Analysis of 57 Post - Endophthalmitis R Etinal D Etachment and Predi Ctive Factors for Visual Outcome

Abstract

OBJECTIVE: Evaluation of cases of endophthalmitis developing Rhegmatogenous retinal detachment and managed with vitreoretinal surgery, their clinical profile, factors responsible for retinal detachment and the predictive factors for the final outcome. SETTING: Vivekanand Netralaya, Lions NAB Eye hospital, Miraj. MATERIAL AND METHODS: This is a retrospective nonrandomized case series involving 57 consecutive cases of post endophthalmitis Rhegmatogenous Retinal Detachment. 168 cases of endophthalmitis that were managed were reviewed. Amongst these cases 57 developed rhegmatogrnous RD at various stages of presentation and management. All these cases were managed by Parsplana vitrectomy with Fluid Ggas Exchange with endolaser and silicon oil/C3F8 implantation. RESULTS: 168 cases of endophthalmitis (90-posttraumatic/ 72-postoperative/ 6 endogenous), were managed of which 33.92% developed Retinal Detachment. Of the patients with RD 24.6% it was noted post vitrectomy surgery for endophthalmitis in the rest it was noted pre or intraoperative. CONCLUSION: Factors compatible with good visual outcome were macula on RD (68%), PVD induction (56%), and also the cases with silicon oil tamponade, breaks and retinal detachment noted introperatively (During vitrectomy for endophthalmitis) fared much better. With better surgical techniques, availability of antimicrobials, long acting tamponading agents the vitreoretinal surgical results are encouraging, can be even better if intervened early.

A Multicenter Review Evaluating the Risk of Rhegmatogenous Retinal Detachment Post Endophthalmitis

“…Nelsen et al 9 reported that postoperative causes of endophthalmitis were most frequently complicated by RD. Som et al, and Dave et al however, found that posttraumatic causes were the most frequent, 7,10 and Lee et al, 11 contrarily, found that endogenous etiology was associated with a higher rate of RD. Finally, in the EVS, management of the endophthalmitis by pars plana vitrectomy (PPV) or tap-and-inject did not change the rate of subsequent RD.…”

“…2 In the current literature, the rate of RD post endophthalmitis varies from 7% to 34%. [3][4][5][6][7] There are inconsistent findings regarding whether certain causative organisms, etiologies, or management approaches for endophthalmitis are more likely to be complicated by RD. In the endophthalmitis vitrectomy study (EVS), endophthalmitis caused by more virulent organisms, specifically gram-negative bacteria and gram-positive organisms that were not coagulasenegative micrococci, was more likely to be complicated by RD.…”