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Kimberly D Tran, Ella Hoshuen Leung, Ajay E. Kuriyan, Harry W Flynn, Darlene Miller, Laura Huang; Clinical features and outcomes of patients with persistent endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6377.
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© ARVO (1962-2015); The Authors (2016-present)
To report the bacterial isolates, clinical features, antibiotic sensitivities, and visual outcomes of patients with persistent endophthalmitis.
Design: Retrospective, comparative case series. Methods: Twenty-nine eyes of 29 patients with the same bacteria on repeat vitreous cultures after receiving intravitreal antibiotics at a university referral center from January 1, 1981 to January 1, 2011 were included.
Results: The mean follow up was 28.7 months. The most common clinical settings were after cataract extraction (15/29, 51%) and glaucoma surgery (9/29, 31%). The most common bacteria were Staphylococcus (10/29, 34%), Streptococcus (7/29, 24%), and Enterococcus (5/29, 14%). Gram positive bacteria were sensitive to vancomycin (22/22, 100%) and ceftazidime (10/13, 77%); gram negative bacteria were sensitive to amikacin (3/3, 100%). The antibiotic sensitivities were the same on repeat cultures in 93% (27/29). A tap and inject of intravitreal antibiotics was the initial treatment in 76% (22/29). There was no difference in the final visual acuities in patients who had an initial tap/inject or a pars plana vitrectomy (p=0.86) nor in those who did and did not receive initial intravitreal steroids (p=0.23). The initial vision was 2.21 ± 0.74 logMAR (Snellen equivalent ≈20/3,200), which did not improve significantly at last follow up (1.98 ± 1.1 logMAR, ≈20/1,900, p=0.32). Ten patients (34%) had no light perception; only 11 patients (38%) improved to 20/200 or better.
Conclusions: The most commonly identified organisms in persistent endophthalmitis after intravitreal antibiotics were gram positive bacteria. There was good concordance in antibiotic sensitivities between initial and subsequent cultures. The visual acuity outcomes were generally poor.
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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