A Cluster of Acute-onset Endophthalmitis Following Cataract Surgery

Abstract

Abstract: : Purpose: To report a recent cluster of patients with acute-onset endophthalmitis following cataract surgery Methods: Ten cases of postoperative endophthalmitis from three different anterior segment surgeons were seen between October 28^th and November 27^th 2002 by one of us (NAC). The three surgeons belonged to three geographically separate surgery facilities within a forty-mile radius. All 3 surgeons had 3 cases each following a single surgery day. Results: Hypopyon and vitritis was present in 8/10 cases while the remaining 2 eyes had significant anterior segment fibrin with early vitritis. Presenting visual acuities ranged from 20/40 to hand motion (mean 20/80). Eight cases were diagnosed on the first postoperative day while the remaining 2 were seen on postoperative day 2 and 3 respectively. All patients were treated with intravitreal injections of vancomycin and ceftazidime. Only two of the 10 vitreous cultures were positive and both grew Staphylococcus epidermidis. Aqueous cultures were negative. Follow-up ranged from 7 to 31 days (mean 15 days). Nine eyes have shown significant resolution of inflammation along with marked visual improvement (20/40 or better in 8 eyes). The tenth eye remains at hand motions with significant vitreous opacities but resolution of the hypopyon. Secondary procedures have not been performed on any study eye. Conclusions: Multiple outbreaks of acute-onset endophthalmitis in a short time frame have not been reported previously. The source of these infections is being investigated but instrument sterilzation or intraocular lens manufacturing contamination are major concerns in this setting.

Keywords: endophthalmitis • clinical (human) or epidemiologic studies: out • antibiotics/antifungals/antiparasitics