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C.D. Quinn, H.W. Flynn, I.U. Scott, W.E. Smiddy; Acute–onset endophthalmitis following cataract surgery: Association between time of diagnosis, causative organism, and final visual acuity outcome. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):522.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To investigate the association between the time of diagnosis, causative organisms, treatment strategies, and visual acuity outcomes of endophthalmitis following cataract surgery. Methods: Retrospective, noncomparative, case series of patients who were treated at Bascom Palmer Eye Institute for acute onset (£ 6 weeks) endophthalmitis following cataract surgery between January 1996 to January 2003. Results: The study population consists of 63 patients who were treated for acute–onset endophthalmitis within six weeks of cataract surgery. Patients were stratified into Group 1, early presentation (within 7 days) and Group 2, late (8–42 days.) Group 1 consisted of 20 (32.0%) and Group 2 consisted of 43 (68%) patients, with an average time to presentation of 17.4 days following cataract surgery. The initial treatment for 42/63 (66.6%) patients was a vitreous tap and injection of vancomycin, ceftazidime, and dexamethasone , and 21/63 (33.3%) underwent pars plana vitrectomy with injection of intravitreal antibiotics. Coagulase negative staphylococcus was the most common organism cultured in both groups, including 8/20 (40%) in Group 1 and 27/43 (62.7%) Group 2. In Group 1, 10/20 (50.0%) patients had more virulent organisms (streptococcal, enterococcal, and pseudomonas species.) However in Group 2 only 8/43 (18.6%) patients had infections with more virulent organisms. Patients with less virulent organisms, (coagulase negative staphylococcus species) had a better visual outcome in both groups compared to all other species. In Group 1 6/20 (30%) patients with coagulase negative staphylococcal infections achieved a visual acuity of ≥20/200 and in Group 2 26/43 (60.4%) patients achieved a visual acuity of ≥20/200. In Group 1 8/20 (40%) achieved a visual acuity of ≥20/200, while in Group 2 36/43 (83.7%) achieved a visual acuity of ≥20/200 (p value = 0.001, chi–square test.) Thirty–nine out of 63 patients (62.0%) underwent temporal clear cornea phacoemulsification, 14/63 (22.5%) underwent extracapsular cataract surgery, and 10/63 (15.8%) had other types of phacoemulsification. Conclusions:In this study of acute–onset endophthalmitis following cataract surgery, more favorable visual outcomes were associated with late (8–42 days post cataract surgery) diagnosis and with less virulent organisms.
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