Abstract
Purpose
To report a large, consecutive series of endophthalmitis of all causes managed at a tertiary referral retina center.
Methods
Retrospective chart review of all cases diagnosed with endophthalmitis that received reatment and follow-up between January 2000 and January 2005.
Results
A total of 67 patients were diagnosed with endophthalmitis. The most common cause was postoperative endopthalmitis after cataract surgery. Initial management was vitreous needle biopsy with intravitreal antimicrobial injection in a majority of cases (79%). Vitreous cultures were positive in 32 eyes (44.4%); the most common isolate was coagulase negative Staphylococci. Final visual acuity was improved in 61% of patients. More than a third (38%) had vision worse than count fingers. Twenty-eight eyes (39%) needed pars plana vitrectomy for secondary complications as a consequence of endophthalmitis.
Conclusions
Cataract surgery remains the most common cause of endophthalmitis in this large tertiary referral retina center. Endophthalmitis resolved with vitreous needle biopsy and intravitreal injections in more than half of the cases. However, more than a third of patients required additional vitreoretinal surgery for secondary complications. More than a third of patients had nonfunctional vision after the resolution of endophthalmitis, which highlights the severity of this condition in the current expanding era of office-based intravitreal pharmacotherapy for retinal diseases.
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References
West ES, Behrens A, McDonnell PJ, Tielsch JM, Schein OD (2005) The incidence of endophthalmitis after cataract surgery among the U.S. Medicare population increased between 1994 and 2001. Ophthalmology 112(8):1388–1394
Eter N, Krohne TU, Holz FG (2006) New pharmacologic approaches to therapy for age-related macular degeneration. BioDrugs 20(3):167–179
Jonas JB (2006) Intravitreal triamcinolone acetonide: a change in a paradigm. Ophthalmic Res 38(4):218–245
Results of the Endophthalmitis Vitrectomy Study (1995) A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis Vitrectomy Study Group. Arch Ophthalmol 113(12):1479–1496
Taban M, Behrens A, Newcomb RL, Nobe MY, Saedi G, Sweet PM, McDonnell PJ ()(2005) Acute endophthalmitis following cataract surgery: a systematic review of the literature. Arch Ophthalmol 123(5):613–620
Cooper BA, Holekamp NM, Bohigian G, Thompson PA (2003) Case-control study of endophthalmitis after cataract surgery comparing scleral tunnel and clear corneal wounds. Am J Ophthalmol 136(2):300–305
Miller JJ, Scott IU, Flynn HW Jr., Smiddy WE, Newton J, Miller D (2005) Acute-onset endophthalmitis after cataract surgery (2000–2004): incidence, clinical settings, and visual acuity outcomes after treatment. Am J Ophthalmol 139(6):983–987
Ng JQ, Morlet N, Pearman JW, Constable IJ, McAllister IL, Kennedy CJ, Isaacs T, Semmens JB (2005) Management and outcomes of postoperative endophthalmitis since the endophthalmitis vitrectomy study: the Endophthalmitis Population Study of Western Australia (EPSWA)’s fifth report. Ophthalmology 112(7):1199–1206
Busbee BG, Recchia FM, Kaiser R, Nagra P, Rosenblatt B, Pearlman RB (2004) Bleb-associated endophthalmitis: clinical characteristics and visual outcomes. Ophthalmology 111(8):1495–1503; discussion 1503
Wu PC, Kuo HK, Li M, Lai IC, Fang PC, Lin SA, Shin SJ, Chen YJ, Teng MC (2006) Nosocomial postoperative endophthalmitis: a 14-year review. Graefes Arch Clin Exp Ophthalmol 244(8):920–929
Taban M, Behrens A, Newcomb RL, Nobe MY, McDonnell PJ (2005) Incidence of acute endophthalmitis following penetrating keratoplasty: a systematic review. Arch Ophthalmol 123(5):605–609
Leibovitch I, Lai T, Raymond G, Zadeh R, Nathan F, Selva D (2005) Endogenous endophthalmitis: a 13-year review at a tertiary hospital in South Australia. Scand J Infect Dis 37(3):184–189
Jackson TL, Eykyn SJ, Graham EM, Stanford MR (2003) Endogenous bacterial endophthalmitis: a 17-year prospective series and review of 267 reported cases. Surv Ophthalmol 48(4):403–423
Okada AA, Johnson RP, Liles WC, D’Amico DJ, Baker AS (1994) Endogenous bacterial endophthalmitis Report of a ten-year retrospective study. Ophthalmology 101(5):832–838
Binder MI, Chua J, Kaiser PK, Procop GW, Isada CM (2003) Endogenous endophthalmitis: an 18-year review of culture-positive cases at a tertiary care center. Medicine (Baltimore) 82(2):97–105
Schiedler V, Scott IU, Flynn HW Jr., Davis JL, Benz MS, Miller D (2004) Culture-proven endogenous endophthalmitis: clinical features and visual acuity outcomes. Am J Ophthalmol 137(4):725–731
Westfall AC, Osborn A, Kuhl D, Benz MS, Mieler WF, Holz ER (2005) Acute endophthalmitis incidence: intravitreal triamcinolone. Arch Ophthalmol 123(8):1075–1077
Moshfeghi DM, Kaiser PK, Scott IU, Sears JE, Benz M, Sinesterra JP, Kaiser RS, Bakri SJ, Maturi RK, Belmont J, Beer PM, Murray TG, Quiroz-Mercado H, Mieler WF (2003) Acute endophthalmitis following intravitreal triamcinolone acetonide injection. Am J Ophthalmol 136(5):791–796
Gupta A, Gupta V, Dogra MR, Chakrabarti A, Ray P, Ram J, Patnaik B (2000) Fungal endophthalmitis after a single intravenous administration of presumably contaminated dextrose infusion fluid. Retina 20(3):262–268
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Karacal, H., Kymes, S.M. & Apte, R.S. Retrospective analysis of etiopathogenesis of all cases of endophthalmitis at a large tertiary referral center. Int Ophthalmol 27, 251–259 (2007). https://doi.org/10.1007/s10792-007-9068-3
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DOI: https://doi.org/10.1007/s10792-007-9068-3