Article in PDF
How to Cite
Citation Manager
Readers' Comments (0)
Audio Visual Article Statistics
Link
to PUBMED
Print this Article
Send to a Friend
Advertisers
Access Statistics Resources
Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Microbiological Profile and Visual Recovery in Various Clinical Types of Endophthalmitis at a Tertiary Eye Care Hospital of Tamil Nadu, India: A Retrospective Cohort Study
Correspondence Address :
Dr. Poomalar Periasamy,
Junior Resident, Department of Ophthalmology, Trichy SRM Medical College Hospital and Research Centre, SRM Nagar, Irungalur, Trichy-621105, Tamil Nadu, India.
E-mail: drvinnarasiii88@gmail.com
Introduction: Endophthalmitis is a serious, sight-threatening purulent inflammation of the intraocular cavities of the eyeball. It greatly affects vision and can lead to severe complications such as panophthalmitis. The prevalence of endophthalmitis varies from one place to another.
Aim: To identify the various aetiological and predisposing factors that contribute to endophthalmitis and to assess the visual outcomes following medical intervention (intravitreal antibiotics only) and surgical intervention (both intravitreal antibiotics and pars plana vitrectomy).
Materials and Methods: The present study was conducted in the Department of Ophthalmology at Trichy SRM Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India between January 2023 and February 2023. Demographic and clinical data of patients diagnosed with endophthalmitis over a two year period from October 2020 to September 2022 were collected from the Medical Records Department of the Institution for analysis. A total of 50 case records were selected using convenience sampling. Demographic details such as age, gender, predisposing risk factors, visual acuity, microbiological profiles, treatment modalities, and final visual acuity were collected from the present study. Quantitative data was presented as Mean and Standard Deviation (SD), while qualitative data was presented as frequencies and percentages. Summary statistics were analysed using Microsoft Excel version 2018.
Results: In present study, 29 (58%) were males and 21 (42%) were females, with the majority falling within the age group of 50-70 years. The mean age of the sample was 53.8±16.1 years. Postoperative causes accounted for 39 (78%) of the cases, with phacoemulsification surgery with foldable intraocular lens implantation being the leading cause in 23 (58.7%) cases. Culture positivity was observed in only 22 (44%) cases, with Staphylococcus (Staph) epidermidis as the major causative organism. The best visual acuity achieved was 6/12 for two patients.
Conclusion: Postoperative endophthalmitis remains the most common cause of endophthalmitis. Additionally, patients who presented with better visual acuity had a better visual outcome after treatment. Therefore, patients should be educated about the early signs of endophthalmitis to ensure prompt medical attention and improve visual recovery.
Endogenous, Intravitreal, Postoperative, Vitrectomy
Endophthalmitis is a serious, sight-threatening purulent inflammation of the intraocular cavities of the eyeball. It greatly affects vision, leading to dreadful complications. The prevalence of endophthalmitis varies widely, ranging from 0.04% to as high as 7.5%. It occurs due to infection or invasion by rapidly growing microorganisms into the eye (1). Endophthalmitis can be classified based on its clinical course (acute or chronic), aetiology (infectious or non infectious), route of entry of the causative factor (endogenous or exogenous), and causative organisms (bacterial, fungal, parasitic, and rarely viral) (2). Early intervention is crucial to preserve vision (3). To prevent endophthalmitis, careful clinical evaluation of preoperative risk factors, proper surgical procedures, and preoperative and intraoperative antibiotic prophylaxis should be performed.
Despite meticulous work-up, infections can still occur. In such cases, prompt diagnosis and adequate treatment are necessary to restore vision (4). Previous literature on endophthalmitis suggests that patients with only perception of light should undergo pars plana vitrectomy with intravitreal antibiotics, while other patients can be treated with intravitreal antibiotics alone (5). It is disheartening that most endophthalmitis cases occur after cataract surgery (6). Patients undergoing cataract surgery expect improved vision, but if, they develop endophthalmitis, they risk losing not only their vision but also the entire eye. Therefore, a comprehensive understanding of the disease is essential.
Since, there is limited literature available on endophthalmitis in the South Indian demography (7), the present study aimed to evaluate various aetiological factors, microbiological details, and treatment outcomes to benefit patients in the community. The study aimed to identify predisposing factors and patterns of microbiological growth in patients with endophthalmitis and assess improvements in visual outcomes after medical and surgical intervention, including intravitreal antibiotics and Pars Plana Vitrectomy.
