Purchase this article with an account.
samuel yun, Katherine Davis, Ryan Aronberg, John Huang; Comparison of Visual Outcomes in Various Etiologies of Endophthalmitis with Different Treatment Modalities. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4187.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Endophthalmitis Vitrectomy Study (EVS) results have been extrapolated in considering treatment decision of endophthalmitis from other causes including; post-operative, corneal ulcer, traumatic, endogenous, and intravitreal injection. However it is unclear how well the results of the EVS have been applied in various etiologies of endophthalmitis in clinical practice. We performed retrospective, observational, case-control study to learn about the visual outcomes in various etiologies of endophthalmitis with different treatment modalities (tap and injection (TAP) or pars plana vitrectomy (PPV)).
644 patient charts with diagnosis of corneal ulcer, blebitis, and endophthalmitis at Yale Eye Center from January 1st of 2005 to December 31st of 2013 were reviewed for clinical diagnosis of acute bacterial endophthalmitis. Inclusion criteria included clinical diagnosis of endophthalmitis as well as treatment with either TAP or PPV. Exclusion criteria included clinical diagnosis of sterile or fungal endophthalmitis and uveitis. Main outcome measures were visual acuity score, culture positivity with species, interventions (TAP vs. PPV), and the rate of enucleation.
71 patients were identified with endophthalmitis from trauma (n=2), corneal ulcer (n=15), intravitreal injection (n=11), bacteremia (n=7), cataract surgery (n=11), and other intraocular surgery (n=24). The final visual acuity was the highest in the cataract surgery group and the lowest in the corneal ulcer group. Culture positivity was 35.7% (n = 25). Of those, gram-positive bacteria (n=21) were the most common organisms. 16 of 71 patients (22.5%) received PPV as a part of treatment. The cataract surgery group was most likely to receive PPV (5/11[45.5%]). None of the patients in the cornea ulcer group received PPV. There were total of 7 cases that resulted in enucleation with the corneal ulcer being the most frequent etiology (n=3). 6 of the 7 enucleated cases were treated with TAP only. None of the patients in the cataract surgery group was enucleated.
Endophthalmitis from cataract surgery resulted in the best visual outcome among other etiologies, and was frequently treated with PPV. Endophthalmitis from other etiologies were less likely to be treated with PPV, and resulted in enucleation in few cases. This new data may encourage PPV to be employed more frequently to salvage the globe from enucleation.
This PDF is available to Subscribers Only