Endophthalmitis: Aetiology, Isolated Microorganisms, Therapy And Outcome

Abstract

Purpose: : To report the etiology, treatment outcome and spectrum of isolated microorganisms of all endophthalmitis cases treated in our Hospital from January 2002 to February 2010.

Methods: : After approval by the Institutional Review Board, medical records from all 201 patients (204 eyes) were collected retrospectively. Endophthalmitis categories included postoperative, post-traumatic, endogenous, post- intravitreal injection and miscellaneous cases. The outcome measures included categories of endophthalmitis, general data, treatment, isolated microorganisms and visual acuity outcome.

Results: : Of the 204 cases of endophthalmitis 136 (67%) were post-operative ones, (116 extern and 20 intern patients), 33 (16 %) endogenous, 17 (8%) post-traumatic, 14 (7%) post-intravitreal injection (9 extern and 5 intern patients) and 4 (2%) miscellaneous cases. Specimens were collected in 136/204 cases. Microorganisms were isolated in 119 from 136 (87.5%) cases. The most common microorganisms were Coagulase-negative Staphylococcus, 45 (37.8%), Streptococci 35 (29.4%), Staphylococcus aureus 9 (7.5%), Propionibacterium acnes 7 (5.8%), Fungi 17 (14.2%), others isolates 6 (5.0%). In case of bacterial endophthalmitis 84% of the patients received systemic antibiotic treatment with imipinem/cilastin. The most commonly used antibiotics for intravitreal injection were vancomycin in combination with amikacin in 78% of the cases. In case of a fungal endophthalmitis, fluconazol was used as the initial systemic therapy in 70 % of cases. In 71% of patients amphotericin B was used for intravitreal therapy. Over 70 % of the endophthalmitis cases underwent pars-plana vitrectomy (ppV). To demonstrate the success of the conducted therapy visual acuity before and after treatment was compared. The result illustrated a significant statistical (P = >0.05). An improvement of the visual outcome for all forms of the treated Endophthalmitis.

Conclusions: : Prompt treatment of all patients presenting with endophthalmitis is mandatory regardless of the time of presentation. The appropriate choice of therapy (pars-plana vitrectomy and intravitreal application of vancomycin/amikacin for bacterial endophthalmitis) resulted in a significant improvement of visual acuity and a low rate of enucleations. Also ppV appears to reduce the recurrence-rate of Endophthalmitis

Keywords: cataract • endophthalmitis • bacterial disease