Abstract
Purpose: :
Endophthalmitis is a relatively rare but severe infection that can occur following cataract surgery. We report population-based results related to pathogens and treatment patterns.
Methods: :
Post-cataract surgery endophthalmitis cases were identified using 2003-2004 Medicare billing claims. Cases were then limited to individuals diagnosed in California, Florida, Illinois, Michigan and Texas. Treating physicians were contacted via telephone and requested to complete a questionnaire on clinical and microbiological data and to submit any relevant chart information. Materials were reviewed by two independent observers for confirmation of culture proven endophthalmitis.
Results: :
507 cases of presumed endophthalmitis were confirmed. Among these, 447 (88%) had culture results available, and 268 (60%) of this subset were culture positive. 92% cultured gram-positive organisms, and 16 specimens cultured MRSA. 3 fungal cases were reported.The distribution of pathogens differed by age group. Among the 85+ age group, MRSA accounted for 15% of organisms versus 5% in the younger populations (p=.04). MRSA was more common among non-whites, accounting for 14% of all culture positive organisms compared to 5% within the white population (p=0.08). No differences in pathogen distribution were seen between men and women.Presenting visual acuity was 20/200 or worse for 92% of culture positive cases and for 79% of culture negative cases (p=0.0002). Culture positive compared to culture negative cases were more likely to undergo vitrectomy (64% vs. 44%, respectively; p<0.0001). 99% of both culture positive and culture negative cases received intravitreal vancomycin, usually in combination with ceftazidime (70%), amikacin (22%) or another antibiotic. 25% also received a systemic antibiotic. Final visual acuity was 20/200 or worse for 40% of culture positive cases compared to 29% of culture negative cases (p=0.02). Among culture positive cases, those treated with intravitreal vancomycin and amikacin were less likely to have poor visual acuity (20/200 or worse) at follow-up compared to other regimens (p=0.06).
Conclusions: :
Intravitreal injection with vancomycin, combined with either ceftazidime or amikacin, is the most common treatment regimen for post-cataract surgery endophthalmitis. Culture positive cases had poorer visual outcomes compared to culture negative cases. A trend towards better visual outcomes was found for culture positive cases treated with vancomycin combined with amikacin.
Keywords: cataract • endophthalmitis • clinical (human) or epidemiologic studies: outcomes/complications