Acute Postcataract Surgery Endophthalmitis Due to Streptococcus Species Differs From Endophthalmitis Due to Staphylococcus Species at Presentation

Abstract

Purpose: : To correlate the presenting clinical ophthalmic features with the bacterial identification in 100 patients with acute post catarcat endophthalmitis enrolled in the FRench Instutionnal ENdophthalmitis Study (FRIENDS).

Methods: : Demographic data, past medical history and initial eye examination were recorded in a standardized form in 100 patients with acute endophthalmitis after cataract extraction (< 6 weeks) in a prospective multicenter study. Relationship between microbiological identification (using conventional cultures and panbacterial PCR) and clinical factors at baseline was studied using univariate (ANOVA).

Results: : 100 patients were hospitalized for endophthalmitis treatment with a mean delay of 8±7.5 (SD) days (range: 2-31 days) after the cataract surgery, complicated by capsular rupture in 19% of the cases. Main symptoms were loss of vision (95%) frequently limited to light perception (32%), and pain (75%). More frequent clinical signs were hypopion (72%), cyclitic membrane (77.5%) and absence of fundus visibility (90%). As compared with Staphylococcus species, the identification of Streptococcus species was more frequently identified (p<0.05) in male and diabetic patients, with initial visual acuity limited to light perceptions and a painfull eye. The Staphylococcus aureus and lugdunensis group differed from other coagulase negative Staphylococcus group (p<0.05) for the height of hypopion.

Conclusions: : The baseline features of acute endophthalmitis after cataract surgery in the era of phacoemulsification are similar to those reported in the EVS 10 years ago. The presenting characteristics of acute post cataract endophthalmitis differ according to the infecting organism. The association between clinical factors at baseline and bacteria identified using cultures and/or eubacterial PCR does not appear sufficiently predictive to guide empiric intraocular antibiotic therapy. However our results suggest that other baseline characteristics than initial visual acuity may be useful to detect presumed infected patients with a virulent species needing a more aggressive therapeutic approach.

Keywords: endophthalmitis • microbial pathogenesis: clinical studies • bacterial disease