Sunir Garg, MD2, Russell Van Gelder, MD PhD1
1University of Washington, Seattle, WA; 2Willís Eye Hospital, Jefferson University, Philadelphia, PA

Purpose: To associate molecular detection of potential pathogens in endophthalmitis with clinical outcomes.

Methods: Patients diagnosed with a post-surgical endophthalmitis following an intraocular procedure were recruited in a prospective, observational cohort study. Clinical data from baseline, week 1, month 1 and 3 visits were collected. Intraocular biopsy samples were cultured by standard methods. Quantitative polymerase chain reaction for specific pathogens and whole genome sequencing (WGS) were performed. Determinants of month 1 and 3 outcome were evaluated by Wilcoxon rank sum, Fisherís test, and survival analyses.

Results: A total of 50 patients (mean age 72, 52% male) were enrolled. Twenty-four cases were culture-positive and 26 were culture-negative. Torque teno virus (TTV) and merkel cell polyomavirus (MCV) were detected in 49% and 19% of cases, respectively. WGS identified the cultured organism in 76% of culture-positive cases and identified potential pathogens in 33% of culture-negative cases. Clinical outcomes of S. epidermidis endophthalmitis either by culture or molecular detection were no different than culture-negative cases and relatively favorable, while the cases infected with other pathogens trended towards worse outcome. Higher baseline bacterial loads of non-S.epidermidis infected cases were associated with worse month 1 and 3 visual acuity. Presence of TTV at presentation was associated with higher rate of secondary PPV (p=0.009), particularly for retinal detachment.

Conclusion: Molecular detection of specific potential pathogens, in particular non-S. Epidermidis and TTV are associated with a worse outcome in post-surgical endophthalmitis.

Disclosure: S: Supported by NIH/NEI K23EY024921 (CL), P30EY001730 (CL, RVG), Research to Prevent Blindness Unrestricted Grant (CL, AL, RVG), Mark J. Daily MD Research Fund (CL, AL, RVG).


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