A 12–Year Survey on Endophthalmitis in Germany: Etiology, Incidence, Therapy and Outcome

Abstract

Abstract: : Purpose: To review the success in change of strategy for the prevention and management of endophthalmitis considering pre–operative prophylaxis and therapeutic measures over a 12–year period. Methods: Retrospective review of 258 cases of endophthalmitis treated between 1990 and 2001 at the Ludwig–Maximilians University Eye Hospital. Date were collected from patient records to determine the causes, incidence, and treatment outcomes of endophthalmitis. Comparison of different endophthalmitis prophylaxis regiment were analyzed: Period A (1990–1995) with antiobitic and two drops of povidone–iodine (PVI) before surgery and Period B (1996–2001) with antibiotic, PVI irrigation of the fornix, and preoperative conjunctival culture. Results: Of the 258 cases of endophthalmitis (107 cases in Period A and 151 cases in Period B), 140 were acute, 47 delayed–onset post–operative, 31 post–traumatic, and 40 endogenous endophthalmitis. The incidence of acute endophthalmitis decreased from 0.23% to 0.11% from Period A to B (P = 0.015). The most common organisms isolated were coagulase–negative staphylococci. The median visual acuity (VA) after treatment for all patients with post–operative and and post–traumatic endophthalmitis was 20/200, compared to counting fingers for endogenous endophthalmitis. The mean visual outcome improved significantly from 20/1000 (Period A) to 20/200 (Period B) with fewer patients requiring enucleations (P = 0.001). The time delay between diagnosis and treatment decreased from a mean of 17 hours in period A to 8 hours in period B (P = 0.024). Patients who received intraocular vancomycin and amikacin had the best mean visual outcome of 20/200 compared to those who received vancomycin and gentamicin (VA = 10/1000; P = 0.037) or gentamicin alone (VA = counting finger;" P = 0.005). Treatment with pars plana vitrectomy (PPV) reduced the recurrence rate of infections from 23% to 5% (P = 0.004). Conclusions: Improved pre–operative endopthalmitis prophylaxis regimen may be one factor in reducing the incidence of postoperative endophthalmitis. Prompt treatment of endophthalmitis with intravitreal vancomycin and amikacin appear to yield a more favorable visual outcome and fewer enucleations. PPV appears to reduce the recurrence rate of endophthalmitis.

Keywords: endophthalmitis • bacterial disease • vitreous