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boris rysanek, jean jacques parienti, frederic mouriaux; Acute endophthalmitis: a 222 cases multicentric retrospective study. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1687.
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Acute endophthalmitis is a dramatic event after cataract surgery. The aim of this multicentric retrospective study is to analyse initial signs and management and then to compare our results to the guidelines of Endophthalmitis Vitrectomy Study.
All cases of endophthalmitis after cataract surgery from 3 french ophthalmological university centers between 1997 to 2007 were reviewed. Only patients with an acute endophthalmitis were recorded. Initial visual acuity and clinical signs, microbiological results, medical or surgical management, ocular complications and final visual acuity were recorded. All visual acuity score were modified in logmar scale.
222 patients were included in this study. The mean age was 73.3 year. Vitreous biopsy or vitrectomy was realised in 117 patients. The choice of surgical treatment was statistically associated with lower initial visual acuity. Cyclitic membrane in the pupillary area could explain some low visual acuity. There was no significant difference for final visual acuity between medical treatment and surgical treatment. Use of ocular ultrasound was informative to analyse the vitreous body. Intraocular samples were taken in 95% of the patients. Pathogens were identified in cultures in 55.5% of cases. 40% of "aggressive pathogens" like staphylococcus aureus, streptococcus species and bacilles gram-negative were found. Final visual acuity 12 months after treatment was 20/40 or better in 55.5%. Loss of red reflex at the initial examination was statistically associated with a lower final visual acuity (p<0,001). Positive bacteriological culture was statistically associated with a lower final visual acuity (p<0,001). "Aggressive pathogens" were statistically associated with ocular complications (p<0,001).
The EVS guidelines are not always valid in our experience, especially with the cyclitic membranes. The initial visual acuity and slip lamp examination is essential for optimized management. The most predictive criteria for final acuity in our study were the red reflex and presence and type of bacteria in acute postoperative endophthalmitis.
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