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M.M. Thakker, D.J. D'Amico, S.K. Ray; Ultrasonographic Characteristics of Eyes with Endophthalmitis . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1847.
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Purpose: To report ultrasound abnormalities and their incidence in eyes with endophthalmitis Methods: We reviewed the records of 70 consecutive patients with the clinical diagnosis of endopthalmitis who underwent ultrasound evaluation at the MEEI from 1999-2002. Preoperative ultrasounds of 6 patients with dense cataracts were used as controls. Sonographic findings evaluated included the density of vitreous and membranous debris, retinal and choroidal detachments; macular edema, disc edema, choroidal thickening, and the presence of sub-Tenon's fluid. Vitreous debris was graded as 1, 2, or 3 if less than 10%, between 10-50%, or greater than 50% of the vitreous cavity was involved. Results: Fifty-four patients met inclusion criteria. The most common causative organism was coagulase-negative Staphylococcus (N=17, 31.5%). 5.6% of eyes had initial visual acuities of 20/50-20/200, 33 (61.1%) had acuities of 19/200 to hand movements, and 13 (24.1%) were light perception or worse. Ultrasound findings of only moderate vitreous debris was seen in 14.8% of eyes with endophthalmitis. Severe vitreous debris (grade 3) was detected in 70.4% of eyes with endophthalmitis vs. 0% of controls. Loculated pockets of debris were common in patients with endophthalmitis (36%) and was membranous in 70.4% of eyes. Macular edema and disc edema were seen in 16.7% and 7.4% of eyes with endophthalmitis. Choroidal thickening was observed in 16.7% of eyes while choroidal and retinal detachments were present in 14.8% and 7.4% of eyes with endophthalmitis. Fluid in sub-Tenon's space was detected in 13% of eyes. Conclusions: Predominant ultrasound findings in eyes with endophthalmitis are: 1) severe levels of vitreous debris, 2) moderate and severe membranous debris, and 3) loculated pockets of vitreous debris. These findings were not found in control eyes. We also found that detachments of the retina or choroid are present in more than one-fifth of all patients with endophthalmitis. Less common findings include macular edema, disc edema, choroidal thickening, and sub-Tenon's fluid. These findings support the use of ultrasonography as an important clinical aid in the diagnosis and management of endophthalmitis. Future prospective studies may help define which of these ultrasound findings are important prognostic indicators.
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