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Ahmed Sheikh, Marco A Zarbin, Paul D Langer, Neelakshi Bhagat; Post-Operative Endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6369.
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© ARVO (1962-2015); The Authors (2016-present)
Endophthalmitis is a severe complication of ophthalmic surgery. This study describes our institution’s experience with post-operative endophthalmitis.
A retrospective case series of post-operative endophthalmitis at University Hospital, Newark, NJ between 2002 and 2014 was performed.
Thirty cases (13 men) were identified. Average age was 63.6 years (range 22 – 89). Mean follow-up was 34.2 months. Endophthalmitis was diagnosed after glaucoma surgery (14 patients), cataract extraction (9), penetrating keratoplasty (PKP) (4), pterygium excision (1), and intra-vitreal injection (1). Presenting visual acuity (VA) ranged from no light perception to 20/50, with 43.3% presenting with hand motion. Pain was the most common presenting symptom. Most reported presenting signs were conjunctival injection and hypopyon (76.7%). Seventeen eyes were pseudophakic, 7 phakic, 3 aphakic, and 3 unknown. Diabetes was present in 7 patients, and HIV in 2. A glaucoma procedure (Trabeculectomy, Ahmed, Baerveldt, or express shunt) was the most common surgical procedure encountered before endophthalmitis (14/30; 46.7%). Average time from a glaucoma procedure to endophthalmitis was 49.9 months (11 patients), all presented non-acutely. Six cataract extractions presented acutely (average of 5.2 days) and 3 cases presented non-acutely at an average of 20 months. Amongst 3 PKP eyes, endophthalmitis was diagnosed after a mean duration of 42.7 months. All eyes underwent cultures; only 17 (56.6%) of 30 were positive. Positive cultures in post- cataract infections grew gram-positive organisms; in post-glaucoma procedures grew gram-positive, acid-fast bacilli, and fungi. The most common organism in glaucoma patients was Streptococcus viridans. At presentation, patients underwent either PPV with intravitreal antibiotics (10 eyes;average VA 2.19 logMAR), an intravitreal antibiotic injection only (18; average VA 1.73 logMAR), or primary enucleation (2, both NLP). All hospitalized patients received systemic antibiotics (19 intravenous; 2 oral). Three NLP eyes underwent enucleation secondarily (2 post-cataract extractions; 1 post-trabeculectomy). Six month follow-up was reported in 17 patients: 6 patients had a VA of 20/50 or better while 11 had worse than 20/50.
Visual outcome after post-surgical endophthalmitis is poor. One-sixth of eyes underwent enucleation in our series.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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