A multicentre prospective study of post‐traumatic endophthalmitis

Abstract

ABSTRACT.Purpose: Study the clinical and microbiological characteristics and the prognostic factors of post-traumatic endophthalmitis. Methods: Seventeen eyes were included between 2004 and 2010, with clinical and microbiological data collected prospectively. Conventional cultures and panbacterial PCR were performed on aqueous and vitreous samples. Results: Clinical signs of endophthalmitis were observed soon after trauma (1.5 ± 2.5 days). Laceration with an intraocular foreign body (IOFB) was noted in 53% of the patients. At admission, all patients had aqueous humour (71%) and ⁄ or vitreous (53%) samples. Fifteen patients (88%) underwent a pars plana vitrectomy. Bacteria were identified in 77% of the cases: Staphylococcus epidermidis (n = 5), Streptococcus (n = 4), Bacillus (n = 2), Pseudomonas stuzeri (n = 1), and Streptococcus salivarius and Gemella haemolysans (multibacterial infection, n = 1). Progression toward phthisis was observed in 35% of the cases; 41% of the patients recuperated visual acuity (VA) ‡20 ⁄ 40. A good final visual prognosis ( ‡20 ⁄ 40) was significantly associated with initial VA better than light perception (0% versus 70%, p = 0.01) and absence of pupillary fibrin membrane (80% versus 20%, p = 0.05). There was no correlation between visual prognosis and age, the type of laceration (corneal or scleral) or presence of an IOFB. We found a statistical trend toward an association between bacterial virulence and poor final VA. Conclusion: This series showed that better final VA outcomes were associated with initial VA better than light perception, S. epidermidis or culture-negative cases and absence of retinal detachment during the clinical course.

Causative organisms of post-traumatic endophthalmitis: a 20-year retrospective study

“…We have observed that both S. epidermidis and S. saprophyticus were more frequently cultured from conjunctiva and eyelid margin smears compared with intraocular samples in patients with endophthalmitis (unpublished observation), indicating that there is a high possibility of these species penetrating through open wounds, especially in cases with delayed wound closure and injury caused by a metallic wire. There was also a relatively high incidence of Gram-negative bacilli associated with infection in our study, which has also been reported previously [8,10,11,18,21], though disagrees with findings from a study by Abu el-Asrar et al [20]. In addition to predominantly-isolated CNS species and bacilli, we identified sporadic cases of Acinetobacter lwoffii , Klebsiella pneumoniae , Enterobacter cloacae , Morgan’s bacillus, Bacillus alcaligenes , Corynebacterium pyogenes (Gram-positive), Stenotrophomonas maltophilia , and Staphylococcus liquefaciens (Gram-positive), most of which (21/24) are virulent Gram-negative bacteria (Table 2).…”

Bacterial and Fungal Endophthalmitis

“…Final visual acuity is variable and depends to a great extent on the pathogen, but one multicenter study found that 41% of all cases achieved 20/40 or better, while 47% were left with minimal (light perception only) or no vision (60).…”

Baseline Factors Predictive of Visual Prognosis in Acute Postoperative Bacterial Endophthalmitis in Patients Undergoing Cataract Surgery

“…Patients were then further classified into the following groups according to microbiological results: detection of no microorganism, coagulase-negative Staphylococci species (CNSP), or a more virulent species, including Streptococcus species, Staphylococcus aureus, Staphylococcus lugdunensis, and gramnegative bacteria. 18…”

“…Previous microbiological results, using conventional cultures and panbacterial PCR analysis, have been previously published. 6,[18][19][20][21] The aim of this report was to identify baseline clinical and microbiological factors of good (VA of 20/40 or better) and poor (VA of worse than 20/100) visual outcomes at 6 months in a large series of patients with acute postoperative endophthalmitis.…”