Acute Endophthalmitis After Cataract Surgery: 250 Consecutive Cases Treated at a Tertiary Referral Center in the Netherlands

• Published in: American journal of ophthalmology Vol. 149; no. 3; pp. 482 - 487.e2
• Main Authors: Pijl, Benjamin J, Theelen, Thomas, Tilanus, Maurits A.D, Rentenaar, Rob, Crama, Niels
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-03-2010; Elsevier; Elsevier Limited
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bacteria; Bacteria - isolation & purification; Biological and medical sciences; Cataracts; Ceftazidime - therapeutic use; Combined Modality Therapy; Confidence intervals; Endophthalmitis - diagnosis; Endophthalmitis - drug therapy; Endophthalmitis - microbiology; Eye Infections, Bacterial - diagnosis; Eye Infections, Bacterial - drug therapy; Eye Infections, Bacterial - microbiology; Eye surgery; Female; Follow-Up Studies; Gram-positive bacteria; Humans; Lens diseases; Light; Male; Medical sciences; Middle Aged; Miscellaneous; Netherlands; Ophthalmology; Phacoemulsification; Postoperative Complications; Referral and Consultation; Retrospective Studies; Statistical analysis; Success; Surgery; Treatment Outcome; Vancomycin - therapeutic use; Visual Acuity; Vitrectomy; Vitreous Body - microbiology; Young Adult; Netherlands; Europe; Eye disease; Cataract; Lens disease; Treatment; Acute; Surgery; Uvea disease; Ophthalmology; Endophtalmitis; Anterior segment disease
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2009.09.021

Purpose To evaluate the clinical characteristics, bacterial culture, and visual outcome of patients with acute endophthalmitis after cataract surgery. Design Retrospective consecutive interventional case series. Methods Clinical notes from patients treated for acute endophthalmitis after cataract surgery in a single center from 1996 to 2006 were reviewed. Patients with less than 1 month of follow-up and missing bacterial cultures were excluded. Vitreous biopsy or primary vitrectomy followed by intravitreal injection of vancomycin and ceftazidime (± prednisolone) was performed. Main outcome measures were bacterial culture and final visual acuity. Results Bacterial cultures (total 250 cases) showed bacterial growth in 166 cases (66.4%). From these 166 cultures, 89 (53.6%) revealed gram-positive coagulase-negative, 63 (38.0%) other gram-positive, 10 (6.0%) gram-negative, and 4 (2.4%) polymicrobial cultures. Vitreous biopsy with intravitreal antibiotics injection was performed in 225 (90.0%) of cases. Primary vitrectomy with intravitreal antibiotics was performed in 25 eyes (10.0%). Final visual acuity ≥0.5 was achieved in 129 (51.6%) of all cases, 54 (60.7%) of the 89 gram-positive coagulase-negative cultures, 20 (31.7%) of the 63 other gram-positive cultures, 5 (50.0%) of the 10 gram-negative cultures, and 9 (45.0%) of the 20 Staphylococcus aureus cultures. There was no additional effect for treatment by primary vitrectomy or intravitreal prednisolone. Conclusions Treatment outcome after endophthalmitis is highly dependent on the causative organism. Treatment outcomes for gram-negative bacteria and S. aureus may be better than previously reported. Prompt treatment of endophthalmitis remains essential and the role of complete primary vitrectomy remains subject to debate.