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H. Karacal, R.S. Apte; Retrospective Analysis of All Cases of Endophthalmitis at a Tertiary Referral Center . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5284.
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To analyze endophthalmitis cases in a tertiary retina practice over a period of five years.
Forty thousand three hundred and seventy one patients were seen at Barnes Retina Institute between 2000 and 2005, and 1872 patients had intravitreal injections during same time period. 68 cases of endophthalmitis were identified and reviewed retrospectively for patient age, sex, laterality, etiology, initial and final visual acuity, management, culture results, complications and secondary interventions.
Of the 68 patients with endophthalmitis, 31 were female (45.5%) and 37 male. Mean age was 70.3 (range 18–93). Five patients (7%) had bilateral involvement whereas 32 (50.7%) patients had right eye involved. Vision on presentation was between 20/20–20/100 in 12 (16.4%) eyes, whereas 64.3% had count fingers or worse vision. Fifty (68.4%) cases were postoperative (cataract: 70%, combined procedures including cataract (12%), trabeculectomy (10%), keratoplasty (6%), and pars plana vitrectomy (2%). Three patients had history of penetrating trauma; 9 patients (13.2%) were diagnosed with endogenous endophthalmitis; 4 (5.8%) had had intravitreal triamcinolone injections. More than half of the patients (56%) received systemic antimicrobial treatment in addition to vitreous biopsy and intravitreal injections (79.4%) or pars plana vitrectomy (17.8%). Three patients who had cataract surgery needed IOL removal. Vancomycin and ceftazidime were antibiotics of choice; patients allergic to penicillin received amikacin. Most frequent isolate was coagulase negative staphylococcus (17.6%); 32.3% were culture negative. One patient had HIV/AIDS; six patients (8.8%) had bacteremia. Most common complication was retinal detachment (10.2%); two patients developed phthisis and one required enucleation. 41% of eyes maintained a vision 20/80 or better and 34.2% were count fingers or worse. Most common intervention for and after the resolution of endophthalmitis was pars plana vitrectomy(47%).
Cataract surgery is still the most common cause of endophthalmitis. Endophthalmitis resolved following vitreous tap and injections in 49.3 % of our patients. However, almost 50% required pars plana vitrectomy and a third of all patients had final vision of count fingers or worse. Close monitoring and prompt intervention in cases of endophthalmitis is warranted given the relatively high incidence of complications and associated visual loss.
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