This retrospective cohort study was conducted between January 2023 and February 2023. The medical records of all cases of endophthalmitis who attended Outpatient Department (OPD) of Ophthalmology at Trichy SRM Medical College Hospital and Research Centre in Trichy, Tamil Nadu, India were reviewed over a period of two years, from October 2020 to September 2022. A total of 50 cases were selected using a convenient sampling method.
Inclusion and Exclusion criteria: Cases of all age groups diagnosed with endophthalmitis following any modes of infection were included in the study. Cases with associated choroidal and retinal detachment diagnosed with Ultrasonoud B (USG B)-scan were excluded.
Study Procedure
Endophthalmitis was diagnosed based on defective vision, lid oedema, conjunctival chemosis and congestion, circumcorneal congestion, corneal oedema, leucocornea, keratic precipitates, hypopyon in the anterior chamber, fibrinous exudates in the anterior chamber, exudates over the anterior surface of the crystalline lens or pseudophakic lens, vitreous exudates, and retinal oedema (3). Demographic details and clinical data such as age, gender, predisposing risk factors, visual acuity, microbiological profiles, treatment modalities, and final visual acuity were collected from the medical record department of the institution for analysis. Aaetiological and predisposing factors, details about intraocular procedures performed, and the mode of ocular injuries were noted in detail from the available case records. The clinical diagnosis confirmed with Ultrasound B-scan was also recorded. Preoperative and postoperative examinations, investigations, and interventions were all collected and analysed.
Preoperative and postoperative best-corrected visual acuity, recorded using Snellen’s chart, was noted for analysing the improvement. Microbiological profile data were obtained from smear, culture, and sensitivity reports of the vitreous tap samples (8). Details about vitreous tapping, topical and systemic antimicrobials, intravitreal injections, pars plana vitrectomy, and evisceration were noted from the records. Visual outcomes after medical intervention (only intravitreal antibiotics) (9),(10) and surgical intervention (both intravitreal antibiotics and pars plana vitrectomy) were also recorded (11),(12).
Statistical Analysis
The collected data was studied and analysed. Quantitative data were presented as means and standard deviations. Qualitative data were presented as frequencies and percentages, and the summary statistics tabulated were analysed using Microsoft Excel version 2018.
A total of 50 patients, 29 (58%) males and 21 (42%) females, were included in present study. The number of males outnumbered the females. The mean age of the was 53.8±16.1 years. Most of the patients belonged to the age group of 50-70 years, which is the most common age range for cataract surgery (Table/Fig 1).
(Table/Fig 2) shows that most cases of endophthalmitis occurred postoperatively following intraocular surgeries. In the present study, out of eight cases of post-traumatic endophthalmitis, three cases occurred following an injury with a metal rod, two cases followed road traffic accidents, one case followed an injury with a stick, one with a card, and one case followed a fishhook injury.
(Table/Fig 3) shows that Phacoemulsification with foldable Intraocular Len (IOL) was the most common cause of postoperative endophthalmitis (n=39). Two cases were seen following intravitreal injection.
(Table/Fig 4) shows that most of the cases were Gram-positive cocci, and only one case of gram-positive bacilli was found in the smear report.
A total of 22 cases out of 50 showed positive culture results. Staphylococcus (Staph) epidermidis (50%) was the most commonly isolated organism. Bacillus species were isolated from one case (Table/Fig 5).
A total of 12 (24%) cases of endophthalmitis presented with no perception of light, out of which three patients had uncontrolled spreading infection. So, the infected eyes were eviscerated in fear of complications like panophthalmitis. Infection was controlled in the remaining nine patients (Table/Fig 6).
Patients who presented with good initial visual acuity had good final visual acuity. The best visual acuity achieved was 6/12 for two patients (Table/Fig 7).
USG B-scan echography showed vitreous opacities with membranes, typical of endophthalmitis (Table/Fig 8). Dense hyper reflective echoes in the vitreous cavity was suggestive of exudates and membrane like echo in the scan was suggestive of retinal detachment (Table/Fig 9).
Male patients, 29 (58%), outnumbered female patients, 21 (42%), which might be due to increased occupational exposure among males compared to females (13). Most of the patients were in the age group of 50-70 years, which falls within a similar range as another study published by Wadbudhe AM et al., where articles from the years 2007 to 2022 were analysed (14).
