A case–control study of post-traumatic endophthalmitis at a spanish hospital

Abstract

Our aim was to identify the potential risk factors for developing post-traumatic endophthalmitis (PTE) and the possible measures of prevention. Retrospective case-control study, with 15 cases of PTE and 2 matched controls. We reviewed the medical records of the cases and their respective controls during the period 1996-2008 at a Spanish Hospital. We collected demographic data and information about the type of trauma, the potential risk factors, comorbidities, microbial isolations, antimicrobial susceptibility, administered treatments, and the visual outcome. The independent predictor factors identified for PTE were intraocular foreign body (IOFB) (OR 5.48; CI 95 % 1.05-28.7), dirty wound (OR 4.91; CI 95 % 0.96-25.3), and wound closure delays of 24 h or more (OR 5.48; CI 95 % 1.05-28.7). The probability of endophthalmitis in patients without these risk factors was 5.9 %, but ascended to 65.3 % and 90.3 %, in those patients with two and three risk factors, respectively. Infected patients presented a complication rate of 80 %, with an evisceration rate of 53 %; both were significantly associated with infection. The visual outcome was poor and related to the presence of IOFB and virulent microorganisms (Bacillus sp., filamentous fungus), visual acuity at presentation, and retinal detachment. Patients who presented an IOFB, dirty wound, and delayed wound closure were 15 times more likely to develop infection, and when infected, patients fared much worse than those non-infected. We thus recommend aggressive prophylactic measures in patients with these risk factors, adding antifungal prophylaxis when the injury is contaminated with vegetable matter.

Chronic postcataract endophthalmitis caused by <em>Penicillium</em> species in an immunocompetent patient

“…Treatment of fungal endophthalmitis is difficult; no clear protocols exist because of the lack of well-controlled double-blind studies and the low incidence of the diseases. 2 In the present case, systemic fosfluconazole and topical pimaricin ophthalmic ointment did not lead to complete remission, whereas systemic flucytosine indicated a splendid effect. For Penicillium infection in HIV patients, antifungal medication including flucytosine is selected, 13 and flucytosine is highly active against Penicillium species.…”

“…Penicillium species are abundant, generally saprophytic, and widely distributed in the environment. 1 , 2 They rarely cause disease in humans, although they are increasingly recognized as a potential pathogen in immunocompromised hosts. 3 In the eye, Penicillium species can cause infectious keratitis, 4 but rarely is endophthalmitis developed, even in patients who are immunocompromised or using an immunosuppressive agent.…”

Prognostic factors associated with visual outcome of salvageable eyes with posttraumatic endophthalmitis

“…It is certainly important to study the prognostic factors associated with visual outcome of posttraumatic endophthalmitis. Previous studies have reported that culture positivity, presence of virulent organisms, delayed treatment and retinal detachments were associated with poor visual outcomes in posttraumatic endophthalmitis 2–8 . However, whether baseline visual acuity, or the presence of intraocular foreign body affect visual outcome is controversial.…”

“…However, whether baseline visual acuity, or the presence of intraocular foreign body affect visual outcome is controversial. While some reports found that baseline visual acuity did not influence the final visual outcome 5,8 , others reported that baseline visual acuity was significantly associated with visual outcomes of posttraumatic endophthalmitis 2,4,9 . There were few studies suggested that the presence of intraocular foreign body was not associated with final visual acuity of posttraumatic endophthalmitis 2,4,8 .…”

“…Asencio et al . 2 reported a case-control study of posttraumatic endophthalmitis and found that 73% of the eyes had a final visual acuity <20/200. It is certainly important to study the prognostic factors associated with visual outcome of posttraumatic endophthalmitis.…”