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Xintong Li, Marco A Zarbin, Paul D Langer, Neelakshi Bhagat; Endophthalmitis After Open Globe Repair. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3052. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Post-traumatic endophthalmitis is a rare, devastating condition, and late-onset cases have never been described separately from those diagnosed at injury presentation. This retrospective review reports demographics, characteristics, management, and outcomes of eyes developing endophthalmitis after open globe repair (OGR).
Retrospective cohort analysis of all patients diagnosed with endophthalmitis after primary OGR from 1997-2015 at University Hospital, Newark, NJ.
Fourteen eyes were identified; nine of 10 initially repaired at our institution underwent primary OGR <1 day after initial injury, each receiving prophylactic intravenous antibiotics (mean duration: 3.8 days, range: 0-11). Machinery operation or mechanical work accounted for 10 (77%) cases; 9 (69%) were penetrating injuries and 3 (23%) had an intraocular foreign body (IOFB), with duration from injury to removal of 0 and 5 days (1 with unknown removal date repaired elsewhere). Tissue prolapse was present in 70%, organic matter wound contamination in 17%. Injury was either in zone 1 (8 eyes, 57%) or zone 2 (6 eyes, 43%). Average wound size was 2.3 mm (range: 1-10). Three (25%) eyes presented with cataracts; 5 (42%) eyes later developed traumatic cataract, all ≤3 weeks. One eye had retained lens fragments. Mean duration from primary repair to endophthalmitis was 23 days (range: 1-98); all eyes had initial visual acuity (VA) of CF or worse. One patient refused invasive treatment at presentation; 12 (86%) eyes were treated with vitreous biopsy, vitrectomy, and intravitreal antibiotics. One severely infected NLP eye underwent primary enucleation. All were empirically treated with broad-spectrum antibiotics, most commonly vancomycin plus ceftazidime (intravitreally and intravenously). Ten (77%) eyes had a positive culture: 6 (60%) had Staphylococcus sp.; 4 (40%) grew fungus (2 had IOFBs; 2 had wound leaks). The 4 (29%) eyes with wound leak after OGR all had injuries in zone 1, averaging 3 days from OGR to leak repair (n=3; the NLP was excluded and underwent enucleation). Final mean VA was poor at CF (20/1000), comparable to presenting VA. Four (29%) eyes had final NLP vision, 3 (21%) of which were enucleated (1 primary enucleation for endophthalmitis); implants were placed primarily in all.
Post-traumatic endophthalmitis has a very poor prognosis. Wound leak after primary repair may confer increased risk of endophthalmitis.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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