In a study conducted by Lee A et al., culture positivity was found in 21 eyes (72.4%) of the intraocular sample (15). In the present study, however, the culture positive result was only 22 (44%). Nobe JR et al., conducted a study between 1972-1985, where their culture positivity was 64%, and the most common causative organism was Staph epidermidis (16). In present study as well, Staph epidermidis remains the most common organism. Additionally, a study conducted in central India showed Staphylococcus (Staph) epidermidis as the most common organism. A study conducted by Thapa R and Paudyal G, showed culture positivity in 13.6% of cases (17).
Authors noted a disparity in smear reports, with 15 (30%) positive smears, and culture reports, with 22 (44%) positive cultures, which was also observed in a study conducted by Ma WJ et al., on infectious endophthalmitis, where the smear positivity of vitreous samples was 11 (45.8%) and the culture positivity was 15 (62.5%) (18).
Negretti GS et al., conducted a study at Moorfields Eye Hospital over a five year period between 2013 and 2018, where the incidence of endogenous endophthalmitis was 18.1% (19). In the present study, it was only 2%, which falls within the range reported in a review study published by Sadiq MA, where the incidence was reported as 2-8% (20). Tamboli S et al., conducted a prospective observational and interventional study, where the incidence of postoperative endophthalmitis was found in 35 (45.5%) cases, post-traumatic endophthalmitis in 31 (40.3%) cases, and 11 (14.3%) cases of endogenous endophthalmitis (21). In the present study, approximately 39 (78%) cases were postoperative, 8 (16%) cases were post-traumatic, and only 1 (2%) was endogenous. Dehghani AR et al., conducted a study where the overall incidence of post-traumatic endophthalmitis was 22 (2.1%), which was clearly less than the findings (3.3% to 17%). In the present study, the incidence was 8 (16%), which falls within the range (22).
Postoperative endophthalmitis outnumbers other causes of endophthalmitis due to the higher volume of cataract surgeries performed worldwide. This increase is attributed to improved healthcare facilities, even in remote areas. However, inadequate sterilisation techniques, intraoperative complications such as posterior capsular rent, vitreous loss, wound leaks, and improper postoperative care all contribute to the occurrence of endophthalmitis (23).
Ba’arah BT and Smiddy WE, reported an incidence rate of bleb-related endophthalmitis ranging from 0.2% to 1.3%. The use of antiproliferative agents increases the range to 3% (24). In the present study, the incidence rate was 6%, which is significantly higher. In a study conducted by Jeong SH et al., at Kim’s Eye Hospital between January 2008 and December 2015, a final visual acuity of ≥20/40 was achieved in 92 out of 164 cases (56.1%) after treatment (25).
Lee A et al., conducted a study where a final visual acuity of 6/12 or better was achieved in 19 (70.4%) eyes, and a visual acuity of 6/18 or better was achieved in 10 (37.0%) eyes out of 27. Two eyes had a final visual acuity of hand motion, one with light perception, and one with no light perception. None of the patients required evisceration or enucleation due to endophthalmitis (15). In present study, only 6 (12%) eyes and 2 (4%) eyes out of 50 achieved good visual acuity of 6/18 and 6/12, respectively. Additionally, 16 (32%) eyes out of 50 had a visual acuity worse than 6/60. Three eyes required evisceration due to uncontrolled infection. This decreased visual outcome may be attributed to late presentation, possibly due to a lack of awareness of signs and symptoms. Soomro AR et al., published a study in which 19 (57.6%) patients had a final visual acuity of finger counting, 8 (24.2%) patients had hand movement, and 6 (18.2%) patients reported a visual acuity of 6/60 (26). Authors achieved better visual outcomes, which might be attributed to early intervention with intraocular antibiotics and pars plana vitrectomy.
Limitation(s)
The present study had certain limitations. As it was a retrospective study, there was limited opportunity to delve deeper into the aetiological factors contributing to the outcomes.
Postoperative endophthalmitis remains the most common cause of endophthalmitis. Additionally, patients who had better visual acuity at the time of presentation showed better visual outcomes after treatment. Therefore, it is crucial to adhere to the highest standard of sterilisation techniques, improve surgical techniques, and provide good postoperative care to minimise its occurrence. Furthermore, patients should be educated about the imminent signs of endophthalmitis to ensure early presentation. This way, they can benefit from early intervention and achieve better visual outcomes.
DOI: 10.7860/JCDR/2023/64927.18461
Date of Submission: May 22, 2023
Date of Peer Review: Jun 22, 2023
Date of Acceptance: Aug 28, 2023
Date of Publishing: Sep 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 22, 2023
• Manual Googling: Jul 05, 2023
• iThenticate Software: Aug 18, 2023 (8%)
ETYMOLOGY: Author Origin
EMENDATIONS: 9
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com