Outcome of endophthalmitis treatment in a tertiary referral center in Southern Iran

Abstract

Purpose:The purpose of this study was to investigate the causative organisms, the clinical characteristics, visual outcomes, and the incidence of acute endophthalmitis after cataract surgery.Materials and Methods:In this retrospective study, a chart review was performed for patients treated in a tertiary referral center for acute endophthalmitis after cataract surgery from January 2005 to December 2009. During the study period, 62 additional patients with acute postoperative endophthalmitis were referred to and treated in this center. Therefore the cohort comprised 70 patients (8 of whom underwent cataract surgery at our center, and 62 who were referred). Demographic, clinical, and laboratory data were analyzed. The primary outcome measure was final visual acuity. P<0.05 indicated statistical significanceResults:During the study period, 7737 cataract surgeries were performed in this center. Eight (0.10%) of 7737 eyes developed acute postoperative endophthalmitis. Subgroup analysis indicated that extracapsular cataract extraction was associated with a fourfold higher risk of endophthalmitis compared with phacoemulsification. We found better initial visual acuity (VA) (≥ hand motion) (P<0.001) and negative cultures (P=0.021) were independently associated with a more favorable visual outcome. Patients with relative afferent papillary defect (RAPD) were associated with lower initial VA (P<0.001) and worse visual outcome (P=0.001). Positive microbial cultures were found for 33 (42.9%) cases. Staphylococcus aureus was the most common organism isolated. Positive cultures were more frequently found in patients with RAPD. The “gram-positive coagulase-negative” and “no growth” groups had the best visual outcome. Associated keratitis and avoiding intraocular steroids were associated with the risk of evisceration.Conclusion:The visual outcome after endophthalmitis was generally poor and only one eighth of the eyes achieved a final corrected visual acuity of ≥20/200. Therefore, better treatment strategies are warranted. Immediate treatment is essential and the role of primary vitrectomy requires further investigation. In addition, RAPD, as an objective test, may complement VA for predicting the prognosis and planning the course of treatment.

Treatment outcomes of post cataract surgery endophthalmitis in a tertiary referral center in Iran

“…study was 5.7% (4 from 70 eyes). 22 Only one eye ended up to evisceration in our study (2.3%), and the bacterial isolate in this case was Pseudomonas aeruginosa .…”

“…reported the outcome of endophthalmitis in southern Iran. 22 The rate of evisceration in the Rahimi et al. study was 5.7% (4 from 70 eyes).…”

Combined Therapeutic Penetrating Keratoplasty and Pars Plana Vitrectomy for the Treatment of Infectious Keratitis Endophthalmitis: Mexican Endophthalmitis Study Group Protocol 4

“…10,13 Although the logical scientific process of thought indicates that such a conclusion should be interpreted with caution when addressing any other type of endophthalmitis, the reality has been the systematic delay of surgical treatment and only included as a potential option after failure of the initial medical treatment, after long periods of active disease with progressive visual loss or tissue, or as a "last-resource" type of treatment. 3,14,21,22 Evidence has shown us that the impact of such a stance in the case of IKE, in which the source of infection is contiguous to the intraocular space, leads to significantly different functional and anatomical outcomes from those reported by the EVS, with a high prevalence of NLP and a huge proportion of patients requiring enucleation/evisceration surgery to achieve the control of the infection. 14,23,24 Moreover, the presence of severe corneal pathologies, such as corneal infiltration, ulcers, or opacities, hinders the correct assessment of visual acuity at the moment of diagnosis.…”

Recurrent Endophthalmitis after Trabeculectomy for Glaucoma: Importance of Timely Filtering Bleb Coverage for the Conjunctiva

“…This is obviously contradictory to the treatment goals of glaucoma where the construction of the filtering bleb facilitates germ invasion. However, since the visual prognosis of eyes after endophthalmitis is poor [ 2 , 3 , 4 , 11 , 12 ] – and even much more so after recurrence [ 13 , 14 , 15 ] –, the course of treatment for endophthalmitis after trabeculectomy should emphasize recurrence prophylaxis and therefore include a safe bleb leak coverage [ 16 ].…”

“…The spectrum of causative organisms is broad and includes typical skin bacteria as well as nosocomial pathogens that may unveil hospital hygiene deficiencies [ 2 , 3 , 4 , 5 , 6 ]. While the treatment of endophthalmitis with regular- and small-gauge vitrectomy is possible [ 7 , 8 ], there are no established standard operating procedures [ 9 , 10 ], and the visual outcome is generally poor even if the eye itself can be preserved [ 2 , 3 , 4 , 11 , 12 ]. The latter statement is especially true with regard to recurrent and/or chronic endophthalmitis [ 13 , 14 , 15 ], and therefore recurrence prophylaxis should have a very high priority in treatment decision-making.…”