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Anita R. Shirodkar, Darlene Miller, Geeta A. Lalwani, Harry W. Flynn, Jr.; Outcomes and Microbiology of Delayed-Onset Endophthalmitis Compared to Acute-Onset Endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5605.
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To report a large consecutive case series of patients who developed delayed-onset and acute-onset endophthalmitis after clear corneal cataract surgery, and to compare the microbiology and treatment outcomes between these two groups.
Retrospective consecutive case series from a large medical center of patients who developed culture-proven endophthalmitis within six weeks of cataract surgery, and were treated between January 2000 and December 2009. Acute-onset endophthalmitis was defined as <= 6 weeks after cataract surgery, and delayed-onset endophthalmitis was defined as > 6 weeks after cataract surgery. Organisms cultured and visual acuity outcomes were compared.
A total of 107 patients met study criteria; 92 cases were acute-onset, and 15 cases were delayed-onset. A presenting visual acuity of <= 5/200 was found in 89% of acute-onset cases, and in 20% of delayed-onset cases. Hypopyon was found in 80% and 53% of acute and delayed-onset cases, respectively. Coagulase-negative Staphylococcus was cultured in 57/92 acute-onset cases, and 56% of patients had a final visual acuity of >= 20/100. Propionibacterium acnes was cultured in 7/15 delayed-onset cases, and 100% of patients had a final visual acuity of >= 20/100.
Patients with delayed-onset endophthalmitis generally presented with better initial visual acuities, less frequent hypopyon, and as late as one year or more after initial surgery. Final visual acuities tended to be better in delayed-onset endophthalmitis than in acute-onset endophthalmitis. Coagulase-negative Staphylococcus and Propionibacterium acnes were the most common organisms cultured in acute and delayed-onset endophthalmitis, respectively, and were associated with the best final visual acuities in each group.
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