Aggressive management of an epidemic of chronic pseudophakic endophthalmitis: results and literature survey.

Abstract

Six cases of chronic endophthalmitis following extracapsular cataract extraction and lens implantation are reviewed. All were referred for tertiary management by one surgeon over a period of just over 2 years. In two of the cases coagulase negative staphylococci were isolated and in three Propionibactenum spp were retrieved. In the remaining case a mixed growth of coagulase negative staphylococci and Propionibactenum acnes was cultured. The surgical management, microbiological results, and eventual visual outcome are discussed. To our knowledge, this is the first documented outbreak of chronic pseudophakic endophthalmitis with commensal organisms from a single centre.

Outbreak of Empedobacter brevis endophthalmitis after cataract extraction

“…Literature concerning endemics of endophthalmitis is rare, and most published papers deal with patients operated upon over a relatively long period of time [7,8,10,20,24,25,27,28,30].A Medline search for publications describing acute endophthalmitis in patients who had undergone operation on the same day revealed only two papers about cataract extraction and another one about endophthalmitis after penetrating keratoplasty [2,6,21]. This makes our series exceptional.…”

Complications Associated with Cataract Surgery

“…Bacterial growths from vitrectomy cassette specimens have the same prognostic value as specimens taken from other intraocular sources (25). The chronic form of postoperative endophthalmitis is more insidious and usually manifests after several weeks or even months after the surgery (figure 2).The ratio of acute to chronic cases ranges between 5:1 to 2:1 (17). The organisms responsible tend to be less virulent bacteria or fungi.…”

“…Fortunately the incidence is very low and ranges from 1-3 in 1000 or even less (17). Postoperative endophthalmitis can present as early as the first postoperative day and up to two weeks after surgery.…”

Real-Time PCR for Detection and Differentiation of Gram-Positive and Gram-Negative Bacteria

“…In practice, most infections are treated empirically with broad-spectrum antibiotics because of the usual delay of 24 to 48 h for routine microbiological processing of the clinical samples (19,28). PCR has been successfully used to detect bacterial DNA in clinical samples and has improved the rate of microbial detection (5,13,14,22).…”

“…One important reason for inadequate treatment with specific antibiotics is the delay in routine microbiological detection systems, which require at least 24 to 48 h for detection (19,28). Yet, early detection and adequate treatment of bacterial infections have a great impact on the outcome for the patient (12).…”