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S. H. Tekwani, F. De Alba, A. Jayaram, B. Gaynes, M. Daily, C. S. Bouchard, K. Skledar, T. Risma, K. Andrews; Chicago Multicenter Endophthalmitis Registry (CMER). Invest. Ophthalmol. Vis. Sci. 2010;51(13):6050.
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The goal of this multicenter project is to create a data repository of all endophthalmitis cases over a 10 year period in the Chicago area from large academic and private institutions. By analyzing the common infecting microorganisms in this area, treatments, and visual outcomes, this data repository will aid in developing preventative, diagnostic, and treatment strategies in addressing endophthalmitis in this area.
Retrospective chart review of patients over a 10 year period from 7/1/1999 to 6/30/2009 from a tertiary academic center and a large multispecialty eye clinic was performed using ICD-9 codes for endophthalmitis. The categories of endophthalmitis studied were post-surgical/procedural, endogenous, local extension from primary ocular infection, and post-traumatic.
Pooled and individual study center analyses are presented. Overall, 32 cases have been reviewed. Mean age of subjects between the two study centers was 65.7 years (range 23-94, median 68). 71.9% of subjects developed infectious endophthalmitis post-surgically, while 18.8% were of endogenous origin rising to 31.6% of patients at one specific study site. Overall, 83.9% of cases presented with anterior chamber reaction. 50% of aqueous and/or vitreous cultures grew microorganisms. While the majority of positive cultures grew bacteria, aggregate analysis of both study sites revealed the causative organism to be fungal in 12.5% of cases, all endogenous. Interestingly, breakdown of cases examined in one study center identified a cluster of causative organisms as coagulase negative staph aureus, found in 38.46% of cases. Comparing management strategies showed 100% of post-surgical endophthalmitis cases at one site underwent vitrectomy for diagnosis and treatment, compared to 75% of patients at the other site. Overall, visual outcome was less than 20/40 in 56.3% of subjects examined, 15.6% retained better than 20/40 vision.
As expected, the pooled data shows that the majority of endophthalmitis patients were post-surgical, specifically post uncomplicated cataract surgery. The academic site showed a wider variety of infecting microorganisms compared to the private institution and more cases of endogenous endophthalmitis due to its large inpatient population. As more sites are added, future comparisons can be made between cases in Chicago and the rest of the nation.
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