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D. Parver, S. El-Agha, Y. He; Treatment Outcomes in Different Subgroups of Endophthalmitis . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1855.
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Purpose: To characterize causative organisms in culture positive patients of different subgroups of endophthalmitis; to examine post-surgical, traumatic and endogenous subgroups of endophthalmitis and compare treatment outcomes after intravitreal antibiotic administration alone versus pars plana vitrectomy/injection of intravitreal antibiotics; and to examine treatment outcomes in patients who had culture positive vitreous biopsies versus those with culture negative biopsies. Methods: A retrospective review of 36 patients (40 total eyes) diagnosed with endophthalmitis at the Parkland Memorial Hospital eye clinic from 1998-2002. Post-surgical, traumatic and endogenous subgroup patients with culture positive vitreous biopsy had analysis to identify causative organism. Initial treatment was with vitreous tap/injection of antibiotics, PPV with intravitreal antibiotics or repair of penetrating injury with or without removal of intraocular foreign body. Criteria of treatment success based on Snellen visual acuity measurement and examination of ocular media. Treatment success was defined as a resolution of the signs of infection seen on exam with stabilization or improvement in vision. Results: In the post-surgical subgroup there was a 40% success rate with intravitreal tap/injection of antibiotics (T/I) and a 20% success rate with PPV. The success rate in culture negative cases was 60% versus 0% success rate for culture positive cases. There was no distinct causative organism found in patients that failed treatment. In the traumatic subgroup there was a 40% success rate with T/I and a 60% success rate with PPV. The success rate in culture negative cases was 50% versus 40% success in culture positive cases. In the endogenous subgroup there was a 43% success rate with T/I while there was a 67% success rate with PPV. There was a 0% success rate in culture negative cases while 64% of culture positive cases had treatment success. Conclusions: In our series post-surgical and traumatic endophthalmitis were caused primarily by bacterial organisms while fungal organisms caused the majority of cases in the endogenous subgroup. In the post- surgical group intravitreal antibiotic administration and PPV were roughly equal in success rate; in the trauamtic and endogenous groups treatment outcomes were better with PPV compared to intravitreal antibiotic administration alone. In the post-surgical group culture negative cases had significantly better treatment outcomes vs. culture positive patients. In the traumatic group success rates were roughly equal between culture positive and negative patients.
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