Purpose:
Post traumatic endophthalmitis is a serious complication that occurs in 3-15% of open globe cases. We investigated the post traumatic endophthalmitis rate and risk factors in a large tertiary care eye infirmary with a dedicated trauma service and a standardized treatment protocol.
Methods:
Retrospective review of all open globe injuries treated at the Massachusetts Eye and Ear Infirmary between January, 2000 and October, 2006.Standardized Open Globe Repair Protocol:Intravenous vancomycin 1 gm q12 hrs and intravenous ceftazidime 1 gm q8 hrs were started on initial referral or admission and were administered for a total of 48hrs unless contraindicated by allergy (substituted with 4th generation fluoroquinolone). Open globe repair was performed within 24hrs (usually less than 12 hrs). After surgical repair, topical Moxifloxacin and Predforte were administered qid along with cycloplegia bid. Patients were discharged on a topical regimen only.
Results:
In 6.5 years, 641 open globe injuries were treated at our infirmary. Average follow-up was 6 months (2mo-6yrs). There were only 4 culture positive cases and 1 culture negative case of endophthalmitis that developed within 1 month of open globe repair (0.78%). One other patient developed bleb associated endophthalmitis 1 year later following corneal transplant and glaucoma filtering procedure.Two of the 5 cases were associated with intra-ocular foreign bodies (IOFB). The odds ratio of endophthalmitis in Open Globe with IOFB vs. no IOFB was 4.1. The average time from injury to presentation was 6.4 hours. The time to repair was 17.2 hours post injury and 10.8 hours post presentation in the patients who developed endophthalmitis. This was not significantly different than the 636 non-endophthalmitis cases.
Conclusions:
This is one of the largest series of open globe repair with a standardized treatment protocol. Forty-eight hours of intravenous antibiotics and timely closure by a dedicated eye trauma service resulted in the lowest published rate of post traumatic endophthalmitis.
Keywords: endophthalmitis • trauma