Purpose To report a large consecutive case series of patients who developed delayed-onset and acute-onset endophthalmitis after cataract surgery. Design Retrospective consecutive case series. Methods The current study is a retrospective consecutive case series of patients treated between January 2000 and December 2009 for culture-proven endophthalmitis after cataract surgery. The study defined two groups after cataract surgery: acute-onset endophthalmitis (≤ 6 weeks after surgery) and delayed-onset endophthalmitis (> 6 weeks after surgery). Results A total of 118 patients met study criteria and included 26 delayed-onset cases and 92 acute-onset cases. The following clinical features and outcomes occurred in delayed versus acute-onset cases: (1) the presenting visual acuity was ≤ 5/200 in 31% versus 89%, (2) hypopyon was found in 46% versus 80%, (3) the most frequent isolate was Propionibacterium acnes (11/26) versus coagulase-negative Staphylococcus (57/92), (4) patients with the most frequent isolate achieved a visual outcome of ≥ 20/100 in 91% versus 56%. In delayed-onset cases, the intraocular lens was removed or exchanged in 19/26 (73%). Of these 19 cases, 13 achieved a visual outcome of ≥ 20/100. Conclusions Patients with delayed-onset endophthalmitis generally presented with better initial visual acuities, had a lower frequency of hypopyon, and had better visual outcomes compared to acute-onset patients. Propionibacterium acnes and coagulase-negative Staphylococcus species were the most common organisms cultured in delayed and acute-onset categories, respectively, and were associated with the best visual acuity outcomes in each group.

PurposeTo identify patients who developed acute-onset endophthalmitis after clear corneal cataract surgery, and to compare treatment outcomes between cases caused by fluoroquinolone susceptible organisms versus fluoroquinolone resistant organisms.DesignRetrospective case series.MethodsPatients who developed endophthalmitis within six weeks of cataract surgery, and were treated between January 1996 and December 2008 at Bascom Palmer Eye Institute in Miami, Florida, were identified retrospectively. Clinical features, organisms cultured, and visual acuity outcomes were evaluated.ResultsA total of 97 patients met study criteria, and 37 (38%) demonstrated in vitro fluoroquinolone resistance. All fluoroquinolone resistant endophthalmitis in the study was caused by either Staphylococcus epidermidis (n = 32) or Staphylococcus aureus (n = 5). Presenting clinical features were similar between fluoroquinolone resistant and fluoroquinolone susceptible groups. Final visual acuity was ≥20/40 in 49% of fluoroquinolone-resistant cases and 42% of fluoroquinolone-susceptible cases. All fluoroquinolone-resistant isolates were susceptible to vancomycin.ConclusionIn the current study, approximately one-third of isolates were resistant to fluoroquinolones. There was no significant difference in clinical outcomes in this study, regardless of fluoroquinolone susceptibility.

A 75-year-old woman developed acute-onset endophthalmitis following phacoemulsification in the left eye. She was treated with intravitreal injections of vancomycin, ceftazidime, and gentamicin. The patient had persistent visual loss in the left eye after treatment. Her best-corrected visual acuity was 2/200 in the left eye and examination revealed a pale disc, retinal hemorrhages, and multiple nerve fiber layer infarcts. Fluorescein angiography showed retinal vascular non-perfusion in the macula. On spectral-domain optical coherence tomography (SD-OCT), there was diffuse retinal thinning, absence of the foveal depression, and increased reflectivity of the nerve fiber and ganglion cell layers, but with an intact inner segment/outer segment junction. This case demonstrates SD-OCT features in macular infarction following intravitreal gentamicin, specifically changes involving the inner retina with a relatively intact outer retina.

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