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Jayanth Sridhar, Nadim Rayess, Sunir J Garg; Clinical presentation, microbiologic spectrum, and visual outcomes of acute endophthalmitis undergoing therapeutic pars plana vitrectomy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4190.
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Purpose: To report the clinical presentation, microbiologic spectrum, and visual outcomes associated with acute endophthalmitis undergoing therapeutic pars plana vitrectomy within 14 days of diagnosis.
Methods: A non-comparative consecutive case series. Billing records were reviewed to identify all patients undergoing pars plana vitrectomy for acute endophthalmitis from January 2011 through September 2014 at a large tertiary referral academic private practice. Patients who had vitrectomy after 14 days from presentation were excluded from further analysis. The clinical records were reviewed to evaluate clinical features, microbiologic spectrum, and treatment outcomes.
Results: Thirteen patients were identified. Clinical settings included post-cataract surgery (n=7), post-traumatic (n=1), trabeculectomy bleb-associated (n=1), post-vitrectomy (n=1), post-intravitreal injection (n=1), post-penetrating keratoplasty (n=1), and endogenous (n=1). All patients presented with hypopyon and no view of the fundus. Presenting visual acuities were finger count (n=2), hand motions (n=7), and light perception (n=4). Initial treatment strategies were vitreous tap and injection (n=12) and pars plana vitrectomy with intravitreal antibiotics (n=1). All patients eventually underwent pars plana vitrectomy an average of 3.5 days after initial presentation (range 0 to 11 days). Positive vitreous cultures were obtained in 11 of 13 patients (84.6%). Identified organisms included alpha-hemolytic Streptococcus species (n=5), Staphylococcus epidermidis (n=3), Streptococcus pneumoniae (n=2), and Haemophilus influenzae (n=1). All organisms were sensitive to the initially administered antibiotics (intravitreal vancomycin and either intravitreal ceftazidime or amikacin). Visual acuities on final follow-up were 20/70 (n=1), 20/400 (n=2), finger count (n=2), hand motions (n=3), light perception (n=2), and no light perception (n=3). No patients underwent enucleation or evisceration.
Conclusions: Pars plana vitrectomy for acute endophthalmitis was utilized most frequently in post-cataract surgery cases and in cases with proven Streptococcus sp. infection. Although there were no cases of enucleation or evisceration, outcomes were still poor with the majority of patients having finger count vision or worse.
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