Abstract
Purpose :
The purpose of this study was to determine the clinical features, bacterial isolates, antibiotic sensitivities, and visual outcomes of patients with culture positive endophthalmitis after penetrating keratoplasty (PKP).
Methods :
Retrospective case series of patients with culture positive endophthalmitis after PKP from 1/1/2006-12/31/2016. Patients who had undergone therapeutic PKP for infectious keratitis or other intraocular procedures within 30 days prior to endophthalmitis were excluded.
Results :
11 eyes of 11 patients were included. The median age was 66 years (range 42-80), 5/11 (46%) Males, and mean follow-up time was 74 months (range 11-214). The mean time from most recent PKP to endophthalmitis was 175 days (range 2-924) with frequency within postoperative week one 3/11 (27%), postoperative month one 3/11 (27%), and thereafter 5/11(46%). Gram positive (GP), gram negative (GN), gram variable bacteria and fungal comprised 9/11 (82%), 1/11 (9%), 0/11 (0%) and 1/11 (9%) respectively. The frequency of isolates was Staphylococcus aureus 1/11 (9%), coagulase negative Staphylococcus species 5/11 (45%), Streptococcus species 2/11 (18%), Enterococcus 1/11(9%), Pseudomonas aeriginosa 1/11(9%), and Candida albicans 1/11 (9%). Of GP bacteria tested, 9/9 (100%) were sensitive to Vancomycin. Of GN bacteria tested 0/1 (0%) were sensitive to Amikacin and/or Ceftazidime. Of fungal isolates tested 0/1 (0%) were sensitive to Amphoteracin, Fluconazole, and/or Voriconazole. 1/7 (14%) donor rims were culture positive for Candida glabrata and 6/7 (86%) were culture negative. 1/11 (9%) donors were retrospectively contraindicated (died of sepsis).The frequency of VA on presentation of endophthalmitis was NLP 0/11 (0%), LP 6/11 (54.5%), HM 3/11(27.3%), CF 0/11 (0%), better than CF 2/11 (18.2%). The frequency of final VA at last follow up was NLP 1/11 (9.1%), HM-LP 4/11 (36.4%), 20/400 to CF 3/11 (27.3%), better than 20/400 3/11 (27.3%). The final VA significantly improved compared to presenting visual acuity (p<0.01). There was no statistical difference in final VA between GP vs. GN vs. fungal isolates.
Conclusions :
Patients with endophthalmitis after PKP generally had poor visual outcomes. The causative organism were predominantly GP bacteria (82%).
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.