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Fabian Schwarzbach, Martin M. Nentwich, Lisa He, Yazmin Antonieta Yactayo Miranda, Christos Haritoglou, Arnd Gandorfer, Martin Grueterich, Anselm Kampik, Herminia Mino de Kaspar; Endophthalmitis: Aetiology, Isolated Microorganisms, Therapy And Outcome. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5600.
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© ARVO (1962-2015); The Authors (2016-present)
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.
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.
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.
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
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