INCIDENCE AND VISUAL OUTCOME OF ACUTE POSTOPERATIVE ENDOPHTHALMITIS

Authors

  • Ashok Kumar Narsani
  • Partab Rai Nagdev
  • Mahesh Kumar Lohana
  • Shafi Muhammad Jatoi
  • Imtiaz Gilal

Abstract

Objectives: To assess the incidence and visual outcome of acute post operative endophthalmitis treatedby intravitreal antibiotics. Methods: This Prospective study was conducted at Department ofOphthalmology, Liaquat University Eye Hospital Hyderabad from November 2002 to October 2010.One hundred and nine patients of acute post operative endophthalmitis were treated with intravitrealantibiotics. The inclusion criteria of the patients was the clinical diagnosis of acute post operativeendophthalmitis within 14 days of post operative period and visual acuity better than or equal to handmovement close to face. After enrolment, vitreous tap was carried out followed by intravitrealantibiotics injection. The outcome was measured in terms of clinical resolution of endophthalmitis andpost resolution best corrected visual acuity. Results: Of the 109 patients 97 meet the criteria andfollowed completely were included. Sixty patients (61.9%) had extracapsular cataract extraction(ECCE) with posterior chamber intraocular lens implantation while phacoemulsification done in 37(38.1%) patients. The visual acuity at presentation was 6/60 or worse in 80 (82.5%) patients. Vitreoustap was done in 86 (88.7%) patients. Vitreous biopsy yields an organism in 32 (33%) patients.Coagulase positive were the most common organism. 75 (77.3%) patients received single dose ofintravitreal antibiotic. Forty five (46.4%) patients received single antibiotic, ceftazidime while twoantibiotics given in 52 (53.6%) patients. Twenty five (25.8%) patients also had oral steroids. Ninety one(93.8%) patients responded to intravitreal antibiotics. Seventy five (77.32%) patients achieved finalvisual outcome better than 6/60 in meantime of 54.08 days. Six (6.2%) patients developed noperception of light and another six patients (6.2%) referred for vitrectomy. Conclusion: The final visualoutcome of the patients with acute postoperative endophthalmitis is strongly associated with the visualacuity at presentation as well as type of infective organisms.Keywords: Endophthalmitis, visual outcome, intravitreal antibiotics

References

Chisari G. Endophthalmitis:Gram Positive Etiological agents and

susceptiblity to Glycolipids. Current clinical pharmacology.

;3:153–5.

Lloyd JC, Braga-Mele R. Incidence of postoperative

endophthalmitis in a high-volume cataract surgicentre in Canada.

Canadian journal of ophthalmology. 2009;44:288–92.

J Ayub Med Coll Abbottabad 2011;23(2)

http://www.ayubmed.edu.pk/JAMC/23-2/Ashok.pdf 103

Bohigian GM. A retrospective study of the incidence of culture

positive endophthalmitis after cataract surgery and the use of

preoperative antibiotics. Ophthalmic Surg Lasers Imaging

;38:103–6.

Taban M, Behrens A, Newcomb RL, Nobe MY, Saedi G,

Sweet PM, et al. Acute endophthalmitis following cataract

surgery: a systemic review of the literature, Arch Ophthalmol

;123:613–20.

Callegan MC, Engelbert M, Parke DW 2nd, Jett BD, Gilmore

MS. Bacterial endophthalmitis: epidemiology, therapeutics, and

bacterium-host interactions. Clin Microbiol Rev 2002;15:111–24.

Aaberg TM Jr, Flynn HW Jr, Schiffman J, Newton J.

Nosocomial acute-onset postoperative endophthalmitis survey. A

-year review of incidence and outcomes. Ophthalmology

;105:1004–10.

Clark WL, Kaiser PK, Flynn HW Jr, Belfort A, Miller D, Meisler

DM. Treatment strategies and visual acuity outcomes in chronic

postoperative Propionibacterium acnes endophthalmitis.

Ophthalmology 1999;106:1665–70.

Schemmer GR, Driebe WT. Post-traumatic Bacillus cereus

endophthalmitis. Arch. Ophthalmol 1987;105:342–4.

Costello P, Bakri SJ, Beer PM, Singh RJ, Falk NS, Peter GB, et

al, Vitreous penetration of topical moxifloxcin and gatifloxcin in

humans. Retina 2005;25:1.

Hanscom TA. Postoperative endophthalmitis. Clin Infect Dis

;38:542–6.

Kwok AK, Hui M, Pang CP, Chan RC, Cheung SW, Yip CM, et

al. An In Vitro study of Ceftazidime and Vancomycin

Concentrations in Various Fluid Media: Implications for Use in

Treating Endophthalmitis. Invest Ophthalmol Vis Sci

;43:1182–8.

Rains CP, Bryson HM, Peters DH. Ceftazidime. An update of its

antibacterial activity, pharmacokinetic properties and therapeutic

efficacy. Drugs 1995;49:577–617.

Elder MJ, Morlet N; EPSWA. Endophthalmitis Population

Study of Western Australia. Endophthalmitis. Clin Experiment

Ophthalmol 2002;30:394–8.

Kamala Rajah S, Silvestri G, Sharma N, Khan A, Foot B, Ling R,

et al. Surveillance of endophthalmitis following cataract surgery

in the UK. Eye 2004;18:580–7.

Campochiaro PA, Conway BP. Aminoglycoside toxicity--a

survey of retinal specialists. Implications for ocular use. Arch

Ophthalmol 1991;109:946–50.

Abelson M, Forbes M. The Engima of Endophthalmitis. Rev

Ophthalmol 2002;30:394–8.

Desai P, Minassian DC, Reidly A. National cataract surgery

survey 1997–8. A report of the result of the cilinical outcomes. Br

J Ophthalmol 1999;83:893–6

Nichamin LD, Chang DF, Johonson SH, Mamalis N, Masket S,

Packard RB, et al. ASCRS white paper: what is the association

between clear corneal incision and post operative

endophthalmitis? J Catract Refrct Surg 2006;32:1556–9.

Carrim ZI, Richardson J, Wykes WN. Incidence and visual out

come of acute endophthalmitis after cataract surgery-Experience

of a single eye department in Scotland. Br J Ophthalmol

;93:721–5.

Mayer E, Cadman D, Ewings P, , Twomey JM, Gray RH,

Claridge KG, et al. A 10 years retrospective survey of cataract

surgery and endophthalmitis in a single eye unit: injectable lenses

lower the incidence of endophthalmitis. Br J Ophthalmol

;87:867–9.

Endophthalmitis Vitrectomy Study Group. Microbiologic factors

and visual outcome in the Endophthalmitis Vitrectomy Study.

Am J Ophthalmol 1996;122:830–46.

Desai P. The National cataract surgery survey: Clinical

outcomes. Eye 1993;7:489–94.

Mollan SP, Gao A, Lockwood A, Durrani OM, Butler L.

Postcataract endophthalmitis: incidence and microbial isolates in

a united kingdom region from 1996 through 2004. J Ctaract

Refract Surg 2007;33:265–8.

Published

2011-06-01