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U. Wiehler, S. Zimmermann, A. Dalpke, M. D. Becker, F. Mackensen; Diagnosing Infectious Endophthalmitis: Comparison of Molecular Biology-Based Methods and Cultural Methods. Invest. Ophthalmol. Vis. Sci. 2008;49(13):959.
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Rapid detection of the infectious pathogen is crucial when confronted with a patient with endophthalmitis. Conventional culture methods used to be the standard with either very low detection rates or if done in theater with a risk of contamination. Developments in molecular biology allow new approaches in the diagnostic of ocular fluids such as PCR of intraocular fluids. Especially broad-range PCR testing for 16s ribosomal genes have increased detection rates and help to decrease contamination. 18 months ago we changed our approach to endophthalmitis diagnostics and want to report first results.
Intraocular fluids (anterior chamber and/or vitreous) of patients presenting with acute or chronic endophthalmitis were obtained. Culture medium (thiobroth) was inoculated with the undiluted specimen directly in the operating room. Remaining specimen was left in the sterile syringe and used for eubacterial or panfungal PCR. A positive result was sequenced with specific primers.
In 8 of 24 patients (30%) a specific pathogen could be detected with PCR within 1-2 days. Later on the results could be confirned by the culture methods. There were no discrepancies between both methods concerning the detected pathogen. In 16 patients no pathogen could be identified with either method.
Compared to culture PCR allows a faster detection of microbes in endophthalmitis patients. This is very important regarding the therapeutical consequences. The number of cases with negative results in both methods remains high in our study.
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