Purchase this article with an account.
Nausheen Abbas, John Huang; Characterization of Prognostic Factors of Endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1120.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To characterize the prognostic factors associated with different etiologies of endophthalmitis in order to tailor therapy for maximal benefit.
A retrospective chart review was performed of all patients who presented with endophthalmitis over a period of 5 years. One hundred charts were reviewed and 74 patients were excluded (age <18, pre-existing visual acuity (VA) <20/60, misdiagnosed endophthalmitis and infections treated solely with topical therapy). Data collected included age, gender, presenting visual acuity, final visual acuity, treatment modality (vitrectomy vs. tap/inject) and use of adjuvant oral fluoroquinolones. Univariate analysis of variance was performed on the visual outcomes.
Of the 26 eyes that were analyzed, etiologies included blebitis, corneal ulcers, cataract surgery, endogenous and intravitreal injections. The biggest difference in terms of visual outcome was seen with treatment modalities. Of the bleb associated infections, 50% of the vitrectomy group had an improvement of VA compared with 25% of the tap/inject group (p=0.633). In the corneal ulcer group, 100% had improved VA with vitrectomy compared with 66% with tap/inject (p=0.576). In the post cataract group, 75% had improved VA with vitrectomy as compared with 100% in the tap/inject group (p=0.685). When stratified according to visual acuity at presentation, all of the groups had a better visual outcome with vitrectomy than with tap and inject. No difference was seen with diabetes or with the addition of oral fluoroquinolones.
Endophthalmitis is a severe intraocular condition, which can lead to devastating visual loss if not promptly diagnosed and treated. Treatment guidelines set forth in the Endophthalmitis Vitrectomy Study are currently being extrapolated and implemented for etiologies of endophthalmitis other than post-cataract extraction, however every etiology has a different prognostic profile and should be treated as such. In our study, bleb associated and corneal ulcer groups had worse visual outcomes and endogenous and intravitreal groups had better visual outcomes. All of the etiologies (except for cataract) showed better visual outcomes with vitrectomy compared to tap/inject, regardless of initial visual acuity. Our results indicate that a lower threshold for vitrectomy may result in better visual outcomes in certain cases of endophthalmitis.
This PDF is available to Subscribers Only