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Ryan C Young, David W Parke, Hassan Aziz, Harry W Flynn; Open Globe Injuries With Positive Intraocular Cultures, 2000 To 2012: A Case Series.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3849.
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To investigate the clinical features influencing final visual outcomes of eyes with positive intraocular cultures after penetrating ocular injury.
A retrospective interventional consecutive case series of all patients treated at Bascom Palmer Eye Institute for traumatic penetrating ocular injury with positive intraocular cultures between January 1, 2000 and December 31, 2012. Examination on presentation, timing and mechanism of injury, zone of injury, presence of intraocular foreign body, etiology of endophthalmitis, management, postoperative course, and visual outcomes are analyzed.
51 patients were included during the study period, with 45 male (88.5%) and 6 female. The mean age at presentation was 34.5 years (range 1.5 to 85 years). The right eye was involved in 23 patients and the left eye in 28. Presenting visual acuity was greater than 20/400 in 10 patients and less than 20/400 in 41 patients. The zone of injury included zone 1 in 43 (84.5%), zone 2 in 3, and zone 3 in 5 patients. Retained intraocular foreign body was noted in 22 (43%) on presentation, retinal detachment in 10 (20%), traumatic cataract in 33 (65%). Primary surgical management included prophylactic intraocular antibiotics in 72% and pars plana vitrectomy in 57%. 33 (65%) patients presented with clinical endophthalmitis, 11 (22%) developed endophthalmitis post-repair, and 9 (17.6%) had positive intraocular cultures without developing clinical endophthalmitis. Microbial isolates included bacteria in 34 (67%), fungi in 6, and mixed isolates in 11. The most common organism identified in this study was Staphylococcus epidermidis. Poor final best corrected visual acuity was associated with decreased presenting visual acuity (p=0.043) and retinal detachment (p=0.033).
Endophthalmitis is a serious and sight-threatening complication of open globe injury. Staph epidermidis was the most commonly isolated organism in this series. Fungal isolates comprise a minority of organisms responsible for open globe-associated endophthalmitis. Poor final BCVA outcomes are associated with presenting visual acuity and retinal detachment.
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